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Content

• WhatDoourPatientsThinkaboutUs?• Chairmen’sCorner• Workload• AcuteCTServiceforUrologicalOutpatients• PresentationofourTeams:TheAbdominalTeam• PresentationofourTeams:TheOncologicalTeam• PresentationofourTeams:TheBreastTeam• PresentationofourTeams:TheMusculoskeletalTeam• PresentationofourTeams:TheUltrasoundTeam• DiagnosticRadiographersintheDepartmentofDiagnosticRadiology• InnovationinComputedTomography• Research:MonitoringAbnormalitiesinLiverandAdiposeTissuebyMRImagingandSpectroscopy• Research:AssessmentofInflammationandStructuralDamageinPsoriaticArthritiswithModernMRIandCT• Research:Non-renalandRenalAdverseEventsafterEnhancedandUnenhancedCTandMRI• Publications

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Editors:

HenrikS.ThomsenElizavetaChabanovaNannaB.VolqvartzVibekeLøgagerHelleB.KaulbergMichelNèmery(responsible)

Contributors:

MichelNèmeryPrebenThomassenHelleB.KaulbergHenrikNørgaardLisaMarieHoppeAnna-JaneBurchardtAne-HelleReenbergJeanetteBrusMortensenLoneBaldingLoneRaschJesperBeyerPetersenChristinaKinnanderKennethFuglevigGrinderslevHenrietteRaaschouJensRyttovAdriansenAstaLindskovHjorthHenrikBørgesenThomasBretlauElizavetaChabanovaManalAzzouzRenéPanduroPoggenborgWearegratefultoJudithA.W.Webb,M.D.,Lon-

donforrevisingourEnglish

Thisreportispublishedby:

DepartmentofDiagnosticRadiologyCopenhagenUniversityHospitalHerlevHerlevRingvej75DK-2730HerlevDenmarkTel:(+45)38683211http://www.herlevhospital.dk/radiologi

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WhatdoOurPatientsThinkaboutUs?

InSeptember2013,theDepartmentofDiagnosticRadi-ologywasthefirstradiologicaldepartmentintheCapitalRegionofDenmarktohaveafeedbacksessionwithpa-tientswhohadbeenexaminedinthedepartment.

FivepatientsagreedtosharetheirexperienceofhavingCTandultrasoundscans.ProfessionalinterviewersfromtheDanishCenterforPatientExperienceandEvaluationorganisedtheprocess,whichwashighlystructured.

Duringtheinterview,thepatientswereaskedhowtheyexperienced thecompleteexaminationprocedure fromreceivingtheirappointmenttogettingtheirdiagnosis.WewantedtofindoutwhatwasimportanttothemandwhatwecoulddotoimprovetheirtimeintheDepartmentofDiagnosticRadiology.

Whatthepatientssaid

Howweusethedirectpatientfeedback.

• Inaninterview,thepatientstellustheirexperienceofbeingexaminedinthedepartment.

• Welearnmoreaboutpatientexperiencesandper-ceptionsthroughouttheexamination.

• Weusethisknowledgeinourworktoimprovethequalityofthepatientexperience.

Everyoneinthegroupoffiveratedthequalityoftheex-aminationhighlyand found thestaff tobeprofessionalandempathetic.Evenatbusytimes,thestaffconveyedenergyanddrive,andusedhumouraspartofprovidingarelaxedatmosphere.

Everyoneagreed that themost important thingwas toget a quick report after the examination because thisleads to quicker decisions about any further examina-tionsandabouttreatment.

Noneofthepatientsenjoyedhavingcontrastmediain-jected. They expressed a strong preference for usingpreviouslyinsertedcatheters,suchasPowerports.

Thereweremanygoodsuggestions.Forexample,itwassuggestedthattheofficestaffwritethenumberoftheex-aminationroomthepatientsaretobeexaminedinwhentheyreceivethepatients.Thiswouldmakeiteasierforpatientstogethelpiftheyarelostortohelpothers.

Whatwewilldonext

From the next day, the office staff started towrite theroomnumberon theappointmentpapersor onapre-pared sheet given to patients when they arrive at thereceptionarea.

Also,wehavecontinuedtothinkabouthowwecanmakeourwaitingareasmorewelcomingandcomfortable.

Atstaffmeetings,wehaveexchangedtipsandideasongood techniques for injecting, andwe have discussedhowmanytimesitisfairto”attempt”toinjectapatientbefore calling for assistance.We have placed greateremphasisonstaff training in theuseofcatheterssuchasPowerports.

Fasterturn-aroundtimeshavebeengivenahigherprior-ity.In2013,wehaveworkedwith”warmreporting”,withthegoal of having theexamination report available bythefollowingworkingday.Thisispartofmakingthepa-tientpathwaymoreefficientso thatclinicianscanplanany further examinations quickly and any necessarytreatmentcanstartwithoutdelay.

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Weproudlypresentthe9thannualreportoftheDepart-mentofDiagnosticRadiology,CopenhagenUniversityHospitalHerlev.

2013 was a great year for our department, becausewe managed to significantly improve the quality ofour patient care, wemade a flying start in our clini-cal innovation project and our working environmentwasimprovedbothbygrowthandbyabetterbalancebetweenstaffingandworkload.Webelievethat2013marksthebeginningofpromisingnewtimes.

Herlev Hospital now covers all but a couple of themedical specialities, and has amajor strategic focusoncreatingitsfutureasanemergencyhospital.Beauti-fulbuildingscoveringatotalof77.000m2willbeaddedtothecurrenthospitaltoaccommodatefuturepatients,modern healthcare and new technology – The NewHerlevHospital-openingin2017.

Wearenowwell underwaywithexperimenting,andwithdesigningandplanningradiologyservicesfortheNew Herlev Hospital. While this process is inspiringandcreative,itrelatestothefuture.Itis,however,be-comingincreasinglyclearthatmakingchangestointer-disciplinarycollaborationandpatientpathwayscannotwaituntil2017,andthatourdepartmentplaysanim-portantroleinmanyofthechangesneeded.Weneedtoworkonthesechangesnow.

Thus,attheendof2013,wedecidedtoallocateaspe-cific radiographer to theEmergencyDepartment.We

wanttofindoutwhathappenstopatientflowwhentheskillsandexperienceofa radiographerareadded totheteamofnursesresponsiblefortheinitialdiagnos-ticsandtreatmentofacutelyillpatients.Wehavegreathopes for the learning,coordinationandcommunica-tionwhichweexpecttoevolve.

InJune2013,weestablishedaCT-innovationunit-anew idea for our department, and also for theCapi-talRegionofDenmark and forDenmark.Theunit isintended to drive innovation in the clinical setting byprovidingstate-of-the-artCT-technology,togetherwiththestaffandresourcesforuser-driveninnovationthatcanbeimplementedimmediately,asnewdiscoveriesemerge.Weaimtopushthediscoveryofwhatworksforandwithourpatientsasfastaspossible.Ourdedi-catedandprofessionallyenquiringmedicalstaffworkwith engineers fromour scannermanufacturing part-ner,withradiographyteachersandstudents,andwithdesignersandinventors.

Weplantodevelopamobile,tablet-based,communi-cations interfacewith our patients. Thiswill allow usto systematically investigate the patient’s experiencebefore, during and after their scan.Wewant to bet-terunderstandandtooptimisethepatientexperiencebyaskingstructuredquestionsandbycollectingandanalysing patient feedback throughout the patient’sinteractionwith thedepartment.Ouraim iswhereverpossibletoempowerourpatients.

Chairmen’sCorner

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In 2013, we also implemented fast track CT-scanningofpatients fromtheDepartmentofUrologytooptimiseoutpatientflowandthroughput.Theprojecthasbeenasuccessandthemodelwillbeofferedtootherkeyrefer-ringdepartmentsinthenearfuture.Toguideoureffortstochangeinthenearfutureourde-partmenthasdevelopedtwo“beacons”–“Qualityinallwedo-involvingpatientswhenpossible”and“Researchandinnovationputintopractice”.

Ourtwonew256-sliceCT-scannershaveallowedustoincreasethequalityofourimagingservice,notonlyforpaediatric,cardiacandoncologicimaging,butacrossthewholeclinicalspectrum.Wehavealreadyreducedwait-inglistsforthisexpandingimagingmodalityandexpectgreat diagnostic advances from the spectral imagingtechnology.

InApril2013,weopenedanew3TeslaMR-suite–ournewflagshipintechnologyandindesignoftheenviron-ment forbothpatientsandstaff.Thescannerprovidesthe state-of-the-art technology needed for performingMRI of patients suspected of having prostate cancer,

and is the first department of Diagnostic Radiology inDenmark todo this. Inclosecollaborationwith thede-partmentofUrologyatHerlevHospital,wenowdiagnoseandlocalisemalignanttumoursintheprostateglandthatpreviouslywere biopsied “blind” under ultrasonic guid-ance.Beingable toactuallyseethetumourduring thebiopsy procedure greatly improves the quality of bothdiagnosisandtreatmentplanning.

