Radiographics最新文献

Screening US for developmental dysplasia of the hip in infants with risk factors should optimally be performed after 6 weeks corrected gestational age (CGA). Scanning before this age leads to higher false-positive rates and the potential need for repeat examination, which creates waste and undue stress on the child and family. Pediatric radiologists at the authors' institution observed that many premature infants were being scheduled too early for their screening US. This quality improvement project aimed to decrease incorrectly scheduled screening examinations from a baseline rate of 50% to less than 25% within 6 months. Key drivers and interventions addressed the lack of clarity regarding whether the examination was screening or diagnostic (physical examination finding), poor visibility and manual calculation of CGA by schedulers, and lack of automated scheduling guidance. Ordering clinicians were educated, and an electronic health record (EHR) report was created to prospectively identify examinations that may need rescheduling. Next, a mandatory order question was added in the EHR to clearly identify which examinations were ordered for screening, with embedded guidance for schedulers to time these examinations after 6 weeks CGA. Finally, a special work queue was created to leverage the expertise of certain schedulers assigned to this task. After the final plan-do-study-act cycle, incorrectly scheduled examinations decreased from 50% to 10%. By using people- (specialized scheduling team), process- (dedicated work queue), and system-related (EHR order question with scheduling guidance) interventions, the group was able to create and sustain change and decreased incorrectly scheduled pediatric hip US examinations by 80%. ^©RSNA, 2025.

Gynecologic manifestations often serve as key diagnostic clues associated with a broad spectrum of hereditary syndromes. The authors summarize the spectrum of gynecologic abnormalities observed with these syndromes, emphasizing their implications for radiologic practice. Hereditary cancer predisposition syndromes such as Lynch syndrome, BRCA and BRCA2 mutations, and Cowden syndrome are associated with distinct gynecologic features, including increased risks of cancers and structural anomalies, which can be effectively assessed with imaging. The authors synthesize current knowledge on the imaging characteristics of gynecologic abnormalities linked to these syndromes and highlight the diagnostic challenges in image interpretation. Current syndrome-specific imaging recommendations, including screening and surveillance guidelines, are also summarized herein. The authors emphasize the importance of integrating radiologic findings with clinical context, with the aim enhancing awareness and expertise in the detection and characterization of gynecologic manifestations associated with hereditary syndromes, thereby contributing to optimal patient management. ^©RSNA, 2025.

Low-dose-rate (LDR) brachytherapy with iodine 125 (¹²⁵I) seeds is an effective treatment of localized prostate cancer, delivering targeted doses to the prostate while minimizing radiation exposure to adjacent tissues. ¹²⁵I seeds implanted under transrectal US guidance provide tailored radiation distribution through loose or stranded configurations. Loose seeds allow flexible placement but carry a higher migration risk than stranded seeds. Optimal placement strategies involve targeting the peripheral zone near the prostate capsule to achieve adequate dose coverage for potential extracapsular extensions, with careful consideration to minimize toxicity to adjacent organs. Seed migration, primarily to the lungs, typically occurs through venous pathways due to the extensive periprostatic venous plexus. Less common migration sites include the heart, vertebral venous plexus, kidneys, liver, and testicular veins. Migration mechanisms involve retrograde venous flow and, in rare cases, arterial pathways through pulmonary arteriovenous malformations or intracardiac shunts. These seed migrations are typically incidental findings at imaging and rarely necessitate intervention because of the gradual radioactive decay of the seeds. Hydrogel spacers composed of polyethylene glycol are increasingly used during brachytherapy to reduce rectal toxicity by creating a separation between the prostate and rectum. Although these spacers are generally effective, complications such as asymmetric distribution, intraprostatic or intrarectal injection, and fistula formation can compromise radiation safety and efficacy. These complications can be identified at postprocedural imaging. Accurate imaging assessment is crucial for evaluating seed placement, detecting seed migration, and identifying complications related to hydrogel spacers, ultimately contributing to improved patient outcomes in prostate cancer treated with LDR brachytherapy. ^©RSNA, 2025 Supplemental material is available for this article.

The authors present a framework for integrating trauma-informed care principles into radiologic procedures. Trauma-informed care is an approach that acknowledges the widespread impact of psychological trauma, incorporating this understanding into health care practices to prioritize patient safety, trust, and support while minimizing the risk of retraumatization. Given the high prevalence of psychological trauma among patients, radiologic procedures-some of which can be physically and emotionally distressing, such as breast biopsies, hysterosalpingography, and fluoroscopic enemas-must be approached with sensitivity. However, despite the growing awareness of trauma-informed care in health care, there is limited literature specifically addressing its application in the field of radiology. Without established frameworks, radiologists and imaging staff may unintentionally overlook critical aspects of patient-centered care, increasing the risk of psychological retraumatization. The authors aim to bridge that gap by providing a structured approach to implementing trauma-informed care in radiology. They outline key principles, including clear communication, patient autonomy, environmental modifications, and procedural adjustments, to foster a sense of safety and control. Additionally, they offer actionable recommendations for before, during, and after imaging examinations-the START, CARES, and FOLLOW framework-to enhance patient comfort and trust. By incorporating trauma-informed strategies and considering barriers to implementation, radiologists and imaging teams can improve patient experiences, foster stronger provider-patient relationships, and ultimately contribute to more compassionate, patient-centered care. Given the integral role of radiology in modern medicine, these considerations are crucial to ensuring equitable and supportive health care for all patients, particularly those with a history of psychological trauma. ^©RSNA, 2025 Supplemental material is available for this article.

