Stephanie Aroney, Thomas Lloyd, Simone Birch, Belinda Godwin, Kylie Walters, Jeremy Khoo, Simone Geere, Linda Shen, Petar Vujovic, Ian Bennett, Gorane Santamaría
Introduction
The purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment.
Methods
This retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected.
Results
Mean pathological tumour size was 36.4 mm (range 5–140 mm). Dense breasts had larger tumours compared to non-dense breasts (P = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non-MRI subgroup, 64% (14/22) of patients underwent breast-conserving surgery, but 29% of them (4/14) required a second-stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (P = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (P < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE.
Conclusion
Breast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.
{"title":"Preoperative breast MR imaging influences surgical management in patients with invasive lobular carcinoma","authors":"Stephanie Aroney, Thomas Lloyd, Simone Birch, Belinda Godwin, Kylie Walters, Jeremy Khoo, Simone Geere, Linda Shen, Petar Vujovic, Ian Bennett, Gorane Santamaría","doi":"10.1111/1754-9485.13754","DOIUrl":"10.1111/1754-9485.13754","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean pathological tumour size was 36.4 mm (range 5–140 mm). Dense breasts had larger tumours compared to non-dense breasts (<i>P</i> = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non-MRI subgroup, 64% (14/22) of patients underwent breast-conserving surgery, but 29% of them (4/14) required a second-stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (<i>P</i> = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (<i>P</i> < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Breast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"680-686"},"PeriodicalIF":2.2,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shu Su, Xiao Chen, Sarah Warby, Julie Tate, Penelope Brooke, Shane Barwood, Gregory Hoy, Brendan Soo, Richard Dallalana, Warwick Wright, Andrew H Rotstein
Introduction
Acromial stress fracture (ASF) is an uncommon but acknowledged complication of reverse total shoulder arthroplasty (RTSA). There is no standardised method to directly measure the bone mineral density of the acromion to allow a detailed analysis of the potential mechanism of ASF. The aim is to establish a reliable and reproducible technique for measurement of acromial density on computer tomography (CT).
Methods
A retrospective review on CT scans obtained for three groups of patients: those planned for RTSA (n = 26); age and gender-matched non-operative (n = 26); and young non-operative patients (n = 28) were performed. Standardised axial images of 1 mm thickness at 1 mm increments were created following horizontal straightening on the coronal and sagittal views. To assess inter-rater reliability, two senior CT radiographers performed density measurements using standard region of interest (ROI) tool on the CTs with the ROI placed on the mid (ROI 1) and posterior (ROI 2) acromion. ROIs were selected as the most common locations for acromion fracture post RTSA. Measurements were repeated at least 6 weeks apart. Intra-class coefficients (ICC) were used to determine intra- and inter-rater reliability.
Results
ICCs demonstrated good to high intra-rater and inter-rater reliability for both ROI 1 and ROI 2 across all three groups. The lower margin of 95% confidence intervals was more than 0 for all intra-class coefficients.
Conclusion
This study demonstrates a reliable method of measuring acromion density on CT. This method can be used to assess bone mineral density in the clinical setting and in future studies investigating ASF following RTSA.
