Clinical Radiology Research Articles

The Pediatric Neuroradiologist's Practical Guide to Capture and Evaluate Pre- and Postoperative Velopharyngeal Insufficiency.

Up to 30% of children with cleft palate will develop a severe speech disorder known as velopharyngeal insufficiency. Management of velopharyngeal insufficiency typically involves structural and functional assessment of the velum and pharynx by endoscopy and/or videofluoroscopy. These methods cannot provide direct evaluation of underlying velopharyngeal musculature. MR imaging offers an ideal imaging method, providing noninvasive, high-contrast, high-resolution imaging of soft-tissue anatomy. Furthermore, focused-speech MR imaging techniques can evaluate the function of the velum and pharynx during sustained speech production, providing critical physiologic information that supplements anatomic findings. The use of MR imaging for velopharyngeal evaluation is relatively novel, with limited literature describing its use in clinical radiology. Here we provide a practical approach to perform and interpret velopharyngeal MR imaging examinations. This article discusses the velopharyngeal MR imaging protocol, methods for interpreting velopharyngeal anatomy, and examples illustrating its clinical applications. This knowledge will provide radiologists with a new, noninvasive tool to offer to referring specialists.

Anatomical Variations of The Diaphragma Sellae and Pituitary Stalk in Human Adult Cadavers in Myanmar

Objective: The middle cerebral fossa contains the sellar area. The diaphragma sellae, a dural fold, covers the sella turcica, which is located in the bony depression of the sphenoid bone. One of the most significant endocrine glands in the body, the pituitary gland’s stalk protrudes from the base of the brain through the diaphragma sellae’s primary hole.Material and Methods: This study was a cross-sectional experimental study and carried out on 30 human adult cadavers (20 males and 10 females) in order to describe the anatomical variations of diaphragma sellae and pituitary stalk.Results: The shapes of the diaphragma sellae were 17 flat types (56.7%), 12 concave types (40%) and 1 convex type (3.3%). The shapes of the central opening of the diaphragma sellae were 21 round types (70%), 5 coronal elliptical types (16.7%), and 4 sagittal elliptical types (13.3%). The mean anteroposterior diameter of the central opening of the diaphragma sellae was 6.92±1.47 mm and the transverse diameter was 7.06±1.46 mm. The mean anteroposterior diameter of the pituitary stalk was 1.83±0.41 mm and the transverse diameter of the pituitary stalk was 2.00±0.33 mm. The locations of the pituitary stalk were 20 posterior types (66.7%), 5 central types (16.7%), and 5 anterior types (16.7%).Conclusion: Neurosurgeons, maxillofacial surgeons, and clinical radiologists may find the current study of the diphragama sellae and sellar region helpful in contemplating the diseases and operational techniques in this area.

Traumatic Chylothorax due to Cervical Stab Wound: A Case Report

Background: Chylothorax corresponds to the incidence of chyle in the pleural space; it was described for the first time in 1633. Its most common cause is associated with iatrogenic injuries to the thoracic duct; 80% of them take place during surgeries, such as pneumonectomy or esophagectomy. Case presentation: A case of an unusual cervical stab wound complication in a 23-year-old man who presented a late large volume chylothorax has been presented and discussed in this paper, as well as its management. Discussion: The presented case demonstrates a rare complication after a cervical stab wound. The management of chylothorax can involve non-operative management, non-operative intervention, or operative management depending on the symptoms and duration. Usually, surgical interventions are required after two weeks of clinical treatment. The differential diagnosis in a post-trauma acute onset ventilatory manifestation is mandatory to rule out pulmonary embolism. Conclusion: Traumatic chylothorax is a rare event; however, its morbidity and mortality rates can be catastrophic when it is not diagnosed early and when the treatment is not established based on a proper flowchart. Thus, dietary and drug-based clinical measures, interventional radiology, videothoracoscopy, and thoracotomy for thoracic duct ligation are valid therapeutic options for the proper management of these cases.

