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Ibarra Vilar P, Jani JC, Cannie MM, Shelmerdine SC, Lecomte S, Verhoye M, Hutchinson CJ, Arthurs OJ, Carlin A, Kang X. Postmortem imaging of fetuses at early gestations: A comparison of microfocus computed tomography with postmortem magnetic resonance at 9.4 T and postmortem ultrasound. Prenat Diagn 2024; 44:572-579. [PMID: 38367004 DOI: 10.1002/pd.6532] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/27/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To compare the diagnostic performance of postmortem ultrasound (PMUS), 9.4 T magnetic resonance imaging (MRI) and microfocus computed tomography (micro-CT) for the examination of early gestation fetuses. METHOD Eight unselected fetuses (10-15 weeks gestational age) underwent at least 2 of the 3 listed imaging examinations. Six fetuses underwent 9.4 T MRI, four underwent micro-CT and six underwent PMUS. All operators were blinded to clinical history. All imaging was reported according to a prespecified template assessing 36 anatomical structures, later grouped into five regions: brain, thorax, heart, abdomen and genito-urinary. RESULTS More anatomical structures were seen on 9.4 T MRI and micro-CT than with PMUS, with a combined frequency of identified structures of 91.9% and 69.7% versus 54.5% and 59.6 (p < 0.001; p < 0.05) respectively according to comparison groups. In comparison with 9.4 T MRI, more structures were seen on micro-CT (90.2% vs. 83.3%, p < 0.05). Anatomical structures were described as abnormal on PMUS in 2.7%, 9.4 T MRI in 6.1% and micro-CT 7.7% of all structures observed. However, the accuracy test could not be calculated because conventional autopsy was performed on 6 fetuses of that only one structure was abnormal. CONCLUSION Micro-CT appears to offer the greatest potential as an imaging adjunct or non-invasive alternative for conventional autopsies in early gestation fetuses.
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Affiliation(s)
- Patricia Ibarra Vilar
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sophie Lecomte
- Department of Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Ciaran J Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Xin Kang
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Shelmerdine SC. Revolutionising paediatric radiology: the future impact of artificial intelligence. Eur Radiol 2024; 34:2294-2296. [PMID: 37819275 DOI: 10.1007/s00330-023-10288-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.
- Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK.
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
- Department of Clinical Radiology, St George's Hospital, London, UK.
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3
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Dupré M, Spruce R, Evans E, Meshaka R, Shelmerdine SC. Paediatric radiology training in the UK: a national trainee survey by the British Society of Paediatric Radiologists (BSPR). Clin Radiol 2024; 79:312-318. [PMID: 38302376 DOI: 10.1016/j.crad.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
AIM To survey current UK radiology trainee experiences and opinions regarding the quality of paediatric radiology training encountered in their core years, and assess their career ambitions with regards to paediatric radiology. MATERIALS AND METHODS A 22-question online survey, approved by the BSPR committee, was promoted over 12 months (1 February 2022 to 31 January 2023) across current radiology trainees and fellows via regional radiology training programme directors (TPDs), Junior Radiology Forum (JRF) trainee representatives, at BSPR Junior Forum webinar teaching sessions, and via social media/word of mouth. RESULTS Eighty-three UK survey responses were received from 17/19 (89%) training schemes. Sixty of the 83 (72%) had taken or were due to take a 2-4 month core paediatric radiology placement partly at tertiary centres (66/83, 80%), with 67/83 (81%) receiving dedicated didactic teaching. Only 26/83 (31%) reported fulfilling core curriculum competencies and 32/83 (39%) reported not receiving enough paediatric radiology training. Almost a quarter (18/83, 22%) reported <2 months of paediatric radiology rotation during core training and 12% (10/83) across six training schemes, reported no dedicated paediatric teaching sessions. Respondents who left negative comments around their experience were more likely to reject paediatric radiology as a future career option (p<0.05). CONCLUSIONS Only 31% of UK radiology trainees reported having enough paediatric radiology training to achieve core competencies. Standardised training, teaching, and increased on-call support could improve confidence in dealing with emergency cases and encourage interest in paediatric radiology beyond junior years.
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Affiliation(s)
- M Dupré
- Department of Clinical Radiology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - R Spruce
- Department of Clinical Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - E Evans
- Department of Clinical Radiology, University Hospital Coventry and Warwickshire, UK
| | - R Meshaka
- Department of Clinical Radiology, Great Ormond Street Hospital, London, UK
| | - S C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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Ciet P, Eade C, Ho ML, Laborie LB, Mahomed N, Naidoo J, Pace E, Segal B, Toso S, Tschauner S, Vamyanmane DK, Wagner MW, Shelmerdine SC. The unintended consequences of artificial intelligence in paediatric radiology. Pediatr Radiol 2024; 54:585-593. [PMID: 37665368 DOI: 10.1007/s00247-023-05746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
Over the past decade, there has been a dramatic rise in the interest relating to the application of artificial intelligence (AI) in radiology. Originally only 'narrow' AI tasks were possible; however, with increasing availability of data, teamed with ease of access to powerful computer processing capabilities, we are becoming more able to generate complex and nuanced prediction models and elaborate solutions for healthcare. Nevertheless, these AI models are not without their failings, and sometimes the intended use for these solutions may not lead to predictable impacts for patients, society or those working within the healthcare profession. In this article, we provide an overview of the latest opinions regarding AI ethics, bias, limitations, challenges and considerations that we should all contemplate in this exciting and expanding field, with a special attention to how this applies to the unique aspects of a paediatric population. By embracing AI technology and fostering a multidisciplinary approach, it is hoped that we can harness the power AI brings whilst minimising harm and ensuring a beneficial impact on radiology practice.
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Affiliation(s)
- Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC - Sophia's Children's Hospital, Rotterdam, The Netherlands
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Mai-Lan Ho
- University of Missouri, Columbia, MO, USA
| | - Lene Bjerke Laborie
- Department of Radiology, Section for Paediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Nasreen Mahomed
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Jaishree Naidoo
- Paediatric Diagnostic Imaging, Dr J Naidoo Inc., Johannesburg, South Africa
- Envisionit Deep AI Ltd, Coveham House, Downside Bridge Road, Cobham, UK
| | - Erika Pace
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Bradley Segal
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Seema Toso
- Pediatric Radiology, Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Dhananjaya K Vamyanmane
- Department of Pediatric Radiology, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Matthias W Wagner
- Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1H 3JH, UK.
- Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK.
- NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, UK.
- Department of Clinical Radiology, St George's Hospital, London, UK.
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Pauling C, Kanber B, Arthurs OJ, Shelmerdine SC. Commercially available artificial intelligence tools for fracture detection: the evidence. BJR Open 2024; 6:tzad005. [PMID: 38352182 PMCID: PMC10860511 DOI: 10.1093/bjro/tzad005] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 02/16/2024] Open
Abstract
Missed fractures are a costly healthcare issue, not only negatively impacting patient lives, leading to potential long-term disability and time off work, but also responsible for high medicolegal disbursements that could otherwise be used to improve other healthcare services. When fractures are overlooked in children, they are particularly concerning as opportunities for safeguarding may be missed. Assistance from artificial intelligence (AI) in interpreting medical images may offer a possible solution for improving patient care, and several commercial AI tools are now available for radiology workflow implementation. However, information regarding their development, evidence for performance and validation as well as the intended target population is not always clear, but vital when evaluating a potential AI solution for implementation. In this article, we review the range of available products utilizing AI for fracture detection (in both adults and children) and summarize the evidence, or lack thereof, behind their performance. This will allow others to make better informed decisions when deciding which product to procure for their specific clinical requirements.
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Affiliation(s)
- Cato Pauling
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 6BT, United Kingdom
| | - Baris Kanber
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London WC1N 3BG, United Kingdom
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London WC1E 6BT, United Kingdom
| | - Owen J Arthurs
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 6BT, United Kingdom
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Bloomsbury, London WC1N 1EH, United Kingdom
| | - Susan C Shelmerdine
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 6BT, United Kingdom
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Bloomsbury, London WC1N 1EH, United Kingdom
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6
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Simcock IC, Shelmerdine SC, Hutchinson JC, Sebire NJ, Arthurs OJ. Body weight-based iodinated contrast immersion timing for human fetal postmortem microfocus computed tomography. BJR Open 2024; 6:tzad006. [PMID: 38352185 PMCID: PMC10860501 DOI: 10.1093/bjro/tzad006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives The aim of this study was to evaluate the length of time required to achieve full iodination using potassium tri-iodide as a contrast agent, prior to human fetal postmortem microfocus computed tomography (micro-CT) imaging. Methods Prospective assessment of optimal contrast iodination was conducted across 157 human fetuses (postmortem weight range 2-298 g; gestational age range 12-37 weeks), following micro-CT imaging. Simple linear regression was conducted to analyse which fetal demographic factors could produce the most accurate estimate for optimal iodination time. Results Postmortem body weight (r2 = 0.6435) was better correlated with iodination time than gestational age (r2 = 0.1384), producing a line of best fit, y = [0.0304 × body weight (g)] - 2.2103. This can be simplified for clinical use whereby immersion time (days) = [0.03 × body weight (g)] - 2.2. Using this formula, for example, a 100-g fetus would take 5.2 days to reach optimal contrast enhancement. Conclusions The simplified equation can now be used to provide estimation times for fetal contrast preparation time prior to micro-CT imaging and can be used to manage service throughput and parental expectation for return of their fetus. Advances in knowledge A simple equation from empirical data can now be used to estimate preparation time for human fetal postmortem micro-CT imaging.
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Affiliation(s)
- Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
| | - John Ciaran Hutchinson
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
- Department of Histopathology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
- Department of Histopathology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
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Abstract
Post-mortem computed tomography (PMCT) imaging is gaining popularity and acceptance for use alongside forensic autopsies of children, predominantly to aid in the detection of traumatic injuries. Recent research on this topic has provided a breadth of new information regarding the appropriate usage, imaging guidance, and diagnostic accuracy for the identification of different paediatric pathologies. Additionally, advanced CT imaging techniques, such as PMCT angiography or ventilated PMCT, have been trialled, and post-mortem micro-CT is now being used in specialist centres for the assessment of subtle fractures in extracted bone specimens. Various image post-processing methods (e.g., three-dimensional printing from PMCT imaging data) are being used for the illustration of injuries in the medicolegal setting to a lay audience and provide another avenue for the future of forensic radiology research. In this review, the evidence-based principles and benefits of post-mortem imaging for forensic investigation in childhood deaths are presented, with a particular focus on PMCT and current practices. Variations in forensic imaging strategies around the world, published diagnostic accuracy rates, and expected normal post-mortem imaging findings are discussed, as well as potential future applications and research in this area.
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Affiliation(s)
- H Edwards
- Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
| | - S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK.
