1
|
Schroeder MK, Abushamma S, George AT, Ravella B, Hickman J, Elumalai A, Wise P, Zulfiqar M, Ludwig DR, Shetty A, Viswanath SE, Luo C, Sebastian S, Ballard DH, Deepak P. TOpCLASS Expert Consensus Classification of Perianal Fistulizing Crohn's Disease: A Real-World Application in a Serial Fistula MRI Cohort. J Crohns Colitis 2024:jjae056. [PMID: 38642332 DOI: 10.1093/ecco-jcc/jjae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND AIMS Perianal fistulizing Crohn's disease (PFCD) is an aggressive phenotype of Crohn's disease defined by frequent relapses and disabling symptoms. A novel consensus classification system was recently outlined by the TOpCLASS consortium that seeks to unify disease severity with patient-centered goals but has not yet been validated. We aimed to apply this to a real-world cohort and identify factors that predict transition between classes over time. METHODS We identified all patients with PFCD and at least one baseline and one follow-up pelvic (pMRI). TOpCLASS classification, disease characteristics, and imaging indices were collected retrospectively at time periods corresponding with respective MRIs. RESULTS We identified 100 patients with PFCD of which 96 were assigned TOpCLASS Classes 1 - 2c at baseline. Most patients (78.1%) started in Class 2b, but changes in classification were observed in 52.1% of all patients. Male sex (72.0%, 46.6%, 40.0%, p = 0.03) and prior perianal surgery (52.0% vs 44.6% vs 40.0%, p = 0.02) were more frequently observed in those with improved class. Baseline pMRI indices were not associated with changes in classification, however, greater improvements in mVAI, MODIFI-CD, and PEMPAC were seen among those who improved. Linear mixed effect modeling identified only male sex (-0.31, 95% CI -0.60 to -0.02) with improvement in class. CONCLUSION The TOpCLASS classification highlights the dynamic nature of PFCD over time, however, our ability to predict transitions between classes remains limited and requires prospective assessment. Improvement in MRI index scores over time was associated with a transition to lower TOpCLASS classification.
Collapse
Affiliation(s)
- Matthew K Schroeder
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Suha Abushamma
- Division of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Alvin T George
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | | | - John Hickman
- Division of Gastroenterology, University of Virginia, Charlottesville, VA, USA
| | - Anusha Elumalai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Paul Wise
- Section of Colon and Rectal Surgery, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Maria Zulfiqar
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Anup Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Satish E Viswanath
- Department of Biomedical Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | | | - David H Ballard
- Division of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| |
Collapse
|
2
|
Rumrill WM, Ballard DH. Metastatic Renal Cell Carcinoma in a Patient With Autosomal Dominant Polycystic Kidney Disease. Clin Nucl Med 2024; 49:e131-e133. [PMID: 38271253 DOI: 10.1097/rlu.0000000000005059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT Autosomal dominant polycystic kidney disease (ADPKD) manifests as multiple cysts in the kidneys and liver but can also present with musculoskeletal and cardiovascular abnormalities. ADPKD patients are at increased risk for renal cell carcinoma development. We show the FDG PET/CT findings in a patient with renal cell carcinoma secondary to ADPKD and complicated by worsening pulmonary metastasis. The primary renal tumor shows intense FDG uptake despite no suspicious features with contrast CT.
Collapse
Affiliation(s)
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| |
Collapse
|
3
|
Devi J, Ballard DH, Aswani-Omprakash T, Parian AM, Deepak P. Perianal fistulizing Crohn's disease: Current perspectives on diagnosis, monitoring and management with a focus on emerging therapies. Indian J Gastroenterol 2024; 43:48-63. [PMID: 38308773 DOI: 10.1007/s12664-024-01524-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024]
Abstract
Crohn's disease (CD), a chronic inflammatory bowel disorder, manifests in various phenotypes, with fistulizing perianal CD (CD-PAF) being one of its most severe phenotypes. Characterized by fistula formation and abscesses, CD-PAF impacts 17% to 34% of all CD cases and with a significantly deleterious impact on patient's quality of life, while increasing the risk for anorectal cancers. The pathogenesis involves a complex interplay of genetic, immunological and environmental factors, with cytokines such as tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) playing pivotal roles. Diagnostic protocols require a multi-disciplinary approach including colonoscopy, examination under anesthesia and magnetic resonance imaging. In terms of treatment, biologics alone often prove inadequate, making surgical interventions such as setons and fistula surgeries essential. Emerging therapies such as mesenchymal stem cells are under study. The South Asian context adds layers of complexity, including diagnostic ambiguities related to high tuberculosis prevalence, healthcare access limitations and cultural stigma toward perianal Crohn's disease and ostomy surgery. Effective management necessitates an integrated, multi-disciplinary approach, especially in resource-constrained settings. Despite advances, there remain significant gaps in understanding the disease's pathophysiology and a dearth of standardized outcome measures, underscoring the urgent need for comprehensive research.
Collapse
Affiliation(s)
- Jalpa Devi
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in Saint Louis, 660 S. Euclid Avenue, Campus Box 8124, Saint Louis, MO, 63110, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | | | - Alyssa M Parian
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
| | - Parakkal Deepak
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in Saint Louis, 660 S. Euclid Avenue, Campus Box 8124, Saint Louis, MO, 63110, USA.
| |
Collapse
|
4
|
Reyes Genere J, Ballard DH, Deepak P. Three-Dimensional Modeling to Guide Interventional Endoscopy in Fibrostenotic Crohn's Disease. Am J Gastroenterol 2024; 119:239. [PMID: 37830639 DOI: 10.14309/ajg.0000000000002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Juan Reyes Genere
- Division of Gastroenterology, Inflammatory Bowel Diseases Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Inflammatory Bowel Diseases Center, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
5
|
Huang K, Garuba F, Ganapathy A, Bishop G, Zhang H, Lovato A, Itani M, Viswanath SE, Fraum TJ, Deepak P, Ballard DH. Quantifying 18F-Fluorodeoxyglucose Uptake in Perianal Fistulas on PET/CT: A Retrospective Analysis. Acad Radiol 2024:S1076-6332(23)00695-5. [PMID: 38177032 DOI: 10.1016/j.acra.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Abstract
RATIONALE AND OBJECTIVES The use of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) in assessing inflammatory diseases has shown significant promise. Uptake patterns in perianal fistulas, which may be an incidental finding on PET/CT, have not been purposefully studied. Our aim was to compare FDG uptake of perianal fistulas to that of the liver and anal canal in patients who underwent PET/CT for hematologic/oncologic diagnosis or staging. MATERIALS AND METHODS We retrospectively identified patients who underwent FDG-PET/CT imaging between January 2011 and May 2023, where the report described a perianal fistula or abscess. PET/CTs of patients included in the study were retrospectively analyzed to record the maximum standardized uptake value (SUVmax) of the fistula, abscess, anal canal, rectum, and liver. Fistula-to-liver and Fistula-to-anus SUVmax ratios were calculated. We statistically compared FDG activity among the fistula, liver, and anal canal. We also assessed FDG activity in patients with vs. without anorectal cancer, as well as across different St. James fistula grades. RESULTS The study included 24 patients with identifiable fistulas. Fistula SUVmax (mean=10.8 ± 5.28) was significantly higher than both the liver (mean=3.09 ± 0.584, p < 0.0001) and the anal canal (mean=5.98 ± 2.63, p = 0.0005). Abscess fistula SUVmax was 15.8 ± 4.91. St. James grade 1 fistulas had significantly lower SUVmax compared to grades 2 and 4 (p = 0.0224 and p = 0.0295, respectively). No significant differences existed in SUVmax ratios between anorectal and non-anorectal cancer groups. CONCLUSION Perianal fistulas have increased FDG avidity with fistula SUVmax values that are significantly higher than the anal canal.
Collapse
Affiliation(s)
- Katherine Huang
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA (K.H., P.D.)
| | - Favour Garuba
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA (F.G., A.G.)
| | - Aravinda Ganapathy
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA (F.G., A.G.)
| | - Grace Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Hanjing Zhang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Adriene Lovato
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Satish E Viswanath
- Department of Biomedical Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA (S.E.V.)
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.)
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA (K.H., P.D.)
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd, Campus Stop 8131, St. Louis, Missouri, 63110, USA (G.B., H.Z., A.L., M.I., T.J.F., D.H.B.).
| |
Collapse
|
6
|
Ganapathy A, Navale P, Mutch MG, Kim H, Ballard DH, Deepak P. Long-Standing Symptomatic Fistulizing Perianal Crohn's Disease: Progression Beyond Inflammation. Gastroenterology 2024; 166:36-43.e2. [PMID: 37709172 DOI: 10.1053/j.gastro.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Aravinda Ganapathy
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Pooja Navale
- Division of Anatomic & Molecular Pathology, Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Matthew G Mutch
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
| | - Parakkal Deepak
- Inflammatory Bowel Diseases Center, Division of Gastroenterology and Hepatology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
| |
Collapse
|
7
|
Rubeiz MG, Ballard DH, Reyes Genere J. Radiographic and endoscopic findings of checkpoint inhibitor cholangitis. Gastrointest Endosc 2023:S0016-5107(23)03168-1. [PMID: 38141689 DOI: 10.1016/j.gie.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Michael G Rubeiz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Juan Reyes Genere
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
8
|
Ballard DH, Nguyen GK, Atagu N, Camps G, Salter A, Jaswal S, Naeem M, Ludwig DR, Mellnick VM, Peterson LR, Hawkins WG, Fields RC, Luo J, Ippolito JE. Female-specific pancreatic cancer survival from CT imaging of visceral fat implicates glutathione metabolism in solid tumors. Acad Radiol 2023:S1076-6332(23)00630-X. [PMID: 38129228 DOI: 10.1016/j.acra.2023.11.012] [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: 05/30/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
RATIONALE AND OBJECTIVES To identify if body composition, assessed with preoperative CT-based visceral fat ratio quantification as well as tumor metabolic gene expression, predicts sex-dependent overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS This was a retrospective analysis of preoperative CT in 98 male and 107 female patients with PDAC. Relative visceral fat (rVFA; visceral fat normalized to total fat) was measured automatically using software and corrected manually. Median and optimized rVFA thresholds were determined according to published methods. Kaplan Meier and log-rank tests were used to estimate OS. Multivariate models were developed to identify interactions between sex, rVFA, and OS. Unsupervised gene expression analysis of PDAC tumors from The Cancer Genome Atlas (TCGA) was performed to identify metabolic pathways with similar survival patterns to rVFA. RESULTS Optimized preoperative rVFA threshold of 38.9% predicted significantly different OS in females with a median OS of 15 months (above threshold) vs 24 months (below threshold; p = 0.004). No significant threshold was identified in males. This female-specific significance was independent of age, stage, and presence of chronic pancreatitis (p = 0.02). Tumor gene expression analysis identified female-specific stratification from a five-gene signature of glutathione S-transferases. This was observed for PDAC as well as clear cell renal carcinoma and glioblastoma. CONCLUSION CT-based assessments of visceral fat can predict pancreatic cancer OS in females. Glutathione S-transferase expression in tumors predicts female-specific OS in a similar fashion.
