Consultant Radiologist Research Articles

An NHS Trust comparison of reporting radiographers and consultant radiologists ability to identify cancer on chest radiographs with confirmation through a Fast track CT thorax referral system

IntroductionThe National Institute for Health and Care Excellence (NICE) recommends that GPs initially refer patients with suspected lung cancer for a chest X-ray (CXR). The Radiology department has a ‘fast track system’ to identify those patients who may have lung cancer on CXR and are referred for a CT thorax with contrast to help determine a cancer diagnosis. This fast track system was put in place to ensure the NICE guidelines and NHS England's standards on a faster cancer diagnosis are being met. This audit studied the ability of radiologists and reporting radiographers to identify lung cancer on CXRs and the accuracy of the fast-track system. Methods846 cases with lung alerts were analysed and 545 CXRs were audited. The CXRs were split into images reported by radiologists (168) and those reported by reporting radiographers (377). CT thorax results were collected through PACS and Cerner computer systems to identify if the ‘fast track’ system had yielded a “positive”, “negative”, or “other findings” result for lung cancer. Results32.8% (179) of CXRs flagged for lung cancer were positive, 40.6% (221) were negative, and 26.6% (145) had other findings. Chi square statistical test showed no significant difference (p = 0.14) between the two reporting groups in their ability to identify lung cancer on CXRs. 27% (38) of CXRs flagged by radiologists and 35% (125) by reporting radiographers were positive for lung cancer. ConclusionThis clinical audit indicates, reporting radiographers and radiologists are not statistically significantly different regarding their ability to identify lung cancer on CXRs, when supported by the fast track system. The fast-track system had a 59.4 % accuracy rate, detected by the number of imaging of reports that identified a serious pathology. This concludes that the system is performing well, yet could still be improved. Implications for practiceThis audit provides further evidence for the value of developing and deploying reporting radiographers for projection radiography reporting.

Pediatric vocal cord mobility: Translaryngeal ultrasound application for resource-limited laryngologists

Background: Flexible fibreoptic laryngoscopy (FFL) is currently the gold standard for assessment of true vocal cord (TVC) mobility but is invasive and not without risk. The aim of this study was to determine the accuracy of an application-based translaryngeal ultrasonography (TLUS) as a screening tool for mobility of TVCs and to assess the feasibility of its use by an otolaryngologist not formally trained in ultrasonography.Methods: Forty children were recruited at the ear, nose and throat (ENT) clinic at Red Cross War Memorial Children’s Hospital (RCWMCH). The first author (DR), an ENT trainee, was trained by a consultant radiologist (MJ) on the use of an ultrasound probe to assess TVC mobility. Two qualified ENT specialists (neither trained in ultrasonography) consented to evaluate TLUS and FFL videos for TVC mobility.Results: In total, 135 videos were obtained from 40 participants. Ages ranged from 10 days to 9 years, and the genders were equally represented. The overall accuracy of TLUS evaluation was 95.5% (sensitivity of 100%, specificity of 60%). The reliability of TLUS when compared to FFL showed a p 0.001 and a 100% agreement between ENT specialists evaluating the shared videos.Conclusion: Our study shows TLUS to be a reliable method of assessing TVC mobility.Contribution: Translaryngeal ultrasonography is portable, noninvasive and easy to use, making it a potentially useful screening tool for practitioners other than radiologists, for example, otolaryngologists, who have a good understanding of laryngeal anatomy, especially in resource-limited settings, where FFL might not be readily available.

The Inter-Observer Agreement Between Resident and Consultant Radiologists in Reporting Emergency Head CT Scans

Objectives: To determine the inter-observer agreement between resident and consultant radiologists in reporting emergency head CT scans. Materials and Methods: This descriptive cross-sectional retrospective study was performed in a tertiary care hospital Karachi from 1st October 2021 to 31st march 2022. Total of 111 number of patients of 18-70 years of age of either gender who underwent emergency Head CT scans were included. Patients who came for follow-up CT scans were excluded. CT findings were interpreted by the radiology resident on duty. Subsequently, these CT images were interpreted by a consultant radiologist, and the decision of both resident and faculty member CT was correlated for inter-observer agreement. Results: The mean age was 47.47 ± 14.20 years. The majority of the patients 46 (41.44%) were between 56 to 70 years of age. Out of these 111 patients, 72 (64.86%) were male and 39 (35.14%) were female with a ratio of 1.9:1. Discrepancy between resident and consultant radiologists in reporting emergency head CT scans is seen in 6 (5.41%) patients. Inter-observer agreement between resident and consultant radiologists in reporting emergency head CT scans was found to be 94.59% with a kappa “κ” value of 0.885 which showed a very strong agreement. Conclusion: This study concluded that little discrepancy was found in inter-observer agreement between the radiology residents and the faculty members for interpretation of CT images of Head.