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Simcock IC, Lamouroux A, Sebire NJ, Shelmerdine SC, Arthurs OJ. Less-invasive autopsy for early pregnancy loss. Prenat Diagn 2023; 43:937-949. [PMID: 37127547 DOI: 10.1002/pd.6361] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
Autopsy investigations provide valuable information regarding fetal death that can assist in the parental bereavement process, and influence future pregnancies, but conventional autopsy is often declined by parents because of its invasive approach. This has led to the development of less-invasive autopsy investigations based on imaging technology to provide a more accessible and acceptable choice for parents when investigating their loss. Whilst the development and use of more conventional clinical imaging techniques (radiographs, CT, MRI, US) are well described in the literature for fetuses over 20 weeks of gestational age, these investigations have limited diagnostic accuracy in imaging smaller fetuses. Techniques such as ultra-high-field MRI (>3T) and micro-focus computed tomography have been shown to have higher diagnostic accuracy whilst still being acceptable to parents. By further developing and increasing the availability of these more innovative imaging techniques, parents will be provided with a greater choice of acceptable options to investigate their loss, which may in turn increase their uptake. We provide a narrative review focussing on the development of high-resolution, non-invasive imaging techniques to evaluate early gestational pregnancy loss.
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Affiliation(s)
- Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Audrey Lamouroux
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- Obstetrical Gynaecology Department, Nîmes University Hospital, Nîmes, France
- Clinical Genetics Department, Montpellier University Hospital, Montpellier, France
- ICAR Research Team, LIRMM, CNRS and Charles Coulomb Laboratory, UMR 5221 CNRS-UM, BNIF User Facility Imaging, University of Montpellier, Nîmes and Montpellier, Montpellier, France
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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9
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Laborie LB, Naidoo J, Pace E, Ciet P, Eade C, Wagner MW, Huisman TAGM, Shelmerdine SC. European Society of Paediatric Radiology Artificial Intelligence taskforce: a new taskforce for the digital age. Pediatr Radiol 2023; 53:576-580. [PMID: 35731260 PMCID: PMC9214669 DOI: 10.1007/s00247-022-05426-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/26/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022]
Abstract
A new task force dedicated to artificial intelligence (AI) with respect to paediatric radiology was created in 2021 at the International Paediatric Radiology (IPR) meeting in Rome, Italy (a joint society meeting by the European Society of Pediatric Radiology [ESPR] and the Society for Pediatric Radiology [SPR]). The concept of a separate task force dedicated to AI was borne from an ESPR-led international survey of health care professionals' opinions, expectations and concerns regarding AI integration within children's imaging departments. In this survey, the majority (> 80%) of ESPR respondents supported the creation of a task force and helped define our key objectives. These include providing educational content about AI relevant for paediatric radiologists, brainstorming ideas for future projects and collaborating on AI-related studies with respect to collating data sets, de-identifying images and engaging in multi-case, multi-reader studies. This manuscript outlines the starting point of the ESPR AI task force and where we wish to go.
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Affiliation(s)
- Lene Bjerke Laborie
- grid.412008.f0000 0000 9753 1393Department of Radiology, Section for Paediatrics, Haukeland University Hospital, Bergen, Norway
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jaishree Naidoo
- Paediatric Diagnostic Imaging and Envisionit Deep AI, Johannesburg, South Africa
| | - Erika Pace
- grid.5072.00000 0001 0304 893XDepartment of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Pierluigi Ciet
- grid.5645.2000000040459992XDepartment of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- grid.5645.2000000040459992XDepartment of Pediatric Pulmonology and Allergology, Erasmus MC, Sophia’s Children’s Hospital, Rotterdam, The Netherlands
| | - Christine Eade
- grid.8391.30000 0004 1936 8024University of Exeter Medical School, Exeter, UK
| | - Matthias W. Wagner
- grid.42327.300000 0004 0473 9646Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, Toronto, Canada
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, University of Toronto, Toronto, Ontario Canada
| | - Thierry A. G. M. Huisman
- grid.39382.330000 0001 2160 926XEdward B. Singleton Department of Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas USA
| | - Susan C. Shelmerdine
- grid.424537.30000 0004 5902 9895Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, WC1H 3JH London, UK
- grid.83440.3b0000000121901201UCL Great Ormond Street Institute of Child Health, London, UK
- grid.451056.30000 0001 2116 3923NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- grid.464688.00000 0001 2300 7844Department of Clinical Radiology, St. George’s Hospital, London, UK
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Turmezei TD, Shelmerdine SC, Ashok AH, Goh V. Academic clinical fellows in radiology: how can we improve success? Clin Radiol 2023; 78:e300-e310. [PMID: 36702709 DOI: 10.1016/j.crad.2022.12.008] [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: 10/26/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023]
Abstract
AIM To survey past and current radiology academic clinical fellows (ACFs) for feedback on their experiences, academic achievements, challenges faced in balancing academic and clinical responsibilities, and opinion on how to optimise the fellowship programme. MATERIALS & METHODS A 26-question online survey approved by the Royal College of Radiologists (RCR) Academic Committee was distributed over a 7-month period (June 2021 to January 2022) to current and past radiology ACFs via the National Institute for Health and Care Research (NIHR) integrated academic training imaging leads, radiology training programme directors, and social media. RESULTS Thirty-five survey responses were received from past or present ACFs. Of the respondents, 42.8% (15/35) entered ACF training from another research post, and most continued their academic interests after ACF training (59.3%, 16/27 that had completed the post). The majority (22/35, 63%) had or were in the process of obtaining a postgraduate research degree. The most common academic outputs were scientific publications and national/international conference presentations. Most (23/35, 66%) would recommend the ACF post to colleagues, although some found it challenging balancing on-call and examination commitments during training. CONCLUSIONS Entry into the radiology ACF programme is often after a prior academic post. Many ACFs appear to enjoy their fellowship experience and continue academic interests after training, some achieving higher research degrees. Challenges in balancing clinical workload require some flexibility from local clinical and academic supervisors. Suggestions for alternative structuring of the ACF pathway and how to optimise entry into these competitive posts are also outlined.
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Affiliation(s)
- T D Turmezei
- Norwich Medical School, University of East Anglia, Norwich, UK; Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - S C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK; Department of Clinical Radiology, St George's Hospital, London, UK.
| | - A H Ashok
- Department of Radiology, University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - V Goh
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK; Department of Radiology, Guy's and St Thomas' Hospital, London, UK
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11
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Chambers G, Shelmerdine SC, Aertsen M, Dohna M, Goergen SK, Johnson K, Klein WM, Miller E, Pärtan G, Perry D, Rao P, Robinson C, Stegmann J, Taranath A, Whitby E, van Rijn RR, Arthurs OJ. Current and future funding streams for paediatric postmortem imaging: European Society of Paediatric Radiology survey results. Pediatr Radiol 2023; 53:273-281. [PMID: 36097227 PMCID: PMC9468234 DOI: 10.1007/s00247-022-05485-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/11/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Perinatal and childhood postmortem imaging has been accepted as a noninvasive alternative or adjunct to autopsy. However, the variation in funding models from institution to institution is a major factor prohibiting uniform provision of this service. OBJECTIVE To describe current funding models employed in European and non-European institutions offering paediatric postmortem imaging services and to discuss the perceived barriers to future postmortem imaging service provision. MATERIALS AND METHODS A web-based 16-question survey was distributed to members of the European Society of Paediatric Radiology (ESPR) and ESPR postmortem imaging task force over a 6-month period (March-August 2021). Survey questions related to the radiologic and autopsy services being offered and how each was funded within the respondent's institute. RESULTS Eighteen individual responses were received (13/18, 72.2% from Europe). Only one-third of the institutions (6/18, 33.3%) have fully funded postmortem imaging services, with the remainder receiving partial (6/18, 33.3%) or no funding (5/18, 27.8%). Funding (full or partial) was more commonly available for forensic work (13/18, 72%), particularly where this was nationally provided. Where funding was not provided, the imaging and reporting costs were absorbed by the institute. CONCLUSION Increased access is required for the expansion of postmortem imaging into routine clinical use. This can only be achieved with formal funding on a national level, potentially through health care commissioning and acknowledgement by health care policy makers and pathology services of the value the service provides following the death of a fetus or child. Funding should include the costs involved in training, equipment, reporting and image acquisition.
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Affiliation(s)
- Greg Chambers
- Department of Radiology, Clarindon Wing, B Floor, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, LS1 3EX, UK.
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Martha Dohna
- Department of Paediatric Radiology, Hannover Medical School, Hannover, Germany
| | - Stacy K Goergen
- Monash Health Imaging, Clayton, VIC, Australia.,Department of Imaging, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Karl Johnson
- Radiology Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Willemijn M Klein
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gerald Pärtan
- Department of Radiology, Danube Hospital, Vienna, Austria
| | - David Perry
- Radiology Department, National Women's Health and Starship Children's Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Padma Rao
- Department of Medical Imaging, Royal Children's Hospital, Melbourne, Australia
| | - Claire Robinson
- Department of Imaging, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joachim Stegmann
- Department of Radiology, Children's Hospital Wilhelmstift gGmbH, Hamburg, Germany
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia.,Faculty of Health and Medical Sciences, University of Adelaide, South Adelaide, Adelaide, Australia
| | - Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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12
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Rockall AG, Shelmerdine SC, Chen M. AI and ML in radiology: Making progress. Clin Radiol 2023; 78:81-82. [PMID: 36639174 DOI: 10.1016/j.crad.2022.10.010] [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] [Received: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 01/12/2023]
Affiliation(s)
- A G Rockall
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Rd, W12 0NN, UK.
| | - S C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - M Chen
- Department of Surgery and Cancer, Imperial College London, UK
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13
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Tanturri de Horatio L, Shelmerdine SC, d'Angelo P, Di Paolo PL, Magni-Manzoni S, Malattia C, Damasio MB, Tomà P, Avenarius D, Rosendahl K. A novel magnetic resonance imaging scoring system for active and chronic changes in children and adolescents with juvenile idiopathic arthritis of the hip. Pediatr Radiol 2023; 53:426-437. [PMID: 36149477 PMCID: PMC9968695 DOI: 10.1007/s00247-022-05502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hip involvement predicts severe disease in juvenile idiopathic arthritis (JIA) and is accurately assessed by MRI. However, a child-specific hip MRI scoring system has not been validated. OBJECTIVE To test the intra- and interobserver agreement of several MRI markers for active and chronic hip changes in children and young adults with JIA and to examine the precision of measurements commonly used for the assessment of growth abnormalities. MATERIALS AND METHODS Hip MRIs from 60 consecutive children, adolescents and young adults with JIA were scored independently by two sets of radiologists. One set scored the same MRIs twice. Features of active and chronic changes, growth abnormalities and secondary post-inflammatory changes were scored. We used kappa statistics to analyze inter- and intraobserver agreement for categorical variables and a Bland-Altman approach to test the precision of continuous variables. RESULTS Among active changes, there was good intra- and interobserver agreement for grading overall inflammation (kappa 0.6-0.7). Synovial enhancement showed a good intraobserver agreement (kappa 0.7-0.8), while the interobserver agreement was moderate (kappa 0.4-0.5). Regarding acetabular erosions on a 0-3 scale, the intraobserver agreement was 0.6 for the right hip and 0.7 for the left hip, while the interobserver agreement was 0.6 for both hips. Measurements of joint space width, caput-collum-diaphyseal angle, femoral neck-head length, femoral width and trochanteric distance were imprecise. CONCLUSION We identified a set of MRI markers for active and chronic changes in JIA and suggest that the more robust markers be included in future studies addressing clinical validity and long-term patient outcomes.
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Affiliation(s)
- Laura Tanturri de Horatio
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy.
