Papers by Jonathan McNulty
European stroke journal, Jul 22, 2023
Background: The Oxford Carotid Stenosis tool (OCST) and Essen Stroke Risk Score (ESRS) are valida... more Background: The Oxford Carotid Stenosis tool (OCST) and Essen Stroke Risk Score (ESRS) are validated to predict recurrent stroke in patients with and without carotid stenosis. The Symptomatic Carotid Atheroma Inflammation Lumen stenosis (SCAIL) score combines stenosis and plaque inflammation on fluorodeoxyglucose positron-emission tomography (18FDG-PET). We compared SCAIL with OCST and ESRS to predict ipsilateral stroke recurrence in symptomatic carotid stenosis. Patients and methods: We pooled three prospective cohort studies of patients with recent (<30 days) non-severe ischaemic stroke/TIA and internal carotid artery stenosis (>50%). All patients had carotid 18FDG-PET/CT angiography and late follow-up, with censoring at carotid revascularisation. Results: Of 212 included patients, 16 post-PET ipsilateral recurrent strokes occurred in 343 patient-years follow-up (median 42 days (IQR 13–815)). Baseline SCAIL predicted recurrent stroke (unadjusted hazard ratio [HR] 1.96, CI 1.20–3.22, p = 0.007, adjusted HR 2.37, CI 1.31–4.29, p = 0.004). The HR for OCST was 0.996 (CI 0.987–1.006, p = 0.49) and for ESRS was 1.26 (CI 0.87–1.82, p = 0.23) (all per 1-point score increase). C-statistics were: SCAIL 0.66 (CI 0.51–0.80), OCST 0.52 (CI 0.40–0.64), ESRS 0.61 (CI 0.48–0.74). Compared with ESRS, addition of plaque inflammation (SUVmax) to ESRS improved risk prediction when analysed continuously (HR 1.51, CI 1.05–2.16, p = 0.03) and categorically ( ptrend = 0.005 for risk increase across groups; HR 3.31, CI 1.42–7.72, p = 0.006; net reclassification improvement 10%). Findings were unchanged by further addition of carotid stenosis. Conclusions: SCAIL predicted recurrent stroke, had discrimination better than chance, and improved the prognostic utility of ESRS, suggesting that measuring plaque inflammation may improve risk stratification in carotid stenosis.
BJR|open, Jun 30, 2023
Artificial intelligence (AI) has transitioned from the lab to the bedside, and it is increasingly... more Artificial intelligence (AI) has transitioned from the lab to the bedside, and it is increasingly being used in healthcare. Radiology and Radiography are on the frontline of AI implementation, because of the use of big data for medical imaging and diagnosis for different patient groups. Safe and effective AI implementation requires that responsible and ethical practices are upheld by all key stakeholders, that there is harmonious collaboration between different professional groups, and customised educational provisions for all involved. This paper outlines key principles of ethical and responsible AI, highlights recent educational initiatives for clinical practitioners and discusses the synergies between all medical imaging professionals as they prepare for the digital future in Europe. Responsible and ethical AI is vital to enhance a culture of safety and trust for healthcare professionals and patients alike. Educational and training provisions for medical imaging professionals on AI is central to the understanding of basic AI principles and applications and there are many offerings currently in Europe. Education can facilitate the transparency of AI tools, but more formalised, university-led training is needed to ensure the academic scrutiny, appropriate pedagogy, multidisciplinarity and customisation to the learners’ unique needs are being adhered to. As radiographers and radiologists work together and with other professionals to understand and harness the benefits of AI in medical imaging, it becomes clear that they are faced with the same challenges and that they have the same needs. The digital future belongs to multidisciplinary teams that work seamlessly together, learn together, manage risk collectively and collaborate for the benefit of the patients they serve.