A pilot screening project for the detection of hip dysplasia in young patients

ABSTRACT Hip dysplasia in young adults is underdiagnosed and can cause pain and discomfort. Progression to osteoarthritis (OA) is common, necessitating total hip arthroplasty at an early age. When discovered early, symptomatic patients can be offered physiotherapy and/or hip-preserving surgery to alleviate pain and decrease the risk of early OA. A pilot project to screen radiograms for hip dysplasia was started across the Swedish region of Örebro Län in January 2019, comparing the incidence of dysplasia before and after initiation of the screening program. All elective conventional radiograms of the hip (age 12–44 years), requested by primary care physicians, were analyzed by consultant radiologists according to a pre-established algorithm to identify hip abnormalities. If the hip radiograms showed dysplastic changes, or other pathological signs, the radiologist advised referral to a specialized Youth Hip Clinic for further work-up and treatment. A total of 1056 radiograms were requested by clinicians during the study periods (601 and 455 during 2018 and 2020, respectively). A total of 457 trauma-related cases were excluded, resulting in 599 available for analysis (348 and 251 during 2018 and 2020, respectively). During 2018, 17 patients (4.9%) received the radiologic diagnosis of dysplasia, compared with 44 patients (17.5%) during 2020 (P < 0. 001). A three-fold increase of patients diagnosed with hip dysplasia was detected as a result of the implementation of the screening program. The advantage of screening is early referral to an orthopedic department for evaluation and consideration for physiotherapy and/or surgical intervention.

A survey of the NHS reporting radiographer workforce in England

Introduction: At present there is no national register of the population size and scope of reporting radiographers in England. This makes operational workforce and succession planning for sustainable healthcare services in the National Health Service England (NHSE) difficult, affecting implementing NHSE policies and priorities such as 50% of X-rays reported by reporting radiographers and decreasing reporting Turnaround Times (TATs). This survey aimed to establish the workforce population employed as reporting radiographers in NHSE. Methods: An online anonymous seven question survey was distributed on social media and at the UK Imaging and Oncology Congress. Participant criteria included NHSE radiology staff (diagnostic radiographer, reporting radiographer, radiology manager, imaging superintendent modality lead, consultant radiologist, etc.) or a student diagnostic radiographer working within an NHSE trust. The survey recorded the participant's NHSE region (North Western, North Eastern and Yorkshire, Midlands, East of England, London, South Eastern and South Western regions), Integrated Care Systems (ICS), NHSE Trust, hospital, the amount of reporting radiographers and trainees employed, the Agenda for Change (AfC) job banding and imaging modality reported (X-ray, CT, MRI, NM, PET, DEXA). The data analysis applied descriptive statistics for estimating patterns and trends in the distrubtion of data (English region, AfC banding and imaging modality). Results: Responses were received from all seven of the NHSE regions (n=36/43 ICSs). The data demonstrated a larger workforce in the north of England than in the south, with employment at a range of AfC bandings from 5-8. The imaging modalities reported by radiographers in England demonstrated X-ray (n=34), the most reported imaging examination by region, and Nuclear Medicine (n=3) the least, with evidence of clinical reporting for CT (n=20), MRI (n=18), DEXA (n=16), Mammography (n=13) and fluoroscopy (n=12) being completed by radiographers in England. Conclusion: The findings for England (n=704 reporters; n=142 trainees) provide an estimate based on the response rate of the current reporting radiographer workforce across the NHSE regions, and their contribution to the skills mix radiology reporting service delivery. It is hoped future surveys will provide ongoing workforce estimates for the diagnostic radiographer reporting workforce in NHSE to support workforce transformation and sustainability plans for the radiography profession and to meet government healthcare targets and priorities.

