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Damer A, Hamilton L, Tu A, Johnston DL, Ramphal R, Wilson N. Primary intramedullary extradural Ewing sarcoma. Radiol Case Rep 2024; 19:2381-2389. [PMID: 38572274 PMCID: PMC10987877 DOI: 10.1016/j.radcr.2024.02.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
Ewing sarcoma is the second most frequent primary bone tumour of childhood and adolescence. The aim of this report is to describe the imaging, pathology, clinical findings, and treatment of a primary intradural extramedullary Ewing sarcoma with a unique intracranial metastatic component in a pediatric patient. A 14-year-old girl with a history of mood disorders presented to the emergency department with a 3-week history of neck torticollis, cervical pain, paresis, and paresthesia of the upper and lower extremities on the left side. Initially, non-organic causes such as somatization or conversion disorder were suspected. She returned 3 months later when her symptoms worsened. MRI of the head and spine was performed, and demonstrated the presence of a suprasellar, retro-chiasmatic mass lesion. There was also diffuse leptomeningeal enhancement, another well-defined intradural extramedullary lesion the sacral region and several multifocal cauda equina soft tissue nodules. The patient first underwent surgery. The patient was also treated with a combination of chemotherapy (vincristine, doxorubicin and cyclophosphamide alternating with ifosfamide and etoposide (VDC/IE)) and radiation as per the Children's Oncology Group AEWS1221 protocol. Most recent imaging conducted 22 months after the initial mass discovery revealed improvement of the suprasellar mass lesion with residual stable appearance of the prominence and enhancement of the pituitary stalk and tuber cinereum. There was interval improvement of the spinal lesions with no convincing residual. Clinically, at almost three years since initial imaging findings, and 25 months since completing treatment, she is stable from an oncology perspective.
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Affiliation(s)
- Alameen Damer
- University of Toronto, Department of Medical Imaging, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Leslie Hamilton
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Albert Tu
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Donna L. Johnston
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Division of Hematology/Oncology, Ottawa ON, Canada
| | - Raveena Ramphal
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Division of Hematology/Oncology, Ottawa ON, Canada
| | - Nagwa Wilson
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
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2
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Kang N, Al-Ajam Y, Keen P, Woollard A, Steinitz H, Farrant J, Chow G. Radiological evaluation before and after treatment with an osseointegrated bone-anchor following major limb amputation-a guide for radiologists. Skeletal Radiol 2024; 53:1033-1043. [PMID: 38044373 PMCID: PMC11001742 DOI: 10.1007/s00256-023-04524-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
Osseointegrated implants have been developed to allow direct skeletal fixation of a prosthesis as an alternative to traditional socket-fitted prostheses for patients who have suffered from a major limb amputation. The implants contribute to improvements in functional outcome and quality of life and radiological evaluation plays a crucial role in pre- and post-operative assessment. This article acts as a guide for radiologists who may be tasked with providing the radiological information required by surgeons and prosthetists. We also look at the radiological appearances of complications that may arise in patients treated with an osseointegrated implant. Plain X-rays are used to screen patients who wish to undergo treatment. Limb-length X-rays are then used to measure the length of any residual bone, and comparisons can be made with the normal side (if present). From this, decisions about the likely size of the implant and the need for further amputation can be made. CT scans enable accurate assessment of the medullary cavity and cortical thickness. Post-operatively, plain X-rays form the mainstay of the routine monitoring of the bone-implant interface. Potential complications include infection, aseptic loosening, mechanical fracture of the implant and periprosthetic fracture. Infection and aseptic loosening can be seen as a lucency at the bone-implant interface which (if left untreated) can lead to loss of the implant. Implant and periprosthetic fractures are radiographically obvious. Radiologists involved in the care of patients undergoing treatment with an osseointegrated implant should become familiar with the imaging requirements so they can contribute to optimal patient outcomes.
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Affiliation(s)
- Norbert Kang
- Department of Plastic Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Yazan Al-Ajam
- Department of Plastic Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Phyllis Keen
- Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, Imperial College Rd, London, UK.
| | - Alexander Woollard
- Department of Plastic Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Hannah Steinitz
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Joanna Farrant
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Geoffrey Chow
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
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3
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Kwee RM, Toxopeus R, Kwee TC. Publication pressure in medical imaging. Eur J Radiol 2024; 174:111404. [PMID: 38442475 DOI: 10.1016/j.ejrad.2024.111404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To investigate the degree of perceived publication pressure in medical imaging. METHOD Corresponding authors who published an article in one of the top 12 general radiology journals were invited to complete a survey about publication pressure. The revised Publication Pressure Questionnaire (PPQr) was used. Higher PPQr scores (5-point Likert scale) indicate a more negative view towards the various domains of publication pressure. RESULTS 203 corresponding authors participated. Median PPQr scores in the domains "publication stress", "publication attitude", and "publication resources" were 3.33, 3.50, and 3.67, respectively. Age 25-34 years (β coefficient 0.366, P = 0.047), female gender (β coefficient 0.293, P = 0.020), and 5-10 years of research experience (β coefficient 0.370, P = 0.033) were associated with a higher level of perceived publication stress, whereas age ≥ 65 years was negatively associated with perceived publication stress (β coefficient -0.846, P < 0.001). Age 55-64 years and age > 65 years were associated with a more positive view towards the publication climate (β coefficients -0.391 and -0.663, P = 0.018 and P = 0.002, respectively). Age 45-54 years was associated with a perception of fewer factors available to alleviate publication pressure (β coefficient 0.301, P = 0.014), whereas age 25-34 years was associated with a perception of more factors available to alleviate publication pressure (β coefficient -0.352, P = 0.012). CONCLUSION Perceived publication pressure among medical imaging researchers appears to be appreciable and is associated with several (academic) demographics.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands.
| | - Romy Toxopeus
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, the Netherlands
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Qian W, Curtain BMM, Deshwal A, Chetrit S. Massive appendiceal mucinous neoplasm diagnosed after abdominal trauma: Pitfalls in imaging and diagnosis. Radiol Case Rep 2024; 19:1956-1959. [PMID: 38434782 PMCID: PMC10909596 DOI: 10.1016/j.radcr.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Low grade appendiceal mucinous neoplasm (LAMN) is a rare tumor presenting typically with symptoms of acute appendicitis. A 33-year-old gentleman presented with abdominal fullness and discomfort secondary to abdominal trauma obtained during boxing training. Investigations with magnetic resonance imaging (MRI), ultrasound, and colonoscopy revealed a large cystic lesion in the ascending colon mesentery with unclear continuation with the appendix. There were no obvious features of malignancy. Laparoscopy revealed a large, firm mass connected to the appendix with enlarged lymph nodes, and the patient underwent radical resection with a right hemicolectomy. Histopathology revealed complete excision of LAMN with no lymphatic involvement. Post traumatic intra-abdominal cystic lesions pose a diagnostic challenge, and neoplastic lesions cannot be ruled out with imaging alone, even with benign appearances. Careful surgical excision and histopathological diagnosis is the only definitive method of ruling-out malignancy.
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Affiliation(s)
- Wanyang Qian
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, WA, USA
| | | | - Avinash Deshwal
- Department of Radiology, Fiona Stanley Hospital, Murdoch, WA, USA
| | - Stephanie Chetrit
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, WA, USA
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du Preez L, Flaherty F, Elkabbani R. Dual ectopy: Unique appearance of ectopic thyroid. Radiol Case Rep 2024; 19:1801-1805. [PMID: 38390425 PMCID: PMC10883775 DOI: 10.1016/j.radcr.2024.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/13/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
A 67-year-old female underwent a computed tomography angiogram (CTA) of the head in the setting of acute, short-term memory loss. Two lobulated hyperattenuating lesions were incidentally discovered at the base of the tongue and the hyoid bone. Upon further investigation in the outpatient setting including further imaging and ultrasound-guided biopsy, the lesions were confirmed to be ectopic thyroid tissue with dual ectopy. Heterotopic tissue, especially when arising at separate sites, can be concerning for a broad differential diagnosis including malignancy, and further evaluation is certainly recommended. When evaluating possible heterotopic tissue, one must always keep in mind the expected embryologic development of the organ in question. Further, in cases where biopsy is less favorable, consideration of the heterotopic tissue's expected physiology is equally important. With these 2 facts in mind, midline hyperattenuating, enhancing lesions in the neck must always be considered to be a possible developmental anomaly of the thyroid, even when there are multiple lesions.
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Affiliation(s)
- Liam du Preez
- Norwalk Hospital Diagnostic Radiology Residency, 34 Maple St Norwalk, CT 06850 USA
| | - Francis Flaherty
- Norwalk Hospital Diagnostic Radiology Residency, 34 Maple St Norwalk, CT 06850 USA
| | - Ragaa Elkabbani
- Danbury Hospital Clinical Pathology Residency, 24 Hospital Ave Danbury, CT 068102 USA
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Khounsarian F, Abu-Omar A, Emara A, Marinescu D, Yong-Hing CJ, Ali IT, Khosa F. A trend, analysis, and solution on women's representation in diagnostic radiology in North America: a narrative review. Clin Imaging 2024; 109:110135. [PMID: 38547670 DOI: 10.1016/j.clinimag.2024.110135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/17/2024]
Abstract
Despite the demonstrated benefits of gender diversity in medicine, women in Radiology in North America are still underrepresented. We reviewed the literature to highlight the current status of women in Radiology in North America, identify the underlying causes of the gender gap, and provide potential strategies to close this gap. We conducted a narrative literature review using the terms ("Gender Disparity" OR "Gender Inequality") AND ("Radiology Department" OR "Radiology Residency"), searching data from April 2000 to April 2022 in Ovid Medline, Embase, PubMed, and Scopus. Our results indicate that Radiology in North America lacks gender diversity in its subspecialties, academic leadership, and research productivity, which the COVID-19 pandemic has further exacerbated. Challenges stemming from a dearth of women role models, limited preclinical contact, and a high rate of burnout contribute to the current gender inequality. Several complementary and supplementary steps can enhance gender diversity in Radiology. These include increasing education and exposure to Radiology at earlier stages and optimizing mentorship opportunities to attract a more diverse pool of talent to the discipline. In addition, supporting resident parents and enhancing the residency program's culture can decrease the rate of burnout and encourage women to pursue careers and leadership positions in Radiology.