Colourschemes,light,sound,movies,androomdesigninournewMR-suitehavebeenchosentoreducestressandgivepatientsa feelingofbeingpampered.Patientexperience in the new MR-scanner is “VIP standard”.Resultsareverypromisingaswenowrarelyexperiencepatientswithclaustrophobiaorhighanxiety levelswhoareunabletocompletetheirscan.Infact,wenowrou-tinelybringsuchpatientstothe3Teslascannerforanimmediatesecondtryafterafailedscanattemptinan-otherscanner.Someradiographershaveactuallyneverexperiencedanon-completedsecondscan in thenewscanner–andwehavecaughtavaluableglimpseoftheimportanceofthebehaviourofindividualradiographerstotheresultsandqualityofourdiagnosticservices.

In2013,weinvitedahandfulofourpatientstoourfirstformal feedback meeting – a structured interview anddiscussionbetweenpatientsandstafffocusedonshar-inggoodandbadexperiencesandsuggestions.Aslead-erofthedepartment,itwasheart-warmingtolistentoourpatients’ appraisal of the high level of professionalismandempathyofourstaff.Theyfeelthattheyareingoodhandsandreceivediagnosticimagingofveryhighqual-ity–but theyallexpressaneed for faster turn-aroundtimes.Wecallit“warmreporting”andarecommittedtoournewgoalofreportingwithinoneworkingday.

Inourpursuitofcorevaluessuchascorrectandopera-tional imaging analysis, high quality images at low ra-diation dose and safe and prompt communication, wewillneedtoworkmoreefficientlytoachievetheoptimalbalancebetweenworkload,qualityandagoodworkingenvironment.

Our research team continues to put the departmentamong the top rankeddepartmentsof radiology in thecountry for numbers of scientific publications and cita-tions.Ourambitioninresearchandinnovationistocon-tinuethegrowthandexpansiondescribedinthisreportbyestablishingandmaintainingfruitfulcollaborationwithinternalandexternalresearchandfundingpartners.

Thechangingandincreasingdemandsforourdiagnosticimagingserviceshavebeenmetbecauseofthecreativ-ityandcommitmentofourcompetentstaff.In2013ourclinicalexaminationworkloadincreasedby10%.

Thegreatresultsachievedinthepastyear,ofwhichwecanallbeproud,werepossibleonlythankstotheprofes-sionalismandco-operationofourcommittedstaff.

2013wasagreatyearforourdepartment–andthefu-tureislookingbright.

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Workload

Thenumberofexaminationsperformedat theDepart-ment of Diagnostic Radiology of Herlev Hospital hasbeencountedthesamewayfor13years,sotheactivityfrom2001through2013canbecompared.Overthe13years,totalactivityhasincreasedby120%.From2012to2013workloadincreasedby10%.

CTscanninghasincreasedmorethan18%from2012to2013,andbymorethan300%since2007.InMay2013our department replaced 3 conventional X-ray roomswith2state-of-the-artCT-scanners,oneofwhichisthecoreof thedepartment’snewCT InnovationUnit.Thisallowsustoperformatechnologysupportedleapinclini-calqualityinpaediatric,cardiac,oncologic,urologicandemergencyimaging–andtoincreaseworkload.

Innovationinclinicalpracticeenablesustoworksmarter,totest,inventandclinicallyvalidatenewtechnology,andtojoinwithourpatientsinimprovingqualityofcareandthe creation of value – from the user and patient per-spective.

ThechangingclinicalprofileofHerlevHospital,within-creasingly complex examinations supporting decisionmaking in the departments of Neurology andPaediat-rics,andtheagingtechnologyofanexistingMRscannerawaitingreplacement,leadtoadecreaseinnumbersofMRscansperformedin2011and2012.

InApril2013ournewstate-of-the-art3TeslaMRscan-nerwas installedandwestarted touseMRI todetectprostatecancerinclinicalpractice,asthefirsthospitalinDenmarktodothis.MRexaminationworkloadincreasedby2%from2012to2013.Thistrendisexpectedtocon-tinueoverthecomingyearsasMRIofprostatecancerbecomesroutine.However,wearestillfacingchallengesrecruitingqualifiedradiologistsforthetask.

ThenumberofUltrasoundExaminationscontinues theupwardtrendwhichstartedin2010.Thisrelatestohigh-erthroughputofpatientsduetotheemergingemergencyprofile ofHerlevHospital, the breast cancer screeningprogrammeandacceleratedpatient throughput ingen-eral.

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AcuteCTServiceforUrologicalOutpatients

OnAugust 1, 2013, theDepartment ofDiagnosticRadi-ology, in co-operation with the Department of Urology,introducedan acuteCT service for someof the urologyoutpatients.A‘walk-in’CTservicewaslaunchedinwhich8-10 permanent appointmentswere allocated every dayforoutpatientsfromDepartmentofUrology.Theoutpatientclinicbooks thepatients inadvancewhen theoutpatientreferrals are received,mainly fromgeneral practitioners.ThissystemgivesthepatientsamedayaccesstotheCTscanner, but is not a true ‘walk-in’ service, such as thatused,forexample,forchestX-rays.

Feweroutpatientvisits

The idea was to reduce the number of repeat appoint-mentsforpatientsintheUrologyOutpatientClinicandsotoprovidequickerpatientassessmentandtoreducethedailyattendanceattheoutpatientclinic.

Thenew system involves patients attending theDepart-mentofUrologyinthemorningwheretheirhistoryisob-tained,andbloodsamplesandanynecessarycytologicalspecimensare taken.Thepatientsare thentakento theCTscannerwhichprovides theacuteurological service,which is usually themachine in the square close to theUrologyOutpatientClinic.

Afterbeingscanned,patientsusuallywaitforaboutacou-pleofhourswhiletheCTscanisreportedandthevarioustestsareanalysed.Intheafternoon,patientsreturntotheoutpatientclinic for their testresults.Possible furtherex-aminationsandanynecessarytreatmentcanbeplannedorthepatientscanbedischargedfromtheclinic.

Haematuriaandstonediseasereview

Sofar, twopatientpathwaysare included in theservice:patientswithhaematuriaandpatientssuspectedofhavingstonedisease.

Inpatientsreferredbytheirgeneralpractitioner,CTurogra-phy,cystoscopyandcytologyexaminationsareperformedandreportsaresentoutonthesameday.Thisreducesthenumberofvisitsperpatientfromthreetoone.

ThisleadstoasignificantimprovementintheefficiencyoftheUrologyOutpatientClinic,butthepatientmustremaininthehospitallongeronthedayoftheirappointment.Theschemeprovidesafurthersavingbecausethemedicalre-cordsandtestresultsdonothavetoberetrievedseveraltimes.Also,itisusuallythesamedoctorwhoseesthepa-tientthroughouttheday,soprovidingbettercontinuityforboththedoctorandthepatient.

Thepatients are very pleased to receive their diagnosisquickly,especiallysincethepatientswithhaematuriacouldpotentially havea seriousmalignant disease, but in factmorethan60%ofthemdonothaveaseriouscondition.

In patients suspected of having stone disease, the his-torytakingandtheurinarytractCTscancanbedoneandtheresultsgivenonthesameday.Ifnostonesarefound,thepatientcanbedischargedfromthecliniconthesameday.Ifstonediseaseisdetected,thecourseoftreatment

can be planned, usually by consultationwith a urologistspecialisinginstonetreatment.Thisgroupofpatientstoohavebeensatisfiedwith thenewclinicarrangementandapproximately 75%of themcanbedischarged from thecliniconthesameday.

Qualityandresources

Thereisnowadirectphonelinebetweentheurologistinthestone/haematuriaoutpatientclinicand theradiologistwhoreportsthescan.Inmostcasestheurologistwilljustreadtheradiologist’sreport,butproblematiccasescanbediscussedimmediatelybetweenthetwomedicalspecial-istsand itcanbedecidedwhetherany furtherexamina-tionsarenecessary.

UsuallytheCTscansarenotshownataurologic/radiologi-calconferenceunlessthereisaparticularproblemwhichtheurologistortheradiologistwantstohavediscussedinalargerforum.Thishasreducedthenumberofoutpatientsdiscussedatthedailyurologicmorningconferences,pro-ducingafurthersmallfinancialsaving.

Overall,thesystemisasuccess.BothpatientsatisfactionandtheefficiencyintheUrologyOutpatientClinichavein-creasedsignificantly.

