Background: Despite significant advancements in healthcare in the United Arab Emirates (UAE), limited research has explored the motivational factors influencing UAE radiography students’ choice of this field. Materials and Methods: Institutional using a cross-sectional survey, to explore motivational factors influencing career decisions among UAE radiography students. It was conducted in 2023 and involved 100 students from four universities across the UAE. Nonprobability sampling, including convenience and snowball methods, was used. Data were collected through an online questionnaire validated through expert reviews and pilot testing. The analysis involved descriptive and inferential statistics using SPSS software to assess demographic characteristics and career motivation factors. Results: The findings of this study demonstrate that the primary reason for choosing diagnostic radiography as a profession was primarily due to their interest in medical imaging technology (47%). Additional motivations included job availability (18%), personal interest, and high-income potential (14%). Most participants (40%) expressed satisfaction with their career choice and an interest in further education. Further training in ultrasound or nuclear medicine was desired by 17%, and both magnetic resonance imaging (MRI) and computed tomography (CT) by 23%. Conclusion: The appeal of diagnostic radiography arises from a combination of interest in advanced imaging technologies, such as MRI and CT, alongside promising career prospects and opportunities for specialization. Targeted early career guidance and well-structured educational and policy interventions are essential to attract and retain skilled professionals. These measures are critical for sustaining the UAE’s healthcare sector’s growth and provide a replicable model for advancing diagnostic radiography in other regions.

Introduction To compare thoracic vasculature opacification between the direct-drive and the peristaltic drive contrast injection systems and the effect on quantitative and qualitative image quality during computed tomography. Method A retrospective chart review of 88 patients who underwent chest computed tomography (CT) following a direct-drive injector before 2016 (Group A) or a peristaltic injector after 2016 (Group B). Both protocols employed 80mL of iodinated contrast media volume. Quantitative measurements of the thoracic vascular opacification, contrast-to-noise ratio (CNR), effective radiation dose, and arterial venous contrast ratio (AVCR) for each vessel were computed and compared. The measured values of vascular opacification, CNR, and dose length product (DLP) were assessed utilizing paired t-test and Pearson's correlation. Receiver operating characteristic (ROC), visual grading characteristics (VGC), and Cohen's kappa methodology were measured. Results There was no significant difference in the mean opacification of the chest vasculature (p > 0.05). The CNR in Group B was significantly lower than in Group A (p < 0.05) except for the brachiocephalic artery, proximal descending aorta, and the right pulmonary artery. Arterial venous contrast ratio at all anatomic levels demonstrated no statistical significance between groups. There were no differences in ROC, VGC, or kappa values between groups. Conclusion When comparing two contrast media injection systems in chest CT, there was no qualitative difference in image quality or pathology detection. However, quantitatively, direct-drive injectors provided higher CNR. Direct-drive contrast injectors also provided a superior quantitative image quality of chest vasculature compared to peristaltic injectors.

Radiographers play a crucial role in ensuring the safe and effective delivery of iodinated contrast media in pediatric CT imaging. However, practice variability across institutions, such as differences in contrast medium dosing protocols, injection techniques, and timing of image acquisition, raises concerns about consistency, patient safety, and diagnostic quality. To examine the range of real-world practices in pediatric iodinated contrast medium administration, focusing on protocol adherence and variations in technique. An international cross-sectional survey was conducted among 103 CT radiographers. The online questionnaire assessed demographic data, clinical practices, protocol modification behaviors, and institutional procedures. Data were collected over 9 weeks and analyzed using descriptive and comparative statistics to identify trends and practice variability. The findings revealed considerable variability in iodinated contrast medium administration practices, including differences in injection rates, contrast volumes, catheter gauge selection, and use of saline flush techniques. Although 93.2

