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Seifert R, Gafita A, Solnes LB, Iagaru A. Prostate-specific Membrane Antigen: Interpretation Criteria, Standardized Reporting, and the Use of Machine Learning. PET Clin 2024:S1556-8598(24)00017-8. [PMID: 38705743 DOI: 10.1016/j.cpet.2024.03.002] [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: 05/07/2024]
Abstract
Prostate-specific membrane antigen targeting positron emission tomography (PSMA-PET) is routinely used for the staging and restaging of patients with various stages of prostate cancer. For clear communication with referring physicians and to improve inter-reader agreement, the use of standardized reporting templates is mandatory. Increasingly, tumor volume is used by reporting and response assessment frameworks to prognosticate patient outcome or measure response to therapy. However, the quantification of tumor volume is often too time-consuming in routine clinical practice. Machine learning-based tools can facilitate the quantification of tumor volume for improved outcome prognostication.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland; Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.
| | - Andrei Gafita
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lilja B Solnes
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive H2200, Stanford 94305, USA
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Martin E, Aubry JF, Schafer M, Verhagen L, Treeby B, Pauly KB. ITRUSST consensus on standardised reporting for transcranial ultrasound stimulation. Brain Stimul 2024:S1935-861X(24)00071-8. [PMID: 38670224 DOI: 10.1016/j.brs.2024.04.013] [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: 02/07/2024] [Revised: 03/30/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
As transcranial ultrasound stimulation (TUS) advances as a precise, non-invasive neuromodulatory method, there is a need for consistent reporting standards to enable comparison and reproducibility across studies. To this end, the International Transcranial Ultrasonic Stimulation Safety and Standards Consortium (ITRUSST) formed a subcommittee of experts across several domains to review and suggest standardised reporting parameters for low intensity TUS, resulting in the guide presented here. The scope of the guide is limited to reporting the ultrasound aspects of a study. The guide and supplementary material provide a simple checklist covering the reporting of: (1) the transducer and drive system, (2) the drive system settings, (3) the free field acoustic parameters, (4) the pulse timing parameters, (5) in situ estimates of exposure parameters in the brain, and (6) intensity parameters. Detailed explanations for each of the parameters, including discussions on assumptions, measurements, and calculations, are also provided.
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Affiliation(s)
- Eleanor Martin
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Jean-François Aubry
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR8063, PSL University, Paris, France
| | - Mark Schafer
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Lennart Verhagen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 GD Nijmegen, The Netherlands
| | - Bradley Treeby
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Kim Butts Pauly
- Department of Radiology, Stanford University, Stanford, CA, USA.
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Koelker M, Bradtke M, Klemm J, von Deimling M, Gild P, Dahlem R, Fisch M, Rink M, Vetterlein MW. Rational peri-operative management of antithrombotic therapy in patients undergoing radical cystectomy: A 30-day morbidity analysis based on the updated European Association of Urology guidelines for standardized complication reporting. Eur J Surg Oncol 2023; 49:107123. [PMID: 37879160 DOI: 10.1016/j.ejso.2023.107123] [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: 07/12/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Radical cystectomy (RC) in bladder cancer patients with cardiovascular comorbidity poses challenges due to the need for antithrombotic therapy and high perioperative risk. We aimed to assess 30-day complications after RC in patients receiving antithrombotic therapy. PATIENTS AND METHODS Retrospective study of 416 bladder cancer patients (2009-2017) undergoing open RC with pelvic lymph node dissection, with or without antithrombotic therapy. Antithrombotic therapy and complication reporting followed European guidelines. Procedure-specific 30-day complications were cataloged, graded (Clavien-Dindo), and quantified using the 30-day Comprehensive Complication Index. Multivariable regressions evaluated antithrombotic therapy's independent effect on key morbidity outcomes. RESULTS Median age was 70 years, 78% were male. Patients on antithrombotic therapy were mostly male, had higher comorbidity burden, worse kidney function, more frequent incontinent diversion, and shorter operative time (all p ≤ 0.027). Bleeding complications occurred in 135 patients (32%; 95%CI = 28-37%), more prevalent with antithrombotic therapy (46% vs. 29%; p = 0.004). Thromboembolic complications occurred in 18 patients (4.3%; 95%CI = 2.6-6.8%), no difference between patients with and without antithrombotic therapy (8.4% vs. 3.3%; p = 0.063). Prevalence of myocardial infarction, new-onset hypertension, acute congestive heart failure, and angina pectoris showed no difference (all p ≥ 0.3). Multivariable analyses indicated no association between antithrombotic therapy and cardiac complications, 30-day major complications, or cumulative morbidity (all p ≥ 0.2). Antithrombotic therapy was associated with bleeding complications (OR = 1.92; 95%CI = 1.07-3.45; p = 0.028), predominantly transfusion-related (75% of 152 bleeding complications). Limitations include retrospective data assessment with biases. CONCLUSIONS RC in patients on antithrombotic therapy exhibits a higher incidence of adverse events due to underlying comorbidities. Adherence to thromboprophylaxis guidelines enables safe RC in patients with significant comorbidities, without substantial increase in major bleeding or severe thromboembolic events.
