Diagnostic Reference Levels for Patient Radiation Doses in Pelvis and Lumbar spine Radiography in Korea

Energy Technology Data Exchange (ETDEWEB)

Lee, Kwang Yong; Lee, Byung Young; Lee, Jung Eun; Lee, Hyun Koo; Jung, Seunbg Hwan; Kim, Byung Woo; Kim, Hyeog Ju; Kim, Dong Sup [Radiation Safety Division National Institute of Food and Drug Safety Evaluation, Seoul (Korea, Republic of)

2009-12-15

Pelvis and lumbar spine radiography, among various types of diagnostic radiography, include gonads of the human body and give patients high radiation dose. Nevertheless, diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography has not yet been established in Korea. Therefore, the radiation dose that patients receive from pelvis and lumbar radiography is measured and the diagnostic reference level on patient radiation dose for the optimization of radiation protection of patients in pelvis and lumbar spine radiography was established. The conditions and diagnostic imaging information acquired during the time of the postero-anterior view of the pelvis and the postero-anterior and lateral view of the lumbar spine at 125 medical institutions throughout Korea are collected for analysis and the entrance surface dose received by patients is measured using a glass dosimeter. The diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography to be recommended to the medical institutes is arranged by establishing the dose from the patient radiation dose that corresponds to the 3rd quartile values as the appropriate diagnostic reference level for patient radiation dose. According to the results of the assessment of diagnostic imaging information acquired from pelvis and lumbar spine radiography and the measurement of patient entrance surface dose taken at the 125 medical institutes throughout Korea, the tube voltage ranged between 60-97 kVp, with the average use being 75 kVp, and the tube current ranged between 8-123 mAs, with the average use being 30 mAs. In the posteroanterior and lateral views of lumbar spine radiography, the tube voltage of each view ranged between 65-100 kVp (average use: 78 kVp) and 70-109 kVp (average use: 87 kVp), respectively, and the tube current of each view ranged between 10-100 mAs(average use: 35 mAs) and between 8.9-300 mAs(average use: 64 mAs), respectively. The measurements of

Diagnostic Reference Levels for Patient Radiation Doses in Pelvis and Lumbar spine Radiography in Korea

International Nuclear Information System (INIS)

Lee, Kwang Yong; Lee, Byung Young; Lee, Jung Eun; Lee, Hyun Koo; Jung, Seunbg Hwan; Kim, Byung Woo; Kim, Hyeog Ju; Kim, Dong Sup

2009-01-01

Pelvis and lumbar spine radiography, among various types of diagnostic radiography, include gonads of the human body and give patients high radiation dose. Nevertheless, diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography has not yet been established in Korea. Therefore, the radiation dose that patients receive from pelvis and lumbar radiography is measured and the diagnostic reference level on patient radiation dose for the optimization of radiation protection of patients in pelvis and lumbar spine radiography was established. The conditions and diagnostic imaging information acquired during the time of the postero-anterior view of the pelvis and the postero-anterior and lateral view of the lumbar spine at 125 medical institutions throughout Korea are collected for analysis and the entrance surface dose received by patients is measured using a glass dosimeter. The diagnostic reference levels for patient radiation dose in pelvis and lumbar spine radiography to be recommended to the medical institutes is arranged by establishing the dose from the patient radiation dose that corresponds to the 3rd quartile values as the appropriate diagnostic reference level for patient radiation dose. According to the results of the assessment of diagnostic imaging information acquired from pelvis and lumbar spine radiography and the measurement of patient entrance surface dose taken at the 125 medical institutes throughout Korea, the tube voltage ranged between 60-97 kVp, with the average use being 75 kVp, and the tube current ranged between 8-123 mAs, with the average use being 30 mAs. In the posteroanterior and lateral views of lumbar spine radiography, the tube voltage of each view ranged between 65-100 kVp (average use: 78 kVp) and 70-109 kVp (average use: 87 kVp), respectively, and the tube current of each view ranged between 10-100 mAs(average use: 35 mAs) and between 8.9-300 mAs(average use: 64 mAs), respectively. The measurements of

French diagnostic reference levels in diagnostic radiology, computed tomography and nuclear medicine: 2004-2008 Review

International Nuclear Information System (INIS)

Roch, P.; Aubert, B.

2013-01-01

After 5 y of collecting data on diagnostic reference levels (DRLs), the Nuclear Safety and Radiation Protection French Inst. (IRSN) presents the analyses of this data. The analyses of the collected data for radiology, computed tomography (CT) and nuclear medicine allow IRSN to estimate the level of regulatory application by health professionals and the representativeness of current DRL in terms of relevant examinations, dosimetric quantities, numerical values and patient morphologies. Since 2004, the involvement of professionals has highly increased, especially in nuclear medicine, followed by CT and then by radiology. Analyses show some discordance between regulatory examinations and clinical practice. Some of the dosimetric quantities used for the DRL setting are insufficient or not relevant enough, and some numerical values should also be reviewed. On the basis of these findings, IRSN formulates recommendations to update regulatory DRL with current and relevant examination lists, dosimetric quantities and numerical values. (authors)

Regional Diagnostic Reference Levels and Collective Effective Doses from Computed Tomography (CT) Scanners in India

International Nuclear Information System (INIS)

Livingstone, R.S.; Dinakaran, P.M.

2011-01-01

Diagnostic examinations performed using computed tomography (CT) are on the increase, and the use of this modality needs to be monitored periodically. The aim of this study was to formulate regional diagnostic reference levels (DRLs) and assess collective effective doses from CT scanners in Tamil Nadu, India. In-site CT dose measurements were performed for 127 CT scanners in Tamil Nadu as a part of the Atomic Energy Regulatory Board (AERB) funded project for a period of two years. Regional DRLs were formulated at third quartile level for three CT protocols such as thorax, abdomen and pelvis and were found to be 557 mGy.cm, 521 mGy.cm and 294 mGy.cm, respectively. The collective effective dose in Tamil Nadu was found to be 14.93 man Sv per day. (author)

Local diagnostic reference levels at the Portuguese Institute of oncology francisco gentil of coimbra

International Nuclear Information System (INIS)

Bras, S.; Sousa, M.C. de; Lopes, M.C.

2006-01-01

In the scope of medical radiological exposures and according to European recommendations and national legal requirements [14], the maximum responsible for an installation must assure the establishment of local dose levels for each type of radiological examination and also assure that they are available for the doctor who prescribes the examination. In the absence of national reference dose levels, the so called Local Diagnostic Reference Levels (L.D.R.L.) should be in agreement with the European Diagnostic Reference Levels published for the different types of medical exposures. The aim of this work was to establish a protocol of measurement for each type of more frequent examination, namely in conventional radiology, in CT and in mammography performed in our hospital. For each kind of examination the recommended dose descriptor was adopted and directly measured or derived from basic charge measurements. The patient sample corresponded in each case to at least a minimum of 10 standard-sized patients, as recommended, in order to obtain averages that constitute for each type of radiological examination the L.D.R.L. that could be compared with the European D.R.L.. The results obtained are in the large majority of the situations below the corresponding D.R.L.. Nevertheless we have identified some situations that deserve more attention.In conventional radiology all L.D.R.L. are below the reference levels. However we have detected some skull post anterior (skull P.A.) exposures where entrance skin doses exceeded the standard value. This may be due to equipment age problems but, as always, improvement of staff education will contribute to better practices and we hope that this work can contribute to this objective. In CT the L.D.R.L. that corresponds to single slice scan meet the standards whereas complete examinations described by dose length product (D.L.P.) values show a larger variation and also some situations where the reference level is exceeded. It is possible that

Local diagnostic reference levels at the Portuguese Institute of oncology francisco gentil of coimbra

Energy Technology Data Exchange (ETDEWEB)

Bras, S.; Sousa, M.C. de [Algarve Univ., LIP-Algarve, FCT (Portugal); Lopes, M.C. [IPOFG-CROC, S.A., Medical Physics Dept., Coimbra (Portugal)

2006-07-01

In the scope of medical radiological exposures and according to European recommendations and national legal requirements [14], the maximum responsible for an installation must assure the establishment of local dose levels for each type of radiological examination and also assure that they are available for the doctor who prescribes the examination. In the absence of national reference dose levels, the so called Local Diagnostic Reference Levels (L.D.R.L.) should be in agreement with the European Diagnostic Reference Levels published for the different types of medical exposures. The aim of this work was to establish a protocol of measurement for each type of more frequent examination, namely in conventional radiology, in CT and in mammography performed in our hospital. For each kind of examination the recommended dose descriptor was adopted and directly measured or derived from basic charge measurements. The patient sample corresponded in each case to at least a minimum of 10 standard-sized patients, as recommended, in order to obtain averages that constitute for each type of radiological examination the L.D.R.L. that could be compared with the European D.R.L.. The results obtained are in the large majority of the situations below the corresponding D.R.L.. Nevertheless we have identified some situations that deserve more attention.In conventional radiology all L.D.R.L. are below the reference levels. However we have detected some skull post anterior (skull P.A.) exposures where entrance skin doses exceeded the standard value. This may be due to equipment age problems but, as always, improvement of staff education will contribute to better practices and we hope that this work can contribute to this objective. In CT the L.D.R.L. that corresponds to single slice scan meet the standards whereas complete examinations described by dose length product (D.L.P.) values show a larger variation and also some situations where the reference level is exceeded. It is possible that

Fluoroscopy in paediatric fractures - Setting a local diagnostic reference level

International Nuclear Information System (INIS)

Pillai, A.; McAuley, A.; McMurray, K.; Jain, M.

2006-01-01

Background: The ionizing radiations (Medical Exposure) Regulation 2000 has made it mandatory to establish diagnostic reference levels (DRLs) for all typical radiological examinations. Objectives: We attempt to provide dose data for some common fluoroscopic procedures used in orthopaedic trauma that may be used as the basis for setting DRLs for paediatric patients. Materials and methods: The dose area product (DAP) in 865 paediatric trauma examinations was analysed. Median DAP values and screening times for each procedure type along with quartile values for each range are presented. Results: In the upper limb, elbow examinations had maximum exposure with a median DAP value of 1.21 cGy cm 2 . Median DAP values for forearm and wrist examinations were 0.708 and 0.538 cGy cm 2 , respectively. In lower limb, tibia and fibula examinations had a median DAP value of 3.23 cGy cm 2 followed by ankle examinations with a median DAP of 3.10 cGy cm 2 . The rounded third quartile DAP value for each distribution can be used as a provisional DRL for the specific procedure type. (authors)

A conceptual framework for managing radiation dose to patients in diagnostic radiology using reference dose levels

International Nuclear Information System (INIS)

Almen, Anja; Baath, Magnus

2016-01-01

The overall aim of the present work was to develop a conceptual framework for managing radiation dose in diagnostic radiology with the intention to support optimisation. An optimisation process was first derived. The framework for managing radiation dose, based on the derived optimisation process, was then outlined. The outset of the optimisation process is four stages: providing equipment, establishing methodology, performing examinations and ensuring quality. The optimisation process comprises a series of activities and actions at these stages. The current system of diagnostic reference levels is an activity in the last stage, ensuring quality. The system becomes a reactive activity only to a certain extent engaging the core activity in the radiology department, performing examinations. Three reference dose levels-possible, expected and established-were assigned to the three stages in the optimisation process, excluding ensuring quality. A reasonably achievable dose range is also derived, indicating an acceptable deviation from the established dose level. A reasonable radiation dose for a single patient is within this range. The suggested framework for managing radiation dose should be regarded as one part of the optimisation process. The optimisation process constitutes a variety of complementary activities, where managing radiation dose is only one part. This emphasises the need to take a holistic approach integrating the optimisation process in different clinical activities. (authors)

A CONCEPTUAL FRAMEWORK FOR MANAGING RADIATION DOSE TO PATIENTS IN DIAGNOSTIC RADIOLOGY USING REFERENCE DOSE LEVELS.

Science.gov (United States)

Almén, Anja; Båth, Magnus

2016-06-01

The overall aim of the present work was to develop a conceptual framework for managing radiation dose in diagnostic radiology with the intention to support optimisation. An optimisation process was first derived. The framework for managing radiation dose, based on the derived optimisation process, was then outlined. The outset of the optimisation process is four stages: providing equipment, establishing methodology, performing examinations and ensuring quality. The optimisation process comprises a series of activities and actions at these stages. The current system of diagnostic reference levels is an activity in the last stage, ensuring quality. The system becomes a reactive activity only to a certain extent engaging the core activity in the radiology department, performing examinations. Three reference dose levels-possible, expected and established-were assigned to the three stages in the optimisation process, excluding ensuring quality. A reasonably achievable dose range is also derived, indicating an acceptable deviation from the established dose level. A reasonable radiation dose for a single patient is within this range. The suggested framework for managing radiation dose should be regarded as one part of the optimisation process. The optimisation process constitutes a variety of complementary activities, where managing radiation dose is only one part. This emphasises the need to take a holistic approach integrating the optimisation process in different clinical activities. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Patient dose measurement in common medical X-ray examinations and propose the first local dose reference levels to diagnostic radiology in Iran

Science.gov (United States)

Rasuli, Behrouz; Tabari Juybari, Raheleh; Forouzi, Meysam; Ghorbani, Mohammad

2017-09-01

Introduction: The main purpose of this study was to investigate patient dose in pelvic and abdomen x-ray examinations. This work also provided the LDRLs (local diagnostic reference levels) in Khuzestan region, southwest of Iran to help establish the NDRLs (national diagnostic reference levels). Methods: Patient doses were assessed from patient's anatomical data and exposure parameters based on the IAEA indirect dosimetry method. With regard to this method, exposure parameters such as tube output, kVp, mAs, FFD and patient anatomical data were used for calculating ESD (entrance skin dose) of patients. This study was conducted on 250 standard patients (50% men and 50% women) at eight high-patient-load imaging centers. Results: The results indicate that mean ESDs for the both pelvic and abdomen examinations were lower than the IAEA and EC reference levels, 2.3 and 3.7 mGy, respectively. Mean applied kVps were 67 and 70 and mean FFDs were 103 and 109, respectively. Tube loadings obtained in this study for pelvic examination were lower than all the corresponding values in the reviewed literature. Likewise, the average annual patient load across all hospitals were more than 37000 patients, i.e. more than 100 patients a day. Conclusions: The authors recommend that DRLs (diagnostic reference levels) obtained in this region, which are the first available data, can be used as local DRLs for pelvic and abdomen procedures. This work also provides that on-the-job training programs for staffs and close cross collaboration between physicists and physicians should be strongly considered.

Establishment of national diagnostic reference level for renal doses in nuclear medicine departments at Khartoum-Sudan

International Nuclear Information System (INIS)

Alameen, Suhaib; Hamid, Alhadi; Rushdi, M. A. H.

2016-01-01

In this work we established a diagnostic reference level (DRL) for patient dose focusing on the investigation of activity to the kidneys during(99mTc-DTPA) kidney scan, selected two department nuclear medicine in main hospitals in Khartoum state. The DRLs is an investigational level used to identify unusually high radiation doses for common diagnostic medical in Nuclear Medicine procedures and suggested action levels above which a facility should review its methods and determine if acceptable image quality can be achieved at lower doses. The high specific activity of 99mTc makes it suitable as a first pass agent, for multiple or sequential studies, 99mTc diethylenetriaminepentaacetic acid (DTPA) is preferred to 99mTc-pertechnetate. Patients who had been prepared for the kidney scan 99mTc- DTPA were divided to three groups. The first group received dose less than 5 mCi, are represent (27.03%) from all patients, second group received dose 5 to 5.5 mCi are represent(66.67%) and the third group received dose from 5.6 to 6.2 mCi are represent (6.31%) from all patients 99mTc-DTPA. And according to the IAEA recommendation for adult doses(5-10mCi) this study show that about 93.1% of the sample examines by dose less than 5.5 mCi. The results presented will serve as a baseline data needed for deriving reference doses for renal examinations for nuclear medicine departments in Sudan.(Author)

Diagnostic reference levels in intraoral dental radiography in Korea

International Nuclear Information System (INIS)

Kim, Eun Kyung; Han, Won Jeong; Choi, Jin Woo; Jung, Yun Hoa; Yoon, Suk Ja; Lee, Jae Seo

2012-01-01

The objectives of this study were to survey the radiographic exposure parameters, to measure the patient doses for intraoral dental radiography nationwide, and thus to establish the diagnostic reference levels (DRLs) in intraoral dental X-ray examination in Korea. One hundred two intraoral dental radiographic machines from all regions of South Korea were selected for this study. Radiographic exposure parameters, size of hospital, type of image receptor system, installation duration of machine, and type of dental X-ray machine were documented. Patient entrance doses (PED) and dose-area products (DAP) were measured three times at the end of the exit cone of the X-ray unit with a DAP meter (DIAMENTOR M4-KDK, PTW, Freiburg, Germany) for adult mandibular molar intraoral dental radiography, and corrections were made for room temperature and pressure. Measured PED and DAP were averaged and compared according to the size of hospital, type of image receptor system, installation duration, and type of dental X-ray machine. The mean exposure parameters were 62.6 kVp, 7.9 mA, and 0.5 second for adult mandibular molar intraoral dental radiography. The mean patient dose was 2.11 mGy (PED) and 59.4 mGycm2 (DAP) and the third quartile one 3.07 mGy (PED) and 87.4 mGycm 2 (DAP). Doses at university dental hospitals were lower than those at dental clinics (p 2 (DAP) as the DRLs in adult mandibular molar intraoral dental radiography in Korea.

Guidance levels for diagnostic radiology in Romania

International Nuclear Information System (INIS)

Iacob, O.; Diaconescu, C.

2002-01-01

Over two decades surveys of radiological practice in Romania have demonstrated wide variations in patient dose levels between different hospitals. Local and national investigations revealed poor performances as well as of radiological equipment, darkroom procedure or technology of investigation. Hitherto, the annual collective effective dose to the population of Romania from diagnostic medical exposures attained a value of 13,820 manSv. Since the annual frequencies of radiological examinations remain unchanged over last ten years, this value is mostly attributed to the individual dose levels in different X-ray procedures. Notwithstanding the huge benefits to patients, the reduction of unnecessary exposures and individual doses are our principal concern and the establishment of national reference dose levels should solve this problem. British experience demonstrated that reference doses are a practical tool in this purpose and the adoption of national reference dose values indicated an overall improvement in patient exposure. Even the local of reference dose values proved a useful way to achieve patient dose reduction. In meantime the optimization of patient protection, each X-ray examination should be conducted with lowest necessary dose to achieve the clinical aim. This paper presents the first approach to establish local reference dose levels for some diagnostic examinations based on the measurements made in six (from the eighth of Eastern territory of Romania) districts, invited to cooperate in this end

Establishment of diagnostic reference levels for dental panoramic radiography in Greece

International Nuclear Information System (INIS)

Manousaridis, G.; Koukorava, C.; Hourdakis, C.J.; Kamenopoulou, V.; Yakoumakis, E.; Tsiklakis, K.

2015-01-01

The purpose of the present study was to present the national diagnostic reference levels (DRL) established for panoramic dental examinations in Greece. The establishment of DRL, as a tool for the optimisation of radiological procedures, is a requirement of national regulations. Measurements performed by the Greek Atomic Energy Commission on 90 panoramic systems have been used for the derivation of DRL values. DRL values have been proposed for exposure settings of different patient types (child, small adult and standard adult), both for film and digital imaging. The DRLs for different patient types are grouped in three categories: children, small adults (corresponding to female) and average adults (corresponding to male). Proposed DRLs for these groups are 2.2, 3.3 and 4.1 mGy, respectively. In order to investigate the correlation of DRLs with the available imaging modalities (CR, DR and film), this parameter was taken into account. DR imaging DRL is the lowest at 3.5 mGy, CR imaging the highest at 4.2 mGy and film imaging at 3.7 mGy. In order to facilitate comparison with other studies, kerma-width product values were calculated from K i , air and field size. (authors)

Estimating the population dose from nuclear medicine examinations towards establishing diagnostic reference levels

International Nuclear Information System (INIS)

Niksirat, Fatemeh; Monfared, Ali Shabestani; Deevband, Mohammad Reza; Amiri, Mehrangiz; Gholami, Amir

2016-01-01

This study conducted a review on nuclear medicine (NM) services in Mazandaran Province with a view to establish adult diagnostic reference levels (DRLs) and provide updated data on population radiation exposure resulting from diagnostic NM procedures. The data were collected from all centers in all cities of Mazandaran Province in the North of Iran from March 2014 to February 2015. The 75 th percentile of the distribution and the average administered activity (AAA) were calculated and the average effective dose per examination, collective effective dose to the population and annual effective dose per capita were estimated using dose conversion factors. The gathered data were analyzed via SPSS (version 18) software using descriptive statistics. Based on the data of this study, the collective effective dose was 95.628 manSv, leading to a mean effective dose of 0.03 mSv per capita. It was also observed that the myocardial perfusion was the most common procedure (50%). The 75 th percentile of the distribution of administered activity (AA) represents the DRL. The AAA and the 75 th percentile of the distribution of AA are slightly higher than DRL of most European countries. Myocardial perfusion is responsible for most of the collective effective dose and it is better to establish national DRLs for myocardial perfusion and review some DRL values through the participation of NM specialists in the future

Patient doses in CT examinations in Switzerland: Implementation of national diagnostic reference levels

International Nuclear Information System (INIS)

Treier, R.; Aroua, A.; Verdun, F. R.; Samara, E.; Stuessi, A.; Trueb, P. R.

2010-01-01

Diagnostic reference levels (DRLs) were established for 21 indication-based CT examinations for adults in Switzerland. One hundred and seventy-nine of 225 computed tomography (CT) scanners operated in hospitals and private radiology institutes were audited on-site and patient doses were collected. For each CT scanner, a correction factor was calculated expressing the deviation of the measured weighted computed tomography dose index (CTDI) to the nominal weighted CTDI as displayed on the workstation. Patient doses were corrected by this factor providing a realistic basis for establishing national DRLs. Results showed large variations in doses between different radiology departments in Switzerland, especially for examinations of the petrous bone, pelvis, lower limbs and heart. This indicates that the concept of DRLs has not yet been correctly applied for CT examinations in clinical routine. A close collaboration of all stakeholders is mandatory to assure an effective radiation protection of patients. On-site audits will be intensified to further establish the concept of DRLs in Switzerland. (authors)

Method of evaluation of diagnostics reference levels in computerized tomography; Metodo de avaliacao de niveis de referencia de radiodiagnostico em tomografia computadorizada

Energy Technology Data Exchange (ETDEWEB)

Vega, Walter Flores

1999-04-01

Computerized tomography is a complex technique with several selectable exposition parameters delivering high doses to the patient. In this work it was developed a simple methodology to evaluate diagnostic reference levels in computerized tomography, using the concept of Multiple Scan Average Dose (MSAD), recently adopted by the Health Ministry. For evaluation of the MSAD, a dose distribution was obtained through a measured dose profile on the axial axis of a water phantom with thermoluminescence dosemeters, TLD-100, for different exam technique. The MSAD was evaluated hrough two distinct methods. First, it was evaluated by the integration of the dose profile of a single slice and, second, obtained by the integration on central slice of the profile of several slices. The latter is in of accordance with the ionization chamber method, suggesting to be the most practical method of dose evaluation to be applied in the diagnostic reference level assessment routine for CT, using TLDs. (author)

Fluoroscopy-guided insertion of nasojejunal tubes in children - setting local diagnostic reference levels

International Nuclear Information System (INIS)

Vitta, Lavanya; Raghavan, Ashok; Sprigg, Alan; Morrell, Rachel

2009-01-01

Little is known about the radiation burden from fluoroscopy-guided insertions of nasojejunal tubes (NJTs) in children. There are no recommended or published standards of diagnostic reference levels (DRLs) available. To establish reference dose area product (DAP) levels for the fluoroscopy-guided insertion of nasojejunal tubes as a basis for setting DRLs for children. In addition, we wanted to assess our local practice and determine the success and complication rates associated with this procedure. Children who had NJT insertion procedures were identified retrospectively from the fluoroscopy database. The age of the child at the time of the procedure, DAP, screening time, outcome of the procedure, and any complications were recorded for each procedure. As the radiation dose depends on the size of the child, the children were assigned to three different age groups. The sample size, mean, median and third-quartile DAPs were calculated for each group. The third-quartile values were used to establish the DRLs. Of 186 procedures performed, 172 were successful on the first attempt. These were performed in a total of 43 children with 60% having multiple insertions over time. The third-quartile DAPs were as follows for each age group: 0-12 months, 2.6 cGy cm 2 ; 1-7 years, 2.45 cGy cm 2 ; >8 years, 14.6 cGy cm 2 . High DAP readings were obtained in the 0-12 months (n = 4) and >8 years (n = 2) age groups. No immediate complications were recorded. Fluoroscopy-guided insertion of NJTs is a highly successful procedure in a selected population of children and is associated with a low complication rate. The radiation dose per procedure is relatively low. (orig.)

Dosimetric methodology and reference system for diagnostic level X radiation

International Nuclear Information System (INIS)

Potiens, Maria da Penha Albuquerque

1999-01-01

Several methodologies for the calibration of diagnostic radiology instruments were developed and established at the Calibration Laboratory of IPEN. These established radiation qualities are recommended by international standards. The methods may be used in the calibration procedures of survey meters used in radiation protection measurements (scattered radiation), instruments used in direct beams (attenuated and non attenuated beams) and quality control instruments. A reference system was proposed using two identical ionization chambers developed at IPEN. They differ only by the collecting electrode material, one of aluminium and the other of graphite. The different energetic dependence of the chamber's response provided a ratio related to the tube potential. The variation of only 0.28%, from 14.3 to 111 keV, on the energetic dependence of the graphite electrode chamber, provided the possibility of air kerma rate determination in the studied radiation beams. (author)

A study to establish international diagnostic reference levels for paediatric computed tomography

International Nuclear Information System (INIS)

Vassileva, J.; Rehani, M.; Kostova-Lefterova, D.; Al-Naemi, H.M.; Al Suwaidi, J.S.; Arandjic, D.; Bashier, E.H.O.; Kodlulovich Renha, S.; El-Nachef, L.; Aguilar, J.G.; Gershan, V.; Gershkevitsh, E.; Gruppetta, E.; Hustuc, A.; Jauhari, A.; Hassan Kharita, Mohammad; Khelassi-Toutaoui, N.; Khosravi, H.R.; Khoury, H.; Kralik, I.; Mahere, S.; Mazuoliene, J.; Mora, P.; Muhogora, W.; Muthuvelu, P.; Nikodemova, D.; Novak, L.; Pallewatte, A.; Pekarovic, D.; Shaaban, M.; Shelly, E.; Stepanyan, K.; Thelsy, N.; Visrutaratna, P.; Zaman, A.

2015-01-01

The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol ) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDI w , CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75. percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided. (authors)

Diagnostic reference levels and complexity indices in interventional radiology: a national programme

Energy Technology Data Exchange (ETDEWEB)

Ruiz-Cruces, R.; Perez-Martinez, M.; Pastor-Vega, J.M.; Canete, S. [University of Malaga, School of Medicine, Malaga (Spain); Vano, E.; Fernandez-Soto, J.M.; Sanchez-Casanueva, R.; Gallego-Beuter, J.J. [Complutense University, San Carlos Hospital, Medical School, Madrid (Spain); Carrera-Magarino, F.; Moreno-Rodriguez, F.; Moreno-Sanchez, T. [Juan Ramon Jimenez University Hospital, Huelva (Spain); Soler-Cantos, M.M.; Canis-Lopez, M. [Reina Sofia University Hospital, Cordoba (Spain); Hernandez-Armas, J.; Diaz-Romero, F.J. [University Hospital of Canary Islands, Tenerife (Spain); Rosales-Espizua, F.; Lopez-Medina, A.; Gonzalez-de-Garay, M. [Basurto Hospital, Bilbao (Spain); Martin-Palanca, A. [Virgen de la Victoria University Hospital, Malaga (Spain); Gil-Agudo, A.; Zarca-Diaz, M.A.; Zapata-Jimenez, J.C. [General University Hospital, Ciudad Real (Spain); Parra-Osorio, V.; Munoz Ruiz-Canela, J.J.; Moreno-Saiz, C.; Galan-Montenegro, P. [Carlos Haya University Hospital, Malaga (Spain)

2016-12-15

To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. The KAP (3rd quartile) in Gy cm{sup 2} for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. (orig.)

Developing patient-specific dose protocols for a CT scanner and exam using diagnostic reference levels

International Nuclear Information System (INIS)

Strauss, Keith J.

2014-01-01

The management of image quality and radiation dose during pediatric CT scanning is dependent on how well one manages the radiographic techniques as a function of the type of exam, type of CT scanner, and patient size. The CT scanner's display of expected CT dose index volume (CTDI vol ) after the projection scan provides the operator with a powerful tool prior to the patient scan to identify and manage appropriate CT techniques, provided the department has established appropriate diagnostic reference levels (DRLs). This paper provides a step-by-step process that allows the development of DRLs as a function of type of exam, of actual patient size and of the individual radiation output of each CT scanner in a department. Abdomen, pelvis, thorax and head scans are addressed. Patient sizes from newborns to large adults are discussed. The method addresses every CT scanner regardless of vendor, model or vintage. We cover adjustments to techniques to manage the impact of iterative reconstruction and provide a method to handle all available voltages other than 120 kV. This level of management of CT techniques is necessary to properly monitor radiation dose and image quality during pediatric CT scans. (orig.)

The establishment and use of dose reference levels in general paediatric radiology

International Nuclear Information System (INIS)

Marsden, P.J.; Hardwick, J.; Mencik, C.; McLaren, C.; Young, C.; Mashford, P.

2001-01-01

Diagnostic reference levels for general paediatric radiology have been established in terms of delivered exposure parameters rather than skin dose or dose-area product. With supporting measurements from equipment quality assurance and assumptions of standard patient sizes it was possible to derive reference levels in terms of entrance surface dose. This allowed comparison to be made with other published data. The reference levels for common examinations are presented for different age bands. There is a notable variation with patient age for some examinations which is not apparent in other published data. (author)

An approach to local diagnostic reference levels (DRL's) in the context of national and international DRL's

International Nuclear Information System (INIS)

Rogers, A.T.

2001-01-01

In recent years there has been a greater focus on the management of patient doses. This effort has been driven by the realisation of both the increasing magnitude of patient doses and their variation both intra- and inter-nationally. Legislators and guidance-issuing bodies have developed the idea of 'Diagnostic Reference Levels' (DRL's). In particular, the European Union, in their Council Directive 97/43/Euratom, required Member States to develop DRL's. The UK Government, when consolidating this EU Directive into UK legislation, extended the concept of DRL's from a national to an employer level. However, the methodologies used for development of national and international DRL's do not translate to a local level and hence a new approach is required. This paper describes one particular approach made by a UK hospital to introduce 'Local DRL's' in such a manner as to aid the optimisation process. This approach utilises a dose index, based on the local patient population, which is monitored for trends. Any trend in patient dose triggers an investigation linked to the clinical audit system within the Clinical Radiology Department. It is the audit cycle that ensures a continuing move towards an optimised situation. Additional triggers may be employed such as large patient dose variations. (author)

A comparison of the suitability of patient dosimetry methods for establishing diagnostic dose reference levels and optimisation strategies

International Nuclear Information System (INIS)

Gfirtner, Hans; Moores, B. Michael; Stieve, Friedrich E.

2008-01-01

For 50 adult patients referred for chest radiography, air kerma at the diaphragm KD, dose area product and entrance skin dose were measured. The air kerma at the diaphragm and the dose area product were determined using Diamentor M4KDK(PTW) which allows measuring air kerma and dose area product simultaneously. For the measurement of entrance skin dose TLDs are used. A 50% variation in dose, incident dose as well as entrance skin dose, was registered for the same patient thickness. The recommendation of ICRP to perform the measurements for DRLs at 'representative patients' and that of the CEC to use 'standard-sized patients' seem to make little sense in the case of chest radiography. It could be demonstrated, that the dose area product is the least appropriate dose quantity for patient measurements and to define dose reference levels. For some radiological examinations like chest, pelvis and lumbar spine the dose area product is even sex dependent. Incident dose and entrance surface dose are of equal quality for patient dose measurements in diagnostic radiography. (author)

Towards the definition of Institutional diagnostic reference levels in paediatric interventional cardiology procedures in Greece.

Science.gov (United States)

Kottou, S; Kollaros, N; Plemmenos, C; Mastorakou, I; Apostolopoulou, S C; Tsapaki, V

2018-02-01

This study aimed to evaluate paediatric radiation doses in a dedicated cardiology hospital, with the objective of characterising patterns in dose variation. The ultimate purpose was to define Local (Institutional) Diagnostic Reference Levels (LDRLs) for different types of paediatric cardiac interventional procedures (IC), according to patient age. From a total of 710 cases performed during three consecutive years, by operators with more than 15 years of experience, the age was noted in only 477 IC procedures. The median values obtained for Fluoroscopy Time (FT), Number of Frames (N) and Kerma Area Product (P KA ) by age range were 5.8 min, 1322 and 2.0 Gy.cm 2 for definition of LDRLs presents challenges mainly due to the multiple clinical and technical factors affecting the outcome. On the other hand the lack of paediatric IC DRLs makes the identification of good practices more difficult. A consensus is needed on IC procedures nomenclature and grouping in order to allow a common assessment and comparison of doses. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Establishment of local diagnostic reference levels for quality control in intraoral radiography.

Science.gov (United States)

Izawa, Maki; Harata, Yasuo; Shiba, Noriyoshi; Koizumi, Nobuhide; Ozawa, Tomonori; Takahashi, Nobutoshi; Okumura, Yasuhiko

2017-01-01

To investigate the dosage and imaging conditions for patients undergoing intraoral radiography at Meikai University Hospital and establish assurance and quality control data. Tube voltage, exposure time, and air kinetic energy released per unit mass (air kerma) of three intraoral radiography units were measured. To calculate the patient entrance dose (PED) for each radiograph using Insight film, we extracted data for 1063 patients from their exposure records. The PED was compared with the diagnostic reference level (DRL) from the European Commission and the UK. The tube voltage of the three units was maintained at 60 ± 2 kV. Differences in exposure time were less than 1.7 % for all units. The air kerma rates were well maintained within a 4.2 % error. Based on the patient data, there were no significant differences in the mean exposure times for males and females for all anatomical sites. The mean PED ranged from 1.09 ± 0.31 mGy for the mandibular incisors to 2.42 ± 0.33 mGy for the maxillary molars. The mean PED at the mandibular molars using InSight film was 1.59 ± 0.20 mGy, being less than the recommended value based on the DRL for intraoral radiography in the UK. We concluded that radiographic conditions at the hospital have been properly maintained. This basic quality control data may assist other dental radiation facilities to reduce patient dosage.

Radiation safety concerns and diagnostic reference levels for computed tomography scanners in Tamil Nadu

International Nuclear Information System (INIS)

Livingstone, Roshan S.; Dinakaran, Paul M.

2011-01-01

Radiation safety in computed tomography (CT) scanners is of concern due its widespread use in the field of radiological imaging. This study intends to evaluate radiation doses imparted to patients undergoing thorax, abdomen and pelvic CT examinations and formulate regional diagnostic reference levels (DRL) in Tamil Nadu, South India. In-site CT dose measurement was performed in 127 CT scanners in Tamil Nadu for a period of 2 years as a part of the Atomic Energy Regulatory Board (AERB)-funded project. Out of the 127 CT scanners,13 were conventional; 53 single-slice helical scanners (SSHS); 44 multislice CT (MSCT) scanners; and 17 refurbished scanners. CT dose index (CTDI) was measured using a 32-cm polymethyl methacrylate (PMMA)-body phantom in each CT scanner. Dose length product (DLP) for different anatomical regions was generated using CTDI values. The regional DRLs for thorax, abdomen and pelvis examinations were 557, 521 and 294 mGy cm, respectively. The mean effective dose was estimated using the DLP values and was found to be 8.04, 6.69 and 4.79 mSv for thorax, abdomen and pelvic CT examinations, respectively. The establishment of DRLs in this study is the first step towards optimization of CT doses in the Indian context. (author)

The impact of diagnostic reference levels on patient doses from X-ray examinations

International Nuclear Information System (INIS)

Leitz, W.; Almen, A.

2008-01-01

The aim of this study was to evaluate the effect of diagnostic reference levels (DRL). For this study patient doses for the years 1999 and 2006 were available. Patient doses on a national level for eleven specified X-ray examinations were assessed. For the conventional examinations DRL have been used after the first survey in 1999, for computed tomography no DRL were used and for mammography DRL have been used for more than 20 years. Whereas the patient doses for conventional examinations were 30% lower in 2006 compared to 1999 the doses remained essentially the same for computed tomography and mammography. The widths of the dose distributions had only slightly decreased for conventional examinations and remained the same for computed tomography and mammography. This study has shown that after implementation of DRL a considerable dose reduction can be expected. Practices exceeding DRL will perform remedial actions with the aim to reduce dose, as demonstrated for the conventional examinations. Despite the fact that practices for computed tomography could compare doses with others practices, in the absence of DRL no actions to reduce doses were performed. The margin for further dose reductions in mammography is small due to the long term use of DRL. The impact of DRL on patient doses is changing with time. When introduced large dose reductions can be expected. After long term use DRL will counteract the introduction of new technique with unjustified high patient doses. Despite the merits in terms of dose saving it must be recognized that DRL has its limits - it has to be amended with other radiological protection activities. Other means and measures have to be developed, for example by the authorities, in order to ensure that optimisation is continued even when the patient doses are below the DRL. (author)

Dose area product measurement for diagnostic reference levels and analysis of patient dose in dental radiography

International Nuclear Information System (INIS)

Han, S.; Lee, B.; Shin, G.; Choi, J.; Kim, J.; Park, C.; Park, H.; Lee, K.; Kim, Y.

2008-01-01

In this study, diagnostic reference levels (DRLs) were suggested and patient doses were analysed through the dose-area product value in dental radiography. In intraoral radiography, at three sites, i.e. molar, premolar and incisor on the maxilla and acquired third quartile values: 55.5, 46 and 36.5 mGy cm 2 , respectively, were measured. In panoramic, cephalo-metric and cone beam computed tomography, the values were 120.3, 146 and 3203 mGy cm 2 (16 x 18 cm), respectively. It has been shown that, in intraoral radiography, the patient dose changes proportionally to the value of mA s, but the change in extra-oral radiography in response to mA s could not be confirmed. The authors could confirm, however, the difference in dose according to the manufacturer in all dental radiography examinations, except for panoramic radiography. Depending on the size of hospital, there were some differences in patient dose in intraoral radiography, but no difference in patient dose in extra-oral radiography. (authors)

Patient dose measurements in fluoroscopic examinations, aiming to the establishment of reference levels in Brazil

International Nuclear Information System (INIS)

Canevaro, L.; Drexler, G.

2001-01-01

This work was performed to investigate the actual exposure levels of the patients submitted to fluoroscopic procedures in diagnostic radiology. The data will be useful for a baseline in the establishment of local reference levels for fluoroscopic procedures, as recommended by the European Commission and IAEA. At present time there are no internationally accepted definitions for references levels for fluoroscopic complex procedures. Dose-area product (DAP) meters were employed in a pilot survey expressing the radiation exposures in terms of this quantity. This class of instrumentation has not yet been employed in Brazil. Parameters recorded were radiographic technique, fluoroscopy time, number of images, fluoroscopic and radiographic field sizes and DAPs. For fluoroscopy practice, a reference parameters set is recommended, instead of one diagnostic reference level. High patient exposures were found, calling for joined actions of health authorities, physicians, medical physicists, technicians and manufacturers. Monitoring of patient exposure, optimizing the radiation protection and establishing quantitative assessments of the exposition to the population in Brazil in this kind of procedure is important. (author)

Local diagnostic reference levels, approaches and compare the values in the South Bohemia Region in view of radiation protection inspector

International Nuclear Information System (INIS)

Zemanova, E.

2014-01-01

This paper compares the value of local diagnostic reference levels(the LDRL)in health facilities of the South Bohemia Region. The work is motivated by questions of licensees, who would like to know their position in terms of the LDRL compared to other workplaces. Also by the activity of the inspector who can identify the problematic workplaces, where is necessary to increase attention to optimization, exposure, or justification. In connection with the ongoing internal audits in licensee workplaces the information about the status of the LDRL among others is current, motivating licensee to changes, optimization and verification of compliance with the recommendation of the National radiological standard of Ministry of Health (author)

Patient dose audit of the most frequent radiographic examinations and the proposed local diagnostic reference levels in southwestern Nigeria: Imperative for dose optimisation

Directory of Open Access Journals (Sweden)

N.N. Jibiri

2016-07-01

Full Text Available Diagnostic reference levels (DRLs is a veritable tool for dose optimisation and patient protection in diagnostic radiology. However, it is essential to have information on the local situation especially in a large hospital with several units or a cluster of healthcare centres within a geographical region with several X-ray units. In the present study, entrance surface doses (ESDs were measured in twelve (12 healthcare centres consisting of 15 radiological units using thermoluminescent dosimeters (TLDs. Seven radiological procedures such as; chest PA, abdomen AP, pelvis AP, lumbar spine AP, skull AP, knee AP, and hand AP frequently carried out in Nigeria were included in the study, and their local diagnostic reference levels (LDRLs were determined. The values of the determined LDRLs were compared with established NDRLs in UK, US, Slovenia, Italy and Brazil. The LDRLs determined in the two groups (healthcare centres studied ranged from 1.78 to 3.01, 2.71 to 2.84, 2.11 to 3.79, 3.93 to 8.79, 1.06 to 1.73 and 1.10 to 1.44 mGy for chest PA, pelvis AP, lumbar spine AP, skull AP, knee AP and hand AP respectively. Large variations were found among the X-ray units studied even within the same centre. Entrance surface doses obtained in pelvis AP and lumbar spine AP in both GROUP A and were found to be lower than the NRPB-HPA 2010 review for UK, while in all other five examinations, value of the measured entrance surface dose (ESD are higher than the doses reported in the UK review. The relative higher doses found in the study are attributable to higher tube load (mAs used and indicative of the need for dose optimisation in Nigerian radiological practice.

Prevalence of Autism Spectrum Disorder in Children Referred for Diagnostic Autism Evaluation.

Science.gov (United States)

Monteiro, Sonia A; Spinks-Franklin, Adiaha; Treadwell-Deering, Diane; Berry, Leandra; Sellers-Vinson, Sherry; Smith, Eboni; Proud, Monica; Voigt, Robert G

2015-12-01

Increased public awareness of autism spectrum disorders (ASD) and routine screening in primary care have contributed to increased requests for diagnostic ASD evaluations. However, given the scarcity of subspecialty autism diagnostic resources, overreferral of children suspected of having ASD may be contributing to long waiting lists at tertiary care autism centers and delaying diagnosis for those children who truly have ASD. To determine whether children are being excessively referred to ASD-specific diagnostic clinics, our objective was to determine the prevalence of true ASD diagnoses in children referred for diagnostic ASD evaluation. Charts of all patients referred to a regional autism center between April 2011 and August 2012 for suspicion of a possible ASD were retrospectively reviewed and demographic and clinical diagnoses abstracted. Only 214 of 348 patients evaluated (61%) received an ASD diagnosis. Thus, concerns about autism are not confirmed by an ASD diagnosis in a significant number of children. © The Author(s) 2015.

A reference guide to quality assurance for diagnostic radiography

International Nuclear Information System (INIS)

1986-01-01

The College of Radiographers, through its Professional and Technical Committee, set up a small Working Party to compile a list of references which would help radiographers to become experts at Quality Assurance in Diagnostic Imaging departments. The list is not comprehensive, but includes references which the Working Party have experience of and have found useful. The references provided should aid in the objectives of:- 1. determining acceptable standards of new equipment; 2. making comparisons during use with accepted base line performance; 3. establishing loss of cost effectiveness and the need for replacement. (author)

Diagnostic reference levels for X-ray investigations in pain management units in Belgium

International Nuclear Information System (INIS)

Lichtherte, S.; Le Polain de Waroux, B.

2008-01-01

X-rays are commonly used in pain treatment centres where infiltrative techniques are performed. Although X-rays are useful in increasing the precision of infiltrative techniques, their use puts patients and staff at risk of radiation exposure. As a result, medical staff now have to obtain a certificate of training on the use of X-rays before being allowed to use X-rays in practice. This analysis was based on 373 detailed registrations of procedure-related parameters in the six centres that participated in this study between January 2009 and July 2009. Examinations chosen for inclusion in this study were the most commonly performed fluoroscopic imaging-guided procedures in a pain management unit: epidural (cervical/lumbar), facet joint nerve blocks (cervical/lumbar) and trans-foraminal (cervical/lumbar). The sample size, the dose-area product (DAP) range for whole population, the mean and the third quartile DAP corrected for patient size (DAP corr ), the screening time range, the mean and the third quartile screening time are presented. The proposed DRLs for epidural, facet joint nerve blocks and trans-foraminal are 0.5, 2.5 and 3 Gy cm 2 for DAP values and 12, 60 and 50 s for screening times, respectively. In the absence of national diagnostic reference levels (DRLs) for pain management fluoroscopic procedures, these DAP and screening time values provide a possible way of establishing provisional DRLs for local use. The values for each examination type could be used as a baseline against which to monitor the effectiveness of dose reduction strategies as part of the optimisation process that is the goal of any quality control and patient dose monitoring system. (authors)

Use of the mini C-arm for wrist fractures - Establishing a diagnostic reference level

International Nuclear Information System (INIS)

Love, G. J.; Pillai, A.; Gibson, S.

2008-01-01

The establishment of diagnostic reference levels (DRLs) for all typical radiological examinations became mandatory following the implementation of the Ionising Radiations (Medical Exposure) Regulations Act 2000. At present, there are no national dosage guidelines in the UK regarding use of fluoroscopy in orthopaedic trauma. The increasing popularity of the mini C-arm image intensifier amongst surgeons has led to concerns regarding use of ionizing radiation by personnel who have not been trained in radiation protection. It is therefore essential to have formal protocols for use of the mini C-arm to comply with the law and to maintain safe clinical practice. It is attempted to provide dose data for wrist fracture manipulations that may be used as a basis for setting a DRL for this procedure. Screening times were recorded for 80 wrist manipulations in a fracture clinic setting using a mini C-arm image intensifier. A DRL was set using the third quartile value for screening time. The median screening time for wrist fractures was 20 s with a range from 1 to 177 s. The third quartile value for screening time was 34 s. This value can be used as a provisional DRL for wrist fracture manipulations. The DRL is a quantitative guide for the optimisation of radiological protection. IR(ME)R 2000 states that if it is consistently exceeded by an individual operator or a piece of equipment, investigation and remedial action must be taken. We recommend that trauma units establish their own local DRLs for common procedures as made mandatory by legislation. (authors)

Reference levels at diagnosis (NRD) for explorations in TC of the university Hospital Donostia

International Nuclear Information System (INIS)

Iriondo Igerabide, U.; Puertolas Hernandez, J. R.; Masso Odriozola, A.; Alonso Espinaco, M. t.; Pino Leon, C.; Lozano Flores, F. J.; Larretxea Etxarri, R.

2013-01-01

The objective of this work is the establishment of diagnostic reference levels in TC, for the anatomical regions, in the University Hospital Donostia, in order to reduce the dose to patients and without prejudice to the required diagnosis. (Author)

Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values

Energy Technology Data Exchange (ETDEWEB)

Ubeda, Carlos, E-mail: cubeda@uta.cl [Medical Technology Department, Radiological Sciences Center, Health Sciences Faculty, Tarapaca University, Arica 1000000 (Chile); Miranda, Patricia [Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago 7500539 (Chile); Vano, Eliseo [Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, Madrid 28040 (Spain)

2015-02-15

Purpose: To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Methods: Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Results: Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm{sup 2} for <1 yr; 1.74 and 1.90 Gy cm{sup 2} for 1 to <5 yr; 2.83 and 3.22 Gy cm{sup 2} for 5 to <10 yr; and 7.34 and 8.68 Gy cm{sup 2} for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm{sup 2}/kg) for diagnostic and therapeutic procedures. Conclusions: The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there

Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values

International Nuclear Information System (INIS)

Ubeda, Carlos; Miranda, Patricia; Vano, Eliseo

2015-01-01

Purpose: To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Methods: Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Results: Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm 2 for <1 yr; 1.74 and 1.90 Gy cm 2 for 1 to <5 yr; 2.83 and 3.22 Gy cm 2 for 5 to <10 yr; and 7.34 and 8.68 Gy cm 2 for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm 2 /kg) for diagnostic and therapeutic procedures. Conclusions: The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there may be large differences

SU-E-P-08: Establishment of Local Diagnostic Reference Levels of Routine Abdomen Exam in Computed Tomography According to Body Weight

International Nuclear Information System (INIS)

Wang, H; Wang, Y; Weng, H

2015-01-01

Purpose: The national diagnostic reference levels (NDRLs) is an efficient, concise and powerful standard for optimizing radiation protection of a patient. However, for each hospital the dose-reducing potential of focusing on establishment of local DRLs (LDRLs). A lot of study reported that Computed tomography exam contributed majority radiation dose in different medical modalities, therefore, routine abdomen CT exam was choose in initial pilot study in our study. Besides the mAs of routine abdomen CT exam was decided automatic exposure control by linear attenuation is relate to body shape of patient. In this study we would like to establish the local diagnostic reference levels of routine abdomen exam in computed tomography according to body weight of patient. Methods and Materials: There are two clinical CT scanners (a Toshiba Aquilion and a Siemens Sensation) were performed in this study. For CT examinations the basic recommended dosimetric quantity is the Computed Tomography Dose Index (CTDI). The patient sample involved 82 adult patients of both sexes and divided into three groups by their body weight (50–60 kg, 60–70 kg, 70–80 kg).Carried out the routine abdomen examinations, and all exposure parameters have been collected and the corresponding CTDIv and DLP values have been determined. The average values were compared with the European DRLs. Results: The majority of patients (75%) were between 50–70 Kg of body weight, the numbers of patient in each group of weight were 40–50:7; 50–60:29; 60–70:33; 70–80:13. The LDRLs in each group were 10.81mGy, 14.46mGy, 20.27mGy and 21.04mGy, respectively. The DLP were 477mGy, 630mGy, 887mGy and 959mGy, respectively. No matter which group the LDRLs were lower than European DRLs. Conclusions: We would like to state that this was a pioneer work in local hospital in Chiayi. We hope that this may lead the way to further developments in Taiwan

SU-E-P-08: Establishment of Local Diagnostic Reference Levels of Routine Abdomen Exam in Computed Tomography According to Body Weight

Energy Technology Data Exchange (ETDEWEB)

Wang, H; Wang, Y; Weng, H [Chiayi Chang Gung Memorial Hospital of The C.G.M.F, Puzi City, Chiayi County, Taiwan (China)

2015-06-15

Purpose: The national diagnostic reference levels (NDRLs) is an efficient, concise and powerful standard for optimizing radiation protection of a patient. However, for each hospital the dose-reducing potential of focusing on establishment of local DRLs (LDRLs). A lot of study reported that Computed tomography exam contributed majority radiation dose in different medical modalities, therefore, routine abdomen CT exam was choose in initial pilot study in our study. Besides the mAs of routine abdomen CT exam was decided automatic exposure control by linear attenuation is relate to body shape of patient. In this study we would like to establish the local diagnostic reference levels of routine abdomen exam in computed tomography according to body weight of patient. Methods and Materials: There are two clinical CT scanners (a Toshiba Aquilion and a Siemens Sensation) were performed in this study. For CT examinations the basic recommended dosimetric quantity is the Computed Tomography Dose Index (CTDI). The patient sample involved 82 adult patients of both sexes and divided into three groups by their body weight (50–60 kg, 60–70 kg, 70–80 kg).Carried out the routine abdomen examinations, and all exposure parameters have been collected and the corresponding CTDIv and DLP values have been determined. The average values were compared with the European DRLs. Results: The majority of patients (75%) were between 50–70 Kg of body weight, the numbers of patient in each group of weight were 40–50:7; 50–60:29; 60–70:33; 70–80:13. The LDRLs in each group were 10.81mGy, 14.46mGy, 20.27mGy and 21.04mGy, respectively. The DLP were 477mGy, 630mGy, 887mGy and 959mGy, respectively. No matter which group the LDRLs were lower than European DRLs. Conclusions: We would like to state that this was a pioneer work in local hospital in Chiayi. We hope that this may lead the way to further developments in Taiwan.

ENRAF gauge reference level calculations

Energy Technology Data Exchange (ETDEWEB)

Huber, J.H., Fluor Daniel Hanford

1997-02-06

This document describes the method for calculating reference levels for Enraf Series 854 Level Detectors as installed in the tank farms. The reference level calculation for each installed level gauge is contained herein.

Sci-Fri AM: MRI and Diagnostic Imaging - 02: Quality Improvement: Diagnostic Reference Levels for Interior Health CT exams – L-Spine, Chest/Abdomen/pelvis, Abdomen/Pelvis, Head

Energy Technology Data Exchange (ETDEWEB)

Bjarnason, Thorarin [Diagnostic Imaging / Interior Health, Mathematics, Statistics, Physics & Computer Science / UBCO (Canada); Radiology / UBC (Canada)

2016-08-15

Diagnostic Reference Levels are used to optimize patient dose and image quality in the clinical setting. It is assumed that the majority of exams are of diagnostic quality, or the radiologists would request protocol adjustments. By investigating the dose indicator distributions from all scanners, the upper DRL can be set to the 75th percentile of the distribution and a lower DRL can be set to the 10th percentile. Scanners using doses consistently outside the upper/lower DRL range can be adjusted accordingly. 11 CT scanners, all contributing to the American College of Radiology Dose Index Registry (ACR DIR) were used in this study. Dose indicator data were compiled from the ACR DIR data and local DRLs established. Scanners with median doses outside the upper/lower DRL were followed-up with. Using effective dose and exam volumes, collective dose was determined before and after protocol adjustments to evaluate the effect of this quality improvement effort. The quality initiative is complete for L-spine and Chest/Abdomen/Pelvis exams and only initial surveys were completed for Head and Abdomen/Pelvis examsg. Median Scanner Dose reductions were 8.8 and 4.9 % for L-spine and Chest/Abdomen/Pelvis exams, respectively, resulting with collective dose reductions of 0.7 and 3.2 person•Sv/yr. Follow-up is ongoing for Abdomen/Pelvis and Head exams.

Sci-Fri AM: MRI and Diagnostic Imaging - 02: Quality Improvement: Diagnostic Reference Levels for Interior Health CT exams – L-Spine, Chest/Abdomen/pelvis, Abdomen/Pelvis, Head

International Nuclear Information System (INIS)

Bjarnason, Thorarin

2016-01-01

Diagnostic Reference Levels are used to optimize patient dose and image quality in the clinical setting. It is assumed that the majority of exams are of diagnostic quality, or the radiologists would request protocol adjustments. By investigating the dose indicator distributions from all scanners, the upper DRL can be set to the 75th percentile of the distribution and a lower DRL can be set to the 10th percentile. Scanners using doses consistently outside the upper/lower DRL range can be adjusted accordingly. 11 CT scanners, all contributing to the American College of Radiology Dose Index Registry (ACR DIR) were used in this study. Dose indicator data were compiled from the ACR DIR data and local DRLs established. Scanners with median doses outside the upper/lower DRL were followed-up with. Using effective dose and exam volumes, collective dose was determined before and after protocol adjustments to evaluate the effect of this quality improvement effort. The quality initiative is complete for L-spine and Chest/Abdomen/Pelvis exams and only initial surveys were completed for Head and Abdomen/Pelvis examsg. Median Scanner Dose reductions were 8.8 and 4.9 % for L-spine and Chest/Abdomen/Pelvis exams, respectively, resulting with collective dose reductions of 0.7 and 3.2 person•Sv/yr. Follow-up is ongoing for Abdomen/Pelvis and Head exams.

Sci-Thur PM – Colourful Interactions: Highlights 07: Canadian Computed Tomography Survey: National Diagnostic Reference Levels

Energy Technology Data Exchange (ETDEWEB)

Wardlaw, Graeme M; Martel, Narine [Consumer & Clinical Radiation Protection Bureau / Health Canada (Canada)

2016-08-15

Purpose: The Canadian Computed (CT) Tomography Survey sought to collect CT technology and dose index data (CTDI and DLP) at the national level in order to establish national diagnostic reference levels (DRLs) for seven common CT examinations of standard-sized adults and pediatric patients. Methods: A single survey booklet (consisting of four sections) was mailed to and completed for each participating CT scanner. Survey sections collected data on (i) General facility and scanner information, (ii) routine protocols (as available), (iii) individual patient data (as applied) and (iv) manual CTDI measurements. Results: Dose index (CTDIvol and DLP) and associated patient data from 24 280 individual patient exam sequences was analyzed for seven common CT examinations performed in Canada: Adult Head, Chest, Abdomen/Pelvis, and Chest/Abdomen/Pelvis, and Pediatric Head, Chest, and Abdomen. Pediatric examination data was sub-divided into three age ranges: 0–3, 3–7 and 7–13 years. DRLs (75th percentile of dose index distributions) were found for all thirteen groups. Further analysis also permitted segmentation of examination data into 8 sub-groups, whose dose index data was displayed along with group histograms – showing relative contribution of axial vs. helical, contrast use (C+ vs. C-), and application of fixed current vs. dose reduction (DR) – 75th percentiles of DR sub-groups were, in almost all cases, lower than whole group (examination) DRLs. Conclusions: The analysis and summaries presented in the pending survey report can serve to aid local CT imaging optimization efforts within Canada and also contribute further to international efforts in radiation protection of patients.

A comparison of mean glandular dose diagnostic reference levels within the all-digital irish national breast screening programme and the Irish symptomatic breast services

International Nuclear Information System (INIS)

O'Leary, D.; Rainford, L.

2013-01-01

Data on image quality, compression and radiation dose were collected from symptomatic breast units within the Republic of Ireland. Quantitative and qualitative data were analysed using SPSS. Recommendations of mean glandular dose (MGD) diagnostic reference levels were made at various levels for film-screen and full field digital mammography units to match levels published worldwide. MGDs received by symptomatic breast patients within Ireland are higher than those received in the all-digital Irish Breast Screening service; 55-65 mm breast: 1.75 mGy (screening) vs. 2.4 mGy (symptomatic) at the 95. percentile; various reasons are proposed for the differences. MGDs achieved in the screening service may be lower because of the exacting requirements for radiographer training, characteristics of the patients and equipment quality assurance levels. More precise imaging guidelines, standards and training of symptomatic radiographers performing mammography are suggested to remediate MGDs delivered to the breasts of Irish women attending the symptomatic breast services. (authors)

The establishment of local diagnostic reference levels in endoscopic retrograde cholangiopancreatography: a practical tool for the optimisation and for quality assurance management

International Nuclear Information System (INIS)

Saukko, E.; Henner, A.; Nieminen, M.T.; Ahonen, S.-M.

2017-01-01

Fluoroscopic procedures are an area of special concern in relation to radiation protection. The aim of this study was to describe the current level of patient radiation doses in endoscopic retrograde cholangiopancreatography (ERCP) collected from a single centre, as well as to establish and review local diagnostic reference levels (DRLs) in ERCP. A total of 100 patients' radiation doses in ERCP were recorded, and the third-quartile method was adopted to establish local DRLs for ERCP. The mean dose area product (DAP) was 2.05 Gy cm 2 , fluoroscopy time (FT) 1.7 min and the number of images was 3. The proposed local DRLs for ERCP were 3.00 Gy cm 2 and 3.0 min. Local DRLs were reviewed in a sample of 25 patients 5 y after they had been established. In reviewing data, the averages of DAP and FT were below the local DRLs. Local DRLs help in the optimisation process of fluoroscopic procedures and guides to a good clinical practice. (authors)

Reference handbook: Level detectors

International Nuclear Information System (INIS)

1990-01-01

The purpose of this handbook is to provide Rocky Flats personnel with the information necessary to understand level measurement and detection. Upon completion of this handbook you should be able to do the following: List three reasons for measuring level. Describe the basic operating principles of the sight glass. Demonstrate proper techniques for reading a sight glass. Describe the basic operating principles of a float level detector. Describe the basic operating principles of a bubbler level indicating system. Explain the differences between a wet and dry reference leg indicating system, and describe how each functions. This handbook is designed for use by experienced Rocky Flats operators to reinforce and improve their current knowledge level, and by entry-level operators to ensure that they possess a minimum level of fundamental knowledge. Level Detectors is applicable to many job classifications and can be used as a reference for classroom work or for self-study. Although this reference handbook is by no means all-encompassing, you will gain enough information about this subject area to assist you in contributing to the safe operation of Rocky Flats Plant

Diagnostic reference activities for nuclear medicine in Australia and New Zealand

International Nuclear Information System (INIS)

Towson, J.E.; Smart, R.C.

2001-01-01

Nuclear medicine centres in Australia and New Zealand were surveyed in 1998 on behalf of the Australian and New Zealand Society of Nuclear Medicine (ANZSNM) and the Australasian Radiation Protection Society (ARPS) in order to establish diagnostic reference levels. A survey form was mailed to all centres, requesting information on the usual radiopharmaceutical activity administered to a standard adult patient and how the activity is calculated for children. The overall response rate was 89.5%. Data was obtained for 80 imaging procedures and 17 non-imaging tracer studies. For the 68 procedures for which data was available from 10 or more centres, the Most Common Activity and the Reference Activity were found from the mode and 75 th percentile of the distribution of activities. A follow-up survey of the 8 hospital centres specialising in pediatric nuclear medicine in Australia was conducted in 1999-2000. Data on the maximum and minimum administered activities (A max and A min ) was obtained for 43 pediatric imaging procedures. A max values were significantly less than the Reference Activities determined for adults. The median values of A max and A min are recommended as Pediatric Reference Activities. The effective dose from the Reference Activities was calculated for adults (male and female) and children. The survey results are available on the ANZSNM and ARPS web sites at http://www.anzsnm.org.au and http://www.arps.org.au. (author)

Diagnostic reference levels for common computed tomography (CT) examinations: results from the first Nigerian nationwide dose survey.

