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Hassan A, Maki R, Aljawad M, Alzayer A, Habeeb A, Alzaher A, Alawami A, Alaithan F, Adnan J. Beyond pulmonary embolism: Alternative diagnosis and incidental findings on CT pulmonary angiography in sickle cell disease. Emerg Radiol 2024; 31:321-330. [PMID: 38619803 DOI: 10.1007/s10140-024-02229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Sickle cell disease (SCD) is a genetic hematological disorder associated with severe complications, such as vaso-occlusive crises, acute chest syndrome (ACS), and an increased risk of thromboembolic events, including pulmonary embolism (PE). The diagnosis of PE in SCD patients presents challenges due to the overlapping symptoms with other pulmonary conditions. Our previous study revealed that nearly 96% of computed tomography pulmonary angiography (CTPA) scans in SCD patients were negative for PE, highlighting a gap in understanding the significance of CTPA findings when PE is absent. METHODS In this retrospective follow-up study conducted at the Salmaniya Medical Complex in Bahrain, we examined SCD patients with HbSS genotypes who underwent CTPA from January 1, 2018, to December 31, 2021, for suspected PE, but the results were negative. The aim of this study was to identify alternative diagnoses and incidental findings from CTPA scans. Experienced radiologists reviewed the CTPA images and reports to assess potential alternative diagnoses and incidental findings, incorporating an additional analysis of chest X-rays to evaluate the diagnostic value of CTPA. Incidental findings were classified based on their location and clinical significance. RESULTS Among the 230 evaluated SCD patients (average age 39.7 years; 53% male) who were CTPA negative for PE, 142 (61.7%) had identifiable alternative diagnoses, primarily pneumonia (49.1%). Notably, 88.0% of these alternative diagnoses had been previously suggested by chest radiographs. Furthermore, incidental findings were noted in 164 (71.3%) patients, with 11.0% deemed clinically significant, necessitating immediate action, and 87.8% considered potentially significant, requiring further assessment. Notable incidental findings included thoracic abnormalities such as cardiomegaly (12.2%) and an enlarged pulmonary artery (11.3%), as well as upper abdominal pathologies such as hepatomegaly (19.6%), splenomegaly (20.9%), and gallstones (10.4%). CONCLUSION This study underscores the limited additional diagnostic yield of CTPA for identifying alternative diagnoses to PE in SCD patients, with the majority of diagnoses, such as pneumonia, already suggested by chest radiographs. The frequent incidental findings, most of which necessitate further evaluation, highlight the need for a cautious and tailored approach to using CTPA in the SCD population.
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Affiliation(s)
- Ali Hassan
- Radiology Department, Governmental Hospitals, Salmaniya Medical Complex, Manama, Bahrain.
| | - Reem Maki
- Radiology Department, Governmental Hospitals, Salmaniya Medical Complex, Manama, Bahrain
| | - Mahdi Aljawad
- Radiology Department, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Ali Alzayer
- Radiology Department, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Ali Habeeb
- Radiology Department, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Aqeel Alzaher
- Radiology Department, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Adnan Alawami
- Radiology Department, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Fatimah Alaithan
- Radiology Department, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Jalila Adnan
- Radiology Department, Governmental Hospitals, Salmaniya Medical Complex, Manama, Bahrain
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McKee H, Brown MJ, Kim HHR, Doo FX, Panet H, Rockall AG, Omary RA, Hanneman K. Planetary Health and Radiology: Why We Should Care and What We Can Do. Radiology 2024; 311:e240219. [PMID: 38652030 DOI: 10.1148/radiol.240219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Climate change adversely affects the well-being of humans and the entire planet. A planetary health framework recognizes that sustaining a healthy planet is essential to achieving individual, community, and global health. Radiology contributes to the climate crisis by generating greenhouse gas (GHG) emissions during the production and use of medical imaging equipment and supplies. To promote planetary health, strategies that mitigate and adapt to climate change in radiology are needed. Mitigation strategies to reduce GHG emissions include switching to renewable energy sources, refurbishing rather than replacing imaging scanners, and powering down unused scanners. Radiology departments must also build resiliency to the now unavoidable impacts of the climate crisis. Adaptation strategies include education, upgrading building infrastructure, and developing departmental sustainability dashboards to track progress in achieving sustainability goals. Shifting practices to catalyze these necessary changes in radiology requires a coordinated approach. This includes partnering with key stakeholders, providing effective communication, and prioritizing high-impact interventions. This article reviews the intersection of planetary health and radiology. Its goals are to emphasize why we should care about sustainability, showcase actions we can take to mitigate our impact, and prepare us to adapt to the effects of climate change. © RSNA, 2024 Supplemental material is available for this article. See also the article by Ibrahim et al in this issue. See also the article by Lenkinski and Rofsky in this issue.
