• Radiation protection to the eye and thyroid during diagnostic cerebral angiography: a phantom study.

      Shortt, C P; Malone, L; Thornton, J; Brennan, P; Lee, M J; Department of Radiology, Beaumont Hospital, Dublin, Ireland. (2008-08)
      We measured radiation doses to the eye and thyroid during diagnostic cerebral angiography to assess the effectiveness of bismuth and lead shields at dose reduction. Phantom head angiographic studies were performed with bismuth (study 1) and lead shields (study 2). In study 1 (12 phantoms), thermoluminescent dosimeters (TLD) were placed over the eyes and thyroid in three groups: (i) no shields (four phantoms); (ii) anterior bismuth shields (four phantoms) and (iii) anterior and posterior bismuth shields (four phantoms). In a second study (eight phantoms), lead shields were placed over the thyroid only and TLD dose measurements obtained in two groups: (i) no shielding (four phantoms) and (ii) thyroid lead shielding (four phantoms). A standard 4-vessel cerebral angiogram was performed on each phantom. Study 1 (bismuth shields) showed higher doses to the eyes compared with thyroid (mean 13.03 vs 5.98 mSv, P < 0.001) and a higher eye dose on the X-ray tube side. Overall, the use of bismuth shielding did not significantly reduce dose to either eyes or thyroid in the measured TLD positions. In study 2, a significant thyroid dose reduction was found with the use of lead shields (47%, mean 2.46 vs 4.62 mSv, P < 0.001). Considerable doses to the eyes and thyroid highlight the need for increased awareness of patient protection. Eye shielding is impractical and interferes with diagnostic capability. Thyroid lead shielding yields significant protection to the thyroid, is not in the field of view and should be used routinely.
    • Radiation safety knowledge and practices among Irish orthopaedic trainees.

      Nugent, M; Carmody, O; Dudeney, S; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland, nugentmary@gmail.com. (Irish journal of medical science, 2014-04-23)
      Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively; however, little work has been done to evaluate current knowledge and practices among orthopaedic trainees.
    • Radical cystectomy in the octogenarian population: a single centre experience

      Raheem, Omer A.; Kamel, Mohamed H.; Leung, Peter; Shields, William P.; Connolly, Stephen S.; Zimmerman, Antonio J.; Mohan, Ponnusammy; Hickey, David P. (2011)
    • Radical pancreaticoduodenectomy for benign disease.

      Kavanagh, D O; O'Riain, C; Ridgway, P F; Neary, P; Crotty, T C; Geoghegan, J G; Traynor, O; Liver Unit, St Vincent's University Hospital, Elm Park, Dublin. dara_kav@hotmail.com (The Scientific World Journal, 2008)
      Whipple's procedure is the treatment of choice for pancreatic and periampullary malignancies. Preoperative histological confirmation of malignancy is frequently unavailable and some patients will subsequently be found to have benign disease. Here, we review our experience with Whipple's procedure for patients ultimately proven to have benign disease. The medical records of all patients who underwent Whipple's procedure during a 15-year period (1987-2002) were reviewed; 112 patients underwent the procedure for suspected malignancy. In eight cases, the final histology was benign (7.1%). One additional patient was known to have benign disease at resection. The mean age was 50 years (range: 30-75). The major presenting features included jaundice (five), pain (two), gastric outlet obstruction (one), and recurrent gastrointestinal haemorrhage (one). Investigations included ultrasound (eight), computerised tomography (eight), endoscopic retrograde cholangiopancreatography (seven; of these, four patients had a stent inserted and three patients had sampling for cytology), and endoscopic ultrasound (two). The pathological diagnosis included benign biliary stricture (two), chronic pancreatitis (two), choledochal cyst (one), inflammatory pseudotumour (one), cystic duodenal wall dysplasia (one), duodenal angiodysplasia (one), and granular cell neoplasm (one). There was no operative mortality. Morbidity included intra-abdominal collection (one), anastomotic leak (one), liver abscess (one), and myocardial infarction (one). All patients remain alive and well at mean follow-up of 41 months. Despite recent advances in diagnostic imaging, 8% of the patients undergoing Whipple's procedure had benign disease. A range of unusual pathological entities can mimic malignancy. Accurate preoperative histological diagnosis may have allowed a less radical operation to be performed. Endoscopic ultrasound-guided fine needle aspirate (EUS-FNA) may reduce the need for Whipple's operation in benign pancreaticobiliary disease in the future.
    • Radical prostatectomy outcome when performed with PSA above 20 ng/ml.