P670 Intestinal Motility Changes in Patients Undergoing Removable Stent Treatment for Focal Crohn’s Disease Strictures

Abstract Background Management and assessment of fibrostenotic Crohn’s disease(CD) is a research priority. Deep phenotyping is key for effective therapeutic development. In this study, we explore MRI assessed bowel motility before and after endoscopic stent treatment of focal fibrotic strictures in patients with CD. Methods Patients (n = 12, median age = 51 y) undergoing removable stent treatment were recruited as part of an approved study. Average CD diagnosis was 31y (range 16-57 y). All strictures were fibrotic in nature- three were de novo, while the remaining were anastomotic (ileocolonic). All patients had symptoms attributable to focal stricturing. Each patient had an MR – Enterography (MRE) scan (median 21 weeks) before and after (median 17 weeks) stent dilation. MR – Enterography (MRE) protocol included oral preparation, anatomical and cine ‘motility’ sequences across the abdomen in 20s breath hold (1 image/second). Motility sequences were processed with CE/FDA cleared GIQuant (Motilent, UK) to produce a quantitative map from which, objective data could be generated across the bowel. Stricture assessment was performed by a consultant radiologist. Non parametric statistics were used to investigate the following questions: 1. Was the baseline regional motility (mean, range) at stricture, dilation and morphologically normal bowel different across patients (Kruskal-Wallis)? 2. What were the changes in stricture motility pre and post stent placement (Wilcoxin Rank)? 3. Was stricture motility associated with stricture morphology (Spearman’s Rho)? Results 1. Motility at the stricture (126, range 62 to 139), pre-stenotic terminal ileum (252, range 80 to 478) and the global small bowel (269, range 166 to 339) was varied across the cohort (P < 0.001). 2. All patients had improvement in symptom scores & reporting, without change in stricture motility (P = 0.94). 3. A positive change in stricture motility was associated with reduced length of pre stricture dilatation (R = 0.64, P = 0.02) Conclusion Strictured intestine displayed reduced motility compared with adjacent bowel segments. While reduced, peristalsis was still present although paired analysis suggested no change pre and post stent stricture management. This implies that symptomatic relief was not related to altered peristalsis across the study. Finally, the length of dilation did appear to be associated with dynamic changes in stricture motility. In summary, as noted in stent-treated CD strictures, a dynamic physiological environment exists which can be captured with Cine MRI. These motility assessments, which have been studied as a proxy indicator of active CD, represent the first reported dynamic motility outcomes following stricture intervention.

Pre-TAVI imaging: an Italian survey by the CT PRotocol optimization (CT-PRO) group

PurposeThe purpose of this survey was to evaluate the current state-of-art of pre-TAVI imaging in a large radiological professional community.MethodsBetween December 2022 and January 2023 all members of the Italian Society of Medical and Interventional Radiology (SIRM) were invited by the CT PRotocol Optimization group (CT-PRO group) to complete an online 24-item questionnaire about pre-TAVI imaging.Results557 SIRM members participated in the survey. The greatest part of respondents were consultant radiologists employed in public hospitals and 84% claimed to routinely perform pre-TAVI imaging at their institutions. The most widespread acquisition protocol consisted of an ECG-gated CT angiography (CTA) scan of the aortic root and heart followed by a non-ECG-synchronized CTA of the thorax, abdomen, and pelvis. Contrast agent administration was generally tailored on the patient’s body weight with a preference for using high concentration contrast media. The reports were commonly written by radiologists with expertise in cardiovascular imaging, and included all the measurements suggested by current guidelines for adequate pre-procedural planning. About 60% of the subjects affirmed that the Heart Team is present at their institutions, however only 7% of the respondents regularly attended the multidisciplinary meetings.ConclusionsThis survey defines the current pre-TAVI imaging practice in a large radiological professional community. Interestingly, despite the majority of radiologists follow the current guidelines regarding acquisition and reporting of pre-TAVI imaging studies, there is still a noteworthy absence from multidisciplinary meetings and from the Heart Team.

Is reassessment of Computed Tomography Reports Worthwhile in Acute Diverticulitis?

Introduction: Since the assessment of the disease severity in acute diverticulitis (AD) is of utmost importance to determine the optimal treatment and the need for follow-up investigations, we wanted to investigate whether the first CT report is compatible with daytime reassessment report and whether the value of initial report changes according to the experience of the radiologist. Methods: Consecutive patients from tertiary referral centre with AD were included. CT images done in the emergency department were initially analysed by either resident radiologists or consultant radiologists and then later reanalysed by consultant abdominal radiologists. Discrepancies between reports were noted. Results: Of total of 562 patients with AD, CT images were reanalysed in 439 cases. In 22 reports (5.0%) the final report was significantly different from the initial report and management changed in 20 cases. In reports of uncomplicated acute diverticulitis, reanalysis changed initial assessment in 4.0% of the cases and in complicated acute diverticulitis (CAD) in 9.1%. When consultant and resident radiologists were compared, there was no significant difference. Conclusion: Although no statistical difference could be noted between residents and consultants, the final report was significantly different in overall 5% of the cases when reanalysed at normal working hours by an experienced consultant abdominal radiologist. Therefore, we conclude that reassessment of CT reports is worthwhile in AD.