However,sincethesystemrequiresareportfromtheDe-partment of Diagnostic Radiology within a few hours, agreaterminimumnumberofradiologistsisneededinthedepartment,aswellasamedicalsecretarytopreparethereport immediately, so that theotherwork in thedepart-mentdoesnotsuffer.

Also,initiallytherewereproblemsbecausesomepatientsdidnotattendfor theiroutpatientappointments.Thisap-pears tohavebeensolvedbecause theoutpatient cliniccanusuallyusetheseappointmentsforotherpatients,withtheresultthatinNovember2013therewereonlyfiveun-usedappointmentsforCToftheurinarytractandnoneforCTurography,

Inconclusion,thisprojectcontributestoensuringsomeoftheaimsofHerlevHospital,namelyincreasedpatientsat-isfaction,abetterqualityserviceand increasedworkflowinthehospital.

DUAL-energy-based, computer-assisted stone sizemeasurementandcharacterisationofkidneystonewithhighcalciumconcentration.

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PresentationofourTeams:TheAbdominalTeam

The Abdominal Team consists of 25 radiographers,6 Senior Hospital Physicians and 3 Staff Specialists.Therearealways2-3radiographystudentsand3-4resi-dentsassociatedwith the team.The team ismanagedbySeniorHospitalPhysicianHenrikNørgaardandteammanaging radiographerLisaMarieNilsen,whostartedasnewteammanagingradiographeronMarch1,2013.

Originally, theAbdominal Team’s work was to provideaservicetothegeneralsurgicalandurologicaldepart-mentsofthehospital.Theworkconsistedofdoingplainx-rays, intravenous urography, pyelography, gastroin-testinalexaminationswithcontrastmedia,arteriographyandotherinterventionalprocedures.Later,theAbdomi-nalTeamgotitsownCTscanner.CTurographyreplacedintravenous urography, and CT colonography (virtualcolonoscopy) replaced fluoroscopic colonexamination.Urologic examshavealwaysbeenamajor part of theworkloadoftheAbdominalTeam,andtoday,forexam-ple,weprovidefasttrackaccesstoCTinco-operationwiththeDepartmentofUrology.

Herlev Hospital has grown over the years and radiol-ogyhasgainedagreater role inpatientmanagement.Theexaminationshavebecomemorecomplicatedandrequiremore specialisation.This has led to sharing of

some examinations among the Abdominal, Oncologi-cal andMusculoskeletalTeam.For instance, radiogra-phers from the teams participate in skeletal radiology,abdominalCTisperformedbyradiographersfromboththeAbdominalandOncologicalTeamandabdominalMRscansareperformedbytheMusculoskeletalTeam.Theradiologists have become increasingly specialized andsometopics,suchascolorectalcancerandcoronaryar-terydisease,aretreatedbyspecialistgroupsofradiolo-gistsfromthedifferentteams.

Fluoroscopically-guided interventional radiology, how-ever,isstilltheexclusiveresponsibilityoftheAbdominalTeam.Theproceduresaremostlychemoembolizationoflivermetastasesandlivercancer,andcatheterisationoftheurinarytract.TheAbdominalTeamisalsoresponsi-bleforCTcolonography,andfourradiographersarepartofaprojectofdescribingCTcolonography.

Itwillbeinterestingtoseehowtheworkloadisbestallo-catedamongthespecialistsofthedepartmentinthefu-ture,whenthehospitalgetsitsnewextensionandthera-diologicaldepartmentissplitintotwoseparateparts.Welook forward to takingpart in thisprocessand leadingtheteamthroughfuturechallengesanddevelopments.

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PresentationofourTeams:TheOncologicalTeam

Shortdescription

The Oncological Team consists of 25 Radiographers,10MedicalSpecialists(8SeniorHospitalPhysicians,2StaffSpecialists)and2-3Residents.Theteamisman-aged by Senior Hospital Physician Lone Rasch andTeamManagingRadiographerJesperBeyerPedersen.The team primarily conducts examinations for 4 maindepartments: Department of Oncology, Department ofHaematology,DepartmentofCardiologyand theDiag-nosticUnitof theDepartmentofMedicine. Inaddition,theteamradiographersruntheplainX-rayexaminationroomwherepatientsfromalldepartmentsandspeciali-tiesareexamined, including theemergencyroom.TheOncological Team works with theAbdominal Team tocoveracuteCTscanningduringtheday.

TheteamhasthemainresponsibilityfortheradiologicalpartofPET/CT inco-operationwith theDepartmentofClinicalPhysiologyandNuclearMedicine.TheOncologi-calTeamisoneoftwoteamsinthedepartmentwithon-callduties,whichmeansthatthereisaminimumofoneradiographerfromtheOncologicalTeampresent inthehospitaltwenty-fourhoursaday,allyearround.

Thelasttwoyears

During the last twoyears, therehavebeenmanynewandexcitingdevelopments.Afewoftheseare:

• Theteamhasplacedgreatemphasisonachievingthegoalofhaving90%ofallexaminationsreportedatthelatestby12middayonthenextday.

• TworadiographersfromtheOncologicalTeamarestudyingtobecomediagnosticradiographers.Theyhavepassedtheexaminationsattheendofthefirstpartoftheircourseandstartthesecond(andlast)partofthecourseonFebruary1,2014.

• Reconstruction of the examination room in theemergency room has been undertaken so thatchest X-rays can be performed. This has beendonetoachievebetterpatientthroughput.

• Duringthelasttwoyears,thenumberofCTscan-ners in the department has increased from 5 to7. The number of PET/CT scanners has also in-creased. This allows the department to respondfaster,soprovidingabetterservicetothereferringdepartments and allowing them to dealwith theirpatientswithoutdelay.

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PresentationofourTeams:TheBreastTeam

TheBreastTeamoftheDepartmentofDiagnosticRadiol-ogy is involved in the diagnosis of breast diseases. Theteamexaminespatientswhohavebeenreferredfromtheirgeneralpractitionerorhospitaldepartmentwithsuspectedbreastcancer,andalsoexaminespatientsaspartoftheirfollow-upafterbreastcancer.TheteamisalsopartoftheCapitalRegionofDenmark’smammographyscreeningpro-gram,togetherwiththeUniversityHospitalofCopenhagen.Intheteamthereare5SeniorHospitalPhysicians,2StaffSpecialists,13radiographersand10mammographyassis-tants.Theclinicalsectionwhereexaminationsandfollow-upofbreastcancertakesplaceisatHerlevHospitalintheDe-partmentofDiagnosticRadiology.Mammographyscreen-ingtakesplacepartlyinabuildingconnectedtoHerlevHos-pital,andpartlyinabuildingconnectedtoHillerødHospital.Intheclinicalsection,therearesevendoubleroomswhichhavemammographymachines and ultrasound scanners,andtwofurtherroomswithultrasoundscannersonly.Therearethreemammographyroomsineachscreeningclinic.Theclinical sectionshavedigital x-rayequipmentandul-trasoundscannersespeciallysuitedtobreastdiagnostics.Within the past two years, themammography equipmentwhichtheteamacquiredin2009hasbeenupgraded,anditisnowpossibletoperformtomosynthesis.Theteamthere-fore now has the most modern equipment available forbreastdiagnosis.Mammographyandultrasoundscanningareperformedonmost patients.Mammography can be supplementedwithdifferentspecialrecordingsandtomosynthesis(seebelow).Ultrasound scanning can be supplemented with Dopplerexaminationandelastography.Dopplerexaminationallowsthetumourbloodsupplytobevisualised,andsoassesseswhether the tumour is benignormalignant.Elastographyassesseshowelasticthetumourtissueis,whichhelpstodecidewhether the tumour is benign ormalignant, sincemostmalignanttumourshaveveryhardtissue.Forthede-finitive decision onwhether a tumour is benign ormalig-nant,anultrasound-guidedbiopsy isusuallyperformedtoobtainatissuesample.

