Search Results (250)

Background/Objectives: Computed tomography (CT) of the head is vital in diagnosing neurological conditions but poses concerns regarding radiation exposure. Traditional diagnostic reference levels (DRLs) are based on anatomical regions, potentially overlooking variations in radiation requirements driven by clinical indication. This study aimed to establish clinical indication-specific DRLs (DRLCIs) for adult head CT to support precision benchmarking and optimise patient safety. Methods: A retrospective observational study was conducted using data from 378 adult patients undergoing non-contrast CT head scans between September 2022 and February 2024. Data on patient demographics, protocols, and radiation dose metrics (Computed Tomography Dose Index Volume and Dose–Length Product) were extracted using DoseWatch™ software. Protocol parameters were standardised across clinical indications such as trauma, stroke, headache, seizure, and infection. Descriptive statistics and correlation analyses were performed. Descriptive statistics, including means, standard deviations, and percentile distributions, were calculated. Correlation analyses were conducted using Pearson’s correlation coefficient to examine relationships between dose metrics and patient variables such as age and body mass index. Results: Mean CTDIvol values ranged from 50.58 mGy (trauma) to 52.90 mGy (infection), while DLP values ranged from 1052.52 to 1219.98 mGy·cm. Percentile distributions were narrow, indicating effective protocol standardisation. The strongest correlation was observed between CTDIvol and DLP (r = 0.89), while age and body mass index showed negligible influence on dose metrics. Comparative analysis showed alignment with international benchmarks from the UK, Qatar, Bahrain, and Nigeria. Conclusions: This study establishes DRLCIs for adult head CT, demonstrating consistent radiation dose delivery across indications with minimal variability. Clinical indication-based benchmarking enhances dose optimisation and aligns with global radiological protection frameworks. Full article

Introduction: Pertussis, a vaccine-preventable disease caused by Bordetella pertussis, is resurging globally due to declining immunization rates. This study explores the clinical and epidemiological features of pediatric pertussis cases in a regional Romanian hospital amid growing vaccine hesitancy. Methods: We conducted a retrospective cohort study on 99 children diagnosed with pertussis and admitted to Ploiești Pediatric Hospital between January 2024 and January 2025. Demographic, clinical, laboratory, and radiological data were analyzed using SPSS 25.0. Results: The median age was 11 months (IQR 4–25), with 12.1% under two months, and ineligible for the first DTaP dose. Notably, 72.7% of children were unvaccinated; 59.4% had missed scheduled doses. None of the mothers received the DTaP vaccination during pregnancy. Most cases (55.6%) had bilaterally accentuated interstitial patterns on chest X-ray, significantly associated with vaccination status (p = 0.019). The leukocyte count was higher in children with alveolar infiltrates (p = 0.028), and as the number of vaccine doses increased, the leukocyte count tended to slightly decrease (p = 0.022, R = −0.229). PCR confirmation was obtained after a mean of 2.2 days, with 12.1% of cases confirmed post-discharge. Azithromycin was used in 74.7% of cases, with good tolerability. Conclusions: Low pediatric and maternal vaccine uptake was a major contributor to pertussis resurgence in this cohort. Radiological severity correlated with vaccination status, suggesting that vaccination may confer protection not only against infection but also against severe pulmonary involvement. These findings support urgent public health efforts to restore vaccine confidence and coverage, particularly among vulnerable infant populations and expectant mothers. Full article

