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Anatomical Variations of the Willis Circle: A Risk Factor for Brain Lesions in Sickle Cell Patients
Nwatsock Joseph-Francis,
Gharingam Marie Laure,
Moulion-Tapouh Jean-Roger,
Simoni Paolo,
Moifo Boniface
Issue:
Volume 11, Issue 1, March 2023
Pages:
1-5
Received:
23 November 2022
Accepted:
15 December 2022
Published:
10 January 2023
Abstract: Background and objective: The brain lesions observed in sickle cell patients are often known to be due to vessels occlusions. But other factors could be associated with the genesis of these lesions. The objective of this study was to assess the association between the presence of anatomical variations in the Willis circle and that of brain lesions found on MRI in sickle cell patients. Methods: We conducted a bicentric cross-sectional study with retrolective analysis of images at the medical imaging departments of the HUDERF in Brussels (Belgium) and the Yaoundé General Hospital (Cameroon), over a period of 12 months from November 2020 to October 2021. We included 187 homozygous sickle cell patients with documented electrophoresis and brain MRI results. The MRI were carried out in T1, T2, T2*, FLAIR, Diffusion and 3D TOF sequences on Siemens® 1.5 Tesla devices. The collected data were analyzed using SPSS® software version 20.0 for Windows® with a significant p<0.05. Results: The mean age of patients was 8.76 years with no significant difference between the sexes. Variations in the Willis circle were present in 20 cases (10.70%) with a predominance in the posterior hemicircle (6.96% versus 3.74% for the anterior hemicircle; p=0.04). The most common variation was type G corresponding to hypoplasia or absence of the anterior communicating artery in the anterior hemicircle, and hypoplasia or unilateral absence of a posterior communicating artery in the posterior hemicircle. At the parenchymal level, brain lesions were found in 11 cases (5.88%) including ischemic lesions (3.21%) and leukopathies (1.07%). In general, the existence of these lesions was significantly associated with the presence of the Willis circle variations (p=0.01). Conclusion and recommendation: The presence of anatomical variations of the Willis arterial circle in sickle cell patients is associated with the existence of brain lesions. We therefore conclude that anatomical variations of the Willis circle could be an unknown factor increasing the risk of brain damages and therefore morbidity in these patients. We recommend that a larger sample study be conducted to verify our findings.
Abstract: Background and objective: The brain lesions observed in sickle cell patients are often known to be due to vessels occlusions. But other factors could be associated with the genesis of these lesions. The objective of this study was to assess the association between the presence of anatomical variations in the Willis circle and that of brain lesions ...
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Effect of Continuous Medical Education on Awareness of Clinical Imaging Guidelines Among Imaging Referrers in Sub-Saharan Africa
Harriet Nalubega Kisembo,
Richard Malumba,
Ritah Nassanga,
Faith Ameda,
Dina Husseiny Salama,
Michael Grace Kawooya
Issue:
Volume 11, Issue 1, March 2023
Pages:
6-11
Received:
11 December 2022
Accepted:
30 December 2022
Published:
10 January 2023
Abstract: Rationale and objectives: In recent decades, there has been an effort to improve the quality and safety of medical imaging globally. Such, has been promoted through the application of decision aid tools. Clinical Imaging Guidelines (CIGs) are systematically developed statements to assist referrers to make appropriate patient imaging decisions for screening, diagnosis and management of conditions. Awareness of such guidelines prompts their application thus enhancing safety of imaging procedures. There is evidence of low levels of awareness elsewhere but such hasn’t been assessed in Sub-Saharan Africa. The study assessed the CIGs awareness level among imaging referrers before and after giving continuous medical education (CME) and awareness materials. Methods: A pre and post -CME mean score of 18 item questionnaire on awareness on CIGs for 109 referrers from 5 health facilities were compared. A statistical difference in the mean scores for the pre and post intervention assessment was determined using a paired T-test at P > 0.05 and Confidence interval of 95%. Results - At baseline, we found a 47% level of CIGs awareness and after the intervention we found a level of 59%. There was a significant statistical change of 12% level of CIGs awareness from pre-intervention 47% to post intervention 59% at P-value < 0.0001 and 95% confidence interval (7.8-16.4). Conclusion and Recommendation: Routine CMEs are a good to start platforms for enhancing awareness of CIGs and strengthening justification of medical exposures.
Abstract: Rationale and objectives: In recent decades, there has been an effort to improve the quality and safety of medical imaging globally. Such, has been promoted through the application of decision aid tools. Clinical Imaging Guidelines (CIGs) are systematically developed statements to assist referrers to make appropriate patient imaging decisions for s...