{"title":"Reliable technique for acromion density assessment on CT","authors":"Shu Su, Xiao Chen, Sarah Warby, Julie Tate, Penelope Brooke, Shane Barwood, Gregory Hoy, Brendan Soo, Richard Dallalana, Warwick Wright, Andrew H Rotstein","doi":"10.1111/1754-9485.13742","DOIUrl":"10.1111/1754-9485.13742","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acromial stress fracture (ASF) is an uncommon but acknowledged complication of reverse total shoulder arthroplasty (RTSA). There is no standardised method to directly measure the bone mineral density of the acromion to allow a detailed analysis of the potential mechanism of ASF. The aim is to establish a reliable and reproducible technique for measurement of acromial density on computer tomography (CT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review on CT scans obtained for three groups of patients: those planned for RTSA (<i>n</i> = 26); age and gender-matched non-operative (<i>n</i> = 26); and young non-operative patients (<i>n</i> = 28) were performed. Standardised axial images of 1 mm thickness at 1 mm increments were created following horizontal straightening on the coronal and sagittal views. To assess inter-rater reliability, two senior CT radiographers performed density measurements using standard region of interest (ROI) tool on the CTs with the ROI placed on the mid (ROI 1) and posterior (ROI 2) acromion. ROIs were selected as the most common locations for acromion fracture post RTSA. Measurements were repeated at least 6 weeks apart. Intra-class coefficients (ICC) were used to determine intra- and inter-rater reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ICCs demonstrated good to high intra-rater and inter-rater reliability for both ROI 1 and ROI 2 across all three groups. The lower margin of 95% confidence intervals was more than 0 for all intra-class coefficients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates a reliable method of measuring acromion density on CT. This method can be used to assess bone mineral density in the clinical setting and in future studies investigating ASF following RTSA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"673-679"},"PeriodicalIF":2.2,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chi Lap Nicholas Tsang, David Luong, Troy Stapleton
Despite ubiquitous use of medical imaging in daily medical practice, the quality of referrals varies significantly across a variety of practice types and locations. This systematic review summarises studies in the literature that have employed interventions aimed at improving radiology referrals, excluding clinical decision support software. A systematic review of literature was conducted in PubMed, EMBASE, Scopus, and Cochrane. Two reviewers independently identified studies for inclusion. All studies that included interventions with any outcome measure were included. Any irrelevant studies, non-English studies or not retrievable studies were excluded. Studies were grouped into Education, Feedback, Rationing, Penalties, and Other. The outcomes of the studies were summarised and qualitatively analysed due to anticipated heterogeneity. Four thousand six hundred and forty-two studies were identified throughout PubMed, EMBASE, Scopus, and Cochrane. One hundred and eighty-seven duplicates were removed and 4436 abstracts were screened. Two hundred and forty were identified on the first phase of the screening with 167 then excluded for non-relevancy. Seventy-five full studies were included in the final analysis following the addition of 2 additional studies. Fifty-seven studies were grouped into Education, 10 into Feedback, 4 into Rationing, 8 into Penalties, 9 into Other and 11 containing multiple. Eighty-four percent of the studies reported an improvement in the quality of the referrals. Despite a variable rate of quality referrals, there are many interventions that radiology departments across the world can utilise to improve the referral process.
{"title":"Systematic review of interventions aimed at improving the quality of referrals to radiology","authors":"Chi Lap Nicholas Tsang, David Luong, Troy Stapleton","doi":"10.1111/1754-9485.13736","DOIUrl":"10.1111/1754-9485.13736","url":null,"abstract":"<div>\u0000 \u0000 <p>Despite ubiquitous use of medical imaging in daily medical practice, the quality of referrals varies significantly across a variety of practice types and locations. This systematic review summarises studies in the literature that have employed interventions aimed at improving radiology referrals, excluding clinical decision support software. A systematic review of literature was conducted in PubMed, EMBASE, Scopus, and Cochrane. Two reviewers independently identified studies for inclusion. All studies that included interventions with any outcome measure were included. Any irrelevant studies, non-English studies or not retrievable studies were excluded. Studies were grouped into Education, Feedback, Rationing, Penalties, and Other. The outcomes of the studies were summarised and qualitatively analysed due to anticipated heterogeneity. Four thousand six hundred and forty-two studies were identified throughout PubMed, EMBASE, Scopus, and Cochrane. One hundred and eighty-seven duplicates were removed and 4436 abstracts were screened. Two hundred and forty were identified on the first phase of the screening with 167 then excluded for non-relevancy. Seventy-five full studies were included in the final analysis following the addition of 2 additional studies. Fifty-seven studies were grouped into Education, 10 into Feedback, 4 into Rationing, 8 into Penalties, 9 into Other and 11 containing multiple. Eighty-four percent of the studies reported an improvement in the quality of the referrals. Despite a variable rate of quality referrals, there are many interventions that radiology departments across the world can utilise to improve the referral process.</p>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"687-695"},"PeriodicalIF":2.2,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study compared the predictive ability of radiation-induced cataract between maximum point dose of the lens (Lens Dmax) ≥7 Gy, mean lens dose (Lens Dmean) ≥7 Gy, Lens Dmax ≥10 Gy, and Lens Dmean ≥10 Gy.
