Prospective Research Projects
Radiographers role in population safeguarding: Non-accidental injury (NAI) / Suspected physical injury (SPI)
Bo Mussmann, Research Radiographer, Post Doc, PhD
Radiographers often work with members of society most vulnerable to experiencing physical abuse, and as such, require the knowledge and skills to identify and escalate any concerns relating to (physical) abuse.
Physical abuse is rarely seen in isolation and is considered to be only a single factor in the spectrum of abuse that extends from neglect and emotional stress through to physical and sexual abuse and death. Physical abuse is often only recognised within the emergency environment, often involving diagnostic imaging and removal of clothing to prevent image artefacts. As a result, the radiographer is often one of the first people to see the victim undressed and to identify injuries.
Despite this early patient contact, radiographers are often ignored within safeguarding procedures and are therefore uncertain of escalation processes or lack confidence to raise concerns. Where physical abuse is suspected in children, a radiographic skeletal survey, undertaken with the full knowledge and consent of parents or guardians, is often the first line of investigation. The rationale for this is that fractures are the second most common finding after bruises and contusions in physical abuse. Due to predictable fracture healing patterns in children, the skeletal survey may both reveal fractures and provide an estimate of their age. High quality image acquisition is essential as osseous signs of physical injury may be subtle and thus easily overlooked in blurred or noisy images. However, there is no consensus on threshold for acceptable noise in skeletal surveys or paediatric images and international dose reference levels are lacking.
This research program provides a unique opportunity to develop standards of education and clinical practice and identify the personal and environmental factors that prevent identification and escalation of abuse. On completion, the substantial evidence base developed will:
- Provide the underpinning framework for high quality radiographic practice with respect to NAI/SPI;
- Form the basis of a standardised international curriculum;Clarify and promote radiographer responsibilities within the safeguarding team and reporting pathway
- Clarify and promote radiographer responsibilities within the safeguarding team and reporting pathway
Clinical outcome after nephron sparing treatment of renal cancer
Louise Aarup Duus, MD, Guest Researcher
Surgery is the gold standard curable treatment of renal cancer. Minimally invasive nephron sparing treatments such as ablation (destruction of cancer cells with heat or cold) were developed approximately 15 years ago as a treatment option for comorbid patients that could not undergo surgery. Cryoablation has proved to be a good alternative to surgery.
Today, cryoablation is also offered patients that are otherwise healthy.
In this project we investigate clinical, oncological and kidney functional outcome in patients with renal cancer treated with partial nephrectomy or cryoablation.
The project includes four studies:
- A retrospective study of oncological outcome and complications after CT-guided cryoablation of renal cancer performed in 2012-2017 at Odense University Hospital
- A retrospective study of renal functional outcome after CT-guided cryoablation of renal tumors performed in 2014-2018 at Odense University Hospital
- Systematic literature review of renal functional outcome after minimally invasive partial nephrectomy or CT-guided cryoablation of renal cancer
A prospective cohort study of renal functional outcome in patients with renal cancer treated with minimally invasive partial nephrectomy or cryoablation. Renal function is investigated with DTPA clearance and renography before and 6 months after treatment.
Distal radius fractures and accuracy of measurements - does positioning influence clinician decision-making?
Janni Jensen, Radiographer, PhD student
A wrist fracture is one of the most common injuries seen in emergency rooms worldwide, accounting for approximately 15% of all fractures in the adult population. A wrist fracture is of significant socioeconomic concern particularly because of the high incidence and the possible long-term disability caused by post-traumatic osteoarthrosis. Treatment of a wrist fracture is mainly decided based on radiographic characterization of the fracture. Measurements of tilt of the distal radius, radial inclination (RI), and ulnar variance (UV), are often used to decide between operative and non-operative treatment.
