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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, 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: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 379, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
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: 237, 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   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, 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: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, 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: 139, 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: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, 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: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 6, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, 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: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, 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: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
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: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
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: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 10)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, 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: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, 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: 13)
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: 7)
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: 20, SJR: 1.5, h-index: 62)
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: 370, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
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: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 338, 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: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 432, 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: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
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: 5, 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: 8)
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: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, 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: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, 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: 32, 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: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, 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: 208, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, 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: 24, 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: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, 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: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, 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: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 171, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 176, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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Journal Cover Academic Radiology
  [SJR: 1.008]   [H-I: 75]   [22 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1076-6332
   Published by Elsevier Homepage  [3123 journals]
  • Volumetric MRI in Neurofibromatosis Type 1 (NF1) Comes of Age to Help
           Determine Initiation and Monitoring of Targeted Therapies for Plexiform
    • Authors: David Viskochil; Luke L. Linscott
      Pages: 141 - 143
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): David Viskochil, Luke L. Linscott

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.11.003
  • Volumetric MRI Analysis of Plexiform Neurofibromas in Neurofibromatosis
           Type 1
    • Authors: Wenli Cai; Seth M. Steinberg; Miriam A. Bredella; Gina Basinsky; Bhanusupriya Somarouthu; Scott R. Plotkin; Jeffrey Solomon; Brigitte C. Widemann; Gordon J. Harris; Eva Dombi
      Pages: 144 - 152
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Wenli Cai, Seth M. Steinberg, Miriam A. Bredella, Gina Basinsky, Bhanusupriya Somarouthu, Scott R. Plotkin, Jeffrey Solomon, Brigitte C. Widemann, Gordon J. Harris, Eva Dombi
      Objectives Plexiform neurofibromas (PNs) are complex, histologically benign peripheral nerve sheath tumors that are challenging to measure by simple line measurements. Computer-aided volumetric segmentation of PN has become the recommended method to assess response in clinical trials directed at PN. Different methods for volumetric analysis of PN have been developed. The goal of this study is to test the level of agreement in volume measurements and in interval changes using two separate methods of volumetric magnetic resonance imaging analysis. Methods Three independent volume measurements were performed on 15 PN imaged at three time-points using 3DQI software at Massachusetts General Hospital (MGH) and National Cancer Institute (NCI) and MEDx software at NCI. Results Median volume differences at each time-point comparing MGH-3DQI and NCI-3DQI were −0.5, −4.2, and −19.9 mL; comparing NCI-3DQI and NCI-MEDx were −21.0, −47.0, and −21.0 mL; comparing MGH-3DQI and NCI-MEDx were −10.0, −70.3, and −29.9 mL. Median differences in percentage change over time comparing MGH-3DQI and NCI-3DQI were −1.7, 1.1, and −1.0%; comparing NCI-3DQI and NCI-MEDx were −2.3, 3.3, and −1.1%; comparing MGH-3DQI and NCI-MEDx were −0.4, 2.0, and −1.5%. Volume differences were <20% of the mean of the two measurements in 117 of 135 comparisons (86.7%). Difference in interval change was <20% in 120 of the 135 comparisons (88.9%), while disease status classification was concordant in 115 of 135 comparisons (85.2%). Conclusions The volumes, interval changes, and progression status classifications were in good agreement. The comparison of two volumetric analysis methods suggests no systematic differences in tumor assessment. A prospective comparison of the two methods is planned.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.004
  • Spectral Beam Shaping in Unenhanced Chest CT Examinations
    • Authors: Saravanabavaan Suntharalingam; Thomas Allmendinger; Sebastian Blex; Mohammad Al-Bayati; Kai Nassenstein; Bernd Schweiger; Michael Forsting; Axel Wetter
      Pages: 153 - 158
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Saravanabavaan Suntharalingam, Thomas Allmendinger, Sebastian Blex, Mohammad Al-Bayati, Kai Nassenstein, Bernd Schweiger, Michael Forsting, Axel Wetter
      Rationale and Objectives This study aimed to determine the optimal tube potential for unenhanced chest computed tomographies (CTs) with age-related phantoms. Materials and Methods Three physical anthropomorphic phantoms (newborn, 5-year-old child, and adult) were scanned on a third-generation dual-source CT using CAREkV in semi-mode and CAREDose4D (ref. KV: 120; ref. mAs 50). Scans were performed with all available tube potentials (70–150 kV and Sn150 kV). The lowest volume computed tomography dose index (CTDIvol) was selected to perform additional Sn100-kV scans with matched and half (Sn100-half) CTDIvol value. Image quality was evaluated on the basis of contrast-to-noise ratio (CNR). Results For the newborn phantom, 70–110 kV was selected as the optimal range (0.36–0.37 mGy). Using Sn150 kV led to an increase in radiation dose (0.75 mGy) without improving CNR (96.9 vs 101.5). Sn100-half showed a decrease in CNR (73.1 vs 101.5). The lowest CTDIvol for the child phantom was achieved between 100 and 120 kV (0.78–0.80 mGy). Using Sn150 kV increased radiation dose (1.02 mGy) without improvement of CNR (92.4 vs 95.8). At Sn100-half CNR was decreased (61.4 vs 95.8). For adults, 140 and 150 kV revealed the lowest CTDIvol (2.68 and 2.67 mGy). The Sn150 kV scan delivered comparable CNR (54.4 vs 56.6), but a lower CTDIvol (2.08 mGy). At Sn100-half CNR was comparable to the 150 kV scan (58.1 vs 56.6). Conclusion Unenhanced chest CT performed at 100 kV or 150 kV with tin filtration enables radiation dose reduction for the adult phantom, but not for the pediatric phantoms.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.08.011
  • On the Potential Role of MRI Biomarkers of COPD to Guide Bronchoscopic
           Lung Volume Reduction
    • Authors: Colin J. Adams; Dante P.I. Capaldi; Robert Di Cesare; David G. McCormack; Grace Parraga
      Pages: 159 - 168
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Colin J. Adams, Dante P.I. Capaldi, Robert Di Cesare, David G. McCormack, Grace Parraga
      Rationale and Objectives In patients with severe emphysema and poor quality of life, bronchoscopic lung volume reduction (BLVR) may be considered and guided based on lobar emphysema severity. In particular, x-ray computed tomography (CT) emphysema measurements are used to identify the most diseased and the second–most diseased lobes as BLVR targets. Inhaled gas magnetic resonance imaging (MRI) also provides chronic obstructive pulmonary disease (COPD) biomarkers of lobar emphysema and ventilation abnormalities. Our objective was to retrospectively evaluate CT and MRI biomarkers of lobar emphysema and ventilation in patients with COPD eligible for BLVR. We hypothesized that MRI would provide complementary biomarkers of emphysema and ventilation that help determine the most appropriate lung lobar targets for BLVR in patients with COPD. Materials and Methods We retrospectively evaluated 22 BLVR-eligible patients from the Thoracic Imaging Network of Canada cohort (diffusing capacity of the lung for carbon monoxide = 37 ± 12%predicted, forced expiratory volume in 1 second = 34 ± 7%predicted, total lung capacity = 131 ± 17%predicted, and residual volume = 216 ± 36%predicted). Lobar CT emphysema, measured using a relative area of <−950 Hounsfield units (RA950) and MRI ventilation defect percent, was independently used to rank lung lobe disease severity. Results In 7 of 22 patients, there were different CT and MRI predictions of the most diseased lobe. In some patients, there were large ventilation defects in lobes not targeted by CT, indicative of a poorly ventilated lung. CT and MRI classification of the most diseased and the second–most diseased lobes showed a fair-to-moderate intermethod reliability (Cohen κ = 0.40–0.59). Conclusions In this proof-of-concept retrospective analysis, quantitative MRI ventilation and CT emphysema measurements provided different BLVR targets in over 30% of the patients. The presence of large MRI ventilation defects in lobes next to CT-targeted lobes might also change the decision to proceed or to guide BLVR to a different lobar target.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.08.010
  • Regional Heterogeneity of Lobar Ventilation in Asthma Using Hyperpolarized
           Helium-3 MRI
    • Authors: Wei Zha; Stanley J. Kruger; Robert V. Cadman; David G. Mummy; Michael D. Evans; Scott K. Nagle; Loren C. Denlinger; Nizar N. Jarjour; Ronald L. Sorkness; Sean B. Fain
      Pages: 169 - 178
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Wei Zha, Stanley J. Kruger, Robert V. Cadman, David G. Mummy, Michael D. Evans, Scott K. Nagle, Loren C. Denlinger, Nizar N. Jarjour, Ronald L. Sorkness, Sean B. Fain
