American College Of Radiology Research Articles

Establishing a quality assurance program for photon counting detector (PCD) CT: Tips and caveats.

To determine the suitability of a quality assurance (QA) program based on the American College of Radiology's (ACR) CT quality control (QC) manual to fully evaluate the unique capabilities of a clinical photon-counting-detector (PCD) CT system. A daily QA program was established to evaluate CT number accuracy and artifacts for both standard and ultra-high-resolution (UHR) scan modes. A complete system performance evaluation was conducted in accordance with the ACR CT QC manual by scanning the CT Accreditation Phantom with routine clinical protocols and reconstructing low-energy-threshold (T3D) and virtual monoenergetic images (VMIs) between 40 and 120keV. Spatial resolution was evaluated by computing the modulation transfer function (MTF) for the UHR mode, and multi-energy performance was evaluated by scanning a body phantom containing four iodine inserts with concentrations between 2 and 15mg I/cc. The daily QA program identified instances when the detector needed recalibration or replacement. CT number accuracy was impacted by image type: CT numbers at 70keV VMI were within the acceptable range (defined for 120kV). Other keV VMIs and the T3D reconstruction had at least one insert with CT number outside the acceptable range. The limiting resolution was nearly 40 lp/cm based on MTF measurements, which far exceeds the 12 lp/cm maximum capability of the ACR phantom. The CT numbers in the iodine inserts were accurate on all VMIs (3.8% average percentage error), while the iodine concentrations had an average root mean squared error of 0.3mg I/cc. Protocols and parameters must be properly selected on PCD-CT to meet current accreditation requirements with the ACR CT phantom. Use of the 70keV VMI allowed passing all tests prescribed in the ACR CT manual. Additional evaluations such an MTF measurement and multi-energy phantom scans are also recommended to comprehensively evaluate PCD-CT scanner performance.

Diagnostic performance of the EU TI-RADS and ACR TI-RADS scoring systems in predicting thyroid malignancy.

Several ultrasound scoring systems have been developed to stratify the risk of malignancy of thyroid nodules, including ACR (American College of Radiology) and EU (European) TI-RADS. This study aimed to assess the diagnostic performance of these two classifications using histology as a reference standard. It was a single-centre, retrospective study including 156 patients who underwent thyroidectomy. Ultrasound data of 198 nodules (99 malignant nodules and 99 benign nodules) were analysed. Both classifications were applied for all nodules. Ultrasound criteria associated with malignancy were solid composition (OR=7.81; p < 10-3 ), hypoechoic character (OR=16.42; p < 10-3 ), irregular contours (OR=7.47; p < 10-3 ), taller-than-wide shape (OR=3.58; p = 0.02), microcalcifications (OR=3.02; p = .006) and the presence of cervical adenopathy (OR=3.89; p = .006). The prevalence of malignancy was 15.5%, 69% and 76.9% for EU TI-RADS categories 3, 4 and 5, respectively. It was 33.3%, 57% and 91.1% for ACR TI-RADS categories 3, 4 and 5, respectively. For category 5, EU TI-RADS and ACR TI-RADS had sensitivities of 60% and 41%, specificities of 82% and 96%, respectively. For categories 4 and 5 combined, the diagnostic performance of these two classification systems became comparable with a sensitivity of 89% and 86% for EU-TIRADS and ACR-TIRADS, respectively. The area under the ROC curve was 0.81 for the EU TI-RADS classification and 0.82 for the ACR TI-RADS classification. EU TI-RADS and ACR TI-RADS scoring systems seem to be comparable in predicting malignancy in thyroid nodules.

Analysis of Thyroid Imaging Reporting and Data System Criteria and Its Correlation With the Pathological Results.