Theteamalsoroutinelydostereotacticvacuum-assistedbi-opsies.Suspiciousormalignantchangesinthebreasttissuecan occurwhich cannot be felt on physical examination. Ifthesechangescanbeseenusingultrasoundscanning,anultrasound-guidedbiopsycanbeperformed. If thechangesareonlyseenonmammography,stereotacticbiopsyisper-formedinstead.Duringthestereotacticbiopsy,imagesofthesuspiciousareaaretakenfromtwoangles.Whenthesuspi-ciousareaismarkedonbothimages,themammographyap-paratuscanworkoutwhereandhowdeepthebreastbiopsyshouldbedone.Thebiopsy is takenusing a biopsy needle connected to avacuumsystem.Thismeans thatmoreand largerbiopsiescanbeperformedinrapidsuccessionwithouttakingthenee-dleoutaftereachbiopsy.Thetissuesampleissuckedintoacontainerby thevacuum.After theprocedure, thesamplesaresenttotheDepartmentofPathologyforassessment.Thestereotacticequipmentisalsousedwhenthebreastsur-geonswant to removeanabnormalitywhichcannotbe feltbutcanonlybeseenonmammography.Insuchcases,athinmetalwiremustbeinsertedintotheabnormalitysothatthebreastsurgeoncanfinditduringsurgery.Inthesamewayasinastereotacticbiopsy,themammographyapparatusworksoutwherethemetalwiremustbeinserted.Thismethodhasledtomorepreciseplacementofthemetalwire,andalsoisquickerandlessunpleasantthanwhenthemarkingwirewasplacedwithoutstereotacticguidance.During 2013, the new examination of tomosynthesis wasintroduced.Duringtomosynthesis, imagesof thebreastaretaken in the sameway as with normalmammography butinsteadofonlymakingthe image inoneplane,15differentimagesaremadeatdifferentangles.Themammographyap-paratuscanmanipulate the imageselectronically,andusesthemtomakeimagereconstructionswhichshowthebreastinslices.Thismakesitpossibletofindsmallertumourswhichwouldotherwisebehiddenbythesurroundingbreasttissue.Tomosynthesis is especially suited to the examination ofbreastswithalotofglandulartissue.Despitethelargernum-berofimages,onlyaninsignificantradiationdoseisused.Weconstantly seek to improve thequality of theexamina-tions,andinthetwoscreeningclinicsrepeatedauditsofim-agequalityareperformed.Thehighestpossiblestandardofthe interpretation of themammography images and of thereportsareensuredbysystematicfollowupchecks.Duringthepastyear,theteamhadagreatchallengewhenitreceivedpatientsonthe“NationalIntegratedCancerPath-way”.Thepurposeofthe“NationalIntegratedCancerPath-way” is to ensure that patients start their examination forbreastcancerwithinsevenworkingdaysof thehospital re-ceiving the referral.We have attempted to achieve this bychangingourproceduresso that the teamusually receivespatientsforexaminationashort timeafter thewomenhaveseentheirownGeneralPractitioner.Theworkoftheteamisundertakenincloseco-operationwithotherdepartmentsthatworkwithbreastcancerpatients–theDepartmentofBreastSurgery,theDepartmentofPathologyandtheDepartmentofOncology.Theteamethosistoworktoahighprofessionalstandardforthebenefitofbothpatientsandstaff.

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PresentationofourTeams:TheMusculoskeletalTeam

The Musculoskeletal Team has had an exciting2012/2013withnewdevelopmentsinseveralareas.

During this time the Musculoskeletal Team receivedanewMRIscannerwitha70cmopeningwhichgivesmoreroomforlargerpatientsandforpatientswithclaus-trophobia. The scanner room has been provided withAmbient Experience, which through light, sound andpicturesgivesadifferentandbetterexperience for thepatientsandstaff.Oneofourmaindutiesistomakeourexaminations as patient-friendly as possible, and thisis facilitatedby theAmbientExperience roomarrange-ment.

The musculoskeletal team undertakes prostate MRIscans,andthisistheonlyplaceinDenmarkwherethey

aredone.Theprostatescansstartedasaresearchpro-jectincooperationwithDepartmentofUrologyatHerlevHospital,buthavenowbecomestandardexaminations.ThistypeofMRscanisoneareawhereDenmarklagsbehindothercountries.

During 2012/2013, the Musculoskeletal Team co-op-eratedcloselywith thedepartment’s researchunit inanumberofveryinterestingprojectssuchascardiacMRI,breastMRIandMRangiographyof the lower limbs. Inaddition,wehavefocusedondiffusionweightedimaging(DWI)oftheliverandtheMRIsafetyofimplantedstents.

TheMusculoskeletalTeamco-operatescloselyandwellwith the clinical departments and with other partnersbothinternallyandexternally.

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PresentationofourTeams:TheUltrasoundTeam

We are pleased to present the dedicated UltrasoundTeamoftheDepartmentofDiagnosticRadiologyatHer-levHospital.

Ultrasoundimaging(alsocalledsonography)useshigh-frequency sound waves to obtain images from insidethe human body, which generate real-time sonogramsofpatients.UnlikeX-rayradiographyandCTscanning,sonographyinvolvesnoionisingradiationexposureandthisisbetterforpatients,especiallyforchildren.

TheUltrasoundTeamconsists of 3-4 doctorswhoareradiologistsspecialisedinultrasoundimaging,4sonog-raphersand1medicalsecretary.Thesonographersarehighlytrainedandexperiencedandareabletocompletemanyexaminationswithoutconsultingadoctor.Weworkexclusivelywithsonography,sothatourserviceisofahighprofessionalquality.Inaddition,weoftenhave2-3residentsattachedtotheteam,soweparticipateinthepostgraduateeducationoffutureradiologists.Whatdis-tinguisheseducation inultrasound is thehands-onap-proachtosonographicdiagnosis,andthefactthatultra-soundishighlyoperator-dependent.

Eachyearweperformapproximately12,500examina-tions of adult and paediatric patients.We undertake awide variety of ultrasound procedures, from generalabdominal and paediatric ultrasonography to themostadvancedtechniques,includingcontrastenhancedultra-sound(CEUS),andultrasonographicallyguidedbiopsiesandaspirations.Weperformahighnumberofinterven-tional procedures: 20% of all ultrasound examinationsinvolvesomesortofinvasiveintervention.

Ourmedicalsecretaryhasachallengingjobplanningourdayandhelpingusoptimiseourworkflow, forexamplebycheckingbloodtestresultsbeforeinterventionalpro-ceduresandensuringthatthepatientsarriveattherighttime.Weuse speech recognition dictation, somost ofourreportsarereadyimmediatelyaftertheexamination.

Weprovideaservicetoalmostallclinicaldepartmentsinthehospital:emergency,abdominalsurgery,medicalgastroenterology, nephrology, urology, intensive care,paediatric,neurology, internalmedicine,cardiology,on-cology, haematology, orthopaedic surgery and plasticsurgery.Wealsoprovideservicestolocalprimaryhealthcare.

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Hypertrophic pyloric stenosis. The image shows thethickenedpylorus.

SpectralDoppleroftheinternalcarotidarteryshowingahighgradestenosis.

NormalcolourDopplerimageofthefemoralvein.

Longitudinalultrasoundscanof thehipshowinga jointeffusion.

Atheroscleroticplaquesofthecarotidartery. Normalkidneyofanewborn.

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DiagnosticRadiographersintheDepartmentofDiagnosticRadiology

InSeptember2012,threeradiographersfromtheDepart-mentofDiagnosticRadiologyatHerlevHospitalstartedacourseatUniversityofSouthernDenmarktolearnhowtobecomediagnosticradiographers.Themainpurposeof thecourse is to increasetheskillsof radiographers,whonormallyobtain radiographs (X-rays),so that theycanalsomakeadiagnosisonconventionalskeletalx-rays. The first part of the course is about diagnosingabnormalitiesoftheperipheralskeleton,i.e.thelongtu-bularbones,which include theupperand lower limbs,and thesecondpart isaboutdiagnosingabnormalitiesof theaxialskeleton, i.e. thespine.Thecourseshouldbecompletedintwoyears.TeachingmainlytakesplaceonFridayandSaturday,andinpartonesevendifferentcoursesmustbecompleted.Thesubjectsinthecourseincludehealthlawandhealthstatistics.Thesesubjectsarenotnecessary toestablishacorrectdiagnosis,buttheyhelptoprovideanoverallcontext forradiographicpractice.Thecoursealsoaimstoestablishcompetenceinqualityassurancesothatthediagnosticradiographerscanbeinvolvedinmonitoringanddevelopingstandardsforradiographyoftheaxialandperipheralskeleton.

At the same time as the university course, one day aweekhasbeensetasidefortheradiographerstoreportx-rays from the emergency room. This new task hasbeenamajorchallenge,becauseittakesamethodicalapproachandconsiderableknowledge toseparate theappearancesofnormalandabnormalbones.ThereportmustdescribetheboneabnormalitieswiththeLatinana-tomical terms to provide the emergency room doctors

with the information theyneed togive thepatients thecorrect treatment.Because these tasksarenewto theradiographers,thesupervisingdoctorssometimeshavetoshowconsiderablepatience.InAugust2013,allthreeradiographers took the final exam for part one of thecourse.Thisfive-hourwrittenexamconsistsof50care-fully chosen radiographs of different skeletal diseaseswhichhavetobeidentifiedandascoreofatleastof95%isrequiredtopass.Attheendof2013,allthreeradiog-raphershadcompletedpartoneandtheystartparttwoonFebruary1,2014.