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Affiliation(s)
| | - Ahmad Abu-Omar
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Aida Emara
- Health Education England North East, United Kingdom
| | | | - Charlotte J Yong-Hing
- Clinical Associate Professor, Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ismail Tawakol Ali
- Clinical Associate Professor, Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faisal Khosa
- Clinical Associate Professor, Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Parikh JR, Cavanaugh KJ. Formal wellness training of academic radiology leaders improves work-life conflict. Eur Radiol 2024:10.1007/s00330-024-10735-2. [PMID: 38639913 DOI: 10.1007/s00330-024-10735-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/11/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To investigate the effect of formal leadership training of academic radiology leaders within an academic center on their own burnout and professional fulfillment. METHODS The study cohort was academic radiology leaders within one of the largest academic organizations of academic radiologists within the United States. All academic radiology leaders within the organization were electronically mailed a weblink to a confidential IRB-approved survey in April 2021. The survey included validated questions from the Stanford Professional Fulfillment Index (PFI), values alignment, teamwork, overload, and work-family conflict. Academic leaders were invited in May 2021 to participate in instructor-led formal training on leading wellness focusing on 5 core leadership skills - emotional intelligence, self-care, resilience support, demonstrating care, and managing burnout. An identical follow-up survey was electronically mailed 6 months after initial training in November 2021. RESULTS The overall response rate of academic radiology leaders was 59% (19/32). For both measures, there was acceptable internal consistency (Cronbach's α = 0.63 for work exhaustion and α = 0.90 for fulfillment). There was a statistically significant improvement in work-family conflict (3.32 vs 2.86; p = 0.04). No statistically significant differences were identified for fulfillment, work exhaustion, alignment, work overload, and teamwork scores after training. CONCLUSION Formal instruction in leading wellness improved work-life conflict for academic radiology leaders. There was no significant change in burnout, fulfillment nor organizational alignment of the leaders. CLINICAL RELEVANCE STATEMENT Formal instruction in leading wellness raised awareness and improved work-life conflict in academic radiology leaders.
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Affiliation(s)
- Jay R Parikh
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX, 77030, USA.
| | - Katelyn J Cavanaugh
- Leadership Institute, The University of Texas MD Anderson Cancer Center, 7007 Bertner Avenue, Houston, TX, 77030, USA
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Huang ML, Lane DL, Bomar H, Kuerer H. Breast cryoablation for the palliative treatment of indolent subtype of multicentric triple-negative breast cancer. BMJ Case Rep 2024; 17:e259465. [PMID: 38627044 DOI: 10.1136/bcr-2023-259465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Breast cryoablation for palliative and curative treatment of breast cancer has been performed for decades. Although there is a recent resurgence of interest in breast cryoablation with curative intent for unifocal, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, this report highlights the essential role that cryoablation can play in the palliative treatment of multicentric oestrogen and progesterone receptor-negative and human epidermal growth factor receptor 2-negative (triple-negative) breast cancer, meeting the select pretreatment objectives such as breast or nipple pain relief and prevention of tumour erosion through the skin or nipple in patients who have failed or cannot tolerate the standard of care treatment.
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Affiliation(s)
- Monica L Huang
- Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Deanna L Lane
- Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hannah Bomar
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Henry Kuerer
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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John DS, Kankara SR, Palasamudram Kumaran S, Hussain AS. Clinicoradiological features of probable chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) syndrome. BMJ Case Rep 2024; 17:e258067. [PMID: 38627057 DOI: 10.1136/bcr-2023-258067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently described chronic inflammatory central nervous system disease. This case report describes a young female patient presenting with weakness in bilateral upper and lower limbs and tinnitus for 2 months. A neurological examination revealed signs of brainstem and cerebellar involvement. MRI brain showed characteristic features of CLIPPERS, with punctate and nodular enhancement in the pons and cerebellum. Differential diagnoses were systematically considered and excluded. The patient showed significant clinical and radiological improvement with steroid therapy. No clinical or radiological red flags occurred during the follow-up. This case underscores the critical role of integrating clinical and radiological findings to effectively diagnose and manage CLIPPERS. It emphasises the importance of ruling out alternative diagnoses through a thorough evaluation.
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Affiliation(s)
- Deepa Susan John
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Shreyas Reddy Kankara
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | | | - Adnan Sarfaraz Hussain
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
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Siepmann R, Huppertz M, Rastkhiz A, Reen M, Corban E, Schmidt C, Wilke S, Schad P, Yüksel C, Kuhl C, Truhn D, Nebelung S. The virtual reference radiologist: comprehensive AI assistance for clinical image reading and interpretation. Eur Radiol 2024:10.1007/s00330-024-10727-2. [PMID: 38627289 DOI: 10.1007/s00330-024-10727-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/27/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Large language models (LLMs) have shown potential in radiology, but their ability to aid radiologists in interpreting imaging studies remains unexplored. We investigated the effects of a state-of-the-art LLM (GPT-4) on the radiologists' diagnostic workflow. MATERIALS AND METHODS In this retrospective study, six radiologists of different experience levels read 40 selected radiographic [n = 10], CT [n = 10], MRI [n = 10], and angiographic [n = 10] studies unassisted (session one) and assisted by GPT-4 (session two). Each imaging study was presented with demographic data, the chief complaint, and associated symptoms, and diagnoses were registered using an online survey tool. The impact of Artificial Intelligence (AI) on diagnostic accuracy, confidence, user experience, input prompts, and generated responses was assessed. False information was registered. Linear mixed-effect models were used to quantify the factors (fixed: experience, modality, AI assistance; random: radiologist) influencing diagnostic accuracy and confidence. RESULTS When assessing if the correct diagnosis was among the top-3 differential diagnoses, diagnostic accuracy improved slightly from 181/240 (75.4%, unassisted) to 188/240 (78.3%, AI-assisted). Similar improvements were found when only the top differential diagnosis was considered. AI assistance was used in 77.5% of the readings. Three hundred nine prompts were generated, primarily involving differential diagnoses (59.1%) and imaging features of specific conditions (27.5%). Diagnostic confidence was significantly higher when readings were AI-assisted (p > 0.001). Twenty-three responses (7.4%) were classified as hallucinations, while two (0.6%) were misinterpretations. CONCLUSION Integrating GPT-4 in the diagnostic process improved diagnostic accuracy slightly and diagnostic confidence significantly. Potentially harmful hallucinations and misinterpretations call for caution and highlight the need for further safeguarding measures. CLINICAL RELEVANCE STATEMENT Using GPT-4 as a virtual assistant when reading images made six radiologists of different experience levels feel more confident and provide more accurate diagnoses; yet, GPT-4 gave factually incorrect and potentially harmful information in 7.4% of its responses.
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Affiliation(s)
- Robert Siepmann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Marc Huppertz
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Annika Rastkhiz
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Reen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Eric Corban
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Stephan Wilke
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Schad
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Can Yüksel
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
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Panther EJ, Lyons H, Shychuk AJ. Dedifferentiated liposarcoma of the spermatic cord. BMJ Case Rep 2024; 17:e258954. [PMID: 38627046 DOI: 10.1136/bcr-2023-258954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
A man in his 60s presented to an outside hospital with persistent groin pain and a scrotal mass which was thought to be a recurrent hernia. Three months after initial presentation, the patient was found to have dedifferentiated liposarcoma (LPS) of the spermatic cord. LPS of the spermatic cord is a rare entity; however, clinicians should have LPS on the differential diagnosis especially in men with recurrent scrotal pain and mass. If unrecognised, LPS is associated with a high degree of morbidity and mortality. LPS can be subdivided into well-differentiated LPS, dedifferentiated LPS, myxoid LPS and pleomorphic LPS. In patients with advanced or metastatic LPS, chemotherapy consisting of Adriamycin, ifosfamide and mesna is used despite LPS being relatively chemoresistant. Therapies inhibiting mouse double minute 2 homologue, an oncoprotein that is a negative regulator of the tumour suppressor p53, appear to be promising in preclinical trials.
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Affiliation(s)
- Eric James Panther
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Hannah Lyons
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrew Jacob Shychuk
- Internal Medicine, University of Florida, Gainesville, Florida, USA
- Internal Medicine, Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA
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Sachdeva S, Bhatia S, Al Harrasi A, Shah YA, Anwer K, Philip AK, Shah SFA, Khan A, Ahsan Halim S. Unraveling the role of cloud computing in health care system and biomedical sciences. Heliyon 2024; 10:e29044. [PMID: 38601602 PMCID: PMC11004887 DOI: 10.1016/j.heliyon.2024.e29044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
Cloud computing has emerged as a transformative force in healthcare and biomedical sciences, offering scalable, on-demand resources for managing vast amounts of data. This review explores the integration of cloud computing within these fields, highlighting its pivotal role in enhancing data management, security, and accessibility. We examine the application of cloud computing in various healthcare domains, including electronic medical records, telemedicine, and personalized patient care, as well as its impact on bioinformatics research, particularly in genomics, proteomics, and metabolomics. The review also addresses the challenges and ethical considerations associated with cloud-based healthcare solutions, such as data privacy and cybersecurity. By providing a comprehensive overview, we aim to assist readers in understanding the significance of cloud computing in modern medical applications and its potential to revolutionize both patient care and biomedical research.
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Affiliation(s)
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Center, University of Nizwa, P.O. Box 33, 616 Birkat Al Mauz, Nizwa, Oman
- School of Health Science, University of Petroleum and Energy Studies, Prem Nagar, Dehradun, Uttarakhand, 248007, India
| | - Ahmed Al Harrasi
- Natural & Medical Sciences Research Center, University of Nizwa, P.O. Box 33, 616 Birkat Al Mauz, Nizwa, Oman
| | - Yasir Abbas Shah
- Natural & Medical Sciences Research Center, University of Nizwa, P.O. Box 33, 616 Birkat Al Mauz, Nizwa, Oman
| | - Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Anil K. Philip
- School of Pharmacy, University of Nizwa, Birkat Al Mouz, Nizwa, 616, Oman
| | - Syed Faisal Abbas Shah
- Faculty of Computer Science & Information Technology, Virtual University of Pakistan, Lahore, 54000, Pakistan
| | - Ajmal Khan
- Natural & Medical Sciences Research Center, University of Nizwa, P.O. Box 33, 616 Birkat Al Mauz, Nizwa, Oman
| | - Sobia Ahsan Halim
- Natural & Medical Sciences Research Center, University of Nizwa, P.O. Box 33, 616 Birkat Al Mauz, Nizwa, Oman
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Kim DH, Choi SH. Inter-reader Agreement for CT/MRI LI-RADS Category M Imaging Features: A Systematic Review and Meta-analysis. J Liver Cancer 2024:jlc.2024.04.05. [PMID: 38616543 DOI: 10.17998/jlc.2024.04.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
Backgrounds/Aims To systematically evaluate inter-reader agreement in the assessment of individual Liver Imaging Reporting and Data System (LI-RADS) category M (LR-M) imaging features in computed tomography/magnetic resonance imaging (CT/MRI) LI-RADS v2018, and to explore the causes of poor agreement in LR-M assignment. Methods Original studies reporting inter-reader agreement for LR-M features on multiphasic CT or MRI were identified using the MEDLINE, EMBASE, and Cochrane databases. The pooled kappa coefficient (κ) was calculated using the DerSimonian-Laird random-effects model. Heterogeneity was assessed using Cochran's Q test and I2 statistics. Subgroup meta-regression analyses were conducted to explore the study heterogeneity. Results In total, 24 eligible studies with 5,163 hepatic observations were included. The pooled κ values were 0.72 (95% confidence interval, 0.65-0.78) for rim arterial phase hyperenhancement, 0.52 (0.39-0.65) for peripheral washout, 0.60 (0.50-0.70) for delayed central enhancement, 0.68 (0.57-0.78) for targetoid restriction, 0.74 (0.65-0.83) for targetoid transitional phase/hepatobiliary phase appearance, 0.64 (0.49-0.78) for infiltrative appearance, 0.49 (0.30-0.68) for marked diffusion restriction, and 0.61 (0.48-0.73) for necrosis or severe ischemia. Substantial study heterogeneity was observed for all LR-M features (Cochran's Q test: p < 0.01; I2 ≥ 89.2%). Studies with a mean observation size of <3 cm, those performed using 1.5-T MRI, and those with multiple image readers, were significantly associated with poor agreement of LR-M features. Conclusions The agreement for peripheral washout and marked diffusion restriction was limited. The LI-RADS should focus on improving the agreement of LR-M features.
