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Showing 1 - 200 of 3162 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 30, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 88, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 35, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 396, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 243, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 15)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 8)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 136, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 29, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 53, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 16, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 387, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 335, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 10, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 438, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 51, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 43, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 200, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 15)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 173, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

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Journal Cover Academic Radiology
  Journal Prestige (SJR): 1.008
  Citation Impact (citeScore): 75
  Number of Followers: 22  
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1076-6332
   Published by Elsevier Homepage  [3162 journals]
  • Subspecialist Reader Reinterpretation of Referred Imaging Studies
    • Authors: Mahmoud Al-Hawary
      Pages: 823 - 824
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Mahmoud Al-Hawary

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2018.03.018
  • Does Second Reader Opinion Affect Patient Management in Pancreatic Ductal
    • Authors: Giuseppe Corrias; Sandra Huicochea Castellanos; Ryan Merkow; Russel Langan; Vinod Balachandran; Monica Ragucci; Gabriella Carollo; Marcello Mancini; Luca Saba; Lorenzo Mannelli
      Pages: 825 - 832
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Giuseppe Corrias, Sandra Huicochea Castellanos, Ryan Merkow, Russel Langan, Vinod Balachandran, Monica Ragucci, Gabriella Carollo, Marcello Mancini, Luca Saba, Lorenzo Mannelli
      Rationale and Objectives To determine the impact of second-opinion assessment on cancer staging and patient management in patients with pancreatic ductal adenocarcinoma. Methods and Materials This retrospective study was approved by our institutional review board with a waiver of informed consent. Second-opinion reports between January 1, 2009 and December 31, 2013, alongside outside reports for 65 consecutive cases of biopsy-proven pancreatic adenocarcinomas, were presented in random order to two experienced abdominal surgeons who independently reviewed them blinded to the origin of the report, images of the examinations, and patient identifier. Each surgeon filled in a questionnaire for each report recommending cancer staging and patient management. Recommended patient management and staging were evaluated against reference standards (actual patient management at 6 months following second-opinion assessment, and pathology or other clinical and imaging reference standards at 6 months or longer, respectively) using Cohen kappa. Results Cancer staging differed in 13% (9 of 65) of cases for surgeon 1 and in 18.4% (12 of 65) for surgeon 2. Patient management changed in 38.4% (25 of 65) of cases for surgeon 1 and in 20% (13 of 65) for surgeon 2. When compared to the pathologic staging gold standard, second opinion was correct in 85.7% (six of seven) of the time for both surgeons. Recommended patient management from second-opinion reports showed good agreement with the reference standard (weighted k = 0.6467 [0.4014–0.892] and weighted k = 0.6262 [0.3954–0.857] for surgeon 2). Conclusion Second-opinion review by subspecialized oncologic radiologists can impact patient care, specifically in terms of management decision.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.12.010
  • Coregistration of Preoperative MRI with Ex Vivo Mesorectal Pathology
           Specimens to Spatially Map Post-treatment Changes in Rectal Cancer Onto In
           Vivo Imaging
    • Authors: Jacob Antunes; Satish Viswanath; Justin T. Brady; Benjamin Crawshaw; Pablo Ros; Scott Steele; Conor P. Delaney; Raj Paspulati; Joseph Willis; Anant Madabhushi
      Pages: 833 - 841
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Jacob Antunes, Satish Viswanath, Justin T. Brady, Benjamin Crawshaw, Pablo Ros, Scott Steele, Conor P. Delaney, Raj Paspulati, Joseph Willis, Anant Madabhushi
      Rationale and Objectives The objective of this study was to develop and quantitatively evaluate a radiology-pathology fusion method for spatially mapping tissue regions corresponding to different chemoradiation therapy-related effects from surgically excised whole-mount rectal cancer histopathology onto preoperative magnetic resonance imaging (MRI). Materials and Methods This study included six subjects with rectal cancer treated with chemoradiation therapy who were then imaged with a 3-T T2-weighted MRI sequence, before undergoing mesorectal excision surgery. Excised rectal specimens were sectioned, stained, and digitized as two-dimensional (2D) whole-mount slides. Annotations of residual disease, ulceration, fibrosis, muscularis propria, mucosa, fat, inflammation, and pools of mucin were made by an expert pathologist on digitized slide images. An expert radiologist and pathologist jointly established corresponding 2D sections between MRI and pathology images, as well as identified a total of 10 corresponding landmarks per case (based on visually similar structures) on both modalities (five for driving registration and five for evaluating alignment). We spatially fused the in vivo MRI and ex vivo pathology images using landmark-based registration. This allowed us to spatially map detailed annotations from 2D pathology slides onto corresponding 2D MRI sections. Results Quantitative assessment of coregistered pathology and MRI sections revealed excellent structural alignment, with an overall deviation of 1.50 ± 0.63 mm across five expert-selected anatomic landmarks (in-plane misalignment of two to three pixels at 0.67- to 1.00-mm spatial resolution). Moreover, the T2-weighted intensity distributions were distinctly different when comparing fibrotic tissue to perirectal fat (as expected), but showed a marked overlap when comparing fibrotic tissue and residual rectal cancer. Conclusions Our fusion methodology enabled successful and accurate localization of post-treatment effects on in vivo MRI.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.12.006
  • Dynamic CTA in Native Kidneys Using a Multiphase CT Protocol—Potential
           of Significant Reduction of Contrast Medium
    • Authors: Margarita Braunagel; Florian Ortner; Ulf Schönermarck; Antje Habicht; Andreas Schindler; Manfred Stangl; Frederik F. Strobl; Maximilian Reiser; Dirk A. Clevert; Christoph Trumm; Andreas Helck
      Pages: 842 - 849
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Margarita Braunagel, Florian Ortner, Ulf Schönermarck, Antje Habicht, Andreas Schindler, Manfred Stangl, Frederik F. Strobl, Maximilian Reiser, Dirk A. Clevert, Christoph Trumm, Andreas Helck
      Rationale and Objective The objective of this study was to assess an optimized renal multiphase computed tomography angiography (MP-CTA) protocol regarding reduction of contrast volume. Materials and Methods Thirty patients underwent MP-CTA (12 phases, every 3.5 seconds, 80 kV/120 mAs) using 30 mL of contrast medium. The quality of MP-CTA was assessed quantitatively measuring vessel attenuation, image noise, and contrast-to-noise ratio. MP-CTA was evaluated qualitatively regarding depiction of vessels, cortex differentiation, and motion artifacts (grades 1–4, 1 = best). Mean effective radiation dose was registered. Results were compared to standard renal computed tomography angiography (CTA) (80 mL). Student t test was applied, if variables followed normal distribution. For other variables, nonparametric Mann-Whitney U test was used. Results All acquisitions were successfully performed, and no patient had to be excluded from the study. MP-CTA enabled high attenuation (aorta: 503 ± 91 HU, renal arteries: 450 ± 73 HU/456 ± 72 HU) at adequate image noise (13.7 ± 1.5) and good contrast-to-noise ratio (34.2 ± 10.2). Good attenuation of renal veins was observed (286 ± 43 HU/282 ± 42 HU). Arterial enhancement was significantly higher compared to renal CTA (aorta: 396 ± 90 HU, renal arteries: 331 ± 74 HU/333 ± 80 HU; P < .001). MP-CTA protocol enabled good image quality of renal arteries (1.5 ± 0.6) and veins (1.7 ± 0.6). Cortex differentiation and motion artifacts were ranked 1.8 ± 0.8 and 1.6 ± 0.8. The mean effective radiation dose was 9 mSv (MP-CTA). Conclusions Compared to standard renal CTA, the renal MP-CTA enabled the significant reduction of contrast volume and simultaneously provided a significantly higher arterial attenuation.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.11.012
