Pub Date : 2025-08-11DOI: 10.1067/j.cpradiol.2025.08.006
Liang Meng Loy , Sanchalika Acharyya , Hsien Min Low , Uei Pua , Cher Heng Tan
Objective
To systematically determine the diagnostic performance of diffusion weighted imaging (DWI) in early imaging assessment following Y-90 transarterial radioembolization (TARE) of HCC.
Materials and methods
Searches were conducted in PubMed and Cochrane library electronic databases up to July 2024 to identify original studies that reported the diagnostic performance of DWI/apparent diffusion coefficient (DWI/ADC) for assessing early treatment response following TARE. The summary measures of diagnostic accuracy were estimated using bivariate random effect meta-analysis.
Results
Our search identified 194 titles, of which 5 studies with data from 104 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.90 (95%-confidence interval [CI] 0.75,0.96) and 0.81 (95%-CI 0.58,0.92) with a diagnostic odds ratio (DOR) of 45.4 (95% CI 10.2, 132). The area under the summary receiver-operating characteristic curve was 0.919 (95%-CI 0.708,0.924). Exploratory analysis of predictive values projected DWI/ADC to have a NPV of 46.4% (95%-CI 26.8%,69.4%) and projected PPV of 97.6% (95%-CI 95.1%,99.0%), assuming a 90% treatment response rate. The diagnostic performance for early response assessment was comparable with that of traditional imaging criteria reported in literature.
Conclusion
Restricted diffusion has high diagnostic accuracy in early response assessment after TARE. Our study validates the inclusion of restricted diffusion as an ancillary criterion in the LI-RADS TR 2024 algorithm for radiation-based treatment.
目的：系统评价弥散加权成像（DWI）在肝细胞癌Y-90经动脉放射栓塞（TARE）术后早期影像学评估中的诊断价值。材料和方法：截至2024年7月，检索PubMed和Cochrane图书馆电子数据库，以确定报道DWI/表观扩散系数（DWI/ADC）用于评估TARE早期治疗反应的诊断性能的原始研究。使用双变量随机效应荟萃分析估计诊断准确性的汇总测量。结果：我们检索了194篇文献，其中5篇文献的数据来自104名患者被纳入meta分析。合并敏感性和特异性分别为0.90（95%可信区间[CI] 0.75,0.96）和0.81(95%可信区间[CI] 0.58,0.92)，诊断优势比（DOR）为45.4 （95% CI 10.2, 132）。综合受试者-工作特征曲线下面积为0.919 （95% ci 0.708,0.924）。探索性分析预测值预测DWI/ADC的NPV为46.4% (95%-CI 26.8%,69.4%)， PPV为97.6% (95%-CI 95.1%,99.0%)，假设治疗有效率为90%。早期反应评估的诊断性能与文献报道的传统影像学标准相当。结论：限制性弥散对TARE术后早期反应评价具有较高的诊断准确性。我们的研究验证了将受限扩散作为辅助标准纳入LI-RADS TR 2024放射治疗算法。
{"title":"Diagnostic performance of diffusion weighted imaging for early response assessment after Y-90 transarterial radioembolization of Hepatocellular Carcinoma (HCC) – A systematic review and meta-analysis","authors":"Liang Meng Loy , Sanchalika Acharyya , Hsien Min Low , Uei Pua , Cher Heng Tan","doi":"10.1067/j.cpradiol.2025.08.006","DOIUrl":"10.1067/j.cpradiol.2025.08.006","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically determine the diagnostic performance of diffusion weighted imaging (DWI) in early imaging assessment following Y-90 transarterial radioembolization (TARE) of HCC.</div></div><div><h3>Materials and methods</h3><div>Searches were conducted in PubMed and Cochrane library electronic databases up to July 2024 to identify original studies that reported the diagnostic performance of DWI/apparent diffusion coefficient (DWI/ADC) for assessing early treatment response following TARE. The summary measures of diagnostic accuracy were estimated using bivariate random effect meta-analysis.</div></div><div><h3>Results</h3><div>Our search identified 194 titles, of which 5 studies with data from 104 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.90 (95%-confidence interval [CI] 0.75,0.96) and 0.81 (95%-CI 0.58,0.92) with a diagnostic odds ratio (DOR) of 45.4 (95% CI 10.2, 132). The area under the summary receiver-operating characteristic curve was 0.919 (95%-CI 0.708,0.924). Exploratory analysis of predictive values projected DWI/ADC to have a NPV of 46.4% (95%-CI 26.8%,69.4%) and projected PPV of 97.6% (95%-CI 95.1%,99.0%), assuming a 90% treatment response rate. The diagnostic performance for early response assessment was comparable with that of traditional imaging criteria reported in literature.</div></div><div><h3>Conclusion</h3><div>Restricted diffusion has high diagnostic accuracy in early response assessment after TARE. Our study validates the inclusion of restricted diffusion as an ancillary criterion in the LI-RADS TR 2024 algorithm for radiation-based treatment.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 2","pages":"Pages 234-241"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1067/j.cpradiol.2025.08.010
Jeffrey Girardot MD , Anthony Higinbotham MD , Kamand Khalaj MD, MPH , Ameya Nayate MD , Inas Mohamed MD , Michael Wien MD , Navid Faraji MD
Objective
The aim of this study was to evaluate the impact of a "no-pull" policy in radiology residency programs, which prevents residents from being pulled from their scheduled rotations to cover other services. The hypothesis was that such a policy reduces the uneven distribution of training across subspecialties, ensuring that residents receive a more comprehensive education.