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Affiliation(s)
- Dong Hwan Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Republic of Korea
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14
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van der Beek JN, Schenk JP, Morosi C, Watson TA, Coma A, Graf N, Chowdhury T, Ramírez-Villar GL, Spreafico F, Welter N, Dzhuma K, van Tinteren H, de Krijger RR, van den Heuvel-Eibrink MM, Littooij AS. Diagnostic magnetic resonance imaging characteristics of congenital mesoblastic nephroma: a retrospective multi-center International Society of Pediatric Oncology-Renal Tumor Study Group (SIOP-RTSG) radiology panel study. Pediatr Radiol 2024:10.1007/s00247-024-05918-4. [PMID: 38609702 DOI: 10.1007/s00247-024-05918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Congenital mesoblastic nephroma is the most common solid renal tumor in neonates. Therefore, patients <3 months of age are advised to undergo upfront nephrectomy, whereas invasive procedures at diagnosis in patients ≥3 months of age are discouraged by the International Society of Pediatric Oncology-Renal Tumor Study Group (SIOP-RTSG). Nevertheless, discriminating congenital mesoblastic nephroma, especially from the more common Wilms tumor, solely based on imaging remains difficult. Recently, magnetic resonance imaging (MRI) has become the preferred modality. Studies focusing on MRI characteristics of congenital mesoblastic nephroma are limited. OBJECTIVE This study aims to identify diagnostic MRI characteristics of congenital mesoblastic nephroma in the largest series of patients to date. MATERIALS AND METHODS In this retrospective multicenter study, five SIOP-RTSG national review radiologists identified 52 diagnostic MRIs of histologically proven congenital mesoblastic nephromas. MRI was performed following SIOP-RTSG protocols, while radiologists assessed their national cases using a validated case report form. RESULTS Patients (24/52 classic, 11/52 cellular, and 15/52 mixed type congenital mesoblastic nephroma, 2/52 unknown) had a median age of 1 month (range 1 day-3 months). Classic type congenital mesoblastic nephroma appeared homogeneous with a lack of hemorrhage, necrosis and/or cysts, showing a concentric ring sign in 14 (58.3%) patients. Cellular and mixed type congenital mesoblastic nephroma appeared more heterogeneous and were larger (311.6 and 174.2 cm3, respectively, versus 41.0 cm3 for the classic type (P<0.001)). All cases were predominantly T2-weighted isointense and T1-weighted hypointense, and mean overall apparent diffusion coefficient values ranged from 1.05-1.10×10-3 mm2/s. CONCLUSION This retrospective international collaborative study showed classic type congenital mesoblastic nephroma predominantly presented as a homogeneous T2-weighted isointense mass with a typical concentric ring sign, whereas the cellular type appeared more heterogeneous. Future studies may use identified MRI characteristic of congenital mesoblastic nephroma for validation and for exploring the discriminative non-invasive value of MRI, especially from Wilms tumor.
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Affiliation(s)
- Justine N van der Beek
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Jens-Peter Schenk
- Clinic of Diagnostic and Interventional Radiology, Division of Pediatric Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tom A Watson
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ana Coma
- Department of Pediatric Radiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Norbert Graf
- Department of Pediatric Oncology & Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Tanzina Chowdhury
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Gema L Ramírez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Filippo Spreafico
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nils Welter
- Department of Pediatric Oncology & Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Kristina Dzhuma
- Developmental Biology and Cancer Department, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Child Health, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Annemieke S Littooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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15
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Ryu B, Mochizuki T, Shima S, Sato S, Inoue T, Kawamata T, Niimi Y. Perioperative Management of Spinal Arteriovenous Malformation Embolization: Delayed Venous Thrombosis and Implications for Severe Back Pain. Clin Neuroradiol 2024:10.1007/s00062-024-01403-5. [PMID: 38592446 DOI: 10.1007/s00062-024-01403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE The prognosis of untreated spinal arteriovenous malformations (SAVMs) is poor. Embolization plays an important role in the management of intramedullary SAVMs. Delayed aggravation due to spinal venous thrombosis following successful embolization has been reported; however, perioperative management strategies to prevent thrombosis have not been explored. We present our single-center experience of SAVM embolization and perioperative management, including anticoagulation. MATERIAL AND METHODS We retrospectively evaluated 18 patients with SAVMs who underwent transarterial embolization. Perioperative anticoagulation therapy was administered to selected patients. We compared the characteristics of the patients, including perioperative management procedures, between those with and without postoperative worsening following embolization. RESULTS Acute postoperative worsening within 1 week occurred in 4 (22.2%) patients. Of these, immediate worsening was observed in one patient as a procedure-related complication. Delayed worsening after 24 h was observed in 3 patients, caused by delayed venous thrombosis with severe back pain. Rescue anticoagulation for delayed worsening improved symptoms in two patients. A comparison between patients with and without acute postoperative worsening revealed significant differences in age (median 46.5 vs. 26.5 years, p = 0.009) and the presence of postoperative back pain (75.0% vs. 0%, p = 0.005); however, there was no significant difference in use of selective anticoagulation (p = 0.274). CONCLUSION The results of this study suggest that SAVM embolization can cause acute worsening due to postoperative venous thrombosis with severe back pain, which may be reversed by anticoagulation therapy. Back pain is an important finding that suggests venous thrombosis, and anticoagulation should be urgently administered.
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Affiliation(s)
- Bikei Ryu
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560, Tokyo, Japan.
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560, Tokyo, Japan.
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan.
| | - Tatsuki Mochizuki
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560, Tokyo, Japan
| | - Shogo Shima
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560, Tokyo, Japan
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, 104-8560, Tokyo, Japan
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Bernal D, Nugent K, Abdelnabi M. Atypical chest pain and haemoptysis as the initial presentation of spindle rhabdomyosarcoma in elderly smoker man. BMJ Case Rep 2024; 17:e260472. [PMID: 38589242 PMCID: PMC11015322 DOI: 10.1136/bcr-2024-260472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Diego Bernal
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Kenneth Nugent
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Mahmoud Abdelnabi
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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17
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Treat RM, Hsiao SK, Ismail A, Javan R. The US Government's Latest Presidential Executive Order on AI: Potential Implications in Radiology. J Am Coll Radiol 2024:S1546-1440(24)00355-7. [PMID: 38599359 DOI: 10.1016/j.jacr.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Rachel Michelle Treat
- George Washington University of Health Sciences and Medicine, Washington, DC, USA, 20037.
| | - Sabrina Kelly Hsiao
- George Washington University of Health Sciences and Medicine, Washington, DC, USA, 20037.
| | - Ahmed Ismail
- George Washington University of Health Sciences and Medicine, Washington, DC, USA, 20037.
| | - Ramin Javan
- Department of Radiology, George Washington University Hospital, Washington, DC, USA, 20037.
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18
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Liu RH, Lindeborg M, Ncogoza I, Nyiraneza SE, Barrera KJ, Shaye DA. Geospatial evaluation of radiologic access in Rwanda. Insights Imaging 2024; 15:105. [PMID: 38589631 PMCID: PMC11001820 DOI: 10.1186/s13244-024-01624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/18/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Rwanda has aimed to rebuild its health care system since the Rwandan genocide against the Tutsis in 1994, though one of the challenges has been a scarcity of radiologic resources. OBJECTIVE To assess the location and accessibility of radiologic facilities in Rwanda using geospatial mapping and population-based data. METHODS A cross-sectional study was conducted in May 2023 using location and radiologic modality data provided by the Department of Radiology at the University Teaching Hospital of Kigali and the WorldPop database, a publicly available database providing open-access geospatial population data. Radiologic equipment included magnetic resonance (MR), computed tomography (CT), positron emission tomography (PET), radiotherapy, X-ray, mammography, and fluoroscopy machines. Geospatial analysis was performed using ArcGIS Pro 2.8.6 software. RESULTS Fifty-six radiologic facilities were identified, including 5 MR, 7 CT, 1 radiotherapy, 52 X-ray, 5 mammography, 5 fluoroscopy, and 0 PET machines. There were 0.4 MR, 0.5 CT, 0 PET, 0.1 radiotherapy, 3.9 X-ray, 0.4 mammography, and 0.4 fluoroscopy units per 1 million people. CONCLUSION Rwanda is one of the countries with the lowest radiologic access in East Africa; however, there is evidence of progress, particularly in more advanced diagnostic imaging techniques such as computed tomography and magnetic resonance imaging. CRITICAL RELEVANCE STATEMENT This study provides a 10-year update on current radiologic resources and access in Rwanda, identifying areas of progress and ongoing scarcity, serving as a guide for future direction of growth. KEY POINTS • As Rwanda works on rebuilding its health care system, this study provides an assessment of the current radiologic resources within the country. • There is less than one radiologic unit for every million of the Rwandan population for every imaging modality other than X-ray. • While radiologic access in Rwanda lags behind that of its neighbors, there has been growth focused on advanced imaging modalities and the training of human resources.