Methods
Patients aged 3–18 years received cranial irradiation or radiation therapy at head and neck area between January 2010 and December 2019 at our institute were included. Patients without baseline and/or follow-up eye examination were excluded. Receiver operating characteristic (ROC) curves identified potential predictors and Cox regression analysed correlations between potential factors and cataract occurrence.
Results
Sixty-three patients (122 eyes) were analysed. Cataracts were detected in 14 eyes (11.5%). Median follow-up time was 4 years (range 0.5–10 years), with cataract developing in a median of 2.5 years (range 0.3–7 years). Three patients (21.4%) developed grade ≥3 cataract. Lens Dmean ≥10 Gy was associated with cataract formation.
Conclusion
Lens Dmean ≥10 Gy showed the highest ability for predicting radiation-induced cataract in paediatric patients. Net reclassification improvement (NRI) suggested that changing lens dose constraint from Dmax <7 Gy to Dmean <10 Gy would miss 7% of cataract cases but avoid 28% of unnecessary restrictions. Adopting a mean lens dose <10 Gy was suggested as a constraint for lens dose.
{"title":"Comparison of dosimetric parameters for predicting radiation-induced cataract in paediatric patients","authors":"Siriphan Leangcharoensap, Kullathorn Thephamongkhol, Putthipong Chanwichu, Teeradon Treechairusame, Nan Suntornpong, Warissara Rongthong","doi":"10.1111/1754-9485.13748","DOIUrl":"10.1111/1754-9485.13748","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study compared the predictive ability of radiation-induced cataract between maximum point dose of the lens (Lens Dmax) ≥7 Gy, mean lens dose (Lens Dmean) ≥7 Gy, Lens Dmax ≥10 Gy, and Lens Dmean ≥10 Gy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged 3–18 years received cranial irradiation or radiation therapy at head and neck area between January 2010 and December 2019 at our institute were included. Patients without baseline and/or follow-up eye examination were excluded. Receiver operating characteristic (ROC) curves identified potential predictors and Cox regression analysed correlations between potential factors and cataract occurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-three patients (122 eyes) were analysed. Cataracts were detected in 14 eyes (11.5%). Median follow-up time was 4 years (range 0.5–10 years), with cataract developing in a median of 2.5 years (range 0.3–7 years). Three patients (21.4%) developed grade ≥3 cataract. Lens Dmean ≥10 Gy was associated with cataract formation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lens Dmean ≥10 Gy showed the highest ability for predicting radiation-induced cataract in paediatric patients. Net reclassification improvement (NRI) suggested that changing lens dose constraint from Dmax <7 Gy to Dmean <10 Gy would miss 7% of cataract cases but avoid 28% of unnecessary restrictions. Adopting a mean lens dose <10 Gy was suggested as a constraint for lens dose.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 7","pages":"835-842"},"PeriodicalIF":2.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1754-9485.13748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mayooran Kandasamy, Stanley Xue, Nigel McGregor, Hao Xiang
Introduction
Central venous catheter (CVC) tip placement guided by chest X-ray (CXR) landmarks is currently prone to inconsistency and malpositioning. This study aims to better define the relationship between the cavoatrial junction (CAJ) and selected X-ray landmarks.
