RADIOLOGY

The accuracy of multi-detector computed tomography and laparoscopy in the prediction of peritoneal carcinomatosis index score in primary ovarian cancer Publication date: Available online 14 May 2019 Source: Academic Radiology Author(s): Shimaa Abdalla Ahmed, Hisham Abou-Taleb, Ahmed Yehia, Noha Ali Abd El Malek, Gehan S. Siefeldein, Dalia M. Badary, Murad Aly Jabir Rationale and Objectives The purpose of this study was to compare the accuracy of MDCT and laparoscopy in the prediction of peritoneal carcinomatosis index score. Reproducibility of MDCT interpretation was also assessed. Methods This prospective study included 85 ovarian cancer patients underwent MDCT and diagnostic laparoscopy before cytoreductive surgery. We calculated the accuracy of diagnostic modalities in the calculation of the peritoneal cancer index score (PCI). Radiologist interobserver agreement was calculated using kappa statistics. Results Nine hundred-thirty (84.2%) of the 1105 regions had peritoneal deposits at exploratory laparotomy. Computed tomography (CT) and laparoscopy sensitivity were 94.9%, 98.3%, specificity 86.7%, 80.4%, PPV 97.9 %, 96.8%, NPV 72.2%, 88.8 %, and accuracy 93.8 %, 95.7%, respectively. However, computed tomography (CT) diagnostic performance is less accurate than laparoscopy in pelvic and small intestinal regions; no statistically significant differences were evident regarding total PCI score compared to surgery (p> 0.05). CT and laparoscopy correctly depicted peritoneal carcinomatosis in 88.2%, 90.6% of patients, respectively. Optimal cytoreduction was achieved in 68 (80%) patients. Conclusion Both CT and laparoscopy seems to be effective tools for assessment of peritoneal carcinomatosis using the PCI score. Dedicated MDCT protocol with routine use of a standardized PCI form may provide better comprehensive multi-regional analysis that may help surgeons referring patients to the best treatment option. Laparoscopy is a valuable tool in cases with a high risk of suboptimal cytoreduction related to disease extent.

Critical Challenges to the Management of Clinical Trial Imaging: Recommendations for the Conduct of Imaging at Investigational Sites Publication date: Available online 13 May 2019 Source: Academic Radiology Author(s): Nicholas P. Gruszauskas, Samuel G. Armato Rationale and Objectives Participation in clinical research can be both highly rewarding and logistically demanding. As highlighted by recent Food and Drug Administration guidance, imaging has become an integral part of this research. The unique technical and administrative aspects of clinical trial imaging may differ substantially from those of standard-of-care imaging and thus burden the established clinical infrastructure at investigational sites. Failure to comply with requirements can lead to unusable data, repeat imaging, or the removal of patients from the trial. It is therefore imperative that all stakeholders address these challenges to engage in clinical research successfully. Materials and Methods The authors' experiences in managing clinical trial imaging requirements at their institution were used to identify common challenges. The impact of these challenges was assessed from an operational perspective. Results Although contract research organizations attempt to minimize these challenges, their efforts are necessarily limited and insufficient, and there is a lack of infrastructure available at investigational sites to address these issues. As such, recommendations are proposed for addressing these challenges at institutional and industry levels. Conclusion The challenges associated with clinical trial imaging require an investment of resources from all stakeholders. Investigational sites must confront these challenges to satisfy trial requirements effectively, maintain a superior level of patient care, and guarantee trial integrity. Similarly, sponsors must acknowledge the burden of clinical trial imaging and support the development of the necessary local infrastructure. The implementation of the recommendations described here will improve the conduct of clinical trial imaging.