Large language models (LLMs) show promise in enhancing medical research through domain-specific question answering. However, their clinical application is limited by hallucination risk, limited domain specialization, and privacy concerns. Public LLMs like GPT-4-Consensus pose challenges for use with institutional data, due to the inability to ensure patient data protection. In this work, we present a secure, custom-designed retrieval-augmented generation (RAG) LLM system deployed entirely within our institution and tailored for radiology research. Radiology researchers at our institution evaluated the system against GPT-4-Consensus through a blinded survey assessing factual accuracy (FA), citation relevance (CR), and perceived performance (PP) using 5-point Likert scales. Our system achieved mean ± SD scores of 4.15 ± 0.99 for FA, 3.70 ± 1.17 for CR, and 3.55 ± 1.39 for PP. In comparison, GPT-4-Consensus obtained 4.25 ± 0.72, 3.85 ± 1.23, and 3.90 ± 1.12 for the same metrics, respectively. No statistically significant differences were observed (p = 0.97, 0.65, 0.42), and 50% of participants preferred our system’s output. These results validate that secure, local RAG-based LLMs can match state-of-the-art performance while preserving privacy and adaptability, offering a scalable tool for medical research environments. Full article

Thyroid nodules are a common clinical finding, with their prevalence influenced by multiple environmental and occupational factors, including exposure to ionizing radiation. Healthcare workers, particularly those operating in radiology, nuclear medicine, interventional cardiology, and radiation oncology, are potentially at increased risk due to chronic low-dose radiation exposure. This review aims to evaluate the current evidence regarding the association between occupational radiation exposure and the development of thyroid nodules among healthcare professionals. The findings suggest a higher prevalence of thyroid nodules in radiation-exposed workers compared to the general population, although data heterogeneity and methodological limitations exist. Factors such as the duration of exposure, radiation protection practices, and frequency of monitoring play critical roles in modulating the individual risk. While some studies report no significant difference in malignancy rates, the increased detection of nodules underlines the need for regular thyroid surveillance in at-risk populations. Further longitudinal and multicentric studies are warranted to clarify the causality and guide preventive strategies. This review highlights the importance of occupational health protocols, including radiation shielding and periodic thyroid evaluation, in safeguarding the long-term endocrine health of healthcare workers. Full article

Interventional radiology offers minimally invasive procedures guided by real-time imaging, reducing surgical risks and enhancing patient recovery. While beneficial to patients, these advancements increase occupational hazards for physicians due to chronic exposure to ionizing radiation. This exposure raises health risks like radiation-induced cataracts, cardiovascular disease, and cancer. Despite regulations like the European Council Directive 2013/59/EURATOM, which sets limits on whole-body and eye lens doses, no dose limits exist for the brain and meninges, since the brain has traditionally been considered a radioresistant organ. Recent studies, however, have highlighted radiation-induced brain damage, suggesting that meningeal exposure in interventional radiology may be underestimated. This study evaluates the entrance air Cumulative mean annual entrance air kerma to the skullull during interventional radiology procedures, using thermoluminescent dosimeters and controlled exposure simulations. Data were collected by varying the exposure time and analyzing the contribution to the entrance air kerma on each side of the head. The results indicate that, considering the attenuation of the cranial bone, the absorbed dose to the brain, obtained by averaging the head entrance air kerma for the right, front, and left sides of the operator’s head, could represent 0.81% to 2.18% of the annual regulatory limit in Italy of 20 mSv for the average annual effective dose of exposed workers (LD 101/2020). These results provide an assessment of brain exposure, highlighting the relatively low but non-negligible contribution of brain irradiation to the overall occupational dose constraint. Additionally, a correlation between entrance air kerma and the Kerma-Area Product was observed, providing a potential method for improved dose estimation and enhanced radiation safety for interventional radiologists. Full article

