Accuracy Of Radiologists Research Articles

Internal Rotation Traction Radiograph Improves Proximal Femoral Fracture Classification Accuracy and Agreement.

The objective of this study is to assess the clinical utility of internal rotation traction radiography in the classification of proximal femoral fractures. The study cohort included 78 consecutive patients who were surgically treated for a proximal femoral fracture and for whom preoperative physician-assisted internal rotation traction radiographs of the fractured hip were obtained in addition to standard radiographs. Two radiologists who were blinded to clinical information independently classified each fracture without the traction view and then with the traction view. The radiologists also reported their confidence (expressed as a percentage) in their classifications. The reference standard was the consensus interpretation of intraoperative C-arm fluoroscopic images by two orthopedic surgeons and one radiologist. Classification accuracy was compared using the McNemar test. Subjective confidence and confidence-weighted accuracy were compare using paired t tests. Agreement with the reference standard and interreader agreement were calculated using the kappa statistic and were compared using the z-test after bootstrapping was performed to obtain the standard error. With the traction view, the pooled accuracy increased from 44.9% to 72.4%, subjective confidence increased from 87% to 94%, and confidence-weighted accuracy increased from 51.7% to 74.3% (p < 0.001). With the traction view, the kappa statistic for agreement with the reference standard increased from 0.530 to 0.791 and from 0.381 to 0.625 for the two readers, and interreader agreement increased from 0.480 to 0.678 (p < 0.001). The addition of an internal rotation traction radiographic view significantly improves radiologist accuracy and confidence as well as interreader agreement in the classification of proximal femoral fractures, all of which would be expected to best guide appropriate surgical management.

Accuracy of outside radiologists' reports of computed tomography exams of emergently transferred patients.

Growing numbers of patient with advanced imaging being transferred to trauma centers has resulted in increased numbers of outside CT scans received at trauma centers. This study examines the degree of agreement between community radiologists' interpretations of the CT scans of transferred patients and trauma center radiologists' reinterpretation. All CT scans of emergency transfer patients received over a 1month period were reviewed by an emergency radiologist. Patients were classified as trauma or non-trauma and exams as neuro or non-neuro. Interpretive discrepancies between the emergency radiologist and community radiologist were classified as minor, moderate, or major. Major discrepancies were confirmed by review of a second emergency radiologist. Discrepancy rates were calculated on a per-patient and per exam basis. Six hundred twenty-seven CT scans of 326 patients were reviewed. Major discrepancies were encountered in 52 (16.0%, 95% CI 12.2-20.5) patients and 53 exams (8.5%, 95% CI 6.5-10.5). These were discovered in 46 trauma patients (21.6%, 95% CI 16.4-27.9) compared to six non-trauma patients (5.3%, 95% CI 2.2-11.7) (P < 0.001). A significant difference in the major discrepancy rate was also found between non-neuro and neuro exams (12.4 vs 3.3%, respectively, P < 0.001), primarily due to discrepancies in trauma patients, rather than non-trauma patients. Potentially management-changing interpretive changes affected 16% of transferred patients and 8.5% of CT exams over a 1month period. Trauma center reinterpretations of community hospital CT scans of transferred patients provide valuable additional information to the clinical services caring for critically ill patients.

Impact of Variability in Portal Venous Phase Acquisition Timing in Tumor Density Measurement and Treatment Response Assessment: Metastatic Colorectal Cancer as a Paradigm.

