To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) in... more To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) into the Dutch language (SRQ-DLV) and evaluate its internal consistency, reliability, validity and responsiveness to clinical changes. Prospective study. Outpatient departments of orthopaedics, radiology and physical therapy of an academic and a non-academic hospital. One hundred and seven patients treated for unilateral shoulder disorder (adhesive capsulitis 68, calcifying tendinitis 22, impingement syndrome or rotator cuff tear 17). The original SRQ was translated and adapted following international guidelines. The SRQ-DLV was used among other measures of body function and structure, activities and societal participation in order to determine reliability, internal consistency, validity and responsiveness. Assessments were done at baseline and three months after treatment, with the SRQ-DLV being re-administered within one week before the baseline measurement and the start of the treatment for testing reliability. Cronbach's alpha for internal consistency was 0.89 for the total questionnaire and 0.81, 0.80, 0.72 and 0.84 for the domains pain, daily activities, sports/recreational activities and work, respectively. Test-retest reliability of the SRQ-DLV and its subscales ranged from 0.63 to 0.86. The summary score of the SRQ-DLV correlated with measures of shoulder function, daily activities and quality of life. Except for the work subscale of the SRQ-DLV, large effect sizes, reflecting its responsiveness to clinical changes after treatment, were found for both the summary and the subscales scores. Empirical data support that the SRQ-DLV is a reliable, valid and responsive measure to be used in clinical trials including Dutch patients with various shoulder disorders.
This study aimed to assess patient dose and occupational dose in established and new applications... more This study aimed to assess patient dose and occupational dose in established and new applications of MDCT fluoroscopy. Electronic personal dosimeters were used to measure occupational dose equivalent. Effective patient dose was derived from the recorded dose-length product. Acquisition parameters that were observed during CT fluoroscopy (CTF) provided the basis for the estimation of an entrance skin dose profile. Two hundred ten CT-guided interventional procedures were included in the study. The median effective patient dose was 10 mSv (range, 0.1-235 mSv; 107 procedures). The median peak entrance skin dose was 0.4 Sv (0.1-2.1 Sv; 27 procedures). From 547 measurements of occupational dose equivalent, a median occupational effective dose of 3 muSv per procedure was derived for the interventional radiologists and 0.4 muSv per procedure for the assisting radiologists and radiology technologists. The estimated maximum occupational effective dose reached 0.4 mSv. The study revealed high effective patient doses, up to 235 mSv, mainly for relatively new applications such as CTF-guided radiofrequency ablations using MDCT, vertebroplasty, and percutaneous ethanol injections of tumors. Entrance doses were occasionally in the range of the warning level for deterministic skin effects but were always below the threshold for serious deterministic effects. The complexity of the procedure, expected benefits of the treatment, and general health state of the patient contribute to the justification of observed high effective patient doses.
In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobiliza... more In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder. One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or =50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study. Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Pr...
The purpose of this case report is to describe the use of end-range mobilization techniques in th... more The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean fl...
A prospective study on 24 patients with spinal osteoid osteoma treated with radiofrequency ablati... more A prospective study on 24 patients with spinal osteoid osteoma treated with radiofrequency ablation (RFA). To determine if and when computed tomography (CT)-guided RFA is a safe and effective treatment for spinal osteoid osteomas. Surgery has been considered the standard treatment for spinal osteoid osteomas. Surgery may cause spinal instability, infection, and nervous injury. We evaluated CT-guided RFA as an alternative treatment. A total of 28 RFA procedures in 24 patients with spinal osteoid osteoma were performed, using a 5-mm noncooled electrode. Clinical symptoms and spinal deformity were evaluated before and after the procedure. Unsuccessful treatment was defined as the presence of residual or recurrent symptoms. The mean follow-up was 72 months (range: 9-142 months). Nineteen (79%) patients were successfully treated after 1 RFA, and all except one after repeat RFA. One patient with nerve root compression needed further surgery. No complications were observed. Spinal deformity persisted in 3 of 7 patients after successful RFA. CT-guided RFA is a safe and effective treatment for spinal osteoid osteoma. Surgery should be reserved for lesions causing nerve root compression.
