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Intraosseous vascular access is a commonly conducted procedure especially in pediatric resuscitation. Very high success rates for intraosseous (IO) devices are reported. Aim of the study was to describe the rates of malposition of intraosseous needles (ION) in pediatric cadavers via post-mortem computed tomography (PMCT). 212 consecutive pediatric cadavers underwent PMCT, of which 38 cadavers had visible ION and were included in the study. They were divided into two subgroups depending on their age (n = 22 infant cadavers (age <1 year) and n = 16 child cadavers (age ≥1 year)). Two independent readers evaluated the number and position of ION. In 22 infant cadavers 34 ION were found. Malposition of at least one ION was visible in 14 subjects (64%), among which 7 cadavers (32%) even had no correctly placed ION, thus being without established vascular access. Overall, 16 of the 34 used ION devices (47%) were in malposition. 23 ION were found in 16 child cadavers. In 8 subjects (50%) at least one ION was malpositioned, among which 3 cadavers (19%) had no correctly placed ION, resulting in a complete absence of vascular access. Overall, 9 of the 23 ION devices (39%) were malpositioned. Our study showed relatively high malposition rates for ION devices in pediatric cadavers which was not to be assumed regarding the success rates of 80% and higher in previous literature. This should be clarified by further studies in living patients. [ABSTRACT FROM AUTHOR]

Rationale and Objectives Dose reduction may compromise patients because of a decrease of image quality. Therefore, the amount of dose savings in new dose-reduction techniques needs to be thoroughly assessed. To avoid repeated studies in one patient, chest computed tomography (CT) scans with different dose levels were performed in corpses comparing model-based iterative reconstruction (MBIR) as a tool to enhance image quality with current standard full-dose imaging. Materials and Methods Twenty-five human cadavers were scanned (CT HD750) after contrast medium injection at different, decreasing dose levels D0–D5 and respectively reconstructed with MBIR. The data at full-dose level, D0, have been additionally reconstructed with standard adaptive statistical iterative reconstruction (ASIR), which represented the full-dose baseline reference (FDBR). Two radiologists independently compared image quality (IQ) in 3-mm multiplanar reformations for soft-tissue evaluation of D0–D5 to FDBR (−2, diagnostically inferior; −1, inferior; 0, equal; +1, superior; and +2, diagnostically superior). For statistical analysis, the intraclass correlation coefficient (ICC) and the Wilcoxon test were used. Results Mean CT dose index values (mGy) were as follows: D0/FDBR = 10.1 ± 1.7, D1 = 6.2 ± 2.8, D2 = 5.7 ± 2.7, D3 = 3.5 ± 1.9, D4 = 1.8 ± 1.0, and D5 = 0.9 ± 0.5. Mean IQ ratings were as follows: D0 = +1.8 ± 0.2, D1 = +1.5 ± 0.3, D2 = +1.1 ± 0.3, D3 = +0.7 ± 0.5, D4 = +0.1 ± 0.5, and D5 = −1.2 ± 0.5. All values demonstrated a significant difference to baseline ( P < .05), except mean IQ for D4 ( P = .61). ICC was 0.91. Conclusions Compared to ASIR, MBIR allowed for a significant dose reduction of 82% without impairment of IQ. This resulted in a calculated mean effective dose below 1 mSv. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare in a prospective noninferiority study optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in popliteal and infrapopliteal vessels. Materials and Methods: OCT and IVUS images of 112 popliteal and infrapopliteal arterial segments were prospectively obtained from 16 patients with peripheral arterial occlusive disease. Three observers evaluated the corresponding OCT and IVUS images for image quality, artifact frequency, discriminability of vessel wall layers, and plaque composition. Measurements of the lumen, vessel, and plaque areas were compared for both modalities. Results: The intrareader and interreader reproducibility of plaque tissue discrimination (0.88 vs 0.75), overall image quality, and vessel wall layer discriminability were significantly higher for OCT (all P < .001). Artifact frequency was higher in OCT, constraining the imaging of the tibioperoneal trunk. The results of measurements of the lumen and vessel area were comparable for both modalities (correlation > 0.9, P < .001). Plaque area measurements differed (correlation 0.8, P < .01) because OCT underestimated it. The OCT procedure caused vessel spasms in two patients. Conclusions: OCT imaging of infrapopliteal arteries is feasible and safe and provides high image quality. It enables an accurate assessment of vessel lumen, wall, and plaque. Compared with IVUS, OCT images provide excellent image quality and superior visualization of vessel wall layers and different plaque components. The penetration depth of OCT restricts its use to suitable vessel regions. [Copyright &y& Elsevier]

Our study cannot clarify this either, since in almost all cases the proximal tibia was chosen as the access site (only two cases with a different access site; in both cases malpositions of the needle[3]). - In our study, the malpositions in which the corticalis was perforated on both sides were the minority of malpositions (31% in infants and 11% in children[3]). 2 L. Szarpak, Z. Truszewski, J. Smereka, A randomized cadaver study comparing first-attempt success between tibial and humeral intraosseous insertions using NIO device by paramedics: a preliminary investigation. [Extracted from the article]