BACKGROUND: To reduce radiation dose and subsequent risks, several legislative documents in different countries describe the need for Diagnostic Reference Levels (DRLs). Spinal radiography is a common and high-dose examination. Therefore, the aim of this work was to establish the DRL for Computed Tomography (CT) examinations of the spine in healthcare institutions across Jordan. METHODS: Data was retrieved from the picture archiving and communications system (PACS), which included the CT Dose Index (CTDI(vol)) and Dose Length Product (DLP). The median radiation dose values of the dosimetric indices were calculated for each site. DRL values were defined as the 75th percentile distribution of the median CTDI( vol) and DLP values. RESULTS: Data was collected from 659 CT examinations (316 cervical spine and 343 lumbar-sacral spine). Of the participants, 68% were males, and the patients' mean weight was 69.7 kg (minimum = 60; maximum = 80, SD = 8.9). The 75th percentile for the DLP of cervical and LS-spine CT scans in Jordan were 565.2 and 967.7 mGy.cm, respectively. CONCLUSIONS: This research demonstrates a wide range of variability in CTDI( vol) and DLP values for spinal CT examinations; these variations were associated with the acquisition protocol and highlight the need to optimize radiation dose in spinal CT examinations.

INTRODUCTION:Previous research has delved into the attitudes and behaviors of diverse professions regarding environmental sustainability. However, there needs to be more research specifically targeting radiographers. This study aims to survey radiographers' perceptions, practices, and barriers to change concerning environmental sustainability in radiology. METHODS:Institutional ethical approval was obtained (IRB-COHS-FAC-110-2024) and data collection was conducted using Google Forms (Google Inc., Mountain View, CA). The survey targeted 104 practicing radiographers across several countries. Questions were structured around five domains to gather insights into demographics, training in global warming and climate change, perceptions of sustainability and climate change, sustainability barriers, and current radiology practices on sustainability. Data analysis utilized descriptive and d inferential statistics. RESULTS:One hundred and four radiographers completed the study. Females had a significantly higher attendance rate in environmental protection campaigns (P = 0.01). The majority of respondents (68%) believe in climate change's knowledge and impact on the natural world. Our survey findings demonstrate that 74% of respondents believe there's a need to improve sustainability practices. The most commonly used strategies to decrease energy consumption and emissions were low-energy lighting (60%), real-time power monitoring tools (41%), and energy-efficient heating systems (32%). A significant concern regarding sustainability emerges among respondents: time (50%) and lack of leadership (48%) are prevalent concerns among the identified barriers. CONCLUSION:Participants are recognising the importance of environmental sustainability in radiology, but lack of leadership, support, authority, and facility limitations hinder their adoption. IMPACT ON PRACTICE:Radiology must prioritize environmental sustainability by providing resources and training for radiographers and collaborating with healthcare professionals, policymakers, and environmental experts to develop comprehensive strategies for a sustainable healthcare system.

Background. Artificial intelligence (AI) applications are rapidly advancing in the field of medical imaging. This study is aimed at investigating the perception and knowledge of radiographers towards artificial intelligence. Methods. An online survey employing Google Forms consisting of 20 questions regarding the radiographers’ perception of AI. The questionnaire was divided into two parts. The first part consisted of demographic information as well as whether the participants think AI should be part of medical training, their previous knowledge of the technologies used in AI, and whether they prefer to receive training on AI. The second part of the questionnaire consisted of two fields. The first one consisted of 16 questions regarding radiographers’ perception of AI applications in radiology. Descriptive analysis and logistic regression analysis were used to evaluate the effect of gender on the items of the questionnaire. Results. Familiarity with AI was low, with only 52 out of 100 respondents (52%) reporting good familiarity with AI. Many participants considered AI useful in the medical field (74%). The findings of the study demonstrate that nearly most of the participants (98%) believed that AI should be integrated into university education, with 87% of the respondents preferring to receive training on AI, with some already having prior knowledge of AI used in technologies. The logistic regression analysis indicated a significant association between male gender and experience within the range of 23-27 years with the degree of familiarity with AI technology, exhibiting respective odds ratios of 1.89 (COR=1.89) and 1.87 (COR=1.87). Conclusions. This study suggests that medical practices have a favorable attitude towards AI in the radiology field. Most participants surveyed believed that AI should be part of radiography education. AI training programs for undergraduate and postgraduate radiographers may be necessary to prepare them for AI tools in radiology development.

