Research Articles (Radiodiagnosis)

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Accuracy of "red-dot" after-hour trauma-radiograph triage by radiographers in a South African regional hospital
(Stellenbosch University, 2013) Hlongwane, S. T.; Pitcher, R. D.
BACKGROUND: The global demand for diagnostic imaging exceeds the supply of radiologists and is of particular significance in poorly resourced healthcare environments where many radiographs are unreported. Delayed or absent reporting may negatively impact patient management. In well-resourced countries there is recognition that extending the role of radiographers to radiological reporting tasks helps meet service demands. AIM: To determine the accuracy of acute fracture detection by South African radiographers working in an after-hour setting. METHOD: We performed a retrospective study of radiographers at a Western Cape Regional Hospital over 2 months in 2011. The sensitivity and specificity of radiographers' fracture detection were compared with that of a consultant radiologist. Differences were evaluated using the McNemar chi-squared test, with p<0.05 regarded as significant. RESULTS: A total of 369 radiographs were analysed. The overall accuracy of reporting by radiographers was 93.7%, with 74.4% sensitivity for fracture detection. Experienced radiographers performed better than inexperienced radiographers; adult fractures were more consistently identified than paediatric fractures, and appendicular fractures were better visualised than axial fractures. In all instances there was a significant difference between fracture detection by radiographers and the radiologist. Experienced radiographers evaluating appendicular fractures in adults achieved the highest sensitivity (89.9%), which was not significantly different from that of a consultant radiologist (p=0.88). CONCLUSION: The performance of experienced radiographers in our study is comparable with that of experienced radiographers internationally, who have no specific training in trauma radiograph reporting. However, additional training is required if role extension is to be considered.
The accuracy of after-hour registrar Computed Tomography (CT) reporting in a tertiary South African teaching hospital
(AOSIS Publishing, 2014-05-16) De Witt, Juruan F.; Griffith-Richards, Stephanie; Pitcher, Richard D.
Background: The Division of Radiodiagnosis at Tygerberg Academic Hospital, a 1384-bed tertiary training institution in Cape Town, South Africa provides a comprehensive 24-hour clinical radiology service, and has a duty registrar on-site at all times. The demand for computed tomography (CT) imaging is increasing and plays a pivotal role in patient management. Objectives: The purpose of this study was to determine the accuracy of after-hour registrar CT reporting, to identify possible factors that may affect the error rate, and to assess whether or not errors had any clinical impact. Method: A set of senior registrar reports (provisional reports) issued during a 28-day period was compared with the corresponding consultant reports (final reports). Discrepancies were identified and quantified, based on their impact on patient management. Results: The overall discrepancy rate was 8% (18 out of 225) and the overall accuracy rate was 92% (207 out of 225). The major error rate was 4% (9 out of 225) and the minor error rate was also 4% (9 out of 225). Conclusion: We observed that the accuracy of after-hour CT reporting by senior registrars at the Division of Radiodiagnosis at Tygerberg Hospital was on par with international standards. We investigated three factors which may have affected discrepancy rates, and only found one factor, namely the time of day, to be significant. Steps can be taken to create awareness of this fact amongst registrars, which hopefully would result in improved patient care and management.