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Affiliation(s)
- Rui Han Liu
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA.
| | - Michael Lindeborg
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Isaie Ncogoza
- University Teaching Hospital of Kigali, University of Rwanda, College of Medicine & Health Sciences, Kigali, Rwanda
| | - Sabine E Nyiraneza
- University Teaching Hospital of Kigali, University of Rwanda, College of Medicine & Health Sciences, Kigali, Rwanda
| | - Keisha J Barrera
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - David A Shaye
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
- University Teaching Hospital of Kigali, University of Rwanda, College of Medicine & Health Sciences, Kigali, Rwanda
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19
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Gomaa A, Biyanwila C, Jantre M. Synchronous subarachnoid haemorrhage and ischaemic stroke as a result of complete internal carotid artery occlusion. BMJ Case Rep 2024; 17:e258341. [PMID: 38589243 PMCID: PMC11015294 DOI: 10.1136/bcr-2023-258341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
A previously healthy man in his 60s presents with a one-day history of insidious onset headache and 'walking into doors'. He reported transient right arm pain and tingling but no weakness. A CT brain showed a right middle cerebral artery (MCA) infarct as well as a synchronous right frontal lobe convexal subarachnoid haemorrhage (cSAH). An arch to vertex CT angiogram demonstrated right MCA occlusion and complete right internal carotid artery (ICA) occlusion from its origin. Reconstitution of flow was seen within the distal right ICA at the level of the distal foramen lacerum. A repeat CT of the brain after one week showed a stable appearance of the bleeding and infarct. He was commenced on antiplatelet therapy for the treatment of the ischaemic stroke as well as secondary prevention.This is a rare case of synchronous right MCA infarct as well as a right frontal cSAH secondary to ipsilateral carotid artery occlusion.
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Affiliation(s)
- Aysha Gomaa
- General Internal Medicine, East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK
| | - Chemindra Biyanwila
- Stroke Medicine, East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK
| | - Mansi Jantre
- Radiology, East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK
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20
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VanBerlo B, Hoey J, Wong A. A survey of the impact of self-supervised pretraining for diagnostic tasks in medical X-ray, CT, MRI, and ultrasound. BMC Med Imaging 2024; 24:79. [PMID: 38580932 PMCID: PMC10998380 DOI: 10.1186/s12880-024-01253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 03/18/2024] [Indexed: 04/07/2024] Open
Abstract
Self-supervised pretraining has been observed to be effective at improving feature representations for transfer learning, leveraging large amounts of unlabelled data. This review summarizes recent research into its usage in X-ray, computed tomography, magnetic resonance, and ultrasound imaging, concentrating on studies that compare self-supervised pretraining to fully supervised learning for diagnostic tasks such as classification and segmentation. The most pertinent finding is that self-supervised pretraining generally improves downstream task performance compared to full supervision, most prominently when unlabelled examples greatly outnumber labelled examples. Based on the aggregate evidence, recommendations are provided for practitioners considering using self-supervised learning. Motivated by limitations identified in current research, directions and practices for future study are suggested, such as integrating clinical knowledge with theoretically justified self-supervised learning methods, evaluating on public datasets, growing the modest body of evidence for ultrasound, and characterizing the impact of self-supervised pretraining on generalization.
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Affiliation(s)
- Blake VanBerlo
- Cheriton School of Computer Science, 200 University Ave W, N2L 3G1, Waterloo, Canada.
| | - Jesse Hoey
- Cheriton School of Computer Science, 200 University Ave W, N2L 3G1, Waterloo, Canada
| | - Alexander Wong
- Department of Systems Design Engineering, 200 University Ave W, N2L 3G1, Waterloo, Canada
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21
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Hassankhani A, Amoukhteh M, Vasavada PS, Sair HI, Ghadimi DJ, Gholamrezanezhad A. Bridging borders in radiology research: The virtual radiology research network initiative. Clin Imaging 2024; 110:110145. [PMID: 38615552 DOI: 10.1016/j.clinimag.2024.110145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/14/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Amir Hassankhani
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Melika Amoukhteh
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Pauravi S Vasavada
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Haris I Sair
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Delaram J Ghadimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
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22
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Mert S, Stoerzer P, Brauer J, Fuchs B, Haas-Lützenberger EM, Demmer W, Giunta RE, Nuernberger T. Diagnostic power of ChatGPT 4 in distal radius fracture detection through wrist radiographs. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05298-2. [PMID: 38578309 DOI: 10.1007/s00402-024-05298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Distal radius fractures rank among the most prevalent fractures in humans, necessitating accurate radiological imaging and interpretation for optimal diagnosis and treatment. In addition to human radiologists, artificial intelligence systems are increasingly employed for radiological assessments. Since 2023, ChatGPT 4 has offered image analysis capabilities, which can also be used for the analysis of wrist radiographs. This study evaluates the diagnostic power of ChatGPT 4 in identifying distal radius fractures, comparing it with a board-certified radiologist, a hand surgery resident, a medical student, and the well-established AI Gleamer BoneView™. Results demonstrate ChatGPT 4's good diagnostic accuracy (sensitivity 0.88, specificity 0.98, diagnostic power (AUC) 0.93), surpassing the medical student (sensitivity 0.98, specificity 0.72, diagnostic power (AUC) 0.85; p = 0.04) significantly. Nevertheless, the diagnostic power of ChatGPT 4 lags behind the hand surgery resident (sensitivity 0.99, specificity 0.98, diagnostic power (AUC) 0.985; p = 0.014) and Gleamer BoneView™(sensitivity 1.00, specificity 0.98, diagnostic power (AUC) 0.99; p = 0.006). This study highlights the utility and potential applications of artificial intelligence in modern medicine, emphasizing ChatGPT 4 as a valuable tool for enhancing diagnostic capabilities in the field of medical imaging.
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Affiliation(s)
- Sinan Mert
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany.
| | - Patrick Stoerzer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Johannes Brauer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Benedikt Fuchs
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | | | - Wolfram Demmer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
| | - Tim Nuernberger
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336, München, Germany
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23
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Rawson JV, Rubin E, Smetherman D. Short-Term Strategies for Augmenting the National Radiologist Workforce. AJR Am J Roentgenol 2024. [PMID: 38568035 DOI: 10.2214/ajr.24.30920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
The current radiology landscape has an imbalance between the rising demand for radiology services and the national radiologist workforce available. More vacant radiology positions exist than graduating radiology trainees. The origins of this problem are complex and require long-term solutions. Rather than working longer and/or faster, there are ways for radiologist to work smarter. In this article, we present multiple short-term strategies to increase the effective radiologist workforce and/or increase workforce efficiency, in order to alleviate the current workload challenges. These strategies are derived based on an analysis of possible practice-level changes in personnel, process, and physical plant. The impacts of the potential changes are estimated. No single change addresses the mismatch between supply and demand for radiology services. By creating an inventory of potential solutions, practices can choose the potential mechanism(s) to address the workforce shortage that best fit their needs and local environment.
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Affiliation(s)
- James V Rawson
- Vice Chair of Operations & Special Projects, Department of Radiology, Beth Israel Medical Center, Harvard Medical School, One Deconess Road, Boston, MA 02215
| | - Eric Rubin
- Medical Director, CT Division, Crozer Health, 1 Medical Center Blvd, Upland, PA 19013
| | - Dana Smetherman
- Chair, Department of Radiology, Ochsner Medical Center - New Orleans, 1516 Jefferson Hwy., New Orleans, LA 70121
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24
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Burgdorf E, Jensen J, Grimm P, von Huth S. Atypical presentation of Lemierre's syndrome caused by penicillin-susceptible Staphylococcus aureus in a patient with chronic stomatitis and COVID-19. BMJ Case Rep 2024; 17:e258776. [PMID: 38569736 PMCID: PMC10989154 DOI: 10.1136/bcr-2023-258776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
A healthy man in his late 20s was admitted to the emergency department due to a flare-up in his severe chronic stomatitis, along with flu-like symptoms. CXR showed multiple bilateral consolidations and subsequent CT revealed thrombosis of the left facial and internal jugular vein, together with septic embolism in both lungs. Blood cultures showed penicillin-susceptible Staphylococcus aureus The patient was diagnosed with Lemierre's syndrome, despite atypical bacteria and clinical presentation. During hospitalisation, he developed pulmonary empyema as a complication and was admitted for 4 weeks. During hospitalisation and after discharge, the patient was examined for multiple rheumatic, immunological and dermatological diseases, but no underlying cause for Lemierre's syndrome has been found. We present this case due to the rarity of its nature, with atypical clinical presentation and pathogen for Lemierre's syndrome, but with classic radiological findings.
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Affiliation(s)
- Emma Burgdorf
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
| | - Janni Jensen
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Peter Grimm
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
| | - Sebastian von Huth
- Department of Infectious Diseases, Odense Universitetshospital, Odense, Syddanmark, Denmark
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Gray BR, Gunderman RB. Gratitude, Humility, and the Impulse to Make a Mark. Acad Radiol 2024; 31:1714-1715. [PMID: 38245455 DOI: 10.1016/j.acra.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Affiliation(s)
- Benjamin R Gray
- Department of Radiology, Indiana University School of Medicine, 702 North Barnhill Drive, Room 1053, Indianapolis, Indiana, 46202, USA
| | - Richard B Gunderman
- Department of Radiology, Indiana University School of Medicine, 702 North Barnhill Drive, Room 1053, Indianapolis, Indiana, 46202, USA.
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Jabal MS, Hamouda N, Ibrahim MK, Kobeissi H, Ghozy S, Shehata MA, Bilgin C, Brinjikji W, Kallmes DF. Impact analysis of primary and secondary research in radiology journals. Clin Imaging 2024; 108:110089. [PMID: 38430717 DOI: 10.1016/j.clinimag.2024.110089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Primary and secondary studies are considered the two major research categories. In this study, we examined the scientific and social media impact of primary and secondary publication types in papers published radiological journals during 2010-2020. MATERIALS AND METHODS PubMed publication type tags were used to filter original articles and systematic review and meta-analysis (SR/MA) articles. Clarivate Web of Science was utilized to obtain a list of all radiology journals from the category "Radiology, Nuclear Medicine and Imaging" in Science Citation Index Expanded (SCIE). Automated approach was developed for programmatic extraction of bibliometric and Altmetric yearly citations of each included article using Dimensions API and Altmetric API with Python. Statistical analysis was performed to compare the citation rates between primary and secondary research articles. RESULTS A total of 96,684 published articles from 2010 to 2020 were identified and their meta-data collected. The mean 2-year citation count following publication year was 5.8 for primary research and 10.2 for SR/MA articles (p < 0.001). Between 2010 and 2020, the mean number of citations per SR/MA article was 51.3 compared to 30.5 per primary research article (p < 0.001). Mean Altmetric score was 8.2 in SR/MA compared to 3.7 for primary research articles (p < 0.001). CONCLUSION Secondary research studies have been increasing in impact in both academia and social media compared to primary research. Our results highlight the importance and impact of systematic reviews and meta-analysis articles as a scientifically influential study type in radiology.