Hybrid Interactive and Didactic Teaching Format Improves Resident Retention and Attention Compared to Traditional Lectures Publication date: Available online 11 May 2019 Source: Academic Radiology Author(s): Vishwan Pamarthi, Lars Grimm, Karen Johnson, Charles Maxfield Purpose To compare the traditional lecture to a hybrid interactive and didactic teaching format with regards to radiology resident short- and long-term retention, as well as attention. Materials and Methods The tested hybrid format consists of a 30-minute didactic lecture followed by 30 minutes of interactive cases based on material from the lecture portion. Faculty members were randomly selected to give a 60-minute lecture or a hybrid presentation. To assess short- and long-term retention, a test developed from the presenter's slides was sent to all residents approximately 15 minutes after each presentation, and again approximately 3 months later. The presenters were blinded to the survey questions. Attention was assessed by comparing the proportion of questions answered correctly from each quarter of the presentation. Equality in difficulty of questions was validated across teaching methods. Results For 6 hybrid presentations, 106 and 60 retention tests were submitted, answering 848 and 480 short- and long-term survey questions, respectively. For 6 lectures, 91 and 55 retention tests were submitted, answering 728 and 440 short- and long-term survey questions, respectively. Short-term retention was 75.7% (640/848) for hybrid presentations, versus 63.2% (460/728) for lectures (p < 0.0001). Long-term retention was 59.4% (285/480) for hybrid presentations, versus 49.3% (217/440) for lectures (p = 0.002). Regarding attention, 61.6% (554/600) of questions from the first 3 quarters of traditional lectures were answered correctly versus 49.3% (148/300) of final quarter questions (p = 0.0003). No significant drop-off was noted for hybrid presentations. Conclusion A hybrid interactive and didactic teaching format for radiology residents demonstrates better short-term retention, long-term retention, and attention when compared to traditional lectures.

How can Artistic Paintings Broaden Medical Students' Understanding of the Radiology Profession? Publication date: Available online 9 May 2019 Source: Academic Radiology Author(s): Kari L. Visscher, Lynn F. Bloom, Kori A. LaDonna, Lisa Faden, Kawan S. Rakhra Rationale and Objectives The purpose of this study is to explore how representational paintings of radiology encounters with patients may impact medical students' understanding and impression of both radiologists and the radiology profession. Methods Participants included third year medical students at a single institution rotating through a one-week radiology elective. Three works of art were analyzed using the validated Visual Thinking Strategies technique. Data collected included a postsession questionnaire and transcriptions of audio-recorded sessions. Data analysis involved both qualitative and quantitative methodology. Results Fifty students participated; all participants completed the postsession questionnaire and 10 participated in the audio recorded sessions. Total 82% found the experience "very enjoyable" and 86% agreed that the paintings positively affected their understanding of how radiologists provide care to patients; 96% would recommend this session to others. Exploring representational paintings of radiology encounters seemed to influence perception and understanding of radiology with students reporting "light bulb moments;" create a dissonance between the student experience and the experience depicted in the paintings; and address gaps in content specific knowledge. Conclusion The findings of this study suggest that analyzing paintings depicting radiology encounters with patients can challenge negative stereotypes that medical students have of the radiology profession and radiologists. This arts-based learning module employing a learning strategy such as Visual Thinking Strategies, should be considered by the radiology profession as a strategy to positively inform and educate trainees about the specialty.

Characteristics of Radiologists' Clinical Practice Patterns by Career Stage Publication date: Available online 8 May 2019 Source: Academic Radiology Author(s): Andrew B. Rosenkrantz, Howard B. Fleishon, Patricia A. Hudgins, Claire E. Bender, Richard Duszak Purpose To assess characteristics of radiologists' clinical practice patterns by career stage. Methods Radiologists' 2016 billed services were extracted from the Medicare Physician and Other Supplier Public Use File. Billed clinical work was weighted using work relative value units. Medical school graduation years were obtained from Medicare Physician Compare. Practice patterns were summarized by decades after residency. Results Among 28,463 included radiologists, 32.7% were ≤10 years postresidency, 29.3% 11–20 years, 25.0% 21–30 years, 10.5% 31–40 years, 2.4% 41–50 years, 0.1% ≥51 years. Billed clinical work (normalized to a mean of 1.00 among all radiologists) ranged 0.92–1.07 from 1 to 40 years, decreasing to 0.64 for 41–50 years and 0.43 for ≥51 years. Computed tomography represented 34.7%–38.6% of billed clinical work from 1 to 30 years, decreasing slightly to 31.5% for 31–40 years. Magnetic resonance imaging represented 13.9%–14.3% from 1 to 30 years, decreasing slightly to 11.2% for 31–40 years. Ultrasonography represented 6.2%–11.6% across career stages. Nuclear medicine increased steadily from 1.7% for ≤10 years to 7.0% for 41–50 years. Mammography represented 9.9%–12.9% from 1 to 50 years. Radiography/fluoroscopy represented 15.1%–29.8% from 1 to 50 years, but 65.9% for ≥51 years. Conclusion The national radiologist workforce declines abruptly by more than half approximately 30 years after residency. Radiologists still working at 31–40 years, however, contribute similar billed clinical work, both overall and across modalities, as earlier career radiologists. Strategies to retain later-career radiologists in the workforce could help the specialty meet growing clinical demands, mitigate burnout in earlier career colleagues, and expand robust patient access to both basic and advanced imaging services.