Collapse
Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.)
| | - Gerard K Nguyen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.)
| | - Norman Atagu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland (N.A.)
| | - Garrett Camps
- Washington University School of Medicine, Washington University School of Medicine, St. Louis, MO (G.C.)
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX (A.S.)
| | - Shama Jaswal
- Department of Radiology, Weill Cornell Medical Center/New York Presbyterian Hopsital, New York, NY (S.J.)
| | - Muhammad Naeem
- Department of Radiology, Emory University School of Medicine, Atlanta, GA (M.N.)
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.)
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.)
| | - Linda R Peterson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO (L.R.P.)
| | - William G Hawkins
- Department of Surgery, Washington University School of Medicine, St. Louis, MO (W.G.H., R.C.F.)
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, MO (W.G.H., R.C.F.)
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO (J.L.)
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (D.H.B., G.K.N., S.J., D.R.L., V.M.M., J.E.I.).
| |
Collapse
|
9
|
Ganapathy A, Ballard DH, Chen DZ, Schneider M, Lanier MH, Mazaheri P, Ilahi O, Kirby JP, Raptis CA, Mellnick VM. Preoperative computed tomography in Fournier's gangrene does not delay time to surgery. Emerg Radiol 2023; 30:711-717. [PMID: 37857761 DOI: 10.1007/s10140-023-02177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Fournier's gangrene (FG), a rapidly progressive necrotizing soft tissue infection of the external genitalia and perineum, necessitates urgent surgical debridement. The time to surgery effect of preoperative computed tomography (CT) in managing this condition is yet to be fully explored. The purpose of this study was to assess whether obtaining a preoperative CT in patients with FG impacts the time to surgical intervention. METHODS This was a single-center retrospective study of patients who underwent CT prior to surgical debridement of FG during a 9-year period vs patients who did not undergo CT. In 76 patients (male = 39, mean age = 51.8), 38 patients with FG received a preoperative CT, and 38 patients with FG did not receive CT prior to surgical debridement. Time to operating room and outcome metrics were compared between CT and non-CT groups. RESULTS The time from hospital presentation to surgical intervention was not significantly different between patients who underwent CT and those who did not (6.65 ± 3.71 vs 5.73 ± 4.33 h, p = 0.37). There were also no significant differences in cost ($130,000 ± $102,000 vs $142,000 ± $152,000, p = 0.37), mortality (8 vs 7, p = 1), duration of hospital stay (15.5 ± 15 vs 15.7 ± 11.6 days, p = 0.95), average intensive care unit stay (5.82 ± 5.38 days vs 6.97 ± 8.58 days, p = 0.48), and APACHE score (12 ± 4.65 vs 13.9 ± 5.6, p =0.12). CONCLUSION Obtaining a preoperative CT did not delay surgical intervention in patients with FG.
Collapse
Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA.
| | - David Z Chen
- School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - McGinness Schneider
- School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - M Hunter Lanier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA
| | - Obeid Ilahi
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - John P Kirby
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA
| |
Collapse
|
10
|
McPhie JM, Garuba FO, Thomas J, Ballard DH. Visualizing the malperfusion effect of coronary occlusion as a sequela of limited type A aortic dissection. Emerg Radiol 2023; 30:801-805. [PMID: 37801151 DOI: 10.1007/s10140-023-02173-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
Limited type A aortic dissection (LTAAD) is a rare subtype of dissection that is confined within a well-defined border of the ascending aorta. These dissections may occur in the remaining native portion of the aortic root following aortic root replacement and can be complicated by malperfusion syndrome-a syndrome where dissections compromise the aortic branches and lead to end-organ ischemia. Because LTAAD is confined within the ascending aorta, malperfusion syndrome may preferentially affect the coronary arteries resulting in coronary malperfusion, myocardial infarction, and increased mortality. We report a case of LTAAD and malperfusion syndrome of the left main coronary artery which resulted in inadequate contrast opacification of the aorta and failure of the dissection protocol to trigger on computed tomography (CT). Upon further evaluation of the situation, the radiologist oversaw the manual triggering of CT acquisitions which yielded an actionable CT at 6 minutes post-contrast and real-time visualization of the patient's developing cardiac ischemia.
Collapse
Affiliation(s)
- Josh M McPhie
- Washington University School of Medicine, St. Louis, MO, USA
| | - Favour O Garuba
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joel Thomas
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box, St. Louis, MO, 8131, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box, St. Louis, MO, 8131, USA.
| |
Collapse
|
11
|
Lee J, Chadalavada SC, Ghodadra A, Ali A, Arribas EM, Chepelev L, Ionita CN, Ravi P, Ryan JR, Santiago L, Wake N, Sheikh AM, Rybicki FJ, Ballard DH. Clinical situations for which 3D Printing is considered an appropriate representation or extension of data contained in a medical imaging examination: vascular conditions. 3D Print Med 2023; 9:34. [PMID: 38032479 PMCID: PMC10688120 DOI: 10.1186/s41205-023-00196-6] [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: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medical three-dimensional (3D) printing has demonstrated utility and value in anatomic models for vascular conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (3DPSIG) provides appropriateness recommendations for vascular 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with vascular indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for the following areas: aneurysm, dissection, extremity vascular disease, other arterial diseases, acute venous thromboembolic disease, venous disorders, lymphedema, congenital vascular malformations, vascular trauma, vascular tumors, visceral vasculature for surgical planning, dialysis access, vascular research/development and modeling, and other vasculopathy. Recommendations are provided in accordance with strength of evidence of publications corresponding to each vascular condition combined with expert opinion from members of the 3DPSIG. CONCLUSION This consensus appropriateness ratings document, created by the members of the 3DPSIG, provides an updated reference for clinical standards of 3D printing for the care of patients with vascular conditions.
Collapse
Affiliation(s)
- Joonhyuk Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | - Elsa M Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
- Department of Neurological Surgery, University of California San Diego Health, San Diego, CA, USA
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Adnan M Sheikh
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Arizona - Phoenix, Phoenix, AZ, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
| |
Collapse
|
12
|
Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [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: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
Collapse
Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
| |
Collapse
|
13
|
Elumalai A, Nayak Y, Ganapathy AK, Chen D, Tappa K, Jammalamadaka U, Bishop G, Ballard DH. Reverse Engineering and 3D Printing of Medical Devices for Drug Delivery and Drug-Embedded Anatomic Implants. Polymers (Basel) 2023; 15:4306. [PMID: 37959986 PMCID: PMC10647997 DOI: 10.3390/polym15214306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
In recent years, 3D printing (3DP) has advanced traditional medical treatments. This review explores the fusion of reverse engineering and 3D printing of medical implants, with a specific focus on drug delivery applications. The potential for 3D printing technology to create patient-specific implants and intricate anatomical models is discussed, along with its ability to address challenges in medical treatment. The article summarizes the current landscape, challenges, benefits, and emerging trends of using 3D-printed formulations for medical implantation and drug delivery purposes.
Collapse
Affiliation(s)
- Anusha Elumalai
- 3D Printing Lab, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (Y.N.); (A.K.G.); (D.C.)
| | - Yash Nayak
- 3D Printing Lab, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (Y.N.); (A.K.G.); (D.C.)
| | - Aravinda K. Ganapathy
- 3D Printing Lab, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (Y.N.); (A.K.G.); (D.C.)
| | - David Chen
- 3D Printing Lab, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (Y.N.); (A.K.G.); (D.C.)
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas, 7000 Fannin Street, Houston, TX 77030, USA;
| | | | - Grace Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| |
Collapse
|
14
|
Ballard DH. Editorial Comment: Is the Spleen Normal? Redefining Splenomegaly. AJR Am J Roentgenol 2023; 221:619. [PMID: 37436036 DOI: 10.2214/ajr.23.29893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
|
15
|
Ballard DH, Goh VJ, Moy L. Diagnosis Please Certificates of Recognition Awarded to Four Individuals and to International and North American Radiology Resident Groups. Radiology 2023; 309:e232766. [PMID: 37987661 DOI: 10.1148/radiol.232766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
|
16
|
Traylor KS, Bastawrous S, Riedesel EL, Ballard DH, Hochhegger B, Ukeh I, Jaswal S, Agarwal M, Clarke JE, Lakhani DA, Balthazar P, Tomblinson CM, Bunch PM. A New (Digital) Era in Medical Journalism: Leveraging Social Media and Other Online Tools to Increase Reach and Engagement. Radiographics 2023; 43:e230103. [PMID: 37883299 DOI: 10.1148/rg.230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Social media is a popular communication and marketing tool in modern society, with the power to reach and engage large audiences. Many members of the medical and radiology communities have embraced social media platforms, particularly X (formerly known as Twitter), as an efficient and economic means for performing patient outreach, disseminating research and educational materials, building networks, and promoting diversity. Editors of medical journals with a clear vision and relevant expertise can leverage social media and other digital tools to advance the journal's mission, further their interests, and directly benefit journal authors and readers. For editors, social media offers a means to increase article visibility and downloads, expand awareness of volunteer opportunities, and use metrics and other feedback to inform future initiatives. Authors benefit from broader dissemination of their work, which aids establishment of a national or international reputation. Readers can receive high-quality high-yield content in a digestible format directly on their devices while actively engaging with journal editors and authors in the online community. The authors highlight the multifaceted benefits of social media engagement and digital tool implementation in the context of medical journalism and summarize the activities of the RadioGraphics Social Media and Digital Innovation Team. By enumerating the social media activities of RadioGraphics and describing the underlying rationale for each activity, the authors present a blueprint for other medical journals considering similar initiatives. ©RSNA, 2023.
