Clinical Imaging最新文献

Purpose

To assess the anatomical complexity of the left atrial appendage (LAA) using fractal dimension (FD) based on cardiac computed tomography angiography (CTA) and the association between LAA FD and LAA thrombosis.

Materials and methods

Patients with atrial fibrillation (AF) who underwent both cardiac CTA and transesophageal echocardiography (TEE) between December 2018 and December 2022 were retrospectively analyzed. Patients were categorized into normal (n = 925), circulatory stasis (n = 82), and thrombus groups (n = 76) based on TEE results and propensity score matching (PSM) was performed for subsequent analysis. FD was calculated to quantify the morphological heterogeneity of LAA. Independent risk factors for thrombus were screened using logistic regression. The diagnostic performance of FD and CHA₂DS₂-VaSc score for predicting thrombus was evaluated using the area under the receiver operating characteristics curve (AUC).

Results

LAA FD was higher in the thrombus group (1.61 [1.49, 1.70], P < 0.001) than in the circulatory stasis (1.33 [1.18, 1.47]) and normal groups (1.30 [1.18, 1.42]) both before and after PSM. LAA FD was also an independent risk factor in the thrombus (OR [odds ratio] = 570,861.15 compared to normal, 41,122.87 compared to circulatory stasis; all P < 0.001) and circulatory stasis group (OR = 98.87, P = 0.001) after PSM. The diagnostic performance of LAA FD was significantly better than the CHA₂DS₂-VaSc score in identifying thrombus.

Conclusions

Patients with high LAA FD are more likely to develop LAA thrombus, and the use of FD provides an effective method for assessing the risk of thrombosis in AF patients, thereby guiding individualized clinical treatment.

Purpose

Diagnosing pulmonary embolism (PE) is still challenging due to other conditions that can mimic its appearance, leading to incomplete or delayed management and several inter-observer variabilities. This study evaluated the performance and clinical utility of an artificial intelligence (AI)-based application designed to assist clinicians in the detection of PE on CT pulmonary angiography (CTPA).

Patients and methods

CTPAs from 230 US cities acquired on 57 scanner models from 6 different vendors were retrospectively collected. Three US board certified expert radiologists defined the ground truth by majority agreement. The same cases were analyzed by CINA-PE, an AI-driven algorithm capable of detecting and highlighting suspected PE locations. The algorithm's performance at a per-case and per-finding level was evaluated. Furthermore, cases with PE not mentioned in the clinical report but correctly detected by the algorithm were analyzed.

Results

A total of 1204 CTPAs (mean age 62.1 years ± 16.6[SD], 44.4 % female, 14.9 % positive) were included in the study. Per-case sensitivity and specificity were 93.9 % (95%CI: 89.3 %–96.9 %) and 94.8 % (95%CI: 93.3 %–96.1 %), respectively. Per-finding positive predictive value was 89.5 % (95%CI: 86.7 %–91.9 %). Among the 196 positive cases, 29 (15.6 %) were not mentioned in the clinical report. The algorithm detected 22/29 (76 %) of these cases, leading to a reduction in the miss rate from 15.6 % to 3.8 % (7/186).

Conclusions

The AI-based application may improve diagnostic accuracy in detecting PE and enhance patient outcomes through timely intervention. Integrating AI tools in clinical workflows can reduce missed or delayed diagnoses, and positively impact healthcare delivery and patient care.

Purpose

Acute nipple inversion can be unsettling for patients and is sometimes associated with an underlying breast malignancy. It also poses a diagnostic challenge with lack of consensus management guidelines. This study reviewed institutional experience with new nipple inversion, including malignant association, imaging utilization, and outcomes, in an effort to improve management.

Methods

A multisite institutional retrospective review was conducted of all breast imaging reports from 1/2010 to 6/2022 mentioning nipple inversion as an indication or finding. Patients with new nipple inversion, defined as arising since the time of last breast imaging exam or if reported as new by the patient/provider, were included for analysis. Retroareolar imaging findings, BI-RADS assessments/recommendations, pathology obtained from percutaneous or excisional biopsies, and follow-up imaging and clinical exams were collated. Cases of chronic or stable nipple inversion were excluded. Descriptive statistics were performed.

Results

A total of 414 patients had new nipple inversion, 387/414 (93.5 %) with benign or negative results at initial imaging and 27/414 (6.5 %) with malignant lesions. Diagnostic mammography/ultrasound detected 25/27 (92.6 %) cancers (sensitivity 92.6 %, specificity 75.5 %, PPV 20.8 %, NPV 99.3 %). Of 62 breast MRI exams performed in patients with negative mammogram/ultrasound, no cancers were detected in the retroareolar space with 2 incidental malignant lesions discovered distant from the nipple.