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Affiliation(s)
- Hayley McKee
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Maura J Brown
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Helen H R Kim
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Florence X Doo
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Hayley Panet
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Andrea G Rockall
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Reed A Omary
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Kate Hanneman
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
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3
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Chartash D, Bruno MA. Algorithms in medical decision-making and in everyday life: what's the difference? Diagnosis (Berl) 2024; 0:dx-2024-0010. [PMID: 38386866 DOI: 10.1515/dx-2024-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
Algorithms are a ubiquitous part of modern life. Despite being a component of medicine since early efforts to deploy computers in medicine, clinicians' resistance to using decision support and use algorithms to address cognitive biases has been limited. This resistance is not just limited to the use of algorithmic clinical decision support, but also evidence and stochastic reasoning and the implications of the forcing function of the electronic medical record. Physician resistance to algorithmic support in clinical decision making is in stark contrast to their general acceptance of algorithmic support in other aspects of life.
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Affiliation(s)
- David Chartash
- Section for Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, USA
- School of Medicine, University College Dublin-National University of Ireland, Dublin, Republic of Ireland
| | - Michael A Bruno
- Penn State Milton S. Hershey Medical Center and College of Medicine, Hershey, PA, USA
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Malik RF, Sun KJ, Azadi JR, Lau BD, Whelton S, Arbab-Zadeh A, Wilson RF, Johnson PT. Opportunistic Screening for Coronary Artery Disease: An Untapped Population Health Resource. J Am Coll Radiol 2024:S1546-1440(24)00197-2. [PMID: 38382860 DOI: 10.1016/j.jacr.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Coronary artery disease is the leading cause of death in the United States. At-risk asymptomatic adults are eligible for screening with electrocardiogram-gated coronary artery calcium (CAC) CT, which aids in risk stratification and management decision-making. Incidental CAC (iCAC) is easily quantified on chest CT in patients imaged for noncardiac indications; however, radiologists do not routinely report the finding. OBJECTIVE To determine the clinical significance of CAC identified incidentally on routine chest CT performed for noncardiac indications. DESIGN An informationist developed search strategies in MEDLINE, Embase, and SCOPUS, and two reviewers independently screened results at both the abstract and full text levels. Data extracted from eligible articles included age, rate of iCAC identification, radiologist reporting frequency, impact on downstream medical management, and association of iCAC with patient outcomes. RESULTS From 359 unique citations, 83 research publications met inclusion criteria. The percentage of patients with iCAC ranged from 9% to 100%. Thirty-one investigations measured association(s) between iCAC and cardiovascular morbidity and mortality, and 29 identified significant correlations, including nonfatal myocardial infarction, fatal myocardial infarction, major adverse cardiovascular event, cardiovascular death, and all-cause death. iCAC was present in 20% to 100% of the patients in these cohorts, but when present, iCAC was reported by radiologists in only 31% to 44% of cases. Between 18% and 77% of patients with iCAC were not on preventive medications in studies that reported these data. Seven studies measured the effect of reporting on guideline directed medical therapy, and 5 (71%) reported an increase in medication prescriptions after diagnosis of iCAC, with one confirming reductions in low-density lipoprotein levels. Twelve investigations reported good concordance between CAC grade on noncardiac CT and Agatston score on electrocardiogram-gated cardiac CT, and 10 demonstrated that artificial intelligence tools can reliably calculate an Agatston score on noncardiac CT. CONCLUSION A body of evidence demonstrates that patients with iCAC on routine chest CT are at risk for cardiovascular disease events and death, but they are often undiagnosed. Uniform reporting of iCAC in the chest CT impression represents an opportunity for radiology to contribute to early identification of high-risk individuals and potentially reduce morbidity and mortality. AI tools have been validated to calculate Agatston score on routine chest CT and hold the best potential for facilitating broad adoption.