Methods
Chest CTs of 100 patients were retrospectively assessed. CT images were converted to a ‘virtual CXR’ using a digital workstation, enabling simultaneous localisation of the CAJ and evaluation of CXR landmarks. Vertical distances between the CAJ and selected landmarks were measured for each patient. Measurements were assessed for correlation with age and compared between age groups and sexes.
Results
The mean vertical distance of the following landmarks above the CAJ was found: the carina (46.2 mm), the intersection of the bronchus intermedius and the right heart border (7.6 mm) and the superior inflection of the right heart border (Sup-RHB) (13.0 mm). The maximum lateral bulge of the right heart border (Lat-RHB) was 18.4 mm below the CAJ. A new landmark: the mid-superior right heart border, defined as the mid-point between the Sup-RHB and Lat-RHB, was the closest to the CAJ, lying 2.6 mm below the CAJ.
Conclusion
We propose that the CVC tip can be placed at the mid-superior right heart border landmark.
{"title":"Optimising central venous catheter placement by comparing cavoatrial junction position to chest X-ray landmarks: A cross-sectional study using CT chest reconstruction","authors":"Mayooran Kandasamy, Stanley Xue, Nigel McGregor, Hao Xiang","doi":"10.1111/1754-9485.13741","DOIUrl":"10.1111/1754-9485.13741","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Central venous catheter (CVC) tip placement guided by chest X-ray (CXR) landmarks is currently prone to inconsistency and malpositioning. This study aims to better define the relationship between the cavoatrial junction (CAJ) and selected X-ray landmarks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Chest CTs of 100 patients were retrospectively assessed. CT images were converted to a ‘virtual CXR’ using a digital workstation, enabling simultaneous localisation of the CAJ and evaluation of CXR landmarks. Vertical distances between the CAJ and selected landmarks were measured for each patient. Measurements were assessed for correlation with age and compared between age groups and sexes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean vertical distance of the following landmarks above the CAJ was found: the carina (46.2 mm), the intersection of the bronchus intermedius and the right heart border (7.6 mm) and the superior inflection of the right heart border (Sup-RHB) (13.0 mm). The maximum lateral bulge of the right heart border (Lat-RHB) was 18.4 mm below the CAJ. A new landmark: the mid-superior right heart border, defined as the mid-point between the Sup-RHB and Lat-RHB, was the closest to the CAJ, lying 2.6 mm below the CAJ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We propose that the CVC tip can be placed at the mid-superior right heart border landmark.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"667-672"},"PeriodicalIF":2.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Epipericardial fat necrosis (EFN) is a rare benign, self-limiting cause of acute chest pain that mimics serious clinical conditions such as acute coronary syndrome and pulmonary embolism.<span><sup>1</sup></span></p><p>The exact prevalence is unknown due to its rare occurrence.<span><sup>1</sup></span> Seventy to ninety per cent of EFN cases are misdiagnosed and often result in over-investigation and unnecessary invasive biopsies.<span><sup>2</sup></span> Clinically, EFN manifests as acute chest pain, tachycardia and diaphoresis.<span><sup>1, 3</sup></span> Blood results may include elevated D-dimer, CRP and white blood cell counts.<span><sup>1, 3</sup></span> Serum troponin levels are usually within normal limits.<span><sup>1</sup></span></p><p>Given the low specificity of clinical findings and blood tests, computed tomography (CT) is paramount for its opportunistic diagnosis. The main CT findings include an encapsulated or well-circumscribed ovoid fatty lesion with surrounding inflammatory changes within epicardial fat.<span><sup>1, 3</sup></span></p><p>A 39-year-old woman (Gravida-2, Para-1) presented with acute retrosternal chest pain, pleurisy and palpitations 4 days after an egg retrieval procedure. Her past medical history includes stage four endometriosis and mild–moderate ovarian hyperstimulation syndrome (conservatively managed).</p><p>Her medications include Orgalutran (gonadotrophin-releasing hormone antagonist), and Ovidrel trigger shot (beta-human chorionic gonadotrophin) administered 48 h before oocyte retrieval. There was no history of sepsis or preceding trauma.