Enhancing paranasal sinus disease detection with AutoML: efficient AI development and evaluation via magnetic resonance imaging

PurposeArtificial intelligence (AI) in the form of automated machine learning (AutoML) offers a new potential breakthrough to overcome the barrier of entry for non-technically trained physicians. A Clinical Decision Support System (CDSS) for screening purposes using AutoML could be beneficial to ease the clinical burden in the radiological workflow for paranasal sinus diseases.MethodsThe main target of this work was the usage of automated evaluation of model performance and the feasibility of the Vertex AI image classification model on the Google Cloud AutoML platform to be trained to automatically classify the presence or absence of sinonasal disease. The dataset is a consensus labelled Open Access Series of Imaging Studies (OASIS-3) MRI head dataset by three specialised head and neck consultant radiologists. A total of 1313 unique non-TSE T2w MRI head sessions were used from the OASIS-3 repository.ResultsThe best-performing image classification model achieved a precision of 0.928. Demonstrating the feasibility and high performance of the Vertex AI image classification model to automatically detect the presence or absence of sinonasal disease on MRI.ConclusionAutoML allows for potential deployment to optimise diagnostic radiology workflows and lay the foundation for further AI research in radiology and otolaryngology. The usage of AutoML could serve as a formal requirement for a feasibility study.

Determination of Sensitivity and Positive Predictive Value for Handheld Doppler in the Assessment of Thoracodorsal Artery Perforators and Literature Review

Abstract Background: Hand-held Doppler (HHD) is still a very useful tool in the reconstructive surgeon’s armamentarium. One hundred percent specificity in detecting perforators can be achieved with HHD when a perforator compression test is applied. The study aimed to determine the sensitivity and positive predictive value (PPV) for HHD in the assessment of thoracodorsal artery perforators, by applying the perforator compression test, using the color Doppler ultrasound (CDU) as the standard. Materials and Methods: This was a cross-sectional study. The Plastic Surgeon assessed for perforators using HHD on both lateral thoracic areas for each patient, with a re-evaluation of the same locations by a Consultant Radiologist using the CDU. The data generated were analysed using the Statistical Package for the Social Sciences (SPSS) software version 20, and results were presented in charts and tables. The sensitivity and PPV for HHD were then calculated. Results: A total of 70 patients were included, 58 males (82.9%) and 12 females (17.1%). The age range was 18–65 years, with a mean of 31.77 years ± 11.72 years. Overall, 247 perforators were identified by HHD. The true positive, false-positive, and false-negative values for HHD were 127 (51.4%), 120 (48.6%), and 20 (8.1%), respectively. The sensitivity and PPV for the HHD were calculated as 86.3% and 51.4%, respectively. Conclusion: The sensitivity of HHD was high while the PPV was much lower compared to other studies. This implies that for patients with positive HHD signals, the probability of having perforators intraoperative is low.

Impact on patient attitudes towards lung cancer screening and smoking cessation with radiology consultation: Pilot survey project

PurposeWe developed a novel patient-radiologist consultation for patients scheduled for lung cancer screening (LCS). We hypothesized that this intervention would improve patient attitudes towards LCS adherence and smoking cessation. MethodsThis quality improvement project enrolled 38 LCS patients (a majority were African American) and included 20 current and 18 former smokers. The intervention, a 5–10 min consultation with a radiologist who provided preliminary interpretation of pertinent imaging findings in conjunction with smoking cessation counseling, took place in the radiology reading room immediately after the low dose computed tomography (LDCT) patient scan. Pre- and post-intervention surveys assessed patient attitudes towards LCS and smoking cessation. ResultsAll recruited patients consented to participate in this project. Regarding viewing their LCS imaging, 86.8% (33/38) expressed general interest initially, with 100.0% (38/38) being more interested afterwards. On LCS logistics, 71.1% (27/38) reported prior knowledge at baseline, while 89.5% (34/38) reported being more informed following the intervention. Among current smokers, 90.0% (18/20) were already motivated towards quitting smoking at baseline, with 100.0% (20/20) exiting the intervention being more interested in doing so. Regarding smoking cessation resources, 95.0% (19/20) were interested in accessing such resources at baseline, and 90.0% (18/20, 2 were same/neutral) were more interested afterwards. ConclusionsPatients’ attitudes towards LCS and self-reported interest in quitting smoking were directionally higher after the consultation than at baseline. Incorporating LCS consultations with radiologists as part of patient-centered care provides a resource to educate patients on their own LCS imaging findings while promoting LCS adherence and smoking cessation.

Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy

IntroductionPeople with Degenerative Cervical Myelopathy (DCM) often experience diagnostic delay. This could lead to poorer outcomes, including disability. Research questionDoes the modified Japanese Orthopaedic Association scale (mJOA) have clinical utility as an early detection tool for possible DCM? Materials and methodsThis is a prospective study of consecutive adult patients, referred to a National Neurosurgical Centre with a neck problem. Assessing clinicians undertook standard clinical examination and calculated the mJOA score. A consultant radiologist independently reported radiological findings, after which the assessing clinician determined the diagnosis. The sensitivity and specificity of mJOA for DCM at various cut-points was statistically analysed using Receiver Operating Characteristics (ROC) curves. ResultsOf 201 patients (98 male, mean age 52.6 ± 13y) assessed over 13 months, 21 were diagnosed with DCM (prevalence 10.4%). Fifteen (71.4%) had a mJOA score classifying disease severity as mild, 4/21 (19%) had moderate disease and two (9.5%) had severe disease. A mJOA score ≤17 (cutpoint ≥1) showed sensitivity of 95% and specificity of 71% for the clinical diagnosis of DCM. mJOA score ≤16 (cutpoint ≥2) had sensitivity of 62% and specificity of 90%. The ROC area under the curve was 0.885 (95% confidence interval: 0.82 to 0.95). 87% of patients were correctly classified. Discussion and conclusionmJOA score ≤16 is 90% specific for a subsequent diagnosis of DCM in people with neck problems and has potential to be used as an early detection tool. Further research is needed to replicate these findings and establish feasibility and acceptability in primary care.

Comparison of T2-Weighted 3D-Space and T2-Weighted 2D-TSE Sequences in Lumbar Spine Magnetic Resonance Imaging (MRI)

Background: Spine-related issues like low back pain have substantially increased in the past few decades across all age categories having various reasons. Objectives: To compare the image quality and diagnostic value of 3D space MRI sequence with 2D TSE MRI sequence in lumbar spine imaging. Methods: Fifty patients, irrespective of gender having age between 30-70 years, who presented with lower back pain were enrolled for the study. Lumbar spine imaging was done using 2D TSE and 3D space sequences and the subsequent images were evaluated by two senior consultant radiologists for qualitative analysis of visibility and pathologic indices of both sequences. Data was analyzed on SPSS 25.0. Statistical analysis was done using Cohen's kappa (k). Results: Female participants were 56% of total study population. Mean age of study participants found to be 53.62±10.76 years. Statistically significant difference (p-value =0.000) was noted for visibility score of all the lumbar spine components, when the 3D SPACE and 2D TSE images were compared with 3D-SPACE images found being superior in visibility. Inter- observer agreement for visibility of various regions of lumber spine was nearly perfect (k> 0.8) and substantial (0.6 to 0.8) for 3D-SPACE, while substantial (0.8<k> 0.6) for 2D-TSE. Pathologic indexes had a significant level of inter-observer agreement (k > 0.6). Inter-observer agreement for 3D sequence (k = 0.72) was greater than that for 2D-TSE sequence (k = 0.64). Conclusion: Images from 3D-SPACE sequences provide superior visibility over 2D-TSE and could be recommended as alternative imaging method for lumbar spine pathologies. Higher inter observer agreement illustrate that it may be included in routine sequences to make the better diagnosis for lumbar spine pathologies correctly.

