Canadian Association of Radiologists Journal-Journal De L Association Canadienne Des Radiologistes最新文献

The Canadian Association of Radiologists (CAR) Spine Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurology, neurosurgery, physiatry, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 10 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 23 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 22 recommendation statements across the 8 scenarios (one scenario points to the CAR Trauma Referral Guideline and one scenario points to the CAR Musculoskeletal Guideline). This guideline presents the methods of development and the referral recommendations for myelopathy, suspected spinal infection, possible atlanto-axial instability (non-traumatic), axial pain (non-traumatic), radicular pain (non-traumatic), cauda equina syndrome, suspected spinal tumour, and suspected compression fracture. Spondyloarthropathies and spine trauma point to other CAR Diagnostic Imaging Referral Guidelines, Musculoskeletal and Trauma, respectively.

Purpose: To evaluate whether single-exposure, dual-energy chest X-ray (DEX) improves visualization of coronary artery calcium (CAC) and valve/vascular calcifications compared to conventional X-ray. Materials and Methods: Sixty-one bone-marrow transplant patients (22- 79 years; median 61; IQR 15; w/m, 24/37), underwent single-exposure dual-energy X-ray (Reveal 35C, KA imaging) in pa and lateral projection, followed by a standard-of-care chest CT. Two DEX pairs (pa/lateral) were calculated: a composite image (COMP) and a bone image with soft-tissue subtraction (BI). The COMP pair was reviewed by 2 chest radiologists, assessing the presence/absence of CAC and valve/vascular calcifications on a confidence scale from -2 (confidently not present) to 2 (confidently present). Subsequently, the BI pair was revealed, and readers reevaluated both pairs (COMP and BI) jointly using the identical scale. CTCAC scores were categorized according to the CAC-DRS (0-3) and served as standard of reference, valve/vascular calcifications were categorized on CT as present or absent. Results: For detecting CAC on DEX in any CAC-DRS category (1-3), in category 2-3, in category 3, and for valve/vascular calcifications, the ROC-AUC (combined for both readers) for COMP images was 0.74 (CI: 0.64-0.84), 0.81 (CI: 0.68-0.94), 0.84 (CI: 0.69-0.98), and 0.90 (CI: 0.83-0.99), and for the BI images 0.91 (CI: 0.83-0.98), 0.94 (CI: 0.86- 1.00), 0.89 (CI: 0.77-1.00), and 0.98 (CI: 0.96-1.00), with P = .0003, P = .044, P = .42, and P = .55, respectively. The Intraclass-Correlation-Coefficient (ICC) for CAC on COMP/BI was 0.973/0.954, and for valve/vascular calcifications 0.971/0.965. Conclusion: Single-exposure, dual-energy acquisition improves diagnostic confidence for coronary artery calcium and valve/vascular calcification identification on chest X-rays.

Purpose: Use a tailored version of the Quality Assessment of Diagnostic Accuracy Studies tool to evaluate risk of bias and applicability across LIRADS related publications. Method: A tailored QUADAS-2 tool was created through consensus approach to assess risk of bias and applicability across 37 LI-RADS related publications. Studies were selected from 2017 to 2022 using the assistance of experienced hospital librarians to search for studies evaluating the diagnostic accuracy of CT, MRI, or contrast-enhanced ultrasound for HCC using LI-RADS through multiple different databases. QUADAS-2 assessments were performed in duplicate and independently by 2 authors with experience using the QUADAS-2 tool. Disagreements were resolved with a third expert reviewer. Consensus QUADAS-2 assessments were tabulated for each domain. Results: Using the tailored QUADAS-2 tool, 31 of the 37 included LI-RADS studies were assessed as high risk of bias, and 9 out of 37 studies demonstrated concerns for applicability. Patient selection (21 out of 37 studies) and flow/timing (24 out of 37 studies) domains demonstrated the highest risk of bias. 6 out of 37 studies in the index domain demonstrated high risk of bias. 2 out of 37 studies showed high risk of bias in the reference standard domain. Conclusion: A significant proportion of LI-RADS research is at risk of bias with concerns for applicability. Identifying risk of bias in such research is essential to recognize limitations of a study that may affect the validity of the results. Areas for improvement in LI-RADS research include reducing selection bias, avoiding inappropriate exclusions, and decreasing verification bias.