  • Fully Automated Segmentation of Polycystic Kidneys From Noncontrast
           Computed Tomography
    • Authors: Dario Turco; Maddalena Valinoti; Eva Maria Martin; Carlo Tagliaferri; Francesco Scolari; Cristiana Corsi
      Pages: 850 - 855
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Dario Turco, Maddalena Valinoti, Eva Maria Martin, Carlo Tagliaferri, Francesco Scolari, Cristiana Corsi
      Rationale and Objectives Total kidney volume is an important biomarker for the evaluation of autosomal dominant polycystic kidney disease progression. In this study, we present a novel approach for automated segmentation of polycystic kidneys from non–contrast-enhanced computed tomography (CT) images. Materials and Methods Non–contrast-enhanced CT images were acquired from 21 patients with a diagnosis of autosomal dominant polycystic kidney disease. Kidney volumes obtained from the fully automated method were compared to volumes obtained by manual segmentation and evaluated using linear regression and Bland-Altman analyses. Dice coefficient was used for performance evaluation. Results Kidney volumes from the automated method well correlated with the ones obtained by manual segmentation. Bland-Altman analysis showed a low percentage bias (−0.3%) and narrow limits of agreements (11.0%). The overlap between the three-dimensional kidney surfaces obtained with our approach and by manual tracing, expressed in terms of Dice coefficient, showed good agreement (0.91 ± 0.02). Conclusions This preliminary study showed the proposed fully automated method for renal volume assessment is feasible, exhibiting how a correct use of biomedical image processing may allow polycystic kidney segmentation also in non–contrast-enhanced CT. Further investigation on a larger dataset is needed to confirm the robustness of the presented approach.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.11.015
  • Combining Washout and Noncontrast Data From Adrenal Protocol CT
    • Authors: Chaan S. Ng; Emre Altinmakas; Wei Wei; Payel Ghosh; Xiao Li; Elizabeth G. Grubbs; Nancy A. Perrier; Victor G. Prieto; Jeffrey E. Lee; Brian P. Hobbs
      Pages: 861 - 868
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Chaan S. Ng, Emre Altinmakas, Wei Wei, Payel Ghosh, Xiao Li, Elizabeth G. Grubbs, Nancy A. Perrier, Victor G. Prieto, Jeffrey E. Lee, Brian P. Hobbs
      Rationale and Objectives To determine if combination of washout and noncontrast data from delayed adrenal computed tomography (CT) improves diagnostic performance, and demonstration of an optimizing analytical framework. Materials and Methods This retrospective study consisted of 97 adrenal lesions, in 96 patients, with pathologically proven adrenal lesions (75 benign; 22 malignant), who had undergone noncontrast, portal- and approximate 15-minute delayed-phase CT. Lesion CT attenuations (Hounsfield units [HU]) during each phase, and “absolute” and “relative” percent enhancement washouts (APEW and RPEW) were assessed. The optimum combination of sequential parameters and thresholds was determined by recursive partitioning analysis; resultant diagnostic performance was compared to commonly applied single-parameter criteria for malignancy (noncontrast > 10 HU, APEW < 60%, RPEW < 40%). Results The above single-parameter criteria yielded sensitivities, specificities, and accuracies for malignancy of 100.0%, 41.3%, and 54.6%; 97.9%, 61.3%, and 69.1%; and 96.6%, 74.7%, and 78.4%, respectively. Recursive partitioning analysis identified noncontrast ≥24.75 HU, with subsequent APEW ≤63.49%, as the optimum sequential parameter-threshold combination, which yielded increased sensitivity, specificity, and accuracy of 100.0%, 85.3%, and 90.7%, respectively. Discrimination using the combined sequential classifier yielded statistically significant improvements in accuracy when compared to the above conventional single-parameter criteria (all P ≤ .039). Conclusion Sequential application of noncontrast and washout criteria from delayed contrast-enhanced adrenal CT can improve diagnostic performance beyond that of commonly applied single-parameter criteria. Validation of the sequential ordering and refinement of the specific threshold values warrant further study.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.12.005
  • Effect of Matrix Size on the Image Quality of Ultra-high-resolution CT of
           the Lung
    • Authors: Akinori Hata; Masahiro Yanagawa; Osamu Honda; Noriko Kikuchi; Tomo Miyata; Shinsuke Tsukagoshi; Ayumi Uranishi; Noriyuki Tomiyama
      Pages: 869 - 876
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Akinori Hata, Masahiro Yanagawa, Osamu Honda, Noriko Kikuchi, Tomo Miyata, Shinsuke Tsukagoshi, Ayumi Uranishi, Noriyuki Tomiyama
      Rationale and Objectives This study aimed to assess the effect of matrix size on the spatial resolution and image quality of ultra-high-resolution computed tomography (U-HRCT). Materials and Methods Slit phantoms and 11 cadaveric lungs were scanned on U-HRCT. Slit phantom scans were reconstructed using a 20-mm field of view (FOV) with 1024 matrix size and a 320-mm FOV with 512, 1024, and 2048 matrix sizes. Cadaveric lung scans were reconstructed using 512, 1024, and 2048 matrix sizes. Three observers subjectively scored the images on a three-point scale (1 = worst, 3 = best), in terms of overall image quality, noise, streak artifact, vessel, bronchi, and image findings. The median score of the three observers was evaluated by Wilcoxon signed-rank test with Bonferroni correction. Noise was measured quantitatively and evaluated with the Tukey test. A P value of <.05 was considered significant. Results The maximum spatial resolution was 0.14 mm; among the 320-mm FOV images, the 2048 matrix had the highest resolution and was significantly better than the 1024 matrix in terms of overall quality, solid nodule, ground-glass opacity, emphysema, intralobular reticulation, honeycombing, and clarity of vessels (P < .05). Both the 2048 and 1024 matrices performed significantly better than the 512 matrix (P < .001), except for noise and streak artifact. The visual and quantitative noise decreased significantly in the order of 512, 1024, and 2048 (P < .001). Conclusion In U-HRCT scans, a large matrix size maintained the spatial resolution and improved the image quality and assessment of lung diseases, despite an increase in image noise, when compared to a 512 matrix size.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.11.017
  • Accuracy of Opposed-phase Magnetic Resonance Imaging for the Evaluation of
           Treated and Untreated Spinal Metastases
    • Authors: Michael T. Perry; Ronnie Sebro
      Pages: 877 - 882
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Michael T. Perry, Ronnie Sebro
