Aim: The F+10 method in supine position, which has been implemented at our Nuclear Medicine department since 2015, involves a 30- minute long dynamic acquisition. The diuretic is only administered when necessary and decision is taken by the radiographers in a semi-automated fashion without consulting a physician, by calculating the remaining activity in the kidneys seven minutes post 99mTc-MAG3 injection and comparing the value with an arbitrary threshold of 75 %. If needed, the diuretic is injected three minutes later. The aim of this study was to correlate our method with the established previously used F+20 protocol in adults. Is the currently used threshold of 75% of activity left in any kidney at seven minutes the optimal cut-off value for diuretic administration?

Material and Methods: This is an ongoing retrospective study which include 320 F+20 examinations of adult patients performed during 2013-2015. They were all re-evaluated according to the currently used F+10 method, categorized as requiring diuretic or not and correlated to the original F+20 examination. A ROC-curve was drawn to delineate the best cut-off value for remaining renal activity. Sensitivity, specificity and accuracy were calculated.

Results: Preliminary results indicate that the F+10 re-evaluations with the currently used cut-off value of 75% did not correlate with the original F+20 examinations. In 80% (255 examinations) of the F+10 re-evaluations diuretic would have been considered necessary while only 52% (167 examinations) received diuretics in the original F+20 renographies (sensitivity 1.0, specificity 0.42). However, all the patients who required furosemide in the original F+20 renographies would have received diuretic if they had been imaged with the F+10 protocol. Furthermore, examination time is considerably reduced. After an evaluation of the ROC-curve the optimal cut-off value was 94% (sensitivity 0.92, specificity 0.84, accuracy 0.88). However, by implementing this value, 13 patients (4%) would have been falsely categorized as not requiring diuretic.

Conclusions: The 99mTc-MAG3 renography with the F+10 protocol in supine position is a feasible and acceptable method in clinical practice.

Abstract

This Concept Analysis according to Walker & Avant (1995) studies the concept of uncertainty in the nursing context. It consists of four parts where uncertainty in general have been encircled in a semantic analysis (part one) and a qualitative content analysis consisting of an questionnaire, distributed to the staff members at one nursing and medicine institution, with an open question about the meaning of uncertainty (part two). The third part is a literature study of the nursing context to find out how uncertainty is described (part three). Part four is the actual concept analysis based on the three first parts.

Uncertainty in the nursing context is an individual conscious experience witch is changeable and impressionable. It is chained together with its antecendents and consequences. The uncertainty has to be conscious and people’s experiences are individual. In the changeability for example there is a difference in degree from being nearly certain to a total uncertainty and positive/negative. Uncertainty can be experienced positively and negatively at the same time for example in the diagnostic phase where there still is a possibility that nothing is wrong, and at the same time a possibility to have been affected of a serious illness with arduous treatment and a bad prognosis. The impressionability includes at one hand the person’s own ability to influence his/hers experience of uncertainty through out different strategies and at the other hand professional support to manage the uncertainty.

Antecendents of uncertainty is threat of disease, disease and risk of relapse. The consequences that are caused by uncertainty can be individual and social. The consequences are also affected by a row of factors that causes uncertainty, type of uncertainty, influencing factors with negative or positive connections.

The concept is complex and in covering its attributes, the characteristics of these attributes will be described in a quite general way. This also includes earlier performed concept analysis independent of the method for analysis, where no method itself succeeds to cover the entirety but highlights different characteristics. In this study a clearer picture has been achieved in the literature study, where uncertainty in the nursing context is encircled. Four main themes emerged: Causes of uncertainty, Type of uncertainty, Influencing factors of uncertainty and Strategies to handle uncertainty. They are in themselves divided into subgroups exemplified through previous research studies. The complexity can also bee demonstrated in the long list of synonyms in the semantic analysis. In the second part themes emerge that in several cases can be associated with the literature.

The impressionability and the possibility to experience uncertainty that are simultaneously positive and negative in their attributes are the main findings of this concept analysis and its meaning in the nursing context has been developed in comparison to earlier definitions.