</p><p>The patient was mildly hypertensive (143/92 mmHg) and tachycardic (107 bpm) with good oxygen saturation (98%) and normal respiratory rate (12/min). She had vague focal tenderness on palpation over the left parasternal region. She had an elevated white blood cell count 16.5 (×10<sup>9</sup>/L) (4–11 × 10<sup>9</sup>/L) with neutrophilia 15.5 (×10<sup>9</sup>/L) (2–8 × 10<sup>9</sup>/L), C-reactive protein 56 mg/L (<10 mg/L), D-dimer 14.96 μg/mL (<0.5 μg/mL) and troponin 4 ng/L (<11 ng/L). ECG showed sinus tachycardia. The remaining clinical and biochemical profiles were unremarkable.</p><p>Computed tomography pulmonary angiogram was negative for pulmonary embolism. Within the epicardial fat, there was a 15 × 18 × 10 mm soft tissue density structure with surrounding extensive fat stranding (Figs 1-3). There was no pericardial effusion or overlying chondroosseous fracture.</p><p>The patient was discharged with a working diagnosis of EFN and had a 3-month follow-up CT which demonstrated complete resolution of the ovoid soft tissue structure with mild residual fat stranding (Figs 4,5).</p><p>The exact pathophysiology of EFN is not well understood. Major theories include inflammatory changes within the epipericardial fat and necrosis triggered by torsion of a vascularised fat appendage, Valsalva manoeuvre and trauma.<span><sup>1, 3</sup></span></p><p>Although
{"title":"Spontaneous atraumatic epipericardial fat necrosis in the context of recent oocyte retrieval and ovarian hyperstimulation syndrome","authors":"Lea Tiffany, Ranjit Singh, Lincoln J Lim","doi":"10.1111/1754-9485.13750","DOIUrl":"10.1111/1754-9485.13750","url":null,"abstract":"<p>Epipericardial fat necrosis (EFN) is a rare benign, self-limiting cause of acute chest pain that mimics serious clinical conditions such as acute coronary syndrome and pulmonary embolism.<span><sup>1</sup></span></p><p>The exact prevalence is unknown due to its rare occurrence.<span><sup>1</sup></span> Seventy to ninety per cent of EFN cases are misdiagnosed and often result in over-investigation and unnecessary invasive biopsies.<span><sup>2</sup></span> Clinically, EFN manifests as acute chest pain, tachycardia and diaphoresis.<span><sup>1, 3</sup></span> Blood results may include elevated D-dimer, CRP and white blood cell counts.<span><sup>1, 3</sup></span> Serum troponin levels are usually within normal limits.<span><sup>1</sup></span></p><p>Given the low specificity of clinical findings and blood tests, computed tomography (CT) is paramount for its opportunistic diagnosis. The main CT findings include an encapsulated or well-circumscribed ovoid fatty lesion with surrounding inflammatory changes within epicardial fat.<span><sup>1, 3</sup></span></p><p>A 39-year-old woman (Gravida-2, Para-1) presented with acute retrosternal chest pain, pleurisy and palpitations 4 days after an egg retrieval procedure. Her past medical history includes stage four endometriosis and mild–moderate ovarian hyperstimulation syndrome (conservatively managed).</p><p>Her medications include Orgalutran (gonadotrophin-releasing hormone antagonist), and Ovidrel trigger shot (beta-human chorionic gonadotrophin) administered 48 h before oocyte retrieval. There was no history of sepsis or preceding trauma.</p><p>The patient was mildly hypertensive (143/92 mmHg) and tachycardic (107 bpm) with good oxygen saturation (98%) and normal respiratory rate (12/min). She had vague focal tenderness on palpation over the left parasternal region. She had an elevated white blood cell count 16.5 (×10<sup>9</sup>/L) (4–11 × 10<sup>9</sup>/L) with neutrophilia 15.5 (×10<sup>9</sup>/L) (2–8 × 10<sup>9</sup>/L), C-reactive protein 56 mg/L (<10 mg/L), D-dimer 14.96 μg/mL (<0.5 μg/mL) and troponin 4 ng/L (<11 ng/L). ECG showed sinus tachycardia. The remaining clinical and biochemical profiles were unremarkable.</p><p>Computed tomography pulmonary angiogram was negative for pulmonary embolism. Within the epicardial fat, there was a 15 × 18 × 10 mm soft tissue density structure with surrounding extensive fat stranding (Figs 1-3). There was no pericardial effusion or overlying chondroosseous fracture.</p><p>The patient was discharged with a working diagnosis of EFN and had a 3-month follow-up CT which demonstrated complete resolution of the ovoid soft tissue structure with mild residual fat stranding (Figs 4,5).