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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
Mrkonjic, A., Geijer, M., Lindau, T. & Tägil, M. (2018). No long-term risk of wrist osteoarthritis due to subchondral haematomas in distal radial fractures. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 52(2), 163-165
Open this publication in new window or tab >>No long-term risk of wrist osteoarthritis due to subchondral haematomas in distal radial fractures
2018 (English)In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 52, no 2, p. 163-165Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The objective of this study of distal radius fractures was to determine if a subchondral haematoma in an unfractured compartment predicts secondary osteoarthritis.

METHODS: In 1995-1997, 41 patients, 22 women, a median age of 41 years (20-57 years) with a displaced distal radius fracture underwent diagnostic wrist arthroscopy in addition to the fracture treatment. In 12 patients (7/12 women), subchondral haematomas were identified in a joint compartment not involved in the fracture.

RESULTS: At 13-15 years, 37 patients were still alive. Twenty-eight patients attended the follow-up and 8/28 had had a subchondral haematoma within an uninjured compartment at the time of arthroscopy. The range of motion at 13-15 years was impaired in the injured wrist, but unrelated to the presence of a subchondral haematoma. The mean grip strength in patients with subchondral haematoma was 80% of the contralateral, compared to 78% in patients without. No correlation was found between the presence of a subchondral haematoma at arthroscopy and the development of radiographic osteoarthritis in the long term.

CONCLUSION: The presence of a subchondral hematoma in an uninjured compartment at the time of fracture did not alter the long-term clinical or radiographic outcome after a distal radius fracture.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Bone bruise, cartilage, distal radial fracture, long-term outcome
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-62487 (URN)10.1080/2000656X.2017.1372290 (DOI)000427727400005 ()28885132 (PubMedID)2-s2.0-85029723768 (Scopus ID)
Funder
Swedish Research Council, project 2031
Note

Funding agencies:

Greta and Johan Kock

Alfred Österlund foundation

Maggie Stephens foundation

Thure Carlsson foundation

Medical Faculty of Lund

Available from: 2017-11-27 Created: 2017-11-27 Last updated: 2018-08-11Bibliographically approved
Lindqvist, U., Wernroth, M.-L. -., Husmark, T., Larsson, P., Geijer, M., Teleman, A., . . . Alenius, G.-M. -. (2017). DAPSA, DAS28 and MDA predict long-term treatment regime in psoriatic arthritis: The Swedish Early Psoriatic Arthritis Cohort. Clinical and Experimental Rheumatology, 35(6), 936-942
Open this publication in new window or tab >>DAPSA, DAS28 and MDA predict long-term treatment regime in psoriatic arthritis: The Swedish Early Psoriatic Arthritis Cohort
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2017 (English)In: Clinical and Experimental Rheumatology, ISSN 0392-856X, E-ISSN 1593-098X, Vol. 35, no 6, p. 936-942Article in journal (Refereed) Published
Abstract [en]

Objective: To describe treatment patterns in the Swedish early psoriatic arthritis cohort (SwePsA) of the mono-/oligo-arthritic (M/O) and polyarthritis (P) and identify early predictive factors for treatment with disease-modifying anti-rheumatic (DMARD), non-steroidal anti-inflammatory drugs (NSAID), and tumour necrosis factor inhibition (TNFi) after 5 years.

Methods: Data for 198 M/O and P PsA were obtained within the programme for SwePsA. Multinomial and binary logistic regression analyses were used to assess the association between early predictive factors and treatment after 5 years adjusted for age at inclusion. The analysis of DMARD/NSAID was adjusted for medication at inclusion.

Results: After inclusion visit, DMARD was prescribed in 30% of M/O and 56% of P PsA; mainly methotrexate. TNFi was not prescribed at inclusion, but 23 patients were treated at 5-year follow-up. The adjusted OR (95% CI) for treatment with both DMARD and NSAID after 5 years was 3.65 (1.34 - 9.89) (p=0.010) for Disease Activity Score 28 (DAS28) >3.2 and 2.90 (1.20-6.99) (p=0.038) for Disease Activity Index in Psoriatic Arthritis (DAPSA) >14 at inclusion. TNFi treatment was, after adjusting for age, associated with high erythrocyte sedimentation rate (p=0.0043), high C-reactive protein (p=0.013), DAPSA (p<0.001), not reaching minimal disease activity (p=0.001) high health assessment questionnaire (p=0.001), patient's overall assessment on the visual analogue scale (VAS) (p=0.009), high pain VAS (p=0.007), and high number of tender and swollen joints (p=0.031) at inclusion.

Conclusion: Disease activity in early M/O and P PsA is to be considered in deciding the level of health care assessment and future pharmacological treatment. DAS28 >3.2 and DAPSA>14 early in the disease predict subsequent treatment with DMARD. For prediction of biological treatment, not reaching MDA at onset of disease, would be the composite index of choice.