      Connolly, S S; Oon, S F; Carroll, C; Kinsella, S; O'Brien, M F; Mulvin, D W; Quinlan, D M; Department of Urology, St Vincent's University Hospital, Elm Park, Dublin 4., stephensconnolly@gmail.com (2012-02-01)
      Many centres currently do not offer radical prostatectomy (RP) to men with high-risk localised prostate cancer due to concerns regarding poor outcome, despite evidence to the contrary. We identified 18 men undergoing RP with serum PSA >20 ng/ml (high-risk by National Comprehensive Cancer Network definition) and minimum follow-up of 12 years (mean 13.5). Mean preoperative PSA was 37.0 ng/ml (Range 21.1-94.0). Prostatectomy pathology reported extracapsular disease in 16 (88.9%), positive surgical margins in 15 (83%) and positive pelvic lymph nodes in 5 (27.8%). Overall and cancer-specific survival at 5 and 10-years was 83.3%, 88.2%, 72% and 76.5% respectively. With complete follow-up 11 (61.1%) are alive, and 5 (27.8%) avoided any adjuvant therapy. Complete continence (defined as no involuntary urine leakage and no use of pads) was achieved in 60%, with partial continence in the remainder. We conclude that surgery for this aggressive variant of localised prostate cancer can result in satisfactory outcome.
    • Radical prostatectomy outcome when performed with PSA above 20ng/ml

      Connolly, SS; Oon, SF; Carroll, C (Irish Medical Journal, 2011-04)
    • A radiographic analysis of implant component misfit.

      Sharkey, Seamus; Kelly, Alan; Houston, Frank; O'Sullivan, Michael; Quinn, Frank; O'Connell, Brian; Division of Restorative Dentistry and Periodontology, Dublin Dental School and Hospital, Trinity College, Dublin, Ireland. (2011-07)
      Radiographs are commonly used to assess the fit of implant components, but there is no clear agreement on the amount of misfit that can be detected by this method. This study investigated the effect of gap size and the relative angle at which a radiograph was taken on the detection of component misfit. Different types of implant connections (internal or external) and radiographic modalities (film or digital) were assessed.
    • Radiographic appearance of a post-epidural headache.

      Weekes, G; Breslin, D; St Vincent's University Hospital, Elm Park, Dublin 4. gavin.weekes@gmail.com (2012-02-01)
      We report the case of a 35-year-old lady who presented with a 6-day history of a postural headache following an uncomplicated epidural catheter insertion. Meningitis was initially suspected and a neurology review was obtained. CT and MRI brain revealed features suggestive of meningitis. However these radiological features are also consistent with post dural puncture headache (PDPH). This case highlights the under reported and possible misleading radiographical features of PDPH.
    • Radiographic evaluation of the technical quality of undergraduate endodontic 'competence' cases in the Dublin Dental University Hospital: an audit.

      Kumar, Mohit; Duncan, Henry F; Great Western Hospitals NHS Foundation Trust, Great Western Hospital, Marlborough Road, Swindon, United Kingdom. (Journal of the Irish Dental Association, 2012-06)
      The aim of this audit was to evaluate the technical quality of undergraduate de novo endodontic competence cases in the Dublin Dental University Hospital (DDUH) compared to European standards.
    • Radiography of the lumbar spine

      Calvert, David; Midlands Regional Hospital, Portlaoise (2012-12)
    • Radioiodine therapy for hyperthyroidism.

      O'Connell, J; Hayes, F (Irish Medical Journal (IMJ), 2012-03)
    • Radiological abnormalities associated with Aspergillus colonization in a cystic fibrosis population.

      McMahon, Michelle A; Chotirmall, Sanjay Haresh; McCullagh, Brian; Branagan, Peter; McElvaney, N G; Logan, P M; Department of Radiology, Nottingham University Hospitals, Derby Road, Nottingham NG7 2UH, UK. mmcm75@yahoo.com (2012-03)
      To determine if sputum colonization with Aspergillus species in patients with cystic fibrosis (PWCF) correlates with radiological abnormalities and/or a reduction in pulmonary function (FEV1).
    • The radiological diagnosis and treatment of renal angiomyolipoma-current status.