Methods
Resident schedules from two years prior to the implementation of the no-pull policy were compared with those from two years after the policy was enacted. Any instance where a resident was reassigned from their scheduled rotation to cover a different subspecialty due to staffing needs was recorded as a "pull." The number of pull days was calculated and compared across both periods. A total of 40 residents' schedules were analyzed for both pre- and post-policy periods.
Results
Two- and one-year pre-policy, the number of total pulls was substantial at 369 and 372 pull days, respectively. One- and two-years post-policy, the number of pull days dramatically decreased to 76 and 89 pull days, respectively. This equates to an average of 82.5 total pull days per year, or just 2 pull days per resident annually—a 78% reduction.
Discussion
The implementation of a no-pull policy in radiology residency programs significantly decreased the number of days residents were reassigned to cover under-staffed specialties. This change contributed to a more consistent and well-rounded training experience, ensuring residents gained valuable time in all subspecialty rotations without being diverted to cover others.
{"title":"Effects of the implementation of a no-pull policy on radiology resident staffing","authors":"Jeffrey Girardot MD , Anthony Higinbotham MD , Kamand Khalaj MD, MPH , Ameya Nayate MD , Inas Mohamed MD , Michael Wien MD , Navid Faraji MD","doi":"10.1067/j.cpradiol.2025.08.010","DOIUrl":"10.1067/j.cpradiol.2025.08.010","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to evaluate the impact of a \"no-pull\" policy in radiology residency programs, which prevents residents from being pulled from their scheduled rotations to cover other services. The hypothesis was that such a policy reduces the uneven distribution of training across subspecialties, ensuring that residents receive a more comprehensive education.</div></div><div><h3>Methods</h3><div>Resident schedules from two years prior to the implementation of the no-pull policy were compared with those from two years after the policy was enacted. Any instance where a resident was reassigned from their scheduled rotation to cover a different subspecialty due to staffing needs was recorded as a \"pull.\" The number of pull days was calculated and compared across both periods. A total of 40 residents' schedules were analyzed for both pre- and post-policy periods.</div></div><div><h3>Results</h3><div>Two- and one-year pre-policy, the number of total pulls was substantial at 369 and 372 pull days, respectively. One- and two-years post-policy, the number of pull days dramatically decreased to 76 and 89 pull days, respectively. This equates to an average of 82.5 total pull days per year, or just 2 pull days per resident annually—a 78% reduction.</div></div><div><h3>Discussion</h3><div>The implementation of a no-pull policy in radiology residency programs significantly decreased the number of days residents were reassigned to cover under-staffed specialties. This change contributed to a more consistent and well-rounded training experience, ensuring residents gained valuable time in all subspecialty rotations without being diverted to cover others.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 42-47"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1067/j.cpradiol.2025.08.004
Mehrshad Bakhshi M.D. , Marie-Xinyi Sun DEC , Charles-Antoine Boucher B.H.Sc. , Tharshanna Nadarajah PhD , Ralph Nelson M.D. , Karl Muchantef M.D. , Josephine Pressacco M.D.
Rationale and Objectives
Radiology plays a critical role in healthcare but is marked by stark global inequities. Low- and middle-income countries have far fewer imaging resources and trained personnel compared to high-income countries. As global health interest grows among trainees, understanding Canadian radiology residents’ perspectives on global health imaging (GHI) is essential. This study aimed to assess their prior experiences, perceived barriers, and recommendations for integrating GHI into residency training.