      Rationale and Objectives To assess whether the accuracy of opposed-phase magnetic resonance (MR) imaging to differentiate spinal metastases from benign lesions is influenced by treatment. Materials and Methods We retrospectively evaluated 25 benign lesions, 25 untreated spinal metastases, and 89 treated spinal metastases in 101 patients who underwent opposed-phase MR spine imaging at our institution. The largest possible region of interest was placed over the lesion in question on out-of-phase and in-phase MR sequences, and the signal intensity ratio (SIR) of the lesions was calculated. The SIRs were compared between benign, untreated, and treated lesions. Receiver operator characteristic (ROC) curves were used to identify the optimal threshold to differentiate benign lesions from untreated spinal metastases, and the accuracy of this threshold was assessed for treated spinal metastases, chemotherapy-treated spinal metastases, and radiated spinal metastases. Results Benign lesions had lower mean SIR than untreated (P = 2.4 × 10−8, 95% confidence interval [0.29, 0.51]) and treated spinal metastases (P = .51; 95% confidence interval [−0.13, 0.06]). A cutoff SIR of 0.856 had an accuracy of 88.00% for untreated lesions, 77.48% for previously treated lesions, and 70.45% for previously radiated lesions. The ROC curve to differentiate benign lesions from radiated spinal metastases was significantly different from the ROC curve to differentiate benign lesions from untreated spinal metastases (P = .0180). The ROC curve to differentiate benign lesions from lesions treated with chemotherapy only was significantly different from the ROC curve to differentiate between benign lesions and radiated spinal metastases (P = .041). Conclusions Opposed-phase imaging is less accurate for treated spinal metastases, in particular after radiation.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.11.022
  • Associations of County-level Radiologist and Mammography Facility Supply
           with Screening Mammography Rates in the United States
    • Authors: Andrew B. Rosenkrantz; Linda Moy; Margaret M. Fleming; Richard Duszak
      Pages: 883 - 888
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Andrew B. Rosenkrantz, Linda Moy, Margaret M. Fleming, Richard Duszak
      Rationale and Objectives The present study aims to assess associations of Medicare beneficiary screening mammography rates with local mammography facility and radiologist availability. Materials and Methods Mammography screening rates for Medicare fee-for-service beneficiaries were obtained for US counties using the County Health Rankings data set. County-level certified mammography facility counts were obtained from the United States Food and Drug Administration. County-level mammogram-interpreting radiologist and breast imaging subspecialist counts were determined using Centers for Medicare & Medicaid Services fee-for-service claims files. Spearman correlations and multivariable linear regressions were performed using counties' facility and radiologist counts, as well as counts normalized to counties' Medicare fee-for-service beneficiary volume and land area. Results Across 3035 included counties, average screening mammography rates were 60.5% ± 8.2% (range 26%–88%). Correlations between county-level screening rates and total mammography facilities, facilities per 100,000 square mile county area, total mammography-interpreting radiologists, and mammography-interpreting radiologists per 100,000 county-level Medicare beneficiaries were all weak (r = 0.22–0.26). Correlations between county-level screening rates and mammography rates per 100,000 Medicare beneficiaries, total breast imaging subspecialist radiologists, and breast imaging subspecialist radiologists per 100,000 Medicare beneficiaries were all minimal (r = 0.06–0.16). Multivariable analyses overall demonstrated radiologist supply to have a stronger independent effect than facility supply, although effect sizes remained weak for both. Conclusion Mammography facility and radiologist supply-side factors are only weakly associated with county-level Medicare beneficiary screening mammography rates, and as such, screening mammography may differ from many other health-care services. Although efforts to enhance facility and radiologist supply may be helpful, initiatives to improve screening mammography rates should focus more on demand-side factors, such as patient education and primary care physician education and access.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.11.023
  • Angiogenesis Research in Mouse Mammary Cancer Based on Contrast-enhanced
    • Authors: Ming Wang; Hai-Liang Feng; Yu-Qin Liu; He Liu; Yu-Xin Jiang; Qing-Li Zhu; Qing Dai; Jian-Chu Li
      Pages: 889 - 897
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Ming Wang, Hai-Liang Feng, Yu-Qin Liu, He Liu, Yu-Xin Jiang, Qing-Li Zhu, Qing Dai, Jian-Chu Li
      Rationale and Objectives The objective of this study was to investigate the contrast-enhanced ultrasound (CEUS) characteristics of tumor angiogenesis in mouse mammary cancer. Materials and Methods Twenty-four mice were examined with ultrasound and CEUS at 2–12 days after implantation. Four to five mice were assessed daily, and one to three mice were then sacrificed for histology. All of the histologic slides were reviewed and correlated with CEUS findings. Results A total of 46 cases of ultrasound examination had been performed in 24 mice. The mice were classified into three groups according to the tumor growth: group 1 (2~6 days after implantation, n = 20 cases), group 2 (7~9 days after implantation, n = 15 cases), and group 3 (10~12 days after implantation, n = 11 cases). In group 1, all tumors presented as a homogeneous hypoechoic mass with no color Doppler signals. However, three CEUS patterns were observed: 14 tumors presented as type I (peripheral ring enhancement with no enhancement within the tumor), 4 tumors presented as type II (peripheral ring enhancement with deep penetration), and 2 tumors presented as type III (homogeneous or heterogeneous enhancement in the entire tumor). In group 2, there was only difference in the echo (heterogeneous or not) and color Doppler signals (with or without) among the tumors in conventional ultrasound, but four CEUS patterns were observed and most presented as type III (53.3%, 8/15). In group 3, most tumors presented as a heterogeneous solid mass (81.8%, 9/11) with color signals (100%, 11/11), and almost all tumors presented as enhancement of type IV (peripheral ring enhancement with focal nodular enhancement) (90.9%, 10/11).The histologic results showed that the enhanced areas mainly corresponded to tumor cells, large tortuous vessels, and an inflammatory cell infiltrate. Nonenhanced areas corresponded to large areas of necrotic tissue or tumor cells, which arranged loosely with the small zone of necrosis. Conclusions CEUS could image the progression of vessel formation. Moreover, most importantly, CEUS is able to identify angiogenesis before the change of tumor color Doppler, and presents different enhanced patterns at different tumor growth times, which corresponded to tumor histologic features.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.12.004
  • Magic Angle in Cardiac CT
    • Authors: Sebastian D. Reinartz; Christiane K. Kuhl; Kerstin Fehrenbacher; Andreas Napp
      Pages: 898 - 903
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Sebastian D. Reinartz, Christiane K. Kuhl, Kerstin Fehrenbacher, Andreas Napp
      Rationale and Objective To identify the influence of various parameters for reducing artifacts in computed tomography (CT) of commonly used pacemakers or implantable cardioverter-defibrillator (ICD) lead tips. Materials and Methods This ex vivo phantom study compared two CT techniques (Dual-Energy CT [DECT] vs. Dual-Source CT [DSCT]), as well as the influence of incremental alterations of current-time product and pacemaker lead-tip angle with respect to the gantry plane. Four pacemaker leads and one ICD lead were evaluated. The images were assessed visually on a five-point Likert scale (1 = artifact free to 5 = massive artifacts). Likert values 1–3 represent clinically relevant, diagnostic image quality. Results 344 of 400 total images were rated with diagnostic image quality. The DECT and dual-source DSCT technique each scored 86% diagnostic image quality. Statistically, DECT images showed significantly improved image quality (P < .05). Concerning the current-time product, no statistically significant change was found. Regarding lead-tip positioning, an angle of ≤70° yielded 100% diagnostic image quality. Pacemaker and ICD leads were assessed to have statistically significant differences. Conclusions Surprisingly, the lead-tip angle of 70° has been established as the key angle under which diagnostic image quality is always ensured, regardless of the imaging technique. Thus, we call 70° the “Magic angle” in CT pacemaker imaging.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.12.003
  • Discriminating Depth of Response to Therapy in Multiple Myeloma Using
           Whole-body Diffusion-weighted MRI with Apparent Diffusion Coefficient
    • Authors: Chao Wu; Juan Huang; Wen-Bin Xu; Yong-Jing Guan; Hua-Wei Ling; Jian-Qing Mi; Hua Yan