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Affiliation(s)
| | - Noha Hamouda
- Department of Radiology, Alexandria University, Alexandria, Egypt
| | | | | | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Bajaj S, Gandhi D, Nayar D. Potential Applications and Impact of ChatGPT in Radiology. Acad Radiol 2024; 31:1256-1261. [PMID: 37802673 DOI: 10.1016/j.acra.2023.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 10/08/2023]
Abstract
Radiology has always gone hand-in-hand with technology and artificial intelligence (AI) is not new to the field. While various AI devices and algorithms have already been integrated in the daily clinical practice of radiology, with applications ranging from scheduling patient appointments to detecting and diagnosing certain clinical conditions on imaging, the use of natural language processing and large language model based software have been in discussion for a long time. Algorithms like ChatGPT can help in improving patient outcomes, increasing the efficiency of radiology interpretation, and aiding in the overall workflow of radiologists and here we discuss some of its potential applications.
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Affiliation(s)
- Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205 (S.B.)
| | - Darshan Gandhi
- Department of Diagnostic Radiology, University of Tennessee Health Science Center, Memphis, Tennessee 38103 (D.G.).
| | - Divya Nayar
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205 (D.N.)
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Bouillon-Minois JB, Lambert C, Dutheil F, Raconnat J, Benamor M, Dalle B, Laurent M, Adeyemi OJ, Lhoste-Trouilloud A, Schmidt J. Assessment of discordance between radiologists and emergency physicians of RADIOgraphs among discharged patients in an emergency department: the RADIO-ED study. Emerg Radiol 2024; 31:125-131. [PMID: 38253984 DOI: 10.1007/s10140-024-02206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND The possibility to perform standard X-rays is mandatory for all French Emergency Department (ED). Initial interpretation is under the prescriber emergency physician-who continually works under extreme conditions, but a radiologist needs to describe a report as soon as possible. We decided to assess the rate of discordance between emergency physicians and radiologists among discharged patients. METHODS We performed a monocentric study on an adult ED among discharged patients who had at least one X-ray during their consult. We used an automatic electronic system that classified interpretation as concordant or discordant. We review all discordant interpretation, which were classified as false negative, false positive, or more exam needed. RESULTS For 1 year, 8988 patients had 12,666 X-rays. We found a total of 742 (5.9%) discordant X-rays, but only 277 (2.2%) discordance had a consequence (new consult or exam not initially scheduled). We found some factors associated with discordance such as male sex, or ankle, foot, knee, finger, wrist, ribs, and elbow locations. CONCLUSIONS On discharged patients, using a systematic second interpretation of X-ray by a radiologist, we found a total of 2.2% discordance that had an impact on the initial care.
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Affiliation(s)
- Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Emergency Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
- Emergency Department, 58, Rue Montalembert, 63000, Clermont-Ferrand, France.
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Occupational and Environmental Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Julien Raconnat
- Emergency Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Mouna Benamor
- Emergency Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Batiste Dalle
- Emergency Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Maxime Laurent
- Emergency Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Oluwaseun J Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York University Langone Health, New York, NY, 10016, USA
| | | | - Jeannot Schmidt
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Emergency Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
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Jabal MS, Ibrahim MK, McDonald JS, Shehata MA, Kobeissi H, Ghozy S, Bilgin C, Brinjikji W, Kallmes DF. The Effect of the COVID-19 Pandemic on Academic Research Gender Disparities in Radiology. Acad Radiol 2024; 31:1265-1271. [PMID: 37863777 DOI: 10.1016/j.acra.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/22/2023]
Abstract
RATIONALE AND OBJECTIVES Gender disparities have long existed in radiology. The COVID-19 pandemic disrupted research activities worldwide and have impacted gender disparities across medical specialties. This study investigates the effect of the COVID-19 pandemic on gender disparities in radiology academic authorship. MATERIALS AND METHODS A retrospective observational study was conducted using data from 110 843 global and 23 977 US radiology articles. The gender of authors was determined using an automated gender inference tool. Descriptive statistics were applied to explore authorship changes overall globally, in the US as well as across countries and states. RESULTS Female first-authorship increased globally from 16.9% to 17.6% (p < 0.001), and in the US, from 19.0% to 19.6% (p = 0.19) in the peri-COVID period. The combined female percentage increased from 19.7% to 20.0% globally (p = 0.021), and from 20.2% to 21.1% in the US (p = 0.006). Country-level analysis revealed significant increases in female authorship in Colombia, Denmark, Egypt, France, India, and Japan, while New Zealand demonstrated a decrease in female authorship. In the US, Florida, Indiana, Louisiana, Massachusetts, and Ohio experienced increases in female authorship, whereas South Carolina demonstrated a decrease in female authorship. CONCLUSION In contrast with other medical fields, the study demonstrates that radiology experienced a slight increase in female authorship in radiology research globally and in the US during the COVID period. While the pandemic may have influenced these findings, further research is needed to establish regional causal relationships and identify best practices for promoting gender equity in radiology research.
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Affiliation(s)
- Mohamed Sobhi Jabal
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.); Department of Computer and Information Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA (M.S.J.).
| | - Mohamed K Ibrahim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.)
| | - Jennifer S McDonald
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.)
| | - Mostafa A Shehata
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.)
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.)
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.)
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.)
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.)
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (M.S.J., M.K.I., J.S.M., M.A.S., H.K., S.G., C.B., W.B., D.F.K.)
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Marcus E, Teuwen J. Artificial intelligence and explanation: How, why, and when to explain black boxes. Eur J Radiol 2024; 173:111393. [PMID: 38417186 DOI: 10.1016/j.ejrad.2024.111393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Artificial intelligence (AI) is infiltrating nearly all fields of science by storm. One notorious property that AI algorithms bring is their so-called black box character. In particular, they are said to be inherently unexplainable algorithms. Of course, such characteristics would pose a problem for the medical world, including radiology. The patient journey is filled with explanations along the way, from diagnoses to treatment, follow-up, and more. If we were to replace part of these steps with non-explanatory algorithms, we could lose grip on vital aspects such as finding mistakes, patient trust, and even the creation of new knowledge. In this article, we argue that, even for the darkest of black boxes, there is hope of understanding them. In particular, we compare the situation of understanding black box models to that of understanding the laws of nature in physics. In the case of physics, we are given a 'black box' law of nature, about which there is no upfront explanation. However, as current physical theories show, we can learn plenty about them. During this discussion, we present the process by which we make such explanations and the human role therein, keeping a solid focus on radiological AI situations. We will outline the AI developers' roles in this process, but also the critical role fulfilled by the practitioners, the radiologists, in providing a healthy system of continuous improvement of AI models. Furthermore, we explore the role of the explainable AI (XAI) research program in the broader context we describe.
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Affiliation(s)
- Eric Marcus
- AI for Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - Jonas Teuwen
- AI for Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
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31
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Faghani S, Gamble C, Erickson BJ. Uncover This Tech Term: Uncertainty Quantification for Deep Learning. Korean J Radiol 2024; 25:395-398. [PMID: 38528697 PMCID: PMC10973738 DOI: 10.3348/kjr.2024.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Shahriar Faghani
- Artificial Intelligence Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Cooper Gamble
- Artificial Intelligence Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Bradley J Erickson
- Artificial Intelligence Laboratory, Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Davis L, D'Souza S. Private equity in radiology - Why aren't we more concerned? Curr Probl Diagn Radiol 2024:S0363-0188(24)00056-2. [PMID: 38604880 DOI: 10.1067/j.cpradiol.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
There has been recent scrutiny of private equity involvement in the healthcare market by federal and state governmental agencies who are concerned about the corporatization and financialization of healthcare in the United States. Data is emerging that patient costs increase, quality of healthcare decreases, physician autonomy decreases, and physician burnout and moral injury increases when corporate interests like private equity enter the medical market. Like other medical specialties, the field of radiology has been affected by corporatization and radiologists should understand how private equity interests may affect individual radiologists and the radiology workforce on a larger scale.
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Affiliation(s)
- Leah Davis
- Grand Traverse Radiologists, PC, 10850 Traverse Highway, Suite 1175, Traverse City, Michigan 49684, United States.
| | - Sharon D'Souza
- Tulsa Radiology Associates, 4111 S Darlington Ave Ste 700, Tulsa, OK 74135, United States
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Raviprasad A, Pierre K, Kang D, Turetsky J, Thakkar R, Batmunh B, Quisling R, Rees J, Lanier L, Slater RM, Sistrom CL, Sharma PG, Rajderkar DA, Mancuso AA. An assessment of radiology resident competency in identifying suppurative retropharyngeal lymphadenitis: an examination using the WIDI SIM platform. Emerg Radiol 2024; 31:187-192. [PMID: 38340256 DOI: 10.1007/s10140-024-02210-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND PURPOSE Suppurative retropharyngeal lymphadenitis is a retropharyngeal space infection almost exclusively seen in the young (4-8 years old) pediatric population. It can be misdiagnosed as a retropharyngeal abscess, leading to unnecessary invasive treatment procedures. This retrospective study aims to assess radiology residents' ability to independently identify CT imaging findings and make a definitive diagnosis of suppurative retropharyngeal lymphadenitis in a simulated call environment. MATERIALS AND METHODS The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a computer-aided emergency imaging simulation proven to be a reliable method for assessing resident preparedness for independent radiology call. The simulation included 65 cases across various imaging modalities of varying complexity, including normal studies, with one case specifically targeting suppurative retropharyngeal adenitis identification. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. RESULTS A total of 543 radiology residents were tested in three separate years on the imaging findings of suppurative retropharyngeal lymphadenitis using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Suppurative retropharyngeal lymphadenitis was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 3.5% of radiology residents were able to correctly identify suppurative retropharyngeal lymphadenitis on a contrast-enhanced computed tomography (CT). CONCLUSIONS Our findings underscore a potential gap in radiology residency training related to the accurate identification of suppurative retropharyngeal lymphadenitis, highlighting the potential need for enhanced educational efforts in this area.