Science.gov (United States)

Ekpo, Ernest U; Adejoh, Thomas; Akwo, Judith D; Emeka, Owujekwe C; Modu, Ali A; Abba, Mohammed; Adesina, Kudirat A; Omiyi, David O; Chiegwu, Uche H

2018-01-29

To explore doses from common adult computed tomography (CT) examinations and propose national diagnostic reference levels (nDRLs) for Nigeria. This retrospective study was approved by the Nnamdi Azikiwe University and University Teaching Hospital Institutional Review Boards (IRB: NAUTH/CS/66/Vol8/84) and involved dose surveys of adult CT examinations across the six geographical regions of Nigeria and Abuja from January 2016 to August 2017. Dose data of adult head, chest and abdomen/pelvis CT examinations were extracted from patient folders. The median, 75th and 25th percentile CT dose index volume (CTDI vol ) and dose-length-product (DLP) were computed for each of these procedures. Effective doses (E) for these examinations were estimated using the k conversion factor as described in the ICRP publication 103 (E DLP  =  k × DLP ). The proposed 75th percentile CTDI vol for head, chest, and abdomen/pelvis are 61 mGy, 17 mGy, and 20 mGy, respectively. The corresponding DLPs are 1310 mGy.cm, 735 mGy.cm, and 1486 mGy.cm respectively. The effective doses were 2.75 mSv (head), 10.29 mSv (chest), and 22.29 mSv (abdomen/pelvis). Findings demonstrate wide dose variations within and across centres in Nigeria. The results also show CTDI vol comparable to international standards, but considerably higher DLP and effective doses.

Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values.

Science.gov (United States)

Ubeda, Carlos; Miranda, Patricia; Vano, Eliseo

2015-02-01

To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there may be large differences in child size. These DRLs were obtained at the largest pediatric hospital in Chile, with an active optimization program, and could be used by other hospitals in the Latin America region to compare their current patient dose values and determine whether corrective action is appropriate. © 2015 American Association of Physicists in Medicine.

The role and impact of reference doses on diagnostic radiology, how to use them at the national level?

International Nuclear Information System (INIS)

Nikodemova, D.; Horvathova, M.; Karkus, R.

2003-01-01

Results of patient dose audits reported in this paper for several types of examinations and various technical units have shown the importance of applications of reference dose levels in radiological practice. On the basis of national surveys slightly lower or higher standard dose reference levels (DRL) values could be justified. Continuing revision of DRL values and their extension to other types of radiographic and fluoroscopic examinations is needed

Evidence of dose saving in routine CT practice using iterative reconstruction derived from a national diagnostic reference level survey.

Science.gov (United States)

Thomas, P; Hayton, A; Beveridge, T; Marks, P; Wallace, A

2015-09-01

To assess the influence and significance of the use of iterative reconstruction (IR) algorithms on patient dose in CT in Australia. We examined survey data submitted to the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) National Diagnostic Reference Level Service (NDRLS) during 2013 and 2014. We compared median survey dose metrics with categorization by scan region and use of IR. The use of IR results in a reduction in volume CT dose index of between 17% and 44% and a reduction in dose-length product of between 14% and 34% depending on the specific scan region. The reduction was highly significant (p sum test) for all six scan regions included in the NDRLS. Overall, 69% (806/1167) of surveys included in the analysis used IR. The use of IR in CT is achieving dose savings of 20-30% in routine practice in Australia. IR appears to be widely used by participants in the ARPANSA NDRLS with approximately 70% of surveys submitted employing this technique. This study examines the impact of the use of IR on patient dose in CT on a national scale.

SU-E-I-33: Establishment of CT Diagnostic Reference Levels in Province Nova Scotia

Energy Technology Data Exchange (ETDEWEB)

Tonkopi, E; Abdolell, M; Duffy, S [Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS (Canada)

2015-06-15

Purpose: To evaluate patient radiation dose from the most frequently performed CT examinations and to establish provincial diagnostic reference levels (DRLs) as a tool for protocol optimization. Methods: The study investigated the following CT examinations: head, chest, abdomen/pelvis, and chest/abdomen/pelvis (CAP). Dose data, volume CT dose index (CTDIvol) and dose-length product (DLP), were collected from 15 CT scanners installed during 2004–2014 in 11 hospital sites of Nova Scotia. All scanners had dose modulation options and multislice capability (16–128 detector rows). The sample for each protocol included 15 average size patients (70±20 kg). Provincial DRLs were calculated as the 75th percentile of patient dose distributions. The differences in dose between hospitals were evaluated with a single factor ANOVA statistical test. Generalized linear modeling was used to determine the factors associated with higher radiation dose. A sample of 36 abdominal studies performed on three different scanners was blinded and randomized for an assessment by an experienced radiologist who graded the imaging quality of anatomic structures. Results: Data for 900 patients were collected. The DRLs were proposed using CTDIvol (mGy) and DLP (mGy*cm) values for CT head (67 and 1049, respectively), chest (12 and 393), abdomen/pelvis (16 and 717), and CAP (14 and 1034). These DRLs were lower than the published national data except for the head CTDIvol. The differences between the means of the dose distributions from each scanner were statistically significant (p<0.05) for all examinations. A very weak correlation was found between the dose and the scanner age or the number of slices with Pearson’s correlation coefficients of 0.011–0.315. The blinded analysis of image quality demonstrated no clinically significant difference except for the noise category. Conclusion: Provincial DRLs were established for typical CT examinations. The variations in dose between the hospitals

A Meta-Analysis of Typhoid Diagnostic Accuracy Studies: A Recommendation to Adopt a Standardized Composite Reference.

Directory of Open Access Journals (Sweden)

Helen L Storey

Full Text Available Novel typhoid diagnostics currently under development have the potential to improve clinical care, surveillance, and the disease burden estimates that support vaccine introduction. Blood culture is most often used as the reference method to evaluate the accuracy of new typhoid tests; however, it is recognized to be an imperfect gold standard. If no single gold standard test exists, use of a composite reference standard (CRS can improve estimation of diagnostic accuracy. Numerous studies have used a CRS to evaluate new typhoid diagnostics; however, there is no consensus on an appropriate CRS. In order to evaluate existing tests for use as a reference test or inclusion in a CRS, we performed a systematic review of the typhoid literature to include all index/reference test combinations observed. We described the landscape of comparisons performed, showed results of a meta-analysis on the accuracy of the more common combinations, and evaluated sources of variability based on study quality. This wide-ranging meta-analysis suggests that no single test has sufficiently good performance but some existing diagnostics may be useful as part of a CRS. Additionally, based on findings from the meta-analysis and a constructed numerical example demonstrating the use of CRS, we proposed necessary criteria and potential components of a typhoid CRS to guide future recommendations. Agreement and adoption by all investigators of a standardized CRS is requisite, and would improve comparison of new diagnostics across independent studies, leading to the identification of a better reference test and improved confidence in prevalence estimates.

Diagnostic reference activities for nuclear medicine procedures in Australia and New Zealand

International Nuclear Information System (INIS)

Smart, R.C.; Towson, J.E.

2000-01-01

In July 1998 a survey of diagnostic nuclear medicine procedures in Australia and New Zealand was undertaken on behalf of the Australian and New Zealand Society of Nuclear Medicine (ANZSNM) and the Australasian Radiation Protection Society (ARPS) in order to establish diagnostic reference activities. A total of 96 responses were received representing 154 practices, comprising 45 public hospital departments, 21 private hospital departments, 87 private practices and 1 unspecified practice. The survey requested the usual activities administered for a standard adult, the method used to determine the activity for children and the minimum activities used for paediatric patients. Data was obtained for 80 different imaging procedures and for 17 non-imaging tracer studies. For those procedures for which information was available from 10 or more practices, 68 in total, the reference activity was calculated as the 75th percentile of the distribution of activities. The Most Common Activity, the Reference Activity, together with the effective dose in both male and female patients, is tabulated for all these procedures. Copyright (2000) Australasian Radiation Protection Society Inc

Analysis of data relative to the update of diagnostic reference levels in radiology and nuclear medicine. 2011-2012 review

International Nuclear Information System (INIS)

2014-01-01

Applying the Order of 24 October 2011 on diagnostic reference levels, departments of radiology and nuclear medicine must send a sample of 'patient' dosimetric data to the IRSN each year. The results of the analysis of dosimetric data performed between the 1 January 2011 and the 31 December 2012 presented in this report should enable the authority to define the needs for updating regulations. Professional involvement in DRLs improved globally over the 2011-2012 period but is heterogeneous according to the imaging area considered. The participation of conventional radiology professionals is still low, with less than 30% against over 75% in CT and 85% in nuclear medicine. Data collection in pediatrics, considering all the fields of medical imaging, remains extremely limited. This shows almost no dose assessment for children by imaging departments, and has the effect of not allowing authorities to provide professionals with DRLs representative of pediatric practices. The analysis of radiology doses and nuclear medicine administered activities by IRSN shows an overall decrease of statistical indicators on which DRLs are indexed. These results lead to proposals for updating reference values for a large number of examinations. In addition to the analysis of data collected for examinations currently mentioned in regulatory texts, IRSN recommends to update DRLs in a more general way by changing the strategy for collecting and updating pediatric DRLs, by including interventional radiology - specialty in which the radiation protection presents a major challenge - by introducing a more ambitious indicator than the 75. percentile in conventional radiology and nuclear medicine - the 25. percentile statistical indicator, and by taking into account new technologies inducing additional exposures to the patient as CT-scan associated with the PET. (authors)

MO-FG-CAMPUS-IeP1-03: Establishment of Provincial Diagnostic Reference Levels in Pediatric Imaging

International Nuclear Information System (INIS)

Tonkopi, E; O’Brien, K

2016-01-01

Purpose: To establish provincial diagnostic reference levels (DRLs) in pediatric general radiography and computed tomography (CT) as a tool for the optimization of exposure parameters. Methods: Patient dose survey was conducted in the only pediatric hospital in the province of Nova Scotia. The DRLs were established as the 75th percentile of patient dose distributions in different age groups. For routine radiography projections the DRLs were determined in terms of entrance surface dose (ESD) calculated from the radiation output measurements and the tube current-exposure time product (mAs) recorded for each examination. Patient thickness was measured by the technologist during the examination. The CR and DR systems, employing respectively a fixed technique and phototiming, were evaluated separately; a two-tailed Student’s t-test was used to determine the significance of differences between the means of dose distributions. The CT studies included routine head, chest, abdomen/pelvis, and chest/abdomen/pelvis. The volume CT dose index (CTDIvol) and dose-length product (DLP) values were extracted retrospectively from PACS. The correction factors based on the effective diameter of the patient were applied to the CT dosimetry metrics based on the standard phantoms. Results: The provincial DRLs were established in the following age groups: newborn, 1, 5, 10, and 15 year olds. In general radiography the DR systems demonstrated slightly lower dose than the CR for all views, however the differences were not statistically significant (p > 0.05) for all examinations. In CT the provincial DRLs were lower than the published data, except for head DLPs in all age categories. This might be due to the small patient sample size in the survey. Future work will include additional CT data collection over an extended period of time. Conclusion: Provincial DRLs were established in the dedicated children’s hospital to provide guidance for the other facilities in examinations of pediatric

MO-FG-CAMPUS-IeP1-03: Establishment of Provincial Diagnostic Reference Levels in Pediatric Imaging

Energy Technology Data Exchange (ETDEWEB)

Tonkopi, E [Dalhousie University (Canada); Queen Elizabeth II Health Sciences Ctr (Canada); O’Brien, K [Dalhousie University (Canada); IWK Health Centre, Halifax, NS (Canada)

2016-06-15

Purpose: To establish provincial diagnostic reference levels (DRLs) in pediatric general radiography and computed tomography (CT) as a tool for the optimization of exposure parameters. Methods: Patient dose survey was conducted in the only pediatric hospital in the province of Nova Scotia. The DRLs were established as the 75th percentile of patient dose distributions in different age groups. For routine radiography projections the DRLs were determined in terms of entrance surface dose (ESD) calculated from the radiation output measurements and the tube current-exposure time product (mAs) recorded for each examination. Patient thickness was measured by the technologist during the examination. The CR and DR systems, employing respectively a fixed technique and phototiming, were evaluated separately; a two-tailed Student’s t-test was used to determine the significance of differences between the means of dose distributions. The CT studies included routine head, chest, abdomen/pelvis, and chest/abdomen/pelvis. The volume CT dose index (CTDIvol) and dose-length product (DLP) values were extracted retrospectively from PACS. The correction factors based on the effective diameter of the patient were applied to the CT dosimetry metrics based on the standard phantoms. Results: The provincial DRLs were established in the following age groups: newborn, 1, 5, 10, and 15 year olds. In general radiography the DR systems demonstrated slightly lower dose than the CR for all views, however the differences were not statistically significant (p > 0.05) for all examinations. In CT the provincial DRLs were lower than the published data, except for head DLPs in all age categories. This might be due to the small patient sample size in the survey. Future work will include additional CT data collection over an extended period of time. Conclusion: Provincial DRLs were established in the dedicated children’s hospital to provide guidance for the other facilities in examinations of pediatric

Analysis of data relative to the update of diagnostic reference levels in radiology and nuclear medicine. 2013-2015 review

International Nuclear Information System (INIS)

2016-11-01

Applying the Order of 24 October 2011 on diagnostic reference levels, departments of radiology and nuclear medicine must send a sample of 'patient' dosimetric data to the IRSN each year. The results of the analysis of dosimetric data performed between the 1 January 2013 and the 31 December 2015 presented in this report should enable the authority to define the needs for updating regulation. This assessment takes place in a national and international context particularly rich and active since the last years. More than 20 years after the official introduction of the DRL concept by ICRP and the first regulation requirements at a European level, the good and the bad sides of the DRLs systems implemented by several countries, including France, has shown the necessity of complementary actions regarding some specific practices (pediatrics, interventional radiology). On one hand, from a national point of view, the current collection and analysis system is highly efficient for evaluation of practices in France and for DRL update ability. On the other hand, as an optimization implementation tool, regarding the lack of professionals involvement, the current system should not be considered as fully effective in radiology. However, when the professionals carry out DRL data collection and analysis, optimization actions are implemented for nearly all the cases. During the 2013-2015 period, professionals involvement in DRLs globally improved but is heterogeneous according to the imaging area considered. The participation of conventional radiology professionals is still low, with less than 30% against about 80% in CT and more than 85% in nuclear medicine. From a dosimetric point of view, the national analysis shows an overall decrease of statistical indicators in radiology, computed tomography and nuclear medicine on which DRLs are indexed. These results lead to proposals for updating reference values for a large number of examinations. In addition to the analysis of data collected

Swiss National Reference Levels in Fluoroscopy

International Nuclear Information System (INIS)

Aroua, A.; Baechler, S.; Verdun, F.R.; Rickli, H.; Trueb, Ph.R.; Vock, P.

2006-01-01

A nationwide survey was launched in Switzerland in order to investigate the use of fluoroscopy and to establish national reference levels (R.L.) for dose-intensive procedures particularly in interventional radiology. The 2-year investigation covered 5 radiology and 9 cardiology departments in public hospitals and private clinics, and focused on twelve types of examinations: six diagnostic and six interventional. The performance of the fluoroscopy units used in these health-care centres (image quality and dose) was assessed extensively and 1000 examinations were registered. Information on the fluoroscopy time (T), the number of frames (N), the dose-area product (D.A.P.), the difficulty of the case, the age, gender, height and weight of the patient, as well as the experience of the practitioner was provided. The whole set of data was used in relative values (to the mean values for each type of examination) to establish the distributions of T, N and the D.A.P.. From these distributions a set of R.L. values was deduced for the types of examinations investigated using the 3.-quartile method. The R.L. values found are compared to the data published in the literature. (authors)

Radiation levels in nuclear diagnostic examinations

International Nuclear Information System (INIS)

Vermeulen, A.M.T.I.

1987-01-01

To estimate the risks for a pregnant radiological worker, radiation level measurements are executed for common nuclear diagnostic techniques. These measurements are combined with the time which the radiologic worker is present during the performance of the diagnostic techniques. It is concluded that a radiologic worker is receiving less than 5 mSv during pregnancy. This is the case with in vivo determination in a department of nuclear medicine with common diagnostic techniques. Reduction of radiation doses during pregnancy is possible by reduction of heart function examinations, skeletal examinations and brain scans. 1 figure; 13 tabs

Serum Inhibin B and follicle-stimulating hormone levels as tools in the evaluation of infertile men: significance of adequate reference values from proven fertile men

DEFF Research Database (Denmark)

Andersson, A.-M.; Petersen, Jørgen Holm; Jørgensen, N.

2004-01-01

Inhibin B and FSH levels in 289 idiopathic infertile men were compared with reference materials consisting of 303 proven fertile men (reference group 1) and 307 healthy men from the general population with unknown fertility status (reference group 2). The diagnostic power of these two serum markers...... of spermatogenesis was evaluated by the use of receiver operating characteristic plot analysis, and an example of how both markers can be used simultaneously in a bivariate reference chart is presented. Inhibin B levels were significantly lower and FSH levels were significantly higher in the infertile men, compared...

Establishment of institutional diagnostic reference level for computed tomography with automated dose-tracking software.

Science.gov (United States)

Liang, Chong R; Chen, Priscilla X H; Kapur, Jeevesh; Ong, Michael K L; Quek, Swee T; Kapur, Subhash C

2017-06-01

The aim of this study was to establish institutional diagnostic reference levels (DRLs) by summarising doses collected across the five computed tomography (CT) system in our institution. CT dose data of 15940 patients were collected retrospectively from May 2015 to October 2015 in five institutional scanners. The mean, 75th percentile and 90th percentile of the dose spread were calculated according to anatomic region. The common CT examinations such as head, chest, combined abdomen/pelvis (A/P), and combined chest/abdomen/pelvis (C/A/P) were reviewed. Distribution of CT dose index (CTDIvol), dose-length product (DLP) and effective dose (ED) were extracted from the data for single-phasic and multiphasic examinations. The institutional DRL for our CT units were established as mean (50th percentile) of CTDIvol (mGy), DLP (mGy.cm) and ED (mSv) for single and multiphasic studies using the dose-tracking software. In single phasic examination, Head: (49.0 mGy), (978.0 mGy.cm), (2.4 mSv) respectively; Chest: (6.0 mGy), (254.0 mGy.cm), (4.9 mSv) respectively; CT A/P (10.0 mGy), (514.0 mGy.cm), (8.9 mSv) respectively; CT C/A/P (10.0 mGy), (674.0 mGy.cm), (11.8 mSv) respectively. In multiphasic studies: Head (45.0 mGy), (1822.0 mGy.cm), (5.0 mSv) respectively; Chest (8.0 mGy), (577.0 mGy.cm), (10.0 mSv) respectively; CT A/P: (10.0 mGy), (1153.0 mGy.cm), (20.2 mSv) respectively; CT C/A/P: (11.0 mGy), (1090.0 mGy.cm), (19.2 mSv) respectively. The reported metrics offer a variety of information that institutions can use for quality improvement activities. The variations in dose between scanners suggest a large potential for optimisation of radiation dose. © 2017 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

Establishment of dose reference levels for mammography in Greece

International Nuclear Information System (INIS)

Kalathaki, M.; Hourdakis, C.J.; Economides, S.; Tritakis, P.; Manousaridis, G.; Kalyvas, N.; Simantirakis, G.; Kipouros, P.; Kamenopoulou, V.

2006-01-01

Full text of publication follows: Diagnostic Reference Levels (D.R.L.) are dose levels established in medical practices for typical x-ray examinations concerning groups of standard size patients or standard phantoms and broadly defined types of equipment. When good and normal practice is performed, these levels are not expected to be exceeded. This work is an attempt to establish for the first time the D.R.L. for mammography in Greece. At present, there are 402 mammographic systems in clinical use all over the country. This study that lasted 3 years (2000-2003), includes 117 of these systems, 85% of which are installed in private and 15% in public sector countrywide. Measurements of entrance surface dose (E.S.D.) were performed as a part of the regular inspections performed by the Licensing and Inspections Department of Greek Atomic Energy Commission on the basis of the laboratories licensing procedure. Moreover, the entire performance of the mammographic units was assessed by quantitative and qualitative measurements of specific parameters. In order to establish the national D.R.L., a standard phantom was used during the quality control of the mammographic units and E.S.D. measurements were performed based on the clinical practice of each laboratory. The D.R.L. for this type of examination was established according to the 75. percentile of the E.S.D. curve and found equal to 7 mGy per single view. The comparison of this value with the one reported by the European Commission (10 mGy per view), indicates that the D.R.L. for mammography is lower in Greece. However, the primary concern of a mammographic examination is to keep breast dose as low as reasonably achievable while providing images with the maximum amount of diagnostic information. The quality of the produced images was therefore assessed for all systems examined, regardless of meeting or exceeding the quality criteria reference surface entrance dose. The results showed that the average total score of the

The level of diagnostic assessment in severe asthma

DEFF Research Database (Denmark)

von Bulow, Anna; Backer, Vibeke; Bodtger, Uffe

2017-01-01

INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated. AIMS & OBJECTIVES: To describe the diagnostic work-...

Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population.

Science.gov (United States)

Moore, R; Brødsgaard, I; Birn, H

1991-01-01

This study aimed to clarify how manifestations and acquisition relate to diagnostic categories of dental fear in a population of self-referred dental fear patients, since diagnostic criteria specifically related to dental fear have not been validated. DSM III-R diagnostic criteria for phobias were used to compare with four existing dental fear diagnostic categories, referred to as the Seattle system. Subjects were 208 persons with dental fear who were telephone interviewed, of whom a subsample of 155 responded to a mailed Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory and a modified FSS-II Geer Fear Scale (GFS). Personal interviews and a Dental Beliefs Scale of perceived trust and social interaction with dentists were also used to evaluate a subsample of 80 patients selected by sex and high dental fear. Results showed that the majority of the 80 patients (66%), suffered from social embarrassment about their dental fear problem and their inability to do something about it. The largest cause of their fear (84%) was reported to be traumatic dental experiences, especially in childhood (70%). A minority of patients (16%) could not isolate traumatic experiences and had a history of general fearfulness or anxiety. Analysis of GFS data for the 155 subjects showed that fear of snakes and injuries were highest among women; heights and injections among men. Fear of blood was rarely reported. Spearman correlations between GFS individual items and DAS scores indicated functional independence between dental fear and common fears such as blood, injections and enclosures in most cases. Only in specific types of dental fear did these results support Rachman and Lopatka's contention that fears are thought to summate.(ABSTRACT TRUNCATED AT 250 WORDS)

Dose evaluation and establishment of reference levels in activity for nuclear medicine

International Nuclear Information System (INIS)

Ribeiro, Julio Cesar de Souza

2017-01-01

The International Commission on Radiation Protection (ICRP) has emphasized the importance of accurately determining the mean dose levels, or administered activity, received by the patients for each medical procedure that uses ionizing radiation. However, the number of bibliographic references addressing the need to know and optimize these levels is insufficient, or rather limited, which may lead to non-standardizes techniques, a lack of exposures control, and also the increase of associated radiological risks of these procedures. In this context, a software in Visual Basic® of Microsoft© language was developed whose function is to elaborate a method of obtaining the Reference Levels in Activity (RLA) for nuclear medicine patients by determining the third quartile of the examinations carried out. The program also allows obtaining absorbed dose values in critical organs based on patient specificities as age, sex and Body Mass Index (BMI) in order to evaluate the risk involved in each procedure. The main nuclear medicine diagnostic procedures were evaluated through the database of two public hospitals and a private clinic, obtaining the NRAs of each facility, where the software was validated by comparison with the traditionally accepted calculation methods. Due to the results obtained in each installation, in addition to NRA determination, gaps in treatment capacities and unjustified dose variations for the same procedure were identified, indicating the need for optimization. Thus, the developed program is able to provide the estimated values of effective and absorbed doses involved in each procedure, for each patient, providing reference values for nuclear medicine field, not available in the national scenario so far. (author)

Nationwide survey of radiation exposure during pediatric computed tomography examinations and proposal of age-based diagnostic reference levels for Japan

International Nuclear Information System (INIS)

Takei, Yasutaka; Miyazaki, Osamu; Matsubara, Kosuke; Koshida, Kichiro; Shimada, Yoshiya; Akahane, Keiichi; Muramatsu, Yoshihisa; Fujii, Keisuke; Suzuki, Shoichi

2016-01-01

Diagnostic reference levels (DRLs) have not been established in Japan. To propose DRLs for CT of the head, chest and abdomen for three pediatric age groups. We sent a nationwide questionnaire by post to 339 facilities. Questions focused on pediatric CT technology, exposure parameters, CT protocols, and radiation doses for age groups <1 year, 1-5 years, and 6-10 years. For the three age groups in the 196 facilities that responded, the 75th percentile values of volume CT dose index based on a 16-cm phantom (CTDI vol 16 [mGy]) for head, chest and abdominal CT were for infants 39.1, 11.1 and 12.0, respectively; for 1-to 5-year-olds 46.9, 14.3 and 16.7, respectively; and for 6-to 10-year-olds 67.7, 15.0 and 17.0, respectively. The corresponding dose-length products (DLP 16 [mGy·cm]) for head, chest and abdominal CT were for infants 526.1, 209.1 and 261.5, respectively; for 1-to 5-year-olds 665.5, 296.0 and 430.8, respectively; and for 6-to 10-year-olds 847.9, 413.0 and 532.2, respectively. The majority of CTDI vol 16 and DLP 16 values for the head were higher than DRLs reported from other countries. For risk reduction, it is necessary to establish DRLs for pediatric CT in Japan. (orig.)

Nationwide survey of radiation exposure during pediatric computed tomography examinations and proposal of age-based diagnostic reference levels for Japan

Energy Technology Data Exchange (ETDEWEB)

Takei, Yasutaka [Kanazawa University, Department of Quantum Medical Technology, Division of Health Sciences, Graduate School of Medical Science, Kanazawa, Ishikawa (Japan); Miyazaki, Osamu [National Center for Child Health and Development, Department of Radiology, Tokyo (Japan); Matsubara, Kosuke; Koshida, Kichiro [Kanazawa University, Department of Quantum Medical Technology, Faculty of Health Sciences, Ishikawa (Japan); Shimada, Yoshiya; Akahane, Keiichi [National Institute of Radiological Sciences, Medical Exposure Research Project, Chiba (Japan); Muramatsu, Yoshihisa [National Cancer Center Hospital East, Department of Radiology, Chiba (Japan); Fujii, Keisuke [Nagoya University, Radiological Technology, Graduate School of Medicine, Aichi (Japan); Suzuki, Shoichi [Fujita Health University, Faculty of Radiological Technology, School of Health Sciences, Aichi (Japan)

2016-02-15

Diagnostic reference levels (DRLs) have not been established in Japan. To propose DRLs for CT of the head, chest and abdomen for three pediatric age groups. We sent a nationwide questionnaire by post to 339 facilities. Questions focused on pediatric CT technology, exposure parameters, CT protocols, and radiation doses for age groups <1 year, 1-5 years, and 6-10 years. For the three age groups in the 196 facilities that responded, the 75th percentile values of volume CT dose index based on a 16-cm phantom (CTDI{sub vol} 16 [mGy]) for head, chest and abdominal CT were for infants 39.1, 11.1 and 12.0, respectively; for 1-to 5-year-olds 46.9, 14.3 and 16.7, respectively; and for 6-to 10-year-olds 67.7, 15.0 and 17.0, respectively. The corresponding dose-length products (DLP 16 [mGy·cm]) for head, chest and abdominal CT were for infants 526.1, 209.1 and 261.5, respectively; for 1-to 5-year-olds 665.5, 296.0 and 430.8, respectively; and for 6-to 10-year-olds 847.9, 413.0 and 532.2, respectively. The majority of CTDI{sub vol} 16 and DLP 16 values for the head were higher than DRLs reported from other countries. For risk reduction, it is necessary to establish DRLs for pediatric CT in Japan. (orig.)

Patients exposure assessment for radiographic procedures in diagnostic radiology

International Nuclear Information System (INIS)

Arandjic, D.; Ciraj-Bjelac, O.; Stankovic, K.; Lazarevic, Dj.; Ciraj-Bjelac, O.)

2007-01-01

In this work the results of dose assessment for the most frequent radiographic procedures in diagnostic radiology are shown. Entrance surface doses were assessed for 7 radiographic procedures. Three hospitals, six x-ray units in total, were enrolled in investigation. Patient doses were estimated based on results of x-ray tube output measurements. Finally, doses were compared with Diagnostic reference level. Higher dose values were observed for chest examinations. In comparison with results from other countries, doses from this procedure in Serbia are significantly higher. Estimated doses for other procedures were well below Diagnostic reference levels [sr

Establishment of multi-slice computed tomography (MSCT) reference level in Johor, Malaysia

Science.gov (United States)

Karim, M. K. A.; Hashim, S.; Bakar, K. A.; Muhammad, H.; Sabarudin, A.; Ang, W. C.; Bahruddin, N. A.

2016-03-01

Radiation doses from computed tomography (CT) are the highest and most hazardous compared to other imaging modalities. This study aimed to evaluate radiation dose in Johor, Malaysia to patients during computed tomography examinations of the brain, chest and abdomen and to establish the local diagnostic reference levels (DRLs) as are present with the current, state- of-art, multi-slice CT scanners. Survey forms were sent to five centres performing CT to obtain data regarding acquisition parameters as well as the dose information from CT consoles. CT- EXPO (Version 2.3.1, Germany) was used to validate the dose information. The proposed DRLs were indicated by rounding the third quartiles of whole dose distributions where mean values of CTDIw (mGy), CTDIvol (mGy) and DLP (mGy.cm) were comparable with other reference levels; 63, 63, and 1015 respectively for CT Brain; 15, 14, and 450 respectively for CT thorax and 16, 17, and 590 respectively for CT abdomen. The study revealed that the CT practice and dose output were revolutionised, and must keep up with the pace of introductory technology. We suggest that CTDIvol should be included in current national DRLs, as modern CTs are configured with a higher number of detectors and are independent of pitch factors.

Establishment of multi-slice computed tomography (MSCT) reference level in Johor, Malaysia

International Nuclear Information System (INIS)

Karim, M K A; Hashim, S; Ang, W C; Bahruddin, N A; Bakar, K A; Muhammad, H; Sabarudin, A

2016-01-01

Radiation doses from computed tomography (CT) are the highest and most hazardous compared to other imaging modalities. This study aimed to evaluate radiation dose in Johor, Malaysia to patients during computed tomography examinations of the brain, chest and abdomen and to establish the local diagnostic reference levels (DRLs) as are present with the current, state- of-art, multi-slice CT scanners. Survey forms were sent to five centres performing CT to obtain data regarding acquisition parameters as well as the dose information from CT consoles. CT- EXPO (Version 2.3.1, Germany) was used to validate the dose information. The proposed DRLs were indicated by rounding the third quartiles of whole dose distributions where mean values of CTDI w (mGy), CTDI vol (mGy) and DLP (mGy.cm) were comparable with other reference levels; 63, 63, and 1015 respectively for CT Brain; 15, 14, and 450 respectively for CT thorax and 16, 17, and 590 respectively for CT abdomen. The study revealed that the CT practice and dose output were revolutionised, and must keep up with the pace of introductory technology. We suggest that CTDI vol should be included in current national DRLs, as modern CTs are configured with a higher number of detectors and are independent of pitch factors. (paper)

Integrating Nursing Diagnostic Concepts into the Medical Entities Dictionary Using the ISO Reference Terminology Model for Nursing Diagnosis

OpenAIRE

Hwang, Jee-In; Cimino, James J.; Bakken, Suzanne

2003-01-01

Objective: The purposes of the study were (1) to evaluate the usefulness of the International Standards Organization (ISO) Reference Terminology Model for Nursing Diagnoses as a terminology model for defining nursing diagnostic concepts in the Medical Entities Dictionary (MED) and (2) to create the additional hierarchical structures required for integration of nursing diagnostic concepts into the MED.

Quality assurance in CT: implementation of the updated national diagnostic reference levels using an automated CT dose monitoring system.

Science.gov (United States)

Appel, E; Kröpil, P; Bethge, O T; Aissa, J; Thomas, C; Antoch, G; Boos, J

2018-03-20

To evaluate the implementation of the updated computed tomography (CT) diagnostic reference levels (DRLs) from the German Federal Office for Radiation Protection into clinical routine using an automatic CT dose monitoring system. CT radiation exposure was analysed before and after implementing the updated national DRLs into routine clinical work in 2016. After the implementation process, institutional CT protocols were mapped to the anatomical regions for which DRLs were provided. Systematically, protocols that exceeded the thresholds were optimised and analysed in detail. The CT radiation output parameters analysed were volumetric CT dose index (CTDIvol) and dose-length product (DLP). Three radiologists evaluated subjective image quality using a three-point Likert scale. The study included 94,258 CT series (from 27,103 CT examinations) in adult patients performed in 2016. When averaged over all body regions with available DRL, institutional CTDIvol/DLP values were always below the DRLs (65.2±32.9%/67.3±41.5% initially; 59.4±32%/60.5±39.9% after optimisation). Values exceeding the national DRLs were found for pelvis (n=268; CTDIvol 107.7±65.7%/DLP 106.3±79.3%), lumbar spine (n=91; 160.8±74.7%/175.2±104.1%), and facial bones (n=527; 108±39%/152.7±75.7%). After optimisation, CTDIvol and DLP were 87.9±73%/87.8±80.8% for the pelvis, 67.8±33.2%/74.5±50.6% for the lumbar spine and 95.1±45.8%/133.3±74.6% for the viscerocranium. An automatic CT dose monitoring system enabled not only comprehensive monitoring of a DRL implementation process but can also help to optimise radiation exposure. Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Exploring the utility of narrative analysis in diagnostic decision making: picture-bound reference, elaboration, and fetal alcohol spectrum disorders.

Science.gov (United States)

Thorne, John C; Coggins, Truman E; Carmichael Olson, Heather; Astley, Susan J

2007-04-01

To evaluate classification accuracy and clinical feasibility of a narrative analysis tool for identifying children with a fetal alcohol spectrum disorder (FASD). Picture-elicited narratives generated by 16 age-matched pairs of school-aged children (FASD vs. typical development [TD]) were coded for semantic elaboration and reference strategy by judges who were unaware of age, gender, and group membership of the participants. Receiver operating characteristic (ROC) curves were used to examine the classification accuracy of the resulting set of narrative measures for making 2 classifications: (a) for the 16 children diagnosed with FASD, low performance (n = 7) versus average performance (n = 9) on a standardized expressive language task and (b) FASD (n = 16) versus TD (n = 16). Combining the rates of semantic elaboration and pragmatically inappropriate reference perfectly matched a classification based on performance on the standardized language task. More importantly, the rate of ambiguous nominal reference was highly accurate in classifying children with an FASD regardless of their performance on the standardized language task (area under the ROC curve = .863, confidence interval = .736-.991). Results support further study of the diagnostic utility of narrative analysis using discourse level measures of elaboration and children's strategic use of reference.

Adaptive Reference Levels in a Level-Crossing Analog-to-Digital Converter

Directory of Open Access Journals (Sweden)

Andrew C. Singer

2008-11-01

Full Text Available Level-crossing analog-to-digital converters (LC ADCs have been considered in the literature and have been shown to efficiently sample certain classes of signals. One important aspect of their implementation is the placement of reference levels in the converter. The levels need to be appropriately located within the input dynamic range, in order to obtain samples efficiently. In this paper, we study optimization of the performance of such an LC ADC by providing several sequential algorithms that adaptively update the ADC reference levels. The accompanying performance analysis and simulation results show that as the signal length grows, the performance of the sequential algorithms asymptotically approaches that of the best choice that could only have been chosen in hindsight within a family of possible schemes.

An N+3 Technology Level Reference Propulsion System

Science.gov (United States)

Jones, Scott M.; Haller, William J.; Tong, Michael To-Hing

2017-01-01

An N+3 technology level engine, suitable as a propulsion system for an advanced single-aisle transport, was developed as a reference cycle for use in technology assessment and decision-making efforts. This reference engine serves three main purposes: it provides thermodynamic quantities at each major engine station, it provides overall propulsion system performance data for vehicle designers to use in their analyses, and it can be used for comparison against other proposed N+3 technology-level propulsion systems on an equal basis. This reference cycle is meant to represent the expected capability of gas turbine engines in the N+3 timeframe given reasonable extrapolations of technology improvements and the ability to take full advantage of those improvements.

Bayesian modeling and inference for diagnostic accuracy and probability of disease based on multiple diagnostic biomarkers with and without a perfect reference standard.

Science.gov (United States)

Jafarzadeh, S Reza; Johnson, Wesley O; Gardner, Ian A

2016-03-15

The area under the receiver operating characteristic (ROC) curve (AUC) is used as a performance metric for quantitative tests. Although multiple biomarkers may be available for diagnostic or screening purposes, diagnostic accuracy is often assessed individually rather than in combination. In this paper, we consider the interesting problem of combining multiple biomarkers for use in a single diagnostic criterion with the goal of improving the diagnostic accuracy above that of an individual biomarker. The diagnostic criterion created from multiple biomarkers is based on the predictive probability of disease, conditional on given multiple biomarker outcomes. If the computed predictive probability exceeds a specified cutoff, the corresponding subject is allocated as 'diseased'. This defines a standard diagnostic criterion that has its own ROC curve, namely, the combined ROC (cROC). The AUC metric for cROC, namely, the combined AUC (cAUC), is used to compare the predictive criterion based on multiple biomarkers to one based on fewer biomarkers. A multivariate random-effects model is proposed for modeling multiple normally distributed dependent scores. Bayesian methods for estimating ROC curves and corresponding (marginal) AUCs are developed when a perfect reference standard is not available. In addition, cAUCs are computed to compare the accuracy of different combinations of biomarkers for diagnosis. The methods are evaluated using simulations and are applied to data for Johne's disease (paratuberculosis) in cattle. Copyright © 2015 John Wiley & Sons, Ltd.

Practical considerations in the development and application of reference levels

International Nuclear Information System (INIS)

Selby, J. M.; Kennedy, W. E. Jr.; Swinth, K. L.; Gilbert, R. O.; Soldat, J. K.

1988-05-01

Radiological exposures to the public during an accident that releases radioactive materials to the environment occur initially through the air pathway, secondly through a water pathway, and finally, through the food chain. From these exposure pathways, reference levels of radionuclides must be applied to limit public radiation doses. Such reference levels are difficult to develop and apply, particularly if the contaminants are transuranic elements such as plutonium. The reference level must be related to a resultant theoretical dose to the public through generic calculations. However, to permit rapid decisions after an accident, the reference levels need to be related to conditions or media in the environment that can be directly measured. They must also be tied to specific countermeasures such as sheltering, evacuation, or interdiction of drinking water or food supplies. This paper discusses the practical considerations in the development and application of reference levels for transuranic in the environment and the present capability to rapidly detect and quantify their concentrations following accidental contamination events. 16 refs., 3 tabs

Cloud-based CT dose monitoring using the DICOM-structured report. Fully automated analysis in regard to national diagnostic reference levels

International Nuclear Information System (INIS)

Boos, J.; Rubbert, C.; Heusch, P.; Lanzman, R.S.; Aissa, J.; Antoch, G.; Kroepil, P.

2016-01-01

To implement automated CT dose data monitoring using the DICOM-Structured Report (DICOM-SR) in order to monitor dose-related CT data in regard to national diagnostic reference levels (DRLs). Materials and Methods: We used a novel in-house co-developed software tool based on the DICOM-SR to automatically monitor dose-related data from CT examinations. The DICOM-SR for each CT examination performed between 09/2011 and 03/2015 was automatically anonymized and sent from the CT scanners to a cloud server. Data was automatically analyzed in accordance with body region, patient age and corresponding DRL for volumetric computed tomography dose index (CTDI vol ) and dose length product (DLP). Results: Data of 36 523 examinations (131 527 scan series) performed on three different CT scanners and one PET/CT were analyzed. The overall mean CTDI vol and DLP were 51.3 % and 52.8 % of the national DRLs, respectively. CTDI vol and DLP reached 43.8 % and 43.1 % for abdominal CT (n = 10 590), 66.6 % and 69.6 % for cranial CT (n = 16 098) and 37.8 % and 44.0 % for chest CT (n = 10 387) of the compared national DRLs, respectively. Overall, the CTDI vol exceeded national DRLs in 1.9 % of the examinations, while the DLP exceeded national DRLs in 2.9 % of the examinations. Between different CT protocols of the same body region, radiation exposure varied up to 50 % of the DRLs. Conclusion: The implemented cloud-based CT dose monitoring based on the DICOM-SR enables automated benchmarking in regard to national DRLs. Overall the local dose exposure from CT reached approximately 50 % of these DRLs indicating that DRL actualization as well as protocol-specific DRLs are desirable. The cloud-based approach enables multi-center dose monitoring and offers great potential to further optimize radiation exposure in radiological departments.

Age- and Gender-Specific Reference Intervals for Fasting Blood Glucose and Lipid Levels in School Children Measured With Abbott Architect c8000 Chemistry Analyzer.

Science.gov (United States)

Tamimi, Waleed; Albanyan, Esam; Altwaijri, Yasmin; Tamim, Hani; Alhussein, Fahad

2012-04-01

Reference intervals for pubertal characteristics are influenced by genetic, geographic, dietary and socioeconomic factors. Therefore, the aim of this study was to establish age-specific reference intervals of glucose and lipid levels among local school children. This was cross-sectional study, conducted among Saudi school children. Fasting blood samples were collected from 2149 children, 1138 (53%) boys and 1011 (47%) girls, aged 6 to 18 years old. Samples were analyzed on the Architect c8000 Chemistry System (Abbott Diagnostics, USA) for glucose, cholesterol, triglycerides, HDL and LDL. Reference intervals were established by nonparametric methods between the 2.5th and 97.5th percentiles. Significant differences were observed between boys and girls for cholesterol and triglycerides levels in all age groups (P glucose levels except at age 12 to 13 years. Saudi children have comparable serum cholesterol levels than their Western counterparts. This may reflect changing dietary habits and increasing affluence in Saudi Arabia. Increased lipid screening is anticipated, and these reference intervals will aid in the early assessment of cardiovascular and diabetes risk in Saudi pediatric populations.

Computed Tomography (CT) radiation dose in children: A survey to propose regional diagnostic reference levels in Greater Accra-Ghana

International Nuclear Information System (INIS)

Addo, Patience

2016-07-01

The aim of this work was to assess the doses delivered to paediatric patients during computed tomography (CT) examinations of the head, chest and abdomen, and establishing regional diagnostic reference levels (RDRLs) for four age groups. The patient data, technique parameters and dose descriptors collected include: age, sex, tube voltage, tube current, rotation time, slice thickness, scan length, volume CT dose index (CTDI_v_o_l) and dose length product (DLP). Currently, paediatric CT examinations account for 11% of radiation exposure. For the paediatric age groups; < 1 year, (1-5 years), (6-10 years) and (11-15 years), the proposed RDRLs for head in terms of CTDI_v_o_l are (28, 38, 48 and 86 mGy) and in terms of DLP; (395, 487, 601, 1614 mGy cm) respectively. For Chest examinations, proposed RDRLs in terms of CTDI_v_o_l are (1 and 5 mGy) and in terms of DLP; (18 and 110 mGy cm) for age groups; < 1 year and (1-5 years) respectively. For Abdomino-pelvic examinations, proposed RDRLs in terms of CTDI_v_o_l are (3, 3 and 10 mGy) and in terms of DLP; (71, 120 and 494 mGy cm) for age groups; < 1 year, (1-5 years) and (6-10 years) respectively. For abdomen examinations, proposed RDRLs in terms of CTDI_v_o_l are (3, 5 and 5 mGy) and in terms of DLP; (83, 124 and 233 mGy cm) for age groups; < 1 year, (1-5 years) and (11-15 years) respectively. RDRLs have been proposed for CTDI_v_o_l and DLP for head, chest, abdomen and Abdomino-pelvic paediatric CT examinations in this study. An optimisation is required for 11-15 years age group for the DLP values which was higher than their corresponding international DRLs. For an effective optimization of patient protection a trade-off between image quality and patients doses studies should be investigated. (au)

Determination of diagnostic reference levels in general radiography in Latin America

International Nuclear Information System (INIS)

Blanco, S.; Mora, P.; Almonte, N.; Benavente, T.; Benson, N.; Blanco, D.; Cardenas, J.; Gomez, Y. D.; Edding, O.; Escobar, C.; Fonseca, M.; Gamarra, M.; Aguilar, J. G.; Khoury, H. J.; Quintero, A. R.; Zuniga, N. R.; Zaire, E.; Nader, A.

2013-01-01

The International Atomic Energy Agency (IAEA) through the International Action Plan on Radiation Protection of Patients and the International Commission on Radiological Protection have for some time carried out important efforts to assure that in the medical applications of the ionising radiations, the optimisation of radiological protection of patients is fundamental, to such a point that the IAEA includes it directly as a requirement for these practices (in its International Basic Safety Standards for Protection against Ionising Radiation and for the Safety of Radiation Sources (BSS)-GSR Part 1, 2011). For this reason, among the objectives of Regional Project RLA/9/057 and Regional Project RLA/9/067, the intention was to establish the dose references in conventional radiology for Latin America, for the purposes of determining whether these doses comply with the requirements of the BSS and to tend to improve practices, in order to minimise the dose received by the patients. (authors)

Integrating nursing diagnostic concepts into the medical entities dictionary using the ISO Reference Terminology Model for Nursing Diagnosis.

Science.gov (United States)

Hwang, Jee-In; Cimino, James J; Bakken, Suzanne

2003-01-01

The purposes of the study were (1) to evaluate the usefulness of the International Standards Organization (ISO) Reference Terminology Model for Nursing Diagnoses as a terminology model for defining nursing diagnostic concepts in the Medical Entities Dictionary (MED) and (2) to create the additional hierarchical structures required for integration of nursing diagnostic concepts into the MED. The authors dissected nursing diagnostic terms from two source terminologies (Home Health Care Classification and the Omaha System) into the semantic categories of the ISO model. Consistent with the ISO model, they selected Focus and Judgment as required semantic categories for creating intensional definitions of nursing diagnostic concepts in the MED. Because the MED does not include Focus and Judgment hierarchies, the authors developed them to define the nursing diagnostic concepts. The ISO model was sufficient for dissecting the source terminologies into atomic terms. The authors identified 162 unique focus concepts from the 266 nursing diagnosis terms for inclusion in the Focus hierarchy. For the Judgment hierarchy, the authors precoordinated Judgment and Potentiality instead of using Potentiality as a qualifier of Judgment as in the ISO model. Impairment and Alteration were the most frequently occurring judgments. Nursing care represents a large proportion of health care activities; thus, it is vital that terms used by nurses are integrated into concept-oriented terminologies that provide broad coverage for the domain of health care. This study supports the utility of the ISO Reference Terminology Model for Nursing Diagnoses as a facilitator for the integration process.

Diagnostic value of MRS-quantified brain tissue lactate level in identifying children with mitochondrial disorders

International Nuclear Information System (INIS)

Lunsing, Roelineke J.; Strating, Kim; Koning, Tom J. de; Sijens, Paul E.

2017-01-01

Magnetic resonance spectroscopy (MRS) of children with or without neurometabolic disease is used for the first time for quantitative assessment of brain tissue lactate signals, to elaborate on previous suggestions of MRS-detected lactate as a marker of mitochondrial disease. Multivoxel MRS of a transverse plane of brain tissue cranial to the ventricles was performed in 88 children suspected of having neurometabolic disease, divided into 'definite' (n = 17, ≥1 major criteria), 'probable' (n = 10, ≥2 minor criteria), 'possible' (n = 17, 1 minor criterion) and 'unlikely' mitochondrial disease (n = 44, none of the criteria). Lactate levels, expressed in standardized arbitrary units or relative to creatine, were derived from summed signals from all voxels. Ten 'unlikely' children with a normal neurological exam served as the MRS reference subgroup. For 61 of 88 children, CSF lactate values were obtained. MRS lactate level (>12 arbitrary units) and the lactate-to-creatine ratio (L/Cr >0.22) differed significantly between the definite and the unlikely group (p = 0.015 and p = 0.001, respectively). MRS L/Cr also differentiated between the probable and the MRS reference subgroup (p = 0.03). No significant group differences were found for CSF lactate. MRS-quantified brain tissue lactate levels can serve as diagnostic marker for identifying mitochondrial disease in children. (orig.)

Investigation of reference levels and radiation dose associated with abdominal EVAR (endovascular aneurysm repair) procedures across several European Centres

Energy Technology Data Exchange (ETDEWEB)

Tuthill, E.; Rainford, L. [University College Dublin, Diagnostic Imaging, School of Medicine, Dublin (Ireland); O' Hora, L.; O' Donohoe, M. [Mater Misericordiae University Hospital, Dublin (Ireland); Panci, S. [San Giovanni di Dio Hospital, Florence (Italy); Gilligan, P.; Fox, E. [Mater Private Hospital, Dublin (Ireland); Campion, D. [Mauriziano-Umberto Hospital, Turin (Italy); Trenti, R. [Policlinico S. Orsola-Malpighi, Bologna (Italy); Catania, D. [AITRI, Association of Italian Interventional Radiographers, Milan (Italy)

2017-11-15

Endovascular aneurysm repair (EVAR) is considered the treatment of choice for abdominal aortic aneurysms with suitable anatomy. In order to improve radiation safety, European Directive (2013/59) requires member states to implement diagnostic reference levels (DRLs) in radio-diagnostic and interventional procedures. This study aimed to determine local DRLs for EVAR across five European centres and identify an interim European DRL, which currently remains unestablished. Retrospective data was collected for 180 standard EVARs performed between January 2014 and July 2015 from five specialist centres in Ireland (n=2) and Italy (n=3). Data capture included: air kerma-area product (P{sub KA}), total air kerma at the reference point (K{sub a,r}), fluoroscopic time (FT), number of acquisitions, frame rate of acquisition, type of acquisition, patient height, weight, and gender. The mean values for each site A, B, C, D, and E were: P{sub KA}s of 4343 ± 994 μGym{sup 2}, 18,200 ± 2141 μGym{sup 2}, 11,423 ± 1390 μGym{sup 2}, 7796 ± 704 μGym{sup 2}, 31,897 ± 5798 μGym{sup 2}; FTs of 816 ± 92 s, 950 ± 150 s, 708 ± 70 s, 972 ± 61 s, 827 ± 118 s; and number of acquisitions of 6.72 ± 0.56, 10.38 ± 1.54, 4.74 ± 0.19, 5.64 ± 0.36, 7.28 ± 0.65, respectively. The overall pooled 75th percentile P{sub KA} was 15,849 μGym{sup 2}. Local reference levels were identified. The pooled data has been used to establish an interim European DRL for EVAR procedures. (orig.)

Dose reference levels in Spanish intraoral dental radiology: stabilisation of the incorporation of digital systems in dental clinical practices

International Nuclear Information System (INIS)

Alcaraz, M.; Velasco, F.; Olivares, A.; Velasco, E.; Canteras, M.

2016-01-01

A total of 34 044 official quality assurance reports in dental radiodiagnostic surgery from 16 regions of Spain, compiled from 2002 to 2014, were studied in order to determine the progress of diagnostic reference levels (DRLs) for obtaining diagnostic images under normal conditions for clinical practice in Spanish dental clinics. A DRL of 2.8 mGy was set in 2014, which represents a 41.7 % decrease compared with that of 2002 (4.8 mGy). Over the same time period, the mean dose fell by 55.2 %. However, over the last 3 y, the stabilisation of the mean dose administered to patients has been observed with only a 6.7 % reduction in DRLs, which corresponds to the stabilisation of dental radiodiagnostic surgery on replacing the use of radiographic film with digital imaging systems. (authors)

Diagnostic accuracy of routine blood examinations and CSF lactate level for post-neurosurgical bacterial meningitis.

Science.gov (United States)

Zhang, Yang; Xiao, Xiong; Zhang, Junting; Gao, Zhixian; Ji, Nan; Zhang, Liwei

2017-06-01

To evaluate the diagnostic accuracy of routine blood examinations and Cerebrospinal Fluid (CSF) lactate level for Post-neurosurgical Bacterial Meningitis (PBM) at a large sample-size of post-neurosurgical patients. The diagnostic accuracies of routine blood examinations and CSF lactate level to distinguish between PAM and PBM were evaluated with the values of the Area Under the Curve of the Receiver Operating Characteristic (AUC -ROC ) by retrospectively analyzing the datasets of post-neurosurgical patients in the clinical information databases. The diagnostic accuracy of routine blood examinations was relatively low (AUC -ROC CSF lactate level achieved rather high diagnostic accuracy (AUC -ROC =0.891; CI 95%, 0.852-0.922). The variables of patient age, operation duration, surgical diagnosis and postoperative days (the interval days between the neurosurgery and examinations) were shown to affect the diagnostic accuracy of these examinations. The variables were integrated with routine blood examinations and CSF lactate level by Fisher discriminant analysis to improve their diagnostic accuracy. As a result, the diagnostic accuracy of blood examinations and CSF lactate level was significantly improved with an AUC -ROC value=0.760 (CI 95%, 0.737-0.782) and 0.921 (CI 95%, 0.887-0.948) respectively. The PBM diagnostic accuracy of routine blood examinations was relatively low, whereas the accuracy of CSF lactate level was high. Some variables that are involved in the incidence of PBM can also affect the diagnostic accuracy for PBM. Taking into account the effects of these variables significantly improves the diagnostic accuracies of routine blood examinations and CSF lactate level. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Determination of carbon-14 in environmental level, solid reference materials

Energy Technology Data Exchange (ETDEWEB)

Blowers, Paul, E-mail: paul.blowers@cefas.co.uk [Cefas Lowestoft Laboratory, Pakefield Road, Lowestoft, Suffolk, NR33 0HT (United Kingdom); Caborn, Jane, E-mail: jane.a.caborn@nnl.co.uk [NNL, Springfields, Salwick, Preston, Lancashire, PR4 0XJ (United Kingdom); Dell, Tony [Veterinary Laboratories Agency, New Haw, Addlestone, Surrey, KT15 3NB (United Kingdom); Gingell, Terry [DSTL, Radiation Protection Services, Crescent Road, Alverstoke, Gosport, Hants, PO12 2DL (United Kingdom); Harms, Arvic [National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW (United Kingdom); Long, Stephanie [Radiological Protection Institute of Ireland, 3 Clonskeagh Square, Clonskeagh Road, Dublin 14, Ireland (United Kingdom); Sleep, Darren [Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP (United Kingdom); Stewart, Charlie [UKAEA (Waste Management Group), Chemical Support Services, D1310/14, Dounreay, Thurso, Caithness, KW14 7TZ (United Kingdom); Walker, Jill [Radiocarbon Dating, The Old Stables, East Lockinge, Wantage, Oxon OX12 8QY (United Kingdom); Warwick, Phil E. [GAU-Radioanalytical, National Oceanography Centre Southampton, European Way, Southampton, SO14 3ZH (United Kingdom)

2011-10-15

An intercomparison exercise to determine the {sup 14}C activity concentrations in a range of solid, environmental level materials was conducted between laboratories in the UK. IAEA reference materials, C2, C6 and C7, and an in-house laboratory QA material were dispatched in 2006 to ten laboratories comprising of members of the Analyst Informal Working Group (AIWG) and one other invited party. The laboratories performed the determinations using a number of techniques, and using the results each one was evaluated in terms of levels of precision, sensitivity and limits of detection. The results of the study show that all techniques are capable of successfully analysing {sup 14}C in environmental level materials, however, a shortage of certified environmental reference materials exists. The suitability of the IAEA reference materials and other material for use as reference materials was also assessed.

Determination of carbon-14 in environmental level, solid reference materials

International Nuclear Information System (INIS)

Blowers, Paul; Caborn, Jane; Dell, Tony; Gingell, Terry; Harms, Arvic; Long, Stephanie; Sleep, Darren; Stewart, Charlie; Walker, Jill; Warwick, Phil E.

2011-01-01

An intercomparison exercise to determine the 14 C activity concentrations in a range of solid, environmental level materials was conducted between laboratories in the UK. IAEA reference materials, C2, C6 and C7, and an in-house laboratory QA material were dispatched in 2006 to ten laboratories comprising of members of the Analyst Informal Working Group (AIWG) and one other invited party. The laboratories performed the determinations using a number of techniques, and using the results each one was evaluated in terms of levels of precision, sensitivity and limits of detection. The results of the study show that all techniques are capable of successfully analysing 14 C in environmental level materials, however, a shortage of certified environmental reference materials exists. The suitability of the IAEA reference materials and other material for use as reference materials was also assessed.

Diagnostic value of MRS-quantified brain tissue lactate level in identifying children with mitochondrial disorders

Energy Technology Data Exchange (ETDEWEB)

Lunsing, Roelineke J.; Strating, Kim [University Medical Centre Groningen, University of Groningen, Department of Child Neurology, Groningen (Netherlands); Koning, Tom J. de [University Medical Centre Groningen, University of Groningen, Department of Pediatric Metabolic Diseases, Groningen (Netherlands); Sijens, Paul E. [University Medical Centre Groningen, University of Groningen, Department of Radiology, Groningen (Netherlands)

2017-03-15

Magnetic resonance spectroscopy (MRS) of children with or without neurometabolic disease is used for the first time for quantitative assessment of brain tissue lactate signals, to elaborate on previous suggestions of MRS-detected lactate as a marker of mitochondrial disease. Multivoxel MRS of a transverse plane of brain tissue cranial to the ventricles was performed in 88 children suspected of having neurometabolic disease, divided into 'definite' (n = 17, ≥1 major criteria), 'probable' (n = 10, ≥2 minor criteria), 'possible' (n = 17, 1 minor criterion) and 'unlikely' mitochondrial disease (n = 44, none of the criteria). Lactate levels, expressed in standardized arbitrary units or relative to creatine, were derived from summed signals from all voxels. Ten 'unlikely' children with a normal neurological exam served as the MRS reference subgroup. For 61 of 88 children, CSF lactate values were obtained. MRS lactate level (>12 arbitrary units) and the lactate-to-creatine ratio (L/Cr >0.22) differed significantly between the definite and the unlikely group (p = 0.015 and p = 0.001, respectively). MRS L/Cr also differentiated between the probable and the MRS reference subgroup (p = 0.03). No significant group differences were found for CSF lactate. MRS-quantified brain tissue lactate levels can serve as diagnostic marker for identifying mitochondrial disease in children. (orig.)

Establishing Local Reference Dose Values and Optimisation Strategies

International Nuclear Information System (INIS)

Connolly, P.; Moores, B.M.

2000-01-01

The revised EC Patient Directive 97/43 EURATOM introduces the concepts of clinical audit, diagnostic reference levels and optimisation of radiation protection in diagnostic radiology. The application of reference dose levels in practice involves the establishment of reference dose values as actual measurable operational quantities. These values should then form part of an ongoing optimisation and audit programme against which routine performance can be compared. The CEC Quality Criteria for Radiographic Images provides guidance reference dose values against which local performance can be compared. In many cases these values can be improved upon quite considerably. This paper presents the results of a local initiative in the North West of the UK aimed at establishing local reference dose values for a number of major hospital sites. The purpose of this initiative is to establish a foundation for both optimisation strategies and clinical audit as an ongoing and routine practice. The paper presents results from an ongoing trial involving patient dose measurements for several radiological examinations upon the sites. The results of an attempt to establish local reference dose values from measured dose values and to employ them in optimisation strategies are presented. In particular emphasis is placed on the routine quality control programmes necessary to underpin this strategy including the effective data management of results from such programmes and how they can be employed to optimisation practices. (author)

Reference hearing threshold levels for short duration signals

DEFF Research Database (Denmark)

Poulsen, Torben; Legarth, Søren Vase

2008-01-01

for the determination of reference hearing threshold levels. The results are given as peak-to-peak equivalent threshold sound pressure levels (peETSPL). The results are in good agreement with other sparse results from literature and are part of the basis for the ISO 389-6 standard from 2007....

Pregnancy and variations of carbohydrate-deficient transferrin levels measured by the candidate reference HPLC method.

Science.gov (United States)

Bianchi, Vincenza; Ivaldi, Alessandra; Raspagni, Alessia; Arfini, Carlo; Vidali, Matteo

2011-01-01

Contrasting data are available on the diagnostic accuracy of carbohydrate-deficient transferrin (CDT) during pregnancy. These differences may depend in part on how CDT was evaluated and expressed. Here, we report on variations of CDT levels in pregnant women using the high performance liquid chromatography (HPLC) candidate reference method. Alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, mean corpuscular volume, serum transferrin, urine and serum ethyl glucuronide and CDT were measured in 64 women, self-reporting as non-alcohol abusers (age: median 34, IQR: 28-38), at different stages of normal pregnancy (gestational weeks: median 28, IQR: 8-33). CDT was expressed as percentage of disialotransferrin to total transferrin (%CDT). Transferrin was associated with both %CDT (r = 0.66; P pregnancy trimester (first trimester: mean 1.01% (SD 0.19); second trimester: 1.30% (SD 0.14); third trimester: 1.53% (SD 0.22); ANOVA P pregnancy trimesters (P pregnancy and CDT could be more complex. The diagnostic accuracy of CDT for detecting alcohol abuse in a legal context may be limited in pregnant women and the effect of gestational age should be considered.