International postgraduate fellowships in radiology: the good, the bad, and the paperwork

Abstract Postgraduate fellowships in clinical and interventional radiology are a well-recognized path to enhancing subspecialty skills and widening professional opportunities. They involve 1-2 years of higher-level intensive training in a chosen subspecialty and can aid in the transition from registrar to consultant. International fellowships combine this professional development with a unique exposure to new concepts, healthcare systems, and communities. However, they require careful planning, with applications opening up to 2 years in advance and various processes to navigate prior to commencing the fellowship. Understanding the benefits and considerations of international fellowships, choosing the right fellowship programme, and appreciating the steps to take prior to commencement are important in making an informed decision.

Paediatric radiotherapy in the United Kingdom: an evolving subspecialty and a paradigm for integrated teamworking in oncology.

Many different malignancies occur in children, but overall, cancer in childhood is rare. Survival rates have improved appreciably and are higher compared with most adult tumour types. Treatment schedules evolve as a result of clinical trials and are typically complex and multi-modality, with radiotherapy an integral component of many. Risk stratification in paediatric oncology is increasingly refined, resulting in a more personalized use of radiation. Every available modality of radiation delivery: simple and advanced photon techniques, proton beam therapy, molecular radiotherapy, and brachytherapy, have their place in the treatment of children's cancers. Radiotherapy is rarely the sole treatment. As local therapy, it is often given before or after surgery, so the involvement of the surgeon is critically important, particularly when brachytherapy is used. Systemic treatment is the standard of care for most paediatric tumour types, concomitant administration of chemotherapy is typical, and immunotherapy has an increasing role. Delivery of radiotherapy is not done by clinical or radiation oncologists alone; play specialists and anaesthetists are required, together with mould room staff, to ensure compliance and immobilization. The support of clinical radiologists is needed to ensure the correct interpretation of imaging for target volume delineation. Physicists and dosimetrists ensure the optimal dose distribution, minimizing exposure of organs at risk. Paediatric oncology doctors, nurses, and a range of allied health professionals are needed for the holistic wrap-around care of the child and family. Radiographers are essential at every step of the way. With increasing complexity comes a need for greater centralization of services.

A Small Intestinal Stromal Tumor Detection Method Based on an Attention Balance Feature Pyramid.

Small intestinal stromal tumor (SIST) is a common gastrointestinal tumor. Currently, SIST diagnosis relies on clinical radiologists reviewing CT images from medical imaging sensors. However, this method is inefficient and greatly affected by subjective factors. The automatic detection method for stromal tumors based on computer vision technology can better solve these problems. However, in CT images, SIST have different shapes and sizes, blurred edge texture, and little difference from surrounding normal tissues, which to a large extent challenges the use of computer vision technology for the automatic detection of stromal tumors. Furthermore, there are the following issues in the research on the detection and recognition of SIST. After analyzing mainstream target detection models on SIST data, it was discovered that there is an imbalance in the features at different levels during the feature fusion stage of the network model. Therefore, this paper proposes an algorithm, based on the attention balance feature pyramid (ABFP), for detecting SIST with unbalanced feature fusion in the target detection model. By combining weighted multi-level feature maps from the backbone network, the algorithm creates a balanced semantic feature map. Spatial attention and channel attention modules are then introduced to enhance this map. In the feature fusion stage, the algorithm scales the enhanced balanced semantic feature map to the size of each level feature map and enhances the original feature information with the original feature map, effectively addressing the imbalance between deep and shallow features. Consequently, the SIST detection model's detection performance is significantly improved, and the method is highly versatile. Experimental results show that the ABFP method can enhance traditional target detection methods, and is compatible with various models and feature fusion strategies.