</p><p>The exact pathophysiology of EFN is not well understood. Major theories include inflammatory changes within the epipericardial fat and necrosis triggered by torsion of a vascularised fat appendage, Valsalva manoeuvre and trauma.<span><sup>1, 3</sup></span></p><p>Although ","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"696-698"},"PeriodicalIF":2.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1754-9485.13750","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advanced Practice Radiation Therapy roles offer a solution to improving patient care and impacting service delivery","authors":"Rebecca Height BAppSc(MedRad), MSc (Research), Kristie Matthews BAppSc(MedRad), MTrainDev, PhD, Sandro V Porceddu BSc, MBBS, FRANZCR MD (Research)","doi":"10.1111/1754-9485.13751","DOIUrl":"10.1111/1754-9485.13751","url":null,"abstract":"","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"770"},"PeriodicalIF":2.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ilana N Ackerman, Fiona Doukas, Rachelle Buchbinder, Sally Dooley, Wendy Favorito, Phoebe Holdenson Kimura, David J Hunter, James Linklater, John B North, Louise Elvin-Walsh, Christopher Vertullo, Alice L Bhasale, Samantha Bunzli
<p>Knee osteoarthritis is a prevalent and disabling condition that impacts activities of daily living, participation in work and family roles and overall quality of life. With population growth and ageing, an increasing number of Australians are living with knee osteoarthritis (over 1.9 million people in 2019, representing 126% growth relative to 1990 numbers).<span><sup>1</sup></span> National estimates indicate that knee osteoarthritis is associated with over 59,000 years lived with disability annually, exceeding the disability burden of dementia, stroke or ischaemic heart disease.<span><sup>1</sup></span> Knee osteoarthritis also has a major economic impact in Australia, with over $3.5 billion spent annually on osteoarthritis-related hospital admissions<span><sup>2</sup></span> and an estimated productivity loss of $424 billion.<span><sup>3</sup></span> International clinical guidelines consistently recommend non-surgical modalities as the mainstay of knee osteoarthritis management, with referral for consideration of joint replacement surgery reserved for people with late-stage disease.<span><sup>4-6</sup></span> Concerningly, low value care (care that is wasteful, ineffective and/or harmful) persists across the knee osteoarthritis journey. This is often fuelled by misconceptions about osteoarthritis, including inaccurate beliefs around diagnosis and management, that are amenable to change through education and effective communication.<span><sup>7</sup></span></p><p>The Australian Commission on Safety and Quality in Health Care has developed a range of Clinical Care Standards. These aim to: (i) support the delivery of evidence-based clinical care for a health condition or procedure; (ii) reduce variation in clinical care across Australia; and (iii) promote shared decision making between health professionals and consumers. Unlike clinical guidelines, Clinical Care Standards do not describe all the components of care. Instead, they encompass a limited set of quality statements that describe the expected care for a health condition or procedure and highlight priorities for quality improvement.</p><p>Evidence of low value osteoarthritis care (specifically, high rates of knee arthroscopy among older Australians, with substantial geographic variation)<span><sup>8</sup></span> pointed to the need for the first Clinical Care Standard targeting knee osteoarthritis. In 2017, the Osteoarthritis of the Knee Clinical Care Standard was launched following a comprehensive development process that involved topic experts and consumers, wider stakeholder consultation and national peak body endorsement. Seven years on, we introduce the updated Osteoarthritis of the Knee Clinical Care Standard and indicator set (available at www.safetyandquality.gov.au/oak-ccs),<span><sup>9</sup></span> which have been carefully revised to ensure alignment with new evidence, contemporary international guidelines and advances in person-centred care. The updates also target current
