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  • 1.
    Alshamari, Muhammed
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Geijer, Mats
    Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Norrman, Eva
    Region Örebro län.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Low-dose computed tomography of the lumbar spine: a phantom study on imaging parameters and image quality2014Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 55, nr 7, s. 824-832Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Lumbar spine radiography has limited diagnostic value but low radiation dose compared with computed tomography (CT). The average effective radiation dose from lumbar spine radiography is about 1.1 mSv. Low-dose lumbar spine CT may be an alternative to increase the diagnostic value at low radiation dose, around 1 mSv.

    Purpose: To determine the optimal settings for low-dose lumbar spine CT simultaneously aiming for the highest diagnostic image quality possible.

    Material and Methods: An ovine lower thoracic and lumbar spine phantom, with all soft tissues around the vertebrae preserved except the skin, was placed in a 20 L plastic container filled with water. The phantom was scanned repeatedly with various technical settings; different tube potential, reference mAs, and with different convolution filters. Five radiologists evaluated the image quality according to a modification of the European guidelines for multislice computed tomography (MSCT) quality criteria for lumbar spine CT 2004. In a visual comparison the different scans were also ranked subjectively according to perceived image quality. Image noise and contrast were measured.

    Results: A tube potential of 120 kV with reference mAs 30 and medium or medium smooth convolution filter gave the best image quality at a sub-millisievert dose level, i.e. with an effective dose comparable to that from lumbar spine radiography.

    Conclusion: Low-dose lumbar spine CT thus opens a possibility to substitute lumbar spine radiography with CT without obvious increase in radiation dose.

  • 2.
    Alshamari, Muhammed
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden; Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden.
    Norrman, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Lidén, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Krauss, Wolfgang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Jendeberg, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Region Örebro län.
    Geijer, Håkan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Impact of iterative reconstruction on image quality of low-dose CT of the lumbar spine2017Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, nr 6, s. 702-709Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 3.
    Alshamari, Muhammed
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Geijer, Mats
    Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden.
    Norrman, Eva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medical Physics,, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lidén, Mats
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Krauss, Wolfgang
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Wilamowski, Franciszek
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice2016Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, nr 5, s. 602-611Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Lumbar spine radiography is often performed instead of CT for radiation dose concerns.

    Purpose: To compare image quality and diagnostic information from low dose lumbar spine CT at an effective dose of about 1 mSv with lumbar spine radiography.

    Material and Methods: Fifty-one patients were examined by both methods. Five reviewers scored all examinations on eight image quality criteria using a five-graded scale and also assessed three common pathologic changes.

    Results: Low dose CT scored better than radiography on the following: sharp reproduction of disc profile and vertebral end-plates (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.5), intervertebral foramina and pedicles (OR, 4.3; 95% CI, 3.1-5.9), intervertebral joints (OR, 139; 95% CI, 59-326), spinous and transverse processes (OR, 7.0; 95% CI, 4.3-11.2), sacro-iliac joints (OR, 4.2; 95% CI, 3.2-5.7), reproduction of the adjacent soft tissues (OR, 2.9; 95% CI, 2.1-4.0), and absence of any obscuring superimposed gastrointestinal gas and contents (OR, 188; 95% CI, 66-539). Radiography scored better on sharp reproduction of cortical and trabecular bone (OR, 0.3; 95% CI, 0.2-0.4). The reviewers visualized disk degeneration, spondylosis/diffuse idiopathic skeletal hyperostosis (DISH) and intervertebral joint osteoarthritis more clearly and were more certain with low dose CT. Mean time to review low dose CT was 204 s (95% CI, 194-214 s.), radiography 152 s (95% CI, 146-158 s.). The effective dose for low dose CT was 1.0-1.1 mSv, for radiography 0.7 mSv.

    Conclusion: Low dose lumbar spine CT at about 1 mSv has superior image quality to lumbar spine radiography with more anatomical and diagnostic information.

  • 4.
    Alshamari, Muhammed
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Norrman, Eva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Geijer, Mats
    Department of Medical Imaging and Physiology, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Jansson, Kjell
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review2016Inngår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 26, nr 6, s. 1766-1774Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels.

    Methods: Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present.

    Results: Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %.

    Conclusions: Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain.

    Key points: • Low-dose CT has a higher diagnostic accuracy than radiography. • A systematic review shows that CT has better diagnostic accuracy than radiography. • Radiography has no place in the workup of acute non-traumatic abdominal pain.

