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

Background: Physicians in Canada are disproportionately concentrated in urban centers, with rural regions facing significant gaps in specialist care. The geo-spatial characteristics of Interventional Radiology (IR) in Canada have not been systematically studied. This study examines the distribution of Canadian Association of Interventional Radiology (CAIR) members and the sociodemographic characteristics of the populations they serve.

Methods: A list of active members of the Canadian Association of IR (CAIR) was obtained in May 2025. Data from the Canadian Census was used to gather census division (CD)-level information on population size and demographics including data on ethnicity, income, education, employment, and income. CDs were grouped and compared between those with access to IR care and those without, compared between top and bottom quartiles for each population characteristic, and mapped.

Results: Of 293 CDs in Canada, only 48 (19.6%) had at least one CAIR IR, leaving 31.6% of the national population without local access. CAIR IRs were strongly clustered in high-population CDs, with Toronto, Vancouver, and Montreal alone accounting for 56.5% of IRs. CDs with CAIR IRs had significantly higher mean populations (527 322 vs 47 675; P < .001), median incomes ($82 760 vs $75 821; P = .002), and educational attainment (31% vs 16%; P < .001). Conversely, CDs with higher proportions of the population being Indigenous were less likely to have CAIR IRs (5% vs 14%; P < .001).

Conclusion: CAIR member IRs are disproportionately concentrated in large urban centers, leaving substantial geographic disparities. Addressing this maldistribution will require coordinated strategies, including outreach models, telehealth integration, and national workforce planning.

Patient-reported outcome measures (PROMs) are standardized, validated instruments that measure how patients feel and function, collected directly from the patient. Traditionally, key metrics in radiology include technical aspects such as image quality, radiation dose, and diagnostic accuracy. However, medical imaging and image-guided therapies shape patient experience in informational, emotional, physical, and logistical domains that are rarely measured. Failing to capture this information is an important gap in radiology research and practice today that needs to be addressed. This review synthesizes the science of PROMs through a radiology lens: what PROMs are; why PROMs are relevant to diagnostic imaging and interventional practice; how to select and interpret PROMs responsibly, with explicit attention to bias, conflicts of interest, and minimal important differences; and how to implement PROMs pragmatically using contemporary digital workflows. This article highlights radiology-specific frameworks for patient-centred outcomes of diagnostic tests, summarizes evidence on how electronic PROM (ePROM) programs can improve patient experience and clinical outcomes, and proposes a practical roadmap for department-level implementation. Throughout, this review aligns recommendations with current methodological and regulatory guidance, draws on Canadian implementation experience, and translates lessons from applied PROM programs in complex clinical services to radiology settings. Implemented thoughtfully, PROMs give radiologists a rigorous, low-burden way to document benefits radiology already provides, strengthen outcome and health-economic analyses, and co-design services around what patients value. Integrating PROMs alongside established technical and diagnostic metrics can extend radiology's value proposition, and make radiology's patient-centred impact visible, measurable, and improvable.

Despite the centrality of radiology and radiologists in much clinical investigation and care of patients, the precise roles radiologists fulfil are often poorly understood by patients, and, sometimes, sadly, by our colleagues in healthcare. Loose use of language often designates those who refer patients for radiological investigation as "clinicians," implying that this descriptor does not apply to radiologists. The term "clinician" applies to physicians with direct responsibility for patient care; this includes typical radiologist activity. For a variety of reasons (personal preference, workload demands, modern methods of communication and working), direct contact between radiologists and patients, and between radiologists and referring colleagues is in decline. Yet this trend is occurring against a backdrop of increased reliance upon radiology and other investigative tests, as opposed to history-taking and physical examination, for diagnosis and management decision-making. Given the opportunity this trend creates for radiology and radiologists to demonstrate and enhance our clinical centrality, and the concurrent increasing expectation on the part of patients for direct interaction with those making decisions with respect to their healthcare, radiologists need to emphasise our clinical role by embracing every opportunity for direct contact with our patients and our referring colleagues, rather than allowing ourselves to become overwhelmed by and hidden behind ever-increasing workload. It is only by being true, active clinicians that radiologists can deliver most value for our patients, and ensure that our speciality prospers and grows.

