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Zheng M, Guo C, Zhu Y, Gang X, Fu C, Wang S. Segmentation model of soft tissue sarcoma based on self-supervised learning. Front Oncol 2024; 14:1247396. [PMID: 39011486 PMCID: PMC11246874 DOI: 10.3389/fonc.2024.1247396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/27/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Soft tissue sarcomas, similar in incidence to cervical and esophageal cancers, arise from various soft tissues like smooth muscle, fat, and fibrous tissue. Effective segmentation of sarcomas in imaging is crucial for accurate diagnosis. Methods This study collected multi-modal MRI images from 45 patients with thigh soft tissue sarcoma, totaling 8,640 images. These images were annotated by clinicians to delineate the sarcoma regions, creating a comprehensive dataset. We developed a novel segmentation model based on the UNet framework, enhanced with residual networks and attention mechanisms for improved modality-specific information extraction. Additionally, self-supervised learning strategies were employed to optimize feature extraction capabilities of the encoders. Results The new model demonstrated superior segmentation performance when using multi-modal MRI images compared to single-modal inputs. The effectiveness of the model in utilizing the created dataset was validated through various experimental setups, confirming the enhanced ability to characterize tumor regions across different modalities. Discussion The integration of multi-modal MRI images and advanced machine learning techniques in our model significantly improves the segmentation of soft tissue sarcomas in thigh imaging. This advancement aids clinicians in better diagnosing and understanding the patient's condition, leveraging the strengths of different imaging modalities. Further studies could explore the application of these techniques to other types of soft tissue sarcomas and additional anatomical sites.
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Affiliation(s)
- Minting Zheng
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
- School of Software, Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Taiyuan, China
| | - Chenhua Guo
- School of Software, Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Taiyuan, China
| | - Yifeng Zhu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaoming Gang
- Cardiovascular Department, Anshan Municipal Central Hospital, Anshan, China
| | - Chongyang Fu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shaowu Wang
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Machado PAB, Bartolomeu GFP, Handeri AM, Wainstein AJA, Drummond-Lage AP. Assessment of Medical Students' Knowledge of Imaging Methods for Bone Sarcomas. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1571-1576. [PMID: 37185942 DOI: 10.1007/s13187-023-02301-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
Cancer is a leading cause of death in Brazil and worldwide. However, Brazilian medical education fails to include oncology as an essential topic. This creates a gap between the health status of the population and medical education. Bone sarcomas fall into both the group of malignant neoplasms and rare diseases and are thus doubly influenced by misinformation. To assess medical students' knowledge of imaging diagnostic methods for bone sarcomas. A cross-sectional, quantitative study was undertaken by obtaining the responses of medical students to a questionnaire containing radiographic images and questions about the radiological aspects of bone sarcomas. The categorical variables were compared using the chi-square test. The level of significance was 5% for all the tests. SPSS software version 25.0 was used for the analysis. A total of 325 responses were collected, with 72% of the participants having no interest in oncology and 55.6-63.9% not knowing how to diagnose a periosteal reaction on bone radiography. Only 11.1-17.1% of the students correctly interpreted the radiographic image of osteosarcoma. Medical students fail to correctly interpret images of bone sarcomas. It is important to promote oncology undergraduate education in general and to include the approach to bone sarcomas in this context.
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Affiliation(s)
- Pedro Alcântara Botelho Machado
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias 275/3º - Centro, Belo Horizonte, MG, Brazil
| | | | | | | | - Ana Paula Drummond-Lage
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias 275/3º - Centro, Belo Horizonte, MG, Brazil.
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Guedes A, Oliveira MBDR, Melo ASD, Carmo CCMD. Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas. Rev Bras Ortop 2023; 58:179-190. [PMID: 37252301 PMCID: PMC10212631 DOI: 10.1055/s-0041-1736569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/08/2021] [Indexed: 10/19/2022] Open
Abstract
The evolution in imaging evaluation of musculoskeletal sarcomas contributed to a significant improvement in the prognosis and survival of patients with these neoplasms. The precise characterization of these lesions, using the most appropriate imaging modalities to each clinical condition presented, is of paramount importance in the design of the therapeutic approach to be instituted, with a direct impact on clinical outcomes. The present article seeks to update the reader regarding imaging methodologies in the context of local and systemic evaluation of bone sarcomas and soft tissues.
