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Uthayananthan P, Tanwar N, Rahi JS, Dick AD, Solebo AL. Imaging-Based Detection of Anterior Chamber Inflammation: A Comparative Diagnostic Accuracy Study. Am J Ophthalmol 2025; 270:131-139. [PMID: 39089356 DOI: 10.1016/j.ajo.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE We investigated the impact of operator parameters on the diagnostic performance of anterior-segment optical coherence tomography (AS-OCT) in anterior uveitis. DESIGN Prospective comparative diagnostic analysis. METHODS Setting: Single site. STUDY POPULATION Children younger than 18 years with anterior uveitis, recruited consecutively. OBSERVATION PROCEDURES Index testing: Optovue RTVue80 AS-OCT using "low-volume" (LV, horizontal and vertical cross-sections) and "high-volume" (HV, 68 horizontal cross-sections) protocols. Reference testing: slitlamp examination with anterior chamber inflammation graded using standardization of uveitis nomenclature (SUN). MAIN OUTCOME MEASURE Index test performance metrics (sensitivity, specificity, and likelihood ratios), utility for "ruling-in" and "ruling-out" disease (positive/negative predictive values, PPV/NPV), receiver operating characteristic curves to explore the impact of different imaging-derived metrics, multivariable multilevel regression analyses to quantify correlation of index to reference testing, and repeatability indices across protocols. RESULTS A total of 40 children (77 eyes: 51 eyes at SUN grade 0, 10 at SUN 0.5+, 8 at SUN 1+, and 8 SUN ≥2+ or higher) were included. There was high repeatability across protocols (0.98, P < .001, 95% CI: 0.75-1.0). OCT resulted in strong predictive values for "ruling-out" (LV-scan NPV 82.9%, 95% CI: 71.5%-90.4%; HV-scan NPV 100%, 95% CI: 3%-100%) but a less predictive value for "ruling-in" SUN ≥0.5+ (LV-scan PPV 52.8%, 95% CI: 41.5%-63.7%; HV-scan PPV 34.2%, 95% CI: 33.3%-35.1%). Detection of more than 1 cell within a cross-sectional scan was strongly suggestive of clinical activity, with an area under the curve of 0.76 (95% CI: 0.62-0.89) for SUN ≥0.5+ and 0.85 (95% CI: 0.73-0.98) for the detection of SUN ≥1+. Cell count correlated with SUN grades at higher levels of inflammation (SUN ≥2+ both protocols, SUN ≥1+ HV-scans). There was an independent positive association between age and AS-OCT cell (adjusted correlation coefficient 0.2 cells for each additional year of age). CONCLUSIONS Operator-dependent factors impact the diagnostic and quantification performance of AS-OCT for anterior chamber inflammation. However, the strong, "dose-respondent" correlation of LV protocols with SUN grading promises clinical utility without the storage and analysis burden of HV approaches. Further work will involve exploration of the need for age-specific image metric interpretation.
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Affiliation(s)
- Prithi Uthayananthan
- From the Population, Policy and Practice Programme, UCL GOS Institute of Child Health (P.U., J.S.R., A.L.S.); Division of Medicine, University College London (P.U.)
| | - Nakita Tanwar
- Great Ormond Street Hospital for Children NHS Trust (N.T., J.S.R., A.L.S.)
| | - Jugnoo S Rahi
- From the Population, Policy and Practice Programme, UCL GOS Institute of Child Health (P.U., J.S.R., A.L.S.); Great Ormond Street Hospital for Children NHS Trust (N.T., J.S.R., A.L.S.); National Institute for Health Research Great Ormond Street Biomedical Research Centre (J.S.R., A.L.S.); UCL Institute of Ophthalmology (J.S.R., A.D.D.); National Institute for Health Research Moorfields Biomedical Research Centre (J.S.R., A.D.D.); Ulverscroft Vision Research Group (J.S.R., A.L.S.), London
| | - Andrew D Dick
- UCL Institute of Ophthalmology (J.S.R., A.D.D.); National Institute for Health Research Moorfields Biomedical Research Centre (J.S.R., A.D.D.); School of Cellular and Molecular Medicine, University of Bristol, Bristol (A.D.D.), UK
| | - Ameenat Lola Solebo
- From the Population, Policy and Practice Programme, UCL GOS Institute of Child Health (P.U., J.S.R., A.L.S.); Great Ormond Street Hospital for Children NHS Trust (N.T., J.S.R., A.L.S.); National Institute for Health Research Great Ormond Street Biomedical Research Centre (J.S.R., A.L.S.); Ulverscroft Vision Research Group (J.S.R., A.L.S.), London.