Study A – Systematic review (doi: 10.1177/0284185119834687)
Prior to using radiographs in the treatment decision an assessment of measurement accuracy is essential. To summarize existing evidence on accuracy of the radiographic measurements we made a systematic literature review. Five studies addressed this, all indicating a lack of radiographic stringency and perhaps, therefore, differing results. We were not able to draw any conclusions on accuracy and must conclude that there appears to be a lack of evidence on accuracy of abovementioned measurements.
Study B – laboratory study
This is a diagnostic accuracy study using donor-arms in which radiostereometric analyses (RSA) Tantalum beads are injected and artificially created wrist fractures are made. The overall purpose of this study is, in a laboratory setting, to assess:
- Accuracy of the radiographic measured values of UV, RI and tilt and,
- the influence of forearm supination/pronation on reproducibility of the radiographic measured values of UV, RI and tilt
RSA is a validated and highly precise research tool originally developed to measure micromotion of joint implant in relation to bone. In this study RSA is used to give a precise measure of supination and pronation of the forearm between alternating exams. RSA is also used for highly accurate values of UV, RI and tilt in the fractured arms.
The goal in the long run is to improve outcome for patients with wrist fractures by ensuring that characterization of fracture and decision to treat is based on evidence based measurements. Hypothesizing that long-term complication such as post-traumatic osteoarthrosis can be minimized.
Nephspare PRO - Patient reported outcome after nephron sparing treatment of small renal tumors
Theresa Junker, RN, PhD student
Surgery in the form of partial nephrectomy (PN) has traditionally been the preferred treatment of small renal tumours. Cryoablation (Cryo) is another nephron sparing treatment introduced 20 years ago as a treatment option of comorbid renal cancer patients with high surgical risk.
The purpose is to assess and compare clinical outcome and quality of life after PN and Cryo, respectively.
The project is designed as a prospective comparative cohort study, including a literature study. We include patients from Region Zealand and the Region of region of Southern Denmark in a two-year time period. We only include patients with biopsy verified renal cell carcinoma.
Investigation of image quality, radiation exposure to the patients and diagnostic performance of micro dose 2D/3D slot scanner X-ray imaging system compared with conventional Direct Radiography (DR) X-ray imaging system
Ahmed Abdi Abdel, MSc, PhD student
The study aims are:
- To evaluate the image quality of the micro dose 2D/3D slot scanner compared with the conventional DR X-ray imaging system using different evaluation methods
- To evaluate the use of the micro dose2D/3D slot scanner system for clinical diagnostics, particularly in the determination of bone fractures and assessment of bone structures and chest examinations
- To compare the radiation exposure to the patient between the micro dose 2D/3D slot scanner and conventional DR X-ray imaging system
Intrapleural Fibrinolysis and DNase versus Video-Assisted Thoracic Surgery (VATS) for the treatment of pleural empyema (FIVERVATS): a randomised, controlled trial - surgery as first line treatment
Stefan Harders, Consultant, PhD
Pleural empyema is a frequent disease with a high morbidity and mortality.
The aim of this study is to determine the difference in outcome in patients diagnosed with complex parapneumonic effusion (stage II) and pleural empyema (stage III) who are treated with either VATS surgery or TUS guided drainage and intrapleural therapy (fibrinolytic (Alteplase) with DNase (Pulmozyme®)) as first line treatment.
The study is a national, multicentre randomised, controlled study.
The total number of patients included is 184, all newly diagnosed community acquired complicated parapneumonic effusion of pleural empyema, and are randomised to either
- VATS procedure with drainage or
- TUS-guided pigtail catheter placement and intrapleural therapy with Actilyse and DNase
The results of this study will be published in peer-reviewed journals and presented at various conferences.
Long-term Pulmonary Outcomes After Infection With SARS-CoV-2
Stefan Harders, Consultant, PhD
In the autumn of 2019, a new coronavirus (SARS-CoV2) emerged in Wuhan, China, causing the subsequently named Coronavirus disease 2019 (Covid-19).
The virus spread fast to the rest of Asia, Europe, United States and other continents.