Accuracy of patients' self-reporting of pregnancy and awareness of risks to the fetus from x-ray radiation
(Health and Medical Publishing Group (HMPG), 2008) Vadachia, Yousuf; Els, Hein; Andronikou, Savvas
[No abstract available]
The accuracy of radiology speech recognition reports in a multilingual South African teaching hospital
(BioMed Central, 2015-03) Du Toit, Jacqueline; Hattingh, Retha; Pitcher, Richard
Background: Speech recognition (SR) technology, the process whereby spoken words are converted to digital text, has been used in radiology reporting since 1981. It was initially anticipated that SR would dominate radiology reporting, with claims of up to 99% accuracy, reduced turnaround times and significant cost savings. However, expectations have not yet been realised. The limited data available suggest SR reports have significantly higher levels of inaccuracy than traditional dictation transcription (DT) reports, as well as incurring greater aggregate costs. There has been little work on the clinical significance of such errors, however, and little is known of the impact of reporter seniority on the generation of errors, or the influence of system familiarity on reducing error rates. Furthermore, there have been conflicting findings on the accuracy of SR amongst users with English as first- and second-language respectively. Methods: The aim of the study was to compare the accuracy of SR and DT reports in a resource-limited setting. The first 300 SR and the first 300 DT reports generated during March 2010 were retrieved from the hospital’s PACS, and reviewed by a single observer. Text errors were identified, and then classified as either clinically significant or insignificant based on their potential impact on patient management. In addition, a follow-up analysis was conducted exactly 4 years later. Results: Of the original 300 SR reports analysed, 25.6% contained errors, with 9.6% being clinically significant. Only 9.3% of the DT reports contained errors, 2.3% having potential clinical impact. Both the overall difference in SR and DT error rates, and the difference in ‘clinically significant’ error rates (9.6% vs. 2.3%) were statistically significant. In the follow-up study, the overall SR error rate was strikingly similar at 24.3%, 6% being clinically significant. Radiologists with second-language English were more likely to generate reports containing errors, but level of seniority had no bearing. Conclusion: SR technology consistently increased inaccuracies in Tygerberg Hospital (TBH) radiology reports, thereby potentially compromising patient care. Awareness of increased error rates in SR reports, particularly amongst those transcribing in a second-language, is important for effective implementation of SR in a multilingual healthcare environment.
The accuracy of radiology speech recognition reports in a multilingual South African teaching hospital
(Springer Verlag, 2015-03) Du Toit, Jacqueline; Hattingh, Retha; Pitcher, Richard; Medical Imaging and Clinical Oncology: Radiodiagnosis
Background Speech recognition (SR) technology, the process whereby spoken words are converted to digital text, has been used in radiology reporting since 1981. It was initially anticipated that SR would dominate radiology reporting, with claims of up to 99% accuracy, reduced turnaround times and significant cost savings. However, expectations have not yet been realised. The limited data available suggest SR reports have significantly higher levels of inaccuracy than traditional dictation transcription (DT) reports, as well as incurring greater aggregate costs. There has been little work on the clinical significance of such errorshowever, and little is known of the impact of reporter seniority on the generation of errors, or the influence of system familiarity on reducing error rates. Furthermore, there have been conflicting findings on the accuracy of SR amongst users with English as first- and second-language respectively. Methods The aim of the study was to compare the accuracy of SR and DT reports in a resource-limited setting. The first 300 SR and the first 300 DT reports generated during March 2010 were retrieved from the hospital’s PACS, and reviewed by a single observer. Text errors were identified, and then classified as either clinically significant or insignificant based on their potential impact on patient management. In addition, a follow-up analysis was conducted exactly 4 years later. Results Of the original 300 SR reports analysed, 25.6% contained errors, with 9.6% being clinically significant. Only 9.3% of the DT reports contained errors, 2.3% having potential clinical impact. Both the overall difference in SR and DT error rates, and the difference in ‘clinically significant’ error rates (9.6% vs. 2.3%) were statistically significant. In the follow-up study, the overall SR error rate was strikingly similar at 24.3%, 6% being clinically significant. Radiologists with second-language English were more likely to generate reports containing errors, but level of seniority had no bearing. Conclusion SR technology consistently increased inaccuracies in Tygerberg Hospital (TBH) radiology reports, thereby potentially compromising patient care. Awareness of increased error rates in SR reports, particularly amongst those transcribing in a second-language, is important for effective implementation of SR in a multilingual healthcare environment.
Advanced osteitis fibrosa cystica in the absence of phalangeal subperiosteal resorption : a case report and review of the literature
(Health & Medical Publishing Group, 1985) Wagener, G. W. W.; Sandler, M.; Hough, F. S.
A case of primary hyperparathyroidism with advanced osteitis fibrosa cystica but without any subperiosteal phalangeal bone resorption is described. A review of this unusual rdiological feature is presented. High-detail magnification radiography (microradiography) is advocated for the early diagnosis of bony defects in hyperparathyroidism.
Advanced radiological investigations and findings amongst community assault victims admitted to a tertiary South African hospital
(Health and Medical Publishing Group, 2019) Du Toit, F.; Griffith-Richards, S. B.; Van Zyl, B. C.; Pitcher, Richard D.