      Pages: 904 - 914
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Chao Wu, Juan Huang, Wen-Bin Xu, Yong-Jing Guan, Hua-Wei Ling, Jian-Qing Mi, Hua Yan
      Rationale and Objectives This study aimed to measure apparent diffusion coefficient (ADC) in Chinese patients with newly diagnosed multiple myeloma by whole-body diffusion-weighted magnetic resonance imaging (WB-DWI MRI) and assess the diagnostic accuracy of ADC in the discrimination of deep response to induction chemotherapy. Materials and Methods Seventeen patients underwent WB-DWI MRI before and after induction chemotherapy (week 20). DWI images and ADC maps were produced and 89 regions of interest were chosen. ADC percent changes were compared between deep (complete response or very good partial response) and non–deep responders (partial response, minimal response, stable disease, or progressive disease) as International Myeloma Working Group criteria. Diagnostic accuracy of ADC was calculated using specific cut offs. Predictive positive value of ADC was calculated to predict deep response to consolidation therapy. Results Lesions reduced in size and number and signal intensity decreased in follow-up DWI, which did not differ between deep and non–deep responders. ADC percent changes were significantly higher in deep responders (36.79%) than in non–deep responders (11.50%) after induction therapy (P = .02) in per lesion analysis. ADC percent increases by 46.96%, 78.0% yielded specificity at 81.4%, 90.7% in discriminating deep response to induction therapy. Predictive positive value predicting deep response to consolidation therapy was 60.5% by using ADC cutoff >1.00 × 10−3 mm2/s at week 20. Conclusions ADC from WB-DWI MRI increased remarkably in patients who achieved deep response at the end of induction chemotherapy, which represented a confirmatory diagnostic tool to discriminate deep response to induction therapy for patients with multiple myeloma. ADC may have a potential to predict deep response to consolidation therapy.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.12.008
  • Predictors of Shunt Dysfunction and Overall Survival in Patients with
           Variceal Bleeding Treated with Transjugular Portosystemic Shunt Creation
           Using the Fluency Stent Graft
    • Authors: Yue-Meng Wan; Yu-Hua Li; Ying Xu; Hua-Mei Wu; Ying-Chun Li; Xi-Nan Wu; Jin-Hui Yang
      Pages: 925 - 934
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Yue-Meng Wan, Yu-Hua Li, Ying Xu, Hua-Mei Wu, Ying-Chun Li, Xi-Nan Wu, Jin-Hui Yang
      Rationale and Objectives Transjugular intrahepatic portosystemic shunt (TIPS) is an established method for portal hypertension. This study was to investigate the long-term safety, technical success, and patency of TIPS, and to determine the risk factors and clinical impacts of shunt dysfunction. Materials and Methods A total of 154 consecutive patients undergoing embolotherapy of gastric coronary vein and/or short gastric vein and TIPS creation were prospectively studied. Follow-up data included technical success, patency and revision of TIPS, and overall survival of patients. Results During the study, the primary and secondary technical success rates were 98.7% and 100%, respectively. Sixty-three patients developed shunt dysfunction, 30 with shunt stenosis and 33 with shunt occlusion. The cumulative 60-month primary, primary assisted, and secondary patency rates were 19.6%, 43.0%, and 93.4%, respectively. The cumulative 60-month overall survival rates were similar between the TIPS dysfunction group and the TIPS non-dysfunction group (68.6% vs. 58.6%, P = .096). Baseline portal vein thrombosis (P < .001), use of bare stents (P = .018), and portal pressure gradient (PPG) (P = .020) were independent predictors for shunt dysfunction, hepatocellular carcinoma (P < .001), and ascites (P = .003) for overall survival. The accuracy of PPG for shunt dysfunction was statistically significant (P < .001), and a cutoff value of 8.5 had 77.8% sensitivity and 64.8% specificity. Conclusions The long-term safety, technical success, and patency of TIPS were good; baseline portal vein thrombosis, use of bare stents, and PPG were significantly associated with shunt dysfunction; shunt dysfunction has little impact on patients' long-term survival because of high secondary patency rates.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.11.020
  • Radiologist Engagement as a Potential Barrier to the Clinical Translation
           of Quantitative Imaging for the Assessment of Tumor Heterogeneity
    • Authors: Kenneth Alan Miles; Julia Squires; Michelle Murphy
      Pages: 935 - 942
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Kenneth Alan Miles, Julia Squires, Michelle Murphy
      Rationale and Objective This study aims to identify potential barriers to the clinical implementation of quantitative imaging for the assessment of tumor heterogeneity. Materials and Methods An 18-month prospective observational study was undertaken in which the clinical implementation of computed tomography texture analysis (CTTA) as a technique for quantifying tumor heterogeneity in patients with non–small cell lung cancer was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results Adopters of the technology comprised five specialists with dual accreditation in radiology and nuclear medicine supervising two trainees. Tumor heterogeneity information was extracted and reported in 190 of 322 eligible cases (59%) and presented at the multidisciplinary team meeting in 124 of 152 patients (82%) for whom CTTA had been performed. The maximum proportion of eligible cases in which heterogeneity information had been extracted and reported in any quarter was 80%, but fell in the latter half of the study. The maximum frequency with which available CTTA results were presented at the multidisciplinary team meeting in any quarter was 92% and was maintained in the latter part of the study. Significant differences in survival were observed for patients categorized using the two reported CTTA values (P = 0.004 and P = 0.0057, respectively). Conclusions Radiologist engagement is a potential barrier to the effective translation of quantitative imaging assessments of tumor heterogeneity into clinical practice and will need to be addressed before tumor heterogeneity information can successfully contribute to clinical decision making in oncology.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.11.019
  • A Review of Resources and Methodologies Available for Teaching and
           Assessing Patient-Related Communication Skills in Radiology
    • Authors: David Sarkany; Carolynn M. DeBenedectis; Stephen D. Brown
      Pages: 955 - 961
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): David Sarkany, Carolynn M. DeBenedectis, Stephen D. Brown
      ACGME expectations for radiology trainees' proficiencies in communication skills pose a challenge to program directors who wish to develop curricula addressing these competencies. Numerous educational resources and pedagogical approaches have emerged to address such competencies specifically for radiology, but have yet to be systematically catalogued. In this paper, we review and compile these resources into a toolkit that will help residencies develop curricula around patient-centered communication. We describe numerous web-based resources and published models that have incorporated innovative, contemporary pedagogical techniques. In undertaking this compilation, our hope is to kindle discussion about the development of formalized or standardized communication curricula or guides for radiology residencies.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2017.11.018
  • Educational Assumptions
    • Authors: Richard B. Gunderman
      Pages: 962 - 963
      Abstract: Publication date: July 2018
      Source:Academic Radiology, Volume 25, Issue 7
      Author(s): Richard B. Gunderman

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2018.02.015
  • (Lack of) Measurable Clinical or Knowledge Gains From Resident
           Participation in Noon Conference
    • Authors: Nathaniel B. Meyer; Kara Gaetke-Udager; Kimberly L. Shampain; Amy Spencer; Richard H. Cohan; Matthew S. Davenport
      Pages: 719 - 726
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Nathaniel B. Meyer, Kara Gaetke-Udager, Kimberly L. Shampain, Amy Spencer, Richard H. Cohan, Matthew S. Davenport