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Affiliation(s)
- Mara Koelker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlon Bradtke
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus von Deimling
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Katholisches Marienkrankenhaus, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Ginocchio LA, Dane B, Smereka PN, Megibow AJ, Remzi FH, Esen E, Huang C. Structured versus non-structured reporting of pelvic MRI for ileal pouch evaluation: clarity and effectiveness. Abdom Radiol (NY) 2023; 48:2978-2985. [PMID: 36871233 DOI: 10.1007/s00261-023-03858-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Given that ileal pouch-anal anastomosis (IPAA) surgery is a technically challenging and high-morbidity procedure, there are numerous pertinent imaging findings that need to be clearly and efficiently communicated to the IBD surgeons for essential patient management and surgical planning. Structured reporting has been increasingly used over the past decade throughout various radiology subspecialties to improve reporting clarity and completeness. We compare structured versus non-structured reporting of pelvic MRI for ileal pouch to evaluate for clarity and effectiveness. METHODS 164 consecutive pelvic MRI's for ileal pouch evaluation, excluding subsequent exams for the same patient, acquired between 1/1/2019 and 7/31/2021 at one institution were included, before and after implementation (11/15/2020) of a structured reporting template, which was created with institutional IBD surgeons. Reports were assessed for the presence of 18 key features required for complete ileal pouch assessment: anastomosis (IPAA, tip of J, pouch body), cuff (length, cuffitis), pouch body (size, pouchitis, stricture), pouch inlet/pre-pouch ileum (stricture, inflammation, sharp angulation), pouch outlet (stricture), peripouch mesentery (position, mesentery twist), pelvic abscess, peri-anal fistula, pelvic lymph nodes, and skeletal abnormalities. Subgroup analysis was performed based on reader experience and divided into three categories: experienced (n = 2), other intra-institutional (n = 20), or affiliate site (n = 6). RESULTS 57 (35%) structured and 107 (65%) non-structured pelvic MRI reports were reviewed. Structured reports contained 16.6 [SD:4.0] key features whereas non-structured reports contained 6.3 [SD:2.5] key features (p < .001). The largest improvement following template implementation was for reporting sharp angulation of the pouch inlet (91.2% vs. 0.9%, p < .001), tip of J suture line and pouch body anastomosis (both improved to 91.2% from 3.7%). Structured versus non-structured reports contained mean 17.7 versus 9.1 key features for experienced readers, 17.0 versus 5.9 for other intra-institutional readers, and 8.7 versus 5.3 for affiliate site readers. CONCLUSION Structured reporting of pelvic MRI guides a systematic search pattern and comprehensive evaluation of ileal pouches, and therefore facilitates surgical planning and clinical management. This standardized reporting template can serve as baseline at other institutions for adaptation based on specific radiology and surgery preferences, fostering a collaborative environment between radiology and surgery, and ultimately improving patient care.
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Affiliation(s)
- Luke A Ginocchio
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA.
| | - Bari Dane
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Paul N Smereka
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Alec J Megibow
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Feza H Remzi
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Eren Esen
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Chenchan Huang
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
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Becker AS, Giganti F, Purysko AS, Fainberg J, Vargas HA, Woo S. Taking PI-QUAL beyond the prostate: Towards a standardized radiological image quality score (RI-QUAL). Eur J Radiol 2023; 165:110955. [PMID: 37421773 PMCID: PMC10404469 DOI: 10.1016/j.ejrad.2023.110955] [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: 05/24/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To compare the interreader agreement of a novel quality score, called the Radiological Image Quality Score (RI-QUAL), to a slighly modified version of the existing Prostate Imaging Quality (mPI-QUAL) score for magnetic resonance imaging (MRI) of the prostate. METHODS A total of 43 consecutive scans were evaluated by two subspecialized radiologists who assigned scores using both the RI-QUAL and mPI-QUAL methods. The interreader agreement was analyzed using three statistical methods: concordance correlation coefficient (CCC), intraclass correlation coefficient (ICC), and Cohen's kappa. Time needed to arrive at a quality judgment was measured and compared using the Wilcoxon signed rank test. RESULTS The interreader agreement for RI-QUAL and mPI-QUAL scores was comparable, as evidenced by the high CCC (0.76 vs. 0.77, p = 0.93), ICC (0.86 vs. 0.87, p = 0.93), and moderate Cohen's kappa (0.61 vs. 0.64, p = 0.85) values. Moreover, RI-QUAL assessment was faster than mPI-QUAL (19 vs. 40 s, p = 0.001). CONCLUSION RI-QUAL is a new quality score that has comparable interreader agreement to the mPI-QUAL score, but with the potential to be applied to different MRI protocols and even different modalities. Like PI-QUAL, RI-QUAL may also facilitate communication about quality to referring physicians, as it provides a standardized and easily interpretable score. Further studies are warranted to validate the usefulness of RI-QUAL in larger patient cohorts and for other imaging modalities.
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Affiliation(s)
- Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Radiology, NYU Langone, New York, NY, United States.
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Andrei S Purysko
- Department of Radiology, Abdominal Imaging Section, Cleveland Clinic, Cleveland, OH, United States
| | - Jonathan Fainberg
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Radiology, NYU Langone, New York, NY, United States
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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de Jong CCM, Ardura-Garcia C, Pedersen ESL, Mallet MC, Mueller-Suter D, Jochmann A, Singer F, Casaulta CA, Regamey N, Moeller A, Goutaki M, Kuehni CE. Standardization of Reporting Obstructive Airway Disease in Children: A National Delphi Process. J Allergy Clin Immunol Pract 2023; 11:187-194.e6. [PMID: 36108926 DOI: 10.1016/j.jaip.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/17/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pediatric pulmonologists report asthma and obstructive bronchitis in medical records in a variety of ways, and there is no consensus for standardized reporting. OBJECTIVE We investigated which diagnostic labels and features pediatric pulmonologists use to describe obstructive airway disease in children and aimed to reach consensus for standardized reporting. METHODS We obtained electronic health records from 562 children participating in the Swiss Pediatric Airway Cohort from 2017 to 2018. We reviewed the diagnosis section of the letters written by pediatric pulmonologists to referring physicians and extracted the terms used to describe the diagnosis. We grouped these terms into diagnostic labels (eg, asthma) and features (eg, triggers) using qualitative thematic framework analysis. We also assessed how frequently the different terms were used. Results were fed into a modified Delphi process to reach consensus on standardized reporting. RESULTS Pediatric pulmonologists used 123 different terms to describe the diagnosis, which we grouped into 6 diagnostic labels and 17 features. Consensus from the Delphi process resulted in the following recommendations: (i) to use the diagnostic label "asthma" for children older than 5 years and "obstructive bronchitis" or "suspected asthma" for children younger than 5 years; (ii) to accompany the diagnosis with relevant features: diagnostic certainty, triggers, symptom control, risk of exacerbation, atopy, treatment adherence, and symptom perception. CONCLUSION We found great heterogeneity in the reporting of obstructive airway disease among pediatric pulmonologists. The proposed standardized reporting will simplify communication among physicians and improve quality of research based on electronic health records.
