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

The Canadian Association of Radiologists (CAR) Cancer Expert Panel is made up of physicians from the disciplines of radiology, medical oncology, surgical oncology, radiation oncology, family medicine/general practitioner oncology, a patient advisor, and an epidemiologist/guideline methodologist. The Expert Panel developed a list of 29 clinical/diagnostic scenarios, of which 16 pointed to other CAR guidelines. A rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of the remaining 13 scenarios. Recommendations from 21 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop the recommendation for these scenarios. During recommendation formulation, one additional scenario was mapped to an existing CAR guideline scenario, leaving 12 scenarios with new recommendations. The guideline focuses on cancer diagnosis and does not cover cancer staging, follow-up, and surveillance. This guideline presents the methods of development and the referral recommendations for suspected pancreatic cancer, suspected liver cancer, incidental liver mass, incidental colon mass or suspected colon cancer, suspected anal cancer, suspected penile cancer, suspected cervical cancer, suspected endometrial/uterine cancer, suspected vulvar cancer, suspected vaginal cancer, suspected haematologic malignancies, and suspected skin cancer. The guideline also points to other CAR guidelines for suspected neck, thyroid, brain, lung, intracardiac/pericardial, esophageal/gastric, renal, adrenal, bladder, testicular, prostate and ovarian cancers, suspected soft tissue mass or tumour, suspected bone tumour, suspected bone tumour --myeloma, suspected spine tumours, and incidental lung cancer.

Contrast media, including iodinated contrast media and gadolinium-based contrast agents, are commonly administered pharmaceuticals with excellent safety profiles. However, a minority of the population may experience a hypersensitivity reaction following intravenous administration. Hypersensitivity reactions can be immediate or delayed, and range from mild, such as urticaria, to severe, including anaphylaxis. There is emerging evidence that longstanding pretreatment protocols, such as diphenhydramine and corticosteroids, are ineffective and have the potential for side effects and other harms. Moreover, the evidence for efficacy on which this practice is based is weak and outdated. A joint collaborative working group of representatives from the Canadian Association of Radiologists and the Canadian Society of Allergy and Clinical Immunology was assembled to inform medical professionals and hospital policies regarding hypersensitivity reactions to contrast media. The objectives of the working group were to provide an overview of the epidemiology, physiology, risk factors, and types of hypersensitivity reactions; to synthesize the evidence for pretreatment strategies that minimize the risk of a breakthrough reaction for both iodinated contrast media and gadolinium-based contrast agents; to review the allergy investigations used to evaluate patients with a history of severe hypersensitivity reaction; and to provide an overview of existing guidelines. Following appraisal of the evidence, the working group established recommendations based on consensus in this practice guidance.

This practice guideline serves as an update to the Canadian Association of Radiologists' 2013 Technical Standards for Bone Mineral Densitometry Reporting. It aims to align bone mineral density testing and reporting practices in Canada with current clinical best practices, including guidelines from Osteoporosis Canada and the International Society for Clinical Densitometry. Key updates include the endorsement of both FRAX and CAROC tools for evaluating fracture risk, guidance for analyzing male patients and transgender patients, and provision of clinical management guidance of relevance to BMD reporting harmonized with that of Osteoporosis Canada. The document emphasizes the importance of accurate data collection in fracture risk assessment and provides recommendations for reporting fracture risk, T-scores, and clinical management strategies. Additionally, it outlines indications for baseline BMD testing and reassessment timelines, aiming to facilitate appropriate patient management and enhance bone health outcomes. This guideline is intended to complement existing standards and support healthcare professionals in delivering optimal care for patients undergoing BMD testing in Canada.

Radiologists and other diagnostic imaging specialists play a pivotal role in the management of osteoporosis, a highly prevalent condition of reduced bone strength and increased fracture risk. Bone mineral density (BMD) measurement with dual-energy X-ray absorptiometry (DXA) is a critical component of identifying individuals at high risk for fracture. Strategies to prevent fractures are consolidated in the Osteoporosis Canada clinical practice guideline which was updated in 2023. In this guideline, treatment recommendations are based upon a consideration of fracture history, 10-year major osteoporotic fracture (MOF) risk, and BMD T-score in conjunction with age. The current review aims to familiarize radiologists and other diagnostic imaging specialists with the reporting requirements needed to support implementation of this guideline using the FRAX™ risk calculation tool. Fortunately, for specialists already familiar with the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool, the transition to FRAX-based reporting is readily accommodated in a radiology workflow.