Community assault (CA) has been increasing in certain Cape Town suburbs over the past decade. There are limited CA-related imaging data. The aim of this study was to review CA-related advanced radiological investigations and findings at a Level 1 South African Trauma Centre. METHODS: A retrospective study at Tygerberg Hospital, Cape Town, from 1 January through 30 June 2013. All advanced radiological investigations performed on CA victims at the time of admission were retrieved and analysed by patient demographics, imaging investigations and radiological findings. RESULTS: Sixty-two patients (n=62) with a median age of 25 years were included; CT brain was acquired in 90% (n=56) and was abnormal in 68% (n=42). Craniofacial fractures were demonstrated in 60% (n=37), with involvement of the paranasal sinuses in 32% (n=20) and the base of skull in 19% (n=12). Almost half (n=28/62; 45%) had intracranial haemorrhage, which was intra-axial in 36% (n=22/62), extra-axial in 34% (n=21/62) and both intra- and extra-axial in 23% (n=14/62). Cerebral oedema was present in 29% (n=18/62), with herniation in 10% (n=6/62). Non-cranial CT was acquired in 52% (n=32/62), of whom 19 (n=19/32; 59%) also underwent CT brain. CT abdomen was acquired in approximately a quarter of the cohort (n=16/62, 26%), demonstrating abnormalities in 15 (24%). Fifteen cervical spine CTs were performed (n=15/62; 24%) demonstrating no acute bony injury. CONCLUSION: We recommend a high index of suspicion for severe intracranial injury in CA victims and urgent tertiary referral of those with a depressed level of consciousness. Prospective work is required to determine the long-term outlook for survivors.
The anatomical extent of the pyloric sphincteric cylinder, the pyloric mucosal zone and the pyloric antrum
(Health & Medical Publishing Group, 1982-8) Keet, A. D.
The anatomy of the pyloric sphincteric cylinder is discussed. The pyloric ring is not a separate anatomical structure, but is an inherent part of the cylinder. Contraction of the cylinder narrows the diameter of the pyloric ring, and thus of the pyloric aperture. The extent of the sphincteric cylinder is determined on radiographs. It is seen to be 3-5 cm in length when fully contracted. Anatomical features of the pyloric mucosal zone are reviewed. On the aboral side both the cylinder and the mucosal zone end at the ring. The entire cylinder is lined by pyloric mucosa, but the mucosal zone extends orally beyond the confines of the cylinder. In gastric ulcer it may extend much further up the stomach. In contrast to the cylinder, the greatest length of the mucosal zone is on the lesser curvature. The sphincteric cylinder and the pyloric mucosal zone are clearly defined anatomically. The term 'pyloric antrum', in contrast, has been used in many different senses.
An anatomico physiological principle governing the direction of the gastro intestinal mucosal folds during life
(HMPG, 1974-03) Keet A. D.
The mucosa, being the innermost layer of the gastro intestinal tract, is intimately concerned with digestion and absorption, and, presumably, also with the transport of intestinal contents. In anatomical, physiological and motility studies, possible movements of the mucosa and its folds are neither considered nor investigated. Dogmatic statements about the direction of the folds are often made. Radiologists have long been aware of mucosal movements, but after the fundamental work of Forssell, no further views have been put forward. Radiological procedures have been used to investigate the normal, macroscopic, physiological movements of mucosal folds. A general rule follows. Normally, when the intestine is filled, but inactive, the folds are circular; when the walls contract, the folds change in direction, to become longitudinal. This phenomenon is confirmed by in vivo baboon studies and elucidated by wire spirals. It is seen to be an inherent characteristic of 'peristaltic' and 'segmental' contractions. In this manner longitudinal mucosal furrows are formed simultaneously with the contraction wave of the walls, thus facilitating transit. Were this not so, peristalsis would be an ineffective mechanism, with contraction waves acting against the resistance of circular folds.
The anatomy and movements of the pyloric sphincteric cylinder
(1982) Keet, A. D.; Heydenrych, J. J.
Disagreement about various aspects of the structure and function of the pylorus persists. Morbid anatomical, living anatomical, manometric and radiographic studies were done in an attempt to clarify some problems. It is shown that the pyloric ring (sphincteric ring) is not a separate anatomical structure, but that it constitutes the aboral end of the pyloric sphincteric cylinder, a muscular tube several centimeters in length. The ring does not function independently and conventional peristaltic waves do not proceed as far as the ring. Consequently the ring does not relax reciprocally with an oncoming peristaltic wave in the sense that a wave travels up to the ring, which relaxes upon its arrival. Each peristaltic wave stops on arrival at the oral end of the cylinder, simultaneously initiating a concentric or systolic contraction of the entire cylinder, including the ring. The cylinder, including the ring, is open at rest.