Due to longer survival of patients with cancer, better recognition and understanding of immunocompromising conditions, and emerging immune-modulating therapies for malignant and nonmalignant diseases, the number of immunocompromised individuals has increased. Immunocompromised patients require complex, often individualized, evaluation and treatment of an expanded spectrum of pathogens. Pneumonia is a leading cause of death due to infectious disease in these patients, and identification of the pathogen is key to providing appropriate therapy. One important factor in evaluating an immunocompromised patient with pneumonia is the type of immunocompromise, because this will help determine the potential opportunistic agents that should be included in the differential diagnosis. Radiologists can play a vital role in the diagnosis of a wide range of pulmonary diseases associated with immunocompromise, including many opportunistic pulmonary infections, by recognizing key imaging features. The authors summarize the types of immunocompromise encountered in different clinical settings and associate these with specific opportunistic organisms, describe patterns of disease seen in patients with HIV infection with different CD4 cell counts, and describe the imaging appearance of viral and fungal infections in patients with neutropenia. ^©RSNA, 2025.

US is an important diagnostic tool in evaluation of the pancreas, as it is noninvasive, does not require irradiation, and offers real-time imaging capability and broad accessibility. Despite the utility of pancreatic US, it often has limited effectiveness due to the complex anatomy of the pancreas and peripancreatic structures, which inevitably leads to diagnostic errors. The authors summarize the lessons learned from quality assurance rounds at a high-volume tertiary care center. The errors are systematically categorized as perceptual, interpretive, information transfer, and process errors. Each error type is discussed with detailed case studies from clinical practice to underscore common pitfalls and their impact on patient management. Perceptual errors occur when the operators overlook subtle pathologic signs due to the complex anatomy. Interpretive errors arise from misjudgments regarding the clinical significance of visible abnormalities, while information transfer errors stem from inadequate communication of patient history or suboptimal review of previous imaging findings. Process errors reflect systemic issues related to US protocol and scanning techniques. The authors advocate having a thorough understanding of the US appearances of normal and variant pancreatic anatomy and emphasize the importance of correlating US findings with findings of complementary imaging modalities to improve diagnostic accuracy. They also highlight the need to use high-resolution US transducers, embrace new technologies, and adopt meticulous scanning techniques as valuable practical strategies to mitigate diagnostic errors. By providing a detailed analysis of cases, this review demonstrates how structured quality assurance measures and continuous education can significantly reduce diagnostic errors. These efforts are crucial in ensuring accurate diagnoses and optimizing patient outcomes. ^©RSNA, 2025 Supplemental material is available for this article.

Despite technical advances and careful preparation, motion artifacts are commonly encountered in cardiac CT. Artifacts due to patient motion or breathing are not correctable and may necessitate repeat scanning; however, cardiac motion artifacts may be mitigated without repeating the scan. Cardiac motion artifacts may manifest as blur, transition, interpolation, or duplication. Blur artifact due to mismatch between cardiac motion speed and the scanner's temporal resolution can be mitigated by using a different cardiac phase, a motion-correction algorithm, or multisegment reconstruction. Transition artifact at the interface between different scanned segments with different R-R interval lengths may be mitigated by using a different cardiac phase or edge-correction algorithms. Interpolation artifact results when the pitch is too high for the heart rate (HR) at some point of a retrogated scan, either due to the patient taking a deep breath, missing electrocardiographic (ECG) synchronization (sync)-points, or long ECG pauses after premature atrial contractions (PACs) or premature ventricular contractions (PVCs). The scanner fills the data gaps by interpolating (ie, "smearing") data from above and below the gap. Duplication artifact results when the pitch is too low for the HR at some point of a retrogated scan, due to contrast material injection, medications, premature or extra beats, or spurious ECG sync-points. Interpolation and duplication artifacts can often be mitigated by manipulating ECG sync-points. In sync-point editing, sync-points are added (eg, for a missed R wave) or deleted (eg, tagging of a tall T wave, exercise spike, or bifid R waves) such that every R wave (and only R waves) are tagged. In sync-point composing, sync-points are artificially manipulated to improve image quality in arrhythmias with variable R-R intervals (eg, PACs or PVCs, atrial fibrillation). ^©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Ufuk and Landeras in this issue.