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway.
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
- Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Bloomsbury, London, UK
- Department of Radiology, St. George's Hospital, London, UK
| | - Paola d'Angelo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Pier Luigi Di Paolo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | | | - Clara Malattia
- Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Paolo Tomà
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Derk Avenarius
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Karen Rosendahl
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
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14
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Meshaka R, Pinto Dos Santos D, Arthurs OJ, Sebire NJ, Shelmerdine SC. Artificial intelligence reporting guidelines: what the pediatric radiologist needs to know. Pediatr Radiol 2022; 52:2101-2110. [PMID: 34196729 DOI: 10.1007/s00247-021-05129-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/06/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
There has been an exponential rise in artificial intelligence (AI) research in imaging in recent years. While the dissemination of study data that has the potential to improve clinical practice is welcomed, the level of detail included in early AI research reporting has been highly variable and inconsistent, particularly when compared to more traditional clinical research. However, inclusion checklists are now commonly available and accessible to those writing or reviewing clinical research papers. AI-specific reporting guidelines also exist and include distinct requirements, but these can be daunting for radiologists new to the field. Given that pediatric radiology is a specialty faced with workforce shortages and an ever-increasing workload, AI could help by offering solutions to time-consuming tasks, thereby improving workflow efficiency and democratizing access to specialist opinion. As a result, pediatric radiologists are expected to be increasingly leading and contributing to AI imaging research, and researchers and clinicians alike should feel confident that the findings reported are presented in a transparent way, with sufficient detail to understand how they apply to wider clinical practice. In this review, we describe two of the most clinically relevant and available reporting guidelines to help increase awareness and engage the pediatric radiologist in conducting AI imaging research. This guide should also be useful for those reading and reviewing AI imaging research and as a checklist with examples of what to expect.
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Affiliation(s)
- Riwa Meshaka
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | | | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK.,Department of Pathology, Great Ormond Street Hospital for Children, London, UK
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK. .,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK. .,Department of Clinical Radiology, St. George's Hospital, London, UK.
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15
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Shelmerdine SC, White RD, Liu H, Arthurs OJ, Sebire NJ. Artificial intelligence for radiological paediatric fracture assessment: a systematic review. Insights Imaging 2022; 13:94. [PMID: 35657439 PMCID: PMC9166920 DOI: 10.1186/s13244-022-01234-3] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/12/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Majority of research and commercial efforts have focussed on use of artificial intelligence (AI) for fracture detection in adults, despite the greater long-term clinical and medicolegal implications of missed fractures in children. The objective of this study was to assess the available literature regarding diagnostic performance of AI tools for paediatric fracture assessment on imaging, and where available, how this compares with the performance of human readers. MATERIALS AND METHODS MEDLINE, Embase and Cochrane Library databases were queried for studies published between 1 January 2011 and 2021 using terms related to 'fracture', 'artificial intelligence', 'imaging' and 'children'. Risk of bias was assessed using a modified QUADAS-2 tool. Descriptive statistics for diagnostic accuracies were collated. RESULTS Nine eligible articles from 362 publications were included, with most (8/9) evaluating fracture detection on radiographs, with the elbow being the most common body part. Nearly all articles used data derived from a single institution, and used deep learning methodology with only a few (2/9) performing external validation. Accuracy rates generated by AI ranged from 88.8 to 97.9%. In two of the three articles where AI performance was compared to human readers, sensitivity rates for AI were marginally higher, but this was not statistically significant. CONCLUSIONS Wide heterogeneity in the literature with limited information on algorithm performance on external datasets makes it difficult to understand how such tools may generalise to a wider paediatric population. Further research using a multicentric dataset with real-world evaluation would help to better understand the impact of these tools.
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Affiliation(s)
- Susan C. Shelmerdine
- grid.420468.cDepartment of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,grid.83440.3b0000000121901201Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK ,grid.420468.cGreat Ormond Street Hospital NIHR Biomedical Research Centre, London, UK ,grid.464688.00000 0001 2300 7844Department of Clinical Radiology, St. George’s Hospital, London, UK
| | - Richard D. White
- grid.241103.50000 0001 0169 7725Department of Radiology, University Hospital of Wales, Cardiff, UK
| | - Hantao Liu
- grid.5600.30000 0001 0807 5670School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Owen J. Arthurs
- grid.420468.cDepartment of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,grid.83440.3b0000000121901201Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK ,grid.420468.cGreat Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Neil J. Sebire
- grid.420468.cDepartment of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,grid.83440.3b0000000121901201Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK ,grid.420468.cGreat Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
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16
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Meshaka R, Garbera DM, Arthurs OJ, Shelmerdine SC. Re: value of additional lateral radiographs in paediatric skeletal surveys for suspected physical abuse. A reply. Clin Radiol 2022; 77:475. [PMID: 35354534 DOI: 10.1016/j.crad.2022.02.014] [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] [Received: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/25/2022]
Affiliation(s)
- R Meshaka
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | - D M Garbera
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK
| | - S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK
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17
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Abstract
Post-mortem imaging for the investigation of perinatal deaths is an acceptable tool amongst parents and religious groups, enabling a less invasive autopsy examination. Nevertheless, availability is scarce nationwide, and there is some debate amongst radiologists regarding the best practice and optimal protocols for performing such studies. Much of the published literature to date focusses on single centre experiences or interesting case reports. Diagnostic accuracy studies are available for a variety of individual imaging modalities (e.g. post-mortem CT, MRI, ultrasound and micro-CT), however, assimilating this information is important when attempting to start a local service.In this article, we present a comprehensive review summarising the latest research, recently published international guidelines, and describe which imaging modalities are best suited for specific indications. When the antenatal clinical findings are not supported by the post-mortem imaging, we also suggest how and when an invasive autopsy may be considered. In general, a collaborative working relationship within a multidisciplinary team (consisting of radiologists, radiographers, the local pathology department, mortuary staff, foetal medicine specialists, obstetricians and bereavement midwives) is vital for a successful service.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, UK.,Department of Radiology, St. George's Hospital, Blackshaw Road, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, UK
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18
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Shelmerdine SC, Ashworth MT, Carmichael J, Arthurs OJ. Micro-CT imaging of congenital high airway obstruction syndrome. Ultrasound Obstet Gynecol 2022; 59:687-689. [PMID: 34580943 DOI: 10.1002/uog.24782] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Affiliation(s)
- S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - M T Ashworth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - J Carmichael
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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19
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Meshaka R, Whittam FC, Guessoum M, Eleti S, Shelmerdine SC, Arthurs OJ, McHugh K, Hiorns MP, Humphries PD, Calder AD, Easty MJ, Gaynor EP, Watson T. Abdominal US in Pediatric Inflammatory Multisystem Syndrome Associated with SARS-CoV-2 (PIMS-TS). Radiology 2022; 303:173-181. [PMID: 34874199 PMCID: PMC8961721 DOI: 10.1148/radiol.211737] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Children with pediatric inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS), also known as multisystem inflammatory syndrome in children, present with abdominal pain among other nonspecific symptoms. Although initial imaging features of PIMS-TS have been reported, the duration of sonographic features remains unknown. Purpose To describe the abdominal US features of PIMS-TS at initial presentation and follow-up. Materials and Methods A retrospective review of children and young adults presenting with clinical features suspicious for PIMS-TS between April 2020 and June 2021 was carried out. US features were documented and reviewed at initial presentation and follow-up. Descriptive statistics were used and interobserver variability was calculated. Results Of 140 children and young adults presenting with suspected PIMS-TS, 120 had confirmed PIMS-TS (median age, 9 years; interquartile range, 7-12 years; 65 male patients) and 102 underwent abdominal US at presentation. PIMS-TS was present as a single abnormality in 109 of the 120 patients (91%) and abdominal symptoms were present in 104 of the 109 (95%). US examinations were abnormal in 86 of 102 patients (84%), with ascites being the most common abnormality in 65 (64%; 95% CI: 54, 73). Bowel wall thickening was present at US in 14 of the 102 patients (14%; 95% CI: 7, 20) and mesenteric inflammation was present in 16 (16%; 95% CI: 9, 23); all of these patients presented with abdominal symptoms. Among the patients with bowel wall thickening, the distal and terminal ileum were most involved (eight of 14 patients, 57%). Abdominal symptoms decreased to seven of 56 patients (13%) in those followed up at 6 months. Thirty-eight patients underwent follow-up US, and the presence of bowel inflammation had decreased to three of 27 patients (11%; 95% CI: -1, 23) in those followed up for less than 2 months and 0 of 17 (0%) in those followed up for more than 2 months. Conclusion Of 102 patients with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 who underwent US at presentation, 14 (14%) had abdominal US findings of bowel inflammation and 16 (16%) had mesenteric edema. All US abnormalities resolved after 2 months. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by van Rijn and Pajkrt in this issue.
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Affiliation(s)
- Riwa Meshaka
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Fern C Whittam
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Myriam Guessoum
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Saigeet Eleti
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Susan C Shelmerdine
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Owen J Arthurs
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Kieran McHugh
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Melanie P Hiorns
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Paul D Humphries
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Alistair D Calder
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Marina J Easty
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Edward P Gaynor
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
| | - Tom Watson
- From the Department of Imaging, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, England (R.M., F.C.W., M.G., S.E., K.M., M.P.H., P.D.H., A.D.C., M.J.E., E.P.G., T.W.); NIHR Great Ormond Street Hospital Biomedical Research Centre, London, England (S.C.S., O.J.A.); and University College London Hospital, London, England (P.D.H.)
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20
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Abstract
Artificial intelligence (AI) is defined as the development of computer systems to perform tasks normally requiring human intelligence. A subset of AI, known as machine learning (ML), takes this further by drawing inferences from patterns in data to 'learn' and 'adapt' without explicit instructions meaning that computer systems can 'evolve' and hopefully improve without necessarily requiring external human influences. The potential for this novel technology has resulted in great interest from the medical community regarding how it can be applied in healthcare. Within radiology, the focus has mostly been for applications in oncological imaging, although new roles in other subspecialty fields are slowly emerging.In this scoping review, we performed a literature search of the current state-of-the-art and emerging trends for the use of artificial intelligence as applied to fetal magnetic resonance imaging (MRI). Our search yielded several publications covering AI tools for anatomical organ segmentation, improved imaging sequences and aiding in diagnostic applications such as automated biometric fetal measurements and the detection of congenital and acquired abnormalities. We highlight our own perceived gaps in this literature and suggest future avenues for further research. It is our hope that the information presented highlights the varied ways and potential that novel digital technology could make an impact to future clinical practice with regards to fetal MRI.