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Debnath M, Ojha S, Sharma DA, Shah S, Boora N. Role of green and sustainable practices in shaping the future of medical imaging technology: A cross-sectional multi-stakeholder analysis among students, radiographers, and academic experts. Radiography (Lond) 2024; 30:1332-1341. [PMID: 39084131 DOI: 10.1016/j.radi.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION The detection and treatment of diseases like COVID, diabetes, cancer, cardiovascular conditions, etc., have made medical imaging technology more necessary, so it is expected that the demands of imaging modalities are also increasing and are major contributors to carbon emissions in the healthcare industry. Hence, the Radiology departments, like the rest of the healthcare industry should adapt the procedures to become more sustainable. METHODS A total of 1016 respondents completed the online survey to assess the perception, current practices, and challenges in adopting green and sustainable practices in medical imaging. The radio technologists, teaching faculties, and students of medical imaging were recruited for the study. The survey tool was distributed to the closed groups through social media and emails. RESULTS The majority of participants (66.6%) highlighted the importance of green and sustainable practices in medical imaging whereas only 21.06% of participants seem to have implemented these practices. Most of the participants give positive responses on the use of zero-lead aprons (77%), refurbished medical systems (85.8%), and eco-friendly packaging (89.5%). The mixed response was received from waste segregation and energy-saving measures. The majority (60.3%) of them have no formal education or training. However, they have a good attitude towards the willingness to adopt green practices. CONCLUSIONS There is a gap between perception and implementation of green and sustainable practices due to leadership and information barriers. Comprehensive training for stakeholders of medical imaging is crucial to fully integrate sustainability practices, possibly through webinars or educational modules. IMPLICATIONS FOR PRACTICE The study's findings shed light on how important medical imaging stakeholders view green and sustainable practices as well as potential obstacles to their implementation at the local level whilst suggesting the need for exclusive training on these practices to promote sustainability.
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Affiliation(s)
- M Debnath
- Department of Medical Imaging Technology, Bapubhai Desaibhai Patel Institute of Paramedical Sciences (BDIPS), Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - S Ojha
- Department of Medical Imaging Technology, Bapubhai Desaibhai Patel Institute of Paramedical Sciences (BDIPS), Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - D A Sharma
- Department of Medical Imaging Technology, Bapubhai Desaibhai Patel Institute of Paramedical Sciences (BDIPS), Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - S Shah
- Department of Medical Imaging Technology, Bapubhai Desaibhai Patel Institute of Paramedical Sciences (BDIPS), Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - N Boora
- Radio-Imaging Department, College of Paramedical Sciences, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India.
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Natembeya MC, Anudjo MNK, Ackah JA, Osei MB, Akudjedu TN. The environmental sustainability implications of contrast media supply chain disruptions during the COVID-19 pandemic: A document analysis of international practice guidelines. Radiography (Lond) 2024; 30 Suppl 1:43-54. [PMID: 38901086 DOI: 10.1016/j.radi.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Travel restrictions implemented during the acute phases of the COVID-19 pandemic disrupted supply chain for critical radiology consumables including contrast media (CM) leading to shortages. Consequently, some departments had to restructure their clinical workflows in accordance to recommended guidelines to ensure safe continuity of patient care. This study aimed to summarise the temporary crisis-driven recommendations with implicit environmental sustainability essence and to analyse how these measures might inform the development of a more sustainable, long-term clinical guideline for safer and cost-effective CM usage without compromising diagnostic quality. METHODS Documents were obtained through an electronic database search together with a relevant manual search in Google Scholar and relevant reference lists. The selected documents were subjected to a pre-defined eligibility criteria for inclusion. The READ approach was employed for document analysis and a thematic analysis of the obtained data was conducted. RESULTS Of the 17 documents included, 70% (n = 12) emanate from the United States of America. The summary of the findings relate to minimising CM usage through strategic clinical approaches including optimisation of CM volumes, prioritisation of non-contrast imaging and/or alternative imaging depending on patient need without compromising diagnostic quality. CONCLUSION Critical lessons of sustainability essence are implicitly embedded in the policy guidelines issued during the periods of acute CM shortage in the COVID-19 pandemic. These lessons were themed around CM conservation based on: type and priority of medical imaging investigation, kind of imaging modality and use of smaller vials over multi-dose vials packaging. IMPLICATIONS FOR PRACTICE The temporary crisis-driven strategies may offer critical lessons for post-pandemic service delivery to enhance patient safety while saving cost and promoting greener practice via strategic clinical and operational monitoring of CM through policy renewal, education and training and collaboration with industry partners.