      Rationale and Objectives To determine lobar ventilation patterns in asthmatic lungs with hyperpolarized 3He magnetic resonance imaging (HP 3He MRI). Materials and Methods Eighty-two subjects (14 normal, 48 mild-to-moderate asthma, and 20 severe asthma) underwent HP 3He MRI, computed tomography (CT), and pulmonary function testing. After registering proton to 3He images, we segmented the lungs from proton MRI and further segmented the five lung lobes (right upper lobe [RUL], right middle lobe [RML], and right lower lobe [RLL]; left upper lobe and left lower lobe [LLL]) by referring to the lobar segmentation from CT. We classified the gas volume into four signal intensity levels as follows: ventilation defect percent (VDP), low ventilation percent, medium ventilation percent, and high ventilation percent. The local signal intensity variations in the ventilated volume were estimated using heterogeneity score (Hs). We compared each ventilation level and Hs measured in the whole lung and lobar regions across the three subject groups. Results In mild-to-moderate asthma, the RML and RUL showed significantly greater VDP than the two lower lobes (RLL and LLL) (P ≤ .047). In severe asthma, the pattern was more variable with the VDP in the RUL significantly greater than in the RLL (P = .026). In both asthma groups, the lower lobes (RLL and LLL) showed significantly higher high ventilation percent and Hs compared to the three upper lobes (all P ≤ .015). Conclusions In asthma, the RML and RUL showed greater ventilation abnormalities, and the RLL and LLL were more highly ventilated with greater local heterogeneity. These findings may facilitate guided bronchoscopic sampling and localized airway treatment in future studies.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.014
  • Apparent Diffusion Coefficient Value to Evaluate Tumor Response After
           Neoadjuvant Chemotherapy in Patients with Breast Cancer
    • Authors: Yazmín Aseret Ramírez-Galván; Servando Cardona-Huerta; Guillermo Elizondo-Riojas; Neri Alejandro Álvarez-Villalobos
      Pages: 179 - 187
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Yazmín Aseret Ramírez-Galván, Servando Cardona-Huerta, Guillermo Elizondo-Riojas, Neri Alejandro Álvarez-Villalobos
      Rationale and Objectives This study explored tumor behavior in patients with breast cancer during neoadjuvant chemotherapy (NAC) by sequential measurements of tumor apparent diffusion coefficient (ADC) after each chemotherapy cycle. The aim was to determine if the tumor ADC is useful to differentiate complete pathological response (cPR) from partial pathological response (pPR) during NAC. Materials and Methods A total of 16 cases (in 14 patients) with diagnosis of breast cancer eligible to receive NAC were included. There were 70 magnetic resonance imaging examinations performed, 5 for each patient, during NAC cycles. Diffusion-weighted imaging was performed on a 1.5T system (b values of 0 and 700s/mm2). Four ADC ratios between the five MRI examinations were obtained to assess ADC changes during NAC. Absence of invasive breast cancer at surgical specimens (Miller-Payne 5) was considered as cPR and was used as reference for ADC cutoff ratios. Results In this study, we were able to differentiate between cPR and pPR, after two cycles of NAC until the end of NAC before surgery (ADC ratios 2–4). The thresholds to differentiate between cPR and pPR of ADC ratios 2, 3, and 4, were 1.14 × 10−3mm2/s, 1.08 × 10−3mm2/s, and 1.25 × 10−3mm2/s, respectively, and have a cross-validated sensitivity and specificity of 79.2%, 79.7% (ADC ratio 2); 100%, 66.7% (ADC ratio 3); and 100%, 83.8% (ADC ratio 4), respectively. Conclusions The ADC ratios were useful to differentiate cPR from pPR in breast cancer tumors after NAC. Thus, it may be useful in tailoring treatment in these patients.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.08.009
  • Imaging Facilities' Adherence to PI-RADS v2 Minimum Technical Standards
           for the Performance of Prostate MRI
    • Authors: Steven J. Esses; Samir S. Taneja; Andrew B. Rosenkrantz
      Pages: 188 - 195
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Steven J. Esses, Samir S. Taneja, Andrew B. Rosenkrantz
      Purpose This study aimed to assess variability in imaging facilities' adherence to the minimum technical standards for prostate magnetic resonance imaging acquisition established by Prostate Imaging-Reporting and Data System (PI-RADS) version 2 (v2). Methods A total of 107 prostate magnetic resonance imaging examinations performed at 107 unique imaging facilities after the release of PI-RADS v2 and that were referred to a tertiary care center for secondary interpretation were included. Image sets, DICOM headers, and outside reports were reviewed to assess adherence to 21 selected PI-RADS v2 minimum technical standards. Results Hardware arrangements were 23.1%, 1.5T without endorectal coil; 7.7%, 1.5T with endorectal coil; 63.5%, 3T without endorectal coil; and 5.8%, 3T with endorectal coil. Adherence to minimum standards was lowest on T2 weighted imaging (T2WI) for frequency resolution ≤0.4 mm (16.8%) and phase resolution ≤0.7 mm (48.6%), lowest on diffusion-weighted imaging (DWI) for field of view (FOV) 120–220 mm (30.0%), and lowest on dynamic contrast-enhanced (DCE) imaging for slice thickness 3 mm (33.3%) and temporal resolution <10 s (31.5%). High b-value (≥1400 s/mm2) images were included in 58.0% (calculated in 25.9%). Adherence to T2WI phase resolution and DWI inter-slice gap were greater (P < .05) at 3T than at 1.5T. Adherence did not differ (P > .05) for any parameter between examinations performed with and without an endorectal coil. Adherence was greater for examinations performed at teaching facilities for T2WI slice thickness and DCE temporal resolution (P < .05). Adherence was not better for examinations performed in 2016 than in 2015 for any parameter (P > .05). Conclusion Facilities' adherence to PI-RADS v2 minimum technical standards was variable, being particularly poor for T2WI frequency resolution and DCE temporal resolution. The standards warrant greater community education. Certain technical standards may be too stringent, and revisions should be considered.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.08.013
  • Accuracy of Computed Tomographic Enterography for Obscure Gastrointestinal
    • Authors: Bosheng He; Jushun Yang; Jing Xiao; Jinhua Gu; Feixiang Chen; Lin Wang; Junbo Qian; Shenchu Gong
      Pages: 196 - 201
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Bosheng He, Jushun Yang, Jing Xiao, Jinhua Gu, Feixiang Chen, Lin Wang, Junbo Qian, Shenchu Gong
      Rationale and Objectives Obscure gastrointestinal bleeding (OGIB) is the bleeding from the gastrointestinal tract without definite source that persists and recurs after a negative endoscopic evaluation. The study aimed to systematically evaluate the diagnostic accuracy of computed tomography enterography on OGIB detection by meta-analysis. Materials and Methods Studies were searched in relevant databases. With predefined inclusion criteria, eligible studies were included, followed by quality assessment using the Quality Assessment of Diagnostic Accuracy Studies scoring system. The Meta-DiSc software was used to implement the meta-analysis, and sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio with their 95% confidence intervals (CIs) were used as the effect size. Publication bias was determined by Egger test. Results A set of nine studies was included in this meta-analysis, having a relatively high quality. Under the random effects model, the pooled sensitivity and specificity were 0.724 (95% CI: 0.651–0.789) and 0.752 (95% CI: 0.691–0.807), respectively. Under the fixed effects model, the pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 2.949 (95% CI: 2.259–3.850), 0.393 (95% CI: 0.310–0.497), and 9.452 (95% CI: 5.693–15.692), respectively. The area under curve of the summary receiver operating characteristic curve was 0.7916 (95% CI: 0.723–0.860). No obvious publication bias was detected (t = 1.62, P = .181). Conclusions Computed tomography enterography might be used as a complementary to video capsule endoscopy instead of an alternative for the detection of OGIB.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.001
  • Educational Effects of Radiation Reduction During Fluoroscopic Examination
           of the Adult Gastrointestinal Tract
    • Authors: Moon Hyung Choi; Seung Eun Jung; Soon Nam Oh; Jae Young Byun
      Pages: 202 - 208
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Moon Hyung Choi, Seung Eun Jung, Soon Nam Oh, Jae Young Byun
      Rationale and Objectives This study aimed to evaluate the effects of educating radiology residents and radiographers about radiation exposure on reduction of dose area product (DAP) and fluoroscopy time in diagnostic fluoroscopy of the gastrointestinal (GI) tract in adult patients. Materials and Methods In April 2015, we offered 1 hour of education to radiology residents and radiographers on how to reduce radiation doses during fluoroscopic examinations. Fluoroscopic examinations of the GI tracts of adult patients performed from June 2014 to February 2016 were evaluated. A total of 2326 fluoroscopic examinations (779 and 1547 examinations before and after education, respectively) were performed, including 10 kinds of examinations. Fluoroscopy time and DAP were collected. A radiologist evaluated the number of spot images, captured images, cine video, captured video, and the use of collimation or magnification. We used the Mann-Whitney U test to assess the difference in fluoroscopy-related factors before and after education. Results Median DAP decreased significantly after education, from 21.1 to 18.2 Gy∙cm2 (P < .001) in all examinations. After education DAP decreased significantly in defecography (P < .001) and fluoroscopy time decreased significantly in upper gastrointestinal series with water-soluble contrast (P < .001). Spot and cine images that increased the radiation dose were used less frequently after education than before in some kinds of examinations, especially in defecography (P < .001). More images were collimated after education in barium swallow than before (P < .001). Conclusions Educating radiologist residents and radiographers could reduce DAP in fluoroscopy examinations of the GI tract in adult patients.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.009
  • Expanding the Definition of a Benign Renal Cyst on Contrast-enhanced CT
    • Authors: Eric M. Hu; James H. Ellis; Stuart G. Silverman; Richard H. Cohan; Elaine M. Caoili; Matthew S. Davenport
      Pages: 209 - 212
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Eric M. Hu, James H. Ellis, Stuart G. Silverman, Richard H. Cohan, Elaine M. Caoili, Matthew S. Davenport
      Rationale and Objective We aimed to determine the frequency and clinical significance of homogeneous renal masses measuring 21–39 Hounsfield units on contrast-enhanced computed tomography (CT). Methods Subjects 40–69 years old undergoing portal-venous-phase contrast-enhanced abdominal CT from January 1, 2006 to December 31, 2010 with slice thickness ≤5 mm and no prior CT or magnetic resonance imaging were identified (n = 1387) for this institutional review board-approved retrospective cohort study. Images were manually reviewed by three radiologists in consensus to identify all circumscribed homogeneous renal masses (maximum of three per subject) ≥10 mm with a measured attenuation of 21–39 Hounsfield units. Exclusion criteria were known renal cancer or imaging performed for a renal indication. The primary outcome was retrospective characterization as a clinically significant mass, defined as a solid mass, a Bosniak IIF/III/IV mass, or extirpative therapy or metastatic renal cancer within 5 years' follow-up. Results Eligible masses (n = 74) were found in 5% (63/1387) of subjects. Of those with a reference standard (n = 42), none (0% [95% CI: 0.0%–8.4%]) were determined to be clinically significant. Conclusion Incidental renal masses on contrast-enhanced CT that are homogeneous and display an attenuation of 21–39 Hounsfield units are uncommon in patients 40–69 years of age, unlikely to be clinically significant, and may not need further imaging evaluation. If these results can be replicated in an independent and larger population, the practical definition of a benign cyst on imaging may be able to be expanded.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.021