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Affiliation(s)
- Riwa Meshaka
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Trevor Gaunt
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, UK.,Department of Radiology, St. George's Hospital, Blackshaw Road, London, UK
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21
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Meshaka R, Garbera DM, Arthurs OJ, Shelmerdine SC. Value of additional lateral radiographs in paediatric skeletal surveys for suspected physical abuse. Clin Radiol 2022; 77:e40-e47. [PMID: 34742547 DOI: 10.1016/j.crad.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
Abstract
AIM To determine the added value of lateral limb radiographs in suspected physical abuse (SPA), particularly with regard to fracture detection and reporter confidence. METHODS AND MATERIALS A 3-year (October 2017 to November 2020) retrospective study was conducted. Two blinded paediatric radiologists independently reviewed the appendicular radiographs for the presence of fractures, first by reviewing just the frontal projections, then both frontal and lateral radiographs. The additional yield of fractures and changes in reporting confidence scores were recorded. RESULTS One hundred and thirty-eight skeletal surveys (29 live, 109 deceased children) were assessed, consisting of 16 appendicular fractures imaged in two projections (six wrist, five knee, five ankle). In the majority of cases (14/16) the fractures were already visible on the frontal view with only two fractures (one distal radius, one distal tibial) identified only by lateral projection on the blinded review. One fracture (distal tibia) was visible only on the frontal radiograph (not lateral view). The addition of lateral projection did not lead to overcalling of fractures in the remaining normal studies. Radiologist confidence scores showed an improvement with the addition of a lateral projection when a study was thought to be normal (p=0.001-0.003), but not when a fracture was identified (p>0.05). CONCLUSION The addition of lateral radiographs improves reporting confidence in normal skeletal surveys, but only rarely helped to detect additional fractures given that most were visible on frontal projections. Larger multicentre studies of clinical practice are required to confirm these findings.
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Affiliation(s)
- R Meshaka
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | - D M Garbera
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK
| | - S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK
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22
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Simkus P, Edwards H, Banisauskaite A, Shelmerdine SC, Arzanauskaite M. Finding the right home for your radiology article: a useful tool. Clin Radiol 2021; 76:938-939. [PMID: 34583827 DOI: 10.1016/j.crad.2021.09.011] [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: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Affiliation(s)
- P Simkus
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - H Edwards
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - A Banisauskaite
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK; Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - M Arzanauskaite
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK; Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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23
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Shelmerdine SC, Hutchinson JC, Lewis C, Simcock IC, Sekar T, Sebire NJ, Arthurs OJ. A pragmatic evidence-based approach to post-mortem perinatal imaging. Insights Imaging 2021; 12:101. [PMID: 34264420 PMCID: PMC8282801 DOI: 10.1186/s13244-021-01042-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Post-mortem imaging has a high acceptance rate amongst parents and healthcare professionals as a non-invasive method for investigating perinatal deaths. Previously viewed as a 'niche' subspecialty, it is becoming increasingly requested, with general radiologists now more frequently asked to oversee and advise on appropriate imaging protocols. Much of the current literature to date has focussed on diagnostic accuracy and clinical experiences of individual centres and their imaging techniques (e.g. post-mortem CT, MRI, ultrasound and micro-CT), and pragmatic, evidence-based guidance for how to approach such referrals in real-world practice is lacking. In this review, we summarise the latest research and provide an approach and flowchart to aid decision-making for perinatal post-mortem imaging. We highlight key aspects of the maternal and antenatal history that radiologists should consider when protocolling studies (e.g. antenatal imaging findings and history), and emphasise important factors that could impact the diagnostic quality of post-mortem imaging examinations (e.g. post-mortem weight and time interval). Considerations regarding when ancillary post-mortem image-guided biopsy tests are beneficial are also addressed, and we provide key references for imaging protocols for a variety of cross-sectional imaging modalities.
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Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute of Child Health, London, UK. .,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK.
| | - J Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Celine Lewis
- Population, Policy and Practice Department, UCL GOS Institute of Child Health, London, UK.,North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK
| | - Ian C Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Thivya Sekar
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
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24
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Shelmerdine SC, Sebire NJ, Arthurs OJ. Three-dimensional versus two-dimensional postmortem ultrasound: feasibility in perinatal death investigation. Pediatr Radiol 2021; 51:1259-1266. [PMID: 33674890 DOI: 10.1007/s00247-020-04934-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/29/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
Three- and four-dimensional US techniques in antenatal screening are commonplace, but they are not routinely used for perinatal postmortem US. In this technical innovation, we performed both two-dimensional (2-D) and three-dimensional (3-D) postmortem US on 11 foetuses (mean gestation: 23 weeks; range: 15-32 weeks) to determine whether there was any benefit in 3-D over conventional 2-D methods. In one case of osteogenesis imperfecta, both 2-D and 3-D US images were non-diagnostic because of small foetal size. Of the remaining 10 foetuses, 7 were normal at imaging and autopsy, and 3 had abnormalities detected on both 2-D and 3-D US. There were no false-positive diagnoses by 2-D or 3-D US. Whilst 3-D postmortem US was a feasible technique, it did not provide additional information over 2-D US. Routine 3-D postmortem US cannot therefore be routinely recommended based on our findings.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.
- Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK.
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
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25
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Simcock IC, Shelmerdine SC, Hutchinson JC, Sebire NJ, Arthurs OJ. Human fetal whole-body postmortem microfocus computed tomographic imaging. Nat Protoc 2021; 16:2594-2614. [PMID: 33854254 DOI: 10.1038/s41596-021-00512-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/05/2021] [Indexed: 02/02/2023]
Abstract
Perinatal autopsy is the standard method for investigating fetal death; however, it requires dissection of the fetus. Human fetal microfocus computed tomography (micro-CT) provides a generally more acceptable and less invasive imaging alternative for bereaved parents to determine the cause of early pregnancy loss compared with conventional autopsy techniques. In this protocol, we describe the four main stages required to image fetuses using micro-CT. Preparation of the fetus includes staining with the contrast agent potassium triiodide and takes 3-19 d, depending on the size of the fetus and the time taken to obtain consent for the procedure. Setup for imaging requires appropriate positioning of the fetus and takes 1 h. The actual imaging takes, on average, 2 h 40 min and involves initial test scans followed by high-definition diagnostic scans. Postimaging, 3 d are required to postprocess the fetus, including removal of the stain, and also to undertake artifact recognition and data transfer. This procedure produces high-resolution isotropic datasets, allowing for radio-pathological interpretations to be made and long-term digital archiving for re-review and data sharing, where required. The protocol can be undertaken following appropriate training, which includes both the use of micro-CT techniques and handling of postmortem tissue.
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Affiliation(s)
- Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - J Ciaran Hutchinson
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK. .,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK. .,NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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26
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Shelmerdine SC, Sebire NJ, Calder AD, Arthurs OJ. Three-dimensional cinematic rendering of fetal skeletal dysplasia using postmortem computed tomography. Ultrasound Obstet Gynecol 2021; 57:659-660. [PMID: 33038273 DOI: 10.1002/uog.23140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/25/2020] [Indexed: 06/11/2023]
Affiliation(s)
- S C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - N J Sebire
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A D Calder
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - O J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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27
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Tolend M, Junhasavasdikul T, Cron RQ, Inarejos Clemente EJ, von Kalle T, Kellenberger CJ, Koos B, Miller E, van Rossum MA, Saurenmann RK, Spiegel L, Stimec J, Twilt M, Tzaribachev N, Abramowicz S, Appenzeller S, Arvidsson LZ, Guleria S, Jaremko JL, Kirkhus E, Larheim TA, Meyers AB, Panwar J, Resnick CM, Shelmerdine SC, Feldman BM, Doria AS. Discrete Choice Experiment on a Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 74:308-316. [PMID: 33555146 DOI: 10.1002/acr.24577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the relative importance weights of items and grades of a newly developed additive outcome measure called the juvenile idiopathic arthritis (JIA) magnetic resonance imaging (MRI) scoring system for temporomandibular joints (TMJ, JAMRIS-TMJ). METHODS An adaptive partial-profile discrete choice experiment (DCE) survey using the 1000Minds platform was independently completed by members of an expert group consisting of radiologists and non-radiologist clinicians to determine the group-averaged relative weights for JAMRIS-TMJ. Subsequently, an image-based vignette ranking exercise was done, during which experts individually rank-ordered 14 patient vignettes for disease severity while blinded to the weights and unrestricted to JAMRIS-TMJ assessment criteria. Validity of the weighted JAMRIS-TMJ was tested by comparing the consensus-graded, DCE-weighted JAMRIS-TMJ score of the vignettes with their unrestricted image-based ranks provided by the experts. RESULTS Nineteen experts completed the DCE survey and 21 completed the vignette ranking exercise. Synovial thickening and joint enhancement showed higher weights per raw score compared to bone marrow items and effusion in the inflammatory domain, while erosions and condylar flattening showed non-linear and higher weights compared to disk abnormalities in the damage domain. The weighted JAMRIS-TMJ score of the vignettes correlated highly with the ranks from the unrestricted comparison method, with median Spearman's rho of 0.92 (intra-quartile range: 0.87-0.95) for the inflammation and 0.93 (0.90-0.94) for the damage domain. CONCLUSIONS A DCE survey was used to quantify the importance weights of the items and grades of the JAMRIS-TMJ. The weighted score showed high convergent validity with an unrestricted, holistic vignette ranking method.
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Affiliation(s)
- Mirkamal Tolend
- The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Randy Q Cron
- Children's of Alabama, Birmingham, AL, United States
| | | | | | | | - Bernd Koos
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marion A van Rossum
- Emma Children's Hospital, Academic Medical Centre, and Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, and University of Calgary, Calgary, Alberta, Canada
| | | | - Shelly Abramowicz
- Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | | | | | | | | | | | - Arthur B Meyers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jyoti Panwar
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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28
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Whitby E, Offiah AC, Shelmerdine SC, van Rijn RR, Aertsen M, Klein WM, Perry D, Goergen SK, Abel C, Taranath A, Gascho D, Miller E, Arthurs OJ. Current state of perinatal postmortem magnetic resonance imaging: European Society of Paediatric Radiology questionnaire-based survey and recommendations. Pediatr Radiol 2021; 51:792-799. [PMID: 33367939 PMCID: PMC8055569 DOI: 10.1007/s00247-020-04905-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postmortem magnetic resonance imaging (MRI) in perinatal and childhood deaths is increasingly used as a noninvasive adjunct or alternative to autopsy. Imaging protocols vary between centres and consensus guidelines do not exist. OBJECTIVE Our aim was to develop practical, standardised recommendations for perinatal postmortem MRI. MATERIALS AND METHODS Recommendations were based on the results of two surveys regarding local postmortem MRI practices sent electronically to all 14 members of the European Society of Paediatric Radiology (ESPR) Postmortem Imaging Task Force and 17 members of the International Society of Forensic Radiology and Imaging Task Force (25 different centres). RESULTS Overall, 11/14 (78.6%) respondents from different institutions perform postmortem MRI. All of these centres perform postmortem MRI for perinatal and neonatal deaths, but only 6/11 (54.5%) perform imaging in older children. CONCLUSION We propose a clinical standard for postmortem MRI sequences plus optional sequences for neuroimaging and cardiac anatomy depending on available scanning time and referral indications.
