Scielo RSS <![CDATA[SA Journal of Radiology ]]> vol. 24 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>American College of Radiology Thyroid Imaging Reporting and Data System standardises reporting of thyroid ultrasounds</b>]]> BACKGROUND: Thyroid nodules are common, the majority benign. The small risk of malignancy leads to excessive workup. Thyroid ultrasound is essential for risk stratification and management guidance. Without an organised reporting guideline, reports do not add significant value to referring clinicians. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) was developed to aid ultrasound reporting, lessen excessive biopsies and diagnose thyroid cancers. OBJECTIVES: To standardise reporting of thyroid ultrasounds by utilising an organised reporting guideline based on ACR TI-RADS. METHOD: Thyroid ultrasound reports generated by radiology registrars at an academic hospital were studied in two phases. In Phase 1, the reports were generated as free text, and in Phase 2, using a guideline based on ACR TI-RADS. The percentages of reports that described the maximum size, the five ACR TI-RADS features and a management recommendation were compared. RESULTS: A total of 130 reports were studied. Significant improvement was observed in the description of all five ACR TI-RADS categories (p < 0.0001) from Phase 1 to Phase 2. Of all the reports, 89% included a management recommendation. Reports including an ACR TI-RADS-based recommendation increased from 48% to 75% (p < 0.05). Recommendation for biopsy increased from 35.4% to 53.8% (p < 0.05). CONCLUSION: Introduction of an organised reporting guideline based on ACR TI-RADS, standardised reporting of thyroid ultrasounds by increasing description of thyroid nodule features and ensuring appropriate management recommendations. This, in future, will prevent underdiagnosis of thyroid cancer and unnecessary workup of benign nodules. <![CDATA[<b>The knowledge, awareness and practices of radiation safety amongst orthopaedic surgeons</b>]]> BACKGROUND: Fluoroscopic imaging in orthopaedic theatres is increasing, with added risk to the orthopaedic surgeon who is increasingly being exposed to ionising radiation. It is thus crucial for orthopaedic surgeons to have a working knowledge of radiation safety. In spite of these concerns, however, many orthopaedic surgeons do not receive standard training in radiation safety. OBJECTIVES: The evaluation of orthopaedic surgeons' knowledge, awareness and everyday practices regarding radiation safety in an academic hospital. METHODS: A questionnaire with multiple-choice-type questions was developed by a panel of experts and used to conduct a descriptive study. The questionnaire had multiple dimensions, each evaluating orthopaedic knowledge, awareness and practices, respectively. The study population included orthopaedic surgeons rotating within the orthopaedic circuit of the University of Pretoria. RESULTS: Orthopaedic surgeons regularly make use of fluoroscopic imaging in theatre, with 34 (77%) participants indicating that they use fluoroscopy in more than half of all their procedures performed. Most participants have insufficient knowledge of radiation safety, with the majority failing to correctly answer basic questions on radiation safety. Forty (91%) participants do not wear personal dosimeters, in spite of 39 participants (89%) believing that they are vulnerable to adverse effects. Basic radiation protection devices are underutilised, with 32 (73%) participants indicating that they have not received adequate training in radiation safety. CONCLUSION: The majority of orthopaedic surgeons regularly use fluoroscopic imaging in theatre yet lack in-depth knowledge and awareness regarding radiation safety associated with this imaging modality. Implementation of a radiation safety training programme is thus recommended. <![CDATA[<b>Incidental amniocele in a case of antepartum haemorrhage</b>]]> An amniocele, or contained uterine rupture, is a phenomenon in which there is herniation of the amniotic sac through a uterine defect, secondary to various causes. It is associated with severe morbidity and mortality. This case presents the findings in a 36-year-old female at 29 weeks gestation who was initially managed as antepartum haemorrhage secondary to placenta previa, based on ultrasound. Upon further imaging, an amniocele was diagnosed. This case report illustrates the importance of early identification of this life-threatening condition. <![CDATA[<b>Hysterosalpingographic evaluation of human immunodeficiency virus-infected and uninfected infertile women</b>]]> BACKGROUND: Hysterosalpingography (HSG) is an outpatient fluoroscopy-guided procedure that evaluates the uterine cavity and fallopian tube patency in infertile women. Its cost-effective use is being challenged with the human immunodeficiency virus (HIV) burden in KwaZulu-Natal, which characteristically affects multiple organs.OBJECTIVES: The aim of this study was to describe the HSG findings in a group of HIV-infected and uninfected infertile women.METHOD: This was a retrospective study conducted over a 4-year period (2012-2016) in which the HSG images and reports of 178 infertile patients from records of the Radiology Department were re-reviewed for abnormalities of the cervix, uterus and fallopian tubes. Their clinical data and radiological findings were entered into a pre-coded data sheet and analysed.RESULTS: The frequency of HIV infection amongst patients with infertility was found to be 32.6%. Forty-four patients were on antiretroviral therapy at the time of the HSG examination, whereas three had not yet started treatment. From the 178 HSG reports, 109 (61.2%) were abnormal. Tubal pathologies were the most common abnormalities, accounting for 79 of the 109 cases and was higher in HIV-infected women than in HIV-uninfected women (p = 0.001). Uterine filling defects were demonstrated in 13 of the 109 cases. There were two cases of cervical abnormalities.CONCLUSION: The study demonstrated that tubal abnormalities were the most common findings amongst infertile women undergoing HSG and occurred predominantly in HIV-infected patients. <![CDATA[<b>'Soccer toe': Chronic physeal injury of the great toe metatarsal in a skeletally immature child - A case report</b>]]> Chronic physeal stress injuries in children can result from ongoing, repetitive compression, distraction and/or shear forces during sports-related activity, and manifest as physeal widening on imaging. We present an 11-year-old soccer athlete with focal physeal widening of her great toe metatarsal and postulate that ongoing or repetitive stress from soccer play may manifest as this imaging appearance. We suggest that recognition of this entity in growing children might explain pain, if present, and guide conservative treatment. <![CDATA[<b>How useful are clinical details in blunt trauma referrals for computed tomography of the abdomen?