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Savvopoulos, C. & Geijer, H. (2019). 99mTc-MIBI Embolus in the Late Phase of a Parathyroid Scan. Clinical Nuclear Medicine, 44(8), 655-656
Open this publication in new window or tab >>99mTc-MIBI Embolus in the Late Phase of a Parathyroid Scan
2019 (English)In: Clinical Nuclear Medicine, ISSN 0363-9762, E-ISSN 1536-0229, Vol. 44, no 8, p. 655-656Article in journal, Editorial material (Other academic) Published
Abstract [en]

We report a case of a transient focal MIBI uptake in the late, 90 minutes postinjection phase of a parathyroid scintigraphy in which SPECT/CT imaging proved valuable in delineating the nature of this incidental finding.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
Keywords
Tc-99m-MIBI, parathyroid scintigraphy, SPECT/CT, pulmonary embolus
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-75717 (URN)10.1097/RLU.0000000000002648 (DOI)000475950300023 ()31274615 (PubMedID)2-s2.0-85069269702 (Scopus ID)
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14Bibliographically approved
Geijer, H. & Geijer, M. (2019). Double reading in diagnostic radiology: a systematic review. In: : . Paper presented at ECR - European Congress of Radiology, Vienna, Austria.
Open this publication in new window or tab >>Double reading in diagnostic radiology: a systematic review
2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-73785 (URN)
Conference
ECR - European Congress of Radiology, Vienna, Austria
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-16Bibliographically approved
Geijer, H. & Geijer, M. (2018). Added value of double reading in diagnostic radiology, a systematic review. Insight into Imaging, 9(3), 287-301
Open this publication in new window or tab >>Added value of double reading in diagnostic radiology, a systematic review
2018 (English)In: Insight into Imaging, ISSN 1869-4101, E-ISSN 1869-4101, Vol. 9, no 3, p. 287-301Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVES: Double reading in diagnostic radiology can find discrepancies in the original report, but a systematic program of double reading is resource consuming. There are conflicting opinions on the value of double reading. The purpose of the current study was to perform a systematic review on the value of double reading.

METHODS: A systematic review was performed to find studies calculating the rate of misses and overcalls with the aim of establishing the added value of double reading by human observers.

RESULTS: The literature search resulted in 1610 hits. After abstract and full-text reading, 46 articles were selected for analysis. The rate of discrepancy varied from 0.4 to 22% depending on study setting. Double reading by a sub-specialist, in general, led to high rates of changed reports.

CONCLUSIONS: The systematic review found rather low discrepancy rates. The benefit of double reading must be balanced by the considerable number of working hours a systematic double-reading scheme requires. A more profitable scheme might be to use systematic double reading for selected, high-risk examination types. A second conclusion is that there seems to be a value of sub-specialisation for increased report quality. A consequent implementation of this would have far-reaching organisational effects.

KEY POINTS: • In double reading, two or more radiologists read the same images. • A systematic literature review was performed. • The discrepancy rates varied from 0.4 to 22% in various studies. • Double reading by sub-specialists found high discrepancy rates.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Diagnostic errors, Observer variation, Diagnostic imaging, Review, Quality assurance, healthcare
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-66447 (URN)10.1007/s13244-018-0599-0 (DOI)000434755100002 ()29594850 (PubMedID)2-s2.0-85048261776 (Scopus ID)
Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2018-08-20Bibliographically approved
Bäck, A., Savvopoulos, C., Funk, E. & Geijer, H. (2018). Diuretic decision seven minutes post Tc-99m-MAG3 administration in a renography. Paper presented at 31st Annual Congress of the European-Association-of-Nuclear-Medicine (EANM'18), Düsseldorf, Germany, October 13-17, 2018. European Journal of Nuclear Medicine and Molecular Imaging, 45(Suppl. 1), S765-S765, Article ID E-TPW52.
Open this publication in new window or tab >>Diuretic decision seven minutes post Tc-99m-MAG3 administration in a renography
2018 (English)In: European Journal of Nuclear Medicine and Molecular Imaging, ISSN 1619-7070, E-ISSN 1619-7089, Vol. 45, no Suppl. 1, p. S765-S765, article id E-TPW52Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Aim: The F+10 method in supine position, which has been implemented at our Nuclear Medicine department since 2015, involves a 30- minute long dynamic acquisition. The diuretic is only administered when necessary and decision is taken by the radiographers in a semi-automated fashion without consulting a physician, by calculating the remaining activity in the kidneys seven minutes post 99mTc-MAG3 injection and comparing the value with an arbitrary threshold of 75 %. If needed, the diuretic is injected three minutes later. The aim of this study was to correlate our method with the established previously used F+20 protocol in adults. Is the currently used threshold of 75% of activity left in any kidney at seven minutes the optimal cut-off value for diuretic administration?