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Andreasen CM, Klicman RF, Herlin T, Hauge EM, Jurik AG. Standardized reporting and quantification of whole-body MRI findings in children with chronic non-bacterial osteomyelitis treated with pamidronate. Pediatr Rheumatol Online J 2022; 20:85. [PMID: 36183086 PMCID: PMC9526975 DOI: 10.1186/s12969-022-00746-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The objectives were to assess changes in radiological disease activity in children with chronic non-bacterial osteomyelitis (CNO) receiving pamidronate therapy and to test a modified radiological index for non-bacterial osteitis (mRINBO) in CNO. mRINBO was used for standardized reporting and quantification of whole-body MRI (WBMRI) findings resulting in an individual summary patient score. METHODS WBMRI was retrospectively assessed in 18 children with CNO at baseline and after receiving pamidronate therapy for one year. Parameters of interest were: number and anatomic site of radiologically active bone lesions (RAL), size of RAL, extramedullary affection, spinal involvement and changes in mRINBO, which includes both the number and maximal size of RAL (RALmax) in addition to extramedullary and chronic changes. RESULTS At the time of diagnosis, the mean age of the children was 9.8 (sd, 8.7-10.9) years and 11/18 were females. The number of RALs per patient decreased from median [interquartile range] 4.5 [3-8] to 3 [2-5] RALs per patient (p = 0.02) and extramedullary inflammatory changes regressed. Sixty-one percent of all RALs occurring at baseline resolved and three children became without active inflammatory lesions by WBMRI. The median size of RALs did not change when taking new lesions occurring in 7/18 children into account, but RALmax decreased significantly from 39 [29-45] mm at baseline to 28 [20-40] mm (p < 0.01) at year-one with a concomitant decrease of mRINBO from a median of 5 [4-7] to 4 [3-5] (p = 0.05). CONCLUSIONS Pamidronate therapy resulted in a decrease of mRINBO from baseline to year one. mRINBO may be a potential scoring method to quantify changes in radiological disease activity in children with CNO. However, further studies are needed to test feasibility and validity of mRINBO.
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Affiliation(s)
- C. M. Andreasen
- grid.154185.c0000 0004 0512 597XDepartment of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark ,Department of Medicine, Rheumatology, Gødstrup Hospital, Herning, Denmark
| | - R. F. Klicman
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - T. Herlin
- grid.154185.c0000 0004 0512 597XDepartment of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark
| | - E. M. Hauge
- grid.154185.c0000 0004 0512 597XDepartment of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark
| | - A. G. Jurik
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Incuba Skejby, Aarhus N, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Radiology, Aarhus University Hospital, Aarhus N, Denmark
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Bates DD, Shaish H, Gollub MJ, Harisinghani M, Lall C, Sheedy S. Multi-practice survey on MR imaging practice patterns in rectal cancer in the United States. Abdom Radiol (NY) 2022; 47:28-37. [PMID: 34605968 PMCID: PMC9671700 DOI: 10.1007/s00261-021-03279-2] [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: 08/04/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate practice patterns related to MR technique and structured reporting for MRI of rectal cancer at academic centers and private practice groups in the United States. METHODS AND MATERIALS A survey developed by active members of the Society of Abdominal Radiology Rectal and Anal Cancer Disease Focus Panel was sent to 100 private practice and 189 academic radiology groups. The survey asked targeted questions about practice demographics and utilization, technical MR parameters and reporting practices related to MRI of rectal cancer. The results were analyzed using software in an online survey program. RESULTS The survey received 47 unique responses from academic (37/47, 78.7%) and private practice (10/47, 21.3%) groups. Most practices report using rectal MR for staging newly diagnosed rectal cancer always (29/47, 61.7%), and less than half always do so for re-staging after neoadjuvant chemoradiation (20/47, 42.6%). Most groups perform between 1 to 5 rectal MR studies for baseline staging per week (32/47, 68.1%) and most groups perform 0 to 2 MR studies for re-staging per week (27/47, 57.4%). Regarding patient preparation and MR technical parameters, there is variability, but a few key points include most practices (27/47, 57.4%) acquire axial T2-weighted images at a slice thickness of 3 mm or less, axial T2-weighted images with 2D acquisition (30/47, 63.8%), a T2-weighted axial oblique sequence through the tumor (43/47, 91.5%), and T2-weighted images without fat suppression (37/47, 78.7%). Equal numbers of groups report using a maximal b-value less than 1000 s/mm2 (19/43, 44.2%) and 1000 s/mm2 or greater (19/43, 44.2%); the rest were unsure. A substantial portion of respondents do not use intravenous contrast (13/47, 27.7%). Most believe that structured report templates contribute to uniformity of reporting practices (39/47, 83.0%), though there is considerable heterogeneity in usage and included elements. CONCLUSION There is considerable technical heterogeneity among respondents' answers and reporting practices in MR for rectal cancer, and most of the groups report reading only a modest number of studies per week. Our findings suggest there may be room for improvement in terms of radiologist education for performance and standardization of clinical practice for MR imaging of rectal cancer.