  • Sonographic Criteria Predictive of Malignant Thyroid Nodules
    • Authors: Carlos Miguel Oliveira; Rui Alves Costa; Miguel Patrício; Amélia Estêvão; Bruno Graça; Filipe Caseiro-Alves
      Pages: 213 - 218
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Carlos Miguel Oliveira, Rui Alves Costa, Miguel Patrício, Amélia Estêvão, Bruno Graça, Filipe Caseiro-Alves
      Rationale and Objectives The objective of this study was to evaluate the ultrasound features of thyroid nodules and their association with malignancy, focusing on establishing feature-oriented ultrasound criteria to determine proper management of a thyroid nodule. Materials and Methods A sample of 379 thyroid nodules were biopsied (from a total of 357 patients aged 59.8 ± 14.8 years) and 300 were included in the final study (271 benign nodules and 29 malignant ones). Ultrasound features were recorded for each nodule: size, echogenicity, homogeneity, contours, shape, texture, peripheral halo, calcifications, and the presence of adenopathy. Statistical analysis of the data was performed using the Mann-Whitney U test and chi-square test. The sensitivity and the specificity of variables seen to have a statistically significant association with the malignancy of nodules were assessed and a logistic regression was performed. Results A taller-than-wide shape, an ill-defined contour, the presence of a halo, microcalcifications, and adenopathy were found to have a statistically significant relationship (P < 0.05) with malignancy, although with a low sensitivity and a high specificity. The presence of at least one suspicious feature yields great sensitivity (89.7%) in detecting malignant disease. Conclusions The ultrasound features of thyroid nodules alone do not allow the radiologist to make a confident diagnosis regarding the malignancy of a nodule without performing a biopsy. However, a nodule showing a taller-than-wide shape, microcalcifications, a peripheral halo, an ill-defined contour, or associated adenopathy should be considered for cytology.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.006
  • Physician Specialty and Radiologist Characteristics Associated with Higher
           Medicare Patient Complexity
    • Authors: Andrew B. Rosenkrantz; Wenyi Wang; Arvind Vijayasarathi; Richard Duszak
      Pages: 219 - 225
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Andrew B. Rosenkrantz, Wenyi Wang, Arvind Vijayasarathi, Richard Duszak
      Rationale and Objectives Meaningfully measuring physician outcomes and resource utilization requires appropriate patient risk adjustment. We aimed to assess Medicare patient complexity by physician specialty and to further identify radiologist characteristics associated with higher patient complexity. Materials and Methods The average beneficiary Hierarchical Condition Category (HCC) risk scores (Medicare's preferred measure of clinical complexity) were identified for all physicians using 2014 Medicare claims data. HCC scores were compared among physician specialties and further stratified for radiologists based on a range of characteristics. Univariable and multivariable analyses were performed. Results Of 549,194 physicians across 54 specialties, the mean HCC risk score was 1.62 ± 0.75. Of the 54 specialties, interventional radiology ranked 4th (2.60 ± 1.29), nuclear medicine ranked 16th (1.87 ± 0.45), and diagnostic radiology ranked 21st (1.75 ± 0.61). Among 31,175 radiologists, risk scores were higher (P < 0.001) for those with teaching (2.03 ± 0.74) vs nonteaching affiliations (1.72 ± 0.61), practice size ≥100 (1.94 ± 0.70) vs ≤9 (1.59 ± 0.79) members, urban (1.79 ± 0.69) vs rural (1.67 ± 0.59) practices, and subspecialized (1.85 ± 0.81) vs generalized (1.68 ± 0.42) practice patterns. Among noninterventional radiology subspecialties, patient complexity was highest for cardiothoracic (2.09 ± 0.57) and lowest for breast (1.08 ± 0.32) imagers. At multivariable analysis, a teaching affiliation was the strongest independent predictor of patient complexity for both interventional (β = +0.23, P = 0.005) and noninterventional radiologists (β = +0.21, P < 0.001). Conclusions Radiologists on average serve more clinically complex Medicare patients than most physicians nationally. However, patient complexity varies considerably among radiologists and is particularly high for those with teaching affiliations and interventional radiologists. With patient complexity increasingly recognized as a central predictor of clinical outcomes and resource utilization, ongoing insights into complexity measures may assist radiologists navigating emerging risk-based payment models.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.008
  • Can Radiologists Learn From Airport Baggage Screening'
    • Authors: Andrew Phelps; Andrew L. Callen; Peter Marcovici; David M. Naeger; John Mongan; Emily M. Webb
      Pages: 226 - 234
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Andrew Phelps, Andrew L. Callen, Peter Marcovici, David M. Naeger, John Mongan, Emily M. Webb
      Rationale and Objectives For both airport baggage screeners and radiologists, low target prevalence is associated with low detection rate, a phenomenon known as “prevalence effect.” In airport baggage screening, the target prevalence is artificially increased with fictional weapons that are digitally superimposed on real baggage. This strategy improves the detection rate of real weapons and also allows airport supervisors to monitor screener performance. A similar strategy using fictional patients could be applied in radiology. The purpose of this study was twofold: (1) to review the psychophysics literature regarding low target prevalence and (2) to survey radiologists' attitudes toward using fictional patients as a quality assurance tool. Materials and Methods We reviewed the psychophysics literature on low target prevalence and airport x-ray baggage screeners. An online survey was e-mailed to all members of the Association of University Radiologists to determine their attitudes toward using fictional patients in radiology. Results Of the 1503 Association of University Radiologists member recipients, there were 153 respondents (10% response rate). When asked whether the use of fictional patients was a good idea, the responses were as follows: disagree (44%), neutral (25%), and agree (31%). The most frequent concern was the time taken away from doing clinical work (89% of the respondents). Conclusions The psychophysics literature supports the use of fictional targets to mitigate the prevalence effect. However, the use of fictional patients is not a popular idea among academic radiologists.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.08.014
  • Virtual Simulation in Enhancing Procedural Training for Fluoroscopy-guided
           Lumbar Puncture
    • Authors: Saad Ali; Monther Qandeel; Rishi Ramakrishna; Carina W. Yang
      Pages: 235 - 239
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Saad Ali, Monther Qandeel, Rishi Ramakrishna, Carina W. Yang
      Rationale and Objectives Fluoroscopy-guided lumbar puncture (FGLP) is a basic procedural component of radiology residency and neuroradiology fellowship training. Performance of the procedure with limited experience is associated with increased patient discomfort as well as increased radiation dose, puncture attempts, and complication rate. Simulation in health care is a developing field that has potential for enhancing procedural training. We demonstrate the design and utility of a virtual reality simulator for performing FGLP. Materials and Methods An FGLP module was developed on an ImmersiveTouch platform, which digitally reproduces the procedural environment with a hologram-like projection. From computed tomography datasets of healthy adult spines, we constructed a 3-D model of the lumbar spine and overlying soft tissues. We assigned different physical characteristics to each tissue type, which the user can experience through haptic feedback while advancing a virtual spinal needle. Virtual fluoroscopy as well as 3-D images can be obtained for procedural planning and guidance. The number of puncture attempts, the distance to the target, the number of fluoroscopic shots, and the approximate radiation dose can be calculated. Preliminary data from users who participated in the simulation were obtained in a postsimulation survey. Results All users found the simulation to be a realistic replication of the anatomy and procedure and would recommend to a colleague. On a scale of 1–5 (lowest to highest) rating the virtual simulator training overall, the mean score was 4.3 (range 3–5). Conclusions We describe the design of a virtual reality simulator for performing FGLP and present the initial experience with this new technique.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.08.002
  • Recipe for a Successful Hybrid Academic-Community Radiology Practice
    • Authors: Kaela L. Gusenbauer; Michael N. Patlas; Ania Z. Kielar; Douglas S. Katz
      Pages: 240 - 243
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Kaela L. Gusenbauer, Michael N. Patlas, Ania Z. Kielar, Douglas S. Katz

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.08.017
  • Automated Radiology-Operative Note Communication Tool; Closing the Loop in
           Musculoskeletal Imaging
    • Authors: William Moore; Ankur Doshi; Priya Bhattacharji; Soterios Gyftopoulos; Gina Ciavarra; Danny Kim; Michael Recht
      Pages: 244 - 249
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): William Moore, Ankur Doshi, Priya Bhattacharji, Soterios Gyftopoulos, Gina Ciavarra, Danny Kim, Michael Recht
      Rationale and Objectives Correlation of imaging studies and reference standard outcomes is a significant challenge in radiology. This study evaluates the effectiveness of a new communication tool by assessing the ability of this system to correctly match the imaging studies to arthroscopy reports and qualitatively assessing radiologist behavior before and after the implementation of this system. Materials and Methods Using a commercially available communication or educational tool and applying a novel matching rule algorithm, radiology and arthroscopy reports were matched from January 17, 2017 to March 1, 2017 based on anatomy. The interpreting radiologist was presented with email notifications containing the impression of the imaging report and the entire arthroscopy report. Total correlation rate of appropriate report pairings, modality-specific correlation rate, and the anatomy-specific correlation rate were calculated. Radiologists using the system were given a survey. Results Overall correlation rate for all musculoskeletal imaging was 83.1% (433 or 508). Low correlation was found in fluoroscopic procedures at 74.4%, and the highest correlation was found with ultrasound at 88.4%. Anatomic location varied from 51.6% for spine to 98.8% for hips and pelvis studies. Survey results revealed 87.5% of the respondents reporting being either satisfied or very satisfied with the new communication tool. The survey also revealed that some radiologists reviewed more cases than before. Conclusions Matching of radiology and arthroscopy reports by anatomy allows for excellent report correlation (83.1%). Automated correlation improves the quality and efficiency of feedback to radiologists, providing important opportunities for learning and improved accuracy.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.08.016
