Current problems in diagnostic radiology最新文献

The periarticular adipose tissues play a crucial role in knee biomechanics, yet they are often overlooked in daily radiology practice. As the primary mechanical shock absorbers of the knee, intra-articular fat pads reduce the friction between intra-articular structures during joint movement. They also contribute to inflammatory regulation, endocrine secretion, and pain detection. Periarticular fat pads are susceptible to a spectrum of traumatic, degenerative, inflammatory, and neoplastic changes. MRI enables radiologists to assess the anatomy of periarticular fat pads and their related pathologies to make accurate diagnoses and to guide appropriate management. The MRI presentation of these pathologies can be categorized into three groups: (a) signal change and thickening of synovial lining, (b) edema-like change in fat pads, and (c) mass-like lesions. While degeneration and impingement appear as high signal edema-like intensity on fluid-sensitive sequences, inflammatory or infectious synovitis, hemosiderin deposition, and lipoma arborescens can change the signal intensity of the synovial lining. A mass-like lesion arising from these structures could be a true neoplastic lesion, or a variety of non-neoplastic pathologies. A comprehensive understanding of adipose tissues and their pathologies is fundamental for accurate diagnosis and interpretation. In this review, we aim to provide an in-depth assessment of the anatomy and common pathologies of these adipose tissues.

The Anti-Kickback Statute was passed by Congress in the 1970s to reduce the overuse of government-reimbursed medical services. It attempts to eliminate fraud, abuse, and waste of medical services by outlawing the incentive of personal gain when referring patients for government-funded services. Although safe harbors were written into the law to maintain transactions beneficial to society, they require strict adherence. Anti-Kickback Statute violations are subject to the whistleblower provision of the False Claims Act, and violations can yield significant civil and criminal penalties.

Background: Imaging Surgical Patients (ISP) and Essential Imaging for Clinicians (EIC) are online medical imaging units of study for non-radiologist medical practitioners within the Master of Surgery and Master of Medicine programs at the University of Sydney. This paper presents the findings of evaluations of the coursework associated with these units.

Methods: ISP and EIC were reviewed after successful delivery of 8 and 4 semesters, respectively. Reflection and analyses were drawn from the educational team's experiences, formal student feedback, and cohort demographic data in the context of changes made to the units' structure, content, and assessment activities.

Results: From 2016 to 2022, 568 students completed ISP, and 108 completed EIC from 2019-2022. For ISP, course revisions were progressively made to prioritise imaging skills and clinically significant knowledge, to balance the course load against the busy clinical lives of the students, and to offer a flexible learning experience that could be tailored to clinical interests. The design and delivery of EIC were informed by experiences delivering ISP, including the importance of clear learning outcomes and stakeholder consultation. Student and faculty engagement in an online learning environment presents an ongoing challenge. Both units continue to attract strong enrolments within their respective programs.

Conclusions: ISP and EIC are unique Master-level units of study for medical practitioners in the Australian tertiary setting, given that their sole focus is improving non-radiologist clinicians' medical imaging knowledge and skills. By prioritising high-yield and clinically relevant learning experiences, the educational team hopes that engagement with radiology as a specialty will benefit from these units' continued delivery and refinement.

Purpose: To assess the clinical utility of pelvic computed tomography angiography (CTA) in predicting the need for intervention following blunt traumatic pelvic vascular injury, independent of other trauma severity assessment metrics.

Materials and methods: This retrospective study was IRB approved and HIPAA compliant; informed consent was waived. Eligible patients presented with blunt abdominopelvic trauma and underwent triple-phase pelvic CTA on admission from 1/1/2006 - 8/31/2019. Of the 21,162 eligible patients, 350 met criteria (males 225, females 125, mean age 42 years, range 11-96 years). Vessels were evaluated for contrast extravasation, occlusion, narrowing/spasm, dissection, and pseudoaneurysm. Fisher's exact test was used to compare differences in outcome based on vascular injury on CTA.