The combustion of hard coal and lignite in power and combined heat and power plants generates significant amounts of coal fly ash (CFA), a waste material with variable properties. CFA naturally contains radionuclides, specifically naturally occurring radioactive materials (NORMs), which pose potential radiological risks to the environment and human health during their storage and utilization, including their incorporation into building materials. Although global research on the radionuclide content in CFA is available, there is a clear gap in detailed and current data specific to Central and Eastern Europe and notably, a lack of a systematic analysis investigating the influence of installed power plant capacity on the concentration profile of these radionuclides in the generated ash. This study aimed to fill this gap and provide crucial data for the Polish energy and environmental context. The objective was to evaluate the concentrations of selected radionuclides (²³²Th, ²²⁶Ra, and ⁴⁰K) in coal fly ash samples collected between 2020 and 2023 from 19 Polish power and combined heat and power plants with varying capacities (categorized into four groups: S1–S4) and to assess the associated radiological risk. Radionuclide concentrations were determined using gamma spectrometry, and differences between groups were analyzed using non-parametric statistical methods, including PERMANOVA. The results demonstrated that plant capacity has a statistically significant influence on the concentration profiles of thorium and potassium but not radium. Calculated radiological hazard assessment factors (Ra_eq, H_ex, H_in, IAED) revealed that although most samples fall near regulatory limits (e.g., 370 Bq kg⁻¹ for Ra_eq), some exceed these limits, particularly in groups S1 (plants with a capacity less than 300 MW) and S4 (plants with a capacity higher than 300 MW). It was also found that the frequency of exceeding the annual effective dose limits (IAEDs) showed an increasing trend with the increasing installed capacity of the facility. These findings underscore the importance of plant capacity as a key factor to consider in the radiological risk assessment associated with coal fly ash. This study’s outcomes are crucial for informing environmental risk management strategies, guiding safe waste processing practices, and shaping environmental policies within the energy sector in Central and Eastern European countries, including Poland. Full article

Background/Objectives: Lung-protective ventilation (LPV) reduces postoperative pulmonary complications (PPCs) in obese patients. While the roles of low tidal volume and positive end-expiratory pressure (PEEP) in LPV have been established in patients with healthy lungs, the protective effect of alveolar recruitment strategies (ARSs) remains a subject of debate. This study aims to evaluate the benefit of ARSs in patients with low-to-moderate risk according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score undergoing gynecologic cancer surgery with LPV and low tidal volume intraoperatively. Methods: A total of 88 obese patients were evaluated in this study. They were divided into two groups as the non-ARS group (non-ARS) and the ARS group (ARS). Intraoperative hemodynamics, blood gas analyses, respiratory mechanics, mechanical ventilator parameters, and postoperative outcomes were compared in these obese patients. Results: A total of 40 obese patients undergoing major gynecological cancer surgery were included in this study. Although the non-ARS group presented with higher weight (p < 0.05), body mass indexes were similar to the ARS group. Intraoperative blood gas analysis revealed higher end-tidal carbon dioxide (etCO₂) levels in the non-ARS group during the T2 and T3 time intervals (p < 0.05). In the ARS group, peak inspiratory pressure (PIP) at T3 was lower, while drive pressures at T1 and T2 and dynamic compliance at T3 were higher (p < 0.05). Radiologic atelectasis scores were higher in the non-ARS group, indicating more atelectatic lung images (p < 0.05). PPC rates were similar across both groups. Conclusions: Although the ARS demonstrated positive effects on lung mechanics and radiologic atelectasis scores in major open gynecologic cancer surgeries, it did not effectively reduce postoperative pulmonary complications. Full article

Background: Incisional hernias are a frequent complication following ileostomy closure, with rates reaching 24%. Protective ileostomies are commonly performed in colorectal surgery, but their closure presents a significant risk for abdominal wall defects. Identifying risk factors for incisional hernias at the ileostomy site is crucial for improving patient outcomes. Methods: This retrospective study analyzed data from 95 patients who underwent loop ileostomy closure at two Romanian hospitals between 2018 and 2023. Patient demographics, surgical details, and follow-up data were reviewed. Incisional hernias were diagnosed through clinical examination or radiological imaging. Statistical analyses, including univariate and multivariate regression, were performed to identify independent risk factors. Results: The incidence of incisional hernias at the ileostomy site was 13.7% (13/95). Univariate analysis identified BMI (HR 30.08; p = 0.007), previous hernia (HR 7.99; p = 0.059), radiotherapy (HR 299.15; p = 0.029), and chemotherapy (HR 0.004; p = 0.026) as significant factors. Multivariate analysis confirmed BMI > 30 kg/m² (HR 12.27; p = 0.002) and prior hernia (HR 8.14; p = 0.007) as independent risk factors. Conclusions: Obesity and previous hernias significantly increase the risk of incisional hernias following ileostomy closure. Radiological follow-up enhances early detection, and further studies should explore the benefits of prophylactic mesh reinforcement. Optimizing patient selection and surgical technique may reduce postoperative hernia rates, improving long-term outcomes. Full article