Materials and Methods
A bilingual, anonymous survey was developed and distributed to residents across all 16 Canadian radiology residency programs from May 2024 to April 2025. The questionnaire included items on demographics, prior global health involvement, interest in GHI, perceived preparedness, institutional opportunities, and barriers to international engagement. Respondents were also asked to identify preferred approaches for integrating GHI into training programs.
Results
Fifty-one trainees responded from 14 different programs. 64.7% reported prior work in developing countries, with 54.9% perceiving an unmet need for medical imaging in those settings. Nearly half (47.1%) expressed plans to engage in GHI. On-site collaboration and education of local staff (47.1%) and residents (49%) were the most preferred methods of contribution. However, 78.4% felt unprepared or unsure to get involved in GHI. 45.1% reported no GHI opportunities in their current program. Major barriers included call coverage (94.1%), lack of funding (90.2%), and limited infrastructure (90.2%). The top proposed solutions were international electives (86.3%), teleradiology (60.8%), and case presentations focused on diseases highly prevalent in developing countries (51%).
Conclusion
Canadian radiology trainees show strong interest in global health imaging but face systemic barriers. Curricular integration of electives, teleradiology, and global health education, along with improved access to funding, could bridge the gap between interest and participation.
{"title":"Resident perspectives on global health imaging in canadian radiology training: A national survey","authors":"Mehrshad Bakhshi M.D. , Marie-Xinyi Sun DEC , Charles-Antoine Boucher B.H.Sc. , Tharshanna Nadarajah PhD , Ralph Nelson M.D. , Karl Muchantef M.D. , Josephine Pressacco M.D.","doi":"10.1067/j.cpradiol.2025.08.004","DOIUrl":"10.1067/j.cpradiol.2025.08.004","url":null,"abstract":"<div><h3>Rationale and Objectives</h3><div>Radiology plays a critical role in healthcare but is marked by stark global inequities. Low- and middle-income countries have far fewer imaging resources and trained personnel compared to high-income countries. As global health interest grows among trainees, understanding Canadian radiology residents’ perspectives on global health imaging (GHI) is essential. This study aimed to assess their prior experiences, perceived barriers, and recommendations for integrating GHI into residency training.</div></div><div><h3>Materials and Methods</h3><div>A bilingual, anonymous survey was developed and distributed to residents across all 16 Canadian radiology residency programs from May 2024 to April 2025. The questionnaire included items on demographics, prior global health involvement, interest in GHI, perceived preparedness, institutional opportunities, and barriers to international engagement. Respondents were also asked to identify preferred approaches for integrating GHI into training programs.</div></div><div><h3>Results</h3><div>Fifty-one trainees responded from 14 different programs. 64.7% reported prior work in developing countries, with 54.9% perceiving an unmet need for medical imaging in those settings. Nearly half (47.1%) expressed plans to engage in GHI. On-site collaboration and education of local staff (47.1%) and residents (49%) were the most preferred methods of contribution. However, 78.4% felt unprepared or unsure to get involved in GHI<strong>.</strong> 45.1% reported no GHI opportunities in their current program. Major barriers included call coverage (94.1%), lack of funding (90.2%), and limited infrastructure (90.2%). The top proposed solutions were international electives (86.3%), teleradiology (60.8%), and case presentations focused on diseases highly prevalent in developing countries (51%).</div></div><div><h3>Conclusion</h3><div>Canadian radiology trainees show strong interest in global health imaging but face systemic barriers. Curricular integration of electives, teleradiology, and global health education, along with improved access to funding, could bridge the gap between interest and participation.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 37-41"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the perception of clinical faculty and staff on the discontinuation of routine gonadal shielding for diagnostic imaging procedures and assess the impact of targeted educational intervention on awareness and comfort levels.
Methods
A pre-post survey study was conducted among radiology and non-radiology staff involved in imaging operations at a large academic center. A pre-rollout survey (August 2023) established baseline awareness and attitudes toward gonadal shielding discontinuation, while a post-rollout survey (August 2024) reassessed these measures following policy implementation while also assessing the impact of educational outreach. The surveys included Likert-scale questions on comfort levels, policy awareness, and perceived preparedness, along with open-ended responses for qualitative analysis. Educational interventions included email communications, online FAQs, informational flyers, and live Q&A sessions. Cumulative logit models evaluated changes in responses, and subgroup analyses examined differences based on departmental affiliation and years of experience.