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Affiliation(s)
- David D.B. Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hiram Shaish
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
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Weiss VL, Heher YK, Seegmiller A, VanderLaan PA, Nishino M. All in for patient safety: a team approach to quality improvement in our laboratories. J Am Soc Cytopathol 2022; 11:87-93. [PMID: 34996748 PMCID: PMC8885884 DOI: 10.1016/j.jasc.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/22/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 01/21/2023]
Abstract
Patient safety and quality improvement initiatives are integral parts of every cytopathology laboratory. The need to revisit our approaches to patient safety are essential in light of the expanding test menu, ancillary studies, comprehensive diagnostic reports, and emergence of new technologies for augmenting cytologic diagnosis. Our interview with Drs. Yael Heher, Adam Seegmiller, and Paul VanderLaan explores recent developments that have shaped their perspectives in patient safety, test usage, and laboratory quality. The practical strategies presented provide tools for enhanced patient safety and improved outcomes in a new era of ancillary and molecular testing and standardized reporting in the cytopathology laboratory.
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Affiliation(s)
- Vivian L. Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN,Correspondence: Vivian Weiss, M.D. Ph.D., Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, 1161 21st Ave. S., MCN C-3321, Nashville, TN 37232, Phone: 615-875-3002, , Michiya Nishino, M.D. Ph.D., Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, Phone: 617-667-5731,
| | - Yael K. Heher
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Adam Seegmiller
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Paul A. VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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An JY, Fowler KJ. Accurate Prostate Volumes from Manual Calculations-A Comparison of PI-RADS v2 and v2.1 Measurement Techniques. Acad Radiol 2021; 28:1557-1558. [PMID: 34078573 PMCID: PMC10374411 DOI: 10.1016/j.acra.2021.03.027] [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] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/18/2022]
Abstract
There is a theoretical risk of volume overestimation if prostate AP dimension is taken on axial imaging given the anatomic obliquity of the gland on axial plane. This is analogous to slicing a salami sausage diagonally rather than perpendicularly to obtain larger slices. The most recent PI-RADS update (v2.1) now recommends obtaining the anterior-posterior measurement on sagittal imaging to mitigate the theoretical risk of the so called "salami effect" when using the ellipsoid formula for volume calculations. The authors of the recent article Comparison of PI-RADS Versions 2.0 and 2.1 for MRI-based Calculation of the Prostate Volume found the theoretical "salami effect" may not be as significant as originally thought, and perhaps slight overestimation of the AP diameter on axial measurements may yield more accurate volume estimates. Future validation studies are needed for to validate their findings. In this contemporary study, there is excellent interreader agreement among radiologist' three dimensional measurements-confirming manual calculation can be reliably replicated in practice settings where of software-based segmentation tools are not available.
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Affiliation(s)
- Julie Y An
- Department of Radiology, University of California San Diego, San Diego, 9500 Gilman Drive, 0888 California.
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, San Diego, 9500 Gilman Drive, 0888 California
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Johnsson K, Brynolfsson J, Sahlstedt H, Nickols NG, Rettig M, Probst S, Morris MJ, Bjartell A, Eiber M, Anand A. Analytical performance of aPROMISE: automated anatomic contextualization, detection, and quantification of [ 18F]DCFPyL (PSMA) imaging for standardized reporting. Eur J Nucl Med Mol Imaging 2021. [PMID: 34463809 DOI: 10.1007/s00259-021-05497-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022]
Abstract
Purpose The application of automated image analyses could improve and facilitate standardization and consistency of quantification in [18F]DCFPyL (PSMA) PET/CT scans. In the current study, we analytically validated aPROMISE, a software as a medical device that segments organs in low-dose CT images with deep learning, and subsequently detects and quantifies potential pathological lesions in PSMA PET/CT. Methods To evaluate the deep learning algorithm, the automated segmentations of the low-dose CT component of PSMA PET/CT scans from 20 patients were compared to manual segmentations. Dice scores were used to quantify the similarities between the automated and manual segmentations. Next, the automated quantification of tracer uptake in the reference organs and detection and pre-segmentation of potential lesions were evaluated in 339 patients with prostate cancer, who were all enrolled in the phase II/III OSPREY study. Three nuclear medicine physicians performed the retrospective independent reads of OSPREY images with aPROMISE. Quantitative consistency was assessed by the pairwise Pearson correlations and standard deviation between the readers and aPROMISE. The sensitivity of detection and pre-segmentation of potential lesions was evaluated by determining the percent of manually selected abnormal lesions that were automatically detected by aPROMISE. Results The Dice scores for bone segmentations ranged from 0.88 to 0.95. The Dice scores of the PSMA PET/CT reference organs, thoracic aorta and liver, were 0.89 and 0.97, respectively. Dice scores of other visceral organs, including prostate, were observed to be above 0.79. The Pearson correlation for blood pool reference was higher between any manual reader and aPROMISE, than between any pair of manual readers. The standard deviations of reference organ uptake across all patients as determined by aPROMISE (SD = 0.21 blood pool and SD = 1.16 liver) were lower compared to those of the manual readers. Finally, the sensitivity of aPROMISE detection and pre-segmentation was 91.5% for regional lymph nodes, 90.6% for all lymph nodes, and 86.7% for bone in metastatic patients. Conclusion In this analytical study, we demonstrated the segmentation accuracy of the deep learning algorithm, the consistency in quantitative assessment across multiple readers, and the high sensitivity in detecting potential lesions. The study provides a foundational framework for clinical evaluation of aPROMISE in standardized reporting of PSMA PET/CT. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05497-8.