  • 5.
    Andersson, Karin M.
    et al.
    Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Norrman, Eva
    Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Krauss, Wolfgang
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Jendeberg, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Geijer, Mats
    Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Lidén, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Thunberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden .
    Visual grading evaluation of commercially available metal artefact reduction techniques in hip prosthesis computed tomography2016Inngår i: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 89, nr 1063, artikkel-id 20150993Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To evaluate metal artefact reduction (MAR) techniques from four computed tomography (CT) vendors in hip prosthesis imaging.

    Methods: Bilateral hip prosthesis phantom images, obtained by using MAR algorithms for single energy CT data or dual energy CT (DECT) data and by monoenergetic reconstructions of DECT data, were visually graded by five radiologists using ten image quality criteria. Comparisons between the MAR images and a reference image were performed for each scanner separately. Ordinal probit regression analysis was used.

    Results: The MAR algorithms in general improved the image quality based on the majority of the criteria (up to between 8/10 and 10/10) with a statistically improvement in overall image quality (P<0.001). However, degradation of image quality, such as new artefacts, was seen in some cases. A few monoenergetic reconstruction series improved the image quality (P<0.004) for one of the DECT scanners, but it was only improved for some of the criteria (up to 5/10). Monoenergetic reconstructions resulted in worse image quality for the majority of the criteria (up to 7/10) for the other DECT scanner.

    Conclusions: The MAR algorithms improved the image quality of the hip prosthesis CT images. However, since additional artefacts and degradation of image quality were seen in some cases, all algorithms should be carefully evaluated for every clinical situation. Monoenergetic reconstructions were in general concluded to be insufficient for reducing metal artifacts. Advances in knowledge: Qualitative evaluation of the usefulness of several MAR techniques from different vendors in CT imaging of hip prosthesis.

  • 6.
    Bozovic, Gracijela
    et al.
    Department of Radiology, Skåne University Hospital, Lund University, Lund, Sweden.
    Adlercreutz, Catharina
    Department of Radiology, Skåne University Hospital, Lund University, Lund, Sweden.
    Höglund, Peter
    Deptartment Lab Medicine, Lund University, Lund, Sweden; Division Clinical Chemistry & Pharmacology, Lund University, Lund, Sweden.
    Björkman-Burtscher, Isabella
    Department of Radiology, Skåne University Hospital, Lund University, Lund, Sweden; Lund University Bioimaging Centre, Lund, Sweden .
    Reinstrup, Peter
    Departments of Neurosurgery, Skåne Universty Hospital, Lund, Sweden.
    Ingemansson, Richard
    Departments of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden .
    Schaefer-Prokop, Cornelia
    Meander Medical Centre, Amersfoort, Netherlands .
    Siemund, Roger
    Department of Radiology, Skåne University Hospital, Lund University, Lund, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Imaging of the Lungs in Organ Donors and its Clinical Relevance: A Retrospective Analysis2017Inngår i: Journal of thoracic imaging, ISSN 0883-5993, E-ISSN 1536-0237, Vol. 32, nr 2, s. 107-114Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7.
    Deminger, Anna
    et al.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Klingberg, Eva
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lorentzon, Mattias
    Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Göthlin, Jan
    Department of Radiology, Sahlgrenska University Hospital, Mölndal, Sweden.
    Hedberg, Martin
    Section of Rheumatology, Södra Älvsborg Hospital, Borås, Sweden.
    Rehnberg, Eva
    Section of Rheumatology, Alingsås Hospital, Alingsås, Sweden.
    Carlsten, Hans
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jacobsson, Lennart T.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Forsblad-d'Elia, Helena
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden.
    Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study2017Inngår i: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 19, artikkel-id 273Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Studies have shown increased prevalence of osteoporosis and increased risk for vertebral fractures in patients with ankylosing spondylitis (AS). Measurements of bone mineral density (BMD) in the lumbar spine anterior-posterior (AP) projection may be difficult to interpret due to the ligamentous calcifications, and the lateral projection might be a better measuring site. Our objectives were to investigate BMD changes after 5 years at different measuring sites in patients with AS and to evaluate disease-related variables and medications as predictors for BMD changes.

