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Preparation of patient prior to application intravenous of contrast medium in relation to the prevention of renal failure
PUCHOLTOVÁ, Lenka
The topic of the bachelor thesis is the patient preparation prior to intravenous contrast in relation to the prevention of renal failure. The theoretical part deals with the anatomy and physiology of the kidney, provides information about the contrast media of their properties, uses and side effects. At the end of the theoretical part describes the contrast medium-induced nephropathy. In the practical part I focused on finding out what is the incidence of contrast nephropathy in individuals with normal creatinine levels depending on the amount of contrast agent and the preparation of the patient. I obtained the data from the hospital information system Masaryk Hospital Townsville. The database contained a set of hospitalized patients in the years 2009 - 2011, which were performed CT examinations associated with the administration of iodinated contrast media. Part of the personal data of patients, the tests used, the type and amount of contrast agent and creatinine values. Since creatinine values were available for all patients, the final database was created from 938 patients with baseline of normal creatinine levels before the examination for which they may be level <than 130 mmol/l. The final group of patients was analyzed according to the defined aims and statistically processed. Hypothesis of this study: the incidence of contrast nephropathy in individuals with normal creatinine levels depending on the amount of contrast agent as a suitable preparation of patients prior to administration of iodinated contrast material does not exceed 10% - was confirmed. In the investigated group of patients was proved preventive effect of patient preparation before the test - hydration. A higher incidence of CN was observed in the group of patients whose preparation has taken place.
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CT angiography vs. ultrasound imaging of the bloodstream - efectivity, limitation and impact on patients' health.
ADAMEC, Jaroslav
The subject of the BA thesis is "CT angiography vs. ultrasound imaging of the bloodstream - efectivity, limitation and impact on patients' health". Examination of blood vessels by computed tomography - CT angiography, using modern equipment and technological development, takes over the diagnostics of vascular diseases from digital subtraction angiography primarily due to the speed of the examination and the lesser invasiveness with regard to the patient. The second method treated in this thesis is ultrasonography. Which of these imaging methods yields better diagnostic information on blood vessel pathologies? Which entails fewer risks to the patient and which is more limited? I have tried to find the answers to these questions in this BA thesis. In this thesis I set out to find which of the two imaging modalities is more suitable for examining vascular diseases. A further aim of the thesis is to introduce and compare various examination methods of computed tomography and ultrasonography. The hypothesis of the BA thesis states: "Ultrasonography is a more suitable method for the examination of the blood vessel tree - it is a method which provides good diagnostic information and at the same time entails a lower risk to the patient than does computed tomography". The introductory part of the thesis is devoted to the anatomy of the blood vessel tree. It describes main blood vessels, veins, their construction and branches. This part also introduces the technological equipment which is used for the examination of the blood vessel tree - computed tomography machine, ultrasonography machine - and their historical development. The basic physical principles of these devices, their methods of imaging and general methods of the examination of the blood vessel tree are also described in this chapter. In the case of computed tomography it is CT angiography, and in ultrasonography it is Doppler examination. The chapter also briefly deals with the advantages and disadvantages of these methods and with the contrast media which are applied in connection with the examination of the vascular system. I have studied all available specialized literature and web sites related to the subject for the purpose of writing this BA thesis. Data from the Institute of Health Information and Statistics were used for the analysis of the technological equipment. Data from the information network of the R+S Benešov a.s. hospital were used for the analysis of the number of blood vessel examinations carried out by ultrasonography and computed tomography. Examination methods of the vascular system performed by computed tomography and ultrasonography have been summarized in the result. Furthermore, both modalities are compared in this chapter with regard to their utilization rate, limitations and risks. The chapter also includes an analysis of the data on the computed tomography and ultrasonography technology in the Czech Republic and on the number of blood vessel examinations carried out by computed tomography and ultrasonography. In the chapter "Discussion" I present my own opinion on the given matter. It also includes a reflection on the issue of indicating examinations on computed tomography. In the conclusion of the thesis, examination methods of the vascular system by computed tomography and ultrasonography are assessed, and established findings on the studied matter are summed up. After studying all available specialized literature I have found that it is impossible to determine which of the two imaging methods is more suitable for the examination of the blood vessel tree because each of them has its specific advantages and disadvantages. The two modalities are thus not opposed to each other in the decision making which method should be indicated; on the contrary, the two methods should be used in close collaboration. The hypothesis of the thesis therefore has not been proved.