Results
Of 266 pre-rollout and 188 post-rollout responses, awareness of shielding discontinuation guidelines significantly increased post-rollout (26% to 75%, p < 0.0001), with radiology-affiliated staff demonstrating higher awareness than non-radiology staff (91% vs. 45%). Complete comfort with discontinuation improved significantly (28% to 49%, p < 0.0001), with radiology staff experiencing a larger shift (p = 0.045). The need for more information was the main driver of discomfort pre-rollout (49%), dropping to 26% post-rollout. However, concerns regarding pediatric and pregnant patient populations remained consistent despite educational efforts.
Conclusion
Educational and communication initiatives increased awareness and improved comfort levels for hospital staff after gonadal shielding discontinuation. Concerns remain around how to best communicate this change to patients and whether patients will accept the end of decades-long routine shielding practices.
{"title":"Faculty and staff attitudes towards discontinuation of routine gonadal shielding: perceptions before and after policy change in an academic medical center","authors":"Obaidah Bitar MD, Aparna Joshi MD, FACR, Tresa Griffith, Sarah Clos, Ashok Srinivasan MD, FACR, Emily Bellile, Gunjan Malhotra MD","doi":"10.1067/j.cpradiol.2025.08.011","DOIUrl":"10.1067/j.cpradiol.2025.08.011","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the perception of clinical faculty and staff on the discontinuation of routine gonadal shielding for diagnostic imaging procedures and assess the impact of targeted educational intervention on awareness and comfort levels.</div></div><div><h3>Methods</h3><div>A pre-post survey study was conducted among radiology and non-radiology staff involved in imaging operations at a large academic center. A pre-rollout survey (August 2023) established baseline awareness and attitudes toward gonadal shielding discontinuation, while a post-rollout survey (August 2024) reassessed these measures following policy implementation while also assessing the impact of educational outreach. The surveys included Likert-scale questions on comfort levels, policy awareness, and perceived preparedness, along with open-ended responses for qualitative analysis. Educational interventions included email communications, online FAQs, informational flyers, and live Q&A sessions. Cumulative logit models evaluated changes in responses, and subgroup analyses examined differences based on departmental affiliation and years of experience.</div></div><div><h3>Results</h3><div>Of 266 pre-rollout and 188 post-rollout responses, awareness of shielding discontinuation guidelines significantly increased post-rollout (26% to 75%, p < 0.0001), with radiology-affiliated staff demonstrating higher awareness than non-radiology staff (91% vs. 45%). Complete comfort with discontinuation improved significantly (28% to 49%, p < 0.0001), with radiology staff experiencing a larger shift (p = 0.045). The need for more information was the main driver of discomfort pre-rollout (49%), dropping to 26% post-rollout. However, concerns regarding pediatric and pregnant patient populations remained consistent despite educational efforts.</div></div><div><h3>Conclusion</h3><div>Educational and communication initiatives increased awareness and improved comfort levels for hospital staff after gonadal shielding discontinuation. Concerns remain around how to best communicate this change to patients and whether patients will accept the end of decades-long routine shielding practices.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 2","pages":"Pages 188-193"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-08DOI: 10.1067/j.cpradiol.2025.08.002
Ashkan Bahrami , Long H. Tu , Milad Ghanikolahloo , Zohreh Sadeghi , Armin Tafazolimoghadam , Mahan Farzan , Mobina Fathi , Yaser Khakpour , Arian Tavasol , Milad Alipour , Ahmad Shoja , Mobin Azami , Thomas Clifford , Ramtin Hajibeygi , Samra Iftikhar
Background
Prostate cancer (PC) is one of the most prevalent cancers and is the second leading cause of cancer death in men. Recent evidence has demonstrated racial disparities in imaging utilization and, as a result, PC diagnosis.
Purpose
The goal of this systematic review and meta-analysis was to quantify the disparity in utilization of Magnetic Resonance Imaging (MRI) and Transrectal Ultrasound (TRUS) for PC diagnosis among different races (Whites, Blacks, Asians, Caucasians, Hispanics, and other races). Our study, however, focuses on disparities observed in the North American population, as most of the studies included were carried out in Canada and the United States.
Materials and methods
We carried out a systematic search in Google Scholar, PubMed/Medline, Web of Science, Scopus, and EMBASE databases. A total of 33 relevant articles published before August 2024 were included. We used Stata version 15 for statistical analysis. I2 statistics was employed to assess heterogeneity. Egger and Begg's tests evaluated any publication bias.