Development and validation of open-source deep neural networks for comprehensive chest x-ray reading: a retrospective, multicentre study

Artificial intelligence (AI) systems for automated chest x-ray interpretation hold promise for standardising reporting and reducing delays in health systems with shortages of trained radiologists. Yet, there are few freely accessible AI systems trained on large datasets for practitioners to use with their own data with a view to accelerating clinical deployment of AI systems in radiology. We aimed to contribute an AI system for comprehensive chest x-ray abnormality detection. In this retrospective cohort study, we developed open-source neural networks, X-Raydar and X-Raydar-NLP, for classifying common chest x-ray findings from images and their free-text reports. Our networks were developed using data from six UK hospitals from three National Health Service (NHS) Trusts (University Hospitals Coventry and Warwickshire NHS Trust, University Hospitals Birmingham NHS Foundation Trust, and University Hospitals Leicester NHS Trust) collectively contributing 2 513 546 chest x-ray studies taken from a 13-year period (2006-19), which yielded 1 940 508 usable free-text radiological reports written by the contemporary assessing radiologist (collectively referred to as the "historic reporters") and 1 896 034 frontal images. Chest x-rays were labelled using a taxonomy of 37 findings by a custom-trained natural language processing (NLP) algorithm, X-Raydar-NLP, from the original free-text reports. X-Raydar-NLP was trained on 23 230 manually annotated reports and tested on 4551 reports from all hospitals. 1 694 921 labelled images from the training set and 89 238 from the validation set were then used to train a multi-label image classifier. Our algorithms were evaluated on three retrospective datasets: a set of exams sampled randomly from the full NHS dataset reported during clinical practice and annotated using NLP (n=103 328); a consensus set sampled from all six hospitals annotated by three expert radiologists (two independent annotators for each image and a third consultant to facilitate disagreement resolution) under research conditions (n=1427); and an independent dataset, MIMIC-CXR, consisting of NLP-annotated exams (n=252 374). X-Raydar achieved a mean AUC of 0·919 (SD 0·039) on the auto-labelled set, 0·864 (0·102) on the consensus set, and 0·842 (0·074) on the MIMIC-CXR test, demonstrating similar performance to the historic clinical radiologist reporters, as assessed on the consensus set, for multiple clinically important findings, including pneumothorax, parenchymal opacification, and parenchymal mass or nodules. On the consensus set, X-Raydar outperformed historical reporter balanced accuracy with significance on 27 of 37 findings, was non-inferior on nine, and inferior on one finding, resulting in an average improvement of 13·3% (SD 13·1) to 0·763 (0·110), including a mean 5·6% (13·2) improvement in critical findings to 0·826 (0·119). Our study shows that automated classification of chest x-rays under a comprehensive taxonomy can achieve performance levels similar to those of historical reporters and exhibit robust generalisation to external data. The open-sourced neural networks can serve as foundation models for further research and are freely available to the research community. Wellcome Trust.

Risk Factors of In-Hospital Mortality of Ischemic Stroke Patients in Gunung Jati General Hospital

Background: Stroke is the leading cause of death and the most significant contributor to disabilities worldwide. Predicting the mortality of stroke patients and giving optimal care remain challenges in developing countries like Indonesia. In this study, we aimed to identify factors associated with in-hospital mortality after acute ischemic stroke.
 Methods: The study conducted a retrospective cohort of cerebral infarct patients administered in 2022 to Gunung Jati General Hospital, West Java, Indonesia. This study included hospitalized patients with a clinical history of stroke confirmed by a CT scan or MRI. The clinical data, radiology, and laboratory tests were collected at admission or within 24 hours after admission.
 Results: This study involved a total of 92 ischemic stroke patients with a median age of 62. The most prevalent comorbidities were dyslipidemia (93.5%), hypertension (83.7% of patients), and concomitant infection (50%). Patients who experienced in-hospital mortality had a significantly higher number of comorbidities, such as chronic kidney disease, concomitant infection, and atrial fibrillation. Statistically higher neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were also shown in non-survived patients. Ischemic stroke patients with concomitant infection and atrial fibrillation, respectively, had 6.679 (aOR: 6.679, 95% CI 1.802-27.029) and 6.904 times (aOR: 6.904, 95% CI 1.290-36.959) greater to have in-hospital mortality.
 Conclusion: Concomitant infection and atrial fibrillation were associated with in-hospital mortality in ischemic stroke patients at Gunung Jati General Hospital. The findings indicated the importance of identifying timely management for improving better outcomes.