{"title":"Ensuring a fit-for-purpose resource for consumers, clinicians and health services: The updated Osteoarthritis of the Knee Clinical Care Standard","authors":"Ilana N Ackerman, Fiona Doukas, Rachelle Buchbinder, Sally Dooley, Wendy Favorito, Phoebe Holdenson Kimura, David J Hunter, James Linklater, John B North, Louise Elvin-Walsh, Christopher Vertullo, Alice L Bhasale, Samantha Bunzli","doi":"10.1111/1754-9485.13732","DOIUrl":"10.1111/1754-9485.13732","url":null,"abstract":"<p>Knee osteoarthritis is a prevalent and disabling condition that impacts activities of daily living, participation in work and family roles and overall quality of life. With population growth and ageing, an increasing number of Australians are living with knee osteoarthritis (over 1.9 million people in 2019, representing 126% growth relative to 1990 numbers).<span><sup>1</sup></span> National estimates indicate that knee osteoarthritis is associated with over 59,000 years lived with disability annually, exceeding the disability burden of dementia, stroke or ischaemic heart disease.<span><sup>1</sup></span> Knee osteoarthritis also has a major economic impact in Australia, with over $3.5 billion spent annually on osteoarthritis-related hospital admissions<span><sup>2</sup></span> and an estimated productivity loss of $424 billion.<span><sup>3</sup></span> International clinical guidelines consistently recommend non-surgical modalities as the mainstay of knee osteoarthritis management, with referral for consideration of joint replacement surgery reserved for people with late-stage disease.<span><sup>4-6</sup></span> Concerningly, low value care (care that is wasteful, ineffective and/or harmful) persists across the knee osteoarthritis journey. This is often fuelled by misconceptions about osteoarthritis, including inaccurate beliefs around diagnosis and management, that are amenable to change through education and effective communication.<span><sup>7</sup></span></p><p>The Australian Commission on Safety and Quality in Health Care has developed a range of Clinical Care Standards. These aim to: (i) support the delivery of evidence-based clinical care for a health condition or procedure; (ii) reduce variation in clinical care across Australia; and (iii) promote shared decision making between health professionals and consumers. Unlike clinical guidelines, Clinical Care Standards do not describe all the components of care. Instead, they encompass a limited set of quality statements that describe the expected care for a health condition or procedure and highlight priorities for quality improvement.</p><p>Evidence of low value osteoarthritis care (specifically, high rates of knee arthroscopy among older Australians, with substantial geographic variation)<span><sup>8</sup></span> pointed to the need for the first Clinical Care Standard targeting knee osteoarthritis. In 2017, the Osteoarthritis of the Knee Clinical Care Standard was launched following a comprehensive development process that involved topic experts and consumers, wider stakeholder consultation and national peak body endorsement. Seven years on, we introduce the updated Osteoarthritis of the Knee Clinical Care Standard and indicator set (available at www.safetyandquality.gov.au/oak-ccs),<span><sup>9</sup></span> which have been carefully revised to ensure alignment with new evidence, contemporary international guidelines and advances in person-centred care. The updates also target current ","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"774-780"},"PeriodicalIF":2.2,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1754-9485.13732","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The trainee research curriculum: Time to ENHANCE it?","authors":"Daniel E Roos, Paulina Stehlik, Paul M Parizel","doi":"10.1111/1754-9485.13735","DOIUrl":"10.1111/1754-9485.13735","url":null,"abstract":"","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"771-773"},"PeriodicalIF":2.2,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Mark, Isabella Papalia, Jeffrey KC Lai, Diane M Pascoe
Introduction
Early-stage lung cancer diagnosis through detection of nodules on computed tomography (CT) remains integral to patient survivorship, promoting national screening programmes and diagnostic tools using artificial intelligence (AI) convolutional neural networks (CNN); the software of AI-Rad Companion™ (AIRC), capable of self-optimising feature recognition. This study aims to demonstrate the practical value of AI-based lung nodule detection in a clinical setting; a limited body of research.