    METHODS: In a longitudinal study, BMD in Swedish AS patients, 50 ± 13 years old, was measured with dual-energy x-ray absorptiometry (DXA) at the hip, the lumbar spine AP and lateral projections, and the total radius at baseline and after 5 years. Patients were assessed with questionnaires, blood samples, and spinal radiographs for grading of AS-related alterations in the spine with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and assessment of vertebral fractures by the Genant score. Multiple linear regression analyses were used to investigate predictors for BMD changes.

    RESULTS: Of 204 patients included at baseline, 168 (82%) were re-examined after 5 years (92 men and 76 women). BMD decreased significantly at the femoral neck and radius and increased significantly at the lumbar spine, both for AP and lateral projections. Mean C-reactive protein during follow-up predicted a decrease in the femoral neck BMD (change in %, β = -0.15, p = 0.046). Use of bisphosphonates predicted an increase in BMD at all measuring sites (p < 0.001 to 0.013), except for the total radius. Use of tumor necrosis factor inhibitors (TNFi) predicted an increase in AP spinal BMD (β = 3.15, p = 0.012).

    CONCLUSION: The current study (which has a long follow-up, many measuring sites, and is the first to longitudinally assess the lateral projection of the spine in AS patients) surprisingly showed that lateral projection spinal BMD increased. This study suggests that the best site to assess bone loss in AS patients is the femoral neck and that inflammation has an adverse effect, and the use of bisphosphonates and TNFi has a positive effect, on BMD in AS patients.

  • 8.
    Dozet, Alexander
    et al.
    Department of Healthcare Governance, Region Skåne, Malmö, Sweden.
    Ivarsson, Bodil
    Medicine Service University Trust, Department of Cardiothoracic Surgery, Skåne University Hospital, Region Skåne, Lund University, Lund, Sweden.
    Eklund, Karin
    Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden.
    Klefsgard, Rosemarie
    Hospital Management, Skåne University Hospital, Malmö, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Radiography on wheels arrives to nursing homes - an economic assessment of a new health care technology in southern Sweden2016Inngår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, nr 6, s. 994-1001Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rationale, aims and objectives: The process of transferring older, vulnerable adults from an elder care facility to the hospital for medical care can be an emotionally and physically stressful experience. The recent development of modern mobile radiography may help to ease this anxiety by allowing for evaluation in the nursing home itself. Up until this point, no health economic evaluation of the technology has been attempted in a Swedish setting. The objective of this study was to determine whether examinations of patients in elder care facilities with mobile radiography were cost-effective from a societal perspective compared with hospital-based radiological examinations.

    Methods: This prospective study included two groups of nursing home residents in two different areas in southern Sweden. All residents in the nursing homes were targeted for the study. Seventy-one patients were examined with hospital-based radiography at two hospitals, and 312 patients were examined using mobile radiography in nursing homes. Given that the diagnostic effects are regarded as equivalent, a cost minimization method was applied. Direct costs were estimated using prices from the county council, Region Skane, Sweden.

    Results: From a societal perspective, mobile radiography was shown to have significantly lower costs per examination compared with hospital-based radiography. The difference in health care-related costs was also significant in favour of mobile radiography.

    Conclusion: Mobile radiography can be used to examine patients in nursing homes at a lower cost than hospital-based radiography. Patients benefit from not having to transfer to a hospital for radiography, resulting in reduced anxiety for patients.

  • 9.
    Geijer, Håkan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Radiology, Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Added value of double reading in diagnostic radiology, a systematic review2018Inngår i: Insight into Imaging, ISSN 1869-4101, E-ISSN 1869-4101, Vol. 9, nr 3, s. 287-301Artikkel, forskningsoversikt (Fagfellevurdert)
    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.

