Imaging Reporting Research Articles

Tumour-pleura relationship on computed tomography (CT) provides effective risk stratification for peripheral pulmonary nodules with Lung Imaging Reporting and Data System (Lung-RADS) score of 4X.

Pulmonary nodules with Lung Imaging Reporting and Data System (Lung-RADS) 4X are of greater clinical significance, and accurate differentiation of pathological types and visceral pleural invasion (VPI) of Lung-RADS 4X peripheral pulmonary nodules before treatment can aid in stratification. This study set out to investigate whether the tumour-pleura relationship on computed tomography (CT) can provide effective risk stratification for peripheral pulmonary nodules with Lung-RADS 4X. This was a single institution, retrospective study of 482 consecutive patients with Lung-RADS score 4X, who were pathologically diagnosed with tuberculous granuloma and adenocarcinoma from January 2019 to December 2023. We assessed clinical factors (baseline characteristics and tumour markers) and CT findings. Univariate and multivariate logistic regression analyses were used to determine the classification of pulmonary nodules and predictors of VPI. Multivariate analysis revealed that gender [odds ratio (OR) =0.392; P<0.001], carcinoembryonic antigen (CEA) level (OR =8.331; P<0.001), type of nodules (OR =13.551 and 7.478; P<0.001 and P=0.016) and maximum base width of soft tissue component on the pleura side (OR =0.857; P=0.005) were significant independent factors for distinguishing tuberculous granuloma from adenocarcinoma. And the type of linear connection between lesion and pleura (OR =3.936; P<0.001), and the maximum base width of soft tissue components on the pleura side (OR =1.359; P=0.001) were correlated independently with VPI. The area under the curve (AUC) for predicting pulmonary nodules classification was 82.60% [95% confidence interval (CI): 78.85-86.35%), and the AUC for predicting VPI was 76.10% (95% CI: 69.83-82.38%). The tumour-pleura relationship will be helpful in further risk stratification for peripheral pulmonary nodules with a score of Lung-RADS 4X.

Avoidable biopsies? Validating artificial intelligence–based decision support software in indeterminate thyroid nodules

BackgroundMultiple artificial intelligence (AI) systems have been approved to risk-stratify thyroid nodules through sonographic characterization. We sought to validate the ability of one such AI system, Koios DS (Koios Medical, Chicago, IL), to aid in improving risk stratification of indeterminate thyroid nodules. MethodsA retrospective single-institution dataset was compiled of 28 cytologically indeterminate thyroid nodules having undergone molecular testing and surgical resection, with surgical pathology categorized as malignant or benign. Nodules were retrospectively evaluated with Koios DS. After nodule selection, automated and AI-adapter–derived Thyroid Imaging Reporting and Data System (TI-RADS) levels were recorded, and agreement with radiologist-derived levels was assessed using Cohen’s κ statistic. The performance of malignancy classification was compared between the radiologist and AI-adapter. Biopsy thresholds were re-evaluated using the AI-adapter. ResultsIn this cohort, 7 (25%) nodules were malignant on surgical pathology. The median nodule size was 2.4 cm (interquartile range: 1.8–2.9 cm). Median radiologist and automated TI-RADS levels were both 4, with κ 0.25 (“fair agreement”). Malignancy classification by the radiologist provided sensitivity 100%, specificity 33.3%, positive predictive value (PPV) 33.3%, and negative predictive value (NPV) 100%, compared with the AI-adapter’s performance with sensitivity 85.7%, specificity 76.2%, PPV 54.5%, and NPV 94.1%. Using the AI-adapter, 14 of 28 biopsies would have been deferred, 13 of which were surgically benign. ConclusionKoios automated and radiologist-derived TI-RADS levels were in consistent agreement for indeterminate thyroid nodules. Malignancy reclassification with the AI-adapter improved PPV at minimal cost to NPV. Risk stratification with the addition of the AI-adapter may allow for more accurate patient counseling and the avoidance of biopsies in select cases that would otherwise be cytologically indeterminate.