Results
A total of 33 articles collectively contained 94,020 cases with a mean age of 77.9 across six defined races (African-American or Black, White, Asians, Caucasians, Hispanics, and other races). Analysis demonstrated greater utilization of MRI in White patients 66 % (95 % CI: 0.59-0.73; I2 = 99.5 %),19 % (95 % CI: 0.17-0.22; I2 = 98.95 %) in Blacks, 67 % (95 % CI: 0.56-0.78; I2 = 98.99 %) in Caucasians, 7 % (95 % CI: 0.04-0.09; I2 = 97.55 %) in Hispanics, 4 % (95 % CI: 0.03-0.05; I2 = 86.53 %) in Asians, and 24 % (95 % CI: 0.11-0.37; I2 = 99.94 %) in other races. Also, relatively low utilization of TRUS was demonstrated in Black patients at 30 % (95 % CI: 0.15-0.44, I2=99.75 %)
Conclusion
This systematic review and meta-analysis demonstrate a higher utilization of MRI for PC diagnosis in White patients relative to Blacks, Hispanics, and Asians, respectively. In addition, the use of TRUS in the Black population is relatively limited. These outcomes indicate a need for a change in radiologic utilization and health policies.
{"title":"Disparities in MRI and TRUS for prostate cancer detection: A systematic review and meta-analysis of 94,020 cases","authors":"Ashkan Bahrami , Long H. Tu , Milad Ghanikolahloo , Zohreh Sadeghi , Armin Tafazolimoghadam , Mahan Farzan , Mobina Fathi , Yaser Khakpour , Arian Tavasol , Milad Alipour , Ahmad Shoja , Mobin Azami , Thomas Clifford , Ramtin Hajibeygi , Samra Iftikhar","doi":"10.1067/j.cpradiol.2025.08.002","DOIUrl":"10.1067/j.cpradiol.2025.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Prostate cancer (PC) is one of the most prevalent cancers and is the second leading cause of cancer death in men. Recent evidence has demonstrated racial disparities in imaging utilization and, as a result, PC diagnosis.</div></div><div><h3>Purpose</h3><div>The goal of this systematic review and meta-analysis was to quantify the disparity in utilization of Magnetic Resonance Imaging (MRI) and Transrectal Ultrasound (TRUS) for PC diagnosis among different races (Whites, Blacks, Asians, Caucasians, Hispanics, and other races). Our study, however, focuses on disparities observed in the North American population, as most of the studies included were carried out in Canada and the United States.</div></div><div><h3>Materials and methods</h3><div>We carried out a systematic search in Google Scholar, PubMed/Medline, Web of Science, Scopus, and EMBASE databases. A total of 33 relevant articles published before August 2024 were included. We used Stata version 15 for statistical analysis. I<sup>2</sup> statistics was employed to assess heterogeneity. Egger and Begg's tests evaluated any publication bias.</div></div><div><h3>Results</h3><div>A total of 33 articles collectively contained 94,020 cases with a mean age of 77.9 across six defined races (African-American or Black, White, Asians, Caucasians, Hispanics, and other races). Analysis demonstrated greater utilization of MRI in White patients 66 % (95 % CI: 0.59-0.73; I2 = 99.5 %),19 % (95 % CI: 0.17-0.22; I2 = 98.95 %) in Blacks, 67 % (95 % CI: 0.56-0.78; I2 = 98.99 %) in Caucasians, 7 % (95 % CI: 0.04-0.09; I2 = 97.55 %) in Hispanics, 4 % (95 % CI: 0.03-0.05; I2 = 86.53 %) in Asians, and 24 % (95 % CI: 0.11-0.37; I2 = 99.94 %) in other races. Also, relatively low utilization of TRUS was demonstrated in Black patients at 30 % (95 % CI: 0.15-0.44, I2=99.75 %)</div></div><div><h3>Conclusion</h3><div>This systematic review and meta-analysis demonstrate a higher utilization of MRI for PC diagnosis in White patients relative to Blacks, Hispanics, and Asians, respectively. In addition, the use of TRUS in the Black population is relatively limited. These outcomes indicate a need for a change in radiologic utilization and health policies.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 148-169"},"PeriodicalIF":1.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine whether low-energy (LE) images acquired during contrast-enhanced mammography (CEM) are diagnostically and technically comparable to full-field digital mammography (FFDM) using standardised image quality and lesion conspicuity metrics.
