3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The effects of MRI personnel shortages on waiting time and Bed Stay Costs in a Tertiary Referral(2019) Sithole, NhlanhlaThe study evaluates the effects of the removal of overtime payment on MRI scan personnel on waiting time and bed-stay cost resulting from decreased MRI scanning hours, which occurred as a result of MRI personnel over-time pay withdrawal dated 20th April 2012, as a surrogate representation of the benefit of increasing scanning hours. The study motives are to determine the number of patients occupying hospital beds while awaiting MRI scans over a 6-month period in a tertiary referral radiology department, BEFORE and AFTER the 20th April 2012, when overtime payment for technologists was terminated, to determine number of ‘waiting days’ (waiting time), overall, and per patient, and bed stay cost for those patients identified in objective one BEFORE and AFTER the specific event above, where overtime payment was terminated. The researcher identified a target population of 300 MRI scanning patients registered at Charlotte Maxeke Johannesburg Academic Hospital MRI radiology department, during the period under study and employed a simple random sampling technique to choose the research sample frame. Different diagnostic tests were conducted in order to find whether the data collected was best fit or not for the research in question. These tests formed part of a data clean-up exercise. Tests conducted enabled the researcher to have objective and reliable research results. The data adequacy requirement tests include measures of central tendency, Pearson product moment correlation coefficient, coefficient of determination, autocorrelation, chi-square, stationarity, long-term relationship and Granger causality. The researcher found out that the impact of the removal of overtime on MRI scan personnel resulted in longer waiting times by patients and a corresponding higher bed stay costs at Charlotte Maxeke referral hospital over the period under the study. The research results further indicate the removal of overtime payment had a Granger effect on MRI scan patients’ waiting time, which ultimately led to high bed stay costs. The researcher recommends that referral hospitals, in conjunction with the Ministry of Health, must ensure that MRI scan personnel are well trained and equipped to deliver quality health services. The MRI scan personnel must periodically be sent for retraining through medical workshops, seminars and refresher courses to ensure that the MRI scan personnel are up to date with the current trends in the medical fraternity.Item Correlation of magnetic resonance imaging and arthroscopic findings in patients with soft tissue knee injuries(2018) Ncube, ThandoThe knee is indispensable in everyday life and injuries to it can be debilitating with significant loss of earnings incurred. Clinical diagnosis may not always be made with certainty and Magnetic Resonance Imaging (MRI) helps further elucidate intra-articular injuries. MRI reporting has its shortcomings and may provide spurious results according to the interpretor’s level of experience. This study aims to test the diagnostic reliability of MRI done in a teaching hospital for the evaluation of anterior cruciate ligament and meniscal injuries using arthroscopy as the baseline for comparison. Due to the long waiting times to have surgery we also determined if there was a change in the reliability of an MRI result as time elapsed. A retrospective review of records of patients who had knee arthroscopies at Chris Hani Baragwanath Academic Hospital (Johannesburg, South Africa) from May 2009 to May 2015 was done. Adults (16 − 60 years) with one major episode of trauma to the knee and had MRI done prior to surgery at the above institution were included. Arthroscopy was performed by 2 senior surgeons or by residents under their direct supervision. Arthroscopic findings of anterior cruciate ligament (ACL) and medial (MM) or lateral meniscal (LM) injuries were compared to MRI findings. Data was analysed by STATA version 13.1 to determine injury demographics, sensitivity, specificity and diagnostic accuracy of MRI. The effect of time interval from MRI to surgery on the diagnostic accuracy was determined. A total of 72 patients (74 knees) qualified for review. The median age was 35 years (IQR 26 − 43) with a significant difference between males and females (28 vs 41 years, p = 0.0019). Leading causes of injury were traffic accidents (32.4%), falls (27.0%) and sports injuries (17.6%). Median interval from MRI to surgery was 71.5 days (IQR 29 − 143). The sensitivity of MRI for ACL, MM and LM injuries was (63.6%, 58.8% and 52.6%), specificity (92.7%, 86.0% and 80.0%) and diagnostic accuracy (79.7%, 79.7% and 73.0%) respectively. The patients were divided into subgroups of early (< 6 weeks), intermediate (6 − 16 weeks) and late intervention (> 16 weeks) post-MRI. There were marked differences in the diagnostic accuracy in the three groups for the ACL (70.8% vs 92.6% vs 73.9%) and LM (62.5% vs 81.5% vs 73.9%). This was unremarkable for the MM (75.0% vs 81.5% vs 82.6%). MRI findings correlate well with arthroscopic findings making it a reliable preoperative