Machine learning model based on dynamic contrast-enhanced ultrasound assisting LI-RADS diagnosis of HCC: A multicenter diagnostic study

BackgroundTo enhance the accuracy of hepatocellular carcinoma (HCC) diagnosis using contrast-enhanced (CE) US, the American College of Radiology developed the CEUS Liver Imaging Reporting and Data System (LI-RADS). However, the system still exhibits limitations in distinguishing between HCC and non-HCC lesions. PurposeTo investigate the viability of employing machine learning methods based on quantitative parameters of contrast-enhanced ultrasound for distinguishing HCC within LR-M nodules. Materials and methodsThis retrospective analysis was conducted on pre-treatment CEUS data from liver nodule patients across multiple centers between January 2013 and June 2022. Quantitative analysis was performed using CEUS images, and the machine learning diagnostic models based on quantitative parameters were utilized for the classification diagnosis of LR-M nodules. The performance of the model was assessed using the area under the receiver operating characteristic curve (AUC) and compared with the performance of four radiologists. ResultsThe training and internal testing datasets comprised 168 patients (median age, 53 years [IQR, 18 years]), while the external testing datasets from two other centers included 110 patients (median age, 54 years [IQR, 16 years]). In the internal independent test set, the top-performing Random Forest model achieved an AUC of 0.796 (95%CI: 0.729–0.853) for diagnosing HCC. This model exhibited a sensitivity of 0.752 (95%CI: 0.750–0.755) and a specificity of 0.761 (95%CI: 0.758–0.764), outperforming junior radiologists who achieved an AUC of 0.619 (95%CI: 0.543–0.691, p < .01) with sensitivity and specificity of 0.716 (95%CI: 0.713–0.718) and 0.522 (95%CI: 0.519–0.526), respectively. ConclusionSignificant differences in contrast-enhanced ultrasound quantitative parameters are observed between HCC and non-HCC lesions. Machine learning models leveraging these parameters effectively distinguish HCC categorized as LR-M, offering a valuable adjunct for the accurate classification of liver nodules within the CEUS LI-RADS framework.

Influence of Prior Imaging Review on Recommendations for Additional Diagnostic Testing: Retrospective Analysis of Imaging Reports in a Chiropractic Radiology Practice

ObjectiveThe purpose of this study was to assess the influence of prior imaging review on recommendations for additional diagnostic testing in an academic chiropractic radiology practice. A secondary aim was to explore the influence of prior imaging review on radiographic interpretation. MethodsWe retrospectively reviewed radiology reports generated from July 18, 2022, to July 18, 2023, from the Palmer College of Chiropractic main campus (Davenport, Iowa) clinic system. Imaging interpretation included an automated search for prior images in an internal picture archival and communication system (PACS). Images from regional health system databases were available and sought by radiologists when (1) unclear radiologic findings had potential clinical implications or (2) prior imaging could clarify potential problems detected in a clinical history. Data were abstracted to a secure adaptive electronic questionnaire and analyzed descriptively. ResultsWe reviewed 1712 radiographic and 165 musculoskeletal diagnostic ultrasound reports for 1552 unique individuals (811 [52.3%] females and 741 [47.7%] males) with a mean age of 42.1 years (range, 2-93 years). Prior imaging was described in 417 (22.2%) reports; 246 (58.9%) indicated images from internal PACS, 192 (46.0%) indicated images from external PACS, and 21 noted both internal and external PACS. Prior imaging findings were credited with answering a clinical question in 98 (23.5%), and a radiographic question in 228 (54.7%) of 417 reports. The process negated the need for follow-up diagnostic testing recommendations in 119 (28.5%) instances, leading to additional imaging recommendations in 19 (4.6%). ConclusionData obtained in this study suggest that comparing current and previous imaging may help reduce unnecessary additional imaging or follow-up diagnostic testing recommendations. Prior imaging review may also facilitate diagnostic confidence and interpretation clarity.