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The comparison of imaging methods in diagnosis of renal artery diseases
PAVLIŠOVÁ, Ivana
The present brings much information on development and course of various health disorders, including those of renal arteries. These disorders may be in the majority of cases both the cause and effect of serious diseases. The disorders of renal arteries represent risks to the patients undergoing their diagnostics. With development of technical and testing procedures, and with acquiring of new experience, the new, ionizing-radiation-free methods become more available. My bachelor's thesis maps the available methods carried out at the Department of Imaging Methods in the Motol University Hospital. The thesis describes the methods applying imaging by ionizing radiation (digital substraction angiography and computer tomography), as well as the methods using other physical principles for imaging, i.e. magnetic resonance and ultrasonic diagnostics. The thesis explores the algorithm of testing according to the indications and contraindications to the specific examination, and according to the age and sex of the patient. I have pointed out both advantages and disadvantages of the individual methods that might influence the expected results of examination. I concentrated on the contemporary situation of magnetic resonance in the diagnostics of renal arteries, which is gradually replacing the digital substraction angiography. The hypothesis consists of the role of the magnetic resonance in diagnostics of renal arteries, which is minimally limited by contraindications. The description of diagnostic procedures is based on medical literature and specialized sources. The information on the patients' examination has been drawn from the UNIS hospital information system in the Motol University Hospital. The conclusions shall serve as the basis for the internal methodical approach in diagnostics of the disorders of renal arteries.
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Rotational angiography
JAŠAROVÁ, Eva
Digital Subtraction Angiography (DSA) is a special X-ray examination of the blood vessel system. Despite the development of other visual techniques it has not lost its importance so far. In the 1960s and 1970s it developed itself into the most detailed method of visualization of the blood-vessel system. DSA requires much more expensive device and equipment with tools than only ten years ago. The price is equal to the quality and amount of information. DSA further remains the invasive method. One or two-projection system for acquiring the complete picture of blood vessels is the most used technique of record in angiography. Common methodologies require two applications of the contrast medium for the same part of the body. Rotation angiography is a special modern technique for three-dimensional visualization of arteries. It is mainly used for visualization of neck or brain arteries. Its principle is in the application of the contrast medium into the artery, when the examined area is X-rayed and C-arm is continuously turned by 180°. The final angiography can be assessed that we turn the picture step by step. If we display the same area once more without the application of the contrast medium, we get a mask for DSA and both sequences we can subtract. Only one artery is displayed as well as during classic DSA.
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Comparsion of the Classical Catheter Angiography and CTAG; the Benefits and Deficiencies of Both Methods, including Radiation Load
BLAHNÍKOVÁ, Kateřina
The title of this Bachelor{\crq}s Thesis is Comparison of the Classical Catheter Angiography and CTAG; the Benefits and Deficiencies of Both Methods, including Radiation Load. I carried out the comparison in the area of positives and negatives of these methods, related risks and mainly in the area of patient radiation load, which is the subject of the research. The first part deals with brief characteristics of anatomy and vascular system physiology, introduction to both methods, including a chapter dedicated to contrast media and a brief description of radiation protection. When defining the benefits, deficiencies and potential risks I came to a conclusion that there cannot be unequivocally recommended just one method, for both methods provide different advantages and therefore the final decision must be made by the doctor. To assess patient radiation load I used data from 1 July 2008 to 30 June 2009 of patients, who underwent an examination of brain blood vessels in České Budějovice Hospital. To carry out the comparison it was necessary to convert the results into an effective dose. In case of CTAG I made the calculation using a literature available coefficient. For classical catheter angiography I used the version 1.5 PCXMC program. Due to a lack of data (e.g. the angle of a primary beam incidence) the calculation made was only approximate. To find out the occurred error I used data of patients examined from 8 March to 23 March 2010. The consequent statistical data assessment showed that the CTAG method represents bigger radiation exposure for human organism than classical catheter angiography, which proved the hypothesis. In connection with the lack of data regarding the carried out classical catheter angiography I would consider keeping a larger amount of data beneficial for potential calculation of an effective dose. All data required for an accurate calculation of an effective dose can currently be obtained only during the examination.
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The specific approach to diagnostic imaging methods in patients with diabetes mellitus
KLIMEŠOVÁ, Jitka
Diabetes mellitus occurs as a result of absolute or relative lack of insulin. It is a chronic disease which can lead to damage of other systems and organs. Number of patients with diabetes mellitus undergoing medical examinations or interventional therapy by the diagnostic imaging methods has been increasing. It brings higher demand on technical parameters of the methods and more exact work of medical staff. Examinations connected with administering contrast media can cause many complications to these patients and the routine examination can be changed into the dangerous one. The position of a radiological assistant has become more responsible. The aim of this Bachelor´s work was to outline diagnostic options while examining patients with diabetes mellitus and consider using diagnostic imaging methods as the administration of diagnostic contrast media can be risky for the patients. Twenty six per cent (236 patients) out of 918 patients with diabetes mellitus type 1 or type 2 who visited the Diabetological Centre and the Department of Radiology of the Hospital in České Budějovice were examined by some of the diagnostic imaging methods. Adult diabetic patients underwent these radiological examinations: 188 skiagraphies of lungs, 119 skiagraphies of skeletons and 18 examinations under skiascopic control. Forty-four patients were examined by the sonography, 10 by the mammography, 110 by the computed tomography, 9 by the magnetic resonance and 10 patients by the angiography. Most diabetic patients were examined by common skiagraphy of arms and legs, sculls, vertebral columns due to injuries, fractures and degenerative changes. Skiagraphies of heart and lungs were indicated before and after operations or they preceded applying an insulin pump. The other numerous group was made up by patients with tumours. They were mostly examined by computed tomography. Fifty-seven patients developed complications caused by diabetes. The examinations of carotid arteries, cerebral arteries, arteries and varicose veins in the legs were carried out by sonography, computed tomography and magnetic resonance. In six cases diagnostic angiography was followed by percutaneous transluminal angioplasty. The use of contrast media in 64 patients was also considered. In all cases non-ionic contrast media of low or medium osmolarity in the volume of 80 {--} 125 ml were used. The findings compared with those presented in literature proved the hypothesis that radiological assistant work requires a specific approach towards the diabetic patients.