Coronary Atherosclerotic Plaque Volume Quantified by Computed Tomographic Angiography in Smokers Compared to Nonsmokers Publication date: Available online 7 May 2019 Source: Academic Radiology Author(s): Zhi-hui Hou, Bin Lu, Zhen-nan Li, Yun-qiang An, Yang Gao, Wei-hua Yin Rationale and Objectives We sought to compare the prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque in patients with smokers versus nonsmokers. Materials and Methods We studied consecutive patients suspected of coronary artery disease and who underwent coronary computed tomography angiography. A structured interview and review of existing clinical data was conducted before computed tomography angiography to collect information on demographic characteristics, the presence of cardiovascular risk factors. The volume of lipid, fibrous, and calcified plaque were automatically calculated and marked in different colors according to predefined Hounsfield unit thresholds. The prevalence and volume of plaques were compared between smokers and nonsmokers. Results Overall 6380 patients (3351 men and 3029 women, mean age 55.35 years) were finally analyzed, of whom 2075 (32.5%) were smokers, and 4305 (67.5%) were never smokers. The prevalence of any plaque in smokers was significantly higher compared to never smokers (47.7% vs. 32.3%, p < 0.001). Smoking was an independent risk factor of the presence of any plaque after correcting for age, gender, body mass index, hypertension, dyslipidemia, diabetes, and family history in a multivariate model (odds ratio = 1.250 (1.088–1.437), p = 0.002). The volume of lipid plaque, fibrous plaque, calcified plaque, and total plaque in smokers was significantly greater than nonsmokers (p < 0.001). Conclusion The prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque were significantly higher in smokers versus never smokers.

Evaluation of Pseudoreader Study Designs to Estimate Observer Performance Results as an Alternative to Fully Crossed, Multireader, Multicase Studies Publication date: Available online 7 May 2019 Source: Academic Radiology Author(s): Rickey E. Carter, David R. Holmes, Joel G. Fletcher, Cynthia H. McCollough Rationale and Objectives To examine the ability of a pseudoreader study design to estimate the observer performance obtained using a traditional fully crossed, multireader, multicase (MRMC) study. Materials and Methods A 10-reader MRMC study with 20 computed tomography datasets was designed to measure observer performance on four novel noise reduction methods. This study served as the foundation for the empirical evaluation of three different pseudoreader designs, each of which used a similar bootstrap approach for generating 2000 realizations from the fully crossed study. Our three approaches to generating a pseudoreader varied in the degree to which reader performance was matched and integrated into the pseudoreader design. One randomly selected simulation was selected as a "mock study" to represent a hypothetical, prospective implementation of the design. Results Using the traditional fully crossed design, figures of merit) (95% CIs) for the four noise reductions methods were 68.2 (55.5–81.0), 69.6 (58.4–80.8), 70.8 (60.2–81.4), and 70.9 (60.4–81.3), respectively. When radiologists' performances on the fourth noise reduction method were used to pair readers during the mock study, there was strong agreement in the estimated figures of merits with estimates using the pseudoreader design being within ±3% of the fully crossed design. Conclusion Fully crossed MRMC studies require significant investment in resources and time, often resulting in delayed implementation or minimal human testing before dissemination. The pseudoreader approach accelerates study conduct by combining readers judiciously and was found to provide comparable results to the traditional fully crossed design by making strong assumptions about exchangeability of the readers.

Immediate Migration of Biopsy Clip Markers After Upright Digital Breast Tomosynthesis-Guided Vacuum-Assisted Core Biopsy Publication date: Available online 7 May 2019 Source: Academic Radiology Author(s): Davis C. Teichgraeber, Sarah Martaindale, Toma S. Omofoye, Kenneth R. Hess, Jay R. Parikh, Gary J. Whitman Rationale and Objectives The goal of this retrospective study was to evaluate the rate of immediate post-biopsy clip migration on an upright digital tomosynthesis-guided vacuum-assisted core biopsy unit and determine if any factors were associated with immediate clip migration. Materials and Methods We performed a retrospective review of patients who had undergone a biopsy performed at one facility from November 1, 2014 to September 30, 2016. Post-biopsy mammograms were reviewed to assess immediate clip position relative to the targeted lesion. The effects of age, lesion type, breast density, biopsy approach, number of samples, size of the biopsy chamber, and clip type on clip migration were examined using logistic regression analysis. Results One hundred ninety-seven biopsies were performed on 188 patients for calcifications (n = 159), architectural distortions (n = 29), masses (n = 5), and asymmetries (n = 4). The clip migration rate was 38% as defined as greater than 0.5 cm from the site of the biopsied lesion. The only independently predictive variable of clip migration was breast density in a numeric covariate in the logistic regression model, as migration was more likely with decreased breast density. The estimated odds ratio for a single level increase in BI-RADS breast density was 0.60 (95% confidence interval: 0.40, 0.91) with p = 0.018. Conclusion Immediate clip migration following biopsy was more likely with decreased breast density. Radiologists should be aware of immediate clip migration as correct clip location guides preoperative localization and allows the biopsy site to be monitored for changes on future mammograms.