ThefutureworkplanforthediagnosticradiographersatHerlevHospitalremainsanopenquestion,andisstillun-derdiscussionbetweenmanagement, thedepartmentsinvolvedandourselves.Ouraimistobemembersoftheteam that deals with emergency patients and patientswhohavea fracture in the peripheral skeleton and sotohelpoptimisethepatientpathwayandtheworkflowintheemergencyroom.Eventually,diagnosisof theaxialskeletonwillalsobepartofourrole.Anotherpartofournew role will be to contribute to optimising the imagequality of X-rays. This will involve establishing greaterqualityawarenessintheradiographersproducingtheim-ages,andalsocheckingthetechnicalaspects,suchaswhetherourequipmentisinstalledtodeliverthebestim-agespossible.WehopethatournewrolewillallowustoprovideabetterservicetotheDepartmentofDiagnosticRadiology,toourreferringdepartmentsandmostimpor-tantlytoourpatients.

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InnovationinComputedTomography

Duringspring2013,theDepartmentofDiagnosticRadi-ologyexpandeditsCTcapacitybyacquiring2newCTscanners, so the department now has a total of 7CTscanners.Thetwonewmachinesare‘SomatomDefini-tionFlash’scanners,whicharedescribedas“stateoftheart”bythesupplierSiemens.

Rightfromthestart-upphase,fromthedesignoftheCTscanner room to thepurchasingprocedure, innovationhas been integral to the whole plan. The CT scannerroomsaredecoratedinaminimalstyleandhaveround-edcorners,bluesky,andmusicure(aseriesofspeciallycomposed‘soundscapes’createdspecificallyforavari-etyoftherapeuticpurposes)intheloudspeakers,Thesemeasuresall aim toestablisha calmandprofessionalenvironmentforthebenefitofthepatientsandthestaff.Animportantpartoftheplanhasbeentoestablishco-operative working between radiographers and radiolo-gists.Thishasbeenachievedbysitingtheirworkspacesclose together to promote interdisciplinary discussionandco-operation.

To encourage innovation asmuch as possible, one ofthetwoCTscannersisdedicatedtoinnovation,develop-mentandresearchfor50%ofthetime.Muchofthede-velopmentinvolvesoptimisingCTscanningproceduresto reduce radiation and contrast media doses withoutcompromisingthediagnosticqualityoftheimages.Tworadiographers and one radiologist are permanently at-tached to thenewscanners todevelopand implementnew ideas,buteveryone in thedepartment is involvedandisencouragedtocontributenewideasandsugges-tionsforchangestopractice.

WealsoworkcloselywithSiemensandtheirspecialistssothattheycontributetotheinnovation.Inaddition,weco-operate with Metropolitan University College, withotherdepartments inHerlevHospital,and in thefuturehopealso to co-operatewithother hospitals in the re-gion.

Wewould like to be able to use the scanners to theirfullesttechnicalcapability,andhopetousesomeofthenewtechniquestooptimiseCTproceduresintheother5CTscannersintheDepartmentofDiagnosticRadiology.

We place great emphasis on patient experience andinvolvement, andwewould like to support the patientempowermentprojectoftheCapitalRegionofDenmark.HowcanweintegratetheseaspirationsintoabusydayintheCTscanner?Canwehelpthepatientshelpthem-selvesandalsoourselvestoachieveanoptimalpatientpathway?All of thiswill be part of our innovation anddevelopmentworkduringmostof2014.

So,what can our newCT scanners dowhich has notbeenpossibleatHerlevHospitalpreviously?

Siemens Somatom Definition Flash, unlike other CTscanners, is equippedwith twoX-ray tubes instead oftheusualone.Wecanthereforescanwithdualenergy,

meaning that we can scan the same area of the pa-tientwithdifferentX-rayenergies(KV).Technically,thismeansthatwecanremoveiodine-basedcontrastmediafromtheimages,removebonesfromvascularexamina-tions,reducenoisefromimplantedmetal,andmoreeas-ilydiagnosegoutandcharacterisekidneystones.

Theopenings in thescannergantriesarea little largerthanintheotherCTscannersintheDepartmentofDiag-nosticRadiology.ThistogetherwiththetwoX-Raytubesmeansthatitispossibletooptimisethequalityofexami-nationsinobese(bariatric)patients.

Another innovation is the Flash technique, where wecanusethetwoX-raytubesandthequickcouchmove-ment to scan the lung and abdomen in approximately2 seconds, 5-6 times faster thanwehavedoneprevi-ously.Amajoradvantageofthisisseenforinstancewithheart scans where we can scan the coronary vesselsfullywithoutinterferencefromheartmotion,becausethescannerspeedalmostmakestheheart“standstill”.An-othermajoradvantageofthequickscantimeisforscan-ning childrenwho cannot lie still and also for patientswho have difficulties breathing or holding their breathduringanexamination.

Allinall,thetwonewCTscannersaretechnicallyveryadvanced.Apartoftheinnovationintheradiologicalde-partmentistofocusonstaffeducationinusingthisnewadvanced technique. Over a four-week period, a pilotprojectwillbecarriedouttoassessalternativelearningmethods in thenewCTscanners so that staff trainingcanbeoptimised.Thefamiliarperson-to-persontrainingwillbetested,andthecompetenceofthestaffinCTwillbeincreasedatthesametime.

Welookforwardtoanexciting,challengingandinnova-tive2014intheCTscanners.

16 16

Research:MonitoringAbnormalitiesinLiverandAdiposeTissue

byMRImagingandSpectroscopy

Overweight andobesity aregrowingproblems inDen-mark and can lead to chronic complications such asdiabetesmellitus,hypertension,non-alcoholicfattyliverdisease, hypercholesterolemia, polycystic ovarian syn-drome,andotherdiseasesof thecardiovascularordi-gestivesystems.

TheDepartment of Diagnostic Radiology at Copenha-genUniversityHospitalHerlevparticipatesinanumberof researchprojectsdevoted tooverweight,obeseanddiabeticpatients.Overrecentyearswehaveundertakenthemostresearchexaminationsoffattyliver,musclefatand subcutaneous/visceral fat distribution inDenmark.Intheresearchprojectswecooperatewithotherdepart-ments at Herlev University Hospital, with BispebjergHospital,HvidovreHospital,HolbækUniversityHospital,Århus University Hospital and University of Copenha-gen.Overrecentyearswehaveparticipatedinthefol-lowingprojects:• “DIRECT:DiabetesResearchonpatientstratifica-

tion” (http://www.direct-diabetes.org/, The NovoNordisk Foundation Centre for Basic MetabolicResearch,FacultyofHealthSciences,UniversityofCopenhagen)

• “CUT-IT: Randomized study comparing intervaltrainingandweight loss inobese(BMI28-40)pa-tientswith ischemicheartdisease (DepartmentofCardiologyY,BispebjergHospital)

• “ERGEM:effectsofgastricbypasssurgeryonen-ergy consumption, gastrointestinal hormones andbody composition.” (Department of Human Nutri-tion,UniversityofCopenhagen&HvidovreHospi-tal)

• “COLA: Energy in liquid form. Importance of ap-petite, appetite regulatory hormones, metabolicfactors and the weight “ (Department of HumanNutrition,UniversityofCopenhagen&MedicalEn-docrinologyDepartment,ÅrhusUniversityHospital)

• “TheDanishChildhoodObesityBiobank:Establish-ing reference limits on adipocytokines, cytokinesand CVD markers distributions of gene polymor-phisms, and ensuring biological materials for re-search in lifestyle diseases related to obesity inchildhood.”(TheChildren’sObesityClinic,HolbækUniversityHospital)

• “Immit FASTE: The effect of fasting every otherday inpatientswith type2diabetes” (BiomedicalInstitute,FacultyofHealthSciences,UniversityofCopenhagen)

• “APPROACH:Anoptimizedprogrammingofhealthychildren-themostfavourabledietaryprotein:car-bohydrateratioduringpregnancyinthecontextofNewNordicDiet“(Centralkitchen,HerlevHospital)

• “LIPT–Liraglutideforwomenwithpolycysticovarysyndrome” (Gynaecology and Obstetrics Depart-ment,HerlevUniversityHospital)

Techniques.TheadvantagesofMagneticResonancetechniquesarethattheyarenon-invasiveandusenoionisingradiation,sotheyaresafe.TheDepartment ofDiagnosticRadiology atHerlevHospi-tal contributes to the research projects by measuring: 1)Volumesofsubcutaneousandvisceralfat(MagneticReso-nanceImaging)2)Fatcontentinliverandinmuscle(Mag-neticResonanceSpectroscopy)MeasurementoffatvolumeswithMagneticResonanceIm-aging.Therearetwotypesoffat:subcutaneousandvisceral.Sub-cutaneous fat is found just underneath the skin, andmaycausedimplingandcellulite.Visceralfatislocatedwithintheabdominalcavityandsurroundsvitalorgans.Visceralfatislinkedtoeverythingfrombadcholesterolandhypertensiontodiabetes,heartdiseaseandstroke,so it is important tomeasure fatdistributionand,especially, thevolumeof thevisceralfat.SincefatiseasilyidentifiedonMRimages,thevolumesofvisceralandsubcutaneousfatcanbecalculated.MeasurementofliverfatcontentwithMagneticResonanceSpectroscopy.Fattyliverdiseaseisoneofthediseasescausedbyobesity.Fattyliverdiseaseinadultsisconsideredpresentwhenthefatcontentofthelivercellsmakesupmorethan5-10%ofthe liver’sweight. Liverbiopsy is thegold standard fordi-agnosingandassessing theseverityof fatty liverdisease,butitisaninvasiveprocedureassociatedwithseriousrisks.Therefore, non-invasive measurement by magnetic reso-nancespectroscopy(MRS)isabetteralternativefordetect-ingfattyliverdisease.MRSshowsthecompositionoftissuemetabolitesinagivenvolume.