Journal of Medical Imaging and Radiation Sciences, Jun 1, 2023
BMC Medical Education, 2013
Background: Research on emotional intelligence (EI) suggests that it is associated with more pro-... more Background: Research on emotional intelligence (EI) suggests that it is associated with more pro-social behavior, better academic performance and improved empathy towards patients. In medical education and clinical practice, EI has been related to higher academic achievement and improved doctor-patient relationships. This study examined the effect of EI on academic performance in first-and final-year medical students in Malaysia. Methods: This was a cross-sectional study using an objectively-scored measure of EI, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Academic performance of medical school students was measured using continuous assessment (CA) and final examination (FE) results. The first-and final-year students were invited to participate during their second semester. Students answered a paper-based demographic questionnaire and completed the online MSCEIT on their own. Relationships between the total MSCEIT score to academic performance were examined using multivariate analyses. Results: A total of 163 (84 year one and 79 year five) medical students participated (response rate of 66.0%). The gender and ethnic distribution were representative of the student population. The total EI score was a predictor of good overall CA (OR 1.01), a negative predictor of poor result in overall CA (OR 0.97), a predictor of the good overall FE result (OR 1.07) and was significantly related to the final-year FE marks (adjusted R 2 = 0.43). Conclusions: Medical students who were more emotionally intelligent performed better in both the continuous assessments and the final professional examination. Therefore, it is possible that emotional skill development may enhance medical students' academic performance.
Radiation Protection Dosimetry, 2022
This study investigated the effects of cone-beam computed tomography (CBCT) guidance in trans-art... more This study investigated the effects of cone-beam computed tomography (CBCT) guidance in trans-arterial chemoembolisation (TACE) procedures on the number of digital subtraction angiography (DSA) runs acquired and total patient radiation exposure in patients with hepatocellular carcinoma (HCC). A retrospective, analytical cross-sectional, single institution, study was conducted. Dose data were compared across the control (DSA guidance alone) and study (DSA and CBCT guidance) groups. A total of 122 procedures were included within the study. There was a significant reduction in the number of DSA runs (3 vs 5, p < 0.001) and DSA air kerma-area product (PKA) (3077.3 vs 4276.6 μGym 2 , p = 0.042) for the study group when compared to the control group. Total procedural PKA and total procedural reference air kerma (K a,r) were shown to be 50 and 73% higher, respectively, for the study group when compared to the control group. CBCT imaging guidance does reduce the number of DSA runs and DSA PKA required to complete the TACE procedure for patients diagnosed with HCC; however, a substantial increase in total procedural PKA is to be expected and it is thus important that this increased dose is carefully considered and justified.
Alzheimers & Dementia, Jul 1, 2015
Background:The posterior cingulate cortex (PCC) is an area that has recently seen an increasedMRS... more Background:The posterior cingulate cortex (PCC) is an area that has recently seen an increasedMRS focus in studies of ageing and dementia due to its important role in the default mode network and dementia research. When using MRS to measure neurochemistry, correct estimates of relaxation times are important for accurate quantification of metabolite concentration levels (Gasparovic et al., 2006). The purpose of this study was to investigate proton metabolite transverse relaxation (T2) times in the posterior cingulate cortex across age. Transverse relaxation timeswere obtained for choline (Cho), total creatine (tCr), N-acetyl-aspartate (NAA), myo-inositol (MI) and glutamate (Glu). Methods: Single voxel Point Resolved spectrally selective spectroscopy (PRESS) was performed in the PCC with five selected echo times of 40, 80, 105, 256, and 400ms (repetition time of 2000ms) in thirteen young and eleven older participants at 3 Tesla. Metabolites were fit using TARQUIN (Wilson et al., 2011) and
Neurology, Apr 13, 2022