An audit of elective outpatient magnetic resonance imaging in a tertiary South African public-sector hospital
(AOSIS Publishing, 2014-12-09) Van Schouwenburg, Francois; Ackermann, Christelle; Pitcher, Richard
Background: Increasing demand for magnetic resonance imaging (MRI) has resulted in longer waiting times for elective MRI, particularly in resource-limited healthcare environments.However, inappropriate imaging requests may also contribute to prolonged MRI waiting times. At the time of the present study, the waiting time for elective MRI studies at Tygerberg Hospital (TBH), a tertiary-level public-sector healthcare facility in Cape Town (South Africa),was 24 weeks. Objectives: To document the nature and clinical appropriateness of scheduled TBH outpatient MRI examinations. Method: A retrospective analysis of the referral forms of all elective outpatient MRIexaminations scheduled at TBH from 01 June to 30 November 2011 was conducted. Patient age, gender, clinical details, provisional diagnosis, examination requested and referring clinician were recorded on a customised data sheet. Two radiologists independently evaluated the appropriateness of each request by comparing the clinical details and the provisional diagnosis provided with the 2012 American College of Radiology (ACR) guidelines for the appropriate use of MRI. Results: Four hundred and sixty-six patients (median age 42 years; interquartile range 19–55) who had 561 examinations were scheduled in the review period; 70 (15%) were children less than 6 years old. Neurosurgery (n = 164; 35%), orthopaedic (n = 144; 31%),neurology (n = 53; 11%) and paediatric (n = 27; 6%) outpatients accounted for the majority(81%) of referrals; 464 (99.6%) were from specialist clinics. MRIs of the spine (n = 314; 56%),brain (n = 152; 27%) and musculoskeletal system (n = 70, 13%) accounted for more than 95%of the investigations. In 455 cases (98%), the referral was congruent with published ACR guidelines for appropriate MRI utilisation. Conclusion: Scheduled outpatient MRI examinations at TBH reflect optimal clinical use of a limited resource. MRI utilisation is largely confined to traditional neuro-imaging. Any initiative to decrease the elective MRI waiting time should focus on service expansion.
An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity
(Pan African Medical Journal, 2019-10-01) Maboreke, Tashinga; Banhwa, Josephat; Pitcher, Richard D.
Introduction: approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources. Methods: the equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data. Results: public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure. Conclusion: there exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data.
Benadering van interpretasie van rontgenfoto's van die longe
(HMPG, 1979-11) Beyers, J. A.
Different approaches to the analysis of radiographs of the lungs are briefly discussed. A systematic routine is proposed, outlined and briefly motivated. It is emphasized that radiological findings must be correlated with clinical findings if meaningful conclusions are to be drawn.
Bodysurfing injuries of the spinal cord
(Health & Medical Publishing Group, 1995) Scher, A. T.
In a group of 104 patients paralysed as a result of injury while swimming or diving, 3 patients were identified in whom the injury was sustained during bodysurfing. The mechanism of the injury and the clinical and radiological findings in this group differ markedly from the findings in the 101 patients paralysed after diving into shallow water. The 3 patients were significantly older with a mean age of 46 years. No fracture or dislocation of the cervical spine was present, but evidence of osteo-arthrosis was present in all cases. The pattern of spinal cord injury was that of incomplete paralysis consistent with the central cord syndrome. This combination of findings suggests that the mechanism of injury was forced hyperextension of the head and neck due to the surfers having been caught up in turbulent wave action and driven into the sandy sea bottom.
Burkitt lymphoma research in East Africa: highlights from the 9th African organization for research and training in cancer conference held in Durban, South Africa in 2013
(BioMed Central, 2014-09) Simbiri, Kenneth O.; Biddle, Joshua; Kinyera, Tobias; Were, Pamela A.; Tenge, Constance; Kawira, Esther; Masalu, Nestory; Sumba, Peter O.; Lawler-Heavner, Janet; Stefan, Cristina D.; Buonaguro, Franco M.; Robinson, Detra; Newton, Robert; Harford, Joe; Bhatia, Kishor; Mbulaiteye, Sam M.