To retrospectively identify risk factors that may impede a favorable clinical outcome after therm... more To retrospectively identify risk factors that may impede a favorable clinical outcome after thermocoagulation for osteoid osteoma. Informed consent (permission for the procedure and permission to use patient data for analysis) was obtained from all patients who met study criteria, and institutional review board did not require approval. Analysis included age, sex, size and location of osteoid osteoma, presence of calcified nidus, number of needle positions used for coagulation, coagulation time, accuracy of needle position, learning curve of radiologist, and previous treatment in 95 consecutive patients with osteoid osteoma treated with thermocoagulation. With chi(2) analysis, Fisher exact test, or unpaired Student t test and logistic regression analysis, 23 unsuccessfully treated patients were compared with 72 successfully (pain-free) treated patients. Parameters associated with decreased risk for treatment failure were advanced age (mean age, 24 years in treatment success group vs 20 years in treatment failure group) and increased number of needle positions during thermocoagulation. Estimated odds ratios were, respectively, 0.93 (95% confidence interval: 0.88, 0.99) and 0.10 (95% confidence interval: 0.02, 0.41). Patients with a lesion of 10 mm or larger seemed at risk for treatment failure (odds ratio = 2.68), but the 95% confidence interval of 0.84 to 8.52 included the 1.00 value. Needle position was inaccurate in nine of 23 patients with treatment failure; only one needle position was used in eight of these nine patients. Lesion location, calcification, sex, coagulation time, radiologist's learning curve, and previous treatment were not risk factors. Multiple needle positions reduce the risk of treatment failure in all patients and should especially, but not exclusively, be used in large (> or =10-mm) lesions or lesions that are difficult to engage to reduce the risk for unsuccessful treatment.
To determine the clinical results in an unselected group of consecutive patients with osteoid ost... more To determine the clinical results in an unselected group of consecutive patients with osteoid osteoma treated with thermocoagulation. In 97 consecutive patients with clinical and/or radiologic evidence of osteoid osteoma at any location, the clinical symptoms were assessed before and after thermocoagulation with computed tomographic guidance. A good response was defined as disappearance of symptoms that were manifested at presentation and attributed to osteoid osteoma. Clinical assessment was performed prior to discharge; within 2 weeks after the procedure; and at 3, 6, 12, and 24 months follow-up. After 24 months, a postal questionnaire was used for assessment. The mean clinical follow-up after the only or the last thermocoagulation session was 41 months (range, 5-81 months). Response was good after one session of thermocoagulation in 74 (76%) of 97 patients, and the 95% CI was 68% to 85%. Patients with persistent symptoms did well after repeated thermocoagulation (good response in 10 of 12 patients), but results of repeated thermocoagulation were poor in patients with recurrent symptoms (good response in five of 10). The overall success rate after one or two thermocoagulation procedures combined was 92% (89 of 97 patients), and the 95% CI was 86% to 97%. Complications were observed in two patients. Percutaneous thermocoagulation is a safe and effective method for treatment of osteoid osteoma at any location. Repeated thermocoagulation is successful in patients with persistent symptoms.
Loosening of orthopedic hip prostheses is an increasing health problem. In elderly patients with ... more Loosening of orthopedic hip prostheses is an increasing health problem. In elderly patients with comorbidity,revision surgery may lead to high mortality rates. A less invasive surgical technique is therefore required to reduce these patient risks. To this end a percutaneous gene therapy approach was designed to destroy the periprosthetic loosening membrane, and enable refixing of the hip prosthesis with percutaneous bone cement injections under radiological guidance. In this phase 1/2 dose-escalating gene therapy clinical trial, 12 patients were treated. Toxicity and hip function variables were monitored up to 6 months posttreatment. All patients completed the study and no dose-limiting toxicity was observed. Improvement in walking distance, independence,and pain was demonstrated particularly in patients receiving 3 x 10(10) and 1 x 10(11) viral particles. Taken together, these data show that this gene therapy approach targeted at the interface membrane around a loosened hip prosthesis is a feasible treatment option for elderly patients for whom surgical intervention is not appropriate.