Material and Methods: This is an ongoing retrospective study which include 320 F+20 examinations of adult patients performed during 2013-2015. They were all re-evaluated according to the currently used F+10 method, categorized as requiring diuretic or not and correlated to the original F+20 examination. A ROC-curve was drawn to delineate the best cut-off value for remaining renal activity. Sensitivity, specificity and accuracy were calculated.

Results: Preliminary results indicate that the F+10 re-evaluations with the currently used cut-off value of 75% did not correlate with the original F+20 examinations. In 80% (255 examinations) of the F+10 re-evaluations diuretic would have been considered necessary while only 52% (167 examinations) received diuretics in the original F+20 renographies (sensitivity 1.0, specificity 0.42). However, all the patients who required furosemide in the original F+20 renographies would have received diuretic if they had been imaged with the F+10 protocol. Furthermore, examination time is considerably reduced. After an evaluation of the ROC-curve the optimal cut-off value was 94% (sensitivity 0.92, specificity 0.84, accuracy 0.88). However, by implementing this value, 13 patients (4%) would have been falsely categorized as not requiring diuretic.

Conclusions: The 99mTc-MAG3 renography with the F+10 protocol in supine position is a feasible and acceptable method in clinical practice.

Place, publisher, year, edition, pages
Springer, 2018
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-70372 (URN)10.1007/s00259-018-4148-3 (DOI)000449266207098 ()
Conference
31st Annual Congress of the European-Association-of-Nuclear-Medicine (EANM'18), Düsseldorf, Germany, October 13-17, 2018
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2018-11-29Bibliographically approved
Piippo-Huotari, O., Norrman, E., Anderzen-Carlsson, A. & Geijer, H. (2018). New patient-controlled abdominal compression method in radiography: radiation dose and image quality. Acta radiologica open, 7(5), 1-8, Article ID 2058460118772863.
Open this publication in new window or tab >>New patient-controlled abdominal compression method in radiography: radiation dose and image quality
2018 (English)In: Acta radiologica open, ISSN 2058-4601, Vol. 7, no 5, p. 1-8, article id 2058460118772863Article in journal (Refereed) Published
Abstract [en]

Background: The radiation dose for patients can be reduced with many methods and one way is to use abdominal compression. In this study, the radiation dose and image quality for a new patient-controlled compression device were compared with conventional compression and compression in the prone position.

Purpose: To compare radiation dose and image quality of patient-controlled compression compared with conventional and prone compression in general radiography.

Material and Methods: An experimental design with quantitative approach. After obtaining the approval of the ethics committee, a consecutive sample of 48 patients was examined with the standard clinical urography protocol. The radiation doses were measured as dose-area product and analyzed with a paired t-test. The image quality was evaluated by visual grading analysis. Four radiologists evaluated each image individually by scoring nine criteria modified from the European quality criteria for diagnostic radiographic images.

Results: There was no significant difference in radiation dose or image quality between conventional and patient-controlled compression. Prone position resulted in both higher dose and inferior image quality.