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Abstract
The hybrid closed-loop (HCL) system has been shown to improve glycemic control and reduce hypoglycemia. Optimization of HCL settings requires interpretation of the glucose, insulin, and factors affecting glucose such as food intake and exercise. To the best of our knowledge, there is no published guidance on the standardized reporting of HCL systems. Standardization of HCL reporting would make interpretation of data easy across different systems. We reviewed the literature on patient and provider perspectives on downloading and reporting glucose metric preferences. We also incorporated international consensus on standardized reporting for glucose metrics. We describe a single-page HCL data reporting, referred to here as "artificial pancreas (AP) Dashboard." We propose seven components in the AP Dashboard that can provide detailed information and visualization of glucose, insulin, and HCL-specific metrics. The seven components include (A) glucose metrics, (B) hypoglycemia, (C) insulin, (D) user experience, (E) hyperglycemia, (F) glucose modal-day profile, and (G) insight. A single-page report similar to an electrocardiogram can help providers and patients interpret HCL data easily and take the necessary steps to improve glycemic outcomes. We also describe the optimal sampling duration for HCL data download and color coding for visualization ease. We believe that this is a first step in creating a standardized HCL reporting, which may result in better uptake of the systems. For increased adoption, standardized reporting will require input from providers, patients, diabetes device manufacturers, and regulators.
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Affiliation(s)
- Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Writing group of the International Urogynecological Association. IUGA report on reporting urodynamics in women. Int Urogynecol J 2021. [PMID: 33694003 DOI: 10.1007/s00192-021-04742-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND AIM Urodynamics (UDS) is the current gold standard investigation for explaining pathology in lower urinary tract dysfunction. The role of UDS is to answer a urodynamic question based on reproducing the patient's symptoms. Despite the introduction of several standardization documents on terminology and methodology for performing UDS and the standard of equipment required, there remains no standardization on how to report and therefore how to interpret UDS findings. The lack of guidance in this specific area may undermine the value of this extremely important tool in the patient evaluation. The aim of this article is to propose a standardized proforma and checklist for the reporting of UDS studies; the main text discusses the rationale for the proforma. METHODS This document underwent four rounds of review by the working group and external review by Andrew Gammie. Between each round the document was re-circulated for comment and the comments collated and then reviewed for adoption or rejection based on consensus prior to the document going for further external review. The comments of the external review were then collated and again circulated for consideration prior to adoption based on consensus and the paper put out to review by an IUGA committee public consultation prior to being submitted for publication. RESULTS This article sets out the rationale for a standardized proforma for reporting female UDS. CONCLUSION This document gives a standardized approach to reporting of UDS. The importance of this is based on UDS being part of a process and not an isolated event. Standardized reporting, like the WHO checklist, gives a framework to ensure that the test has been ordered appropriately and that the final report refers to the indication rather than merely the observations. As such, a standardized report has a better chance of being interpreted appropriately for the woman's symptoms.
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14
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Unsdorfer KML, An JY, Binkovitz LA. Pediatric appendiceal ultrasound: maintaining accuracy, increasing determinacy and improving clinical outcomes following the introduction of a standardized reporting template. Pediatr Radiol 2021; 51:265-72. [PMID: 32902698 DOI: 10.1007/s00247-020-04820-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/26/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric patients who underwent appendiceal US and received an equivocal interpretation had poorer clinical outcomes and higher medical costs compared to those to whom a definitive interpretation was given, either positive or negative. In an effort to reduce equivocal interpretations, we educated our group on the importance of increasing determinacy and encouraged the use of a reporting template with a definitive impression. OBJECTIVE We hypothesized that educational sessions and implementation of an optional reporting template with only a definitive impression would reduce equivocal reporting and improve clinical outcomes without negatively impacting US diagnostic performance. MATERIALS AND METHODS We retrospectively reviewed the charts of all patients <18 years old at Mayo Clinic Rochester whose initial evaluation for acute appendicitis was a US in the 3-year period following educational sessions and template implementation. All studies were interpreted by board-certified fellowship-trained pediatric radiologists. We performed statistical analysis to compare the pre- and post-implementation cohorts. RESULTS Following intervention, the rate of equivocal US interpretations was reduced from 23.7% to 9.3% (P<0.001). For studies with a definitive interpretation, measures of diagnostic performance of appendiceal US were similar for the pre- and post-implementation groups. US performance parameters were independent of appendiceal visualization. Follow-up CT utilization decreased from 18.7% to 8.9% (P<0.001). The negative laparotomy rate resulting from false-positive US interpretations remained low (6.8% vs. 5.0%, P=0.31). CONCLUSION Following education sessions and implementation of an appendiceal US reporting template encouraging definitive reporting, equivocation was reduced, excellent diagnostic performance was maintained, follow-up CT utilization was reduced, and a low negative laparotomy rate was preserved.
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Caulley L, Cheng W, Catalá-López F, Whelan J, Khoury M, Ferraro J, Husereau D, Altman DG, Moher D. Citation impact was highly variable for reporting guidelines of health research: a citation analysis. J Clin Epidemiol 2020; 127:96-104. [PMID: 32712175 DOI: 10.1016/j.jclinepi.2020.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Over 400 reporting guidelines are currently published, but the frequency of their use by authors to accurately and transparently report research remains unclear. This study examined citation counts of reporting guidelines and characteristics contributing to their citation impact. STUDY DESIGN AND SETTING Web of Science database was searched for citation counts of all reporting guidelines with a minimum citation age of 5 years. The total citation impact, mean citation impact and the factors contributing to 2- and 5-year citation rate were established. RESULTS The search identified 296 articles of reporting guidelines from 1995 to 2013. The mean citations per year was 32.4 (95% confidence interval, 22.3-42.4 citations). The factors associated with 2- and 5-year citation performance of reporting guidelines included the following: open access to the reporting guideline, field of the publishing journal (general vs. specialized medical journal), impact factor of the publishing journal, simultaneous publication in multiple journals, and a male first author. CONCLUSION The citation rate across reporting guidelines varied with journal impact factor, open access publication, field of the publishing journal, simultaneous publications, and a male first author. Gaps in citations highlight opportunities to increase visibility and encourage author use of reporting guidelines.