Supplementary cementitious materials (SCMs) may be prepared using industrial byproduct streams, aiding in the development of a more environmentally sustainable circular economy. However, these byproducts may carry a risk of exhibiting elevated levels of radioactivity because of the preceding processing that may have concentrated the radionuclides naturally occurring in the raw material. This processing causes the byproducts to be considered technologically enhanced naturally occurring radioactive material (NORM). Thus, the safe use of such SCMs requires robust data on the activity concentrations of three main radionuclides (²²⁶Ra, ²³²Th, ⁴⁰K) represented by the activity concentration index (ACI) used as a radiological suitability indicator. In this work, candidate SCMs derived from the alumina industry byproduct processed bauxite (PB), also referred to as bauxite residue, were assessed by measuring the activity of all available samples, including input raw materials and intermediate substances, through gamma spectrometry. PB was found to significantly impact the final ACI value of the building material. As a key analysis outcome applicable to the substances assessed in this work, no additional dose assessment is required, given the low ACI value of the building materials. This result indicates that, from a radiological perspective, the PB samples studied are suitable precursors for SCMs. In addition, a generalized approach was found to provide good estimations of the ACI value of building materials, which is useful to screen materials for regulatory compliance, without needing to prepare samples of the materials in question. Full article

Machine Learning models, more specifically Artificial Neural Networks, are transforming medical imaging by enabling precise liver segmentation, a crucial task for diagnosing and treating liver diseases. However, these models often face challenges in adapting to diverse clinical data sources as differences in dataset volume, resolution, and origin impact generalization and performance. This study introduces a Private Data Incrementalization, a data-centric approach to enhance the adaptability of Artificial Neural Networks by progressively exposing them to varied clinical data. As the target of this study is not to propose a new image segmentation model, the existing medical imaging segmentation models—including U-Net, ResUNet++, Fully Convolutional Network, and a modified algorithm based on the Conditional Bernoulli Diffusion Model—are used. The study evaluates these four models using a curated private dataset of computed tomography scans from Coimbra University Hospital, supplemented by two public datasets, 3D-IRCADb01 and CHAOS. The Private Data Incrementalization method systematically increases the volume and diversity of training data, simulating real-world conditions where models must handle varied imaging contexts. Pre-processing and post-processing stages, incremental training, and performance evaluations reveal that structured exposure to diverse datasets improves segmentation performance, with ResUNet++ achieving the highest accuracy (0.9972) and Dice Similarity Coefficient (0.9449), and the best Average Symmetric Surface Distance (0.0053 mm), demonstrating the importance of dataset diversity and volume for segmentation models’ robustness and generalization. Private Data Incrementalization thus offers a scalable strategy for building resilient segmentation models, ultimately benefiting clinical workflows, patient care, and healthcare resource management by addressing the variability inherent in clinical imaging data. Full article