Conclusion: Patient-controlled compression gave similar dose levels as conventional compression and lower than prone compression. Image quality was similar with both patient-controlled and conventional compression and was judged to be better than in the prone position.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Compression, X-ray, image quality, radiation dose, radiography
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-67002 (URN)10.1177/2058460118772863 (DOI)000434653700001 ()29760949 (PubMedID)
Note

Funding Agencies:

Research Committee of Region Örebro County  

Örebro University, Sweden 

Available from: 2018-05-23 Created: 2018-05-23 Last updated: 2018-07-24Bibliographically approved
Jendeberg, J., Geijer, H., Alshamari, M. & Lidén, M. (2018). Prediction of spontaneous ureteral stone passage: Automated 3D-measurements perform equal to radiologists, and linear measurements equal to volumetric. European Radiology, 28(6), 2474-2483
Open this publication in new window or tab >>Prediction of spontaneous ureteral stone passage: Automated 3D-measurements perform equal to radiologists, and linear measurements equal to volumetric
2018 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 28, no 6, p. 2474-2483Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare the ability of different size estimates to predict spontaneous passage of ureteral stones using a 3D-segmentation and to investigate the impact of manual measurement variability on the prediction of stone passage.

METHODS: We retrospectively included 391 consecutive patients with ureteral stones on non-contrast-enhanced CT (NECT). Three-dimensional segmentation size estimates were compared to the mean of three radiologists' measurements. Receiver-operating characteristic (ROC) analysis was performed for the prediction of spontaneous passage for each estimate. The difference in predicted passage probability between the manual estimates in upper and lower stones was compared.

RESULTS: The area under the ROC curve (AUC) for the measurements ranged from 0.88 to 0.90. Between the automated 3D algorithm and the manual measurements the 95% limits of agreement were 0.2 ± 1.4 mm for the width. The manual bone window measurements resulted in a > 20 percentage point (ppt) difference between the readers in the predicted passage probability in 44% of the upper and 6% of the lower ureteral stones.

CONCLUSIONS: All automated 3D algorithm size estimates independently predicted the spontaneous stone passage with similar high accuracy as the mean of three readers' manual linear measurements. Manual size estimation of upper stones showed large inter-reader variations for spontaneous passage prediction.

KEY POINTS:• An automated 3D technique predicts spontaneous stone passage with high accuracy.• Linear, areal and volumetric measurements performed similarly in predicting stone passage.• Reader variability has a large impact on the predicted prognosis for stone passage.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Computed tomography, Ureteral calculi, Kidney stone, Ureter, Renal colic
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-64712 (URN)10.1007/s00330-017-5242-9 (DOI)000431653200024 ()29368161 (PubMedID)
Note

Funding Agency

Research Committee of Region Orebro County 

Available from: 2018-02-02 Created: 2018-02-02 Last updated: 2018-08-20Bibliographically approved
Alshamari, M., Geijer, M., Norrman, E., Lidén, M., Krauss, W., Jendeberg, J., . . . Geijer, H. (2017). Impact of iterative reconstruction on image quality of low-dose CT of the lumbar spine. Acta Radiologica, 58(6), 702-709
Open this publication in new window or tab >>Impact of iterative reconstruction on image quality of low-dose CT of the lumbar spine
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2017 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 6, p. 702-709Article in journal (Refereed) Published
Abstract [en]

Background: Iterative reconstruction (IR) is a recent reconstruction algorithm for computed tomography (CT) that can be used instead of the standard algorithm, filtered back projection (FBP), to reduce radiation dose and/or improve image quality.

Purpose: To evaluate and compare the image quality of low-dose CT of the lumbar spine reconstructed with IR to conventional FBP, without further reduction of radiation dose.

Material and Methods: Low-dose CT on 55 patients was performed on a Siemens scanner using 120 kV tube voltage, 30 reference mAs, and automatic dose modulation. From raw CT data, lumbar spine CT images were reconstructed with a medium filter (B41f) using FBP and four levels of IR (levels 2-5). Five reviewers scored all images on seven image quality criteria according to the European guidelines on quality criteria for CT, using a five-grade scale. A side-by-side comparison was also performed.

Results: There was significant improvement in image quality for IR (levels 2-4) compared to FBP. According to visual grading regression, odds ratios of all criteria with 95% confidence intervals for IR2, IR3, IR4, and IR5 were: 1.59 (1.39-1.83), 1.74 (1.51-1.99), 1.68 (1.46-1.93), and 1.08 (0.94-1.23), respectively. In the side-by-side comparison of all reconstructions, images with IR (levels 2-4) received the highest scores. The mean overall CTDIvol was 1.70 mGy (SD 0.46; range, 1.01-3.83 mGy). Image noise decreased in a linear fashion with increased strength of IR.