New response patterns to anticancer drugs have led tumor size-based response criteria to shift to also include density measurements. Choi criteria, for instance, categorize antiangiogenic therapy response as a decrease in tumor density > 15% at the portal venous phase (PVP). We studied the effect that PVP timing has on measurement of the density of liver metastases (LM) from colorectal cancer (CRC). Pretreatment PVP computed tomography images from 291 patients with LM-CRC from the CRYSTAL trial (Cetuximab Combined With Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer; ClinicalTrials.gov identifier: NCT00154102) were included. Four radiologists independently scored the scans' timing according to a three-point scoring system: early, optimal, late PVP. Using this, we developed, by machine learning, a proprietary computer-aided quality-control algorithm to grade PVP timing. The reference standard was a computer-refined consensus. For each patient, we contoured target liver lesions and calculated their mean density. Contrast-product administration data were not recorded in the digital imaging and communications in medicine headers for injection volume (94%), type (93%), and route (76%). The PVP timing was early, optimal, and late in 52, 194, and 45 patients, respectively. The mean (95% CI) accuracy of the radiologists for detection of optimal PVP timing was 81.7% (78.3 to 85.2) and was outperformed by the 88.6% (84.8 to 92.4) computer accuracy. The mean ± standard deviation of LM-CRC density was 68 ± 15 Hounsfield units (HU) overall and 59.5 ± 14.9 HU, 71.4 ± 14.1 HU, 62.4 ± 12.5 HU at early, optimal, and late PVP timing, respectively. LM-CRC density was thus decreased at nonoptimal PVP timing by 14.8%: 16.7% at early PVP ( P < .001) and 12.6% at late PVP ( P < .001). Nonoptimal PVP timing should be identified because it significantly decreased tumor density by 14.8%. Our computer-aided quality-control system outperformed the accuracy, reproducibility, and speed of radiologists' visual scoring. PVP-timing scoring could improve the extraction of tumor quantitative imaging biomarkers and the monitoring of anticancer therapy efficacy at the patient and clinical trial levels.

A novel method based on independent component analysis for brain MR image tissue classification into CSF, WM and GM for atrophy detection in Alzheimer’s disease

Brain Magnetic Resonance Image (MRI) plays a vital role in diagnosis of diseases like Brain Tumor, Alzheimer, Multiple Sclerosis, Schizophrenia and other White Matter Lesions. In most of the cases accurate segmentation of Brain MRI into tissue types like Cerebro-Spinal Fluid (CSF), White Matter (WM) and Grey Matter (GM) is of interest. The diagnostic accuracy of expert and non-expert Radiologists can be improved with accurate and automated tissue segmentation and classification system. Such system can also be used for trainees to understand the individual tissue distribution in MRI scans. In this paper, we propose a novel automated tissue segmentation and classification method based on Independent Component Analysis (ICA) with Band Expansion Process (BEP) and Support Vector Machine (SVM) classifier which with input as T1, T2 and Proton Density (PD) scans of patient, provides output as CSF, WM and GM indicating the possible atrophy in brain which can help in diagnosis of Alzheimer’s disease (AD). The objective of this work is to test the effectiveness of ICA with different input images generated using BEP for accurate brain tissue segmentation by validating results with different quality metrics. The novel method for generating input images for ICA has been implemented and segmented tissues are used for atrophy detection. The BEP + ICA + Thresholding + ‘SVM trained with Grey Level Co-occurrence Matrix (GLCM) based texture features’ is giving 100% tissue classification accuracy for test samples under consideration.

Accuracy of dual bolus single acquisition computed tomography in the diagnosis and grading of adult traumatic splenic parenchymal and vascular injury.

Dual Bolus Single Acquisition Computed Tomography (DBSA-CT) has been advocated for use in trauma imaging through its ability to concurrently optimise abdominal arterial and visceral parenchymal enhancement while minimising scan times and radiation dose. However, concerns have been raised regarding excessive splenic parenchymal heterogeneity using this technique. The purpose of this study is to establish and compare the accuracy of DBSA-CT to traditional sequential multiphase scanning techniques in the diagnosis and grading of traumatic adult splenic injury. All patients diagnosed with a traumatic splenic parenchymal and/or vascular injury using DBSA-CT at a Level 1 trauma centre, who then proceeded to Digital Subtraction Angiography (DSA) or surgery were used for analysis over the time period June 2014 to March 2016. Two consultant radiologists each independently retrospectively reviewed all CT examinations documenting the degree of splenic heterogeneity, splenic injury grade using the American Association for the Surgery of Trauma (AAST) system and presence of vascular injury. Individual radiologist accuracy and inter-observer variability were evaluated. Splenic parenchymal enhancement was diagnostic in all cases with, at worst, moderate splenic heterogeneity. CT AAST parenchymal injury grading correlated poorly with operative findings. Average radiologist diagnostic sensitivity was 50.0% and 38.9% for active arterial haemorrhage and pseudoaneurysm, respectively, when correlated with DSA findings. Inter-observer agreement ranged from moderate to excellent in all cases. Dual Bolus Single Acquisition Computed Tomography may lead to reduced radiologist accuracy in the diagnosis of splenic injury, particularly pseudoaneurysm; however, such conclusions remain tentative given the small patient numbers examined.