Collapse
Affiliation(s)
- Katie S Traylor
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Sarah Bastawrous
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Erica L Riedesel
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - David H Ballard
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Bruno Hochhegger
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Ifechi Ukeh
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Shama Jaswal
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Mohit Agarwal
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Jamie E Clarke
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Dhairya A Lakhani
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Patricia Balthazar
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Courtney M Tomblinson
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Paul M Bunch
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| |
Collapse
|
17
|
Garuba FO, McPhie JM, Anolik RA, Deepak P, Ballard DH, Smith RK. Perineal hernia as a sequela of anal reconstruction surgeries in perianal Crohn's disease. Radiol Case Rep 2023; 18:3988-3992. [PMID: 37691760 PMCID: PMC10483503 DOI: 10.1016/j.radcr.2023.08.071] [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: 06/23/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Perineal hernia is a rare complication of pelvic surgeries that can occur in patients with perianal Crohn's disease (pCD) as a long-term outcome of surgeries for complex fistula treatment. We present a case of a symptomatic pCD male patient with multiple perianal surgeries who presents with anal pain, diarrhea, and discharge. Magnetic resonance imaging showed a perineal hernia in the ischioanal fossa violating the convergence of the left external sphincter complex. The hernia was treated with an open primary hernia repair via the perineal approach. It recurred after 3 months, and the patient underwent secondary hernia repair with gracilis muscle interposition and mesh placement. Unfortunately, this was complicated by superficial skin dehiscence and mesh extrusion, but the flap remained viable and the hernia repair was intact. Incidence, symptoms, risk factors, imaging findings, and management of perineal hernias are reviewed.
Collapse
Affiliation(s)
| | - Josh M. McPhie
- Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel A. Anolik
- Section of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis MO, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis MO, USA
| | - Radhika K. Smith
- Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
18
|
Kalidindi Y, Ganapathy AK, Nayak Y, Elumalai A, Chen DZ, Bishop G, Sanchez A, Albers B, Shetty AS, Ballard DH. Computed Tomography Attenuation of Three-Dimensional (3D) Printing Materials-Depository to Aid in Constructing 3D-Printed Phantoms. Micromachines (Basel) 2023; 14:1928. [PMID: 37893365 PMCID: PMC10609050 DOI: 10.3390/mi14101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Three-dimensionally printed phantoms are increasingly used in medical imaging and research due to their cost-effectiveness and customizability, offering valuable alternatives to commercial phantoms. The purpose of this study was to assess the computed tomography (CT) attenuation characteristics of 27 resin materials from Formlabs, a 3D printing equipment and materials manufacturer. Cube phantoms (both solid and hollow constructions) produced with each resin were subjected to CT scanning under varying tube current-time products with attenuation measurements recorded in Hounsfield units (HU). The resins exhibited a wide range of attenuation values (-3.33 to 2666.27 HU), closely mimicking a range of human tissues, from fluids to dense bone structures. The resins also demonstrated consistent attenuation regardless of changes in the tube current. The CT attenuation analysis of FormLabs resins produced an archive of radiological imaging characteristics of photopolymers that can be utilized to construct more accurate tissue mimicking medical phantoms and improve the evaluation of imaging device performance.
Collapse
Affiliation(s)
- Yuktesh Kalidindi
- School of Medicine, Saint Louis University, St. Louis, MO 63104, USA;
| | - Aravinda Krishna Ganapathy
- School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; (A.K.G.); (Y.N.); (D.Z.C.)
| | - Yash Nayak
- School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; (A.K.G.); (Y.N.); (D.Z.C.)
| | - Anusha Elumalai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (G.B.); (A.S.); (A.S.S.)
| | - David Z. Chen
- School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; (A.K.G.); (Y.N.); (D.Z.C.)
| | - Grace Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (G.B.); (A.S.); (A.S.S.)
| | - Adrian Sanchez
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (G.B.); (A.S.); (A.S.S.)
| | - Brian Albers
- St. Louis Children’s Hospital Medical 3D Printing Center, BJC Healthcare, St. Louis, MO 63110, USA;
| | - Anup S. Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (G.B.); (A.S.); (A.S.S.)
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (A.E.); (G.B.); (A.S.); (A.S.S.)
| |
Collapse
|
19
|
Khoo A, Ho C, Ballard DH, Gould JE, Marquis KM. Results of the 2021-2022 Survey of the American Alliance of Academic Chief Residents in Radiology. Acad Radiol 2023; 30:2050-2058. [PMID: 36813667 DOI: 10.1016/j.acra.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/22/2023]
Abstract
RATIONALE AND OBJECTIVES An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). Special topics surveyed for the 2021-2022 academic year were procedural competency and virtual radiology education in the COVID-19 pandemic. The purpose of this study is to summarize the 2021-2022 A3CR2 chief resident survey. MATERIALS AND METHODS An online survey was distributed to chief residents from 197 Accreditation Council on Graduate Medical Education-accredited radiology residency programs. Chief residents responded to questions regarding their individual procedural readiness and attitudes on virtual radiology education. A single chief resident from each residency answered programmatic questions including the use of virtual education, faculty coverage, and fellowship choices among their graduating classes. RESULTS We received 110 individual responses from 61 programs, yielding a 31% program response rate. Although the majority (80%) of programs maintained purely in-person attending readout throughout the COVID 19 pandemic, only 13% of programs reported purely in-person didactics and 26% converted to all virtual didactics. The majority (53%-74%) of chief residents perceived virtual learning (in read-out, case conference, and didactic formats) to be less effective than in-person learning. One third of chief residents reported decreased procedural exposure during the pandemic, and 7%-9% of chief residents felt uncomfortable with basic procedures (basic fluoroscopy examinations, basic aspiration/drainage procedures, and superficial biopsy procedures). The number of programs with 24/7 attending coverage increased from 35% in 2019 to 49% in 2022. Body, neuroradiology, and interventional radiology were the most popular advanced training options among graduating radiology residents. CONCLUSION The COVID-19 pandemic had a profound impact on radiology training, particularly in terms of virtual learning. These survey results suggest that although digital learning offers increased flexibility, most residents still prefer in-person readout and didactics. Despite this, virtual learning will likely remain a viable option as programs continue to evolve following the pandemic.
Collapse
Affiliation(s)
- Allison Khoo
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher Ho
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer E Gould
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Kaitlin M Marquis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| |
Collapse
|
20
|
Chen DZ, Ganapathy A, Nayak Y, Mejias C, Bishop GL, Mellnick VM, Ballard DH. Analysis of Superficial Subcutaneous Fat Camper's and Scarpa's Fascia in a United States Cohort. J Cardiovasc Dev Dis 2023; 10:347. [PMID: 37623360 PMCID: PMC10455117 DOI: 10.3390/jcdd10080347] [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: 07/12/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Together, the Camper's and Scarpa's fasciae form the superficial fat layer of the abdominal wall. Though they have clinical and surgical relevance, little is known about their role in body composition across diverse patient populations. This study aimed to determine the relationship between patient characteristics, including sex and body mass index, and the distribution of Camper's and Scarpa's fascial layers in the abdominal wall. A total of 458 patients' abdominal CT examinations were segmented via CoreSlicer 1.0 to determine the surface area of each patient's Camper's, Scarpa's, and visceral fascia layers. The reproducibility of segmentation was corroborated by an inter-rater analysis of segmented data for 20 randomly chosen patients divided between three study investigators. Pearson correlation and Student's t-test analyses were performed to characterize the relationship between fascia distribution and demographic factors. The ratios of Camper's fascia, both as a proportion of superficial fat (r = -0.44 and p < 0.0001) and as a proportion of total body fat (r = -0.34 and p < 0.0001), showed statistically significant negative correlations with BMI. In contrast, the ratios of Scarpa's fascia, both as a proportion of superficial fat (r = 0.44 and p < 0.0001) and as a proportion of total body fat (r = 0.41 and p < 0.0001), exhibited statistically significant positive correlations with BMI. Between sexes, the females had a higher ratio of Scarpa's facia to total body fat compared to the males (36.9% vs. 31% and p < 0.0001). The ICC values for the visceral fat, Scarpa fascia, and Camper fascia were 0.995, 0.991, and 0.995, respectively, which were all within the 'almost perfect' range (ICC = 0.81-1.00). These findings contribute novel insights by revealing that as BMI increases the proportion of Camper's fascia decreases, while the ratio of Scarpa's fascia increases. Such insights expand the scope of body composition studies, which typically focus solely on superficial and visceral fat ratios.
Collapse
Affiliation(s)
- David Z. Chen
- School of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; (D.Z.C.); (A.G.)
| | - Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; (D.Z.C.); (A.G.)
| | - Yash Nayak
- School of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA;
| | - Christopher Mejias
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (C.M.); (G.L.B.); (V.M.M.)
| | - Grace L. Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (C.M.); (G.L.B.); (V.M.M.)
| | - Vincent M. Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (C.M.); (G.L.B.); (V.M.M.)