Introduction Thyroid nodules are frequently encounteredand may be discovered roughly in around 4-8% of individuals by clinical palpation. Aim The present study aims to analyze the Thyroid Imaging Reporting and Data Systems (TIRADS) classification and assess the validity of each criterion in predicting malignancy. Methods A prospective observational study was conducted at Sri Ramachandra Institute of Higher Education and Research from June 2020 to October 2021. Fifty patients who presented to the outpatient clinic with thyroid swelling got an ultrasound (USG) neck performed followed by either fine-needle aspiration cytology (FNAC) or thyroidectomy. They were included in the study and informed consent was obtained from all patients. Results Among50 patients considered for the study, 36 were females. The mean age for malignant patients is 46 years with a standard deviation (SD) of 15, and for benign lesions is 47 years with an SD of 1. Most of the patients were TIRADS 4, which has a 56.2% risk of malignancy. The pathological results show a significant difference in ACR (American College of Radiology) TIRADS and echogenic foci between FNAC. The present study's solid composition showed a sensitivity of 25% and specificity of 75%, with an odds ratio of 0.90 in picking up malignant nodules. The shape of a nodule taller than wider, a malignant feature, showed a specificity of 92.3%. Punctate echogenic foci showed a sensitivity of 50% and specificity of 76.9% with a statistical significance of p-value 0.048. Conclusion TIRADS scoring avoids unessential invasive techniques for lower TIRADS scores. Certain criteria are more specific in recognizing malignant nodules. Proportional priority shall be given to certain criteria over others, and not all criteria should be considered.

The Size of a Thyroid Nodule with ACR TI-RADS Does Not Provide a Better Prediction of the Nature of the Nodule: A Single-Center Retrospective Real-Life Observational Study.

We investigated if thyroid nodule size has a predictive value of malignancy on a par with composition, echogenicity, shape, margin, and echogenic foci, and what would be the consequence of observing the rule of the American College of Radiology (ACR) to perform a fine-needle aspiration biopsy (FNAB). We conducted a retrospective real-life observational study on 86 patients who underwent surgery after a standardized diagnostic protocol. We divided the TR3, TR4, and TR5 classes into sub-classes according to the size threshold indicating FNAB (a: up to the threshold for no FNAB; b: over the threshold for FNAB suggested). We computed sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for the different sub-classes and Youden's index (Y) for the different possible cutoffs. Each sub-class showed the following PPV (0.67, 0.68, 0.70, 0.78, 0.72), NPV (0.56, 0.54, 0.51, 0.52, 0.59), and Y (0.20, 0.20, 0.22, 0.31, 0.30). In this real-life series, we did not find a significant difference in prediction of malignancy between the sub-categories according to the size threshold. All nodules have a pre-evaluation likelihood of being malignant, and the impact and utility of size thresholds may be less clear than suggested by the ACR TIRADS guidelines in patients undergoing standardized thyroid work up.

Radiographic views for hand fractures - call for three view national uk guidelines - a quality improvement study.

A three-view radiographic examination (comprising of antero-posterior, oblique and lateral views) is crucial for the accurate assessment and subsequent decision making in hand fracture management. The superiority of a three-view examination, compared to only two-views, has been demonstrated by multiple studies, citing increased diagnostic accuracy and reduced rates of misdiagnosis. As such, the American College of Radiology (ACR) now recommend a standard three-view examination for finger and hand injuries, despite this no formal guidance exists in the United Kingdom. Out of the 235 patients referred to our tertiary hand trauma unit with a confirmed hand fracture, less than half (45%) had three-view radiographic examination performed. Less than two-thirds (57%) of metacarpal fractures had three-views available at assessment in our unit, with the lateral radiograph most commonly lacking (38%). Less than a third (30%) of phalangeal fractures had all three-views, with the oblique view most commonly absent (64% of cases). Reviewed radiology protocols from six local hospitals were inconsistent; all recommended three-views for suspected metacarpal fractures, but only two for suspected phalangeal injuries. Despite the superiority of a three-view examination and no additional cost of a third view, over half of the patients in this study lacked a three-view radiographic series. We would like to call for national published guidance advocating the use of three-view radiographic series in all patients with a high hand fracture suspicion (as defined by the presence of swelling, bruising and/ or deformity) to reduce variability in local radiology hand fracture protocols and increase availability of three-view radiographs in the primary, secondary and tertiary setting.

