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OBJECTIVES: Diagnostic reference levels (DRLs) are crucial tools for optimizing radiation exposure during different radiological examinations. This study aimed to establish preliminary DRLs for commonly performed computed tomographic angiography (CTA) examinations in Saudi Arabia. METHODS: Data for three types of CTA examinations (cerebral, pulmonary, and lower-extremity) were collected from six medical cities across Saudi Arabia. Data sets related to 723 CTAs with a mean patient weight of 75 kg were analysed in detail. The DRL values were determined based on the 75th, median, and 25th CT dose index volume (CTDIvol) and dose length product (DLP) values. RESULTS: The established DRLs were 1221 mGy cm for cerebral CTAs, 475 mGy cm for pulmonary CTAs, and 1040 mGy cm for lower-extremity CTAs. These values were comparable to those reported in other studies. CONCLUSIONS: This study provides preliminary DRLs for three common CTA procedures in Saudi Arabia. The widespread implementation of a low kVp and a high level of image reconstruction (IR) presents an opportunity for further dose reduction. These findings can serve as a foundation for future nationwide DRL surveys and the optimization of CTA imaging protocols in Saudi Arabia.

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Purpose: This study primarily aimed to evaluate the effectiveness of computational data management and analytical software for establishing departmental diagnostic reference levels (DRLs) for computed tomography (CT) scanning in clinical settings, and monitor achievable doses (ADs) for CT imaging, particularly during the coronavirus disease 2019 (COVID-19) era. Secondarily, it aimed to correlate these standards with national and international benchmarks. Patients and Methods: This ambidirectional cohort study enrolled 4668 patients (6419 CT-based examinations) who visited King Fahd Hospital of the University from May 25, 2021, to November 4, 2021. Participants' demographic data were acquired from their electronic medical charts, in addition to all corresponding CT-dose determinant parameters. The study was divided into two phases (pre- and post-data management) based on the implementation of digital data management software. Results: In both phases of the study, the size-specific dose estimate (SSDE) was the most significant confounder of dose determination compared to the dose-length product (DLP) and computed tomography dose index (CTDI) (P = 0.003). The head was the most frequently imaged body region (pre-implementation, 1051 examinations [35.1%]; post-implementation, 1071 examinations [31.3%]; P = 0.001), followed by the abdominal region (pre-implementation, 616 examinations [20.6%]; post-implementation, 256 examinations [7.48%]; P = 0.001). Based on the SSDE, DLP, and volume CTDI, the average per-section radiation exposure among organ-based scanning type was highest for the lumbar spine during the pre- and post-implementation periods. Conclusion: Data management software enabled the establishment of DRLs and reduction of ADs in CT examinations, which consequently improved key performance indicators, despite the ergonomic complexities of COVID-19. Institutions are encouraged to apply DRLs and ADs via automatic systems that monitor patient dose indices to evaluate aggregate results.

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Introduction: Radiation protection for pediatric patients is the main concern in pediatric computed tomography (CT) due to their sensitive organs, such as the brain and the thyroid glands. Accordingly, an optimization of pediatric CT practices is vital to minimize the radiation dose for this population. Aim: To assess the pediatric CT practices of radiologists and technologists in a CT unit. Materials and Methods: The study was conducted among 26 hospitals, located in various regions in Saudi Arabia. A total of 200 hard copies of the questionnaire were distributed manually and were collected for analysis. In total, 117 completed surveys were gathered from technologies, while 49 were gathered from radiologists. Results: In the case of infants with hydrocephalus, 65% of the radiologists ordered an ultrasound (US), 24% ordered a head CT scan, and 10% ordered a magnetic resonance imaging (MRI) and general X-ray for diagnosis. For pediatric patients complaining of persistent headache, 59% and 27% of the radiologists recommended CT and MRI, respectively, for diagnosis. Conclusion: Most of the radiologists utilize CT head scan to diagnose persistent headache (by 59%) and ventriculoperitoneal shunt (VPS) malfunction (by 41%) in pediatric patients compared with the other modalities. The use of CT can increase the risk of later malignancy among pediatric patients due to radiation exposure. Alternative imaging modalities such as US and MRI (non-ionized radiation) should be considered to reduce the ionizing radiation hazards and optimize the current practices of radiologists. Most of the technologists follow radiation protection protocols in this study as 63% of the technologists used lead apron for pediatric patient's protection. Radiation awareness training for the technologists could improve the knowledge about the benefits of using lead apron and reduce the radiation risks in pediatric patients.

