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McNulty, Jonathan P.
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McNulty, Jonathan P.
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McNulty, Jonathan P.
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Now showing 1 - 10 of 14
- PublicationHigh-resolution MRI (HR-MRI) of atherosclerotic plaque in symptomatic carotid stenosis – relationship with risk factors, treatment, and CT angiographic features(2018-05-16)
; ; ; ; ; ; ; ; ; Purpose: Traditional imaging techniques rely on arterial lumen stenosis as an indirect measure of mural plaque. HR-MRI allows direct imaging of mural plaque burden and composition. However, few data exist on the relationship of these parameters to clinical factors in patients with symptomatic carotid stenosis. We investigated the relationship between MR plaque features, clinical characteristics, and plaque morphology on CT angiography. Methods: A sub-group of patients included in the prospective BIOVASC plaque imaging study were included. Inclusion criteria were: (1) Speech/motor TIA or non-severe stroke (Rankin≤3) <72hours (2) Ipsilateral carotid stenosis ≥50% (3) Age≥50 (4) Carotid HR-MRI and CTA performed. Exclusions were pregnancy, malignancy, dementia, renal impairment, cervical irradiation/endarterectomy/stent. Semi-automated analysis of HR-MRI axial plaque images was done using PlaqueView and manual analysis of co-registered CTA performed. Results: 27 patients met inclusion criteria (78% men, mean age 66 years, 36% stroke/64%TIA, 39% current smoking). By HR-MRI, maximum plaque wall area was greater in patients with index stroke compared with TIA (p=0.007). Plaque maximum wall thickness was greater in diabetes (p=0.016) and statin-untreated patients (p=0.003). Volume of lipid-rich necrotic core was less (p=0.018) and fibrous cap thickness (p=0.05) greater in aspirin-treated patients. When HR-MRI was compared with CTA, high correlations were observed for lumen area (rho=0.976, p<0.001), maximum wall thickness (rho=0.878, p<0.001), and maximum wall area (Pearson r=0.981, p<0.001). Conclusion: If replicated, our findings may inform the application of plaque HR-MRI and CTA as surrogate markers in future clinical practice and randomised trials for stroke prevention.106 - PublicationGet comfortable with being uncomfortable: Experiences from diagnostic radiographers a year into the COVID-19 pandemicIn Singapore, the ripple effect from the first imported case has been powerful. In the first few days there was little sign of the impact that was coming. While there was some sense of worry, everyday life went on. No one expected the impact of COVID-19 to be so dramatic that certain aspects of the population's daily life had to be permanently modified. Drastic changes were made to the country's working lifestyle, society, economy, and healthcare sector -a result of public health measures introduced by the government. Through local transmission, the pandemic rapidly reached statistical milestones. Within 2 weeks after first case was reported, Singapore's risk assessment was raised following increased local community spread [2]. The tipping point occurred when Singapore experienced increased risk of asymptomatic spread, which led to the implementation of an elevated set of safe distancing measures from April 7 to June 1 (1 month, 3 weeks and 4 days) [3,4]. The duration of the “circuit breaker”, which included partial lockdowns, had a significant impact on many. From an economic perspective, this safe distancing measure has been estimated to have reduced Singapore's annual real gross domestic product (GDP) by 2.2%
101Scopus© Citations 5 - PublicationExploring the translational challenge for medical applications of ionising radiation and corresponding radiation protection research(Springer Science and Business Media LLC, 2022-03-18)
; ; ; Background: Medical applications of ionising radiation and associated radiation protection research often encounter long delays and inconsistent implementation when translated into clinical practice. A coordinated effort is needed to analyse the research needs for innovation transfer in radiation-based high-quality healthcare across Europe which can inform the development of an innovation transfer framework tailored for equitable implementation of radiation research at scale. Methods: Between March and September 2021 a Delphi methodology was employed to gain consensus on key translational challenges from a range of professional stakeholders. A total of three Delphi rounds were conducted using a series of electronic surveys comprised of open-ended and closed-type questions. The surveys were disseminated via the EURAMED Rocc-n-Roll consortium network and prominent medical