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Affiliation(s)
- Lisa Caulley
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands; Center for Journalology, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Wei Cheng
- Knowledge Synthesis Group, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ferrán Catalá-López
- Knowledge Synthesis Group, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada; Department of Health Planning and Economics, National School of Public Health, Institute of Health Carlos III, Madrid, Spain; Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Jonathan Whelan
- Faculty of Medicine, Department of Undergraduate Medical Education, University of Ottawa, Ottawa, Canada
| | - Michel Khoury
- Faculty of Medicine, Department of Undergraduate Medical Education, University of Ottawa, Ottawa, Canada
| | - Jennifer Ferraro
- Faculty of Medicine, Department of Undergraduate Medical Education, University of Ottawa, Ottawa, Canada
| | - Don Husereau
- Institute of Health Economics, Edmonton, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - David Moher
- Centre for Journalology and Canadian EQUATOR Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
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Abstract
Head and neck cancer surveillance imaging is diagnostically challenging, often with highly distorted anatomy after surgery and chemoradiation therapy. In the era of standardized reporting, the Neck Imaging Reporting and Data System (NI-RADS) was developed as a numerical classification system to provide clear and concise radiology reports and recommend next management step. There are 5 categories, each conveying a certain level of suspicion for the presence of persistent or recurrent disease. This article reviews the goals of NI-RADS, NI-RADS categories and lexicon, current research, and the future direction of NI-RADS in posttreatment head and neck cancer surveillance.
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Affiliation(s)
- Derek Hsu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG03, Atlanta, GA 30322, USA.
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA. https://twitter.com/amyfjuliano
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Abstract
Structured reporting is advocated as a means of improving reporting in radiology to the ultimate benefit of both radiological and clinical practice. Several large initiatives are currently evaluating its potential. However, with numerous characterizations of the term in circulation, “structured reporting” has become ambiguous and is often confused with “standardization,” which may hamper proper evaluation and implementation in clinical practice. This paper provides an overview of interpretations of structured reporting and proposes a clear definition that differentiates structured reporting from standardization. Only a clear uniform definition facilitates evidence-based implementation, enables evaluation of its separate components, and supports (meta-)analyses of literature reports.
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Affiliation(s)
- J Martijn Nobel
- Department of Radiology, Maastricht University Medical Center, Postbox 5800, 6202, AZ, Maastricht, the Netherlands. .,School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Ellen M Kok
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.,Department of Education and Pedagogy, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Center, Postbox 5800, 6202, AZ, Maastricht, the Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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Chandra A, Crothers B, Kurtycz D, Schmitt F. Announcement: The International System for Reporting Serous Fluid Cytopathology. Acta Cytol 2019; 63:349-351. [PMID: 31234178 DOI: 10.1159/000501536] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 02/06/2019] [Accepted: 06/16/2019] [Indexed: 11/19/2022]
Abstract
Serous fluids are a common but important specimen type in a cytopathology laboratory. There is as yet no agreed standardized terminology to allow uniformity in reporting on these specimens. Given that serous fluids are a rich source of cytopathological as well as molecular information on a range of benign and often advanced malignant conditions, a unified approach to handling and reporting these specimens covering the pre-analytical, analytical and postanalytical stages seems timely. Representatives of the international cytology community have come together once again to develop an algorithmic diagnostic and management approach to the reporting of these samples.
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Affiliation(s)
- Ashish Chandra
- Department of Cellular Pathology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom,
| | - Barbara Crothers
- Gynecologic, Breast, and Cytopathology Services, Joint Pathology Center, Silver Spring, Maryland, USA
| | - Daniel Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fernando Schmitt
- Medical Faculty, Porto University, Porto, Portugal
- Institute of Molecular Pathology and Immunology, Porto University, Porto, Portugal
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19
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Kamath A, Roudenko A, Hecht E, Sirlin C, Chernyak V, Fowler K, Mitchell DG. CT/MR LI-RADS 2018: clinical implications and management recommendations. Abdom Radiol (NY) 2019; 44:1306-1322. [PMID: 30671612 DOI: 10.1007/s00261-018-1868-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/07/2023]
Abstract
Unique among solid organ tumors, hepatocellular carcinoma (HCC), may be diagnosed by imaging alone, without the need for biopsy. The Liver Imaging Reporting and Data System (LI-RADS) was developed to provide high-specificity diagnosis of HCC based on imaging while also standardizing the assessment and reporting of the entire spectrum of lesions and pseudolesions encountered in patients at risk for this malignancy. In this pictorial review, we discuss management recommendations associated with CT/MR LI-RADS observations. We emphasize the rationale for the recommendations and the role of multidisciplinary management discussion, and we provide a framework for standardized reporting. Management of patients who undergo ultrasound (US) for screening and surveillance or those who undergo diagnostic contrast-enhanced ultrasound (CEUS) is beyond the scope of this paper.
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Affiliation(s)
- Amita Kamath
- Department of Radiology, Mount Sinai Health System, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA.
| | - Alexandra Roudenko
- Department of Radiology, New York Presbyterian - Weill Cornell Hospital, New York, NY, USA
| | - Elizabeth Hecht
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Claude Sirlin
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | | | - Kathryn Fowler
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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20
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Shea LAG, Towbin AJ. The state of structured reporting: the nuance of standardized language. Pediatr Radiol 2019; 49:500-508. [PMID: 30923882 DOI: 10.1007/s00247-019-04345-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/07/2018] [Revised: 12/04/2018] [Accepted: 01/11/2019] [Indexed: 12/26/2022]
Abstract
Radiology reports are the principal form of communication with the referring provider. Unfortunately, they can be a form of communication riddled with errors and inscrutable statements burying the intended meaning, failing to achieve the main task for which it was made: communicating key imaging findings as they pertain to the clinical question being posed. Structured reporting is a multifaceted and modular solution to problematic reports, with variable iterations and benefits. Structured reports have been adapted across departments and even national societies, with standardized format, content and language. Newer developments include contextual reporting and common data elements. Herein, we discuss the various forms and levels of structured reporting and the latest advancements, as well as the general acceptance within radiology. We also discuss some areas for improvement as the practice of structured reporting matures.