An applicability of this study may be to highlight the patient living with uncertainty in nursing through seminars in nursing education.

Further research should bee addressed to develop several strategies for professional support to patients living with uncertainty in specific interventions adjusted for example to different diagnosis or patients with different type of needs.

Purpose: To investigate two different breath-hold techniques, in terms of patient experience and image quality, and describe patients' experiences of magnetic resonance imaging.

Methods and Materials: Thirty patients referred for an MRI of the liver conducted two separate breath-hold acquisitions in a randomised order, radiographer-directed and patient-initiated. Semi-structured interviews were held and analysed, and images were reviewed according to image quality.

Results: The patients' general experiences of the MRI were that they felt a loss of control, and almost half of the patients seemed to prefer the self-initiated breath-hold. About 20 % of the patients preferred to hand over the responsibility to the radiographer, and for some the technique did not matter.The patients empathized in general the importance of achieving the best image quality. There were no significant differences identified between the two breath-hold techniques, in regards to image quality.

Conclusion: The results show that self-initiated breath-hold acquisitions can be seen as a new alternative worth considering in clinical MRI since it is appreciated by the patients and give similar image quality compared to conventional breath-hold acquisitions. It also offers a possibility to achieve some control over the situation.

Purpose: To investigate MRI image quality using two different breath-hold techniques.

Materials and methods: Thirty patients remitted for MRI, 2D-dual gradient echo acquisition of the liver conducted two separate breath-hold acquisitions in randomized order, operator-instructed and patient-initiated. The images were reviewed by two radiologists.

Results: There were no significant differences in image quality between the two breath-hold techniques either in overall image quality or respiratory motion artifacts. This assessment was equal and concordant for both radiologists.

Conclusion: In terms of image quality, the patient self-initiated breath-hold was shown to be an equal alternative to conventional breath-hold imaging.

Aims: To describe patients' experiences of magnetic resonance examination of the liver and their experiences of two breath-hold techniques.

Background: Traditionally, patients are instructed by the radiographer to hold their breath during the examination. Alternatively, the patient can initiate the breath hold and start the image acquisition. Studies have revealed that magnetic resonance examinations can be experienced as challenging.

Design: Descriptive qualitative.

Methods: Semi-structured interviews were conducted with 28 patients and analysed using qualitative content analysis. The data collection was carried out from autumn 2010 to spring 2011.

Results: The patients' main experience was that they felt loss of control. This was described in terms of feeling trapped, being lost in time and lost as a result of uncertainty. They had many questions in their mind that they did not ask. Although their statements often revealed no clear preference regarding the techniques, almost half of the patients seemed to prefer self-initiated breath hold, as it was easier and less stressful. Those who preferred the radiographer-directed technique felt more confident leaving the responsibility to the radiographer. In general, the patients understood the importance of achieving the best quality images possible.

Conclusion: Magnetic resonance examination can be experienced as being in loss of control. Nevertheless, not all patients wished to actively participate in magnetic resonance examination. Some preferred to hand over the responsibility to the radiographer. These results can form a base for radiographers' reflections of how to individualize and optimize the nursing care of patients undergoing magnetic resonance examinations.

Aim: To describe patients' and radiographers' experiences of abdominal compression using conventional and patient-controlled compression methods.

Design: Qualitative descriptive design.

Methods: Forty-five patients who had used both a conventional and a patient-controlled compression device answered questionnaires. Five radiographers were interviewed. The data-collection took place between September 2015 and February 2017. Data were analysed by qualitative content analysis.

Results: Patient-controlled compression was preferred by slightly more patients because of fear of pain due to excessively hard pressure, maintaining control over the pressure and shorter duration. It was more comfortable, and patients felt they could participate in the examinations. Conventional compression was preferred by some because of more stable pressure and uncertainty of own capacity to provide the optimal compression. Discomfort was more often mentioned concerning the conventional compression method. The radiographers experienced the patient-controlled method as less time-consuming and more comfortable, but uncertainty about correct compression technique and its effect on radiation dose and image quality was reported.