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Affiliation(s)
- M C Natembeya
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
| | - M N K Anudjo
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
| | - J A Ackah
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
| | - M B Osei
- Department of People & Organisations, Bournemouth University Business School, Bournemouth University, UK
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK.
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Kjelle E, Brandsæter IØ, Andersen ER, Hofmann B. Sustainability in healthcare by reducing low-value imaging - A narrative review. Radiography (Lond) 2024; 30 Suppl 1:30-34. [PMID: 38870571 DOI: 10.1016/j.radi.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES This narrative review aims to present the concept of value in imaging and explore why we conduct low-value procedures, how to reduce this wasteful use, and what we could gain from reducing low-value imaging. KEY FINDINGS Imaging of low value to the patient contributes to thousands of metric tons of CO2 emissions, costing several billion US dollars annually. With a 20% reduction in low-value imaging, we would reduce the waste of resources related to 7.2 million procedures and, at the same time, reduce the risk of incidentalomas, overdiagnosis, and overtreatment and reduce wait times for patients in need of imaging services of high value. Multi-component initiatives targeting barriers in all levels of society and healthcare are needed to reduce low-value imaging. Radiographers are key actors in medical imaging and can make substantial contributions to this effort by, together with the radiologists, referrers, and managers, ensuring that all imaging procedures conducted are sustainable along four dimensions of sustainability: value, cost, risk, and environment. CONCLUSION Efforts to secure sustainable imaging considering the four crucial dimensions (value, cost, radiation, and environment) should be made at all levels of society and healthcare, from governmental management to the individual healthcare worker. Radiographers are vital in obtaining sustainability to ensure only sustainable imaging procedures are conducted. IMPLICATIONS FOR PRACTICE When assessing the appropriateness of imaging procedures, we need to consider the environment, safety, effectiveness, and efficiency. To obtain this, we need a collective and coordinated effort locally, nationally, and internationally to deliver sustainable imaging services.
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Affiliation(s)
- E Kjelle
- Department of Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802 Gjøvik Norway; Department of Optometry, Radiography, and Lighting Design at the University of South-Eastern Norway (USN) at Drammen, Post Office Box 4, 3199 Borre, Norway.