      Rationale and Objectives The objective of this study was to determine whether noon conference attendance by diagnostic radiology residents is predictive of measurable performance. Methods This single-center retrospective Health Insurance and Portability and Accountability Act (HIPAA)-compliant cross-sectional study was considered “not regulated” by the institutional review board. All diagnostic radiology residents who began residency training from 2008 to 2012 were included (N = 54). Metrics of clinical performance and knowledge were collected, including junior and senior precall test results, American Board of Radiology scores (z-score transformed), American College of Radiology in-training scores (years 1–3), on-call “great call” and minor and major discrepancy rates, on-call and daytime case volumes, and training rotation scores. Multivariate regression models were constructed to determine if conference attendance, match rank order, or starting year could predict these outcomes. Pearson bivariate correlations were calculated. Results Senior precall test results were moderately correlated with American Board of Radiology (r = 0.41) and American College of Radiology (r = 0.38–0.48) test results and mean rotation scores (r = 0.41), indicating moderate internal validity. However, conference attendance, match rank order, and year of training did not correlate with (r = −0.16–0.16) or predict (P > .05) measurable resident knowledge. On multivariate analysis, neither match rank order (P = .14–.96) nor conference attendance (P = .10–.88) predicted measurable clinical efficiency or accuracy. Year started training predicted greater cross-sectional case volume (P < .0001, β = 0.361–0.516) and less faculty-to-resident feedback (P < 0.0001, β = [−0.628]–[−0.733]). Conclusions Residents with lower conference attendance are indistinguishable from those who attend more frequently in a wide range of clinical and knowledge-based performance assessments, suggesting that required attendance may not be necessary to gain certain measurable core competencies.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2017.12.032
  • The Clinical Impact of Resident-attending Discrepancies in On-call
           Radiology Reporting
    • Authors: Sebastian R. McWilliams; Christopher Smith; Yaseen Oweis; Kareem Mawad; Constantine Raptis; Vincent Mellnick
      Pages: 727 - 732
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Sebastian R. McWilliams, Christopher Smith, Yaseen Oweis, Kareem Mawad, Constantine Raptis, Vincent Mellnick
      Rationale and Objectives The purpose of this study is to quantify the clinical impact of resident-attending discrepancies at a tertiary referral academic radiology residency program by assessing rates of intervention, discrepancy confirmation, recall rate, and management change rate; furthermore, a discrepancy categorization system will be assessed. Materials and Methods Retrospective review of the records was performed for n = 1482 discrepancies that occurred in the 17-month study period to assess the clinical impact of discrepancies. Discrepancies were grouped according to a previously published classification system. Management changes were recorded and grouped by severity. The recall rate was estimated for discharged patients. Any confirmatory testing was reviewed to evaluate the accuracy of the discrepant report. Categorical variables were compared to the chi-square test. Results The 1482 discrepancies led to management change in 661 cases (44.6%). The most common management change was follow-up imaging. Procedural interventions including surgery occurred in 50 cases (3.3%). The recall rate was 2.6%. Management changes were more severe with computed tomography examinations, inpatients, and when the discrepancy was in the chest and abdomen subspecialty. Also, management changes correlated with the discrepancy category assigned by the attending at the time of review. Conclusions Resident-attending discrepancies do cause management changes in 44.6% of discrepancies (0.62% overall); the most frequent change is follow-up imaging. The discrepancy categorization assigned by the attending correlated with the severity of management change.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2017.11.016
  • Social Media and Education in Radiology
    • Authors: Reed A. Omary
      Pages: 744 - 746
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Reed A. Omary

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2018.02.005
  • Survey Research
    • Authors: Prasad R. Shankar; Matthew S. Davenport; Sean A. Woolen; Ruth C. Carlos; Katerine E. Maturen
      Pages: 751 - 756
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Prasad R. Shankar, Matthew S. Davenport, Sean A. Woolen, Ruth C. Carlos, Katerine E. Maturen
      Survey research is appealing to many clinical researchers, including radiologists. Emerging interest in patient preferences and patient-centered outcomes related to imaging likely will stimulate additional use of questionnaires in our field. However, like other quantitative methods, survey-based research requires meticulous planning, execution, and analysis to generate reliable results and support meaningful conclusions. The purpose of this review is to provide a guideline for radiologists embarking on this type of research, with attention to questionnaire design, sampling, survey administration, and analysis.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2018.02.003
  • Quality and Efficiency Improvement Tools for Every Radiologist
    • Authors: Alexei U. Kudla; Olga R. Brook
      Pages: 757 - 766
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Alexei U. Kudla, Olga R. Brook
      In an era of value-based medicine, data-driven quality improvement is more important than ever to ensure safe and efficient imaging services. Familiarity with high-value tools enables all radiologists to successfully engage in quality and efficiency improvement. In this article, we review the model for improvement, strategies for measurement, and common practical tools with real-life examples that include Run chart, Control chart (Shewhart chart), Fishbone (Cause-and-Effect or Ishikawa) diagram, Pareto chart, 5 Whys, and Root Cause Analysis.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2018.02.004
  • Diagnostic Radiology Resident Recruitment Part I
    • Authors: Mark E. Mullins; Arash Anavim; Lori A. Deitte; Theresa C. McLoud; Charles S. Resnik
      Pages: 767 - 773
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Mark E. Mullins, Arash Anavim, Lori A. Deitte, Theresa C. McLoud, Charles S. Resnik
      To the best of our knowledge, there is little available organized advice for diagnostic radiology residency program directors and their programs regarding resident recruitment. We are a group of current and former program directors who are current vice chairs for education and continue to advise and to mentor many educators. We have constructed this article along the yearly schedule of trainee recruitment, including an application review, interviews, and troublesome trends that we have observed.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2017.11.026
  • Diagnostic Radiology Resident Recruitment Part II
    • Authors: Mark E. Mullins; Arash Anavim; Lori A. Deitte; Theresa C. McLoud; Charles S. Resnik
      Pages: 767 - 773
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Mark E. Mullins, Arash Anavim, Lori A. Deitte, Theresa C. McLoud, Charles S. Resnik
      Applicants to diagnostic radiology residencies often obtain advice regarding the process, typically from local individuals. Materials available on the Internet contribute to this process as well. We are a group of current and former Diagnostic Radiology Residency Program Directors and current Vice Chairs for Education who commonly advise medical students, including regarding radiology as a career. This work is meant to provide a “plain talk” resource for those considering a career in radiology via a radiology residency, written from the point of view of an advisor with lots of experience.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2017.11.026
  • Introducing First-Year Medical Students to Radiology
    • Authors: Michael Kraft; Aaron Sayfie; Katherine Klein; Larry Gruppen; Leslie Quint
      Pages: 780 - 788