Can CT and MR Shape and Textural Features Differentiate Benign Versus Malignant Pleural Lesions?

The study aimed to identify a radiomic approach based on CT and or magnetic resonance (MR) features (shape and texture) that may help differentiate benign versus malignant pleural lesions, and to assess if the radiomic model may improve confidence and accuracy of radiologists with different subspecialty backgrounds. Twenty-nine patients with pleural lesions studied on both contrast-enhanced CT and MR imaging were reviewed retrospectively. Three texture and three shape features were extracted. Combinations of features were used to generate logistic regression models using histopathology as outcome. Two thoracic and two abdominal radiologists evaluated their degree of confidence in malignancy. Diagnostic accuracy of radiologists was determined using contingency tables. Cohen's kappa coefficient was used to assess inter-reader agreement. Using optimal threshold criteria, sensitivity, specificity, and accuracy of each feature and combination of features were obtained and compared to the accuracy and confidence of radiologists. The CT model that best discriminated malignant from benign lesions revealed an AUCCT = 0.92 ± 0.05 (P < 0.0001). The most discriminative MR model showed an AUCMR = 0.87 ± 0.09 (P < 0.0001). The CT model was compared to the diagnostic confidence of all radiologists and the model outperformed both abdominal radiologists (P < 0.002), whereas the top discriminative MR model outperformed one of the abdominal radiologists (P = 0.02). The most discriminative MR model was more accurate than one abdominal (P = 0.04) and one thoracic radiologist (P = 0.02). Quantitative textural and shape analysis may help distinguish malignant from benign lesions. A radiomics-based approach may increase diagnostic confidence of abdominal radiologists on CT and MR and may potentially improve radiologists' accuracy in the assessment of pleural lesions characterized by MR.

Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease.

ObjectiveTo describe and quantify the main changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease, as well as to evaluate the radiologist accuracy in determining the type of hemoglobinopathy.Materials and MethodsA prospective study involving 44 adult patients with sickle cell disease who underwent inspiration and expiration computed tomography of the chest. The frequency of tomography findings and the extent of involvement are reported. We also calculated radiologist accuracy in determining the type of hemoglobinopathy by analyzing the pulmonary alterations and morphology of the spleen.ResultsThe changes found on computed tomography scans, in descending order of frequency, were as follows: fibrotic opacities (81.8%); mosaic attenuation (56.8%); architectural distortion (31.8%); cardiomegaly (25.0%); lobar volume reduction (18.2%); and increased caliber of peripheral pulmonary arteries (9.1%). For most of the findings, the involvement was considered mild, five or fewer lung segments being affected. The accuracy in determining the type of hemoglobinopathy (HbSS group versus not HbSS group) was 72.7%.ConclusionIn adult patients with sickle cell disease, the main tomography findings reflect fibrotic changes. In addition, computed tomography can be helpful in differentiating among hemoglobinopathies.

A new fuzzy Gaussian mixture model (FGMM) based algorithm for mammography tumor image classification

Computer aided diagnosis systems are recently introduced to increase the accuracy of mammography interpretation. This paper introduces a new classification algorithm based on Fuzzy Gaussian Mixture Model (FGMM) by combining the power of Gaussian Mixture Model (GMM) and Fuzzy Logic System (FLS) for computer aided diagnosis system, to classify the detected regions in mammogram images into malignant or benign categories. The experimental results are obtained from a data set of 300 images taken from the Digital Database for Screening Mammography (DDSM, University of South Florida) for different classes. Confusion matrix analysis is used to measure the performance of the proposed FGMM system. The results show that the proposed FGMM classifier has achieved an overall Matthews Correlation Coefficient (MCC) classification quality of 86.16 %, with 93 % accuracy, 90 % sensitivity and 96 % specificity, and outperformed other classifiers in all aspects. The experimental results obtained from the developed classifier prove that the proposed technique will improve the diagnostic accuracy and reliability of radiologists' image interpretation in the diagnosis of breast cancer. The resulting breast cancer Computer Aided Diagnosis (CAD) detection system is a promising tool to provide preliminary decision support information to physicians for further diagnosis.

Digital platform for improving non-radiologists' and radiologists' interpretation of chest radiographs for suspected tuberculosis - a method for supporting task-shifting in developing countries.