Place, publisher, year, edition, pages
Clinical and Experimental Rheumatology, 2017
Keywords
DMARD, NSAID, TNF-inhibition, minimal disease activity, remission
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-63965 (URN)000418418300008 ()28628468 (PubMedID)
Note

Funding Agency:

Swedish Psoriasis Foundation 

Available from: 2018-01-09 Created: 2018-01-09 Last updated: 2018-09-12Bibliographically approved
Geijer, M., Rundgren, G., Weber, L. & Flivik, G. (2017). Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty. Acta Radiologica, 58(10), 1276-1282
Open this publication in new window or tab >>Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty
2017 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 10, p. 1276-1282Article in journal (Refereed) Published
Abstract [en]

Background: Recently, total hip arthroplasty (THA) has come to focus on restoration of individual anatomy including femoral neck anteversion and global offset (femoral and acetabular offset). Three-dimensional (3D) computed tomography (CT) data could provide a better basis for preoperative templating. The use of CT has been hampered by high radiation dose.

Purpose: To evaluate the effective dose used in pelvis and hip CT for THA templating.

Material and Methods: CT data from two clinical trials of THA were evaluated for CT scan length and volume CT dose index (CTDIvol). The effective doses from hip-knee-ankle CT and pelvis and hip radiography were compared. Conversion factors for effective dose for radiography were calculated using the PCXMC software.

Results: A reduced dose CT protocol for pelvis imaging gave a substantial dose reduction compared with standard CT, while maintaining sufficient image quality. Between the two clinical trials there was a significant reduction in effective CT dose corresponding to changes in the CT protocol (P<0.01). The CT dose for the latter group was similar to, but nevertheless significantly higher than for, radiography (P<0.01). However, in the latter group the theoretical minimum dose for CT, using the minimum scan length required by the templating software, was equal to the dose from radiography.

Conclusion: Although the CT dose remained higher than for radiography, potential reductions in scan length could reduce the dose further so that CTwould have a comparable level of risk to radiography with the added benefit of 3D templating.

Place, publisher, year, edition, pages
London, United Kingdom: Sage Publications, 2017
Keywords
X-ray computed tomography (CT), radiography, hip arthroplasty, radiation dose
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-61035 (URN)10.1177/0284185117693462 (DOI)000408644400016 ()28347158 (PubMedID)2-s2.0-85027459537 (Scopus ID)
Available from: 2017-09-19 Created: 2017-09-19 Last updated: 2018-09-06Bibliographically approved
Olofsson, T., Mogård, E., Andreasson, K., Marsal, J., Geijer, M., Kristensen, L.-E. -., . . . Wallman, J. K. (2017). Faecal Calprotectin, But Not Anti-Saccharomyces Cerevisiae Antibodies, Is Linked To Worse Disease Status In Axial Spondyloarthritis Patients Without Inflammatory Bowel Disease: Results From The Spartakus Cohort. Paper presented at Annual European Congress of Rheumatology, Madrid, Spain, June 14-17, 2017. Annals of the Rheumatic Diseases, 76(Suppl. 2), 655-655
Open this publication in new window or tab >>Faecal Calprotectin, But Not Anti-Saccharomyces Cerevisiae Antibodies, Is Linked To Worse Disease Status In Axial Spondyloarthritis Patients Without Inflammatory Bowel Disease: Results From The Spartakus Cohort
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2017 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, no Suppl. 2, p. 655-655Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-62824 (URN)10.1136/annrheumdis-2017-eular.2391 (DOI)000413181402009 ()
Conference
Annual European Congress of Rheumatology, Madrid, Spain, June 14-17, 2017
Note

Funding Agencies:

AbbVie  

Ferring  

Hospira  

Oak Foundation 

Available from: 2017-11-24 Created: 2017-11-24 Last updated: 2018-08-31Bibliographically approved
Bozovic, G., Adlercreutz, C., Höglund, P., Björkman-Burtscher, I., Reinstrup, P., Ingemansson, R., . . . Geijer, M. (2017). Imaging of the Lungs in Organ Donors and its Clinical Relevance: A Retrospective Analysis. Journal of thoracic imaging, 32(2), 107-114
Open this publication in new window or tab >>Imaging of the Lungs in Organ Donors and its Clinical Relevance: A Retrospective Analysis
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2017 (English)In: Journal of thoracic imaging, ISSN 0883-5993, E-ISSN 1536-0237, Vol. 32, no 2, p. 107-114Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them.

Materials and methods: Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and cardiovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation.

Results: Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differences were found in 71 (52%) examinations (P<0.0001). In 31 of 42 (74%) complete or incomplete CT examinations, 50 of 74 findings with relevance for lung donation were not primarily reported (P<0.0001).