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Affiliation(s)
- Rubab F Malik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristie J Sun
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javad R Azadi
- Assistant Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D Lau
- Assistant Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seamus Whelton
- Associate Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Armin Arbab-Zadeh
- Director of Cardiac CT, Professor of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Renee F Wilson
- Evidence Based Practice Center, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Pamela T Johnson
- Vice President of Care Transformation, Vice Chair of Quality and Safety in Radiology, Professor of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Hu YS, Wu CA, Lin DC, Lin PW, Lee HJ, Lin LY, Lin CJ. Applying ONCO-RADS to whole-body MRI cancer screening in a retrospective cohort of asymptomatic individuals. Cancer Imaging 2024; 24:22. [PMID: 38326850 PMCID: PMC10848416 DOI: 10.1186/s40644-024-00665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Whole-body magnetic resonance imaging (WB-MRI) has emerged as a valuable tool for cancer detection. This study evaluated the prevalence rates of cancer in asymptomatic individuals undergoing WB-MRI according to the Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) classifications in order to assess the reliability of the classification method. METHODS We retrospectively enrolled 2064 asymptomatic individuals who participated in a WB-MRI cancer screening program between 2017 and 2022. WB-MRI was acquired on a 3-T system with a standard protocol, including regional multisequence and gadolinium-based contrast agent-enhanced oncologic MRI. Results of further examinations, including additional imaging and histopathology examinations, performed at our institute were used to validate the WB-MRI findings. Two radiologists blinded to the clinical outcome classified the WB-MRI findings according to the ONCO-RADS categories as follows: 1 (normal), 2 (benign finding highly likely), 3 (benign finding likely), 4 (malignant finding likely), and 5 (malignant finding highly likely). Firth logistic regression analysis was performed to determine the associations between participant characteristics and findings of ONCO-RADS category ≥ 4. RESULTS Of the 2064 participants with median age of 55 years, 1120 (54.3%) were men, 43 (2.1%) had findings of ONCO-RADS category ≥ 4, and 24 (1.2%) had confirmed cancer. The cancer prevalence rates were 0.1%, 5.4%, 42.9%, and 75% for ONCO-RADS categories 2, 3, 4, and 5, respectively. In the multivariable model, older age (OR: 1.035, p = 0.029) and history of hypertension (OR: 2.051, p = 0.026), hepatitis B carrier (OR: 2.584, p = 0.013), or prior surgery (OR: 3.787, p < 0.001) were independently associated with the findings for ONCO-RADS category ≥ 4. CONCLUSIONS The ONCO-RADS categories for cancer risk stratification were validated and found to be positively correlated with cancer risk. The application of ONCO-RADS facilitates risk-based management after WB-MRI for cancer screening.
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Affiliation(s)
- Yong-Sin Hu
- Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-An Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Dao-Chen Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Wei Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Jui Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lo-Yi Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Alves VDPV, Care MM, Leach JL. Incidental Thalamic Lesions Identified on Brain MRI in Pediatric and Young Adult Patients: Imaging Features and Natural History. AJNR Am J Neuroradiol 2024; 45:211-217. [PMID: 38238093 DOI: 10.3174/ajnr.a8090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND PURPOSE Nonspecific, localized thalamic signal abnormalities of uncertain significance are occasionally found on pediatric brain MR imaging. The goal of this study is to describe the MR imaging appearance and natural history of these lesions in children and young adults. MATERIALS AND METHODS This retrospective study evaluated clinically acquired brain MR imaging examinations obtained from February 1995 to March 2022 at a large, tertiary care pediatric hospital. Examinations with non-mass-like and nonenhancing thalamic lesions were identified based on term search of MR imaging reports. A total of 221 patients formed the initial group for imaging assessment. Additional exclusions during imaging review resulted in 171 patients. Imaging appearance and size changes were assessed at baseline and at follow-up examinations. RESULTS A total of 171 patients (102 male) at a median age of 11 years (range: 1-23 years), 568 MR imaging examinations, and 180 thalamic lesions were included. Median time from baseline to the last follow-up MR imaging was 542 days (range: 46-5730 days). No lesion enhanced at any time point. On imaging follow-up, 11% of lesions (18/161) became smaller, 10% (16/161) resolved, 73% (118/161) remained stable, and 6% (9/161) increased in size at some point during evaluation. Median time interval from baseline to enlargement was 430 days (range: 136-1074 days). CONCLUSIONS Most incidental, non-mass-like thalamic signal abnormalities were stable, decreased in size, or resolved on follow-up imaging and are likely of no clinical significance. Surveillance strategies with longer follow-up intervals may be adequate in the management of such findings.