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (C.M.); (G.L.B.); (V.M.M.)
| |
Collapse
|
21
|
Ballard DH. Microvascular Invasion in Hepatocellular Carcinoma: Bridging the Global Gap between Imaging and Clinical Practice. Acad Radiol 2023; 30:1528-1530. [PMID: 37316367 DOI: 10.1016/j.acra.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/16/2023]
Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
| |
Collapse
|
22
|
Shetty AS, Fraum TJ, Ballard DH, Hoegger MJ, Itani M, Rajput MZ, Lanier MH, Cusworth BM, Mehrsheikh AL, Cabrera-Lebron JA, Chu J, Cunningham CR, Hirschi RS, Mokkarala M, Unteriner JG, Kim EH, Siegel CL, Ludwig DR. Renal Mass Imaging with MRI Clear Cell Likelihood Score: A User's Guide. Radiographics 2023; 43:e220209. [PMID: 37319026 DOI: 10.1148/rg.220209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Small solid renal masses (SRMs) are frequently detected at imaging. Nearly 20% are benign, making careful evaluation with MRI an important consideration before deciding on management. Clear cell renal cell carcinoma (ccRCC) is the most common renal cell carcinoma subtype with potentially aggressive behavior. Thus, confident identification of ccRCC imaging features is a critical task for the radiologist. Imaging features distinguishing ccRCC from other benign and malignant renal masses are based on major features (T2 signal intensity, corticomedullary phase enhancement, and the presence of microscopic fat) and ancillary features (segmental enhancement inversion, arterial-to-delayed enhancement ratio, and diffusion restriction). The clear cell likelihood score (ccLS) system was recently devised to provide a standardized framework for categorizing SRMs, offering a Likert score of the likelihood of ccRCC ranging from 1 (very unlikely) to 5 (very likely). Alternative diagnoses based on imaging appearance are also suggested by the algorithm. Furthermore, the ccLS system aims to stratify which patients may or may not benefit from biopsy. The authors use case examples to guide the reader through the evaluation of major and ancillary MRI features of the ccLS algorithm for assigning a likelihood score to an SRM. The authors also discuss patient selection, imaging parameters, pitfalls, and areas for future development. The goal is for radiologists to be better equipped to guide management and improve shared decision making between the patient and treating physician. © RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Pedrosa in this issue.
Collapse
Affiliation(s)
- Anup S Shetty
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Tyler J Fraum
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mark J Hoegger
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mohamed Z Rajput
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Michael H Lanier
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Brian M Cusworth
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Amanda L Mehrsheikh
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jorge A Cabrera-Lebron
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jia Chu
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Christopher R Cunningham
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Ryan S Hirschi
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mahati Mokkarala
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jackson G Unteriner
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Eric H Kim
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Cary L Siegel
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Daniel R Ludwig
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| |
Collapse
|
23
|
Ganapathy A, Ballard DH, Bishop GL, Hoegger MJ, Abraham N, D’Agostino HB. Pilot Study on the Influence of Incentive Spirometry on Percutaneous Image-Guided Intra-Abdominal Drainage Catheter Pressure: A Potential Method to Enhance Drainage. Appl Sci (Basel) 2023; 13:7308. [PMID: 37621554 PMCID: PMC10448541 DOI: 10.3390/app13127308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Background To report the evaluation of incentive spirometry (IS)-induced pressure changes in intra-abdominal drainage catheters and consider its use for maintaining catheter patency and enhancing drainage. Methods Prospective study of patients with indwelling intra-abdominal drainage catheters for abdominal fluid collections who had their intra-abdominal pressures measured while performing incentive spirometry. Patients were instructed in the use of an incentive spirometer. Within a week after initial drainage, pressure changes with IS were evaluated three times at 1500 cc and three times at maximum inspiratory effort. Intra-abdominal pressure (IAP) was measured using a pressure monitor connected to the drainage catheter. Results Twenty patients (men, 12; women, 8). Fluid collection locations were pelvis, Right-upper quadrant (RUQ), Left-upper quadrant (LUQ), Left-lower quadrant (LLQ), and Right-lower quadrant (RLQ). A total of 16 of 20 patients showed an elevation of IAP with IS. At 1500 cc, the pressure increased by an average of 41.24 mmH2O. At maximal inspiratory effort, the pressure increased by an average of 48.26 mmH2O. Pressure increase was greater in upper abdomen catheters. Four patients with lower abdominal and pelvic collections showed minimal pressure changes with IS. Conclusion IS increases IAP and fluid flow through abdominal drainage catheters. Future studies are warranted to determine whether the use of IS enhances catheter performance and facilitates drainage via its effect on IAP.
Collapse
Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Grace L. Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark J. Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nihil Abraham
- Department of Internal Medicine, University of California Riverside School of Medicine, Riverside, CA 92521, USA
| | - Horacio B. D’Agostino
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| |
Collapse
|
24
|
Chen D, Ganapathy A, Abraham N, Marquis KM, Bishop GL, Rybicki FJ, Hoegger MJ, Ballard DH. 3D printing exposure and perception in radiology residency: survey results of radiology chief residents. 3D Print Med 2023; 9:13. [PMID: 37103761 PMCID: PMC10133904 DOI: 10.1186/s41205-023-00173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to summarize a survey of radiology chief residents focused on 3D printing in radiology. MATERIALS AND METHODS An online survey was distributed to chief residents in North American radiology residencies by subgroups of the Association of University Radiologists. The survey included a subset of questions focused on the clinical use of 3D printing and perceptions of the role of 3D printing and radiology. Respondents were asked to define the role of 3D printing at their institution and asked about the potential role of clinical 3D printing in radiology and radiology residencies. RESULTS 152 individual responses from 90 programs were provided, with a 46% overall program response rate (n = 90/194 radiology residencies). Most programs had 3D printing at their institution (60%; n = 54/90 programs). Among the institutions that perform 3D printing, 33% (n = 18/54) have structured opportunities for resident contribution. Most residents (60%; n = 91/152 respondents) feel they would benefit from 3D printing exposure or educational material. 56% of residents (n = 84/151) believed clinical 3D printing should be centered in radiology departments. 22% of residents (n = 34/151) believed it would increase communication and improve relationships between radiology and surgery colleagues. A minority (5%; 7/151) believe 3D printing is too costly, time-consuming, or outside a radiologist's scope of practice. CONCLUSIONS A majority of surveyed chief residents in accredited radiology residencies believe they would benefit from exposure to 3D printing in residency. 3D printing education and integration would be a valuable addition to current radiology residency program curricula.
Collapse
Affiliation(s)
- David Chen
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Nihil Abraham
- Department of Internal Medicine, University of California-Riverside School of Medicine, Riverside, CA, USA
| | - Kaitlin M Marquis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Grace L Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
25
|
Arribas EM, Kelil T, Santiago L, Ali A, Chadalavada SC, Chepelev L, Ghodadra A, Ionita CN, Lee J, Ravi P, Ryan JR, Sheikh AM, Rybicki FJ, Ballard DH. Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: breast conditions. 3D Print Med 2023; 9:8. [PMID: 36952139 PMCID: PMC10037829 DOI: 10.1186/s41205-023-00171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023] Open
Abstract
The use of medical 3D printing has expanded dramatically for breast diseases. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides updated appropriateness criteria for breast 3D printing in various clinical scenarios. Evidence-based appropriateness criteria are provided for the following clinical scenarios: benign breast lesions and high-risk breast lesions, breast cancer, breast reconstruction, and breast radiation (treatment planning and radiation delivery).
Collapse
Affiliation(s)
- Elsa M Arribas
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Tatiana Kelil
- Department of Radiology, University of California, 1600 Divisadero St, C250, Box 1667, San Francisco, CA, 94115, USA
| | - Lumarie Santiago
- Division of Diagnostic Imaging, Department of Breast Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Arafat Ali
- Diagnostic Radiology, Henry Ford Medical Group, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | | | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Anish Ghodadra
- UPMC Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Ciprian N Ionita
- Department of Biomedical Engineering, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, University at Buffalo School of Engineering and Applied Sciences, 8052 Clinical Translational Research Center, 875 Ellicott Street, Buffalo, NY, 14203, USA
| | - Joonhyuk Lee
- University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Justin R Ryan
- 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
| | - Adnan M Sheikh
- Department of Medical Imaging, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA
| | | |
Collapse
|
26
|
Shetty AS, Bhattacharya A, Konstantinoff K, Wilson-Flewelling S, Ballard DH, Hoegger MJ, Itani M, Mellnick VM, Rajput MZ, Zulfiqar M, Balfe D. Fundamentals of Small Bowel Imaging: What Radiology Residents Should Know. Radiographics 2023; 43:e220094. [PMID: 36633972 DOI: 10.1148/rg.220094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Anup S Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Anup Bhattacharya
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Katerina Konstantinoff
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Scott Wilson-Flewelling
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mark J Hoegger
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mohamed Z Rajput
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Dennis Balfe
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| |
Collapse
|
27
|
Marquis KM, Hoegger MJ, Shetty AS, Bishop GL, Balthazar P, Gould JE, Ballard DH. Results of the 2020 Survey of the American Alliance of Academic Chief Residents in Radiology. Clin Imaging 2023; 98:67-73. [PMID: 37023549 DOI: 10.1016/j.clinimag.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/17/2022] [Accepted: 02/10/2023] [Indexed: 02/21/2023]
Abstract
RATIONALE AND OBJECTIVES An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). The purpose of this study is to summarize the 2020 A3CR2 chief resident survey. MATERIALS AND METHODS An online survey was distributed to chief residents from 194 Accreditation Council on Graduate Medical Education-accredited radiology residencies. Questions were designed to gather information about residency program practices, benefits, fellowship or advanced interventional radiology (IR) training choices, and the integration of IR training. Subsets of questions focused on the perception of corporatization, non-physician providers (NPPs), and artificial intelligence (AI) in radiology and their relationship to the radiology job market. RESULTS 174 individual responses from 94 programs were provided, yielding a 48 % program response rate. Extended emergency department coverage has steadily decreased over the last 5 years (2016-2020), however only 52 % of programs have independent overnight call (without attending coverage). Regarding the impact of new integrated IR residencies on training, 42 % indicated there was no appreciable impact on their DR or IR training, while 20 % indicated DR training for IR residents suffered and 19 % indicated IR training for DR residents suffered. Corporatization in radiology was perceived as the biggest potential threat to the future job market. CONCLUSIONS Integration of IR residency did not detrimentally affect DR or IR training in most programs. Radiology resident perception of corporatization, NPPs, and AI may help residency programs shape educational content.