Materials and Methods
In this retrospective study, 268 women (mean age: 44.6 years) who underwent both FFDM and CEM imaging, were included. Three blinded radiologists independently assessed the FFDM and LE-CEM images using 20-point EUREF (European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services) criteria and 5-point Likert scale for image quality, lesion conspicuity, margin clarity, and diagnostic adequacy. An analysis of the additional lesion detection rate was done. Additionally, technical metrics including posterior nipple line (PNL), compressed breast thickness (CBT), and average glandular dose (AGD) were also recorded. Statistical analysis included Wilcoxon signed-rank, McNemar’s test, intraclass correlation coefficient (ICC), and Fleiss’ kappa.
Results
LE images scored significantly higher than FFDM in 11 of 20 EUREF parameters (p < 0.05) and were non-inferior in the remaining. Median Likert scores were significantly higher for LE images across all lesion parameters, including conspicuity against background (5 vs. 4), margin clarity (5 vs. 4), and overall lesion visibility (5 vs. 4) (all p < 0.001). LE images detected significantly more lesions per patient (0.557 vs. 0.314; p < 0.001) with excellent inter-reader agreement (κ > 0.80). PNL and CBT showed near-perfect positional reproducibility (ICC > 0.98), and all AGD values remained within EUREF safety limits.
Conclusion
LE-CEM images match or rather exceed FFDM in image quality, lesion detection, and diagnostic adequacy, while maintaining technical reproducibility. These findings support omitting additional FFDM exposure in patients with indications for CEM, thereby reducing radiation dose and streamlining the workflow.
{"title":"Multiparametric comparison of low-energy contrast-enhanced mammography and full-field digital mammography for image quality and lesion conspicuity using EUREF standards and Likert scoring","authors":"Veenu Singla MD, Dollphy Garg MD, T. Pallavi MD, N.P. Bhavith MD","doi":"10.1067/j.cpradiol.2025.08.001","DOIUrl":"10.1067/j.cpradiol.2025.08.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether low-energy (LE) images acquired during contrast-enhanced mammography (CEM) are diagnostically and technically comparable to full-field digital mammography (FFDM) using standardised image quality and lesion conspicuity metrics.</div></div><div><h3>Materials and Methods</h3><div>In this retrospective study, 268 women (mean age: 44.6 years) who underwent both FFDM and CEM imaging, were included. Three blinded radiologists independently assessed the FFDM and LE-CEM images using 20-point EUREF (European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services) criteria and 5-point Likert scale for image quality, lesion conspicuity, margin clarity, and diagnostic adequacy. An analysis of the additional lesion detection rate was done. Additionally, technical metrics including posterior nipple line (PNL), compressed breast thickness (CBT), and average glandular dose (AGD) were also recorded. Statistical analysis included Wilcoxon signed-rank, McNemar’s test, intraclass correlation coefficient (ICC), and Fleiss’ kappa.</div></div><div><h3>Results</h3><div>LE images scored significantly higher than FFDM in 11 of 20 EUREF parameters (<em>p</em> < 0.05) and were non-inferior in the remaining. Median Likert scores were significantly higher for LE images across all lesion parameters, including conspicuity against background (5 vs. 4), margin clarity (5 vs. 4), and overall lesion visibility (5 vs. 4) (all <em>p</em> < 0.001). LE images detected significantly more lesions per patient (0.557 vs. 0.314; <em>p</em> < 0.001) with excellent inter-reader agreement (κ > 0.80). PNL and CBT showed near-perfect positional reproducibility (ICC > 0.98), and all AGD values remained within EUREF safety limits.</div></div><div><h3>Conclusion</h3><div>LE-CEM images match or rather exceed FFDM in image quality, lesion detection, and diagnostic adequacy, while maintaining technical reproducibility. These findings support omitting additional FFDM exposure in patients with indications for CEM, thereby reducing radiation dose and streamlining the workflow.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 75-84"},"PeriodicalIF":1.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-29DOI: 10.1067/j.cpradiol.2025.07.004
Jeffrey J. Tutman MD , Michael Tchou MD , Kelly Harris RDMS , Colleen Violette RDMS , HaiThuy N. Nguyen MD
Background
Ultrasound is emerging as a viable first-line imaging modality in the assessment of midgut volvulus. However, successful transition to this technique can be challenging.
Objective
The aim of our project was to increase sonographer visualization rates of the superior mesenteric artery and superior mesenteric vein (SMA/SMV) by >39 % from baseline over a 7-month period.