| | - I Ø Brandsæter
- Department of Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802 Gjøvik Norway
| | - E R Andersen
- Department of Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802 Gjøvik Norway
| | - B Hofmann
- Department of Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Postbox 191, 2802 Gjøvik Norway; Centre of Medical Ethics at the University of Oslo, Centre of Medical Ethics, Postbox 1130, Blindern, 0318 Oslo, Norway
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Ghotra SS, Champendal M, Flaction L, Ribeiro RT, Sá Dos Reis C. Approaches to reduce medical imaging departments' environmental impact: A scoping review. Radiography (Lond) 2024; 30 Suppl 1:108-116. [PMID: 39146889 DOI: 10.1016/j.radi.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Global warming stands as a paramount public health issue of our time, and it is fundamental to explore approaches to green medical imaging departments/(MID). This study aims to map the existing actions in the literature that promote sustainable development in MID towards the promotion of environmental impact reduction. METHODS Following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), this literature search was conducted on MEDLINE, Embase and CINAHL to encompass studies published after 2013. Combinations of keywords and relevant terms related to environmental sustainability, recycling, medical waste, and greening radiology were applied for this review. Three independent reviewers screened abstracts, titles, and eligible full-text. Disagreement was solved through consensus. RESULTS 38 out of 4630 articles met all inclusion criteria, and four additional articles were identified and added through reference search. A third of the studies included were published after 2022, and most were conducted in developed countries (36/41). Articles focused on computed tomography (9/41), magnetic resonance imaging (6/41), interventional radiology (4/41), conventional radiography (4/41), ultrasound (2/41), mixed modalities (10/41), or not applicable to an imaging modality (6/41). Four principal categories were identified to decrease ecological footprint: energy consumption, waste management, justification and environmental pollution. CONCLUSION To minimise the environmental impact of MIDs raising awareness and promoting education is fundamental. Examinations must be justified adequately, energy consumption must be reduced, and waste management practices need to be implemented. Further studies are required to prioritise the most effective strategies, supporting decision-making among stakeholders. IMPLICATIONS FOR PRACTICE Several strategies are already possible to implement to reduce the environmental impact of MIDs and improve the healthcare outcomes for patients.
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Affiliation(s)
- S S Ghotra
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland; Department of Radiology, Hospital of Yverdon-les-Bains (eHnv), 1400, Yverdon-les-Bains, Switzerland.
| | - M Champendal
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland.
| | - L Flaction
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland.
| | - R T Ribeiro
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland.
| | - C Sá Dos Reis
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, 1011, Switzerland.
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Boccato C, Vienken J. Do medical devices contribute to sustainability? Environmental, societal and governance aspects. Int J Artif Organs 2024; 47:229-239. [PMID: 38622935 DOI: 10.1177/03913988241245015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Sustainability of a product or device is currently primarily related to its environmental footprint. Here, a wider concept of sustainability is introduced for medical devices and their components in healthcare provision. Such devices sustain healthcare and patient wellbeing due to their quality specifications for material composition, product design and performance. The term quality must be intended in the most comprehensive term, including purity and biocompatibility of materials, device reliability, limited number of recalls and reduced risks as well as acceptability for patients. A close look on medical device specification shows, however, that additional parameters, such as societal, demographic and economic factors also determine medical device sustainability. The medical device life cycle, from design phase, production process to clinical application and the final disposal, also determines its impact. Recommendations for healthcare operators and managers will complete the hypothesis of this paper, that a thoroughly outlined device choice and operation together with a careful waste management of spent medical devices and their components positively affects medical device sustainability. As an example, the limited quantity of wastes and the reduced risks for adverse reaction have a positive impact on both the environmental pollution and on the costs sustained by the healthcare organisations and by the community. These factors determine both, the success of healthcare manoeuvres and the related environmental footprint.
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Picano E. Economic, ethical, and environmental sustainability of cardiac imaging. Eur Heart J 2023; 44:4748-4751. [PMID: 36477859 DOI: 10.1093/eurheartj/ehac716] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/20/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2023] Open
Abstract
Current cardiology guidelines assign a class of recommendation 1 for the diagnosis of chest pain to five imaging techniques based on either anatomic (coronary computed tomography angiography) or functional approaches, such as stress single-photon emission tomography, stress positron emission tomography, stress cardiovascular magnetic resonance, and stress echocardiography. The choice is left to the prescribing physician, based on local availability and expertise. However, the five techniques differ substantially in their cost, applicability based on patient characteristics, long-term risk, and environmental impact. The average European immediate cost ranges from 50 to 1000 euros. The radiation exposure ranges from 0 to 500 chest x-rays. The environmental footprint ranges from 3 to 300 kg of carbon dioxide emissions equivalent. The ethical code of the World Medical Association 2021 recommends the responsible use of healthcare money by doctors, with the minimization of potential damage to patients and the environment. The Euratom law 2013/directive 59 reinforces the justification principle and the optimization principle for medical radiation exposures, with the legal responsibility of both the referrer and the practitioner. A small cost, a minimal long-term risk, and a modest carbon emission per examination multiplied by billions of tests per year become an unaffordable economic burden in the short-term, significant population damage to public health over the years, and impacts on climate change in decades. The cardiology community may wish to adopt a more sustainable practice with affordable, radiation-optimized, and carbon-neutral practices for the benefit of patients, physicians, payers, and the planet.