Conclusions: The majority of donor patients undergo only chest radiography. A targeted imaging review of abnormalities affecting the decision to use donor lungs may be useful in the preoperative stage. With a targeted list, substantial changes were made from initial clinical interpretations. CT can provide valuable information on donor lung pathology, even if the lungs are only partially imaged.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2017
Keywords
heart-lung transplantation, image interpretation, living donor, radiography; tomography, x-ray computed
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-54382 (URN)10.1097/RTI.0000000000000255 (DOI)000395535000005 ()28060192 (PubMedID)2-s2.0-85008311709 (Scopus ID)
Available from: 2017-03-10 Created: 2017-03-10 Last updated: 2018-07-30Bibliographically 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: 2018-07-31Bibliographically approved
Olofsson, T., Mogård, E., Marsal, J., Geijer, M., Kristensen, L. E., Lindqvist, E. & Wallman, J. K. (2017). Irritable Bowel Syndrome and Its Impact on Patient-Reported Outcomes in Axial Spondyloarthritis: Is It an Overlooked Comorbidity?. Arthritis & Rheumatology, 69(Suppl. 10), Article ID 2511.
Open this publication in new window or tab >>Irritable Bowel Syndrome and Its Impact on Patient-Reported Outcomes in Axial Spondyloarthritis: Is It an Overlooked Comorbidity?
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2017 (English)In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 69, no Suppl. 10, article id 2511Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background/Purpose: While inflammatory bowel disease (IBD) is a well-known comorbidity in axial spondyloarthritis (SpA), little is known about functional bowel problems, such as irritable bowel syndrome (IBS), in these patients. In the general population, the IBS prevalence has been estimated to be around 11%.[1] In the present study, we examined the frequency of IBS-symptoms and their relation to patient-reported outcomes in an ongoing survey of axial SpA patients.

Methods: Consecutive axial SpA patients were examined and classified as non-radiographic axial SpA (nr-axSpA; ASAS criteria; n=37) or ankylosing spondylitis (AS; modified New York criteria; n=68). Patients with known IBD were excluded. The ROME III questionnaire was used to assess IBS criteria fulfillment,[2] and faecal (F) calprotectin was measured by a commercially available ELISA kit.

Results: Overall, 30% of patients fulfilled the IBS criteria (n=31; 32%/28% of nr-axSpA/AS patients, no significant between-group difference; Figure 1). In 11 of these subjects (35%), F-calprotectin was, however, also elevated (≥50 mg/kg; F-calprotectin was available in 86 of the 105 patients; Figure 2), making it hard to rule out inflammation rather than functional disease as cause of the symptoms. Applying a stricter definition of IBS, i.e. a combination of fulfilled IBS criteria and a non-pathologic F-calprotectin level (<50 mg/kg), this was met by 19% of the patients (n=16; 23%/16% of nr-axSpA/AS patients, no significant between-group difference; Figure 1). Irrespective of F-calprotectin levels, the presence of IBS symptoms was associated with worse patient-reported outcomes, especially regarding disease activity and health-related quality of life (Table).

Conclusion: In axial SpA patients without known IBD, IBS-symptoms were substantially more common than described for the general population, affecting almost 1/3 of patients, and were linked to worse patient-reported outcomes. To establish the true IBS prevalence in the cohort would require colonoscopy of certain subjects, although even based on a highly conservative definition (fulfillment of IBS criteria and F-calprotectin <50 mg/kg) the observed prevalence was >1.5 times higher than that reported in the general population.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Ankylosing spondylitis (AS), Bowel, non-radiographic, patient outcomes and spondylarthritis
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-62165 (URN)10.1002/art.40321 (DOI)000411824106015 ()
Available from: 2017-11-07 Created: 2017-11-07 Last updated: 2018-09-14Bibliographically approved
Mogard, E., Marsal, J., Geijer, M., Kristensen, L. E., Lindqvist, E. & Wallman, J. K. (2017). Irritable Bowel Syndrome and Its Impact on Patient-Reported Outcomes in Axial Spondyloarthritis: Is It an Overlooked Comorbidity?. In: : . Paper presented at 2017 ACR/ARHP Annual Meeting, San Diego, CA, USA, November 3-8, 2017.
Open this publication in new window or tab >>Irritable Bowel Syndrome and Its Impact on Patient-Reported Outcomes in Axial Spondyloarthritis: Is It an Overlooked Comorbidity?
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2017 (English)Conference paper (Refereed)
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-67403 (URN)
Conference
2017 ACR/ARHP Annual Meeting, San Diego, CA, USA, November 3-8, 2017
Available from: 2018-06-21 Created: 2018-06-21 Last updated: 2018-09-14Bibliographically approved
Tägil, M., Berne, H., Geijer, M., Kopylov, P. & Abramo, A. (2017). Primary hemi-prosthetic replacement of the distal radio-ulnar joint (DRUJ) in 12 rheumatoid patients after minimum 5 year.: A clinical report and a radiographic analysis focusing on periimplant bone remodeling. In: : . Paper presented at ORS 2017 Orthopedic Research Society annual meeting, San Diego, CA, USA, March 19-22, 2017.
Open this publication in new window or tab >>Primary hemi-prosthetic replacement of the distal radio-ulnar joint (DRUJ) in 12 rheumatoid patients after minimum 5 year.: A clinical report and a radiographic analysis focusing on periimplant bone remodeling
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2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-67402 (URN)
Conference
ORS 2017 Orthopedic Research Society annual meeting, San Diego, CA, USA, March 19-22, 2017
Available from: 2018-06-21 Created: 2018-06-21 Last updated: 2018-06-21Bibliographically approved
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