Methods
We conducted a quality improvement project targeting the ultrasound department at a large academic children’s hospital system. The study included 615 patients who underwent pyloric or volvulus ultrasounds. Interventions included implementation of a team goal, monthly review of deficient exams and radiologist to sonographer peer review. Our primary outcome measure was percentage of exams in which the SMA/SMV vascular pedicle was successfully visualized.
Results
The average baseline rate of SMA/SMV visualization was 37 %. This rate increased to 72 % within one month of implementation, and an average of 83 % visualization was achieved over the 7-month period of observation. This improvement was sustained during the 2 months immediately following the conclusion of the formal observation period and remained evident 2 years post-completion.
Conclusion
Our quality improvement initiative resulted in significant, rapid, and sustained improvement in sonographer visualization rates of the superior mesenteric vasculature. Given widespread interest in volvulus ultrasound, we provide a framework for successfully training sonographers to perform this exam. The approach we used may also have potential to be utilized in the implementation of other imaging protocols.
{"title":"Improving pediatric sonographer visualization of the superior mesenteric vasculature: A local quality improvement initiative","authors":"Jeffrey J. Tutman MD , Michael Tchou MD , Kelly Harris RDMS , Colleen Violette RDMS , HaiThuy N. Nguyen MD","doi":"10.1067/j.cpradiol.2025.07.004","DOIUrl":"10.1067/j.cpradiol.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound is emerging as a viable first-line imaging modality in the assessment of midgut volvulus. However, successful transition to this technique can be challenging.</div></div><div><h3>Objective</h3><div>The aim of our project was to increase sonographer visualization rates of the superior mesenteric artery and superior mesenteric vein (SMA/SMV) by >39 % from baseline over a 7-month period.</div></div><div><h3>Methods</h3><div>We conducted a quality improvement project targeting the ultrasound department at a large academic children’s hospital system. The study included 615 patients who underwent pyloric or volvulus ultrasounds. Interventions included implementation of a team goal, monthly review of deficient exams and radiologist to sonographer peer review. Our primary outcome measure was percentage of exams in which the SMA/SMV vascular pedicle was successfully visualized.</div></div><div><h3>Results</h3><div>The average baseline rate of SMA/SMV visualization was 37 %. This rate increased to 72 % within one month of implementation, and an average of 83 % visualization was achieved over the 7-month period of observation. This improvement was sustained during the 2 months immediately following the conclusion of the formal observation period and remained evident 2 years post-completion.</div></div><div><h3>Conclusion</h3><div>Our quality improvement initiative resulted in significant, rapid, and sustained improvement in sonographer visualization rates of the superior mesenteric vasculature. Given widespread interest in volvulus ultrasound, we provide a framework for successfully training sonographers to perform this exam. The approach we used may also have potential to be utilized in the implementation of other imaging protocols.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 18-24"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-30DOI: 10.1067/j.cpradiol.2025.06.010
Dr. Rashmi Dixit, Dr. Sonali Garg, Dr. Gaurav Shanker Pradhan
Pott's spine is associated with high morbidity, long-term disabling sequelae and even mortality. The classical paradiscal form, where there is destruction of end plates of adjacent 2-3 vertebral bodies along with intervening disc involvement and associated paravertebral abscess is well recognized. However, due to its varied clinical and radiological presentations, it remains a diagnostic challenge often resulting in delay in diagnosis. This is especially true of countries where tuberculosis has been almost eliminated but now are witnessing increase in incidence both due to immigration and HIV infection. Overlooking tuberculosis as a differential diagnostic consideration is very likely when the radiological presentation is not classical and consequent delay in diagnosis may have devastating consequences for the patient. In this review, we aim to describe various typical and atypical imaging findings of Pott’s spine with special emphasis on atypical presentations including single vertebral body involvement, isolated posterior element involvement, intraspinal epidural abscess without vertebral involvement and skip lesions along with differential diagnostic considerations like metastases, fractures and spinal infections. The major focus is on magnetic resonance imaging findings which is the imaging modality of choice in patients presenting with neurological symptoms referable to the spine. Radiographic and Computed tomography findings are also discussed in brief. We also describe treatment and post treatment imaging in brief. Radiologists need to be aware of these atypical presentations as they may be the first to raise the possibility of tuberculosis which can avoid disabling long term sequalae.