BackgroundThe effect of gadolinium-based contrast agents (GBCA) on the spinal cord is not established, especially in patients with diabetes mellitus.PurposeTo investigate neuronal and myelin loss in the spinal cord when employing macrocyclic ionic Gadoterate Meglumine (Gd-DOTA) and non-ionic Gadobuterol (Gd-BT-DO3A) GBCA in rats with and without diabetes mellitus.Materials and methodsThis study was performed between November 2018 and February 2020. Sixty young Sprague Dawley white rats (n = 6/group) were given injections of two macrocyclic GBCA: 0.5 mmol/ml Gd-DOTA and 1 mmol/ml Gd-BT-DO3A, using volumes based of the recommended doses (0.1 ml and 0.2 ml) for 42 days in both healthy and diabetic rats. Control groups received saline injections. Morphological assessment of spinal cord tissues was performed on three spinal segments. Neuronal counts in the ventral horns and myelin sparing percentage in the white matter were determined and compared in each group employing one-way ANOVA and Dunnett test for each category followed by three-way factorial analysis.ResultsLow neuronal count and myelin percentage-area were obtained in groups receiving 0.2 ml Gd-DOTA (p = .001;p = .002;p < .001 neurons; and p < .001;p = .007;p = .001 myelin %) and Gd-BT-DO3A (p = .01;p = .048;p = .006 neurons; p < .001;p = .01;p = .001 myelin %). Similarly, neuronal loss was seen in diabetics receiving low volume-injection (0.1 ml) of Gd-DOTA (p = .04;p = .03;p = .42), Gd-BT-DO3A (p = .002;p = .007;p = .01); or high volume-injection (0.2 ml) of Gd-DOTA (p = .001;p = .003;p = .01) or Gd-BT-DO3A (p < .001,p = .002;p = .002), with associated decrease in myelin sparing for each category with low dose Gd-DOTA (p < .001, p = .001; p. = 09),Gd-BT-DO3A (p = .003;p = .003;p = .007); or the higher dose counterparts of Gd-DOTA (p < .001; p < .00; p = .001) and Gd-BT-DO3A (p < .001, p < .001, p < .001).Damage was observed using the standard dose (equivalent of 0.1 mmol/kg for rats) of Gd-DOTA (0.2 ml) but not that of Gd-BT-DO3A (0.1 ml) in healthy rats.ConclusionMultiple high-volume injections of gadoterate meglumine and gadobuterol are associated with neuronal and myelin injury in the spinal cord, more so in rats with diabetes mellitus.

Introduction Increased breast density (BD) is significantly correlated to higher rates of breast cancer (BC), yet awareness among women remains low. This study assesses women's understanding of BD, its implications for cancer risk, and their engagement in screening practices. Methods A cross-sectional survey of 212 women aged 40 to 74 was conducted using an online questionnaire developed within Google Forms, including open and closed-ended questions. Demographic information was collected, followed by BC awareness and BD knowledge questions. Data were analyzed using IBM SPSS software, with categorical data reported as numbers and percentages, and Chi-square tests employed to explore associations between variables. Results Of the 212 participants, those with healthcare involvement were significantly more likely to recognize BD as a BC risk factor, with 25.0 % acknowledging its impact compared to 16.8 % of non-professionals (χ2 = 9.520, p = 0.009). Formal training was associated with increased engagement in breast self-examinations (BSE), with 58.6 % of trained individuals practicing BSE versus 30.1 % without training (χ2 = 9.108, p = 0.003). Conclusion Findings underscore the need for targeted educational initiatives to improve BD awareness among women in the general public, empowering them to identify as at-risk and to participate in screening programs. Impact on practice This study emphasizes integrating BD awareness into clinical practice. Healthcare providers are encouraged to implement educational strategies that inform women of BD, its associated risks, and the value of regular screening. Enhancing self-awareness among patients may facilitate earlier detection, ultimately improving BC outcomes and public health efforts.