Mammography in women with sickle cell disease.

e22509 Background: Sickle cell disease (SCD) is an inherited blood disorder affecting 100,000 people in the US with a median life expectancy of 54 years. As this population ages, it is important to focus on wellness screenings. Literature review has mixed results on the prevalence of malignancies in SCD. Initiation of BC screening is recommended between age 40-50. Patients with SCD have risk factors for breast cancer (BC) including radiation exposure, nulliparity/decreased parity, dense breasts, African American race, lack of physical activity, and use of allogenic Hematopoietic Stem Cell Transplant with total body irradiation and alkylating agent conditioning regimens. This study's purpose is to determine if these patients are being adequately screened and if guidelines for the general population are appropriate for SCD patients given their potential increased risk. Methods: This is a single center retrospective study of women with SCD who are &gt;40 with an encounter between 2018-2022. Data collection included: screening age, recent mammogram date, American College of Radiology (ACR) category for breast density (BD), family history of cancer, type of SCD, menopausal status, and Body Mass Index (BMI). Ordinal logistical regression model was used for statistical analysis. Results: A total of 156 patients were identified and 71% screened for BC; however only 56% had screening in the last 2 years. With a binomial test, the difference between CDC 2019 African American women and SCD regarding screen is not significant (P=1). The average age for screening was 44. Over half of our patients (53%) have dense breasts. Younger age at screen and lower BMI are both related to a higher density score (Table). Conclusions: As per guidelines, breast awareness (age 25) and mammography (age 40) should be offered to ensure early detection in the general population. The question arises if there should be earlier screening with an alternative imaging modality in SCD patients given increased breast density, potential risk factors, and lower life expectancy. However, it is important to consider the risks versus benefits of early screening. Screening can provide better outcomes, as SCD patients might not tolerate standard treatments for advanced disease. Our findings present a new challenge regarding BD. Increased BD decreases the accuracy of mammograms and requires additional imaging. Higher BD is found in younger women with lower BMI, but here fertility may be an additional factor as it differs in patients with SCD. The limitation of our study is that it is a retrospective, single institution study during a pandemic. Future studies are needed to closely examine if SCD patients are at increased risk given density findings and if there is a need for earlier or alternative modality of screening other than mammography. [Table: see text]

Diagnostic value of a dynamic artificial intelligence ultrasonic intelligent auxiliary diagnosis system for benign and malignant thyroid nodules in patients with Hashimoto thyroiditis.

A dynamic artificial intelligence (AI) ultrasonic intelligent assistant diagnosis system (dynamic AI) is a joint application of AI technology and medical imaging, which can conduct real-time synchronous dynamic analysis of nodules from multiple sectional views with different angles. This study explored the diagnostic value of dynamic AI for benign and malignant thyroid nodules in patients with Hashimoto thyroiditis (HT) and its significance in guiding surgical treatment strategies. Data of 487 patients (154 with and 333 without HT) with 829 thyroid nodules who underwent surgery were collected. Differentiation of benign and malignant nodules was performed using dynamic AI, and diagnostic effects (specificity, sensitivity, negative predictive value, positive predictive value, accuracy, misdiagnosis rate and missed diagnosis rate) was assessed. Differences in diagnostic efficacy were compared among AI, preoperative ultrasound based on the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS), and fine needle aspiration cytology (FNAC) diagnoses. The accuracy, specificity and sensitivity of dynamic AI reached 88.06%, 80.19%, and 90.68%, respectively; besides, there was consistency with postoperative pathological consequences (κ=0.690; P<0.001). The diagnostic efficacy of dynamic AI was equivalent between patients with and without HT, and there were no significant differences in sensitivity, specificity, accuracy, positive predictive value, negative predictive value, missed diagnosis rate, and misdiagnosis rate. In patients with HT, dynamic AI had significantly higher specificity and a lower misdiagnosis rate than did preoperative ultrasound based on the ACR TI-RADS (P<0.05). Compared with FNAC diagnosis, dynamic AI had a significantly higher sensitivity and a lower missed diagnosis rate (P<0.05). Dynamic AI possessed an elevated diagnostic worth of malignant and benign thyroid nodules in patients with HT, which can provide a new method and valuable information for the diagnosis and development of management strategy of patients.

Empowering self-advocacy for breast health: A successful educational campaign on breast cancer risk and screening recommendations.