Measurementofvisceralandsubcutaneousfat.

MRSpectroscopymeasurementofliverfatcontent.

1717

Research:AssessmentofInflammationandStructuralDamage inPsoriaticArthritis

withModernMRIandCT

Psoriaticarthritis(PsA)isaninflammatoryjointdiseaseassociatedwiththeskindiseasepsoriasis.Therearenopreciseandsensitivemethodsformeasuringthemani-festationsofthedisease.Computedtomography(CT)isconsidered the referencemodality for evaluating bonestructure, and recently, two new magnetic resonanceimaging(MRI)methodshavebeenintroduced.Dynamiccontrast-enhanced MRI allows quantification, which ispartiallyuser independent,of inflammation,andwhole-bodyMRIallowstheentiremusculoskeletalsystemtobevisualisedinonesession.

ThemainobjectiveofthisthesisprojectwastoassessinflammationandstructuraldamageinPsAusingmod-ernMRIandCTmethods.Weperformedalongitudinalobservationalstudy(studyI),andacross-sectionalstudy(studyII).

Instudy I,weusedCTas the referencemethod to in-vestigate structural changes in the hands of 41 PsApatients.Boneerosionswerelocatedinthemetacarpalheadsin90%,butboneproliferationswereprimarilylo-cateddistallyon thesidesof thedistal interphalangealjoints.During48weeksofadalimumabtherapy,weob-servednooverallchange instructuraldamage.MRI instudy I gave a sensitivity and specificity for bone ero-sionsof100and40%,and forproliferationsof83and93% respectively.Weobserved longitudinal decreasesinMRIscoresforsynovitis,tenosynovitisandbonemar-rowoedema.InflammationwaspresentonMRIinall24patientsscannedatweek48,despiteaclinicalresponsetotreatment.Baselinebonemarrowoedemawasasso-ciatedwithprogressionoferosionsonCT,althoughwerarelyobservedprogression.Baselinedynamiccontrast-enhancedMRIswereavailableforninepatients,andthedynamicMRIparametersofinflammationdecreasedbe-tweenbaselineandfollow-up.Twenty-twopatientshadat leastonedynamiccontrast-enhancedMRIavailableandtheparametersofinflammationcorrelatedwithMRIsynovitis(rho0.43-0.62).

InstudyII,weusedwhole-bodyMRItoevaluateinflam-mationandstructuraldamage in18patientswithPsA,18withaxialspondyloarthritisand12healthysubjects.Evaluationofwhole-bodyMRIwasmostfrequentlypos-sibleand reproducible inareas locatedcentrally in thescanner. Bone marrow oedema assessed in periph-eraljointsshowedhigherscoresinPsAthaninhealthysubjects, and correlated with the swollen joint count.Whole-body MRI in PsA showed similar involvementin the hands and feet, but in spondyloarthritis the feetweremore frequently involved.Enthesitisassessedbywhole-bodyMRIshowedlimitedcorrelationwithclinicalexamination.

Inconclusion,patternsofstructuraldamageandinflam-

ThefigureshowexamplesofimagesacquiredinthePhDproject“Assessmentofinflammationandstructuraldam-ageinpsoriaticarthritiswithmodernMRIandCTmeth-ods”.Ontheleftacoronalwhole-bodyMRIofahealthysubjectisshown.AtthetoprightacoronalCTimageofthe2-3rdmetacarpophalangeal joints inapsoriaticar-thritispatientshowsaboneerosionattheproximal3rdjoint.Below,inthemiddle,onaconventionalMRIofthesame joints, theerosion in the3rd joint iseasilyseen,and,inaddition,inflammationisseeninthe2ndjoint.Inthelowerrow,thejointinflammation(colouredpixels)isshownonadynamicMRIsequence.

mationinpsoriaticarthritiswereinvestigatedbyCTandMRI,andaspectsofreproducibility,inter-modalityagree-ment, relation toclinicalfindings,sensitivity tochange,andprognosticvalueofconventionalMRI,dynamiccon-trast-enhanced MRI and whole-body MRI were evalu-ated.

18 18

Research:Non-renalandRenalAdverseEventsafter

EnhancedandUnenhancedCTandMRI

Contrastmediaareimportantandfrequentlyusedtoolsfor diagnosing disease during computed tomography(CT)andmagnetic resonance imaging(MRI)examina-tions, but they can cause serious and potentially fatalnon-renal and renal adverse events. It is very impor-tanttoclarifywhetheradverseeventsafterCTandMRIscansdirectlyrelatetothecontrastmediaorhaveothercauses.

Thepurposeofthisstudywastocomparepatientshav-ingenhancedandunenhancedCTandMRItodeterminethetruefrequencyofadverseeffectsrelatedtocontrastmedium. The frequencies of non-renal acute adverseevents(AAEs),lateandverylateadverseevents(LAEsandVLAEs) inpatientsundergoingenhancedorunen-hanced CT or MRI weremeasured. The frequency ofrenaladverseevents,asevidencedbyfluctuationsines-timatedglomerularfiltrationrate(eGFR) inoutpatients,wasmeasuredand thevalueofastructuredquestion-nairetoidentifyoutpatientswithrenaldysfunctionbeforeCTorMRexaminationswasstudied.

This investigation was done by Manal Azzouz (MSc.Pharmacy) as a PhD project in theDepartment ofDi-agnosticRadiologyatCopenhagenUniversityHospitalHerlevfrom2010to2013.

Beforetheirexamination,allpatientscompletedaques-

tionnairetodetectfiveriskfactors indicatingrenaldys-function, and had estimated glomerular filtration rate(eGFR)determined immediatelybefore theCTorMRIscan.Thepatientswere interviewed72hoursafter theCTorMRIexaminationabout theoccurrenceofAAEsusingastructuredquestionnaire.TheyalsohadeGFRdetermined,andwereinterviewedabouttheoccurrenceofLAEs.Onemonthlater,thepatientsreceivedaques-tionnairetocheckfortheoccurrenceofVLAEs.

Fromtheresultsof thisPhDstudyseveralconclusionswere drawn.AAEs, LAEs and VLAEswere all experi-encedbypatientsundergoingunenhancedCTorMRI,aswellasbythosereceivingcontrastmedium,buttheincidenceofAAEs,LAEsandVLAEswashigherinthepatientswhohadreceivedcontrastmedium.Thesefind-ingsindicatethatAAEs,LAEsandVLAEsarenotalwayscausedbythecontrastmedia.TheeGFRinoutpatientsundergoingCTorMRIvariedindependentlyofwhetherthe patient received contrast media or not. The find-ingsreflectnaturalvariationsinserumcreatininelevels,whichshouldbetakenintoconsiderationwhencontrast-inducednephropathyisstudied.Thequestionnaireusedtoidentifyrenaldysfunctioninpatientsagedlessthan70andeGFRdeterminationinpatientsagedover70identi-fied99.6%ofpatientswithaneGFRbetween30-45ml/min/1.73m2.

1919

2012AxelsenMB,HetlandML,Hørslev-PetersenK,Stengaard-PedersenK,JunkerP,PødenphantJetal.Dynamiccontrast-enhancedmagneticresonanceimagingofthewristinrheumatoidarthritispatientstreatedwithmethotrexate,intra-articu-larglucocorticoidandadalimumab/placebo.Arthritis&Rheumatism.2012;64(10suppl.):S452-3.

AxelsenMB,DuerA,EshedI,MøllerJM,PedersenSJ,ØstergaardM.Whole-bodymagneticresonanceimagingofdis-easemanifestationsinaxialandperipheraljointsandenthesesinrheumatoidarthritispatients.Arthritis&Rheumatism.2012;64(10suppl.):S691.

BarentszJO,RichenbergJ,ClementsR,ChoykeP,VermaS,VilleirsGetal.ESURprostateMRguidelines2012.EurRadiol2012;22:746-57.