Introduction Perceptions of environmental sustainability among radiographers can potentially be influenced by individual experiences and educational backgrounds. This study aims to investigate the perceptions and practices of radiographers regarding sustainability initiatives, emphasizing the significance of understanding their diverse experiences and backgrounds. Methods This was an online survey involving 104 radiographers from various regions worldwide to evaluate their training related to global warming, their perceptions of sustainability, current practices, and the barriers they face in implementing sustainability practices. Results Participants' knowledge regarding sustainability was significantly influenced by their social networks, including friends and family (χ2 = 12.505, p = 0.004). Notable correlations were observed between years' of experience and the belief in pollution's contribution to climate change (χ2 = 8.096,p = 0.038), as well as the perception of human activities as the primary cause of climate change (χ2 = 22.68,p = 0.011). Furthermore, involvement in environmental protection initiatives (χ2 = 19.268, p = 0.033) and the perception of local climate impacts (χ2 = 22.478, p = 0.012) were positively correlated with experience. In the field of radiography, the adoption of energy-efficient practices (χ2 = 10.482, p = 0.011) and the recycling of imaging waste (χ2 = 25.778, p = 0.004) were significantly associated with levels of experience. Lastly, the barrier identified as “Lack of Authority to make change” also exhibited a significant relationship with years of experience (χ2 = 9.449, p = 0.022). Conclusion This study indicates that staff experiences play a significant factor influencing sustainability engagement among radiographers. Barriers identified include financial constraints, insufficient leadership, safety concerns, and inadequate training. Impact on practice The current study highlights the essential requirement for customized strategies based on radiographers' experiences to improve sustainable practices in radiography. It acknowledges the impact of organizational barriers and suggests that progress toward a more sustainable future can be achieved through individual empowerment and collaboration within the healthcare sector.

BACKGROUND:Despite the escalated production rate, the Iodinated Contrast Media (ICM) shortage continues, and demand outweighs supply. AIM:The aim of this study is to investigate the knowledge and practice of ICM delivery in computed tomography (CT) among radiographers and radiologic technologists worldwide. METHODS:An IRB-approved cross-sectional survey used Google Forms for data collection. It involved 94 CT radiographers from 27 countries and was divided into five sections. The first section gathered demographic information, followed by sections on experience, self-assessment of ICM reactions, and delivery technique. The third section explored ICM knowledge and its relation to CT parameters. The fourth and fifth sections focus on practices during pulmonary angiography CT and renal CT scans. Data analysis involved descriptive statistics, the Chi- Square test, and ANOVA. RESULTS:Knowledge was assessed with seven questions, and a score of at least 3.5 was needed for categorization. The median score was two, indicating low knowledge. Specifically, 64.9% of the participants scored lower than the two scores. Years of experience are strongly correlated with the level of knowledge, with 51.6% of radiographers having more than 10 years of experience demonstrating adequate knowledge. 41.7% of respondents demonstrated adequate knowledge when their duty was focused on CT. Furthermore, wide practice variability exists in all CT pulmonary angiography protocols among radiographers with adequate and inadequate knowledge. CONCLUSION:Inexperienced individuals showed knowledge gaps, leading to varied practices and highlighting the need for educational programs. The study underscores establishing standardized Protocols and Practice Guidelines (PPGs) for contrast media administration in Radiology Departments. Additionally, it emphasizes the importance of regular training programs, and international knowledge sharing. The potential for self-selection bias in the online survey sample is highlighted.

Background Increased radiation doses from computed tomography (CT) examinations is well known with proven risks of inducing cancers for effective dose >100 mSv (according to some studies >50 mSvs). Purpose To establish the diagnostic reference level (DRL) for low-dose renal CT examinations in the evaluation of renal stones. Material and Methods Patient demographics, CT parameters, and dosimetric indices (CTDIvol and dose length product [DLP]) were collected from 12 tertiary hospitals that routinely perform renal CT in the detection and evaluation of renal stones over a period of 12 weeks. Data obtained from 1418 average-sized patients in each category were recorded. The median values of dosimetric indices for each site were calculated. The DRL values were defined as the 75th percentile of the distribution of the median values of CTDIvol and DLP. Results There were no significant differences between patient demographics. Mean kVp and mAs for protocols were 121.67 ± 11.56 and 226.91 ± 78.44, respectively. The CTDIvol values were in the range of 2–36.2 mGy, while the DLP values were in the range of 43–1942 mGy.cm. The DRL for the CTDIvol was 16.15 mGy and for the DLP 851.77 mGy.cm. The local median values of CDTIvol and DLP are higher than DRL in two hospitals. Conclusion Comparison of local median values of CDTIvol and DLP with DRL suggests the needs of an optimization strategy in some hospitals.