Conclusion

Diagnostic mammography/ultrasound is reliable in workups of acute nipple inversion, with a high sensitivity and NPV for excluding malignancy. Breast MRI and surgical referral should be reserved for patients with suspicious associated symptoms or clinical findings.

Purpose

Computed tomographic colonography (CTC) is a non-invasive screening test for colorectal cancer (CRC) with high sensitivity and low risk of complications. We used a nationally representative sample of screening-eligible adults to examine trends in and factors associated with CTC use.

Methods

We examined CTC use among 58,058 adults in the National Health Interview Survey in 2010, 2015, 2018, 2019, and 2021. For each survey year, we estimated CTC use by sociodemographic and health factors. We used multivariable logistic regression to identify factors associated with CTC use.

Results

A total of 1.7 % adults reported receiving CTC across all survey years. CTC use was similar in 2010 (1.3 %), 2015 (0.8 %), 2018 (1.4 %), and 2019 (1.4 %) but increased in 2021 (3.5 %, p < 0.05). In multivariable analysis, survey year 2021 [vs. 2010, odds ratio (OR) 2.51, 95 % confidence interval (CI) 1.83–3.43], Hispanic (OR 1.73, 95 % CI 1.34–2.23), non-Hispanic Black (OR 2.07, 95 % CI 1.67–2.57), and household income <200 % federal poverty level (vs. >400 %, OR 1.25, 95 % CI 1.01–1.57) was associated with CTC use. Further, adults with a history of diabetes (OR 1.20, 95 % CI 1.01–1.45), chronic obstructive pulmonary disease (OR 1.58, 95 % CI 1.25–1.99), cancer (OR 1.29, 95 % CI 1.05–1.58), or past-year hospital admissions (OR 1.44, 95 % CI 1.18–1.78) were more likely to receive CTC.

Conclusion

CTC use remained low from 2010 to 2019 but increased in 2021. CTC use was more frequent among adults with chronic health conditions, minorities, and adults with lower income, and may help reduce disparities in CRC screening.

Demand for online educational tools has risen steadily as technological innovations have evolved over the past several decades. Websites were the first platform to be introduced, and eventually used for online schooling, soon after the advent of the World Wide Web. Access to information and updated content in a short period of time on a wide-screen device such as a computer made websites popular early in their development. With the technological revolution of smart phones, mobile applications have been developed on various operating systems and, through this progress, a new form of educational platform was initiated. The portable features of mobile applications represent a pioneer era of educational tools for medical professionals. Online communications have transformed into social media over the last decade and have since been adopted by much of the world. All three of these educational platforms have created a significant impact on medical education communities, specifically in radiology. We describe the relative strengths of each platform and illustrate how our experience over more than two decades guides our recommendations.

Rationale and objectives

Many barriers to breastfeeding upon return to the workplace are reported by female radiologists, which have implications on maternal/infant health and physician burnout. The Department of Radiology at our institution piloted an initiative to provide a free portable breast pump to address these barriers.

Materials and methods

An anonymous voluntary 32-question survey assessing the impact of the portable pump on postpartum work-life integration was sent to all female radiologists and radiologists-in-training in the department from May 2023 to July 2023.

Results

A total of 59 surveys were completed (65 % response rate). Overall, respondents reported a positive or very positive impact of the pump on transitioning back to work (median 4.5/5 on a 5-point Likert scale), on their decision to continue breastfeeding when returning to work (median 4/5), and duration of breastfeeding (median 4/5). Use of the pump was reported as favorable, with utilization of the pump while simultaneously engaging in clinical work (median 4.5/5) obviating necessity of dedicated lactation rooms, and positive impact on daily productivity (median score of 4/5). Nearly all (94 %, 16/17) users of the portable pump had their lactational needs addressed while returning to work, compared to 54 % (6/13) of those returning from leave prior to the pump initiative (p = 0.003). Compared to those utilizing traditional lactational resources, those who utilized the portable pump were significantly less likely to miss educational opportunities (0 % vs 44 %, p = 0.03), or academic engagements due to lactational practices at work (0 % v 44 %, p = 0.01).

Conclusion

A department-sponsored portable breast pump initiative proved to be an effective resource to support physician breastfeeding and work-life integration.