Conclusion: Iterative reconstruction at levels 2, 3, and 4 improves image quality of low-dose CT of the lumbar spine compared to FPB.

Place, publisher, year, edition, pages
London: Sage Publications, 2017
Keywords
X-ray computed tomography (CT), image manipulation/reconstruction, lumbar vertebrae, radiation dosage, spine
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-57646 (URN)10.1177/0284185116669870 (DOI)000399995700011 ()28157395 (PubMedID)2-s2.0-85019010032 (Scopus ID)
Available from: 2017-05-12 Created: 2017-05-12 Last updated: 2019-03-26Bibliographically approved
Jendeberg, J., Geijer, H., Alshamari, M., Cierzniak, B. & Lidén, M. (2017). Size matters: The width and location of a ureteral stone accurately predict the chance of spontaneous passage. European Radiology, 27(11), 4775-4785
Open this publication in new window or tab >>Size matters: The width and location of a ureteral stone accurately predict the chance of spontaneous passage
Show others...
2017 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 27, no 11, p. 4775-4785Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To determine how to most accurately predict the chance of spontaneous passage of a ureteral stone using information in the diagnostic non-enhanced computed tomography (NECT) and to create predictive models with smaller stone size intervals than previously possible.

METHODS: Retrospectively 392 consecutive patients with ureteric stone on NECT were included. Three radiologists independently measured the stone size. Stone location, side, hydronephrosis, CRP, medical expulsion therapy (MET) and all follow-up radiology until stone expulsion or 26 weeks were recorded. Logistic regressions were performed with spontaneous stone passage in 4 weeks and 20 weeks as the dependent variable.

RESULTS: The spontaneous passage rate in 20 weeks was 312 out of 392 stones, 98% in 0-2 mm, 98% in 3 mm, 81% in 4 mm, 65% in 5 mm, 33% in 6 mm and 9% in ≥6.5 mm wide stones. The stone size and location predicted spontaneous ureteric stone passage. The side and the grade of hydronephrosis only predicted stone passage in specific subgroups.

CONCLUSION: Spontaneous passage of a ureteral stone can be predicted with high accuracy with the information available in the NECT. We present a prediction method based on stone size and location.

KEY POINTS: • Non-enhanced computed tomography can predict the outcome of ureteral stones. • Stone size and location are the most important predictors of spontaneous passage. • Prediction models based on stone width or length and stone location are introduced. • The observed passage rates for stone size in mm-intervals are reported. • Clinicians can make better decisions about treatment.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Spiral computed tomography; Ureteral calculi; Kidney stone; Ureter; Renal colic
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-61961 (URN)10.1007/s00330-017-4852-6 (DOI)000412820500037 ()28593428 (PubMedID)2-s2.0-85020305726 (Scopus ID)
Note

Funding Agency:

Research Committee of Region Örebro County

Available from: 2017-10-26 Created: 2017-10-26 Last updated: 2018-08-07Bibliographically approved
Samano, N., Geijer, H., Bodin, L., Arbeus, M., Mannion, J. D., Dashwood, M. & Souza, D. (2017). The no-touch saphenous vein graft in elderly coronary bypass patients with multiple comorbidities is a promising conduit to substitute the left internal thoracic artery. Journal of Thoracic and Cardiovascular Surgery, 154(2), 457-466.e3
Open this publication in new window or tab >>The no-touch saphenous vein graft in elderly coronary bypass patients with multiple comorbidities is a promising conduit to substitute the left internal thoracic artery
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2017 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 154, no 2, p. 457-466.e3Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: We investigated the patency rates of no-touch saphenous vein grafts anastomosed to the left anterior descending artery compared with the left internal thoracic artery. Further, we compared the patency of no-touch vein grafts to the left anterior descending artery with the patency of no-touch vein grafts to other coronary arteries.