Objective To evaluate the performance of two versions of ChatGPT, GPT4 and GPT3.5, on the Final FRCR (Part A) also referred to as FRCR Part 2A radiology exam. The primary objective is to assess whether these large language models (LLMs) can effectively answer radiology test questions while providing accurate explanations for the answers.Methods The evaluation involves a total of 281 multiple choice questions, combining the 41 FRCR sample questions found on The Royal Collage of Radiologists website and 240 questions from a supplementary test bank. Both GPT4 and GPT3.5 were given the 281 questions with the answer choices, and their responses were assessed for correctness and accuracy of the explanations provided. The 41 FRCR sample questions difficulty was ranked into “low order” and “high order” questions. A significance level of p<0.05 was used.Results GPT4 demonstrated significant improvement over GPT3.5 in answering the 281 questions, achieving 76.5% correct answers compared to 52.7%, respectively (p<0.001). GPT4 demonstrated significant improvement over GPT3.5 in providing accurate explanations for the 41 FRCR sample questions, with an accuracy of 65.9% and 31.7% respectively (p=0.002). The difficulty of the question did not significantly affect the models’ performances.Conclusion The findings of this study demonstrate a significant improvement in the performance of GPT4 compared to GPT3.5 on FRCR style examination. However, the accuracy of the provided explanations might limit the models’ reliability as learning tools.Advances in Knowledge The study indirectly explores the potential of LLMs to contribute to the diagnostic accuracy and efficiency of medical imaging while raising questions about the current LLMs limitations in providing reliable explanations for radiology related questions hindering its uses for learning and in clinical practice.Highlights ### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis study did not receive any funding### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors* FRCR : Fellowship of Royal College of Radiologists RCR : Royal College of Radiologists LMLs : Large Language Models ChatGPT : Chat Generative Pre-trained Transformer AI : Artificial Intelligence LSAT : Law School Admission Test USMLE : United States Medical License Examination PGY : Post Graduate Year

Background: Although paediatrics' are more radio-sensitivity than adults, the number of requested paediatric CT examinations is increasing globally. Significant efforts have been focused on achieving the lowest possible radiation dose for paediatric patients, particularly adjusting for size differences. This study aims to establish Diagnostic Reference Levels (DRLs) for paediatric patients based on size-specific dose estimates (SSDE).Method: In this retrospective national study, CT scans for brain, chest, abdominopelvic, and chest, abdomen, and pelvis (CAP) were collected from four hospitals in Jordan undergoing paediatric CT scans. A total of 1818 cases were randomly selected in four age categories (<1 year, 1-4 years, 5-10 years, 11-18 years). The SSDE values were determined by multiplying the volume CT dose index (CTDIvol) with the conversion factor extracted from the American Association of Physicists in Medicine Report 204.Results: Variations exist between the DRLs between the different hospitals, age groups, and variations in protocols with different types of CT scanners. The DRL values (CTDIvol, dose-length product (DLP) and SSDE) for the four age categories were as follows; <1 year: brain (47.88 mGy, 741.67 mGy cm and 58.40 mGy), chest (5.65 mGy, 124 mGy cm and 13.91 mGy), abdominopelvic (12.65 mGy, 321.5 mGy cm and 28.72 mGy) and CAP (16.12 mGy, 507.72 mGy cm and 38.04 mGy). 1-4 years, brain (54.79 mGy, 979.12 mGy cm and 55.88 mGy), chest (7.37 mGy, 220.85 mGy cm and 14.68 mGy), abdominopelvic (16.16 mGy, 424.72 mGy cm and 32.68 mGy) and CAP (16.13 mGy, 742.1 mGy cm and 33.54 mGy). 5-10 years: brain (65.03 mGy, 1129.94 mGy cm and 55.92 mGy), chest (12.57 mGy, 383.9 mGy cm and 22.45 mGy), abdominopelvic (12.34 mGy, 450.75 mGy cm and 22.23 mGy) and CAP (13.46 mGy, 748.85 mGy cm and 25.69 mGy). 11-18 years, brain (60.7 mGy, 1207.9 mGy cm and 41.81 mGy), chest examination (12.94 mGy, 496.2 mGy cm and 20.49 mGy), abdominopelvic (16.13 mGy, 803.07 mGy cm and 23.06 mGy) and CAP (16.13 mGy, 1101.5 mGy cm and 23.85 mGy).Conclusion: There were increases in CTDIvol, DLP, and SSDE with ascending age groups. SSDE and age are closely matched to delivered radiation in paediatric CT; however, radiation dose levels remain high in Jordan. This work highlights the need for caution when administering radiation in the paediatric population.

