Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.

(2014). Similarities and discrepancies—implementing restorative justice in Finland. Restorative Justice: Vol. 2, No. 2, pp. 225-231.

Review question/objective The objective of this review is to synthesize the best available evidence regarding the effectiveness of methods in identifying child maltreatment in social and health care settings. Background Child maltreatment is a sensitive and complex issue both in terms of clinical practice and research. It is a matter of concern for both child protective services and health services. Health and social professionals may have knowledge of child maltreatment, but formal identification of the problem is complicated by its sensitive nature, on the job time pressures and the absence of uniform guidelines. Interventions of identifying child maltreatment may be further complicated by conceptions of family privacy, fear of false allegations and the ensuing client families' loss of trust in the services available.1,2,3 Social and health care professionals are often reluctant to identify maltreatment, or report or intervene in suspected cases of child maltreatment. Gilbert et al., have estimated that internationally, only 10% of child maltreatment cases are being identified.4 Child maltreatment can be defined as the physical or psychological abuse or neglect of young people, under 18 years of age. Very often, psychological abuse can also be referred to as emotional abuse. Physical abuse includes acts that cause a child physical pain or impairs a child's physical functioning either temporarily or permanently. This can include bruises, burns, head injuries, fractures, internal injuries and gashes. It may even result in the death of a child. In such cases, it has often been found that the abuse had persisted for a long period of time before the death.5 Psychological abuse may involve terrorizing or ridiculing a child, humiliation, belittling and other forms of psychological threat, to the extent that the child's emotional well-being and development are placed at risk. Physical punishment and other types of physical abuse are always associated with emotional abuse.6 Child neglect involves the failure to provide appropriate care or protection and failing to adequately provide for the child's physical and emotional needs. As a result, child neglect may impact the child's overall development.7 Neglect, as with other forms of maltreatment, can vary in type, severity, or duration. Children subjected to violence usually do not seek help actively because they may regard the behavior of their family as normal. Even if they are aware of the abnormality of the violence being perpetrated, they lack the means to solve the problem and are often faithful to their family members. Help-seeking is further hindered by the secrecy and shame associated with maltreatment. Studies have shown that interventions in child maltreatment are often insufficient and lack determination and that for instance health professionals need continuous training, clinical supervision, attitude change at the individual level and coherent tools to identify cases of maltreatment and family violence in general.8 Interventions for identification of child maltreatment include the use of screening tools and questionnaires for children and families, observation, discussions with families, home visits and physical and psychological examination of children. Social welfare and health professionals, including social workers and nurses, are in a very good position to identify child maltreatment because they meet and examine children and families in settings, such as child welfare clinics or hospitals, where period and follow-up examinations take place and various injuries or symptoms of maltreatment are cared for. Other professionals, such as nursery and other teachers, are also in good position for identifying cases of child maltreatment. In Finland, the National Nursing Guideline for identifying and intervening in child maltreatment, based on a systematic search and review,9 was published by the Nursing Research Foundation in 2008.10,11 This systematic search and review covered multidisciplinary research published between 1998-2007 on how to identify child maltreatment defined as physical or psychological abuse or neglect of young people under 18 years of age. In line with previous findings, home visits and different training programs have been shown to be promising in assisting social and health care professionals to identify child maltreatment.10,11 The main purpose of this guideline was to find methods with which it was possible to identify child maltreatment cases and following that, continue to help children and families by finding ways out of the situation. Also in other countries, such as in the UK, guidelines have been developed for multi-professional use.12 However, no systematic reviews of this specific topic were found by searching central databases, such as Cochrane, Campbell and Prospero. Research evidence from an effectiveness point of view is available, for example risk assessment scales,13,14,15,16 show potential in identifying child physical or emotional maltreatment and multi-professional work in the identification of child maltreatment.17 In 2012 a survey examining how public health nurses use the Finnish guideline found that the guideline was quite well-known and utilized,10,11 but multi-professional practices concerning identification practices were not very well developed.18 To further advance the research and development of these practices in social and health care settings globally, a more detailed synthesis of previous knowledge, especially concerning the effectiveness of identifying cases of child maltreatment, is needed.

Since December 2006, approximately 3800 clinical chest tomosynthesis examinations have been performed at our department at Sahlgrenska University Hospital. A subset of the examinations has been included in studies of the detectability of pulmonary nodules, using computed tomography (CT) as the gold standard. Visibility studies, in which chest tomosynthesis and CT have been compared side-by side, have been used to determine the depiction potential of chest tomosynthesis. Comparisons with conventional chest radiography have been made. In the clinical setting, chest tomosynthesis has mostly been used as an additional examination. The most frequent indication for chest tomosynthesis has been suspicion of a nodule or tumour. In visibility studies, tomosynthesis has depicted over 90 % of the nodules seen on the CT scan. The corresponding figure for chest radiography has been <30 %. In the detection studies, the lesion-level sensitivity has been approximately 60 % for tomosynthesis and 20 % for chest radiography. In one of the detection studies, an analysis of all false-positive nodules was performed. This analysis showed that all findings had morphological correlates on the CT examinations. The majority of the false-positive nodules were localised in the immediate subpleural region. In conclusion, chest tomosynthesis is an improved chest radiography method, which can be used to optimise the use of CT resources, thereby reducing the radiation dose to the patient population. However, there are some limitations with chest tomosynthesis. For example, patients undergoing tomosynthesis have to be able to stand still and hold their breath firmly for 10 s. Also, chest tomosynthesis has a limited depth resolution, which may explain why pathology in the subpleural region is more difficult to interpret and artefacts from medical devices may occur.