  • The Current State of Radiology Call Assistant Triage Programs Among US
           Radiology Residency Programs
    • Authors: Jennifer Shaffer Ngo; Charles M. Maxfield; Gary R. Schooler
      Pages: 250 - 254
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Jennifer Shaffer Ngo, Charles M. Maxfield, Gary R. Schooler
      Rationale and Objectives Given increasing volume and workflow interruptions in radiology, we sought to identify and characterize radiology call assistant triage (RCAT) programs among US radiology residency programs. Materials and Methods A survey was created using Qualtrics survey software and emailed to all members of the Association of Program Directors in Radiology listserv. A total of 296 active members belong to this listserv, including program directors and assistant program directors. The survey included questions about the existence and specifics of a call triage assistant program. Results Data were obtained from 88 active members of the Association of Program Directors in Radiology (30% response rate). Of those, 20 programs (23%) have an RCAT program. Triage assistant staffing includes nonmedical or clerical staff (60%), medical students (30%), first-year radiology residents (5%), and technologists (5%). All respondents with RCAT programs report satisfaction with their program and plan to continue. A significant majority (75%) have no plans to change, whereas the remaining 25% are considering program expansion and pay increases. Among residency programs without RCAT programs, none reported termination of their triage program. The most common reasons for not having triage assistants include cost, lack of awareness, differing opinions on utility, and the presence of 24/7 attending coverage. Conclusion Twenty US radiology residency programs report having an RCAT program. All report satisfaction with their program despite different staffing models. RCAT programs may represent an effective measure in limiting interruptions and potentially decreasing interpretative errors made by residents on call.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.019
  • The Benefits of Maintaining a Diagnostic and Interventional Co-sponsored
           Radiology Interest Group
    • Authors: Michael V. Friedman; Jennifer E. Gould; Gretchen M. Foltz
      Pages: 255 - 259
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Michael V. Friedman, Jennifer E. Gould, Gretchen M. Foltz

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.022
  • Educational Implications of Health Insurance Changes
    • Authors: Lindsey Shea; Darel E. Heitkamp; Jeffrey W. Dunkle; Richard B. Gunderman
      Pages: 260 - 261
      Abstract: Publication date: February 2018
      Source:Academic Radiology, Volume 25, Issue 2
      Author(s): Lindsey Shea, Darel E. Heitkamp, Jeffrey W. Dunkle, Richard B. Gunderman

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.003
  • Utility of Clinical Parameters and Multiparametric MRI as Predictive
           Factors for Differentiating Uterine Sarcoma From Atypical Leiomyoma
    • Authors: Qiu Bi; Zhibo Xiao; Fajin Lv; Yao Liu; Chunxia Zou; Yiqing Shen
      Abstract: Publication date: Available online 13 February 2018
      Source:Academic Radiology
      Author(s): Qiu Bi, Zhibo Xiao, Fajin Lv, Yao Liu, Chunxia Zou, Yiqing Shen
      Objectives The objective of this study was to find clinical parameters and qualitative and quantitative magnetic resonance imaging (MRI) features for differentiating uterine sarcoma from atypical leiomyoma (ALM) preoperatively and to calculate predictive values for uterine sarcoma. Materials and Methods Data from 60 patients with uterine sarcoma and 88 patients with ALM confirmed by surgery and pathology were collected. Clinical parameters, qualitative MRI features, diffusion-weighted imaging with apparent diffusion coefficient values, and quantitative parameters of dynamic contrast-enhanced MRI of these two tumor types were compared. Predictive values for uterine sarcoma were calculated using multivariable logistic regression. Results Patient clinical manifestations, tumor locations, margins, T2-weighted imaging signals, mean apparent diffusion coefficient values, minimum apparent diffusion coefficient values, and time-signal intensity curves of solid tumor components were obvious significant parameters for distinguishing between uterine sarcoma and ALM (all P < .001). Abnormal vaginal bleeding, tumors located mainly in the uterine cavity, ill-defined tumor margins, and mean apparent diffusion coefficient values of <1.272 × 10−3 mm2/s were significant preoperative predictors of uterine sarcoma. When the overall scores of these four predictors were greater than or equal to 7 points, the sensitivity, the specificity, the accuracy, and the positive and negative predictive values were 88.9%, 99.9%, 95.7%, 97.0%, and 95.1%, respectively. Conclusions The use of clinical parameters and multiparametric MRI as predictive factors was beneficial for diagnosing uterine sarcoma preoperatively. These findings could be helpful for guiding treatment decisions.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2018.01.002
  • Magic Angle in Cardiac CT
    • Authors: Sebastian D. Reinartz; Christiane K. Kuhl; Kerstin Fehrenbacher; Andreas Napp
      Abstract: Publication date: Available online 13 February 2018
      Source:Academic Radiology
      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: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.12.003
  • Fat Necrosis of the Breast
    • Authors: Hebatallah Hassan Mamdouh Hassan; Amr Magdi El Abd; Amany Abdel Bary; Nagy N.N. Naguib
      Abstract: Publication date: Available online 13 February 2018
      Source:Academic Radiology
      Author(s): Hebatallah Hassan Mamdouh Hassan, Amr Magdi El Abd, Amany Abdel Bary, Nagy N.N. Naguib
      Rationale and Objectives This study aims to describe the magnetic resonance imaging (MRI) features of fat necrosis on magnetic resonance mammography, which may downstage a suspicious lesion to a merely benign finding. Materials and Methods This prospective study included 82 female patients (mean age 50 years) who were diagnosed to have suspicious lesions by mammography, ultrasonography or both. All patients underwent MRI including diffusion-weighted imaging and spectroscopy. Image postprocessing and analysis included signal intensity, enhancement characteristics, diffusion restriction, and spectroscopic analysis. All patients underwent histopathological analysis for confirmation. Sensitivity, specificity, positive predictive value (PPV), and negative (NPV) predictive value were calculated. Results To label a lesion as fat necrosis on MRI analysis, presence of fat signal in a lesion revealed sensitivity of 98.04%, specificity of 100%, PPV of 100%, and NPP of 96.88%, whereas nonenhancement of the lesion itself revealed sensitivity of 96.08%, specificity of 100%, PPV of 100%, and NPP of 93.94%. However, adding both the nonrestriction on diffusion analysis and the lack of tCholine at 3.22 ppm increased the sensitivity and specificity to 100%, as well as PPV of 100% for fat necrosis and hence a NPV for malignancy of 100%. Conclusions MRI proved to be of value in differentiating fat necrosis from malignancy based on the molecular composition of fat necrosis, clearly depicted by MRI without the need for invasive confirmation by biopsy.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.12.019
  • Invited Commentary
    • Authors: Charles E. Ray
      Abstract: Publication date: Available online 12 February 2018
      Source:Academic Radiology
      Author(s): Charles E. Ray

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2018.01.001
  • A Dynamic Graph Cuts Method with Integrated Multiple Feature Maps for
           Segmenting Kidneys in 2D Ultrasound Images
    • Authors: Qiang Zheng; Steven Warner; Gregory Tasian; Yong Fan
      Abstract: Publication date: Available online 12 February 2018
      Source:Academic Radiology
      Author(s): Qiang Zheng, Steven Warner, Gregory Tasian, Yong Fan
      Rationale and Objectives Automatic segmentation of kidneys in ultrasound (US) images remains a challenging task because of high speckle noise, low contrast, and large appearance variations of kidneys in US images. Because texture features may improve the US image segmentation performance, we propose a novel graph cuts method to segment kidney in US images by integrating image intensity information and texture feature maps. Materials and Methods We develop a new graph cuts-based method to segment kidney US images by integrating original image intensity information and texture feature maps extracted using Gabor filters. To handle large appearance variation within kidney images and improve computational efficiency, we build a graph of image pixels close to kidney boundary instead of building a graph of the whole image. To make the kidney segmentation robust to weak boundaries, we adopt localized regional information to measure similarity between image pixels for computing edge weights to build the graph of image pixels. The localized graph is dynamically updated and the graph cuts-based segmentation iteratively progresses until convergence. Our method has been evaluated based on kidney US images of 85 subjects. The imaging data of 20 randomly selected subjects were used as training data to tune parameters of the image segmentation method, and the remaining data were used as testing data for validation. Results Experiment results demonstrated that the proposed method obtained promising segmentation results for bilateral kidneys (average Dice index = 0.9446, average mean distance = 2.2551, average specificity = 0.9971, average accuracy = 0.9919), better than other methods under comparison (P < .05, paired Wilcoxon rank sum tests). Conclusions The proposed method achieved promising performance for segmenting kidneys in two-dimensional US images, better than segmentation methods built on any single channel of image information. This method will facilitate extraction of kidney characteristics that may predict important clinical outcomes such as progression of chronic kidney disease.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2018.01.004
  • Gender Trends in Academic Radiology Publication in the United States
    • Authors: Erin E. O'Connor; Pauline Chen; Brian Weston; Redmond Anderson; Timothy Zeffiro; Awad Ahmed; Thomas A. Zeffiro
      Abstract: Publication date: Available online 12 February 2018
      Source:Academic Radiology
      Author(s): Erin E. O'Connor, Pauline Chen, Brian Weston, Redmond Anderson, Timothy Zeffiro, Awad Ahmed, Thomas A. Zeffiro