Background and ObjectivesIn pooled analyses of endarterectomy trials for symptomatic carotid sten... more Background and ObjectivesIn pooled analyses of endarterectomy trials for symptomatic carotid stenosis, several subgroups experienced no net benefit from revascularization. The validated symptomatic carotid atheroma inflammation lumen-stenosis (SCAIL) score includes stenosis severity and inflammation measured by PET and improves the identification of patients with recurrent stroke compared with lumen-stenosis alone. We investigated whether the SCAIL score improves the identification of recurrent stroke in subgroups with uncertain benefit from revascularization in endarterectomy trials.MethodsWe did an individual-participant data pooled analysis of 3 prospective cohort studies (Dublin Carotid Atherosclerosis Study [DUCASS], 2008–2011; Biomarkers and Imaging of Vulnerable Atherosclerosis in Symptomatic Carotid Artery Disease [BIOVASC], 2014–2018; Barcelona Plaque Study, 2015–2018). Eligible patients had a recent nonsevere (modified Rankin Scale score ≤3) anterior circulation ischemic stroke/TIA and ipsilateral mild carotid stenosis (&lt;50%); ipsilateral moderate carotid stenosis (50%–69%) plus at least 1 of female sex, age &lt;65 years, diabetes mellitus, TIA, or delay &gt;14 days to revascularization; or monocular loss of vision. Patients underwent coregistered carotid 18F-fluorodeoxyglucosePET/CT angiography (≤7 days from inclusion). The primary outcome was 90-day ipsilateral ischemic stroke. Multivariable Cox regression modeling was performed.ResultsWe included 135 patients. All patients started optimal modern-era medical treatment at admission, and 62 (45.9%) underwent carotid revascularization (36 within the first 14 days and 26 beyond). At 90 days, 18 (13.3%) patients had experienced at least 1 stroke recurrence. The risk of recurrence increased progressively according to the SCAIL score (0.0% in patients scoring 0–1, 15.1% scoring 2–3, and 26.7% scoring 4–5; p = 0.04). The adjusted (age, smoking, hypertension, diabetes, carotid revascularization, antiplatelets and statins) hazard ratio for ipsilateral recurrent stroke per 1-point SCAIL increase was 2.16 (95% CI 1.32–3.53; p = 0.002). A score ≥2 had a sensitivity of 100% for recurrence.DiscussionThe SCAIL score improved the identification of early recurrent stroke in subgroups who did not experience benefit in endarterectomy trials. Randomized trials are needed to test whether a combined stenosis-inflammation strategy will improve selection for carotid revascularization when benefit is currently uncertain.Classification of EvidenceThis study provides Class II evidence that, in patients with recent anterior circulation ischemic stroke who do not benefit from carotid revascularization, the SCAIL score accurately distinguishes those at risk for recurrent ipsilateral ischemic stroke.
Radiography, Mar 1, 2023
Objectives: The COVID-19 pandemic had a major effect on teaching and learning. This study aimed t... more Objectives: The COVID-19 pandemic had a major effect on teaching and learning. This study aimed to describe a range of teaching, learning, and assessment strategies related to radiography education which have become more common due to the pandemic through a narrative literature review. Key findings: Educational change in radiography was accelerated by the disruption caused by the pandemic. Changes included the site and mode of teaching and conducting of assessment. While some of the digital transformation trends were introduced before the pandemic, others were further amplified during this period of time. Alternative solutions such as virtual reality technology, gamification, and technology-enhanced learning were especially salient and have the potential to mitigate challenges brought about by the pandemic. The use of technology in the clinical setting, in assessment, and to facilitate feedback, are important tools for improving learners' clinical skills performance. Collectively, these digital technologies can maximise learning and support mastery of knowledge, skills and attitudes. Conclusion: The pandemic has cast a new light on existing methodologies and pedagogies in education. This review suggests that digital technology is shaping teaching and learning within radiography education and also that educators cannot ignore this digital shift. With the digital trajectory, it would be highly useful to transform approaches to education within radiography to support learning as radiography education moves towards the new normal era. Implications for practice: Digital technology in education can help improve the learning experience for learners but educators need to be equipped with the technological skills and be adaptable to these changes. Continual sharing of experiences and knowledge among radiography educators is essential. Safety nets need to be in place to ensure digital inclusiveness and that no learner gets left behind due to the digital divide in education.
