Conventional Radiology Research Articles

The Role of Small-Bowel Endoscopy in the Diagnosis and Management of Small-Bowel Neuroendocrine Tumours

Neuroendocrine tumours (NETs) are relatively rare neoplasms but represent one of the most frequent types of primary small-bowel tumours. Their incidence is rising, and this is most likely because of their more frequent early-stage detection, physician awareness, and increasing availability and use of imaging and small-bowel endoscopic techniques, such as video capsule endoscopy and device-assisted enteroscopy, which enable the detection, localisation, and histological sampling of previously inaccessible and underdiagnosed small-bowel lesions. This review summarises the role of small-bowel endoscopy in the diagnosis and management of small-bowel NETs to assist clinicians in their practice. Small-bowel endoscopy may play a complementary role in the diagnosis of these tumours alongside other diagnostic tests, such as biomarkers, conventional radiology, and functional imaging. In addition, small-bowel enteroscopy may play a role in the preoperative setting for the identification and marking of these tumours for surgical resection and the management of rare complications, such as small-bowel variceal bleeding, in cases of portal hypertension due to the encasement of mesenteric vessels in fibrotic small-bowel NETs.

MRI Radiomics-Based Machine Learning to Predict Lymphovascular Invasion of HER2-Positive Breast Cancer.

This study aims to develop and prospectively validate radiomic models based on MRI to predict lymphovascular invasion (LVI) status in patients with HER2-positive breast cancer. A total of 225 patients with HER2-positive breast cancer who preoperatively underwent breast MRI were selected, forming the training set (n = 99 LVI-positive, n = 126 LVI-negative). A prospective validation cohort included 130 patients with breast cancer from the Affiliated Zhongshan Hospital of Dalian University (n = 57 LVI-positive, n = 73 LVI-negative). A total of 390 radiomic features and eight conventional radiological characteristics were extracted. For the optimum feature selection phase, the LASSO regression model with tenfold cross-validation (CV) was employed to identify features with non-zero coefficients. The conventional radiological (CR) model was determined based on visual morphological (VM) features and the optimal radiomic features correlated with LVI, identified through multivariate logistic analyses. Subsequently, various machine learning (ML) models were developed using algorithms such as support vector machine (SVM), k-nearest neighbor (KNN), gradient boosting machine (GBM), and random forest (RF). The performance of ML and CR models. The results show that the AUC of the CR model in the training and validation sets were 0.81 (95% confidence interval [CI], 0.74-0.86) and 0.82 (95% CI, 0.69-0.89), respectively. The ML model achieved the best performance, with AUCs of 0.96 (95% CI, 0.99-1.00) in the training set and 0.95 (95% CI, 0.89-0.96) in the validation set. There were significant differences between the CR and ML models in predicting LVI status. Our study demonstrated that the machine learning models exhibited superior performance in predicting LVI status based on pretreatment MRI compared to the CR model, which does not necessarily rely on a priori knowledge of visual morphology.

DETERMINATION OF LOCAL DIAGNOSTIC REFERENCE LEVEL (DRL) ON CONVENTIONAL RADIOTHERAPY SIMULATOR WITH BRAIN METASTASIS CASES AT DR. ADHYATMA, MPH HOSPITAL