Results: 74 of 350 (21%) patients demonstrated vascular injury on CTA. 65 had arterial extravasation, 12 had venous injury, 3 had thrombosis, 3 had pseudoaneurysm, 1 had dissection, and 16 had arterial narrowing/spasm. 42 of 65 (65%) patients with active arterial extravasation on pelvic CTA underwent conventional angiography, and 31 demonstrated active bleeding requiring intervention; 5 patients without extravasation underwent negative conventional angiographies. None of the 276 patients without active arterial extravasation received intervention, and all survived. Contrast extravasation on admission pelvic CTA significantly predicted the need for direct intervention and overall mortality (p<0.0001).

Conclusion: Pelvic CTA can be safely implemented in trauma imaging protocols to diagnose vascular injury and determine the need for subsequent intervention. Absence of contrast extravasation on CTA precludes the need for further intervention, independent of newer trauma severity assessment metrics.

Rationale and objectives: Ultrasound-guided breast biopsies are the most frequently performed imaging-guided breast procedures. During training, learners may lack exposure due to limited volume and sensitive anatomy. Current simulation training often involves the use of manufactured or homemade (chicken or turkey breast) phantoms. Virtual reality is an emerging technology, allowing learners to have flexibility in learning, real-life interactive experiences and measurable feedback. The purpose of this study is to assess the feasibility of a novel virtual reality breast biopsy simulation trainer.

Methods: This was a HIPAA-compliant, IRB-approved prospective feasibility study. The participants were three fellowship-trained breast radiologists with varying years of experience. Participants received an introduction to the virtual reality (VR) breast biopsy simulation and brief training session, describing how to enter the simulation and navigate controls. The participants were instructed to perform as many breast biopsies as possible within a 15-min time period. One biopsy cycle consisted of entering the breast with the biopsy needle, taking a biopsy sample and removing the needle. Time to successfully biopsy the mass was recorded by the VR program, and this data was recorded to assess improvement from start to finish of the simulation. A post-procedure survey was administered to all participants immediately after completion of the simulation. Qualitative open-ended subjective feedback was also obtained via Qualtrics.

Results: All three breast radiologists completed the simulation. There were no complications from the procedure, including no motion sickness or fatigue resulting in simulation termination. Results of data obtained from the simulation showed decreased time to successful biopsy (slope = -19.23) with each subsequent trial for all three participant breast radiologists. A decreased time to biopsy was associated with a higher cumulative number of successful biopsies (p = 0.0037). A higher number of cumulative successful biopsies was associated with decreased number of body entries (p = 0.0332) and biopsy fires (p = 0.0221) before a successful tissue sample. Mean responses for Likert scale survey results were overall high. The radiologists found the simulator to be engaging (4.67/5.00 ± 0.47), realistic (2.67/3.00 ± 0.47) and would recommend the simulation to other healthcare professionals (2.67/3.00 ± 0.47). The radiologists participating in the trial also provided overall favorable subjective feedback.

Conclusions: This study presents a novel approach for ultrasound-guided breast biopsy training with a VR simulation that showed to be successfully capable of recording time-to-completion of each biopsy attempt. Future studies will be directed toward assessing the utility of the simulation in improving trainee skills.

Introduction: PowerPoint presentations containing radiographic images continue to be an important educational tool for healthcare professionals. When properly deidentified, these radiographic imaging files are valuable and do not pose any privacy concerns for patients. However, when these images are not properly managed, patient information can be uncovered; raising concerns about patient privacy and potential legal consequences for healthcare systems and academic institutions. This study revisited and expanded upon previous work published by Weadock et. al in an attempt to see how this issue has changed in the last 15 years.

Methods: This study consisted of 8 separate Google Web searches related to a medical imaging modality. Each PowerPoint file was manually inspected for imaging files including x rays, CT scans, MRI's, PET scans, CT and MR angiography and ultrasounds. If a PowerPoint contained an image file, it was then inspected for PHI. Full PHI included all of the following: patient's full name, medical registration number (MRN), date and a geographic indicator smaller than a state.

Results: The first two Google searches "Magnetic Resonance Imaging filetype:ppt" and "Cardiac CT CAT Scan filetype:ppt" returned 146 search results with 7.6 % containing full PHI. "Radiology Chest X-ray filetype:ppt" resulted in accessible PHI in 40 % of the presentations with images and "Post-Operative CT Scan filetype:ppt" resulted in accessible PHI in 29 %. Magnetic Resonance Imaging filetype:pptx" returned 0 results with PHI. "Cardiac CT CAT scan filetype:pptx" returned 1 result with partial PHI."Radiology Chest X-ray filetype:pptx" contained 4 results with partial PHI and 1 result with full PHI. "Post-Operative CT scan filetype:pptx" contained 2 presentations with partial PHI.