  • 10.
    Geijer, Håkan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Double reading in diagnostic radiology: a systematic review2019Konferansepaper (Annet vitenskapelig)
  • 11.
    Geijer, Mats
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Gunnlaugsson, Eirikur
    Department of Medical Imaging and Physiology, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Götestrand, Simon
    Department of Medical Imaging and Physiology, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Weber, Lars
    Department of Radiation Physics, Skåne University Hospital, Lund, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Radiology.
    Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly2017Inngår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 27, nr 2, s. 491-497Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 12.
    Geijer, Mats
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden .
    Jureus, Jan
    Department of Orthopedic Surgery, Skåne University Hospital and Lund University, Lund, Sweden.
    Hanni, Mari
    Department of Radiology, Akademiska Hospital, Uppsala, Sweden.
    Shalabi, Adel
    Department of Radiology, Akademiska Hospital, Uppsala, Sweden.
    MR appearance of the temporal evolution and resolution of spontaneous osteonecrosis of the knee: a case report2017Inngår i: Acta Radiologica Open, E-ISSN 2058-4601, Vol. 6, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Spontaneous osteonecrosis of the knee (SONK) is a feared condition of unknown cause, in its classic form appearing in the medial femoral condyle in middle-aged or elderly subjects. Diagnosis with radiography is notoriously difficult with a long latency before typical changes appear. Magnetic resonance imaging (MRI) is regarded as a diagnostic tool with the possibility to give an earlier diagnosis with improved chances for treatment. However, also with MRI there may be an initial diagnostic blind spot before typical changes appear. Little is known about the temporal evolution of the MRI changes. In the current case report, a case of SONK is reported where serial imaging with MRI was performed, from initial symptoms to eventual resolution after almost three years.

  • 13.
    Geijer, Mats
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Laurin, Olof
    Slogstorp, Björkdala, Löberöd, Sweden.
    Johnsson, Ragnar
    Department of Orthopedic surgery, Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Laurin, Sven
    Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    A computer-assisted systematic quality monitoring method for cervical hip fracture radiography2016Inngår i: Acta Radiologica Open, ISSN 2058-4601, Vol. 5, nr 12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A thorough quality analysis of radiologic performance is cumbersome. Instead, the prevalence of missed cervical hip fractures might be used as a quality indicator.

    Purpose: To validate a computer-based quality study of cervical hip fracture radiography.

    Material and Methods: True and false negative and positive hip trauma radiography during 6 years was assessed manually. Patients with two or more radiologic hip examinations before surgery were selected by computer analysis of the databases. The first of two preoperative examinations might constitute a missed fracture. These cases were reviewed.

    Results: Out of 1621 cervical hip fractures, manual perusal found 51 (3.1%) false negative radiographic diagnoses. Among approximately 14,000 radiographic hip examinations, there were 27 (0.2%) false positive diagnoses. Fifty-seven percent of false negative reports were occult fractures, the other diagnostic mistakes. There were no significant differences over the years. Diagnostic sensitivity was 96.9% and specificity 99.8%. Computer-assisted analysis with a time interval of at least 120 days between the first and the second radiographic examination discovered 39 of the 51 false negative reports.

    Conclusion: Cervical hip trauma radiography has high sensitivity and specificity. With computer-assisted analysis, 76% of false negative reports were found.

  • 14.
    Geijer, Mats
    et al.
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Rundgren, Gustav
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Weber, Lars
    Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Radiation Physics, Skåne University Hospital, Lund, Sweden.
    Flivik, Gunnar
    Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Orthopedics, Skåne University Hospital, Lund, Sweden.
    Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty2017Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, nr 10, s. 1276-1282Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 15.
    Landgren, Marcus
    et al.
    Department of Orthopedics, Clinical Sciences Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Abramo, Antonio
    Department of Hand Surgery Malmö, Skåne University Hospital, Malmö, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Clinical sciences, Lund University, Lund, Sweden.
    Kopylov, Philippe
    Department of Orthopedics, Clinical Sciences Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Tägil, Magnus
    Department of Orthopedics, Clinical Sciences Lund University, Lund, Sweden; Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
    Similar 1-year subjective outcome after a distal radius fracture during the 10-year-period 2003-2012: A longitudinal register-based study involving 3,666 patients2017Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, nr 4, s. 451-456Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose: During the last decades, treatment of distal radius fractures (DRFs) has changed, with surgical intervention being more common and with new techniques. We investigated whether this change has influenced the subjective outcome. Here we report, year by year, the 1-year score after a DRF over a 10-year-period, using a patient-reported outcome measure.

    Patients and methods: Patients aged 18 years or more with a DRF between 2003 and 2012 were prospectively and consecutively registered in a longitudinal outcome database. 1 year after the fracture, all the patients were sent a validated subjective outcome questionnaire, the Disabilities of the Arm, Shoulder, and Hand (DASH). The lower the score (0-100), the better the outcome.