Collapse
Affiliation(s)
- Kaitlin M Marquis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Grace L Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Patricia Balthazar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer E Gould
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
28
|
Ravi P, Burch MB, Farahani S, Chepelev LL, Yang D, Ali A, Joyce JR, Lawera N, Stringer J, Morris JM, Ballard DH, Wang KC, Mahoney MC, Kondor S, Rybicki FJ. Utility and Costs During the Initial Year of 3D Printing in an Academic Hospital. J Am Coll Radiol 2023; 20:193-204. [PMID: 35988585 DOI: 10.1016/j.jacr.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/18/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is a paucity of utility and cost data regarding the launch of 3D printing in a hospital. The objective of this project is to benchmark utility and costs for radiology-based in-hospital 3D printing of anatomic models in a single, adult academic hospital. METHODS All consecutive patients for whom 3D printed anatomic models were requested during the first year of operation were included. All 3D printing activities were documented by the 3D printing faculty and referring specialists. For patients who underwent a procedure informed by 3D printing, clinical utility was determined by the specialist who requested the model. A new metric for utility termed Anatomic Model Utility Points with range 0 (lowest utility) to 500 (highest utility) was derived from the specialist answers to Likert statements. Costs expressed in United States dollars were tallied from all 3D printing human resources and overhead. Total costs, focused costs, and outsourced costs were estimated. The specialist estimated the procedure room time saved from the 3D printed model. The time saved was converted to dollars using hospital procedure room costs. RESULTS The 78 patients referred for 3D printed anatomic models included 11 clinical indications. For the 68 patients who had a procedure, the anatomic model utility points had an overall mean (SD) of 312 (57) per patient (range, 200-450 points). The total operation cost was $213,450. The total cost, focused costs, and outsourced costs were $2,737, $2,180, and $2,467 per model, respectively. Estimated procedure time saved had a mean (SD) of 29.9 (12.1) min (range, 0-60 min). The hospital procedure room cost per minute was $97 (theoretical $2,900 per patient saved with model). DISCUSSION Utility and cost benchmarks for anatomic models 3D printed in a hospital can inform health care budgets. Realizing pecuniary benefit from the procedure time saved requires future research.
Collapse
Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Michael B Burch
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Shayan Farahani
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Leonid L Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Arafat Ali
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer R Joyce
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Nathan Lawera
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Jimmy Stringer
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | | | - David H Ballard
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri
| | - Kenneth C Wang
- Department of Radiology, University of Maryland, Baltimore, Maryland; and Department of Radiology, Baltimore VA Medical Center, Baltimore, Maryland; and Co-Chair, ACR 3D Printing Registry Governance Committee
| | - Mary C Mahoney
- Chair, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shayne Kondor
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Frank J Rybicki
- Vice Chair of Operations & Quality, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio; and Co-Chair, ACR 3D Printing Registry Governance Committee.
| | | |
Collapse
|
29
|
Li Z, Benabdallah N, Abou DS, Baumann BC, Dehdashti F, Ballard DH, Liu J, Jammalamadaka U, Laforest R, Wahl RL, Thorek DLJ, Jha AK. A Projection-Domain Low-Count Quantitative SPECT Method for α-Particle-Emitting Radiopharmaceutical Therapy. IEEE Trans Radiat Plasma Med Sci 2023; 7:62-74. [PMID: 37201111 PMCID: PMC10191330 DOI: 10.1109/trpms.2022.3175435] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Single-photon emission-computed tomography (SPECT) provides a mechanism to estimate regional isotope uptake in lesions and at-risk organs after administration of α-particle-emitting radiopharmaceutical therapies (α-RPTs). However, this estimation task is challenging due to the complex emission spectra, the very low number of detected counts (~20 times lower than in conventional SPECT), the impact of stray-radiation-related noise at these low counts, and the multiple image-degrading processes in SPECT. The conventional reconstruction-based quantification methods are observed to be erroneous for α-RPT SPECT. To address these challenges, we developed a low-count quantitative SPECT (LC-QSPECT) method that directly estimates the regional activity uptake from the projection data (obviating the reconstruction step), compensates for stray-radiation-related noise, and accounts for the radioisotope and SPECT physics, including the isotope spectra, scatter, attenuation, and collimator-detector response, using a Monte Carlo-based approach. The method was validated in the context of 3-D SPECT with 223Ra, a commonly used radionuclide for α-RPT. Validation was performed using both realistic simulation studies, including a virtual clinical trial, and synthetic and 3-D-printed anthropomorphic physical-phantom studies. Across all studies, the LC-QSPECT method yielded reliable regional-uptake estimates and outperformed the conventional ordered subset expectation-maximization (OSEM)-based reconstruction and geometric transfer matrix (GTM)-based post-reconstruction partial-volume compensation methods. Furthermore, the method yielded reliable uptake across different lesion sizes, contrasts, and different levels of intralesion heterogeneity. Additionally, the variance of the estimated uptake approached the Cramér-Rao bound-defined theoretical limit. In conclusion, the proposed LC-QSPECT method demonstrated the ability to perform reliable quantification for α-RPT SPECT.
Collapse
Affiliation(s)
- Zekun Li
- Department of Biomedical Engineering, Washington University, St. Louis, MO 63130 USA
| | - Nadia Benabdallah
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110 USA
| | - Diane S Abou
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110 USA
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University, St. Louis, MO 63110 USA
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110 USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110 USA
| | - Jonathan Liu
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110 USA
| | - Uday Jammalamadaka
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110 USA
| | - Richard Laforest
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110 USA
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110 USA
| | - Daniel L J Thorek
- Department of Biomedical Engineering, the Mallinckrodt Institute of Radiology, and the Program in Quantitative Molecular Therapeutics, Washington University, St. Louis, MO 63110 USA
| | - Abhinav K Jha
- Department of Biomedical Engineering and the Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63130 USA
| |
Collapse
|
30
|
Hoegger MJ, Strnad BS, Ballard DH, Siegel CL, Shetty AS, Weimholt RC, Yano M, Stanton ML, Mellnick VM, Kawashima A, Zulfiqar M. Urinary Bladder Masses, Rare Subtypes, and Masslike Lesions: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e220034. [PMID: 36490210 DOI: 10.1148/rg.220034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Urinary bladder masses are commonly encountered in clinical practice, with 95% arising from the epithelial layer and rarer tumors arising from the lamina propria, muscularis propria, serosa, and adventitia. The extent of neoplastic invasion into these bladder layers is assessed with multimodality imaging, and the MRI-based Vesical Imaging Reporting and Data System is increasingly used to aid tumor staging. Given the multiple layers and cell lineages, a diverse array of pathologic entities can arise from the urinary bladder, and distinguishing among benign, malignant, and nonneoplastic entities is not reliably feasible in most cases. Pathologic assessment remains the standard of care for classification of bladder masses. Although urothelial carcinoma accounts for most urinary bladder malignancies in the United States, several histopathologic entities exist, including squamous cell carcinoma, adenocarcinoma, melanoma, and neuroendocrine tumors. Furthermore, there are variant histopathologic subtypes of urothelial carcinoma (eg, the plasmacytoid variant), which are often aggressive. Atypical benign bladder masses are diverse and can have inflammatory or iatrogenic causes and mimic malignancy. © RSNA, 2022 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Mark J Hoegger
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Benjamin S Strnad
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Cary L Siegel
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - R Cody Weimholt
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Motoyo Yano
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Melissa L Stanton
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Akira Kawashima
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology (M.J.H., B.S.S., D.H.B., C.L.S., A.S.S., V.M.M.) and Department of Pathology (R.C.W.), Washington University School of Medicine, Campus Box 8131, 510 Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology (M.Y., A.K., M.Z.) and Department of Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic Arizona, Scottsdale, Ariz
| |
Collapse
|
31
|
Schwartz J, Ballard DH. Feasibility of Customized Pillboxes to Enhance Medication Adherence: A Randomized Controlled Trial. Arch Phys Med Rehabil 2022; 103:2288-2295. [PMID: 35430239 DOI: 10.1016/j.apmr.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To test the (1) feasibility of an assistive technology based pillbox intervention on medication adherence; (2) feasibility of trial procedures; and (3) preliminary effectiveness of the pillbox intervention on medication adherence. DESIGN A single-blinded randomized controlled clinical trial was conducted during 2-4 weeks. SETTING Researchers recruited a convenience sample to participate in this university laboratory-based study. PARTICIPANTS English-speaking consumers of 2 or more daily medications (N=15) participated in the study. Individuals with cognitive impairment or who did not manage their own medications were excluded. INTERVENTIONS Participants were randomized to 1 of 3 pillbox interventions: (1) standard-of-care pillbox; (2) customized off-the-shelf pillbox; or (3) customized 3-dimensional (3D) printed pillbox. MAIN OUTCOME MEASURES Outcome measures were divided among the 3 goals of the study. In addition to feasibility metrics, the Adherence to Refills and Medications Scale was used to measure the primary outcome measure, medication adherence. The Quebec User Evaluation of Satisfaction with Assistive Technology was used to measure pillbox satisfaction. RESULTS Researchers successfully administered 6 standard-of-care, 5 custom off-the-shelf, and 4 custom 3D printed pillboxes. Compared with the standard-of-care pillboxes, customized 3D printed pillboxes had large (d=1.04) and customized off-the-shelf pillboxes had medium (d=0.67) effects on medication adherence. CONCLUSIONS Prescription of customized pillboxes using a manualized and novel assistive technology approach that leverages 3D printing is feasible.