Revision surgery for loosened hip prostheses is a heavy burden for elderly patients with comorbid... more Revision surgery for loosened hip prostheses is a heavy burden for elderly patients with comorbidity. As an alternative to surgery we performed a study to stabilize the prosthesis by percutaneous cement injection after removing inflammatory tissue with an intraarticular virus-directed enzyme prodrug approach. Twelve elderly patients with debilitating pain from a loosened hip prosthesis were included in a phase 1 dose-escalating clinical study. The patients were admitted to the hospital for 10 days for an intraarticular vector and prodrug injection, and subsequently for a percutaneous bone cement injection. This paper reports the adverse and serious adverse events of the study. After prodrug injection 9 of 12 patients had gastrointestinal adverse events (nausea, vomiting, and diarrhea), and 8 patients had hepatic adverse events (rise in aspartate aminotransferase and alanine aminotransferase). Five patients developed anemia (World Health Organization grade 1 or 2) from hematomas after cement injection. There were four serious adverse events in the first 6 months after vector injection, but these were not related to gene therapy as judged by an independent safety committee. There was no dose-limiting toxicity. However, the extensive comorbidity in these patients makes it difficult to fully establish the safety of the approach in this small and heterogeneous patient population.
To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) in... more To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) into the Dutch language (SRQ-DLV) and evaluate its internal consistency, reliability, validity and responsiveness to clinical changes. Prospective study. Outpatient departments of orthopaedics, radiology and physical therapy of an academic and a non-academic hospital. One hundred and seven patients treated for unilateral shoulder disorder (adhesive capsulitis 68, calcifying tendinitis 22, impingement syndrome or rotator cuff tear 17). The original SRQ was translated and adapted following international guidelines. The SRQ-DLV was used among other measures of body function and structure, activities and societal participation in order to determine reliability, internal consistency, validity and responsiveness. Assessments were done at baseline and three months after treatment, with the SRQ-DLV being re-administered within one week before the baseline measurement and the start of the treatment for testing reliability. Cronbach's alpha for internal consistency was 0.89 for the total questionnaire and 0.81, 0.80, 0.72 and 0.84 for the domains pain, daily activities, sports/recreational activities and work, respectively. Test-retest reliability of the SRQ-DLV and its subscales ranged from 0.63 to 0.86. The summary score of the SRQ-DLV correlated with measures of shoulder function, daily activities and quality of life. Except for the work subscale of the SRQ-DLV, large effect sizes, reflecting its responsiveness to clinical changes after treatment, were found for both the summary and the subscales scores. Empirical data support that the SRQ-DLV is a reliable, valid and responsive measure to be used in clinical trials including Dutch patients with various shoulder disorders.
This study aimed to assess patient dose and occupational dose in established and new applications... more This study aimed to assess patient dose and occupational dose in established and new applications of MDCT fluoroscopy. Electronic personal dosimeters were used to measure occupational dose equivalent. Effective patient dose was derived from the recorded dose-length product. Acquisition parameters that were observed during CT fluoroscopy (CTF) provided the basis for the estimation of an entrance skin dose profile. Two hundred ten CT-guided interventional procedures were included in the study. The median effective patient dose was 10 mSv (range, 0.1-235 mSv; 107 procedures). The median peak entrance skin dose was 0.4 Sv (0.1-2.1 Sv; 27 procedures). From 547 measurements of occupational dose equivalent, a median occupational effective dose of 3 muSv per procedure was derived for the interventional radiologists and 0.4 muSv per procedure for the assisting radiologists and radiology technologists. The estimated maximum occupational effective dose reached 0.4 mSv. The study revealed high effective patient doses, up to 235 mSv, mainly for relatively new applications such as CTF-guided radiofrequency ablations using MDCT, vertebroplasty, and percutaneous ethanol injections of tumors. Entrance doses were occasionally in the range of the warning level for deterministic skin effects but were always below the threshold for serious deterministic effects. The complexity of the procedure, expected benefits of the treatment, and general health state of the patient contribute to the justification of observed high effective patient doses.