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Affiliation(s)
- Abheek Raviprasad
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA.
| | - Kevin Pierre
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Dahyun Kang
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jordan Turetsky
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Rajvi Thakkar
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bayar Batmunh
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Ronald Quisling
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - John Rees
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Linda Lanier
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Roberta M Slater
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Christopher L Sistrom
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Priya G Sharma
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Dhanashree A Rajderkar
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Anthony A Mancuso
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
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Alzghoul H, Kadri F, Ismail MF, Youssef R, Shamaileh M, Al-Assi AR, Adzhieva L, Alzghoul B. Paraneoplastic NMDA encephalitis, a case report and an extensive review of available literature. Radiol Case Rep 2024; 19:1371-1385. [PMID: 38288050 PMCID: PMC10823033 DOI: 10.1016/j.radcr.2023.11.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/31/2024] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis is a prevalent autoimmune condition marked by diverse neuropsychiatric symptoms, primarily impacting young females. The exact mechanisms underlying the development of NMDAr encephalitis have not been fully elucidated. Nonetheless, studies have demonstrated that auto-antibodies targeting the NR1-NR2 subunits of the NMDAr can trigger receptor dysfunction within the central nervous system, thus giving rise to the associated symptoms. Notably, an association exists between NMDAr encephalitis and an underlying neoplastic condition, with approximately 38% of cases exhibiting this paraneoplastic relationship with ovarian teratomas being the most commonly associated malignancy. While the association between NMDAr encephalitis and renal cell carcinoma (RCC) is exceedingly rare. This case report presents the clinical scenario of a 20-year-old female patient diagnosed with NMDAr encephalitis in conjunction with RCC discovered incidentally on a CT abdomen and pelvis performed to rule out an ovarian teratoma. The presented case underscores the importance of adopting a multidisciplinary approach in the diagnosis and treatment of NMDAr encephalitis, particularly when it is linked to an underlying malignancy. Furthermore, it emphasizes the significance of expanding our understanding of the molecular pathogenesis of NMDAr encephalitis to enhance patient care and optimize clinical outcomes. Additionally, a comprehensive review of the existing literature is included, summarizing all reported malignancies associated with NMDAr encephalitis.
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Affiliation(s)
- Hamza Alzghoul
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, USA
| | - Ferdous Kadri
- Division of Pulmonary and Critical Care Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mohamed F. Ismail
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, USA
| | - Robeer Youssef
- Jordan University of Science and Technology College of Medicine, Irbid, Jordan
| | | | | | | | - Bashar Alzghoul
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Saad A, Jenko N, Petrou E, Ariyaratne S, Mehta JS, Djearaman MG, Rasul FT, Botchu R. Assessing bone density on MRI: comparison between routine MRI sequences and DEXA scans. Eur Spine J 2024; 33:1498-1503. [PMID: 38055038 DOI: 10.1007/s00586-023-08021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Magnetic Resonance Imaging (MRI) is frequently utilised to aid in the comprehensive assessment of back pain, while dual-energy x-ray absorptiometry (DEXA) is the gold standard test for the assessment of bone density. Assessing bone density on MRI could reduce costs and avoid exposing patients to ionising radiation. The aim of this paper is to investigate whether the relative signal intensity of vertebral bodies compared to other structures can detect osteoporosis on MRI. METHODS 100 patients that had undergone both a lumbar spine MRI and a DEXA scan were identified. The T1 and T2 signal intensity of L1-L4 vertebral bodies (VB), cerebro-spinal fluid (CSF), and psoas muscle were measured within a 1-cm2 region of interest (ROI), and the signal intensity ratios were calculated. The ratios were stratified as normal, osteopenic, or osteoporotic based on DEXA T-scores. RESULTS The T1 VB /T1 CSF ratio was significantly higher in the osteoporotic group than the normal and osteopenic groups (p < 0.001). The T1 VB /T1 CSF ratio had excellent discrimination (AUC = 0.841) for the presence of osteoporosis. The Pearson correlation coefficient between the DEXA T-score and the T1 VB/T1 CSF ratio was -0.474 (p < 0.001). The intra-observer (ICC = 0.910, 95% CI = 0.757-0.966) and inter-observer reliability (ICC = 0.927, 95% CI = 0.824-0.970) were excellent. In our cohort, a T1 VB / T1 CSF ratio of greater than 4 is 66.7% sensitive but 90.0% specific for the presence of osteoporosis. CONCLUSION A high T1 VB/T1 CSF ratio suggests osteoporosis on MRI. Prospective validation is needed to confirm these findings.
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Affiliation(s)
- A Saad
- Spinal Surgery, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - N Jenko
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK.
| | - E Petrou
- Radiology, University Hospitals Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - S Ariyaratne
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - J S Mehta
- Spinal Surgery, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - M G Djearaman
- Radiology, University Hospitals Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - F T Rasul
- Neurosurgery, University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - R Botchu
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
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Loftus JR, Kadom N, Baran TM, Hans K, Waldman D, Wandtke B. Impact of Early Direct Patient Notification on Follow-Up Completion for Nonurgent Actionable Incidental Radiologic Findings. J Am Coll Radiol 2024; 21:558-566. [PMID: 37820835 DOI: 10.1016/j.jacr.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The aim of this study was to evaluate whether early direct patient notification in addition to an existing multistage recommendation-tracking system (Backstop) increases follow-up completion rates for actionable incidental findings (AIFs). Patient attitudes toward early notification were also assessed. METHODS This prospective, randomized controlled trial recruited patients with AIFs requiring follow-up being enrolled into the Backstop system. Patients were randomized into four groups: those receiving additional early direct notification in a mailed letter (group 1, similar to Pennsylvania Act 112), by phone (group 2), or in an electronic portal message (group 3) and a control group (group 4) without additional notifications added to the existing Backstop system. Differences in follow-up completion rates among these groups were determined using χ2 tests. Patients were surveyed on binary yes/no and Likert-type scale questions, and descriptive statistics are reported. RESULTS Data from 2,548 randomized patients were analyzed for the study, including 593 patients notified by letter, 637 notified by phone, 701 notified by portal, and 617 control patients. Group 3 demonstrated the lowest rate of follow-up completion within 1 month of the follow-up due date at 36.4%, compared with 58.7% for group 1, 60.4% for group 2, and 53.2% for group 4 (P < .0001 for all). Group 2 was the only group to have a significantly higher completion rate than group 4 (P = .014). Patients responded positively regarding early notification and preferred electronic portal communication. CONCLUSIONS Early direct notification had a mixed impact on follow-up completion rates on the basis of communication modality but was positively received by patients and may have health care benefits when implemented within a recommendation-tracking system.
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Affiliation(s)
- James Ryan Loftus
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York.
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, Georgia; Chair, ACR Metrics Committee; Interim Medical Director for Radiology Quality, Emory Healthcare, Atlanta, Georgia
| | - Timothy M Baran
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
| | - Kristen Hans
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
| | - David Waldman
- Chief Medical IT Development Officer and Associate Vice President, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
| | - Ben Wandtke
- Vice Chair of Quality and Safety, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
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Calder AD, Perucca G, Johnson SM, Pandey AR, Moshal K, Kusters MA. Lung infections in immunocompromised children. Pediatr Radiol 2024; 54:530-547. [PMID: 37589764 DOI: 10.1007/s00247-023-05735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
Pulmonary infection is the leading cause of infectious morbidity and mortality in children with immune defects. We provide a comprehensive review of lung infections in immunocompromised children, with a focus on imaging findings and imaging-based management. We include an overview of the immune defences of the respiratory tract, the aetiologies of immune defects in children, the features of specific infections and important differential diagnoses and describe diagnostic strategies using imaging and non-imaging-based techniques.
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Affiliation(s)
- Alistair D Calder
- Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | - Giulia Perucca
- Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Sarah May Johnson
- Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ashwin R Pandey
- Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Karyn Moshal
- Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Maaike A Kusters
- Immunology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Ciet P, Eade C, Ho ML, Laborie LB, Mahomed N, Naidoo J, Pace E, Segal B, Toso S, Tschauner S, Vamyanmane DK, Wagner MW, Shelmerdine SC. The unintended consequences of artificial intelligence in paediatric radiology. Pediatr Radiol 2024; 54:585-593. [PMID: 37665368 DOI: 10.1007/s00247-023-05746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
Over the past decade, there has been a dramatic rise in the interest relating to the application of artificial intelligence (AI) in radiology. Originally only 'narrow' AI tasks were possible; however, with increasing availability of data, teamed with ease of access to powerful computer processing capabilities, we are becoming more able to generate complex and nuanced prediction models and elaborate solutions for healthcare. Nevertheless, these AI models are not without their failings, and sometimes the intended use for these solutions may not lead to predictable impacts for patients, society or those working within the healthcare profession. In this article, we provide an overview of the latest opinions regarding AI ethics, bias, limitations, challenges and considerations that we should all contemplate in this exciting and expanding field, with a special attention to how this applies to the unique aspects of a paediatric population. By embracing AI technology and fostering a multidisciplinary approach, it is hoped that we can harness the power AI brings whilst minimising harm and ensuring a beneficial impact on radiology practice.
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Affiliation(s)
- Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC - Sophia's Children's Hospital, Rotterdam, The Netherlands
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Mai-Lan Ho
- University of Missouri, Columbia, MO, USA
| | - Lene Bjerke Laborie
- Department of Radiology, Section for Paediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Nasreen Mahomed
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Jaishree Naidoo
- Paediatric Diagnostic Imaging, Dr J Naidoo Inc., Johannesburg, South Africa
- Envisionit Deep AI Ltd, Coveham House, Downside Bridge Road, Cobham, UK
| | - Erika Pace
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Bradley Segal
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Seema Toso
- Pediatric Radiology, Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Dhananjaya K Vamyanmane
- Department of Pediatric Radiology, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Matthias W Wagner
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1H 3JH, UK.
- Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK.
- NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, UK.
- Department of Clinical Radiology, St George's Hospital, London, UK.
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Kaim A, Singer C, Bergovoy-Yellin L, Luxenburg O, Vaknin S, Boldor N, Wilf-Miron R, Myers V. Exploring pre-MRI imaging tests: patient survey reveals potential implications for healthcare efficiency in Israel. Isr J Health Policy Res 2024; 13:7. [PMID: 38556863 PMCID: PMC10983758 DOI: 10.1186/s13584-024-00593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/27/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Medical imaging tests are vital in healthcare but can be costly, impacting national health expenditures. Magnetic resonance imaging (MRI) is a crucial diagnostic tool for assessing medical conditions. However, the rising demand for MRI scans has frequently strained available resources. This study aimed to estimate the prevalence of different imaging tests in individuals who eventually had an MRI, in the Israeli public health system. METHODS An online survey of patient experience of scheduling an MRI was conducted in January-February 2023, among 557 Israeli adults, representing all four health maintenance organizations (HMOs). All participants had undergone an MRI in the public health system within the past year. RESULTS Results showed that 60% of participants underwent other imaging tests before their MRI scan. Of those, computed tomography (CT) scans (43%), X-rays (39%), and ultrasounds (32%) were the most common additional imaging procedures. In addition, of the 60% of participants, 23% had undergone more than one prior imaging examination. CONCLUSIONS These findings highlight the high prevalence of preliminary imaging tests prior to MRI, with many patients undergoing multiple tests for the same problem. The health system may need to evaluate whether current clinical guidelines defining the use of various imaging tests are cost-effective.