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Affiliation(s)
- Lindsey A G Shea
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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21
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Rees MA, Dillman JR, Anton CG, Rattan MS, Smith EA, Towbin AJ, Zhang B, Trout AT. Inter-radiologist agreement using Society of Abdominal Radiology-American Gastroenterological Association (SAR-AGA) consensus nomenclature for reporting CT and MR enterography in children and young adults with small bowel Crohn disease. Abdom Radiol (NY) 2019; 44:391-397. [PMID: 30120514 DOI: 10.1007/s00261-018-1743-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/16/2022]
Abstract
PURPOSE To assess inter-radiologist agreement using the Society of Abdominal Radiology-American Gastroenterological Association (SAR-AGA) consensus recommendations for reporting CT/MR enterography exams in pediatric and young adult small bowel Crohn disease (CD). METHODS Institutional review board approval was obtained for this HIPAA-compliant retrospective investigation; the requirement for informed consent was waived. 25 CT and 25 MR enterography exams performed in children and young adults (age range: 6-23 years) between January 2015 and April 2017 with a distribution of ileal CD severity (phenotype) were identified: normal or chronic CD without active inflammation (40%), active inflammatory CD (20%), stricturing CD (20%), and penetrating CD (20%). Five fellowship-trained pediatric radiologists, blinded to one another, documented key imaging findings and standardized impressions based on SAR-AGA consensus recommendations. Inter-radiologist agreement was evaluated using Fleiss' multi-rater kappa statistic (κ) with 95% confidence intervals (CI). RESULTS Inter-radiologist agreement was moderate for all key imaging findings except presence of ulcerations (κ 0.37 [95% CI 0.28-0.46]) and sacculations (κ 0.31 [95% CI 0.23-0.40]). Agreement for standardized impressions was substantial for stricturing disease (κ 0.79 [95% CI 0.70-0.87]) and moderate for presence of inflammation (κ 0.49 [95% CI 0.44-0.56]) and penetrating disease (κ 0.58 [95% CI 0.49-0.67]). No significant difference in agreement was found between CT and MRI. CONCLUSIONS Agreement among five pediatric radiologists was moderate to substantial for SAR-AGA standardized impressions and fair to moderate for key imaging findings of pediatric and young adult CD.
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Affiliation(s)
- Mitchell A Rees
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Mantosh S Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Ethan A Smith
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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22
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Bewick BM, Ondersma SJ, Høybye MT, Blakstad O, Blankers M, Brendryen H, Helland PF, Johansen AB, Wallace P, Sinadinovic K, Sundström C, Berman AH. Key Intervention Characteristics in e-Health: Steps Towards Standardized Communication. Int J Behav Med 2017; 24:659-64. [PMID: 28405917 DOI: 10.1007/s12529-016-9630-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE This paper reports expert opinion on e-health intervention characteristics that enable effective communication of characteristics across the diverse field of e-health interventions. The paper presents a visualization tool to support communication of the defining characteristics. METHODS An initial list of e-health intervention characteristics was developed through an iterative process of item generation and discussion among the 12 authors. The list was distributed to 123 experts in the field, who were emailed an invitation to assess and rank the items. Participants were asked to evaluate these characteristics in three separate ways. RESULTS A total of 50 responses were received for a response rate of 40.7%. Six respondents who reported having little or no expertise in e-health research were removed from the dataset. Our results suggest that 10 specific intervention characteristics were consistently supported as of central importance by the panel of 44 e-intervention experts. The weight and perceived relevance of individual items differed between experts; oftentimes, this difference is a result of the individual theoretical perspective and/or behavioral target of interest. CONCLUSIONS The first iteration of the visualization of salient characteristics represents an ambitious effort to develop a tool that will support communication of the defining characteristics for e-health interventions aimed to assist e-health developers and researchers to communicate the key characteristics of their interventions in a standardized manner that facilitates dialog.
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23
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Rossi ED, Baloch Z, Pusztaszeri M, Faquin WC. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): an ASC-IAC-sponsored system for reporting salivary gland fine-needle aspiration. J Am Soc Cytopathol 2018; 7:111-118. [PMID: 31043307 DOI: 10.1016/j.jasc.2018.02.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 12/21/2017] [Revised: 01/30/2018] [Accepted: 02/07/2018] [Indexed: 06/09/2023]
Abstract
The diagnostic role of salivary gland fine-needle aspiration (SG-FNA) is well established in the preoperative evaluation of patients with salivary gland lesions. At present, most salivary SG-FNA specimens are diagnosed based on conventional diagnostic criteria. Nevertheless, there exists a lack of uniform reporting for these specimens to guide the clinical management of patients. This void motivated a group of experienced cytopathologists to spearhead the development of a uniform reporting system. This international panel, under the sponsorship of the American Society of Cytopathology (ASC) and the International Academy of Cytology (IAC), gathered in September 2015 at the European Congress of Cytology, held in Milan, Italy, to propose "The Milan System for Reporting Salivary Gland Cytopathology. This effort sparked the interest of many and brought forth an agreement to develop an evidence-based tiered classification consisting of 6 diagnostic categories. We hope that this standard reporting system will enhance the overall effectiveness of SG-FNA reporting across institutions, with the ultimate result being better communication and improved patient care.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy.
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marc Pusztaszeri
- Division of Pathology, Jewish General Hospital and McGill University, Montréal, Canada
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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24
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Abstract
A radiologist issuing a LI-RADS category is, implicitly or explicitly, a member of a multidisciplinary team. If the definite diagnosis of a benign or malignant entity is not possible, categorizing the uncertainty as LR-2, -3, -4, or -M has important management implications. In this article, we discuss the range of options for management or further diagnostic testing and how a LR category may affect the choice between them. We then review recent published data regarding eventual diagnoses following assignment of a LR category.