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Affiliation(s)
- Alex Guedes
- Grupo de Oncologia Ortopédica, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
| | - Marcelo Bragança dos Reis Oliveira
- Serviço de Traumato-ortopedia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Adelina Sanches de Melo
- Serviço de Medicina Nuclear, Hospital Santa Izabel, Santa Casa da Misericórdia da Bahia, Salvador, BA, Brasil
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Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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Gaume M, Chevret S, Campagna R, Larousserie F, Biau D. The appropriate and sequential value of standard radiograph, computed tomography and magnetic resonance imaging to characterize a bone tumor. Sci Rep 2022; 12:6196. [PMID: 35418602 PMCID: PMC9008011 DOI: 10.1038/s41598-022-10218-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/28/2022] [Indexed: 12/13/2022] Open
Abstract
Radiographs (XR), computed tomography (CT) or magnetic resonance imaging (MRI) are regularly analyzed to determine whether a bone lesion is benign or malignant. An online quiz was created providing 15 cases with a clinical summary, MRI, CT, and XR. After each image, participants were asked to rate the probability (0–100%) the bone tumor was malignant. Order and difficulty of the images were randomly determined. Probability statements regarding the diagnosis were actualized along the sequence of exam, to quantify how the degree of belief changed to account for evidence from those exams. 64 physicians participated and provided 154 assessments from 1 (n = 18) to 3 (n = 44) different cases. After the first image, participants favored the correct malignancy status at 70%; 80% after the second and 80% after the third one. Participants were more likely to favor the correct malignancy status when the lesion was malignant and when first confronted with XR or CT, rather than MRI, though the most predictive factor of correct diagnosis was the difficulty of the case. In conclusion, the additional information provided by successive imaging studies was moderate. XR or CT seemed more appropriate than MRI as first imaging study. Bypassing XR should be discouraged.
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Affiliation(s)
- M Gaume
- Department of Orthopedic Surgery, Cochin Hospital, Université de Paris, AP-HP, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - S Chevret
- Department of Biostatistics and Clinical Epidemiology, INSERM, Paris University, Paris, France
| | - R Campagna
- Department of Radiology, Cochin Hospital, Université de Paris, AP-HP, Assistance Publique Hôpitaux de Paris, Paris, France
| | - F Larousserie
- Department of Pathology, Cochin Hospital, Université de Paris, AP-HP, Assistance Publique Hôpitaux de Paris, Paris, France
| | - D Biau
- Department of Orthopedic Surgery, Cochin Hospital, Université de Paris, AP-HP, Assistance Publique Hôpitaux de Paris, Paris, France
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Farhan-Alanie MM, Lee Y, Underwood M, Metcalfe A, Wilkinson MJ, Price AJ, Warwick J, Wall PDH. Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set. BMJ Open 2021; 11:e045353. [PMID: 34108163 PMCID: PMC8191625 DOI: 10.1136/bmjopen-2020-045353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Tourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet. DESIGN We analysed data from the National Joint Registry (NJR) for all primary cemented TKRs performed in England and Wales between April 2003 and December 2003. Kaplan-Meier plots and Cox regression were used to assess the influence of tourniquet use, age at time of surgery, sex and American Society of Anaesthesiologists (ASA) classification on risk of revision for all-causes. RESULTS Data were available for 16 974 cases of primary cemented TKR, of which 16 132 had surgery with a tourniquet and 842 had surgery without a tourniquet. At 10 years, 3.8% had undergone revision (95% CI 2.6% to 5.5%) in the no-tourniquet group and 3.1% in the tourniquet group (95% CI 2.8% to 3.4%). After adjusting for age at primary surgery, gender and primary ASA score, the HR for all-cause revision for cemented TKR without a tourniquet was 0.82 (95% CI 0.57 to 1.18). CONCLUSIONS We did not find evidence that using a tourniquet for primary cemented TKR offers a clinically important or statistically significant reduction in the risk of all-cause revision up to 13 years after surgery. Surgeons should consider this evidence when deciding whether to use a tourniquet for cemented TKR.