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Affiliation(s)
- Elspeth Whitby
- University of Sheffield and Sheffield Teaching Hospitals Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 1SF, UK.
| | - Amaka C. Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK ,Department of Radiology, Sheffield Children’s NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Susan C. Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rick R. van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Aertsen
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium
| | - Willemijn M. Klein
- Department of Radiology and Nuclear Medicine and Anatomy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David Perry
- Radiology Department, National Women’s Health and Starship Children’s Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Stacy K. Goergen
- Monash Imaging, Clayton, Victoria Australia ,School of Clinical Sciences, Monash University, Clayton, Victoria Australia
| | - Christian Abel
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales Australia
| | - Ajay Taranath
- Department of Medical Imaging, Women’s and Children’s Hospital, North Adelaide, South Australia Australia ,University of Adelaide, Adelaide, South Australia Australia
| | - Dominic Gascho
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Elka Miller
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Owen J. Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK ,UCL Great Ormond Street Institute of Child Health, London, UK
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29
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Shelmerdine SC, Simcock IC, Hutchinson JC, Guy A, Ashworth MT, Sebire NJ, Arthurs OJ. Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses. Am J Obstet Gynecol 2021; 224:103.e1-103.e15. [PMID: 32682860 PMCID: PMC7805479 DOI: 10.1016/j.ajog.2020.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Background Noninvasive imaging autopsy alternatives for fetuses weighing <500 grams are limited. Microfocus computed tomography has been reported as a viable option in small case series with the potential to avoid an invasive autopsy. Implementation of postmortem microfocus computed tomography in a large cohort as part of routine clinical service has yet been unreported, and realistic “autopsy prevention rates” are unknown. Objective This study aimed to describe the range of abnormalities detectable on fetal microfocus computed tomography in a clinical setting and additional findings identified on the antenatal ultrasound and to estimate the invasive autopsy avoidance rate (ie, cases in which imaging was sufficient to deem autopsy unnecessary). Study Design A prospective observational case series of all fetuses referred for microfocus computed tomography imaging at a single institution was conducted for 3 years (2016–2019). Imaging was reported by 2 pediatric radiologists before autopsy, with “decision to proceed” based on the specialist perinatal pathologists’ judgment and parental consent. Agreement rates between microfocus computed tomography and antenatal ultrasound were evaluated, and where feasible, diagnostic accuracy for microfocus computed tomography was calculated using autopsy as a reference standard. Results A total of 268 fetuses were included (2–350 grams body weight; 11–24 weeks’ gestation), with cause for demise in 122 of 268 (45.5%). Of the 122 fetuses, 64 (52.5%) exhibited fetal anomalies. Although 221 of 268 (82.5%) fetuses had consent for invasive autopsy, only 29 of the 221 (13.1%) underwent this procedure, which implied an autopsy avoidance rate of 192 of 221 (86.9%). Complete agreement was present for all brain, thoracic, and abdominal pathologies, whereas sensitivity and specificity for cardiac anomalies were 66.7% and 91.7%, respectively. Microfocus computed tomography and antenatal ultrasound agreement was found in 219 of 266 cases (81.9%), with partial agreement in 21 of 266 (7.9%) and disagreement in 26 of 266 (10.5%), mostly because of additional cardiac, soft tissue, or genitourinary findings by microfocus computed tomography, which were not seen on the ultrasound. Conclusion Fetal microfocus computed tomography imaging is a viable and useful tool for imaging early gestational fetuses and can avoid the need for invasive autopsy. Confirmation of antenatal diagnoses is achieved in most cases, and additional anomalies may also be detected.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom.
| | - Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - John Ciaran Hutchinson
- Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Anna Guy
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Michael T Ashworth
- Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
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30
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Davendralingam N, Sebire NJ, Arthurs OJ, Shelmerdine SC. Artificial intelligence in paediatric radiology: Future opportunities. Br J Radiol 2021; 94:20200975. [PMID: 32941736 PMCID: PMC7774693 DOI: 10.1259/bjr.20200975] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/11/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
Artificial intelligence (AI) has received widespread and growing interest in healthcare, as a method to save time, cost and improve efficiencies. The high-performance statistics and diagnostic accuracies reported by using AI algorithms (with respect to predefined reference standards), particularly from image pattern recognition studies, have resulted in extensive applications proposed for clinical radiology, especially for enhanced image interpretation. Whilst certain sub-speciality areas in radiology, such as those relating to cancer screening, have received wide-spread attention in the media and scientific community, children's imaging has been hitherto neglected.In this article, we discuss a variety of possible 'use cases' in paediatric radiology from a patient pathway perspective where AI has either been implemented or shown early-stage feasibility, while also taking inspiration from the adult literature to propose potential areas for future development. We aim to demonstrate how a 'future, enhanced paediatric radiology service' could operate and to stimulate further discussion with avenues for research.
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Affiliation(s)
- Natasha Davendralingam
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Frauenfelder C, Shelmerdine SC, Simcock IC, Hall A, Hutchinson JC, Ashworth MT, Arthurs OJ, Butler CR. Micro-CT Imaging of Pediatric Thyroglossal Duct Cysts: A Prospective Case Series. Front Pediatr 2021; 9:746010. [PMID: 34557462 PMCID: PMC8453197 DOI: 10.3389/fped.2021.746010] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: To determine the feasibility of micro-CT as a high-resolution 3D imaging tool for thyroglossal duct cysts and to evaluate its role augmenting traditional histopathological examination of resected specimens. Methods: A single centre, prospective case series of consecutive children undergoing excision of a thyroglossal duct cyst was performed at a quaternary paediatric referral hospital in the United Kingdom. Consecutive children listed for excision of a thyroglossal duct cyst whose parents agreed to participate were included and there were no exclusion criteria. Results: Surgically excised thyroglossal duct cyst or remnant specimens from five patients (two males, three females) were examined using micro-CT alongside traditional histopathological examination. In all cases, micro-CT imaging was able to demonstrate 3D imaging datasets of the specimens successfully and direct radio-pathological comparisons were made (Figures 1-5, Supplementary Video 1). Conclusions: The study has shown the feasibility and utility of post-operative micro-CT imaging of thyroglossal duct cysts specimens as a visual aid to traditional histopathological examination. It better informs the pathological specimen sectioning using multi-planar reconstruction and volume rendering tools without tissue destruction. In the complex, often arborised relationship between a thyroglossal duct cyst and the hyoid, micro-CT provides valuable image plane orientation and indicates proximity of the duct to the surgical margins. This is the first case series to explore the use of micro-CT imaging for pediatric thyroglossal duct specimens and it informs future work investigating the generalizability of micro-CT imaging methods for other lesions, particularly those from the head and neck region where precisely defining margins of excision may be challenging.
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Affiliation(s)
- Claire Frauenfelder
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Discipline of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Ian C Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Andrew Hall
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom.,Department of Histopathology, St Thomas' Hospital, London, United Kingdom
| | - Michael T Ashworth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Colin R Butler
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom
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Shelmerdine SC, Lovrenski J, Caro-Domínguez P, Toso S. Coronavirus disease 2019 (COVID-19) in children: a systematic review of imaging findings. Pediatr Radiol 2020; 50:1217-1230. [PMID: 32556807 PMCID: PMC7300372 DOI: 10.1007/s00247-020-04726-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND COVID-19 is a novel coronavirus infection that can cause a severe respiratory illness and has been declared a pandemic by the World Health Organization (WHO). Because children appear to be less severely affected than adults, their imaging appearances have not been extensively reported. OBJECTIVE To systematically review available literature regarding imaging findings in paediatric cases of COVID-19. MATERIALS AND METHODS We searched four databases (Medline, Embase, Cochrane, Google Scholar) for articles describing imaging findings in children with COVID-19. We included all modalities, age <18 years, and foreign language articles, using descriptive statistics to identify patterns and locations of imaging findings, and their association with outcomes. RESULTS Twenty-two articles were included, reporting chest imaging findings in 431 children, of whom 421 (97.7%) underwent CT. Criteria for imaging were lacking. At diagnosis, 143/421 (34.0%) had a normal CT. Abnormalities were more common in the lower lobes and were predominantly unilateral. The most common imaging pattern was ground-glass opacification (159/255, 62.4%). None of the studies described lymphadenopathy, while pleural effusions were rare (three cases). Improvement at follow-up CT imaging (3-15 days later) was seen in 29/100 (29%), remained normal in 25/100 (25%) and progressed in 9/100 (9%). CONCLUSION CT chest findings in children with COVID-19 are frequently normal or mild. Lower lobes are predominantly affected by patchy ground-glass opacification. Appearances at follow-up remain normal or improve in the majority of children. Chest CT imaging adds little to the further management of the patient and should be reserved for severe cases or for identifying alternative diagnoses.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.
- Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK.
| | - Jovan Lovrenski
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute for Children and Adolescents Health Care of Vojvodina, Novi Sad, Serbia
| | - Pablo Caro-Domínguez
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Seema Toso
- Department of Diagnostics, Pediatric Radiology, Geneva Children's Hospitals, Geneva, Switzerland
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Raissaki M, Shelmerdine SC, Damasio MB, Toso S, Kvist O, Lovrenski J, Hirsch FW, Görkem SB, Paterson A, Arthurs OJ, Rossi A, van Schuppen J, Petit P, Argyropoulou MI, Offiah AC, Rosendahl K, Caro-Domínguez P. Management strategies for children with COVID-19: ESPR practical recommendations. Pediatr Radiol 2020; 50:1313-1323. [PMID: 32621013 PMCID: PMC7332738 DOI: 10.1007/s00247-020-04749-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Received: 04/13/2020] [Revised: 04/18/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023]
Abstract
During the outbreak of the COVID-19 pandemic, guidelines have been issued by international, national and local authorities to address management and the need for preparedness. Children with COVID-19 differ from adults in that they are less often and less severely affected. Additional precautions required in the management of children address their increased radiosensitivity, need for accompanying carers, and methods for dealing with children in a mixed adult-paediatric institution. In this guidance document, our aim is to define a pragmatic strategy for imaging children with an emphasis on proven or suspected COVID-19 cases. Children suspected of COVID-19 should not be imaged routinely. Imaging should be performed only when expected to alter patient management, depending on symptoms, preexisting conditions and clinical evolution. In order to prevent disease transmission, it is important to manage the inpatient caseload effectively by triaging children and carers outside the hospital, re-scheduling nonurgent elective procedures and managing symptomatic children and carers as COVID-19 positive until proven otherwise. Within the imaging department one should consider conducting portable examinations with COVID-19 machines or arranging dedicated COVID-19 paediatric imaging sessions and performing routine nasopharyngeal swab testing before imaging under general anaesthesia. Finally, regular personal hygiene, appropriate usage of personal protective equipment, awareness of which procedures are considered aerosol generating and information on how to best disinfect imaging machinery after examinations should be highlighted to all staff members.
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Affiliation(s)
- Maria Raissaki
- Department of Radiology, University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.