Shifting X-ray interpretation to non-radiologists can help to address radiologist shortages in developing countries. To determine the change in accuracy of non-radiologists and radiologists for the radiographic diagnosis of paediatric tuberculosis after a short skill-development course. Participants interpreted 15 paediatric chest radiographs before and after a 30-minute course using three possible responses: (1) diagnostic for tuberculosis, (2) abnormal but inconclusive for diagnosis of tuberculosis and (3) normal. We compared proportions of correct diagnoses, sensitivity, and specificity, before and after the course. We included 256 participants comprising 229 non-radiologists (134 radiographers, 32 paediatricians, 39 Médecins Sans Frontières clinicians and 24 physicians including paediatricians) and 27 radiologists. Mean change proportions of correct diagnosis ranged from -27% to 53% for individuals and 9% to 20% for groups. All groups showed a statistically significant improvement. Mean change in diagnostic sensitivity ranged from -38% to 100% for individuals and from 16% to 41% for groups. All groups showed a statistically significant improvement. Mean change in specificity ranged from -57% to 57% for individuals and from -15% to -4% for groups. The decrease was statistically significant for physicians, paediatricians and radiographers. The course resulted in increased correct diagnoses and improved sensitivity at the expense of specificity.

Dual-Energy CT-based Display of Bone Marrow Edema in Osteoporotic Vertebral Compression Fractures: Impact on Diagnostic Accuracy of Radiologists with Varying Levels of Experience in Correlation to MR Imaging.

Purpose To evaluate whether a dual-energy (DE) computed tomographic (CT) virtual noncalcium technique can improve the detection rate of acute thoracolumbar vertebral compression fractures in patients with osteoporosis compared with that at magnetic resonance (MR) imaging depending on the level of experience of the reading radiologist. Materials and Methods This retrospective study was approved by the institutional ethics committee. Informed consent was obtained from all patients. Forty-nine patients with osteoporosis who were suspected of having acute vertebral fracture underwent DE CT and MR imaging. Conventional linear-blended CT scans and corresponding virtual noncalcium reconstructions were obtained. Five radiologists with varying levels of experience evaluated gray-scale CT scans for the presence of fractures and their suspected age. Then, virtual noncalcium images were evaluated to detect bone marrow edema. Findings were compared with those from MR imaging (the standard of reference). Sensitivity and specificity analyses for diagnostic performance and matched pair analyses were performed on vertebral fracture and patient levels. Results Sixty-two fractures were classified as fresh and 52 as old at MR imaging. The diagnostic performance of all readers in the detection of fresh fractures improved with the addition of virtual noncalcium reconstructions compared with that with conventional CT alone. Although the diagnostic accuracy of the least experienced reader with virtual noncalcium CT (accuracy with CT alone, 61%; accuracy with virtual noncalcium technique, 83%) was within the range of that of the most experienced reader with CT alone, the latter improved his accuracy with the noncalcium technique (from 81% to 95%), coming close to that with MR imaging. The number of vertebrae rated as unclear decreased by 59%-90% or from 15-53 to 2-13 in absolute numbers across readers. The number of patients potentially referred to MR imaging decreased by 36%-87% (from 11-23 to 2-10 patients). Considering the gain in true decisions with the virtual noncalcium technique on a patient level, between 12 (most experienced reader) and 17 (least experienced reader) MR examinations could have been avoided. Conclusion The DE CT-based virtual noncalcium technique may enable depiction of bone marrow edema in thoracolumbar vertebral compression fractures in patients with osteoporosis, with good accordance with MR imaging when images are read by experienced radiologists. Although less experienced readers improved their diagnostic performance to some degree, the experienced reader's diagnostic performance approached that with MR imaging. (©) RSNA, 2016.

Comparison of dual energy subtraction chest radiography and traditional chest X-rays in the detection of pulmonary nodules.

Dual energy subtraction (DES) radiography is a powerful but underutilized technique which aims to improve the diagnostic value of an X-ray by separating soft tissue from bones, producing two different images. Compared to traditional chest X-rays, DES requires exposure to higher doses of radiation but may achieve higher accuracy. The objective of this study was to assess the clinical benefits of DES radiography by comparing the speed and accuracy of diagnosis of pulmonary nodules with DES versus traditional chest X-rays. Five radiologists and five radiology residents read the DES and traditional chest X-rays of 51 patients, 34 with pulmonary nodules and 17 without. Their accuracy and speed in the detection of nodules were measured using specialized image display software. DES radiography reduced reading time from 13 to 10 sec (P<0.0001) in staff and from 21 to 15 sec in residents (P<0.0001). There was also a small increase in sensitivity 0.58 to 0.67 overall (P<0.10) with no change in specificity (0.85 overall). By eliminating rib shadows in soft tissue images, DES improved the speed and accuracy of radiologists in the diagnosis of pulmonary nodules.