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Affiliation(s)
- Eugenio Picano
- Research Director, Institute of Clinical Physiology of the National Research Council, CNR Research Campus, Via Moruzzi, 1, Building C- First floor- Room 130, 56124 Pisa, Italy
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Chivers DJ. Energy intensive imaging is a major contributor to healthcare emissions. BMJ 2023; 383:2554. [PMID: 37923342 DOI: 10.1136/bmj.p2554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
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Jackson MR. Re: A bump in the night: a 15-year retrospective analysis of urgent inpatient and emergency CT reporting out of hours in a tertiary referral centre. Clin Radiol 2023; 78:e153. [PMID: 36543615 DOI: 10.1016/j.crad.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022]
Affiliation(s)
- M R Jackson
- Royal Hospital for Children and Young People, Edinburgh, UK.
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Estimating Carbon Dioxide Emissions and Direct Power Consumption of Linear Accelerator-Based External Beam Radiation Therapy. Adv Radiat Oncol 2022; 8:101170. [PMID: 36798606 PMCID: PMC9926191 DOI: 10.1016/j.adro.2022.101170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 01/02/2023] Open
Abstract
Purpose Climate change is one of the direst health threats that humanity faces. We aim to estimate the carbon dioxide (CO2) emissions associated with the energy usage from linear accelerator (LINAC)-based external beam radiation therapy (EBRT) for the most common cancer diagnoses. Methods and Materials We identified patients with the 4 most common cancer types treated with curative-intent EBRT. Beam-on time for each fraction was extracted from the treatment planning system and averaged over each site and treatment modality. The power was multiplied by the beam-on time in hours to yield kilowatt hours (kWh). Using the US Environmental Protection Agency Greenhouse Gas Equivalencies calculator, we converted the kWh into estimates of CO2-equivalent emissions for the average US power grid. Idle time of the LINAC was estimated via Varian Medical Systems. Results A total of 10 patients were included for each of the following modalities: conventionally fractionated for prostate cancer (28 fractions [fx]), prostate stereotactic body radiation therapy (SBRT) (5 fx), 15- and 5-fx regimens for early-stage breast cancer, 3- and 5-fx SBRT regimens for early-stage lung cancer, conventional EBRT (30 fx) for locally advanced lung cancer, and short- (5 fx) and long-course (25-28 fx) for rectal cancer. The modality with the lowest and highest carbon emissions per course, on average, was prostate SBRT (2.18 kg CO2; interquartile range, 1.92-2.30) and conventional treatment for prostate cancer (17.34 kg CO2; interquartile range, 10.26-23.79), respectively. This corresponds to CO2-equivalent emissions of driving an average of 5.4 miles and 41.2 miles in a standard vehicle, respectively. "Standby" mode for a LINAC TrueBeam and Clinac IX uses 112 kWh and 64.8 kWh per day, respectively. Conclusions We have estimated CO2 emissions arising from direct energy usage of a LINAC for 4 common cancers treated with EBRT. "Standby" mode of a LINAC uses the most energy per day. Comprehensive studies are warranted to minimize the environmental effects of health and cancer care.
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Cotrim CA, Café H, João I, Cotrim N, Guardado J, Cordeiro P, Cotrim H, Baquero L. Exercise stress echocardiography: Where are we now? World J Cardiol 2022; 14:64-82. [PMID: 35316975 PMCID: PMC8900523 DOI: 10.4330/wjc.v14.i2.64] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/04/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
Exercise stress echocardiography (ESE) is a widely used diagnostic test in cardiology departments. ESE is mainly used to study patients with coronary artery disease; however, it has increasingly been used in other clinical scenarios including valve pathology, congenital heart disease, hypertrophic and dilated cardiomyopathies, athlete evaluations, diastolic function evaluation, and pulmonary circulation study. In our laboratories, we use an established methodology in which cardiac function is evaluated while exercising on a treadmill. After completing the exercise regimen, patients remain in a standing position or lie down on the left lateral decubitus, depending on the clinical questions to be answered for further evaluation. This method increases the quality and quantity of information obtained. Here, we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail. We also present alternatives to ESE that may be used and their advantages and disadvantages. We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.
