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Personal development plans (PDPs) have been a requirement for NHS hospital staff, Foundation Training and Dental Core Training for some years; however, the General Dental Council (GDC) are changing continuing professional development (CPD) requirements in 2018 (enhanced CPD) making a PDP a requirement for all members of the dental team. A PDP consists of objectives for targeting CPD most relevant to your practice or intended practice to undertake over a defined period to maximise the improvement of your professional development. The aim of this article is to explain how to prepare a PDP ahead of the requirement to utilise its benefits in training and performance for the dental team. This article references a template for all members of the dental team to record their PDP.

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RATIONALE AND OBJECTIVES: This study was conducted to determine whether significant reduction in radiation dose (250 mAs-->50 mAs), in chest computed tomography (CT) using volume acquisition affects image quality or the detectability of pathologic findings in the lung and mediastinum. METHODS: Phantom studies were conducted to evaluate resolution and noise level, then a patient study was then done. Fifty consecutive patients (10 normal and 40 abnormal) cases were examined. After a scan (250 mAs, 120OkVp) of the entire thorax, five additional slices (50 mAs, 120kVp) at the level of the abnormality were obtained. Three independent observers evaluated the visibility of normal lung and mediastinal structures, as well as image noise. The mean score was compared between the standard and low doses. In a second study, an independent evaluation of the presence or absence of pathologic findings was made by four observers. RESULTS: Lucite phantom studies demonstrated diminished low-contrast resolution and increased noise level for the low-dose technique. Observers assessed more noise in the low-dose images (P < 0.001). The normal structures were judged to be more visible with standard dose (P < 0.01), but the magnitude of the judged differences was small especially in the lung. No differences were found in the detection of lung and mediastinal abnormalities (P > 0.10). CONCLUSIONS: The low-dose technique was effective in demonstrating pathologic findings for the lung and mediastinum. Low-dose spiral CT should be considered as a viable alternative to standard-dose spiral CT.

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PURPOSE: To evaluate the accuracy of CT angiography of occlusive disease of the carotid arteries using three-dimensional surface-rendered images alone and in conjunction with display of axial source images. METHODS: Forty-eight symptomatic patients had conventional angiography followed by CT angiography within 24 hours. Images of 96 carotid arteries were acquired using contrast-enhanced spiral CT. Image postprocessing was performed on a free-standing workstation to produce 3-D shaded surface display (SSD) images. Two readers independently evaluated the CT angiographic (SSD) images and then reevaluated each case while simultaneously reviewing the SSD and axial source images. Digital subtraction angiograms were evaluated in a separate session and eventually compared with CT angiograms. All evaluations were performed under blinded conditions to control for reader bias. RESULTS: SSD images alone underestimated stenosis relative to angiograms whereas combined SSD and axial images did not. CONCLUSION: SSD angiograms in conjunction with the source images are better than SSD images alone in estimating the degree of stenosis in carotid artery disease.

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A model that derives multiple-observer decision strategy ROC curves for boolean decision rules applied to binary decisions of two or three observers is presented. It is assumed that covert decision variables consistent with ROC models of observer performance underlie decisions and that readers' decision criteria are in a fixed relationship. The specific parameters of individual ROC curves and the correlational structure that describes interobserver agreement have dramatic effects upon the relative benefits to be derived from different boolean strategies. A common strategy employed in clinical practice, in which the overall decision is positive if any observer makes a positive decision, is most effective when the readers are of similar ability, when they adopt similar decision criteria, when interreader agreement is greater for negative than for positive cases, and when the individual ROC slope is <<1.0. Different multiple-observer decision strategies can be evaluated using the model equations. A bootstrap method for testing model-associated hypotheses is described.

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PURPOSE: To produce cerebral venograms with thin-section helical computed tomography (CT) and to assess their diagnostic utility. MATERIALS AND METHODS: Thirty-six CT venograms were obtained in 33 patients after intravenous administration of iodinated contrast material. Eighteen patients had suspected dural sinus thrombosis. Twelve patients had tumor adjacent to a major venous structure. Three patients underwent CT venography during CT angiography. RESULTS: Superior sagittal, transverse, and straight sinuses were identified on every CT venogram. Other veins were seen with high frequency. Dural sinus thrombosis was diagnosed in seven patients, with magnetic resonance (MR) venographic correlation in five patients. CT venograms were easier to interpret and had fewer artifacts than MR venograms. Relationships of tumor to adjacent cerebral venous structures were well shown on CT venograms. CONCLUSION: CT venography yields detailed images of the intracranial venous circulation with consistently high quality. It is a rapid, useful method for diagnosis of dural sinus thrombosis and for preoperative mapping of venous structures in patients with neoplasm.