Pathogen evolution, prevention/control strategy and clinical features of COVID-19: experiences from China.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages, which was defined by the World Health Organization as coronavirus disease 2019 (COVID-19). The pandemic is considered a significant threat to global public health till now. In this review, we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2, including its prototype and variants. The overall clinical features of variants of concern (VOC), heterogeneity in the clinical manifestations, radiology and pathology of COVID-19 patients are also discussed, along with advances in therapeutic agents.

CONTRAST-INDUCED NEPHROPATHY IN POST-COVID-19 PATIENTS

Abstract. Introduction. Contrast-induced nephropathy is a serious cause of acute kidney injury and represents an urgent problem in clinical practice. Until recently, there are contradictions in the understanding of many aspects of contrast-induced nephropathy. However, the current situation with using CAs in patients with COVID-19, thus causing contrast-induced nephropathy, has become an urgent issue for clinical physicians and radiologists. Aim of this study is to review some up-to-date information on the use of newer and less nephrotoxic drugs among post-COVID-19 patients with a previous renal impairment. Material and Methods. Topical studies published on studying contrast- induced nephropathies in post-COVID-19 patients have been reviewed herein. Results and Discussion. In case of developing the acute renal failure syndrome caused by using CAs in past-COVID-19 patients, first it is necessary to exclude alternative (non-contrast-induced) causes of its occurrence, such as thromboembolism syndrome that may develop upon angiography, ischemic nephropathy, nephrotoxic effects. Upon administration of the X-ray ca, a short-term increase in creatinine levels is possible after 24 hours, but this does not mean the development of contrast-induced nephropathy. Conclusions. To prevent the development of contrast-induced nephropathies, patients must be adequately hydrated. Nephrotoxic drugs should be discontinued at least 24 hours before ca administration. Moreover, the choice of a suitable ca is important.

Evaluation of Climate-Aware Metrics Tools for Radiology Informatics and Artificial Intelligence: Toward a Potential Radiology Ecolabel

Radiology is a major contributor to health care's impact on climate change, in part due to its reliance on energy-intensive equipment as well as its growing technological reliance. Delivering modern patient care requires a robust informatics team to move images from the imaging equipment to the workstations and the health care system. Radiology informatics is the field that manages medical imaging IT. This involves the acquisition, storage, retrieval, and use of imaging information in health care to improve access and quality, which includes PACS, cloud services, and artificial intelligence. However, the electricity consumption of computing and the life cycle of various computer components expands the carbon footprint of health care. The authors provide a general framework to understand the environmental impact of clinical radiology informatics, which includes using the international Greenhouse Gas Protocol to draft a definition of scopes of emissions pertinent to radiology informatics, as well as exploring existing tools to measure and account for these emissions. A novel standard ecolabel for radiology informatics tools, such as the Energy Star label for consumer devices or Leadership in Energy and Environmental Design certification for buildings, should be developed to promote awareness and guide radiologists and radiology informatics leaders in making environmentally conscious decisions for their clinical practice. At this critical climate juncture, the radiology community has a unique and pressing obligation to consider our shared environmental responsibility in innovating clinical technology for patient care.

Improving induction for clinical radiology trainees in the west of Scotland

Improving induction for clinical radiology trainees in the west of Scotland

Sepsis Inpatient Diagnostic Testing at Mid-Size Academic and Non-academic Health Systems