To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) in... more To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) into the Dutch language (SRQ-DLV) and evaluate its internal consistency, reliability, validity and responsiveness to clinical changes. Prospective study. Outpatient departments of orthopaedics, radiology and physical therapy of an academic and a non-academic hospital. One hundred and seven patients treated for unilateral shoulder disorder (adhesive capsulitis 68, calcifying tendinitis 22, impingement syndrome or rotator cuff tear 17). The original SRQ was translated and adapted following international guidelines. The SRQ-DLV was used among other measures of body function and structure, activities and societal participation in order to determine reliability, internal consistency, validity and responsiveness. Assessments were done at baseline and three months after treatment, with the SRQ-DLV being re-administered within one week before the baseline measurement and the start of the treatment for testing reliability. Cronbach's alpha for internal consistency was 0.89 for the total questionnaire and 0.81, 0.80, 0.72 and 0.84 for the domains pain, daily activities, sports/recreational activities and work, respectively. Test-retest reliability of the SRQ-DLV and its subscales ranged from 0.63 to 0.86. The summary score of the SRQ-DLV correlated with measures of shoulder function, daily activities and quality of life. Except for the work subscale of the SRQ-DLV, large effect sizes, reflecting its responsiveness to clinical changes after treatment, were found for both the summary and the subscales scores. Empirical data support that the SRQ-DLV is a reliable, valid and responsive measure to be used in clinical trials including Dutch patients with various shoulder disorders.
This study aimed to assess patient dose and occupational dose in established and new applications... more This study aimed to assess patient dose and occupational dose in established and new applications of MDCT fluoroscopy. Electronic personal dosimeters were used to measure occupational dose equivalent. Effective patient dose was derived from the recorded dose-length product. Acquisition parameters that were observed during CT fluoroscopy (CTF) provided the basis for the estimation of an entrance skin dose profile. Two hundred ten CT-guided interventional procedures were included in the study. The median effective patient dose was 10 mSv (range, 0.1-235 mSv; 107 procedures). The median peak entrance skin dose was 0.4 Sv (0.1-2.1 Sv; 27 procedures). From 547 measurements of occupational dose equivalent, a median occupational effective dose of 3 muSv per procedure was derived for the interventional radiologists and 0.4 muSv per procedure for the assisting radiologists and radiology technologists. The estimated maximum occupational effective dose reached 0.4 mSv. The study revealed high effective patient doses, up to 235 mSv, mainly for relatively new applications such as CTF-guided radiofrequency ablations using MDCT, vertebroplasty, and percutaneous ethanol injections of tumors. Entrance doses were occasionally in the range of the warning level for deterministic skin effects but were always below the threshold for serious deterministic effects. The complexity of the procedure, expected benefits of the treatment, and general health state of the patient contribute to the justification of observed high effective patient doses.
In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobiliza... more In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder. One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or =50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study. Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Pr...
The purpose of this case report is to describe the use of end-range mobilization techniques in th... more The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean fl...
A prospective study on 24 patients with spinal osteoid osteoma treated with radiofrequency ablati... more A prospective study on 24 patients with spinal osteoid osteoma treated with radiofrequency ablation (RFA). To determine if and when computed tomography (CT)-guided RFA is a safe and effective treatment for spinal osteoid osteomas. Surgery has been considered the standard treatment for spinal osteoid osteomas. Surgery may cause spinal instability, infection, and nervous injury. We evaluated CT-guided RFA as an alternative treatment. A total of 28 RFA procedures in 24 patients with spinal osteoid osteoma were performed, using a 5-mm noncooled electrode. Clinical symptoms and spinal deformity were evaluated before and after the procedure. Unsuccessful treatment was defined as the presence of residual or recurrent symptoms. The mean follow-up was 72 months (range: 9-142 months). Nineteen (79%) patients were successfully treated after 1 RFA, and all except one after repeat RFA. One patient with nerve root compression needed further surgery. No complications were observed. Spinal deformity persisted in 3 of 7 patients after successful RFA. CT-guided RFA is a safe and effective treatment for spinal osteoid osteoma. Surgery should be reserved for lesions causing nerve root compression.