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Michael Kraft, Aaron Sayfie, Katherine Klein, Larry Gruppen, Leslie Quint
      Rationale and Objectives The aims of our study were (1) to describe a new educational intervention for first-year medical students that gave a substantial, early exposure to radiology and (2) to examine how this early exposure was received by the students. Materials and Methods Our new curriculum incorporated a new 2-week course very early in the M1 year entitled Foundations of Diagnostics and Therapeutics. Among other topics, the course included a substantial introduction to radiology primarily through small-group seminars and online materials, administered using a flipped-classroom approach. The students were given pre- and postcourse surveys that assessed the degree to which they felt prepared to learn about radiology, as well as their interest in radiology. Results were analyzed using the Wilcoxon signed-rank test. Results Survey responses were obtained from 170 students before the course and 65 students afterward. Upon completing the course, students showed significantly increased academic interest in radiology (P = .008) and a heightened perception of the effect of radiology on patient care (P = .04), without a significant change in interest in pursuing radiology as a career. Students showed an overwhelmingly positive response to the course, although some noted that previous anatomy training would have been helpful. Eighty percent agreed or strongly agreed that the flipped-classroom structure was an effective educational model. Conclusions Our study demonstrated that students were very excited to gain exposure to radiology early in their medical school curriculum, and such exposure led to an improved perception of the field.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2018.02.002
  • Best Practices From the APDR
    • Authors: Daryl T. Goldman; Gail L. Peters; Aaron M. Fischman; George G. Vatakencherry; Peter R. Bream; Jonathan G. Martin; Janice M. Newsome; Zachary L. Bercu; Michael A. Schacht; Karen S. Johnson; James M. Milburn; Seng Ong; Vivek Kalia; Eric England; Darel E. Heitkamp
      Pages: 789 - 791
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Daryl T. Goldman, Gail L. Peters, Aaron M. Fischman, George G. Vatakencherry, Peter R. Bream, Jonathan G. Martin, Janice M. Newsome, Zachary L. Bercu, Michael A. Schacht, Karen S. Johnson, James M. Milburn, Seng Ong, Vivek Kalia, Eric England, Darel E. Heitkamp

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2017.11.021
  • Viewing the Value of Radiology Through Patient Web Portals
    • Authors: Geraldine J. Liao; Christoph I. Lee
      Pages: 792 - 793
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Geraldine J. Liao, Christoph I. Lee
      With widespread adoption of web portals and unfettered patient access to online radiology reports, these previous end products are quickly becoming springboards for direct radiologist-patient interactions, further increasing the value proposition for radiologists in an era of patient-centered care. Here, we provide a real-world scenario demonstrating a teachable moment on how imaging examination reporting in the digital era is expanding the radiologist's role in patient consultation.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2018.01.032
  • Teaching Radiology Physics Interactively with Scientific Notebook Software
    • Authors: Michael L. Richardson; Behrang Amini
      Pages: 801 - 810
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Michael L. Richardson, Behrang Amini
      Rationale and Objectives The goal of this study is to demonstrate how the teaching of radiology physics can be enhanced with the use of interactive scientific notebook software. Methods We used the scientific notebook software known as Project Jupyter, which is free, open-source, and available for the Macintosh, Windows, and Linux operating systems. Results We have created a scientific notebook that demonstrates multiple interactive teaching modules we have written for our residents using the Jupyter notebook system. Conclusions Scientific notebook software allows educators to create teaching modules in a form that combines text, graphics, images, data, interactive calculations, and image analysis within a single document. These notebooks can be used to build interactive teaching modules, which can help explain complex topics in imaging physics to residents.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2017.11.024
  • Integration of a Zero-footprint Cloud-based Picture Archiving and
           Communication System with Customizable Forms for Radiology Research and
    • Authors: Jason Hostetter; Nishanth Khanna; Jacob C. Mandell
      Pages: 811 - 818
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Jason Hostetter, Nishanth Khanna, Jacob C. Mandell
      Rationale and Objectives The purpose of this study was to integrate web-based forms with a zero-footprint cloud-based Picture Archiving and Communication Systems (PACS) to create a tool of potential benefit to radiology research and education. Materials and Methods Web-based forms were created with a front-end and back-end architecture utilizing common programming languages including Vue.js, Node.js and MongoDB, and integrated into an existing zero-footprint cloud-based PACS. Results The web-based forms application can be accessed in any modern internet browser on desktop or mobile devices and allows the creation of customizable forms consisting of a variety of questions types. Each form can be linked to an individual DICOM examination or a collection of DICOM examinations. Conclusions Several uses are demonstrated through a series of case studies, including implementation of a research platform for multi-reader multi-case (MRMC) studies and other imaging research, and creation of an online Objective Structure Clinical Examination (OSCE) and an educational case file.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2018.01.031
  • Instagram as a Vehicle for Education
    • Authors: Serena Shafer; Michael B. Johnson; Rachel B. Thomas; Pamela T. Johnson; Elliot K. Fishman
      Pages: 819 - 822
      Abstract: Publication date: June 2018
      Source:Academic Radiology, Volume 25, Issue 6
      Author(s): Serena Shafer, Michael B. Johnson, Rachel B. Thomas, Pamela T. Johnson, Elliot K. Fishman
      Since its inception in 2010, Instagram has rapidly grown into one of the world's largest social media forums, with over 700 million registered users. In the field of medicine, Instagram has been used for professional development and is also being added to the armamentarium of social media vehicles for education. Utilization of Instagram for medical education lags behind Facebook and Twitter, as many educators may not recognize the potential role. The purpose of this manuscript is to describe unique features of Instagram that are not found on Facebook and Twitter, with the aim of facilitating use of Instagram for radiology education.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2018.03.017
  • Are Mammographically Occult Additional Tumors Identified More Than 2 Cm
           Away From the Primary Breast Cancer on MRI Clinically Significant'
    • Authors: Sarah Goodman; Victoria Mango; Lauren Friedlander; Elise Desperito; Ralph Wynn; Richard Ha
      Abstract: Publication date: Available online 9 June 2018
      Source:Academic Radiology
      Author(s): Sarah Goodman, Victoria Mango, Lauren Friedlander, Elise Desperito, Ralph Wynn, Richard Ha