An evaluation of radiographers’ extended practice in the detection of brain metastases on magnetic resonance images

IntroductionPatients who undergo magnetic resonance (MR) imaging to confirm or rule out metastatic brain disease are required to wait for image review by a radiologist before leaving the department at the institute where this study was carried out. The aim was to evaluate whether radiographers can review images and reduce waiting times in those patients without metastases. MethodsProspective observational study of MR radiographers (n = 11) was undertaken. Radiographers commented on images to confirm whether the images showed evidence of metastatic disease, pathology but no metastases, or no pathology. Responses were compared to the radiological report (reference standard). Online questionnaires determined the views and opinions of radiographers (n = 8) and consultant radiologists (n = 6) towards radiographers expanding their scope of practice to include the confirmation or exclusion of brain metastases. ResultsDespite a lack of formal training for image reviewing, overall level of agreement between the radiographer reviews and reference standard was 77.9 % (κ = 0.45). Pooled sensitivity and specificity were 88.6 % & 71.3 % respectively. Kendall's τ = −0.03 (bootstrap 95 % CI -0.73 to 0.61, p = 0.925). Positive predictive value (PPV) was 65.5 % (CI 59.2%–71.4 %) and negative predictive value (NPV) 91.1 % (CI 84.9%–94.9 %). Radiographers and radiologists surveyed demonstrated a willingness to engage with role expansion. ConclusionBased on our small study and interdisciplinary survey, local radiographers and radiologists agree, following a program of radiographer training, screening for brain metastases by radiographers could be implemented. Implications for practiceWith appropriate governance and training support, the introduction of formal radiographer screening for patients referred to exclude brain metastases could provide more efficient working practice.

Artificial Intelligence-Assisted Detection of Osteoporotic Vertebral Fractures on Lateral Chest Radiographs in Post-Menopausal Women.

Osteoporotic vertebral fractures (OVFs) are often not reported by radiologists on routine chest radiographs. This study aims to investigate the clinical value of a newly developed artificial intelligence (AI) tool, Ofeye 1.0, for automated detection of OVFs on lateral chest radiographs in post-menopausal women (>60 years) who were referred to undergo chest x-rays for other reasons. A total of 510 de-identified lateral chest radiographs from three clinical sites were retrieved and analysed using the Ofeye 1.0 tool. These images were then reviewed by a consultant radiologist with findings serving as the reference standard for determining the diagnostic performance of the AI tool for the detection of OVFs. Of all the original radiologist reports, missed OVFs were found in 28.8% of images but were detected using the AI tool. The AI tool demonstrated high specificity of 92.8% (95% CI: 89.6, 95.2%), moderate accuracy of 80.3% (95% CI: 76.3, 80.4%), positive predictive value (PPV) of 73.7% (95% CI: 65.2, 80.8%), and negative predictive value (NPV) of 81.5% (95% CI: 79, 83.8%), but low sensitivity of 49% (95% CI: 40.7, 57.3%). The AI tool showed improved sensitivity compared with the original radiologist reports, which was 20.8% (95% CI: 14.5, 28.4). The new AI tool can be used as a complementary tool in routine diagnostic reports for the reduction in missed OVFs in elderly women.

Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study

BackgroundChest X-ray (CXR) has typically been the main investigation in children with suspected respiratory pathology. Recent advances in lung point-of-care ultrasound (POCUS) have shown the potential for it to be...

Improving traumatic fracture detection on radiographs with artificial intelligence support: a multi-reader study.

The aim of this study was to evaluate the diagnostic performance of nonspecialist readers with and without the use of an artificial intelligence (AI) support tool to detect traumatic fractures on radiographs of the appendicular skeleton. The design was a retrospective, fully crossed multi-reader, multi-case study on a balanced dataset of patients (≥2 years of age) with an AI tool as a diagnostic intervention. Fifteen readers assessed 340 radiographic exams, with and without the AI tool in 2 different sessions and the time spent was automatically recorded. Reference standard was established by 3 consultant radiologists. Sensitivity, specificity, and false positives per patient were calculated. Patient-wise sensitivity increased from 72% to 80% (P < .05) and patient-wise specificity increased from 81% to 85% (P < .05) in exams aided by the AI tool compared to the unaided exams. The increase in sensitivity resulted in a relative reduction of missed fractures of 29%. The average rate of false positives per patient decreased from 0.16 to 0.14, corresponding to a relative reduction of 21%. There was no significant difference in average reading time spent per exam. The largest gain in fracture detection performance, with AI support, across all readers, was on nonobvious fractures with a significant increase in sensitivity of 11 percentage points (pp) (60%-71%). The diagnostic performance for detection of traumatic fractures on radiographs of the appendicular skeleton improved among nonspecialist readers tested AI fracture detection support tool showed an overall reader improvement in sensitivity and specificity when supported by an AI tool. Improvement was seen in both sensitivity and specificity without negatively affecting the interpretation time. The division and analysis of obvious and nonobvious fractures are novel in AI reader comparison studies like this.