ENGLISH ABSTRACT: A one-day workshop on Burkitt lymphoma (BL) was held at the 9th African Organization for Research and Training in Cancer (AORTIC) conference in 2013 in Durban, South Africa. The workshop featured 15 plenary talks by delegates representing 13 institutions that either fund or implement research on BL targeting AORTIC delegates primarily interested in pediatric oncology. The main outcomes of the meeting were improved sharing of knowledge and experience about ongoing epidemiologic BL research, BL treatment in different settings, the role of cancer registries in cancer research, and opportunities for African scientists to publish in scientific journals. The idea of forming a consortium of BL to improve coordination, information sharing, accelerate discovery, dissemination, and translation of knowledge and to build capacity, while reducing redundant efforts was discussed. Here, we summarize the presentations and discussions from the workshop.
A case control study of breast cancer risk and exposure to injectable progestogen contraceptives : methods and patterns of use among controls
(Health and Medical Publishing Group (HMPG), 1997-03) Bailie, R.; Katzenellenbogen, J.; Hoffman, M.; Schierhout, G.; Truter, H.; Dent, D.; Gudgeon, A.; Van Zyl, J.; Rosenberg, L.; Shapiro, S.
Objective. To describe the patterns of use of injectable progestogen contraceptives (IPCs) among coloured and black women in the Western Cape. These data are part of an ongoing study in the Western Cape, the main aim of which is to explore the relationship between IPCs and breast cancer. Design. A population-based case-control study of breast cancer risk in relation to the use of IPCs among coloured and black women. Setting. The Western Cape, including the Cape metropole and surrounding rural areas. Study subjects. All coloured and black women with newly diagnosed breast cancer, resident in the study area and below age 55 years, who present at either of the two tertiary care hospitals in the Western Cape are recruited. Controls are a sample of hospitalised patients representative of the populations from which the patients are drawn. Cases are frequency-matched according to cross-tabulation of age, ethnic group and residential area in a ratio of approximately 1:3. Measurements. Questionnaires are administered by trained nurse interviewers. Information is elicited on a wide range of variables, including sociodemographic variables, medical history, family history of breast disease, lifetime history of all methods of contraception and use of non-contraceptive female steroids, reproductive variables, cigarette smoking, alcohol consumption and other potentially confounding variables. Results. Between January and December 1994, 122 incident cases and 389 controls were enrolled. Ever-use of IPCs among the controls was 72% (N = 280) and use for 5 years or more was 30% (N = 117). Use of IPCs in the distant past was common, with 61% (N = 232) of all controls having initiated use 10 or more years previously. Current use was also high (19%). Other contraceptive methods were used far less commonly. Conclusion. Coloured and black women in South Africa have been using and continue to use IPCs far more commonly and for longer periods than women anywhere else in the world. It is therefore especially important to evaluate the risk of breast cancer and other health effects of IPCs. The rates of use identified in this study ensure that there will be adequate statistical power to evaluate long-term use, use in the distant past and current use of IPCs.
Chemotherapy, medical oncology and nomenclature
(Health & Medical Publishing Group, 1992) Smith, B. J.
[No abstract available]
Cholesistografie en ultraklank in die diagnose van galstene
(Health & Medical Publishing Group, 1982) Loxton, A. J.; Schulman, A.; Grove, H.
Oral cholecystography and ultrasonography of the gallbladder were performed in 190 patients with the aim of diagnosing gallstones. At surgery gallstones were found in 23 patients and a roundworm in 1 patient. The results obtained with the two methods are comparable. Since neither radiation nor contrast agents are employed in ultrasonography, it is suggested that this be regarded as the primary special examination in the diagnosis of gallstones.
Comparative morphological study of the pituitary gland by computed tomography and magnetic resonance imaging
(Health & Medical Publishing Group, 1988) Loxton, A. J.
A prospective study was undertaken to compare the morphology of the pituitary gland by computed tomography (CT) and magnetic resonance imaging (MRI) in 27 consecutive patients. CT is an accepted imaging modality but this study suggested that MRI has certain advantages. MRI is proposed as the imaging modality of choice for lesions of the pituitary gland.
Congenital CMV infection
(AOSIS Publishing, 2015-12) Vlok, Sucari; Du Plessis, Vicci
Meconium pseudocyst is a rare complication of fetal bowel perforation in utero, following extravasation and localised containment of meconium within the intra-peritoneal cavity.

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