The aim of the present study was to investigate nodule size measurements with chest tomosynthesis (TS) and computed tomography (CT). A 26-mm thick phantom, composed of a Polylite block with embedded spheres of different materials and sizes (4-20 mm), was scanned by both CT and TS. Six observers without prior knowledge of the true diameters of the spheres independently measured the diameter of the spheres on the CT and TS images. Four observers were allowed to change the window settings and two of the observers used predetermined fixed viewing conditions. The mean relative errors for all observers and all measured spheres compared with the known diameter of the spheres were 1.4 % (standard deviation, SD: 5.4 %) on CT images and -1.1 % (SD: 5.0 %) on TS images. With regard to the four observers where the window settings were at the discretion of the observer, the mean relative errors were 1.4 % (SD: 6.4 %) on CT images and -1.7 % (SD: 5.7 %) on TS images. Regarding the two observers using identical viewing conditions the mean relative error was 1.5 % (SD: 2.8 %) on CT images and 0.2 % (SD: 2.6 %) on TS images. In conclusion, the study suggests that nodule size measurements on chest TS might be an alternative to measurements on CT.

BACKGROUND:The new technique chest tomosynthesis refers to the principle of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest at a radiation dose comparable to that of chest radiography.PURPOSE:To investigate if, for experienced thoracic radiologists, the detectability of pulmonary nodules obtained after only a short initial learning period of chest tomosynthesis improves with additional clinical experience of the new technique.MATERIAL AND METHODS:Two readings of the same clinical chest tomosynthesis cases, the first performed after 6 months of clinical experience and the second after an additional period of 1 year, were conducted. Three senior thoracic radiologists, with more than 20 years of experience of chest radiography, acted as observers, with the task of detecting pulmonary nodules in a jackknife free-response receiver operating characteristics (JAFROC1) study. The image material consisted of 42 patients with and 47 patients without pulmonary nodules examined with chest tomosynthesis. Multidetector computed tomography (MDCT) was used as a reference. The total number of nodules was 131. The JAFROC1 figure of merit (FOM) was used as the principal measure of detectability.RESULTS:The difference in the observer-averaged JAFROC1 FOM of the two readings was 0.004 (95% confidence interval: -0.11, 0.12; F-statistic: 0.01 on 1 and 2.65 df; P=0.91). Thus, no significant improvement in detectability was found after the additional clinical experience of tomosynthesis.CONCLUSION:The study indicates that experienced thoracic radiologists already within the first months of clinical use of chest tomosynthesis are able to take advantage of the new technique in the task of detecting pulmonary nodules.

Background: Dose modulation can be used to reduce the radiation dose in computed tomography (CT) examinations while still obtaining the necessary diagnostic image quality. Multidetector-row computed tomography (MDCT) provides the possibility of simultaneous reconstruction of thin and thick slices from the same raw data. Purpose: To compare thin slices reconstructed from a dose-modulated helical acquisition and conventional high-resolution computed tomography (HRCT) images taken with the “step and shoot” technique in terms of visibility and motion artifacts, in order to investigate the possibility of excluding “step and shoot” acquisition from the HRCT examination. Material and Methods: Twenty patients were examined by a dose-modulated helical acquisition, “MDCT smart mA,” and by a noncontiguous cross-sectional high-resolution 16-row MDCT examination, “MDCT step and shoot.” Images from four anatomical levels, made anonymous regarding identity and technical data, were analyzed in random order by four thoracic radiologists. Results: “MDCT smart mA” was worse than “MDCT step and shoot” in terms of visibility. Concerning motion artifacts, “MDCT smart mA” was better than “MDCT step and shoot.” Conclusion: Thin images reconstructed from a dose-modulated 16-row helical MDCT acquisition (“MDCT smart mA”), as performed in our study, do not provide sufficient image quality regarding visibility compared to the “MDCT step and shoot” technique for the latter technique to be excluded from the HRCT examination.