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25
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Maroules CD, Hamilton-Craig C, Branch K, Lee J, Cury RC, Maurovich-Horvat P, Rubinshtein R, Thomas D, Williams M, Guo Y, Cury RC. Coronary artery disease reporting and data system (CAD-RADS TM): Inter-observer agreement for assessment categories and modifiers. J Cardiovasc Comput Tomogr 2017; 12:125-130. [PMID: 29217341 DOI: 10.1016/j.jcct.2017.11.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 08/09/2017] [Revised: 09/21/2017] [Accepted: 11/30/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Coronary Artery Disease Reporting and Data System (CAD-RADS) provides a lexicon and standardized reporting system for coronary CT angiography. OBJECTIVES To evaluate inter-observer agreement of the CAD-RADS among an panel of early career and expert readers. METHODS Four early career and four expert cardiac imaging readers prospectively and independently evaluated 50 coronary CT angiography cases using the CAD-RADS lexicon. All readers assessed image quality using a five-point Likert scale, with mean Likert score ≥4 designating high image quality, and <4 designating moderate/low image quality. All readers were blinded to medical history and invasive coronary angiography findings. Inter-observer agreement for CAD-RADS assessment categories and modifiers were assessed using intra-class correlation (ICC) and Fleiss' Kappa (κ).The impact of reader experience and image quality on inter-observer agreement was also examined. RESULTS Inter-observer agreement for CAD-RADS assessment categories was excellent (ICC 0.958, 95% CI 0.938-0.974, p < 0.0001). Agreement among expert readers (ICC 0.925, 95% CI 0.884-0.954) was marginally stronger than for early career readers (ICC 0.904, 95% CI 0.852-0.941), both p < 0.0001. High image quality was associated with stronger agreement than moderate image quality (ICC 0.944, 95% CI 0.886-0.974 vs. ICC 0.887, 95% CI 0.775-0.95, both p < 0.0001). While excellent inter-observer agreement was observed for modifiers S (stent) and G (bypass graft) (both κ = 1.0), only fair agreement (κ = 0.40) was observed for modifier V (high risk plaque). CONCLUSION Inter-observer reproducibility of CAD-RADS assessment categories and modifiers is excellent, except for high-risk plaque (modifier V) which demonstrates fair agreement. These results suggest CAD-RADS is feasible for clinical implementation.
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Affiliation(s)
- Christopher D Maroules
- Department of Radiology, Naval Medical Center, Portsmouth, VA, United States; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States.
| | | | - Kelley Branch
- Department of Cardiology, University of Washington, Seattle, WA, United States
| | - James Lee
- Henry Ford Health System, Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, United States.
| | | | | | | | - Dustin Thomas
- Brooke Army Medical Center, San Antonio, TX, United States
| | | | - Yanshu Guo
- Department of Cardiology, University of Washington, Seattle, WA, United States
| | - Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States
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Baadh AS, Rockman CB, Mitnick RJ, Lim RP. Bovine arch and carotid artery atherosclerosis: are they related? Clin Imaging 2014; 38:681-5. [PMID: 24993641 DOI: 10.1016/j.clinimag.2014.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/29/2014] [Revised: 04/09/2014] [Accepted: 05/20/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The prevalence of the "bovine" arch in the population is known (8-25%). However, its prevalence in patients with significant carotid atherosclerosis has never been investigated. Altered flow patterns or turbulence that may occur in these patients may play a causative role in the development of atherosclerotic lesions. The primary purpose of this study was to retrospectively compare the prevalence of aortic arch variants in patients with and without significant carotid artery atherosclerosis, as we hypothesize that carotid atherosclerosis may be more prevalent in patients with a bovine arch due to hemodynamic alterations. A secondary objective was to review radiologist reporting of arch anatomy. METHODS Single-center, retrospective, case-control study in which 79 patients with hemodynamically significant carotid artery atherosclerosis who underwent computed tomography angiography, magnetic resonance angiography, or unenhanced computed tomography (CT) imaging including the aortic arch were identified. These patients were then compared with 95 randomly selected controls without carotid atherosclerosis that underwent similar imaging during the same time period. Images were independently reviewed by two blinded radiologists, who assessed arch anatomy as normal, bovine, or other variant. The original radiology reports were reviewed for reporting of arch anatomy. RESULTS In controls, 70% had normal arch anatomy, and 24% had a bovine arch. Among patients with significant carotid disease, these numbers were 70% and 20%, respectively. There was no statistically significant difference between incidence of arch variants in subjects with and without carotid artery atherosclerosis (P=.97). There was good interreader agreement. Among patients with aortic arch anomalies, 20% of the original radiology reports did not mention arch anatomy. CONCLUSIONS In our experience, percentage of bovine arch anomalies in patients with significant carotid atherosclerosis is not significantly different from those without disease. Clinicians should be aware of the high prevalence of arch anomalies, which can impact endovascular approach and management, and radiologists should be aware of the clinical importance of reporting such variants.
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Affiliation(s)
- Amanjit S Baadh
- Department of Radiology, Winthrop University Hospital, 259 1st ST, Mineola, NY, 11501.
| | - Caron B Rockman
- Department of Vascular Surgery, New York University Medical Center, 530 First, Avenue, Suite 6 F, New York, NY, 10016.
| | - Robin J Mitnick
- Department of Radiology, New York University Medical Center, 660 First Avenue, New York, NY, 10016.
| | - Ruth P Lim
- Department of Radiology, New York University Medical Center, 660 First Avenue, New York, NY, 10016; Department of Radiology, Austin Health, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia,; Department of Radiology, University of Melbourne, Melbourne, Victoria, 3050, Australia.
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