BennettCL,QureshiZP,SartorAO,NorrisLB,MurdayA,XirasagarSetal.Gadolinium-inducednephrogenicsystemicfibrosis:theriseandfallofaniatrogenicdisease.ClinKidneyJ2012;5:82-88.

BennettCL,StarkoKM,ThomsenHS,CowperS,SartorO,MacdougallICetal.LinkingDrugstoObscureIllnesses:Les-sonsfromPureRedCellAplasia,NephrogenicSystemicFibrosis,andReye’sSyndrome.AReportFromtheSouthernNetworkonAdverseReactions(SONAR).JGenInternMed2012Dec;27:1697-703.

BilleDS,ChabanovaE,GamborgMO,FonvigCE,NielsenTRH,ThistedEetal.Liverfatcontentbymagneticresonancespectroscopyinobesechildrenandyouths includedinmultidisciplinarytreatment.ClinObes2012;24;Volume2(Issue1-2).

BilleDS.Evaluationofaclinicalinterventionprograminoverweightandobesechildrenandstudiesinadultsofunderlyingmetabolicphenotypesofselectedobesitygenes.2012.

ChabanovaE,BilleDS,ThistedE,HolmJ-C,ThomsenHS.MRspectroscopyofliverinoverweightchildrenandadoles-cents:investigationof¹HT2relaxationtimesat3T.EurJRadiol2012;81:811-4.

Duer-JensenA,HetlandML,Hørslev-PetersenK,LB,EjbjergBJ,HansenMSetal.ReplytocommentbyvanderHelm-vanMiletal. “Theadditivevalueofmagnetic resonance imaging forboneedema inpredicting rheumatoidarthritisdevelopmentinearlyundiffentiatedarthritis”.Arthritis&Rheumatism.2012;64:322-3.

Duer-JensenA,Hørslev-PetersenK,BakL,JohansenJS,HansenMS,HetlandMLetal.UsingMRIsynovitistocountinvolvedjointsintheACR/EULAR2010RAcriteriaincreasestheirsensitivityandspecificity.AnnRheumaDis2012;71(3suppl.):601.

Engell-NoerregaardL,HendelHW,JohannesenHH,AlslevL,SvaneIM.FDGPETscansasevaluationofclinicalre-sponse to dendritic cell vaccination in patients withmalignantmelanoma. Cancer immunology, immunotherapy: CII.2012;62:17-25.

EshedI,KrabbeS,ØstergaardM,BøyesenP,MøllerJM,TherkildsenFetal.IscontrastmaterialneededfortheMRIscoringofsynovitisofthehandinpatientswithrheumatoidarthritis:Asystematiccomparisonof0.23,0.6,1.5and3.0teslaMRI.AnnRheumaDis2012;71(3suppl.):299.

FonvigCE,BilleDS,ChabanovaE,NielsenT,ThomsenHS,HolmJ-C.Musclefatcontentandabdominaladiposetis-suedistributioninvestigatedbymagneticresonancespectroscopyandimaginginobesechildrenandyouths.PediatricReports.2012;4:e11.

KrabbeS,Eshed I,PedersenSJ,BøyesenP,MøllerJM,TherkildsenFRetal.BonemarrowedemaassessmentbymagneticresonanceimaginginrheumatoidarthritiswristandMCPjoints–Theimportanceoffieldstrength,coiltypeandimageresolution.ScandinavianJournalofRheumatology.Supplement.2012;41(126suppl.):27-8.

LauridsenC,LefereP,GerkeO,GryspeerdtS.Effectofatele-trainingprogrammeonradiographersintheinterpretationofCTcolonography.EurJRadiol2012;81:851-856.

LauridsenC.AComparisonoftheDiagnosticPerformanceinCTColonographyInterpretedbyExperiencedRadiologistsandTrainedRadiographers.2012.

MaerskM,BelzaA,Stødkilde-JørgensenH,RinggaardS,ChabanovaE,ThomsenHetal.Sucrose-sweetenedbever-agesincreasefatstorageintheliver,muscle,andvisceralfatdepot:a6-morandomizedinterventionstudy.AmJClinNutrition.2012;95:283-9.

MahmoodF.ElectroporationintheBrain–DevelopingMethodsforDeliveryandVerification.2012.

MatthiessenLW,JohannesenHH,HendelHW,MossT,KambyC,Gehl J.Electrochemotherapy for largecutaneousrecurrenceofbreastcancer:aphaseIIclinicaltrial.ActaOncol2012;51:713-21.

NielsenYW,ThomsenHS.Contrast-enhancedperipheralMRA:techniqueandcontrastagents.ActaRadiol2012;53:769-77.

NielsenYW,AzzouzM,ThomsenHS.Contrastmediaadministration:safetyissuesandlegalaspects.IRomanoL,PintoA,red.,Errorsinradiology.Milan.2012.s.293-302.

NielsenYWCase10507Pericardiallipoma[Online]2012URL:http://eurorad.org/eurorad/case.php?id=10507

NielsenKJ,LindRamskovK,AzzouzM,ThomsenHSSymphysispubiscyst[Online]2012URL:http://www.eurorad.org/case.php?id=10108

NielsenDL,NørgaardH,VestermarkLW,PfeifferP,JensenBK,NelausenKMetal.Intrahepaticandsystemictherapywithoxaliplatincombinedwithcapecitabineinpatientswithhepaticmetastasesfrombreastcancer.Breast.2012;21:556-61.

NørgaardHH.Kemoemboliseringaflevermetastaser.UgeskrLaeger.2012;174:784.

PoggenborgRP,EshedI,PedersenSJ,SørensenIJ,MadsenOR,MøllerJMetal.Whole-bodyMRIforassessmentofenthesitisinpsoriaticarthritis,axialspondyloarthritisandhealthysubjects-Acomparisonwith7clinicalenthesitisindices.AnnRheumaDis2012;71(Suppl.3):110.

PoggenborgRP,EshedI,PedersenSJ,SørensenIJ,MadsenOR,MøllerJMetal.Enthesitisassessedbywhole-bodyMRIinperipheralpsoriaticarthritis,axialspoldyloarthritisandhealthysubjects–Acomparisonwith7clinicalenthesitisindices.ScandJRheumatol2012;41(126suppl.):20-1.

PoggenborgRP,BøyesenP,WiellC,PedersenSJ,SørensenIJ,MadsenORetal.Afollow-upstudyapplyingdynamicMRI,conventionalMRIandclinicalmeasuresinpsoriaticarthritispatients.ScandJRheumatol2012;41(126suppl.):63-4.

PoggenborgRP,PedersenSJ,EshedI,SørensenIJ,MadsenOR,MøllerJMetal.Psoriaticarthritisandspondyloarthritis:inflammationassessedby“headtotoe”wholebodymagneticresonanceimaging—Acomparisonwithclinicaljointexami-nation.Arthritis&Rheumatism.2012;64(10suppl.):S444-5.

PoggenborgRP,BoyesenP,WiellC,PedersenSJ,SørensenIJ,MadsenORetal.Psoriaticarthritispatientsassessedbydynamiccontrast-enhancedMRIinhighdiseaseversusminimaldiseaseactivitystate-across-sectionalstudycorrelatingconventionalMRIandclinicalcompositemeasures.Arthritis&Rheumatism.2012;S451-2(2):S451-2.

PoggenborgRP,PedersenSJ,Eshed I,Sørensen IJ,MadsenOR,MøllerJMetal.Comparisonofconventionalandwholebodymagneticresonanceimagingforassessinginflammationandstructuraldamageinpsoriaticarthritisandaxialspondyloarthritis.Arthritis&Rheumatism.2012;64(10suppl.):S690-1.

PoggenborgRP,BøyesenP,WiellC,PedersenSJ,SørensenIJ,MadsenORetal.Psoriaticarthritis-afollow-upstudyapplyingdynamicMRI,conventionalMRIandclinicalmeasures.AnnRheumaDis.2012;71(3suppl.):711.

SchouJV,LarsenFO,RaschL,LinnemannD,LanghoffJ,HøgdallEetal.Inductionchemotherapywithcapecitabineandoxaliplatinfollowedbychemoradiotherapybeforetotalmesorectalexcisioninpatientswithlocallyadvancedrectalcancer.AnnOncol.2012;23(10):2627-33.

Serup-HansenE,HendelHW,JohannesenHH,OttosonW,HollensenC,PerssonGBFetal.VariationingrosstumorvolumedelineationusingCT,MRI,andFDG-PETinplanningradiotherapyofanalcancer.JClinOncol2012;30(Suppl.4).Abstract652.

SkougaardK,McCullaghMJD,NielsenD,HendelHW,JensenBV,JohannesenHH.ObservervariabilityinaphaseIItrial-assessingconsistencyinRECISTapplication.ActaOncol2012;51:774-80.