      Rationale and Objectives Although substantial increases in publications by female academic radiologists have appeared over the last several decades, it is possible that the rate of increase is decreasing. We examined temporal trends in gender composition for full-time radiology faculty, radiology residents, and medical students over a 46-year period. Methods We examined authorship gender trends to determine if the increases in female authorship seen since 1970 have been sustained in recent years and whether female radiologists continue to publish in proportion to their numbers in academic departments. Original articles for selected years in Radiology and in the American Journal of Roentgenology between 1970 and 2016 were examined to determine the gender of first, corresponding, and last authors. Generalized linear models evaluated (1) changes in proportions of female authorship over time and (2) associations between proportions of female authorship and female radiology faculty representation. Results While linear increases in first, corresponding, and senior authorships were observed for female radiologists from 1970 to 2000, the rate of increase in female first and corresponding authorships then changed, with the slope of the first author relationship decreasing from 0.81 to 0.34, corresponding to 47% fewer female first authors added per year. In contrast, the proportion of female last authorship continued to increase at the same rate. The proportion of female first authorship was linearly related to the proportion of female radiology faculty from 1970 to 2016. Conclusions Annual increases in first author academic productivity of female radiologists have lessened in the past 16 years, possibly related to reductions in the growth of female radiology faculty and trainees. As mixed, compared to homogeneous gender, authorship teams are associated with more citations, efforts to encourage more women to pursue careers in academic radiology could benefit the radiology research community.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.12.030
  • Neurometabolites Alteration in the Acute Phase of Mild Traumatic Brain
           Injury (mTBI)
    • Authors: Vigneswaran Veeramuthu; Pohchoo Seow; Vairavan Narayanan; Jeannie Hsiu Ding Wong; Li Kuo Tan; Aditya Tri Hernowo; Norlisah Ramli
      Abstract: Publication date: Available online 12 February 2018
      Source:Academic Radiology
      Author(s): Vigneswaran Veeramuthu, Pohchoo Seow, Vairavan Narayanan, Jeannie Hisu Ding Wong, Li Kuo Tan, Aditya Tri Hernowo, Norlisah Ramli
      Rationale and Objectives Magnetic resonance spectroscopy is a noninvasive imaging technique that allows for reliable assessment of microscopic changes in brain cytoarchitecture, neuronal injuries, and neurochemical changes resultant from traumatic insults. We aimed to evaluate the acute alteration of neurometabolites in complicated and uncomplicated mild traumatic brain injury (mTBI) patients in comparison to control subjects using proton magnetic resonance spectroscopy (1H magnetic resonance spectroscopy). Material and Methods Forty-eight subjects (23 complicated mTBI [cmTBI] patients, 12 uncomplicated mTBI [umTBI] patients, and 13 controls) underwent magnetic resonance imaging scan with additional single voxel spectroscopy sequence. Magnetic resonance imaging scans for patients were done at an average of 10 hours (standard deviation 4.26) post injury. The single voxel spectroscopy adjacent to side of injury and noninjury regions were analysed to obtain absolute concentrations and ratio relative to creatine of the neurometabolites. One-way analysis of variance was performed to compare neurometabolite concentrations of the three groups, and a correlation study was done between the neurometabolite concentration and Glasgow Coma Scale. Results Significant difference was found in ratio of N-acetylaspartate to creatine (NAA/Cr + PCr) (χ2(2) = 0.22, P < .05) between the groups. The sum of NAA and N-acetylaspartylglutamate (NAAG) also shows significant differences in both the absolute concentration (NAA + NAAG) and ratio to creatine (NAA + NAAG/Cr + PCr) between groups (χ2(2) = 4.03, P < .05and (χ2(2) = 0.79, P < .05)). NAA values were lower in cmTBI and umTBI compared to control group. A moderate weak positive correlation were found between Glasgow Coma Scale with NAA/Cr + PCr (ρ = 0.36, P < .05 and NAA + NAAG/Cr + PCr (ρ = 0.45, P < .05)), whereas a moderate correlation was seen with NAA + NAAG (ρ = 0.38, P < .05). Conclusion Neurometabolite alterations were already apparent at onset of both complicated and uncomplicated traumatic brain injury. The ratio of NAA and NAAG has potential to serve as a biomarker reflecting injury severity in a quantifiable manner as it discriminates between the complicated and uncomplicated cases of mTBI.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2018.01.005
  • Communication Practices of Mammography Facilities and Timely Follow-up of
           a Screening Mammogram with a BI-RADS 0 Assessment
    • Authors: Marilyn M. Schapira; William E. Barlow; Emily F. Conant; Brian L. Sprague; Anna N.A. Tosteson; Jennifer S. Haas; Tracy Onega; Elisabeth F. Beaber; Martha Goodrich; Anne Marie McCarthy; Sally D. Herschorn; Celette Sugg Skinner; Tory O. Harrington; Berta Geller
      Abstract: Publication date: Available online 9 February 2018
      Source:Academic Radiology
      Author(s): Marilyn M. Schapira, William E. Barlow, Emily F. Conant, Brian L. Sprague, Anna N.A. Tosteson, Jennifer S. Haas, Tracy Onega, Elisabeth F. Beaber, Martha Goodrich, Anne Marie McCarthy, Sally D. Herschorn, Celette Sugg Skinner, Tory O. Harrington, Berta Geller
      Rationale and Objectives The objective of this study was to evaluate the association of communication practices with timely follow-up of screening mammograms read as Breast Imaging Reporting and Data Systems (BI-RADS) 0 in the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. Materials and Methods A radiology facility survey was conducted in 2015 with responses linked to screening mammograms obtained in 2011–2014. We considered timely follow-up to be within 15 days of the screening mammogram. Generalized estimating equation models were used to evaluate the association between modes of communication with patients and providers and timely follow-up, adjusting for PROSPR site, patient age, and race and ethnicity. Results The analysis included 34,680 mammography examinations with a BI-RADS 0 assessment among 28 facilities. Across facilities, 85.6% of examinations had a follow-up within 15 days. Patients in a facility where routine practice was to contact the patient by phone if follow-up imaging was recommended were more likely to have timely follow-up (odds ratio [OR] 4.63, 95% confidence interval [CI] 2.76–7.76), whereas standard use of mail was associated with reduced timely follow-up (OR 0.47, 95% CI 0.30–0.75). Facilities that had standard use of electronic medical records to report the need for follow-up imaging to a provider had less timely follow-up (OR 0.56, 95% CI 0.35–0.90). Facilities that routinely contacted patients by mail if they missed a follow-up imaging visit were more likely to have timely follow-up (OR 1.65, 95% CI 1.02–2.69). Conclusions Our findings support the value of telephone communication to patients in relation to timely follow-up. Future research is needed to evaluate the role of communication in completing the breast cancer screening episode.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.12.028
  • An MRI-based Radiomics Classifier for Preoperative Prediction of Ki-67
           Status in Breast Cancer
    • Authors: Cuishan Liang; Zixuan Cheng; Yanqi Huang; Lan He; Xin Chen; Zelan Ma; Xiaomei Huang; Changhong Liang; Zaiyi Liu
      Abstract: Publication date: Available online 7 February 2018
      Source:Academic Radiology
      Author(s): Cuishan Liang, Zixuan Cheng, Yanqi Huang, Lan He, Xin Chen, Zelan Ma, Xiaomei Huang, Changhong Liang, Zaiyi Liu
      Rationale and Objectives This study aims to investigate the value of a magnetic resonance imaging–based radiomics classifier for preoperatively predicting the Ki-67 status in patients with breast cancer. Materials and Methods We chronologically divided 318 patients with clinicopathologically confirmed breast cancer into a training dataset (n = 200) and a validation dataset (n = 118). Radiomics features were extracted from T2-weighted (T2W) and contrast-enhanced T1-weighted (T1+C) images of breast cancer. Radiomics feature selection and radiomics classifiers were generated using the least absolute shrinkage and selection operator regression analysis method. The correlation between the radiomics classifiers and the Ki-67 status in patients with breast cancer was explored. The predictive performances of the radiomics classifiers for the Ki-67 status were evaluated with receiver operating characteristic curves in the training dataset and validated in the validation dataset. Results Through the radiomics feature selection, 16 and 14 features based on T2W and T1+C images, respectively, were selected to constitute the radiomics classifiers. The radiomics classifier based on T2W images was significantly correlated with the Ki-67 status in both the training and the validation datasets (both P < .0001). The radiomics classifier based on T1+C images was significantly correlated with the Ki-67 status in the training dataset (P < .0001) but not in the validation dataset (P = .083). The T2W image–based radiomics classifier exhibited good discrimination for Ki-67 status, with areas under the receiver operating characteristic curves of 0.762 (95% confidence interval: 0.685, 0.838) and 0.740 (95% confidence interval: 0.645, 0.836) in the training and validation datasets, respectively. Conclusions The T2W image–based radiomics classifier was a significant predictor of Ki-67 status in patients with breast cancer. Thus, it may serve as a noninvasive approach to facilitate the preoperative prediction of Ki-67 status in clinical practice.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2018.01.006
  • Educating Radiologists for Self-governance
    • Authors: Richard B. Gunderman; Paul J. Martin
      Abstract: Publication date: Available online 7 February 2018
      Source:Academic Radiology
      Author(s): Richard B. Gunderman, Paul J. Martin

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.12.017
  • Semiautomatic Assessment of the Terminal Ileum and Colon in Patients with
           Crohn Disease Using MRI (the VIGOR++ Project)
    • Authors: Carl A.J. Puylaert; Peter J. Schüffler; Robiel E. Naziroglu; Jeroen A.W. Tielbeek; Zhang Li; Jesica C. Makanyanga; Charlotte J. Tutein Nolthenius; C. Yung Nio; Douglas A. Pendsé; Alex Menys; Cyriel Y. Ponsioen; David Atkinson; Alastair Forbes; Joachim M. Buhmann; Thomas J. Fuchs; Haralambos Hatzakis; Lucas J. van Vliet; Jaap Stoker; Stuart A. Taylor; Frans M. Vos
      Abstract: Publication date: Available online 7 February 2018
      Source:Academic Radiology
      Author(s): Carl A.J. Puylaert, Peter J. Schüffler, Robiel E. Naziroglu, Jeroen A.W. Tielbeek, Zhang Li, Jesica C. Makanyanga, Charlotte J. Tutein Nolthenius, C. Yung Nio, Douglas A. Pendsé, Alex Menys, Cyriel Y. Ponsioen, David Atkinson, Alastair Forbes, Joachim M. Buhmann, Thomas J. Fuchs, Haralambos Hatzakis, Lucas J. van Vliet, Jaap Stoker, Stuart A. Taylor, Frans M. Vos