{"title":"Imaging in Pott’s spine: A review of typical and atypical imaging features and diagnostic challenges","authors":"Dr. Rashmi Dixit, Dr. Sonali Garg, Dr. Gaurav Shanker Pradhan","doi":"10.1067/j.cpradiol.2025.06.010","DOIUrl":"10.1067/j.cpradiol.2025.06.010","url":null,"abstract":"<div><div>Pott's spine is associated with high morbidity, long-term disabling sequelae and even mortality. The classical paradiscal form, where there is destruction of end plates of adjacent 2-3 vertebral bodies along with intervening disc involvement and associated paravertebral abscess is well recognized. However, due to its varied clinical and radiological presentations, it remains a diagnostic challenge often resulting in delay in diagnosis. This is especially true of countries where tuberculosis has been almost eliminated but now are witnessing increase in incidence both due to immigration and HIV infection. Overlooking tuberculosis as a differential diagnostic consideration is very likely when the radiological presentation is not classical and consequent delay in diagnosis may have devastating consequences for the patient. In this review, we aim to describe various typical and atypical imaging findings of Pott’s spine with special emphasis on atypical presentations including single vertebral body involvement, isolated posterior element involvement, intraspinal epidural abscess without vertebral involvement and skip lesions along with differential diagnostic considerations like metastases, fractures and spinal infections. The major focus is on magnetic resonance imaging findings which is the imaging modality of choice in patients presenting with neurological symptoms referable to the spine. Radiographic and Computed tomography findings are also discussed in brief. We also describe treatment and post treatment imaging in brief. Radiologists need to be aware of these atypical presentations as they may be the first to raise the possibility of tuberculosis which can avoid disabling long term sequalae.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 2","pages":"Pages 311-320"},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-06DOI: 10.1067/j.cpradiol.2025.06.007
Ives R. Levesque , Véronique Fortier , Jorge Campos Pazmiño , Zaki Ahmed , Evan McNabb
Objective
The purpose of this work was to critically assess safety guidance and practices in clinical magnetic resonance (MR) using the hierarchy of hazard controls (HHC).
Methods
Publicly available, widely used guidance documents for MR safety practice were gathered. The most recent guidance, the American College of Radiology (ACR) MR Safety Manual (2024) was selected for detailed analysis. A 5-point scale was assigned to the various levels in the hierarchy of hazard controls, from Elimination (score=5, most effective) to Personal Protective Equipment (score=1, least effective). MR safety practices recommended in the ACR MR Safety Manual were surveyed and scored using the 5-point scale. The safety practices were grouped by category of hazard addressed (e.g. main field, radio-frequency field, gradient field).
Results
Overall, Administrative Controls were the most common controls, followed by Engineering Controls. Controls within each hazard category featured a range of HHC scores, and all categories were predominantly served by Administrative Controls.
Conclusion
The analysis presented in this work could serve as a tool to analyze choices made in the deployment of safety measures, to motivate decision- or policy-making, as a tool for assessment of MR safety programs, or as an approach to motivate future work in the design of hazard controls for MR.
{"title":"The hierarchy of hazard controls in clinical magnetic resonance safety: an analysis of the American College of Radiology Manual on MR Safety","authors":"Ives R. Levesque , Véronique Fortier , Jorge Campos Pazmiño , Zaki Ahmed , Evan McNabb","doi":"10.1067/j.cpradiol.2025.06.007","DOIUrl":"10.1067/j.cpradiol.2025.06.007","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this work was to critically assess safety guidance and practices in clinical magnetic resonance (MR) using the hierarchy of hazard controls (HHC).</div></div><div><h3>Methods</h3><div>Publicly available, widely used guidance documents for MR safety practice were gathered. The most recent guidance, the American College of Radiology (ACR) MR Safety Manual (2024) was selected for detailed analysis. A 5-point scale was assigned to the various levels in the hierarchy of hazard controls, from Elimination (score=5, most effective) to Personal Protective Equipment (score=1, least effective). MR safety practices recommended in the ACR MR Safety Manual were surveyed and scored using the 5-point scale. The safety practices were grouped by category of hazard addressed (e.g. main field, radio-frequency field, gradient field).</div></div><div><h3>Results</h3><div>Overall, Administrative Controls were the most common controls, followed by Engineering Controls. Controls within each hazard category featured a range of HHC scores, and all categories were predominantly served by Administrative Controls.</div></div><div><h3>Conclusion</h3><div>The analysis presented in this work could serve as a tool to analyze choices made in the deployment of safety measures, to motivate decision- or policy-making, as a tool for assessment of MR safety programs, or as an approach to motivate future work in the design of hazard controls for MR.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 31-36"},"PeriodicalIF":1.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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