Collapse
Affiliation(s)
- Jaclyn Schwartz
- Program in Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| |
Collapse
|
32
|
Shetty AS, Fraum TJ, Ludwig DR, Hoegger MJ, Zulfiqar M, Ballard DH, Strnad BS, Rajput MZ, Itani M, Salari R, Lanier MH, Mellnick VM. Body MRI: Imaging Protocols, Techniques, and Lessons Learned. Radiographics 2022; 42:2054-2074. [DOI: 10.1148/rg.220025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anup S. Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Tyler J. Fraum
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Daniel R. Ludwig
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mark J. Hoegger
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - David H. Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Benjamin S. Strnad
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mohamed Z. Rajput
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Reza Salari
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Michael H. Lanier
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Vincent M. Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| |
Collapse
|
33
|
Ganapathy A, Chen D, Elumalai A, Albers B, Tappa K, Jammalamadaka U, Hoegger MJ, Ballard DH. Guide for starting or optimizing a 3D printing clinical service. Methods 2022; 206:41-52. [PMID: 35964862 DOI: 10.1016/j.ymeth.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022] Open
Abstract
Three-dimensional (3D) printing has applications in many fields and has gained substantial traction in medicine as a modality to transform two-dimensional scans into three-dimensional renderings. Patient-specific 3D printed models have direct patient care uses in surgical and procedural specialties, allowing for increased precision and accuracy in developing treatment plans and guiding surgeries. Medical applications include surgical planning, surgical guides, patient and trainee education, and implant fabrication. 3D printing workflow for a laboratory or clinical service that produces anatomic models and guides includes optimizing imaging acquisition and post-processing, segmenting the imaging, and printing the model. Quality assurance considerations include supervising medical imaging expert radiologists' guidance and self-implementing in-house quality control programs. The purpose of this review is to provide a workflow and guide for starting or optimizing laboratories and clinical services that 3D-print anatomic models or guides for clinical use.
Collapse
Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - David Chen
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Anusha Elumalai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Brian Albers
- 3D Printing Center, Barnes Jewish Hospital, St. Louis, MO, USA.
| | - Karthik Tappa
- Anatomic 3D Printing and Visualization Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | - Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - David H Ballard
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
34
|
Thomas J, Ludwig DR, Ballard DH, Mellnick VM, Siegel CL, Fraum TJ. Spilling the beans: an inside scoop on the imaging of renal parenchymal disease. Abdom Radiol (NY) 2022; 47:2420-2441. [PMID: 35562564 DOI: 10.1007/s00261-022-03540-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Renal parenchymal disease is commonly encountered on imaging, and an understanding of the spectrum of pathology is vital to making correct diagnoses and recommendations for management. These conditions can be categorized based on the presence of calcifications, cysts, solid masses, patterns of enhancement, and other characteristic non-mass findings, as well as on their spatial distribution (i.e., medullary vs. cortical). Making an accurate diagnosis is often challenging, as there is overlap in the features of various diseases, and many benign entities may mimic pathology. OBJECTIVE This review broadly discusses imaging features of renal parenchymal disease and provides a systematic approach to characterize findings and appropriately guide further management.
Collapse
|
35
|
Garg T, Kearns C, Kim E, Ballard DH. Multiple Systemic Arterial Aneurysms in Kawasaki Disease. Radiographics 2022; 42:E88-E89. [PMID: 35333632 DOI: 10.1148/rg.220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tushar Garg
- From The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (T.G.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (E.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.)
| | - Ciléin Kearns
- From The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (T.G.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (E.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.)
| | - Esther Kim
- From The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (T.G.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (E.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.)
| | - David H Ballard
- From The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (T.G.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (E.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.)
| |
Collapse
|
36
|
Ballard DH. Invited Commentary: Starting a Radiology-led 3D Printing Laboratory as a Clinical Service-Funding and Untold Expenses. Radiographics 2022; 42:E70-E72. [PMID: 35119969 DOI: 10.1148/rg.210220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110. The author has provided disclosures (see end of article)
| |
Collapse
|
37
|
Murphy AN, Balthazar P, Khurana A, Ballard DH. RadioGraphics Content Curation: A Comprehensive Curriculum for Radiology Trainees. Radiographics 2022; 42:E39-E41. [PMID: 35148242 DOI: 10.1148/rg.210232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexandra N Murphy
- From the Department of Radiology, Austin Hospital, 145 Studley Rd, Heidelberg 3084, Australia (A.N.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.). P.B. and D.H.B. have provided disclosures (see end of article)
| | - Patricia Balthazar
- From the Department of Radiology, Austin Hospital, 145 Studley Rd, Heidelberg 3084, Australia (A.N.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.). P.B. and D.H.B. have provided disclosures (see end of article)
| | - Aditya Khurana
- From the Department of Radiology, Austin Hospital, 145 Studley Rd, Heidelberg 3084, Australia (A.N.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.). P.B. and D.H.B. have provided disclosures (see end of article)
| | - David H Ballard
- From the Department of Radiology, Austin Hospital, 145 Studley Rd, Heidelberg 3084, Australia (A.N.M.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.). P.B. and D.H.B. have provided disclosures (see end of article)
| |
Collapse
|
38
|
Grimm LJ, Ballard DH, Beckman NM, Mansoori B, Solnes LB, Sodagari F, Zohrabian VM. Geographic Trends in Publications and Submissions in Radiology Journals: Decade Report (2010 - 2020). Acad Radiol 2022; 29:1248-1254. [PMID: 35031153 DOI: 10.1016/j.acra.2021.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 12/23/2022]
Abstract
RATIONALE AND OBJECTIVE The Radiology Research Alliance (RRA) of the Association of University Radiologists (AUR) organized a task force to quantify geographic changes in submissions to and publications within radiology journals over time. MATERIALS AND METHODS Twenty journals were selected: 7 US-based general, 4 European-based general, and 9 subspecialty radiology journals. Journals were solicited for submissions and publications based on country of origin from 2010 -2020. Regression models assessed changes over time across countries, and by continent, with an emphasis on the US and China, for each journal category. RESULTS There were 104,679 publications and 92,446 submissions from 149 countries. Overall, there were significant increases in numbers of publications from Asia (R2 = 0.66, p <0.01), and specifically, China (R2 = 0.87, p <0.01). For US journals, there were increased numbers of publications from Asia (R2 = 0.72, p <0.01) and China (R2 = 0.98, p <0.01), but decreased numbers from North America (R2 = 0.41, p = 0.03). For European journals, there were increased numbers of publications from Asia (R2 = 0.79, p <0.01), North America (R2 = 0.75, p <0.01), and China (R2 = 0.82, p <0.01). For subspecialty journals, there were increased numbers of publications from North America (R2 = 0.38, p = 0.04) and China (R2 = 0.73, p <0.01). There was an acute COVID spike in submissions during 2020, with a continuous increase most notable in China (R2 = 0.96, p <0.01). CONCLUSION In the last decade, the numbers of submissions to and publications within general and subspecialty US and European radiology journals have generally increased around the world, with the largest growth in Asia and in particular China.
Collapse
|
39
|
Ballard DH, Jokerst C, Raptis CA, Pilgram TK, Woodard PK. Myocardial Cut-off Sign is a Sensitive and Specific Cardiac Computed Tomography and Magnetic Resonance Imaging Sign to Distinguish Left Ventricular Pseudoaneurysms From True Aneurysms. J Thorac Imaging 2022; 37:58-65. [PMID: 32427649 PMCID: PMC7666661 DOI: 10.1097/rti.0000000000000525] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to describe the myocardial cut-off sign, assess its ability to distinguish left ventricular pseudoaneurysms (LV PSAs) from true aneurysms (LVAs), and compare its performance with other imaging findings and quantitative measurements used to differentiate LV PSAs from LVAs. MATERIALS AND METHODS This retrospective single-center study identified patients with preoperative cardiac computed tomography (CT) or magnetic resonance imaging (MRI) and surgically confirmed LVAs or LV PSAs over a 10-year period. Seventeen LV PSAs (11 MRI, 6 CT) and 18 LVAs (10 MRI, 8 CT) were included. The myocardial cut-off sign was objectively a >50% decrease in aneurysm sac wall thickness measured at 1 cm from the aneurysmal neck (measurements at 2 cm were also assessed) and subjectively an abrupt "cut-off" of myocardium for the aneurysm sac for PSA compared with a gradual tapering of sac wall thickness for LVA. Two radiologists independently evaluated images for the subjective presence of this sign. RESULTS The myocardial cut-off sign was 91% sensitive and 97% specific when measured 1 cm from the aneurysm neck. When measured at 2 cm from the neck, the sign was 100% sensitive and 69% specific. Subjective analysis of whether the myocardium appeared "cut-off" was 94% to 100% sensitive and 78% to 94% specific with excellent agreement for both PSA (κ=0.94) and LVA (κ=0.83). CONCLUSIONS The myocardial cut-off sign on cardiac CT and MRI is a sensitive and specific finding of LV PSA. Specificity is improved with objective measurements compared with subjective assessment (97% vs. 78% to 94%). This sign may help radiologists distinguish between LV PSAs and LVAs.