      Rationale and Objectives The objective of this study was to develop and validate a predictive magnetic resonance imaging (MRI) activity score for ileocolonic Crohn disease activity based on both subjective and semiautomatic MRI features. Materials and Methods An MRI activity score (the “virtual gastrointestinal tract [VIGOR]” score) was developed from 27 validated magnetic resonance enterography datasets, including subjective radiologist observation of mural T2 signal and semiautomatic measurements of bowel wall thickness, excess volume, and dynamic contrast enhancement (initial slope of increase). A second subjective score was developed based on only radiologist observations. For validation, two observers applied both scores and three existing scores to a prospective dataset of 106 patients (59 women, median age 33) with known Crohn disease, using the endoscopic Crohn's Disease Endoscopic Index of Severity (CDEIS) as a reference standard. Results The VIGOR score (17.1 × initial slope of increase + 0.2 × excess volume + 2.3 × mural T2) and other activity scores all had comparable correlation to the CDEIS scores (observer 1: r = 0.58 and 0.59, and observer 2: r = 0.34–0.40 and 0.43–0.51, respectively). The VIGOR score, however, improved interobserver agreement compared to the other activity scores (intraclass correlation coefficient = 0.81 vs 0.44–0.59). A diagnostic accuracy of 80%–81% was seen for the VIGOR score, similar to the other scores. Conclusions The VIGOR score achieves comparable accuracy to conventional MRI activity scores, but with significantly improved reproducibility, favoring its use for disease monitoring and therapy evaluation.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.12.024
  • Computed Tomography Window Blending
    • Authors: Jacob C. Mandell; Jeremy R. Wortman; Tatiana C. Rocha; Les R. Folio; Katherine P. Andriole; Bharti Khurana
      Abstract: Publication date: Available online 7 February 2018
      Source:Academic Radiology
      Author(s): Jacob C. Mandell, Jeremy R. Wortman, Tatiana C. Rocha, Les R. Folio, Katherine P. Andriole, Bharti Khurana
      Rationale and Objectives This study aims to demonstrate the feasibility of processing computed tomography (CT) images with a custom window blending algorithm that combines soft-tissue, bone, and lung window settings into a single image; to compare the time for interpretation of chest CT for thoracic trauma with window blending and conventional window settings; and to assess diagnostic performance of both techniques. Materials and Methods Adobe Photoshop was scripted to process axial DICOM images from retrospective contrast-enhanced chest CTs performed for trauma with a window-blending algorithm. Two emergency radiologists independently interpreted the axial images from 103 chest CTs with both blended and conventional windows. Interpretation time and diagnostic performance were compared with Wilcoxon signed-rank test and McNemar test, respectively. Agreement with Nexus CT Chest injury severity was assessed with the weighted kappa statistic. Results A total of 13,295 images were processed without error. Interpretation was faster with window blending, resulting in a 20.3% time saving (P < .001), with no difference in diagnostic performance, within the power of the study to detect a difference in sensitivity of 5% as determined by post hoc power analysis. The sensitivity of the window-blended cases was 82.7%, compared to 81.6% for conventional windows. The specificity of the window-blended cases was 93.1%, compared to 90.5% for conventional windows. All injuries of major clinical significance (per Nexus CT Chest criteria) were correctly identified in all reading sessions, and all negative cases were correctly classified. All readers demonstrated near-perfect agreement with injury severity classification with both window settings. Conclusions In this pilot study utilizing retrospective data, window blending allows faster preliminary interpretation of axial chest CT performed for trauma, with no significant difference in diagnostic performance compared to conventional window settings. Future studies would be required to assess the utility of window blending in clinical practice.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.12.029
  • Cardiothoracic MRI in the ICU
    • Authors: Narmadan Kumarasamy; Nima Tishbi; Shey Mukundan; Ariel Shiloh; Jeffrey M. Levsky; Linda B. Haramati
      Abstract: Publication date: Available online 6 February 2018
      Source:Academic Radiology
      Author(s): Narmadan Kumarasamy, Nima Tishbi, Shey Mukundan, Ariel Shiloh, Jeffrey M. Levsky, Linda B. Haramati
      Rationale and Objective The objective of this study was to identify the feasibility and pitfalls of cardiothoracic magnetic resonance imaging (MRI) in intensive care unit (ICU) patients. Materials and Methods This retrospective study identified adult ICU patients scheduled for cardiothoracic MRIs during a 10-year study period. ICU patients scheduled for brain MRIs served as a comparison group. A chart review was performed to identify factors impacting a patient's ability to undergo an MRI. Differences between completed and canceled examinations for both cardiothoracic and brain MRIs were evaluated. For the cardiothoracic group, clinical indications and the diagnostic value of the study performed were also identified. Results A total of 143 cardiothoracic MRIs and 1011 brain MRIs were requested. Cardiothoracic MRI patients were less frequently completed (52% vs 62%), more frequently men (64% vs 43%), younger (55 vs 63 years), less likely mechanically ventilated (8% vs 29%), more likely to require intravenous contrast (83% vs 23%), and had longer examination times compared to brain MRI patients (64 vs 21 minutes). Successful completion of cardiothoracic MRI was associated with lower serum creatinine, higher glomerular filtration rate, and the absence of mechanical ventilation; significant differences were not seen with regard to gender and use of vasoactive agents. Cardiothoracic MRI results were diagnostic in 69% of examinations, most frequently when performed for myocardial disease (84%) and aortic disease (33%), and less frequently for viability (33%). Conclusions In an ICU population, successful completion of cardiothoracic MRI is challenging but feasible in patients with intact renal function and the absence of mechanical ventilation. Examinations were most frequently diagnostic for myocardial and aortic disease indications.

      PubDate: 2018-02-14T09:45:12Z
      DOI: 10.1016/j.acra.2017.09.017
  • Burnout
    • Authors: Jeffrey Guenette; Stacy Smith
      Abstract: Publication date: Available online 6 February 2018
      Source:Academic Radiology
      Author(s): Jeffrey P. Guenette, Stacy E. Smith
      Objective We aimed to identify job resources and job demands associated with measures of personal accomplishment (PA) in radiology residents in the United States. Materials and Methods A 34-item online survey was administered between May and June 2017 to U.S. radiology residents and included the 8 Likert-type PA questions from the Maslach Burnout Inventory-Human Services Survey, 19 visual analog scale job demands-resources questions, and 7 demographic questions. Multiple linear regression was calculated to predict PA based on job demands-resources. Effects of binomial demographic factors on PA scores were compared with independent-samples t tests. Effects of categorical demographic factors on PA scores were compared with one-way between-subjects analysis of variance tests. A linear regression was calculated to evaluate the relationship of age on PA scores. Results “The skills and knowledge that I am building are important and helpful to society” (P = 2 × 10−16), “I have good social support from my co-residents” (P = 4 × 10−5), and “I regularly receive adequate constructive feedback” (P = 4 × 10−6) all positively correlated with PA. PA scores were significantly lower for individuals who were single vs those married or partnered (P = .01). Conclusions Radiology residents score higher in the PA domain of burnout when they receive adequate constructive feedback, have good co-resident social support, and feel that the skills and knowledge they are building are important to society. Improving constructive feedback mechanisms, enabling resident-only social time, and supporting opportunities that reinforce the importance of their contributions may therefore improve radiology residents' sense of PA.

      PubDate: 2018-02-14T09:45:12Z
  • 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
      Abstract: Publication date: Available online 3 February 2018
      Source:Academic Radiology
      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: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.005
  • Effect of Implementing Community of Practice Modified Thyroid Imaging
           Reporting and Data System on Reporting Adherence and Number of Thyroid
    • Authors: Tetyana Maniuk; Ania Z. Kielar; Joseph P. O'Sullivan; Mohamed El-Khodary; Heather Lochnan; Bibianna Purgina; Michael J. Odell
      Abstract: Publication date: Available online 3 February 2018
      Source:Academic Radiology
      Author(s): Tetyana Maniuk, Ania Z. Kielar, Joseph P. O'Sullivan, Mohamed El-Khodary, Heather Lochnan, Bibianna Purgina, Michael J. Odell
      Rationale and Objectives Thyroid nodules are common in the population, although the rate of malignancy is relatively low (5%–15%). The purpose of this study was to determine if introducing a modified standardized reporting format and management algorithm (Thyroid Imaging Reporting and Data System [TI-RADS]) affects radiologist reporting adherence, number of thyroid biopsies, and other measurable outcomes. Materials and Methods All thyroid biopsies performed over two 6-month periods were evaluated at a tertiary care hospital with Research Ethics Board approval. The first period was before implementation of TI-RADS and the second was several months after implementation of TI-RADS (using a modified version made through a multidisciplinary collaboration). The number of biopsies performed was determined in each of the two periods as well as the percent of positive malignancy, wait times, and rates of non-diagnostic/unsatisfactory and inconclusive biopsies, which included atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). Results The average number of biopsies performed prior to implementing modified Kwak's TI-RADS was 74 thyroid biopsies per month and the average number of diagnostic ultrasounds was 271. After the introduction of modified Kwak's TI-RADS, the average number of thyroid biopsies decreased to 60 per month (an 18.9% reduction, P < .05), and the number of diagnostic ultrasound increased to 287 per month (a 5.9% increase from 2016 to 2017). The average wait time for a thyroid biopsy decreased from 5 to 3 weeks (P < .05). There was a slight increase in the rate of positive malignancy results (from 15% to 18%), although it was not statistically significant. The rate of non-diagnostic/unsatisfactory and inconclusive results (including AUS and FLUS) remained unchanged (18% AUS/FLUS/15% non-diagnostic/unsatisfactory before and 17% AUS/FLUS/15% non-diagnostic/unsatisfactory after TI-RADS introduction, P > .05). Conclusions Introduction of a multidisciplinary-approved standardized reporting system with evidence-based management recommendations led to no statistically significant change in the number of diagnostic ultrasounds but a statistically significant reduction in the number of monthly thyroid biopsies and associated reduction in wait times.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.009
  • Accuracy of Opposed-phase Magnetic Resonance Imaging for the Evaluation of
           Treated and Untreated Spinal Metastases
    • Authors: Michael T. Perry; Ronnie Sebro
      Abstract: Publication date: Available online 3 February 2018
      Source:Academic Radiology