Objective

This study aims to assess the efficacy of polyenergetic reconstruction methods in reducing streak artifacts caused by dual source imaging in Photon Counting Detector Computed Tomography (PCD-CT) imaging, thereby improving image quality and diagnostic accuracy.

Methods

A retrospective cohort study was conducted, involving 50 patients who underwent chest Computed Tomography Angiography with PCD-CT, focusing on those with streak artifacts. Quantitative and qualitative analyses were performed on images reconstructed using monoenergetic and polyenergetic techniques. Quantitative evaluations measured the attenuation of tracheal air density in regions affected by streak artifacts, while qualitative assessments employed a modified Likert scale to rate image quality. Statistical analyses included Wilcoxon's signed-rank tests and Spearman's correlation, alongside assessments of inter-rater reliability.

Results

There was significantly lower attenuation of tracheal air density on the polyenergetic reconstructions (Median − 1010 ± 62 HU vs −930 ± 110 HU; P < 0.001), and significantly decreased variation on the polyenergetic reconstructions (Median 65.2 ± 79.5 HU vs 38.8 ± 33.9 HU; P < 0.001). The median modified-Likert scale were significantly better for the polyenergetic reconstructions (median modified-Likert 4 ± 0.5 vs 2.5 ± 1; P < 0.001). The inter-rater agreement was substantial and not significantly different between reconstructions (Gwet's ACPolyenergetic = 0.78 vs Gwet's ACVMI = 0.775).

Conclusion

Polyenergetic reconstruction significantly mitigates streak artifacts in PCD-CT imaging, enhancing quantitative and qualitative image quality. This advancement addresses a known limitation of current PCD-CT reconstruction techniques, offering a promising approach to improving diagnostic reliability and accuracy in clinical practice. We demonstrate that future software implementations can resolve this artifact.

Purpose

To compare the indications, specimen quality, and cost of CT versus non-image guided bone marrow aspirate and biopsy (BMAB).

Methods

All CT and non-image guided BMAB performed from January 2013–July 2022 were studied. Body-mass-index (BMI), skin-to-bone distance, aspirate, and core specimen quality, and core sample length were documented. Indications for CT guided BMAB were recorded. Categorical variables were compared using chi-squared test and continuous variables using Mann-Whitney test. Analysis of per-biopsy factors used linear mixed-effect models to adjust for clustering. Cost of CT and non-image guided BMAB was taken from patient billing data.

Results

There were 301 CT and 6535 non-image guided BMABs studied. All CT guided BMAB were studied. A subset of 317 non-image guided BMAB was selected randomly from the top ten CT BMAB referrers. BMI (kg/m²) and skin-to-bone distance (cm) was higher in the CT versus the non-image guided group; 34.4 v 26.8, p < 0.0001; 4.8 v 2.5, p < 0.0001, respectively. Aspirate and core sample quality were not different between groups, p = 0.21 and p = 0.12, respectively. CT guided core marrow samples were longer, p < 0.0001. The most common CT BMAB referral indications were large body habitus (47.7 %), failed attempt (18.8 %) and not stated (17.4 %). Cost of a CT guided BMAB with conscious sedation was $3945 USD versus $310 USD for non-image guided.

Conclusion

CT guided BMAB are commonly performed in patients with large body habitus and failed attempt. However, the cost is 12.7 fold higher with no increase in specimen quality. These findings can help referrers be cost conscious.

Background

Industry payments to physicians are common, but it is unknown how the payments in different categories to radiologists compare to other specialties.

Objective

The aim of this study is to assess the proportion of industry payments to physicians in radiology in certain categories relative to other specialties.

Methods

The Open Payments Database was analyzed from January 1, 2017 to December 31, 2021 for industry payments to all allopathic & osteopathic physicians, and classified into distinct clinical specialties. Payments to physicians in three categories were calculated in relation to total payments in each specialty during the study period: consulting fees, research, and royalties/ownership (royalty, license, or current or prospective ownership or investment).

Results

The total value of industry payments to physicians across all specialties was just under $13 billion over the six-year period from 2017 to 2022. During this period, 51.4 million total payments were made to 791,746 physicians. US physicians in radiology received 452,027 payments for a total value of $357 million (2.8 % of total value). For radiologists, 32.8 % of industry payment value was attributed to royalties/ownership and 9.9 % to research, collectively adding up to 42.7 % of all industry payment. The only specialties with higher payments in these two categories considered reflective of innovation payments were the surgical specialties with higher royalty payments.

Conclusion

The proportion of industry payments in radiology in categories reflecting innovation (royalty/ownership and research fees) is high and second only to surgical specialties.