Diffuse liver diseases, including steatosis, cirrhosis, and fibrosis, significantly alter hepatic architecture, and can obscure, mimic, or alter the imaging features of focal liver lesions and reduce the diagnostic accuracy of specific imaging modalities. This review outlines the key imaging pitfalls created by diffuse liver disease and offers practical, evidence-based strategies to overcome them. We describe several key imaging pitfalls in interpreting liver lesions in diffuse liver disease, including the atypical appearance of focal lesions on ultrasound and CT due to altered background parenchyma; the phenomenon of "vanishing washout" of hepatocellular carcinoma on CT in steatotic livers; and the significant risk of underestimating metastatic disease burden or missing occult lesions. For each pitfall, we discuss the strengths and weaknesses of various imaging modalities and suggest problem-solving strategies, such as guidance on selecting the most appropriate next-line imaging modality for lesion characterization. We highlight the roles of contrast-enhanced ultrasound and MRI in resolving diagnostic uncertainty when initial ultrasound or CT imaging is atypical or equivocal. A comprehensive understanding of how diffuse liver disease affects the imaging of both benign and malignant lesions is important for accurate diagnosis. Recognizing these pitfalls allows a tailored, multimodality imaging approach that optimizes the detection and characterization of focal liver lesions, ultimately guiding clinical management and improving patient care.

The rising global burden of cancer drives increased demands for medical imaging, which is essential throughout cancer care. However, delivering medical imaging presents significant environmental challenges including high energy use, reliance on single-use supplies, and the production of environmental pollutants. Environmental factors, such as ultraviolet radiation, wildfire smoke, and carcinogenic pollutants contribute to rising cancer rates, while extreme weather events driven by climate change disrupt cancer care delivery-highlighting the close connection between patient and planetary health. This review explores opportunities to improve the environmental sustainability of oncologic imaging, emphasizing the importance of patient-relevant outcomes-such as quality of life and overall survival-as a guiding principle in cancer care. Key strategies include optimizing imaging schedules to reduce low-value imaging, selecting modalities with lower environmental impact where clinically appropriate, minimizing waste streams, and adopting energy-efficient practices. Artificial intelligence offers the potential to personalize imaging schedules and improve efficiency, though its benefits must be weighed against energy use. Mobile imaging programs and integrated scheduling reduce patient travel-related emissions while promoting health equity, particularly in underserved communities. Future research should focus on optimizing imaging intervals to address patient-relevant outcomes better, expanding the use of abbreviated imaging protocols, and the judicious deployment of artificial intelligence, ensuring its benefits justify energy use.

Climate change is the most important challenge of this century. Global surface temperature is continuously rising to new record highs, adversely affecting the health of the planet and humans. The purpose of this article is to review the impact of climate related environmental exposures on human health, healthcare delivery, and medical imaging and explore the potential to leverage medical imaging as a non-invasive tool to advance our understanding of climate related health effects. Radiology departments and healthcare systems must focus on building resilience to the effects of climate change while ensuring that the delivery of care is environmentally sustainable. Further research is needed to refine our understanding of the effects of climate change on human health and to forecast the expected changes in the demand for healthcare and radiology services.

Interventional neuro-oncology is an evolving subspecialty that leverages minimally invasive endovascular and percutaneous techniques to improve outcomes for patients with spine, brain, and head-neck tumours. While conventional interventions have historically focused on vascular pathologies such as stroke and aneurysms, interventional techniques in oncology are gaining prominence. This review explores the role of image-guided interventions in preoperative tumour embolization, middle meningeal artery embolization in thrombocytopenic cancer patients, management of head and neck hemorrhage, intra-arterial drug delivery, and spinal interventions. Through a synthesis of current evidence, we highlighted the growing importance of interventional techniques in neuro-oncology and discuss future advancements in image guidance, robotics, and targeted drug delivery.

Purpose: Adrenocortical carcinoma (ACC) is a rare condition with a poor and hardly predictable prognosis. This study aims to build and evaluate a preoperative computed tomography (CT)-based score (CT score) using features previously reported as biomarkers in ACC to predict overall survival (OS) in patients with ACC. Methods: A CT score based on preoperative CT examinations combining shape elongation, maximum tumour diameter, and the European Network for the Study of Adrenal Tumors (ENSAT) stage was built using a logistic regression model to predict OS duration in a development cohort of 89 patients with ACC. An optimal cut-off of the CT score was defined and the Kaplan-Meier method was used to assess OS. The CT score was then tested in an external validation cohort of 54 patients wit ACC. The C-index of the CT score for predicting OS was compared to that of ENSAT stage alone. Results: The CT score helped discriminate between patients with poor prognosis and patients with good prognosis in both the validation cohort (54 patients; mean OS, 69.4 months; 95% confidence interval [CI]: 57.4-81.4 months vs mean OS, 75.6 months; 95% CI: 62.9-88.4 months, respectively; P = .022). In the validation cohort the C-index of the CT score was significantly better than that of the ENSAT stage alone (0.62 vs 0.35; P = .002). Conclusion: A CT score combining morphological criteria, radiomics, and ENSAT stage on preoperative CT examinations allows a better prognostic stratification of patients with ACC compared to ENSAT stage alone.