Collapse
Affiliation(s)
- David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University
School of Medicine, St. Louis, MO, USA
| | - Clinton Jokerst
- Department of Radiology, Mayo Clinic Scottsdale,
Scottsdale, AZ
| | - Constantine A. Raptis
- Mallinckrodt Institute of Radiology, Washington University
School of Medicine, St. Louis, MO, USA
| | - Thomas K. Pilgram
- Mallinckrodt Institute of Radiology, Washington University
School of Medicine, St. Louis, MO, USA
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology, Washington University
School of Medicine, St. Louis, MO, USA
| |
Collapse
|
40
|
Sangster GP, Malikayil K, Donato M, Ballard DH. MDCT Findings of Splenic Pathology. Curr Probl Diagn Radiol 2022; 51:262-269. [PMID: 33461801 PMCID: PMC8267054 DOI: 10.1067/j.cpradiol.2020.12.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 01/28/2023]
Abstract
The delineation and characterization of splenic lesions and other abnormalities can be challenging on computed tomography. Many splenic lesions are incidentally found, imaging features tend to overlap, and without the appropriate clinical context, differentials can range from benign to malignant. Radiologists should be familiar with the wide variety of pathologies seen on computed tomography as it is often the first imaging modality a splenic lesion is seen. The purpose of this MDCT-focused review is to understand normal splenic anatomy and its variants, to illustrate and describe typical and atypical imaging patters of inflammatory, infectious, vascular, traumatic, benign, and malignant tumors of the spleen and provide clues in reaching the appropriate differential diagnosis and management.
Collapse
Affiliation(s)
- Guillermo P. Sangster
- Department of Radiology, Louisiana State University Health Shreveport. 1501 Kings Hwy, Shreveport, Louisiana, USA
| | - Kiran Malikayil
- Department of Radiology, Louisiana State University Health Shreveport. 1501 Kings Hwy, Shreveport, Louisiana, USA
| | - Maren Donato
- Fundación Medica de Río Negro y Neuquén, Cipolletti, Río Negro, Argentina
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine. 510 S. Kingshighway Blvd, St. Louis, Missouri, USA
| |
Collapse
|
41
|
Ballard DH, Ludwig DR, Fraum TJ, Salter A, Narra VR, Shetty AS. Quality Control of Magnetic Resonance Elastography Using Percent Measurable Liver Volume Estimation. J Magn Reson Imaging 2021; 55:1890-1899. [PMID: 34704644 DOI: 10.1002/jmri.27976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/17/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although studies have described factors associated with failed magnetic resonance elastography (MRE), little is known about what factors influence usable elastography data. PURPOSE To identify factors that have a negative impact on percent measurable liver volume (pMLV), defined as the proportion of usable liver elastography data relative to the volume of imaged liver in patients undergoing MRE. STUDY TYPE Retrospective. SUBJECTS A total of 264 patients (n = 132 males, n = 132 females; mean age = 57 years) with suspected or known chronic liver disease underwent MRE paired with a liver protocol MRI. FIELD STRENGTH/SEQUENCE MRE was performed on a single 1.5 T scanner using a two-dimensional gradient-recalled echo phase-contrast sequence with a passive acoustic driver overlying the right hemiliver. ASSESSMENT Stiffness maps (usable data at 95% confidence) and liver contours on magnitude images of the MRE acquisition were manually traced and used to assess mean stiffness and pMLV. Hepatic fat fraction and R2 * values were also calculated. The distance from the acoustic wave generator on the skin surface to the liver edge was measured. Two radiologists performed the MR analyses with 50 overlapping cases for inter-reader analysis. STATISTICAL TESTS Linear regression was performed to identify factors significantly associated with pMLV. Intraclass correlation was performed for inter-reader reliability. RESULTS pMLV was 31% ± 20% (range 0%-86%). Complete MRE failure (i.e. pMLV = 0%) occurred in 10 patients (4%). Multivariate linear regression identified higher hepatic fat fraction, R2 *, BMI, and driver-to-liver surface distance; male sex; and lower mean liver stiffness was significantly independently associated with lower pMLV. Intraclass correlation for pMLV was 0.96, suggestive of excellent reliability. DATA CONCLUSION Higher fat fraction, R2 *, BMI, driver-to-liver surface distance, male sex, and lower mean liver stiffness were associated with lower pMLV. Optimization of image acquisition parameters and driver placement may improve MRE quality, and pMLV likely serves as a diagnostic utility quality control metric. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Vamsi R Narra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
42
|
Ballard DH, Sweet DE, Garg T, DiSantis DJ. 21st-Century Fluoroscopy: What Will We Be Doing? A Trainee's Perspective. Radiographics 2021; 41:E166-E168. [PMID: 34597217 DOI: 10.1148/rg.2021210189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (D.E.S.); Department of Radiology, Seth GS Medical College & KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (D.J.D.)
| | - David E Sweet
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (D.E.S.); Department of Radiology, Seth GS Medical College & KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (D.J.D.)
| | - Tushar Garg
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (D.E.S.); Department of Radiology, Seth GS Medical College & KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (D.J.D.)
| | - David J DiSantis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.); Imaging Institute, Cleveland Clinic, Cleveland, Ohio (D.E.S.); Department of Radiology, Seth GS Medical College & KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (D.J.D.)
| |
Collapse
|
43
|
Kim E, Jean J, Kearns C, Ballard DH. Perivenous Hepatic Iron Deposition in Alcoholic Cirrhosis. Radiographics 2021; 41:1570-1571. [PMID: 34597224 DOI: 10.1148/rg.2021210190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esther Kim
- From the Department of Radiology, Max Rady College of Medicine, University of Manitoba, 820 Sherbrooke St, GA-216, Winnipeg, MB, Canada R3A 1R9 (E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.)
| | - Jolie Jean
- From the Department of Radiology, Max Rady College of Medicine, University of Manitoba, 820 Sherbrooke St, GA-216, Winnipeg, MB, Canada R3A 1R9 (E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.)
| | - Ciléin Kearns
- From the Department of Radiology, Max Rady College of Medicine, University of Manitoba, 820 Sherbrooke St, GA-216, Winnipeg, MB, Canada R3A 1R9 (E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.)
| | - David H Ballard
- From the Department of Radiology, Max Rady College of Medicine, University of Manitoba, 820 Sherbrooke St, GA-216, Winnipeg, MB, Canada R3A 1R9 (E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.H.B.)
| |
Collapse
|
44
|
Benabdallah N, Scheve W, Dunn N, Silvestros D, Schelker P, Abou D, Jammalamadaka U, Laforest R, Li Z, Liu J, Ballard DH, Maughan NM, Gay H, Baumann BC, Hobbs RF, Rogers B, Iravani A, Jha AK, Dehdashti F, Thorek DLJ. Practical considerations for quantitative clinical SPECT/CT imaging of alpha particle emitting radioisotopes. Theranostics 2021; 11:9721-9737. [PMID: 34815780 PMCID: PMC8581409 DOI: 10.7150/thno.63860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/15/2021] [Indexed: 02/05/2023] Open
Abstract
Rationale: Alpha particle emitting radiopharmaceuticals are generating considerable interest for the treatment of disseminated metastatic disease. Molecular imaging of the distribution of these agents is critical to safely and effectively maximize the clinical potential of this emerging drug class. The present studies aim to investigate the feasibility and limitations of quantitative SPECT for 223Ra, 225Ac and 227Th. Methods: Three state-of-the-art SPECT/CT systems were investigated: the GE Discovery NM/CT 670, the GE Optima NM/CT 640, and the Siemens Symbia T6. A series of phantoms, including the NEMA IEC Body phantom, were used to compare and calibrate each camera. Additionally, anthropomorphic physical tumor and vertebrae phantoms were developed and imaged to evaluate the quantitative imaging protocol. Results: This work describes and validates a methodology to calibrate each clinical system. The efficiency of each gamma camera was analyzed and compared. Using the calibration factors obtained with the NEMA phantom, we were able to quantify the activity in 3D-printed tissue phantoms with an error of 2.1%, 3.5% and 11.8% for 223Ra, 225Ac, and 227Th, respectively. Conclusion: The present study validates that quantitative SPECT/CT imaging of 223Ra, 225Ac, and 227Th is achievable but that careful considerations for camera configuration are required. These results will aid in future implementation of SPECT-based patient studies and will help to identify the limiting factors for accurate image-based quantification with alpha particle emitting radionuclides.
Collapse
Affiliation(s)
- Nadia Benabdallah
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Program in Quantitative Molecular Therapeutics, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | - Diane Abou
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Program in Quantitative Molecular Therapeutics, Washington University School of Medicine, St. Louis, Missouri
| | - Uday Jammalamadaka
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Richard Laforest
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Zekun Li
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Jonathan Liu
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - David H. Ballard
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Nichole M. Maughan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert F. Hobbs
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Buck Rogers
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Amir Iravani
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Abhinav K. Jha
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
- Oncologic Imaging Program, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Farrokh Dehdashti
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Oncologic Imaging Program, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel L. J. Thorek
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Program in Quantitative Molecular Therapeutics, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Oncologic Imaging Program, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
45
|
Ballard DH, Dang AJ, Kumfer BM, Weisensee PB, Meacham JM, Scott AR, Ruppert-Stroescu M, Burke BA, Morris J, Gan C, Hu J, King B, Jammalamadaka U, Sayood S, Liang S, Choudhary S, Dhanraj D, Maranhao B, Millar C, Bertroche JT, Shomer N, Woodard PK, Biswas P, Axelbaum R, Genin G, Williams BJ, Meacham K. Protection levels of N95-level respirator substitutes proposed during the COVID-19 pandemic: safety concerns and quantitative evaluation procedures. BMJ Open 2021; 11:e045557. [PMID: 34475144 PMCID: PMC8413478 DOI: 10.1136/bmjopen-2020-045557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has precipitated widespread shortages of filtering facepiece respirators (FFRs) and the creation and sharing of proposed substitutes (novel designs, repurposed materials) with limited testing against regulatory standards. We aimed to categorically test the efficacy and fit of potential N95 respirator substitutes using protocols that can be replicated in university laboratories. SETTING Academic medical centre with occupational health-supervised fit testing along with laboratory studies. PARTICIPANTS Seven adult volunteers who passed quantitative fit testing for small-sized (n=2) and regular-sized (n=5) commercial N95 respirators. METHODS Five open-source potential N95 respirator substitutes were evaluated and compared with commercial National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirators as controls. Fit testing using the 7-minute standardised Occupational Safety and Health Administration fit test was performed. In addition, protocols that can be performed in university laboratories for materials testing (filtration efficiency, air resistance and fluid resistance) were developed to evaluate alternate filtration materials. RESULTS Among five open-source, improvised substitutes evaluated in this study, only one (which included a commercial elastomeric mask and commercial HEPA filter) passed a standard quantitative fit test. The four alternative materials evaluated for filtration efficiency (67%-89%) failed to meet the 95% threshold at a face velocity (7.6 cm/s) equivalent to that of a NIOSH particle filtration test for the control N95 FFR. In addition, for all but one material, the small surface area of two 3D-printed substitutes resulted in air resistance that was above the maximum in the NIOSH standard. CONCLUSIONS Testing protocols such as those described here are essential to evaluate proposed improvised respiratory protection substitutes, and our testing platform could be replicated by teams with similar cross-disciplinary research capacity. Healthcare professionals should be cautious of claims associated with improvised respirators when suggested as FFR substitutes.
