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Introduction: The optimal pre-participation screening strategy to identify athletes at risk for exercise-induced cardiovascular events is unknown. We therefore aimed to compare the American College of Sports Medicine (ACSM) and European Society of Cardiology (ESC) pre-participation screening strategies against extensive cardiovascular evaluations in identifying high-risk individuals among 35.50- year-old apparently healthy men. Methods: We applied ACSM and ESC pre-participation screenings to 25 men participating in a study on first-time marathon running. We compared screening outcomes against medical history, physical examination, electrocardiography, blood tests, echocardiography, cardiopulmonary exercise testing, and magnetic resonance imaging. Results: ACSM screening classified all participants as "medical clearance not necessary."ESC screening classified two participants as "high-risk."Extensive cardiovascular evaluations revealed ≥1 minor abnormality and/or cardiovascular condition in 17 participants, including three subjects with mitral regurgitation and one with a small atrial septal defect. Eleven participants had dyslipidaemia, six had hypertension, and two had premature atherosclerosis. Ultimately, three (12%) subjects had a serious cardiovascular condition warranting sports restrictions: aortic aneurysm, hypertrophic cardiomyopathy (HCM), and myocardial fibrosis post-myocarditis. Of these three participants, only one had been identified as "high-risk"by the ESC screening (for dyslipidaemia, not HCM) and none by the ACSM screening. Conclusion: Numerous occult cardiovascular conditions are missed when applying current ACSM/ ESC screening strategies to apparently healthy middle-aged men engaging in their first high-intensity endurance sports event.
Introduction: In the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice. Methods: A national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey. Results: For six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure. Conclusion: The results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg. Implications for practice: The current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.
MULTIFILE
Introduction: In the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice. Methods: A national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey. Results: For six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure. Conclusion: The results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg. Implications for practice: The current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.
MULTIFILE
Medical imaging practice changed dramatically with the introduction of digital imaging. Although digital imaging has many advantages, it also has made it easier to delete images that are not of diagnostic quality. Mistakes in imaging—from improper patient positioning, patient movement during the examination, and selecting improper equipment—could go undetected when images are deleted. Such an approach would preclude a reject analysis from which valuable lessons could be learned. In the analog days of radiography, saving the rejected films and then analyzing them was common practice among radiographers. In principle, reject analysis can be carried out easier and with better tools (ie, software) in the digital era, provided that rejected images are stored for analysis. Reject analysis and the subsequent lessons learned could reduce the number of repeat images, thus reducing imaging costs and decreasing patient exposure to radiation. The purpose of this study, which was conducted by order of the Dutch Healthcare Inspectorate, was to investigate whether hospitals in the Netherlands store and analyze failed imaging and, if so, to identify the tools used to analyze those images.
Medical imaging practice changed dramatically with the introduction of digital imaging. Although digital imaging has many advantages, it also has made it easier to delete images that are not of diagnostic quality. Mistakes in imaging—from improper patient positioning, patient movement during the examination, and selecting improper equipment—could go undetected when images are deleted. Such an approach would preclude a reject analysis from which valuable lessons could be learned. In the analog days of radiography, saving the rejected films and then analyzing them was common practice among radiographers. In principle, reject analysis can be carried out easier and with better tools (ie, software) in the digital era, provided that rejected images are stored for analysis. Reject analysis and the subsequent lessons learned could reduce the number of repeat images, thus reducing imaging costs and decreasing patient exposure to radiation. The purpose of this study, which was conducted by order of the Dutch Healthcare Inspectorate, was to investigate whether hospitals in the Netherlands store and analyze failed imaging and, if so, to identify the tools used to analyze those images.