Purpose: The aim of SETANTA (Study of HEarT DiseAse and ImmuNiTy After COVID-19 in Ireland) study... more Purpose: The aim of SETANTA (Study of HEarT DiseAse and ImmuNiTy After COVID-19 in Ireland) study was to investigate symptom burden and incidence of cardiac abnormalities after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 and correlate these results with immunological response and biomarkers of coagulation. Methods: SETANTA was a prospective, single-arm observational cross-sectional study in a primary practice setting, prospectively registered with ClinicalTrials.gov identifier: NCT04823182. Patients with recent COVID-19 infection ≥6 weeks and ≤12 months before enrolment were enrolled. Primary outcomes of interest were markers of cardiac injury detected by cardiac magnetic resonance imaging (MRI), including left ventricular ejection fraction, late gadolinium enhancement and pericardial abnormalities, and serum biomarker levels. Results: 100 patients (n= 129 approached) were included, 64% were female. Mean age was 45.2 years. The median (interquartile range) ...
Autism in Adulthood
Background: Autistic individuals might undergo a magnetic resonance imaging (MRI) examination for... more Background: Autistic individuals might undergo a magnetic resonance imaging (MRI) examination for clinical concerns or research. Increased sensory stimulation, lack of appropriate environmental adjustments or lack of streamlined communication in the MRI suite may pose challenges to autistic patients and render MRI scans inaccessible. This study aimed to i) explore the MRI scan experiences of autistic adults in the UK, ii) identify barriers and enablers towards successful and safe MRI examinations, iii) assess autistic individuals' satisfaction with MRI service, and iv) inform future recommendations for practice improvement. Methods: We distributed an online survey to the autistic community on social media, using snowball sampling. Inclusion criteria were: being older than 16, have an autism diagnosis or self-diagnosis, self-reported capacity to consent and having had an MRI scan in the UK. We used descriptive statistics for demographics, inferential statistics for group comparisons/correlations, and content analysis for qualitative data. Results: We received 112 responses. A total of 29.6% of the respondents reported not being sent any information before the scan. Most participants (68%) confirmed that radiographers provided detailed information on the day of the examination but only 17.1% reported that radiographers offered some reasonable environmental adjustments. Only 23.2% of them confirmed they disclosed their autistic identity when booking MRI scanning. We found that quality of communication, physical environment, patient emotions, staff training and confounding societal factors impacted autistic people's experiences. Autistic individuals rated their overall MRI experience as neutral and reported high levels of claustrophobia (44.8%). Conclusion: The study highlighted a lack of effective communication and coordination of care, either between healthcare services or between patients and radiographers, and lack of reasonable adjustments as vital for more accessible and person-centred MRI scanning for autistic individuals. Enablers of successful scans included effective communication, adjusted MRI environment, scans tailored to individuals' needs/preferences, and well-trained staff. • Adjust communication style to the individual. 10,21 • Ensure communication and coordination of services between GPs/referring consultants and Radiology. 24 • Implement tailored pre-scan communication COMFORT
European Journal of Radiology
PURPOSE To gain further insight into Irish medical students' and interns' specialty prefe... more PURPOSE 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.
Higher Education Research and Development Society of Australasia Conference, 2014
2014-2015 > Academic research: refereed > Refereed conference pape
Poster: "ECR 2016 / B-1247 / An investigation of how to improve recall and awareness of radi... more Poster: "ECR 2016 / B-1247 / An investigation of how to improve recall and awareness of radiation dose levels associated with cardiovascular interventional procedures" by: "S. Mullen, J. P. McNulty, L. O'Hora, V. Mc Guire, T. Buchanan, P. Gilligan, L. Rainford; Dublin/IE"
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Papers by Jonathan McNulty