11041 Background: The purpose was to develop and distribute an educational campaign on breast cancer risk and screening recommendations to empower women, men, and transgender individuals to take charge of their breast health. Identifying individuals at high risk for developing breast cancer through educational campaigns can lead to earlier detection and improved health outcomes. It was hypothesized that the development of a multi-platform educational campaign including televised ads, website, and mobile applications (apps), would result in a broad reach and accessibility of breast cancer risk and screening recommendations. Methods: The campaign ran from 10/1/22 – 12/2/22 and included a variety of mediums, such as televised ads, website, and mobile apps for iOS and Android devices, all of which were available in English and Spanish. An educational video series was developed to raise awareness about the updated guidelines for breast cancer screening from the American College of Radiology (ACR). Videos focused on the importance of screening for women with a high risk of breast cancer and transgender individuals taking hormone therapy. To complement the televised video, case-based teaching illustrations were created for the website and apps. Resources included screening recommendations, local resources for breast cancer screening and foundations for financial assistance. These materials could be accessed at the website https://myriskbreastcancer.com . The website and mobile apps featured a risk calculator developed using the GAIL model from SAS, coded in the Dart programming language to ensure compatibility and all user inputs were stored in a secure Firebase database. To reach a wider audience, responsive social media ads were developed and distributed through targeted Google Ads campaign. Analytics were collected and analyzed using Google Analytics and user inputs from the mobile application to assess the campaign's effectiveness. Results: Televised ads reached a total of 673,920 impressions over 142 educational video sessions. Google display ads had 152,672 impressions and 462 click-throughs with an audience of 49.2% female and 50.8% male. The mobile application was downloaded 2,030 times on iOS and 722 times on Android, and installed in 131 countries. The website saw 930 impressions and 637 users completed the online calculator, with 72 identified as high risk at time of initial data collection on 12/1/22. Conclusions: The educational campaign was successful in reaching &gt; 500,000 impressions within two months of release, sharing knowledge about breast cancer risk and screening recommendations across all gender types. Use of multiple platforms, including television, social media, and mobile apps, allowed for broad reach and accessibility nationally and internationally, including the identification of 72 individuals at high risk for developing breast cancer.

Comparison of the diagnostic performance and clinical role of different ultrasound-based thyroid malignancy risk stratification systems for medullary thyroid carcinoma.

This study sought to investigate the applicability of different ultrasound (US) thyroid risk stratification systems in diagnosing medullary thyroid carcinoma (MTC) and determining the need for biopsy. In total, 34 MTC nodules, 54 papillary thyroid carcinoma (PTC) nodules, and 62 benign thyroid nodules were examined in this study. All the diagnoses were histopathologically confirmed postoperatively. All the thyroid nodule sonographic features were recorded and categorized by 2 independent reviewers according to the Thyroid Imaging Reporting and Data System (TIRADS) of the American College of Radiology (ACR), the American Thyroid Association (ATA) guidelines, the European Thyroid Association (EU) TIRADS, the Kwak-TIRADS, and the Chinese TIRADS (C-TIRADS). The sonographic differences and risk stratifications of the MTCs, PTCs, and benign thyroid nodules were analyzed. The diagnostic performance and recommended biopsy rates for each classification system were evaluated. The risk stratifications of MTCs were all higher than the benign thyroid nodules (P<0.01) and lower than PTCs (P<0.01) with each classification system. Hypoechogenicity and malignant marginal features were independent risk factors for identifying malignant thyroid nodules, and the area under the receiver operating characteristic curve (AUC) for identifying MTCs was lower than that for identifying PTCs (0.873 vs. 0.954, respectively). The AUCs, sensitivity, specificity, positive predictive values, negative predictive values, and accuracy values of the 5 systems for MTC were all lower than those for PTC. The best cut-off values for diagnosing MTC were TIRADS (TR) 4 in the ACR-TIRADS, intermediate suspicion in the ATA guidelines, TR 4 in EU-TIRADS, and TR 4b in both the Kwak-TIRADS and the C-TIRADS. The Kwak-TIRADS had the highest recommended biopsy rate for MTCs (97.1%), followed by the ATA guidelines, the EU-TIRADS (88.2%), the C-TIRADS (85.3%), and the ACR-TIRADS (79.4%). The US-based thyroid malignancy risk stratification systems analyzed in this study were able to satisfactorily identify MTC and recommend biopsy, but the diagnostic performance of these systems for MTC was not as good as that for PTC.