      Halpenny, D; Snow, A; McNeill, G; Torreggiani, W C; Department of Radiology, Adelaide and Meath Hospitals Incorporating the National Childrens Hospital, Tallaght, Dublin, Ireland. (Clinical radiology, 2010-02)
      Angiomyolipomas (AMLs) are the most common benign renal neoplasm and are often discovered incidentally. Due to both an increase in the use of imaging, as well as advances in imaging technology, they are being increasing identified in the general population. As these lesions are benign, there is good evidence that the majority of them can be safely followed up without treatment. However, there is an increasing wealth of information available suggesting there are individuals with AMLs where prophylactic treatment is indicated to prevent complications such as haemorrhage. In such cases, treatment with radiological interventional techniques with subselective particle embolization has superseded surgical techniques in most cases. Even in emergency cases with catastrophic rupture, prompt embolization may save the patient with the additional benefit of renal salvage. Confident identification of a lesion as an AML is important as its benign nature obviates the need for surgery in most cases. The presence of fat is paramount in the confirmatory identification and characterization of these lesions. Although fat-rich AMLs are easy to diagnose, some lesions are fat poor and it is these cases where newer imaging techniques, such as in-phase and out-of-phase magnetic resonance imaging (MRI) may aid in making a confident diagnosis of AML. In this paper, we comprehensively review the imaging techniques in making a diagnosis of AML, including features of both characteristic lesions as well as atypical lesions. In addition, we discuss current guidelines for follow-up and prophylactic treatment of these lesions, as well as the increasing role that the interventional radiologist has to play in these cases.
    • Radiological error an early assessment of departmental radiology discrepancy meetings

      O Driscoll, Dearbhail; Halpenny, D (Irish Medical Journal, 2012-06)
    • Radiological versus clinical evidence of malrotation, a tortuous tale--10-year review.

      Stephens, Linda Ruth; Donoghue, Veronica; Gillick, John; Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland. lrstephens80@gmail.com (2012-06)
      Malrotation is a common abnormality, often diagnosed in the neonatal period. Symptoms may be nonspecific and clinical signs of volvulus are often only seen in the late stages when there has been significant ischemic insult to the bowel. The gold standard diagnostic investigation is the upper gastrointestinal (UGI) contrast study. This study was designed to assess the incidence of negative laparotomy in patients with malrotation diagnosed on UGI contrast study and to identify the clinical signs and symptoms at presentation.
    • Radiology Encyclopaedia

      Buckley, O; Torreggiani, W (2012-11-20)
    • Radiotherapy and breast reconstruction: a meta-analysis.

      Barry, M; Kell, M R; Department of Breast Surgery, BreastCheck, Mater Misericordiae University Hospital, Dublin, Ireland. (2011-05)
      The optimum sequencing of breast reconstruction (BR) in patients receiving postmastectomy radiation therapy (PMRT) is controversial. A comprehensive search of published studies that examined postoperative morbidity following immediate or delayed BR with combined radiotherapy was performed. Medical (MEDLINE & EMBASE) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured. A total of 1,105 patients were identified from 11 appropriately selected studies. Patients undergoing PMRT and BR are more likely to suffer morbidity compared with patients not receiving PMRT (OR = 4.2; 95% CI, 2.4-7.2 [no PMRT vs. PMRT]). Reconstruction technique was also examined with outcome when PMRT was delivered after BR, and this demonstrated that autologous reconstruction is associated with less morbidity in this setting (OR = 0.21; 95% CI, 0.1-0.4 [autologous vs. implant-based]). Delaying BR until after PMRT had no significant effect on outcome (OR = 0.87; 95% CI, 0.47-1.62 [delayed vs. immediate]). PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared with implant-based reconstruction.
    • Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

      Harewood, G C; Clancy, K; Engela, J; Abdulrahim, M; Lohan, K; O'Reilly, C; Department of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin, Ireland. Royal College of Surgeons of Ireland Medical School, Dublin, Ireland. (2011-05-17)
      Background  In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. Aim  To determine the impact of a 'nudge' strategy - prefilling either 3 mL or 5 mL syringes with midazolam - on endoscopic sedation practice. Methods  Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3 mL or 5 mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. Results  Overall, 120 patients received sedation for EGD [59 (5 mL), 61 (3 mL)] and 86 patients were sedated for colonoscopy [38 (5 mL), 48 (3 mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2 mg) vs. 3-mL group (3.3 mg), (P < 0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1 mg) vs. 3-mL group (3.3 mg), (P < 0.0001). There was no significant difference in mean meperidine dose (42.1 mg vs. 42.8 mg, P = 0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. Conclusions  These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.
    • Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

      Harewood, G C; Clancy, K; Engela, J; Abdulrahim, M; Lohan, K; O'Reilly, C; Department of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin,, Ireland. harewood.gavin@gmail.com (2012-02-01)
      BACKGROUND: In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. AIM: To determine the impact of a 'nudge' strategy - prefilling either 3mL or 5mL syringes with midazolam - on endoscopic sedation practice. METHODS: Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3mL or 5mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. RESULTS: Overall, 120 patients received sedation for EGD [59 (5mL), 61 (3mL)] and 86 patients were sedated for colonoscopy [38 (5mL), 48 (3mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2mg) vs. 3-mL group (3.3mg), (P<0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1mg) vs. 3-mL group (3.3mg), (P<0.0001). There was no significant difference in mean meperidine dose (42.1mg vs. 42.8mg, P=0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. CONCLUSIONS: These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.