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Affiliation(s)
- Arielle Kaim
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel.
- Department of Emergency and Disaster Management, Faculty of Medicine, School of Public Health, Tel Aviv University, P.O. Box 39040, 6139001, Tel Aviv, Israel.
| | - Clara Singer
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
| | - Lucia Bergovoy-Yellin
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Sharona Vaknin
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Noga Boldor
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
| | - Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
- Department of Health Promotion, Faculty of Medicine, School of Public Health, Tel Aviv University, P.O. Box 39040, 6139001, Tel Aviv, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
- Department of Health Promotion, Faculty of Medicine, School of Public Health, Tel Aviv University, P.O. Box 39040, 6139001, Tel Aviv, Israel
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40
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Wang J, Goldberg JE, Block T, Ostrow D, Carbone D, Recht M, Doshi A. Patterns of Access to Radiology Reports and Images Through a Patient Portal. J Imaging Inform Med 2024; 37:504-509. [PMID: 38315344 DOI: 10.1007/s10278-024-00996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 02/07/2024]
Abstract
Access to radiology reports and images through a patient portal offers several advantages. The purpose of this study was to characterize patient's interactions with their radiology results. This was a retrospective study that evaluated radiography, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, exams performed between July 2020 and June 2021 for patients aged 12 and older. Exam information, access logs of radiology reports and images, and patient demographics were obtained from the electronic health record and image viewing software. Descriptive statistics were computed. The study included 1,685,239 exams. A total of 54.1% of reports were viewed. MRI and PET reports were viewed with the greatest frequency (70.2% and 67.6%, respectively); 25.5% of exam images were viewed, with the greatest frequency for MRI (40.1%). Exams were shared a total of 17,095 times and downloaded 8409 times; 64% of reports were viewed for patients aged 18-39 and 34% for patients aged 80 and greater. The rate of reports viewed was greater for patients with English as their preferred language (57.1%) compared to other languages (33.3%). Among those viewed, 56.5% of reports and 48.2% of images were viewed multiple times; 72.8% of images were viewed on smartphones, 25.8% on desktop computers, and 1.4% on tablets. Patients utilize a portal to view reports and view and share images. Continued efforts are warranted to promote the use of portals and create patient-friendly imaging results to help empower patients.
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Affiliation(s)
- Jason Wang
- Department of Radiology, New York University Langone Health, New York, NY, USA.
| | - Julia E Goldberg
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Tobias Block
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Dana Ostrow
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Dan Carbone
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Michael Recht
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Ankur Doshi
- Department of Radiology, New York University Langone Health, New York, NY, USA
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Wells JB, Lewis SJ, Barron M, Trieu PD. Surgical and Radiology Trainees' Proficiency in Reading Mammograms: the Importance of Education for Cancer Localisation. J Cancer Educ 2024; 39:186-193. [PMID: 38100062 PMCID: PMC10994868 DOI: 10.1007/s13187-023-02393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 04/05/2024]
Abstract
Medical imaging with mammography plays a very important role in screening and diagnosis of breast cancer, Australia's most common female cancer. The visualisation of cancers on mammograms often forms a diagnosis and guidance for radiologists and breast surgeons, and education platforms that provide real cases in a simulated testing environment have been shown to improve observer performance for radiologists. This study reports on the performance of surgical and radiology trainees in locating breast cancers. An enriched test set of 20 mammography cases (6 cancer and 14 cancer free) was created, and 18 surgical trainees and 32 radiology trainees reviewed the cases via the Breast Screen Reader Assessment Strategy (BREAST) platform and marked any lesions identifiable. Further analysis of performance with high- and low-density cases was undertaken, and standard metrics including sensitivity and specificity. Radiology trainees performed significantly better than surgical trainees in terms of specificity (0.72 vs. 0.35; P < 0.01). No significant differences were observed between the surgical and radiology trainees in sensitivity or lesion sensitivity. Mixed results were obtained with participants regarding breast density, with higher density cases generally having lower performance. The higher specificity of the radiology trainees compared to the surgical trainees likely represents less exposure to negative mammography cases. The use of high-fidelity simulated self-test environments like BREAST is able to benchmark, understand and build strategies for improving cancer education in a safe environment, including identifying challenging scenarios like breast density for enhanced training.
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Affiliation(s)
- J B Wells
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia
| | - S J Lewis
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia.
| | - M Barron
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia
| | - P D Trieu
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2006, Australia
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Kahraman A, Dirilenoğlu F, Güzeliş İ, Çetinoğlu K. Intraoperative pathologic diagnosis of central nervous system lymphomas: A comparison of frozen and permanent section diagnoses, and the significance of preoperative imaging. Ann Diagn Pathol 2024; 69:152246. [PMID: 38113550 DOI: 10.1016/j.anndiagpath.2023.152246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Central nervous system (CNS) lymphomas, either primary or secondary in origin, are rare malignant tumors affecting the brain, spinal cord, or leptomeninges. Diagnosis of CNS lymphomas is complicated by their diverse clinical presentations, radiological features, and histopathological characteristics. Although frozen section (FS) analysis is commonly employed for various CNS tumors, its role and accuracy in CNS lymphoma diagnosis are less explored. In this study, we conducted a comparative analysis to assess the impact of knowledge of preoperative imaging on enhancing the accuracy of FS diagnosis in CNS lymphomas. METHODS Data collection involved a retrospective review of CNS lymphoma patients from January 2009 to August 2021. Patients who underwent intraoperative consultation were included, excluding those with prior cortisone treatment. The dataset incorporated patient demographics, classification as primary or secondary lymphoma, radiological preliminary diagnoses, FS diagnosis, and permanent section diagnosis. We employed various archived materials, including FSs, touch imprint slides, crush cytology slides, H&E-stained sections, and immunohistochemical stains, and re-evaluated all slides for diagnostic validation. RESULTS Our study included 25 patients, of whom 60 % were female and had a mean age of 56.5 years. Preoperative radiology data were available for 80 % of cases, with preliminary diagnoses commonly including lymphoma and/or metastasis. Intraoperative consultation results indicated lymphoma in 18 (72 %) patients, with discordance observed in 28 % of cases when compared to permanent section diagnoses. Most permanent section diagnoses were diffuse large B-cell lymphomas (92 %), with the remainder being T-cell non-Hodgkin lymphoma (4 %) and follicular lymphoma (4 %). Intraoperative misdiagnoses were significantly associated with the absence of knowledge of preoperative imaging. CONCLUSION Our study demonstrates the reliability of FS diagnosis for CNS lymphomas during surgery, with a favorable complete concordance rate of 72 % when compared to permanent diagnoses. Importantly, lack of knowledge of preoperative imaging significantly impaired diagnostic accuracy in FS, emphasizing the need for close collaboration between pathologists and radiologists.
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Affiliation(s)
- Aslı Kahraman
- Department of Pathology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Türkiye
| | - Fikret Dirilenoğlu
- Department of Pathology, Faculty of Medicine, Near East University, Nicosia, Cyprus.
| | - İsmail Güzeliş
- Department of Pathology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Türkiye
| | - Kenan Çetinoğlu
- Department of Radiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Türkiye
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Zhang Y, Li Q, Shi Z, Li Q, Dai X, Pan C, Ma Y, Yan R, Fei D, Xie J. A novel growth-friendly system alleviates pulmonary dysplasia in early-onset scoliosis combined with thoracic insufficiency syndrome: Radiological, pathological, and transcriptomic assessments. Heliyon 2024; 10:e27887. [PMID: 38509966 PMCID: PMC10951595 DOI: 10.1016/j.heliyon.2024.e27887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
Background The posterior procedure utilizing growth-friendly techniques is the golden standard for patients with early-onset scoliosis combined with thoracic insufficiency syndrome (EOS + TIS). Pulmonary hypoplasia is the main cause of dying prematurely in the EOS + TIS. This study assessed the therapeutic impact of a novel growth-friendly system on the pulmonary development of piglet's EOS + TIS model. Methods The animal procedure period lasts 12 weeks, of which the construction of the EOS + TIS was performed at 0-8 weeks, and implantation of a novel growth-friendly system was applied at 8-12 weeks. During the animal procedure, X-rays and CT were performed to observe scoliosis, thorax, and lungs. After 12 weeks, pathological changes in lung tissue were assessed using HE and IHC staining. RNA-seq characterized novel growth-friendly system-associated differentially expressed genes (DEGs) and validated using RT-qPCR, western blotting, and IHC. Results Implantation of the novel growth-friendly system increased body weight, body length, and total lung volume, as well as decreased the coronal and sagittal Cobb angles for the EOS + TIS model. It also ameliorated EOS + TIS-induced thickening of the alveolar wall, increased alveolar spaces, and decreased alveolar number and diameter. In lung tissue, a total of 790 novel growth-friendly system-associated DEGs were identified, and they were mainly involved in the regulation of immune, inflammatory, calcium transport, and vascular development. Among these DEGs, BDKRB1, THBS1, DUSP1, IDO1, and SPINK5 were hub genes, and their differential expression was consistent with RNA-seq results in lung tissues. Conclusion The novel growth-friendly system has mitigated scoliosis and pulmonary hypoplasia in the EOS + TIS model. We further elucidate the molecular mechanisms underlying the amelioration of pulmonary hypoplasia.