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Affiliation(s)
- Vinicius de Padua V Alves
- From the Department of Radiology (V.d.P.V.A., M.M.C., J.L.L.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marguerite M Care
- From the Department of Radiology (V.d.P.V.A., M.M.C., J.L.L.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Radiology (M.M.C., J.L.L.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James L Leach
- From the Department of Radiology (V.d.P.V.A., M.M.C., J.L.L.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Radiology (M.M.C., J.L.L.), University of Cincinnati College of Medicine, Cincinnati, Ohio
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Kwee TC, Roest C, Yakar D. Is radiology's future without medical images? Eur J Radiol 2024; 171:111296. [PMID: 38224634 DOI: 10.1016/j.ejrad.2024.111296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Thomas C Kwee
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands.
| | - Christian Roest
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Derya Yakar
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
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8
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Malliaras P, O'Keeffe M, Ridgway J, Whale R, Vasan V, L'Huillier P, Towers M, Farlie MK. Patient experiences of rotator cuff-related shoulder pain and their views on diagnostic shoulder imaging: a qualitative study. Disabil Rehabil 2023:1-8. [PMID: 38153258 DOI: 10.1080/09638288.2023.2296986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To explore patient experiences of rotator cuff-related shoulder pain, and their views on the role and value of diagnostic shoulder imaging. MATERIALS AND METHODS Semi-structured interviews were conducted with 20 patients with shoulder pain exploring the impact and management of their shoulder condition, reasons for and experiences of diagnostic imaging, and feelings about and responses to diagnostic imaging findings. Framework analysis was used to analyse the dataset. RESULTS Five themes were identified [1]: Lived experience and beliefs about pain and movement [2]; Contextualisation of imaging findings by health professionals is more important than the imaging report [3]; Factors influencing whether and when to have imaging [4]; Imaging can identify the actual problem and guide treatment; and [5] Treatment responses and treatment decision making. CONCLUSION Patients commonly believe imaging is needed to formulate a diagnosis. There was minimal concern about potential indirect harms that could arise (e.g., inappropriate diagnosis leading to unnecessary treatments). The context of the diagnostic imaging reports (i.e., what needed to be done) was perceived as more important than the exact meaning of the imaging findings. Patients felt that the diagnostic imaging confirmed their existing biomedical beliefs, and these beliefs were not challenged by their healthcare professionals.IMPLICATIONS FOR REHABILITATIONPatients with shoulder pain may believe imaging is necessary for diagnosis and defining treatment yet do not consider potential indirect harms (e.g., unnecessary treatment for findings that are not relevant).Health professionals should ensure patients are aware of imaging limitations and harms and facilitate shared decision-making about whether to have imaging.Health professionals also have an important role in the appropriate contextualisation of imaging findings (i.e., they do not necessarily relate to pain nor guide treatment).
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Affiliation(s)
- Peter Malliaras
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Jacqueline Ridgway
- Physiotherapy Department, Frankston Hospital, Peninsula Health, Victoria, Australia
| | - Rhiannon Whale
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Vasish Vasan
- Physiotherapy Department, Monash University, Melbourne, Australia
| | | | - Mitch Towers
- Physiotherapy Department, Monash University, Melbourne, Australia
| | - Melanie K Farlie
- Physiotherapy Department, Monash University, Melbourne, Australia
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9
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Kwee TC, Yakar D, Sluijter TE, Pennings JP, Roest C. Can we revolutionize diagnostic imaging by keeping Pandora's box closed? Br J Radiol 2023; 96:20230505. [PMID: 37906185 PMCID: PMC10646642 DOI: 10.1259/bjr.20230505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/15/2023] [Accepted: 09/09/2023] [Indexed: 11/02/2023] Open
Abstract
Incidental imaging findings are a considerable health problem, because they generally result in low-value and potentially harmful care. Healthcare professionals struggle how to deal with them, because once detected they can usually not be ignored. In this opinion article, we first reflect on current practice, and then propose and discuss a new potential strategy to pre-emptively tackle incidental findings. The core principle of this concept is to keep the proverbial Pandora's box closed, i.e. to not visualize incidental findings, which can be achieved using deep learning algorithms. This concept may have profound implications for diagnostic imaging.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Derya Yakar
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tim E Sluijter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jan P Pennings
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Christian Roest