In tandem with the ever-increasing global population, the demand for diagnostic radiology service provision is on the rise and at a disproportionate rate compared to the number of radiologists available to practice. The current "revolution in robotics" promises to alleviate personnel shortages in many sectors of industry, including medicine. Despite negative depictions of robots in popular culture, their multiple potential benefits cannot be overlooked, in particular when it comes to health service provision. The type of robots used for interventional procedures are largely robotic-assistance devices, such as the Da Vinci surgical robot. Advances have also been made with regards to robots for image-guided percutaneous needle placement, which have demonstrated superior accuracy compared to manual methods. It is likely that artificial intelligence will come to play a key role in the field of robotics and will result in an increase in the levels of robotic autonomy attainable. However, this concept is not without ethical and legal considerations, most notably who is responsible should an error occur; the physician, the robot manufacturer, software engineers, or the robot itself? Efforts have been made to legislate in order to protect against the potentially harmful effects of unexplainable "black-box" decision outputs of artificial intelligence systems. In order to be accepted by patients, studies have shown that the perceived level of trustworthiness and predictability of robots is crucial. Ultimately, effective, widespread implementation of medical robotic systems will be contingent on developers remaining cognizant of factors that increase human acceptance, as well as ensuring compliance with regulations.

Radiology in France has made major advances in recent years through innovations in research and clinical practice. French institutions have developed innovative imaging techniques and artificial intelligence applications in the field of diagnostic imaging and interventional radiology. These include, but are not limited to, a more precise diagnosis of cancer and other diseases, research in dual-energy and photon-counting computed tomography, new applications of artificial intelligence, and advanced treatments in the field of interventional radiology. This article aims to explore the major research initiatives and technological advances that are shaping the landscape of radiology in France. By highlighting key contributions in diagnostic imaging, artificial intelligence, and interventional radiology, we provide a comprehensive overview of how these innovations are improving patient outcomes, enhancing diagnostic accuracy, and expanding the possibilities for minimally invasive therapies. As the field continues to evolve, France's position at the forefront of radiological research ensures that these innovations will play a central role in addressing current healthcare challenges and improving patient care on a global scale.

Background: Image-guided tumour ablation is a minimally invasive treatment for early stage hepatocellular carcinoma (HCC). Our study reviews the complications and long term outcomes in patients treated at a tertiary referral centre. Methods: Retrospective study. All patients with HCC who underwent microwave ablation (MWA) or radiofrequency ablation (RFA) from 1st January 2014 to 31st December 2022 were identified. Treatment response of target lesion, complications, and survival were recorded. Results: One hundred seventy ablations were performed in 118 patients; 70% MWA, 30% RFA. Median radiological follow-up 21 months (range 3-107). Follow-up imaging was reported using LI-RADS and mRECIST. At first follow-up imaging, 94 patients had complete response (primary efficacy rate 80.3%) while 19.7% (n = 23) had residual disease. Fifteen of these had repeat ablation; 10 had complete response (secondary efficacy rate 85.6%). By end of study duration, 70.5% (n = 79) achieved sustained local complete response from single ablation without documented recurrence. 14.3% (n = 16) required more than one ablation of target lesion. Overall, 84.8% (n = 95) demonstrated long term local complete response to ablation. Complication occurred in 5.9% (n = 10); 40.0% Grade I, 40.0% Grade II, 10.0% Grade III, 10.0% Grade IV as per the CIRSE Classification. 1-, 3-, and 5-year overall survival (OS) rate was 97%, 68%, and 61% respectively. Mean OS was 5.3 years (median 4.7). No difference in OS (P = .7) or local progression free survival (P = .5) between patients treated with MWA versus RFA. Conclusion: This study demonstrates excellent long-term response to TA, with acceptable complication profile. No difference in survival between RFA versus MWA.