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Optimization of the amount of iodine contrast agent (ICU) in CT scan examinations on a multislice CT scanner (64-detector row)
KRAJÍČEK, Ondřej
In my work, I focused on the optimization of the amount of iodine contrast agent during CT scan examinations by comparing various amounts of the contrast agent per kilogram of a patient{\crq}s body weight. I compared three groups of weight amounts: 1 mL/kg vs. 1.25 mL/kg vs. 1.5 mL/kg. I measured the differences in the enhancement of organs and blood vessels of the abdominal cavity. Their enhancement levels were compared quantitatively in the areas of interest by determining Hounsfield units in the aorta and parenchyma of the abdominal organs, and qualitatively by using an independent evaluation by a radiologist. Measurements were made on the GE Lightspeed 64-detector row CT scanner with pressure injector. No parameters were changed during the entire study, enabling the maintenance of standard conditions for high-quality comparisons in all examinations. Patients with any significant lesion in the organ to be measured were excluded from the study measurements, and patients at risk of circulation disorder (patients with severe conditions, such as heart failure, shock, and others) were also not enrolled. A contrast agent with a constant amount of iodine amounting to 300 mg/mL was used for the measurements. The study population comprised 120 patients, of which 51 were women and 69 men. The following data were recorded for each measurement: examination number, age, sex, body weight, HU values, and radiologist{\crq}s evaluation. The data were recorded in tables and further analyzed. Various HU enhancement levels were compared and evaluated and subsequently correlated with the radiologist{\crq}s evaluation. Optimal values of the amount of contrast agent were also compared with those routinely used at the facility concerned. This work provided optimal values of the amount of contrast agent for the examination of abdominal organs and adjusted standards for a CT scan facility. I believe my bachelor{\crq}s thesis contributed to a more precise dosing of the contrast agent during CT scan examinations.
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Disturbing artifacts of radiodiagnostic modalities
ŠEDA, Miroslav
This work gives information on machines used for diagnostic imaging aimed to disturbing scan artefacts of chosen device (CT, MR, USG). Radiology assistant work still more depends on technique which helps in examination. The machines used for clients´ examination are thanks to IT development still more complicated. They allow high-quality and precious images, give more possibilities of treatment ways, save the client. Operating this technique is the domain of radiology assistants. Development without restrain leads to period when operating staff will work more independently. It is necessary for the radiology assistant to manage all steps in examinations which are undergone. He has to keep radiation protection and the quality of the image result as well. The result of most diagnostic examination in radiology department is image information. Image results can be from various reasons changed or deformed in comparison with the reality. Such distorted images can lead up to mistaken or late diagnosis by the physician. Radiology assistant is the first specialist who must be able to judge whether the examination has been done correctly or to warn the physician of possible variation or image deformation. Moderation or suppression of artefacts in image results in examination is easy in some cases. Then it is enough to explain the process of examination to the client and to emphasize how important is to cooperate with the staff. In some cases is technically impossible to impact the manifestation of artefacts as it results from the principle of examination method, or because of high financial costs unbearable for the health institute. In my work I aimed to image artefacts of machines (CT, MR, USG) which can be met in common clinical practice. I tried to document these image artefacts in common running. Part of my work is to describe the causes of artefacts appearance and the way how to avoid or remove their manifestation.
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Diagnosis and endovascular treatment of iliac and femoropopliteal occlusive disease
PĚČKOVÁ, Kristýna
The occlusion disorder in the area pelvic and femoral arteries should be for the patient fatal health complication. Therefore it is important know all risks, which should go before, know the disorder and last but not least is a crucial chapter diagnostics and in final phase treatment. I chose this subject, with the view of give to pertinent readers all above - mentioned information on those problems. For diagnostics of occlusion disorder we use imaging radiodiagnostic methods. For spatial display were developed method of spiral CT angiography ( CTA ), magnetic resonance angiography ( MRA ), a modification of classical angiography {--} digital subtraction angiography ( DSA ) and ultrasonografi (UZ). UZ is part of the basic investigate method of his noninvazive. Spiral CTA is method, which is based on two and three dimensional display using special programmes. Display magnetic resonance is noninvasive examination procedure and is derived from classical nuclear MR. MRA is once from possible examination practice which serves complex information on relation surrounding weaving to vessels and haemodynamic blood flow. DSA allows observation of flow vessels and by the help of digitizing image its graphical processing. Medication of okluziv disorder areas saucepan s and femur s arterys including percutaneous transluminal angioplasty ( PTA ) and implantation stent.
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