societies in the field. Approximately 350 professionals were invited to participate. Participants’ level of agreement with each generated statement was captured using a 6-point Likert scale. Consensus was defined as median ≥ 4 with ≥ 60% of responses in the upper tertile of the scale. Additionally, the stability of responses across rounds was assessed. Results: In the first Delphi round a multidisciplinary panel of 20 generated 127 unique statements. The second and third Delphi rounds recruited a broader sample of 130 individuals to rate the extent to which they agreed with each statement as a key translational challenge. A total of 60 consensus statements resulted from the iterative Delphi process of which 55 demonstrated good stability. Ten statements were identified as high priority challenges with ≥ 80% of statement ratings either ‘Agree’ or ‘Strongly Agree’. Conclusion: A lack of interoperability between systems, insufficient resources, unsatisfactory education and training, and the need for greater public awareness surrounding the benefits, risks, and applications of ionising radiation were identified as principal translational challenges. These findings will help to inform a tailored innovation transfer framework for medical radiation research.52Scopus© Citations 1 - PublicationFactors influencing the choice of radiology as a medical specialty in IrelandPurpose: To gain further insight into Irish medical students' and interns' specialty preferences and explore the various factors that influence choice of specialty with a focus on radiology. Methods: An online cross-sectional survey was conducted of medical students and interns enrolled at a single Irish institution. Survey topics included specialty preferences, associated influential factors, exposure to radiology to date, and respondents' interest in and understanding of radiology. Results: Cardiology, emergency medicine, and paediatrics had the highest overall interest levels, with 27.0% (n = 133/492) of all participants declaring an interest in radiology. The most frequently selected reason for considering radiology as a specialty was the varied nature of the field. Men reported considering a career in radiology more often than women (x2 (1, n = 433) = 9.464, p = 0.002) and non-European respondents considered radiology less often than their Irish and European peers (x2 (1, n = 436) = 7.510, p = 0.006). While there was no significant association between exposure to radiology and interest in the specialty, participants with previous exposure to radiology were found to be more knowledgeable about the roles and responsibilities of a radiologist. Conclusion: The outcomes of this study support previous research which concludes that medical students' choice of specialty is multifactorial. A strategic approach needs to be taken towards undergraduate radiology education which accounts for class composition, emphasises the diversity and impact of the field, and provides clinical exposure to the subject matter, as a tailored means of steering more students and interns towards the underserved discipline.
59 - PublicationA Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke(Wolters Kluwer, 2020-01-17)
; ; ; ; ; ; ; ; ; ; ; ; ; Background and Purpose— In randomized trials of symptomatic carotid endarterectomy, only modest benefit occurred in patients with moderate stenosis and important subgroups experienced no benefit. Carotid plaque 18F-fluorodeoxyglucose uptake on positron emission tomography, reflecting inflammation, independently predicts recurrent stroke. We investigated if a risk score combining stenosis and plaque 18F-fluorodeoxyglucose would improve the identification of early recurrent stroke. Methods— We derived the score in a prospective cohort study of recent (<30 days) non-severe (modified Rankin Scale score ≤3) stroke/transient ischemic attack. We derived the SCAIL (symptomatic carotid atheroma inflammation lumen-stenosis) score (range, 0–5) including 18F-fluorodeoxyglucose standardized uptake values (SUVmax <2 g/mL, 0 points; SUVmax 2–2.99 g/mL, 1 point; SUVmax 3–3.99 g/mL, 2 points; SUVmax ≥4 g/mL, 3 points) and stenosis (<50%, 0 points; 50%–69%, 1 point; ≥70%, 2 points). We validated the score in an independent pooled cohort of 2 studies. In the pooled cohorts, we investigated the SCAIL score to discriminate recurrent stroke after the index stroke/transient ischemic attack, after positron emission tomography-imaging, and in mild or moderate stenosis. Results— In the derivation cohort (109 patients), recurrent stroke risk increased with increasing SCAIL score (P=0.002, C statistic 0.71 [95% CI, 0.56–0.86]). The adjusted (age, sex, smoking, hypertension, diabetes mellitus, antiplatelets, and statins) hazard ratio per 1-point