Diagnostic reference range of κ/λ free light chain ratio to screen for Bence Jones proteinuria is not significantly influenced by GFR.

Science.gov (United States)

Schmidt-Hieltjes, Yvonne; Elshof, Clemens; Roovers, Lian; Ruinemans-Koerts, Janneke

2016-05-01

The aim of our study was to analyse whether the κ/λ free light chain ratio reference range for screening for Bence Jones proteinuria should be dependent on the estimated glomerular filtration rate (eGFR). The serum κ/λ free light chain ratio, eGFR, serum M-protein and Bence Jones protein were measured in 544 patients for whom Bence Jones protein analysis was ordered. In the population of patients without Bence Jones proteinuria or a M-protein (n = 402), there is no gradual increase in κ/λ free light chain ratio with diminishing eGFR. The κ/λ free light chain ratio in this group was 0.56-1.86 (95% interval). With this diagnostic reference range of the κ/λ ratio, 105 of the 110 patients with Bence Jones protein could be identified correctly. Only five patients with Bence Jones proteinuria (free light chain ratio was measured without the presence of Bence Jones proteinuria. A κ/λ free light chain ratio in serum can be used safely and efficiently to select urine samples which should be analysed for Bence Jones proteinuria with an electrophoresis/immunofixation technique. Using this diagnostic reference range, the number of urine samples which should be analysed by electrophoresis/immunofixation could be reduced by 74%. The diagnostic reference interval can be determined best in a group of patients for whom Bence Jones analysis is indicated. For calculation of this reference range, the eGFR value does not need to be taken into account. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Evaluation of entrance skin dose to the skull in diagnostic radiology

International Nuclear Information System (INIS)

Mohamed, Anas Ali Elbushari

2015-12-01

Diagnostic x-ray radiology is a common diagnostic practice.Despite of its increasing hazard to human beings, imaging procedures should be achieved with less radiation dose and sufficient image quality. The aim of this study was to estimate the entrance skin dose(ESD) for patients undergoing selected diagnostic x-ray examinations in four hospitals.The study included the examinations of the skull; posterior- anterior(PA) and lateral projections. Fifty patients were enrolled in this study. ESDs were estimated from patients specific exposure parameters using established relation between output (μGy/mAs) and tube voltage(kVp). The estimated ESDs ranged from 0.0097-0.1846 mGy for skull (PA), 0.0097-0.1399 mGy for skull (LAT). These values were acceptable as compared with the international reference dose levels. This study provides additional data that can help the regulatory authority to establish reference dose levels for diagnostic radiology in Sudan.(Author)

DIAGNOSTICS OF LEVELS OF FORMATION OF FUTURE MUSIC TEACHERS’ ART REFLECTION

Directory of Open Access Journals (Sweden)

Zhang Jingjing

2016-11-01

Full Text Available Features of diagnostics of levels of formation of art reflection are justified in the article. Four levels of future music teachers’ art reflection are defined. These levels are based on the research measures of desire to master art reflection; the degree of understanding the nature and characteristics of art reflection; measures of the emotional involvement into art reflection; degree of possession of the necessary skills for art reflection; formation of professionalism in music and performing activities. They are initial, satisfactory, sufficient and optimal. The importance of formation of future music teachers’ art reflection is considered as the basis for professional development, self-regulation on the acquisition of implementing art knowledge. The formation of art reflection requires the creation and implementation of specific methods of diagnostics of future music teachers’ art reflection. The article is dedicated to the problem of developing and testing diagnostic methods of formation of future music teachers’ art reflection. While writing the article there methods of analysis, synthesis, method of systematization of the material, the principles of objectivity and scientific character are being used. Diagnostics and analysis of the levels of future music teachers’ art reflection shows that the vast majority of students have art reflection at a satisfactory level (67.24%. 22.41% of students are found to have the initial level of formation of art reflection. Only 10.34% of students are found to have the sufficient level of art reflection. There are no students having the optimal level of art reflection. The author concluded that educational and behavior tasks, which the future music teachers have, are identified while testing the features of formation of future music teachers’ art reflection. They cause picking out the most appropriate areas and focus on the most prospective and effective methods of formation in the course of

Patient dosimetry in diagnostic radiology

Directory of Open Access Journals (Sweden)

Ciraj-Bjelac Olivera F.

2003-01-01

Full Text Available The objective of this work is to assess patient organ doses, effective doses and entrance surface doses in conventional diagnostic radiology procedures for standard adult patient. The survey consists of measurements of doses delivered to 239 patients in nine types of X-ray examinations. Three types of data were collected: X-ray machine data, patient data, and output measurements. Entrance surface dose was assessed based on the survey data and subsequently, using conversion coefficients, the organ doses and effective doses were calculated. Values of the entrance surface dose and the effective dose were estimated to be 0.4 to 5.8 mGy and 0.03 to 3.00 mSv for different examinations. Derived doses were compared with recommended general diagnostic reference levels. The impact of examination parameters on dose values was discussed. Except for posterior-anterior chest examination, all estimated doses are lower than stated reference levels. Survey data are aimed at helping development of national quality control and radiation protection programmed for medical exposures.

Adrenal Vein Catecholamine Levels and Ratios: Reference Intervals Derived from Patients with Primary Aldosteronism.

Science.gov (United States)

Sze, Candy W C; O'Toole, Samuel Matthew; Tirador, Roger Kent; Akker, Scott A; Matson, Matthew; Perry, Leslie; Druce, Maralyn Rose; Dekkers, Tanja; Deinum, Jaap; Lenders, Jacques W M; Eisenhofer, Graeme; Drake, William Martyn

2017-06-01

Phaeochromocytoma localisation is generally reliably achieved with modern imaging techniques, particularly in sporadic cases. On occasion, however, there can be diagnostic doubt due to the presence of bilateral adrenal abnormalities, particularly in patients with mutations in genes predisposing them to the development of multiple phaeochromocytomas. In such cases, surgical intervention is ideally limited to large or functional lesions due to the long-term consequences associated with hypoadrenalism. Adrenal venous sampling (AVS) for catecholamines has been used in this situation to guide surgery, although there are few data available to support diagnostic thresholds. Retrospective analyses of AVS results from 2 centres were carried out. A total of 172 patients (88 men, 84 women) underwent AVS under cosyntropin stimulation for the diagnosis of established primary aldosteronism (PA) with measurement of adrenal and peripheral venous cortisol, aldosterone and catecholamines. Six patients (3 men, 3 women) with phaeochromocytoma underwent AVS for diagnostic purposes with subsequent histological confirmation. Reference intervals for the adrenal venous norepinephrine to epinephrine ratio were created from the PA group. Using the 97.5th centile (1.21 on the left, 1.04 on the right), the false negative rate in the phaeochromocytoma group was 0%. In conclusion, this study describes the largest dataset of adrenal venous catecholamine measurements and provides reference intervals in patients without phaeochromocytoma. This strengthens the certainty with which conclusions related to adrenal venous sampling for catecholamines can be drawn, acknowledging the procedure is not part of the routine diagnostic workup and is an adjunct for use only in difficult clinical cases. © Georg Thieme Verlag KG Stuttgart · New York.

Diagnostic and interventional radiology

Energy Technology Data Exchange (ETDEWEB)

Vogl, Thomas J. [Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt am Main (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Reith, Wolfgang [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie; Rummeny, Ernst J. (ed.) [Technische Univ. Muenchen Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Radiologie

2016-08-01

This exceptional book covers all aspects of diagnostic and interventional radiology within one volume, at a level appropriate for the specialist. From the basics through diagnosis to intervention: the reader will find a complete overview of all areas of radiology. The clear, uniform structure, with chapters organized according to organ system, facilitates the rapid retrieval of information. Features include: Presentation of the normal radiological anatomy Classification of the different imaging procedures according to their diagnostic relevance Imaging diagnosis with many reference images Precise description of the interventional options The inclusion of many instructive aids will be of particular value to novices in decision making: Important take home messages and summaries of key radiological findings smooth the path through the jungle of facts Numerous tables on differential diagnosis and typical findings in the most common diseases offer a rapid overview and orientation Diagnostic flow charts outline the sequence of diagnostic evaluation All standard procedures within the field of interventional radiology are presented in a clinically relevant and readily understandable way, with an abundance of illustrations. This is a textbook, atlas, and reference in one: with more than 2500 images for comparison with the reader's own findings. This comprehensive and totally up-to-date book provides a superb overview of everything that the radiology specialist of today needs to know.

Reference materials for molecular diagnostics: Current achievements and future strategies.

Science.gov (United States)

Jing, Rongrong; Wang, Huimin; Ju, Shaoqing; Cui, Ming

2018-06-01

Molecular diagnoses have become more widespread in many areas of laboratory medicine where qualitative or quantitative approaches are used to detect nucleic acids. The increasing number of assay methods and the targets for molecular diagnostics contribute to variability in the test results among clinical laboratories. Thus, reference materials (RMs) are required to enhance the comparability of results. This review focuses on the definition of RMs as well as the production and characteristics of higher order RMs from different organizations and their future strategies. We describe the recent progress in RMs, including the definition of RMs by the Joint Committee for Guides in Metrology, as well as the production and characteristics of higher order RMs by international official bodies. There is an urgent need for RMs in nucleic acid testing, especially higher order RMs. To advance the harmonization and standardization of clinical nucleic acid detection, cooperation between the above organizations is proposed and different approaches to higher order RMs development are also needed. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Diagnostic accuracy of routine blood examinations and CSF lactate level for post-neurosurgical bacterial meningitis

Directory of Open Access Journals (Sweden)

Yang Zhang

2017-06-01

Conclusions: The PBM diagnostic accuracy of routine blood examinations was relatively low, whereas the accuracy of CSF lactate level was high. Some variables that are involved in the incidence of PBM can also affect the diagnostic accuracy for PBM. Taking into account the effects of these variables significantly improves the diagnostic accuracies of routine blood examinations and CSF lactate level.

[Diagnostic value of baseline serum luteinizing hormone level for central precocious puberty in girls].

Science.gov (United States)

Ou-Yang, Li-Xue; Yang, Fan

2017-07-01

To evaluate the diagnostic value of baseline serum luteinizing hormone (LH) level for central precocious puberty (CPP) in girls. A total of 279 girls with precocious puberty were subjected to assessment of growth and development, bone age determination, baseline LH test, and follicle-stimulating hormone (FSH) test, gonadotropin-releasing hormone stimulation test, and other related examinations. Of the 279 patients, 175 were diagnosed with CPP and 104 with premature thelarche (PT). The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of baseline LH and FSH levels and their peak levels for CPP, and the correlation between the baseline LH level and the peak LH level was analyzed. The CPP group had significantly higher bone age, baseline LH and FSH levels, peak LH and FSH levels, and ratio of peak LH level to peak FSH level than the PT group (Pbaseline LH level and peak LH level had good diagnostic values for CPP. Among the three bone age subgroups in the CPP group (7.0-9.0 years, 9.0-11.0 years, and >11.0 years), baseline LH level showed the best diagnostic value in the >11.0 years subgroup, with the largest area under the ROC curve. At a baseline LH level of 0.45 IU/L, the Youden index reached the peak value, and the sensitivity and specificity were 66.7% and 80% respectively, for the diagnosis of CPP. At a peak LH level of 9.935 IU/L, the Youden index reached the peak value, and the sensitivity and specificity were 74.8% and 100% respectively, for the diagnosis of CPP. The baseline LH level was positively correlated with the peak LH level (r=0.440, PBaseline LH level can be used as an primary screening index for the diagnosis of CPP. It has a certain diagnostic value for CPP at different bone ages, and may be used as a monitoring index during the treatment and follow-uP.

Diagnostic performance of dental students in identifying mandibular condyle fractures by panoramic radiography and the usefulness of reference images

International Nuclear Information System (INIS)

Cho, Bong Hae

2011-01-01

The purpose of this study was to evaluate the diagnostic performance of dental students in detection of mandibular condyle fractures and the effectiveness of reference panoramic images. Forty-six undergraduates evaluated 25 panoramic radiographs for condylar fractures and the data were analyzed through receiver operating characteristic (ROC) analysis. After a month, they were divided into two homogeneous groups based on the first results and re-evaluated the images with (group A) or without (group B) reference images. Eight reference images included indications showing either typical condylar fractures or anatomic structures which could be confused with fractures. Paired t-test was used for statistical analysis of the difference between the first and the second evaluations for each group, and student's t-test was used between the two groups in the second evaluation. The intra- and inter-observer agreements were evaluated with Kappa statistics. Intra- and inter-observer agreements were substantial (k=0.66) and moderate (k=0.53), respectively. The area under the ROC curve (Az) in the first evaluation was 0.802. In the second evaluation, it was increased to 0.823 for group A and 0.814 for group B. The difference between the first and second evaluations for group A was statistically significant (p<0.05), however there was no statistically significant difference between the two groups in the second evaluation. Providing reference images to less experienced clinicians would be a good way to improve the diagnostic ability in detecting condylar fracture.

Diagnostic performance of dental students in identifying mandibular condyle fractures by panoramic radiography and the usefulness of reference images

Energy Technology Data Exchange (ETDEWEB)

Cho, Bong Hae [School of Dentistry, Pusan National University, Pusan (Korea, Republic of)

2011-06-15

The purpose of this study was to evaluate the diagnostic performance of dental students in detection of mandibular condyle fractures and the effectiveness of reference panoramic images. Forty-six undergraduates evaluated 25 panoramic radiographs for condylar fractures and the data were analyzed through receiver operating characteristic (ROC) analysis. After a month, they were divided into two homogeneous groups based on the first results and re-evaluated the images with (group A) or without (group B) reference images. Eight reference images included indications showing either typical condylar fractures or anatomic structures which could be confused with fractures. Paired t-test was used for statistical analysis of the difference between the first and the second evaluations for each group, and student's t-test was used between the two groups in the second evaluation. The intra- and inter-observer agreements were evaluated with Kappa statistics. Intra- and inter-observer agreements were substantial (k=0.66) and moderate (k=0.53), respectively. The area under the ROC curve (Az) in the first evaluation was 0.802. In the second evaluation, it was increased to 0.823 for group A and 0.814 for group B. The difference between the first and second evaluations for group A was statistically significant (p<0.05), however there was no statistically significant difference between the two groups in the second evaluation. Providing reference images to less experienced clinicians would be a good way to improve the diagnostic ability in detecting condylar fracture.

Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

International Nuclear Information System (INIS)

Yamada, Yoshitake; Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Kuribayashi, Sachio; Abe, Takayuki; Ogawa, Kenji

2013-01-01

To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA -950 ) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P -950 . The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA -950 . (orig.)

Referent 3D tumor model at cellular level in radionuclide therapy

International Nuclear Information System (INIS)

Spaic, R.; Ilic, R.D.; Petrovic, B.J.

2002-01-01

Aim Conventional internal dosimetry has a lot of limitations because of tumor dose nonuniformity. The best approach for absorbed dose at cellular level for different tumors in radionuclide therapy calculation is Monte Carlo method. The purpose of this study is to introduce referent tumor 3D model at cellular level for Monte Carlo simulation study in radionuclide therapy. Material and Methods The moment when tumor is detectable and when same therapy can start is time period in which referent 3D tumor model at cellular level was defined. In accordance with tumor growth rate at that moment he was a sphere with same radius (10 000 μm). In that tumor there are cells or cluster of cells, which are randomly distributed spheres. Distribution of cells/cluster of cells can be calculated from histology data but it was assumed that this distribution is normal with the same mean value and standard deviation (100±50 mm). Second parameter, which was selected to define referent tumor, is volume density of cells (30%). In this referent tumor there are no necroses. Stroma is defined as space between spheres with same concentration of materials as in spheres. Results: Referent tumor defined on this way have about 2,2 10 5 cells or cluster of cells random distributed. Using this referent 3D tumor model and for same concentration of radionuclides (1:100) and energy of beta emitters (1000 keV) which are homogeneously distributed in labeled cells absorbed dose for all cells was calculated. Simulations are done using FOTELP Monte Carlo code, which is modified for this purposes. Results of absorbed dose in cells are given in numerical values (1D distribution) and as the images (2D or 3D distributions). Conclusion Geometrical module for Monte Carlo simulation study can be standardized by introducing referent 3D tumor model at cellular level. This referent 3D tumor model gives most realistic presentation of different tumors at the moment of their detectability. Referent 3D tumor model at

Progress in diagnostic techniques for sc cavities

International Nuclear Information System (INIS)

Reece, C.E.

1988-01-01

While routinely achieved performance characteristics of superconducting cavities have now reached a level which makes them useful in large scale applications, achieving this level has come only through the knowledge gained by systematic studies of performance limiting phenomena. Despite the very real progress that has been made, the routine performance of superconducting cavities still falls far short of both the theoretical expectations and the performance of a few exception examples. It is the task of systematically applied diagnostic techniques to reveal additional information concerning the response of superconducting surfaces to applied RF fields. Here recent developments in diagnostic techniques are discussed. 18 references, 12 figures

Plasma levels and diagnostic utility of VEGF, MMP-2 and TIMP-2 in the diagnostics of breast cancer patients.

Science.gov (United States)

Ławicki, Sławomir; Zajkowska, Monika; Głażewska, Edyta Katarzyna; Będkowska, Grażyna Ewa; Szmitkowski, Maciej

2017-03-01

We investigated plasma levels and diagnostic utility of vascular endothelial growth factor VEGF, matrix metalloproteinase-2 (MMP-2) and tissue inhibitors of metalloproteinase-2 (TIMP-2) in comparison to cancer antigen 15-3 (CA 15-3). Plasma levels of tested parameters were determined using enzyme-linked immunosorbent assay (ELISA) while CA 15-3 with chemiluminescent microparticle immunoassay (CMIA). The plasma levels of VEGF, TIMP-2 showed significantly higher than CA 15-3 values of the diagnostic sensitivity, the predictive values of positive and negative test results (PPV, NPV) and the area under the receiver-operating characteristics (ROC) curve (AUC) in early stages of breast cancer (BC). The combined use of the tested parameters with CA 15-3 resulted in the increase in sensitivity, NPV and AUC, especially in the combination with VEGF (83%; 72%; 0.888) and TIMP-2 (83%; 72%; 0.894). The highest values were obtained for combination of all three parameters (93%; 85%; 0.923). These findings suggest the usefulness of the tested parameters in the diagnosis of BC, especially VEGF and TIMP-2 with CA 15-3 in early stages of BC, which could be a new diagnostic panel.

Discussion on Implementation of ICRP Recommendations Concerning Reference Levels and Optimisation

International Nuclear Information System (INIS)

2013-02-01

International Commission on Radiological Protection (ICRP) Publication 103, 'The 2007 Recommendations of the International Commission on Radiological Protection', issued in 2007, defines emergency exposure situations as unexpected situations that may require the implementation of urgent protective actions and perhaps longer term protective actions. The ICRP continues to recommend optimisation and the use of reference levels to ensure an adequate degree of protection in regard to exposure to ionising radiation in emergency exposure situations. Reference levels represent the level of dose or risk above which it is judged to be inappropriate to plan to allow exposures to occur and for which protective actions should therefore be planned and optimised. National authorities are responsible for establishing reference levels. The Expert Group on the Implementation of New International Recommendations for Emergency Exposure Situations (EGIRES) performed a survey to analyse the established processes for optimisation of the protection strategy for emergency exposure situations and for practical implementation of the reference level concept in several member states of the Nuclear Energy Agency (NEA). The EGIRES collected information on several national optimisation strategy definitions, on optimisation of protection for different protective actions, and also on optimisation of urgent protective actions. In addition, national criteria for setting reference levels, their use, and relevant processes, including specific triggers and dosimetric quantifies in setting reference levels, are focus points that the EGIRES also evaluated. The analysis of national responses to this 2011 survey shows many differences in the interpretation and application of the established processes and suggests that most countries are still in the early stages of implementing these processes. Since 2011, national authorities have continued their study of the ICRP recommendations to incorporate them into

Establishing a reference range for triiodothyronine levels in preterm infants.

Science.gov (United States)

Oh, Ki Won; Koo, Mi Sung; Park, Hye Won; Chung, Mi Lim; Kim, Min-ho; Lim, Gina

2014-10-01

Thyroid dysfunction affects clinical complications in preterm infants and older children. However, thyroid hormone replacement in preterm infants has no proven benefits, possibly owing to the lack of an appropriate reference range for thyroid hormone levels. We aimed to establish a reference range for triiodothyronine (T3) levels at 1-month postnatal age (PNA) in preterm infants. This retrospective study included preterm infants born at a tertiary referral neonatal center at gestational age (GA)<35 weeks with no apparent thyroid dysfunction, for 6 consecutive years, with follow-up from PNA 2 weeks to 16 weeks. Using thyroid function tests (TFT), the relationships between T3 levels and thyrotropin (TSH) and free thyroxine (fT4) levels, birth weight, GA, postmenstrual age (PMA), and PNA were examined. The conversion trend for fT4 to T3 was analyzed using the T3/fT4 ratio. Overall, 464 TFTs from 266 infants were analyzed, after excluding 65 infants with thyroid dysfunction. T3 levels increased with fT4 levels, birth weight, GA, PMA, and PNA but not with TSH levels. The T3/fT4 ratio also increased with GA, PNA, and PMA. The average T3 level at 1 month PNA was 72.56 ± 27.83 ng/dL, with significant stratifications by GA. Relatively low T3 and fT4 levels in preterm infants were considered normal, with T3 levels and conversion trends increasing with GA, PMA, and PNA. Further studies are required to confirm the role of the present reference range in thyroid hormone replacement therapy. Copyright © 2014 Elsevier Ltd. All rights reserved.

Diagnostic reference levels for paediatric computed tomography ...

African Journals Online (AJOL)

SA Journal of Radiology. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 19, No 2 (2015) >. Log in or Register to get access to full text downloads.

Reference dosimetry for CT in the UK

International Nuclear Information System (INIS)

Shrimpton, P.C.; Wall, B.F.

2001-01-01

Computed tomography is firmly established as a major source of population exposure from diagnostic x-ray examinations and thus a particular focus for radiological protection initiatives. The concept of reference doses is widely recognised as a useful and practical tool for promoting improvements in the optimisation of protection for patients undergoing radiological examinations. National diagnostic reference levels (DRLs) have already been successfully applied in the UK for some conventional x-ray examinations within a framework for advice on patient protection. This approach is being extended to include CT, utilising the robust methodology for reference dosimetry that has been developed by the European Commission (EC) for the particular conditions of exposure in CT. This is based on the dosimetric concepts of weighted computed tomography dose index (CTDI w ) per slice in serial scanning or per rotation in helical scanning, and dose-length product (DLP) per complete examination. Notwithstanding some initial values proposed by the EC, specific national DRLs for CT practice in the UK will be established on the basis of widescale national survey data. (author)

Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

International Nuclear Information System (INIS)

D’Ercole, Loredana; Quaretti, Pietro; Cionfoli, Nicola; Klersy, Catherine; Bocchiola, Milena; Rodolico, Giuseppe; Azzaretti, Andrea; Lisciandro, Francesco; Cascella, Tommaso; Zappoli Thyrion, Federico

2013-01-01

To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity. MESD were evaluated with radiochromic films in 31 patients (mean age 72 ± 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 ± 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included. MESD values (mean 0.96 ± 0.42 Gy) were FR ) were 269 Gy cm 2 , 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1–102.7, p FR overexposures (OR 10.8, 95 % CI 1.1–109.5, p FR overexposure (OR 2.8, 95 % CI 1.1–7.4, p = 0.040). At multivariable analysis, stenosis ≥ 90 % (OR 2.8, 95 % CI 1.1–7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1–109.5, p = 0.027) were associated with overexposure for two or more parameters. Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

Microbiopsy a first-level diagnostic test to rule out oral dysplasia or carcinoma in general dental practice.

Science.gov (United States)

Pentenero, M; Val, M; Rosso, S; Gandolfo, S

2018-03-01

Diagnostic delay in oral oncology could be improved if general dentists had a reliable and easy-to-use first-level diagnostic test to rule out the presence of oral dysplasia or carcinoma. Microbiopsy has been proved to have high sensitivity and high negative predictive value in a clinical setting characterized by high prevalence of disease. Moreover, it has been proved to be easily performed by general dentists. This study aimed to determine the negative predictive value of microbiopsy in routine dental practice: a clinical setting characterized by low prevalence of disease. Within the frame of a previous study, general dentists from the Metropolitan Area of Turin performed microbiopsy for each oral mucosal lesion detected during their practice. The clinical outcome of 129 lesions negative at microbiopsy was checked by a query performed through the database of the Piedmont Cancer Registry, covering the population of the Metropolitan Area of Turin, with particular reference to cancer involving the mouth (ICD-10:C03-06). This allowed us to define "true negative" cases and to calculate the negative predictive value of microbiopsy. In a mean follow-up of 7.5 years (range 7-9 years), with a dropout rate of 7.7%, no case of tumour involving the mouth was observed, thus revealing a negative predictive value approaching 100%. Microbiopsy represents an easy-to-use and reliable first-level test able to aid general dentists to select patients requiring an oral medicine assessment in a short time and definitely to avoid diagnostic delay in oncologically relevant oral mucosal lesions. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.

Histopathological diagnostic discrepancies in soft tissue tumours referred to a specialist centre: reassessment in the era of ancillary molecular diagnosis.

Science.gov (United States)

Thway, Khin; Wang, Jayson; Mubako, Taka; Fisher, Cyril

2014-01-01

Introduction. Soft tissue tumour pathology is a highly specialised area of surgical pathology, but soft tissue neoplasms can occur at virtually all sites and are therefore encountered by a wide population of surgical pathologists. Potential sarcomas require referral to specialist centres for review by pathologists who see a large number of soft tissue lesions and where appropriate ancillary investigations can be performed. We have previously assessed the types of diagnostic discrepancies between referring and final diagnosis for soft tissue lesions referred to our tertiary centre. We now reaudit this 6 years later, assessing changes in discrepancy patterns, particularly in relation to the now widespread use of ancillary molecular diagnostic techniques which were not prevalent in our original study. Materials and Methods. We compared the sarcoma unit's histopathology reports with referring reports on 348 specimens from 286 patients with suspected or proven soft tissue tumours in a one-year period. Results. Diagnostic agreement was seen in 250 cases (71.8%), with 57 (16.4%) major and 41 (11.8%) minor discrepancies. There were 23 cases of benign/malignant discrepancies (23.5% of all discrepancies). 50 ancillary molecular tests were performed, 33 for aiding diagnosis and 17 mutational analyses for gastrointestinal stromal tumour to guide therapy. Findings from ancillary techniques contributed to 3 major and 4 minor discrepancies. While the results were broadly similar to those of the previous study, there was an increase in frequency of major discrepancies. Conclusion. Six years following our previous study and notably now in an era of widespread ancillary molecular diagnosis, the overall discrepancy rate between referral and tertiary centre diagnosis remains similar, but there is an increase in frequency of major discrepancies likely to alter patient management. A possible reason for the increase in major discrepancies is the increasing lack of exposure to soft tissue

Low-level lasers alter mRNA levels from traditional reference genes used in breast cancer cells

Science.gov (United States)

Teixeira, A. F.; Canuto, K. S.; Rodrigues, J. A.; Fonseca, A. S.; Mencalha, A. L.

2017-07-01

Cancer is among the leading causes of mortality worldwide, increasing the importance of treatment development. Low-level lasers are used in several diseases, but some concerns remains on cancers. Reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) is a technique used to understand cellular behavior through quantification of mRNA levels. Output data from target genes are commonly relative to a reference that cannot vary according to treatment. This study evaluated reference genes levels from MDA-MB-231 cells exposed to red or infrared lasers at different fluences. Cultures were exposed to red and infrared lasers, incubated (4 h, 37 °C), total RNA was extracted and cDNA synthesis was performed to evaluate mRNA levels from ACTB, GUSB and TRFC genes by RT-qPCR. Specific amplification was verified by melting curves and agarose gel electrophoresis. RefFinder enabled data analysis by geNorm, NormFinder and BestKeeper. Specific amplifications were obtained and, although mRNA levels from ACTB, GUSB or TRFC genes presented no significant variation through traditional statistical analysis, Excel-based tools revealed that the use of these reference genes are dependent of laser characteristics. Our data showed that exposure to low-level red and infrared lasers at different fluences alter the mRNA levels from ACTB, GUSB and TRFC in MDA-MB-231 cells.

An Evaluation of Serum Procalcitonin and C-Reactive Protein Levels as Diagnostic and Prognostic Biomarkers of Severe Sepsis

Directory of Open Access Journals (Sweden)

Szederjesi Janos

2015-10-01

Full Text Available Background: Recommendations have been made, following the multicenter Surviving Sepsis Campaign study, to standardize the definition of severe sepsis with reference to several parameters such as haemodynamic stability, acid-base balance, bilirubin, creatinine, International Normalized Ratio (INR, urine output and pulmonary functional value of the ratio between arterial oxigen partial pressure and inspiratory oxigen concentration. Procalcitonin (PCT is considered to be a gold standard biomarker for the inflammatory response, and recent studies have shown that it may help to discover whether a seriously ill person is developing sepsis. C-reactive protein (CRP is also used as a marker of inflammation in the body, as its blood levels increase if there is any inflammation in the body. The aim of this study was to evaluate serum procalcitonin and C-reactive protein levels as diagnostic and prognostic biomarkers of severe sepsis.

Quality Control in Diagnostic Radiology in the Netherlands (invited paper)

International Nuclear Information System (INIS)

Zoetelief, J.

1998-01-01

Application of the general principles of radiation protection to medical diagnostic radiology implies that each procedure using X rays or radionuclides is to be justified and optimised. Optimisation in diagnostic radiology implies that the radiation burden to the patient should be as low as possible, but compatible with the image quality necessary to obtain an adequate diagnosis or to guide treatment. Quality control of equipment is a prerequisite for achieving optimisation in diagnostic radiology. This was especially recognised for mammography as employed for breast cancer screening. Existing legislation in the Netherlands includes only a few criteria for equipment used in diagnostic radiology. In addition, the criteria are not all operational and measurement methods are lacking. Therefore, upon the initiative of the Dutch Ministry of Health, Welfare and Sports, the relevant professional societies, in collaboration with the former TNO Centre for Radiological Protection and Dosimetry, formulated eleven guidelines for quality control of equipment used in diagnostic radiology, including test procedures, test frequencies and limiting values. The implementation of quality control of equipment was included in the 1984 European Directive (84/466/Euratom) laying down basic measures for the radiation protection of persons undergoing medical examination or treatment. In the most recent European Directive on medical exposure (97/43/Euratom) the importance of quality control is stressed. In addition, the latter EC directive proposes the use of diagnostic reference levels for limiting the risks for patients undergoing diagnostic radiology. In the Netherlands preliminary reference levels for various procedures employed in diagnostic radiology are suggested. Finally, methods applied in the Netherlands for assessment of image quality are discussed. (author)

Clinical diagnostic ultrasound

International Nuclear Information System (INIS)

Barnett, E.; Morley, P.

1986-01-01

This textbook on diagnostic ultrasound covers the main systems, with emphasis being placed on the clinical application of diagnostic ultrasound in everyday practice. It provides not only a textbook for postgraduates (particularly FRCR candidates), but also a reference work for practitioners of clinical ultrasound and clinicians generally

Local diagnostic reference level based on size-specific dose estimates: Assessment of pediatric abdominal/pelvic computed tomography at a Japanese national children's hospital

Energy Technology Data Exchange (ETDEWEB)

Imai, Rumi; Miyazaki, Osamu; Kurosawa, Hideo; Nosaka, Shunsuke [National Center for Child Health and Development, Department of Radiology, Setagaya-ku, Tokyo (Japan); Horiuchi, Tetsuya [Osaka University, Department of Medical Physics and Engineering, Division of Medical Technology and Science, Course of Health Science, Graduate School of Medicine, Suita, Osaka (Japan)

2015-03-01

A child's body size is not accurately reflected by volume CT dose index (CTDI{sub vol}) and dose-length product (DLP). Size-specific dose estimation (SSDE) was introduced recently as a new index of radiation dose. However, it has not yet been established as a diagnostic reference level (DRL). To calculate the SSDE of abdominal/pelvic CT and compare the SSDE with CTDI{sub vol}. To calculate the DRLs of CTDI{sub vol} and SSDE. Our hypotheses are: SSDE values will be greater than CTDI{sub vol}, and our DRL will be smaller than the known DRLs of other countries. The CTDI{sub vol} and DLP of 117 children who underwent abdominal/pelvic CT were collected retrospectively. The SSDE was calculated from the sum of the lateral and anteroposterior diameters. The relationships between body weight and effective diameter and between effective diameter and CTDI{sub vol}/SSDE were compared. Further, the local DRL was compared with the DRLs of other countries. Body weight and effective diameter and effective diameter and SSDE were positively correlated. In children ages 1, 5 and 10 years, the SSDE is closer to the exposure dose of CTDI{sub vol} for the 16-cm phantom, while in children ages 15 years, the SSDE falls between CTDI{sub vol} for the 16-cm phantom and that for the 32-cm phantom. The local DRL was lower than those of other countries. With SSDE, the radiation dose increased with increasing body weight. Since SSDE takes body size into account, it proved to be a useful indicator for estimating the exposure dose. (orig.)

Comparing climate and cost impacts of reference levels for reducing emissions from deforestation

Energy Technology Data Exchange (ETDEWEB)

Busch, Jonah [Center for Applied Biodiversity Science, Conservation International, 2011 Crystal Drive, Suite 500, Arlington, VA (United States); Strassburg, Bernardo [Center for Social and Economic Research on the Global Environment, University of East Anglia, Norwich NR4 7TJ (United Kingdom); Cattaneo, Andrea [Woods Hole Research Center, 149 Woods Hole Road, Falmouth, MA 02540-1644 (United States); Lubowski, Ruben [Environmental Defense Fund, 1875 Connecticut Avenue NW, Washington, DC (United States); Bruner, Aaron; Rice, Richard; Boltz, Frederick [Conservation International, 2011 Crystal Drive, Suite 500, Arlington, VA (United States); Creed, Anna; Ashton, Ralph, E-mail: jbusch@conservation.or [Terrestrial Carbon Group, 900 17th Street NW, Suite 700, Washington, DC (United States)

2009-10-15

The climate benefit and economic cost of an international mechanism for reducing emissions from deforestation and degradation (REDD) will depend on the design of reference levels for crediting emission reductions. We compare the impacts of six proposed reference level designs on emission reduction levels and on cost per emission reduction using a stylized partial equilibrium model (the open source impacts of REDD incentives spreadsheet; OSIRIS). The model explicitly incorporates national incentives to participate in an international REDD mechanism as well as international leakage of deforestation emissions. Our results show that a REDD mechanism can provide cost-efficient climate change mitigation benefits under a broad range of reference level designs. We find that the most effective reference level designs balance incentives to reduce historically high deforestation emissions with incentives to maintain historically low deforestation emissions. Estimates of emission reductions under REDD depend critically on the degree to which demand for tropical frontier agriculture generates leakage. This underscores the potential importance to REDD of complementary strategies to supply agricultural needs outside of the forest frontier.

Comparing climate and cost impacts of reference levels for reducing emissions from deforestation

International Nuclear Information System (INIS)

Busch, Jonah; Strassburg, Bernardo; Cattaneo, Andrea; Lubowski, Ruben; Bruner, Aaron; Rice, Richard; Boltz, Frederick; Creed, Anna; Ashton, Ralph

2009-01-01

The climate benefit and economic cost of an international mechanism for reducing emissions from deforestation and degradation (REDD) will depend on the design of reference levels for crediting emission reductions. We compare the impacts of six proposed reference level designs on emission reduction levels and on cost per emission reduction using a stylized partial equilibrium model (the open source impacts of REDD incentives spreadsheet; OSIRIS). The model explicitly incorporates national incentives to participate in an international REDD mechanism as well as international leakage of deforestation emissions. Our results show that a REDD mechanism can provide cost-efficient climate change mitigation benefits under a broad range of reference level designs. We find that the most effective reference level designs balance incentives to reduce historically high deforestation emissions with incentives to maintain historically low deforestation emissions. Estimates of emission reductions under REDD depend critically on the degree to which demand for tropical frontier agriculture generates leakage. This underscores the potential importance to REDD of complementary strategies to supply agricultural needs outside of the forest frontier.

Towards the development of multilevel-multiagent diagnostic aids

International Nuclear Information System (INIS)

Stratton, R.C.; Jarrell, D.B.

1991-10-01

Presented here is our methodology for developing automated aids for diagnosing faults in complex systems. We have designed these aids as multilevel-multiagent diagnostic aids based on principles that should be generally applicable to any complex system. In this methodology, ''multilevel'' refers to information models described at successful levels of abstraction that are tied together in such a way that reasoning is directed to the appropriate level as determined by the problem solving requirements. The concept of ''multiagent'' refers to the method of information processing within the multilevel model network; each model in the network is an independent information processor, i.e., an intelligent agent. 19 refs., 15 figs., 9 tabs

Dose evaluation and establishment of reference levels in activity for nuclear medicine; Avaliação de dose e estabelecimento de níveis de referência em atividade para a medicina nuclear

Energy Technology Data Exchange (ETDEWEB)

Ribeiro, Julio Cesar de Souza

2017-07-01

The International Commission on Radiation Protection (ICRP) has emphasized the importance of accurately determining the mean dose levels, or administered activity, received by the patients for each medical procedure that uses ionizing radiation. However, the number of bibliographic references addressing the need to know and optimize these levels is insufficient, or rather limited, which may lead to non-standardizes techniques, a lack of exposures control, and also the increase of associated radiological risks of these procedures. In this context, a software in Visual Basic® of Microsoft© language was developed whose function is to elaborate a method of obtaining the Reference Levels in Activity (RLA) for nuclear medicine patients by determining the third quartile of the examinations carried out. The program also allows obtaining absorbed dose values in critical organs based on patient specificities as age, sex and Body Mass Index (BMI) in order to evaluate the risk involved in each procedure. The main nuclear medicine diagnostic procedures were evaluated through the database of two public hospitals and a private clinic, obtaining the NRAs of each facility, where the software was validated by comparison with the traditionally accepted calculation methods. Due to the results obtained in each installation, in addition to NRA determination, gaps in treatment capacities and unjustified dose variations for the same procedure were identified, indicating the need for optimization. Thus, the developed program is able to provide the estimated values of effective and absorbed doses involved in each procedure, for each patient, providing reference values for nuclear medicine field, not available in the national scenario so far. (author)

Radon reference levels and priority areas considering optimisation and avertable lung cancers

International Nuclear Information System (INIS)

Bochicchio, F.; Venoso, G.; Antignani, S.; Carpentieri, C.

2017-01-01

Protection from radon exposure in workplaces and dwellings, as included in the latest relevant international regulations and recommendations, is based on the new concept of 'reference level' whose meaning is significantly different from that of previous 'action level' concept. In fact, whereas remedial actions had to be considered only for radon concentrations above the action level, actions to optimise radon exposure are requested with priority above reference level but optimisation should be applied also for radon concentrations below reference level. Similar considerations can be applied to the usually called 'Rn-prone' areas, which are here proposed to be regulated as 'priority' areas. The main implication of these new challenging concepts is a substantial increase of avertable lung cancer deaths, as it will be shown using Italian data. Some practical examples of possible policy actions fitting an approach based on these new concepts will also be given, which could be useful for the implementation of the Council Directive 2013/59/Euratom. (authors)

Establishment of standard x-ray qualities to be used in diagnostic level at SSDLs

International Nuclear Information System (INIS)

A-Aziz, R.O.

2007-08-01

The objective of the present work is to modify x-ray machine (used by the secondary standard dosimetry laboratory in Sudan) to produce x-ray qualities suitable for the calibration at diagnostic level. It based on experimental evaluations. The importance of this study appears in development of protocols to calibrate the instruments used in diagnostic radiology in by good response of the instruments and low cost. In particular, the half value layer (HVL) values for the following qualities 40, 60, 80, 100, 120 and 150 were determined using various attenuation layers. Ionization chamber was used to determine the free air kerma rate at a distance of 100 cm from the x-ray generator. The obtained HVL values were compared with standard values of diagnostic levels. It was observed that the HVL of the present x-ray machine in most qualities are smaller than the standard ones. An approved method (described in the standard IEC 61267) was applied to determine the amount of additional filtration required to meet the standard values. The results show that the available cupper layers were not suitable for this purpose as most of the x-ray was absorbed in the material. Aluminum layers, on the other hand , show good performances to reduce the beams to the desired levels. The amount of additional filtration (from aluminum layers) needed in order to establish standard x-ray qualities to be used in diagnostic level were determined.(Author)

Reference levels for assays in opened installations of industrial radiography

International Nuclear Information System (INIS)

Leocadio, Joao C.; Tauhata, Luiz; Crispim, Verginia R.

2001-01-01

This work had as objectives to analyze the facilities open of industrial x-ray to obtain the distribution of doses in the operators and present proposed for the reference levels. The results of the monitoring revealed an improvement of the radiation protection conditions in the facilities and that the risk of potential exposure was reduced. The advantage of the proposed reference levels is that the supervisors would enlarge the frequency of audits in the facilities opened to accomplish the investigations and interventions.The facilities open with 'bunkers' presented distributions with 95% of the doses below 0,2 mSv and the distributions of the facilities with cordoned area they had 75% of the doses below 0,4 mSv. (author)

National reference doses for dental cephalometric radiography.

Science.gov (United States)

Holroyd, J R

2011-12-01

Diagnostic reference levels (DRLs) are an important tool in the optimisation of clinical radiography. Although national DRLs are provided for many diagnostic procedures including dental intra-oral radiography, there are currently no national DRLs set for cephalometric radiography. In the absence of formal national DRLs, the Health Protection Agency (HPA) has previously published National Reference Doses (NRDs) covering a wide range of diagnostic X-ray examinations. The aim of this study was to determine provisional NRDs for cephalometric radiography. Measurements made by the Dental X-ray Protection Service (DXPS) of the HPA, as part of the cephalometric X-ray equipment testing service provided to dentists and dental trade companies throughout the UK, were used to derive provisional NRDs. Dose-area product measurements were made on 42 X-ray sets. Third quartile dose-area product values for adult and child lateral cephalometric radiography were found to be 41 mGy cm² and 25 mGy cm², respectively, with individual measurements ranging from 3 mGy cm² to 108 mGy cm². This report proposes provisional NRDs of 40 mGy cm² and 25 mGy cm² for adult and child lateral cephalometric radiographs, respectively; these doses could be considered by employers when establishing their local DRLs.

Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference.

Science.gov (United States)

Yamada, Yoshitake; Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Abe, Takayuki; Kuribayashi, Sachio; Ogawa, Kenji

2013-08-01

To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA-950) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA-950. The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA-950. • Tomosynthesis showed significantly better diagnostic performance for pulmonary emphysema than radiography. • Interobserver agreement for tomosynthesis was significantly higher than that for radiography. • Sensitivity increased with increasing LAA -950 in both tomosynthesis and radiography. • Tomosynthesis imparts a similar radiation dose to two projection chest radiography. • Radiation dose and cost of tomosynthesis are lower than those of MDCT.

Clinical Diagnostic Utility of IP-10 and LAM Antigen Levels for the Diagnosis of Tuberculous Pleural Effusions in a High Burden Setting

Science.gov (United States)

Dheda, Keertan; Van-Zyl Smit, Richard N.; Sechi, Leonardo A.; Badri, Motasim; Meldau, Richard; Symons, Gregory; Khalfey, Hoosein; Carr, Igshaan; Maredza, Alice; Dawson, Rodney; Wainright, Helen; Whitelaw, Andrew; Bateman, Eric D.; Zumla, Alimuddin

2009-01-01

Background Current tools for the diagnosis of tuberculosis pleural effusions are sub-optimal. Data about the value of new diagnostic technologies are limited, particularly, in high burden settings. Preliminary case control studies have identified IFN-γ-inducible-10kDa protein (IP-10) as a promising diagnostic marker; however, its diagnostic utility in a day-to-day clinical setting is unclear. Detection of LAM antigen has not previously been evaluated in pleural fluid. Methods We investigated the comparative diagnostic utility of established (adenosine deaminase [ADA]), more recent (standardized nucleic-acid-amplification-test [NAAT]) and newer technologies (a standardized LAM mycobacterial antigen-detection assay and IP-10 levels) for the evaluation of pleural effusions in 78 consecutively recruited South African tuberculosis suspects. All consenting participants underwent pleural biopsy unless contra-indicated or refused. The reference standard comprised culture positivity for M. tuberculosis or histology suggestive of tuberculosis. Principal Findings Of 74 evaluable subjects 48, 7 and 19 had definite, probable and non-TB, respectively. IP-10 levels were significantly higher in TB vs non-TB participants (p<0.0001). The respective outcomes [sensitivity, specificity, PPV, NPV %] for the different diagnostic modalities were: ADA at the 30 IU/L cut-point [96; 69; 90; 85], NAAT [6; 93; 67; 28], IP-10 at the 28,170 pg/ml ROC-derived cut-point [80; 82; 91; 64], and IP-10 at the 4035 pg/ml cut-point [100; 53; 83; 100]. Thus IP-10, using the ROC-derived cut-point, missed ∼20% of TB cases and mis-diagnosed ∼20% of non-TB cases. By contrast, when a lower cut-point was used a negative test excluded TB. The NAAT had a poor sensitivity but high specificity. LAM antigen-detection was not diagnostically useful. Conclusion Although IP-10, like ADA, has sub-optimal specificity, it may be a clinically useful rule-out test for tuberculous pleural effusions. Larger multi

Evaluation of serological diagnostic tests for typhoid fever in Papua New Guinea using a composite reference standard.

Science.gov (United States)

Siba, Valentine; Horwood, Paul F; Vanuga, Kilagi; Wapling, Johanna; Sehuko, Rebecca; Siba, Peter M; Greenhill, Andrew R

2012-11-01

Typhoid fever remains a major global health problem. A major impediment to improving outcomes is the lack of appropriate diagnostic tools, which have not significantly improved in low-income settings for 100 years. We evaluated two commercially available rapid diagnostic tests (Tubex and TyphiDot), a prototype (TyphiRapid TR-02), and the commonly used single-serum Widal test in a previously reported high-burden area of Papua New Guinea. Samples were collected from 530 outpatients with axillary temperatures of ≥37.5°C, and analysis was conducted on all malaria-negative samples (n = 500). A composite reference standard of blood culture and PCR was used, by which 47 participants (9.4%) were considered typhoid fever positive. The sensitivity and specificity of the Tubex (51.1% and 88.3%, respectively) and TyphiDot (70.0% and 80.1%, respectively) tests were not high enough to warrant their ongoing use in this setting; however, the sensitivity and specificity for the TR-02 prototype were promising (89.4% and 85.0%, respectively). An axillary temperature of ≥38.5°C correlated with typhoid fever (P = 0.014). With an appropriate diagnostic test, conducting typhoid fever diagnosis only on patients with high-grade fever could dramatically decrease the costs associated with diagnosis while having no detrimental impact on the ability to accurately diagnose the illness.

Tune-Based Halo Diagnostics

International Nuclear Information System (INIS)

Cameron, Peter

2003-01-01

Tune-based halo diagnostics can be divided into two categories -- diagnostics for halo prevention, and diagnostics for halo measurement. Diagnostics for halo prevention are standard fare in accumulators, synchrotrons, and storage rings, and again can be divided into two categories -- diagnostics to measure the tune distribution (primarily to avoid resonances), and diagnostics to identify instabilities (which will not be discussed here). These diagnostic systems include kicked (coherent) tune measurement, phase-locked loop (PLL) tune measurement, Schottky tune measurement, beam transfer function (BTF) measurements, and measurement of transverse quadrupole mode envelope oscillations. We refer briefly to tune diagnostics used at RHIC and intended for the SNS, and then present experimental results. Tune-based diagnostics for halo measurement (as opposed to prevention) are considerably more difficult. We present one brief example of tune-based halo measurement

Audit Programmes in a Diagnostic Radiological Facility (invited paper)

International Nuclear Information System (INIS)

Moores, B.M.; Connolly, P.A.; Cole, P.R.

1998-01-01

The effective implementation of optimisation strategies for radiation protection in diagnostic radiology including nuclear medicine requires mechanisms for ongoing audit of all relevant factors. The Quality Criteria of the Commission of European Communities highlights clearly the three aspects of a radiological examination which needed to be considered, which are: (i) radiographic technique, (ii) patient dose, and (iii) image quality. Therefore, it is important that the choice of a known and acceptable radiographic technique provides a known outcome in terms of patient dose and image quality. This requirement should be capable of being achieved throughout Europe and capable of being updated as new radiological strategies are developed. Audit programmes aimed at monitoring that this situation exists may be considered at three levels: Level 1 involves routine, periodic, assessment of patient doses on a representative sample of patients undergoing a particular type of examination. Results from this audit are then compared with acceptable and clearly defined diagnostic reference levels or reference dose values which provides a framework for guidance on acceptable practice. A summary of such level 1 programmes which are being pursued in Europe is presented. Level 2 audit programmes, beside patient dose assessment, will also involve an assessment of all those parameters relevant to an X ray examination which may have a bearing on the actual dose delivered to the patient. Such level 2 audit programmes provide the basis for implementation of optimisation strategies for radiation protection in terms of risk reduction, one of the fundamental tenets of radiation protection philosophy. Level 3 audit programmes also include assessment and verification of image quality requirements for particular examinations. This latter aspect is a necessary basis for overall optimisation of radiation protection in diagnostic radiology. (author)

The Development of Expertise in Radiology: In Chest Radiograph Interpretation, "Expert" Search Pattern May Predate "Expert" Levels of Diagnostic Accuracy for Pneumothorax Identification.

Science.gov (United States)

Kelly, Brendan S; Rainford, Louise A; Darcy, Sarah P; Kavanagh, Eoin C; Toomey, Rachel J

2016-07-01

Purpose To investigate the development of chest radiograph interpretation skill through medical training by measuring both diagnostic accuracy and eye movements during visual search. Materials and Methods An institutional exemption from full ethical review was granted for the study. Five consultant radiologists were deemed the reference expert group, and four radiology registrars, five senior house officers (SHOs), and six interns formed four clinician groups. Participants were shown 30 chest radiographs, 14 of which had a pneumothorax, and were asked to give their level of confidence as to whether a pneumothorax was present. Receiver operating characteristic (ROC) curve analysis was carried out on diagnostic decisions. Eye movements were recorded with a Tobii TX300 (Tobii Technology, Stockholm, Sweden) eye tracker. Four eye-tracking metrics were analyzed. Variables were compared to identify any differences between groups. All data were compared by using the Friedman nonparametric method. Results The average area under the ROC curve for the groups increased with experience (0.947 for consultants, 0.792 for registrars, 0.693 for SHOs, and 0.659 for interns; P = .009). A significant difference in diagnostic accuracy was found between consultants and registrars (P = .046). All four eye-tracking metrics decreased with experience, and there were significant differences between registrars and SHOs. Total reading time decreased with experience; it was significantly lower for registrars compared with SHOs (P = .046) and for SHOs compared with interns (P = .025). Conclusion Chest radiograph interpretation skill increased with experience, both in terms of diagnostic accuracy and visual search. The observed level of experience at which there was a significant difference was higher for diagnostic accuracy than for eye-tracking metrics. (©) RSNA, 2016 Online supplemental material is available for this article.

Age-specific reference ranges of serum prostate-specific antigen in Iranian men

Directory of Open Access Journals (Sweden)

Gholamreza Pourmand

2015-08-01

Conclusion: Findings of the present study showed that PSA levels are correlated with age. It was also revealed that the PSA age-specific reference range obtained in this study is different from other races and is specific to Iranian men. Therefore, age-specific reference ranges of PSA obtained in the present study can increase PSA test sensitivity and specificity by reducing unnecessary diagnostic procedures and early detection of prostate cancer in Iranian men.

Hearing Tests on Mobile Devices: Evaluation of the Reference Sound Level by Means of Biological Calibration.

Science.gov (United States)

Masalski, Marcin; Kipiński, Lech; Grysiński, Tomasz; Kręcicki, Tomasz

2016-05-30

Hearing tests carried out in home setting by means of mobile devices require previous calibration of the reference sound level. Mobile devices with bundled headphones create a possibility of applying the predefined level for a particular model as an alternative to calibrating each device separately. The objective of this study was to determine the reference sound level for sets composed of a mobile device and bundled headphones. Reference sound levels for Android-based mobile devices were determined using an open access mobile phone app by means of biological calibration, that is, in relation to the normal-hearing threshold. The examinations were conducted in 2 groups: an uncontrolled and a controlled one. In the uncontrolled group, the fully automated self-measurements were carried out in home conditions by 18- to 35-year-old subjects, without prior hearing problems, recruited online. Calibration was conducted as a preliminary step in preparation for further examination. In the controlled group, audiologist-assisted examinations were performed in a sound booth, on normal-hearing subjects verified through pure-tone audiometry, recruited offline from among the workers and patients of the clinic. In both the groups, the reference sound levels were determined on a subject's mobile device using the Bekesy audiometry. The reference sound levels were compared between the groups. Intramodel and intermodel analyses were carried out as well. In the uncontrolled group, 8988 calibrations were conducted on 8620 different devices representing 2040 models. In the controlled group, 158 calibrations (test and retest) were conducted on 79 devices representing 50 models. Result analysis was performed for 10 most frequently used models in both the groups. The difference in reference sound levels between uncontrolled and controlled groups was 1.50 dB (SD 4.42). The mean SD of the reference sound level determined for devices within the same model was 4.03 dB (95% CI 3

Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

Energy Technology Data Exchange (ETDEWEB)

Yamada, Yoshitake [Keio University School of Medicine, Department of Diagnostic Radiology, Tokyo (Japan); Nippon Koukan Hospital, Department of Radiology, Kawasaki-shi, Kanagawa (Japan); Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Kuribayashi, Sachio [Keio University School of Medicine, Department of Diagnostic Radiology, Tokyo (Japan); Abe, Takayuki [Keio University School of Medicine, Center for Clinical Research, Tokyo (Japan); Ogawa, Kenji [Nippon Koukan Hospital, Department of Radiology, Kawasaki-shi, Kanagawa (Japan)

2013-08-15

To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA{sub -950}) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P < 0.0001) of tomosynthesis than radiography for the detection of pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA{sub -950}. The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA{sub -950}. (orig.)

Forget the Desk Job: Current Roles and Responsibilities in Entry-Level Reference Job Advertisements

Science.gov (United States)

Detmering, Robert; Sproles, Claudene

2012-01-01

This study examines the evolving roles and responsibilities of entry-level academic reference positions, as stated in recent job advertisements posted on the American Library Association's JobLIST Web site and other sources. Findings from a content analysis of these advertisements indicate that current entry-level reference positions in academic…

Development of diagnostic test instruments to reveal level student conception in kinematic and dynamics

Science.gov (United States)

Handhika, J.; Cari, C.; Suparmi, A.; Sunarno, W.; Purwandari, P.

2018-03-01

The purpose of this research was to develop a diagnostic test instrument to reveal students' conceptions in kinematics and dynamics. The diagnostic test was developed based on the content indicator the concept of (1) displacement and distance, (2) instantaneous and average velocity, (3) zero and constant acceleration, (4) gravitational acceleration (5) Newton's first Law, (6) and Newton's third Law. The diagnostic test development model includes: Diagnostic test requirement analysis, formulating test-making objectives, developing tests, checking the validity of the content and the performance of reliability, and application of tests. The Content Validation Index (CVI) results in the category are highly relevant, with a value of 0.85. Three questions get negative Content Validation Ratio CVR) (-0.6), after revised distractors and clarify visual presentation; the CVR become 1 (highly relevant). This test was applied, obtained 16 valid test items, with Cronbach Alpha value of 0.80. It can conclude that diagnostic test can be used to reveal the level of students conception in kinematics and dynamics.

Towards diagnostics for a fusion reactor

International Nuclear Information System (INIS)

Costley, A. E.

2009-01-01

The requirements for measurements on modern tokamak fusion plasmas are outlined, and the techniques and systems used to make the measurements, usually referred to as 'diagnostics', are introduced. The basics of three particular diagnostics - magnetics, neutron systems and a laser based optical system - are outlined as examples of modern diagnostic systems, and the implementation of these diagnostics on a current tokamak (JET) are described. The next major step in magnetic confinement fusion is the construction and operation of the International Thermonuclear Experimental Reactor (ITER), which is a joint project of China, Europe, Japan, India, Korea, the Russian Federation, and the United States. Construction has begun in Cadarache, France. It is expected that ITER will operate at the 500 MW level. Because of the harsh environment in the vacuum vessel where many diagnostic components are located, the development of diagnostics for ITER is a major challenge - arguably the most difficult challenge ever undertaken in the field of diagnostics. The main elements in the diagnostic step are outlined using the three chosen techniques as examples. Finally, the step beyond ITER to a demonstration reactor, DEMO, that is expected to produce several GWs of fusion power is considered and the impact on diagnostics outlined. It is shown that the applicability and development steps needed for the individual diagnostics techniques will differ. The challenges for DEMO diagnostics are substantial and a dedicated effort should be made to find and develop new techniques, and especially techniques appropriate to the DEMO environment. It is argued that the limitations and difficulties in diagnostics should be a consideration in the optimization and designs of DEMO. (author)

Reference dose levels for dental panoramic radiography in Gwangju (South Korea)

International Nuclear Information System (INIS)

Lee, J. S.; Kim, Y. H.; Yoon, S. J.; Kang, B. C.

2010-01-01

This study assessed the reference dose levels for dental panoramic radiography in Gwangju city (South Korea) based on the dose width product (DWP) and compared them with those already established elsewhere. A total of 44 panoramic dental radiographic sets (36 digital and 8 analogue panoramic sets) in 41 dental clinics in Gwangju city were chosen. The third quartile DWP was determined from 429 surface dose measurements of the adult surface dose in panoramic dental radiography. The third quartile DWP for panoramic radiography was 60.1 mGy mm. The proposed DWP reference levels of 60.1 mGy mm were less than or equal to those previously reported in other countries, such as Italy and UK, and acceptable for panoramic radiography in Gwangju (KR). (authors)

Serum Glutamine Levels as a Potential Diagnostic Biomarker in Sepsis following Surgery for Peritonitis.

Science.gov (United States)

Yang, Chun-Ju; Huang, Ting-Shuo; Lee, Tung-Liang; Yang, Kang-Chung; Yuan, Shin-Sheng; Lu, Ruey-Hwa; Hsieh, Chung-Ho; Shyu, Yu-Chiau

2017-12-31

Few diagnostic biomarkers for sepsis after emergency peritonitis surgery are available to clinicians, and, thus, it is important to develop new biomarkers for patients undergoing this procedure. We investigated whether serum glutamine and selenium levels could be diagnostic biomarkers of sepsis in individuals recovering from emergency peritonitis surgery. From February 2012 to March 2013, patients who had peritonitis diagnosed at the emergency department and underwent emergency surgery were screened for eligibility. Serum glutamine and selenium levels were obtained at pre-operative, post-operative and recovery time points. The average level of pre-operation serum glutamine was significantly different from that on the recovery day (0.317 ± 0.168 vs. 0.532 ± 0.155 mM, P peritonitis. We recommend including glutamine as a biomarker for sepsis severity assessment in addition to the commonly used clinical indicators.

Computized analysis of diagnostic level in breast diseases and frequency of their clinicoroentgenological symptoms

International Nuclear Information System (INIS)

Babij, Ya.S.; Krakhmaleva, L.P.; Shumakov, A.G.

1988-01-01

A standardized chart with a list of clinicoroentgenological symptoms of the most frequent mammary gland diseases is developed. The data of computer analysis of the diagnostics level and the frequency of clinicoroentgenological symptoms of different diseases of the mammary gland are given. The data obtained can be used for conventional and computer diagnostics of mammary gland diseases, as well as as a basis for the further study of semiotics of different pathological processes in the mammary gland. 22 refs

Principles of validation of diagnostic assays for infectious diseases

International Nuclear Information System (INIS)

Jacobson, R.H.