Abstract Introduction/Objective Comparison of clinical laboratory test and radiology imaging utilization for sepsis inpatients across multiple academic and non-academic health systems would be useful for healthcare resource utilization benchmarking. Methods/Case Report We compared laboratory and imaging utilization for adult patients hospitalized for sepsis procedures at mid-size (250-450 hospital beds), academic (N=12; 31,353 hospitalizations) and non-academic (N=18; 54,192 hospitalizations), hospitals using the Vizient Clinical Data Base™ over 3 years (2019-2021). We used Medicare Severity Diagnosis Related Groups (MSDRG), used by the US Centers for Medicare and Medicaid Services (CMS), to identify hospitalizations for sepsis (MSDRG triplet 870/871/872). We stratified patients by severity comorbid conditions and complications into high, moderate, and low severity groups. We compared the mean number of clinical laboratory (CPT codes 80000-89999) and imaging studies (CPT codes 70000-79999) per hospitalization and per hospital day. We also measured aggregate clinical Resource Intensity Weight (RIW) per hospitalization to quantify diagnostic resource consumption for each encounter. The RIW is based on the US Centers for Medicare and Medicaid Services (CMS) Ambulatory Payment Classification (APC) weights. Results (if a Case Study enter NA) Mean laboratory tests were significantly greater (p<.01) at academic hospitals per encounter (152.2 vs. 95.4 tests, 59.5% higher) and per hospital day (14.5 vs. 9.9 tests, 46.5% higher). Laboratory RIW was also higher per hospitalization (21.0 vs. 13.5 RIW, 55.6% higher) and per hospital day (2.0 vs. 1.4 RIW, 42.9% higher) at academic hospitals. Mean imaging studies at academic hospitals were higher per case (7.8 vs. 7.2 studies, 8.3% higher) but not different per day (0.80 for both hospital groups). Imaging RIW was not significantly different between academic and non-academic hospitals either by encounter (11.1 vs. 9.9, 12.1% higher) or per day (1.2 for both hospital groups). Imaging comparisons lacked statistical significance. Analysis of utilization after stratification for severity levels revealed a similar pattern with greater differences in the high severity group. Conclusion Mean laboratory tests and laboratory RIW per hospitalization are greater at academic hospitals. These differences persist after adjustment for hospital length of stay and severity level. Differences in imaging studies and imaging RIW were not significant.

Classification of Myelin Oligodendrocyte Glycoprotein Antibody-Related Disease and Its Mimicking Acute Demyelinating Syndromes in Children Using MRI-Based Radiomics: From Lesion to Subject

To develop MRI-based radiomics models from the lesion level to the subject level and assess their value for differentiating myelin oligodendrocyte glycoprotein antibody-related disease (MOGAD) from non-MOGAD acute demyelinating syndromes in pediatrics. 66 MOGAD and 66 non-MOGAD children were assigned to the training set (36/35), internal test set (14/16), and external test set (16/15), respectively. At the lesion level, five single-sequence models were developed alongside a fusion model (combining these five sequences). The radiomics features of each lesion were quantified as the lesion-level radscore (LRS) using the best-performing model. Subsequently, a lesion-typing function was employed to classify lesions into two types (MOGAD-like or non-MOGAD-like), and the average LRS of the predominant type lesions in each subject was considered as the subject-level radscore (SRS). Based on SRS, a subject-level model was established and compared toboth clinical models and radiologists' assessments. At the lesion level, the fusion model outperformed the five single-sequence models in distinguishing MOGAD and non-MOGAD lesions (0.867 and 0.810 ofarea under the curve[AUC] in internal and external testing, respectively). At the subject level, the SRS model showed superior performance (0.844 and 0.846 of AUC in internal and external testing, respectively) compared to clinical models and radiologists' assessments for distinguishing MOGAD and non-MOGAD. MRI-based radiomics models have potential clinical value for identifying MOGAD from non-MOGAD. The fusion model and SRS model can distinguish between MOGAD and non-MOGAD at the lesion level and subject level, respectively, providing a differential diagnosis method for these two diseases.

Perceptions of work-life balance and gender issues in private radiology in Australia.