SCAIL increase was 2.4 (95% CI, 1.2–4.5, P=0.01). Findings were confirmed in the validation cohort (87 patients, adjusted hazard ratio, 2.9 [95% CI, 1.9–5], P<0.001; C statistic 0.77 [95% CI, 0.67–0.87]). The SCAIL score independently predicted recurrent stroke after positron emission tomography-imaging (adjusted hazard ratio, 4.52 [95% CI, 1.58–12.93], P=0.005). Compared with stenosis severity (C statistic, 0.63 [95% CI, 0.46–0.80]), prediction of post-positron emission tomography stroke recurrence was improved with the SCAIL score (C statistic, 0.82 [95% CI, 0.66–0.97], P=0.04). Findings were confirmed in mild or moderate stenosis (adjusted hazard ratio, 2.74 [95% CI, 1.39–5.39], P=0.004). Conclusions— The SCAIL score improved the identification of early recurrent stroke. Randomized trials are needed to test if a combined stenosis-inflammation strategy improves selection for carotid revascularization where benefit is currently uncertain.226Scopus© Citations 27 - PublicationCovid-19: free resources to support radiographersThe first report of a new Coronavirus disease (Covid-19) was in December 2019 and the disease was declared a pandemic by the World Health Organisation (WHO) in March 20201. At this point WHO called on governments to change the course of the outbreak by taking urgent and aggressive action. By the end of April, the number of cases was in excess of 3 million with 211,350 deaths worldwide. Covid-19 is related to previous pandemics - SARS-CoV-1 (SARS) and Middle East respiratory syndrome (MERS)2 and it can be asymptomatic or result in mild to severe symptoms. Unlike influenza it can be contagious before symptoms are apparent3. Due to the highly contagious nature of the disease, rapid and reliable diagnosis is critical. Medical imaging has valuable roles in the diagnosis and management of the Covid-19 patient and radiographers have already started to share their experiences with imaging it45678. Chest computed tomography (CT) has diagnostic value9, though presents challenges including CT availability, the complexity of imaging patients who may be on ventilators and the time taken to decontaminate the CT scanner and room after a Covid-19 patient has used it. For these reasons mobile chest radiography (CXR) has become the most commonly utilised imaging modality for the radiological follow up of lung abnormalities1
172Scopus© Citations 11 - PublicationPaediatric imaging radiation dose awareness and use of referral guidelines amongst radiology practitioners and radiographers(Springer, 2016-02)
; ; ; Objectives: The objectives are to investigate radiology practitioners' and radiographers' radiation dose awareness and use of referral guidelines for paediatric imaging examinations. Methods: A prospective cross-sectional survey was conducted amongst radiology practitioners and radiographers working at a primary paediatric referral centre in Malta. Part of the survey asked participants to indicate the typical effective dose (ED) for several commonly performed paediatric imaging examinations, answer five true-false statements about radiation protection principles, and specify their use of referral guidelines for paediatric imaging. Results: The return of 112 questionnaires provided a response rate of 66.7 %. Overall, imaging practitioners demonstrated poor awareness of radiation doses associated with several paediatric imaging examinations, with only 20 % providing the correct ED estimate for radiation-based examinations. Nearly all participants had undertaken radiation protection training, but the type and duration of training undertaken varied. When asked about the use of referral guidelines for paediatric imaging, 77.3 % claimed that they 'did not' or 'were not sure' if they made use of them. Conclusions: Poor awareness of radiation doses associated with paediatric imaging examinations and the non-use of referral guidelines may impede imaging practitioners' role in the justification and optimisation of paediatric imaging examinations. Education and training activities to address such shortcomings are recommended.251Scopus© Citations 20 - PublicationAssociation Between 18-FDG Positron Emission Tomography and MRI Biomarkers of Plaque Vulnerability in Patients With Symptomatic Carotid Stenosis(Frontiers Media, 2021-12-23)