1998-01-01

Assay validation requires a series of inter-related processes. Assay validation is an experimental process: reagents and protocols are optimized by experimentation to detect the analyte with accuracy and precision. Assay validation is a relative process: its diagnostic sensitivity and diagnostic specificity are calculated relative to test results obtained from reference animal populations of known infection/exposure status. Assay validation is a conditional process: classification of animals in the target population as infected or uninfected is conditional upon how well the reference animal population used to validate the assay represents the target population; accurate predictions of the infection status of animals from test results (PV+ and PV-) are conditional upon the estimated prevalence of disease/infection in the target population. Assay validation is an incremental process: confidence in the validity of an assay increases over time when use confirms that it is robust as demonstrated by accurate and precise results; the assay may also achieve increasing levels of validity as it is upgraded and extended by adding reference populations of known infection status. Assay validation is a continuous process: the assay remains valid only insofar as it continues to provide accurate and precise results as proven through statistical verification. Therefore, the work required for validation of diagnostic assays for infectious diseases does not end with a time-limited series of experiments based on a few reference samples rather, to assure valid test results from an assay requires constant vigilance and maintenance of the assay, along with reassessment of its performance characteristics for each unique population of animals to which it is applied. (author)

Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

Energy Technology Data Exchange (ETDEWEB)

D' Ercole, Loredana, E-mail: l.dercole@smatteo.pv.it [Fondazione IRCCS Policlinico San Matteo, Department of Medical Physics (Italy); Quaretti, Pietro; Cionfoli, Nicola [Fondazione IRCCS Policlinico San Matteo, Department of Radiology (Italy); Klersy, Catherine [Fondazione IRCCS Policlinico San Matteo, Biometry and Clinical Epidemiology Service, Research Department, (Italy); Bocchiola, Milena [Fondazione IRCCS Policlinico San Matteo, Department of Medical Physics (Italy); Rodolico, Giuseppe; Azzaretti, Andrea [Fondazione IRCCS Policlinico San Matteo, Department of Radiology (Italy); Lisciandro, Francesco [Fondazione IRCCS Policlinico San Matteo, Department of Medical Physics (Italy); Cascella, Tommaso; Zappoli Thyrion, Federico [Fondazione IRCCS Policlinico San Matteo, Department of Radiology (Italy)

2013-04-15

To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity. MESD were evaluated with radiochromic films in 31 patients (mean age 72 {+-} 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 {+-} 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included. MESD values (mean 0.96 {+-} 0.42 Gy) were <2 Gy without relevant dependence on procedure complexity. Local DRL values for kerma area product (KAP), fluoroscopy time (FT), and number of frames (N{sub FR}) were 269 Gy cm{sup 2}, 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1-102.7, p < 0.05) and N{sub FR} overexposures (OR 10.8, 95 % CI 1.1-109.5, p < 0.05). Type I aortic arch decreased the risk of FT overexposure (OR 0.4, 95 % CI 0.1-0.9, p = 0.042), and stenosis {>=} 90 % increased the risk of N{sub FR} overexposure (OR 2.8, 95 % CI 1.1-7.4, p = 0.040). At multivariable analysis, stenosis {>=} 90 % (OR 2.8, 95 % CI 1.1-7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1-109.5, p = 0.027) were associated with overexposure for two or more parameters. Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

Quality systems in veterinary diagnostics laboratories.

Science.gov (United States)

de Branco, Freitas Maia L M

2007-01-01

Quality assurance of services provided by veterinary diagnostics laboratories is a fundamental element promoted by international animal health organizations to establish trust, confidence and transparency needed for the trade of animals and their products at domestic and international levels. It requires, among other things, trained personnel, consistent and rigorous methodology, choice of suitable methods as well as appropriate calibration and traceability procedures. An important part of laboratory quality management is addressed by ISO/IEC 17025, which aims to facilitate cooperation among laboratories and their associated parties by assuring the generation of credible and consistent information derived from analytical results. Currently, according to OIE recommendation, veterinary diagnostics laboratories are only subject to voluntary compliance with standard ISO/IEC 17025; however, it is proposed here that OIE reference laboratories and collaboration centres strongly consider its adoption.

The Influence of the Terrestrial Reference Frame on Studies of Sea Level Change

Science.gov (United States)

Nerem, R. S.; Bar-Sever, Y. E.; Haines, B. J.; Desai, S.; Heflin, M. B.

2015-12-01

The terrestrial reference frame (TRF) provides the foundation for the accurate monitoring of sea level using both ground-based (tide gauges) and space-based (satellite altimetry) techniques. For the latter, tide gauges are also used to monitor drifts in the satellite instruments over time. The accuracy of the terrestrial reference frame (TRF) is thus a critical component for both types of sea level measurements. The TRF is central to the formation of geocentric sea-surface height (SSH) measurements from satellite altimeter data. The computed satellite orbits are linked to a particular TRF via the assumed locations of the ground-based tracking systems. The manner in which TRF errors are expressed in the orbit solution (and thus SSH) is not straightforward, and depends on the models of the forces underlying the satellite's motion. We discuss this relationship, and provide examples of the systematic TRF-induced errors in the altimeter derived sea-level record. The TRF is also crucial to the interpretation of tide-gauge measurements, as it enables the separation of vertical land motion from volumetric changes in the water level. TRF errors affect tide gauge measurements through GNSS estimates of the vertical land motion at each tide gauge. This talk will discuss the current accuracy of the TRF and how errors in the TRF impact both satellite altimeter and tide gauge sea level measurements. We will also discuss simulations of how the proposed Geodetic Reference Antenna in SPace (GRASP) satellite mission could reduce these errors and revolutionize how reference frames are computed in general.

Profile of usage of a reference diagnostic service on oral pathology: a 10-year evaluation.

Science.gov (United States)

Oliveira e Silva, Karla Rachel; Siqueira, Ana Luísa Lara; Caldeira, Patrícia Carlos; de Abreu, Mauro Henrique Nogueira Guimarães; de Aguiar, Maria Cássia Ferreira

2014-12-20

Despite the professional and academic relevance of the Brazilian oral pathology diagnostic laboratories, no information about their usage profile is available in the English literature. The objective of the present study is to report data about the histopathological and immunohistochemical exams performed in a Brazilian regional reference laboratory of oral pathology, as well as its main users. Information about all histopathological exams performed between 2002 and 2012 was retrieved from the files of the Oral and Maxillofacial Pathology Service of the School of Dentistry of Universidade Federal de Minas Gerais. Data collected included: 1) requestor of exam; 2) diagnosis classification; and 3) immunohistochemical tests. Descriptive statistical analyses were done. 13,522 histopathological exams were performed, mean 1,229/year. The Public Health System of the city of Belo Horizonte was the main requestor of exams (77.13%), followed by private professionals (19.26%), and other cities (2.03%). Most lesions were considered benign (12,599/ 93.17%), with 854 malignant lesions (6.32%). 469 immunohistochemical tests were performed; 324 (69.08%) were from benign diagnosis, and 145 (30.92%) from malignant diagnosis. The most used antibodies were against S100, vimentin, smooth muscle actin, actin muscle specific HHF-35, and pan-cytokeratin AE1/AE3. Public Health System is the major user of the diagnostic service on oral pathology in our institution. Most diagnoses were of benign lesions, although many malignant lesions were detected. Immunohistochemistry was particularly important in solving challenging cases.

The evaluation of diagnostic medical exposures in the Czech Republic

International Nuclear Information System (INIS)

Petrova, K.; Klener, V.; Heribanova, A.; Husak, V.; Masopust, J.

1998-01-01

Surveys were performed in the Czech Republic to evaluate diagnostic medical exposures. The results are presented in 4 tables: (i) burden from the use of radiopharmaceuticals (examination, radiopharmaceutical, no. of procedures, average administered activity, conversion factor, collective effective dose); (ii) use of radiopharmaceuticals at nuclear medicine departments (type of examination, type of radiopharmaceutical, no. of departments, average administered activity); (iii) reference levels of administered activity specified for some diagnostic procedures for the adult patient (examination, radionuclide, chemical form, administered activity); and (iv) X-ray examinations (examination, annual no. of procedures, effective dose, age distribution, sex distribution). (P.A.)

Whole Genome Sequencing Increases Molecular Diagnostic Yield Compared with Current Diagnostic Testing for Inherited Retinal Disease.

Science.gov (United States)

Ellingford, Jamie M; Barton, Stephanie; Bhaskar, Sanjeev; Williams, Simon G; Sergouniotis, Panagiotis I; O'Sullivan, James; Lamb, Janine A; Perveen, Rahat; Hall, Georgina; Newman, William G; Bishop, Paul N; Roberts, Stephen A; Leach, Rick; Tearle, Rick; Bayliss, Stuart; Ramsden, Simon C; Nemeth, Andrea H; Black, Graeme C M

2016-05-01

To compare the efficacy of whole genome sequencing (WGS) with targeted next-generation sequencing (NGS) in the diagnosis of inherited retinal disease (IRD). Case series. A total of 562 patients diagnosed with IRD. We performed a direct comparative analysis of current molecular diagnostics with WGS. We retrospectively reviewed the findings from a diagnostic NGS DNA test for 562 patients with IRD. A subset of 46 of 562 patients (encompassing potential clinical outcomes of diagnostic analysis) also underwent WGS, and we compared mutation detection rates and molecular diagnostic yields. In addition, we compared the sensitivity and specificity of the 2 techniques to identify known single nucleotide variants (SNVs) using 6 control samples with publically available genotype data. Diagnostic yield of genomic testing. Across known disease-causing genes, targeted NGS and WGS achieved similar levels of sensitivity and specificity for SNV detection. However, WGS also identified 14 clinically relevant genetic variants through WGS that had not been identified by NGS diagnostic testing for the 46 individuals with IRD. These variants included large deletions and variants in noncoding regions of the genome. Identification of these variants confirmed a molecular diagnosis of IRD for 11 of the 33 individuals referred for WGS who had not obtained a molecular diagnosis through targeted NGS testing. Weighted estimates, accounting for population structure, suggest that WGS methods could result in an overall 29% (95% confidence interval, 15-45) uplift in diagnostic yield. We show that WGS methods can detect disease-causing genetic variants missed by current NGS diagnostic methodologies for IRD and thereby demonstrate the clinical utility and additional value of WGS. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Diffusion-weighted MRI in prostatic lesions: Diagnostic performance of normalized ADC using normal peripheral prostatic zone as a reference

Directory of Open Access Journals (Sweden)

Tamer F. Taha Ali

2018-03-01

Full Text Available Aim of study: Evaluate the potential value of the normal peripheral zone as a reference organ to normalize prostatic lesion apparent diffusion coefficient (ADC to improve its evaluation of prostatic lesions. Patients and methods: This prospective study included 38 patients with clinical suspicion of cancer prostate (increased PSA levels (>4 ng/ml, hard prostate in digital rectal examination and who are scheduled to undergo a TRUS-guided biopsy. Conventional and DW-MRI was done and ADC was calculated. The normalized ADC value was calculated by dividing the ADC of lesion by ADC of reference site (healthy peripheral zone. DWI-MRI results were compared to the results of biopsy. Comparison of ADCs and nADCs of benign and malignant lesions was done. Receiver operating characteristics (ROC curve analysis was done. Results: The patients were classified by histopathology into non-malignant group (16 patients and malignant group (22 patients. Significant negative correlation between ADC and normalized ADC (nADC and malignancy was detected. There was no significant difference between the mean ADC of peripheral health prostatic zones (PZ between benign and malignant cases (2.221 ± 0.356 versus 1.99 ± 0.538x10−3 mm2/sec, p = 0.144.There was significant difference between the mean ADC and mean nADC in benign and malignant lesions (1.049 ± 0.217 versus 0.659 ± 0.221x10−3 mm2/sec, p < 0.001 and (0.475 ± 0.055 versus 0.328 ± 0.044, p < 0.001 respectively.There was significant higher diagnostic performance of nADC than ADC with ADC Cut-off value 0.75 × 10−3 mm2/sec and nADC cut-off value 0.39 could significantly differentiate between benign and malignant lesion with sensitivity, specificity, PPV,NPV of 86.36,75,82.61 and 80% respectively, p < 0.0001 for ADC and 95.45, 93.75, 95.45 and 93.75%, p < 0.0001 for nADC. Conclusion: diagnostic performance of nADC using normal peripheral zone is higher than

Diagnostic accuracy of contemporary multidetector computed tomography (MDCT) for the detection of lumbar disc herniation

Energy Technology Data Exchange (ETDEWEB)

Notohamiprodjo, S.; Stahl, R.; Braunagel, M.; Kazmierczak, P.M.; Thierfelder, K.M.; Treitl, K.M.; Wirth, S. [University Hospital of Munich, LMU Munich, Institute for Clinical Radiology, Munich (Germany); Notohamiprodjo, M. [University Hospital Tuebingen, Eberhard Karls University Tuebingen, Diagnostic and Interventional Radiology, Tuebingen (Germany)

2017-08-15

To evaluate the diagnostic accuracy of multidetector CT (MDCT) for detection of lumbar disc herniation with MRI as standard of reference. Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNR) of cerebrospinal fluid (CSF), annulus fibrosus (AF) and the spinal cord (SC) were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence and accuracy in the diagnosis of lumbar disc herniation using MRI as standard of reference. Inter-reader correlation was assessed with weighted κ. Sensitivity, specificity, precision and accuracy of MDCT for disc protrusion were 98.8%, 96.5%, 97.1%, 97.8% (disc level), 97.7%, 92.9%, 98.6%, 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the discs. κ (>0.90) was excellent for both algorithms. MDCT of the lumbar spine yields high diagnostic accuracy for detection of lumbar disc herniation. IR improves image quality so that the provided diagnostic accuracy is principally equivalent to MRI. (orig.)

The diagnostic value of plasma N-terminal connective tissue growth factor levels in children with heart failure.

Science.gov (United States)

Li, Gang; Song, Xueqing; Xia, Jiyi; Li, Jing; Jia, Peng; Chen, Pengyuan; Zhao, Jian; Liu, Bin

2017-01-01

The aim of this study was to assess the diagnostic value of plasma N-terminal connective tissue growth factor in children with heart failure. Methods and results Plasma N-terminal connective tissue growth factor was determined in 61 children, including 41 children with heart failure, 20 children without heart failure, and 30 healthy volunteers. The correlations between plasma N-terminal connective tissue growth factor levels and clinical parameters were investigated. Moreover, the diagnostic value of N-terminal connective tissue growth factor levels was evaluated. Compared with healthy volunteers and children without heart failure, plasma N-terminal connective tissue growth factor levels were significantly elevated in those with heart failure (p0.05), but it obviously improved the ability of diagnosing heart failure in children, as demonstrated by the integrated discrimination improvement (6.2%, p=0.013) and net re-classification improvement (13.2%, p=0.017) indices. Plasma N-terminal connective tissue growth factor is a promising diagnostic biomarker for heart failure in children.

The study of practices in planed diagnostic medical exposure

International Nuclear Information System (INIS)

Popescu, Irina-Anca; Perju, Nicoleta Ana-Maria; Cobzeanu, Camelia

2011-01-01

The exposure of population to ionizing radiations in medical diagnostic purposes represents a planed exposure procedure, medically justified, having a direct impact on patient health state. A justification of exposure, with a result that can confirm a clinical diagnostic, implies further important steps in treatment decisions. Optimization in patients radiological protection is the result of observing the reference levels recommendations, which maintains a reasonable individual exposure to ionizing radiation in medical purpose. In this paper we investigated the justification of 4189 exposures of patients who underwent planed diagnostic medical investigation over 36 months in a radiological unit. The most frequent investigation concerned the spinal column in 38.3% of total exposures-mainly at lumbar level (63.0% and 24.1%, respectively of total number of exposures), followed by limb bones (20.6%) and thorax (26.9%). Justification of practices included: rheumatic pains in 45.8% of exposures followed by traumatic injuries (20.6%), pleural and pulmonary pathology (19.3%), malignant processes (12.3%), ear-nose-throat investigations (1.1%) and car accidents (0.9%). The females over 40 years old were the group with the highest number of medical exposures, with 54.5% of total practices. This study revealed that the number of medical exposures justification is almost equal with non-justified examinations, confirming a not so good correlation between clinical diagnostic and the required radiological investigation. The percentages of justified versus non-justified practices indicated by specialist physicians and general practitioners were slightly equal - 59.3% vs. 40.7%, 56.9% vs. 43.1%, respectively. The analysis of data concluded that either specialist/general physicians must evaluate more rigorously the patients and all clinical signs in order to reduce as reasonable as possible the non-justified medical exposures to ionizing radiations, and thus to avoid financial and

Pilot-benchmarking of the WENRA safety reference levels for the spent fuel intermediate storage facility Ahaus

International Nuclear Information System (INIS)

Lorenz, Bernd; Roeder, Markus; Brandt, Klaus-Dieter

2008-01-01

Full text: The Western European Nuclear Regulator's Association (WENRA) has 2007 issued the draft of the 'Waste and Spent Fuel Storage Safety Reference Levels'. The objective of WENRA is to strive for a harmonized safety level of nuclear facilities within the European Community and these Reference Levels are a benchmark method to demonstrate the achieved level for the regulatory system and the implementation as well. Safety Reference Levels exist at the moment for Reactor Safety, Waste Storage and Decommissioning in different stages of development. ENISS, the European Nuclear Installations Safety Standards Initiative, a FORATOM based special organisation of nuclear operators, has discussed these Safety Reference Levels very intensively with WENRA and the agreement was to make a implementation benchmark-exercise for the storage facilities before the authorities finally agree on the Reference Levels. This benchmark was scheduled for the year 2008. Because of the special situation in Germany where a large number of storage facilities is in operation the German authorities felt that it would be useful to initiate a Pilot-Benchmark to get first results on the feasibility of the Reference Levels and the burden imposed to authorities and operators by these benchmark-exercises. GNS, a subsidiary company of the utilities, agreed to step into this process on a voluntary basis with its storage facility for spent fuel in Ahaus. The exercise was done in a very efficient way and in good co-operation between the authorities, local and federal, and the operator. The results in terms of safety assessments have been very satisfactory showing the high degree of safety. Although the facility was for the first time licensed already in 1987 the compliance with nearly all Reference Levels from 2007 could be demonstrated. It became also clear that newer facilities would fulfil the desired safety standard too. Nevertheless, in spite of the good results the exercise revealed some weak

Establishing the standard X-ray beam qualities for calibration of dosimeters used in diagnostic radiology following IAEA-TRS457

International Nuclear Information System (INIS)

Duong Van Trieu; Ho Quang Tuan; Bui Duc Ky

2014-01-01

The determination of the patient dose needs to provide a reference dose for the patient that reference dose levels to assess the relative risk during X- ray diagnostic. This mission, We had established a number of standard beam qualities to perform calibrations of diagnostic dosimeters and methods of measuring patient dose in X-ray diagnostic. At radiation dosimetry room, we had establish RQR2, RQR3, RQR4, RQR5, RQR6 beam qualities based on IAEA-TRS457 documentation with homogeneity coefficient (h) for each beam quality in the range 0.7 - 0.8, and haft-value layers HVL1, HVL2 of experimental and IAEA is different about 10%. Established calibration method for diagnostic dosimeters as KAP meters, UNFORS dosimeters, and the TLD dosimeters, practical measurements of entrance surface air kerma on Shimadzu X-ray machines used phantom. (author)

Pilot project for the establishment of diagnosis reference level in pediatric computerized tomography in Rio de Janeiro city, RJ, Brazil; Projeto piloto para o estabelecimento de niveis de referencia de diagnostico em tomografia computadorizada pediatrica no municipio do Rio de Janeiro, RJ, Brazil

Energy Technology Data Exchange (ETDEWEB)

Jesus, Fillipe Machado de

2014-08-01

Computed tomography (CT) is an important method of diagnostic imaging has been widely used around the world. However, this important diagnostic tool has led to a considerable increase in the frequency of examinations, often without proper clinical justification. Consequently, CT is one of the diagnostic procedures that contributes most to the collective dose. Scientific studies show that the concern in pediatric procedures should be even higher. Despite the fact that these patients have a higher radiosensitivity and a higher life expectancy, the protocols of the examinations are not optimized and adult protocols are applied. Moreover, a recent study performed in the United States showed that one third of the examinations was not justified. The aim of this study was to conduct a pilot study of dose indicators in pediatric CT in four hospitals, in order to verify the feasibility of the diagnostic reference levels establishment for the county of Rio de Janeiro. The dose descriptors were estimated from the beam dosimetry by applying the protocols used in each examination. The total patient sample included 358 children of different age groups. The results observed in examinations of whole trunk (routine chest, upper abdomen and pelvis) and upper abdomen in Institution A, for patients aged 5-10 years, indicated that the mAs values used were not properly selected for patients' body mass index, presenting however, conformity with UK reference levels. In the case of head CT scans and routine chest CT scans in Institution B, although patients aged 5-10 years have shown conformity with UK reference levels, the kV and mAs values used, in some examinations, were also inappropriate for the patient characteristics. Similar result was observed in examinations of head and high resolution chest for patients neonates, in Institution D. For head and routine chest examinations of 1-5 years' age group, was Institution B that showed the lowest DLP values. This result was due to

Diagnostic value of different adherence measures using electronic monitoring and virologic failure as reference standards.

Science.gov (United States)

Deschamps, Ann E; De Geest, Sabina; Vandamme, Anne-Mieke; Bobbaers, Herman; Peetermans, Willy E; Van Wijngaerden, Eric

2008-09-01

Nonadherence to antiretroviral therapy is a substantial problem in HIV and jeopardizes the success of treatment. Accurate measurement of nonadherence is therefore imperative for good clinical management but no gold standard has been agreed on yet. In a single-center prospective study nonadherence was assessed by electronic monitoring: percentage of doses missed and drug holidays and by three self reports: (1) a visual analogue scale (VAS): percentage of overall doses taken; (2) the Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ): percentage of overall doses missed and drug holidays and (3) the European HIV Treatment Questionnaire (EHTQ): percentage of doses missed and drug holidays for each antiretroviral drug separately. Virologic failure prospectively assessed during 1 year, and electronic monitoring were used as reference standards. Using virologic failure as reference standard, the best results were for (1) the SHCS-AQ after electronic monitoring (sensitivity, 87.5%; specificity, 78.6%); (2) electronic monitoring (sensitivity, 75%; specificity, 85.6%), and (3) the VAS combined with the SHCS-AQ before electronic monitoring (sensitivity, 87.5%; specificity, 58.6%). The sensitivity of the complex EHTQ was less than 50%. Asking simple questions about doses taken or missed is more sensitive than complex questioning about each drug separately. Combining the VAS with the SHCS-AQ seems a feasible nonadherence measure for daily clinical practice. Self-reports perform better after electronic monitoring: their diagnostic value could be lower when given independently.

Technical Diagnostics of Ventilation Units for Energy Efficiency and Safety of Operation

Directory of Open Access Journals (Sweden)

Kuzin Evgeny

2017-01-01

Full Text Available The article considers the questions of application of technical diagnostics fan installations methods for providing safe operation, the system of the technical maintenance improvement and repair. Due to the feet that one of the most important aspects in fan operation in mining is energy efficiency and energy saving, the lack of the data in the control of the level in vibration of stationary sensors is shown. The necessity of taking into account the geometric parameters of the intake channel has been shown, and also the necessity of creation of the reference masks for the assessment of technical condition and energy efficiency when operating fan installations in mining. The results of technical diagnostics of the main fans using the methods of vibration diagnostics are provided. Aspects of vibration at characteristic points are shown. The necessity for further accumulation of data characterizing vibration for adjustment of the reference masks and more accurate detection of defects and deviations from the energy-efficient mode of operation of the fan installations is given.

Technical Diagnostics of Ventilation Units for Energy Efficiency and Safety of Operation

Science.gov (United States)

Kuzin, Evgeny; Shahmanov, Vitality; Dubinkin, Dmitriy

2017-11-01

The article considers the questions of application of technical diagnostics fan installations methods for providing safe operation, the system of the technical maintenance improvement and repair. Due to the feet that one of the most important aspects in fan operation in mining is energy efficiency and energy saving, the lack of the data in the control of the level in vibration of stationary sensors is shown. The necessity of taking into account the geometric parameters of the intake channel has been shown, and also the necessity of creation of the reference masks for the assessment of technical condition and energy efficiency when operating fan installations in mining. The results of technical diagnostics of the main fans using the methods of vibration diagnostics are provided. Aspects of vibration at characteristic points are shown. The necessity for further accumulation of data characterizing vibration for adjustment of the reference masks and more accurate detection of defects and deviations from the energy-efficient mode of operation of the fan installations is given.

Nordic Guidance Levels for Patient Doses in Diagnostic Radiology

International Nuclear Information System (INIS)

Saxebol, G.; Olerud, H.M.; Hjardemaal, O.; Leitz, W.; Servomaa, A.; Walderhaug, T.

1998-01-01

Within the framework of Nordic authoritative cooperation in radiation protection and nuclear safety, recommendations have been prepared dealing with dose constraints in diagnostic radiology. A working group with participants from all the Nordic countries has met and discussed possible implementations of the ICRP dose constraint for medical radiology. Dose constraints, expressed as guidance levels, were specified for six different radiological examinations, i.e. chest, pelvis, lumbar spine, urography, barium meal and enema in units of kerma-area product and entrance surface dose. The recommendations are described in report No 5 in the series 'Report on Nordic Radiation Protection Cooperation'. Examples of dose distributions and factors affecting the patient dose are described in the report. (author)

Diagnostic accuracy of high-definition CT coronary angiography in high-risk patients

International Nuclear Information System (INIS)

Iyengar, S.S.; Morgan-Hughes, G.; Ukoumunne, O.; Clayton, B.; Davies, E.J.; Nikolaou, V.; Hyde, C.J.; Shore, A.C.; Roobottom, C.A.

2016-01-01

Aim: To assess the diagnostic accuracy of computed tomography coronary angiography (CTCA) using a combination of high-definition CT (HD-CTCA) and high level of reader experience, with invasive coronary angiography (ICA) as the reference standard, in high-risk patients for the investigation of coronary artery disease (CAD). Materials and methods: Three hundred high-risk patients underwent HD-CTCA and ICA. Independent experts evaluated the images for the presence of significant CAD, defined primarily as the presence of moderate (≥50%) stenosis and secondarily as the presence of severe (≥70%) stenosis in at least one coronary segment, in a blinded fashion. HD-CTCA was compared to ICA as the reference standard. Results: No patients were excluded. Two hundred and six patients (69%) had moderate and 178 (59%) had severe stenosis in at least one vessel at ICA. The sensitivity, specificity, positive predictive value, and negative predictive value were 97.1%, 97.9%, 99% and 93.9% for moderate stenosis, and 98.9%, 93.4%, 95.7% and 98.3%, for severe stenosis, on a per-patient basis. Conclusion: The combination of HD-CTCA and experienced readers applied to a high-risk population, results in high diagnostic accuracy comparable to ICA. Modern generation CT systems in experienced hands might be considered for an expanded role. - Highlights: • Diagnostic accuracy of High-Definition CT Angiography (HD-CTCA) has been assessed. • Invasive Coronary angiography (ICA) is the reference standard. • Diagnostic accuracy of HD-CTCA is comparable to ICA. • Diagnostic accuracy is not affected by coronary calcium or stents. • HD-CTCA provides a non-invasive alternative in high-risk patients.

Estimating the true accuracy of diagnostic tests for dengue infection using bayesian latent class models.

Directory of Open Access Journals (Sweden)

Wirichada Pan-ngum

Full Text Available Accuracy of rapid diagnostic tests for dengue infection has been repeatedly estimated by comparing those tests with reference assays. We hypothesized that those estimates might be inaccurate if the accuracy of the reference assays is not perfect. Here, we investigated this using statistical modeling.Data from a cohort study of 549 patients suspected of dengue infection presenting at Colombo North Teaching Hospital, Ragama, Sri Lanka, that described the application of our reference assay (a combination of Dengue IgM antibody capture ELISA and IgG antibody capture ELISA and of three rapid diagnostic tests (Panbio NS1 antigen, IgM antibody and IgG antibody rapid immunochromatographic cassette tests were re-evaluated using bayesian latent class models (LCMs. The estimated sensitivity and specificity of the reference assay were 62.0% and 99.6%, respectively. Prevalence of dengue infection (24.3%, and sensitivities and specificities of the Panbio NS1 (45.9% and 97.9%, IgM (54.5% and 95.5% and IgG (62.1% and 84.5% estimated by bayesian LCMs were significantly different from those estimated by assuming that the reference assay was perfect. Sensitivity, specificity, PPV and NPV for a combination of NS1, IgM and IgG cassette tests on admission samples were 87.0%, 82.8%, 62.0% and 95.2%, respectively.Our reference assay is an imperfect gold standard. In our setting, the combination of NS1, IgM and IgG rapid diagnostic tests could be used on admission to rule out dengue infection with a high level of accuracy (NPV 95.2%. Further evaluation of rapid diagnostic tests for dengue infection should include the use of appropriate statistical models.

Diagnostics

DEFF Research Database (Denmark)

Donné, A.J.H.; Costley, A.E.; Barnsley, R.

2007-01-01

of the measurements—time and spatial resolutions, etc—will in some cases be more stringent. Many of the measurements will be used in the real time control of the plasma driving a requirement for very high reliability in the systems (diagnostics) that provide the measurements. The implementation of diagnostic systems...... on ITER is a substantial challenge. Because of the harsh environment (high levels of neutron and gamma fluxes, neutron heating, particle bombardment) diagnostic system selection and design has to cope with a range of phenomena not previously encountered in diagnostic design. Extensive design and R......&D is needed to prepare the systems. In some cases the environmental difficulties are so severe that new diagnostic techniques are required. The starting point in the development of diagnostics for ITER is to define the measurement requirements and develop their justification. It is necessary to include all...

Diagnostic Value of Procalcitonin Levels in Acute Mesenteric Ischemia

Directory of Open Access Journals (Sweden)

Yunus Karaca

2015-09-01

Full Text Available Background: Acute mesenteric ischemia (AMI is a potentially fatal disease. Difficulties in diagnosis make it essential to find early biomarkers. Aims: This study investigated the diagnostic value of procalcitonin (PCT levels in AMI. Study Design: Animal experimentation. Methods: Rats were divided into six groups of six animals each. In the experimental group, an experimental ischemia model was established by clamping the superior mesenteric artery from the aortic outflow tract. Blood and tissue specimens were collected from rats in the experimental mesenteric ischemia model at 30 min and 2 and 6 h, and these were compared with specimens from the respective control groups. PCT levels were compared at 30 min and 2 and 6 h. Results: PCT levels were 185.3 pg/mL in the control group and 219.3 pg/mL in the study group, 199.6 pg/mL in the control group and 243.9 pg/mL in the study group, and 201.9 pg/mL in the control group and 286.9 pg/mL in the study group, respectively, at 30 minute, 2 and 6 hours. Significant differences were determined between 6-h control group and ischemia group PCT levels (p=0.005. Conclusion: The absence of a significant increase in PCT levels in the early period, while a significant difference was detected in the later period (6 h, shows that PCT levels rise late in mesenteric ischemia and can be a marker in the late period.

Advice concerning the advantages of a reference incinerator for low-level and intermediate-level radioactive waste processing

International Nuclear Information System (INIS)

Luyten, G.B.

1985-05-01

In this report, an inventory is presented of new incinerators and flue gas filters used in low and intermediate-level radioactive waste combustion. It is argued that a 'reference equipment' for the combustion of solid and liquid low- and intermediate-level wastes best meets existing Dutch radiation protection standards. A cost-benefit analysis of such an equipment is given including annual costs of investment, capital and exploration. A separate combustion process of organic liquids and carrions is considered finally. (G.J.P.)

Implantation of radiodiagnostic reference radiations at the CDTN/CNEN for dosemeter calibration

International Nuclear Information System (INIS)

Baptista Neto, A.T.; Oliveira, P.M.C. de; Ferreira, F.C.B.

2009-01-01

A reliable dosimetry in diagnostic radiology is based on the traceability of calibrated and type-tested dosimeters in reference radiations that were established by the International Electrotechnical Commission (IEC). Metrology laboratories are expected to implement the reference radiations by reproducing the x-ray beam parameters within standard limits. This work shows the results of the implementation in the CDTN/CNEN-MG of the reference radiations for diagnostic radiology. The half value-layers and the homogeneity coefficients were determined for the primary (RQR), attenuated (RQA) and computerized tomography (RQT) x-ray beams. Results complied with the IEC limits which it means that the CDTN and the IEC reference radiations are similar and they can be used for calibration and type-testing of dosimeters to be used in diagnostic radiology. (author)

Diagnostic value of soluble CD163 serum levels in patients suspected of meningitis: comparison with CRP and procalcitonin

DEFF Research Database (Denmark)

Knudsen, Troels Bygum; Larsen, Klaus; Kristiansen, Thomas Birk

2007-01-01

The aim of the study was to evaluate and compare the diagnostic value of sCD163 serum levels with CRP and PCT in meningitis and bacterial infection. An observational cohort study was conducted between February 2001 and February 2005. The study population comprised 55 patients suspected of meningi......The aim of the study was to evaluate and compare the diagnostic value of sCD163 serum levels with CRP and PCT in meningitis and bacterial infection. An observational cohort study was conducted between February 2001 and February 2005. The study population comprised 55 patients suspected...... marker for distinguishing bacterial infection from non-bacterial disease (specificity 0.91; sensitivity 0.47). However, the overall diagnostic accuracy of CRP (AUC =0.91) and PCT (AUC =0.87) were superior (p... infection, the AUC of sCD163 (0.83) did not differ significantly from those of CRP or PCT. All markers had AUCs CRP and PCT had high diagnostic value and were superior as markers of bacterial infection compared to s...

The role of general practice in routes to diagnosis of lung cancer in Denmark: a population-based study of general practice involvement, diagnostic activity and diagnostic intervals.

Science.gov (United States)

Guldbrandt, Louise Mahncke; Fenger-Grøn, Morten; Rasmussen, Torben Riis; Jensen, Henry; Vedsted, Peter

2015-01-22

Lung cancer stage at diagnosis predicts possible curative treatment. In Denmark and the UK, lung cancer patients have lower survival rates than citizens in most other European countries, which may partly be explained by a comparatively longer diagnostic interval in these two countries. In Denmark, a pathway was introduced in 2008 allowing general practitioners (GPs) to refer patients suspected of having lung cancer directly to fast-track diagnostics. However, symptom presentation of lung cancer in general practice is known to be diverse and complex, and systematic knowledge of the routes to diagnosis is needed to enable earlier lung cancer diagnosis in Denmark. This study aims to describe the routes to diagnosis, the diagnostic activity preceding diagnosis and the diagnostic intervals for lung cancer in the Danish setting. We conducted a national registry-based cohort study on 971 consecutive incident lung cancer patients in 2010 using data from national registries and GP questionnaires. GPs were involved in 68.3% of cancer patients' diagnostic pathways, and 27.4% of lung cancer patients were referred from the GP to fast-track diagnostic work-up. A minimum of one X-ray was performed in 85.6% of all cases before diagnosis. Patients referred through a fast-track route more often had diagnostic X-rays (66.0%) than patients who did not go through fast-track (49.4%). Overall, 33.6% of all patients had two or more X-rays performed during the 90 days before diagnosis. Patients whose symptoms were interpreted as non-alarm symptoms or who were not referred to fast-track were more likely to experience a long diagnostic interval than patients whose symptoms were interpreted as alarm symptoms or who were referred to fast-track. Lung cancer patients followed several diagnostic pathways. The existing fast-track pathway must be supplemented to ensure earlier detection of lung cancer. The high incidence of multiple X-rays warrants a continued effort to develop more accurate lung

Diagnostic value of soluble CD163 serum levels in patients suspected of meningitis: comparison with CRP and procalcitonin

DEFF Research Database (Denmark)

Knudsen, Troels Bygum; Larsen, Klaus; Kristiansen, Thomas Birk

2007-01-01

CD163. However, sCD163 may be helpful in rapid identification of patients with systemic bacterial infection. If used as an adjunct to lumbar puncture, PCT and CRP had very high diagnostic accuracy for distinguishing between bacterial and viral infection in patients with spinal fluid pleocytosis. However......-operating characteristic AUCs (areas under curves). Patients were classified by 2 sets of diagnostic criteria into: A) purulent meningitis, serous meningitis or non-meningitis, and B) systemic bacterial infection, local bacterial infection or non-bacterial disease. An elevated serum level of sCD163 was the most specific......The aim of the study was to evaluate and compare the diagnostic value of sCD163 serum levels with CRP and PCT in meningitis and bacterial infection. An observational cohort study was conducted between February 2001 and February 2005. The study population comprised 55 patients suspected...

Patient radiation doses and reference levels in pediatric interventional radiology

Energy Technology Data Exchange (ETDEWEB)

Habib Geryes, Bouchra; Lachaux, Julie; Boddaert, Nathalie; Brunelle, Francis [Hopital Universitaire Necker Enfants Malades, Department of Paediatric Radiology, Paris (France); Bak, Adeline; Ozanne, Augustin; Saliou, Guillaume [Hopital Bicetre, Hopitaux Universitaires Paris-Sud, Department of Neuroradiology, Le Kremlin Bicetre (France); Naggara, Olivier [Hopital Universitaire Necker Enfants Malades, Department of Paediatric Radiology, Paris (France); Centre Hospitalier Sainte-Anne, Universite Paris Descartes Sorbonne Paris Cite, Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasculaire, Paris (France); Centre Hospitalier Sainte-Anne, Department of Neuroradiology, Universite Paris Descartes, Sorbonne Paris Cite, INSERM UMR894, Paris (France)

2017-09-15

To describe, in a multicentric paediatric population, reference levels (RLs) for three interventional radiological procedures. From January 2012 to March 2015, children scheduled for an interventional radiological procedure in two French tertiary centres were retrospectively included and divided into four groups according to age: children younger than 2 years (A1), aged 2-7 years (A5), 8-12 years (A10) and 13-18 years (A15). Three procedures were identified: cerebral digital subtraction angiography (DSA), brain arteriovenous malformation (bAVM) embolization, and head and neck superficial vascular malformation (SVM) percutaneous sclerotherapy. Demographic and dosimetric data, including dose area product (DAP), were collected. 550 procedures were included. For DSA (162 procedures), the proposed RL values in DAP were 4, 18, 12 and 32 Gy.cm{sup 2} in groups A1, A5, A10 and A15, respectively. For bAVM embolization (258 procedures), values were 33, 70, 105 and 88 Gy.cm{sup 2} in groups A1, A5, A10 and A15, respectively. For SVM sclerotherapy (130 procedures), values were 350, 790, 490 and 248 mGy.cm{sup 2} in groups A1, A5, A10 and A15, respectively. Consecutive data were available to permit a proposal of reference levels for three major paediatric interventional radiology procedures. (orig.)

Diagnostic accuracy at several reduced radiation dose levels for CT imaging in the diagnosis of appendicitis

Science.gov (United States)

Zhang, Di; Khatonabadi, Maryam; Kim, Hyun; Jude, Matilda; Zaragoza, Edward; Lee, Margaret; Patel, Maitraya; Poon, Cheryce; Douek, Michael; Andrews-Tang, Denise; Doepke, Laura; McNitt-Gray, Shawn; Cagnon, Chris; DeMarco, John; McNitt-Gray, Michael

2012-03-01

Purpose: While several studies have investigated the tradeoffs between radiation dose and image quality (noise) in CT imaging, the purpose of this study was to take this analysis a step further by investigating the tradeoffs between patient radiation dose (including organ dose) and diagnostic accuracy in diagnosis of appendicitis using CT. Methods: This study was IRB approved and utilized data from 20 patients who underwent clinical CT exams for indications of appendicitis. Medical record review established true diagnosis of appendicitis, with 10 positives and 10 negatives. A validated software tool used raw projection data from each scan to create simulated images at lower dose levels (70%, 50%, 30%, 20% of original). An observer study was performed with 6 radiologists reviewing each case at each dose level in random order over several sessions. Readers assessed image quality and provided confidence in their diagnosis of appendicitis, each on a 5 point scale. Liver doses at each case and each dose level were estimated using Monte Carlo simulation based methods. Results: Overall diagnostic accuracy varies across dose levels: 92%, 93%, 91%, 90% and 90% across the 100%, 70%, 50%, 30% and 20% dose levels respectively. And it is 93%, 95%, 88%, 90% and 90% across the 13.5-22mGy, 9.6-13.5mGy, 6.4-9.6mGy, 4-6.4mGy, and 2-4mGy liver dose ranges respectively. Only 4 out of 600 observations were rated "unacceptable" for image quality. Conclusion: The results from this pilot study indicate that the diagnostic accuracy does not change dramatically even at significantly reduced radiation dose.

Diagnostic value and timing of serum antichlamidial antibody level evaluation during infertility workup among infertile women in whom tubal factor was detected with diagnostic laparoscopy

Directory of Open Access Journals (Sweden)

Serkan Kahyaoğlu

2012-03-01

Full Text Available OBJECTIVES: With normal hysterosalpingography (HSG results, selecting suitable candidates for the laparoscopic treatment of probable pelvic adhesions following previous pelvic inflammatory disease, it would be wise to investigate serum antibody screening against chlamidia trachomatis. It is worth to evaluate whether it is useful to detect a negative antichlamidial antibody disease for cancelling laparoscopy for a while with abnormal HSG findings. These two subjects have been investigated in study. MATERIAL AND METHODS: For detecting diagnostic value of serum antichlamidial antibody, in our infertility clinic, postoperative blood samples of 80 patients who were hospitalized for diagnostic laparoscopy to investigate infertility ethiology between May 2004 and November 2005 have been tested with microelisa method for antichlamidial IgM and IgG antibodies. HSG films of the patients performed at least one year were evaluated. Venous blood was drawn from these patients during postoperative early period for studying serum IgM and IgG antibodies of chlamidia trachomatis and the results were compared with operative findings. RESULTS: According to the antichlamidial antibody levels 60 (75% patients have not been infected with chlamidia and 20 (25% patients have been infected previously. When the patients were divided to two groups; normal and abnormal; based on preoperative HSG films; 18 (30% of the 60 patients with abnormal HSG films and 2 (10% of the 20 patients with normal HSG films had positive antichlamidial antibody levels respectively. CONCLUSION: The relationship between chlamidia trachomatis infection and tubal infertility has been demonstrated among 85% of patients with positive antichlamidial antibody levels and 46.7% of patients with negative levels who had tubal passage defects detected during diagnostic laparoscopy.

Reference Dose Rates for Fluoroscopy Guided Interventions

International Nuclear Information System (INIS)

Geleijns, J.; Broerse, J.J.; Hummel, W.A.; Schalij, M.J.; Schultze Kool, L.J.; Teeuwisse, W.; Zoetelief, J.

1998-01-01

The wide diversity of fluoroscopy guided interventions which have become available in recent years has improved patient care. They are being performed in increasing numbers, particularly at departments of cardiology and radiology. Some procedures are very complex and require extended fluoroscopy times, i.e. longer than 30 min, and radiation exposure of patient and medical staff is in some cases rather high. The occurrence of radiation-induced skin injuries on patients has shown that radiation protection for fluoroscopy guided interventions should not only be focused on stochastic effects, i.e. tumour induction and hereditary risks, but also on potential deterministic effects. Reference dose levels are introduced by the Council of the European Communities as an instrument to achieve optimisation of radiation protection in radiology. Reference levels in conventional diagnostic radiology are usually expressed as entrance skin dose or dose-area product. It is not possible to define a standard procedure for complex interventions due to the large inter-patient variations with regard to the complexity of specific interventional procedures. Consequently, it is not realistic to establish a reference skin dose or dose-area product for complex fluoroscopy guided interventions. As an alternative, reference values for fluoroscopy guided interventions can be expressed as the entrance dose rates on a homogeneous phantom and on the image intensifier. A protocol has been developed and applied during a nationwide survey of fluoroscopic dose rate during catheter ablations. From this survey reference entrance dose rates of respectively 30 mGy.min -1 on a polymethylmethacrylate (PMMA) phantom with a thickness of 21 cm, and of 0.8 μGy.s -1 on the image intensifier have been derived. (author)

Calibration methodology for instruments utilized in X radiation beams, diagnostic level

International Nuclear Information System (INIS)

Penha, M. da; Potiens, A.; Caldas, L.V.E.

2004-01-01

Methodologies for the calibration of diagnostic radiology instruments were established at the Calibration Laboratory of IPEN. The methods may be used in the calibration procedures of survey meters used in radiation protection measurements (scattered radiation), instruments used in direct beams (attenuated and non attenuated beams) and quality control instruments. The established qualities are recommended by the international standards IEC 1267 and ISO 4037-3. Two ionization chambers were used as reference systems, one with a volume of 30 cm 3 for radiation protection measurements, and the other with a volume of 1 cm 3 for direct beam measurements. Both are traceable to the German Primary Laboratory of Physikalisch-Technische Bundesanstalt (PTB). In the case of calibration of quality control instruments, a non-invasive method using the measurement of the spectrum endpoint was established with a portable gamma and X-ray Intertechnique spectrometer system. The methods were applied to survey meters (radiation protection measurements), ionization chambers (direct beam measurements) and k Vp meters (invasive and non-invasive instruments). (Author)

Calibration methodology for instruments utilized in X radiation beams, diagnostic level

Energy Technology Data Exchange (ETDEWEB)

Penha, M. da; Potiens, A.; Caldas, L.V.E. [Instituto de Pesquisas Energeticas e Nucleares, Comissao Nacional de Energia Nuclear, Sao Paulo (Brazil)]. E-mail: mppalbu@ipen.br

2004-07-01

Methodologies for the calibration of diagnostic radiology instruments were established at the Calibration Laboratory of IPEN. The methods may be used in the calibration procedures of survey meters used in radiation protection measurements (scattered radiation), instruments used in direct beams (attenuated and non attenuated beams) and quality control instruments. The established qualities are recommended by the international standards IEC 1267 and ISO 4037-3. Two ionization chambers were used as reference systems, one with a volume of 30 cm{sup 3} for radiation protection measurements, and the other with a volume of 1 cm{sup 3} for direct beam measurements. Both are traceable to the German Primary Laboratory of Physikalisch-Technische Bundesanstalt (PTB). In the case of calibration of quality control instruments, a non-invasive method using the measurement of the spectrum endpoint was established with a portable gamma and X-ray Intertechnique spectrometer system. The methods were applied to survey meters (radiation protection measurements), ionization chambers (direct beam measurements) and k Vp meters (invasive and non-invasive instruments). (Author)

Correlation electron cyclotron emission diagnostic and improved calculation of turbulent temperature fluctuation levels on ASDEX Upgrade

Science.gov (United States)

Creely, A. J.; Freethy, S. J.; Burke, W. M.; Conway, G. D.; Leccacorvi, R.; Parkin, W. C.; Terry, D. R.; White, A. E.

2018-05-01

A newly upgraded correlation electron cyclotron emission (CECE) diagnostic has been installed on the ASDEX Upgrade tokamak and has begun to perform experimental measurements of electron temperature fluctuations. CECE diagnostics measure small amplitude electron temperature fluctuations by correlating closely spaced heterodyne radiometer channels. This upgrade expanded the system from six channels to thirty, allowing simultaneous measurement of fluctuation level radial profiles without repeat discharges, as well as opening up the possibility of measuring radial turbulent correlation lengths. Newly refined statistical techniques have been developed in order to accurately analyze the fluctuation data collected from the CECE system. This paper presents the hardware upgrades for this system and the analysis techniques used to interpret the raw data, as well as measurements of fluctuation spectra and fluctuation level radial profiles.

42 CFR 410.32 - Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

Science.gov (United States)

2010-10-01

... Procedural Terminology published by the American Medical Association. (3) Levels of supervision. Except where... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.32 Diagnostic x-ray tests, diagnostic laboratory...

Exhaled nitric oxide levels in asthma: Personal best versus reference values.

Science.gov (United States)

Smith, Andrew D; Cowan, Jan O; Taylor, D Robin

2009-10-01

Factors affecting the fraction of nitric oxide in exhaled air (FE(NO)) are multiple. Interpreting values when assessing airways disease may be problematic. Clinically optimum levels have not been defined. We aimed to establish the relationship between predicted values for FE(NO) obtained from equations by Olin et al, Travers et al, and Dressel et al, and normalized levels after oral prednisone. We also compared postprednisone FE(NO) levels with those obtained during optimized treatment with inhaled fluticasone. Data were obtained before and after a trial of oral prednisone (30mg/d for 14 days), and also from a previously published study in which patients had their dose of inhaled corticosteroid adjusted using either FE(NO) or symptoms/lung function to optimize treatment. Seventy-three patients completed the study. The geometric mean FE(NO) after prednisone (17.7 parts per billion [ppb]; 95% CI, 15.5-20.2) was significantly lower than mean FE(NO) at the optimized fluticasone dose (20.2 ppb; 95% CI, 17.1-23.8; P=.04) and at loss of control (27.6 ppb; 95% CI, 22.8-33.4; P values of Olin et al (16.8 ppb, 95% CI, 16.0-17.5; P=.44), but were significantly lower than values of Travers et al (predicted, 21.5 ppb; 95% CI, 20.9-22.2; P=.005) and Dressel et al (predicted, 27.8 ppb; 95% CI, 26.7-28.9; P values from the reference equation by Olin et al. However, at optimized doses of inhaled corticosteroid, although FE(NO) levels were higher than predicted, asthma was well controlled. Targeting FE(NO) on reference values is not justified.

Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain

Directory of Open Access Journals (Sweden)

Tropp Hans

2005-06-01

Full Text Available Abstract Background The tissue origin of low back pain (LBP or referred lower extremity symptoms (LES may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. Methods We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses. Results In a sample of chronic LBP patients (n = 216 with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement

Clinical applications of SONIALVISION 100 digital diagnostic table system

International Nuclear Information System (INIS)

Shiomi, Takeshi; Shimizu, Tatsuya; Iinuma, Masao; Takemoto, Hajime; Tanaka, Shuji

2003-01-01

This report refers to the clinical applications of our newly developed SONIALVISION 100 fully digitalized X-ray diagnostic table system. The main design concept of the SONIALVISION 100 system is the improvement of workflow in various clinical fields. The development of digital imaging technologies has come to allow fully digitalized X-ray diagnostic table systems to be widely utilized in various clinical applications, including interventional radiology (IVR) and examinations using contrast medium. This report mainly refers to the clinical applications of the Shimadzu SONIALVISION 100 digitalized X-ray diagnostic table system, also presenting some typical image data demonstrating the high efficiency, made available through the use of this new system, in high-speed spot imaging and digital tomography. (author)

Reference radiology in nephroblastoma: accuracy and relevance for preoperative chemotherapy

International Nuclear Information System (INIS)

Schenk, J.P.; Schrader, C.; Zieger, B.; Ley, S.; Troeger, J.; Furtwaengler, R.; Graf, N.; Leuschner, I.

2006-01-01

Purpose: A reference radiologic diagnosis was carried out for the purpose of quality control and in order to achieve high diagnostic accuracy in the ongoing trial and study SIOP 2001/GPOH for renal tumors during childhood. The aim of the present study is to evaluate the value of diagnostic imaging and the benefit of reference evaluation at a pediatric radiology center. Materials and Methods: In 2004 the imaging studies of 97 patients suspected of having a renal tumor were presented at the beginning of therapy. Diagnostic imaging was compared to the primary imaging results and the histological findings and was analyzed in regard to the therapeutic consequence (primary chemotherapy without prior histology). 77 MRI, 35 CT and 67 ultrasound examinations of 47 girls and 50 boys (mean age 4 years; one day to 15.87 years old) were analyzed. In addition to the histological findings, the reference pathological results were submitted in 86 cases. Results from the primary imaging corresponding to the histology and results from the reference radiology corresponding to the histology and results from the reference radiology corresponding to the histology were statistically compared in a binomial test. Results: In 76 of the reference-diagnosed Wilms' tumors, 67 were confirmed histologically. In 72 cases preoperative chemotherapy was initiated. In 5 cases neither a Wilms' tumor nor a nephroblastomatosis was found. 16 of 21 cases (76%) with reference-diagnosed non-Wilms' tumors were selected correctly. The results of the primary imaging corresponded to the histology in 71 cases, and those of the reference radiology in 82 cases. The statistical evaluation showed that the results of the reference radiology were significantly better (p=0.03971). (orig.)

Development of a concept for radiation patients exposure assessment during dental X-ray examinations and statistical data acquisition for the determination of a diagnostic reference value

International Nuclear Information System (INIS)

Kueppers, C.; Sering, M.; Poppe, B.; Poplawski, A.; Looe, H.K.; Beyer, D.; Pfaffenberger, A.; Chofor, N.; Eenboom, F.

2012-01-01

The research project on the development a concept for radiation patients exposure assessment during dental X-ray examinations and statistical data acquisition for the determination of a diagnostic reference value includes the following issues: Fundamental facts: dental X-ray examination techniques, dose relevant factors and characteristics during X-ray examinations, radiation exposed organs during dental X-ray examinations, dose assessment based on phantoms. Materials and methodologies of the project: TLD measurements using the phantom, calculation of the effective dose during dental X-ray examinations, properties and settings of the reference facilities for the determination of radiation exposure, selection of dental offices, dosimetric measurements, data acquisition and statistical evaluation. Results of dosimetric examinations: results of dosimetric measurements at reference facilities, results of dosimetric measurements in dental offices. Discussion of the concept for the determination of the radiation exposure during dental X-ray examinations.

Discovery and validation of plasma-protein biomarker panels for the detection of colorectal cancer and advanced adenoma in a Danish collection of samples from patients referred for diagnostic colonoscopy

DEFF Research Database (Denmark)

Blume, John E.; Wilhelmsen, Michael; Benz, Ryan W.

2016-01-01

and utilization of such a resource is an important step in the development of blood-based biomarker tests for colorectal cancer.Methods: We have created a subject data and biological sample resource, Endoscopy II, which is based on 4698 individuals referred for diagnostic colonoscopy in Denmark between May 2010...

Diagnostic serum vitamin D level is not a reliable prognostic factor for resectable breast cancer.

Science.gov (United States)

Mizrak Kaya, Dilsa; Ozturk, Bengi; Kubilay, Pinar; Onur, Handan; Utkan, Gungor; Cay Senler, Filiz; Alkan, Ali; Yerlikaya, Halis; Koksoy, Elif B; Karci, Ebru; Demirkazik, Ahmet; Akbulut, Hakan; Icli, Fikri

2018-05-09

There are inconsistent results about the effects of vitamin D level on breast cancer prognosis. We aimed to investigate the effect of vitamin D levels on the prognosis of resectable breast cancer in a patient group with highly different clothing styles. A total of 186 breast cancer patients were enrolled in the study. Vitamin D level was sufficient, insufficient and deficient in 17.2, 52.2 and 30.6% of patients, respectively. There was a significant relationship between clothing style and serum 25 (OH) D levels. We could not establish any relation between vitamin D level and tumor characteristics or survival. Vitamin D supplementation can be more important than diagnostic serum vitamin D level on prognosis of breast cancer.

Quality assurance, quality control and quality audit in diagnostic radiology

International Nuclear Information System (INIS)

Vassileva, J.

2009-01-01

Full text:The lecture aims to present contemporary view of quality assurance in X-Ray diagnosis and its practical realization in Bulgaria. In the lecture the concepts of quality assurance, quality control and clinical audit will be defined and their scope will be considered. An answer of the following questions will be given: why is it necessary to determine the dose of patient in X-ray studies, what is the reference dose level and how it is used for dosimetric quantity which characterized the patient's exposure in X-ray, mammography and CT scans and how they are measured, who conducted the measurement and how to keep the records, what are the variations of doses in identical tests and what defines them? The findings from a national survey of doses in diagnostic radiology, conducted in 2008-2009 and the developed new national reference levels will be presented. The main findings of the first tests of radiological equipment and the future role of quality control as well as the concept of conducting clinical audit and its role in quality assurance are also presented. Quality assurance of the diagnostic process with minimal exposure of patients is a strategic goal whose realization requires understanding, organization and practical action, both nationally and in every hospital. To achieve this the important role of education and training of physicians, radiological technicians and medical physicists is enhanced

Age-specific reference values for serum FSH and estradiol levels throughout the reproductive period.

Science.gov (United States)

Grisendi, Valentina; Spada, Elena; Argento, Cindy; Plebani, Maddalena; Milani, Silvano; Seracchioli, Renato; Volpe, Annibale; La Marca, Antonio

2014-06-01

High serum day 3 FSH levels are associated with poor ovarian reserve and reduced fertility, but the interpretation of FSH values according to age is still not univocal. The purpose of this study was to determine age-dependent reference values in women with regular menstrual cycles and FSH as a guide for specialists. The study was performed at the Department of Mother-Infant of a University-based tertiary care centre. One-hundred ninety-two healthy normal menstruating women were recruited for the study. All patients attended the department on menstrual cycle day 3 for a blood sample for FSH and estradiol determination. A linear relationship between FSH or estradiol serum levels and age was observed. The FSH level increased by 0.11 IU for every year of age (1 IU for every 9 years of age). The values of FSH and estradiol corresponding to the 5th, 25th, 50th, 75th, 95th centiles for any specific age have been calculated. Serum FSH levels need to be interpreted according to age-dependent reference values. Serum FSH levels on 95th centile for any age may represent a warning sign for reduced ovarian reserve.

On detecting reference level of acrolein content in children's blood

Directory of Open Access Journals (Sweden)

T.S. Ulanova

2017-03-01

Full Text Available The article gives the results of complex chemical-analytical and clinical-laboratory research in course of which biological media of children living in Perm region were examined. To study impacts exerted by exogenous acrolein we examined 156 children in 2014–2016, aged 5–10, attending pre-school facilities and schools, and living in Perm region. As we conducted this research we detected average annual acrolein concentration in atmosphere on the examined territory; this concentration was equal to 0.000024 mg/m3, and it was 1.2 times higher than reference acrolein concentration in the air for chronic inhalation exposure. Average group acrolein concentration in children's blood was 1.2 times authentically higher (р3.96, p≤0.05. We used increased content of delta-aminolevulinic acid in urine as a limiting marker for effects occurring at chronic inhalation exposure to acrolein. Basing on the results of the performed examination we recommend concentration equal to 0.10 mgr/dm 3 as a reference level of acrolein content in blood at chronic inhalation exposure.

Dose management for X-ray and CT. Systematic comparison of exposition values from two institutes to diagnostic reference levels and use of results for optimisation of exposition; Dosismanagement fuer konventionelles Roentgen und CT. Systematischer Vergleich der Expositionswerte zweier radiologischer Institute mit den diagnostischen Referenzwerten und Verwendung der Ergebnisse zur Optimierung der Strahlenexposition bei diagnostischen Untersuchungen

Energy Technology Data Exchange (ETDEWEB)

Schaefer, S.; Alejandre-Lafont, E.; Krombach, G.A. [University Hospital Giessen (Germany). Dept. of Radiology; Schmidt, T. [University Hospital Giessen (Germany). Dept. of Neuroradiology; Gizewski, E.R. [University Hospital Innsbruck (Austria). Dept. of Neuroradiology; Fiebich, M. [University of Applied Sciences, Giessen (Germany). Inst. of Medical Physics and Radiation Protection

2014-08-15

Purpose: In 2 institutions exposure values were evaluated and compared with the 2010 updated diagnostic reference levels (DRL) and possibilities for decreasing the dose assessed. Materials and Methods: Mean exposure values obtained during a 3-month period were calculated for all modalities (X-ray: imaging plate system and digital detector; dual-source 64- and 16- slice spiral CT) as well as examination types were compared to old diagnostic reference levels in addition to DRLs introduced in 2010. Then 10 examinations of all modalities and types were accompanied by a medical physicist and optimized stepwise if necessary. Results: The mean values of X-ray examinations were above DRL. All accompanied examinations were beyond DRL except lateral lumbar spine (LSP) and lateral thoracic X-ray, which were elevated due to statistical outliers from morbidly obese patients or patients with metallic implants. For a-p LSP tube voltage was increased. While image quality was maintained, dose area product (DAP) was reduced by 50% to 123 ±61 cGy.cm{sup 2} for LSP a-p and 30% for lateral LSP to 229 ± 116 cGy.cm{sup 2}. For CT examinations, dose was below DRL. Accompanied examinations of the lumbar spine performed on a 16-slice spiral CT demonstrated a result 68% above DRL with dose length product (DLP) of 840 ± 252 cGy . cm. For optimization, pitch and tube voltage were stepwise increased and DLP reduced below DRL. Conclusion: Systematic analysis of our internal exposure values on the occasion of adaptation of DRL is crucial for prompt detection of exceeded values independently from assessment by the responsible authority and initiation of proper measures for decreasing exposure dose. Hereby active dose management is attained. (orig.)

23 CFR Appendix A to Part 772 - National Reference Energy Mean Emission Levels as a Function of Speed

Science.gov (United States)

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false National Reference Energy Mean Emission Levels as a Function of Speed A Appendix A to Part 772 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF... NOISE Pt. 772, App. A Appendix A to Part 772—National Reference Energy Mean Emission Levels as a...

Strengthening the diagnostic capacity to detect Bio Safety Level 3 organisms in unusual respiratory viral outbreaks.

Science.gov (United States)

van Asten, Liselotte; van der Lubben, Mariken; van den Wijngaard, Cees; van Pelt, Wilfrid; Verheij, Robert; Jacobi, Andre; Overduin, Pieter; Meijer, Adam; Luijt, Dirk; Claas, Eric; Hermans, Mirjam; Melchers, Willem; Rossen, John; Schuurman, Rob; Wolffs, Petra; Boucher, Charles; Bouchier, Charles; Schirm, Jurjen; Kroes, Louis; Leenders, Sander; Galama, Joep; Peeters, Marcel; van Loon, Anton; Stobberingh, Ellen; Schutten, Martin; Koopmans, Marion

2009-07-01

Experience with a highly pathogenic avian influenza outbreak in the Netherlands (2003) illustrated that the diagnostic demand for respiratory viruses at different biosafety levels (including BSL3), can increase unexpectedly and dramatically. We describe the measures taken since, aimed at strengthening national laboratory surge capacity and improving preparedness for dealing with diagnostic demand during outbreaks of (emerging) respiratory virus infections, including pandemic influenza virus. Academic and peripheral medical-microbiological laboratories collaborated to determine minimal laboratory requirements for the identification of viruses in the early stages of a pandemic or a large outbreak of avian influenza virus. Next, an enhanced collaborative national network of outbreak assistance laboratories (OAL) was set up. An inventory was made of the maximum diagnostic throughput that this network can deliver in a period of intensified demand. For an estimate of the potential magnitude of this surge demand, historical counts were calculated from hospital- and physician-based registries of patients presenting with respiratory symptoms. Number of respiratory physician-visits ranged from 140,000 to 615,000 per month and hospitalizations ranged from 3000 to 11,500 per month. The established OAL-network provides rapid diagnostic response with agreed quality requirements and a maximum throughput capacity of 1275 samples/day (38,000 per month), assuming other routine diagnostic work needs to be maintained. Thus surge demand for diagnostics for hospitalized cases (if not distinguishable from other respiratory illness) could be handled by the OAL network. Assessing etiology of community acquired acute respiratory infection however, may rapidly exceed the capacity of the network. Therefore algorithms are needed for triaging for laboratory diagnostics; currently this is not addressed in pandemic preparedness plans.