Women comprise almost 30% of practising clinical radiologists in Australia. Despite three-quarters of clinical radiologists working in private practice, there is limited research regarding the experience of female radiologists in private practice and issues surrounding work-life balance. The primary aim of this study was to identify gender issues within private radiology and investigate work-life balance, focusing on issues relevant for female practitioners. Clinical radiologists working in private practice at five major Australian private radiology service providers were sent an email on behalf of the researchers, containing study information and a link to an online questionnaire. Descriptive statistics, chi-square analysis and Fisher's exact test were used. Binary logistic regression was used to determine odds ratios and 95% confidence intervals. Responses to short-answer questions were analysed manually and grouped into themes. There were consistent gender differences in perceptions of gender and its implication upon working and career progression in radiology private practice. There was near unanimous agreement that private radiologists should be able to work flexible/reduced working hours for a proportionate decrease in pay. Two themes with distinct gender differences related to pay equity and transparency. Key themes relating to work-life balance for private radiologists included workload, setting boundaries and flexibility of work hours in private radiology. This preliminary survey highlights areas related to work-life balance and gender issues relevant for female practitioners in private practice radiology in Australia that can be targeted for further investigation and improvement, namely pay equity and transparency, and part-time leadership opportunities.

Unseen allies of pain management: Illuminating the crucial role of clinical radiology in pain medicine.

Unseen allies of pain management: Illuminating the crucial role of clinical radiology in pain medicine.

Challenges and Triumphs: a Case Report on Radical Penectomy and Perineostomy in Penile Cancer

Penile cancer is a rare condition, affecting only about one out of every 100,000 men globally yearly. The risk of developing penile cancer significantly increases with factors like age, inadequate hygiene practices, and having a foreskin. A 62-year-old male patient presented with a complaint of painful urination, which he had been experiencing for the past four months, and this pain had worsened over the last month. The patient had a medical history of benign prostatic hyperplasia (BPH), an incarcerated hernia, and had developed ulcers on his penis four months ago. In this case, the patient's past issues with hygiene and smoking likely contributed to the development of penile cancer. However, in more advanced cases like this one, where the cancer had significantly progressed, necessitating the removal of the entire penile body, a radical penectomy was carried out. Subsequently, a perineal urethrostomy was created to provide an alternative route for urination. It is discovered at an advanced stage and requiring aggressive treatments makes penile cancer challenging to treat. A significant therapeutic option for advanced penile cancer is radical penectomy followed by perineal urethrostomy.

The Effect of Orientation on Increasing Knowledge and Reducing Anxiety During MRI Examination in a Radiology Installation

Radiology services encompass the use of ionizing and non-ionizing radiation sources for diagnostic imaging and therapy. Magnetic Resonance Imaging (MRI) is a crucial clinical radiology service, primarily conducted in hospital-based healthcare facilities. The aim of this research is to assess the influence of patient orientation on MRI-related knowledge and anxiety. This study employs a quasi-experimental design with pretest and posttest measurements, taking into account variables such as age, gender, education, diagnosis, and experience. The results of the research indicate that patient orientation effectively reduces anxiety levels and has a positive impact on the patient's experience during MRI examinations. The conclusions that can be drawn from this research are: The influence of orientation on knowledge in groups that were not given orientation and orientation found that there was no significant difference in the average knowledge before and after orientation (p>0.05), this was because respondents had previously read first about MRI examinations on the internet and after reading the knowledge questionnaire their knowledge increased because after they filled out the questionnaire they asked the researchers what was stated in the knowledge questionnaire. The research suggests that the use of open MRI machines with wider bore diameters, along with patient-oriented practices such as allowing patients to see during the examination, can reduce anxiety.