Differentiating between Subsolid and Solid Pulmonary Nodules at CT: Inter- and Intraobserver Agreement between Experienced Thoracic Radiologists.

To quantify the reproducibility and accuracy of experienced thoracic radiologists in differentiating between subsolid and solid pulmonary nodules at CT. The institutional review board of Beth Israel Deaconess Medical Center approved this multicenter study. Six thoracic radiologists, with a mean of 21 years of experience in thoracic radiology (range, 17-22 years), selected images of 10 solid and 10 subsolid nodules to create a database of 120 nodules; this selection served as the reference standard. Each radiologist then interpreted 120 randomly ordered nodules in two different sessions that were separated by a minimum of 3 weeks. The radiologists classified whether or not each nodule was subsolid. Inter- and intraobserver agreement was assessed with a κ statistic. The number of correct classifications was calculated and correlated with nodule size by using Bland-Altman plots. The relationship between disagreement and nodule morphologic characteristics was analyzed by calculating the intraclass correlation coefficient. Interobserver agreement (κ) was 0.619 (range, 0.469-0.745; 95% confidence interval (CI): 0.576, 0.663) and 0.670 (range, 0.440-0.839; 95% CI: 0.608, 0.733) for interpretation sessions 1 and 2, respectively. Intraobserver agreement (κ) was 0.792 (95% CI: 0.750, 0.833). Averaged for interpretation sessions, correct classification was achieved by all radiologists for 58% (70 of 120) of nodules. Radiologists agreed with their initial determination (the reference standard) in 77% of cases (range, 45%-100%). Nodule size weakly correlated with correct classification (long axis: Spearman rank correlation coefficient, rs = 0.161 and P = .049; short axis: rs = 0.128 and P = .163). The reproducibility and accuracy of thoracic radiologists in classifying whether or not a nodule is subsolid varied in the retrospective study. This inconsistency may affect surveillance recommendations and prognostic determinations.

Does Computer-Aided Diagnosis Permit Differentiation of Angiomyolipoma Without Visible Fat From Renal Cell Carcinoma on MDCT?

The purpose of this study was to evaluate the diagnostic value of computer-aided diagnosis (CADx) in differentiating angiomyolipoma without visible fat from renal cell carcinoma (RCC) on MDCT. The study included 406 patients who had 47 angiomyolipomas without visible fat and 359 RCCs smaller than 4 cm, all of which were diagnosed on the basis of findings from nephrectomy or percutaneous biopsy performed at our institution between 2000 and 2011. MDCT (slice thickness, 2.5 mm for corticomedullary phase image or 5 mm for the other phase images) and clinical findings were blindly reviewed by two radiologists in a single session. At the time the study was performed, radiologist 1 had 8 years of experience, and radiologist 2 had 18 years of experience. On the basis of the MDCT and clinical findings, CADx classified renal tumors as angiomyolipoma and RCC, and each radiologist independently recorded the probability score (0-5) for angiomyolipoma. The accuracy of CADx versus radiologists in diagnosing angiomyolipoma was compared using ROC analysis. Interobserver agreement between the two radiologists was evaluated. CADx yielded an area under the curve (Az) value of 0.949, which was greater than the Az values yielded by radiologists 1 and 2 (0.872 and 0.782, respectively; p < 0.05). In addition, the Az value for radiologist 1 was greater than that for radiologist 2 (p = 0.01). CADx with a threshold of -1.0085 showed greater sensitivity than radiologist 1 and greater sensitivity, specificity, and accuracy than radiologist 2 (p < 0.05). The interobserver agreement for the differentiation was fair (κ = 0.289). CAD can improve diagnostic performance in differentiating angiomyolipoma from RCC. The diagnostic performance of radiologists is variable according to the clinical experience and physical and emotional states of the radiologists.

MDCT and MRI of the ampulla of Vater. Part II: non-epithelial neoplasms, benign ampullary disorders, and pitfalls.