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Examining the Decision of Radiographers in the Selection of Computed Tomography Scan Radiation Doses
Geoffrey Erem,
William Olwit,
Aloysius Gonzaga Mubuuke,
Caroline Otike,
Jacob Godfrey Agea,
Akisophel Kisolo,
Michael Grace Kawooya,
Cyril Schandorf
Issue:
Volume 11, Issue 1, March 2023
Pages:
12-20
Received:
8 March 2023
Accepted:
24 March 2023
Published:
31 March 2023
Abstract: Medical radiation is a controllable source and should be applied on individualized basis to determine whether each patient fits the appropriate criteria for the diagnostic procedure. Appropriate justification of requested CT examinations should ensure that benefits outweigh the risk. CT scan protocols and radiation doses vary greatly across countries and are primarily attributable to local choices regarding technical parameters, rather than the patient, institution, or machine characteristics. These variations call for optimization of doses to consistent standards. This was a mixed methods study, with quantitative and qualitative approaches, undertaken in Uganda. This study involved radiographers scoring the effects of various CT best-practices on dose selection using a Likert scale. The qualitative component explored factors influencing CT scan technical parameter selection, the barriers, and facilitators to best practices to CT radiation protection. The male to female ratio was 3.5: 1 and the average age was 30 years with a range of 21 – 40 years. The respondents either agreed or strongly agreed that Diagnostic Reference Levels were important in dose selection. Key factors influencing the selection of CT scan doses included CT scan machine, examination time, age and body size. Key barriers to best practices were the type or level of health facility, radiographer, and government level related and the facilitators to best practices also included type or level health facility, radiographer and regulator related. Based on the findings, Diagnostic Reference Levels (DRLs), the make, model and year of manufacture of the CT equipment were important in dose selection. Radiographers had limited training on DRLs, and majority were concerned about the lack of these DRLs. Regular training will be designed and implemented for the radiographers through the professional bodies and the regulator to educate the radiographers about CT radiation scan dose selection to optimize patient radiation dose and image quality.
Abstract: Medical radiation is a controllable source and should be applied on individualized basis to determine whether each patient fits the appropriate criteria for the diagnostic procedure. Appropriate justification of requested CT examinations should ensure that benefits outweigh the risk. CT scan protocols and radiation doses vary greatly across countri...
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Evaluated the Correlation Between Serum Ferritin and Iron Overload of Liver, Spleen and Heart in β-Thalassemia Major Patients by MRI T2* Method
Nga Thi Ho Nguyen,
Phuoc Van Le,
Phuoc Thanh Bui,
Dung Van Le,
Lam Hoang Nguyen,
Van Bich Thi Le,
Pham Van Bui
Issue:
Volume 11, Issue 1, March 2023
Pages:
21-24
Received:
17 March 2023
Accepted:
1 April 2023
Published:
18 April 2023
Abstract: β-Thalassemia major often results in an excess of iron in the body due to frequent blood transfusions and enhanced absorption of iron in the gastrointestinal tract. Early detection of this condition and administering sufficient iron chelator therapy can significantly decrease the risk of complications and fatalities resulting from iron overload. MRI (Magnetic Resonance Imaging) T2* is an accurate non-invasive method for assessing organ iron overload in β-Thalassaemia major patients. This study evaluated the correlation between serum ferritin and iron overload of liver, spleen, and heart in β -Thalassaemia major patients by MRI T2* method. The design was a cross-section, descriptive study. We used MRI-T2* to evaluate the correlation between serum ferritin and iron overload of liver, spleen, and heart in 24 Thalassaemia major patients admitted in Cho Ray hospital from 10/2013 to 1/2014, using a 1.5T MRI system (Siemens) with a body coil. T2* measurements were taken in the liver, spleen, and myocardium using different gradient echo pulse sequences. T2* values were calculated within homogeneous regions of interest (ROI) in the liver avoiding major blood vessels, spleen, and the entire thickness of the interventricular septum in the myocardium. Pearson correlation coefficient was used to evaluate correlations in the study with a significance threshold of p < 0.05 using SPSS 16.0 software. As results, moderate negative correlation between serum ferritin and liver, spleen MRI T2* relaxation time (r = 0.57 and 0.755) and a weak negative correlation between serum ferritin and heart MRI T2* relaxation time (r = 0.303). Liver and heart MRI T2* readings were poorly correlated (r = 0.28). In conclusion, MRI T2* is useful to evaluate the iron overload status in β thalassemia patients.
Abstract: β-Thalassemia major often results in an excess of iron in the body due to frequent blood transfusions and enhanced absorption of iron in the gastrointestinal tract. Early detection of this condition and administering sufficient iron chelator therapy can significantly decrease the risk of complications and fatalities resulting from iron overload. MR...
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