METHODS: Of 2635 consecutive patients undergoing coronary artery bypass grafting between 2003 and 2008, 168 (6.3%) were given at least a saphenous vein graft to the left anterior descending artery to avoid harvesting complications in high-risk patients or in response to a left internal thoracic artery injury. A total of 97 patients were consecutively included after informed consent. A clinical examination and computed tomography angiography were performed on 91 patients at a mean of 6 (4-9) years.

RESULTS: The mean age of patients was 75.6 ± 8.5 years. Postoperatively, 88.7% of patients (86/97) were free of angina. The 91 examined patients had 163 grafts with 286 distal anastomoses. Crude patency, according to distal anastomoses, was 94.4% (270/286). The patency of single versus sequential no-touch vein grafts to the left anterior descending artery was 98% (50/51) versus 92.5% (37/40). The total patency rate was 95.6% (87/91), similar to the reported patency rate for the left internal thoracic artery. The no-touch grafts to the left anterior descending artery versus other coronaries had a patency of 95.6% (87/91) versus 93.8% (183/195), a high similarity confirmed by an equivalence analysis.

CONCLUSIONS: In elderly coronary bypass patients with multiple comorbidities, a no-touch saphenous vein graft is a promising substitute for the left internal thoracic artery.

Place, publisher, year, edition, pages
Mosby Inc., 2017
Keywords
bypass graft, computed tomography angiography, coronary artery bypass grafting, left internal thoracic artery, no-touch harvesting technique, patency, saphenous vein
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-57312 (URN)10.1016/j.jtcvs.2017.03.048 (DOI)000406775800023 ()28433355 (PubMedID)
Note

Funding Agencies:

Örebro County Council through the regional research board  

Nyckelfonden  11-029 

Available from: 2017-05-30 Created: 2017-05-30 Last updated: 2019-02-28Bibliographically approved
Geijer, M., Gunnlaugsson, E., Götestrand, S., Weber, L. & Geijer, H. (2017). Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly. European Radiology, 27(2), 491-497
Open this publication in new window or tab >>Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly
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2017 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 27, no 2, p. 491-497Article in journal (Refereed) Published
Abstract [en]

Objectives: Thoracic spine radiography becomes more difficult with age. Tomosynthesis is a low-dose tomographic extension of radiography which may facilitate thoracic spine evaluation. This study assessed the added value of tomosynthesis in imaging of the thoracic spine in the elderly.

Methods: Four observers compared the image quality of 50 consecutive thoracic spine radiography and tomosynthesis data sets from 48 patients (median age 67 years, range 55-92 years) on a number of image quality criteria. Observer variation was determined by free-marginal multirater kappa. The conversion factor and effective dose were determined from the dose-area product values.

Results: For all observers significantly more vertebrae were seen with tomosynthesis than with radiography (mean 12.4/9.3, P < 0.001) as well as significantly more fractures (mean 0.9/0.7, P = 0.017). The image quality score for tomosynthesis was significantly higher than for radiography, for all evaluated structures. Tomosynthesis took longer to evaluate than radiography. Despite this, all observers scored a clear preference for tomosynthesis. Observer agreement was substantial (mean κ = 0.73, range 0.51-0.94). The calibration or conversion factor was 0.11 mSv/(Gy cm(2)) for the combined examination. The resulting effective dose was 0.87 mSv.

Conclusion: Tomosynthesis can increase the detection rate of thoracic vertebral fractures in the elderly, at low added radiation dose.

KEY POINTS:• Tomosynthesis helps evaluate the thoracic spine in the elderly. • Observer agreement for thoracic spine tomosynthesis was substantial (mean κ = 0.73). • Significantly more vertebrae and significantly more fractures were seen with tomosynthesis. • Tomosynthesis took longer to evaluate than radiography. • There was a clear preference among all observers for tomosynthesis over radiography.

Place, publisher, year, edition, pages
New York: Springer, 2017
Keywords
Thoracic vertebrae, radiography, tomography, X-ray, image quality, fracture
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-50617 (URN)10.1007/s00330-016-4392-5 (DOI)000392142000007 ()27246721 (PubMedID)2-s2.0-84973129798 (Scopus ID)
Available from: 2016-06-08 Created: 2016-06-08 Last updated: 2018-07-24Bibliographically approved
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