Current Problems in Diagnostic Radiology最新文献

Patient-centered endometriosis management tailored to the individual patient's subset of symptoms often requires highly sensitive and specific preoperative imaging. In the setting of a present ongoing learning curve among radiologists who interpret pelvis ultrasounds and MRIs for diagnosis of endometriosis, we have found that routine feedback between minimally invasive gynecology surgeons and radiologists, based on pre-operative imaging and postoperative laparoscopic findings, is essential for the continual improvement of imaging-based staging of endometriosis and empower pre-operative imaging as an important pillar of endometriosis management. We share illustrative patient cases, which, after collaborative discussion during our routine multi-institutional, multi-disciplinary conferences (MDCs) have led to improved patient counseling, better pre-surgical planning, and therefore improved patient satisfaction. Our endometriosis MDCs will continue to improve patient management in the future by providing a forum for trainees in medical, surgical, imaging, and pathology specialties to gain expertise directly from subspecialists, and participate in the care of these patients.

Background

Substantial overuse of health care services is identified and intensified efforts are incited to reduce low-value services in general and in imaging in particular.

Objective

To report crucial success factors for developing and implementing interventions to reduce specific low-value imaging examinations based on a case study in Norway.

Materials and methods

Mixed methods design including one systematic review, one scoping review, implementation science, qualitative interviews, content analysis of stakeholders’ input, and stakeholder deliberations.

Results

The description and analysis of an intervention to reduce low-value imaging in Norway identifies six general success factors: 1) Acknowledging complexity: advanced knowledge synthesis, competence of the context, and broad and strong stakeholder involvement is crucial to manage de-implementation complexity. 2) Clear consensus-based criteria for selecting low-value imaging procedures are key. 3) Having a clear target group is critical. 4) Stakeholder engagement is essential to ascertain intervention relevance and compliance. 5) Active and well-motivated intervention collaborators is imperative. 6) Paying close attention to the mechanisms of low-value imaging and the barriers to reduce it is decisive.

Conclusion

Reducing low-value imaging is crucial to increase the quality, safety, efficiency, and sustainability of the health services. Reducing low-value imaging is a complex task and paying attention to specific practical success factors is key.

High-density pulmonary lesions are frequently seen in chest imaging, and it is important to identify their different causes. Radiologists must be able to distinguish between common and rare conditions in order to provide the best diagnosis and treatment. This article provides an overview of the various causes and imaging features of high-density lesions in the lungs. The lesions are classified into various categories, such as pulmonary nodules, inflammatory conditions, deposition diseases, contrast-related lesions, and thoracic devices. A clear understanding of these categories can help radiologists accurately diagnose and manage high-density pulmonary lesions encountered in practice.

This article describes the development and assessment of a neuroimaging curriculum for neonatology fellows. The curriculum is focused on topics that are relevant to the practice of neonatology and employs contemporary teaching methods, such as flipped classroom, learner engagement, and spaced repetition. Since its implementation 2018 the curriculum has been appreciated by our trainees and demonstrated improvements in trainee knowledge.

Objective

To examine the concordance rate of MRI findings with intraoperative and pathologic findings in patients with Placenta Accreta Spectrum (PAS), as well as the use of structured reporting, and their relationship to clinical outcomes.

Methods

An IRB approved retrospective chart review was performed for patients with a history of cesarean delivery, a diagnosis of PAS on post-operative pathology report, and a placental MRI prior to delivery between 2008-2022. Concordance rates were calculated between final MRI, ultrasound, operative, and pathologic diagnoses, as well as impact on clinical outcomes. Quantitative variables were analyzed using a t-test. Categorical variables were analyzed using chi-squared and Fischer's exact tests.

Results

A total of 59 patients met initial inclusion criteria. Of these 59 patients, 8 (13.6%) were interpreted using structured reporting. Discordance between preoperative imaging, operative findings and final pathology diagnoses were associated with increased blood loss, blood transfusion, ICU admission, and postpartum length of stay. Structured reporting was found to significantly reduce the amount of diagnostic discordance (p=.017) and was associated with decreased ICU admissions when utilized (p=.045).

Conclusions

Use of structured reporting in the interpretation of placental MRI may decrease the amount of discordance between imaging and intraoperative or pathologic diagnoses, which in our study is associated with improved patient outcomes including decreased blood loss and amount of blood transfused. Radiologists must be cognizant of key imaging features of PAS on MRI, as interpretation provides an opportunity to positively impact the quality and safety of patient care.

The interinstitutional transfer of outside images in radiology is a critical aspect of modern healthcare, enabling seamless collaboration among healthcare institutions and enhancing patient care. This paper explores the significance of interinstitutional image transfer in radiology, its challenges, and the technological advancements that have facilitated efficient image sharing. This practice offers several benefits, such as improving diagnostic accuracy, treatment planning, and patient outcomes. However, we also highlight the ethical and security issues involved in exchanging sensitive medical data between institutions. Through a review of existing literature and case studies, this manuscript discusses the advancements made in interinstitutional image transfer and the future potential of this evolving field.

Purpose

This study aims to illuminate the enduring contributions of underrepresented pioneers in radiology, emphasizing their resilience, innovations, and the significant barriers they overcame. By weaving their achievements into the broader narrative of medical science, this research highlights the critical role of diversity and progress in the evolution of radiology.