    Results: Between 2003 and 2012, 3,666 patients (2,833 of them women; mean age 62 (18-98) years) were included. 22% were operated and the rate remained constant over the years. The surgical methods shifted from external fixators (42%) and fragment-specific plates (45%) in 2003, to mainly volar locking plates (65%) in 2012. 70% of the patients responded to the 1-year DASH questionnaire. The median DASH score was 9 (IQR: 2-25) for the cohort, both in surgically treated patients (9 (IQR: 3-25)) and in non-surgically treated patients (9 (IQR 2-27)). Subgroup analysis showed a higher median DASH score for women than for men; for patients with AO type C fractures rather than type B or type A fractures; for patients with external fixation or fragment-specific fixation than for those who underwent surgery using volar locking plates; and for patients who were operated by a general orthopedic surgeon rather than a hand surgeon.

    Interpretation: The shift in surgical treatment had no influence on the subjective outcome for the cohort.

  • 16.
    Lindqvist, U.
    et al.
    Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden.
    Wernroth, M. -L
    Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden.
    Husmark, T.
    Department of Rheumatology, Falu Hospital, Falun, Sweden.
    Larsson, P.
    Department of Rheumatology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Radiology, University Hospital, Örebro, Sweden.
    Teleman, A.
    Spenshult Hospital, Spenshult AB, Oskarström, Sweden.
    Theander, E.
    Department of Rheumatology, Skåne University Hospital Malmö, Lund University, Sweden.
    Alenius, G. -M
    Department of Public Health and Clinical, Medicine/Rheumatology, Umeå University, Umeå, Sweden.
    DAPSA, DAS28 and MDA predict long-term treatment regime in psoriatic arthritis: The Swedish Early Psoriatic Arthritis Cohort2017Inngår i: Clinical and Experimental Rheumatology, ISSN 0392-856X, E-ISSN 1593-098X, Vol. 35, nr 6, s. 936-942Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 17.
    Mrkonjic, Ante
    et al.
    Department of Hand Surgery, Skåne University Hospital Malmö, Malmö, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Geijer, Mats
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Lindau, Tommy
    Pulvertaft Hand Centre, Derby, UK.
    Tägil, Magnus
    Department of Hand Surgery, Skåne University Hospital Malmö, Malmö, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital Lund, Lund, Sweden.
    No long-term risk of wrist osteoarthritis due to subchondral haematomas in distal radial fractures2018Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 52, nr 2, s. 163-165Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 18.
    Olofsson, T.
    et al.
    Department of clinical sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Mogård, E.
    Department of clinical sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Andreasson, K.
    Department of clinical sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Marsal, J.
    Department of clinical sciences Lund, Gastroenterology, Lund University, Lund, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Kristensen, L. -E
    Dept Rheumatol, Parker Inst, Copenhagen Univ Hosp, Copenhagen, Denmark; Dept Clin Sci Lund, Rheumatol, Lund Univ, Lund, Sweden.
    Lindqvist, E.
    Department of clinical sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Wallman, J. K.
    Department of clinical sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    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 Cohort2017Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr Suppl. 2, s. 655-655Artikkel i tidsskrift (Annet vitenskapelig)
  • 19.
    Olofsson, Tor
    et al.
    Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Mogård, Elisabeth
    Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Marsal, Jan
    Department of Clinical Sciences Lund, Gastroenterology, Lund University, Lund, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Kristensen, Lars Erik
    Department of Rheumatology, The Parker Institute, Copenhagen University Hospital Frederiksberg and Bispebjerg, Copenhagen, Denmark.
    Lindqvist, Elisabet
    Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Wallman, Johan K.
    Department of Clincial Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
    Irritable Bowel Syndrome and Its Impact on Patient-Reported Outcomes in Axial Spondyloarthritis: Is It an Overlooked Comorbidity?2017Inngår i: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 69, nr Suppl. 10, artikkel-id 2511Artikkel i tidsskrift (Annet vitenskapelig)
    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.

  • 20.
    Tägil, Magnus
    et al.
    Skåne University Hospital/SUS, Malmö/Lund, Sweden.
    Berne, Hanna
    Skåne University Hospital/SUS, Malmö/Lund, Sweden.
    Geijer, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Kopylov, Philippe
    Skåne University Hospital/SUS, Malmö/Lund, Sweden.
    Abramo, Antonio
    Skåne University Hospital/SUS, Malmö/Lund, Sweden.
    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 remodeling2017Konferansepaper (Fagfellevurdert)
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