COVID-19-associated invasive fungal infections (CAIFIs) contribute to increased mortality and morbidity rates. This study explores the epidemiology, laboratory parameters, radiological characteristics, treatments, and 30-day mortality risks of CAIFI in critically ill intubated patients while also evaluating factors associated with prolonged mechanical ventilation (PMV) in this population. Adults admitted to a tertiary hospital from 1 April 2021 to 31 March 2022 who were diagnosed with severe COVID-19, required invasive mechanical ventilation, and developed invasive fungal infection (IFI) during hospitalization were analyzed in this retrospective cohort study. Among 150 patients, 65 (43.3%) required PMV, with an in-hospital mortality rate of 64%. Candida albicans (47%) and Aspergillus fumigatus (27%) were the most prevalent pathogens. Multivariate analysis revealed that COVID-19 vaccination (adjusted odds ratio, aOR = 0.155, 95% confidence interval, 95% CI = 0.029–0.835, p = 0.030) and higher serum protein levels (aOR = 0.900, 95% CI = 0.819–0.989, p = 0.028) were significantly associated with a reduced risk of PMV. Meanwhile, elevated glucose levels (hazard ratio, HR = 1.047, 95% CI = 1.003–1.093, p = 0.036) and an increased neutrophil-to-lymphocyte ratio (HR = 1.024, 95% CI = 1.009–1.039, p = 0.002) were correlated with a greater 30-day mortality risk. Tracheostomy emerged as a protective factor, significantly reducing the risk of 30-day mortality (HR = 0.273, 95% CI = 0.127–0.589, p = 0.001). In this single-center study, patients with CAIFI exhibit a high mortality rate. Clinicians should maintain vigilance for IFI in critically ill COVID-19 patients with mechanical ventilation. Full article

Background/Objectives: Although medical radiation practice is essential for current medical care, many nursing students and nurses lack sufficient basic knowledge about radiation, and they are unfamiliar with learning about it. This study aimed to evaluate the usefulness of self-made video teaching materials for radiation education for nursing students and nurses after clarifying their basic knowledge of radiation. Methods: Educational video materials were developed to provide basic radiation knowledge. The video materials included scenes of radiation measurement, such as the attenuation of scattered X-rays with distance, and illustrations drawn by nursing students to make them familiar to nursing staff. This study included 29 nursing students and 16 nurses. The participants were instructed to answer 20 questions regarding the characteristics of radiation and its influence and protection measures. The same questions were asked again after watching the video materials. Results: Nursing students and nurses correctly recognized the classification of medical or occupational exposure and the three principles for reducing external exposure; however, it became clear that dose limits do not apply to medical exposure and that radiation units and their effects on the human body were not correctly recognized. Furthermore, the educational materials were effective because the scores and the percentage of correct answers increased after viewing the video materials. Furthermore, positive comments were expressed regarding the scenes of the experiments and the illustrations drawn by the students about the teaching materials. Conclusions: The contents that should be addressed more intensively were clarified, and the effectiveness of using video teaching materials in radiation nursing education was demonstrated. Full article

CRISPR-Cas9 has revolutionized genetic research with bioinformatics tools essential for tasks like guide RNA design, off-target prediction, and data analysis. This systematic review summarizes the functionality and key features of such tools. Studies published after 2012 were selected through searches in PubMed, Google Scholar, and other sources, with the final search conducted on 9 November 2024. Seven studies met the criteria, describing around 45 tools, including databases and functional programs. Tools like CRISPResso, CHOPCHOP, and Cas-OFFinder were commonly highlighted, with a major focus on single-guide RNA (sgRNA) design and optimization. Some tools provided specific solutions, while others offered broader functionality, but most lacked experimental validation. Several tools were developed by the authors of the studies, introducing potential bias. Findings highlight a need for integrated platforms that combine functionalities, reducing reliance on fragmented workflows. Current tools often address narrow tasks, complicating their practical application. Future development should focus on comprehensive, multitasking tools to improve accessibility and streamline research processes. Limitations include the descriptive nature of most studies, potential author bias, and challenges in comparing tools objectively. Nonetheless, this review underscores bioinformatics’ critical role in CRISPR research and emphasizes the need for innovative, standardized platforms. This study received no funding and was not registered. Full article