Historical Exploration

This narrative review chronicles the significant contributions of underrepresented radiologists from the early 20th century to the present. By synthesizing historical data, biographical sketches, and contemporary medical literature, we highlight the pivotal roles these pioneers have played in advancing radiology. Their groundbreaking work not only enhanced medical imaging technologies and practices but also championed the cause of diversity and inclusion within the field. These stories of perseverance and innovation underscore the ongoing need for an inclusive approach in the medical community, reflecting on how diversity has shaped and will continue to influence the evolution of radiology.

Findings and Conclusion

The study identifies several pivotal figures, such as Marcus F. Wheatland, the first known African American radiologist, and Ivy O. Roach Brooks, the first woman to lead a radiology department at a major U.S. hospital. It explores their wide-ranging contributions from clinical practice and education to leadership and advocacy for diversity within the medical profession.

The legacies of these radiologists illuminate not just their individual accomplishments but also reflect the broader struggle for equality and representation in the medical field. Their determination and excellence have paved the way for future generations, significantly enhancing the inclusivity and diversity of the radiology field.

Clinical Relevance and Application

Understanding the contributions of these underrepresented radiologists enriches the field's perspective on diversity, equity, and inclusion. Highlighting these pioneers underscores the importance of mentorship, representation, and advocacy in creating an environment where all talented individuals can thrive. Insights from this historical analysis are crucial for shaping future policies and practices in radiology and medical education, ensuring the continuation of these trailblazers' inspiring legacy.

The average post-pandemic modern radiology practice is experiencing an ever-increasing workload volume with overall relatively similar staffing levels, regardless of practice setting. This has resulted in an increased workload demand for the average diagnostic radiologist, which in many cases translates to longer working hours. It is now more important than ever to be cognizant of various work-related injuries, including repetitive-stress injuries and vision-related ailments as examples, in relation to the working conditions of the radiologist. This article will discuss commonly occurring conditions and ergonomic considerations that the radiologist can employ to reduce the risk of work-related injuries.

Objectives

Patients undergoing medical procedures often experience heightened anxiety, which can affect their experience and overall health. The current study aimed at looking at a quality improvement initiative to compare written and audiovisual information delivery methods to reduce anxiety prior to Computed Tomography (CT).

Methods

In this prospective interventional study, we assessed state and trait anxiety in patients scheduled for their first CT scan. Three PDSA cycles were carried out over six months, with each cycle lasting for two months each. The participants were divided into three groups, the baseline, written, and audiovisual intervention groups. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire. State anxiety is a temporary emotional response, while trait anxiety reflects enduring personality characteristics.

Results

The mean age of participants was 43.26 years (SD 15.07) in the baseline group, 39.9 years (SD 14.72) in the written group, and 48.59 years (SD 13.54) in the audiovisual group. For state anxiety, the baseline mean was 58.4 (SD 6.9), notably reduced to 43.2 (SD 5.5) with written intervention and to 38.6 (SD 7.7) with audiovisual intervention (p < 0.001). Trait anxiety scores remained relatively stable in all groups (p = 0.31).

Conclusion

Both written and audiovisual interventions successfully alleviate pre-imaging anxiety in patients undergoing CT scans. The findings underscore the superior efficacy of audiovisual materials in achieving a more substantial reduction in state anxiety compared to written information. These findings are particularly relevant in resource limited settings where simple interventions show significant improvements.

Aim

To investigate the utilization of MRI using a MRI liver protocol with extracellular contrast-enhanced series for hepatocellular carcinoma (HCC) surveillance in high-risk patients.

Methods

Consecutive high-risk patients of a western European cohort who underwent repeated liver MRI for HCC screening were included. Lesions were registered according to the Liver Reporting & Data System (LIRADS) 2018. HCC was staged as very early stage HCC (BCLC stage 0) and more advanced stages of HCC (BCLC stage A-D). Differences in time interval between MRI's for BCLC stage 0 and stage A-D were calculated with the Mann-Whitney U test. The HCC cumulative incidence at one-, three- and five years was calculated with the Kaplan Meier estimator.

Results

From 2010 to 2019 a total of 240 patients were included (71% male; median age: 57 years; IQR: 50-64 years) with 1350 MRI's. Most patients (83 %) had cirrhosis with hepatitis C as the most common underlying cause. Patients underwent on average four MRI's (IQR: 3-7). Forty-two patients (17.5%) developed HCC (52 HCC lesions: 43 LIRADS-5, eight LIRADS-4, and one LIRADS-TIV). Eighteen patients (43%) had BCLC stage 0 HCC with a significant shorter screening time interval (10 months; IQR: 6-21) compared to patients with BCLC stage A-D (21 months; IQR: 10-32) (p = 0.03). Thirty seven percent of patients with a LIRADS-3 lesion (n=43) showed HCC development within twelve months (median: 7.4 months). One, three- and five-year HCC cumulative incidence in cirrhotic patients was 1%, 10% and 17%, respectively.

Conclusion

High-risk patients who underwent surveillance with contrast-enhanced MRI developed HCC in 17.5 % during a follow up period of over 4 years median. Very early stage HCC was seen in compensated cirrhosis after a median time interval of 10 months. Later stages of HCC were related to prolonged screening time interval (median 21 months).