Multiple myeloma
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
MRI is used routinely in many centres because of its high sensitivity, its ability to directly visualize bone marrow, and the absence of radiation (57). In patients with suspected cord compression, MRI is the examination of choice (40) (Figure 26.4) However, it has several disadvantages such as relatively high cost and long scan time (up to 60 minutes), which poses difficulties for patients who are unable to lie still (58). It may not be possible in patients with claustrophobia and metallic implants (59). Administration of intravenous contrast should be avoided in patients with renal impairment because of the risk of nephrogenic systemic fibrosis (60). Comparison with CT indicates that MRI outperforms CT, a recent systematic review yielding a pooled sensitivity of 91% and pooled specificity of 41% (61). It is useful for confirming a diagnosis of solitary plasmacytoma by excluding additional disease, for detecting deposits in symptomatic patients whose skeletal surveys are normal, for assessing disease burden in patients diagnosed with non-secretory or oligosecretory myeloma and for evaluation of extramedullary disease.
Cardiovascular system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
With cardiac gating and advanced imaging protocols, very high quality information can be obtained in a study usually lasting less than 30 minutes, though up to 60 minutes may be required for more complex investigations. Image quality may be reduced by obesity, or patient inability to repeatedly breath-hold for 5–10 seconds. Arrhythmia can be managed by pharmacological control and software programmes to overcome the effect, but highly irregular rhythms may still be problematical. Many cardiac patients have a pacemaker, which has been considered an absolute contraindication to MRI; however, many newer devices may allow access to MRI scanners. Claustrophobia may be difficult to control, but most patients can be persuaded to cope, possibly with the aid of sedation. Patients with impaired renal function may be unsuitable due to the risk of nephrogenic systemic fibrosis in reaction to IV gadolinium contrast agents.
Clinical Practice Principles
Mike Kirby, Kerrie-Anne Calder in On-treatment Verification Imaging, 2019
Stereotactic radiosurgery is the treatment of small intracranial tumours with a high dose and steep dose gradient to minimise treatment to surrounding healthy tissue (Alexander et al 1995). The treatment usually entails a single, high-dose fraction with very small planning and imaging margins. For these reasons, immobilisation is crucial and often involves a fixed frame attached to the patient's skull, or a comprehensive mask and imaging system. The use of surface-tracking for these patients has been investigated with a view to move away from the fixed-frame system allowing a noninvasive procedure for the patient, whilst other studies have investigated the use of an “open” mask system (Pan et al 2012, Li et al 2011, Wiant et al 2016). The use of the open-mask system has been evaluated well by patients in terms of anxiety and claustrophobia experienced during treatment (Wiant et al 2016). The improved patient experience alongside the possible reduction in radiation dose from imaging would show preference for this surface-tracking technique for position verification.
Effects of cloth face masks on physical and cognitive performance during maximal exercise testing
Published in Baylor University Medical Center Proceedings, 2023
Simon Driver, Katelyn D. Brown, Taylor Gilliland, Megan Reynolds, Monica Bennett, Evan McShan, Chol Ho J. Kim, Eric Freese, Patrick Belling, Robert L. Gottlieb, Alan Jones
Participants were recruited from March to July 2021 using a snowball sampling technique through a large healthcare system, sports performance program, and an academic university in the US via fliers, calls, emails, and social media posts. Eligibility was assessed through a self-report screening tool by a trained research coordinator prior to consent. Individuals aged 18 to 39 years were included based on normative data for peak VO2.11 Individuals were excluded if they reported (a) current orthopedic, neurologic, or other limitations that prevented safe exercise testing; (b) cardiopulmonary disease; (c) conditions for which a healthcare provider has discouraged high-intensity exercise; (d) metabolic disease; (e) uncontrolled asthma; (f) claustrophobia; (g) current incarceration; (h) pregnancy; they were also excluded if they had signs or symptoms of active systemic infection or had COVID-19 symptoms within the last 7 days. Although the protocol permitted enrollment of individuals with a history of COVID-19, no specific recruitment measures were implemented, and patients were enrolled sequentially without gating for any specific features.
Radiotherapy respiratory motion management in hepatobiliary and pancreatic malignancies: a systematic review of patient factors influencing effectiveness of motion reduction with abdominal compression
Published in Acta Oncologica, 2022
Mairead Daly, Alan McWilliam, Ganesh Radhakrishna, Ananya Choudhury, Cynthia L. Eccles
Patient discomfort with abdominal compression is frequently cited but has not yet been measured. Physical discomfort increases the risk of the patient adjusting their position mid-treatment [65,78]. Arch systems may be particularly uncomfortable due to the pressure exertion from one point [31]. Due to the nature of abdominal compression, all devices may be uncomfortable for patients, particularly in patients with pre-existing pain [44,65]. Claustrophobia can also be distressing for patients, manifesting in feelings of restriction or suffocation [79], both considerations in abdominal compression. Anti-anxiety medications (i.e. lorazepam) may improve the compression tolerance or even augment motion reduction [80]. Patients with advanced HPB cancer often present with upper abdominal or back pain, which alone can increase free-breathing intrafraction respiratory amplitude changes [40,65]. Pain can limit optimal pressure application [44], therefore an appropriate pain management plan should be formulated for patients if required.
Review of the international hypnosis literature
Published in American Journal of Clinical Hypnosis, 2021
Shelagh Freedman, Ian Wickramasekera
Similar to the Napp article (reviewed above), this is a study of the use of hypnosis to help patients undergoing radiological investigation using magnetic resonance imaging (MRI). The authors discuss that up to 15% of patients undergoing MRI may experience significant claustrophobia, which can reduce the quality of the results and even lead to termination of the procedure altogether. The authors compared the MRI results of 40 patients who had previously experienced significant claustrophobia with MRI, but were able to successfully manage it with hypnosis, with the results of 40 patients who had been sedated for the MRI due to anxiety concerns. Two experienced radiologists blindly and randomly reviewed the MRI data for image quality. There were no significant differences found between the hypnosis and anesthesiology groups. The authors discuss the findings as being supportive of the hypothesis that hypnosis may be a viable alternative to anesthesiology which delivers a similar quality of MRI results with a non-pharmacological intervention for some patients. The authors discuss recommendations for a future prospective study of the uses of hypnosis in radiology settings. Address for reprints: Dr. Stefania Rizzo, Facoltà Di Scienze Biomediche, Università Della Svizzera italiana (USI), Via Buffi 13, 6900, Lugano, Switzerland. Email: [email protected]
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