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PURPOSE: To determine the usefulness of CT angiography in the setting of suspected acute subarachnoid hemorrhage or intracranial aneurysm. METHODS: We prospectively studied 68 patients suspected of having subarachnoid hemorrhage or an intracranial aneurysm with noncontrast CT of the head followed immediately by contrast-enhanced helical CT of the circle of Willis with three-dimensional reconstruction. Twenty-seven patients with CT findings positive for subarachnoid hemorrhage or intracranial aneurysm were evaluated with digital subtraction angiography or MR angiography within 12 hours of CT angiography. Patients with negative CT/CT angiography findings were followed up with lumbar puncture. RESULTS: CT angiography showed 23 of 24 aneurysms and 2 of 2 arteriovenous malformations (sensitivity, 96%; specificity, 100%). Aneurysm size ranged from 2 to 40 mm (mean, 7.9 mm). Interobserver variability was 10%. In the 23 cases of subarachnoid hemorrhage, cisternal blood did not limit the three-dimensional reconstruction. Two patients with aneurysms on CT angiography had normal noncontrast scans. CONCLUSIONS: CT angiography of the circle of Willis is a useful technique for evaluation of suspected acute subarachnoid hemorrhage and intracranial aneurysm. It provides anatomic display of intracranial aneurysms, allowing for planning of conventional angiography and surgical approach. In selected cases, CT angiography may eliminate the need for preoperative conventional angiography.

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RATIONALE AND OBJECTIVES: We determined whether computed radiographs in an adult intensive care unit produce greater agreement between readers in descriptions of radiologic findings and interval changes. METHODS: Fifty-six conventional radiographs and 56 computed radiographs were obtained on 28 patients. Computed and conventional radiographs were imaged simultaneously in a single exposure with the use of a sandwich cassette. The two sets of films per patient were taken less than 1 week apart. RESULTS: Four readers evaluated the chest films and judged interval changes with the use of standardized confidence scales. Overall exposure and film quality also were evaluated. Computed radiographs were rated better in overall quality. Tubes and lines were detected with comparable accuracy. Interobserver agreement in the evaluation of radiologic descriptors was generally greater with computed radiographs (intraclass correlation). No differences were noted in interobserver agreement in the judgment of interval changes. CONCLUSIONS: The diagnostic usefulness of computed radiography is comparable to conventional films in the intensive care unit. The higher interobserver agreement rate for radiologic descriptors with computed radiography is an added advantage of the system.

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OBJECTIVE: The purpose of this investigation was to assess the utility of allowing free adjustment of window width and level in comparison with the use of a fixed lung window in the CT evaluation of diffuse lung disease. MATERIALS AND METHODS: Six radiologists each judged 36 cases (28 diffuse lung disease and 8 normal) using a standardized form. In half of the sessions, images were viewed in a fixed lung window (level = -500 HU; width = 2,000 HU). In the other sessions, the observer was able to adjust the window and level freely while viewing the images. Each case was seen twice in separate sessions: once in a fixed lung window and once with window width and level adjusted by the reader. A variety of diagnostic features were evaluated using a 5 point scale. These included visibility of fine lung structures, abnormalities of the lung parenchyma, and overall evaluation of the lung. RESULTS: The visibility of lung structures was not improved with adjustable window settings. Receiver operating characteristic (ROC) analysis showed fixed windows to be superior to adjustable windows for overall evaluation of the cases [fixed A(z) = 0.90, adjustable A(z) = 0.84, p < 0.05, jackknife method]. Time to rate each case was increased by 15% with window width and level adjustment. CONCLUSION: Free adjustment of window width and level produced no improvement in reader performance over that achieved with fixed window width and level.

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Emergency physicians can expect to see more patients with malignancies. Some of these malignancies can lead to life-threatening emergencies, and the emergency physician must suspect and be able to recognize these problems.