; ; ; ; ; ; ; ; ; ; ; Purpose: Pathologic studies suggest that unstable plaque morphology and inflammation are associated with cerebrovascular events. 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) is a validated technique for non-invasive imaging of inflammation-related plaque metabolism, and MRI can identify morphologic features of plaque instability. The aim of this study was to investigate the association of selected imaging characteristics of plaque vulnerability measured with MRI and PET in patients with symptomatic carotid stenosis. Methods: Patients from the BIOVASC study were selected based on the following inclusion criteria: (1) age ≥ 50 years; (2) recent (<30 days) ischaemic stroke (modified Rankin scale ≤3) or motor/speech/vision TIA; (3) ipsilateral internal carotid artery stenosis (≥5 0% lumen-narrowing); (4) carotid PET/CTA and MRI completed. Semi-automated plaque analysis of MRI images was performed to quantify morphologic features of plaque instability. PET images were co-registered with CTA and inflammation-related metabolism expressed as maximum standardised uptake value (SUVmax). Results: Twenty-five patients met inclusion criteria (72% men, mean age 65 years). MRI-measured plaque volume was greater in men (1,708–1,286 mm3, p = 0.03), patients who qualified with stroke (1,856–1,440 mm3, p = 0.05), and non-statin users (1,325–1,797 mm3, p = 0.03). SUVmax was associated with MRI-measured plaque lipid-rich necrotic core (LRNC) in the corresponding axial slice (rs = 0.64, p < 0.001) and was inversely associated with whole-plaque fibrous cap thickness (rs = −0.4, p = 0.02) and calcium volume (rs = −0.4, p = 0.03). Conclusion: This study demonstrated novel correlations of non-invasive imaging biomarkers of inflammation-related plaque metabolism with morphological MRI markers of plaque instability. If replicated, our findings may support the application of combined MRI and PET to detect vulnerable plaque in future clinical practise and randomised trials.98Scopus© Citations 2 - PublicationThe impact of COVID-19 upon student radiographers and clinical training(Elsevier, 2021-05-01)
; ; ; ; Introduction: To investigate student clinical placement concerns and opinions, during the initial COVID-19 pandemic outbreak and to inform educational institution support planning. Methods: Between mid-June to mid-July 2020, educational institutions from 12 countries were invited to participate in an online survey designed to gain student radiographer opinion from a wide geographical spread and countries with varying levels of COVID-19 cases. Results: 1277 respondents participated, of these 592 had completed clinical placements during January to June 2020. Accommodation and cohabiting risks were identified as challenging, as was isolation from family, travel to clinical placements, and to a lesser extent childcare. Students stated they had been affected by the feeling of isolation and concerns about the virus whilst on placement. Overall 35.4% of all respondents were ‘Not at all worried’ about being a radiographer, however, 64.6% expressed varying levels of concern and individual domestic or health situations significantly impacted responses (p ≤ 0.05). Year 4 students and recent graduates were significantly more likely to be ‘Not worried at all’ compared to Year 2 and 3 students (p ≤ 0.05). The need for improved communication regarding clinical placements scheduling was identified as almost 50% of students on clinical placements between January to June 2020 identified the completion of assessments as challenging. Furthermore, only 66% of respondents with COVID-19 imaging experience stated being confident with personal protective equipment (PPE) use. Conclusion: Student radiographers identified key challenges which require consideration to ensure appropriate measures are in place to support their ongoing needs. Importantly PPE training is required before placement regardless of prior COVID-19 imaging experience. Implications for practice: As the next academic year commences, the study findings identify important matters to be considered by education institutions with responsibility for Radiography training and as students commence clinical placements during the on-going global COVID-19 pandemic.96Scopus© Citations 30 - PublicationValedictory editorial - New horizonsRadiography will celebrate the publication of its 28th Volume in 2022. Guided by our mission to be recognised as the ‘premier peer reviewed journal in radiographic imaging and radiation therapy both within the UK and internationally',3 our revised strategic plan (2019–2023) ensures that the journal continues to showcase excellent radiography research while supporting the development of publishing capability and capacity within the profession. In this editorial we will first reflect on significant strategic developments which have been introduced to continue to address our ambitious mission. We will then share with you some of the journal metrics4 which our Editorial Board regularly reviews against our challenging Key Performance Indicators. Finally we will engage in some ‘horizon scanning’ to consider the challenges and opportunities that may lie ahead for our journal.
35Scopus© Citations 4