Collapse
Affiliation(s)
- David H Ballard
- School of Medicine Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
| | - Audrey J Dang
- Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Benjamin M Kumfer
- Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Patricia B Weisensee
- Department of Mechanical Engineering & Materials Science, Washington University in St Louis, St Louis, Missouri, USA
| | - J Mark Meacham
- Department of Mechanical Engineering & Materials Science, Washington University in St Louis, St Louis, Missouri, USA
| | - Alex R Scott
- School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Mary Ruppert-Stroescu
- Sam Fox School of Design and Visual Arts, Washington University in St Louis, St Louis, Missouri, USA
| | - Broc A Burke
- Department of Anesthesiology, Washington University in St Louis, St Louis, Missouri, USA
| | - Jason Morris
- School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Connie Gan
- School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Jesse Hu
- School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Bradley King
- Department of Environmental Health & Safety, Washington University in St Louis, St Louis, Missouri, USA
| | - Udayabhanu Jammalamadaka
- School of Medicine Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
| | - Sena Sayood
- Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| | - Stephen Liang
- Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| | - Shruti Choudhary
- Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - David Dhanraj
- Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Bruno Maranhao
- Department of Anesthesiology, Washington University in St Louis, St Louis, Missouri, USA
| | - Christine Millar
- Department of Anesthesiology, Memorial Hospital Belleville, St Louis, Missouri, USA
| | - J Tyler Bertroche
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Nirah Shomer
- Division of Comparative Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Pamela K Woodard
- School of Medicine Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
| | - Pratim Biswas
- Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Richard Axelbaum
- Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Guy Genin
- Department of Mechanical Engineering & Materials Science, Washington University in St Louis, St Louis, Missouri, USA
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St Louis, Missouri, USA
- Bioinspired Engineering and Biomechanics Center, School of Life Sciences and Technology, Xi'an Jiaotong University, China, Xi'an, China
| | - Brent J Williams
- Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, Missouri, USA
| | - Kathleen Meacham
- Department of Anesthesiology, Washington University in St Louis, St Louis, Missouri, USA
| |
Collapse
|
46
|
Hoegger MJ, Shetty AS, Denner DR, Gould JE, Wahl RL, Raptis CA, Ballard DH. A Snapshot of Radiology Training During the Early COVID-19 Pandemic. Curr Probl Diagn Radiol 2021; 50:607-613. [PMID: 32690337 PMCID: PMC7322484 DOI: 10.1067/j.cpradiol.2020.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The COVID-19 pandemic transformed the personal and professional lives of radiology trainees. The purpose of this study was to broadly summarize the impact of COVID-19 on radiology trainees and their training programs via data collected during the early pandemic. MATERIALS AND METHODS An online survey was distributed to radiology chief residents in residencies throughout North America with responses collected between March 20th, 2020 and May 15th, 2020, which coincided with the development of initial COVID-19 peaks in North America. A subset of COVID-19 pandemic questions included resident wellness, imaging opinions, residency infrastructure change, and opinions regarding the Core Exam delay. RESULTS One hundred forty chief residents from 86 institutions responded to COVID-19-related questions. Nearly all responding programs (99%; 85/86) reported institutional positive cases of COVID-19. Most residents (94%; 132/140) thought laboratory testing provided more value than imaging. Fifty-seven percent of respondents (80/140) would use COVID-19-related terminology when encountering chest CT findings supportive of viral pneumonia in symptomatic patients. There was little reported change in the number of residents on call (no change reported in >80% of programs). Fifty-nine percent of residents (83/140) reported increased stress related to the COVID-19 pandemic. The majority of programs (93%) had fewer residents on service (80/86 responding programs). CONCLUSIONS COVID-19 dramatically affected radiology residencies during the early pandemic period. As we enter future phases of the COVID-19 pandemic, careful thought should also be given to rebuilding the radiology resident experience.
Collapse
Affiliation(s)
- Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Darcy R Denner
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Jennifer E Gould
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
47
|
Naeem M, Hoegger MJ, Petraglia FW, Ballard DH, Zulfiqar M, Patlas MN, Raptis C, Mellnick VM. CT of Penetrating Abdominopelvic Trauma. Radiographics 2021; 41:1064-1081. [PMID: 34019436 PMCID: PMC8262166 DOI: 10.1148/rg.2021200181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/12/2020] [Indexed: 12/24/2022]
Abstract
Penetrating abdominopelvic trauma usually results from abdominal cavity violation from a firearm injury or a stab wound and is a leading cause of morbidity and mortality from traumatic injuries. Penetrating trauma can have subtle or complex imaging findings, posing a diagnostic challenge for radiologists. Contrast-enhanced CT is the modality of choice for evaluating penetrating injuries, with good sensitivity and specificity for solid-organ and hollow viscus injuries. Familiarity with the projectile kinetics of penetrating injuries is an important skill set for radiologists and aids in the diagnosis of both overt and subtle injuries. CT trajectography is a useful tool in CT interpretation that allows the identification of subtle injuries from the transfer of kinetic injury from the projectile to surrounding tissue. In CT trajectography, after the entry and exit wounds are delineated, the two points can be connected by placing cross-cursors and swiveling the cut planes obliquely in orthogonal planes to obtain a double-oblique orientation to visualize the wound track in profile. The path of the projectile and its ensuing damage is not always straight, and the imaging characteristics of free fluid of different attenuation in the abdomen (including hemoperitoneum) can support the diagnosis of visceral and vascular injuries. In addition, CT is increasingly used for evaluation of patients after damage control surgery and helps guide the management of injuries that were overlooked at surgery. An invited commentary by Paes and Munera is available online. Online supplemental material is available for this article. ©RSNA, 2021.
Collapse
Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Mark J. Hoegger
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Frank W. Petraglia
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - David H. Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Michael N. Patlas
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Constantine Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| | - Vincent M. Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., M.J.H., F.W.P., D.H.B., M.Z., C.R., V.M.M.); and Division of Emergency/Trauma Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada (M.N.P.)
| |
Collapse
|
48
|
Ballard DH, Summers D, Hoegger MJ, Salter A, Gould JE. Results of the 2019 Survey of the American Alliance of Academic Chief Residents in Radiology. Acad Radiol 2021; 28:1018-1028. [PMID: 32546338 DOI: 10.1016/j.acra.2020.04.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). The purpose of this study is to summarize the 2019 A3CR2 chief resident survey. MATERIALS AND METHODS An online survey was distributed to chief residents from 194 Accreditation Council on Graduate Medical Education-accredited radiology residencies. Questions were designed to gather information about residency program details, call and weekend coverage, interventional radiology training, fellowship, social media use, healthcare reform, artificial intelligence, and job market status. RESULTS One hundred and forty-two unique responses from 99 programs were provided, yielding a 51% program response rate. There was a mean of 7.3 women per residency with a mean program size of 28 residents (26% women). Only 3 of the 99 (3%) programs had a proportion of women that was 50% or higher. The proportion of women in radiology residencies is unchanged since 2014 (p= 0.93) and is significantly lower than 2019 graduating women medical students (49.3%; p < 0.001). Thirty-five percent of programs had 24/7 attending coverage and 40% of programs had extended hours attending shifts. Of programs without 24/7 attending coverage, the proportion of programs without face-to-face readout has increased from 34% in 2014 to 55% in 2019 (p = 0.015). The majority (67%) of respondents had no concerns about the radiology job market; compared to 2014, where only 4% had no concerns (p < 0.001). CONCLUSION Women remain underrepresented in radiology, face-to-face readout is decreasing, and there has been a shift towards a positive job market outlook.
Collapse
|
49
|
Naeem M, Menias CO, Cail AJ, Zulfiqar M, Ballard DH, Pickhardt PJ, Kim DH, Lubner MG, Mellnick VM. Imaging Spectrum of Granulomatous Diseases of the Abdomen and Pelvis. Radiographics 2021; 41:783-801. [PMID: 33861648 DOI: 10.1148/rg.2021200172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A granuloma is a compact organization of mature macrophages that forms because of persistent antigenic stimulation. At the microscopic level, granulomas can undergo various morphologic changes, ranging from necrosis to fibrosis, which along with other specialized immune cells define the appearance of the granulomatous process. Accordingly, the imaging features of granulomatous diseases vary and can overlap with those of other diseases, such as malignancy, and lead to surgical excisions and biopsy. However, given the heterogeneity of granulomas as a disease group, it is often hard to make a diagnosis on the basis of the histopathologic features of granulomatous diseases alone owing to overlapping microscopic features. Instead, a multidisciplinary approach is often helpful. Radiologists need to be familiar with the salient clinical manifestations and imaging findings of granulomatous diseases to generate an appropriate differential diagnosis. ©RSNA, 2021.
Collapse
Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Austin J Cail
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Perry J Pickhardt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - David H Kim
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| |
Collapse
|
50
|
Affiliation(s)
- M Hunter Lanier
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.H.L., D.H.B.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.A.W.)
| | - C Austin Wheeler
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.H.L., D.H.B.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.A.W.)
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.H.L., D.H.B.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.A.W.)
| |
Collapse
|