Conventional simulators in 2-dimensional (2D) radiotherapy procedures can be done with fluoroscopy and single exposure features. The most significant percentage of 2D patients in the radiotherapy installation of Dr. Adhyatma MPH Hospital, are patients with brain metastasis cases, with a percentage of 65% of all 2D patients. Therefore, this study focuses on brain metastasis cases. The feature used in the Radiotherapy Installation of Dr. Adhyatma MPH Hospital is the single exposure feature, which is identical to conventional diagnostic radiology examinations. Radiation in diagnostic radiology requires a local Diagnostic Reference Level (DRL) on a conventional radiotherapy simulator as a guideline for optimizing radiation protection for medical exposure. This study aims to determine the local DRL value of a conventional radiotherapy simulator in cases of brain metastasis and compare it with the national DRL in lateral head examinations. The local DRL value obtained is then used as a guideline in improving services to increase the quality of service to patients. The data collection method is carried out in 2 (two) ways, namely calculating the local DRL value from the ESAK value and interviews related to the quality of the resulting image. The exposure factors used in this study followed the same routine exposure factors with a tube voltage of 72 kV and a tube current of 25 mAs. The local DRL value obtained was 0.586 mGy, with a percentage difference of 51% lower than the national DRL. With this value, the quality of the resulting image is classified as optimal and easy to assess. Thus, the exposure factors in the conventional radiotherapy simulation process in cases of brain metastasis can be used as a guideline for clinical practice at RSUD dr. Adhyatma, MPH. Keywords: conventional radiotherapy simulator, 2-dimensional radiotherapy, local DRL, diagnostic patients, radiation dose.

Note on testing of radiological events in conventional and dental radiology.

Since 2013, the adoption of Directive 2013/59/EURATOM in the European Union has mandated emergency plans for facilities housing radiology equipment, including radiology and dental clinics, and required periodical testing of these plans. However, the testing procedures have sparked widespread confusion regarding the definition of radiological emergencies in clinical settings. A potential solution lies in broadening the scope to include 'radiological events', covering accidents, incidents or other type of unjustified exposures. Utilizing realistic scenarios can enhance the radiological protection system within institutions, specifically addressing situations that might lead to unwanted patient exposure.

Enhancing Radiological Reporting in Head and Neck Cancer: Converting Free-Text CT Scan Reports to Structured Reports Using Large Language Models

Objective The aim of this study was to assess efficacy of large language models (LLMs) for converting free-text computed tomography (CT) scan reports of head and neck cancer (HNCa) patients into a structured format using a predefined template. Materials and Methods A retrospective study was conducted using 150 CT reports of HNCa patients. A comprehensive structured reporting template for HNCa CT scans was developed, and the Generative Pre-trained Transformer 4 (GPT-4) was initially used to convert 50 CT reports into a structured format using this template. The generated structured reports were then evaluated by a radiologist for instances of missing or misinterpreted information and any erroneous additional details added by GPT-4. Following this assessment, the template was refined for improved accuracy. This revised template was then used for conversion of 100 other HNCa CT reports into structured format using GPT-4. These reports were then reevaluated in the same manner. Results Initially, GPT-4 successfully converted all 50 free-text reports into structured reports. However, there were 10 places with missing information: tracheostomy tube (n = 3), noninclusion of involvement of sternocleidomastoid muscle (n = 2), extranodal tumor extension (n = 3), and contiguous involvement of the neck structures by nodal mass rather than the primary (n = 2). Few instances of nonsuspicious lung nodules were misinterpreted as metastases (n = 2). GPT-4 did not indicate any erroneous additional findings. Using the revised reporting template, GPT-4 converted all the 100 CT reports into a structured format with no repeated or additional mistakes. Conclusion LLMs can be used for structuring free-text radiology reports using plain language prompts and a simple yet comprehensive reporting template. Summary Statement Large language models can successfully and accurately convert conventional radiology reports for oncology scans into a structured format using a comprehensive predefined template and thus can enhance the utility and integration of these reports in routine clinical practice. Key Points