How AI Responds to Common Lung Cancer Questions: ChatGPT versus Google Bard

Background The recent release of large language models (LLMs) for public use, such as ChatGPT and Google Bard, has opened up a multitude of potential benefits as well as challenges. Purpose To evaluate and compare the accuracy and consistency of responses generated by publicly available ChatGPT-3.5 and Google Bard to non-expert questions related to lung cancer prevention, screening, and terminology commonly used in radiology reports based on the recommendation of Lung Imaging Reporting and Data System (Lung-RADS) v2022 from American College of Radiology and Fleischner society. Materials and Methods Forty of the exact same questions were created and presented to ChatGPT-3.5 and Google Bard experimental version as well as Bing and Google search engines by three different authors of this paper. Each answer was reviewed by two radiologists for accuracy. Responses were scored as correct, partially correct, incorrect, or unanswered. Consistency was also evaluated among the answers. Here, consistency was defined as the agreement between the three answers provided by ChatGPT-3.5, Google Bard experimental version, Bing, and Google search engines regardless of whether the concept conveyed was correct or incorrect. The accuracy among different tools were evaluated using Stata. Results ChatGPT-3.5 answered 120 questions with 85 (70.8%) correct, 14 (11.7%) partially correct, and 21 (17.5%) incorrect. Google Bard did not answer 23 (19.1%) questions. Among the 97 questions answered by Google Bard, 62 (51.7%) were correct, 11 (9.2%) were partially correct, and 24 (20%) were incorrect. Bing answered 120 questions with 74 (61.7%) correct, 13 (10.8%) partially correct, and 33 (27.5%) incorrect. Google search engine answered 120 questions with 66 (55%) correct, 27 (22.5%) partially correct, and 27 (22.5%) incorrect. The ChatGPT-3.5 is more likely to provide correct or partially answer than Google Bard, approximately by 1.5 folds (OR = 1.55, P = 0.004). ChatGPT-3.5 and Google search engine were more likely to be consistent than Google Bard by approximately 7 and 29 folds (OR = 6.65, P = 0.002 for ChatGPT and OR = 28.83, P = 0.002 for Google search engine, respectively). Conclusion Although ChatGPT-3.5 had a higher accuracy in comparison with the other tools, neither ChatGPT nor Google Bard, Bing and Google search engines answered all questions correctly and with 100% consistency.

Influencing Factors and Prediction Model of Performance of Needle Visualization in Fine Needle Aspiration of Thyroid Nodules

Objective To investigate the influencing factors and establish a model predicting the performance of needle visualization in fine-needle aspiration (FNA) of thyroid nodules. Methods This study prospectively included 175 patients who underwent FNA of thyroid nodules in the Department of Ultrasound in China-Japan Friendship Hospital and compared the display of the needle tips in the examination of 199 thyroid nodules before and after the application of needle visualization.We recorded the location,the positional relationship with thyroid capsule,ultrasonic characteristics,and the distribution of the soft tissue strip structure at the puncture site of the nodules with unclear needle tips display before using needle visualization.Furthermore,according to the thyroid imaging reporting and data system proposed by the American College of Radiology,we graded the risk of the nodules.Lasso-Logistic regression was employed to screen out the factors influencing the performance of needle visualization and establish a nomogram for prediction. Results The needle tips were not clearly displayed in the examination of 135 (67.8%) and 53 (26.6%) nodules before and after the application of needle visualization,respectively,which showed a significant difference (P<0.001).Based on the positional relationship between the nodule and capsule,anteroposterior/transverse diameter (A/T) ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site,a nomogram was established to predict the probability of unclear display of the needle tips after application of needle visualization.The C-index of the prediction model was 0.75 (95%CI=0.67-0.84) and the area under the receiver operating characteristic curve was 0.72.The calibration curve confirmed the appreciable reliability of the prediction model,with the C-index of 0.70 in internal validation. Conclusions Needle visualization can improve the display of the needle tip in ultrasound-guided FNA of thyroid nodules.The nomogram established based on ultrasound features such as the positional relationship between the nodule and capsule,A/T ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site can predict whether needle visualization is suitable for the examination of nodules.