screening tool for ACL and meniscal injuries. However its diagnostic accuracy appears to change with time. It is apparent that the diagnostic accuracy is higher between 6 − 16 weeks post MRI. A bigger cohort would help determine an ideal waiting time interval without significant depreciation in diagnostic accuracy.Item Corpus callosum thickness on MRI as a surrogate marker of brain volume in children with HIV-related brain disease and its correlation with developmental scores(2015) Andronikou, SavvasBackground Objective volumetric assessment of white matter in children with HIV involves post M processing, while corpus callosum (CC) thickness measurement on midMsagittal MRI may represent a rapid surrogate marker. Aim To determine whether the thickness of the CC on midMsagittal MRI can be used as a surrogate marker of brain volume in children with HIV Mrelated brain disease and in appropriate controls and to determine whether thickness at particular locations correlates with mental developmental scores and laboratory markers of immunity. Methods A retrospective analysis of 33 children with HIV Mrelated neurology(range 7 M 49 months; median31 months; mean 30 months; 16 boys and 17 girls) and matched controls (range 13 – 48 months; median 34 months; mean 32 months; 6 boys and 5 girls) was performed. A custom software tool imported sagittal MRI images, divided the midline CC contour into 40 segments and measured the thickness of each segment as well as the length of the CC. Brain volume (total brain volume (TBV); white matter volume (WMV);grey matter volume (GMV)) was determined using MATLAB and Statistical Parametric Mapping software. Overall and segmental CC mean and maximum thickness and CC length were checked for correlation with brain volume, Griffiths mental development scores(GMDS) and laboratory parameters. Results Griffiths scores in patients were ‘low average’ (mean Griffiths general quotient (GQ) of 84, range 72 – 101; ‘locomotor’ 84, range 59 – 116; ‘language’ 80; range57 –118). There was no statistical difference in overall and regional CC thickness, CC length, TBV, GMV and WMV between patients and controls. Significant correlation was found in patients for the premotor CC mean with age (p = 0.04). Other significant correlations of CC measurements and laboratory / clinical parameters were the prefrontal CC max with in adir CD4 (p=0.046)(+vecorrelation); motor CC max with GQ (p=0.028) (Mve!correlation) and CC length with CD4(p=0.04) (Mve correlation). Significant correlations between CC thickness and brain volume were found in patients and controls for the CC mean and TBV (p=0.049)(+ve correlation);premotor CC mean and TBV (p=0.039)(+ve correlation); sensory CC mean and TBV (p=0.022)(+ve correlation); prefrontal CC max and WMV (p=0.019)(+ve correlation); premotor CC mean and WMV (p=0.019)(+ve correlation and for the premotor CC max and WMV (p=0.023)(+ve correlation). Conclusion: This research met its objectives in demonstrating a statistically significant, albeit weak, correlation between CC thickness and brain volume in patients and controls, even though patients were not shown to have significantly diminished brain volumes as compared to controls.Item Magnetic resonance imaging findings and clinical outcome scores in patients presenting with degenerative lumbar spinal stenosis(2014-09-02) Ramushu, Leah DimakatjoObjectives 1. Assessment of radiological parameters of spinal stenosis using Magnetic Resonance imaging. 2. Clinical assessment of patients with Oswestry disability index and Neurogenic claudication outcome score questionnaires. 3. To assess correlation between clinical assessment questionnaires’ scores and radiological parameters. Background. Spinal stenosis is a common presentation in the elderly and a reason for surgical intervention. Diagnostic criteria are still inconclusive. There is poor correlation between clinical and radiological findings. New observations have been described and whether they improve diagnostic criteria remains to be seen. Methods. 30 patients with spinal stenosis were included in the study. The 2 questionnaires were administered and Magnetic Resonance Imaging copies were obtained. Questionnaires and images were analyzed. Osirix programme was used to analyze the images and do the measurements. Data was entered onto an excel sheet and analyzed using Statistica software. Frequencies and correlations were done. Results. The age range was between 41 and 85.There were 22 females and 8 males. L4/L5 was the commonest level involved in 23 patients. Multilevel involvement was 23% and those patients had a higher morphological grade, which was statistically insignificant. The commonest morphological grade was C. Sedimentation was positive in 93% of the patients. The Oswestry disability Index and Neurogenic Claudication Outcome score were negatively correlated, which was statistically significant, p = 0.0004. There was no correlation between clinical and radiological features. Conclusion. Spinal stenosis remains a clinical dilemma. There is variability within the population and lack of correlation between clinical and radiologic features. Radiological features however correlate with each other, but do not help with optimizing patient care.