Early detection of metastatic disease through screening ultrasound

Screening ultrasound is crucial in emergency care, providing precise guidance for patients in various situations. Its versatility, real-time imaging, and lack of radiation make it invaluable, especially in settings lacking diagnostic resources and specialized expertise. The widespread use of screening ultrasound among health professionals, regardless of their level of sonographic expertise, emphasizes the need for them to manage clinical uncertainties as part of their daily practice." This article emphasizes the crucial role of screening ultrasound, especially in acute abdomen cases. Its integration alongside conventional radiology significantly improves clinical orientation, facilitating prompt treatment decisions and specialist referrals. In a specific case, we reviewed screening ultrasound images, basic abdominal X-rays, and Computed Tomography scans alongside clinical reports to assess initial evaluations made at a peripheral emergency service. Our patient presented with acute abdominal symptoms, revealing suspected liver metastases, free fluid, and signs of intestinal obstruction on ultrasound. These findings were confirmed through Computed Tomography at a referral hospital, showing ultrasound's role in prompt patient triage and transfer. Operator skill is crucial, but comprehensive training minimizes errors. Screening sonography may revolutionize patient safety saving time by detecting pathologies early, preventing overcrowding in emergency departments of reference hospitals. The ultrasonographic detection of images suspected to be metastases is a common occurrence in hospital settings where various advanced diagnostic means, and medical specialties are present. However, the detection of suspicious images of metastases in a pre-hospital context is innovative and provides clinicians with a much better understanding of the patient's clinical landscape.

Collective Effective Dose from Medical Radiation Use in Indonesia: Si-INTAN Data Study Period 2018-2021

Until now, there has been no information regarding the value of the collective dose per procedure using the X-ray modality in Indonesia. As in the ICRP 103 publication (2007), it is stated that the collective effective dose is an instrument for optimizing protection by comparing radiological technology and the protection procedures that will be taken. This article aims to raise awareness and optimize the use of diagnostic X-ray modalities by providing an estimate of the proportion of Indonesia's total population compared to the number of radiation examinations carried out, the collective annual effective dose, and the potential risks. The information provided is based on a data reported to the Patient Dose Data Information System (Si-INTAN) application from 2018 to 2021. The data is in the form of the number of patient examinations per modality and the national Diagnostic Reference Level (DRL) value for each type of procedure. From the results of the analysis, it was found that the proportion of patient examinations per modality in the sequence was conventional radiology (79.19%), CT Scan (17.56%), dental radiology (1.75%), interventional fluoroscopy (0.70%), medical diagnostic nuclear (0.62%), and mammography (0.18%). The majority of the annual collective effective dose in Indonesia comes from CT Scan (97.45%), interventional fluoroscopy (1.30%), conventional radiology (0.86%), diagnostic nuclear medicine (0.38%), and a small percentage from mammography and dental radiology. It is estimated that around 116.6 million Indonesians receive radiation exposure for medical needs with a collective annual effective dose of 860,000 man-Sv. This collective effective dose provides an estimate of the incidence of cancer in the Indonesian population of around 0.016% of the entire population in 2021. This information can be used as a baseline to evaluate trends in using and monitoring ionizing radiation sources for medical imaging needs in Indonesia. Keywords: effective dose, collective effective dose, diagnostic reference level (DRL), radiation imaging, diagnostic X-rays, radiation protection

[Translated article] Use of ultrasound for hardware removal

IntroductionOsteosynthesis hardware removal is one of the most frequent practices in Orthopaedic electives surgeries and is usually carried out guided under fluoroscopy. There are other tools such as ultrasound that allow us to visualise the hardware with the advantage of being free of ionising radiation and with better availability. The objective of our study is to analyse the results obtained in patients undergoing hardware removal in the operating room under ultrasound assistance and local anaesthesia. Material and methodsA descriptive study was carried out collecting variables such as demographic data, reason for the removal, pain during the procedure and in subsequent days, as well as the duration and rate of success of the procedure and the degree of satisfaction. ResultsWe obtained a 100% success in ultrasound-guided extraction without the need for conventional radiology, with a mean VAS of 1.91 and need for subsequent analgesia in 36.4% of the cases, with syndesmotic dynamisation being the most frequent reason for intervention. ConclusionUltrasound is a useful tool in osteosynthesis hardware removal, and that may be sufficient by itself; also saving health personnel and patients from ionising radiation resulting from the use of conventional fluoroscopy.