Arterial blood gas reference values for sea level and an altitude of 1,400 meters.

Science.gov (United States)

Crapo, R O; Jensen, R L; Hegewald, M; Tashkin, D P

1999-11-01

Blood gas measurements were collected on healthy lifetime nonsmokers at sea level (n = 96) and at an altitude of 1,400 meters (n = 243) to establish reference equations. At each study site, arterial blood samples were analyzed in duplicate on two separate blood gas analyzers and CO-oximeters. Arterial blood gas variables included Pa(O(2)), Pa(CO(2)), pH, and calculated alveolar-arterial PO(2) difference (AaPO(2)). CO-oximeter variables were Hb, COHb, MetHb, and Sa(O(2)). Subjects were 18 to 81 yr of age with 166 male and 173 female. Outlier data were excluded from multiple regression analysis, and reference equations were fitted to the data in two ways: (1) best fit using linear, squared, and cross-product terms; (2) simple equations, including only the variables that explained at least 3% of the variance. Two sets of equations were created: (1) using only the sea level data and (2) using the combined data with barometric pressure as an independent variable. Comparisons with earlier studies revealed small but significant differences; the decline in Pa(O(2)) with age at each altitude was consistent with most previous studies. At sea level, the equation that included barometric pressure predicted Pa(O(2)) slightly better than the sea level specific equation. The inclusion of barometric pressure in the equations allows better prediction of blood gas reference values at sea level and at altitudes as high as 1,400 meters.

Study on the diagnostic values of changes of serum endometrium antibody (EMAb) and CA125 (CA125) levels in patients with endometriosis

International Nuclear Information System (INIS)

Yang Jingxiu; Shi Shaohong; Wang Yuping

2005-01-01

Objective: To explore the diagnostic values of changes of serum EMAb and CA125 levels in patients with endometriosis. Methods: Serum EMAb levels were measured with ELISA and CA125 levels with RIA in 54 patients with endometriosis and 35 controls. Results: Positive rate of serum EMAb was significantly higher in the patients with endometriosis than those in controls (P≤0.01). Serum CA125 levels were also significantly higher than those in controls (P<0.01). Conclusion: Combined detection of serum EMAb positive rate and CA125 levels was of diagnostic value in patients with endometriosis. (authors)

Reference design and operations for deep borehole disposal of high-level radioactive waste

International Nuclear Information System (INIS)

Herrick, Courtney Grant; Brady, Patrick Vane; Pye, Steven; Arnold, Bill Walter; Finger, John Travis; Bauer, Stephen J.

2011-01-01

A reference design and operational procedures for the disposal of high-level radioactive waste in deep boreholes have been developed and documented. The design and operations are feasible with currently available technology and meet existing safety and anticipated regulatory requirements. Objectives of the reference design include providing a baseline for more detailed technical analyses of system performance and serving as a basis for comparing design alternatives. Numerous factors suggest that deep borehole disposal of high-level radioactive waste is inherently safe. Several lines of evidence indicate that groundwater at depths of several kilometers in continental crystalline basement rocks has long residence times and low velocity. High salinity fluids have limited potential for vertical flow because of density stratification and prevent colloidal transport of radionuclides. Geochemically reducing conditions in the deep subsurface limit the solubility and enhance the retardation of key radionuclides. A non-technical advantage that the deep borehole concept may offer over a repository concept is that of facilitating incremental construction and loading at multiple perhaps regional locations. The disposal borehole would be drilled to a depth of 5,000 m using a telescoping design and would be logged and tested prior to waste emplacement. Waste canisters would be constructed of carbon steel, sealed by welds, and connected into canister strings with high-strength connections. Waste canister strings of about 200 m length would be emplaced in the lower 2,000 m of the fully cased borehole and be separated by bridge and cement plugs. Sealing of the upper part of the borehole would be done with a series of compacted bentonite seals, cement plugs, cement seals, cement plus crushed rock backfill, and bridge plugs. Elements of the reference design meet technical requirements defined in the study. Testing and operational safety assurance requirements are also defined. Overall

Reference design and operations for deep borehole disposal of high-level radioactive waste.

Energy Technology Data Exchange (ETDEWEB)

Herrick, Courtney Grant; Brady, Patrick Vane; Pye, Steven; Arnold, Bill Walter; Finger, John Travis; Bauer, Stephen J.

2011-10-01

A reference design and operational procedures for the disposal of high-level radioactive waste in deep boreholes have been developed and documented. The design and operations are feasible with currently available technology and meet existing safety and anticipated regulatory requirements. Objectives of the reference design include providing a baseline for more detailed technical analyses of system performance and serving as a basis for comparing design alternatives. Numerous factors suggest that deep borehole disposal of high-level radioactive waste is inherently safe. Several lines of evidence indicate that groundwater at depths of several kilometers in continental crystalline basement rocks has long residence times and low velocity. High salinity fluids have limited potential for vertical flow because of density stratification and prevent colloidal transport of radionuclides. Geochemically reducing conditions in the deep subsurface limit the solubility and enhance the retardation of key radionuclides. A non-technical advantage that the deep borehole concept may offer over a repository concept is that of facilitating incremental construction and loading at multiple perhaps regional locations. The disposal borehole would be drilled to a depth of 5,000 m using a telescoping design and would be logged and tested prior to waste emplacement. Waste canisters would be constructed of carbon steel, sealed by welds, and connected into canister strings with high-strength connections. Waste canister strings of about 200 m length would be emplaced in the lower 2,000 m of the fully cased borehole and be separated by bridge and cement plugs. Sealing of the upper part of the borehole would be done with a series of compacted bentonite seals, cement plugs, cement seals, cement plus crushed rock backfill, and bridge plugs. Elements of the reference design meet technical requirements defined in the study. Testing and operational safety assurance requirements are also defined. Overall

Thermoluminescent dosemeters characterization for patient dosimetry in diagnostic radiology preliminary results

International Nuclear Information System (INIS)

Castro, William J.; Squair, Peterson L.; Gonzaga, Natalia B.; Nogueira, Maria S.; Silva, Teogenes A. da

2009-01-01

The determination of the metrological characteristics of thermoluminescent (TL) dosimeters plays an important role in dosimetry of patients submitted to x-ray examinations for diagnostic purpose. Entrance surface doses can be measured with TL dosimeters to verify the compliance with the diagnostic reference levels. Organ doses can be estimated through TL measurements in an anthropomorphic phantom which it allows the radiation risk assessment. In this work, LiF:Mg,Ti (TLD-100) rod and chip thermoluminescent dosimeters were characterized considering their use for patient dosimetry in computerized tomography and mammography. Preliminary results showed that TL dosimeters have a response reproducibility of 7.8% and 4.8% and homogeneity of 18.4% and 6.5% for rod and chip shapes, respectively. (author)

Basic Restriction and Reference Level in Anatomically-based Japanese Models for Low-Frequency Electric and Magnetic Field Exposures

Science.gov (United States)

Takano, Yukinori; Hirata, Akimasa; Fujiwara, Osamu

Human exposed to electric and/or magnetic fields at low frequencies may cause direct effect such as nerve stimulation and excitation. Therefore, basic restriction is regulated in terms of induced current density in the ICNIRP guidelines and in-situ electric field in the IEEE standard. External electric or magnetic field which does not produce induced quantities exceeding the basic restriction is used as a reference level. The relationship between the basic restriction and reference level for low-frequency electric and magnetic fields has been investigated using European anatomic models, while limited for Japanese model, especially for electric field exposures. In addition, that relationship has not well been discussed. In the present study, we calculated the induced quantities in anatomic Japanese male and female models exposed to electric and magnetic fields at reference level. A quasi static finite-difference time-domain (FDTD) method was applied to analyze this problem. As a result, spatially averaged induced current density was found to be more sensitive to averaging algorithms than that of in-situ electric field. For electric and magnetic field exposure at the ICNIRP reference level, the maximum values of the induced current density for different averaging algorithm were smaller than the basic restriction for most cases. For exposures at the reference level in the IEEE standard, the maximum electric fields in the brain were larger than the basic restriction in the brain while smaller for the spinal cord and heart.

Diagnostic utility of daytime salivary melatonin levels in Smith-Magenis syndrome.

Science.gov (United States)

Chik, Constance L; Rollag, Mark D; Duncan, Wallace C; Smith, Ann C M

2010-01-01

An inverted circadian rhythm of melatonin (MT) likely contributes to the sleep disturbance in patients with Smith-Magenis syndrome (SMS). Plasma MT levels have documented this altered rhythm, but daytime levels of salivary MT has not been determined. Daytime measures of salivary MT might have utility in home/outpatient settings for assessing MT levels in undiagnosed patients with clinical features of SMS. The objective of this study was to determine the utility of daytime salivary MT as a diagnostic test in SMS. Thirty individuals with confirmed SMS [28 with del 17p11.2 and 2 with the retinoic acid induced 1 (RAI1) gene mutation] and five controls were studied. Single or serial daytime salivary MT levels were measured. The mean midday salivary MT level was 79.0 pg/ml in SMS patients, compared with 16.3 pg/ml in controls, with nine patients having values similar to controls. The median MT level in SMS patients was 49.0 pg/ml (first and third quartile values = 15.5 and 106.8 pg/ml). Twenty-six (90%) of 29 patients had at least one MT value >15.5 pg/ml, including 70 (78%) of 90 samples from patients with del 17p11.2 and one (20%) of five samples from the two patients with the RAI1 mutation. Neither the pattern of medication use nor age had an effect on daytime salivary MT levels. Although most SMS patients had elevated daytime salivary MT levels, multiple sampling appears necessary to distinguish patients with SMS from other conditions.

Farm-level risk factors for Fasciola hepatica infection in Danish dairy cattle as evaluated by two diagnostic methods

DEFF Research Database (Denmark)

Takeuchi-Storm, Nao; Denwood, Matthew; Hansen, Tina Vicky Alstrup

2017-01-01

) as a tool for diagnosis in Danish dairy cattle farms was assessed. This case-control study aimed to identify farm-level risk factors for fasciolosis in Danish dairy farms (> 50 animals slaughtered in 2013) using two diagnostic methods: recordings of liver condemnation at slaughter, and farm-level Fasciola...

Lipid Panel Reference Intervals for Amazon Parrots (Amazona species).

Science.gov (United States)

Ravich, Michelle; Cray, Carolyn; Hess, Laurie; Arheart, Kristopher L

2014-09-01

The lipoprotein panel is a useful diagnostic tool that allows clinicians to evaluate blood lipoprotein fractions. It is a standard diagnostic test in human medicine but is poorly understood in avian medicine. Amazon parrots (Amazona species) are popular pets that frequently lead a sedentary lifestyle and are customarily fed high-fat diets. Similar to people with comparable diets and lifestyles, Amazon parrots are prone to obesity and atherosclerosis. In human medicine, these conditions are typically correlated with abnormalities in the lipoprotein panel. To establish reference intervals for the lipoprotein panel in Amazon parrots, plasma samples from 31 captive Amazon parrots were analyzed for concentrations of cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL). The data were also grouped according to sex, diet, body condition score, and age. Aside from HDL levels, which were significantly different between male and female parrots, no intergroup differences were found for any of the lipoprotein fractions.

Diagnostic accuracy of direct ophthalmoscopy for detection of diabetic retinopathy using fundus photographs as a reference standard.

Science.gov (United States)

Ahsan, Shahid; Basit, Abdul; Ahmed, Kazi Rumana; Ali, Liaquat; Shaheen, Fariha; Ulhaque, Muhammad Saif; Fawwad, Asher

2014-01-01

To determine the diagnostic accuracy of direct ophthalmoscopy for the presence and severity of diabetic retinopathy (DR) using fundus photographs as a reference standard. Patients with type 2 diabetes attending the outpatient department (OPD) of a tertiary care diabetes center, from October 2009 to March 2010 were recruited in the study after obtaining signed informed consent. Patients with type 1 diabetes and gestational diabetes or having eye problems were excluded. After checking visual acuity, direct ophthalmoscopy of each eye was done by diabetologist, followed by photography of two fields of retina by fundus camera. DR was graded by a retinal specialist, according to International Diabetic Retinopathy Disease Severity Scale. According to severity, patients with DR were grouped into non-sight threatening diabetic retinopathy (NSTDR) and sight threatening diabetic retinopathy (STDR). Sensitivity and specificity of direct ophthalmoscopy for detection of any retinopathy, NSTDR and STDR was calculated. A total of 728 eyes were examined by direct ophthalmoscopy as well as fundus photography. Sensitivity (95% CI) of direct ophthalmoscopy for any retinopathy, NSTDR and STDR was found to be 55.67% (50.58-60.78), 37.63% (32.67-42.59) and 68.25% (63.48-73.02) respectively. Whereas, specificity of direct ophthalmoscopy was found to be 76.78% (72.45-81.11), 71.27% (CI: 66.63-75.91) and 90.0% (86.93-93.07) for any retinopathy, NSTDR and STDR respectively. The sensitivity and specificity of direct ophthalmoscopy performed by the diabetologist for the presence and severity of DR was lower compared to the recommended level of sensitivity and specificity of a screening test of DR. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Diagnostic value of combined determination of serum CEA, CA72-4 and TSGF levels in patients with gastric cancer

International Nuclear Information System (INIS)

Wang Yuyi; Gu Yan

2007-01-01

Objective: To explore the diagnostic value of combined determination of serum CEA, CA72-4 and TSGF levels for gastric cancer. Methods: Serum CEA, CA72-4(with RIA) and TSGF (with biochemistry)levels were measured in 31 patients with gastric cancer and 35 controls. Results: As a single tumor marker for diagnosis, the sensitivity of CEA, CA72-4 and TSGF was 23. 0%, 38.0%, 48.0% respectively and the specificity was 23.0%, 38.0%, 48.0% respectively with combined detection of the three markers and assuming two or more markers positive as diagnostic, the sensitivity would be 67.0% and specificity would be 88.0%. Conclusion: Combined determination of serum CEA, CA72-4 and TSGF levels could promote the clinical usefulness for diagnosis of gastric cancer. (authors)

Reference levels in PTCA as a function of procedure complexity

International Nuclear Information System (INIS)

Peterzol, A.; Quai, E.; Padovani, R.; Bernardi, G.; Kotre, C. J.; Dowling, A.

2005-01-01

The multicentre assessment of a procedure complexity index (CI) for the introduction of reference levels (RLs) in percutaneous transluminal coronary angio-plasties (PTCA) is presented here. PTCAs were investigated based on methodology proposed by Bernardi et al. Multiple linear stepwise regression analysis, including clinical, anatomical and technical factors, was performed to obtain fluoroscopy time predictors. Based on these regression coefficients, a scoring system was defined and CI obtained. CI was used to classify dose values into three groups: low, medium and high complexity procedures, since there was good correlation (r = 0.41; P 2 , and 12, 20 and 27 min for fluoroscopy time, for the three CI groups. (authors)

Computer System For Diagnostics of Mobile Machinery Transmission

Directory of Open Access Journals (Sweden)

G. L. Antipenko

2004-01-01

Full Text Available A new method for diagnostics of mechanical transmissions of mobile machinery is proposed in the paper. The method presupposes an application of computing equipment and its purpose is to decrease labor-consumption of diagnostics procedure and increase diagnostics efficiency.The method is based on comparison of duration of impulse periods picked up at primary transducers which are installed at transmission input and output. A signal picked up at a flywheel ring gear is taken as a reference signal.While selecting clearances of one and then the direction in speed-up - braking transmission regime changes in number of reference impulses at output provide data on angular clearance value in every gearing. As data are supplied registration and processing of results and forecasting of residual resource are to be done with the help of a program on the basis of realized algorithms for every gearing.

Development of a low-level radon reference chamber; Entwicklung einer Low-Level-Radon-Referenzkammer

Energy Technology Data Exchange (ETDEWEB)

Linzmaier, Diana

2013-01-04

The naturally occurring, radioactive noble gas radon-222 exists worldwide in different activity concentrations in the air. During the decay of radon-222, decay products are generated which are electrically charged and attach to aerosols in the air. Together with the aerosols, the radon is inhaled and exhaled by humans. While the radon is nearly completely exhaled, ca. 20 % of the inhaled aerosols remain in the lungs in one breath cycle. Due to ionizing radiation, in a chain of events, lung cancer might occur. Consequently, radon and its decay products are according to the current findings the second leading cause of lung cancer. At the workplace and in the home measurements of radon activity concentration are performed to determine the radiation exposition of humans. All measurement devices for the determination of radon activity concentration are calibrated above 1000 Bq/m{sup 3}, even though the mean value of the present investigation in Germany shows only 50 Bq/m{sup 3}. For the calibration of measurement devices in the range below 1000 Bq/m{sup 3} over a long time period, the generation of a stable reference atmosphere is presented in this work. Due to a long term calibration (t>5 days) of the measurement devices, smaller uncertainties result for the calibration factor. For the calibration procedure, a so-called low-level radon reference chamber was set up and started operation. The generation of a stable reference atmosphere is effected by means of emanation sources which consist of a radium-226 activity standard. On the basis of {gamma}-spectrometry, the effective emanation coefficient ofthe emanation sources is determined. The traceability of the activity concentration in the reference volume is realized via the activity ofthe radium-226, the emanation coefficient and the volume. With the emanation sources produced, stable reference atmospheres within the range of 150 Bq/m{sup 3} to 1900 Bq/m{sup 3} are achieved. For the realization, maintenance and

Establishment of new complete blood count reference values for healthy Thai adults.

Science.gov (United States)

Wongkrajang, P; Chinswangwatanakul, W; Mokkhamakkun, C; Chuangsuwanich, N; Wesarachkitti, B; Thaowto, B; Laiwejpithaya, S; Komkhum, O

2018-04-28

Laboratory reference ranges are essential for diagnostic orientation and treatment decision. As complete blood count parameters are influenced by various factors, including gender, geographic origin, and ethnic origin, it is important to establish specific hematologic reference values for specific populations. This study was conducted at the Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Blood samples were taken from healthy adults aged 18-60 years that attended a health check-up program at our hospital during February 2015 to July 2015. Hematologic and routine chemistry analysis were performed. Participants were determined to be healthy based on medical history and routine medical examinations. Serum vitamin B12, folate, ferritin, and hemoglobin typing were also analyzed to exclude the possible presence of anemia. A statistically significant difference was observed between males and females for Hb level, hematocrit level, red blood cell count, mean corpuscular hemoglobin concentration, percentage neutrophils, monocytes and eosinophils, and absolute neutrophil, lymphocyte, basophil, and platelet counts. Accordingly, gender-specific reference intervals were established for all complete blood count parameters in healthy Thai adult population. The reference value ranges established in this study reflect significant differences between genders. It is possible that these reference ranges may be generalizable to adults living in Thailand. The findings of this study emphasize the importance of establishing specific hematologic reference values for specific populations. © 2018 John Wiley & Sons Ltd.

Encyclopedia of diagnostic imaging

International Nuclear Information System (INIS)

Baert, A.L.

2008-01-01

The simple A to Z format provides easy access to relevant information in the field of imaging. Extensive cross references between keywords and related articles enable efficient searches in a user-friendly manner. Fully searchable and hyperlinked electronic online edition. The aim of this comprehensive encyclopedia is to provide detailed information on diagnostic radiology contributing to the broad field of imaging. The wide range of entries are written by leading experts. They will provide basic and clinical scientists in academia, practice and industry with valuable information about the field of diagnostic imaging. Those in related fields, students, teachers, and interested laypeople will also benefit from the important and relevant information on the most recent developments. Please note that this publication is available as print only or online only or print + online set. Save 75% of the online list price when purchasing the bundle. For more information on the online version please type the publication title into the search box above, then click on the eReference version in the results list. (orig.)

Contemporary Australian dose area product levels in the fluoroscopic investigation of paediatric congenital heart disease

International Nuclear Information System (INIS)

Jones, T.; Brennan, P.C.; Mello-Thoms, C.; Ryan, E.

2017-01-01

This study examines radiation dose levels delivered to children from birth to 15 y of age in the investigation of congenital heart disease (CHD) at a major Sydney children's hospital. The aims are to compare values with those derived from similar studies, to provide a template for more consistent dose reporting, to establish local and national diagnostic reference levels and to contribute to the worldwide paediatric dosimetry database. A retrospective review of 1007 paediatric procedural records was undertaken. The cohort consisted of 795 patients over a period from January 2007 to December 2012 who have undergone cardiac catheterisation for the investigation of CHD. The age range included was from the day of birth to 15 y. Archived dose area product (DAP) and fluoroscopy time (FT) readings were retrieved and analysed. The mean, median, 25. and 75. percentile DAP levels were calculated for six specific age groupings. The 75. percentile DAP values for the specific age categories were as follows: 0-30 d-1.9 Gy cm 2 , 1-12 months-2.9 Gy cm 2 , 1-3 y-5.3 Gy cm 2 , 3-5 y-6.2 Gy cm 2 , 5-10 y-7.5 Gy cm 2 and 10-15 y-17.3 Gy cm 2 . These levels were found to be lower than the values reported in comparable overseas studies. Individual year-specific levels were determined, and it is proposed that these are more useful than the common grouping method. The age-specific 75. percentile DAP levels outlined in this study can be used as baseline local diagnostic reference levels. The needs for the standardisation of DAP reporting and for a greater range of age-specific diagnostic reference levels have been highlighted. For the first time, Australian dose values for paediatric cardiac catheterisation are presented. (authors)

Stored object knowledge and the production of referring expressions: The case of color typicality

Directory of Open Access Journals (Sweden)

Hans eWesterbeek

2015-07-01

Full Text Available When speakers describe objects with atypical properties, do they include these properties in their referring expressions, even when that is not strictly required for unique referent identification? Based on previous work, we predict that speakers mention the color of a target object more often when the object is atypically colored, compared to when it is typical. Taking literature from object recognition and visual attention into account, we further hypothesize that this behavior is proportional to the degree to which a color is atypical, and whether color is a highly diagnostic feature in the referred-to object's identity. We investigate these expectations in two language production experiments, in which participants referred to target objects in visual contexts. In Experiment 1, we find a strong effect of color typicality: less typical colors for target objects predict higher proportions of referring expressions that include color. In Experiment 2 we manipulated objects with more complex shapes, for which color is less diagnostic, and we find that the color typicality effect is moderated by color diagnosticity: it is strongest for high-color-diagnostic objects (i.e., objects with a simple shape. These results suggest that the production of atypical color attributes results from a contrast with stored knowledge, an effect which is stronger when color is more central to object identification. Our findings offer evidence for models of reference production that incorporate general object knowledge, in order to be able to capture these effects of typicality on determining the content of referring expressions.

Diagnostics of the Enterprise Export Potential

Directory of Open Access Journals (Sweden)

Skrynkovskyy Ruslan M.

2016-11-01

Full Text Available The aim of the article is to form and develop theoretical and methodological foundations for diagnostics of the enterprise export potential, which should be understood as a process of identification, analysis and assessment of the level of potential possibility and readiness of the enterprise to implement export activities taking into account the impact of interrelated internal variables (goals, technology, structure, tasks, educational and professional potential of the staff and factors of the enterprise external environment (customers, competitors, suppliers, intermediaries, contact audience, etc. in order to ensure a qualitatively new level of its development and formation of its prospects. It is determined that the key business indicators of the system for diagnostics of enterprise export potential are: the level of enterprises competitiveness in the international (global market; the level of competitiveness of enterprise products; the level of competitiveness of enterprise export products; the level of enterprise resource opportunities; the level of enterprise export performance. Prospects for further research in this direction are to develop a classification (specifically detailed list of objectives of the enterprise diagnostics by the level of detail (element, partial, complex, taking into account diagnostics of export potential of the enterprise as part of diagnostic objective.

Dose limits, constraints, reference levels. What does it mean for radiation protection?

International Nuclear Information System (INIS)

Breckow, J.

2016-01-01

The established concept of radiation protection with its basic principles justification, optimization, and limitation has proved its value and is going to be continued. In its deeper meaning, however, the concept is rather subtle and complex. Furthermore, in some aspects there remain some breaches or inconsistencies. This is just true for the terms dose limit, reference lever, and constraint that are tightly associated with the radiation protection principles. In order to guarantee the ability of radiation protection in whole extent, the subtle differences of meaning have to be communicated. There is a permanent need to defend the conceptual function of these terms against deliberate or undeliberate misinterpretations. Reference levels are definitely not the same as dose limits and they may not be misused as such. Any attempt to misinterpret fundamental radiation protection principles for selfish purposes should discouraged vigorously.

Revised and new national reference values for X-ray diagnostic examinations per 2010

International Nuclear Information System (INIS)

2010-01-01

NRPA has revised the national reference values given in the Guide 5b and established reference values for 10 new investigations. The revision / creation is based on new national dose distributions obtained in the period 2006-2009. Reference values are effective from 27 April 2010. (AG)

[Cytology in uropathological diagnostics].

Science.gov (United States)

Gaisa, N T; Lindemann-Docter, K

2015-11-01

Cytology in uropathological diagnostics is mainly performed for oncological purposes. The assessment of malignancy by urothelial cell morphology is therefore decisive; however, cytology is only sensitive enough to detect high-grade tumor cells and the different low-grade tumors cannot be reliably diagnosed. Thus, the four-tier classification system of cytological findings (i.e. negative, atypical cells but significance uncertain, suspicious and positive) refers to high-grade tumor cells only. Furthermore, for valid cytological diagnostics not only the cytological specimen but also clinical information on cystoscopy findings and, if applicable, a biopsy should be evaluated together. In difficult differential diagnostic settings, e.g. differentiation between reactive versus neoplastic atypia or difficult to access lesions in the upper urinary tract, additional fluorescence in situ hybridization of cytological preparations might be helpful. At the moment there are no indications for further immunocytology or additional biomarker tests.

Precise signal amplitude retrieval for a non-homogeneous diagnostic beam using complex interferometry approach

Science.gov (United States)

Krupka, M.; Kalal, M.; Dostal, J.; Dudzak, R.; Juha, L.

2017-08-01

Classical interferometry became widely used method of active optical diagnostics. Its more advanced version, allowing reconstruction of three sets of data from just one especially designed interferogram (so called complex interferogram) was developed in the past and became known as complex interferometry. Along with the phase shift, which can be also retrieved using classical interferometry, the amplitude modifications of the probing part of the diagnostic beam caused by the object under study (to be called the signal amplitude) as well as the contrast of the interference fringes can be retrieved using the complex interferometry approach. In order to partially compensate for errors in the reconstruction due to imperfections in the diagnostic beam intensity structure as well as for errors caused by a non-ideal optical setup of the interferometer itself (including the quality of its optical components), a reference interferogram can be put to a good use. This method of interferogram analysis of experimental data has been successfully implemented in practice. However, in majority of interferometer setups (especially in the case of the ones employing the wavefront division) the probe and the reference part of the diagnostic beam would feature different intensity distributions over their respective cross sections. This introduces additional error into the reconstruction of the signal amplitude and the fringe contrast, which cannot be resolved using the reference interferogram only. In order to deal with this error it was found that additional separately recorded images of the intensity distribution of the probe and the reference part of the diagnostic beam (with no signal present) are needed. For the best results a sufficient shot-to-shot stability of the whole diagnostic system is required. In this paper, efficiency of the complex interferometry approach for obtaining the highest possible accuracy of the signal amplitude reconstruction is verified using the computer

Children with burns referred for child abuse evaluation: Burn characteristics and co-existent injuries.

Science.gov (United States)

Pawlik, Marie-Christin; Kemp, Alison; Maguire, Sabine; Nuttall, Diane; Feldman, Kenneth W; Lindberg, Daniel M

2016-05-01

Intentional burns represent a serious form of physical abuse that must be identified to protect children from further harm. This study is a retrospectively planned secondary analysis of the Examining Siblings To Recognize Abuse (ExSTRA) network data. Our objective was to describe the characteristics of burns injuries in children referred to Child Abuse Pediatricians (CAPs) in relation to the perceived likelihood of abuse. We furthermore compare the extent of diagnostic investigations undertaken in children referred to CAPs for burn injuries with those referred for other reasons. Within this dataset, 7% (215/2890) of children had burns. Children with burns were older than children with other injuries (median age 20 months vs. 10 months). Physical abuse was perceived as likely in 40.9% (88) and unlikely in 59.1% (127). Scalds accounted for 52.6% (113) and contact burns for 27.6% (60). Several characteristics of the history and burn injury were associated with a significantly higher perceived likelihood of abuse, including children with reported inflicted injury, absent or inadequate explanation, hot water as agent, immersion scald, a bilateral/symmetric burn pattern, total body surface area ≥10%, full thickness burns, and co-existent injuries. The rates of diagnostic testing were significantly lower in children with burns than other injuries, yet the yield of skeletal survey and hepatic transaminases testing were comparable between the two groups. This would imply that children referred to CAPs for burns warrant the same level of comprehensive investigations as those referred for other reasons. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

A Comparison of Salivary Steroid Levels during Diagnostic Tests for Adrenal Insufficiency

Directory of Open Access Journals (Sweden)

Michaela Dušková

2016-01-01

Full Text Available Numerous diagnostic tests are used to evaluate the hypothalamic-pituitary-adrenal axis (HPA axis. The gold standard is still considered the insulin tolerance test (ITT, but this test has many limitations. Current guidelines therefore recommend the Synacthen test first when an HPA axis insufficiency is suspected. However, the dose of Synacthen that is diagnostically most accurate and sensitive is still a matter of debate. We investigated 15 healthy men with mean/median age 27.4/26 (SD ±4.8 years, and mean/median BMI (body mass index 25.38/24.82 (SD ±3.2 kg/m2. All subjects underwent 4 dynamic tests of the HPA axis, specifically 1 μg, 10 μg, and 250 μg Synacthen (ACTH tests and an ITT. Salivary cortisol, cortisone, pregnenolone, and DHEA (dehydroepiandrosterone were analysed using liquid chromatography-tandem mass spectrometry. During the ITT maximum salivary cortisol levels over 12.5 nmol/l were found at 60 minutes. Maximum cortisol levels in all of the Synacthen tests were higher than this; however, demonstrating that sufficient stimulation of the adrenal glands was achieved. Cortisone reacted similarly as cortisol, i.e. we did not find any change in the ratio of cortisol to cortisone. Pregnenolone and DHEA were higher during the ITT, and their peaks preceded the cortisol peak. There was no increase of pregnenolone or DHEA in any of the Synacthen tests. We demonstrate that the 10 μg Synacthen dose is sufficient stimulus for testing the HPA axis and is also a safe and cost-effective alternative. This dose also largely eliminates both false negative and false positive results.

Bovine paratuberculosis: a review of the advantages and disadvantages of different diagnostic tests.

Science.gov (United States)

Gilardoni, Liliana R; Paolicchi, Fernando A; Mundo, Silvia L

2012-01-01

Paratuberculosis (PTB), or Johne's disease, is a chronic infectious granulomatous enteritis of ruminants, caused by Mycobacterium avium subspecies paratuberculosis (Map). It is characterized by diarrhea and progressive cachexia, which may cause the death of the animal. Calves are the most susceptible to infection. Infected animals excrete Map mainly by the feces. PTB is endemic worldwide, with high prevalence levels, strong economic impact and public health relevance because of its possible association with Crohn's disease. Although the current reference diagnostic test is identification of Map in the bacterial culture, there are different diagnostic tests to identify infected individuals and/or herds. The sensitivity and specificity of these tests vary according to the stage of the disease in the animals to be evaluated. The correct choice and application of each of these diagnostic tests will ensure their success and may allow to establish a control program. The aim of this work is to review and discuss the different diagnostic tests used in the detection of Map-infected animals, focusing on their advantages and disadvantages.

Component-Level Electronic-Assembly Repair (CLEAR) Spacecraft Circuit Diagnostics by Analog and Complex Signature Analysis

Science.gov (United States)

Oeftering, Richard C.; Wade, Raymond P.; Izadnegahdar, Alain

2011-01-01

The Component-Level Electronic-Assembly Repair (CLEAR) project at the NASA Glenn Research Center is aimed at developing technologies that will enable space-flight crews to perform in situ component-level repair of electronics on Moon and Mars outposts, where there is no existing infrastructure for logistics spares. These technologies must provide effective repair capabilities yet meet the payload and operational constraints of space facilities. Effective repair depends on a diagnostic capability that is versatile but easy to use by crew members that have limited training in electronics. CLEAR studied two techniques that involve extensive precharacterization of "known good" circuits to produce graphical signatures that provide an easy-to-use comparison method to quickly identify faulty components. Analog Signature Analysis (ASA) allows relatively rapid diagnostics of complex electronics by technicians with limited experience. Because of frequency limits and the growing dependence on broadband technologies, ASA must be augmented with other capabilities. To meet this challenge while preserving ease of use, CLEAR proposed an alternative called Complex Signature Analysis (CSA). Tests of ASA and CSA were used to compare capabilities and to determine if the techniques provided an overlapping or complementary capability. The results showed that the methods are complementary.

Wavenumber selection based analysis in Raman spectroscopy improves skin cancer diagnostic specificity at high sensitivity levels (Conference Presentation)

Science.gov (United States)

Zhao, Jianhua; Zeng, Haishan; Kalia, Sunil; Lui, Harvey

2017-02-01

Background: Raman spectroscopy is a non-invasive optical technique which can measure molecular vibrational modes within tissue. A large-scale clinical study (n = 518) has demonstrated that real-time Raman spectroscopy could distinguish malignant from benign skin lesions with good diagnostic accuracy; this was validated by a follow-up independent study (n = 127). Objective: Most of the previous diagnostic algorithms have typically been based on analyzing the full band of the Raman spectra, either in the fingerprint or high wavenumber regions. Our objective in this presentation is to explore wavenumber selection based analysis in Raman spectroscopy for skin cancer diagnosis. Methods: A wavenumber selection algorithm was implemented using variably-sized wavenumber windows, which were determined by the correlation coefficient between wavenumbers. Wavenumber windows were chosen based on accumulated frequency from leave-one-out cross-validated stepwise regression or least and shrinkage selection operator (LASSO). The diagnostic algorithms were then generated from the selected wavenumber windows using multivariate statistical analyses, including principal component and general discriminant analysis (PC-GDA) and partial least squares (PLS). A total cohort of 645 confirmed lesions from 573 patients encompassing skin cancers, precancers and benign skin lesions were included. Lesion measurements were divided into training cohort (n = 518) and testing cohort (n = 127) according to the measurement time. Result: The area under the receiver operating characteristic curve (ROC) improved from 0.861-0.891 to 0.891-0.911 and the diagnostic specificity for sensitivity levels of 0.99-0.90 increased respectively from 0.17-0.65 to 0.20-0.75 by selecting specific wavenumber windows for analysis. Conclusion: Wavenumber selection based analysis in Raman spectroscopy improves skin cancer diagnostic specificity at high sensitivity levels.

Evaluation of multiple scan average dose (MSAD) levels in computerized tomography in Minas Gerais state, Brazil

International Nuclear Information System (INIS)

Alonso, Thessa C.; Vieira, Leandro de A.; Barbosa, Nayra V.; Oliveira, Jeyselaine R. de; Cesar, Adriana C.Z.; Silva, Teogenes A. da

2014-01-01

Computed Tomography (CT) grows every year and is a diagnostic method that has revolutionized radiology with advances in procedures for obtaining image. However, the indiscriminate use of this method generates relatively high doses in patients. The diagnostic reference levels (DRLs) is a practical tool to promote the evaluation of existing protocols. The optimization and the periodic review of the protocols are important to balance the risk of radiation. The present study aims to conduct a survey of levels of MSAD of Minas Gerais following the procedures recommended by current Brazilian law. (author)

Evaluating the diagnostic device DETEC-PC for the thyroid uptakes

International Nuclear Information System (INIS)

Alonso Abad, Dolores; Arista Romeu, Eduardo; Alonso Abad, Ariel

2008-01-01

A study is presented for evaluating the diagnostic capacity of the DETEC-PC, detection measurement system for the Thyroid Uptakes. A clinical trial was designed for that effect and all the patients included were evaluated using the DETEC-PC and the well-known radioimmunoassay (RIA) standard diagnostic procedure known by acronym RIA. For the Thyroid Uptakes using the DETEC-PC patients received an oral administration of a solution of radioactive iodine. The radioactive substance is attracted chemically to the gland and ionising radiation detector captures their emissions. The iodine concentration in the Thyroid, as well as the variation of this concentration over time reflects the function of the gland. The RIA is based on the analysis of the values associated with the t3, t4 and tsh hormones, and when these three parameters are in a certain range the patients can be classified. The sample size was calculated in order to estimate the gross coincidence percent between both methods with a precision of 1 % at a confidence level of 95%. In total 110 patients were included in the trial. Mainly two types of statistical analysis were carried out, in the first analysis all the patients included in the study were considered whereas in the second analysis the patients with doubtful RIA results were not included. Ideally the performance of a diagnostic tool is evaluated through the estimation of its sensitivity and specificity. Nevertheless, in the present study the reference procedure (RIA) can not be considered a gold standard diagnostic device. In such a setting the international regulations advise to use measurements of agreement to evaluate the diagnostic capacity of the new method. In the present study we evaluated the level of diagnostic agreement between the DETEC-PC and the RIA using the Kappa statistics. Additionally, the confidence interval for the Kappa statistics and the corresponding significant test for the present of agreement were also computes. The obtained

Diagnostic Utility of Pleural Fluid Adenosine Deaminase Level in Tuberculousis Pleural Effusion

International Nuclear Information System (INIS)

Suleman, A.; Abbasi, M. A.; Anwar, S. A.; Kamal, M.; Khan, H.

2016-01-01

Background: Early diagnosis and management of tuberculosis is essential for decreasing the disease burden. Pakistan is one of the few countries of world with a very high burden of tuberculosis. Many diagnostic tests are available for detection of tuberculosis but each is fraught with certain limitations of its own. Methods: This study was a cross sectional validation study that sought to determine the validity of pleural fluid adenosine deaminase levels for diagnosis of tuberculous pleural effusion. Results: A total of 160 patients with exudative lymphocytic pleural effusions were enrolled in this study. The mean pleural fluid ADA level was 52.18±1.98 U/L. The mean pleural fluid ADA level in patients diagnosed to have tuberculosis on pleural biopsy/histopathology was higher as compared to patients who did not have tuberculous pleural effusion 52.16±2.4 U/L vs 38.6±3.14 U/L. The difference was found to be statistically significant between the two groups (p<0.05). The sensitivity, specificity, ppv and npv of pleural fluid ADA level were 88.88 percent, 77.04 percent, 86.28 percent and 81.04 percent respectively. Conclusion: Despite wide variations in the reported sensitivity and specificity of pleural fluid ADA level, it can be used as a surrogate for pleural biopsy when the latter is not feasible. (author)

Nanomaterials-Tools, Technology and Methodology of Nanotechnology Based Biomedical Systems for Diagnostics and Therapy.

Science.gov (United States)

Schmidt, Christian; Storsberg, Joachim

2015-07-20

Nanomedicine helps to fight diseases at the cellular and molecular level by utilizing unique properties of quasi-atomic particles at a size scale ranging from 1 to 100 nm. Nanoparticles are used in therapeutic and diagnostic approaches, referred to as theranostics. The aim of this review is to illustrate the application of general principles of nanotechnology to select examples of life sciences, molecular medicine and bio-assays. Critical aspects relating to those examples are discussed.

Value of percutaneous needle biopsy of small renal tumors in patients referred for cryoablation.

Science.gov (United States)

Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Sakurai, Jun; Matsui, Yusuke; Araki, Motoo; Nasu, Yasutomo; Kanazawa, Susumu

2017-04-01

To retrospectively evaluate the safety and diagnostic yield of needle biopsy of small renal tumors, and the clinical consequences of performing needle biopsy in patients referred for percutaneous cryoablation before their treatment. Biopsy was performed for 120 tumors (mean diameter, 2.2 cm) in 119 patients. All procedures were divided into diagnostic and non-diagnostic biopsies. Various variables were compared between the two groups. All cryoablation procedures were divided into two groups: procedures with or without simultaneous biopsy. The rates of benign or non-diagnostic tumors in each group were compared. After performing 120 initial and eight repeat biopsies, Grade 1 bleedings occurred in 44 cases. Six tumors were non-diagnostic and 114 were pathologically diagnosed. There were no significant variables between the diagnostic and non-diagnostic biopsies. Unnecessary cryoablation was avoided in nine benign lesions by performing biopsy in advance. Cryoablation performed simultaneously with biopsy included significantly more benign or non-diagnostic tumors than cryoablation performed after biopsy (15.2% vs. 1.4%; p = .01). Percutaneous biopsy of small renal tumors referred for cryoablation was a safe procedure with high diagnostic yield. The confirmation of pathological diagnosis prior to cryoablation is necessary because patients with benign tumors can avoid unnecessary treatment.

CT guided diagnostic foot injections

International Nuclear Information System (INIS)

Saifuddin, A.; Abdus-Samee, M.; Mann, C.; Singh, D.; Angel, J.C.

2005-01-01

AIM: To describe a CT technique for guiding diagnostic and therapeutic injections in the hind- and mid-foot. MATERIALS AND METHODS: Over a period of 50 months, 28 individuals were referred for diagnostic and therapeutic hind- and mid-foot injections before possible arthrodesis. A CT technique was developed that allowed entry into the various joints using a vertical approach. Numbers of joints injected were as follows: posterior subtalar, 21; talonavicular, 4; calcaneonavicular, calcaneocuboid, navicular-cuneiform and 5th metatarsocuboid joints, 1 each. RESULTS: All injections but one were technically successful. Significant relief of symptoms was noted by 16 participants, whereas for 9 there was no improvement and for 3 a partial response was achieved. CONCLUSION: CT is a simple and safe alternative to fluoroscopy for guiding diagnostic and therapeutic foot injections, and may be the technique of choice in cases of disordered anatomy

Study on the diagnostic value of determination of changes of serum CA125 and CA19-9 levels in patients with endometriosis

International Nuclear Information System (INIS)

Liu Aimin

2008-01-01

Objective: To explore the diagnostic value of determination of changes of serum CA125 and CA19-9 levels in patients with endometriosis. Methods: Serum CA125 and CA19-9 levels were determined with RIA in 45 patients with endometriosis and 40 controls. Results: Serum levels of CA125 and CA19-9 in patients with endometriosis (89.63 ± 30.16u/ml and 95.62±43.67u/ml respectively) were significantly higher than those (16.26±6.37u/ml and 20.26±8.25u/ml respectively) in controls (P<0. 001). Sensitivity of CA125 for diagnosis of endometriosis was 77.78% and that of CA19-9 was 62.22%, while the specificity was 92.50% and 90.00% respectively. If we only took the patients with both markers elevated as being diagnostically positive, the sensitivity would naturally be lower (57.78%) but the specificity would be 100%. Levels of the markers were significantly higher in stage III, IV patients than those in patients with stage I, II disease (P<0.01). Conclusion: Combined determination of serum CA125 and CA19-9 levels were of highly specific diagnostic value in patients with endometriosis. (authors)

Diagnostic accuracy research in glaucoma is still incompletely reported: An application of Standards for Reporting of Diagnostic Accuracy Studies (STARD 2015.

Directory of Open Access Journals (Sweden)

Manuele Michelessi

Full Text Available Research has shown a modest adherence of diagnostic test accuracy (DTA studies in glaucoma to the Standards for Reporting of Diagnostic Accuracy Studies (STARD. We have applied the updated 30-item STARD 2015 checklist to a set of studies included in a Cochrane DTA systematic review of imaging tools for diagnosing manifest glaucoma.Three pairs of reviewers, including one senior reviewer who assessed all studies, independently checked the adherence of each study to STARD 2015. Adherence was analyzed on an individual-item basis. Logistic regression was used to evaluate the effect of publication year and impact factor on adherence.We included 106 DTA studies, published between 2003-2014 in journals with a median impact factor of 2.6. Overall adherence was 54.1% for 3,286 individual rating across 31 items, with a mean of 16.8 (SD: 3.1; range 8-23 items per study. Large variability in adherence to reporting standards was detected across individual STARD 2015 items, ranging from 0 to 100%. Nine items (1: identification as diagnostic accuracy study in title/abstract; 6: eligibility criteria; 10: index test (a and reference standard (b definition; 12: cut-off definitions for index test (a and reference standard (b; 14: estimation of diagnostic accuracy measures; 21a: severity spectrum of diseased; 23: cross-tabulation of the index and reference standard results were adequately reported in more than 90% of the studies. Conversely, 10 items (3: scientific and clinical background of the index test; 11: rationale for the reference standard; 13b: blinding of index test results; 17: analyses of variability; 18; sample size calculation; 19: study flow diagram; 20: baseline characteristics of participants; 28: registration number and registry; 29: availability of study protocol; 30: sources of funding were adequately reported in less than 30% of the studies. Only four items showed a statistically significant improvement over time: missing data (16, baseline

Does MR imaging effectively replace diagnostic arthroscopy

International Nuclear Information System (INIS)

Ruwe, P.; McCarthy, S.; Wright, J.; Randall, L.; Lynch, K.; Jokyl, P.

1990-01-01

This paper determines if MR imaging reduces the number of diagnostic arthroscopic procedures required in patients with knee complaints and if MR imaging is cost-effective compared with diagnostic arthroscopy. The cohort analysis consists of 100 patients seen in a sports medicine clinic by two orthopedic surgeons who agreed on well-defined criteria for performing MR imaging and arthroscopy. Each orthopedic surgeon referring a patient for MR imaging checked a form regarding the plans for arthroscopy. Outcome analysis was conducted at 6 months

Diagnostic criteria for headache attributed to temporomandibular disorders.

Science.gov (United States)

Schiffman, Eric; Ohrbach, Richard; List, Thomas; Anderson, Gary; Jensen, Rigmor; John, Mike T; Nixdorf, Donald; Goulet, Jean-Paul; Kang, Wenjun; Truelove, Ed; Clavel, Al; Fricton, James; Look, John

2012-07-01

We assessed and compared the diagnostic accuracy of two sets of diagnostic criteria for headache secondary to temporomandibular disorders (TMD). In 373 headache subjects with TMD, a TMD headache reference standard was defined as: self-reported temple headache, consensus diagnosis of painful TMD and replication of the temple headache using TMD-based provocation tests. Revised diagnostic criteria for Headache attributed to TMD were selected using the RPART (recursive partitioning and regression trees) procedure, and refined in half of the data set. Using the remaining half of the data, the diagnostic accuracy of the revised criteria was compared to that of the International Headache Society's International Classification of Headache Diseases (ICHD)-II criteria A to C for Headache or facial pain attributed to temporomandibular joint (TMJ) disorder. Relative to the TMD headache reference standard, ICHD-II criteria showed sensitivity of 84% and specificity of 33%. The revised criteria for Headache attributed to TMD had sensitivity of 89% with improved specificity of 87% (p headache that is changed with jaw movement, function or parafunction and (2) provocation of that headache by temporalis muscle palpation or jaw movement. Having significantly better specificity than the ICHD-II criteria A to C, the revised criteria are recommended to diagnose headache secondary to TMD.

Provincial practice: adopting the new reference levels for Radon

International Nuclear Information System (INIS)

Kennedy, Christine; Johnson, Darryl

2008-01-01

Full text: In June 2007 new reference levels for radon gas were announced from Health Canada. These new levels brought new attention to the issue of radon gas exposure in the Province of Newfoundland and Labrador. Research in radon gas exposure has a long history in the fluorspar mines of the Burin Peninsula, indeed, occupational data from the 1950 's and 60 's had been included in Darby et al. large scale occupational meta analyses. Radon was also implicated in a royal commission of occupational mining hazards in Newfoundland in 1968. Although, the occupational exposures of miners have been well documented, very little is known about population exposures in indoor spaces. Geological maps are currently being composed for national areas, but data for this province is not yet published. Information about mining tailings used in construction materials or as fill is very poor (unlike the data known for uranium mining tailings in Ontario and Manitoba). The challenges of estimating radon exposures for the province are myriad and these are explored here in this narrative study of how new information has to be generated, and then incorporated into new environmental public health policies for a population. The process by which new scientific information informs public health policy is described in this study of radon in Newfoundland and Labrador. Anticipated regulations for new buildings are discussed. (author)

Proposed Diagnostic Criteria for Smartphone Addiction.

Science.gov (United States)

Lin, Yu-Hsuan; Chiang, Chih-Lin; Lin, Po-Hsien; Chang, Li-Ren; Ko, Chih-Hung; Lee, Yang-Han; Lin, Sheng-Hsuan

2016-01-01

Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria. We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist's structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists' clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy. Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1) six symptom criteria, (2) four functional impairment criteria and (3) exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%), while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use. The diagnostic criteria of smartphone addiction demonstrated the core symptoms "impaired control" paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment.

Proposed Diagnostic Criteria for Smartphone Addiction.

Directory of Open Access Journals (Sweden)

Yu-Hsuan Lin

Full Text Available Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria.We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist's structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists' clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy.Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1 six symptom criteria, (2 four functional impairment criteria and (3 exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%, while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use.The diagnostic criteria of smartphone addiction demonstrated the core symptoms "impaired control" paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment.

Efficacy of a chairside diagnostic test kit for estimation of C-reactive protein levels in periodontal disease.

Science.gov (United States)

Nagarale, Girish; Ravindra, S; Thakur, Srinath; Setty, Swati

2010-10-01

C-reactive protein [CRP] levels increase to hundreds of mg/mL within hours following infection. Studies have shown that serum CRP levels were elevated in periodontal disease. However, in all the previous studies, CRP levels were measured by using high-sensitivity CRP assay kits with minimal detection limits of 0.1 to 3 mg/L, which was much below the normal value of 10 mg/L. These high-sensitivity CRP assays need a proper laboratory setup, and these methods cannot be used as a routine chair-side test in the dental office. The purpose of this study was to investigate the serum CRP levels in subjects with periodontal disease by using a rapid chair-side diagnostic test kit with a lower detection limit of 6 mg/L and to compare the CRP levels before and after periodontal therapy. A total of 45 systemically healthy subjects were selected for the study. Subjects were divided into three groups: group A: healthy controls, group B: gingivitis, group C: periodontitis. Serum levels of CRP were determined by using a latex slide agglutination method with commercially available kit with lower detection limit of 6 mg/L. CRP was negative in all the 15 subjects in groups A and B at baseline, 7th and 30th day. CRP was positive only in 2 subjects in Group C at baseline and 7th day. Estimation of serum CRP by using a rapid chair-side diagnostic test kit is not of any significance in subjects with periodontitis.

Nanomaterials—Tools, Technology and Methodology of Nanotechnology Based Biomedical Systems for Diagnostics and Therapy

Directory of Open Access Journals (Sweden)

Christian Schmidt

2015-07-01

Full Text Available Nanomedicine helps to fight diseases at the cellular and molecular level by utilizing unique properties of quasi-atomic particles at a size scale ranging from 1 to 100 nm. Nanoparticles are used in therapeutic and diagnostic approaches, referred to as theranostics. The aim of this review is to illustrate the application of general principles of nanotechnology to select examples of life sciences, molecular medicine and bio-assays. Critical aspects relating to those examples are discussed.

Decisions to withhold diagnostic investigations in nursing home patients with a clinical suspicion of venous thromboembolism.

Directory of Open Access Journals (Sweden)

Henrike J Schouten

Full Text Available This study aimed to gather insights in physicians' considerations for decisions to either refer for- or to withhold additional diagnostic investigations in nursing home patients with a suspicion of venous thromboembolism.Our study was nested in an observational study on diagnostic strategies for suspected venous thromboembolism in nursing home patients. Patient characteristics, bleeding-complications and mortality were related to the decision to withhold investigations. For a better understanding of the physicians' decisions, 21 individual face-to-face in-depth interviews were performed and analysed using the grounded theory approach.Referal for additional diagnostic investigations was forgone in 126/322 (39.1% patients with an indication for diagnostic work-up. 'Blind' anticoagulant treatment was initiated in 95 (75.4% of these patients. The 3 month mortality rates were higher for patients in whom investigations were withheld than in the referred patients, irrespective of anticoagulant treatment (odds ratio 2.45; 95% confidence interval 1.40 to 4.29 but when adjusted for the probability of being referred (i.e. the propensity score, there was no relation of non-diagnosis decisions to mortality (odds ratio 1.75; 0.98 to 3.11. In their decisions to forgo diagnostic investigations, physicians incorporated the estimated relative impact of the potential disease; the potential net-benefits of diagnostic investigations and whether performing investigations agreed with established management goals in advance care planning.Referral for additional diagnostic investigations is withheld in almost 40% of Dutch nursing home patients with suspected venous thromboembolism and an indication for diagnostic work-up. We propose that, given the complexity of these decisions and the uncertainty regarding their indirect effects on patient outcome, more attention should be focused on the decision to either use or withhold additional diagnostic tests.

DIAGNOSTIC VALUE OF GALECTIN-3 LEVEL IN PATIENTS WITH CHRONIC HEART FAILURE AND TYPE 2 DIABETES

Directory of Open Access Journals (Sweden)

A. A. Snetkova

2015-09-01

Full Text Available Currently, a greater emphasis is placed on the search for additional biomarkers of chronic heart failure (CHF. Galectin-3, a marker of fibrosis and inflammation, has shown himself as a biomarker of CHF in many studies, but the dynamics of its levels in patients with concomitant diabetes mellitus (DM type 2 is not well-studied.Aim. To identify diagnostic significance of galectin-3 plasma level evaluation and its correlations with echocardiographic criteria for patients with CHF and DM type 2.Material and methods. The study included 33 patients with ischemic CHF (all patients had a history of myocardial infarction and DM type 2. The patients were divided into two groups according to the left ventricle (LV ejection fraction (EF: a group with CHF and preserved ejection fraction (PEF (EF≥50% and with CHF and reduced ejection fraction (EF<50%. Patients underwent clinical laboratory tests and Doppler echocardiography; moreover, the levels of brain natriuretic peptide (BNP and galeсtin-3 were measured.Results. The mean level of galectin-3 in blood plasma in the group with CHF and PEF was significantly higher than in the group with CHF and reduced EF (p=0.007. In the group with CHF and PEF a positive correlation between the level of galectin-3 and diastolic LV function E/E' was found (r=0.620, p=0.01. A significant correlation between galectin-3 level and LV systolic function was stated in the group with reduced EF (r=0.53; p<0.05, while in the group with PEF, the correlation was not significant (p=0.225. In the group of patients with reduced EF a negative correlation between galectin-3 and the volume of left atrium was revealed (r=-0.53; p<0.05.Conclusion. Galectin-3 can be used as a diagnostic biomarker primarily in patients with CHF and PEF.

The establishment of tocopherol reference intervals for Hungarian adult population using a validated HPLC method.

Science.gov (United States)

Veres, Gábor; Szpisjak, László; Bajtai, Attila; Siska, Andrea; Klivényi, Péter; Ilisz, István; Földesi, Imre; Vécsei, László; Zádori, Dénes

2017-09-01

Evidence suggests that decreased α-tocopherol (the most biologically active substance in the vitamin E group) level can cause neurological symptoms, most likely ataxia. The aim of the current study was to first provide reference intervals for serum tocopherols in the adult Hungarian population with appropriate sample size, recruiting healthy control subjects and neurological patients suffering from conditions without symptoms of ataxia, myopathy or cognitive deficiency. A validated HPLC method applying a diode array detector and rac-tocol as internal standard was utilized for that purpose. Furthermore, serum cholesterol levels were determined as well for data normalization. The calculated 2.5-97.5% reference intervals for α-, β/γ- and δ-tocopherols were 24.62-54.67, 0.81-3.69 and 0.29-1.07 μm, respectively, whereas the tocopherol/cholesterol ratios were 5.11-11.27, 0.14-0.72 and 0.06-0.22 μmol/mmol, respectively. The establishment of these reference intervals may improve the diagnostic accuracy of tocopherol measurements in certain neurological conditions with decreased tocopherol levels. Moreover, the current study draws special attention to the possible pitfalls in the complex process of the determination of reference intervals as well, including the selection of study population, the application of internal standard and method validation and the calculation of tocopherol/cholesterol ratios. Copyright © 2017 John Wiley & Sons, Ltd.

[The National Reference Centres and Reference Laboratories. Importance and tasks].

Science.gov (United States)

Laude, G; Ammon, A

2005-09-01

Since 1995, the German Federal Ministry for Health and Social Security funds National Reference Centres (NRC) for the laboratory surveillance of important pathogens and syndromes. Which pathogens or syndromes are selected to be covered by a NRC depends on their epidemiological relevance, the special diagnostic tools, problems with antimicrobial resistance and necessary infection control measures. Currently, there are 15 NRC, which are appointed for a period of 3 years (currently from January 2005 through December 2007). Towards the end of their appointment all NRC are evaluated by a group of specialists. The assessment of their achievements is guided by a catalogue of tasks for the NRC. In addition to the NRC, a total of 50 laboratories are appointed which provide specialist expertise for additional pathogens in order to have a broad range of pathogens for which specialist laboratories are available. Their predominant task is to give advice and support for special diagnostic problems. Both NRC and the specialist laboratories are important parts of the network for infectious disease epidemiology.

Activities of radiopharmaceuticals administered for diagnostic and therapeutic procedures in nuclear medicine in Argentina: results of a national survey

International Nuclear Information System (INIS)

Bomben, Ana M.; Chiliutti, Claudia A.

2004-01-01

Nuclear medicine in Argentine is carried out at 292 centres, distributed all over the country, mainly concentrated in the capital cities of the provinces. With the purpose of knowing the activity levels of radiopharmaceuticals that were administered to patients for diagnostic and therapeutic procedures in nuclear medicine, a national survey was conducted, during 2001 and 2002. This survey was answered voluntarily by 107 centres. Sixty-four percent of the participants centres are equipped with SPECT system while the other centres have a gamma camera or scintiscanner. There were 37 nuclear medicine procedures, chosen among those most frequently performed, were included in the survey. In those diagnostic procedures were included tests for: bone, brain, thyroid, kidney, liver, lung and cardiovascular system; and also activities administered for some therapeutic procedures. The nuclear medicine physicians reported the different radiopharmaceutical activities administered to typical adult patients. In this paper are presented the average radiopharmaceutical activity administered for each of the diagnostic and therapeutic procedures included in the survey and the range and distribution of values. In order to place these data in a frame of reference, these average values were compared to the guidance levels for diagnostic procedures in nuclear medicine mentioned at the Safety Series no. 115. From this comparison it was noticed that the activities administered in the 40% of the diagnostic procedures included in the survey were between ±30% of the reference values. For those nuclear medicine procedures that could not be compared with the above mentioned guidance levels, the comparison was made with values published by UNSCEAR or standards recommended by international bodies. As a result of this study, it is important to point out the need to continue the gathering of data in a wider scale survey to increase the knowledge about national trends. It is also essential to widely

Endogenous steroid hormone levels in early pregnancy and risk of testicular cancer in the offspring: a nested case-referent study.

Science.gov (United States)

Holl, Katsiaryna; Lundin, Eva; Surcel, Heljä-Marja; Grankvist, Kjell; Koskela, Pentti; Dillner, Joakim; Hallmans, Göran; Wadell, Göran; Olafsdottir, Gudridur H; Ogmundsdottir, Helga M; Pukkala, Eero; Lehtinen, Matti; Stattin, Pär; Lukanova, Annekatrin

2009-06-15

According to the leading hypothesis on testicular cancer (TC) etiology exposure to a specific pattern of steroid hormones in utero, in particular, to high levels of estrogens and low levels of androgens is the major determinant of TC risk in the offspring. We performed a case-referent study nested within Finnish, Swedish and Icelandic maternity cohorts exploiting early pregnancy serum samples to evaluate the role of maternal endogenous steroid hormones with regard to the risk of TC. TC cases and referents were aged between 0 and 25 years. For each case-index mother pair, three or four matched referent-referent mother pairs were identified using national population registries. First trimester or early second trimester sera were retrieved from the index mothers of 73 TC cases and 286 matched referent mothers, and were tested for dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone, estradiol, estrone, and sex hormone binding globulin (SHBG). Offspring of mothers with high DHEAS levels had a significantly decreased risk of TC (OR for highest vs. lowest DHEAS quartile, 0.18 (95% CI 0.06-0.58). In contrast, offspring of mothers with high androstenedione levels had an increased risk of TC (OR 4.1; 95% CI 1.2-12.0). High maternal total estradiol level also tended to be associated with an increased risk of TC in the offspring (OR 32; 95% CI 0.98-1,090). We report the first direct evidence that interplay of maternal steroid hormones in the early pregnancy is important in the etiology of TC in the offspring. Copyright 2008 UICC.