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Three methods of breathing retraining (guided breathing retraining, guided breathing retraining with physiologic monitoring of thoracic and abdominal movement plus peripheral temperature, and guided breathing retraining with physiologic monitoring of thoracic and abdominal movement, peripheral temperature and end-tidal carbon dioxide) were compared with a no-treatment control group to determine the effectiveness of breathing retraining on modifying respiratory physiology and reducing functional cardiac symptoms in subjects with signs associated with hyperventilation syndrome. Of 41 subjects studied, 16 were diagnosed with mitral valve prolapse. Results demonstrated that all 3 methods of breathing retraining were equally effective in modifying respiratory physiology and reducing the frequency of functional cardiac symptoms. Results determined that respiratory rate and subject's perception that training had generalized were the best predictors of treatment success. Furthermore, it was found that subjects with mitral valve prolapse responded as well to treatment as did those without prolapse.

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A case of profound digital vasoconstriction caused by the accidental injection of epinephrine from a commercial bee sting kit is reported. One hour later the patient had a cold, painful, blanched finger. A digital block using a 2-mg dose of phentolamine mixed with 2% lidocaine was performed. Thirty minutes after treatment, the finger was pink and warm. The patient reported a marked decrease in pain. Reexamination 12 hours later showed only mild tenderness at the fingertip. No tissue necrosis occurred. One month after injection, there were no apparent sequelae. Although the use of alpha-adrenergic blocking agents by regional infiltration to treat accidental infusion or extravasation of epinephrine has been suggested, no reports of this technique are found in the emergency medicine literature. The mechanism of digital vasoconstriction and the action of phentolamine are discussed.

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The infrared interferometer spectrometer on Voyager 2 obtained thermal emission spectra of Neptune with a spectral resolution of 4.3 cm(-1). Measurements of reflected solar radiation were also obtained with a broadband radiometer sensitive in the visible and near infrared. Analysis of the strong C(2)H(2) emission feature at 729 cm(-1) suggests an acetylene mole fraction in the range between 9 x 10(-8) and 9 x 10(-7). Vertical temperature profiles were derived between 30 and 1000 millibars at 70 degrees and 42 degrees S and 30 degrees N. Temperature maps of the planet between 80 degrees S and 30 degrees N were obtained for two atmospheric layers, one in the lower stratosphere between 30 and 120 millibars and the other in the troposphere between 300 and 1000 millibars. Zonal mean temperatures obtained from these maps and from latitude scans indicate a relatively warm pole and equator with cooler mid-latitudes. This is qualitatively similar to the behavior found on Uranus even though the obliquities and internal heat fluxes of the two planets are markedly different. Comparison of winds derived from images with the vertical wind shear calculated from the temperature field indicates a general decay of wind speed with height, a phenomenon also observed on the other three giant planets. Strong, wavelike longitudinal thermal structure is found, some of which appears to be associated with the Great Dark Spot. An intense, localizd cold region is seen in the lower stratosphere, which does not appear to be correlated with any visible feature. A preliminary estimate of the effective temperature of the planet yields a value of 59.3 +/- 1.0 kelvins. Measurements of Triton provide an estimate of the daytime surface temperature of 38(+3)(-4) kelvins.

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An atlas of high resolution infrared emission spectra identifies a number of gaseous atmospheric features significant to stratospheric chemistry in the 770-900- and 1100-1360-cm(-1) regions at six zenith angles from 86.7 to 95.1 degrees . A balloon-borne Michelson interferometer was flown to obtain ~0.03-cm(-1) resolution spectra. Two 10-cm-1 extracts are presented here.

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The IR limb emission of the lower stratosphere has been measured using a balloon-borne liquid nitrogencooled Michelson interferometer with liquid helium-cooled Si:Ga detectors. Portions of the thermal emission spectrum have been recorded between 650 and 2000 cm(-1) with an unapodized spectral resolution of 0.03 cm(-1). This is the highest spectral resolution limb emission thus far obtained. A preliminary description is given of these data along with a discussion of the significant features. Species identified to date include CO(2), O(3), CFCl(3), CF(2)Cl(2), H(2)O, CH(4), HNO(3), N(2)O, NO(2), and ClONO(2). A tentative identification is made for NO, representing the first direct spectroscopic detection of NO in emission.