Background: High-resolution computed tomography is the image procedure of choice in the evaluation of interstitial lung disease. Multidetector-row computed tomography provides the possibility of simultaneous reconstruction of thin and thick slices from the same raw data, acquired from one single series. Thus, it may be tempting to exclude the step-and-shoot series. Purpose: To compare high-resolution computed tomography (HRCT step-and-shoot) from single-slice CT (SSCT) and 16-channel multidetector CT (MDCT) in terms of visibility and motion artifacts, and to investigate whether thin images reconstructed from helical MDCT are equal to or better than conventional HRCT by SSCT in terms of visibility and motion artifacts. Material and Methods: 20 patients underwent HRCT step-and-shoot by SSCT (SSCT step-and-shoot) and MDCT (MDCT step-and-shoot), and a helical MDCT acquisition (MDCT helical). Images from four anatomical levels were analyzed in random order regarding visibility and motion artifacts. Results: Visibility using MDCT step-and-shoot was significantly better than or equal to SSCT step-and-shoot for segmental bronchi and fissures, but not for subsegmental bronchi. For MDCT helical, visibility was equal to or better than SSCT step-and-shoot for segmental bronchi, but not for fissures and subsegmental bronchi. Concerning motion artifacts, MDCT step-and-shoot and MDCT helical were significantly better than or equal to SSCT step-and-shoot. Conclusion: The image quality (accounting for motion artifacts and visibility) of SSCT step-and-shoot and MDCT step-and-shoot is comparable. The visibility of anatomic structures in images from MDCT helical is inferior to HRCT step-and-shoot.

Aim: To compare the frequency of adverse events after cardioangiography with iohexol and iodixanol in an unselected patient population with special regard to previously defined “risk patients”: age≥65 years, severe coronary artery disease, unstable angina pectoris and left ventricular dysfunction. Methods: A total of 1020 patients referred to cardioangiography were included in this open, prospective cross-sectional study, comparing iodixanol (320 mgI/ml) and iohexol (350 mgI/ml). Adverse events were recorded and the patients answered a questionnaire. Results: Cardiac adverse events (CAE) i.e., angina pectoris, arrhythmia and dyspnea within 24 h of examination were reported by 9% of patients receiving iohexol and by 7% receiving iodixanol. Two cases of ventricular fibrillation occurred, both after iohexol. The proportion of CAE was 11% for patients≥65 years receiving iohexol and 7% in younger patients. For patients receiving iodixanol the proportion was 7%, in both age groups. Patients with severe coronary disease had more CAE than less ill patients in both CM groups. The proportion of unstable patients with CAE was 18% in the iohexol group and 12% in the iodixanol group. Left ventricular dysfunction was not related to CAE. Conclusions: Iodixanol could be advantageous in patients with unstable angina.

Purpose: The non-ionic dimeric contrast medium (CM) iodixanol is isotonic with blood through the addition of electrolytes. In this study, we evaluated computerised dynamic vectorcardiography (VCG) as a tool in CM research by comparing the electrophysiological effects of iodixanol with those of the low-osmolar CM iohexol. Material and Methods: A total of 119 patients referred for cardioangiography were included in this double-blind, randomised, parallel comparison of iodixanol (320 mg I/ml) and iohexol (350 mg I/ml). VCG was recorded and different VCG parameters were analysed. General tolerability, safety and radiographic efficacy were also assessed. Results: Iodixanol induced less changes than iohexol in all VCG parameters and the sensation of warmth was significantly milder after iodixanol, but both CM were well tolerated. VCG might be useful in future studies to analyse electrophysiological effects caused by CM.

AIM:To compare the electrophysiological effects of two contrast media (CM), the non-ionic dimer iodixanol and the ionic dimer ioxaglate using computerised dynamic vectorcardiography (VCG) during coronary angiography.METHODS:The study was designed as a double-blind, three-period crossover, randomised comparison between iodixanol (320 mg I/ml) and ioxaglate (320 mg I/ml). Group 1 (HVV) received ioxaglate (H) in the first injection in the left coronary artery (LCA) and iodixanol (V) in the following injections. Group 2 (VHH) received iodixanol in the first injection in LCA and ioxaglate in the following injections. The first three injections in the LCA were subjected to electrocardiographic analysis.RESULTS:For five out of six VCG variables, there was a significant difference in response between iodixanol and ioxaglate. For these five variables, the deviations from baseline were greater in the ioxaglate than in the iodixanol group (P<0.05). The most pronounced effects from ioxaglate were seen on the ST-segment and T-wave.CONCLUSIONS:Iodixanol caused less pronounced electrophysiological changes than ioxaglate, especially during the repolarisation phase. Vectorcardiography is a sensitive and reproducible technique for detecting electrophysiological effects induced by CM.

The addition of sodium to nonionic contrast media has reduced the incidence of arrhythmias in animal models. The influence on cardiac function and safety of sodium addition to the nonionic contrast medium iohexol (Omnipaque) was studied in a randomized, double-blind trial in patients undergoing cardioangiography. Fifty-nine patients received iohexol 350 mg I/ml with NaCl 28 mmol/l and 58, iohexol only. ECG changes after contrast injections were evaluated with continuous computerized dynamic vectorcardiography (VCG). QRS-vector difference (QRS-vd), which reflects changes in the QRS-complex, was chosen as the main parameter. Both contrast media caused changes in the QRS-complex, but there was no significant difference between the two. No serious arrhythmias were observed. Both contrast media were well tolerated. No beneficial effects from enriching iohexol with sodium were found. VCG was found to be a valuable tool in the study of contrast medium-induced ECG changes.