- NIHR Great Ormond Street Biomedical Research Centre, London, UK.
| | | | - Seema Toso
- Department of Diagnostics, Geneva Children's Hospitals, Geneva, Switzerland
| | - Ola Kvist
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jovan Lovrenski
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute for Children and Adolescent Health Care of Vojvodina, Novi Sad, Serbia
| | | | - Süreyya Burcu Görkem
- Paediatric Radiology Department, Erciyes University School of Medicine, Children's Hospital, Kayseri, Turkey
| | - Anne Paterson
- Department of Radiology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
- NIHR Great Ormond Street Biomedical Research Centre, London, UK
| | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Joost van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Philippe Petit
- Service d'imagerie pédiatrique et prénatale, Aix Marseille University, Hôpital de La Timone-Enfants, Marseille, France
| | - Maria I Argyropoulou
- Department of Clinical Radiology and Imaging, Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Amaka C Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Pablo Caro-Domínguez
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Simcock IC, Hutchinson JC, Shelmerdine SC, Matos JN, Sebire NJ, Fuentes VL, Arthurs OJ. Investigation of optimal sample preparation conditions with potassium triiodide and optimal imaging settings for microfocus computed tomography of excised cat hearts. Am J Vet Res 2020; 81:326-333. [PMID: 32228254 DOI: 10.2460/ajvr.81.4.326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine optimal sample preparation conditions with potassium triiodide (I2KI) and optimal imaging settings for microfocus CT (micro-CT) of excised cat hearts. SAMPLE 7 excised hearts (weight range, 10 to 17.6 g) obtained from healthy adult cats after euthanasia by IV injection of pentobarbital sodium. PROCEDURES Following excision, the hearts were preserved in 10% formaldehyde solution. Six hearts were immersed in 1.25% I2KI solution (n = 3) or 2.5% I2KI solution (3) for a 12-day period. Micro-CT images were acquired at time 0 (prior to iodination) then approximately every 24 and 48 hours thereafter to determine optimal sample preparation conditions (ie, immersion time and concentration of I2KI solution). Identified optimal conditions were then used to prepare the seventh heart for imaging; changes in voltage, current, exposure time, and gain on image quality were evaluated to determine optimal settings (ie, maximal signal-to-noise and contrast-to-noise ratios). Images were obtained at a voxel resolution of 30 μm. A detailed morphological assessment of the main cardiac structures of the seventh heart was then performed. RESULTS Immersion in 2.5% I2KI solution for 48 hours was optimal for sample preparation. The optimal imaging conditions included a tube voltage of 100 kV, current of 150 μA, and exposure time of 354 milliseconds; scan duration was 12 minutes. CONCLUSIONS AND CLINICAL RELEVANCE Results provided an optimal micro-CT imaging protocol for excised cat hearts prepared with I2KI solution that could serve as a basis for future studies of micro-CT for high resolution 3-D imaging of cat hearts.
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McDowell AR, Shelmerdine SC, Lorio S, Norman W, Jones R, Carmichael DW, Arthurs OJ. Multiparametric mapping in post-mortem perinatal MRI: a feasibility study. Br J Radiol 2020; 93:20190952. [PMID: 32330074 DOI: 10.1259/bjr.20190952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To demonstrate feasibility of a 3 T multiparametric mapping (MPM) quantitative pipeline for perinatal post-mortem MR (PMMR) imaging. METHODS Whole body quantitative PMMR imaging was acquired in four cases, mean gestational age 34 weeks, range (29-38 weeks) on a 3 T Siemens Prisma scanner. A multicontrast protocol yielded proton density, T1 and magnetic transfer (MT) weighted multi-echo images obtained from variable flip angle (FA) 3D fast low angle single-shot (FLASH) acquisitions, radiofrequency transmit field map and one B0 field map alongside four MT weighted acquisitions with saturation pulses of 180, 220, 260 and 300 degrees were acquired, all at 1 mm isotropic resolution. RESULTS Whole body MPM was achievable in all four foetuses, with R1, R2*, PD and MT maps reconstructed from a single protocol. Multiparametric maps were of high quality and show good tissue contrast, especially the MT maps. CONCLUSION MPM is a feasible technique in a perinatal post-mortem setting, which may allow quantification of post-mortem change, prior to being evaluated in a clinical setting. ADVANCES IN KNOWLEDGE We have shown that the MPM sequence is feasible in PMMR imaging and shown the potential of MT imaging in this setting.
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Affiliation(s)
- Amy R McDowell
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Sara Lorio
- UCL Great Ormond Street Institute of Child Health, London, UK.,Wellcome EPSRC Centre for Medical EngineeringKCL, London, UK
| | - Wendy Norman
- UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR UCL GOS Institute of Child Health Biomedical Research Centre, London, UK
| | - Rod Jones
- UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR UCL GOS Institute of Child Health Biomedical Research Centre, London, UK
| | - David W Carmichael
- UCL Great Ormond Street Institute of Child Health, London, UK.,Wellcome EPSRC Centre for Medical EngineeringKCL, London, UK
| | - Owen J Arthurs
- RadiologyGreat Ormond Street Hospital NHS Foundation Trust, London, UK.,NIHR UCL GOS Institute of Child Health Biomedical Research Centre, London, UK
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Reid C, Arthurs OJ, Calder AD, Sebire NJ, Shelmerdine SC. The significance of internal calcifications on perinatal post-mortem radiographs. Clin Radiol 2020; 75:561.e25-561.e34. [PMID: 32252991 PMCID: PMC7296345 DOI: 10.1016/j.crad.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022]
Abstract
AIM To determine whether the presence of internal calcifications on perinatal post-mortem skeletal surveys (PMSS) are associated with certain diagnoses of fetal loss. METHODS AND MATERIALS A 6-month retrospective, single-centre, cohort study was conducted on PMSS performed for perinatal death assessment. One reader re-reviewed all PMSS images for the presence and location of internal calcifications, and noted whether these were included within the original radiology report. Findings at autopsy were then reviewed independently by a second researcher and cause of fetal loss or main diagnosis recorded. Chi-squared tests were conducted to identify differences between those with and without internal calcifications at PMSS. RESULTS Two hundred and thirty perinatal deaths (mean gestational age 18 weeks; average 12–35 weeks) were included in the study, of which 42 (18.3%) demonstrated intra-abdominal calcifications, and 16/42 (38.1%) were mentioned in the radiology reports. Most calcifications were found to be within the lumen of the gastrointestinal tract, and in the left upper quadrant of the abdomen. There was no statistical difference between identifiable causes for fetal loss at autopsy in cases with and without calcification at PMSS (59.5% versus 58.5% respectively, p=0.904). Nevertheless, where calcification and a cause for fetal loss were found, the aetiology was more likely to be due a fetal rather than placental issue. CONCLUSION The presence of internal calcifications on PMSS was not associated with an increased likelihood of explainable fetal loss or particular diagnosis at autopsy. Fetal calcifications on post-mortem skeletal surveys are not significantly associated with causes of fetal loss. When present, internal calcifications were usually seen in lower gestational aged fetuses, intra-abdominal in location, with the majority being intraluminal. The majority of radiologists do not report internal fetal calcifications on radiographs, without significant consequences for final outcome at autopsy.
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Affiliation(s)
- C Reid
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - A D Calder
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - N J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK.
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Liu C, Patel R, Ogunjinmi B, Briffa C, Allain-Chapman M, Coffey J, Kallam N, Leung MST, Lim A, Shamsad S, El-Sharnouby F, Tsang E, Whitehead J, Bretherton J, Ramsay L, Shelmerdine SC. Feasibility of a paediatric radiology escape room for undergraduate education. Insights Imaging 2020; 11:50. [PMID: 32193698 PMCID: PMC7082448 DOI: 10.1186/s13244-020-00856-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/02/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To develop a paediatric radiology themed escape room session for undergraduate education and secondly, to determine participant satisfaction and improvement in knowledge. METHODS A paediatric radiology escape room with accompanying tutorial was developed around key learning objectives set within the RCR and ESR undergraduate curriculum. Students were recruited from two different universities and undertook the escape room themed teaching. An 8-question single best answer (SBA) test was completed before, immediately after and at 2 weeks post-teaching to determine participant improvement and retention of knowledge. The general feedback was also collected. RESULTS The escape room sessions were held three times, for 19 students (6-7 students per session). All groups completed the escape room in ≤ 20 min. Students enjoyed the experience, assigning an average satisfaction score of 9.4/10 (range 7-10). The majority (17/19, 89.5%) preferred this method of teaching to a lecture-based tutorial alone, although all said they found the tutorial component useful. For the SBA test, there was an average increase in 3.6 marks (range 1-6 marks) per participant between before and after the escape room. This improved knowledge was mostly sustained after 2 weeks, with an average increase of 3.4 marks difference (range 1 to 6) per participant compared to before the teaching. CONCLUSIONS A paediatric radiology themed escape room is a feasible teaching method, enjoyed by participants and associated with an increase in radiological knowledge. Further work with larger sample size and direct comparison with other traditional teaching methods is required.
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Affiliation(s)
- Chantal Liu
- St. Georges, University of London, Cranmer Terrace, London, SW17 0T, UK
| | - Raeesa Patel
- University College London Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Bukola Ogunjinmi
- St. Georges, University of London, Cranmer Terrace, London, SW17 0T, UK
| | - Corey Briffa
- St. Georges, University of London, Cranmer Terrace, London, SW17 0T, UK
| | | | - Josephine Coffey
- St. Georges, University of London, Cranmer Terrace, London, SW17 0T, UK
| | - Neha Kallam
- St. Georges, University of London, Cranmer Terrace, London, SW17 0T, UK
| | | | - Annabelle Lim
- St. Georges, University of London, Cranmer Terrace, London, SW17 0T, UK
| | - Sabina Shamsad
- University College London Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Farah El-Sharnouby
- University College London Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Emily Tsang
- St. Georges, University of London, Cranmer Terrace, London, SW17 0T, UK
| | - Jennifer Whitehead
- University College London Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Josephine Bretherton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Lauren Ramsay
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute of Child Health, WC1N 1EH, London, UK.
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Gaunt T, D'Arco F, Smets AM, McHugh K, Shelmerdine SC. Emergency imaging in paediatric oncology: a pictorial review. Insights Imaging 2019; 10:120. [PMID: 31853747 PMCID: PMC6920284 DOI: 10.1186/s13244-019-0796-5] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/25/2019] [Indexed: 11/12/2022] Open
Abstract
Despite the decline in mortality rates over the last 20 years, cancer remains one of the leading causes of death in children worldwide. Early recognition and treatment for acute oncological emergencies are vital in preventing mortality and poor outcomes, such as irreversible end-organ damage and a compromised quality of life.Imaging plays a pivotal and adjunctive role to clinical examination, and a high level of interpretative acumen by the radiologist can make the difference between life and death. In contrast to adults, the most accessible cross-sectional imaging tool in children typically involves ultrasound. The excellent soft tissue differentiation allows for careful delineation of malignant masses and along with colour Doppler imaging, thromboses and large haematomas can be easily identified. Neurological imaging, particularly in older children is an exception. Here, computed tomography (CT) is required for acute intracranial pathologies, with magnetic resonance imaging (MRI) providing more definitive results later.This review is divided into a 'body systems' format covering a range of pathologies including neurological complications (brainstem herniation, hydrocephalus, spinal cord compression), thoracic complications (airway obstruction, superior vena cava syndrome, cardiac tamponade), intra-abdominal complications (bowel obstruction and perforation, hydronephrosis, abdominal compartment syndrome) and haematological-related emergencies (thrombosis, infection, massive haemorrhage). Within each subsection, we highlight pertinent clinical and imaging considerations.The overall objective of this pictorial review is to illustrate how primary childhood malignancies may present with life-threatening complications, and emphasise the need for imminent patient management.
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Affiliation(s)
- Trevor Gaunt
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Felice D'Arco
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Anne M Smets
- Academic Medical Center, PO Box 22700, Amsterdam, 1100 DE, The Netherlands
| | - Kieran McHugh
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, London, UK.