Patient radiation dose in diagnostic and interventional procedures for intracranial aneurysms: Experience at a single center

International Nuclear Information System (INIS)

Chun, Chang Woo; Kim, Bum Soo; Lee, Cheol Hyoun; Ihn, Yon Kwon; Shin, Yong Sam

2014-01-01

To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms in a large sample size from a single center. We studied a sample of 439 diagnostic and 149 therapeutic procedures for intracranial aneurysms in 480 patients (331 females, 149 males; median age, 57 years; range, 21-88 years), which were performed in 2012 with a biplane unit. Parameters including fluoroscopic time, dose-area product (DAP), and total angiographic image frames were obtained and analyzed. Mean fluoroscopic time, total mean DAP, and total image frames were 12.6 minutes, 136.6 +/- 44.8 Gy-cm 2 , and 251 +/- 49 frames for diagnostic procedures, 52.9 minutes, 226.0 +/- 129.2 Gy-cm 2 , and 241 frames for therapeutic procedures, and 52.2 minutes, 334.5 +/- 184.6 Gy-cm 2 , and 408 frames for when both procedures were performed during the same session. The third quartiles for diagnostic reference levels (DRLs) were 14.0, 61.1, and 66.1 minutes for fluoroscopy time, 154.2, 272.8, and 393.8 Gy-cm 2 for DAP, and 272, 276, and 535 for numbers of image frames in diagnostic, therapeutic, and both procedures in the same session, respectively. The proportions of fluoroscopy in DAP for the procedures were 11.4%, 50.5%, and 36.1%, respectively, for the three groups. The mean DAP for each 3-dimensional rotational angiographic acquisition was 19.2 +/- 3.2 Gy-cm 2 . On average, rotational angiography was used 1.4 +/- 0.6 times/session (range, 1-4; n = 580). Radiation dose in our study as measured by DAP, fluoroscopy time and image frames did not differ significantly from other reported DRL studies for cerebral angiography, and DAP was lower with fewer angiographic image frames for embolization. A national registry of radiation-dose data is a necessary next step to refine the dose reference level.

Molecular Diagnostics of ?-Thalassemia

OpenAIRE

Atanasovska, B; Bozhinovski, G; Chakalova, L; Kocheva, S; Karanfilski, O; Plaseska-Karanfiska, D

2012-01-01

A high-quality hemoglobinopathy diagnosis is based on the results of a number of tests including assays for molecular identification of causative mutations. We describe the current diagnostic strategy for the identification of ?-thalassemias and hemoglobin (Hb) variants at the International Reference Laboratory for Haemoglobinopathies, Research Centre for Genetic Engineering and Biotechnology (RCGEB) ?Georgi D. Efremov,? Skopje, Republic of Macedonia. Our overall approach and most of the meth...

Design of a far infrared interferometer diagnostic support structure

International Nuclear Information System (INIS)

Brooksby, C.A.; Rice, B.W.; Peebles, W.A.

1987-10-01

The Far Infrared Interferometer (FIR) diagnostic will operate in the 119 to 400 micron range to measure the plasma electron density on the Microwave Tokamak Experiment (MTX) being set up at LLNL. This diagnostic is a multi-channel system which incorporates a long elliptically shaped beam that passes through the plasma and is imaged onto an array of 14 detectors that are located on a table above the machine. The reference beam is brought around the machine and mixed with the plasma beam onto the detectors. The density is measured by a phase shift between these beams and is, therefore, very sensitive to path length changes between the two beam paths due to motion of the support structure. The design goal for allowable phase shifts caused by changes in the path length due to structure movement is 1/50th of a wavelength (2.4 to 8 microns). The structure needs to maintain this stability during the 0.5 second plasma shot. The structure is approximately 5 meters tall to support the optics table above the machine. In order to reduce the structure motion to the required level the forces acting on it were evaluated. The forces evaluated were eddy currents from the pulsed electromagnetic fields, the ambient ground motion, and the floor movement as the magnets are pulsed. The designs for similar diagnostic interferometers on other tokamaks were also reviewed to evaluate the forces and motions that might cause such small deflections in the support structure. Our structure is somewhat unique in that it is designed for operation in relatively large pulsed magnetic fields (100 to 7000 gauss) arising from the air core transformer of MTX. The design chosen incorporates a very rigid structure with high resistive and non-conductive materials. The choice of materials selected is discussed with reference to their response to expected forces. 14 refs., 10 figs

Comparing diagnostic tests on benefit-risk.

Science.gov (United States)

Pennello, Gene; Pantoja-Galicia, Norberto; Evans, Scott

2016-01-01

Comparing diagnostic tests on accuracy alone can be inconclusive. For example, a test may have better sensitivity than another test yet worse specificity. Comparing tests on benefit risk may be more conclusive because clinical consequences of diagnostic error are considered. For benefit-risk evaluation, we propose diagnostic yield, the expected distribution of subjects with true positive, false positive, true negative, and false negative test results in a hypothetical population. We construct a table of diagnostic yield that includes the number of false positive subjects experiencing adverse consequences from unnecessary work-up. We then develop a decision theory for evaluating tests. The theory provides additional interpretation to quantities in the diagnostic yield table. It also indicates that the expected utility of a test relative to a perfect test is a weighted accuracy measure, the average of sensitivity and specificity weighted for prevalence and relative importance of false positive and false negative testing errors, also interpretable as the cost-benefit ratio of treating non-diseased and diseased subjects. We propose plots of diagnostic yield, weighted accuracy, and relative net benefit of tests as functions of prevalence or cost-benefit ratio. Concepts are illustrated with hypothetical screening tests for colorectal cancer with test positive subjects being referred to colonoscopy.

Integrating Research-Informed Teaching within an Undergraduate Level 4 (Year 1) Diagnostic Radiography Curriculum: A Pilot Study

Science.gov (United States)

Higgins, Robert; Hogg, Peter; Robinson, Leslie

2013-01-01

This article discusses the piloting and evaluation of the Research-informed Teaching experience (RiTe) project. The aim of RiTe was to link teaching and learning with research within an undergraduate diagnostic radiography curriculum. A preliminary pilot study of RiTe was undertaken with a group of level 4 (year 1) volunteer BSc (Hons) diagnostic…

Comparative evaluation of bivalent malaria rapid diagnostic tests versus traditional methods in field with special reference to heat stability testing in Central India.

Directory of Open Access Journals (Sweden)

Neeru Singh

Full Text Available Malaria presents a diagnostic challenge in areas where both Plasmodium falciparum and P.vivax are co-endemic. Bivalent Rapid Diagnostic tests (RDTs showed promise as diagnostic tools for P.falciparum and P.vivax. To assist national malaria control programme in the selection of RDTs, commercially available seven malaria RDTs were evaluated in terms of their performance with special reference to heat stability.This study was undertaken in four forested districts of central India (July, 2011- March, 2012. All RDTs were tested simultaneously in field along with microscopy as gold standard. These RDTs were stored in their original packing at 25°C before transport to the field or they were stored at 35°C and 45°C upto 100 days for testing the performance of RDTs at high temperature. In all 2841 patients with fever were screened for malaria of which 26% were positive for P.falciparum, and 17% for P.vivax. The highest sensitivity of any RDT for P.falciparum was 98% (95% CI; 95.9-98.8 and lowest sensitivity was 76% (95% CI; 71.7-79.6. For P.vivax highest and lowest sensitivity for any RDT was 80% (95% CI; 94.9 - 83.9 and 20% (95% CI; 15.6-24.5 respectively. Heat stability experiments showed that most RDTs for P.falciparum showed high sensitivity at 45°C upto 90 days. While for P.vivax only two RDTs maintained good sensitivity upto day 90 when compared with RDTs kept at room temperature. Agreement between observers was excellent for positive and negative readings for both P.falciparum and P.vivax (Kappa >0.6-0.9.This is first field evaluation of RDTs regarding their temperature stability. Although RDTs are useful as diagnostic tool for P.falciparum and P.vivax even at high temperature, the quality of RDTs should be regulated and monitored more closely.

Patient dosimetry in diagnostic radiology

International Nuclear Information System (INIS)

Shrimpton, P.C.

2000-01-01

Full text: X-ray examinations remain an essential and widely used diagnostic tool in medicine and hence the most significant source of exposure to man-made radiation for populations. Patterns of practice in diagnostic radiology continue to evolve, with overall growth in the numbers of procedures worldwide and, particularly in developed countries, increasing importance for complex procedures such as computed tomography (CT) and interventional techniques. In order to maximise the benefits from x-rays relative to the associated radiation risks, there is a need to ensure the prior justification of all examinations and the optimisation of patient protection such that doses are as low as reasonably practicable to meet specific clinical requirements. Accordingly, patient dosimetry is a fundamental requirement in diagnostic radiology. Detailed measurements for the assessment of risks or comparison of different types of procedure require the estimation of organ and effective doses. Such comprehensive dosimetry necessarily involves the simulation of clinical practice using anthropomorphic phantoms, with either measurements in a physical phantom or calculations utilising a mathematical phantom. Simpler measurements for the routine monitoring of dose in x-ray departments can be based on practical quantities such as entrance surface dose, dose-area product and, for CT, weighted CT dose index and dose-length product. Widescale surveys reveal significant variations between departments in the typical doses for a given type of procedure and potential scope for dose reductions. In order to promote improvements in practice, the results of periodic dose surveys in departments should be compared with appropriate standards, such as diagnostic reference levels for adult and paediatric patients, that are set nationally or locally for the purposes of promoting critical review of the equipment and techniques in use. Patient dosimetry should form an essential element of routine quality

Standardized assessment to enhance the diagnostic value of prostate volume; Part II: Correlation with prostate-specific antigen levels

NARCIS (Netherlands)

Aarnink, R. G.; de la Rosette, J. J.; Huynen, A. L.; Giesen, R. J.; Debruyne, F. M.; Wijkstra, H.

1996-01-01

Standardized estimations of prostate volumes are used for interpretation of prostate specific antigen (PSA) levels. In 243 patients with clinically benign diagnosis, automated and reference prostate volumes and transition zone volumes are correlated to PSA levels. Besides, growth curves of PSA level

MERRA 2D IAU Diagnostic, Single Level Meteorology, Diurnal (2/3x1/2L1) V5.2.0

Data.gov (United States)

National Aeronautics and Space Administration — The MATUNXSLV or tavgU_2d_slv_Nx data product is the MERRA Data Assimilation System 2-Dimensional atmospheric single-level diagnostics that is time averaged...

Customized Internal Reference Controls for Improved Assessment of Circulating MicroRNAs in Disease.

Directory of Open Access Journals (Sweden)

Kenny Schlosser

Full Text Available Altered levels of circulating extracellular miRNA in plasma and serum have shown promise as non-invasive biomarkers of disease. However, unlike the assessment of cellular miRNA levels for which there are accepted housekeeping genes, analogous reference controls for normalization of circulating miRNA are lacking. Here, we provide an approach to identify and validate circulating miRNA reference controls on a de novo basis, and demonstrate the advantages of these customized internal controls in different disease settings. Importantly, these internal controls overcome key limitations of external spike-in controls.Using a global RT-qPCR screen of 1066 miRNAs in plasma from pulmonary hypertension patients (PAH and healthy subjects as a case example, we identified a large pool of initial candidate miRNAs that were systematically ranked according to their plasma level stability using a predefined algorithm. The performance of the top candidates was validated against multiple comparators, and in a second independent cohort of PAH and control subjects. The broader utility of this approach was demonstrated in a completely different disease setting with 372 miRNAs screened in plasma from septic shock patients and healthy controls.Normalization of data with specific internal reference controls significantly reduced the overall variation in circulating miRNA levels between subjects (relative to raw data, provided a more balanced distribution of up- and down-regulated miRNAs, replicated the results obtained by the benchmark geometric averaging of all detected miRNAs, and outperformed the commonly used external spike-in strategy.We demonstrate the feasibility of identifying circulating reference controls that can reduce extraneous technical variations, and improve the assessment of disease-related changes in plasma miRNA levels. This study provides a novel conceptual framework that addresses a critical and previously unmet need if circulating miRNAs are to

The diagnostic work up of growth failure in secondary health care; An evaluation of consensus guidelines

Directory of Open Access Journals (Sweden)

Dekker Friedo W

2008-05-01

Full Text Available Abstract Background As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC – Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results Twenty four percent of children older than 3 years were inappropriately referred (NCR. Of the correctly referred children 74–88% were short corrected for parental height, 40–61% had a height SDS Conclusion Existing guidelines for workup of children with suspected growth failure are poorly implemented. Although poorly implemented the DCG detects at least 5% pathologic causes of growth failure in children referred for short stature. New guidelines for referral are required with a better sensitivity and specificity, wherein distance to target height should get more attention. The general diagnostic work up for short stature should include testing for celiac disease in all children and for Turner syndrome in girls.

Harmonization of antimicrobial susceptibility testing among veterinary diagnostic laboratories in the five Nordic countries

DEFF Research Database (Denmark)

Petersen, A.; Aarestrup, Frank Møller; Hofshagen, Merete

2003-01-01

A total of 100 bacterial strains (25 Escherichia coli, 25 Salmonella enterica, 25 Staphylococcus aureus, and 25 Enterococcus strains) and four reference strains were tested for susceptibility toward 8-12 antimicrobial agents in 12 veterinary diagnostic laboratories in the five Nordic countries...... reported as vancomycin resistant. Ten laboratories identified the Enterococcus spp. to species level. All five Enterococcus faecium and 10 Enterococcus faecalis selected from the strain collection at the Danish Veterinary Institute were correctly identified by all laboratories, whereas some problems were...

Cerebrospinal fluid adenosine deaminase levels as a diagnostic marker in tuberculous meningitis in adult Nepalese patients

Directory of Open Access Journals (Sweden)

Anil Chander

2013-02-01

Full Text Available Objective: To study the cerebrospinal fluid (CSF adenosine deaminase (ADA levels in tuberculous meningitis (TBM and non-TBM -viral meningitis cases and to determine its diagnostic significance as a biochemical marker of TBM infection.Methods: The study population comprised two different patient groups. TBM - group I - 28 cases and non-TBM-viral meningitis - 22 cases. These were enrolled consecutively in the study and CSF specimens were collected from them. ADA estimation was carried out by spectrophotometry.Results: ADA levels (mean依 SD in the TBM and non-TBM groups were 16.46依6.24 U/L and 5.13依2.96 U/L, respectively (highly significant P10 IU/L, the test showed a good sensitivity of 82.14% (95% CI 64.41-92.12 and a high specificity of 90.91% (95% CI 72.19-97.47. Positive and negative predictive value and positive and negative likelihood ratios and accuracy of the test in TBM cases were 92% (95% CI 75.03-97.77, 80% (95% CI 60.86-91.13, 9.03 (95% CI 2.38- 34.25, 0.19 (95% CI 0.09-0.44 and 86%, respectively.Conclusion: CSF ADA levels are elevated in the TBM cases as compared to the non-TBM - viral meningitis cases with a good sensitivity and a high specificity. It is a simple and inexpensive diagnostic adjunctive test in the rapid and early diagnosis of TBM.

GENE-07. MOLECULAR NEUROPATHOLOGY 2.0 - INCREASING DIAGNOSTIC ACCURACY IN PEDIATRIC NEUROONCOLOGY

Science.gov (United States)

Sturm, Dominik; Jones, David T.W.; Capper, David; Sahm, Felix; von Deimling, Andreas; Rutkoswki, Stefan; Warmuth-Metz, Monika; Bison, Brigitte; Gessi, Marco; Pietsch, Torsten; Pfister, Stefan M.

2017-01-01

Abstract The classification of central nervous system (CNS) tumors into clinically and biologically distinct entities and subgroups is challenging. Children and adolescents can be affected by >100 histological variants with very variable outcomes, some of which are exceedingly rare. The current WHO classification has introduced a number of novel molecular markers to aid routine neuropathological diagnostics, and DNA methylation profiling is emerging as a powerful tool to distinguish CNS tumor classes. The Molecular Neuropathology 2.0 study aims to integrate genome wide (epi-)genetic diagnostics with reference neuropathological assessment for all newly-diagnosed pediatric brain tumors in Germany. To date, >350 patients have been enrolled. A molecular diagnosis is established by epigenetic tumor classification through DNA methylation profiling and targeted panel sequencing of >130 genes to detect diagnostically and/or therapeutically useful DNA mutations, structural alterations, and fusion events. Results are aligned with the reference neuropathological diagnosis, and discrepant findings are discussed in a multi-disciplinary tumor board including reference neuroradiological evaluation. Ten FFPE sections as input material are sufficient to establish a molecular diagnosis in >95% of tumors. Alignment with reference pathology results in four broad categories: a) concordant classification (~77%), b) discrepant classification resolvable by tumor board discussion and/or additional data (~5%), c) discrepant classification without currently available options to resolve (~8%), and d) cases currently unclassifiable by molecular diagnostics (~10%). Discrepancies are enriched in certain histopathological entities, such as histological high grade gliomas with a molecularly low grade profile. Gene panel sequencing reveals predisposing germline events in ~10% of patients. Genome wide (epi-)genetic analyses add a valuable layer of information to routine neuropathological

MLS/Aura Level 2 Diagnostics, Geophysical Parameter Grid V004

Data.gov (United States)

National Aeronautics and Space Administration — ML2DGG is the EOS Aura Microwave Limb Sounder (MLS) product containing geophysical diagnostic quantities pertaining directly to the standard geophysical data...

Diagnostic performance of a commercial immunoblot assay for myositis antibody testing.

Science.gov (United States)

Bundell, Chris; Rojana-Udomsart, Arada; Mastaglia, Frank; Hollingsworth, Peter; McLean-Tooke, Andrew

2016-06-01

The objective of this study was to establish a population based reference range for a commercial immunoblot assay detecting myositis specific autoantibodies (MSAs) and myositis associated autoantibodies (MAAs), and to assess the diagnostic performance of this reference range against the manufacturer's recommended ranges in a myositis patient cohort. A total of 124 patients from a myositis cohort and 197 healthy controls were serologically assessed using a commercial immunoblot containing eleven autoantigens (Jo-1, EJ, OJ, PL7, PL12, Mi-2, SRP, Ku, PMScl75, PMScl100 and Ro52) according to the manufacturer's instructions. Use of the manufacturer's reference ranges resulted in detection of MSAs in 19.4% of myositis patients and 9.1% of controls; MAAs were detected in 41.1% of myositis patients and 14.2% of controls. Reference values derived from the healthy control population resulted in significant differences in cut-off values for some autoantibodies, particularly Ro52 and PMScl75. Use of local reference ranges reduced detection of MSAs to 16.9% of myositis patients and 3% of healthy controls, with MAAs 23.4% of patients and 2% of healthy controls. Application of population based reference ranges resulted in significant differences in detection of MSAs and MAAs compared to the manufacturer's recommended ranges. Cut-off levels should be assessed to ensure suitability for the population tested. Copyright © 2016. Published by Elsevier B.V.

Organization and standards of screening and diagnostic mammography

International Nuclear Information System (INIS)

Linderbraten, L.D.; Chikirdin, Eh.G.; Rozhkova, N.I.

1999-01-01

Problem of organizing and standards of the reference and diagnostic mammography in our country is discussed. Attention is paid to the terminology, accreditation of mammographic establishments and specialists, specifications of equipment, image quality, mammography results processing, radiation doses [ru

[Diagnostic imaging and radiation hazards].

Science.gov (United States)

Claudon, Michel; Guillaume, Luc

2015-01-01

For the last 20 years, the exposure of the population to medical radiation has been increased by 600%, mainly due to the extension of new imaging modalities such as CT or interventional radiology. The risk for radio-induced hazards is especially marked for children, because of the high sensivity of tissues to radiation especially during the first decade of the life. Two main ways allow to better control and reduce the mean effective dose per patient in diagnostic imaging: the introduction of recent technical improvement (i.e. low dose CT scans using iterative reconstruction algorithms, low dose technique for pediatric spine), and the substitution to non-radiating techniques such as ultrasound and MRI. The French National institute of Radioprotection and Nuclear Safety periodically publishes dose reference levels for conventional films and CT examinations, for both adults and pediatric patients. A close relationship between clinicians and radiologists remains essential for a better appreciation of the risk/benefit ratio of each individual examination using X-Rays.

Characteristics of binge eating disorder in relation to diagnostic criteria

Science.gov (United States)

Wilfley, Denise E; Citrome, Leslie; Herman, Barry K

2016-01-01

The objective of this review was to examine the evidentiary basis for binge eating disorder (BED) with reference to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) diagnostic criteria for BED. A PubMed search restricted to titles and abstracts of English-language reviews, meta-analyses, clinical trials, randomized controlled trials, journal articles, and letters using human participants was conducted on August 7, 2015, using keywords that included “binge eating disorder,” DSM-5, DSM-IV, guilt, shame, embarrassment, quantity, psychological, behavior, and “shape and weight concerns.” Of the 257 retrieved publications, 60 publications were considered relevant to discussions related to DSM-5 diagnostic criteria and were included in the current review, and 20 additional references were also included on the basis of the authors’ knowledge and/or on a review of the reference lists from relevant articles obtained through the literature search. Evidence supports the duration/frequency criterion for BED and the primary importance of loss of control and marked distress in identifying individuals with BED. Although overvaluation of shape/weight is not a diagnostic criterion, its relationship to the severity of BED psychopathology may identify a unique subset of individuals with BED. Additionally, individuals with BED often exhibit a clinical profile consisting of psychiatric (eg, mood, obsessive–compulsive, and impulsive disorders) and medical (eg, gastrointestinal symptoms, metabolic syndrome, and type 2 diabetes) comorbidities and behavioral profiles (eg, overconsumption of calories outside of a binge eating episode and emotional eating). Future revisions of the BED diagnostic criteria should consider the inclusion of BED subtypes, perhaps based on the overvaluation of shape/weight, and an evidence-based reassessment of severity criteria. PMID:27621631

Third-person Diagnostic Interview on the Cognitive Insight Level of Psychotic Patients with an Insight at the Denial Level.

Science.gov (United States)

Mehdizadeh, Mahsa; Rezaei, Omid

2016-01-01

According to the previous findings, the third-person technique improved the clinical insight of psychotic patients, therefore the present study aims to examine the effect of a third-person interview compared to a first-person interview on the level of cognitive insight of psychotic patients with an insight at the denial level. In this study, using interviews and questionnaires, a total number of 44 patients of Razi Psychiatric Educational and Treatment Center with an insight at the denial level being assessed using diagnostic interviews were divided randomly into two groups. Then, the two groups of patients' cognitive insights were evaluated using Beck Cognitive Insight Scale. The findings indicated that in psychotic patients with an insight at the denial level, the third-person technique of interview compared to the first-person had little effect on the improvement of overall cognitive insight and its components, including self-reflection and self-assurance; however, this effect was not strong enough to make a significant difference between the two groups of patients. According to the study findings, we can conclude that the third-person interview compared to the first-person interview has no effect on the improvement of the cognitive insight of psychotic patients with an insight at the denial level. This finding is consistent with the previous studies indicating that although the theory of mind has some correlations with the clinical insight of patients, it has no effect on their cognitive insight.

System theory in medical diagnostic devices: an overview.

Science.gov (United States)

Baura, Gail D

2006-01-01

Medical diagnostics refers to testing conducted either in vitro or in vivo to provide critical health care information for risk assessment, early diagnosis, treatment, or disease management. Typical in vivo diagnostic tests include the computed tomography scan, magnetic resonance imaging, and blood pressure screening. Typical in vitro diagnostic tests include cholesterol, Papanicolaou smear, and conventional glucose monitoring tests. Historically, devices associated with both types of diagnostics have used heuristic curve fitting during signal analysis. However, since the early 1990s, a few enterprising engineers and physicians have used system theory to improve their core processing for feature detection and system identification. Current applications include automated Pap smear screening for detection of cervical cancer and diagnosis of Alzheimer's disease. Future applications, such as disease prediction before symptom onset and drug treatment customization, have been catalyzed by the Human Genome Project.

Accuracy of Referring Provider and Endoscopist Impressions of Colonoscopy Indication.

Science.gov (United States)

Naveed, Mariam; Clary, Meredith; Ahn, Chul; Kubiliun, Nisa; Agrawal, Deepak; Cryer, Byron; Murphy, Caitlin; Singal, Amit G

2017-07-01

Background: Referring provider and endoscopist impressions of colonoscopy indication are used for clinical care, reimbursement, and quality reporting decisions; however, the accuracy of these impressions is unknown. This study assessed the sensitivity, specificity, positive and negative predictive value, and overall accuracy of methods to classify colonoscopy indication, including referring provider impression, endoscopist impression, and administrative algorithm compared with gold standard chart review. Methods: We randomly sampled 400 patients undergoing a colonoscopy at a Veterans Affairs health system between January 2010 and December 2010. Referring provider and endoscopist impressions of colonoscopy indication were compared with gold-standard chart review. Indications were classified into 4 mutually exclusive categories: diagnostic, surveillance, high-risk screening, or average-risk screening. Results: Of 400 colonoscopies, 26% were performed for average-risk screening, 7% for high-risk screening, 26% for surveillance, and 41% for diagnostic indications. Accuracy of referring provider and endoscopist impressions of colonoscopy indication were 87% and 84%, respectively, which were significantly higher than that of the administrative algorithm (45%; P 90%) for determining screening (vs nonscreening) indication, but specificity of the administrative algorithm was lower (40.3%) compared with referring provider (93.7%) and endoscopist (84.0%) impressions. Accuracy of endoscopist, but not referring provider, impression was lower in patients with a family history of colon cancer than in those without (65% vs 84%; P =.001). Conclusions: Referring provider and endoscopist impressions of colonoscopy indication are both accurate and may be useful data to incorporate into algorithms classifying colonoscopy indication. Copyright © 2017 by the National Comprehensive Cancer Network.

Determination of Natural Levels of Radionuclides in Proposed Mushroom Reference Material (A Proficiency Test Exercise)

International Nuclear Information System (INIS)

Waheed, S.; Rahman, A.; Siddique, N.; Ahmad, S.; Zaidi, J.H.

2006-08-01

A proficiency test (PT) was organized within the framework of international Atomic Energy Agency (IAEA) project INT/1/054, entitled 'Preparation' of Reference Materials and Organization of Proficiency Test Rounds'. This exercise served to estimate the proficiency of the analytical laboratories from participating countries. This report presents the results of the proficiency test exercise on the proposed Mushroom Reference Material for the determination of natural levels of radionuclides. Laboratories from 6 different countries submitted data on the following three radionuclides: /sup 134/Cs, /sup 137/Cs, /sup 40/K. Results for /sup 134/Cs, 137/sup 137/Cs, and /sup 40/K in the mushroom reference material were reported by three or more participating laboratories and could be subjected to statistical evaluation. The original data of these raionuclides was subjected to a computer program 'Histo Vession 2.1' provided by IAEA. The four outlier tests i.e. Dixon, Grubbs, Skewness and Kurtosis were applied to the data sets. All values for these three radionuclides were accepted by the software. Consensus (overall) mean value, absolute standard deviation, relative standard deviation, standard error, median and range of values for these three radionuclides have been are obtained (at significance level 0.05). the consensus mean values and confidence intervals are given./sup 134/Cs: 4.4 Bq/kg (3.4-5.3 Bq/kg) /sup 137/Cs: 2899 Bq/kg (2740-3058 Bq/kg) /sup 40/K: 1136 Bq/kg (1046-1226 Bq/kg). (author)

[Cognitive errors in diagnostic decision making].

Science.gov (United States)

Gäbler, Martin

2017-10-01

Approximately 10-15% of our diagnostic decisions are faulty and may lead to unfavorable and dangerous outcomes, which could be avoided. These diagnostic errors are mainly caused by cognitive biases in the diagnostic reasoning process.Our medical diagnostic decision-making is based on intuitive "System 1" and analytical "System 2" diagnostic decision-making and can be deviated by unconscious cognitive biases.These deviations can be positively influenced on a systemic and an individual level. For the individual, metacognition (internal withdrawal from the decision-making process) and debiasing strategies, such as verification, falsification and rule out worst-case scenarios, can lead to improved diagnostic decisions making.

Free insulin-like growth factor I serum levels in 1430 healthy children and adults, and its diagnostic value in patients suspected of growth hormone deficiency

DEFF Research Database (Denmark)

Juul, A; Holm, K; Kastrup, K W

1997-01-01

fraction of the total IGF-I circulates in its free form, which is believed to be the biologically active form. However, our knowledge of the clinical or physiological value of determination of free IGF-I in serum is limited at present. In adults, the diagnostic value of total IGF-I and IGFBP-3......, commercially available immunoradiometric assay (Diagnostic Systems Laboratories) to establish valid normative data for this analysis. We studied the diagnostic value of free IGF-I in relation to total IGF-I and IGFBP-3 determinations in adults who were suspected of GHD. A GH provocative test, using oral...... determinations in patients suspected of GHD has only been reported in a few studies, whereas no previous reports on the diagnostic value of free IGF-I levels in adults suspected of GHD exist. Serum levels of free IGF-I were determined in 1430 healthy children, adolescents, and adults by a newly developed...

Free insulin-like growth factor I serum levels in 1430 healthy children and adults, and its diagnostic value in patients suspected of growth hormone deficiency

DEFF Research Database (Denmark)

Juul, A; Holm, K; Kastrup, K W

1997-01-01

fraction of the total IGF-I circulates in its free form, which is believed to be the biologically active form. However, our knowledge of the clinical or physiological value of determination of free IGF-I in serum is limited at present. In adults, the diagnostic value of total IGF-I and IGFBP-3...... determinations in patients suspected of GHD has only been reported in a few studies, whereas no previous reports on the diagnostic value of free IGF-I levels in adults suspected of GHD exist. Serum levels of free IGF-I were determined in 1430 healthy children, adolescents, and adults by a newly developed......, commercially available immunoradiometric assay (Diagnostic Systems Laboratories) to establish valid normative data for this analysis. We studied the diagnostic value of free IGF-I in relation to total IGF-I and IGFBP-3 determinations in adults who were suspected of GHD. A GH provocative test, using oral...

The relative frequency of common neuromuscular diagnoses in a reference center

OpenAIRE

Cotta, Ana; Paim, Júlia Filardi; Carvalho, Elmano; da-Cunha-Júnior, Antonio Lopes; Navarro, Monica M.; Valicek, Jaquelin; Menezes, Miriam Melo; Nunes, Simone Vilela; Xavier-Neto, Rafael; Baptista Junior, Sidney; Lima, Luciano Romero; Takata, Reinaldo Issao; Vargas, Antonio Pedro

2017-01-01

ABSTRACT The diagnostic procedure in neuromuscular patients is complex. Knowledge of the relative frequency of neuromuscular diseases within the investigated population is important to allow the neurologist to perform the most appropriate diagnostic tests. Objective: To report the relative frequency of common neuromuscular diagnoses in a reference center. Methods: A 17-year chart review of patients with suspicion of myopathy. Results: Among 3,412 examinations, 1,603 (46.98%) yielded confir...

Nuclear power plant diagnostics study at the Midland training simulator

International Nuclear Information System (INIS)

Reifman, J.; Rank, P.; Lee, J.C.

1991-01-01

Training simulators provide a real world environment for testing advanced diagnostic and control systems as an aid to nuclear power plant operators. The simulators not only duplicate the hardware din the actual control room, allowing for analysis of man-machine interface, but also represent the dynamic behavior of the reference plant in real-time, in a realistic manner. Training simulators provide the means to representing the reference plant operations in a wide range of operation conditions including off-normal and emergency conditions. Transient events with very low probability of occurrence can then be represented and used to test the capabilities of advanced diagnostic and control systems. For these reasons, full-scope operator training simulators have been used as a test bed for a number of advanced diagnostic concepts. The University of Michigan and Consumers Power Company have been collaborating in a program devoted to the development and study of advanced concepts for automatic diagnostics and control of nuclear power plants. The program has been focused on the use of the full-scope operator training Midland Nuclear Power Plant Unit 2 (MNP-2) Simulator for development, testing, and verification of advanced diagnostics concepts. In their current efforts, the authors have developed two artificial intelligent (AI) diagnostic concepts that have been applied to the MNP-2 Simulator: the systematic generation and updating of a rule-based knowledge system for nuclear power plant diagnostics and a nonlinear parameter estimation algorithm called the simulation filter. The simulation filter algorithm is used with the MNP-2 Simulator to improve the simulation of the Three Mile Island Unit 2 (TMI-2) accident. 11 refs., 4 figs

Dosimetric studies in diagnostic radiology

International Nuclear Information System (INIS)

Mohamadain, K. E. M.

2004-04-01

A dosimetric study in pediatric radiology and adult patients was currently being carried out at the pediatrics units of two large hospitals in Rio de Janeiro city: IPPMG (Instituto de Pediatric e Puericultura Martagao Gesteira, University hospital of federal University of Rio de Janeiro), IFF (Instituto Fernandes Figueira, FIOCRUZ) and Hospital Geral de Bonsucesso, a large public hospital in Rio de Janeiro city (HGB) Brazil. The dosimetric study was also performed at three pediatrics units in Sudan, namely, Ahmed Gasim, Khartoum and Omdurman hospitals. For chest x-ray examination the entrance skin dose(ESD) for AP, PA and LAT projections of pediatric patients, and the scattered dose at the thyroid, ovary and gonads have been obtained with thermoluminescent dosimeters (TLD) and with use of a software package Dosecal in thr Brazilian hospitals, and with the software dosecal in the Sudanese hospitals.The aim of this work was to estimate the entrance skin dose (ESD), the effective dose (ED) and the body organ dose (BOD) for chest x-ray exposure in pediatric patients, and different exams for adults patients, and to compare the results obtained in the tow Countries Sudan and Brazil with the reference dose level. For ESD evaluation of the chest x-ray, three different TL dosimeters have been used, namely LiF: Mg, Ti (TLD 100) CaSo 4 : Dy and LiF:Mg, Cu,P (TLD 100 H). The age intervals considered were: 0-1 years, 1-5 years, 5-10 years and 10-15 years. The results obtained with all dosimeters were in good agreement with, those obtained by the dosecal software, especially for AP and PA projection. However, some discrepancies were found for the LAT projection. The results within Brazil were some what consistent while in Sudan, large difference were observed, it was also noted that the doses in Brazil hospitals were less than the reference dose levels while in Sudanese hospitals the doses were higher than the reference dose levels. For adult patients only the software dosecal

Reference hearing threshold levels for chirp signals delivered by an ER-3A insert earphone

DEFF Research Database (Denmark)

Gøtsche-Rasmussen, Kristian; Poulsen, Torben; Elberling, Claus

2012-01-01

back from a Tucker Davies Technologies System II, and a Matlab program controlled the test setup. The results are specified in dB peak-to-peak equivalent threshold sound pressure levels (dB peETSPL). Study sample: The test group consisted of 25 otologically-normal young adults (age 18–25 years......Objective: To establish reference hearing threshold levels for chirps and frequency-specific chirps. Design: Hearing thresholds were determined monaurally for broad-band chirps and octave-band chirps using the Etymotic Research, ER-3A insert earphone. The chirps were presented using two repetition...

Psychometric properties of the motor diagnostics in the German football talent identification and development programme.

Science.gov (United States)

HÖner, Oliver; Votteler, Andreas; Schmid, Markus; Schultz, Florian; Roth, Klaus

2015-01-01

The utilisation of motor performance tests for talent identification in youth sports is discussed intensively in talent research. This article examines the reliability, differential stability and validity of the motor diagnostics conducted nationwide by the German football talent identification and development programme and provides reference values for a standardised interpretation of the diagnostics results. Highly selected players (the top 4% of their age groups, U12-U15) took part in the diagnostics at 17 measurement points between spring 2004 and spring 2012 (N = 68,158). The heterogeneous test battery measured speed abilities and football-specific technical skills (sprint, agility, dribbling, ball control, shooting, juggling). For all measurement points, the overall score and the speed tests showed high internal consistency, high test-retest reliability and satisfying differential stability. The diagnostics demonstrated satisfying factorial-related validity with plausible and stable loadings on the two empirical factors "speed" and "technical skills". The score, and the technical skills dribbling and juggling, differentiated the most among players of different performance levels and thus showed the highest criterion-related validity. Satisfactory psychometric properties for the diagnostics are an important prerequisite for a scientifically sound rating of players' actual motor performance and for the future examination of the prognostic validity for success in adulthood.

A comparison and cross-reference of commercial low-level radioactive waste acceptance criteria

International Nuclear Information System (INIS)

Kerr, T.A.

1997-04-01

This document, prepared by the National Low-Level Waste Management Program at the Idaho National Engineering and Environmental Laboratory, is a comparison and cross-reference of commercial low-level radioactive waste acceptance criteria. Many of these are draft or preliminary criteria as well as implemented criteria at operating low-level radioactive waste management facilities. Waste acceptance criteria from the following entities are included: US Nuclear Regulatory Commission, South Carolina, Washington, Utah, Nevada, California, illinois, Texas, North Carolina, Nebraska, Pennsylvania, New York, and the Midwest Compact Region. Criteria in the matrix include the following: physical form, chemical form, liquid limits, void space in packages, concentration averaging, types of packaging, chelating agents, solidification media, stability requirements, sorptive media, gas, oil, biological waste, pyrophorics, source material, special nuclear material, package dimensions, incinerator ash, dewatered resin, transuranics, and mixed waste. Each criterion in the matrix is cross-referenced to its source document so that exact requirements can be determined

The Influence of Phytotherapy on Prolactin Level in Macroprolactinoma Patients

OpenAIRE

Trogrlić, Ivo; Trogrlić, Dragan; Trogrlić, Zoran

2011-01-01

The study aims at demonstrating the efficiency of phytotherapy in regulation of prolactin levels in patients diagnosed with pituitary macroprolactinoma. The study made use of workup outcomes submitted by treating healthcare facilities where the patients were first diagnosed with macroprolactinomas based on diagnostic imaging (MRI and/or CT), laboratory workup, and hormone status estimation. The data in reference served as the baseline for a comparative follow-up of phytotherapeutic efficiency...

Aircraft Engine Gas Path Diagnostic Methods: Public Benchmarking Results

Science.gov (United States)

Simon, Donald L.; Borguet, Sebastien; Leonard, Olivier; Zhang, Xiaodong (Frank)

2013-01-01

Recent technology reviews have identified the need for objective assessments of aircraft engine health management (EHM) technologies. To help address this issue, a gas path diagnostic benchmark problem has been created and made publicly available. This software tool, referred to as the Propulsion Diagnostic Method Evaluation Strategy (ProDiMES), has been constructed based on feedback provided by the aircraft EHM community. It provides a standard benchmark problem enabling users to develop, evaluate and compare diagnostic methods. This paper will present an overview of ProDiMES along with a description of four gas path diagnostic methods developed and applied to the problem. These methods, which include analytical and empirical diagnostic techniques, will be described and associated blind-test-case metric results will be presented and compared. Lessons learned along with recommendations for improving the public benchmarking processes will also be presented and discussed.

Radiation exposure of the Italian population due to medical diagnostic examinations in 1975

International Nuclear Information System (INIS)

Benassai, S.; Curatolo, M.; Dobici, F.; Indovina, P.L.; Pugliani, L.; Salvadori, P.

1977-01-01

The genetically significant dose received by the Italian population in 1975 due to the diagnostic X-ray examinations and radiopharmaceuticals was investigated and the results are presented. Concerning the diagnostic X-ray examinations the data were obtained by a representative sample and extrapolated over the whole population with reference to the over-all X-ray film consumption. From the reported data it can be concluded that about 50% of population was subjected to X-ray examinations and the genetically significant dose amounts to about 30 mrem. With reference to diagnostic use of radiopharmaceuticals the number of collected data was so large to be considered as representative of the situation. From the collected data it can be concluded that about 10% of population was subjected to these examinations and that the genetically significant dose is less than 2 mrem. Both for diagnostic X-ray examinations and use of radiopharmaceuticals results are here presented for the distribution of different uses and examinations. The genetically significant dose to which the Italian population was exposed in 1975 can be said to be of the order of 30 mrem. In view of lowering this dose some indications are presented with reference both to the legislative and technical measures

A suggestion of reference data for flow distribution at ankle and foot level using quantitative 99Tc-HDP three-phase bone scintigraphy

DEFF Research Database (Denmark)

Tøndevold, Niklas; Reving, Sofie; Møller, Nette

2012-01-01

To determine reference intervals for quantitative 99mTc-hydroxymethylene diphosphonate (99mTc-HDP) three-phase bone scintigraphy regarding flow distribution at ankle and mid-foot level.......To determine reference intervals for quantitative 99mTc-hydroxymethylene diphosphonate (99mTc-HDP) three-phase bone scintigraphy regarding flow distribution at ankle and mid-foot level....

Mapping of radio frequency electromagnetic field exposure levels in outdoor environment and comparing with reference levels for general public health.

Science.gov (United States)

Cansiz, Mustafa; Abbasov, Teymuraz; Kurt, M Bahattin; Celik, A Recai

2018-03-01

In this study, radio frequency electromagnetic field exposure levels were measured on the main streets in the city center of Diyarbakır, Turkey. Measured electric field levels were plotted on satellite imagery of Diyarbakır and were compared with exposure guidelines published by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Exposure measurements were performed in dense urban, urban and suburban areas each day for 7 consecutive days. The measurement system consisted of high precision and portable spectrum analyzer, three-axis electric field antenna, connection cable and a laptop which was used to record the measurement samples as a data logger. The highest exposure levels were detected for two places, which are called Diclekent and Batıkent. It was observed that the highest instantaneous electric field strength value for Batıkent was 7.18 V/m and for Diclekent was 5.81 V/m. It was statistically determined that the main contributor band to the total exposure levels was Universal Mobile Telecommunications System band. Finally, it was concluded that all measured exposure levels were lower than the reference levels recommended by ICNIRP for general public health.

Same-day diagnosis based on histology for women suspected of breast cancer: high diagnostic accuracy and favorable impact on the patient.

Directory of Open Access Journals (Sweden)

Maarten W Barentsz

Full Text Available Same-day diagnosis based on histology is increasingly being offered to patients suspected of breast cancer. We evaluated to which extent same-day diagnosis affected diagnostic accuracy and patients' anxiety levels during the diagnostic phase.All 759 women referred for same-day evaluation of suspicious breast lesions between November 2011-March 2013 were included. Diagnostic accuracy was assessed by linking all patients to the national pathology database to identify diagnostic discrepancies, in which case slides were reviewed. Patients' anxiety was measured in 127 patients by the State Trait and Anxiety Inventory on six moments during the diagnostic workup and changes over time (< = 1 week were analyzed by mixed effect models.Core-needle biopsy was indicated in 374/759 patients (49.3% and in 205/759 (27% patients, invasive or in situ cancer was found. Final diagnosis on the same day was provided for 606/759 (79.8% patients. Overall, 3/759 (0.4% discordant findings were identified. Anxiety levels decreased significantly over time from 45.2 to 30.0 (P = <0.001. Anxiety levels decreased from 44.4 to 25.9 (P = <0.001 for patients with benign disease, and remained unchanged for patients diagnosed with malignancies (48.6 to 46.7, P = 0.933. Time trends in anxiety were not affected by other patient or disease characteristics like age, education level or (family history of breast cancer.Same-day histological diagnosis is feasible in the vast majority of patients, without impairing diagnostic accuracy. Patients' anxiety rapidly decreased in patients with a benign diagnosis and remained constant in patients with malignancy.

X-ray application in diagnostics and therapeutics

International Nuclear Information System (INIS)

Braun, H.

1975-01-01

The lecture gives a general survey on the present possibilities of application of X-rays and radio-isotopes in medical diagnostics and therapeutics. The possibility of decreasing the radiation exposure by using image intensifiers and television is particularly indicated. The advantages of scintiscanning in diagnostics are presented by means of a series of examples. The increasing significance of telecurie equipment and particle accelerators are refered to in therapeutics. Finally, the radiation risk due to the medical application of radiation to the patient and the personnel is discussed and compared to the natural radiation exposure. (ORU/LH) [de

Performance diagnostic system for emergency diesel generators

International Nuclear Information System (INIS)

Logan, K.P.

1991-01-01

Diesel generators are commonly used for emergency backup power at nuclear stations. Emergency diesel generators (EDGs) are subject to both start-up and operating failures, due to infrequent and fast-start use. EDG reliability can be critical to plant safety, particularly when station blackout occurs. This paper describes an expert diagnostic system designed to consistently evaluate the operating performance of diesel generators. The prototype system is comprised of a suite of sensor monitoring, cylinder combustion analyzing, and diagnostic workstation computers. On-demand assessments of generator and auxiliary equipment performance are provided along with color trend displays comparing measured performance to reference-normal conditions

Diagnostic Accuracy of the Slump Test for Identifying Neuropathic Pain in the Lower Limb.

Science.gov (United States)

Urban, Lawrence M; MacNeil, Brian J

2015-08-01

Diagnostic accuracy study with nonconsecutive enrollment. To assess the diagnostic accuracy of the slump test for neuropathic pain (NeP) in those with low to moderate levels of chronic low back pain (LBP), and to determine whether accuracy of the slump test improves by adding anatomical or qualitative pain descriptors. Neuropathic pain has been linked with poor outcomes, likely due to inadequate diagnosis, which precludes treatment specific for NeP. Current diagnostic approaches are time consuming or lack accuracy. A convenience sample of 21 individuals with LBP, with or without radiating leg pain, was recruited. A standardized neurosensory examination was used to determine the reference diagnosis for NeP. Afterward, the slump test was administered to all participants. Reports of pain location and quality produced during the slump test were recorded. The neurosensory examination designated 11 of the 21 participants with LBP/sciatica as having NeP. The slump test displayed high sensitivity (0.91), moderate specificity (0.70), a positive likelihood ratio of 3.03, and a negative likelihood ratio of 0.13. Adding the criterion of pain below the knee significantly increased specificity to 1.00 (positive likelihood ratio = 11.9). Pain-quality descriptors did not improve diagnostic accuracy. The slump test was highly sensitive in identifying NeP within the study sample. Adding a pain-location criterion improved specificity. Combining the diagnostic outcomes was very effective in identifying all those without NeP and half of those with NeP. Limitations arising from the small and narrow spectrum of participants with LBP/sciatica sampled within the study prevent application of the findings to a wider population. Diagnosis, level 4-.

MERRA 2D IAU Ocean Surface Diagnostic, Single Level, Diurnal (2/3x1/2L1) V5.2.0

Data.gov (United States)

National Aeronautics and Space Administration — The MATUNXOCN or tavgU_2d_ocn_Nx data product is the MERRA Data Assimilation System 2-Dimensional ocean surface single-level diagnostics that is monthly mean...

Density-dependent lines of one- and two-electron ions in diagnostics of laboratory plasma. I. The rates of collision relaxation of excited levels

Energy Technology Data Exchange (ETDEWEB)

Shevelko, V P; Skobelev, I Yu; Vinogradov, A V [Lebedev Physical Institute, Academy of Sciences of the USSR, Moscow, USSR

1977-01-01

Plasma devices with inertial plasma confinement such as laser produced plasmas, exploding wires, plasma focus, etc., which have been rapidly developed during recent years., appear to be very intensive sources of spectral line radiation in far UV and X-ray regions. Analysis of this radiation provides a good tool for plasma diagnostics with very high electron densities up to 10/sup 22/cm/sup -3/. In this work, consisting of two parts, the authors consider the mechanism of the formation of spectral lines in hot and dense plasma. The key point for density diagnostics is the fact that for some ion levels the rate of collisional relaxation has the same order of magnitude as the radiative decay. Thus the intensities of spectral lines arising from these levels show a strong dependence on electron density which makes diagnostics possible. In this paper, emphasis is laid on the calculation of rates of transition between close ion levels induced by electron or ion impact, which usually gives the main contribution to the collisional relaxation constants. The influence of plasma polarization effects on the collision frequency in a dense plasma is also considered.

Diagnostic development

International Nuclear Information System (INIS)

Barnett, C.F.; Brisson, D.A.; Greco, S.E.

1978-01-01

During the past year the far-infrared or submillimeter diagnostic research program resulted in three major developments: (1) an optically pumped 0.385-μm D 2 O-laser oscillator-amplifier system was operated at a power level of 1 MW with a line width of less than 50 MHz; (2) a conical Pyrex submillimeter laser beam dump with a retention efficiency greater than 10 4 was developed for the ion temperature Thompson scattering experiment; and (3) a new diagnostic technique was developed that makes use of the Faraday rotation of a modulated submillimeter laser beam to determine plasma current profile. Measurements of the asymmetric distortion of the H/sub α/ (6563 A) spectral line profile show that the effective toroidal drift velocity, dv/sub two vertical bars i/dT/sub i/, may be used as an indicator of plasma quality and as a complement to other ion temperature diagnostics

A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain.

Science.gov (United States)

Boswell, Mark V; Manchikanti, Laxmaiah; Kaye, Alan D; Bakshi, Sanjay; Gharibo, Christopher G; Gupta, Sanjeeva; Jha, Sachin Sunny; Nampiaparampil, Devi E; Simopoulos, Thomas T; Hirsch, Joshua A

2015-01-01

Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referred pain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities are unreliable in diagnosing zygapophysial joint pain. A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks. To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain. A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. The level of evidence was classified as Level I to V based on the grading of evidence utilizing best evidence synthesis. Data sources included relevant literature identified through searches of PubMed and other electronic searches published from 1966 through March 2015, Cochrane reviews, and manual searches of the bibliographies of known primary and review articles. Studies must have been performed utilizing controlled local anesthetic blocks. The criterion standard must have been at least 50% pain relief from baseline scores and the ability to perform previously painful movements. The available evidence is Level I for lumbar facet joint nerve blocks with the inclusion of a total of 17 studies with dual diagnostic blocks, with at least 75% pain relief with an average prevalence of 16% to 41% and false-positive rates of 25% to 44%. The evidence for diagnosis of cervical facet joint pain with cervical facet joint nerve blocks is Level II based on a total of 11 controlled diagnostic accuracy studies, with significant variability among the prevalence in a heterogenous population with internal inconsistency. The prevalence rates ranged from 36% to 67% with at least 80% pain relief as the criterion standard and a false-positive rate of 27% to 63%. The level of evidence for the diagnostic accuracy of thoracic facet

Low-level radioactive waste technology: a selected, annotated bibliography. [416 references

Energy Technology Data Exchange (ETDEWEB)

Fore, C.S.; Carrier, R.F.; Brewster, R.H.; Hyder, L.K.; Barnes, K.A.

1981-10-01

This annotated bibliography of 416 references represents the third in a series to be published by the Hazardous Materials Information Center containing scientific, technical, economic, and regulatory information relevant to low-level radioactive waste technology. The bibliography focuses on disposal site, environmental transport, and waste treatment studies as well as general reviews on the subject. The publication covers both domestic and foreign literature for the period 1951 to 1981. Major chapters selected are Chemical and Physical Aspects; Container Design and Performance; Disposal Site; Environmental Transport; General Studies and Reviews; Geology, Hydrology, and Site Resources; Regulatory and Economic Aspects; Social Aspects; Transportation Technology; Waste Production; and Waste Treatment. Entries in each of the chapters are further classified as a field study, laboratory study, theoretical study, or general overview involving one or more of these research areas.

The diagnostic performance of CT-derived fractional flow reserve for evaluation of myocardial ischaemia confirmed by invasive fractional flow reserve: a meta-analysis.

Science.gov (United States)

Li, S; Tang, X; Peng, L; Luo, Y; Dong, R; Liu, J

2015-05-01

To review the literature on the diagnostic accuracy of CT-derived fractional flow reserve (FFRCT) for the evaluation of myocardial ischaemia in patients with suspected or known coronary artery disease, with invasive fractional flow reserve (FFR) as the reference standard. A PubMed, EMBASE, and Cochrane cross-search was performed. The pooled diagnostic accuracy of FFRCT, with FFR as the reference standard, was primarily analysed, and then compared with that of CT angiography (CTA). The thresholds to diagnose ischaemia were FFR ≤0.80 or CTA ≥50% stenosis. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Three multicentre studies (NXT Trial, DISCOVER-FLOW study and DeFACTO study) were included, examining 609 patients and 1050 vessels. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) for FFRCT were 89% (85-93%), 71% (65-75%), 70% (65-75%), 90% (85-93%), 3.31 (1.79-6.14), 0.16 (0.11-0.23), and 21.21 (9.15-49.15) at the patient-level, and 83% (78-63%), 78% (75-81%), 61% (56-65%), 92% (89-90%), 4.02 (1.84-8.80), 0.22 (0.13-0.35), and 19.15 (5.73-63.93) at the vessel-level. At per-patient analysis, FFRCT has similar sensitivity but improved specificity, PPV, NPV, LR+, LR-, and DOR versus those of CTA. At per-vessel analysis, FFRCT had a slightly lower sensitivity, similar NPV, but improved specificity, PPV, LR+, LR-, and DOR compared with those of CTA. The area under the summary receiver operating characteristic curves for FFRCT was 0.8909 at patient-level and 0.8865 at vessel-level, versus 0.7402 for CTA at patient-level. FFRCT, which was associated with improved diagnostic accuracy versus CTA, is a viable alternative to FFR for detecting coronary ischaemic lesions. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

First WHO/IFCC International Reference Reagent for Lipoprotein(a) for Immunoassay--Lp(a) SRM 2B.

Science.gov (United States)

Dati, Francesco; Tate, Jillian R; Marcovina, Santica M; Steinmetz, Armin

2004-01-01

Lipoprotein(a) is an important predictor of cardiovascular disease risk. The lack of internationally accepted standardization has impeded the broad application of this lipoprotein in laboratory medicine. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), through its Working Group on Lipoprotein(a) and together with research institutions and several diagnostic companies, have succeeded in developing an international reference material that is intended for the transfer of a lipoprotein(a) concentration to manufacturers' master calibrators. IFCC SRM 2B has recently been accepted by the WHO Expert Committee on Biological Standardization as the 'First WHO/IFCC International Reference Reagent for Lipoprotein(a) for Immunoassay'. The assigned unitage of 0.1071 nanomoles of lipoprotein(a) per vial is traceable to the consensus reference method for lipoprotein(a) and will enable conformity by diagnostic companies to the European Union's Directive on In vitro Diagnostic Medical Devices for the metrological traceability of calibrator materials.

[Biochemical diagnostics of fatal opium intoxication].

Science.gov (United States)

Papyshev, I P; Astashkina, O G; Tuchik, E S; Nikolaev, B S; Cherniaev, A L

2013-01-01

Biochemical diagnostics of fatal opium intoxication remains a topical problem in forensic medical science and practice. We investigated materials obtained in the course of forensic medical expertise of the cases of fatal opium intoxication. The study revealed significant differences between myoglobin levels in blood, urine, myocardium, and skeletal muscles. The proposed approach to biochemical diagnostics of fatal opium intoxication enhances the accuracy and the level of evidence of expert conclusions.

Application of the new International Code of Practice for dosimetry in diagnostic radiology to conventional exams

International Nuclear Information System (INIS)

Martinez Gonzalez, A.; Cardenas Herrera, J.; Walwyn Salas, G.; Machado, A.; Mora Machado, R. de la

2008-01-01

Full text: During the recent years, a policy for updating and installation of the X-ray equipment, specialized as well as conventional, have been carrying out, in Cuba. Conventional equipment has reached almost the whole primary level. Considering this situation, the quality control programs and clinical dosimetry have become even more important. Regarding the last one, an International Code of Practice for Dosimetry in Diagnostic Radiology had been published by the International Atomic Energy Agency in order to been used as a guide and to standardize the methodologies used to evaluate the patient exposure in radiodiagnostic. Taken into consideration the above reasons, an assessment of the aforementioned code of practice was done in order to choose the most feasible methodology to implement in the country. The evaluation was performed considering the lack of dosimetric equipment and medical physicists in this practice, in the interests of increasing the measurements scope to a large number of services as well as to standardize the methodology on a national scale. The present work shows the results obtained from the application of the new code of practice to conventional radiology exams in some medical institutions. Out of 3 on patients measurements methodologies described in the code of practice, the one of measurement of the incident air kerma was chosen. This methodology allow to the physicist to focus on the diagnostic equipment tests and to delegate the collection of the patient and exposure parameters data to the technicians, which make the increased of the patient and diagnostic departments sample, possible. The measurements were carried out in 2 hospital of the capital. The exams involved in the assessments were thorax PA, lumbar spine AP and lumbar spine LAT. In every diagnostic service, 25 patients were chosen on each projection. The weight and height average of the patient sample were 68 kg and 167 cm respectively. In the assessment were considered only

Simulation and interpretation of ion beam diagnostics on PBFA-II

International Nuclear Information System (INIS)

Mehlhorn, T.A.; Nelson, W.E.; Maenchen, J.E.; Stygar, W.A.; Ruiz, C.L.; Lockner, T.R.; Johnson, D.J.

1988-03-01

Ion diode and beam focusing experiments are in progress on PBFA-II working towards an ultimate goal of significant burn of an ICF pellet. Beam diagnostics on these experiments include a Thomson parabola, K/sub alpha/ x-ray pinhole cameras, filtered ion pinhole cameras, and a magnetic spectrometer. We are developing two new computer programs to simulate and interpret the data obtained from these diagnostics. VIDA is a VAX-based program that manipulates and unfolds data from digitized particle and x-ray diagnostic images. VIDA operations include: image display, background substraction, relative-to-absolute coordinate transformations, and image projection into the beam reference frame. PICDIAG allows us to study the effects of time-dependent ion focusing on the performance of ion beam diagnostics. 10 refs., 5 figs

Model of critical diagnostic reasoning: achieving expert clinician performance.

Science.gov (United States)

Harjai, Prashant Kumar; Tiwari, Ruby

2009-01-01

Diagnostic reasoning refers to the analytical processes used to determine patient health problems. While the education curriculum and health care system focus on training nurse clinicians to accurately recognize and rescue clinical situations, assessments of non-expert nurses have yielded less than satisfactory data on diagnostic competency. The contrast between the expert and non-expert nurse clinician raises the important question of how differences in thinking may contribute to a large divergence in accurate diagnostic reasoning. This article recognizes superior organization of one's knowledge base, using prototypes, and quick retrieval of pertinent information, using similarity recognition as two reasons for the expert's superior diagnostic performance. A model of critical diagnostic reasoning, using prototypes and similarity recognition, is proposed and elucidated using case studies. This model serves as a starting point toward bridging the gap between clinical data and accurate problem identification, verification, and management while providing a structure for a knowledge exchange between expert and non-expert clinicians.

Study of methodology diversification in diagnostics

International Nuclear Information System (INIS)

Suda, Kazunori; Yonekawa, Tsuyoshi; Yoshikawa, Shinji; Hasegawa, Makoto

1999-03-01

There are several research activities to enhance safety and reliability of nuclear power plant operation and maintenance. We are developing a concept of an autonomous operation system where the role of operators is replaced with artificial intelligence. The purpose of the study described in this report is to develop a operator support system in abnormal plant situations. Conventionally, diagnostic modules based on individual methodology such as expert system have been developed and verified. In this report, methodology diversification is considered to integrate diagnostic modules which performance are confirmed using information processing technique. Technical issues to be considered in diagnostic methodology diversification are; 1)reliability of input data, 2)diversification of knowledge models, algorithms and reasoning schemes, 3)mutual complement and robustness. The diagnostic module utilizing the different approaches defined along with strategy of diversification was evaluated using fast breeder plant simulator. As a result, we confirmed that any singular diagnostic module can not meet accuracy criteria for the entire set of anomaly events. In contrast with this, we confirmed that every abnormality could be precisely diagnosed by a mutual combination. In other words, legitimacy of approach selected by strategy of diversification was shown, and methodology diversification attained clear efficiency for abnormal diagnosis. It has been also confirmed that the diversified diagnostic system implemented in this study is able to maintain its accuracy even in case that encountered scale of abnormality is different from reference cases embedded in the knowledge base. (author)

The use of reference image criteria in X-ray diagnostics: an application for the optimisation of lumbar spine radiographs

International Nuclear Information System (INIS)

Almen, A.; Tingberg, A.; Mattsson, S.; Besjakov, J.

2004-01-01

To ensure that sufficient image quality is obtained in diagnostic radiology, the image quality of clinical radiographs has to be evaluated. We present two methods herein for evaluating antero-posterior (AP) radiographs of the lumbar spine. One was using image criteria, including six anatomical details (absolute method). In the other, the visibility of anatomical details relative to a reference radiograph was evaluated (visual grading analysis). In total, 14 technique groups were evaluated. The technique groups differed in tube voltage and detector system characteristics. Six different gradients of the H and D curves were simulated. The visual grading analysis showed larger differences in image quality compared with the absolute method. The influence on the image quality due to a variation in tube voltage was easier to detect than the influence on the image quality from the detector characteristics. The visibility of the anatomical details was significantly dependent on the location in the spine. The visual grading analysis was found to be the preferable evaluation method in studies such as the present; however, it is necessary to guide and train the observer before the evaluation is performed. (orig.)

Mental health issues among college students: who gets referred for psychopharmacology evaluation?

Science.gov (United States)

Kirsch, Daniel J; Doerfler, Leonard A; Truong, Debbie

2015-01-01

To describe diagnostic and psychotropic medication prescription characteristics among college students referred by college counseling centers for psychopharmacologic evaluation. Participants were 540 college students referred by 6 college counseling centers in Massachusetts between November 2005 and May 2011. Students completed self-report measures of depression, anxiety, suicidal ideation and attempts, and substance use. Information regarding DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) diagnosis, previous history of medication prescription, and current psychotropic medication(s) prescribed by the consulting psychiatrist was obtained from medical records. Depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) were the most common psychiatric problems identified in students. Half of these students had been prescribed mediation prior to evaluation. Antidepressant medication was the most frequently prescribed medication. A large proportion of students reported previous thoughts of suicide, and 12% had made at least 1 suicide attempt. Depression, anxiety, and ADHD are common among students referred by college counseling centers for medication evaluation and treatment.