Significant Incidental Findings in the National Lung Screening Trial

Low-dose computed tomography (LDCT) lung screening has been shown to reduce lung cancer mortality. Significant incidental findings (SIFs) have been widely reported in patients undergoing LDCT lung screening. However, the exact nature of these SIF findings has not been described. To describe SIFs reported in the LDCT arm of the National Lung Screening Trial and classify SIFs as reportable or not reportable to the referring clinician (RC) using the American College of Radiology's white papers on incidental findings. This was a retrospective case series study of 26 455 participants in the National Lung Screening Trial who underwent at least 1 screening examination with LDCT. The trial was conducted from 2002 to 2009, and data were collected at 33 US academic medical centers. Significant incident findings were defined as a final diagnosis of a negative screen result with significant abnormalities that were not suspicious for lung cancer or a positive screen result with emphysema, significant cardiovascular abnormality, or significant abnormality above or below the diaphragm. Of 26 455 participants, 10 833 (41.0%) were women, the mean (SD) age was 61.4 (5.0) years, and there were 1179 (4.5%) Black, 470 (1.8%) Hispanic/Latino, and 24 123 (91.2%) White individuals. Participants were scheduled to undergo 3 screenings during the course of the trial; the present study included 75 126 LDCT screening examinations performed for 26 455 participants. A SIF was reported for 8954 (33.8%) of 26 455 participants who were screened with LDCT. Of screening tests with a SIF detected, 12 228 (89.1%) had a SIF considered reportable to the RC, with a higher proportion of reportable SIFs among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]). The most common SIFs reported included emphysema (8677 [43.0%] of 20 156 SIFs reported), coronary artery calcium (2432 [12.1%]), and masses or suspicious lesions (1493 [7.4%]). Masses included kidney (647 [3.2%]), liver (420 [2.1%]), adrenal (265 [1.3%]), and breast (161 [0.8%]) abnormalities. Classification was based on free-text comments; 2205 of 13 299 comments (16.6%) could not be classified. The hierarchical reporting of final diagnosis in NLST may have been associated with an overestimate of severe emphysema in participants with a positive screen result for lung cancer. This case series study found that SIFs were commonly reported in the LDCT arm of the National Lung Screening Trial, and most of these SIFs were considered reportable to the RC and likely to require follow-up. Future screening trials should standardize SIF reporting.

Analysis of 665 thyroid nodules using both EU-TIRADS and ACR TI-RADS classification systems

BackgroundUltrasound-based classification systems allow stratification of thyroid nodules to recommend fine-needle aspiration (FNA) based on their malignancy risk. However, these have discrepancies that may have an impact in thyroid cancer detection. We aimed to compare European Thyroid Association (EU-TIRADS) and American College of Radiology (ACR TI-RADS), in terms of FNA indication and diagnostic performance.MethodsRetrospective study of 665 thyroid nodules from 598 patients who underwent ultrasound and fine-needle aspiration at a tertiary-care institution between January 1st of 2016 and July 31st of 2019. Based on their sonographic features they were classified according to the EU-TIRADS and ACR TI-RADS classification and then their cytological results were obtained. Differences in FNA indications according to these two classifications were analysed. In patients who underwent surgical removal of the nodules, the final pathological diagnosis was obtained.ResultsA statistically significant association was found between EU-TIRADS and ACR TI-RADS classification systems (p < 0.001). ACR TI-RADS allowed greatest reduction in FNA performed (32% vs 24.5%). A different risk category was obtained in 174 (26.1%) nodules, mostly higher with EU-TIRADS. The indication to FNA changed in 54 (8.1%) nodules (49 only indicated following EU-TIRADS recommendations), of which 4 had Bethesda IV and 5 had Bethesda III cytology. The FNA indication in a higher number of nodules using EU-TIRADS was due to difference in the dimensional threshold for FNA on low-risk nodules; to the fact that hypoechogenicity in a mixed nodule ascribes it moderate risk, while using ACR TI-RADS it would only be considered of low risk, and to the use of isolated sonographic features, namely marked hypoechogenicity, microcalcifications and irregular margins, to automatically categorize a nodules as high risk in EU-TIRADS, while ACR TI-RADS requires a group of potentially suspicious features to consider a nodule of high risk. The analysis of pathology proven nodules revealed equally good sensitivity of both systems in the detection of malignancy, but weak specificity, slightly greater with ACR TI-RADS (27.1% vs 18.6%).ConclusionsThe EU-TIRADS and ACR TI-RADS are both suitable to assess thyroid nodules and through risk stratification avoid unnecessary FNA. FNA was less performed using ACR TI-RADS, which was slightly more efficiency in excluding malignancy.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

Evaluation of in-house phantoms for mammography accreditation with various 3D printer filaments