Background: Radiological imaging has improved our insight into how obesity and sarcopenia impacts acute pancreatitis via several measured variables. However, we lack understanding of the association between social determinants of health and these variables within the acute pancreatitis population. Methods: This study included patients at a single tertiary care center between 1 January 2008 and 31 December 2021. Measurements of visceral adiposity (VA), subcutaneous adiposity (SA), the ratio of visceral to total adiposity (VA/TA), and degree of sarcopenia via psoas muscle Hounsfield unit average calculation (HUAC) were obtained on CT scans performed at presentation. Using geocoded patient data, we calculated the social vulnerability index (SVI) from CDC metrics. Descriptive and regression analyses were performed utilizing clinical and radiological data. Results: In 484 patients with 592 acute pancreatitis-related hospitalization, median (IQR) VA was 176 (100–251), SA was 209.5 (138.5–307), VA/TA ratio was 43.5 (32.3–55.3), and HUAC was 51.3 (44.4–58.9). For our primary outcome, geospatial analyses showed a reverse association between VA and SVI with a coefficient of −9.0 (p = 0.04) after adjustment for age, health care behaviors (i.e., active smoking and drinking), and CCI, suggesting residence in areas with higher SVI is linked to lower VA. However, VA/TA, SA, and HUAC showed no significant association with SVI. The SVI subdomain of socioeconomic status had significant association with VA (−39.78 (95% CI: −75.88–−3.70), p = 0.03) after adjustments. For our secondary outcome, acute pancreatitis severity had significant association with higher VA (p ≤ 0.001), VA/TA (p ≤ 0.001), and lower HUAC (p ≤ 0.001). When comparing single vs. recurrent hospitalization patients, there was significantly higher median VA with recurrences (VA-single acute pancreatitis: 149 (77.4–233) vs. VA-recurrent acute pancreatitis: 177 (108–256); p = 0.04). Conclusions: In this study we found that patients residing in more socially vulnerable areas had lower visceral adiposity. This paradoxical result potentially conferred a protective effect against severe and recurrent acute pancreatitis; however, this was not found to be statistically significant. Full article

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a notable cause of morbidity and mortality worldwide and can become complicated by Type 2 respiratory failure. This study aimed to analyze the cardiological and metabolic comorbidities of patients admitted to the intensive care unit (ICU) due to COPD-related Type 2 respiratory failure and evaluate their effects on clinical outcomes. Materials and Methods: A retrospective analysis was conducted on 258 patients admitted to the secondary-level pulmonary disease intensive care unit between January 2022 and January 2024. Patients’ demographic data, cardiological and metabolic comorbidities, laboratory parameters, and ICU-related variables were evaluated using statistical analysis methods. Results: The most common comorbidities were hypertension (57.0%), congestive heart failure (48.1%), diabetes mellitus (31.4%), and obesity (37.6%). Female patients had significantly higher rates of hypothyroidism, hypertension, obesity, and congestive heart failure compared to males. Patients diagnosed with chronic kidney disease (CKD) had markedly higher cardiothoracic ratios and proBNP levels. ICU length of stay was considerably longer in patients with acute kidney injury (AKI) and coronary artery disease (CAD). Cardiomegaly and obstructive sleep apnea syndrome (OSAS) were more frequently observed in obese patients. Additionally, in COPD patients, a body mass index (BMI) threshold of 25.5 was determined as a cutoff value for radiological cardiomegaly findings with a sensitivity of 69.9% and a specificity of 59.5%. Elevated pCO₂ and bicarbonate levels in patients receiving long-term oxygen therapy (LTOT) were associated with advanced-stage COPD. Conclusions: Metabolic and cardiological comorbidities notably impact the clinical prognosis and ICU management of patients diagnosed with COPD and Type 2 respiratory failure. This study, which aims to provide a snapshot of the comorbidities in patients requiring ICU admission due to COPD exacerbation-related Type 2 respiratory failure but without a fatal course, seeks to highlight the key areas where preventive and protective healthcare services should be focused in this patient group. Special attention should be given to monitoring female and obese patients. Future studies should explore how individualized and preventive follow-ups and treatment approaches can improve patient outcomes, with a particular emphasis on these identified areas. Full article