      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: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.11.022
  • Gender Diversity in Academic Radiology Departments
    • Authors: Karla A. Sepulveda; Angelisa M. Paladin; James V. Rawson
      Abstract: Publication date: Available online 3 February 2018
      Source:Academic Radiology
      Author(s): Karla A. Sepulveda, Angelisa M. Paladin, James V. Rawson
      Gender diversity remains a challenge for radiology. As we aspire to embrace Diversity 3.0 and the goal of making diversity core to our organizations' mission, there must be increasing awareness of the barriers to achieving inclusion and to best practices for making diversity integral to achieving excellence. This article reviews the literature on gender diversity in radiology and in academic radiology leadership and discusses lessons learned from non–health-care industry and from academic radiology departments that have been successful in developing and supporting female employees.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.08.018
  • 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
      Abstract: Publication date: Available online 3 February 2018
      Source:Academic Radiology
      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: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.004
  • 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
      Abstract: Publication date: Available online 3 February 2018
      Source:Academic Radiology
      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: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.11.019
  • Artificial Intelligence and Radiology: Have Rumors of the Radiologist's
           Demise Been Greatly Exaggerated'
    • Authors: Tomer Nawrocki; Pierre D. Maldjian; Shira E. Slasky; Sohail G. Contractor
      Abstract: Publication date: Available online 2 February 2018
      Source:Academic Radiology
      Author(s): Tomer Nawrocki, Pierre D. Maldjian, Shira E. Slasky, Sohail G. Contractor
      Artificial intelligence is a rapidly evolving computerized technology affecting multiple aspects of our lives. It is predicted that artificial intelligence will lead to a fundamental change in practice of many professional fields, including medicine. One of the most significant advances in artificial intelligence involves digital imaging and image recognition. Consequently, radiologists, who work in the most digitalized field of medicine, need to be familiar with this rapidly progressing technology. “Artificial intelligence,” “machine learning,” and “deep learning” are terms that tend to be used interchangeably in terms of advanced computer algorithms, but each has a different meaning. Objectives for this article are to demystify these terms for radiologists and to establish a basic understanding of this topic for the reader. We also discuss the impact that artificial intelligence might have on the field of radiology in the foreseeable future. Although artificial intelligence is unlikely to replace radiologists any time soon (if ever), we explore how this technology could be beneficial to radiologists.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.027
  • Comparison of Interobserver Agreement and Diagnostic Accuracy for
           IASLC/ITMIG Thymic Epithelial Tumor Staging Among Co-registered
           FDG-PET/MRI, Whole-body MRI, Integrated FDG-PET/CT, and Conventional
           Imaging Examination with and without Contrast Media Administrations
    • Authors: Yoshiharu Ohno; Yuji Kishida; Shinichiro Seki; Hisanobu Koyama; Masao Yui; Kota Aoyagi; Takeshi Yoshikawa
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      Author(s): Yoshiharu Ohno, Yuji Kishida, Shinichiro Seki, Hisanobu Koyama, Masao Yui, Kota Aoyagi, Takeshi Yoshikawa
      Rationale and Objectives The purpose of this study was to compare the interobserver agreements and diagnostic accuracies for IASLC/ITMIG (International Association for the Study of Lung Cancer/International Thymic Malignancies Interest Group) thymic epithelial tumor staging of co-registered fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (FDG-PET/MRI), MRI, integrated fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), and conventional imaging examination. Materials and Methods Prospective whole-body MRI including diffusion-weighted imaging, integrated PET/CTs, conventional imaging examinations, pathological examinations, and surgical reports, as well as follow-up examinations, were performed for 64 consecutive patients with thymic epithelial tumor. All FDG-PET/MRIs were co-registered PET data with MRI. TNM staging was evaluated by two radiologists on the basis of the IASLC/ITMIG thymic epithelial tumor staging system. Kappa statistics were determined for evaluations of agreements of all factors between each of the methods and final diagnosis. Finally, the diagnostic accuracy of each factor and of determination of the clinical stage was statistically compared to each other using McNemar test. Results Agreements for all factors between each method and final diagnosis were assessed as fair, moderate, substantial, or almost perfect (0.28 ≤ kappa value ≤ 0.80; P < .0001). Diagnostic accuracy for N factor of PET/MRI (93.8% [60/64]) and MRI (93.8% [60/64]) was significantly higher than that of conventional imaging examination (81.3% [52/64] vs PET/MRI and MRI; P = .008). In addition, diagnostic accuracy for staging of PET/MRI (84.4% [54/64]) and MRI (84.4 [54/64]) was significantly higher than that of conventional imaging examination (71.9% [46/64] vs PET/MRI and MRI; P = .008). Conclusions Whole-body PET/MRI, MRI, and PET/CT have better interobserver agreements and accuracies than conventional imaging examination for the new IASLC/ITMIG thymic epithelial tumor staging.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.016
  • Low-dose Lung Cancer Screening at an Academic Medical Center
    • Authors: Altan Ahmed; Nupur Verma; Izabella Barreto; Tan-Lucien Mohammed
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      Author(s): Altan Ahmed, Nupur Verma, Izabella Barreto, Tan-Lucien Mohammed
      Rationale and Objectives Implementation of low dose computed tomography (LDCT) lung cancer screening programs has followed the demonstration of reduced lung cancer mortality in the National Lung Screening Trial and subsequent consensus screening recommendations. Here we aim to assess the initial results of a screening program at an academic medical center, to discuss the challenges of implementing such a program, and suggest strategies for reducing patient dose. Materials and Methods Retrospective review of all patients who underwent LDCT lung cancer screening at our institution between March 2015 and July 2016 was performed to assess the lung cancer detection rate, the spectrum of imaging findings (nodule or mass characteristics, degree of emphysema, etc.), and patient radiation dose indices. Results A total of 272 patients were screened during the study period. Approximately 50% (n = 135) were women. The lung cancer detection rate was 2.2% (n = 6). One patient underwent chemoradiation therapy, whereas the remainder underwent uneventful thoracoscopic resection. Approximately, 80% of screened patients met United States Preventative Services Task Force criteria for LDCT screening. The median pack-years of smoking was 42 pack-years. The mean volume CT dose index for the screening CTs was 3.12 mGy. Utilizing tube current modulation and iterative reconstruction, where available, resulted in lower patient doses. Conclusion Initial LDCT lung cancer screening at our institution yielded results similar to those of the National Lung Screening Trial. Thorough prescreening evaluation, joint decision-making, centralized coordination of screening-related care, and patient size conscious scanning protocols are critical elements of a safe and successful lung cancer screening program.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.023
  • Synthesized Mammography
    • Authors: Emily B. Ambinder; Susan C. Harvey; Babita Panigrahi; Ximin Li; Ryan W. Woods
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      Author(s): Emily B. Ambinder, Susan C. Harvey, Babita Panigrahi, Ximin Li, Ryan W. Woods
      Rationale and Objectives This study aims to evaluate the screening performance of digital breast tomosynthesis (DBT) combined with synthesized mammography (SM) vs combined with full-field digital mammography (FFDM). Materials and Methods We retrospectively reviewed all screening studies utilizing FFDM + DBT (n = 7845) and SM + DBT (n = 14,776) between April 1, 2013, and February 15, 2016. Recall rate, biopsy rate, positive predictive value 1 (PPV1), positive predictive value 3 (PPV3), and cancer detection rate (CDR) were compared between the two groups. A generalized linear mixed model specifying the reading radiologist as the random effect and controlling for age was used to compare clinical outcomes between the two groups. Results The overall recall rate was significantly lower in the SM + DBT cohort compared to the FFDM + DBT cohort (7.06% vs 7.63%, P = .04). There was no difference in biopsy rate, PPV1, PPV3, or CDR between the two groups. Conclusions When DBT is performed for screening, the use of SM rather than acquiring an additional FFDM has no significant effect on biopsy rate, PPV1, PPV3, or CDR. We found a decrease in recall rate in the SM + DBT group, which may be related to the learning curve of interpreting DBT. These findings support the use of SM for patients undergoing screening with DBT.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.015
  • Using Convolutional Neural Networks for Enhanced Capture of Breast
           Parenchymal Complexity Patterns Associated with Breast Cancer Risk
    • Authors: Aimilia Gastounioti; Andrew Oustimov; Meng-Kang Hsieh; Lauren Pantalone; Emily F. Conant; Despina Kontos
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      Author(s): Aimilia Gastounioti, Andrew Oustimov, Meng-Kang Hsieh, Lauren Pantalone, Emily F. Conant, Despina Kontos
      Rationale and Objectives We evaluate utilizing convolutional neural networks (CNNs) to optimally fuse parenchymal complexity measurements generated by texture analysis into discriminative meta-features relevant for breast cancer risk prediction. Materials and Methods With Institutional Review Board approval and Health Insurance Portability and Accountability Act compliance, we retrospectively analyzed “For Processing” contralateral digital mammograms (GE Healthcare 2000D/DS) from 106 women with unilateral invasive breast cancer and 318 age-matched controls. We coupled established texture features (histogram, co-occurrence, run-length, structural), extracted using a previously validated lattice-based strategy, with a multichannel CNN into a hybrid framework in which a multitude of texture feature maps are reduced to meta-features predicting the case or control status. We evaluated the framework in a randomized split-sample setting, using the area under the curve (AUC) of the receiver operating characteristic (ROC) to assess case-control discriminatory capacity. We also compared the framework to CNNs directly fed with mammographic images, as well as to conventional texture analysis, where texture feature maps are summarized via simple statistical measures that are then used as inputs to a logistic regression model. Results Strong case-control discriminatory capacity was demonstrated on the basis of the meta-features generated by the hybrid framework (AUC = 0.90), outperforming both CNNs applied directly to raw image data (AUC = 0.63, P < .05) and conventional texture analysis (AUC = 0.79, P < .05). Conclusions Our results suggest that informative interactions between patterns exist in texture feature maps derived from mammographic images, which can be extracted and summarized via a multichannel CNN architecture toward leveraging the associations of textural measurements to breast cancer risk.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.025