</b>]]> BACKGROUND: The relevance of clinical data included in blunt trauma referrals for abdominal computed tomography (CT) is not known. OBJECTIVES: To analyse the clinical details provided on free-text request forms for abdominal CT following blunt trauma and assess their association with imaging evidence of intra-abdominal injury. METHOD: A single-institution, retrospective study of abdominal CT scans was performed for blunt trauma between 01 January and 31 March 2018. Computed tomography request forms were reviewed with their corresponding CT images. Clinical details provided and scan findings were captured systematically. The relationship between individual clinical features and CT evidence of abdominal injury was tested using one-way cross tabulation and Fisher's exact test. RESULTS: One hundred thirty-nine studies met inclusion criteria. A wide range of clinical details was communicated. Only clinical abdominal examination findings (p = 0.05), macroscopic haematuria (p < 0.01), pelvic fracture or hip dislocation (p = 0.04) and positive focused assessment with sonography in trauma (p < 0.01) demonstrated an associated trend with abdominal injury. CONCLUSION: Key abdominal examination and basic imaging findings remain essential clinical details for the appropriate evaluation of CT abdomen requests in the setting of blunt trauma. Methods to improve consistent communication of relevant clinical details are likely to be of value <![CDATA[<b>Agenesis of the piriformis muscle: A case report with review of literature</b>]]> Agenesis of the piriformis muscle is an extremely rare occurrence. Knowledge about this anatomic variant is important because of its close proximity with the sciatic nerve and sacral plexus. The piriformis muscle also serves as an important anatomic landmark for image-guided intervention and hip surgery. We report a case of piriformis muscle agenesis in a 28-year-old woman, incidentally detected on magnetic resonance imaging of the lumbosacral spine and pelvis, performed for low back pain. <![CDATA[<b>Complicated spontaneous pneumoparotid mimicking a neck mass in a child with Down's syndrome</b>]]> Spontaneous or self-induced pneumoparotid, which usually manifests as acute unilateral gland enlargement, is caused by insufflation of air from the oral cavity via Stensen's duct. A 9-year-old patient, with known Down's syndrome, presented with a progressively enlarging, painless, spontaneous, left neck mass. Computed tomography showed features consistent with pneumoparotid, without underlying associated pathology. Identification of true cases of spontaneous pneumoparotid is crucial, as these require a holistic management approach to prevent recurrence and complications. <![CDATA[<b>Can the posterior:anterior urethral ratio on voiding cystourethrogram be used as a reliable predictor of successful posterior urethral valve ablation in male children?</b>]]> BACKGROUND: The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. OBJECTIVES: We aimed to review the role of the 'ideal' ratio on predicting residual PUV post-ablation. METHODS: A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included 'Urethral Ratio and Posterior urethral valve ablation'. All cited reference lists were further evaluated for additional inclusive studies RESULTS: Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 (p = 0.001), 2.5-3 and 3.5. CONCLUSION: Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2-3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings. <![CDATA[<b>Knowledge and practices of cardiopulmonary arrest and anaphylactic reactions in the radiology department</b>]]> BACKGROUND: Emergencies in the radiology department may arise in critically ill patients who are brought to the department for imaging, interventional procedures or as a result of adverse reactions to contrast media used for imaging. Adverse reactions to contrast media range from minor to severe life-threatening effects and initial, prompt management decreases complications. Radiology staff must possess knowledge of the management of anaphylactic or anaphylactoid contrast reactions and cardiopulmonary arrest (CPA) as they are likely to be the first responders. OBJECTIVES: To determine the knowledge and practices amongst radiologists, radiology residents and radiographers in the management of CPA and adverse reactions to contrast media. METHOD: This cross-sectional study was performed between March and August 2016 at Kenyatta National Hospital using a questionnaire. RESULTS: Eighty participants were enrolled. None answered all the questions correctly, with only 55% of radiologists, 35% of residents and 39% of radiographers scoring above 50%. The majority (82%) of participants had adequate knowledge regarding the symptoms, signs and risk factors of adverse reactions to contrast media; however, only 30% knew that intravenous epinephrine is the recommended therapy for a severe anaphylactic reaction. Shortcomings in terms of adequate training were found in this study, with the majority of respondents having not attended any life support course in the preceding 5 years. CONCLUSION: Health providers within the radiology unit had knowledge about identifying both mild and severe symptoms of anaphylactic reactions. However, there were knowledge gaps regarding the management of these reactions. <![CDATA[<b>Chronic gallbladder wall thickening: Is it always malignancy?</b>]]> Gallbladder wall thickening, associated with features like perforation, fistula formation and invasion of adjacent organs, is often assumed to be malignant. Xanthogranulomatous cholecystitis (XGC) causes gallbladder wall thickening with similar aggressive features and closely mimics gallbladder carcinoma clinically, radiologically and surgically. Differentiating between these two is crucial for management as misdiagnosis of gallbladder cancer can lead to unnecessary radical surgery. We report a case of chronic gallbladder wall thickening, initially suspected to be malignant, but subsequently diagnosed as XGC.