ThomsenHS,HøjgaardL,FrøkiærJ,KarstoftJ.Billeddiagnostik.IThomsenHS,DzigielMH,HellebekA,HøjgaardL,NordestgaardB,PoulsenHE,SchrøderHD,SkovbyF,WesthH,red.,BasisbogiDiagnostiskeFag.København.2012.

ThomsenHS,DziegielMH,HellebekA,HøjgaardL,NordestgaardBG,PoulsenHEetal,red.BasisbogiDiagnostiskeFag.København,2012.

ThomsenHS,KaulbergHB.MR-scanningafblærehalskirtlen[Online]2012.Undersøgelser:www.laegehaandbogen.dk

ThomsenHS,KaulbergHB,AndersenJSMRafblærehalskirtlen[Online]2012URL:https://www.sundhed.dk/borger/sygdomme-a-aa/undersoegelser/undersoegelser/mr/mr-skanning-af-blaerehalskirtlen-prostata/

ThomsenHS,BennettCL.Sixyearsafter.ActaRadiol.2012;53:827-9.

ThomsenHS,WebbJ.TheLalliandWebereffectsandtheincidenceofacutenon-renaladversereactionstocontrastmedia.ActaRadiol.2012;53:953-4.

ThomsenHS,FaberJ. Iodine-basedcontrastmediacausehyperthyroidism-another importantadversereactiontocontrastmedia?.ActaRadiol.2012;53:1079-80.

2013AxelsenMB,Eshed I,Hørslev-PetersenK,Steengaard-PedersenK,HetlandML,Møller JMetal.A treat-to-targetstrategywithmethotrexateandintra-articulartriamcinolonewithorwithoutaddedadalimumabreducessynovitis,os-teitisandtenosynovitisandhaltsstructuraldamageprogressioninearlyrheumatoidarthritis:TheOPERAmagneticresonanceimagingsub-study.Arthritis&Rheumatism.2013;65(Suppl.10):S1199.

AzzouzM,Rømsing J,ThomsenHS.Acutenon-renal adverseevents after unenhancedandenhanced computedtomographyandmagneticresonanceimaging.OJClinDiagn2013;3:85-93.

BoesenL,ThomsenHS.Dererbehandlingsmæssigekonsekvenserafmagnetiskresonans-skanningafpatientermedprostatacancer.UgeskriftforLaeger.2013jun3;175:1634-7.

Boesen L, Thomsen HS. Magnetisk resonans-skanning af patienter med prostatacancer. Ugeskr Laeger.2013;175:1630-3.

BoesenL,NørgaardN,ChabanovaE,LøgagerVB,BalslevI,MikinesKJetal.MultiparametricMRIfordetectionofprostatecancerbeforerepeatedbiopsy.ScandJUrol2013;47,51.

ChabanovaE,BilleD,ThistedE,HolmJ-C,ThomsenHS.(1)HMRSassessmentofhepaticsteatosisinoverweightchildrenandadolescents:comparisonbetween3Tandopen1TMR-systems.AbdomImaging.2013;38:315-9.

DyrbergE,ThomsenHS,MøllerJM,HendelHWCase10602Prostatecancermetastasesevaluatedby3scanningtechniques:Prostatecancermetastasesevaluatedby3scanningtechniques[Online]2013.

URL:http://www.eurorad.org/case.php?id=10602

DøhnUM,TerslevL,SzkudlarekM,HansenMS,HetlandML,HansenAetal.Detection,scoringandvolumeassess-mentofboneerosionsbyultrasonographyinrheumatoidarthritis:comparisonwithCT.AnnRheumaDis2013;72:530-4.

ElmholdtTR,OlesenA,JørgensenB,KvistS,SkovL,ThomsenHSetal.Nephrogenicsystemicfibrosisindenmark-anationwideinvestigation.PLoSOne.2013;8:e82037.

HulthM,AlbersenM,FodeM,PeetersK,RamskovKL,JoniauSetal. Idiopathicpartial thrombosisof thecorpuscavernosum:Aetiology,diagnosisandtreatment.ScandJUrol2013;47:163-168.

KiernanS,HermannKL,FlivikG,RydL,WagnerP.Theimportanceofadequatestemanteversionforrotationalstabilityincementedtotalhipreplacement:aradiostereometricstudywithten-yearfollow-up.BoneJointJ2013;95-B:23-30.

KrabbeS,BolceRJ,BraheCH,DøhnU,CruickshankS,EjbjergBJetal.Earlychangesinamulti-biomarkerdiseaseactivityscoreafterstartingadalimumabtreatmentpredictchangeinMRIinflammationat6months.Arthritis&Rheu-matism.2013;65(Suppl.10):S608-9.

MatthiessenLW,JohannesenHH,SkougaardK,GehlJ,HendelHW.Dualtimepointimagingfluorine-18flourodeoxy-glucosepositronemissiontomographyforevaluationoflargeloco-regionalrecurrencesofbreastcancertreatedwithelectrochemotherapy.RadiolOncol2013;47:358-65.

NielsenYW.Case10861Adnexaltorsion[Online]2013URL:http://www.eurorad.org/eurorad/case.php?id=10861

NielsenYW,YazdanyarN.Case10885Needlefracture-ararecomplicationtospinalanaesthesia[Online]2013

URL:http://www.eurorad.org/eurorad/case.php?id=10885

PedersenSJ,PoddubnyyD,SørensenIJ,LoftAG,HindrupJS,ThamsborgGMetal.Inflammationandstructuralpro-gressioninthesacroiliacjointsofpatientswithaxialSpatreatedwithadalimumaborplaceboasassessedbytheBerlinand theSpondyloarthritis ResearchConsortiumOfCanadaMRImethods.Arthritis &Rheumatism 2013;65(Suppl.10):S1218.

PedersenSJ,SørensenIJ,LoftAG,HindrupJS,ThamsborgGM,AsmussenKetal.Efficacyofadalimumabinpatientswithaxialspondyloarthritis:Resultsofaninvestigator-initiated12-weeksrandomizeddouble-blindplacebocontrolledtrialwitha12weeksopel-labelextensionphase.AnnRheumDis2013;72(Suppl.3):289.

PedersenLR,OlsenRH,FrederiksenM,AstrupA,ChabanovaE,HasbakPetal.Copenhagenstudyofoverweightpa-tientswithcoronaryarterydiseaseundergoinglowenergydietorintervaltraining:therandomizedCUT-ITtrialprotocol.BMCCardiovascularDisorders2013;13:106.

PoggenborgR,BirdP,BoonenA,WiellC,PedersenSJ,SørensenIJetal.Patternofboneerosionandboneprolif-eration inpsoriaticarthritishands:ahigh-resolutioncomputed tomographyand radiography follow-upstudyduringadalimumabtherapy.ScandinavianJournalofRheumatology.2013dec19.

PoggenborgRP.AssessmentofinflammationandstructuraldamageinpsoriaticarthritisbymodernMRIandCTmeth-ods.2013.

SommerUlriksenP,NicoleTalibiMCase10666:Small-bowellobstructionsecondarytocapsuleendoscopyretentioninapatientwithCrohn’sdisease[Online]2013URL:http://eurorad.org/eurorad/case.php?id=10666

ThomsenHS,NielsenYW.ContrastMediainComputedTomographyImaging.InSabaL;SuriJS(eds.)Multi-DetectorCTImagingHandbook.BocaRaton:CRCPressLLC2013.s.69-81.

ThomsenHS,MorcosSK,AlménT,BellinM-F,BertolottoM,BongartzGetal.Nephrogenicsystemicfibrosisandgad-olinium-basedcontrastmedia:updatedESURContrastMediumSafetyCommitteeguidelines.Eurradiol2013;23:307-18.

ThomsenHS.Non-renaladversereactionstocontrastmedia:separatingfactfrommyth.ActaRadiol2013;54:835-6.

ThomsenHS.Forwhom?.ActaRadiol2013;54:473-475.

WebbJA,ThomsenHS.Gadoliniumcontrastmediaduringpregnancyandlactation.ActaRadiol2013;54:599-600.

WiellC,SzkudlarekM,HasselquistM,MøllerJM,NørregaardJ,TerslevLetal.PowerDopplerultrasonographyofpainfulAchilles tendons and entheses in patientswith andwithout spondyloarthropathy-a comparisonwith clinicalexaminationandcontrast-enhancedMRI.ClinRheumatol2013;32:301-8.

YazdanyarN,NielsenYW.Case11250 Inferior venacava rupture [Online]2013URL:http://www.eurorad.org/case.php?id=11250

YazdanyarN,NielsenYW.Case11413Rupturedinternaliliacarteryaneurysm[Online]2013URL:http://www.eurorad.org/case.php?id=11413

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