Introduction: To reduce the dose and subsequent risks, the need for Diagnostic Reference Levels (DRLs) is described in several legislative documents in different countries. Therefore, the aim currently is to establish the DRL for Computed Tomography (CT) examinations of the spine in healthcare institutions across Jordan.Methods: A retrospective study of nine hospitals and medical centers across Jordan was approved by an Institutional Review Board (IRB). Data was retrieved from the picture archiving, and communications system that included CT Dose Index (CTDI(vol)) and Dose Length Product (DLP). DRL values were defined as the 75th percentile distribution of the median values of CTDI(vol) and DLP. In addition, international DRL was compared to the current national DRL level established in the current work.Results: Data was collected from 659 (316 cervical spine (C-spine) and 343 lumbar-sacral (LS)-spine) CT examinations. Of participants, 68%were males, and the mean weight of the patients was 69.78 kg (minimum = 60; maximum = 80, SD = 8.93). The 75th percentile for the DLP of cervical and LS-spine CT scans in Jordan were 565.15 and 967.74 mGy.cm, respectively. When benchmarked with six international countries, Jordan demonstrated high radiation levels for cervical and lumbar CT examination. Causal factors included variations in the mAs, the number of slices, and tube potential.Conclusions: This research demonstrates a wide range of variability in CTDI(vol) and DLP values for spinal CT examinations; these variations were associated with the acquisition protocol and highlight the need to optimize radiation dose.

Abstract There has been an amplified focus on and benefit from the adoption of artificial intelligence (AI) in medical imaging applications. However, deep learning approaches involve training with massive amounts of annotated data in order to guarantee generalization and achieve high accuracies. Gathering and annotating large sets of training images require expertise which is both expensive and time-consuming, especially in the medical field. Furthermore, in health care systems where mistakes can have catastrophic consequences, there is a general mistrust in the black-box aspect of AI models. In this work, we focus on improving the performance of medical imaging applications when limited data is available while focusing on the interpretability aspect of the proposed AI model. This is achieved by employing a novel transfer learning framework, progressive transfer learning, an automated annotation technique and a correlation analysis experiment on the learned representations. Progressive transfer learning helps jump-start the training of deep neural networks while improving the performance by gradually transferring knowledge from two source tasks into the target task. It is empirically tested on the wrist fracture detection application by first training a general radiology network RadiNet and using its weights to initialize RadiNetwrist, that is trained on wrist images to detect fractures. Experiments show that RadiNetwrist achieves an accuracy of 87% and an AUC ROC of 94% as opposed to 83% and 92% when it is pre-trained on the ImageNet dataset. This improvement in performance is investigated within an explainable AI framework. More concretely, the learned deep representations of RadiNetwrist are compared to those learned by the baseline model by conducting a correlation analysis experiment. The results show that, when transfer learning is gradually applied, some features are learned earlier in the network. Moreover, the deep layers in the progressive transfer learning framework are shown to encode features that are not encountered when traditional transfer learning techniques are applied. In addition to the empirical results, a clinical study is conducted and the performance of RadiNetwrist is compared to that of an expert radiologist. We found that RadiNetwrist exhibited similar performance to that of radiologists with more than 20 years of experience. This motivates follow-up research to train on more data to feasibly surpass radiologists’ performance, and investigate the interpretability of AI models in the healthcare domain where the decision-making process needs to be credible and transparent.