Diagnostic accuracy of 201Tl SPECT·MRI in brain diseases and inter-reader variance of diagnostic performance

International Nuclear Information System (INIS)

Machida, Kikuo; Honda, Norinari; Matsumoto, Toru

1996-01-01

Fifteen-four studies of 201 Tl brain tumor SPECT were independently interpreted by 9 nuclear medicine physicians with and without reference magnetic resonance images in 2 separate sessions to define an effect of referring images, and inter-observer variations. The physicians were requested to detect foci of abnormal deposits, and to discriminate whether they were malignant or not according to 5-grade scaling of subjective diagnostic confidence. Receiver-operating characteristics (ROC) analysis was performed. Mean sensitivity for presence of lesions (SFP), and sensitivity and specificity for malignancy of 2 01 Tl SPECT were 84, and 53 and 55%, which were changed to 94 and 74 and 55% after referring to the MR images. The SFP was significantly improved (p 201 Tl brain tumor SPECT has moderate sensitivity and specificity for malignancy, which is not improved by addition of anatomical reference images, that additional MR images reduce inter-observer variation of confidence on lesion presence, and that SPECT localization of lesions has great inter-observer variations. (author)

The diagnostic value of the lactate level in the vaginal fluid for determining the premature rupture of membranes

International Nuclear Information System (INIS)

Ahmadi, M.; Rafaei, F.; Nazari, N.

2013-01-01

Objectives:To determine the diagnostic value of the lactate concentration in vaginal secretions in determining the premature rupture of membranes. Subjects and Methods:One hundred 100 pregnant women with single pregnancy of gestational age 20--41 weeks were divided to two groups of 50 each. One group comprised of women with premature rupture of membranes, and the other (control group) of women with intact membranes. To verify the premature rupture of membranes in both groups, the speculum, fern, and nitrazine tests were done. Lactate Pro manual instrument was used to measure the lactate levels in vaginal fluid via enzymatic staining which was displayed on the instrument's liquid crystal display after 60 seconds. Descriptive analytic statistics and SPSS 17 software were used to analyze the data. Results The lactate concentration of 4.6 mM in the vaginal fluid was diagnostic for premature rupture of membranes. It had a sensitivity of 96%, specificity of 98.8%, accuracy of 97%, positive predictive value of 97.9%, and negative predictive value of 96%. Conclusions:Testing lactate levels in the vaginal fluid is an easy, rapid and reliable method for the diagnosis of premature rupture of membranes in pregnancy. (author)

Functional diagnostics of the cervical spine by using computer tomography

International Nuclear Information System (INIS)

Dvorak, J.; Hayek, J.; Grob, D.

1988-01-01

35 healthy adults and 137 patients after cervical spine injury were examined by functional CT. The range of axial rotation at the level occiput/atlas, atlas/axis and the segment below were measured in all subjects. A rotation occiput/atlas of more than 7 0 , and C1/C2 more than 54 0 could refer to segmental hypermobility, a rotation at the segment C1/C2 less than 29 0 to hypomobility. According to the postulated normal values based upon a 98% confidence level, out of 137 patients examined after cervical spine injury and with therapy-resistant neck pain, 45 showed signs of segmental hypermobility of the upper cervical spine, 17 showed hyper- or hypomobility at different levels, 10 patients presented segmental hypomobility at C1/C2 level alone. In all patients, according to the clinical assessment, functional pathology was suspected in the upper cervical spine. Surgical correction of rotatory instability should be considered as a possible therapeutic procedure after successful diagnostic stabilisation of the cervical spine by minerva cast. (orig.)

Functional diagnostics of the cervical spine by using computer tomography

Energy Technology Data Exchange (ETDEWEB)

Dvorak, J; Hayek, J; Grob, D; Penning, L; Panjabi, M M; Zehnder, R

1988-04-01

35 healthy adults and 137 patients after cervical spine injury were examined by functional CT. The range of axial rotation at the level occiput/atlas, atlas/axis and the segment below were measured in all subjects. A rotation occiput/atlas of more than 7/sup 0/, and C1/C2 more than 54/sup 0/ could refer to segmental hypermobility, a rotation at the segment C1/C2 less than 29/sup 0/ to hypomobility. According to the postulated normal values based upon a 98% confidence level, out of 137 patients examined after cervical spine injury and with therapy-resistant neck pain, 45 showed signs of segmental hypermobility of the upper cervical spine, 17 showed hyper- or hypomobility at different levels, 10 patients presented segmental hypomobility at C1/C2 level alone. In all patients, according to the clinical assessment, functional pathology was suspected in the upper cervical spine. Surgical correction of rotatory instability should be considered as a possible therapeutic procedure after successful diagnostic stabilisation of the cervical spine by minerva cast.

Feasibility and diagnostic power of transthoracic coronary Doppler for coronary flow velocity reserve in patients referred for myocardial perfusion imaging

Directory of Open Access Journals (Sweden)

Nylander Eva

2008-03-01

Full Text Available Abstract Background Myocardial perfusion imaging (MPI, using single photon emission computed tomography (SPECT is a validated method for detecting coronary artery disease. Transthoracic Doppler echocardiography (TTDE of flow at rest and during adenosine provocation has previously been evaluated in selected patient groups. We therefore wanted to compare the diagnostic ability of TTDE in the left anterior descending coronary artery (LAD to that of MPI in an unselected population of patients with chest pain referred for MPI. Our hypothesis was that TTDE with high accuracy would identify healthy individuals and exclude them from the need for further studies, enabling invasive investigations to be reserved for patients with a high probability of disease. Methods Sixty-nine patients, 44 men and 25 women, age 61 ± 10 years (range 35–82, with a clinical suspicion of stress induced myocardial ischemia, were investigated. TTDE was performed at rest and during adenosine stress for myocardial scintigraphy. Results We found that coronary flow velocity reserve (CFVR determined from diastolic measurements separated normal from abnormal MPI findings with statistical significance. TTDE identified coronary artery disease, defined from MPI, as reversible ischemia and/or permanent defect, with a sensitivity of 60% and a specificity of 79%. The positive predictive value was 43% and the negative predictive value was 88%. There was an overlap between groups which could be due to abnormal endothelial function in patients with normal myocardial perfusion having either hypertension or diabetes. Conclusion TTDE is an attractive non-invasive method to evaluate chest pain without the use of isotopes, but the diagnostic power is strongly dependent on the population investigated. Even in our heterogeneous clinical cardiac population, we found that CFVR>2 in the LAD excluded significant coronary artery disease detected by MPI.

Indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography: Assessment of the additional diagnostic value of contrast-enhanced ultrasound in the non-cirrhotic liver

International Nuclear Information System (INIS)

Quaia, Emilio; De Paoli, Luca; Angileri, Roberta; Cabibbo, Biagio; Cova, Maria Assunta

2014-01-01

Objective: To assess the additional diagnostic value of contrast-enhanced ultrasound (CEUS) in the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography (CT). Methods: Fifty-five solid hepatic lesions (1–4 cm in diameter) in 46 non-cirrhotic patients (26 female, 20 male; age ± SD, 55 ± 10 years) underwent CEUS after being detected on contrast-enhanced CT which was considered as non-diagnostic after on-site analysis. Two blinded independent readers assessed CT and CEUS scans and were asked to classify retrospectively each lesion as a malignant or benign based on reference diagnostic criteria for the different hepatic lesion histotypes. Diagnostic accuracy and confidence (area – A z – under ROC curve) were assessed by using gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging (n = 30 lesions), histology (n = 7 lesions), or US follow-up (n = 18 lesions) as the reference standards. Results: Final diagnoses included 29 hemangiomas, 3 focal nodular hyperplasias, 1 hepatocellular adenoma, and 22 metastases. The additional review of CEUS after CT images improved significantly (P < .05) the diagnostic accuracy (before vs after CEUS review = 49% [20/55] vs 89% [49/55] – reader 1 and 43% [24/55] vs 92% [51/55] – reader 2) and confidence (A z , 95% Confidence Intervals before vs after CEUS review = .773 [.652–.895] vs .997 [.987–1] – reader 1 and .831 [.724–.938] vs .998 [.992–1] – reader 2). Conclusions: CEUS improved the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced CT by identifying some specific contrast enhancement patterns.

Radioactivity reference levels in ceramics tiles as building materials for different countries

International Nuclear Information System (INIS)

Ortiz, Josefina; Ballesteros, Luisa; Serradell, Vicente

2008-01-01

Measurements campaigns of ceramic tiles and raw materials used in them, shows that natural radionuclides of uranium ( 238 U) and thorium ( 232 Th) series, together with the radioactive isotope of potassium ( 40 K ), are presents. Uranium series contain radium, which decays to radon ( 222 Rn), an inert gas that can be released from materials and inhaled by individuals. Limits of 226 Ra concentrations are established by different countries in order to control Radon levels (200 Bq.m -3 in European Union). Potassium -40 and others gamma emitters of 226 Ra and 232 Th descendent, can cause an external dose. Therefore, with the purpose that individual doses due to building materials doesn't exceed a certain level recommendations or regulations have been established. A maximum value of 1 mSv.y -1 is recommended in European Union. In practice an easy way to avoid ceramic tiles provide doses to individuals over the reference level is to introduce an index, depending on activities concentrations of 226 Ra, 232 Th and 40 K, defined so that the dose limits due, exclusively, to building materials, will never be exceeded. These limits and indexes present differences between countries. In this paper indexes are compared and differences are discussed. (author)

Diagnostic Value of Serum Adenosine Deaminase (ADA) Level for Pulmonary Tuberculosis.

Science.gov (United States)

Salmanzadeh, Shokrollah; Tavakkol, Heshmatollah; Bavieh, Khalid; Alavi, Seyed Mohammad

2015-03-01

Diagnosis of tuberculosis (TB) is not always easy, thus employing methods with a short duration and acceptable sensitivity and specificity is necessary to diagnose TB. The aim of this study was to investigate the diagnostic value of serum adenosine deaminase (ADA) level for diagnosis of pulmonary tuberculosis. A total of 160 sex and age-matched subjects were included in this study, and were divided to four groups; forty patients with pulmonary tuberculosis (PTB) diagnosed based on the national TB program (NTP), forty patients with non-tuberculosis bacterial pneumonia, forty patients with lung cancer and forty people who were healthy in every respect. Serum adenosine deaminase activity in patients of each group was measured by the Giusti and Galanti calorimetry method using a commercial kit (Diazyme, USA). The ANOVA analysis was used to compare groups for quantitative variables. Mean serum ADA level in the PTB group was clearly higher than the mean serum ADA in the other three groups. Mean serum ADA was 26 IU/L in PTB patients, 19.48 IU/L in patients with pneumonia, 15.8 IU/L in patients with lung cancer, and 10.7 IU/L in the control group (P ADA in patients with PTB sensitivity and specificity was defined as 35% and 91%, respectively. Serum ADA activity with high specificity percentage may be a useful alternative test in restricted resource areas to rule out diagnosis of PTB. However, serum ADA activity is not a useful tool for TB diagnosis.

Characteristics of binge eating disorder in relation to diagnostic criteria

Directory of Open Access Journals (Sweden)

Wilfley DE

2016-08-01

Full Text Available Denise E Wilfley,1 Leslie Citrome,2 Barry K Herman3 1Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 2Department of Psychiatry & Behavioral Sciences, New York Medical College, Valhalla, NY, 3Global Medical Affairs, Shire, Lexington, MA, USA Abstract: The objective of this review was to examine the evidentiary basis for binge eating disorder (BED with reference to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5 diagnostic criteria for BED. A PubMed search restricted to titles and abstracts of English-language reviews, meta-analyses, clinical trials, randomized controlled trials, journal articles, and letters using human participants was conducted on August 7, 2015, using keywords that included “binge eating disorder,” DSM-5, DSM-IV, guilt, shame, embarrassment, quantity, psychological, behavior, and “shape and weight concerns.” Of the 257 retrieved publications, 60 publications were considered relevant to discussions related to DSM-5 diagnostic criteria and were included in the current review, and 20 additional references were also included on the basis of the authors’ knowledge and/or on a review of the reference lists from relevant articles obtained through the literature search. Evidence supports the duration/frequency criterion for BED and the primary importance of loss of control and marked distress in identifying individuals with BED. Although overvaluation of shape/weight is not a diagnostic criterion, its relationship to the severity of BED psychopathology may identify a unique subset of individuals with BED. Additionally, individuals with BED often exhibit a clinical profile consisting of psychiatric (eg, mood, obsessive–compulsive, and impulsive disorders and medical (eg, gastrointestinal symptoms, metabolic syndrome, and type 2 diabetes comorbidities and behavioral profiles (eg, overconsumption of calories outside of a binge eating episode and emotional

MERRA 2D IAU Ocean Surface Diagnostic, Single Level, Monthly Mean (2/3x1/2L1) V5.2.0

Data.gov (United States)

National Aeronautics and Space Administration — The MATMNXOCN or tavgM_2d_ocn_Nx data product is the MERRA Data Assimilation System 2-Dimensional ocean surface single-level diagnostics that is monthly mean...

[Establishment of Reference Value of Hs-cTnT in Sichuan Region and Its Diagnostic Value in Patients with Chest Pain].

Science.gov (United States)

Guo, Ying; Du, Xiang-Yang; Huang, Hua-Lan; Wang, Wei-Qing; Nie, Xin; Li, Gui-Xing

2017-11-01

To establish the reference value of high sensitive cardiac troponin T (hs-cTnT) and the efficiency of reference value in the diagnosis of chest pain. Volunteers from eight independent communities in Chengdu,Sichuan were selected with detailed records of physical examination,electrocardiogram,ultrasound examination. The level of hs-cTnT for healthy volunteers was tested to determine ninety-ninth percentile references according to sex and ages. 2 249 patients with chest pain in the emergency department of Western China Hospital from July 2009 to July 2014 were enrolled to measure the efficiency of reference value for diagnosing acute myocardial infarction (AMI). There were 1 305 volunteers included finally. Among them,the mean hs-cTnT level of male was 4.3 (3.2-5.9) ng/L,which was significantly higher than that of female 3.0 (3.0-3.1) ng/L ( P value was less than 0.01. The 99th percentile values of male were 10.8 ng/L,15.4 ng/L and 19.7 ng/L for values of female were 4.6 ng/L,8.9 ng/L,18.8 ng/L,respectively. There was no difference in sensitivity and specificity between the value we figured out and manufactures provided (14.0 ng/L) for thosevalue did not show diversity ( P >0.05) but the specificity and positive predictive value showed significant difference (male: 0.67 vs. 0.56 and 0.83 vs. 0.79, P value of patients<60 yr. should be 14.0 ng/L,while 20.0 ng/L for those patients≥60 yr.

A retrospective study of relevant diagnostic procedures in vulvodynia

DEFF Research Database (Denmark)

Petersen, Christina Damsted; Kristensen, Ellids; Lundvall, Lene

2009-01-01

OBJECTIVE: To identify objective clinical signs of vulvodynia and determine specific diagnostic tests for vulvodynia in women referred to a vulvar outpatient clinic for vulval complaints. STUDY DESIGN: A retrospective study was performed of the medical records of 201 consecutive Danish patients s...

Current levels of gonadal irradiation from a selection of routine diagnostic X-ray examinations in Great Britain

International Nuclear Information System (INIS)

Wall, B.F.; Fisher, E.S.; Shrimpton, P.C.; Rae, S.

1980-07-01

The gonadal doses from 13 types of diagnostic examination have been measured at 21 hospitals throughout the country in preparation for a new assessment of the genetically significant dose to the population of Great Britain from diagnostic radiology. Thermoluminescent dosemeters, consisting of lithium borate powder contained in adhesive polythene sachets, were used for the measurements. They were attached to patients to monitor the testes dose directly or the entrance skin dose at the level of the ovaries. Skin doses were converted to ovarian doses using factors obtained by measurements in an anthropomorphic phantom exposed to a range of typical diagnostic X-ray fields. The results indicate that for some types of examination there has been an increase and for others there has been a reduction in the mean gonadal dose delivered per examination since a similar survey was made 20 years ago. Individual gonadal doses for the same examination still ranged over 3 or 4 orders of magnitude throughout the country with distributions described by coefficients of variation that were no less than those found in the late 1950s. This large variability in patient exposure, together with the observation that examinations were satisfactorily conducted on children with a much higher degree of gonadal protection than that offered to young adults, indicates that many patients must be receiving doses that are unnecessarily high. (author)

Diagnostic value of full-mouth radiography in cats

International Nuclear Information System (INIS)

Verstraete, F.J.M.; Kass, P.H.; Terpak, C.H.

1998-01-01

Objective-To determine the diagnostic value of full-mouth radiographyin cats.Sample Population-115 cats referred for dental treatment without a previous full-mouth radiographic series available. Procedure-In a prospective nested case-control analysis of multiple outcomes in a hospital cohort of cats referred for dental treatment, full-mouth radiography was done prior to oral examination and charting. After treatment, the clinical and radiographic findings were compared, with reference to presenting problems, main clinical findings, additional information obtained from radiography and unexpected radiographic findings. Importance of the radiographic findings in therapeutic decision making was assessed. Results-The main clinical findings were radiographically confirmed in all cats. Odontoclastic resorption lesions, missed on clinical examination, were diagnosed in 8.7% of cats. Analysis of selected presenting problems and main clinical findings yielded significantly increased odds ratios for a variety of other conditions, either expected or unexpected. Radiographs of teeth without clinical lesions yielded incidental or clinically important findings in 4.8 and 41.7% of cats, respectively, and were considered of no clinical value in 53.6%. Radiographs of teeth with clinical lesions merely confirmed the findings in 13.9% of cats, but yielded additional or clinically essential information in 53.9 and 32.2%, respectively. Clinical Relevance-The diagnostic yield of full-mouth radiography in new feline patients referred for dental treatment is high, and routine use of full-mouth radiography is justifiable

Diagnostic accuracy of surgeons and trainees in assessment of patients with acute abdominal pain.

Science.gov (United States)

2016-09-01

Diagnostic accuracy in the assessment of patients with acute abdominal pain in the emergency ward is not adequate. It has been argued that this is because the investigations are carried out predominantly by a trainee. Resource utilization could be lowered if surgeons had a higher initial diagnostic accuracy. Patients with acute abdominal pain were included in a prospective cohort study. A surgical trainee and a surgeon made independent assessments in the emergency department, recording the clinical diagnosis and proposed diagnostic investigations. A reference standard diagnosis was established by an expert panel, and the proportion of correct diagnoses was calculated. Diagnostic accuracy was expressed in terms of sensitivity, specificity, positive predictive value and negative predictive value. Interobserver agreement for the diagnosis and elements of history-taking and physical examination were expressed by means of Cohen's κ. Certainty of diagnosis was recorded using a visual analogue scale. A trainee and a surgeon independently assessed 126 patients. Trainees made a correct diagnosis in 44·4 per cent of patients and surgeons in 42·9 per cent (P = 0·839). Surgeons, however, recorded a higher level of diagnostic certainty. Diagnostic accuracy was comparable in distinguishing urgent from non-urgent diagnoses, and for the most common diseases. Interobserver agreement for the clinical diagnosis varied from fair to moderate (κ = 0·28-0·57). The diagnostic accuracy of the initial clinical assessment is not improved when a surgeon rather than a surgical trainee assesses a patient with abdominal pain in the emergency department. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

Tails from previous exposures: a general problem in setting reference levels for the assessment of internal contamination

International Nuclear Information System (INIS)

Breuer, F.; Frittelli, L.

1988-01-01

Reference levels for retention and excretion are evaluated for routine and special monitoring following the intake of a fraction of ICRP annual limits (ALIs) or of a unit activity. Methodologies are also suggested for taking into account the contribution by previous intakes to excretion or retention

Recommended aerobic fitness level for metabolic health in children and adolescents: a study of diagnostic accuracy

DEFF Research Database (Denmark)

Adegboye, Amanda Ra; Anderssen, Sigmund A; Froberg, Karsten

2011-01-01

Objective To define the optimal cut-off for low aerobic fitness and to evaluate its accuracy to predict clustering of risk factors for cardiovascular disease in children and adolescents. Design Study of diagnostic accuracy using a cross-sectional database. Setting European Youth Heart Study...... would be expected by chance (AUC >0.5) for all cut-offs. Conclusions Aerobic fitness is easy to measure, and is an accurate tool for screening children with clustering of cardiovascular risk factors. Promoting physical activity in children with aerobic fitness level lower than the suggested cut...

Exposure of the bulgarian population from diagnostic radiology during 2001/2006 y

International Nuclear Information System (INIS)

Kostova-Lefterova, D.; Ingilizova, K.

2008-01-01

Each Member State of the European Union is currently committed to produce national legislation, demonstrating conformity with the European Directive on medical exposures. According to the Directive, each country shall estimate the medical exposure of its population. For this purpose it is necessary to calculate the individual effective dose from each type of diagnostic radiology examination and the frequency of the examinations. The collective effective dose (CED) is disputable indicator for the medical exposures but it is a criterion for the level of the country on the radiation protection of persons undergoing medical exposure. The individual effective doses from each type of diagnostic radiology examination will depend on the patient's age, sex, weight, the number and type of images, the screening time and also the equipment used. Some mean values can be obtained through surveys of patient dose and compared with the national or European reference doses for 'standard sized' patients. The aim of this investigation is to assess the exposure of Bulgarian population undergoing diagnostic radiology examinations. The diagnostic radiology procedures are in 30 positions, distributed in 3 age groups: 0 - 17 y., 17 - 45 y. and over 45 y. For the assessment of the CED the generally accepted formula has been applied. The individual effective doses have been established on the basis of standard tablegrams for the radiographic diagnostic examinations and the results from the national research project 'Phare' in 2002. Presented data are: average number of examinations 3848.92x10 3 , frequency in thousands 500, annual effective individual dose 0.89 mSv/y and average annual collective effective dose - 3314.59 man.Sv/y. The mean effective dose per caput of population for medical exposures can then be compared with that of other countries having similar levels of health care. Comparisons can also be made with exposure of the population from other sources of radiation. The dynamics

Reference range levels of polycyclic aromatic hydrocarbons in the US population by measurement of urinary monohydroxy metabolites

International Nuclear Information System (INIS)

Grainger, James; Huang, Wenlin; Patterson, Donald G.; Turner, Wayman E.; Pirkle, James; Caudill, Samuel P.; Wang, Richard Y.; Needham, Larry L.; Sampson, Eric J.

2006-01-01

We developed a gas chromatography isotope-dilution high-resolution mass spectrometry (GC/Id-HRMS) method for measuring 14 polycyclic aromatic hydrocarbon (PAH) metabolites representing seven parent PAHs in 3 mL of urine at low parts-per-trillion levels. PAH levels were determined in urine samples collected in 1999 and 2000 from approximately 2400 participants in the National Health and Nutrition Examination Survey, and, for the first time, reference range values were calculated for these metabolites in the US population. Using this GC/ID-HRMS method, we found detectable concentrations for monohydroxy metabolite isomers of fluorene, phenanthrene, fluoranthene, pyrene, and chrysene, benzo[c]phenanthrene, and benz[a]anthracene. Some monohydroxy metabolite isomers of benzo[c]phenanthrene, chrysene, and benz[a]anthracene exhibited low detection frequencies that did not allow for geometric mean calculations. Our study results enabled us to establish a reference range for the targeted PAHs in the general US population

Dosimetry in Diagnostic Radiology for Paediatric Patients

International Nuclear Information System (INIS)

2013-01-01

Concern about the radiation dose to children from diagnostic radiology examinations has recently been popularly expressed, particularly as related to computed tomography (CT) procedures. This involves the observation that children can receive doses far in excess of those delivered to adults, in part due to the digital nature of the image receptors that may give no warning to the operator of the dose to the patient. Concern for CT examinations should be extended to the broad range of paediatric diagnostic radiological procedures responsible for radiation doses in children, especially as factors, such as increased radiosensitivity and the longer life expectancy of children, increase the associated radiation risk. In all cases, owing to the added paediatric radiological examination factor of patient size and its associated impact on equipment selection, clinical examination protocol and dosimetric audit, the determination of paediatric dose requires a distinct approach from adult dosimetry associated with diagnostic radiological examinations. In response to this, there is a need to inform health professionals about standardized methodologies used to determine paediatric dose for all major modalities such as general radiography, fluoroscopy and CT. Methodologies for standardizing the conduct of dose audits and their use for the derivation and application of diagnostic reference levels for patient populations, that vary in size, are also required. In addition, a review is needed of the current knowledge on risks specific to non-adults from radiation, and also an analysis of the management of factors contributing to dose from paediatric radiological examinations. In 2007, the IAEA published a code of practice, Dosimetry in Diagnostic Radiology: An International Code of Practice, as Technical Reports Series No. 457 (TRS 457). TRS 457 recommends procedures for dosimetric measurement and calibration for the attainment of standardized dosimetry, and addresses requirements

Is avoidant disorder part of the social phobia spectrum in a referred sample of Brazilian children and adolescents?

Directory of Open Access Journals (Sweden)

Denardin D.

2004-01-01

Full Text Available The diagnosis of avoidant disorder was deleted from the Diagnostic and Statistical Manual of Mental disorders - fourth edition (DSM-IV based on a `committee decision' suggesting that avoidant disorder is part of the social phobia spectrum. The objective of the present study was to examine the nature of this clinical association in a referred sample of Brazilian children and adolescents. We assessed a referred sample of 375 youths using semi-structured diagnostic interview methodology. Demographic (age at admission to the study and sex and clinical (level of impairment, age at onset of symptoms and pattern of comorbidity data were assessed in subsamples of children with avoidant disorder (N = 7, social phobia (N = 26, and comorbidity between both disorders (N = 24. Although a significant difference in the male/female ratio was detected among groups (P = 0.03, none of the other clinical variables differed significantly among subjects that presented each condition separately or in combination. Most of the children with avoidant disorder fulfilled criteria for social phobia. Thus, our findings support the validity of the conceptualization of avoidant disorder as part of the social phobia spectrum in a clinical sample.

Is avoidant disorder part of the social phobia spectrum in a referred sample of Brazilian children and adolescents?

Directory of Open Access Journals (Sweden)

D. Denardin

2004-06-01

Full Text Available The diagnosis of avoidant disorder was deleted from the Diagnostic and Statistical Manual of Mental disorders - fourth edition (DSM-IV based on a `committee decision' suggesting that avoidant disorder is part of the social phobia spectrum. The objective of the present study was to examine the nature of this clinical association in a referred sample of Brazilian children and adolescents. We assessed a referred sample of 375 youths using semi-structured diagnostic interview methodology. Demographic (age at admission to the study and sex and clinical (level of impairment, age at onset of symptoms and pattern of comorbidity data were assessed in subsamples of children with avoidant disorder (N = 7, social phobia (N = 26, and comorbidity between both disorders (N = 24. Although a significant difference in the male/female ratio was detected among groups (P = 0.03, none of the other clinical variables differed significantly among subjects that presented each condition separately or in combination. Most of the children with avoidant disorder fulfilled criteria for social phobia. Thus, our findings support the validity of the conceptualization of avoidant disorder as part of the social phobia spectrum in a clinical sample.

The Use of Nanomaterials and Microfluidics in Medical Diagnostics

DEFF Research Database (Denmark)

Ashley, Jon; Sun, Yi

2018-01-01

and manipulation of materials, systems, and devices at the nanometer scale. The development of nanomaterials and nano-devices can be classified into two general approaches. The top down approach deals exclusively with developing nanostructures through machining, templating and lithographic techniques and refers...... nanotechnology followed by a brief summary of bottom-up approaches to developing nanomaterials and their use in medical diagnostics. Then a discussion on the top-down approach will focus on nano-devices, methods for fabrication and the applications of these devices in medical diagnostics. The chapter will go...

Diagnostic criteria for CRPS I: differences between patient profiles using three different diagnostic sets.

Science.gov (United States)

Perez, Roberto S G M; Collins, Susan; Marinus, Johan; Zuurmond, Wouter W A; de Lange, Jaap J

2007-11-01

Complex Regional Pain Syndrome type I (CRPS I) is an illness which usually occurs due to major or minor tissue injury to the extremities. Because a unique pathophysiological mechanism for CRPS I has not yet been established, the diagnosis is based on observation and measurement of clinical symptoms and signs. In this study, a comparison was made between three sets of diagnostic criteria (the IASP, Bruehl et al. and Veldman et al.) based on patient reports and physicians' assessments of signs and symptoms associated with CRPS I, in 372 outpatients suspected of having CRPS I. Agreement between CRPS I diagnosis among the three sets was poor (kappa-range: 0.29-0.42), leading to positive CRPS I diagnoses according to Veldman et al.'s criteria in 218 cases (59%), according to the IASP in 268 cases (72%), and according to Bruehl et al. in 129 cases (35%). Significant differences in patient profiles were found between the diagnostic sets for the number of patients reporting continuing disproportionate pain, larger area affected than the initial trauma (both pCRPS I were found for reported hyperesthesia (SE+SP:165%), allodynia (160%), observed color asymmetry (162%), hyperesthesia (157%), temperature asymmetry (154%) and edema (152%). The lack of agreement between the different diagnostic sets for CRPS I and the different clinical profiles that result from it may lead to different therapeutic and study populations, hampering adequate treatment and scientific development for this illness. We propose explicit reference to diagnostic criteria used in studies, and registration in trials of a broad variety of CRPS I features, as used in this study, to make subgroup phenotyping and post hoc analyses based on different diagnostic criteria possible.

Identification and diagnostic evaluation of possible dementia in general practice. A prospective study

DEFF Research Database (Denmark)

Waldorff, Frans Boch; Rishøj, Susanne; Waldemar, Gunhild

2005-01-01

, and 4 (3%) were treated for depression or referred for another condition. A total of 6 patients were lost to follow-up. In the remaining 102 undiagnosed patients the main reasons for not performing a diagnostic evaluation of dementia were patient/relative hesitation (34%), the GP thought that it would......OBJECTIVE: To investigate the rate of diagnostic evaluation of dementia for patients in whom a suspicion of dementia was raised, and to investigate reasons why a diagnostic evaluation was not always being performed. DESIGN: A prospective study among elderly patients aged 65+, and a follow-up study...... of dementia, laboratory-screening tests prescribed by the GPs and referral status after 6 months, and follow-up questionnaire. RESULTS: Of 793 patients a total of 138 patients were identified with possible dementia. Among the identified patients 26 (20%) were referred for further evaluation within 6 months...

X-ray radiographic experimental investigation of the reference level in hydrostatic level measurement systems for boiling water reactors; Roentgen-radiografische Untersuchung des Referenzfuellstandes bei der hydrostatischen Fuellstandsmessung in Siedewasserreaktoren

Energy Technology Data Exchange (ETDEWEB)

Schulz, S.; Hampel, R. [Hochschule Zittau/Goerlitz, Zittau (Germany). Inst. fuer Prozesstechnik, Prozessautomatisierung und Messtechnik (IPM); Boden, S. [Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden (Germany). Inst. fuer Fluiddynamik

2012-11-01

Hydrostatic level control is of high priority for normal operation safety of BWR-type reactors. For the prevention of undershooting the limiting values precise and secure measuring techniques are indispensable. Actually the filling level is determined form the hydrostatic pressure difference to a reference column. For the secure non-invasive detection of the phase boundary water/steam in inclined tubes the X-ray radiography has been chosen. The experiments were aimed to study possible geometric influences on the water/steam phase boundary. It was shown that the reference filling level is not significantly changed in spite of permanent phase transitions, provided an ideal mechanical construction of the system is given. Future experiments shall be focused on the analysis of interface behavior in case of non-ideal geometries (welds).

Intercomparison of ionization chambers in standard X-ray beams, at radiotherapy, diagnostic radiology and radioprotection levels

International Nuclear Information System (INIS)

Bessa, Ana Carolina Moreira de

2007-01-01

Since the calibration of radiation measurement instruments and the knowledge of their major characteristics are very important subjects, several different types of ionization chambers were inter compared in terms of their calibration coefficients and their energy dependence, in radiotherapy, diagnostic radiology and radioprotection standard beams. An intercomparison of radionuclide calibrators for nuclear medicine was performed, using three radionuclides: 67 Ga, 201 Tl and 99m Tc; the results obtained were all within the requirements of the national standard CNEN-NE-3.05. In order to complete the range of radiation qualities of the Calibration Laboratory of IPEN, standard radiation beam qualities, radiation protection and low energy radiation therapy levels, were established, according international recommendations. Three methodologies for the calibration of unsealed ionization chambers in X-ray beams were studied and compared. A set of Victoreen ionization chambers, specially designed for use in laboratorial intercomparisons, was submitted to characterization tests. The performance of these Victoreen ionization chambers showed that they are suitable for use in radioprotection beams, because the results obtained agree with international recommendations. However, these Victoreen ionization chambers can be used in radiotherapy and diagnostic radiology beams only with some considerations, since their performance in these beams, especially in relation to the energy dependence and stabilization time tests, did not agree with the international recommendations for dosimeters used in radiotherapy and diagnostic radiology beams. This work presents data on the performance of several types of ionization chambers in different X-ray beams, that may be useful for choosing the appropriate instrument for measurements in ionizing radiation beams. (author)

Intercomparison of ionization chambers in standard X-ray beams, at radiotherapy, diagnostic radiology and radioprotection levels

International Nuclear Information System (INIS)

Bessa, Ana Carolina Moreira de

2006-01-01

Since the calibration of radiation measurement instruments and the knowledge of their major characteristics are very important subjects, several different types of ionization chambers were intercompared in terms of their calibration coefficients and their energy dependence, in radiotherapy, diagnostic radiology and radioprotection standard beams. An intercomparison of radionuclide calibrators for nuclear medicine was performed, using three radionuclides: 67 Ga, 201 Tl and 99m Tc; the results obtained were all within the requirements of the national standard CNEN-NE-3.05. In order to complete the range of radiation qualities of the Calibration Laboratory of IPEN, standard radiation beam qualities, radiation protection and low energy radiation therapy levels, were established, according international recommendations. Three methodologies for the calibration of unsealed ionization chambers in X-ray beams were studied and compared. A set of Victoreen ionization chambers, specially designed for use in laboratorial intercomparisons, was submitted to characterization tests. The performance of these Victoreen ionization chambers showed that they are suitable for use in radioprotection beams, because the results obtained agree with international recommendations. However, these Victoreen ionization chambers can be used in radiotherapy and diagnostic radiology beams only with some considerations, since their performance in these beams, especially in relation to the energy dependence and stabilization time tests, did not agree with the international recommendations for dosimeters used in radiotherapy and diagnostic radiology beams. This work presents data on the performance of several types of ionization chambers in different X-ray beams, that may be useful for choosing the appropriate instrument for measurements in ionizing radiation beams. (author)

Decreased plasma prorenin levels in primary aldosteronism: potential diagnostic implications.

Science.gov (United States)

Berge, Constance; Courand, Pierre-Yves; Harbaoui, Brahim; Paget, Vinciane; Khettab, Fouad; Bricca, Giampiero; Fauvel, Jean-Pierre; Lantelme, Pierre

2015-01-01

Primary aldosteronism could exert a negative feedback on prorenin secretion, of possibly different magnitude, whether it is related to an aldosterone-producing adenoma (APA) or an idiopathic hyperaldosteronism (IHA). The objectives of this study were to evaluate the level of prorenin in three subgroups: APA, IHA, and essential hypertension; and the performance of the aldosterone-to-prorenin ratio (APR) for the diagnosis of an APA. Seven hundred and forty-six hypertensive patients with a standardized work-up, including a prorenin measurement, were considered. Ninety-six patients without neutral treatment and 38 patients with other forms of secondary hypertension were excluded. APA and IHA were categorized according to computed tomography scan, adrenal venous sampling, pathological analysis and improvement of hypertension after surgery. Thirty-five patients had a diagnosis of APA, 57 of IHA and 504 of essential hypertension. Prorenin was lower in APA and IHA than in essential hypertension (32.9, 40.4 and 50.3  pg/ml, respectively; P < 0.001). APR was higher in patients with APA and IHA than in those with essential hypertension (24.0, 11.8, and 4.0  pmol/l per pg/ml, respectively; P < 0.001). The APR was more discriminant than the aldosterone-to-renin ratio to identify APA compared to IHA (area under the receiver operating curve at 0.750 and 0.639, respectively; P = 0.04). The optimal cut-off values were 22  pmol/l per pg/ml for APR (sensitivity 57.0%, specificity 93.0%) and 440  pmol/l per pg/ml for aldosterone-to-renin ratio (sensitivity 54.3%, specificity 82.5%). Primary aldosteronism and particularly its most caricatural form, that is APA, seems associated with a lower level of prorenin than essential hypertension. The APR could be included in the diagnostic strategy of APA.

The value of diagnostic information to patients with suspected multiple sclerosis. Rochester-Toronto MRI Study Group.

Science.gov (United States)

Mushlin, A I; Mooney, C; Grow, V; Phelps, C E

1994-01-01

To determine the value of diagnostic information to patients with suspected multiple sclerosis (MS). Because treatment choices would be only minimally affected by earlier diagnosis for most patients with this clinical problem, this study assessed the "nondecisional" value of diagnosis. Prospective survey of patients before and after diagnostic workup, including imaging with magnetic resonance scanning. We assessed the effect of diagnostic information on patients' sense of well-being, as well as direct measures of the utility of information (using time trade-off and willingness-to-pay techniques). Patients referred from primary care practices for diagnostic workup for suspected MS to neurology clinics and practices. Sixty-eight individuals, mean age 37.5 years, 53 female and 15 male. Thirty-one patients were classified as having "probable MS," and 37 were classified as having "possible MS" by the examining neurologist before workup. Present and future health perception, uncertainty about diagnosis-prognosis, and level of anxiety. Willingness to pay for diagnostic information, quality of life as measured by the time trade-off technique, and psychological state of the patient before and after diagnosis. Diagnostic uncertainty fell significantly as a result of the diagnostic workup. Most patients (59/62) said that they were better off having received diagnostic information. Although anxiety seemed to be reduced by testing, overall anxiety levels did not decrease as much as anticipated. Patients also became less optimistic about their future health after testing. On average, patients were willing to forgo 4.5 quality-adjusted life days to receive an earlier diagnosis and their quality of life after diagnosis improved slightly. Subgroups of patients differed in their response to diagnostic information. Those in whom no definitive diagnosis emerged tend to be more anxious rather than being reassured by the "negative" workup. Individuals with "positive" workups became less

Establish radiation protection programme for diagnostic radiology

International Nuclear Information System (INIS)

Mboya, G.

2014-01-01

Mammography is an effective method used for breast diagnostics and screening. The aim of this project is to review the literature on how to establish radiation protection programme for mammography in order to protect the patients, the occupationally exposed workers and the members of the public from harmful effects of ionizing radiation. It reviews some of the trends in mammography doses and dosimetric principles such as average glandular dose in the glandular tissue which is used for description of radiation risk, also the factors affecting patient doses are discussed. However, the average glandular dose should not be used directly to estimate the radiation risk from mammography. Risk is calculated under certain assumptions from determined entrance surface air kerma. Given the increase in population dose, emphasis is placed on the justification and optimization of the mammographic procedures. Protection is optimized by the radiation dose being appropriate with the purpose of the mammographic examination. The need to establish diagnostic reference levels as an optimization is also discussed. In order to obtain high quality mammograms at low dose to the breast, it is necessary to use the correct equipment and perform periodic quality control tests on mammography equipment. It is noted that in order to achieve the goal of this project, the application of radiation protection should begin at the time of requesting for mammography examination, positioning of the patient, irradiation, image processing and interpretation of mammogram. It is recommended that close cooperation between radiology technologists, radiologist, medical physicists, regulatory authority and other support workers be required and established to obtain a consistent and effective level of radiation protection in a mammography facility. (author)

Magnetic resonance imaging and magnetic resonance arthrography of the shoulder: dependence on the level of training of the performing radiologist for diagnostic accuracy

Energy Technology Data Exchange (ETDEWEB)

Theodoropoulos, John S. [University of Toronto, Division of Orthopaedics, Mount Sinai Hospital and the University Health Network, Toronto, ON (Canada); Andreisek, Gustav [University of Toronto, Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto, ON (Canada); University Hospital Zuerich, Institute for Diagnostic Radiology, Zuerich (Switzerland); Harvey, Edward J. [McGill University, Division of Orthopaedics, MUHC - Montreal General Hospital, Montreal, Quebec (Canada); Wolin, Preston [Center for Athletic Medicine, Chicago, IL (United States)

2010-07-15

Discrepancies were identified between magnetic resonance (MR) imaging and clinical findings in patients who had MR imaging examinations evaluated by community-based general radiologists. The purpose of this study was to evaluate the diagnostic performance of MR imaging examinations of the shoulder with regard to the training level of the performing radiologist. A review of patient charts identified 238 patients (male/female, 175/63; mean age, 40.4 years) in whom 250 arthroscopies were performed and who underwent MR imaging or direct MR arthrography in either a community-based or hospital-based institution prior to surgery. All MR imaging and surgical reports were reviewed and the diagnostic performance for the detection of labral, rotator cuff, biceps, and Hill-Sachs lesions was determined. Kappa and Student's t test analyses were performed in a subset of cases in which initial community-based MR images were re-evaluated by hospital-based musculoskeletal radiologists, to determine the interobserver agreement and any differences in image interpretation. The diagnostic performance of community-based general radiologists was lower than that of hospital-based sub-specialized musculoskeletal radiologists. A sub-analysis of re-evaluated cases showed that musculoskeletal radiologists performed better. {kappa} values were 0.208, 0.396, 0.376, and 0.788 for labral, rotator cuff, biceps, and Hill-Sachs lesions (t test statistics: p =<0.001, 0.004, 0.019, and 0.235). Our results indicate that the diagnostic performance of MR imaging and MR arthrography of the shoulder depends on the training level of the performing radiologist, with sub-specialized musculoskeletal radiologists having a better diagnostic performance than general radiologists. (orig.)

A centrifugal microfluidic platform for point-of-care diagnostic applications

CSIR Research Space (South Africa)

Hugo, S

2014-02-01

Full Text Available Microfluidic systems enable precise control over tiny volumes of fluid in a compact and low-cost form, thus providing the ideal platform on which to develop point-of-care diagnostic solutions. Centrifugal microfluidic systems, also referred...

Parent-Child Diagnostic Agreement on Anxiety Symptoms with a Structured Diagnostic Interview for Mental Disorders in Children.

Science.gov (United States)

Popp, Lukka; Neuschwander, Murielle; Mannstadt, Sandra; In-Albon, Tina; Schneider, Silvia

2017-01-01

Objective: In clinical structured diagnostic interviews, diagnoses based on parent and child reports have low to moderate agreement. The aims of the present study are (1) to examine diagnostic agreement on anxiety disorders between parents and children on the levels of current and lifetime diagnostic category and diagnoses focusing in particular on diagnostic criteria and (2) to identify parent- and child-related predictors for diagnostic agreement. Method: The sample consisted of 166 parent-child dyads interviewed with the Structured Diagnostic Interview for Mental Disorders in Children (Kinder-DIPS, Schneider et al., 2009). The children (51.8% girls) were between the ages of 7 and 18 years ( M = 10.94; SD = 2.22). Results: Overall, parent-child agreement on the diagnostic category of anxiety disorder ( k = 0.21; k = 0.22) and the specific anxiety diagnoses (base rate > 10%) of social phobia, specific phobia and separation anxiety disorder ( k = 0.24-0.52; k = 0.19-0.43) and corresponding diagnostic criteria ( k = 0.22-0.67; k = 0.24-0.41) were low to moderate with the highest agreement on separation anxiety disorder ( k > 0.43). Lower maternal depression, and higher social support reported by mother and father were associated with higher parent-child agreement. Maternal depression was indicated as the strongest predictor. Parental sense of competence, parental anxiety, the amount of parent-child interaction and the child's age and gender had no predictive value. Conclusions: Parent-child agreement can be expected to be higher on the level of anxiety criteria compared to specific anxiety diagnoses and diagnostic anxiety category. Psychological strains in the family-especially maternal depression and low social support-lower the parent-child agreement on anxiety symptoms. Child- and relation-related variables (age, gender, amount of time parent(s) and children interact) play no role in the prediction of low parent-child agreement.

Napsin A levels in epithelial lining fluid as a diagnostic biomarker of primary lung adenocarcinoma.

Science.gov (United States)

Uchida, Akifumi; Samukawa, Takuya; Kumamoto, Tomohiro; Ohshige, Masahiro; Hatanaka, Kazuhito; Nakamura, Yoshihiro; Mizuno, Keiko; Higashimoto, Ikkou; Sato, Masami; Inoue, Hiromasa

2017-12-12

It is crucial to develop novel diagnostic approaches for determining if peripheral lung nodules are malignant, as such nodules are frequently detected due to the increased use of chest computed tomography scans. To this end, we evaluated levels of napsin A in epithelial lining fluid (ELF), since napsin A has been reported to be an immunohistochemical biomarker for histological diagnosis of primary lung adenocarcinoma. In consecutive patients with indeterminate peripheral lung nodules, ELF samples were obtained using a bronchoscopic microsampling (BMS) technique. The levels of napsin A and carcinoembryonic antigen (CEA) in ELF at the nodule site were compared with those at the contralateral site. A final diagnosis of primary lung adenocarcinoma was established by surgical resection. We performed BMS in 43 consecutive patients. Among patients with primary lung adenocarcinoma, the napsin A levels in ELF at the nodule site were markedly higher than those at the contralateral site, while there were no significant differences in CEA levels. Furthermore, in 18 patients who were undiagnosed by bronchoscopy and finally diagnosed by surgery, the napsin A levels in ELF at the nodule site were identically significantly higher than those at the contralateral site. In patients with non-adenocarcinoma, there were no differences in napsin A levels in ELF. The area under the receiver operator characteristic curve for identifying primary lung adenocarcinoma was 0.840 for napsin A and 0.542 for CEA. Evaluation of napsin A levels in ELF may be useful for distinguishing primary lung adenocarcinoma.

Exploring different forest definitions and their impact on developing REDD+ reference emission levels: A case study for Indonesia

NARCIS (Netherlands)

Romijn, J.E.; Ainembabazi, J.H.; Wijaya, A.; Herold, M.; Angelsen, A.; Verchot, L.; Murdiyarso, D.

2013-01-01

Developing countries participating in the mitigation mechanism of reducing emissions from deforestation and forest degradation and the role of conservation, sustainable management of forests and enhancement of forest carbon stocks (REDD+), need to determine a national forest reference emission level

Diagnostic accuracy of triage tests to exclude pulmonary embolism

NARCIS (Netherlands)

Mac Gillavry, M. R.; Lijmer, J. G.; Sanson, B. J.; Büller, H. R.; Brandjes, D. P.

2001-01-01

We performed a study in 403 prospectively included patients with suspected pulmonary embolism to compare the accuracy of a combination of the SimpliRED D-dimer assay and an intuitive clinical probability estimate with either one alone. Based on a conjoint diagnostic refer, ence standard, including

The diagnostic performance of CT-derived fractional flow reserve for evaluation of myocardial ischaemia confirmed by invasive fractional flow reserve: a meta-analysis

International Nuclear Information System (INIS)

Li, S.; Tang, X.; Peng, L.; Luo, Y.; Dong, R.; Liu, J.

2015-01-01

Aim: To review the literature on the diagnostic accuracy of CT-derived fractional flow reserve (FFR CT ) for the evaluation of myocardial ischaemia in patients with suspected or known coronary artery disease, with invasive fractional flow reserve (FFR) as the reference standard. Materials and methods: A PubMed, EMBASE, and Cochrane cross-search was performed. The pooled diagnostic accuracy of FFR CT , with FFR as the reference standard, was primarily analysed, and then compared with that of CT angiography (CTA). The thresholds to diagnose ischaemia were FFR ≤0.80 or CTA ≥50% stenosis. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Results: Three multicentre studies (NXT Trial, DISCOVER-FLOW study and DeFACTO study) were included, examining 609 patients and 1050 vessels. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR) for FFR CT were 89% (85–93%), 71% (65–75%), 70% (65–75%), 90% (85–93%), 3.31 (1.79–6.14), 0.16 (0.11–0.23), and 21.21 (9.15–49.15) at the patient-level, and 83% (78–63%), 78% (75–81%), 61% (56–65%), 92% (89–90%), 4.02 (1.84–8.80), 0.22 (0.13–0.35), and 19.15 (5.73–63.93) at the vessel-level. At per-patient analysis, FFR CT has similar sensitivity but improved specificity, PPV, NPV, LR+, LR−, and DOR versus those of CTA. At per-vessel analysis, FFR CT had a slightly lower sensitivity, similar NPV, but improved specificity, PPV, LR+, LR−, and DOR compared with those of CTA. The area under the summary receiver operating characteristic curves for FFR CT was 0.8909 at patient-level and 0.8865 at vessel-level, versus 0.7402 for CTA at patient-level. Conclusions: FFR CT , which was associated with improved diagnostic accuracy versus CTA, is a viable alternative to FFR for detecting coronary ischaemic lesions

Study on the diagnostic value of combined determination of serum CA125, CA199 and SIL-2R levels in patients with endometriosis

International Nuclear Information System (INIS)

Yang Jingxiu; Shi Shaohong; Wang Yuping; Xie Xueqin; Qin Jibao

2005-01-01

Objective: To investigate the diagnostic values of combined determination of serum CA125, CA199 and SIL-2R levels in patients with endometriosis. Methods: Serum CA125, CA199 were measured with RIA and SIL-2R levels with ELISA in 54 patients with endometriosis and 35 controls. Results: The serum levels of CA125, CA199 and SIL-2R in patients with endometriosis were significantly higher than those in controls (P<0.01). The sensitivity and speciality of CA125 for endometriosis was 70.2% and 80.4% respectively, the sensitivity and speciality of CA199 for endometriosis was 62.4% and 71.8% respectively, the sensitivity and speciality of SIL-2R was 89.5% and 60.2% respectively. The sensitivity of the combined determination of CA125, CA199 and SIL-2R for endometriosis was 86.8% being significantly higher than that of CA125 and CA199 respectively. Conclusion: Combined determination of the serum CA125, CA199 and SIL-2R levels in serum can increase the diagnostic sensitivity for endometriosis. (authors)

Attention Deficit Hyperactivity Disorder in Children With Sickle Cell Disease Referred for an Evaluation.

Science.gov (United States)

Acquazzino, Melissa A; Miller, Meghan; Myrvik, Matthew; Newby, Robert; Scott, John Paul

2017-07-01

Neuropsychological deficits, including difficulties with attention, are well described in children with sickle cell disease (SCD). Very little is known about attention deficit hyperactivity disorder (ADHD) in children with SCD. The objective of this study was to determine the proportion of ADHD in children with SCD referred for neuropsychological evaluation. This prospective, cross-sectional study included patients (age, 4 to 18 y) with SCD and completion of a neuropsychological evaluation between December 2013 and March 2016. Patients were referred for neuropsychological evaluation because of concern regarding school performance, development, and/or behavior. The diagnosis of ADHD was made by a neuropsychologist on the basis of the diagnostic criteria in the Diagnostic Statistical Manual-Fourth or Fifth Editions. ADHD medication usage rate was obtained by medical record review. Of the 89 patients with SCD referred for neuropsychological evaluation, 25% (95% confidence interval, 16%-35%) met diagnostic criteria for ADHD. Only 21% of the patients with SCD and ADHD were prescribed an ADHD medication. Our study supports routine ADHD screening in children with SCD who have poor school performance or behavioral concerns. Despite the benefits of pharmacologic treatment, the majority of patients with SCD and ADHD did not receive a medication for management of their ADHD.

Diagnostic Cut-Off Levels of Plasma Brain Natriuretic Peptide to Distinguish Left Ventricular Failure in Emergency Setting

International Nuclear Information System (INIS)

Hussain, A.; Afridi, F. I.; Lutfi, I. A.

2014-01-01

Objective: To determine the diagnostic cut-off values of brain natriuretic (BNP) peptide to establish left ventricular failure in patients presenting with dyspnoea in emergency department. Study Design: Descriptive study. Place and Duration of Study: Ziauddin University Hospital, Karachi, from July to December 2011. Methodology: BNP estimation was done on Axysm analyzer with kit provided by Abbott diagnostics, while the Doppler echocardiography was done on Toshiba style (UICW-660A) using 2.5 MHz and 5.0 MHz probes. Log transformation was done to normalize the original BNP values. A receiver operating curve was plotted to determine the diagnostic cut-off value of BNP which can be used to distinguish CHF from other causes of dyspnoea. Statistical analysis was performed by SPSS version 17. Results: A total of 92 patients presenting with dyspnoea in the emergency department were studied. There were 38/92 (41.3%) males and 54/92 (58.7%) females, and the average age of the study population was 64 A +- 14.1 years. These patients had BNP levels and Doppler echocardiography done. The average BNP was found to be 1117.78 A +- 1445.74 pg/ml. In log transformation, the average was found to be 2.72 A +- 0.58. BNP value of 531 pg/ml was found to be the cut off to distinguish between cardiogenic and non-cardiogenic causes of dyspnoea. Conclusion: BNP value of 531 pg/ml can distinguish CHF from other conditions as a cause of dyspnoea in emergency. (author)

A national physician survey of diagnostic error in paediatrics.

Science.gov (United States)

Perrem, Lucy M; Fanshawe, Thomas R; Sharif, Farhana; Plüddemann, Annette; O'Neill, Michael B

2016-10-01

This cross-sectional survey explored paediatric physician perspectives regarding diagnostic errors. All paediatric consultants and specialist registrars in Ireland were invited to participate in this anonymous online survey. The response rate for the study was 54 % (n = 127). Respondents had a median of 9-year clinical experience (interquartile range (IQR) 4-20 years). A diagnostic error was reported at least monthly by 19 (15.0 %) respondents. Consultants reported significantly less diagnostic errors compared to trainees (p value = 0.01). Cognitive error was the top-ranked contributing factor to diagnostic error, with incomplete history and examination considered to be the principal cognitive error. Seeking a second opinion and close follow-up of patients to ensure that the diagnosis is correct were the highest-ranked, clinician-based solutions to diagnostic error. Inadequate staffing levels and excessive workload were the most highly ranked system-related and situational factors. Increased access to and availability of consultants and experts was the most highly ranked system-based solution to diagnostic error. We found a low level of self-perceived diagnostic error in an experienced group of paediatricians, at variance with the literature and warranting further clarification. The results identify perceptions on the major cognitive, system-related and situational factors contributing to diagnostic error and also key preventative strategies. • Diagnostic errors are an important source of preventable patient harm and have an estimated incidence of 10-15 %. • They are multifactorial in origin and include cognitive, system-related and situational factors. What is New: • We identified a low rate of self-perceived diagnostic error in contrast to the existing literature. • Incomplete history and examination, inadequate staffing levels and excessive workload are cited as the principal contributing factors to diagnostic error in this study.

Clinical diagnostic value of combined determination of serum tPSA, cPSA and IGF-I levels in patients with prostatic disorders

International Nuclear Information System (INIS)

Zhang Bashan; Zhang Zigang; Lai Fudi

2008-01-01

Objective: To investigate the diagnostic value of combined determination of serum total prostatic specific antigen (tPSA), complex prostatic specific antigen (cPSA) and IGF-I levels in patients with prostatic disorders. Methods: Serum tPSA, cPSA (with CLIA) and IGF-I (with IRMA) levels were determined in 41 patients with prostatic carcinoma, 60 patients with benign prosta- tic hypertrophy (BPH) and 55 controls. Results: The serum tPSA, cPSA and IGF-I levels in patients with prostatic cancer were significantly higher than those in patients with BPH and controls (P<0.01). Taking the cut-off values of 4ng/ml, 3.6ng/ml and 150 for tPSA, cPSA and IGF-I respectively, the combined determination of these three items would yield a sensitivity of 88.6%, specificity of 84.9%, positive predicative value of 83% and negative predicative value of 90.0% for diagnosis of prostatic cancer. Conclusion: Combined determination of tPSA, cPSA and IGF-I would yield better sensitive and accurate diagnostic rate in patients with prostatic cancer, especially in those with laboratory values within the 'grey zone'. (authors)

Assessment of Patients’ Entrance Skin Dose from Diagnostic X-ray Examinations at Public Hospitals of Akwa Ibom State, Nigeria

Directory of Open Access Journals (Sweden)

Esen Nsikan U

2015-07-01

Full Text Available Introduction High doses of ionizing radiation can lead to adverse health outcomes such as cancer induction in humans. Although the consequences are less evident at very low radiation doses, the associated risks are of societal importance. This study aimed at assessing entrance skin doses (ESDs in patients undergoing selected diagnostic X-ray examinations at public hospitals of Akwa Ibom State, Nigeria. Materials and Methods In total, six examinations were performed on 720 patients in this study.   CALDose_X5 software program was used in estimating ESDs based on patients’ information and technical exposure parameters. Results The estimated ESDs ranged from 0.59 to 0.61 mGy for PA and RLAT projections of the thorax, respectively. ESDs for the AP and RLAT projections of the cranium were 1.65 and 1.48 mGy, respectively. Also, ESD values for the AP view of the abdomen and pelvis were 1.89 and 1.88 mGy, respectively. The mean effective dose was within the range of 0.021-0.075 mGy for the thorax (mean= 0.037, 0.008-0.045 mGy for the cranium (mean= 0.016, 0.215-0.225 mGy for the abdomen (mean= 0.219 and 0.101-0.119 mGy for the pelvis (mean= 0.112. Conclusion The obtained results were comparable to the international reference dose levels, except for the PA projection of the thorax. Therefore, quality assurance programs are required in diagnostic X-ray units of Nigeria hospitals. The obtained findings add to the available data and can help authorities establish reference dose levels for diagnostic radiography in Nigeria.

Stuttering Thoughts: Negative Self-Referent Thinking Is Less Sensitive to Aversive Outcomes in People with Higher Levels of Depressive Symptoms.

Science.gov (United States)

Iijima, Yudai; Takano, Keisuke; Boddez, Yannick; Raes, Filip; Tanno, Yoshihiko

2017-01-01

Learning theories of depression have proposed that depressive cognitions, such as negative thoughts with reference to oneself, can develop through a reinforcement learning mechanism. This negative self-reference is considered to be positively reinforced by rewarding experiences such as genuine support from others after negative self-disclosure, and negatively reinforced by avoidance of potential aversive situations. The learning account additionally predicts that negative self-reference would be maintained by an inability to adjust one's behavior when negative self-reference no longer leads to such reward. To test this prediction, we designed an adapted version of the reversal-learning task. In this task, participants were reinforced to choose and engage in either negative or positive self-reference by probabilistic economic reward and punishment. Although participants were initially trained to choose negative self-reference, the stimulus-reward contingencies were reversed to prompt a shift toward positive self-reference (Study 1) and a further shift toward negative self-reference (Study 2). Model-based computational analyses showed that depressive symptoms were associated with a low learning rate of negative self-reference, indicating a high level of reward expectancy for negative self-reference even after the contingency reversal. Furthermore, the difficulty in updating outcome predictions of negative self-reference was significantly associated with the extent to which one possesses negative self-images. These results suggest that difficulty in adjusting action-outcome estimates for negative self-reference increases the chance to be faced with negative aspects of self, which may result in depressive symptoms.

Stuttering Thoughts: Negative Self-Referent Thinking Is Less Sensitive to Aversive Outcomes in People with Higher Levels of Depressive Symptoms

Directory of Open Access Journals (Sweden)

Yudai Iijima

2017-08-01

Full Text Available Learning theories of depression have proposed that depressive cognitions, such as negative thoughts with reference to oneself, can develop through a reinforcement learning mechanism. This negative self-reference is considered to be positively reinforced by rewarding experiences such as genuine support from others after negative self-disclosure, and negatively reinforced by avoidance of potential aversive situations. The learning account additionally predicts that negative self-reference would be maintained by an inability to adjust one’s behavior when negative self-reference no longer leads to such reward. To test this prediction, we designed an adapted version of the reversal-learning task. In this task, participants were reinforced to choose and engage in either negative or positive self-reference by probabilistic economic reward and punishment. Although participants were initially trained to choose negative self-reference, the stimulus-reward contingencies were reversed to prompt a shift toward positive self-reference (Study 1 and a further shift toward negative self-reference (Study 2. Model-based computational analyses showed that depressive symptoms were associated with a low learning rate of negative self-reference, indicating a high level of reward expectancy for negative self-reference even after the contingency reversal. Furthermore, the difficulty in updating outcome predictions of negative self-reference was significantly associated with the extent to which one possesses negative self-images. These results suggest that difficulty in adjusting action-outcome estimates for negative self-reference increases the chance to be faced with negative aspects of self, which may result in depressive symptoms.

Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis.