Discussion: While a declining percentage of PowerPoint files containing PHI is reassuring, this follow up study demonstrated that PHI can still be easily accessed openly on the internet by anyone who has basic familiarity with Microsoft PowerPoint. Work remains to continue to educate users on how to properly protect patient information in PowerPoint files. Appropriately protecting private healthcare information is essential for patient safety and can prevent unintentional HIPAA violations. Radiologists are uniquely positioned to educate other healthcare providers on how to properly remove PHI from radiologic imaging files.

Minority women face disproportionately higher risks of breast cancer diagnosis and mortality under 50. Mobile mammography vans enhance screening accessibility but face challenges like long-term funding and operational viability. This study assesses existing mobile mammography van programs and proposes a sustainable model through literature review and qualitative interviews at a tertiary care academic medical center. The proposed model emphasizes partnerships, sponsorships and long-term funding for ensuring workforce sustainability. Organizational structure, budget allocation, patient workflow and follow-up protocols are aimed at transitioning towards serving primarily uninsured patients while maintaining financial stability. This sustainable approach hopes to enhance screening rates and timely care for underserved women, suggesting scalability and potential to reduce late-stage diagnoses and mortality. Continued implementation and evaluation are essential for validating feasibility and effectiveness, ensuring long-term improvement in screening rates and program longevity.

Background: The integration of Artificial Intelligence (AI) into radiology education presents a transformative opportunity to enhance learning and practice within the field. This scoping review aims to systematically explore and map the current landscape of AI integration in radiology education.

Methods: The review process involved systematically searching four databases, including MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), and Scopus. Inclusion criteria focused on research that addresses the use of AI technologies in radiology education, including but not limited to, AI-assisted learning platforms, simulation tools, and automated assessment systems. This scoping review was registered on Open Science Framework using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping review.

Results: Of the 1081 search results, 9 studies met the inclusion criteria. Key findings indicate a diverse range of AI applications in radiology education, from personalized curriculum generation and diagnostic support tools to automated evaluation systems. The review highlights both the potential benefits, such as enhanced diagnostic accuracy, and the challenges, including technical limitations.

Conclusion: The integration of AI into radiology education, which has significant potential to enhance outcomes and professional practice, requires overcoming existing challenges and ensuring that AI complements rather than replaces traditional methods, with future research needed on longitudinal studies to evaluate its long-term impact.

Background: Pleural infections present significant clinical challenges, particularly in elderly or immunosuppressed patients, leading to prolonged hospital stay, high morbidity and high mortality. While CT and X-ray are standard imaging modalities, MRI's potential remain unexplored due to historical limitations in scan duration and patient discomfort. Advances in MRI technology, however, may enable its broader use in thoracic imaging. The study aimed to explore the feasibility of thoracic MRI from the radiographers' and patients' perspectives.

Methods: A prospective feasibility study was conducted involving thirteen patients with pleural infections who underwent thoracic MRI as an add-on within 48 h of the conventional contrast-enhanced chest CT. Feasibility was assessed on technical success, and scan duration. Patients and radiographers experiences were evaluated through questionnaires and qualitative comments.

Results: Technical success was high as all thirteen patients completed the scans. The mean in-room time was 30.7±5.5 minutes and the mean scan time was 23 ± 5.4 minutes. Radiographers reported the MRI scans as feasible with few patients requiring breaks or assistance. Most patients found the MRI experience manageable though two reported difficulties with breath-hold instructions. No patients were challenged by lying in supine position and no patients felt very anxious. No significant movement- or breathing artefacts were identified on MRI.

Conclusion: Thoracic MRI is feasible with high technical success, acceptable scan time, and good patient experience in patients with pleural infections offering potential as a radiation-free imaging modality. Furthermore, compared to CT, the use of MRI showed potential advantages in identifying pleural effusion septations.