The purpose of this two-part article is to review the cross-sectional imaging features of benign and malignant ampullary conditions with endoscopic and histopathologic correlation and to present the most common pitfalls in the evaluation of the ampulla. In this part, we will review the mesenchymal and secondary neoplasms of the ampulla, a vast array of benign ampullary conditions, causes of bulging papilla, and pitfalls. Familiarity with ampullary pathologic conditions and pitfalls, as well as the use of optimized MDCT and MRI techniques, may improve the diagnostic accuracy of radiologists facing ampullary abnormalities.

MDCT and MRI of the ampulla of Vater. Part I: technique optimization, normal anatomy, and epithelial neoplasms.

The purpose of this two-part article is to review the cross-sectional anatomy of the ampulla and periampullary region, to propose novel and optimized MDCT and MRI techniques that allow accurate evaluation of the ampulla of Vater, and to summarize the cross-sectional imaging features of benign and malignant ampullary conditions. In this first part, we will review the normal anatomy of the ampullary region, provide suggestions on how to optimize evaluation of the ampullary region by MDCT and MRI, and review the imaging features of select epithelial neoplasms of the ampulla. Familiarity with the normal ampullary anatomy and the pathologic conditions involving the ampulla, as well as the use of optimized MDCT and MRI techniques, may improve the diagnostic accuracy of radiologists facing ampullary abnormalities.

Are radiologists superior to orthopaedic surgeons in diagnosing instability-related shoulder lesions on magnetic resonance arthrography? A multicenter reproducibility and accuracy study

We compared the diagnostic reproducibility and accuracy of musculoskeletal radiologists with orthopaedic shoulder surgeons in 2 large medical centers in assessing magnetic resonance arthrograms (MRAs) of patients with traumatic anterior shoulder instability. Forty-five surgically confirmed MRAs were assessed by 4 radiologists, 4 orthopaedic surgeons, 2 radiologic teams, and 2 orthopaedic teams. During MRA assessment and surgery, the same 7-lesion scoring form was used. κ Coefficients, sensitivity, specificity, and differences in percentage of agreement or correct diagnosis (P<.05, McNemar test) were calculated per lesion and overall per the 7 lesion types. The overall κ between the individual radiologists (κ=0.51, κ=0.46) and orthopaedic surgeons (κ=0.46, κ=0.41) was moderate. Although the overall percentage of agreement between the radiologists was slightly higher than that between the orthopaedic surgeons in both centers (80.0% vs 77.5% and 75.2% vs 73.7%), there was no significant difference. In each medical center, however, the most experienced orthopaedic surgeon was exceedingly more accurate than both radiologists per the 7 lesion types (81.9% vs 72.4%/74.6% and 76.5% vs 67.3%/73.7%). In 3 of 4 cases, this difference was significant. Overall accuracy improvement through consensus assessment was merely established for the weakest member of each team. Experienced orthopaedic surgeons are more accurate than radiologists in assessing traumatic anterior shoulder instability-related lesions on MRA. In case of diagnosis disagreement, these orthopaedic surgeons should base their treatment decision on their own MRA interpretation.

MO‐F‐CAMPUS‐I‐01: Accuracy of Radiologists Interpretation of Mammographic Breast Density

Purpose:Several commercial and non‐commercial software and techniques are available for determining breast density from mammograms. However, where mandated by law the breast density information communicated to the subject/patient is based on radiologist's interpretation of breast density from mammograms. Several studies have reported on the concordance among radiologists in interpreting mammographic breast density. In this work, we investigated the accuracy of radiologist's interpretation of breast density.Methods:Volumetric breast density (VBD) determined from 134 unilateral dedicated breast CT scans from 134 subjects was considered the truth. An MQSA‐qualified study radiologist with more than 20 years of breast imaging experience reviewed the DICOM “for presentation” standard 2‐view mammograms of the corresponding breasts and assigned BIRADS breast density categories. For statistical analysis, the breast density categories were dichotomized in two ways; fatty vs. dense breasts where “fatty” corresponds to BIRADS breast density categories A/B, and “dense” corresponds to BIRADS breast density categories C/D, and extremely dense vs. fatty to heterogeneously dense breasts, where extremely dense corresponds to BIRADS breast density category D and BIRADS breast density categories A through C were grouped as fatty to heterogeneously dense breasts. Logistic regression models (SAS 9.3) were used to determine the association between radiologist's interpretation of breast density and VBD from breast CT, from which the area under the ROC (AUC) was determined.Results:Both logistic regression models were statistically significant (Likelihood Ratio test, p&lt;0.0001). The accuracy (AUC) of the study radiologist for classification of fatty vs. dense breasts was 88.4% (95% CI: 83–94%) and for classification of extremely dense breast was 94.3% (95% CI: 90–98%).Conclusion:The accuracy of the radiologist in classifying dense and extremely dense breasts is high. Considering the variability in VBD estimates from commercial software, the breast density information communicated to the patient should be based on radiologist's interpretation.This work was supported in part by NIH R21 CA176470 and R21 CA134128. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or NCI.