Assessment of radiation dose received from knee joint X-ray examinations

BackgroundMedical exposure from diagnostic X-ray machines represents the primary artificial source of human exposure to low ionizing radiation. Knee X-rays are a standard examination to diagnose multiple conditions ranging from traumatic injuries, degeneration, and cancer. In Saudi Arabia, there is a lack of available data and pertinent information regarding the assessment of the patient entrance surface dose (ESD) from knee X-rays. This study aims to estimate the ESD for adult patients undergoing knee X-ray examinations at four major medical centres in Saudi Arabia. Methods and materialsThe ESD was estimated indirectly using X-ray exposure factors for patients and directly using optically stimulated luminescence (OSL). The results were compared with previous studies conducted nationally and internationally and with international reference levels. ResultsThe results of this research showed that the mean patient ESD was 1.4 ± 0.37 mGy using the direct method and 1.12 ± 0.20 mGy using the indirect method. The estimated mean ESD values were found to be much higher than the mean ESD reference values, emphasizing the crucial requirement for optimizing radiation doses in conventional radiology to improve patient safety and diagnostic effectiveness. ConclusionThis confirms the requirement for reducing patients’ doses to the tolerable levels recommended by many international radiation protection commissions.

COST ASSESSMENT OF COMPUTED RADIOGRAPHY TOWARDS CONVENTIONAL RADIOGRAPHY

Introduction: With the expansion of the development of computer equipment and the improvement of software interfaces, there is also a sudden development of radiology without film, through computerized radiography (CR) systems. The CR system made it possible to improve the quality of the radiological image, and thus to make a more accurate and faster diagnosis.Objective: To estimate the costs of computed radiography compared to conventional radiography.Materials and methods: The analysis used data on the costs of radiological materials and existing radiological information systems from the plans and signed contracts for 2019 and 2022 in the Croatian Hospital "Dr. Fr. Mato Nikolić" Nova Bila.Results: Thecosts of conventional radiology are exceptionally high, including the procurement of X-ray films, processing chemicals, and equipment maintenance. The analysis compares the number of procedures and the displayed costs for the hospital.Conclusion: Computerized radiography is more cost-effective than conventional radiography due to reusable phosphor imaging plates and reduced chemical and film expenses.Keywords: Diagnostic Imaging, Radiography, Cost-Effectiveness Analysis,Radiology Information Systems

Design, In Vitro Evaluation and In Vivo Biocompatibility of Additive Manufacturing Three-Dimensional Printing of β beta-Tricalcium Phosphate Scaffolds for Bone Regeneration

The reconstruction of bone deficiencies remains a challenge due to the limitations of autologous bone grafting. The objective of this study is to evaluate the bone regeneration efficacy of additive manufacturing of tricalcium phosphate (TCP) implants using lithography-based ceramic manufacturing (LCM). LCM uses LithaBone TCP 300 slurry for 3D printing, producing cylindrical scaffolds. Four models of internal scaffold geometry were developed and compared. The in vitro studies included cell culture, differentiation, seeding, morphological studies and detection of early osteogenesis. The in vivo studies involved 42 Wistar rats divided into four groups (control, membrane, scaffold (TCP) and membrane with TCP). In each animal, unilateral right mandibular defects with a total thickness of 5 mm were surgically performed. The animals were sacrificed 3 and 6 months after surgery. Bone neoformation was evaluated by conventional histology, radiology, and micro-CT. Model A (spheres with intersecting and aligned arrays) showed higher penetration and interconnection. Histological and radiological analysis by micro-CT revealed increased bone formation in the grafted groups, especially when combined with a membrane. Our innovative 3D printing technology, combined with precise scaffold design and efficient cleaning, shows potential for bone regeneration. However, further refinement of the technique and long-term clinical studies are crucial to establish the safety and efficacy of these advanced 3D printed scaffolds in human patients.