Adult Langerhans Cell Histiocytosis with Liver Involvement

Background Langerhans cell histiocytosis (LCH) is a rare, heterogeneous histiocytic disorder. We demonstrated liver involvement at baseline indicated poor survival in adult LCH in our previous study. Aims The aim of this study was to describe clinical features, liver biochemistry, radiology findings, genomic analyses, treatment approaches, and outcomes of adult LCH patients with liver involvement. Methods We conducted a retrospective analysis of all adult LCH patients (≥ 14 years) seen at Peking Union Medical College Hospital (Beijing, China) between January 2001 and December 2022. Liver involvement by one or more of the following: either hepatomegaly, defined as a liver edge greater than 3 cm below the costal margin at the mid clavicular line, or liver dysfunction defined either by abnormal serum biochemical tests including bilirubin greater than 1.5 times the upper limit of normal, alkaline phosphatase (ALP) greater than 1.5 times the upper limit of normal, γ-glutamyl transpeptidase (GGT) greater than 1.5 times the upper limit of normal; or histopathological findings of active disease. Results Among 451 newly diagnosed adult LCH patients, 93 patients had liver involvement at diagnosis and 22 patients had liver involvement at relapse were enrolled, including 80 males (69.6%), and the median age was 32 years (range, 15-66 years). 111 of 115 patients had full liver function test. 70 patients (63.1%) had elevated ALP; 96 patients (86.5%) had elevated GGT, and the median level was 157 U/L (range, 14-2249 U/L); 16 patients (14.4%) had elevated total bilirubin, and the median level was 12.5 umol/L (range, 1.7-248.1umol/L); Among 48 patients who had sufficient DNA for next-generation sequencing, BRAFV600E (20.8%), BRAFN486_P490 (37.5%) and MAP2K1(12.5%) were the most common alternations. In total, 99 patients (86.1%) received first-line systematic treatment, including 76 patients who received chemotherapies (methotrexate/cytarabine regimens, cytarabine monotherapy, vindesine/prednisone-based regimens, cladribine monotherapy and corticosteroid), 15 patients who received immunomodulatory drugs (IMiDs) therapies (thalidomide/cyclophosphamide/dexamethasone regimens and lenalidomide/dexamethasone regimens) and 8 patients who received target therapies (BRAF inhibitors and MEK inhibitors). After a median 39-month follow-up (range 1-168 months), thirteen patients died during follow-up. The estimated 3-year OS rate was 85.5%. 44 patients had disease progression. The median PFS duration was 31.4 months. Nine patients got cirrhosis during follow-up and 2 patients underwent liver transplantation. Univariate analysis was performed to evaluate the prognostic factors of OS and PFS. Patients with elevated total bilirubin at baseline had significantly shorter OS and PFS. Patients who had 3 or more abnormal serum live function tests (including ALT, AST, ALP, GGT, total bilirubin and ALB), and patients with elevated high sensitive C reactive protein (hsCRP) had significantly shorter PFS. Patients who received target therapy or iMIDs-based therapy had significantly longer PFS than patients who received other systemic treatments. In multivariable analyses, Patients who had 3 or more abnormal serum live function tests (HR 2.652, 95% CI 1.256-5.602), and treatment with iMIDs (HR 0.076, 95% CI 0.010-0.564) remained predictive factors for PFS. Conclusion Adult LCH patients with liver involvement most had elevated GGT and ALP. Elevated hsCRP and 3 or more abnormal live function tests predict poor outcomes. Target therapy or iMIDs-based therapy showed better outcomes.

Model of Calculating Workload and Preparing Human Resource Needs (HR) of Radiographers

Minister of Health Decree Number 24 of 2020 Health About planning clinical radiology service standards, currently Radiotherapy Installation at RSUD. Dr. H. Abdul Moloek of Lampung Province has 12 (twelve) radiographers and has operational modalities in 4 (four) Radiotherapy Installations. This study aims to compile standard guidelines for workload calculation models and preparation of Radiographer needs in the radiotherapy unit of Dr.H. Abdul Moeloek Hospital, Lampung Province. This type of research was carried out in two stages: the first stage of research and development using Research and Development (R&D) and the second stage, the mixed methods method with the Focus Group Discussion (FGD) technique. The research respondents used a purposive sampling method; the respondents in collecting information were 5 (five), and the samples were taken from 12 (twelve) radiographers in the radiotherapy installation. The results of the research show that the NOVITA Formula after testing the 12th (twelfth) product of the radiometer using the Likert scale validity test (Likert interval 1-4) and the reliability test using the Cronbach's alpha method produces a value of 8.3% valid and 0.628 reliable, which shows The model instrument for calculating workload and preparing Radiographer needs using the NOVITA Formula is suitable for implementation or use at RSUD Dr. H. Abdul Moeloek Lampung Province in Radiotherapy at the Linear Accelerator (LINAC) unit. The NOVITA formula can be applied in Radiotherapy in Linear Accelerator (LINAC) units and needs further development for other units.