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Heye T, Segeroth M, Franzeck F, Vosshenrich J. Turning radiology reports into epidemiological data to track seasonal pulmonary infections and the COVID-19 pandemic. Eur Radiol 2023:10.1007/s00330-023-10424-6. [PMID: 37982834 DOI: 10.1007/s00330-023-10424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To automatically label chest radiographs and chest CTs regarding the detection of pulmonary infection in the report text, to calculate the number needed to image (NNI) and to investigate if these labels correlate with regional epidemiological infection data. MATERIALS AND METHODS All chest imaging reports performed in the emergency room between 01/2012 and 06/2022 were included (64,046 radiographs; 27,705 CTs). Using a regular expression-based text search algorithm, reports were labeled positive/negative for pulmonary infection if described. Data for regional weekly influenza-like illness (ILI) consultations (10/2013-3/2022), COVID-19 cases, and hospitalization (2/2020-6/2022) were matched with report labels based on calendar date. Positive rate for pulmonary infection detection, NNI, and the correlation with influenza/COVID-19 data were calculated. RESULTS Between 1/2012 and 2/2020, a 10.8-16.8% per year positive rate for detecting pulmonary infections on chest radiographs was found (NNI 6.0-9.3). A clear and significant seasonal change in mean monthly detection counts (102.3 winter; 61.5 summer; p < .001) correlated moderately with regional ILI consultations (weekly data r = 0.45; p < .001). For 2020-2021, monthly pulmonary infection counts detected by chest CT increased to 64-234 (23.0-26.7% per year positive rate, NNI 3.7-4.3) compared with 14-94 (22.4-26.7% positive rate, NNI 3.7-4.4) for 2012-2019. Regional COVID-19 epidemic waves correlated moderately with the positive pulmonary infection CT curve for 2020-2022 (weekly new cases: r = 0.53; hospitalizations: r = 0.65; p < .001). CONCLUSION Text mining of radiology reports allows to automatically extract diagnoses. It provides a metric to calculate the number needed to image and to track the trend of diagnoses in real time, i.e., seasonality and epidemic course of pulmonary infections. CLINICAL RELEVANCE Digitally labeling radiology reports represent previously neglected data and may assist in automated disease tracking, in the assessment of physicians' clinical reasoning for ordering radiology examinations and serve as actionable data for hospital workflow optimization. KEY POINTS • Radiology reports, commonly not machine readable, can be automatically labeled with the contained diagnoses using a regular-expression based text search algorithm. • Chest radiograph reports positive for pulmonary infection moderately correlated with regional influenza-like illness consultations (weekly data; r = 0.45; p < .001) and chest CT reports with the course of the regional COVID-19 pandemic (new cases: r = 0.53; hospitalizations: r = 0.65; p < 0.001). • Rendering radiology reports into data labels provides a metric for automated disease tracking, the assessment of ordering physicians clinical reasoning and can serve as actionable data for workflow optimization.
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Affiliation(s)
- Tobias Heye
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Martin Segeroth
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Fabian Franzeck
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Jan Vosshenrich
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
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Dhruva SS, Smith-Bindman R, Redberg RF. The Need for Randomized Clinical Trials Demonstrating Reduction in All-Cause Mortality With Blood Tests for Cancer Screening. JAMA Intern Med 2023; 183:1051-1053. [PMID: 37639263 DOI: 10.1001/jamainternmed.2023.3610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Sanket S Dhruva
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Rebecca Smith-Bindman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine
| | - Rita F Redberg
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Division of Cardiology, Department of Medicine, University of California, San Francisco, School of Medicine
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Yan Y, Liu Y, Li T, Liang Q, Thakur A, Zhang K, Liu W, Xu Z, Xu Y. Functional roles of magnetic nanoparticles for the identification of metastatic lymph nodes in cancer patients. J Nanobiotechnology 2023; 21:337. [PMID: 37735449 PMCID: PMC10512638 DOI: 10.1186/s12951-023-02100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
Staging lymph nodes (LN) is crucial in diagnosing and treating cancer metastasis. Biotechnologies for the specific localization of metastatic lymph nodes (MLNs) have attracted significant attention to efficiently define tumor metastases. Bioimaging modalities, particularly magnetic nanoparticles (MNPs) such as iron oxide nanoparticles, have emerged as promising tools in cancer bioimaging, with great potential for use in the preoperative and intraoperative tracking of MLNs. As radiation-free magnetic resonance imaging (MRI) probes, MNPs can serve as alternative MRI contrast agents, offering improved accuracy and biological safety for nodal staging in cancer patients. Although MNPs' application is still in its initial stages, exploring their underlying mechanisms can enhance the sensitivity and multifunctionality of lymph node mapping. This review focuses on the feasibility and current application status of MNPs for imaging metastatic nodules in preclinical and clinical development. Furthermore, exploring novel and promising MNP-based strategies with controllable characteristics could lead to a more precise treatment of metastatic cancer patients.
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Affiliation(s)
- Yuanliang Yan
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Yuanhong Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Tongfei Li
- Hubei Key Laboratory of Embryonic Stem Cell Research, School of Basic Medical Sciences, Hubei University of Medicine, 442000, Shiyan, Hubei, China
| | - Qiuju Liang
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Abhimanyu Thakur
- Pritzker School of Molecular Engineering, Ben May Department for Cancer Research, University of Chicago, 60637, Chicago, IL, USA
| | - Kui Zhang
- Pritzker School of Molecular Engineering, Ben May Department for Cancer Research, University of Chicago, 60637, Chicago, IL, USA
| | - Wei Liu
- Department of Pathology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, 271000, Taian, Shandong, China.
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