  • Assessing Resident Performance in Screening Mammography
    • Authors: Petra J. Lewis; Timothy B. Rooney; Tracy E. Frazee; Steven P. Poplack
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      Author(s): Petra J. Lewis, Timothy B. Rooney, Tracy E. Frazee, Steven P. Poplack
      Rationale and Objectives This study aims to provide objective performance data and feedback, including examination volumes, recall rates, and concordance with faculty interpretations, for residents performing independent interpretation of screening mammography examinations. Method and Materials Residents (r) and faculty (f) interpret screening mammograms separately and identify non-callbacks (NCBs) and callbacks (CBs). Residents review all discordant results. The number of concordant interpretations (fCB-rCB and fNCB-rNCB) and discordant interpretations (fCB-rNCB and fNCB-rCB) are entered into a macro-driven spreadsheet. These macros weigh the data dependent on the perceived clinical impact of the resident's decision. Weighted outcomes are combined with volumes to generate a weighted mammography performance score. Rotation-specific goals are assigned for the weighted score, screening volumes, recall rate relative to faculty, and concordance rates. Residents receive one point for achieving each goal. Results Between July 2013 and May 2017, 18,747 mammography examinations were reviewed by 31 residents, in 71 resident rotations, over 246 resident weeks. Mean resident recall rate was 9.9% and significantly decreased with resident level (R), R2 = 11.3% vs R3 = 9.4%, R4 = 9.2%. Mean resident-faculty discordance rate was 10% and significantly decreased from R2 = 12% to R4 = 9.6%. Weighted performance scores ranged from 1.1 to 2.0 (mean 1.6, standard deviation 0.17), but did not change with rotation experience. Residents had a mean goal achievement score of 2.6 (standard deviation 0.47). Conclusions This method provides residents with easily accessible case-by-case individualized screening outcome data over the longitudinal period of their residency, and provides an objective method of assessing resident screening mammography performance.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.11.006
  • Has the Objective Quality of Evidence in Imaging Papers Changed Over the
           Last 20 Years'
    • Authors: Danielle E. Kostrubiak; Renee F. Cattell; Franco Momoli; Mark E. Schweitzer
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      Author(s): Danielle E. Kostrubiak, Renee F. Cattell, Franco Momoli, Mark E. Schweitzer
      Rationale and Objectives We aimed to determine if both evidence level (EL) as well as clinical efficacy (CE) of imaging manuscripts have changed over the last 20 years. Materials and Methods With our review of medical literature, Institutional Review Board approval was waived, and no informed consent was required. Using Web of Science, we determined the 10 highest impact factor imaging journals. For each journal the 10 most cited and 10 average cited papers were compared for the following years: 1994, 1998, 2002, 2006, 2010, and 2014. EL was graded using the same criteria as the Journal of Bone and Joint Surgery (Wright et al., 2003). CE was graded using the criteria of Thornbury and Fryback (1991). Statistical software R and package lme4 were used to fit mixed regression models with fixed effects for group, year, and a random effect for journal. Results EL has improved −0.03 every year on average (P < .001). The more cited papers had better ELs (group effect = −0.23, SE 0.09, P = .011). CE is lower in top cited compared to average cited articles, although the differences were not statistically significant (group effect = −0.14, SE = 0.09, P = .16). CE level increased modestly in both groups over this 20-year time period (0.06 per year, SE = 0.007, P < .001). Conclusion Over the last 20 years, imaging journal articles have improved modestly in quality of evidence, as measured by EL and CE.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.026
  • Adaptive Iterative Dose Reduction 3D Integrated with Automatic Tube
           Current Modulation for CT Coronary Artery Calcium Quantification
    • Authors: Ya-Chun Tang; Yuan-Chang Liu; Ming-Yi Hsu; Hui-Yu Tsai; Chien-Ming Chen
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      Author(s): Ya-Chun Tang, Yuan-Chang Liu, Ming-Yi Hsu, Hui-Yu Tsai, Chien-Ming Chen
      Rationale and Objectives We aimed to evaluate integrated adaptive iterative dose reduction 3D (AIDR 3D) algorithm in automatic tube current modulation (ATCM) for the quantification of coronary artery calcium score (CACS) and cardiac risk stratification. Materials and Methods A thoracic phantom with calcium inserts of known densities was scanned with filtered back projection (FBP) and AIDR 3D algorithms in small- and medium-sized phantoms. Twenty-four patients underwent two consecutive scans of CACS with FBP and AIDR 3D algorithms. The absolute Agatston score, Agatston score risk, volume score, and Agatston score percentile-based risk were compared, and concordance coefficients and agreement plots were made. Results Agatston and volume scores were significantly different between the phantom sizes (P < .01). There were no significant differences in the Agatston scores between FBP and AIDR 3D for the medium phantoms (P = .25). In the patients, there were no significant differences in Agatston and volume scores between FBP and AIDR 3D (P = .06 and P = .09, respectively). The correlation coefficients of Agatston and volume scores with AIDR 3D were excellent compared to those of FBP. There were no significant differences in Agatston score risk and Agatston score percentile-based risk between FBP and AIDR 3D (P = .74 and P = 1, respectively). There was mean dose reduction of 57.8% ± 18.6% for AIDR 3D. Conclusion The absolute Agatston score differed between FBP and AIDR 3D reconstructions. However, the cardiac risk categorizations of the two methods were comparable. An integrated AIDR 3D algorithm with automatic tube current modulation enables radiation dose savings at a consistent noise level without sacrificing CACS.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.018
  • Evaluation of the Effect of Operator Experience on Outcome of Hepatic
           Artery Embolization of Hepatocellular Carcinoma in a Tertiary Cancer
    • Authors: Hooman Yarmohammadi; Adrian J. Gonzalez-Aguirre; Majid Maybody; Etay Ziv; F. Edward Boas; Joseph P. Erinjeri; Constantinos T. Sofocleous; Stephen B. Solomon; George Getrajdman
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      Author(s): Hooman Yarmohammadi, Adrian J. Gonzalez-Aguirre, Majid Maybody, Etay Ziv, F. Edward Boas, Joseph P. Erinjeri, Constantinos T. Sofocleous, Stephen B. Solomon, George Getrajdman
      Rationale and Objectives There is lack of information on the learning curve and the effect of operator's experience on the quality outcomes of transarterial hepatic embolization (TAE). The aim of this study was to evaluate the effect of operator experience on outcomes of TAE of hepatocellular carcinoma. Materials and Methods Demographic characteristics and outcomes including overall survival (OS), time to local tumor progression (TLP), and post-procedure complications in patients with hepatocellular carcinoma treated with TAE were collected. Operators' experience was measured in years based on the years after completion of fellowship and the date of first embolization, and was divided into five groups: G1, less than 5 years of operator's experience (YOE) at the time of first embolization; G2, 5–10 YOE; G3, 10–15 YOE; G4, 15–20 YOE; and G5, more than 20 YOE. The effects of operator's experience and outcomes were assessed using linear regression. Results From January 2012 to January 2015, 93 patients (age range = 30–86 years) were treated. The number of patients treated by each group was as follows: G1 = 12; G2 = 8; G3 = 23; G4 = 5; and G5 = 45. All groups were similar in regard to degree of cirrhosis, Barcelona Clinic Liver Cancer staging, and Child-Pugh score (P > .05). Median TLP was 8.8 months. TLP was 7.0, 6.8, 19.2, 7.9, and 8.2 months in G1, G2, G3, G4, and G5, respectively (P = .56). OS for 1, 2, and 3 years was 75%, 56%, and 42% for G1; 87%, 54%, and 54% for G2; 91%, 71%, and 45% for G3, 100%, 50%, and 0 for G4; and 84%, 65%, and 40% for G5. Conclusion Among interventional radiology fellowship-trained operators in a tertiary cancer center, OS, TLP, and post-procedure complications of TAE were not affected by the years of post-fellowship experience.

      PubDate: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.12.011
  • 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
      Abstract: Publication date: Available online 1 February 2018
      Source:Academic Radiology
      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: 2018-02-03T08:59:27Z
      DOI: 10.1016/j.acra.2017.11.018
  • Diagnostic Value of Dual-input Computed Tomography Perfusion on Detecting
           Bronchial-Pulmonary Artery Fistula in Tuberculosis Patients with Massive
    • Authors: Haixian Qu; Maoqiang Wang; Zhijun Wang; Guokun Ao; Xiaodong Yuan; Qiang Li; Zepeng Ma; Qianru Xu; Jieyu Yan; Yanhua Bai
      Abstract: Publication date: Available online 19 January 2018
      Source:Academic Radiology
      Author(s): Haixian Qu, Maoqiang Wang, Zhijun Wang, Guokun Ao, Xiaodong Yuan, Qiang Li, Zepeng Ma, Qianru Xu, Jieyu Yan, Yanhua Bai
      Rationale and Objectives This prospective study aimed to evaluate the diagnostic performance of dual-input computed tomography perfusion technique (DI-CTP) in identifying the bronchial-pulmonary artery fistula in patients tuberculosis with massive hemoptysis. Material and Methods Twenty patients with tuberculosis with massive hemoptysis were enrolled from January 2015 to December 2015. The association between DI-CTP parameters and the diagnostic outcomes of digital subtraction angiography was assessed. Diagnostic efficacy of DI-CTP was evaluated by receiver operating curve (ROC) analyses using the diagnostic outcomes of digital subtraction angiography, which is the gold standard for identifying bronchial-pulmonary artery fistula. Results Compared to lung segments with normal blood flow (n = 304), those with bronchial-pulmonary artery fistula (n = 164) had a reduced pulmonary flow value, perfusion index (PI) value, and an elevated bronchial artery (BF) value in the DI-CTP scan, which was further confirmed by multivariate logistic regression. ROC analysis showed that PI and bronchial artery has an excellent diagnostic performance (both area under the ROC curve > 0.9, P < .001) and high sensitivity and specificity (from 0.79 to 0.95 at the optimal cutoff). PI has the best diagnostic performance, with an overall diagnostic accuracy of 0.91. Conclusions DI-CTP scan possesses the diagnostic value for detecting bronchial-pulmonary artery fistula in patients with tuberculosis with massive hemoptysis, providing an alternative diagnostic method.

      PubDate: 2018-01-23T08:00:20Z
      DOI: 10.1016/j.acra.2017.12.013
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