To retrospectively identify risk factors that may impede a favorable clinical outcome after therm... more To retrospectively identify risk factors that may impede a favorable clinical outcome after thermocoagulation for osteoid osteoma. Informed consent (permission for the procedure and permission to use patient data for analysis) was obtained from all patients who met study criteria, and institutional review board did not require approval. Analysis included age, sex, size and location of osteoid osteoma, presence of calcified nidus, number of needle positions used for coagulation, coagulation time, accuracy of needle position, learning curve of radiologist, and previous treatment in 95 consecutive patients with osteoid osteoma treated with thermocoagulation. With chi(2) analysis, Fisher exact test, or unpaired Student t test and logistic regression analysis, 23 unsuccessfully treated patients were compared with 72 successfully (pain-free) treated patients. Parameters associated with decreased risk for treatment failure were advanced age (mean age, 24 years in treatment success group vs 20 years in treatment failure group) and increased number of needle positions during thermocoagulation. Estimated odds ratios were, respectively, 0.93 (95% confidence interval: 0.88, 0.99) and 0.10 (95% confidence interval: 0.02, 0.41). Patients with a lesion of 10 mm or larger seemed at risk for treatment failure (odds ratio = 2.68), but the 95% confidence interval of 0.84 to 8.52 included the 1.00 value. Needle position was inaccurate in nine of 23 patients with treatment failure; only one needle position was used in eight of these nine patients. Lesion location, calcification, sex, coagulation time, radiologist's learning curve, and previous treatment were not risk factors. Multiple needle positions reduce the risk of treatment failure in all patients and should especially, but not exclusively, be used in large (> or =10-mm) lesions or lesions that are difficult to engage to reduce the risk for unsuccessful treatment.
To determine the clinical results in an unselected group of consecutive patients with osteoid ost... more To determine the clinical results in an unselected group of consecutive patients with osteoid osteoma treated with thermocoagulation. In 97 consecutive patients with clinical and/or radiologic evidence of osteoid osteoma at any location, the clinical symptoms were assessed before and after thermocoagulation with computed tomographic guidance. A good response was defined as disappearance of symptoms that were manifested at presentation and attributed to osteoid osteoma. Clinical assessment was performed prior to discharge; within 2 weeks after the procedure; and at 3, 6, 12, and 24 months follow-up. After 24 months, a postal questionnaire was used for assessment. The mean clinical follow-up after the only or the last thermocoagulation session was 41 months (range, 5-81 months). Response was good after one session of thermocoagulation in 74 (76%) of 97 patients, and the 95% CI was 68% to 85%. Patients with persistent symptoms did well after repeated thermocoagulation (good response in 10 of 12 patients), but results of repeated thermocoagulation were poor in patients with recurrent symptoms (good response in five of 10). The overall success rate after one or two thermocoagulation procedures combined was 92% (89 of 97 patients), and the 95% CI was 86% to 97%. Complications were observed in two patients. Percutaneous thermocoagulation is a safe and effective method for treatment of osteoid osteoma at any location. Repeated thermocoagulation is successful in patients with persistent symptoms.
Loosening of orthopedic hip prostheses is an increasing health problem. In elderly patients with ... more Loosening of orthopedic hip prostheses is an increasing health problem. In elderly patients with comorbidity,revision surgery may lead to high mortality rates. A less invasive surgical technique is therefore required to reduce these patient risks. To this end a percutaneous gene therapy approach was designed to destroy the periprosthetic loosening membrane, and enable refixing of the hip prosthesis with percutaneous bone cement injections under radiological guidance. In this phase 1/2 dose-escalating gene therapy clinical trial, 12 patients were treated. Toxicity and hip function variables were monitored up to 6 months posttreatment. All patients completed the study and no dose-limiting toxicity was observed. Improvement in walking distance, independence,and pain was demonstrated particularly in patients receiving 3 x 10(10) and 1 x 10(11) viral particles. Taken together, these data show that this gene therapy approach targeted at the interface membrane around a loosened hip prosthesis is a feasible treatment option for elderly patients for whom surgical intervention is not appropriate.