Imaging in temporomandibular joint disorders

The temporomandibular joint is a unique and complex joint. Various imaging techniques have been developed to properly visualize this complex joint, such as conventional radiology, orthopantomography, CBCT and MRI. Imaging can contribute to the differential diagnosis of temporomandibular joint disorders. Common joint disorders are arthritis and internal derangement. Osseous changes of the temporomandibular joint can be clearly visualized with CBCT. MRI is superior for imaging the internal anatomy of the temporomandibular joint and is preferred in the context of internal derangement.

Imaging of chronic rhinosinusitis with nasal polyps in the era of biological therapies.

Chronic rhinosinusitis (CRS) is a chronic inflammatory disorder of the sinonasal cavities classified into two major phenotypes: CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). The diagnosis of CRS is based on clinical symptoms associated with imaging and/or nasal endoscopy findings of mucosal inflammation. Recently, novel biological therapies have emerged as therapeutic options for CRSwNP. Imaging is helpful in deciding whether surgery is likely to be beneficial and in guiding surgery. It can also help demonstrate a clinical response to medical therapy. However, specific guidelines concerning the role of imaging in CRwNP are lacking. This article provides a comprehensive and critical multidisciplinary review of the role of conventional radiology, computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis and characterization of CRSwNP. Since the complete characterization of nasal polyps on CT or MR images is very challenging, we provide a critical review of the best imaging methods and essential reporting elements used to assess nasal polyps.

Lost needle in the oral cavity: can the nightmare be just a bad dream?

The loss of a scalpel or a needle during surgery can threaten the health of the patient and lead to additional costs, and radiographical assistance during surgery has been the only recovery method. This study evaluates the efficacy of a metal detector compared with conventional radiology for recovering a needle lost in the oropharynx during surgery. Different fragment sizes of needles normally used in pharyngoplasty were embedded at different locations and depths in a lamb's head. Three experienced and three junior otolaryngologists searched for the needle fragments using a metal detector and conventional radiology. All fragments were found with each method, but the mean searching time was 90 per cent shorter with the metal detector. A metal detector can be a useful tool for locating needles that break during ENT surgery, as it requires less time than conventional radiology and avoids exposing patients to radiation.

Is proctoscopy sufficient for the evaluation of colorectal anastomosis prior to ileostomy reversal? A nationwide retrospective analysis of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative group (SICO-CCN).

Several methods for assessing anastomotic integrity have been proposed, but the best is yet to be defined. The aim of this study was to compare the different methods to assess the integrity of colorectal anastomosis prior to ileostomy reversal. A retrospective cohort analysis on patients between 1 January 2010 and 31 December 2020 with a defunctioning stoma for middle and low rectal anterior resection was performed. A propensity score matching comparison between patients who underwent proctoscopy alone and patients who underwent proctoscopy plus any other preoperative method to assess the integrity of colorectal anastomosis prior to ileostomy reversal (transanal water-soluble contrast enema via conventional radiology, transanal water-soluble contrast enema via CT, and magnetic resonance) was performed. The analysis involved 1045 patients from 26 Italian referral colorectal centres. The comparison between proctoscopy alone versus proctoscopy plus any other preoperative tool showed no significant differences in terms of stenoses (p = 0.217) or leakages (p = 0.103) prior to ileostomy reversal, as well as no differences in terms of misdiagnosed stenoses (p = 0.302) or leakages (p = 0.509). Interestingly, in the group that underwent proctoscopy and transanal water-soluble contrast enema the comparison between the two procedures demonstrated no significant differences in detecting stenoses (2 vs. 0, p = 0.98), while there was a significant difference in detecting leakages in favour of transanal water-soluble contrast enema via CT (3 vs. 12, p = 0.03). We can confirm that proctoscopy alone should be considered sufficient prior to ileostomy reversal. However, in cases in which the results of proctoscopy are not completely clear or the surgeon remains suspicious of an anastomotic leakage, transanal water-soluble contrast enema via CT could guarantee its detection.

Conventional Radiology Evaluation of Neonatal Intravascular Devices (NIVDs): A Case Series.