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Shelmerdine SC, Hutchinson JC, Arthurs OJ, Sebire NJ. Latest developments in post-mortem foetal imaging. Prenat Diagn 2019; 40:28-37. [PMID: 31525275 DOI: 10.1002/pd.5562] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/29/2019] [Accepted: 09/07/2019] [Indexed: 12/11/2022]
Abstract
A sustained decline in parental consent rates for perinatal autopsies has driven the development of less-invasive methods for death investigation. A wide variety of imaging modalities have been developed for this purpose and include post-mortem whole body magnetic resonance imaging (MRI), ultrasound, computed tomography (CT) and micro-focus CT techniques. These are also vital for "minimally invasive" methods, which include potential for tissue sampling, such as image guidance for targeted biopsies and laparoscopic-assisted techniques. In this article, we address the range of imaging techniques currently in clinical practice and those under development. Significant advances in high-field MRI and micro-focus CT imaging show particular promise for smaller and earlier gestation foetuses. We also review how MRI biomarkers such as diffusion-weighted imaging and organ volumetric analysis may aid diagnosis and image interpretation in the absence of autopsy data. Three-dimensional printing and augmented reality may help make imaging findings more accessible to parents, colleagues and trainees.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Radiology Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK.,UCL Great Ormond Street Institute of Child Health London, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre London, London, UK
| | - John C Hutchinson
- Department of Radiology Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK.,UCL Great Ormond Street Institute of Child Health London, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre London, London, UK
| | - Owen J Arthurs
- Department of Radiology Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK.,UCL Great Ormond Street Institute of Child Health London, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre London, London, UK
| | - Neil J Sebire
- Department of Radiology Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK.,UCL Great Ormond Street Institute of Child Health London, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre London, London, UK
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Hutchinson JC, Shelmerdine SC, Lewis C, Parmenter J, Simcock IC, Ward L, Ashworth MT, Chitty LS, Arthurs OJ, Sebire NJ. Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure. Ultrasound Obstet Gynecol 2019; 54:661-669. [PMID: 30620444 DOI: 10.1002/uog.20211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Less invasive autopsy techniques in cases of fetal or infant death have good acceptability among parents, but the published sampling adequacy in needle biopsy studies is generally poor. Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) has the potential to increase the diagnostic yield of less invasive autopsy by improving the quality and quantity of tissue samples obtained, whilst permitting visualization, extraction and examination of internal organs through a small incision. The aim of this study was to present the findings of our experience with the MinImAL procedure in cases of fetal, neonatal and pediatric death. METHODS This was a retrospective analysis of 103 prospectively recruited unselected cases of fetal, neonatal or pediatric death that underwent the MinImAL procedure at a tertiary referral center over a 5-year period. Following preprocedure 1.5-T whole-body postmortem magnetic resonance imaging, MinImAL autopsy was performed. Procedure duration, sampling adequacy and cause of death were assessed. Chi-square analysis was used to compare the 'unexplained' rate of intrauterine deaths in the cohort with that in a previously published cohort of > 1000 cases of intrauterine death examined by standard autopsy. RESULTS MinImAL autopsy was performed successfully in 97.8% (91/93) of the cases undergoing a complete procedure. There was a satisfactory rate of adequate histological sampling in most major organs; heart (100%, 91 cases), lung (100%, 91 cases), kidney (100%, 91 cases), liver (96.7%, 88 cases), spleen (94.5%, 86 cases), adrenal glands (89.0%, 81 cases), pancreas (82.4%, 75 cases) and thymus (56.0%, 51 cases). Procedure duration was similar to that of standard autopsy in a previously published cohort of intrauterine deaths. The unexplained rate in stillbirths and intrauterine fetal deaths that underwent MinImAL autopsy was not significantly different from that following standard autopsy. CONCLUSIONS The MinImAL procedure provides good histological yield from major organs with minimal cosmetic damage and can be learned by an autopsy practitioner. The MinImAL procedure is an appropriate minimally invasive alternative for the investigation of perinatal and pediatric deaths in which consent to full autopsy is withheld, and may have applications in both high- and low/middle-income settings. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - S C Shelmerdine
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Parmenter
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - I C Simcock
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - L Ward
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - M T Ashworth
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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Shelmerdine SC, Sebire NJ, Arthurs OJ. Perinatal post-mortem ultrasound (PMUS): radiological-pathological correlation. Insights Imaging 2019; 10:81. [PMID: 31432284 PMCID: PMC6702254 DOI: 10.1186/s13244-019-0762-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/18/2019] [Indexed: 12/16/2022] Open
Abstract
There has been an increasing demand and interest in post-mortem imaging techniques, either as an adjunct or replacement for the conventional invasive autopsy. Post-mortem ultrasound (PMUS) is easily accessible and more affordable than other cross-sectional imaging modalities and allows visualisation of normal anatomical structures of the brain, thorax and abdomen in perinatal cases. The lack of aeration of post-mortem foetal lungs provides a good sonographic window for assessment of the heart and normal pulmonary lobulation, in contrast to live neonates.In a previous article within this journal, we published a practical approach to conducting a comprehensive PMUS examination. This covered the basic principles behind why post-mortem imaging is performed, helpful techniques for obtaining optimal PMUS images, and the expected normal post-mortem changes seen in perinatal deaths. In this article, we build upon this by focusing on commonly encountered pathologies on PMUS and compare these to autopsy and other post-mortem imaging modalities.
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Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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42
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Rogers HJ, Verhagen MV, Shelmerdine SC, Clark CA, Hales PW. An alternative approach to contrast-enhanced imaging: diffusion-weighted imaging and T 1-weighted imaging identifies and quantifies necrosis in Wilms tumour. Eur Radiol 2019; 29:4141-4149. [PMID: 30560365 PMCID: PMC6610268 DOI: 10.1007/s00330-018-5907-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/31/2018] [Revised: 10/26/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Volume of necrosis in Wilms tumour is informative of chemotherapy response. Contrast-enhanced T1-weighted MRI (T1w) provides a measure of necrosis using gadolinium. This study aimed to develop a non-invasive method of identifying non-enhancing (necrotic) tissue in Wilms tumour. METHODS In this single centre, retrospective study, post-chemotherapy MRI data from 34 Wilms tumour patients were reviewed (March 2012-March 2017). Cases with multiple b value diffusion-weighted imaging (DWI) and T1w imaging pre- and post-gadolinium were included. Fractional T1 enhancement maps were generated from the gadolinium T1w data. Multiple linear regression determined whether fitted parameters from a mono-exponential model (ADC) and bi-exponential model (IVIM - intravoxel incoherent motion) (D, D*, f) could predict fractional T1 enhancement in Wilms tumours, using normalised pre-gadolinium T1w (T1wnorm) signal as an additional predictor. Measured and predicted fractional enhancement values were compared using the Bland-Altman plot. An optimum threshold for separating necrotic and viable tissue using fractional T1 enhancement was established using ROC. RESULTS ADC and D (diffusion coefficient) provided the strongest predictors of fractional T1 enhancement in tumour tissue (p < 0.001). Using the ADC-T1wnorm model (adjusted R2 = 0.4), little bias (mean difference = - 0.093, 95% confidence interval = [- 0.52, 0.34]) was shown between predicted and measured values of fractional enhancement and analysed via the Bland-Altman plot. The optimal threshold for differentiating viable and necrotic tissue was 33% fractional T1 enhancement (based on measured values, AUC = 0.93; sensitivity = 85%; specificity = 90%). CONCLUSIONS Combining ADC and T1w imaging predicts enhancement in Wilms tumours and reliably identifies and measures necrotic tissue without gadolinium. KEY POINTS • Alternative method to identify necrotic tissue in Wilms tumour without using contrast agents but rather using diffusion and T 1 weighted MRI. • A method is presented to visualise and quantify necrotic tissue in Wilms tumour without contrast. • The proposed method has the potential to reduce costs and burden to Wilms tumour patients who undergo longitudinal follow-up imaging as contrast agents are not used.
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Affiliation(s)
- Harriet J Rogers
- Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Martijn V Verhagen
- Department of Radiology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Susan C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Christopher A Clark
- Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Patrick W Hales
- Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
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Goergen SK, Alibrahim E, Govender N, Stanislavsky A, Abel C, Prystupa S, Collett J, Shelmerdine SC, Arthurs OJ. Diagnostic assessment of foetal brain malformations with intra-uterine MRI versus perinatal post-mortem MRI. Neuroradiology 2019; 61:921-934. [PMID: 31076826 PMCID: PMC6620257 DOI: 10.1007/s00234-019-02218-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/19/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate differences in diagnostic yield of intra-uterine foetal (iuMR) and post-mortem MRI (PMMR) for complex brain malformations, using autopsy as the reference standard. METHODS In this retrospective, multicentre study spanning 2 years, we reviewed 13 terminated singleton pregnancies with a prenatal ultrasound finding of complex foetal cerebral abnormalities, referred for both iuMR and PMMR. The iuMR and PMMR studies of the brain were reported independently by two groups of radiologists, blinded to each other's reports. Descriptive statistics were used to compare differences in intracranial abnormalities with autopsy (and genetic testing, where present) as reference standard. RESULTS The median gestational age at termination was 24.6 weeks (IQR 22-29) with median time between delivery and PMMR of 133 h (IQR 101-165). There was full concordance between iuMR and PMMR findings and autopsy in 2/13 (15.3%) cases. Partial concordance between both imaging modalities was present in 6/13 (46.2%) and total discordance in the remainder (5/13, 38.5%). When compared to autopsy, PMMR missed important key findings specifically for neuronal migration and cerebellar anomalies, whereas iuMR appeared to overcall CSF space abnormalities which were less crucial to reaching the final overall diagnosis. CONCLUSIONS iuMR should be performed to improve foetal phenotyping where there is a prenatal ultrasound for complex foetal brain abnormalities. Reliance on PMMR alone is likely to result in misdiagnosis in a majority of cases.
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Affiliation(s)
- Stacy K Goergen
- Monash Imaging, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Ekaterina Alibrahim
- Department of Medical Imaging, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Nishentha Govender
- Department of Medical Imaging, Royal Women's Hospital, Parkville, Victoria, Australia
| | | | - Christian Abel
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Anatomical Pathology, Monash Health, Clayton, Victoria, Australia
| | - Stacey Prystupa
- Department of Medical Imaging, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Anatomical Pathology, Monash Health, Clayton, Victoria, Australia
| | - Jacquelene Collett
- Department of Anatomical Pathology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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Verbruggen SW, Kainz B, Shelmerdine SC, Hajnal JV, Rutherford MA, Arthurs OJ, Phillips ATM, Nowlan NC. Stresses and strains on the human fetal skeleton during development. J R Soc Interface 2019; 15:rsif.2017.0593. [PMID: 29367236 PMCID: PMC5805961 DOI: 10.1098/rsif.2017.0593] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/18/2017] [Indexed: 01/11/2023] Open
Abstract
Mechanical forces generated by fetal kicks and movements result in stimulation of the fetal skeleton in the form of stress and strain. This stimulation is known to be critical for prenatal musculoskeletal development; indeed, abnormal or absent movements have been implicated in multiple congenital disorders. However, the mechanical stress and strain experienced by the developing human skeleton in utero have never before been characterized. Here, we quantify the biomechanics of fetal movements during the second half of gestation by modelling fetal movements captured using novel cine-magnetic resonance imaging technology. By tracking these movements, quantifying fetal kick and muscle forces, and applying them to three-dimensional geometries of the fetal skeleton, we test the hypothesis that stress and strain change over ontogeny. We find that fetal kick force increases significantly from 20 to 30 weeks' gestation, before decreasing towards term. However, stress and strain in the fetal skeleton rises significantly over the latter half of gestation. This increasing trend with gestational age is important because changes in fetal movement patterns in late pregnancy have been linked to poor fetal outcomes and musculoskeletal malformations. This research represents the first quantification of kick force and mechanical stress and strain due to fetal movements in the human skeleton in utero, thus advancing our understanding of the biomechanical environment of the uterus. Further, by revealing a potential link between fetal biomechanics and skeletal malformations, our work will stimulate future research in tissue engineering and mechanobiology.