Objectives: To determine the feasibility of implementing Ovarian-Adnexal Reporting & Data System (O-RADS) ultrasound (US) for reporting of adnexal masses at our institution, with a specific goal of increasing the use of O-RADS from a baseline of <5% to at least 75% over a 16-month period. Methods: A prospective interrupted time series quality improvement study was undertaken over a 16-month period. Plan, do, study, act cycles included: (1) Engagement of interested parties, (2) Targeted educational sessions, (3) Development of reporting templates, (4) Weekly audit-feedback. Inter-reader variability assessment was performed on 70% of O-RADS risk-category 2 to 5. The primary outcome was the reporting of an O-RADS risk category. Results: A total of 635 female pelvic US were performed at our centre between July 2022 and April 2023. An O-RADS risk category was provided on the final radiology report by the radiologist for 489/635 (77%) US. From November 2022 to April 2023, the weekly rate of O-RADS risk category reporting reached 88%. The O-RADS score was concordant between readers for 83/103 (81%) of US reports with kappa score of 0.69 corresponding to good agreement. Conclusions: The reporting of O-RADS risk category increased from <5% to 88% over a 16-month period with a high level of agreement among readers in assigning O-RADS risk category. Implementation of a standardizing reporting ultrasound system at a tertiary cancer centre is feasible with rapid learning and uptake curves.

The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and interpretation for advanced imaging modalities associated with diagnosing endometriosis. Advanced pelvic ultrasound is essential in diagnosing and mapping pelvic endometriosis, but pelvic MRI serves as an excellent imaging tool in instances where access to advanced ultrasound is limited, or an alternative imaging modality is required. Despite the known utility of MRI for endometriosis, there is no consensus on imaging protocol and patient preparation in Canada. To improve patient care and support excellence in imaging, the Working Group has developed recommendations for the use of pelvic MRI to assess for endometriosis with an aim to standardize MRI technique for use in both community and academic practices across Canada. The guidelines provide recommendations regarding imaging technique and patient preparation for pelvic MRI, along with suggestions for structured reporting of pelvic MRI for endometriosis.

Neurosonography (NSG) is pivotal for rapid, point-of-care neonatal brain assessment. This review elucidates the comprehensive applications of NSG in pediatric care, emphasizing its role in early diagnosis and management of pathologies affecting the pediatric head-such as scalp lesions, misshapen calvarium, ventricular distortions, and cerebrovascular abnormalities, and its specific role in conditions like hypoxic-ischaemic encephalopathy (HIE) across different neonatal gestational ages. We explore its diagnostic advantage in critical care settings, particularly for infants with stroke risk in sickle cell disease, ECMO-related complications, screening for therapeutic hypothermia, and routine neonatal intensive care unit monitoring. This review discusses the recommendations based on the timing of brain injury (preterm and term) and describes technical considerations that enhance diagnostic accuracy. Ultimately, this article advocates for its incorporation into routine neonatal screening to improve neurodevelopmental outcomes, underscoring its importance in clinical decision-making and long-term management of pediatric brain disorders.

Background: Guidelines suggest the Liver Imaging Reporting and Data System (LI-RADS) may not be applicable for some populations at risk for hepatocellular carcinoma (HCC). However, data assessing the association of HCC risk factors with LI-RADS major features are lacking. Purpose: To evaluate whether the association between HCC risk factors and each CT/MRI LI-RADS major feature differs among individuals at-risk for HCC. Methods: Databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus) were searched from 2014 to 2022. Individual participant data (IPD) were extracted from studies evaluating HCC diagnosis using CT/MRI LI-RADS and reporting HCC risk factors. IPD from studies were pooled and modelled with one-stage meta-regressions. Interactions were assessed between major features and HCC risk factors, including age, sex, cirrhosis, chronic hepatitis B virus (HBV), and study location. A mixed effects model that included the major features, as well as separate models that included interactions between each risk factor and each major feature, were fit. Differences in interactions across levels of each risk factor were calculated using adjusted odds-ratios (ORs), 95% confidence-intervals (CI), and z-tests. Risk of bias was assessed using QUADAS-2. (Protocol: https://osf.io/tdv7j/). Results: Across 23 studies (2958 patients and 3553 observations), the associations between LI-RADS major features and HCC were consistent across several HCC risk factors (P-value range: .09-.99). A sensitivity analysis among the 4 studies with a low risk of bias did not differ from the primary analysis. Conclusion: The association between CT/MRI LI-RADS major features and HCC risk factors do not significantly differ in individuals at-risk for HCC. These findings suggest that CT/MR LI-RADS should be applied to all patients considered at risk by LI-RADS without modification or exclusions, regardless of the presence or absence of the risk factors evaluated in this study.