Revision surgery for loosened hip prostheses is a heavy burden for elderly patients with comorbid... more Revision surgery for loosened hip prostheses is a heavy burden for elderly patients with comorbidity. As an alternative to surgery we performed a study to stabilize the prosthesis by percutaneous cement injection after removing inflammatory tissue with an intraarticular virus-directed enzyme prodrug approach. Twelve elderly patients with debilitating pain from a loosened hip prosthesis were included in a phase 1 dose-escalating clinical study. The patients were admitted to the hospital for 10 days for an intraarticular vector and prodrug injection, and subsequently for a percutaneous bone cement injection. This paper reports the adverse and serious adverse events of the study. After prodrug injection 9 of 12 patients had gastrointestinal adverse events (nausea, vomiting, and diarrhea), and 8 patients had hepatic adverse events (rise in aspartate aminotransferase and alanine aminotransferase). Five patients developed anemia (World Health Organization grade 1 or 2) from hematomas after cement injection. There were four serious adverse events in the first 6 months after vector injection, but these were not related to gene therapy as judged by an independent safety committee. There was no dose-limiting toxicity. However, the extensive comorbidity in these patients makes it difficult to fully establish the safety of the approach in this small and heterogeneous patient population.
To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) in... more To translate and adapt the original English version of the Shoulder Rating Questionnaire (SRQ) into the Dutch language (SRQ-DLV) and evaluate its internal consistency, reliability, validity and responsiveness to clinical changes. Prospective study. Outpatient departments of orthopaedics, radiology and physical therapy of an academic and a non-academic hospital. One hundred and seven patients treated for unilateral shoulder disorder (adhesive capsulitis 68, calcifying tendinitis 22, impingement syndrome or rotator cuff tear 17). The original SRQ was translated and adapted following international guidelines. The SRQ-DLV was used among other measures of body function and structure, activities and societal participation in order to determine reliability, internal consistency, validity and responsiveness. Assessments were done at baseline and three months after treatment, with the SRQ-DLV being re-administered within one week before the baseline measurement and the start of the treatment for testing reliability. Cronbach's alpha for internal consistency was 0.89 for the total questionnaire and 0.81, 0.80, 0.72 and 0.84 for the domains pain, daily activities, sports/recreational activities and work, respectively. Test-retest reliability of the SRQ-DLV and its subscales ranged from 0.63 to 0.86. The summary score of the SRQ-DLV correlated with measures of shoulder function, daily activities and quality of life. Except for the work subscale of the SRQ-DLV, large effect sizes, reflecting its responsiveness to clinical changes after treatment, were found for both the summary and the subscales scores. Empirical data support that the SRQ-DLV is a reliable, valid and responsive measure to be used in clinical trials including Dutch patients with various shoulder disorders.
This study aimed to assess patient dose and occupational dose in established and new applications... more This study aimed to assess patient dose and occupational dose in established and new applications of MDCT fluoroscopy. Electronic personal dosimeters were used to measure occupational dose equivalent. Effective patient dose was derived from the recorded dose-length product. Acquisition parameters that were observed during CT fluoroscopy (CTF) provided the basis for the estimation of an entrance skin dose profile. Two hundred ten CT-guided interventional procedures were included in the study. The median effective patient dose was 10 mSv (range, 0.1-235 mSv; 107 procedures). The median peak entrance skin dose was 0.4 Sv (0.1-2.1 Sv; 27 procedures). From 547 measurements of occupational dose equivalent, a median occupational effective dose of 3 muSv per procedure was derived for the interventional radiologists and 0.4 muSv per procedure for the assisting radiologists and radiology technologists. The estimated maximum occupational effective dose reached 0.4 mSv. The study revealed high effective patient doses, up to 235 mSv, mainly for relatively new applications such as CTF-guided radiofrequency ablations using MDCT, vertebroplasty, and percutaneous ethanol injections of tumors. Entrance doses were occasionally in the range of the warning level for deterministic skin effects but were always below the threshold for serious deterministic effects. The complexity of the procedure, expected benefits of the treatment, and general health state of the patient contribute to the justification of observed high effective patient doses.
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