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Affiliation(s)
- Muhamed M Farhan-Alanie
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yujin Lee
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Metcalfe
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mark J Wilkinson
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jane Warwick
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter David Henry Wall
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Haase DR, Brown K, Templeton KJ. Adolescent Athlete Stress Fractures Associated with Vitamin D Insufficiency: Three Cases with Review of the Literature. JBJS Case Connect 2021; 11:01709767-202103000-00027. [PMID: 33617155 DOI: 10.2106/jbjs.cc.20.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The authors present 3 adolescent athletes who presented with stress fractures in their lower extremities, initially diagnosed as tumors. All 3 patients received an inconclusive magnetic resonance imaging before referral; fractures were confirmed on radiographs and computed tomography. All were found to have vitamin D insufficiency. CONCLUSIONS Vitamin D insufficiency is a global epidemic mainly focused on adults and young-adult athletes. These case reports raise concerns about a growing prevalence of vitamin D insufficiency in adolescents, the potential risk of stress fracture, and the need for screening and possible supplementation in adolescent athletes to improve their bone health.
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Affiliation(s)
- Douglas R Haase
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Kevin Brown
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Kimberly J Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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Morris SC, Nelson SC, Zuckerman LM. Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e19.00172. [PMID: 33986213 PMCID: PMC7537826 DOI: 10.5435/jaaosglobal-d-19-00172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 08/15/2020] [Indexed: 11/18/2022]
Abstract
Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.
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Affiliation(s)
- S Craig Morris
- From the Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA (Dr. Morris, Dr. Nelson); the Department of Surgery, Hopital Adventiste d'Haiti, Port-au-Prince, Haiti (Dr. Nelson); and the Division of Orthopaedic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte CA (Dr. Zuckerman)
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Zhang Y, Yue B, Zhao X, Chen H, Sun L, Zhang X, Hao D. Benign or Malignant Characterization of Soft-Tissue Tumors by Using Semiquantitative and Quantitative Parameters of Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Can Assoc Radiol J 2020; 71:92-99. [PMID: 32062994 DOI: 10.1177/0846537119888409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the efficacy of the semiquantitative and quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiating between benign and malignant soft-tissue tumors. METHODS A total of 45 patients with pathologically confirmed soft-tissue tumors (15 benign and 30 malignant tumors) underwent DCE-MRI. The semiquantitative parameters assessed were as follows: time to peak (TTP), maximum concentration (MAX Conc), area under the curve of time-concentration curve (AUC-TC), and maximum rise slope (MAX Slope). Quantitative DCE-MRI was analyzed with the extended Tofts-Kety model to assess the following quantitative parameters: volume transfer constant (Ktrans), microvascular permeability reflux constant (Kep), and distribute volume per unit tissue volume (Ve). Data were evaluated using the independent t test or Mann-Whitney U test and receiver operating characteristic (ROC) curves. RESULTS The TTP (P = .0035), MAX Conc (P = .0018), AUC-TC (P = .0018), MAX Slope (P = .0018), Ktrans (P = .0018), and Kep (P = .0035) were significantly different between the benign and malignant soft-tissue tumors. The AUC of the ROC curve demonstrated the diagnostic potential of TTP (0.778), MAX Conc (0.849), AUC-TC (0.831), MAX Slope (0.847), Ktrans (0.836), Kep (0.778), and Ve (0.638). CONCLUSIONS The use of semiquantitative and quantitative parameters of DCE-MRI enabled differentiation between benign and malignant soft-tissue tumors. The values of TTP were lower, while those of MAX Conc, AUC-TC, MAX Slope, Ktrans, and Kep were higher in malignant than in benign tumors.