One of the routine activities in the mammography modality is image quality testing using the American College of Radiology (ACR) accreditation phantom, approved by the Mammography Quality Standards Act (MQSA). ACR has approved the CIRS Model 015 for use in the Mammography Accreditation Program. However, because the price of this phantom can be reasonably high, not all hospitals have it. This study aims to fabricate the ACR CIRS model 015 phantom with various 3D printer filaments and compare it with the ACR phantom standard. Phantom was designed by depicting small structures similar to those found clinically to test the capabilities of quantitatively evaluated mammographic imaging systems. The designed in-house phantom consists of fibers, microcalcifications or specks, and masses to simulate tumors. Polylactic Acid (PLA) and Polyvinyl Alcohol (PVA) were used to fabricate in-house phantoms. Meanwhile, the fibers and specks were filled with nylon fiber and Al2CO3. The phantom was designed using the CATIA 3D design based on the CIRS phantom mammography accreditation model 015. The diameter of the specks was printed with the 3D printer in various sizes of 1, 0.9, 0.8, 0.7, and 0.6 mm, respectively. The fabricated phantom was irradiated three times to maintain accuracy using mammography type Siemens Mammomat Inspiration with serial number control 11238. The assessment was conducted with manual irradiation mode at a voltage of 28 kV, 100 mAs, target/filter W/Rh, and a compression rate of 50 N. The all-fabricated phantoms met the ACR standard phantom for fiber, and mass detection with the best result was achieved for the second material with six fibers, four specks, and five masses. The fabricated phantom can potentially be used for image quality control for mammography systems in determining the early detection of breast cancer.

Abstract #1412895: Comparison of Radiological Features of ATA and TIRAD System of Evaluating Thyroid Nodules - A Prospective Study in a Tertiary Care Hospital of Pakistan

The occurrence of thyroid carcinoma had ascended through recent years. Excessive detection of thyroid nodules due to intensified use of thyroid ultrasonography and also increased FNAB (fine- needle aspiration biopsy) procedures are believed to cause the surge in the diagnosis of incidental papillary thyroid carcinomas. There have been two guidelines most commonly used in both clinical practice and scientific area; American Thyroid Association (ATA-2015) guideline and ACR-TIRADS (American College of Radiology - Thyroid Imaging Reporting and Data System) guideline. These guidelines have been established based on sonographic topographies and aim to distinguish nodules according to their doubt of malignancy to give recommendations for FNAB or follow-up. This study aims to compare the radiological features of ATA and TIRADS system of evaluating thyroid nodules. This was a prospective study, enrolling 105 patients. The patients presenting to Radiology Department of the study hospital with neck swelling/nodules for Ultrasound Neck and Thyroid were requested to participate in study after providing the informed consent. The participants must be of 18 years of age or above, however the patients with a known diagnosis of thyroid cancer or having recurrence of prior thyroid cancer were excluded. Proforma was filled as per ATA & ACR TI-RADS classification system. A few patients were followed with FNAB and Histopathology reports. Of all the nodules, 30 (28.5%) were benign, whereas 75 (71.5%) were malignant. ATA guidelines showed improved diagnostic efficiency than ACR TI-RADS (P<0.01). ACR TI-RADS confirmed a higher specificity (P<0.05), whereas the ATA outline had a higher sensitivity (P<0.01). The ACR-TIRADS and ATA guidelines performed better in differentiating nodules >1 cm. Both systems revealed good diagnostic presentation, however, ATA guidelines resulted in a superior number of thyroid biopsies or FNABs. Therefore, we believed that ACR-TIRADS is a better system in this regard, it can help us ruling out unnecessary biopsies.

Prevalence of incidental thyroid abnormalities in patients with degenerative cervical spondylosis: a retrospective cross-sectional magnetic resonance imaging study.