Abstract Purpose: To compare the quantitative and qualitative image quality of hybrid (HBIR) and model based (MBIR) iterative reconstruction during coronary Computed Tomography Angiography (CTA). Materials and Methods: Institutional review board approved this retrospective study. Patients (n=200) underwent a single coronary CTA with two iterative reconstruction techniques. Group A employed HBIR and group B employed MBIR. Quantitative and qualitative image quality was compared for each group. The mean attenuation values and signal-to-noise ratio (SNR) of each group were compared. Visual grading characteristics (VGC) and Cohen’s Kappa methodology were measured employing an image quality scoring system for coronary CTA. Receiver operating (JAFROC) and stenosis severity were compared with conventional coronary angiography. A p-value <0.05 was considered statistically significant. Results: Mean attenuation values (HU) in the HBIR group were significantly greater in the cusp (564.18±118.71) and left coronary (517.59±118.63) whilst in the MBIR group, the right coronary (531.67±138.93), left anterior descending (529.82±120.6) and left circumflex (538.32±132.94) arteries were significantly higher (p<0.001). The SNR was significantly greater in MBIR (5.32±1.1) compared to HBIR (3.64±0.8) (p<0.0001), with MBIR being superior to HBIR in the total and individual segments of the coronary arteries. VGC image quality assessment demonstrated that readers preferred HBIR over MBIR (p<0.001). Analysis of JAFROC data demonstrated a significant difference in detection of coronary stenosis in RCA (p<0.021), LCA (p<0.0001) and LD (p<0.0001) with HBIR showing overall smaller variability range compared to MBIR. Conclusion: When comparing quantitative and qualitative image quality, MBIR was superior in the former, whilst HBIR was superior in the later. Coronary artery stenosis assessment demonstrated less variability in diagnosis when using HBIR compared to MBIR. This highlights the need for careful attention when employing iterative reconstruction in order not to impact clinical outcomes.

Meigs syndrome is a rare disorder characterized by a triad of benign ovarian tumor, ascites, and pleural effusion. Despite its benign nature, its presentation can be similar to metastatic malignancy, making preoperative diagnosis often challenging. The differential diagnosis includes serious and even lifethreatening conditions. Meigs syndrome is most common in postmenopausal women and is extremely rare in children. It is often undiagnosed until an invasive surgery is performed. The fact that surgery includes a unilateral salpingo-oophorectomy in females of reproductive age raises concerns for future fertility and other risks associated with this intervention. Familiarity of radiologists and pediatric surgeons with clinical and imaging findings is beneficial to improve preoperative planning, thereby minimizing invasive surgery and preserving ovarian tissue.

Lebanon has one of the highest number of computed tomography (CT) scanners per capita in the world which could likely be one of the causative factors of its high cancer incidence. In this study, we aimed to establish a national diagnostic reference level (NDRL) in adult CT examinations of the head and body in Lebanon. Dose Length Product (DLP) (n = 2730) were recorded in 91 hospitals/centers in Lebanon for head, chest, and abdomen-pelvis CT. Data was obtained from adult patients (>= 18 years) with a weight range of 75-80 kg, from January 2018 until December 2019. Then, the median, mean and 75th percentile of the DLP was calculated for each anatomical region. NDRL was reported as the 75th percentile. Then, the established NDRL was bench-marked with international countries as the USA, UK, and Australia. In our study, data were collected from im-aging departments (n = 91), with a response rate of 65% of the national total. All CT scanners ranged from 1 to 256 slices. The 75th percentile for the DLP of the head, chest, and abdomen-pelvis CT scan in Lebanon was 1426, 646, and 967 mGy cm respectively. A significant difference in mean DLP of the chest and abdomen-pelvis CT in different governorates was noted with north Lebanon having the highest levels (604 and 882 mGy cm respec-tively) (p < 0.05). When benchmarked with 18 different countries, Lebanon ranked 2nd, 3rd, and 4th highest in 75th percentile DLP for head, chest, and abdomen-pelvis CT scans respectively. In conclusion, the established Lebanese NDRL for adult routine CT scans of head, chest, and abdomen-pelvis were significantly higher than the reported international radiation dose thresholds. This demonstrates a great scope for radiation dose reduction and the need for urgent intervention of DRL to optimize CT scanning procedures and protocols in Lebanon.