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Affiliation(s)
| | - Hugo Café
- Faculdade de Medicina, Algarve University, Faro 8005-139, Portugal
| | - Isabel João
- Department of Cardiology, Garcia de Orta Hospital, Almada 2805-267, Portugal
| | - Nuno Cotrim
- Department of Medicine, Garcia de Orta Hospital, Almada 2805-267, Portugal
| | - Jorge Guardado
- Cardiovascular Unit, UCARDIO, Centro Clinico, Riachos 2350-325, Portugal
| | - Pedro Cordeiro
- Department of Cardiology, Hospital Particular do Algarve, Faro 8005-226, Portugal
| | - Hortense Cotrim
- Faculdade de Medicina, Algarve University, Faro 8005-139, Portugal
| | - Luis Baquero
- Heart Center, Hospital da Cruz Vermelha Portuguesa, Lisboa 1549-008, Portugal
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Chuter R, Lowe G, Dickinson N. Curing a Malignant Climate. Clin Oncol (R Coll Radiol) 2022; 34:148-150. [PMID: 34996685 DOI: 10.1016/j.clon.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Affiliation(s)
- R Chuter
- The Christie NHS Foundation Trust, Manchester, UK.
| | - G Lowe
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, UK
| | - N Dickinson
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Jackson MR. Re: CT coronary angiography-guided cardiovascular risk screening in asymptomatic patients: is it time? Clin Radiol 2021; 77:156. [PMID: 34863508 DOI: 10.1016/j.crad.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- M R Jackson
- Royal Hospital for Children and Young People, Edinburgh, UK.
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Picano E, Zagatina A, Wierzbowska-Drabik K, Borguezan Daros C, D’Andrea A, Ciampi Q. Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography. J Clin Med 2020; 9:3184. [PMID: 33008112 PMCID: PMC7601661 DOI: 10.3390/jcm9103184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022] Open
Abstract
For the past 40 years, the methodology for stress echocardiography (SE) has remained basically unchanged. It is based on two-dimensional, black and white imaging, and is used to detect regional wall motion abnormalities (RWMA) in patients with known or suspected coronary artery disease (CAD). In the last five years much has changed and RWMA is not enough on its own to stratify patient risk and dictate therapy. Patients arriving at SE labs often have comorbidities and are undergoing full anti-ischemic therapy. The SE positivity rate based on RWMA fell from 70% in the eighties to 10% in the last decade. The understanding of CAD pathophysiology has shifted from a regional hydraulic disease to a systemic biologic disease. The conventional view of CAD encouraged the use of coronary anatomic imaging for diagnosis and the oculo-stenotic reflex for the deployment of therapy. This has led to a clinical oversimplification that ignores the lessons of pathophysiology and epidemiology, and in fact, CAD is not synonymous with ischemic heart disease. Patients with CAD may also have other vulnerabilities such as coronary plaque (step A of ABCDE-SE), alveolar-capillary membrane and pulmonary congestion (step B), preload and contractile reserve (step C), coronary microcirculation (step D) and cardiac autonomic balance (step E). The SE methodology based on two-dimensional echocardiography is now integrated with lung ultrasound (step B for B-lines), volumetric echocardiography (step C), color- and pulsed-wave Doppler (step D) and non-imaging electrocardiogram-based heart rate assessment (step E). In addition, qualitative assessment based on the naked eye has now become more quantitative, has been improved by contrast and based on cardiac strain and artificial intelligence. ABCDE-SE is now ready for large scale multicenter testing in the SE2030 study.
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Affiliation(s)
- Eugenio Picano
- Biomedicine Department, CNR Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Clinic, Saint Petersburg State University, 199034 Saint Petersburg, Russia;
| | - Karina Wierzbowska-Drabik
- First Department and Chair of Cardiology, Bieganski Hospital, Medical University, 90926 Lodz, Poland;
| | | | | | - Quirino Ciampi
- Cardiolody Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
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