Curbside radiology consults: how does the time allotted for review, level of training, and subspecialization affect interpretation accuracy?

The interpretation accuracy of resident and attending radiologists was assessed based on time allotted for study review, level of training, and subspecialization. Twelve cases were presented in a time-constrained and a time-unconstrained fashion to eight residents and six attendings. Overall, timed and untimed diagnostic accuracy was similar for all groups tested. Attendings sometimes performed worse than residents and in-field attendings when reviewing out-of-field studies. Residents often had greater specialty-specific accuracy than out-of-field attendings. Residents are capable of providing accurate "curbside" consultations to referring clinicians even under time-constrained conditions. Highly subspecialized attending radiologists should be cognizant of their out-of-field limitations.

Cephalometric landmark variability among orthodontists and dentomaxillofacial radiologists: a comparative study.

PurposeThe aim this study was to compare the accuracy of orthodontists and dentomaxillofacial radiologists in identifying 17 commonly used cephalometric landmarks, and to determine the extent of variability associated with each of those landmarks.Materials and MethodsTwenty digital lateral cephalometric radiographs were evaluated by two groups of dental specialists, and 17 cephalometric landmarks were identified. The x and y coordinates of each landmark were recorded. The mean value for each landmark was considered the best estimate and used as the standard. Variation in measurements of the distance between landmarks and measurements of the angles associated with certain landmarks was also assessed by a subset of two observers, and intraobserver and interobserver agreement were evaluated.ResultsIntraclass correlation coefficients were excellent for intraobserver agreement, but only good for interobserver agreement. The least reliable landmark for orthodontists was the gnathion (Gn) point (standard deviation [SD], 5.92 mm), while the orbitale (Or) was the least reliable landmark (SD, 4.41 mm) for dentomaxillofacial radiologists. Furthermore, the condylion (Co)-Gn plane was the least consistent (SD, 4.43 mm).ConclusionWe established that some landmarks were not as reproducible as others, both horizontally and vertically. The most consistently identified landmark in both groups was the lower incisor border, while the least reliable points were Co, Gn, Or, and the anterior nasal spine. Overall, a lower level of reproducibility in the identification of cephalometric landmarks was observed among orthodontists.

Celiomesenteric and hepatosplenomesenteric trunks: characterization of two rare vascular anomalies with CT.

The purpose of this retrospective investigation is to characterize and illustrate the appearances of celiomesenteric trunk (CMT) and hepatosplenomesenteric trunk (HSMT) using CT with three-dimensional volume-rendering with attention to the proximal branching patterns. We also correlate our results with an embryologic model and assess the accuracy of radiologists in recognizing these entities. CT studies on 36 adult subjects with CMT and 10 with HSMT were analyzed to determine the proximal branching patterns and lengths of the common vascular trunks. The official reports in appropriately selected cases were reviewed to ascertain if the interpreting radiologists recognized the anomalies. Two types of CMT were found. In 29 of 36 cases (81%), the CMT bifurcated into the celiac trunk and superior mesenteric artery (Type A CMT), while in 7 cases the left gastric artery (LGA) arose from the CMT proximal to the hepatosplenic trunk and superior mesenteric artery (Type B CMT). Type A trunks (mean length = 10.4 mm) were significantly shorter (p = 0.007) than Type B trunks (mean length = 17.8 mm). Short common trunks (less than 1.0 cm) were only seen with Type A CMT. Branching patterns in all 10 cases of HSMT were identical with no short common trunks. The CMT was not mentioned in the radiology reports in 88% of the cases assessed. The location of the LGA origin distinguishes the two variants of CMT and differentiates CMT from HSMT. These anomalies are easily overlooked during evaluation of routine clinical cases.