Our radiology department conducted an assessment of 300 neonatal radiographs in the neonatal intensive care unit over almost two years. The purpose was to evaluate the correct positioning of intravascular venous catheters. Our case series revealed that out of a total of 95 cases with misplaced devices, 59 were umbilical venous catheters and 36 were peripherally inserted central catheters. However, all of the central venous catheters were found to be properly positioned. Misplacements of neonatal intravascular devices were found to occur more frequently than expected. The scientific literature contains several articles highlighting the potential complications associated with misplaced devices. Our goal is to highlight the potential misplacements and associated complications that radiologists may encounter while reviewing conventional radiology imaging. Based on our experience, which primarily involved placing UVCs and PICCs, we discovered that conventional radiology is the most effective method for assessing proper device placement with the lowest possible radiation exposure. Given the high number of neonatal vascular device placement procedures, it is essential for radiologists to maintain a high level of vigilance and stay updated on the latest developments in this field.

Conformity Assessment of Lead Aprons Used in Conventional Radiology: A Multi-Centre Survey in Togo

Conformity Assessment of Lead Aprons Used in Conventional Radiology: A Multi-Centre Survey in Togo

Traumatic osteoarticular radiography: indications and systematic interpretation

In most cases, conventional radiology interpretations are straightforward, enabling a precise diagnosis to be made by combining them with a range of anamnestic and clinical arguments. However, omitting post-traumatic osteoarticular anomalies when interpreting radiographs can have serious functional consequences for the patient. In order to prevent diagnostic errors, it is essential to be aware of certain rules governing the indication of imaging and its systematic interpretation.

Occupational Safety And Health System For Radiation Workers In The Conventional Radiology Room Rumkit Tk II Pelamonia Makassar

K3 system for radiation workers in the conventional radiology room at TK II Pelamonia Makassar. The aim of this research is to determine the completeness and compliance of radiation workers in implementing K3. The K3 system in the Conventional Radiology Room at Tk II Pelamonia Makassar is to use PPE aprons when the radiation is carried out. The PPE apron is used only if the patient requires assistance during the radiation. Radiographers also carry out occupational safety and health training and carry out routine health checks carried out by hospitals. When the radiation is carried out, the radiographer stands behind a wall/screen coated with Pb. Radiographers also always use TLD when on duty or carrying out radiation.

Analisa Pengukuran Entrance Surface Dose (ESD) Menggunakan Optically Stimulated Luminescence Dosimeter (OSLD) Pada Pasien Anak

The surface dose of radiation in conventional diagnostic radiology exams, also known as the entrance surface dose (ESD), is measured to ensure optimal radiation protection for patients. This study aimed to determine and analyze the doses received by pediatric patients who underwent a chest X-ray examination while being treated in the NICU and PICU rooms at Hermina Karawang Hospital. The research involved measuring the radiation dose in pediatric patients using the OSLD nanoDot. This susceptible device can detect low-dose X-ray radiation exposure, especially in pediatric patients. The study was conducted from September to December 2022 and included 35 patients aged 0 to 5. The results of the ESD measurements received by pediatric patients at Hermina Karawang Hospital in the 0-1 year age group were found to be in line with the DRL (Diagnostic Reference Levels) of the United Kingdom (UK) and Austria, which recommend a range of 0.05 – 0.055 mGy. The average ESD value for this age group was 0.05 mGy. Similarly, for the 1-5 year age group, an average ESD value of 0.048 mGy was obtained, below the UK and Austria DRL range of 0.05 – 0.069 mGy. These results indicate that the ESD received by pediatric patients during thoracic examination at Hermina Karawang Hospital is close to the DRL values recommended by the UK and Austria. However, it is essential to note that regardless of the dose received, it must always be justified and optimized to prevent unnecessary radiation exposure. Keywords: ESD, OSLD, unnecessary exposure, paediatric radiation protection, radiation exposure