      Rationale and Objectives To evaluate the clinical significance of mammographically occult additional tumors identified more than 2cm away from the primary breast cancer on preoperative magnetic resonance imaging (MRI). Materials and Methods An Institutional Review Board approved review of consecutive preoperative breast MRIs performed from 1/1/08 to 12/31/14, yielded 667 patients with breast cancer. These patients underwent further assessment to identify biopsy proven mammographically occult breast tumors located more than 2cm away from the edge of the primary tumor. Additional MRI characteristics of the primary and secondary tumors and pathology were reviewed. Statistical analysis was performed using SPSS (v. 24). Results Of 667 patients with breast cancer, 129 patients had 150 additional ipsilateral mammographically occult tumors that were more than 2cm away from the edge of the primary tumor. One hundred twelve of 129 (86.8%) patients had one additional tumor and 17/129 (13.2%) had two or more additional tumors. In 71/129 (55.0%), additional tumors were located in a different quadrant and in 58/129 (45.0%) additional tumors were in the same quadrant but ≥2cm away. Overall, primary tumor size was significantly larger (mean 1.87± 1.25 cm) than the additional tumors (mean 0.79 ± 0.61cm, p < 0.001). However, in 20/129 (15.5%) the additional tumor was larger and in 26/129 (20.2%) the additional tumor was ≥1cm. The primary tumor was significantly more likely to be invasive (81.4%, 105/129) compared to additional tumors (70%, 105/150, p = 0.03). In 9/129 (7.0%) patients, additional tumors yielded unsuspected invasive cancer orhigher tumor grade. The additional tumor was more likely to be nonmass lesion type (37.3% vs 24% p = 0.02) and focus lesion type (10% vs 0.08%, p < 0.001) compared to primary tumor. Conclusion Mammographically occult additional tumors identified more than 2cm away from the primary breast tumor on MRI are unlikely to be surgically treated if undiagnosed and may be clinically significant.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2018.05.009
  • Breast Cyst Fluid Analysis Correlations with Speed of Sound Using
           Transmission Ultrasound
    • Authors: Bilal H. Malik; John C. Klock
      Abstract: Publication date: Available online 7 June 2018
      Source:Academic Radiology
      Author(s): Bilal H. Malik, John C. Klock
      Rationale and Objectives The purpose of this work is to determine if the speed of sound value of a breast cyst can aid in the clinical management of breast masses. Breast macrocysts are defined as fluid-filled tissue masses >1cm in diameter and are thought to be aberrations of normal development and involution, often associated with apocrine metaplasia. The benign natural history of breast cysts is well known, and it is important to obtain high specificity in breast imaging to avoid unnecessary biopsies in women who have benign diseases, particularly those with dense breast tissue. Transmission ultrasound is a tomographic imaging modality that generates high-resolution, 3D speed of sound maps that could be used to identify breast tissue types and act as a biomarker to differentiate lesions. We performed this study to investigate the microanatomy of macrocysts observed using transmission ultrasound, as well as assess the relationship of speed of sound to the physical and biochemical parameters of cyst fluids. Materials and Methods Cyst fluid samples were obtained from 37 patients as part of a case-collection study for ultrasound imaging of the breast. The speed of sound of each sample was measured using a quantitative transmission ultrasound scanner in vivo. Electrolytes, protein, cholesterol, viscosity, and specific gravity were also measured (in the aspirated cyst fluid) to assess their relationship to the speed of sound values obtained during breast imaging. Results We found positive correlations between viscosity and cholesterol (r = 0.71) and viscosity and total protein × cholesterol (r = 0.78). Additionally, we performed direct cell counts on cyst fluids and confirmed a positive correlation of number of cells with speed of sound (r = 0.74). The speed of sound of breast macrocysts, as observed using transmission ultrasound, correlated with the cytological features of intracystic cell clumps. Conclusion On the basis of our work with speed as a classifier, we propose a spectrum of breast macrocysts from fluid-filled to highly cellular. Our results suggest high-speed cysts are mature macrocysts with high cell counts and many cellular clumps that correlate with cyst microanatomy as seen by transmission ultrasound. Further studies are needed to confirm our findings and to assess the clinical value of speed of sound measurements in breast imaging using transmission ultrasound.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2018.03.027
  • Whole Left Ventricular Coverage Versus Conventional 3-Slice Myocardial
           Perfusion Magnetic Resonance Imaging for the Detection of Suspected
           Coronary Artery Disease
    • Authors: Heng Ma; Yue Zhang; Jingjing Chen; Jun Yang
      Abstract: Publication date: Available online 7 June 2018
      Source:Academic Radiology
      Author(s): Heng Ma, Yue Zhang, Jingjing Chen, Jun Yang
      Rationale and Objectives Sliding-window conjugate-gradient highly constrained back-projection reconstruction (SW-CG-HYPR) allows whole left ventricular coverage, improved temporal and spatial resolution, and signal-to-noise ratio compared to the conventional 3-slice saturation recovery turbo-fast low-angle shot (SR-Turbo-FLASH) sequence. We prospectively compared the diagnostic value of whole leftventricular coverage myocardial perfusion magnetic resonance imaging (MRI) and conventional 3-slice technique in patients with suspected coronary artery disease (CAD). Materials and Methods Thirty consecutive patients with suspected CAD who were scheduled for coronary angiography underwent myocardial perfusion MRI with both SW-CG-HYPR and SR-Turbo-FLASH in random order at 3.0 T. Perfusion defects were interpreted visually by two blinded observers and were correlated to x-ray angiographic stenoses ≥50%. Receiver-operating characteristic curve analysis was used to compare the diagnostic performance of the two imaging techniques. Results The image quality score of SW-CG-HYPR was significantly higher than that of SR-Turbo-FLASH (3.4 ± 0.6 vs 3.0 ± 0.7, respectively; p < 0.05). In the per-patient analysis, SW-CG-HYPR provided a higher sensitivity (94% vs 89%), specificity (83% vs 75%), and diagnostic accuracy (90% vs 83%) for the detection of CAD than SR-Turbo-FLASH. In the per-vessel analysis, the diagnostic performance of SW-CG-HYPR was significantly greater than that of SR-Turbo-FLASH for the overall detection of CAD (area under receiver-operating characteristic curve: 0.96 ± 0.02 vs 0.90 ± 0.03, respectively; p < 0.05). Conclusion Whole left ventricular coverage myocardial perfusion MRI has higher diagnostic accuracy compared to conventional 3-slice technique for the detection of suspected CAD.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2018.05.008
  • CT Lymphangiography (CTL) in Primary Intestinal Lymphangiectasia (PIL): A
           Comparative Study with Intraoperative Enteroscopy (IOE)
    • Authors: Jian Dong; Jianfeng Xin; Wenbin Shen; Tingguo Wen; Xiaobai Chen; Yuguang Sun; Rengui Wang
      Abstract: Publication date: Available online 6 June 2018
      Source:Academic Radiology
      Author(s): Jian Dong, Jianfeng Xin, Wenbin Shen, Tingguo Wen, Xiaobai Chen, Yuguang Sun, Rengui Wang
      Rationale and Objectives To investigate the clinical feasibility of CT lymphangiography (CTL) in primary intestinal lymphangiectasia (PIL) by comparison with intraoperative enteroscopy (IOE) during exploratory laparotomy. Materials and Methods Eleven PIL patients (F/M, two/nine, age range 10–37 years) were recruited in this study, and they were performed IOE during exploratory laparotomy for suspected serious lymphatic-intestinal leakages. All the patients were performed CTL before surgery, and the imaging data were reviewed by two radiologists separately. CTL assessments included intestinal lesions, edematous lesions, intestinal and mesenteric lymphangiectasia, lymphaticabdominal leakages, lymph fluid reflux, lymphangioma and abnormal lymphatics in other area. The intestinal lymphangiectasia and lymphaticintestinal leakages were confirmed by histology and IOE. Results For CTL, (1) nine intestinal wall thickening; (2) eight ascites, complicated with four pleural effusions, (3) eight intestinal and mesenteric lymphangiectasia, (4) six lymph fluid reflux (5) one lymphatic-abdominal leakage, (6) two lymphangioma. While for IOE, intestinal lymphangiectasia has been confirmed in all patients, including five segemental and six diffusive lesions in intestinal mucosa. Besides, one lymphatic-intestinal fistula, one lymphatic-abdominal leakage was confirmed. Compared to IOE and histology, the accuracy of CTL was 72.7% in detecting intestinal lymphangiectasia. Conclusion Compared to IOE, CTL demonstrates feasibility in detection of intestinal lymphangiectasia and other abnormalities in whole lymphatic circulation for PIL. Combination of CTL with IOE accommodates guidance for preoperative evaluation and therapeutic management for PIL.