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Affiliation(s)
| | - Bernhard Kainz
- Department of Computing, Imperial College London, London, UK
| | | | - Joseph V Hajnal
- Department of Biomedical Engineering & Centre for the Developing Brain, School of Biomedical Engineering and Imaging Science, Kings College London, London, UK
| | - Mary A Rutherford
- Department of Perinatal Imaging and Health & Centre for the Developing Brain, School of Biomedical Engineering and Imaging Science, Kings College London, London, UK
| | - Owen J Arthurs
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Andrew T M Phillips
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Niamh C Nowlan
- Department of Bioengineering, Imperial College London, London, UK
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Shelmerdine SC, Singh M, Norman W, Jones R, Sebire NJ, Arthurs OJ. Automated data extraction and report analysis in computer-aided radiology audit: practice implications from post-mortem paediatric imaging. Clin Radiol 2019; 74:733.e11-733.e18. [PMID: 31160039 DOI: 10.1016/j.crad.2019.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
AIM To determine local departmental adherence to the paediatric post-mortem magnetic resonance imaging (MRI) protocols, using a customised automated computational approach. MATERIALS AND METHODS A retrospective review of 460 whole-body post-mortem MRI examinations performed at Great Ormond Street Hospital for Children over a 5.5-year period was assessed for adherence to a full or abbreviated imaging sequence protocol. A simple computer program was developed to batch process DICOM (digital imaging and communications in medicine) files, extracting imaging sequence details, followed by natural language processing (NLP) of authorised reports to automate information extraction of diagnostic image quality. RESULTS The program was able to extract study parameters from the entire dataset (approximately 80 GB of data) in a few hours, and retrieve information on diagnostic image quality using NLP with an overall diagnostic accuracy for data extraction of 96.7% (445/460, 95% confidence interval [CI]: 94.7-98%). The full imaging protocol was adhered to in 305/460 (66.3%) cases, and an abbreviated protocol in 140/460 (30.4%) cases. Overall, 423/460 (91.9%) of studies were of diagnostic quality. These included 298/305 (97.7%) of the full protocol, 111/140 (79.3%) of the abbreviated protocol. In only five cases were the examinations non-diagnostic for all body systems, all of whom weighed <100 g (24.7-72 g) and imaged using the abbreviated protocol. CONCLUSION The present study demonstrated a successful application of an automated approach for data collection for audit and quality assessment purposes using paediatric post-mortem imaging as a specific example. Re-audit of these data following change implementation will be straightforward now that the automated workflow is clearly established.
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Affiliation(s)
- S C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCL Great Ormond Street Institute of Child Health, London, UK.
| | - M Singh
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - W Norman
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - R Jones
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - N J Sebire
- UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - O J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCL Great Ormond Street Institute of Child Health, London, UK
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46
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Shelmerdine SC, Arthurs OJ, Gilpin I, Norman W, Jones R, Taylor AM, Sebire NJ, Chitty LS. Is traditional perinatal autopsy needed after detailed fetal ultrasound and post-mortem MRI? Prenat Diagn 2019; 39:818-829. [PMID: 30892705 DOI: 10.1002/pd.5448] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/27/2019] [Accepted: 03/14/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the additional yield from autopsy following prenatal ultrasound and post-mortem magnetic resonance imaging (PMMR) for structural abnormalities. METHOD PMMR was performed on consecutive fetuses over a 6-year period. Prenatal ultrasound and PMMR findings were categorised as concordant, partially concordant or discordant findings. The yield of new and clinically significant information from autopsy was assessed. Diagnostic accuracies for both modalities were calculated, using autopsy as reference standard. RESULTS Our study consisted of 81 fetuses. PMMR and prenatal ultrasound findings were concordant in 44/81 (54.3%), partially concordant in 26/81 (32.1%) and discordant in 11/81 (13.6%) cases. In 19/81 cases (23%), autopsy provided additional information, which appeared clinically significant in 12 cases. In 10 of those 12 cases, there was discordance between PMMR and ultrasound. In only 2 of 44 cases where ultrasound and PMMR were concordant, did autopsy provide clinically significant information. Diagnostic accuracy rates for ultrasound were sensitivity of 76.8% (66.6%, 84.6%), specificity of 92.5% (88.9%, 95.0%). For PMMR the sensitivity was 79.0% (68.9%, 86.5%), specificity 97.9% (95.5%, 99.0%). PMMR had a significantly higher concordance rate with autopsy than ultrasound (89.0 vs 93.8%; P < .001). CONCLUSION Where PMMR and ultrasound are concordant, there is little additional yield from autopsy.
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Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Isobel Gilpin
- Perinatal Neurology and Neonatology, Imperial College London, London, UK
| | - Wendy Norman
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Rod Jones
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Andrew M Taylor
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lyn S Chitty
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
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Shelmerdine SC, Chung KL, Hutchinson JC, Elliott C, Sebire NJ, Arthurs OJ. Feasibility of Postmortem Imaging Assessment of Brain: Liver Volume Ratios with Pathological Validation. Fetal Diagn Ther 2019; 46:360-367. [PMID: 30970374 PMCID: PMC6979430 DOI: 10.1159/000497158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/21/2019] [Indexed: 01/17/2023]
Abstract
Introduction Organ volumes at postmortem magnetic resonance imaging (PMMR) should reflect autopsy organ weights, and thus brain: liver volume ratios on imaging could be a surrogate for weight volume ratios at autopsy to indicate fetal growth restriction (FGR). This study aims to determine whether imaging-based organ volume ratios can replace autopsy organ weight ratios. Materials and Methods An unselected cohort of perinatal deaths underwent PMMR prior to autopsy. Semiautomated brain and liver volumes were compared to autopsy organ weights and ratios. Ratios were compared using Bland-Altman plots, and intra- and interobserver variability was assessed. Results A total 49 fetuses (25 male, 51%) at 17–42 weeks gestation were assessed. There was a reasonable correlation between autopsy-derived brain: liver weight ratios (AB: LwR) and imaging-derived brain: liver volume ratios (IB: LvR; r = 0.8). The mean difference between AB: LwR and IB: LvR was +0.7 (95% limits of agreement range −1.5 to +2.9). In a small subset where FGR was present, the optimal IB: LvR ≥5.5 gave 83.3% sensitivity and 86.0% specificity for diagnosis. There was acceptable agreement within readers (mean difference in IB: LvRs 0.77 ± 2.21) and between readers −0.36 ± 0.68. Conclusion IB: LvR provides a surrogate evaluation of AB: LwRs, and may be used as a marker of FGR where autopsy is declined.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom,
| | - Kimberly L Chung
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Claire Elliott
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Imaging and Biophysics, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Abstract
Declining rates of consent for standard perinatal autopsy has led to a rise in interest for postmortem imaging as an alternative, non-invasive method for investigation of childhood and perinatal deaths. Whilst much interest has focussed on cross-sectional techniques such as postmortem CT (PMCT) or MRI (PMMR), other modalities including postmortem ultrasound (PMUS) have been shown to have reasonable diagnostic accuracy rates, with the added benefit of being more readily accessible and affordable. There is little published information or formal guidance available on preparation for postmortem perinatal ultrasound, views to be obtained and differentiating normal postmortem change from potential abnormalities. This article will focus on the role of perinatal postmortem ultrasound as an alternative imaging method for non-invasive autopsy, with emphasis on imaging technique, practical considerations and commonly encountered case examples.
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Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
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Shelmerdine SC, Ashworth MT, Calder AD, Muthialu N, Arthurs OJ. Micro-CT of tracheal stenosis in trisomy 21. Thorax 2019; 74:419-420. [PMID: 30712021 PMCID: PMC6860417 DOI: 10.1136/thoraxjnl-2018-212966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael T Ashworth
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alistair D Calder
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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50
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Kang X, Shelmerdine SC, Hurtado I, Bevilacqua E, Hutchinson C, Mandalia U, Segers V, Cos Sanchez T, Cannie MM, Carlin A, Sebire NJ, Arthurs OJ, Jani JC. Postmortem examination of human fetuses: comparison of two-dimensional ultrasound with invasive autopsy. Ultrasound Obstet Gynecol 2019; 53:229-238. [PMID: 28782198 DOI: 10.1002/uog.18828] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/09/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy of postmortem ultrasound performed by operators blinded to prenatal findings and to invasive autopsy results in fetuses at different gestational ages and to investigate the effect of various parameters on its diagnostic success. METHODS We performed postmortem two-dimensional ultrasound examination, blinded to clinical details, on 163 fetuses at 13-42 weeks' gestation. Logistic regression analysis was used to investigate the effect of: (i) gestational age at postmortem ultrasound, (ii) presence of maceration and (iii) mode of death, on whether the exam succeeded or failed to reach a diagnosis. In 123 cases in which invasive autopsy was available, the diagnostic accuracy of ultrasound in detecting major organ abnormalities was evaluated, using invasive autopsy as the gold standard. RESULTS For the fetal brain, postmortem ultrasound exam was non-diagnostic in significantly more fetuses with maceration (39.5%; 17/43) vs those without maceration (20.0%; 24/120) (P = 0.013). For the fetal thorax, the exam was non-diagnostic in 34.1% (15/44) of fetuses < 20 weeks of gestation and in 10.9% (13/119) of fetuses ≥ 20 weeks (P < 0.001). For the heart and abdominal organs, there was no association between non-diagnostic postmortem ultrasound and the variables tested. For fetuses < 20 weeks, specificity of postmortem ultrasound examination was 83.3% for detection of anomalies of the brain, 68.6% for the thorax and 77.4% for the heart. For fetuses ≥ 20 weeks, sensitivity and specificity were, respectively, 61.9% and 74.2% for detection of anomalies of the brain, 29.5% and 87.0% for the thorax and 65.0% and 83.1% for the heart. For the fetal abdominal organs, sensitivity was 60.7% and specificity 75.8%, and postmortem ultrasound was particularly useful for detection of abnormalities of the kidneys, irrespective of gestational age. CONCLUSION Although maceration may lead to failure of postmortem ultrasound examination in some cases, this technique achieves diagnostically acceptable levels of accuracy for fetal brain and abdominal organs, compared with conventional autopsy. It may therefore play a role as a first-line examination before other virtual autopsy techniques are indicated. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- X Kang
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - I Hurtado
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - E Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - C Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - U Mandalia
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - V Segers
- Department of Feto-Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - T Cos Sanchez
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - N J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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