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Affiliation(s)
- Ying Zhang
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Quan Li
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Zhiyue Shi
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Qitang Li
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Xinfei Dai
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Cheng Pan
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Yujian Ma
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Rongshuang Yan
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Derui Fei
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
| | - Jingming Xie
- Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical University, China
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Hill KA, Brinjikji W, Darin Carabenciov I. Contrast-induced encephalopathy following CT myelogram with non-ionic contrast. BMJ Case Rep 2024; 17:e259525. [PMID: 38553021 PMCID: PMC10982728 DOI: 10.1136/bcr-2023-259525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Affiliation(s)
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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45
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Olivares-Antúnez Y, Dávila-Zablah YJ, Vázquez-Ávila JR, Gómez-Macías GS, Mireles-Aguilar MT, Garza-Montemayor ML. Ductal carcinoma in situ within a fibroadenoma: A case report and review of literature. World J Radiol 2024; 16:58-68. [PMID: 38596169 PMCID: PMC10999957 DOI: 10.4329/wjr.v16.i3.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/20/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Fibroadenoma (FA) is the most common tumor found in young women, although it can occur in any age group. Ductal carcinoma in situ (DCIS) that is confined in a FA is rare; it is most frequently reported as an incidental finding. CASE SUMMARY We report a case of DCIS within a FA in a 46-year-old female without cancer-related personal and family histories. The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year. In the current control image study, we found suspicious microcalcification, as a new finding, within one of the nodules. Consequently, a core biopsy of the tumor, which appeared hypoechoic, oval, and circumscribed, was performed. The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion. The patient underwent breast-conserving surgery and received radiotherapy as well as endocrine therapy (tamoxifen). CONCLUSION We recommend a multidisciplinary approach for adequate treatment and follow-up.
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Affiliation(s)
- Yazmin Olivares-Antúnez
- Department of Diagnostic Breast Imaging Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
| | - Yesika Janett Dávila-Zablah
- Department of Diagnostic Breast Imaging Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
| | - José Raúl Vázquez-Ávila
- Department of Patology Service, Hospital San José, Tecnológico de Monterrey, Nuevo León 64710, Mexico
| | - Gabriela Sofía Gómez-Macías
- Department of Patology Service, Hospital San José, Tecnológico de Monterrey, Nuevo León 64710, Mexico
- Department of Faculty of Medicine, Hospital Universitario de la UANL, Nuevo León 64710, Mexico
| | - María Teresa Mireles-Aguilar
- Department of Breast Surgery Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, Nuevo León 66260, Mexico
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Kadom N. Editorial Comment: The Time to Start Is Now. AJR Am J Roentgenol 2024. [PMID: 38534195 DOI: 10.2214/ajr.24.31188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA
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Whitesell RT, Burnett AM, Johnston SK, Sheafor DH. Pre-hospital emergency medicine: a spectrum of imaging findings. Emerg Radiol 2024:10.1007/s10140-024-02223-3. [PMID: 38528277 DOI: 10.1007/s10140-024-02223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024]
Abstract
The goal of emergency medical services (EMS) is to provide urgent medical care and stabilization prior to patient transport to a healthcare facility for definitive treatment. The number and variety of interventions performed in the field by EMS providers continues to grow as early management of severe injuries and critical illness in the pre-hospital setting has been shown to improve patient outcomes. The sequela of many field interventions, including those associated with airway management, emergent vascular access, cardiopulmonary resuscitation (CPR), patient immobilization, and hemorrhage control may be appreciated on emergency department admission imaging. Attention to these imaging findings is important for the emergency radiologist, who may be the first to identify a malpositioned device or an iatrogenic complication arising from pre-hospital treatment. Recognition of these findings may allow for earlier corrective action to be taken in the acute care setting. This review describes common EMS interventions and their imaging findings.
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Affiliation(s)
- Ryan T Whitesell
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA.
| | - Aaron M Burnett
- Department of Emergency Medicine, Regions Hospital, 640 Jackson St, St. Paul, MN, USA
| | - Sean K Johnston
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA
| | - Douglas H Sheafor
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA
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48
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Bendtsen MG, Hitz MF. Opportunistic Identification of Vertebral Compression Fractures on CT Scans of the Chest and Abdomen, Using an AI Algorithm, in a Real-Life Setting. Calcif Tissue Int 2024:10.1007/s00223-024-01196-2. [PMID: 38530406 DOI: 10.1007/s00223-024-01196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/13/2024] [Indexed: 03/28/2024]
Abstract
This study evaluated the performance of a vertebral fracture detection algorithm (HealthVCF) in a real-life setting and assessed the impact on treatment and diagnostic workflow. HealthVCF was used to identify moderate and severe vertebral compression fractures (VCF) at a Danish hospital. Around 10,000 CT scans were processed by the HealthVCF and CT scans positive for VCF formed both the baseline and 6-months follow-up cohort. To determine performance of the algorithm 1000 CT scans were evaluated by specialized radiographers to determine performance of the algorithm. Sensitivity was 0.68 (CI 0.581-0.776) and specificity 0.91 (CI 0.89-0.928). At 6-months follow-up, 18% of the 538 patients in the retrospective cohort were dead, 78 patients had been referred for a DXA scan, while 25 patients had been diagnosed with osteoporosis. A higher mortality rate was seen in patients not known with osteoporosis at baseline compared to patients known with osteoporosis at baseline, 12.8% versus 22.6% (p = 0.003). Patients receiving bisphosphonates had a lower mortality rate (9.6%) compared to the rest of the population (20.9%) (p = 0.003). HealthVCF demonstrated a poorer performance than expected, and the tested version is not generalizable to the Danish population. Based on its specificity, the HealthVCF can be used as a tool to prioritize resources in opportunistic identification of VCF's. Implementing such a tool on its own only resulted in a small number of new diagnoses of osteoporosis and referrals to DXA scans during a 6-month follow-up period. To increase efficiency, the HealthVCF should be integrated with Fracture Liaison Services (FLS).
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Affiliation(s)
| | - Mette Friberg Hitz
- Research Unit, Medical Department, Zealand University Hospital, Koege, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Koege, Denmark
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49
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Elbanna KY, Kowa JY, Mirajkar N, Khalili K, Kim TK. Radiology domain in the diagnosis of IgG4-RD according to the 2019 American College of Rheumatology and European League Against Rheumatism classification. Insights Imaging 2024; 15:94. [PMID: 38530483 DOI: 10.1186/s13244-024-01638-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/21/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES To evaluate the performance of radiology-related inclusion criteria of the 2019 ACR-EULAR classification system in the diagnosis of IgG4-related disease (IgG4-RD). METHODS This retrospective single-institution study included patients who received a diagnosis of IgG4-RD between January 2010 and December 2020. Two abdominal radiologists independently reviewed baseline imaging studies and scored radiology findings according to the 2019 ACR-EULAR classification criteria. Additional scores were assigned based on serological, histopathological, and immunostaining features. RESULTS Seventy-four patients (58 males and 16 females) with a mean age of 59.3 ± 13.9 years diagnosed with IgG4-RD were included. 51/74 (68.9%) were classified as having IgG4-RD according to the 2019 ACR-EULAR classification criteria. To reach a score ≥ 20 in these 51 patients, the radiology domain was sufficient in 20/51 (39.2%) and adding the serology domain was required for another 20/51 (39.2%). The remaining 11/51 patients (21.6%) required the histopathology and immunostaining domains. Radiological involvement of two or more organs at presentation was significantly associated with a score of ≥ 20 and seen in 43/51 (84.3%) compared to 5/23 (21.7%) of the non-classified group (p < 0.001). The group classified as having IgG4-RD showed a significantly higher proportion of elevated IgG4 levels (39/51, 76.5%) than the non-classified group (8/23, 34.8%) (< 0.001). CONCLUSION The study findings support the effectiveness of the radiology-related inclusion criteria of the 2019 ACR-EULAR classification system in diagnosing IgG4-RD. Combining radiology and serology domains achieved the cut-off in 80% of IgG-RD patients, enabling non-invasive diagnosis. The classification of IgG4-RD was significantly associated with multi-organ involvement, particularly affecting the pancreas and biliary system. CRITICAL RELEVANCE STATEMENT This study is the first to evaluate the diagnostic performance of the radiology domain in the 2019 ACR-EULAR classification criteria. The study results confirm its utility and potential to enable non-invasive diagnosis when combined with serological testing in a significant proportion of patients. KEY POINTS • A significant proportion of patients can be diagnosed with IgG4-RD using the radiology and serology domains exclusively. • Multi-organ involvement is significantly associated with classifying patients as IgG4-RD, with the pancreas and biliary system most frequently affected. • A high level of inter-reader agreement in the scoring of the radiology domain supports its reliability.
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Affiliation(s)
- Khaled Y Elbanna
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada.
| | - Jie-Ying Kowa
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada
| | - Nikhil Mirajkar
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada
| | - Korosh Khalili
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada
| | - Tae Kyoung Kim
- University Medical Imaging Toronto, University Health Network, Toronto, ON, Canada
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50
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Stogiannos N, Litosseliti L, O'Regan T, Scurr E, Barnes A, Kumar A, Malik R, Pogose M, Harvey H, McEntee MF, Malamateniou C. Black box no more: A cross-sectional multi-disciplinary survey for exploring governance and guiding adoption of AI in medical imaging and radiotherapy in the UK. Int J Med Inform 2024; 186:105423. [PMID: 38531254 DOI: 10.1016/j.ijmedinf.2024.105423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Medical Imaging and radiotherapy (MIRT) are at the forefront of artificial intelligence applications. The exponential increase of these applications has made governance frameworks necessary to uphold safe and effective clinical adoption. There is little information about how healthcare practitioners in MIRT in the UK use AI tools, their governance and associated challenges, opportunities and priorities for the future. METHODS This cross-sectional survey was open from November to December 2022 to MIRT professionals who had knowledge or made use of AI tools, as an attempt to map out current policy and practice and to identify future needs. The survey was electronically distributed to the participants. Statistical analysis included descriptive statistics and inferential statistics on the SPSS statistical software. Content analysis was employed for the open-ended questions. RESULTS Among the 245 responses, the following were emphasised as central to AI adoption: governance frameworks, practitioner training, leadership, and teamwork within the AI ecosystem. Prior training was strongly correlated with increased knowledge about AI tools and frameworks. However, knowledge of related frameworks remained low, with different professionals showing different affinity to certain frameworks related to their respective roles. Common challenges and opportunities of AI adoption were also highlighted, with recommendations for future practice.
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Affiliation(s)
- Nikolaos Stogiannos
- Department of Radiography, City, University of London, UK; Magnitiki Tomografia Kerkyras, Greece.
| | - Lia Litosseliti
- School of Health & Psychological Sciences, City, University of London, UK.
| | - Tracy O'Regan
- The Society and College of Radiographers, London, UK.
| | | | - Anna Barnes
- King's Technology Evaluation Centre (KiTEC), School of Biomedical Engineering & Imaging Science, King's College London, UK.
| | | | | | | | | | - Mark F McEntee
- Discipline of Medical Imaging and Radiation Therapy, University College Cork, Ireland.
| | - Christina Malamateniou
- Department of Radiography, City, University of London, UK; European Society of Medical Imaging Informatics, Vienna, Austria.
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