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BACKGROUND: The novel corona virus disease, also known as COVID-19, has emerged as a major health concern globally. Its association with comorbid condition has increased its mortality. Diabetes mellitus (DM) is associated with increased risk of infection in comparison to general population. This risk is higher in type 1 DM that type 2 DM. METHODS: A cross sectional study was done in T1DM patients in whom a structured questionnaire was administered after lockdown. Data regarding social demographical variables, Information regarding sugar levels, psychological effects, changes in weight, exercise habits and other variables were included in the validated, electronic questionnaire. Ethic approval was obtained from the Diabetic center Abha, study duration was from January-2020 to October-2020. RESULTS: Out of 143 total patients (46.9%) were males while 53.1% were females. Mean ± S.D of age was obtained 29.6 ± 1.8. [Figure 1] depicted that 23% of the respondents were effected psychologically. [Figure 2] depicted that 80.4% used insulin as a treatment. [Figure 3] depicted that 8% of the respondents make an emergency visit to the health care centers for high rise in diabetes during lockdown. CONCLUSION: COVID-19 and the lockdown affected the management of T1DM. It resulted in changes in lifestyle, compliance to medication, and psychological impact on the participant.

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OBJECTIVE: Proprioception is very important for the integrity and stability of the knee joint. Patients with anterior cruciate ligament (ACL) tear have a decline in proprioceptive functions of the injured knee. However, improvement of proprioceptive functions of the knee after ACL reconstruction is a subject of considerable debate. This study was conducted to evaluate the results of a simple clinical proprioception test developed by the author in patients with ACL reconstructed knees. METHODS: This study was conducted in King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, from January 1996 to June 2002. The proprioceptive function of the knee joint was studied in a group of ACL reconstructed patients (n=22) and compared them with a group of ACL deficient patients (n=32) and a group of healthy controls (n=30). Proprioception was evaluated based on the performance in a simple clinical test. RESULTS: There was a significant difference in proprioceptive functions between the ACL deficient knees and the ACL reconstructed group (p<0.05), but there was no significant difference between the ACL reconstructed and the normal control group (p>0.05). CONCLUSION: These findings indicate that proprioceptive deficits in ACL deficient knees, as measured clinically using the described test, might improve after ACL reconstruction.

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Catheter-related nosocomial urinary tract infection in postoperative orthopedic and trauma patients was studied prospectively using nitrofuroxone-impregnated urinary catheters (study group) and regular silicone-coated Foley catheters. Fifty adults in each group were randomly assigned. In Group A, antibiotic-impregnated catheters were used, and in the other, non-antibiotic-impregnated urinary catheters were used (Group B). The variables studied were age, sex, type of surgery, duration of surgery, number of catheter days, days of intravenous line, and hospital days. In patients, urinary tract infection (UTI) was diagnosed by culture and the organism was isolated. The average age in the study group was 43.90 years (range, 14-95 years) compared with the control group (mean age, 42.22 years; range, 14-102 years). Catheter days in the nitrofuroxone-impregnated catheters was 7.9 days (range, 2-37 days) versus 7.2 days (range, 2-30 days). The intravenous line in the group was 9.16 days (range, 2-35 days) versus 8.8 days (2-22 days). There were six infections (P = 0.028) in the control group compared with the study group. The length of operation was similar in each group. Our study indicates that nitrofuroxone-impregnated catheters have the potential to reduce nosocomial catheter-related UTIs in postoperative orthopedic and trauma patients.

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Thirty-two meniscal tears in 32 patients were repaired using biodegradable meniscus arrows. The tears were fixed arthroscopically using an all-inside technique. Ten patients had a simultaneous anterior cruciate ligament (ACL) reconstruction. The period of follow-up was an average of 25 (10-40) months. Twenty-six patients were clinically stable and asymptomatic at follow-up. Six patients were considered clinically unstable and all had associated ACL reconstruction and required a repeat arthroscopy. Two meniscal repairs failed to heal, and the broken meniscus arrow was retrieved arthroscopically 6 months after the primary operation. In four cases the meniscal tear healed completely (two cases) or partially. Otherwise, there were no objective signs of complications. The use of meniscus arrows is a simple, safe, and reliable method for repair of properly selected meniscal tears.

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