The importance of weekly Radiology-General Surgery Multi-Disciplinary Meetings (MDMs) in the management of Emergency General Surgery (EGS) patients

Abstract Aims Most patients in Emergency-General-Surgery (EGS) require radiological investigations as part of their management plan. However, unlike cancer services where structured multi-disciplinary-meetings (MDMs) form an integral part of patient management, MDMs are not commonly practised in EGS. Having a weekly Radiology-General Surgery-MDM leads to better outcome in management of EGS-patients, &amp; also improves learning of surgeons &amp; junior-doctors. Methods A prospective study of weekly 1-hour Radiology-GeneralSurgery-MDMs over 10-weeks during May2023-September2023 was performed. These MDMs were led by a consultant radiologist who discussed the scans with consultant surgeons &amp; other junior-doctors. Factors taken into consideration were clinical presentation, original scan report, any missed findings not mentioned in original scan report, any changes recommended in management plan that would lead to better patient outcome. The scans were also discussed with junior-doctors to improve their knowledge of interpretation of scans. Results A total of 70 cases were discussed during the study period, 25 (35.71%) initially reported by the out-of-hours reporting system. Few had missed findings that were noted as result of Radiology-GeneralSurgery-MDM, &amp; 27(38.57%) had change in management plan. The informal feedback collected after these MDMs noted over 85% junior-doctors agreed that these MDMs had significant impact on their understanding of interpretation of radiological-scans in EGS. Conclusion Weekly Radiology-GeneralSurgery-MDMs for EGS-admissions has been seen to improve patient outcome as a result of having an expert 2nd-opinion, &amp; also recommending change in management plan in significant proportion of patients. It also had an impact on learning the clinical correlation of radiological-scans by junior-doctors who regularly attended these meetings.

To determine the frequency of Baker’s cyst on MRI in patients with knee pain.

Objective: To determine the frequency of Baker’s cyst in patients presenting with knee pain, considering MRI as imaging modality. Study Design: Descriptive, Cross-sectional study. Setting: Department of Radiology, JPMC, Karachi. Period: 03 January 2021 till 02 July 2021. Material &amp; Methods: Total 113 patients presenting with knee pain for &gt;4 weeks duration who were referred for knee MRI were selected in the study. Both male and female patients between 15-65 years included in the study. Post-surgical patients and those with contraindication to MRI were excluded from the study. MRI of effected knee was performed in every selected patient by using 1.5 Tesla MRI by placing the knee in extended position with slight external rotation to facilitate imaging. MR images were interpreted by one consultant radiologist for presence or absence of Baker’s cyst. Results: Patients of 15 to 65 years age were included in the study with mean age of 44.94 ± 6.69 years. Out of 113 patients, 65 (57.52%) were male and 48 (42.48%) were female with male to female ratio of 1.4:1. Mean BMI of patients was 27.45 ± 3.02 kg/m2. Mean duration of pain was 5.78 ± 2.30 months. In our study, 22 patients with knee pain were found to have Baker’s cyst on MRI with frequency of 19.47%. Conclusion: This study concluded that frequency of Baker’s cyst on MRI in patients with knee pain is quite high.

DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY IN DIFFERENTIATING BENIGN AND MALIGNANT THYROID NODULES

This study aimed to compare the effectiveness of ultrasonography and fine-needle aspiration cytology (FNAC) in distinguishing between benign and malignant thyroid nodules. To conduct this cross-sectional study, we obtained ethical approval from the institutional review board and collected data from KRL Hospital between December 1, 2021, and April 30, 2022. We included patients of either gender, aged 18 years or above, referred to the radiology department for diagnosis of benign or malignant thyroid nodules or FNAC of nodules, using non-probability consecutive sampling. After giving informed consent, all patients underwent high-resolution Gray ultrasonography performed by a consultant radiologist. The results showed that ultrasonography had a sensitivity of 90.62%, specificity of 88.37%, positive predictive value of 85.29%, negative predictive value of 92.68%, and an overall accuracy of 89.33% in detecting benign and malignant thyroid nodules, as compared to the gold standard, FNAC. Based on these findings, we conclude that ultrasonography is an excellent non-invasive diagnostic tool, with high accuracy and no invasiveness, making it the preferred method for identifying malignant thyroid nodules.