A density model of neurovascular structures was generated from 28 human vastus lateralis muscles isolated from embalmed cadavers. The intramuscular portion of arteries, veins, and nerves was dissected, traced on transparencies, and digitized before adjustment to an average muscle shape using Procrustes analysis to generate density distributions for the relative positions of these structures. The course of arteries, veins, and nerves was highly variable between individual muscles. Nevertheless, a zone of lower average neurovascular density was found between the tributaries from the lateral circumflex femoral and the deep femoral arteries. While the area with the lowest density was covered by the iliotibial tract and would therefore not be suitable for biopsies, another low‐density area was located in the distal portion of vastus lateralis. This was just anterior to the iliotibial tract, in a zone that has been described as a good needle biopsy site. The reported complication rates of needle biopsies (0.1%‐4%) are in the range of expectations when simulated based on this model. It is concluded that the optimal human vastus lateralis biopsy site is in the distal portion of the muscle, between ½ and ¾ of the length from the greater trochanter to the lateral epicondyle, just anterior to the iliotibial band.

Introduction and aimChest X-rays form a vital part of the initial assessment and management of patients seen by medical practitioners. 1 During the acute medical take at University College Hospital (UCH), patients are referred to the medical team by the emergency department (ED) team or via their general practitioner. Due to logistical arrangements, patients may be transferred to the acute medical unit (AMU) without the chest X-ray that they require as beds become available. As a result, patients would then be transferred to the X-ray department at a later time or date to have this crucial investigation when it could have been performed in ED at the time of admission. This can lead to delays in diagnosis and management, as well as unnecessary disruption for the patient. This quality improvement project was designed to tackle these delays in obtaining chest X-rays between October 2018 and March 2019. MethodElectronic health records of 122 patients were analysed preintervention to determine the proportion that did not receive a chest X-ray prior to admission to the AMU. The delay in patients who had the X-ray after AMU admission was recorded. Two plan, do, study, act (PDSA) cycles with interventions focussed around improving communication between ED staff, acute medicine doctors and radiographers were performed. A further 135 patient records were analysed post-intervention to determine if there was any increase in the proportion of patients receiving an X-ray prior to admission and if that corresponded to a reduced delay.Tackling delays in patients requiring chest X-rays on the acute medical take Fig 1. Run chart demonstrating the improving proportions of patients receiving clinically indicated chest X-rays prior to their acute medical unit admission, with labels detailing timing of interventions and the corresponding plan, do, study, act cycle to which they belong.