      PubDate: 2018-06-09T08:57:41Z
      DOI: 10.1016/j.acra.2018.04.023
  • Cultivating Physician Character in Diagnostic Radiology Through Virtuous
           Caring and Collaborative Professionalism
    • Authors: Keith Herr; Tarek Hanna Nicole Restauri
      Abstract: Publication date: Available online 25 May 2018
      Source:Academic Radiology
      Author(s): Keith D. Herr, Tarek N. Hanna, Nicole Restauri
      In the contemporary environment of patient- and value-centered care, it is no longer sufficient to limit the definition of an “excellent radiologist” to someone who is skilled at image interpretation. Since diagnostic radiologists are physicians, they are held to a certain character standard expected of a physician, whose primary objective is to serve the best interest of patients. An “excellent radiologist,” then, is better defined as one who is both skilled at interpreting medical imaging and embodies the attributes of physician character. The concept of physician character can be understood as the interplay between the practice of the care-related virtues, such as empathy, compassion, and kindness, and cooperative efforts with nonradiologist health care team members, termed collaborative professionalism. The very nature of the work of diagnostic radiology, aided by advances in technology, increasingly isolates the radiologist from both patients and other care providers, making it difficult to find opportunities for virtuous care and collaborative professionalism. Using the moral intuitionist model of character development as a conceptual framework, we first delineate the challenges that diagnostic radiologists face in demonstrating virtuous caring and collaborative professionalism. Then, we explore strategies that diagnostic radiologists can employ to overcome these barriers, thereby cultivating their own physician character and setting an example for other radiologists, medical students, and trainees. Finally, we will examine some of the limitations of applying this theoretical model to the real world.

      PubDate: 2018-05-28T09:45:06Z
  • Determination of an Optimized Weighting Factor of Liver Parenchyma for
           Six-point Interference Dixon Fat Percentage Imaging Accuracy in
           Nonalcoholic Fatty Liver Disease Rat Model
    • Authors: Onseok Lee; Suk-Jun Lee Seung-Man
      Abstract: Publication date: Available online 24 May 2018
      Source:Academic Radiology
      Author(s): Onseok Lee, Suk-Jun Lee, Seung-Man Yu
      Rationale and Objectives The aim of this study was to determine the optimal weighting factor (WF) for precise quantification using six-point interference Dixon fat percentage imaging by analyzing changes in WFs of fatty acid metabolites (FMs) in high-fat-induced fatty liver disease rat model. Materials and Methods Individual FM-related WFs were calculated based on concentration ratios of integrated areas of seven peak FMs with four phantom series. Ten 8-week-old male Sprague-Dawley rats were used for baseline quantification of fat in liver magnetic resonance imaging or magnetic resonance spectroscopy data. These seven lipid metabolites were then quantitatively analyzed. Spearman test was used for correlation analysis of different lipid proton concentrations. The most accurate WF for six-point interference Dixon fat percentage imaging was then determined. Results The seven lipid resonance WF values obtained from magnetic resonance spectroscopy data for three different oils (oleic, linoleic, and soybean) were different from each other. In lipid phantoms, except for the phantom containing oleic acid, changes in FP values were significantly different when WFs were changed in six-point interference Dixon fat percentage image. The seven lipid resonance WF values for the nonalcoholic fatty liver animal model were different from human subcutaneous adipose tissue lipid WF values. Conclusions WF affected the calculation of six-point interference Dixon-based fat percentage imaging value in phantom experiment. If WF of liver parenchyma FM which is specific to each liver disease is applied, the accuracy of six-point interference Dixon fat percentage imaging can be further increased.

      PubDate: 2018-05-28T09:45:06Z
  • 3D Printed Antibiotic and Chemotherapeutic Eluting Catheters for Potential
           Use in Interventional Radiology
    • Authors: Jeffery A. Weisman; David H. Ballard; Udayabhanu Jammalamadaka; Karthik Tappa; Jan Sumerel; Horacio B. D'Agostino; David K. Mills; Pamela K. Woodard
      Abstract: Publication date: Available online 22 May 2018
      Source:Academic Radiology
      Author(s): Jeffery A. Weisman, David H. Ballard, Udayabhanu Jammalamadaka, Karthik Tappa, Jan Sumerel, Horacio B. D'Agostino, David K. Mills, Pamela K. Woodard
      Rationale and Objectives Additive manufacturing may be used as a form of personalized medicine in interventional radiology by allowing for the creation of customized bioactive constructs such as catheters that can act as a form of localized drug delivery. The purpose of the present in vitro study was to use three-dimensional (3D) printing to construct bioactive-laden bioabsorbable catheters impregnated with antibiotics and chemotherapeutics. Materials and Methods Polylactic acid bioplastic pellets were coated with the powdered bioactive compounds gentamicin sulfate (GS) or methotrexate (MTX) to incorporate these drugs into the 3D printed constructs. The pellets were then extruded into drug-impregnated filament for fused deposition modeling 3D printing. Computer-aided design files were generated in the shapes of 14-F catheters. Scanning electron microscope imaging was used to visualize the presence of the additive powders on the surface of the printed constructs. Elution profiles were run on the antibiotic-laden catheter and MTX-laden catheters. Antibiotic-laden catheters were tested on bacterial broth and plate cultures. Results Both GS and MTX catheter constructs had sustained drug release up to the 5-day limit of testing. The 3D printed GS-enhanced catheters inhibited all bacterial growth in broth cultures and had an average zone of inhibition of 858 ± 118 mm2 on bacterial plates, whereas control catheters had no effect. Conclusion The 3D printing manufacturing method to create instruments in percutaneous procedures is feasible. Further in vivo studies will substantiate these findings.

      PubDate: 2018-05-28T09:45:06Z
      DOI: 10.1016/j.acra.2018.03.022
  • Vital Signs in Radiologic Education
    • Authors: Priscilla J. Slanetz
      Abstract: Publication date: Available online 29 March 2018
      Source:Academic Radiology
      Author(s): Priscilla J. Slanetz

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.012
  • Toward Augmented Radiologists
    • Authors: Shahein H. Tajmir; Tarik K. Alkasab
      Abstract: Publication date: Available online 26 March 2018
      Source:Academic Radiology
      Author(s): Shahein H. Tajmir, Tarik K. Alkasab
      Radiology practice will be altered by the coming of artificial intelligence, and the process of learning in radiology will be similarly affected. In the short term, radiologists will need to understand the first wave of artificially intelligent tools, how they can help them improve their practice, and be able to effectively supervise their use. Radiology training programs will need to develop curricula to help trainees acquire the knowledge to carry out this new supervisory duty of radiologists. In the longer term, artificially intelligent software assistants could have a transformative effect on the training of residents and fellows, and offer new opportunities to bring learning into the ongoing practice of attending radiologists.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.03.007
  • Teaching Radiology Trainees From the Perspective of a Millennial
    • Authors: Po-Hao Chen; Mary H. Scanlon
      Abstract: Publication date: Available online 21 March 2018
      Source:Academic Radiology
      Author(s): Po-Hao Chen, Mary H. Scanlon
      The millennial generation consists of today's medical students, radiology residents, fellows, and junior staff. Millennials' comfort with immersive technology, high expectations for success, and desire for constant feedback differentiate them from previous generations. Drawing from an author's experiences through radiology residency and fellowship as a millennial, from published literature, and from the mentorship of a long-time radiology educator, this article explores educational strategies that embrace these characteristics to engage today's youngest generation both in and out of the reading room.

      PubDate: 2018-04-10T20:41:10Z
      DOI: 10.1016/j.acra.2018.02.008
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