Diagnosis of Lymphangiomatosis: A Study Based on CT Lymphangiography Publication date: Available online 7 May 2019 Source: Academic Radiology Author(s): Dan Jin, Xiaoli Sun, Wenbin Shen, Qingqing Zhao, Rengui Wang Rationale and Objectives Lymphangiomatosis is a rare disease characterized by the widespread presence of lymphangiomas in any part of the body. In previous studies, lymphatic vessel abnormalities in lymphangiomatosis have only rarely been mentioned. The objective of this paper is to discuss the imaging features of lymphangiomatosis, including cystic lesions and lymphatic abnormalities, on computed tomography lymphangiography (CTL). Materials and Methods All 34 patients who were diagnosed with lymphangiomatosis underwent direct lymphangiography followed by CTL. The CTL images were independently analyzed by two experienced radiologists. The CTL image analyses included assessment of the features of cystic lesions and lymphatic vessel abnormalities. Results (i) CTL revealed several cystic lesions ranging in size from 3 mm to 14 cm; the lesions were located in the neck and shoulders (61.8%), mediastinum (52.9%), retroperitoneum (70.6%), and pelvis and perineum (64.7%). (ii) Approximately 29.4% of patients showed abnormal contrast medium accumulation in cystic masses. (iii) Approximately 67.6% of patients showed lymphatic reflux. (iv) Dilated lymphatic vessels were distributed in the mediastinum (38.2%), retroperitoneum (50.0%), pelvis and lower limbs (47.1%). (v) Finally, 8.8% of patients had perineal lymphatic fistulae, and 2.9% of patients had chyluria. Conclusion Lymphangiomatosis is a type of systemic lymphatic abnormality that is accompanied by multiple cystic lesions. The therapeutic measures for lymphangiomatosis are determined by the size of the cystic lesions. Furthermore, the prognosis of lymphangiomatosis is affected by lymphatic abnormalities.

Association of Parity and Infant Feeding Method with Breast Density on Mammography Publication date: Available online 6 May 2019 Source: Academic Radiology Author(s): Eiji Nakajima, Takuji Iwase, Yumi Miyagi, Takashi Fujita, Norihiko Ikeda, Takashi Ishikawa, Hiroji Iwata Background Mammography (MMG) is widely used for the screening and diagnosis of breast cancer. High breast density on MMG prevents breast cancer detection. In the present study, we analyzed the effects of parity and infant feeding method on mammographic breast density. Materials and Methods Ninety women diagnosed as having breast cancer were analyzed. Using the results of medical questionnaires, subjects were grouped according to their parity and infant feeding method, into either nulliparity or parity, and formula-feeding or breastfeeding. Each group consisted of 30 consecutive women from 45 to 49 years. Nulliparous group was unaffected by either parity or breastfeeding, formula-feeding group was affected by parity but not breastfeeding, and breastfeeding group was affected by both parity and breastfeeding. Mammographic breast density was evaluated on the contralateral and cancer-free breast, and was classified into ≥ 50% dense as high breast density and < 50% dense according to the Boyd quantitative scale. The association of parity and infant feeding method with breast density on MMG was analyzed using the Fisher's exact test. Results Regarding parity, high breast densities were observed in 40% and 17% of nulliparous and parous breasts, respectively. Nulliparous breasts had significantly higher density than parous breasts (p  =  0.010). Regarding infant feeding method, 17% of breasts in both the formula-feeding and breastfeeding groups had high densities. Infant feeding method was not associated with mammographic breast density (p  =  1.0). Conclusion Nulliparity is associated with higher breast density, and parity, regardless of infant feeding method, induces atrophic changes of breast tissue.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174,00302841026182,alsfakia@gmail.com