In March 2020, the World Health Organisation declared the Covid-19 a pandemic. COVID-19 is an acute respiratory disease caused by the coronavirus, SARS-CoV-2.
Patients admitted to the ICU were characterized by an incipient respiratory failure, often with a rapid decline in gas exchange, necessitating the need for ventilatory support and sometimes extracorporeal membrane oxygenation (ECMO), along with optimal management of complications, e.g. super-imposed bacterial infection, and any underlying co-morbidities, e.g. chronic obstructive pulmonary disease, asthma, congestive heart failure and more.
These patients seem to have a very high mortality, with an estimated death rate of 15–22%.
The reason for developing a severe variant of COVID-19 after infection with SARS-Cov2 is not clear. There is a trend to age relation that is not very strong.
Reasons for susceptibility could include (a) dose of virus and route of infection (droplet inhalation to mucosa of the lung, or infection of nasal and conjunctival mucosal surfaces), (b) gene interaction between COVID isolate and the genome of the infected individual, and finally (c) immune and physiologic (fitness, state of exhaustion during infection) vigilance.
The purpose of this study is to evaluate the long-term outcomes on lung function and physical capacity twelve months after hospital admission.
Patients will be invited to an interview with completion of a number of patient related outcome measures, pulmonary function testing, six-minute walk test and HRCT of the lungs.
Pulmonary abnormalities in newly diagnosed rheumatoid arthritis
Stefan Harders, Consultant, PhD
Pulmonary disease is a major cause of excess mortality among patients with rheumatoid arthritis (RA), but the benefit of screening for pulmonary disease in RA is unknown.
The aim of this study was to evaluate pulmonary function and CT imaging in patients with early RA.
Patients with newly diagnosed RA were recruited prospectively at a single center. The patients underwent pulmonary function testing and coronary CT angiography at inclusion, and the pulmonary CT images were used in the respiratory assessment.
CT scans were performed in 136 patients. The most common findings were pulmonary nodules (18 pts), emphysema (13 pts), and bronchiectasis (5pts).
Two patients had manifest interstitial lung disease (one UIP and one NSIP) and four patients had interstitial lung abnormalities.
Thirteen patients had other CT findings, while 82 patients (60%) had no pulmonary CT abnormalities.
Education in focused lung ultrasound using Virtual Reality
Jonas Dragsbaek, Undergraduate Research Year student
Focused lung ultrasound is not only a skill acquirable for medical specialists, which has led to the implementation of ultrasound courses for younger doctors at Odense University Hospital and medical students enrolled at the Southern University of Denmark in Odense.
Virtual Reality (VR) is a new and advancing form of simulation training, that has shown promising results in educating health professionals in clinical skills.
We are currently programming a focused lung ultrasound course that can be accessed through VR.
The target group is young doctors, medical students, and other relevant professions for learning focused lung ultrasound.
We plan for 100 participants to test our course.
The participants will after completion of the VR-course be evaluated on a validated simulation test at the Simulation Center at Odense University Hospital. If the course can be used to obtain core competences in the subject of focused lung ultrasound, VR is expected to be implemented in regional training courses.
an anthropological inquiry of renal cancer treatment practices in the Danish health care system
Henriette List, PhD student
The Danish national cancer monitoring indicates that there is a regional difference in the clinical treatment practices and, hence, in the treatment the patients receive.
This Ph.D. project will explore the practice behind this clinical variety by looking into the case of renal cancer treatment in the Danish health care system; how and why the treatment practice of small renal tumors varies at the hospitals in Denmark, and how we can use this variation productively for the benefit of the patients.
With an anthropological approach and informed by an actor-network analytical framework, the project aims to explore how actors in the Danish health care system contributes to processes of knowledge production, distribution, and practices on cancer treatment.
Methodologically, I will investigate authoritative and professional documents, carry out interviews with decision-makers and conduct fieldwork among relevant health care professionals at selected hospitals.