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Affiliation(s)
- Yu Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Yue
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaodan Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lingling Sun
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Dapeng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Lu YT, Haase SC, Chung TT, Chung KC, Sears ED. The Impact of Pre-Referral Advanced Diagnostic Testing on Wait Time to See a Hand Surgeon for Common Upper-Extremity Conditions. J Hand Surg Am 2019; 44:1013-1020.e2. [PMID: 31677910 PMCID: PMC7429450 DOI: 10.1016/j.jhsa.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 07/09/2019] [Accepted: 09/25/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to evaluate the use of pre- and post-referral advanced diagnostic testing among patients with 3 common hand conditions, rates of subsequent tests, and differences in wait time to see a hand surgeon. METHODS We analyzed a single academic tertiary care center administrative database of encounters from 2006 to 2015 to identify adult patients who were referred to a hand surgeon for 3 conditions (carpal tunnel syndrome [CTS], soft tissue masses [STM], and joint pain [JP]). We recorded patient characteristics, use and timing of diagnostic tests, and wait time for the initial hand surgeon evaluation. RESULTS Among patients who received advanced diagnostic tests before the surgeon evaluation, CTS patients had the highest rate of receiving pre-referral advanced testing (53.4%) compared with JP (10.6% ) and STM patients (5.8%). The CTS patients had the highest rates of repeat testing (19.5%) compared with patients with JP (1.4%) and STM (0%). Across all 3 conditions, patients who received pre-referral advanced testing waited an additional 19 to 94 days to see a surgeon, compared with patients who received only post-referral testing or no testing. CONCLUSIONS Use of pre-referral advanced diagnostic tests is associated with an increased time to see a hand surgeon for common hand conditions. CLINICAL RELEVANCE Hand surgeons should have a role in identifying patients who do or do not benefit from advanced testing before referral to ensure that tests ordered before consultation are useful to both patients and treating surgeons.
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Affiliation(s)
- Yu-Ting Lu
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine
| | - Steven C. Haase
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine
| | - Ting-Ting Chung
- Center for Big Data Analytics and Statistics and Division of Rheumatology, Allergy and Immunology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kevin C. Chung
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Erika D. Sears
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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Abstract
The Musculoskeletal Tumor Society and American Academy of Orthopaedic Surgeons recently collaborated on a clinical practice guideline Use of Imaging Prior to Referral to an Orthopaedic Oncologist. The complete manuscript is available on OrthoGuidelines (www.orthoguidelines.org) and the Musculoskeletal Tumor Society website (www.msts.org). This clinical practice guideline is designed to assist practitioners without specialization in musculoskeletal tumors to determine the most efficacious imaging modalities for establishing an accurate diagnosis and treatment plan when confronted with a bone or soft-tissue lesion of unknown etiology. A panel of experts with interest and expertise in orthopaedic surgery, orthopaedic oncology, and musculoskeletal radiology created relevant questions and synthesized existing literature into 12 topics and 27 recommendations. The group considered several common clinical and radiographic features often seen at the initial presentation of a bone or soft-tissue tumor of the pelvis or extremities. This guideline is intended to inform front-line practitioners to give insight into imaging modalities that are of minimal clinical utility, as well as those that are critical to establishing an accurate diagnosis and assessing the urgency of referral to an oncologic specialist. In addition to a summary of the primary findings of the report, we included three cases that illustrate clinical scenarios in which the guidelines can assist in determining the most appropriate first-line management. The strengths of the relevant guidelines are noted.
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JOURNAL CLUB: Hepatopancreaticobiliary Imaging Second-Opinion Consultations: Is There Value in the Second Reading? AJR Am J Roentgenol 2018; 211:1264-1272. [DOI: 10.2214/ajr.17.19452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Advanced Imaging Utilization and Cost Savings Among Medicare Shared Savings Program Accountable Care Organizations: An Initial Exploratory Analysis. J Am Coll Radiol 2018; 15:396-401. [DOI: 10.1016/j.jacr.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/19/2017] [Indexed: 11/18/2022]
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