Science.gov (United States)

van Dijk, R; van Assen, M; Vliegenthart, R; de Bock, G H; van der Harst, P; Oudkerk, M

2017-11-27

Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-intensity curves produced during the first-pass of gadolinium contrast. Multiple semi-quantitative and quantitative parameters have been introduced. Diagnostic performance of these parameters varies extensively among studies and standardized protocols are lacking. This study aims to determine the diagnostic accuracy of semi- quantitative and quantitative CMR perfusion parameters, compared to multiple reference standards. Pubmed, WebOfScience, and Embase were systematically searched using predefined criteria (3272 articles). A check for duplicates was performed (1967 articles). Eligibility and relevance of the articles was determined by two reviewers using pre-defined criteria. The primary data extraction was performed independently by two researchers with the use of a predefined template. Differences in extracted data were resolved by discussion between the two researchers. The quality of the included studies was assessed using the 'Quality Assessment of Diagnostic Accuracy Studies Tool' (QUADAS-2). True positives, false positives, true negatives, and false negatives were subtracted/calculated from the articles. The principal summary measures used to assess diagnostic accuracy were sensitivity, specificity, andarea under the receiver operating curve (AUC). Data was pooled according to analysis territory, reference standard and perfusion parameter. Twenty-two articles were eligible based on the predefined study eligibility criteria. The pooled diagnostic accuracy for segment-, territory- and patient-based analyses showed good diagnostic performance with sensitivity of 0.88, 0.82, and 0.83, specificity of 0.72, 0.83, and 0.76 and AUC of 0.90, 0.84, and 0.87, respectively. In per territory

MERRA 2D IAU Diagnostic, Single Level Meteorology, Time Average 1-hourly (2/3x1/2L1) V5.2.0

Data.gov (United States)

National Aeronautics and Space Administration — The MAT1NXSLV or tavg1_2d_slv_Nx data product is the MERRA Data Assimilation System 2-Dimensional atmospheric single-level diagnostics that is time averaged...

Diagnostic reasoning strategies and diagnostic success.

Science.gov (United States)

Coderre, S; Mandin, H; Harasym, P H; Fick, G H

2003-08-01

Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

Dose evaluation in medical staff during diagnostics procedures in interventional radiology; Avaliacao da dose na equipe medica durante procedimentos diagnoticos de radiologia intervencionista

Energy Technology Data Exchange (ETDEWEB)

Bacchim Neto, Fernando A.; Alves, Allan F.F.; Rosa, Maria E.D.; Miranda, Jose R.A. [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Instituto de Biociencias. Departamento de Fisica e Biofisica; Moura, Regina [Faculdade de Medicina de Botucatu, SP (Brazil). Departamento de Cirurgia e Ortopedia; Pina, Diana R., E-mail: bacchim@ibb.unesp.br [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Faculdade de Medicina. Departamento de Doencas Tropicais e Diagnostico por Imagem

2014-08-15

Studies show that personal dosimeters may underestimate the dose values in interventional physicians, especially in extremities and crystalline. The objective of this work was to study the radiation exposure levels of medical staff in diagnostic interventional radiology procedures. For this purpose LiF:Mg,Ti (TLD-100) dosimeters were placed in different regions of the physician body. When comparing with reference dose levels, the maximum numbers of annual procedures were found. This information is essential to ensure the radiological protection of those professionals. (author)

Instrumentation for localized superconducting cavity diagnostics

Energy Technology Data Exchange (ETDEWEB)

Conway, Z. A. [Argonne National Lab. (ANL), Argonne, IL (United States). Physics Division; Ge, M. [Cornell Lab. for Accelerator-Based Sciences and Education, Ithaca, NY (United States); Iwashita, Y. [Kyoto Univ. (Japan)

2017-01-12

Superconducting accelerator cavities are now routinely operated at levels approaching the theoretical limit of niobium. To achieve these operating levels more information than is available from the RF excitation signal is required to characterize and determine fixes for the sources of performance limitations. This information is obtained using diagnostic techniques which complement the analysis of the RF signal. In this paper we describe the operation and select results from three of these diagnostic techniques: the use of large scale thermometer arrays, second sound wave defect location and high precision cavity imaging with the Kyoto camera.

[Critical reading of articles about diagnostic tests (part I): Are the results of the study valid?].

Science.gov (United States)

Arana, E

2015-01-01

In the era of evidence-based medicine, one of the most important skills a radiologist should have is the ability to analyze the diagnostic literature critically. This tutorial aims to present guidelines for determining whether primary diagnostic articles are valid for clinical practice. The following elements should be evaluated: whether the study can be applied to clinical practice, whether the technique was compared to the reference test, whether an appropriate spectrum of patients was included, whether expectation bias and verification bias were limited, the reproducibility of the study, the practical consequences of the study, the confidence intervals for the parameters analyzed, the normal range for continuous variables, and the placement of the test in the context of other diagnostic tests. We use elementary practical examples to illustrate how to select and interpret the literature on diagnostic imaging and specific references to provide more details. Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Pulse Wave Velocity as Marker of Preclinical Arterial Disease: Reference Levels in a Uruguayan Population Considering Wave Detection Algorithms, Path Lengths, Aging, and Blood Pressure

Directory of Open Access Journals (Sweden)

Ignacio Farro

2012-01-01

Full Text Available Carotid-femoral pulse wave velocity (PWV has emerged as the gold standard for non-invasive evaluation of aortic stiffness; absence of standardized methodologies of study and lack of normal and reference values have limited a wider clinical implementation. This work was carried out in a Uruguayan (South American population in order to characterize normal, reference, and threshold levels of PWV considering normal age-related changes in PWV and the prevailing blood pressure level during the study. A conservative approach was used, and we excluded symptomatic subjects; subjects with history of cardiovascular (CV disease, diabetes mellitus or renal failure; subjects with traditional CV risk factors (other than age and gender; asymptomatic subjects with atherosclerotic plaques in carotid arteries; patients taking anti-hypertensives or lipid-lowering medications. The included subjects (n=429 were categorized according to the age decade and the blood pressure levels (at study time. All subjects represented the “reference population”; the group of subjects with optimal/normal blood pressures levels at study time represented the “normal population.” Results. Normal and reference PWV levels were obtained. Differences in PWV levels and aging-associated changes were obtained. The obtained data could be used to define vascular aging and abnormal or disease-related arterial changes.

Children's level of word knowledge predicts their exclusion of familiar objects as referents of novel words

Directory of Open Access Journals (Sweden)

Susanne eGrassmann

2015-08-01

Full Text Available When children are learning a novel object label, they tend to exclude as possible referents familiar objects for which they already have a name. In the current study, we wanted to know if children would behave in this same way regardless of how well they knew the name of potential referent objects, specifically, whether they could only comprehend it or they could both comprehend and produce it. Sixty-six monolingual German-speaking 2-, 3-, and 4-year-old children participated in two experimental sessions. In one session the familiar objects were chosen such that their labels were in the children's productive vocabularies, and in the other session the familiar objects were chosen such that their labels were only in the children's receptive vocabularies. Results indicated that children at all three ages were more likely to exclude a familiar object as the potential referent of the novel word if they could comprehend and produce its name rather than comprehend its name only. Indeed, level of word knowledge as operationalized in this way was a better predictor than was age. These results are discussed in the context of current theories of word learning by exclusion.

Severe oligohydramnios with intact membranes: an indication for diagnostic amnioinfusion.

Science.gov (United States)

Pryde, P G; Hallak, M; Lauria, M R; Littman, L; Bottoms, S F; Johnson, M P; Evans, M I

2000-01-01

To quantify the improvement in ultrasonographic fetal imaging following diagnostic amnioinfusion for the indication of unexplained midtrimester oligohydramnios. Patients referred for unexplained midtrimester oligohydramnios were retrospectively reviewed. Videotapes of those undergoing diagnostic antenatal amnioinfusion were analyzed for quality of visualization of routinely imaged structures before and after the infusion procedure. The overall rate of adequate visualization of fetal structures improved from 50.98 to 76.79% (p amnioinfusion can facilitate fetal imaging and increase diagnostic precision in the setting of unexplained severe oligohydramnios. We have quantified the improvement in the rate of optimal visualization of fetal structures which likely translates, in experienced hands, into this observed improved diagnostic precision. Of particular importance is the improvement in appreciation of associated anomalies in cases of obstructive uropathy in which such findings may determine whether or not invasive fetal therapy is indicated. Copyright 2000 S. Karger AG, Basel.

Technology Issues of Burning Plasma Diagnostics

International Nuclear Information System (INIS)

Kaye, A. S.

2008-01-01

The ITER Tokamak will require many diagnostics both for safe and reliable operation of the machine and for understanding of the physics underlying the performance. The design of these diagnostics raises many challenging technical issues not faced on smaller machines. These arise partly from the increase demands on established diagnostics arising from the increased size, higher magnetic field, large heating power, and in particular the dramatically longer pulse duration of ITER, which make issue such as power loading on first wall components more challenging. The demands on reliability and availability of the machine in order to achieve the objectives within the agreed time schedule also place severe additional demands on the design, quality assurance and maintainability of diagnostics. ITER will produce many orders of magnitude more neutrons than previous Tokamaks and will be a licensed nuclear facility. This has important implications for the traceability, quality assurance and availability of safety critical diagnostics, and for the control of the design and procurement of all diagnostics. The high neutron flux/fluence also constrains the design of diagnostics, which must offer shielding consistent with the allowable dose rates on critical components of the Tokamak, and themselves be tolerant of the radiation level at the diagnostic. This paper presents an overview of the more critical issues for ITER diagnostics

Program reference schedule baseline

International Nuclear Information System (INIS)

1986-07-01

This Program Reference Schedule Baseline (PRSB) provides the baseline Program-level milestones and associated schedules for the Civilian Radioactive Waste Management Program. It integrates all Program-level schedule-related activities. This schedule baseline will be used by the Director, Office of Civilian Radioactive Waste Management (OCRWM), and his staff to monitor compliance with Program objectives. Chapter 1 includes brief discussions concerning the relationship of the PRSB to the Program Reference Cost Baseline (PRCB), the Mission Plan, the Project Decision Schedule, the Total System Life Cycle Cost report, the Program Management Information System report, the Program Milestone Review, annual budget preparation, and system element plans. Chapter 2 includes the identification of all Level 0, or Program-level, milestones, while Chapter 3 presents and discusses the critical path schedules that correspond to those Level 0 milestones

Lung cancer: Diagnostic procedures and therapeutic management, with special reference to radiotherapy

International Nuclear Information System (INIS)

Scarantino, C.W.

1985-01-01

This book on lung cancer provides a good overview of this very common cause of death in both men and women. The eight chapters in this book review a number of aspects of the disease including epidemiology, pathology, diagnostic workup, and treatment by radiation and chemotherapy. The two introductory chapters provide a summary of the epidemiology of this disease and an approach to each individual patient. Included are chapters on the many methods of treating lung cancer and the results of clinical trials as well as a brief discussion given to surgical treatment. A chapter on clinical research is directed primarily at ideas relating to chemotherapy. This brief book provides an overview of the many aspects involved in diagnosing and treating lung cancer

User satisfaction with referrals at a collaborative virtual reference service Virtual reference services, Reference services, Referrals, User satisfaction

Directory of Open Access Journals (Sweden)

Nahyun Kwon

2006-01-01

Full Text Available Introduction. This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference service. Method. The data analysed for this study were 420 chat reference transaction transcripts along with corresponding online survey questionnaires submitted by the service users. Both sets of data were collected from an electronic archive of a southeastern state public library system that has participated in 24/7 Reference of the Metropolitan Cooperative Library System (MCLS. Results. Referrals in the collaborative chat reference service comprised approximately 30% of the total transactions. Circulation-related questions were the most often referred among all question types, possibly because of the inability of 'outside' librarians to access patron accounts. Most importantly, user satisfaction with referrals was found to be significantly lower than that of completed answers. Conclusion. The findings of this study addressed the importance of distinguishing two types of referrals: the expert research referrals conducive to collaborative virtual reference services; and the re-directional local referrals that increase unnecessary question traffic, thereby being detrimental to effective use of collaborative reference. Continuing efforts to conceptualize referrals in multiple dimensions are anticipated to fully grasp complex phenomena underlying referrals.

Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs

LENUS (Irish Health Repository)

Giesen, Leonie GM

2010-10-24

Abstract Background Acute urinary tract infections (UTI) are one of the most common bacterial infections among women presenting to primary care. However, there is a lack of consensus regarding the optimal reference standard threshold for diagnosing UTI. The objective of this systematic review is to determine the diagnostic accuracy of symptoms and signs in women presenting with suspected UTI, across three different reference standards (102 or 103 or 105 CFU\\/ml). We also examine the diagnostic value of individual symptoms and signs combined with dipstick test results in terms of clinical decision making. Methods Searches were performed through PubMed (1966 to April 2010), EMBASE (1973 to April 2010), Cochrane library (1973 to April 2010), Google scholar and reference checking. Studies that assessed the diagnostic accuracy of symptoms and signs of an uncomplicated UTI using a urine culture from a clean-catch or catherised urine specimen as the reference standard, with a reference standard of at least ≥ 102 CFU\\/ml were included. Synthesised data from a high quality systematic review were used regarding dipstick results. Studies were combined using a bivariate random effects model. Results Sixteen studies incorporating 3,711 patients are included. The weighted prior probability of UTI varies across diagnostic threshold, 65.1% at ≥ 102 CFU\\/ml; 55.4% at ≥ 103 CFU\\/ml and 44.8% at ≥ 102 CFU\\/ml ≥ 105 CFU\\/ml. Six symptoms are identified as useful diagnostic symptoms when a threshold of ≥ 102 CFU\\/ml is the reference standard. Presence of dysuria (+LR 1.30 95% CI 1.20-1.41), frequency (+LR 1.10 95% CI 1.04-1.16), hematuria (+LR 1.72 95%CI 1.30-2.27), nocturia (+LR 1.30 95% CI 1.08-1.56) and urgency (+LR 1.22 95% CI 1.11-1.34) all increase the probability of UTI. The presence of vaginal discharge (+LR 0.65 95% CI 0.51-0.83) decreases the probability of UTI. Presence of hematuria has the highest diagnostic utility, raising the post-test probability of

Application and Continued Development of Thin Faraday Collectors as a Lost Ion Diagnostic for Tokamak Fusion Plasmas

Energy Technology Data Exchange (ETDEWEB)

F. Ed Cecil

2011-06-30

This report summarizes the accomplishment of sixteen years of work toward the development of thin foil Faraday collectors as a lost energetic ion diagnostic for high temperature magnetic confinement fusion plasmas. Following initial, proof of principle accelerator based studies, devices have been tested on TFTR, NSTX, ALCATOR, DIII-D, and JET (KA-1 and KA-2). The reference numbers refer to the attached list of publications. The JET diagnostic KA-2 continues in operation and hopefully will provide valuable diagnostic information during a possible d-t campaign on JET in the coming years. A thin Faraday foil spectrometer, by virtue of its radiation hardness, may likewise provide a solution to the very challenging problem of lost alpha particle measurements on ITER and other future burning plasma machines.

Experimental and numerical studies on liquid wicking into filter papers for paper-based diagnostics

International Nuclear Information System (INIS)

Liu, Zhi; Hu, Jie; Zhao, Yimeng; Qu, Zhiguo; Xu, Feng

2015-01-01

Paper-based diagnostics have shown promising potential applications in human disease surveillance and food safety analysis at the point-of-care (POC). The liquid wicking behavior in diagnostic fibrous paper plays an important role in development of paper-based diagnostics. In the current study, we performed experimental and numerical research on the liquid wicking height and mass with three width strips into filter paper. The effective porosity could be conveniently measured in the light of the linear correlation between wicking height and mass by the experimental system. A modified model with considering evaporation effect was proposed to predict wicking height and mass. The predicted wicking height and mass using the evaporation model was much closer to the experimental data compared with the model without evaporation. The wicking speed initially decreased significantly and then maintained at a constant value at lower level. The evaporation effect tends to reduce the wicking flow speed. More wicking mass could be obtained at larger strip width but the corresponding reagent loss became significant. The proposed model with evaporation paved a way to understanding the fundamental of fluid flow in diagnostic paper and was essential to provide meaningful and useful reference for the research and development of paper-based diagnostics devices. - Highlights: • A model with considering evaporation was proposed to predict wicking height and mass. • Flow characteristics of filter paper were experimentally and theoretically studied. • Effective porosity could be conveniently measured by the experimental platform. • The evaporation effect tended to reduce the wicking flow speed

Thyroid diagnostics

Energy Technology Data Exchange (ETDEWEB)

Scriba, P C; Boerner, W; Emrich, S; Gutekunst, R; Herrmann, J; Horn, K; Klett, M; Krueskemper, H L; Pfannenstiel, P; Pickardt, C R

1985-03-01

None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted.

Thyroid diagnostics

International Nuclear Information System (INIS)

Scriba, P.C.; Boerner, W.; Emrich, S.; Gutekunst, R.; Herrmann, J.; Horn, K.; Klett, M.; Krueskemper, H.L.; Pfannenstiel, P.; Pickardt, C.R.; Reiners, C.; Reinwein, D.; Schleusener, H.

1985-01-01

None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted. (orig./MG) [de

Empirical likelihood-based confidence intervals for the sensitivity of a continuous-scale diagnostic test at a fixed level of specificity.

Science.gov (United States)

Gengsheng Qin; Davis, Angela E; Jing, Bing-Yi

2011-06-01

For a continuous-scale diagnostic test, it is often of interest to find the range of the sensitivity of the test at the cut-off that yields a desired specificity. In this article, we first define a profile empirical likelihood ratio for the sensitivity of a continuous-scale diagnostic test and show that its limiting distribution is a scaled chi-square distribution. We then propose two new empirical likelihood-based confidence intervals for the sensitivity of the test at a fixed level of specificity by using the scaled chi-square distribution. Simulation studies are conducted to compare the finite sample performance of the newly proposed intervals with the existing intervals for the sensitivity in terms of coverage probability. A real example is used to illustrate the application of the recommended methods.

Parent-Child Diagnostic Agreement on Anxiety Symptoms with a Structured Diagnostic Interview for Mental Disorders in Children

Science.gov (United States)

Popp, Lukka; Neuschwander, Murielle; Mannstadt, Sandra; In-Albon, Tina; Schneider, Silvia

2017-01-01

Objective: In clinical structured diagnostic interviews, diagnoses based on parent and child reports have low to moderate agreement. The aims of the present study are (1) to examine diagnostic agreement on anxiety disorders between parents and children on the levels of current and lifetime diagnostic category and diagnoses focusing in particular on diagnostic criteria and (2) to identify parent- and child-related predictors for diagnostic agreement. Method: The sample consisted of 166 parent-child dyads interviewed with the Structured Diagnostic Interview for Mental Disorders in Children (Kinder-DIPS, Schneider et al., 2009). The children (51.8% girls) were between the ages of 7 and 18 years (M = 10.94; SD = 2.22). Results: Overall, parent-child agreement on the diagnostic category of anxiety disorder (k = 0.21; k = 0.22) and the specific anxiety diagnoses (base rate > 10%) of social phobia, specific phobia and separation anxiety disorder (k = 0.24–0.52; k = 0.19–0.43) and corresponding diagnostic criteria (k = 0.22–0.67; k = 0.24–0.41) were low to moderate with the highest agreement on separation anxiety disorder (k > 0.43). Lower maternal depression, and higher social support reported by mother and father were associated with higher parent-child agreement. Maternal depression was indicated as the strongest predictor. Parental sense of competence, parental anxiety, the amount of parent-child interaction and the child's age and gender had no predictive value. Conclusions: Parent-child agreement can be expected to be higher on the level of anxiety criteria compared to specific anxiety diagnoses and diagnostic anxiety category. Psychological strains in the family—especially maternal depression and low social support—lower the parent-child agreement on anxiety symptoms. Child- and relation-related variables (age, gender, amount of time parent(s) and children interact) play no role in the prediction of low parent-child agreement. PMID:28396644

A web-based test of residents' skills in diagnostic radiology

International Nuclear Information System (INIS)

Finlay, K.; Norman, G.R.; Keane, D.R.; Stolberg, H.

2006-01-01

To develop an objective, Web-based tool for evaluating residents' knowledge of diagnostic radiology. We developed and tested a Web-based evaluation tool (the Diagnostic Radiology Skills Test) that consists of 3 tests, one in each of 3 domains of diagnostic radiology: chest, gastrointestinal, and musculoskeletal imaging. Each test comprises 30 cases representing a range of difficulty in the domain, including normal states, normal variants, typical cases of common diagnoses, and cases with more subtle findings. Cases are presented with a long menu of domain-specific possible diagnoses (response options), each coded for diagnostic appropriateness. Our subjects were 21 residents in postgraduate year (PGY) 2 to 5 and 11 experts in diagnostic radiology. Subjects accessed the tool via a Web site on our Web server. Residents test results were compared for reliability and validity across domain, case, and training level. In addition, results were correlated with commonly used established and objective evaluation tools. The tool demonstrated consistent monotonic improvement in performance with training level. It showed acceptable reliability in discriminating between residents at different performance levels, both within and across training levels (r = 0.53 within level and 0.69 across levels). Test results also had concurrent validity against the American College of Radiology In-Training Examination, a widely accepted objective assessment tool (r = 0.65, P < 0.01), and 2 Objective Structured Clinical Examinations (OSCEs) focusing on diagnostic skills (r = 0.78 and r 0.69, P < 0.01, respectively). Our study demonstrates the feasibility of a Web-based, standardized, objective assessment method for evaluating residents' performance. (author)

Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions.

Science.gov (United States)

Simopoulos, Thomas T; Manchikanti, Laxmaiah; Gupta, Sanjeeva; Aydin, Steve M; Kim, Chong Hwan; Solanki, Daneshvari; Nampiaparampil, Devi E; Singh, Vijay; Staats, Peter S; Hirsch, Joshua A

2015-01-01

The sacroiliac joint is well known as a cause of low back and lower extremity pain. Prevalence estimates are 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic studies and systematic reviews. However, at present there are no definitive management options for treating sacroiliac joint pain. To evaluate the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. A systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. The available literature on diagnostic and therapeutic sacroiliac joint interventions was reviewed. The quality assessment criteria utilized were the Quality Appraisal of Reliability Studies (QAREL) checklist for diagnostic accuracy studies, Cochrane review criteria to assess sources of risk of bias, and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) criteria for randomized therapeutic trials and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for observational therapeutic assessments. The level of evidence was based on a best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. Data sources included relevant literature published from 1966 through March 2015 that were identified through searches of PubMed and EMBASE, manual searches of the bibliographies of known primary and review articles, and all other sources. For the diagnostic accuracy assessment, and for the therapeutic modalities, the primary outcome measure of pain relief and improvement in functional status were utilized. A total of 11 diagnostic accuracy studies and 14 therapeutic studies were included. The evidence for diagnostic accuracy is Level II for dual diagnostic blocks with at least 70% pain relief as the criterion

ITER diagnostics ex-vessel engineering services

Energy Technology Data Exchange (ETDEWEB)

Arumugam, A.P., E-mail: arun.prakash@iter.org; Walker, C.I.; Andrew, P.; Barnsley, R.; Beltran, D.; Bertalot, L.; Dammann, A.; Direz, M.F.; Drevon, J.M.; Encheva, A.; Giacomin, T.; Hourtoule, J.; Kuehn, I.; Lanza, R.; Levesy, B.; Maquet, P.; Patel, K.M.; Patisson, L.; Pitcher, C.S.; Portales, M.; and others

2013-10-15

as well as the total requirements to a significant level of definition. It demonstrates the impact of this as a design restraint and requirement on both the diagnostics and the service systems as they are further specified, designed and procured.

ITER diagnostics ex-vessel engineering services

International Nuclear Information System (INIS)

Arumugam, A.P.; Walker, C.I.; Andrew, P.; Barnsley, R.; Beltran, D.; Bertalot, L.; Dammann, A.; Direz, M.F.; Drevon, J.M.; Encheva, A.; Giacomin, T.; Hourtoule, J.; Kuehn, I.; Lanza, R.; Levesy, B.; Maquet, P.; Patel, K.M.; Patisson, L.; Pitcher, C.S.; Portales, M.

2013-01-01

as well as the total requirements to a significant level of definition. It demonstrates the impact of this as a design restraint and requirement on both the diagnostics and the service systems as they are further specified, designed and procured

Diagnostic Performance of Serum IgG4 Levels in Patients With IgG4-Related Disease

Science.gov (United States)

Yu, Kuang-Hui; Chan, Tien-Ming; Tsai, Ping-Han; Chen, Ching-Hui; Chang, Pi-Yueh

2015-01-01

Abstract The aim of this study is to study the clinical features and diagnostic performance of IgG4 in Chinese populations with IgG4-related diseases (IgG4-RDs). The medical records of 2901 adult subjects who underwent serum IgG4 level tests conducted between December 2007 and May 2014 were reviewed. Serum concentrations of IgG4 were measured in 2901 cases, including 161 (5.6%) patients with IgG4-RD and 2740 (94.4%) patients without IgG4-RD (non-IgG4-RD group). The mean age of the IgG4-RD patients was 58.4 ± 16.1 years (range: 21–87), and 48 (29.8%) were women. The mean serum IgG4 level was significantly much higher in IgG4-RD patients than in non-IgG4-RD (1062.6 vs 104.3 mg/dL, P IgG4 >135 mg/dL, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR)+, and LR− were 86%, 77%, 18%, 99%, 3.70, and 0.19, respectively. When the upper limit of normal was doubled for an IgG4 >270 mg/dL, the corresponding data were 75%, 94%, 43%, 98%, 12.79, and 0.26, respectively. For IgG4 >405 mg/dL (tripling the upper limit of normal), the corresponding data were 62%, 98%, 68%, 98%, 37.00, and 0.39, respectively. When calculated according to the manufacturer's package insert cutoff (>201 mg/dL) for the diagnosis of IgG4-RD, the corresponding sensitivity, specificity, PPV, NPV, LR+, and LR− were 80%, 89%, 29%, 99%, 7.00, and 0.23, respectively. For IgG4 >402 mg/dL (>2× the upper limit of the normal range), the corresponding data were 62%, 98%, 68%, 98%, 36.21, and 0.39, respectively. For IgG4 >603 mg/dL (>3× the upper limit of the normal range), the corresponding data were 50%, 99%, 84%, 97%, 90.77 and 0.51, respectively. The optimal cutoff value of serum IgG4 (measured by nephelometry using a Siemens BN ProSpec instrument and Siemens reagent) for the diagnosis of IgG4-RD was 248 mg/dL, the sensitivity and specificity were 77.6% and 92.8%, respectively. The present study demonstrated that 2 or

Limitations of typhoid fever diagnostics and the need for prevention

NARCIS (Netherlands)

Smits, Henk L.

2013-01-01

Evaluation of: Siba V, Horwood PF, Vanuga K et al. Evaluation of serological diagnostic tests for typhoid fever in Papua New Guinea using a composite reference standard. Clin. Vaccine Immunol. 19(11), 1833-1837 (2012). The study under review evaluated serological tests for typhoid fever against PCR

Reference range determination for whole-blood platelet aggregation using the Multiplate analyzer

NARCIS (Netherlands)

Peerschke, Ellinor I. B.; Castellone, Donna D.; Stroobants, A. K.; Francis, John

2014-01-01

To develop reference ranges for platelet aggregation using the Multiplate analyzer (Roche Diagnostics, Mannheim, Germany) in blood anticoagulated with sodium citrate (Na-citrate), lithium heparin (Li-heparin), or hirudin. The study was performed at three sites on consented, healthy adults (n = 193)

Highly polymorphic RFLP probes as diagnostic tools

International Nuclear Information System (INIS)

Donis-Keller, H.; Barker, D.F.; Knowlton, R.G.; Schumm, J.W.; Braman, J.C.; Green, P.

1986-01-01

In this paper, we describe the identification of highly polymorphic RFLP loci and their application to genotyping in humans and to mapping the CF gene to chromosome 7. We also report the construction of a high-resolution genetic map of chromosome 7 and summarize progress toward the development of a presymptomatic diagnostic test for CF that should be useful in virtually every case. 25 references, 7 figures, 5 tables

The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review

International Nuclear Information System (INIS)

Dones, Valentin C III; Grimmer, Karen; Thoirs, Kerry; Suarez, Consuelo G; Luker, Julie

2014-01-01

Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler

Automated segmentation of reference tissue for prostate cancer localization in dynamic contrast enhanced MRI

Science.gov (United States)

Vos, Pieter C.; Hambrock, Thomas; Barentsz, Jelle O.; Huisman, Henkjan J.

2010-03-01

For pharmacokinetic (PK) analysis of Dynamic Contrast Enhanced (DCE) MRI the arterial input function needs to be estimated. Previously, we demonstrated that PK parameters have a significant better discriminative performance when per patient reference tissue was used, but required manual annotation of reference tissue. In this study we propose a fully automated reference tissue segmentation method that tackles this limitation. The method was tested with our Computer Aided Diagnosis (CADx) system to study the effect on the discriminating performance for differentiating prostate cancer from benign areas in the peripheral zone (PZ). The proposed method automatically segments normal PZ tissue from DCE derived data. First, the bladder is segmented in the start-to-enhance map using the Otsu histogram threshold selection method. Second, the prostate is detected by applying a multi-scale Hessian filter to the relative enhancement map. Third, normal PZ tissue was segmented by threshold and morphological operators. The resulting segmentation was used as reference tissue to estimate the PK parameters. In 39 consecutive patients carcinoma, benign and normal tissue were annotated on MR images by a radiologist and a researcher using whole mount step-section histopathology as reference. PK parameters were computed for each ROI. Features were extracted from the set of ROIs using percentiles to train a support vector machine that was used as classifier. Prospective performance was estimated by means of leave-one-patient-out cross validation. A bootstrap resampling approach with 10,000 iterations was used for estimating the bootstrap mean AUCs and 95% confidence intervals. In total 42 malignant, 29 benign and 37 normal regions were annotated. For all patients, normal PZ was successfully segmented. The diagnostic accuracy obtained for differentiating malignant from benign lesions using a conventional general patient plasma profile showed an accuracy of 0.64 (0.53-0.74). Using the

ECE diagnostics for RTO/RC ITER

International Nuclear Information System (INIS)

Vayakis, G.; Bartlett, D.V.; Costley, A.E.

2001-01-01

This paper presents the current status of the Electron Cyclotron Emission (ECE) diagnostic on the Reduced Technical Objectives/Reduced Cost International Thermonuclear Experimental Reactor (RTO/RC ITER). It discusses the implications of the new machine design on the measurement requirements, the ability of the diagnostic technique to meet these, and the changes in the implementation imposed by the new layout. Finally, it outlines the physics studies, design and R and D work required prior to the detailed design and construction of the diagnostic. Key results are: (i) that the localisation of the measurement is similar to that in ITER-FDR (40-100 mm in X-mode, 60-200 mm in O-mode for the reference scenario), so that the relative spatial resolution degrades in this, smaller, machine, and (ii) the expected effect of transport barriers on the temperature profile in the high temperature region will be poorly resolved, because the effect of the temperature gradient on the outboard side is to degrade the resolution to (∼250 mm in X-mode, ∼350 mm in O-mode). Nevertheless ECE will be able to make a unique and useful contribution to the RTO/RC ITER measurement set

Some aspects of the Unilac beam diagnostic system

International Nuclear Information System (INIS)

Glatz, J.; Klabunde, J.; Strehl, P.

1976-01-01

A survey of the Unilac beam diagnostic system is given with special reference to the operational experience collected during the running-in period. Devices for measurement and display of beam profiles, energy, rf phases and amplitudes and rf matching procedures between the different stages of the accelerator are described. Some aspects concerning future developments and improvements are discussed briefly. (author)

Irregular analytical errors in diagnostic testing - a novel concept.

Science.gov (United States)

Vogeser, Michael; Seger, Christoph

2018-02-23

In laboratory medicine, routine periodic analyses for internal and external quality control measurements interpreted by statistical methods are mandatory for batch clearance. Data analysis of these process-oriented measurements allows for insight into random analytical variation and systematic calibration bias over time. However, in such a setting, any individual sample is not under individual quality control. The quality control measurements act only at the batch level. Quantitative or qualitative data derived for many effects and interferences associated with an individual diagnostic sample can compromise any analyte. It is obvious that a process for a quality-control-sample-based approach of quality assurance is not sensitive to such errors. To address the potential causes and nature of such analytical interference in individual samples more systematically, we suggest the introduction of a new term called the irregular (individual) analytical error. Practically, this term can be applied in any analytical assay that is traceable to a reference measurement system. For an individual sample an irregular analytical error is defined as an inaccuracy (which is the deviation from a reference measurement procedure result) of a test result that is so high it cannot be explained by measurement uncertainty of the utilized routine assay operating within the accepted limitations of the associated process quality control measurements. The deviation can be defined as the linear combination of the process measurement uncertainty and the method bias for the reference measurement system. Such errors should be coined irregular analytical errors of the individual sample. The measurement result is compromised either by an irregular effect associated with the individual composition (matrix) of the sample or an individual single sample associated processing error in the analytical process. Currently, the availability of reference measurement procedures is still highly limited, but LC

Children and adults exposed to electromagnetic fields at the ICNIRP reference levels: theoretical assessment of the induced peak temperature increase.

Science.gov (United States)

Bakker, J F; Paulides, M M; Neufeld, E; Christ, A; Kuster, N; van Rhoon, G C

2011-08-07

To avoid potentially adverse health effects of electromagnetic fields (EMF), the International Commission on Non-Ionizing Radiation Protection (ICNIRP) has defined EMF reference levels. Restrictions on induced whole-body-averaged specific absorption rate (SAR(wb)) are provided to keep the whole-body temperature increase (T(body, incr)) under 1 °C during 30 min. Additional restrictions on the peak 10 g spatial-averaged SAR (SAR(10g)) are provided to prevent excessive localized tissue heating. The objective of this study is to assess the localized peak temperature increase (T(incr, max)) in children upon exposure at the reference levels. Finite-difference time-domain modeling was used to calculate T(incr, max) in six children and two adults exposed to orthogonal plane-wave configurations. We performed a sensitivity study and Monte Carlo analysis to assess the uncertainty of the results. Considering the uncertainties in the model parameters, we found that a peak temperature increase as high as 1 °C can occur for worst-case scenarios at the ICNIRP reference levels. Since the guidelines are deduced from temperature increase, we used T(incr, max) as being a better metric to prevent excessive localized tissue heating instead of localized peak SAR. However, we note that the exposure time should also be considered in future guidelines. Hence, we advise defining limits on T(incr, max) for specified durations of exposure.

Added value of cost-utility analysis in simple diagnostic studies of accuracy: (18)F-fluoromethylcholine PET/CT in prostate cancer staging.

Science.gov (United States)

Gerke, Oke; Poulsen, Mads H; Høilund-Carlsen, Poul Flemming

2015-01-01

Diagnostic studies of accuracy targeting sensitivity and specificity are commonly done in a paired design in which all modalities are applied in each patient, whereas cost-effectiveness and cost-utility analyses are usually assessed either directly alongside to or indirectly by means of stochastic modeling based on larger randomized controlled trials (RCTs). However the conduct of RCTs is hampered in an environment such as ours, in which technology is rapidly evolving. As such, there is a relatively limited number of RCTs. Therefore, we investigated as to which extent paired diagnostic studies of accuracy can be also used to shed light on economic implications when considering a new diagnostic test. We propose a simple decision tree model-based cost-utility analysis of a diagnostic test when compared to the current standard procedure and exemplify this approach with published data from lymph node staging of prostate cancer. Average procedure costs were taken from the Danish Diagnosis Related Groups Tariff in 2013 and life expectancy was estimated for an ideal 60 year old patient based on prostate cancer stage and prostatectomy or radiation and chemotherapy. Quality-adjusted life-years (QALYs) were deduced from the literature, and an incremental cost-effectiveness ratio (ICER) was used to compare lymph node dissection with respective histopathological examination (reference standard) and (18)F-fluoromethylcholine positron emission tomography/computed tomography (FCH-PET/CT). Lower bounds of sensitivity and specificity of FCH-PET/CT were established at which the replacement of the reference standard by FCH-PET/CT comes with a trade-off between worse effectiveness and lower costs. Compared to the reference standard in a diagnostic accuracy study, any imperfections in accuracy of a diagnostic test imply that replacing the reference standard generates a loss in effectiveness and utility. We conclude that diagnostic studies of accuracy can be put to a more extensive use

Definition of reference ranges for free T4, TSH, and thyroglobulin levels in healthy subjects of the Jaén Health District.

Science.gov (United States)

Olmedo Carrillo, Pablo; Santiago Fernández, Piedad; García Fuentes, Eduardo; Ureña Fernández, Tomás; Gutiérrez Alcántara, Carmen; Sánchez-Malo, Carolina; Gassó Campos, Manuela; Martínez Ramírez, María José

2017-10-01

The treatment guidelines for thyroid dysfunction recommend defining reference ranges for thyroid hormones in each area through assessment of local population data considering the iodine nutritional status. The aim of this study was to define the reference ranges of free thyroxine (FT4), TSH, and thyroglobulin levels in a general population from Jaen, an area of southern Spain with an adequate iodine nutritional status, and whether they were associated with urinary iodine levels. A cross-sectional study was conducted in 1,003 subjects of the general population of the Jaen Health District. Levels of urinary iodine, FT4, TSH, thyroglobulin, and thyroid peroxidase (TPO) antibodies were measured according to age and sex. Median and mean urinary iodine levels were 110.59μg/L and 130.11μg/L respectively. Median TSH level was 1.83μIU/mL (p2.5=0.56μIU/mL, p97.5=4.66μIU/mL). Median FT4 level was 0.84ng/dL (p2.5=0.62ng/dL, p97.5=1.18ng/dL). TPO antibodies were detected in 5.7% of subjects. There was no correlation between urinary iodine levels and FT4, TSH or TPO antibodies. Subjects with positive TPO antibodies had higher TSH levels (3.34μIU/L versus 2.14μIU/mL, P=.001; odds ratio=2.42). Urinary iodine levels in Jaen are optimal according to World Health Organization standards. Reference ranges of FT4, TSH, and thyroglobulin do not differ from those reported in the literature and are no associated to urinary iodine levels. The prevalence of positive TPO antibodies was similar to that reported in other Spanish areas. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Access to diphtheria antitoxin for therapy and diagnostics.

Science.gov (United States)

Both, L; White, J; Mandal, S; Efstratiou, A

2014-06-19

The most effective treatment for diphtheria is swift administration of diphtheria antitoxin (DAT) with conjunct antibiotic therapy. DAT is an equine immunoglobulin preparation and listed among the World Health Organization Essential Medicines. Essential Medicines should be available in functioning health systems at all times in adequate amounts, in appropriate dosage forms, with assured quality, and at prices individuals and the community can afford. However, DAT is in scarce supply and frequently unavailable to patients because of discontinued production in several countries, low economic viability, and high regulatory requirements for the safe manufacture of blood-derived products. DAT is also a cornerstone of diphtheria diagnostics but several diagnostic reference laboratories across the European Union (EU) and elsewhere routinely face problems in sourcing DAT for toxigenicity testing. Overall, global access to DAT for both therapeutic and diagnostic applications seems inadequate. Therefore--besides efforts to improve the current supply of DAT--accelerated research and development of alternatives including monoclonal antibodies for therapy and molecular-based methods for diagnostics are required. Given the rarity of the disease, it would be useful to organise a small stockpile centrally for all EU countries and to maintain an inventory of DAT availability within and between countries.

1-GWh diurnal load-leveling superconducting magnetic energy storage system reference design

International Nuclear Information System (INIS)

Hassenzahl, W.V.; Rogers, J.D.

1979-01-01

A point reference design has been completed for a 1-GWh Superconducting Magnetic Energy Storage system. The system is for electric utility dirunal load leveling; however, such a device will function to meet much faster power demands including dynamic stabilization. The study has explored several concepts of design not previously considered in the same detail as treated here. Because the study is for a point design, optimization in all respects is not complete. The study examines aspects of the coil design; superconductor supported off of the dewar shell; the dewar shell, its configuration and stresses; the underground excavation and related construction for holding the superconducting coil and its dewar; the helium refrigeration system; the electrical converter system; the vacuum system; the guard coil; and the costs. The report is a condensation of the more comprehensive study which is in the process of being printed

Diagnostic accuracy of organ electrodermal diagnostics | Szopinski ...

African Journals Online (AJOL)

Objective. To estimate the diagnostic accuracy as well as the scope of utilisation of a new bio-electronic method of organ diagnostics. Design. Double-blind comparative study of the diagnostic results obtained by means of organ electrodermal diagnostics (OED) and clinical diagnoses, as a criterion standard. Setting.

Technology, Safety and Costs of Decommissioning a Reference Low-Level Waste Burial Ground. Appendices

International Nuclear Information System (INIS)

None

1980-01-01

Safety and cost information are developed for the conceptual decommissioning of commercial low-level waste (LLW) burial grounds. Two generic burial grounds, one located on an arid western site and the other located on a humid eastern site, are used as reference facilities for the study. The two burial grounds are assumed to have the same site capacity for waste, the same radioactive waste inventory, and similar trench characteristics and operating procedures. The climate, geology. and hydrology of the two sites are chosen to be typical of real western and eastern sites. Volume 2 (Appendices) contains the detailed analyses and data needed to support the results given in Volume 1.

Nanosecond-level time synchronization of AERA using a beacon reference transmitter and commercial airplanes

Science.gov (United States)

Huege, Tim

2017-03-01

Radio detection of cosmic-ray air showers requires time synchronization of detectors on a nanosecond level, especially for advanced reconstruction algorithms based on the wavefront curvature and for interferometric analysis approaches. At the Auger Engineering Radio Array, the distributed, autonomous detector stations are time-synchronized via the Global Positioning System which, however, does not provide sufficient timing accuracy. We thus employ a dedicated beacon reference transmitter to correct for eventby-event clock drifts in our offline data analysis. In an independent cross-check of this "beacon correction" using radio pulses emitted by commercial airplanes, we have shown that the combined timing accuracy of the two methods is better than 2 nanoseconds.

Study about diagnostic quality in a public-center of mammography of Santa Fe, Argentina

International Nuclear Information System (INIS)

Lescano, R.; Kiguen, J.; Gaitan, L.; Caspani, C.

2001-01-01

The objective is to apply a method that allows us to evaluate the diagnostic quality of a public-center of mammography and to validate it. The representative centers of a social class were grouped; this one is evaluated measuring the mechanics, electrics, dosimetrics and personal parameters of the process to get the mammography diagnostic. The original study and the respective report was submitted to the valuation of a panel of experts, who evaluated image, techniques and diagnostics. The equipment and techniques used are described in this case. The judgment of the ACR and the Argentine legislation are applied. The dosimetric results of the mammography practice serve to determine the local reference levels. The people who intervened in the diagnosis are evaluated, as well as the services that can influence it. Seeking the parametric sensibility in relationship with the succeeded and precocious diagnosis, the success of it is confirmed by the panel of experts. We conclude by indicating that the success percentage in the diagnosis is about 98,36%, that there is 100% of coincidence among the perception and the value of the study quality. The valuation of the image reaches 69,2% of the maximum score, and the placement technique, 73,9%. The parametric sensibilities of the principal variables are discussed. (author)

Electrophysiological evidence for colour effects on the naming of colour diagnostic and noncolour diagnostic objects

OpenAIRE

Bramão, I.; Francisco, A.; Inácio , F.; Faísca, L.; Reis, A.; Petersson, K.

2012-01-01

In this study, we investigated the level of visual processing at which surface colour information improves the naming of colour diagnostic and noncolour diagnostic objects. Continuous electroencephalograms were recorded while participants performed a visual object naming task in which coloured and black-and-white versions of both types of objects were presented. The black-and-white and the colour presentations were compared in two groups of event-related potentials (ERPs): (1) The P1 and N1 c...

Commitments of Psychological Contracts and Diagnostic Use of Management Control Systems

Directory of Open Access Journals (Sweden)

Ivan Canan

2016-06-01

Full Text Available Investigating the commitments the Surveillance Agents from the National Telecommunications Agency (Anatel made in their psychological contracts and the diagnostic use of the management control system of the entity, this study tested the hypothesis that individuals tend to be more committed to aspects they are charged for within organizations. This is a theoretical and empirical study that assumed that the commitments comprise the part of the belief that individuals develop on reciprocal relations of exchange between themselves and their contractors, in line with the model by Rousseau (1989; 1995. It was also assumed that the extent to which aspects are charged from the members of an organization matches their perception of the diagnostic use of formal and informal control systems. Methodologically, the research was developed in two phases, the first qualitative, involving documentary analysis and content analysis of organizational documents; and the second quantitative, with the application of questionnaires answered by individuals who occupy the individual position referred to in the organization, who evaluated behavioral parameters that act on them and that were identified in the first phase. The data showed that 42 respondents tend to maintain high levels of commitment to the rules and standards proposed for their function. Statistical results also suggest that there is a significant positive correlation between the commitments assumed and the perceived diagnostic use of control systems for the surveillance agents who answered the questionnaire.

Domain knowledge patterns in pedagogical diagnostics

Science.gov (United States)

Miarka, Rostislav

2017-07-01

This paper shows a proposal of representation of knowledge patterns in RDF(S) language. Knowledge patterns are used for reuse of knowledge. They can be divided into two groups - Top-level knowledge patterns and Domain knowledge patterns. Pedagogical diagnostics is aimed at testing of knowledge of students at primary and secondary school. An example of domain knowledge pattern from pedagogical diagnostics is part of this paper.

MERRA 2D IAU Ocean Surface Diagnostic, Single Level, Time Avg 1-hr (2/3x1/2L1) V5.2.0

Data.gov (United States)

National Aeronautics and Space Administration — The MAT1NXOCN or tavg1_2d_ocn_Nx data product is the MERRA Data Assimilation System 2-Dimensional ocean surface single-level diagnostics that is time averaged...

Nuclear medicine diagnostic experience for 25 patients with parathyroid disease accompanied elevated serum PTH level

International Nuclear Information System (INIS)

Su Li; Huang Chenggang; Niu Wenqiang; Wu Liwen

2010-01-01

Objective: To explore nuclear medicine diagnostic method for parathyroid disease accompanied elevated serum parathyroid hormone (PTH) level. Methods: The images of 25 patients with parathyroid disease were obtained by SPECT 99 Tc m -MIBI double-phase parathyroid imaging and 99 Tc m -methylene diphosphonate ( 99 Tc m -MDP) whole-body static bone imaging. All subject were measured serum PTH, calcium, phosphorus and alkaline phosphatase. Results: (1) Serum PTH level increased to varying degrees in patients with primary hyperparathyroidism (PHPT), secondary hyperparathyroidism (SHPT). (2) PHPT and SHPT showed significant change before and after surgery (t=6.24 and t=6.85, P 99 Tc m -MIBI were above 90%. (4) Whole-body bone imaging results of SHPT patients showed complex and diverse caused by high background, increased uptakes mainly. 99 Tc m -MIBI dual-phase parathyroid imaging showed hyperparathyroidism in varying degree, up to 56% or more. Conclusion: Determination of serum PTH combined SPECT for parathyroid and whole-body bone imaging showed high clinical value in diagnosis and treatment of parathyroid disease. (authors)

Upgrading the Medical Physics Calibration Laboratory Towards ISO/IEC 17025: Radiation Standards and Calibration in Diagnostic Radiology

International Nuclear Information System (INIS)

Asmaliza Hashim; Muhammad Jamal Md Isa; Abd Aziz Mhd Ramli; Wan Hazlinda Ismail; Norhayati Abdullah; Shahrul Azlan Azizan; Siti Sara Deraman; Nor Azlin Azraai; Md Khairusalih Md Zin

2010-01-01

Calibration of quality control (QC) test tools used in diagnostic radiology is legally required under the Ministry of Health (MOH) requirement. The Medical Physics Calibration Laboratory of the Malaysian Nuclear Agency is the national focal point for the calibration of quality control test tools used in diagnostic radiology. The Medical Physics Calibration Laboratory has measurement traceability to primary standard dosimetry laboratory (Physikalisch-Technische Bundesanstalt (PTB)), thus providing an interface between the primary standard dosimetry laboratory and Malaysian hospitals, clinics and license class H holder. The Medical Physics Calibration Laboratory facility is comprised of a constant potential x-ray system with a capability of 160 kV tube and a series of reference and working standard ion chambers. The stability of reference and working standard ion chambers was measured using strontium-90. Dosimetric instruments used in diagnostic radiology is calibrated in terms of air kerma to comply with an International Code of Practices of dosimetry for example IAEA's Technical Report Series number 457. The new series of standard radiation qualities was established based on ISO/IEC 61267. The measurement of beam homogeneity was measured using film and ion chamber to define the field size at certain distance and kV output was measured using the spectrometer and non-invasive kVp meter. The uncertainties measurement was determined with expended uncertainties to a level of confidence of approximately 95% (coverage factor k=2). This paper describes the available facility and the effort of the Medical Physics Calibration Laboratory to upgrade the laboratory towards ISO/IEC 17025. (author)

Diagnosing alcoholism in high-risk drinking drivers: comparing different diagnostic procedures with estimated prevalence of hazardous alcohol use

NARCIS (Netherlands)

Korzec, A.; Bär, M.; Koeter, M. W.; de Kieviet, W.

2001-01-01

In several European countries, drivers under influence (DUI), suspected of an alcohol use disorder (AUD, 'alcoholism') are referred for diagnostic examination. The accuracy of diagnostic procedures used in diagnosing AUD in the DUI population is unknown. The aim of this study was to compare three

Interlaboratory Reproducibility of Droplet Digital Polymerase Chain Reaction Using a New DNA Reference Material Format.

Science.gov (United States)

Pinheiro, Leonardo B; O'Brien, Helen; Druce, Julian; Do, Hongdo; Kay, Pippa; Daniels, Marissa; You, Jingjing; Burke, Daniel; Griffiths, Kate; Emslie, Kerry R

2017-11-07

Use of droplet digital PCR technology (ddPCR) is expanding rapidly in the diversity of applications and number of users around the world. Access to relatively simple and affordable commercial ddPCR technology has attracted wide interest in use of this technology as a molecular diagnostic tool. For ddPCR to effectively transition to a molecular diagnostic setting requires processes for method validation and verification and demonstration of reproducible instrument performance. In this study, we describe the development and characterization of a DNA reference material (NMI NA008 High GC reference material) comprising a challenging methylated GC-rich DNA template under a novel 96-well microplate format. A scalable process using high precision acoustic dispensing technology was validated to produce the DNA reference material with a certified reference value expressed in amount of DNA molecules per well. An interlaboratory study, conducted using blinded NA008 High GC reference material to assess reproducibility among seven independent laboratories demonstrated less than 4.5% reproducibility relative standard deviation. With the exclusion of one laboratory, laboratories had appropriate technical competency, fully functional instrumentation, and suitable reagents to perform accurate ddPCR based DNA quantification measurements at the time of the study. The study results confirmed that NA008 High GC reference material is fit for the purpose of being used for quality control of ddPCR systems, consumables, instrumentation, and workflow.

Diagnostic properties of C-reactive protein for detecting pneumonia in children.

Science.gov (United States)

Koster, Madieke J; Broekhuizen, Berna D L; Minnaard, Margaretha C; Balemans, Walter A F; Hopstaken, Rogier M; de Jong, Pim A; Verheij, Theo J M

2013-07-01

The diagnostic value of C-reactive protein (CRP) level for pneumonia in children is unknown. As a first step in the assessment of the value of CRP, a diagnostic study was performed in children at an emergency department (ED). In this cross-sectional study, data were retrospectively collected from children presenting with suspected pneumonia at the ED of Antonius Hospital Nieuwegein in The Netherlands between January 2007 and January 2012. Diagnostic outcome was pneumonia yes/no according to independent radiologist. (Un)adjusted association between CRP level and pneumonia and diagnostic value of CRP were calculated. Of 687 presenting children, 286 underwent both CRP measurement and chest radiography. 148 had pneumonia (52%). The proportion of pneumonia increased with CRP level. Negative predictive values declined, but positive predictive values increased with higher CRP thresholds. Univariable odds ratio for the association between CRP level and pneumonia was 1.2 (95% CI 1.11-1.21) per 10 mg/L increase. After adjustment for baseline characteristics CRP level remained associated with pneumonia. CRP level has independent diagnostic value for pneumonia in children presenting at the ED with suspected pneumonia, but low levels do not exclude pneumonia in this setting. These results prompt evaluation of CRP in primary care children with LRTI. Copyright © 2013 Elsevier Ltd. All rights reserved.

Farm-level risk factors for Fasciola hepatica infection in Danish dairy cattle as evaluated by two diagnostic methods

DEFF Research Database (Denmark)

Takeuchi-Storm, Nao; Denwood, Matthew; Hansen, Tina Vicky Alstrup

2017-01-01

) as a tool for diagnosis in Danish dairy cattle farms was assessed. This case-control study aimed to identify farm-level risk factors for fasciolosis in Danish dairy farms (> 50 animals slaughtered in 2013) using two diagnostic methods: recordings of liver condemnation at slaughter, and farm-level Fasciola...... on wet pastures, dry cows grazing on wet pastures, herd size, breed and concurrent beef cattle production were identified as risk factors associated with being classified as a case farm. With the categorised BTM ELISA result as the response variable, heifers grazing on wet pastures, dry cows grazing...... on wet pastures, and purchase of cows were identified as risk factors. Within the case and control groups, 74.8 and 12.7% of farms were positive for fasciolosis on BTM ELISA, respectively. The differences are likely to be related to the detection limit of the farm-level prevalence by the BTM ELISA test...

CSF lactate level: a useful diagnostic tool to differentiate acute bacterial and viral meningitis.

Science.gov (United States)

Abro, Ali Hassan; Abdou, Ahmed Saheh; Ustadi, Abdulla M; Saleh, Ahmed Alhaj; Younis, Nadeem Javeed; Doleh, Wafa F

2009-08-01

To evaluate the potential role of CSF lactate level in the diagnosis of acute bacterial meningitis and in the differentiation between viral and bacterial meningitis. This was a hospital based observational study, conducted at Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates, from July 2004 to June 2007. The patients with clinical diagnosis of acute bacterial meningitis and who had CSF Gram stain/culture positive, CSF analysis suggestive of bacterial meningitis with negative Gram stain and culture but blood culture positive for bacteria and patients with clinical diagnosis suggestive of viral meningitis supported by CSF chemical analysis with negative Gram stain and culture as well as negative blood culture for bacteria were included in the study. CT scan brain was done for all patients before lumber puncture and CSF and blood samples were collected immediately after admission. CSF chemical analysis including lactate level was done on first spinal tap. The CSF lactate level was tested by Enzymatic Colorimetric method. A total 95 adult patients of acute meningitis (53 bacterial and 42 viral) fulfilled the inclusion criteria. Among 53 bacterial meningitis patients, Neisseria meningitides were isolated in 29 (54.7%), Strept. Pneumoniae in 18 (33.96%), Staph. Aureus in 2 (3.77%), Klebsiell Pneumoniae in 2 (3.77%), Strept. Agalactiae in 1 (1.8%) and E. Coli in 1 (1.8%). All the patients with bacterial meningitis had CSF lactate > 3.8 mmol/l except one, whereas none of the patients with viral meningitis had lactate level > 3.8 mmol/l. The mean CSF lactate level in bacterial meningitis cases amounted to 16.51 +/- 6.14 mmol/l, whereas it was significantly lower in viral group 2.36 +/- 0.6 mmol/l, p < .0001. CSF lactate level was significantly high in bacterial than viral meningitis and it can provide pertinent, rapid and reliable diagnostic information. Furthermore, CSF lactate level can also differentiate bacterial meningitis from viral one in a quick

Diagnostic Performance of the Intraoral Radiographs on the Interproximal Dental Caries

International Nuclear Information System (INIS)

Kim, Soo Ji; Kang, Byung Cheol

1998-01-01

The purpose of this study was to evaluated the diagnostic performance of the senior dental students for the proximal dental caries in intraoral radiographs and to compare it with the dental hospital residents, the reference group. It was also investigated the diagnostic performance according to the carious lesion depth. Thirty-five intraoral periapical and bitewing radiographs with 213 proximal surface included in this study were selected from the dental patients at Chonnam National University Hospital. The observers were 181 senior dental students from 5 dental schools and 40 dentists who were second year resident from 5 dental hospitals. They were asked to evaluate the presence ro the absence of the proximal dental caries. The results were as follows : 1. The mean of the hitting rate for the overall observers was 184.51 surfaces and the diagnostic accuracy was 86.62%. 2. The diagnostic performance of the sound proximal tooth surfaces was very high, i.e., 91.5% true negative rate and 8.5% false positive rate. 3. The diagnostic performance of the dentist group was higher than the student group (P 0.001).

Perturbational treatment of spin-orbit coupling for generally applicable high-level multi-reference methods

International Nuclear Information System (INIS)

Mai, Sebastian; Marquetand, Philipp; González, Leticia; Müller, Thomas; Plasser, Felix; Lischka, Hans

2014-01-01

An efficient perturbational treatment of spin-orbit coupling within the framework of high-level multi-reference techniques has been implemented in the most recent version of the COLUMBUS quantum chemistry package, extending the existing fully variational two-component (2c) multi-reference configuration interaction singles and doubles (MRCISD) method. The proposed scheme follows related implementations of quasi-degenerate perturbation theory (QDPT) model space techniques. Our model space is built either from uncontracted, large-scale scalar relativistic MRCISD wavefunctions or based on the scalar-relativistic solutions of the linear-response-theory-based multi-configurational averaged quadratic coupled cluster method (LRT-MRAQCC). The latter approach allows for a consistent, approximatively size-consistent and size-extensive treatment of spin-orbit coupling. The approach is described in detail and compared to a number of related techniques. The inherent accuracy of the QDPT approach is validated by comparing cuts of the potential energy surfaces of acrolein and its S, Se, and Te analoga with the corresponding data obtained from matching fully variational spin-orbit MRCISD calculations. The conceptual availability of approximate analytic gradients with respect to geometrical displacements is an attractive feature of the 2c-QDPT-MRCISD and 2c-QDPT-LRT-MRAQCC methods for structure optimization and ab inito molecular dynamics simulations

Perturbational treatment of spin-orbit coupling for generally applicable high-level multi-reference methods

Energy Technology Data Exchange (ETDEWEB)

Mai, Sebastian; Marquetand, Philipp; González, Leticia [Institute of Theoretical Chemistry, University of Vienna, Währinger Str. 17, 1090 Vienna (Austria); Müller, Thomas, E-mail: th.mueller@fz-juelich.de [Institute for Advanced Simulation, Jülich Supercomputing Centre, Forschungszentrum Jülich, 52425 Jülich (Germany); Plasser, Felix [Interdisciplinary Center for Scientific Computing, University of Heidelberg, Im Neuenheimer Feld 368, 69120 Heidelberg (Germany); Lischka, Hans [Institute of Theoretical Chemistry, University of Vienna, Währinger Str. 17, 1090 Vienna (Austria); Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409-1061 (United States)

2014-08-21

An efficient perturbational treatment of spin-orbit coupling within the framework of high-level multi-reference techniques has been implemented in the most recent version of the COLUMBUS quantum chemistry package, extending the existing fully variational two-component (2c) multi-reference configuration interaction singles and doubles (MRCISD) method. The proposed scheme follows related implementations of quasi-degenerate perturbation theory (QDPT) model space techniques. Our model space is built either from uncontracted, large-scale scalar relativistic MRCISD wavefunctions or based on the scalar-relativistic solutions of the linear-response-theory-based multi-configurational averaged quadratic coupled cluster method (LRT-MRAQCC). The latter approach allows for a consistent, approximatively size-consistent and size-extensive treatment of spin-orbit coupling. The approach is described in detail and compared to a number of related techniques. The inherent accuracy of the QDPT approach is validated by comparing cuts of the potential energy surfaces of acrolein and its S, Se, and Te analoga with the corresponding data obtained from matching fully variational spin-orbit MRCISD calculations. The conceptual availability of approximate analytic gradients with respect to geometrical displacements is an attractive feature of the 2c-QDPT-MRCISD and 2c-QDPT-LRT-MRAQCC methods for structure optimization and ab inito molecular dynamics simulations.

[An exploratory study on the diagnostic cutoff value of International HIV-associated Dementia Scale in minority ethnic groups with different educational levels, in Guangxi].

Science.gov (United States)

Zhao, Ting-ting; Feng, Qi-ming; Liang, Hao; Tang, Xian-yan; Wei, Bo

2011-11-01

Using Intelligence Scale of Mini Mental State Estimated (MMSE) as the gold standard to determine the relevance of International HIV-associated Dementia Scale (IHDS) in minority ethnic areas in Guangxi populations with different cultural values. Corresponding boundary value related to the authenticity and reliability on IHDS were also evaluated. 200 patients with HIV infection were randomly selected from the minority ethnic groups in Guangxi. For each infected person, MMSE and IHDS blind scale were tested at the same period. Using the results from MMSE scale test as the gold standard, ROC curve and IHDS scale in Guangxi minority populations with different education levels which related to the diagnosis of dementia-HIV values were determined. The value of a specific sector under the IHDS sensitivity, specificity, and internal consistency coefficients was also evaluated. When considering the infected person did not differ on their educational level, the IHDS scale diagnostic cutoff appeared as 8.25, while IHDS sensitivity as 0.925, specificity as 0.731 and Kappa as 0.477 (P education groups showed different IHDS diagnostic cutoff values. People with high school, secondary school or higher education levels, the IHDS diagnosis appeared to be 8.25, when sensitivity was 0.917, specificity was 0.895 and Kappa was 0.722 (P education level, the IHDS appeared to be 7.25. When sensitivity was 0.875, specificity was 0.661 and Kappa was 0.372 (P value (IHDS ≤ 10 points). When using IHDS to perform the HIV related dementia screening program, in the minority areas of Guangxi, culture context, the degree and difference of HIV infection should be considered, especially in using IHDS diagnostic cutoff values.

Inadequate Diagnostic Evaluation in Young Patients Registered with a Diagnosis of Dementia