Incidental thyroid abnormalities found on magnetic resonance imaging (MRI) of the neck are not uncommon. This study aimed to investigate the prevalence of incidental thyroid abnormalities in the cervical spine MRI of the degenerative cervical spondylosis (DCS) population indicated for surgery and to identify patients who require additional workup based on the recommendations of the American College of Radiology (ACR). All consecutive patients with DCS and indications for cervical spine surgery from October 2014 to May 2019 in the Affiliated Hospital of Xuzhou Medical University were reviewed. All MRI scans of the cervical spine routinely include the thyroid. Cervical spine MRI scans were retrospectively evaluated for the prevalence, size, morphologic characteristics, and location of incidental thyroid abnormalities. A total of 1,313 patients were included in the analysis, 98 (7.5%) of whom were found to have incidental thyroid abnormalities. The most frequent thyroid abnormality was thyroid nodules (5.3%), followed by goiters (1.4%). Other thyroid abnormalities included Hashimoto thyroiditis (0.4%) and thyroid cancer (0.5%). There was a statistically significant difference in age and sex between patients with DCS with and without incidental thyroid abnormalities (P=0.018 and P=0.007). Stratified by age, the results showed that the highest incidence of incidental thyroid abnormalities was found in patients aged 71 to 80 years (12.4%). Eighteen patients (1.4%) needed further ultrasound (US) and relevant workups. Incidental thyroid abnormalities are common in cervical MRI, with a prevalence of 7.5% identified in patients with DCS. Incidental thyroid abnormalities are large or have suspicious imaging features, and further evaluation with a dedicated thyroid US examination should be completed before cervical spine surgery is undertaken.

DIAGNOSTIC ACCURACY OF CONTRAST-ENHANCED ULTRASOUND TO DIFFERENTIATE BENIGN AND MALIGNANT BREAST LESIONS

Cancer of the breast is caused by a cluster of abnormal breast cells that continue to divide and spread throughout the breast. These cells eventually aggregate as a lump in the affected breast. If the cancerous tumor is not treated, the cancer cells may spread to other areas of the body through a process known as metastasis. A metastasis may develop in the lymph nodes located in the axilla or those located above the scapula. In addition, cancer cells have the ability to colonize the bones, lungs, liver, skin, and even the space directly under the skin. Cancer of the breast tissue is a malignancy that can start from either the ductal or lobule epithelium of the breast. Breast cancer is the most common kind of cancer in women. The ability of ultrasonography to identify cystic masses is one of the technology's many strengths. According to BIRADS, the American College of Radiology has also developed a standardized language for the reading and reporting of ultrasounds, which is quite similar to the language used for mammography. Shape of the mass, borders, orientation, kind of posterior acoustic, lesion boundaries, and echo pattern were the characteristics that were described. CEUS is an imaging technology that evaluates breast lesions by analyzing their qualitative qualities as well as their quantitative aspects. The detection of lymphatic channels and sentinel lymph nodes can be done using this method, and it is practical and effective.

Differential regional importance mapping for thyroid nodule malignancy prediction with potential to improve needle aspiration biopsy sampling reliability.

Existing guidelines for ultrasound-guided fine-needle aspiration biopsy lack specifications on sampling sites, but the number of biopsies improves diagnostic reliability. We propose the use of class activation maps (CAMs) and our modified malignancy-specific heat maps that locate important deep representations of thyroid nodules for class predictions. We applied adversarial noise perturbations to the segmented concentric "hot" nodular regions of equal sizes to differentiate regional importance for the malignancy diagnostic performances of an accurate ultrasound-based artificial intelligence computer-aided diagnosis (AI-CADx) system using 2,602 retrospectively collected thyroid nodules with known histopathological diagnosis. The AI system demonstrated high diagnostic performance with an area under the curve (AUC) value of 0.9302 and good nodule identification capability with a median dice coefficient >0.9 when compared to radiologists' segmentations. Experiments confirmed that the CAM-based heat maps reflect the differentiable importance of different nodular regions for an AI-CADx system to make its predictions. No less importantly, the hot regions in malignancy heat maps of ultrasound images in comparison with the inactivated regions of the same 100 malignant nodules randomly selected from the dataset had higher summed frequency-weighted feature scores of 6.04 versus 4.96 rated by radiologists with more than 15 years of ultrasound examination experience according to widely used ultrasound-based risk stratification American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) in terms of nodule composition, echogenicity, and echogenic foci, excluding shape and margin attributes, which could only be evaluated on the whole rather than on the sub-nodular component levels. In addition, we show examples demonstrating good spatial correspondence of highlighted regions of malignancy heat map to malignant tumor cell-rich regions in hematoxylin and eosin-stained histopathological images. Our proposed CAM-based ultrasonographic malignancy heat map provides quantitative visualization of malignancy heterogeneity within a tumor, and it is of clinical interest to investigate in the future its usefulness to improve fine-needle aspiration biopsy (FNAB) sampling reliability by targeting potentially more suspicious sub-nodular regions.