Methods
One hundred and eighty-three non-contrast CT chest studies from a single centre were assessed for AIRC software analysis. Prospectively collected data from AIRC detection and characterisation of lung nodules (size: ≥3 mm) were assessed against the reference standard; reported findings of a blinded consultant radiologist.
Results
One hundred and sixty-seven CT chest studies were included; 52% indicated for nodule or lung cancer surveillance. Of 289 lung nodules, 219 (75.8%) nodules (mean size: 10.1 mm) were detected by both modalities, 28 (9.7%) were detected by AIRC alone and 42 (14.5%) by radiologist alone. Solid nodules missed by AIRC were larger than those missed by radiologist (11.5 mm vs 4.7 mm, P < 0.001). AIRC software sensitivity was 87.3%, with significant false positive and negative rates demonstrating 12.5% specificity (PPV 0.6, NPV 0.4).
Conclusion
In a population of high nodule prevalence, AIRC lung nodule detection software demonstrates sensitivity comparable to that of consultant radiologist. The clinical significance of larger sized nodules missed by AIRC software presents a barrier to current integration in practice. We consider this research highly relevant in providing focus for ongoing software development, potentiating the future success of AI-based tools within diagnostic radiology.
{"title":"Clinical application of convolutional neural network lung nodule detection software: An Australian quaternary hospital experience","authors":"Peter Mark, Isabella Papalia, Jeffrey KC Lai, Diane M Pascoe","doi":"10.1111/1754-9485.13734","DOIUrl":"10.1111/1754-9485.13734","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Early-stage lung cancer diagnosis through detection of nodules on computed tomography (CT) remains integral to patient survivorship, promoting national screening programmes and diagnostic tools using artificial intelligence (AI) convolutional neural networks (CNN); the software of AI-Rad Companion™ (AIRC), capable of self-optimising feature recognition. This study aims to demonstrate the practical value of AI-based lung nodule detection in a clinical setting; a limited body of research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred and eighty-three non-contrast CT chest studies from a single centre were assessed for AIRC software analysis. Prospectively collected data from AIRC detection and characterisation of lung nodules (size: ≥3 mm) were assessed against the reference standard; reported findings of a blinded consultant radiologist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and sixty-seven CT chest studies were included; 52% indicated for nodule or lung cancer surveillance. Of 289 lung nodules, 219 (75.8%) nodules (mean size: 10.1 mm) were detected by both modalities, 28 (9.7%) were detected by AIRC alone and 42 (14.5%) by radiologist alone. Solid nodules missed by AIRC were larger than those missed by radiologist (11.5 mm vs 4.7 mm, <i>P</i> < 0.001). AIRC software sensitivity was 87.3%, with significant false positive and negative rates demonstrating 12.5% specificity (PPV 0.6, NPV 0.4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In a population of high nodule prevalence, AIRC lung nodule detection software demonstrates sensitivity comparable to that of consultant radiologist. The clinical significance of larger sized nodules missed by AIRC software presents a barrier to current integration in practice. We consider this research highly relevant in providing focus for ongoing software development, potentiating the future success of AI-based tools within diagnostic radiology.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"659-666"},"PeriodicalIF":2.2,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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