PURPOSE To investigate the use of weight-based protocols during full- and half-body fluorodeoxyglucose F 18 (FDG) positron emission tomography-computed tomography (PET-CT) and their effect on image quality, radiation dose, and lifetime attributable risks. METHODS A total of 1817 patients were referred for FDG PET-CT studies. Each scanning group (4 total: full-body groups A and C and half-body groups B and D) was randomly allotted into conventional or weight-based CT. Groups A and B followed a conventional protocol of 120 kVp, 120 mA, 0.5 second rotation time, and pitch 0.8 mm/rotation for all body weights. Groups C and D were scanned using 1 of 4 weight-based CT protocols. All 4 weight-based protocols used 140 kVp, 0.75 seconds rotation time, and pitch 0.8 mm/rotation. Milliamperage varied by body weight as follows: protocol I (≤ 60kg [132.3 lb]), 35 mA; protocol II (61-80 kg [134.5-176.4 lb]), 50 mA; protocol III (81-100 kg [178.6-220.5 lb]), 65 mA; and protocol IV (> 100kg [222.7 lb]), 100 mA. All protocols (weight based and conventional) employed tube current modulation. CT quantitative image quality measurements were evaluated for each protocol, and lifetime attributable risks were calculated for each age group and sex. RESULTS Patient demographics demonstrated no significant differences between groups. Mean effective dose was significantly lower for group C (full body, weight based) compared with A (full body, conventional) (P < .001), as were lifetime attributable risks (P < .001). Mean effective dose and lifetime attributable risks also were significantly lower (P < .001) for group D (half body, weight based) compared with B (half body, conventional). Contrast-to-noise ratios showed no difference between groups (P = .12), supporting a preference for the weigh-based protocols used for groups C and D. For half-body, weight-based protocols (group D), the lifetime attributable risks decreased for men by 91.9% and for women by 38.9%. For full-body, weight-based protocols (group C), the lifetime attributable risks decreased by 72.5% and 66.3% for men and women, respectively. DISCUSSION Radiologists and radiologic technologists face the challenge of balancing the potential risks of radiation-induced cancer against providing diagnostic-quality images and uncompromised disease detection. Weight-based protocols address this challenge without compromising image quality or pathology detection. CONCLUSION Significant reductions in radiation dose and lifetime attributable risks can be achieved using CT weight-based protocols during half- and whole-body FDG PET-CT without compromising CT image quality.

Introduction: This study aims to investigate the association between epi- and pericardial adipose tissue deposits around the heart against patient body habitus when using cardiac computed tomography (CT). Methods: Ninety-two consecutive patients with suspected coronary artery disease underwent coronary CT angiography with quantitative cardiac and adipose tissue volume measurements. Body mass index (BMI), body surface area (BSA), thoracic circumference, anteroposterior diameter, cardiac and adipose tissue volumes were compared between genders by employing Pearson's correlation and results were considered statistically significant if p <= 0.05. Results: Statistically significant differences between genders were observed with males having a greater height (males 1.72 +/- 0.11), BMI (30.76 +/- 7.87 kg/m(2)), BSA (2.06 +/- 0.21 m(2)), thoracic circumference (1022.12 +/- 97.90 mm(2)), and pericardial adipose tissue volume (46.72 +/- 36.62 mm(3)) (p < 0.05). For men, for Group 1 (BMI <= 27) each of the measured volumes showed moderate correlation between pericardial adipose tissue and AP chest-diameter (r = 0.429, p < 0.05), whereas in Group 2 (27 < BMI <= 31.1), coronary artery volume had a strong association with the AP chest-diameter (r = 0.453, p < 0.05). Conclusion: BMI and thoracic circumference are closely related to variable epi- and pericardial adipose tissue volumes in both males and females during cardiac CT. Implications for practice: Quantification of epi- and pericardial adipose tissue deposits between males and females during cardiac CT may help further categorise coronary artery disease risk when including BMI and thoracic circumference for males and females. (C) 2021 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.