The Ovarian-Adnexal Reporting and Data System (O-RADS) US Score Effect on Surgical Resection Rate.

Background The Ovarian-Adnexal Imaging Reporting and Data System (O-RADS) US risk score can be used to accurately stratify ovarian lesions based on morphologic characteristics. However, there are no large multicenter studies assessing the potential impact of using O-RADS US version 2022 risk score in patients referred for surgery for an ovarian or adnexal lesion. Purpose To retrospectively determine the proportion of patients with ovarian or adnexal lesions without acute symptoms who may have been managed conservatively by using the O-RADS US version 2022 risk score. Materials and Methods This multicenter retrospective study included patients with ovarian cystic lesions and nonacute symptoms who underwent surgical resection after US before the introduction of O-RADS US between January 2011 and December 2014. Investigators blinded to the final diagnoses recorded lesion imaging features and O-RADS US risk scores. The frequency of malignancy and the diagnostic performance of the risk score were calculated. The Mann-Whitney test and Fisher exact test were performed, with P < .05 indicating a statistically significant difference. Results A total of 377 patients with surgically resected lesions were included. Among the resected lesions, 42% (157 of 377) were assigned an O-RADS US risk score of 2. Of the O-RADS US 2 lesions, 54% (86 of 157) were nonneoplastic, 45% (70 of 157) were dermoids or other benign tumors, and less than 1% (one of 157) were malignant. Using O-RADS US 4 as the optimal threshold for malignancy prediction yielded a 94% (68 of 72) sensitivity, 64% (195 of 305) specificity, 38% (68 of 178) positive predictive value, and 98% (195 of 199) negative predictive value. Conclusion In patients without acute symptoms who underwent surgery for ovarian and adnexal lesions before the O-RADS US risk score was published, nearly half (42%) of surgically resected lesions retrospectively met the O-RADS US 2 version 2022 criteria. In these patients, imaging follow-up or conservative management could have been offered. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Fournier in this issue.

Pathological response following neoadjuvant immune checkpoint inhibitors in patients with hepatocellular carcinoma: a cross-trial, patient-level analysis

Neoadjuvant use of immune checkpoint inhibitors (ICIs) before liver resection results in pathological tumour regression in patients with hepatocellular carcinoma. We aimed to describe the characteristics of pathological responses after preoperative ICI therapy for hepatocellular carcinoma and to evaluate the association between the depth of tumour regression and relapse-free survival. In this cross-trial, patient-level analysis, we performed a pooled analysis of data from patients with hepatocellular carcinoma receiving ICI therapy before liver resection as part of a global collaborative consortium (NeoHCC) of five phase 1 and 2 clinical trials and standardised observational protocols conducted in 12 tertiary referral centres across the USA, UK, and Taiwan. Eligible patients were adults (aged ≥18 years) diagnosed with hepatocellular carcinoma by tissue core biopsy before treatment initiation, a Liver Imaging Reporting and Data System score of 5 on imaging, or both, with an Eastern Cooperative Oncology Group performance status score of 0-1, and no extrahepatic spread or previous ICI treatment. Pathological response was measured as the percentage of non-viable tumour in the resected surgical specimen, with major pathological response corresponding to at least 70% tumour regression and pathological complete response corresponding to 100% tumour regression. We correlated pathological response with radiological overall response using RECIST criteria (version 1.1) and relapse-free survival, and evaluated the threshold of tumour regression that could be optimally associated with relapse-free survival. At data cutoff on Jan 31, 2024, 111 patients were included in the study, of whom data on pathological response were available for 104 (94%) patients. Patients received treatment from Oct 5, 2017, to Nov 15, 2023, mostly ICI combinations (76 [69%]), for a median of 1·4 months (IQR 0·7-2·9). 87 (78%) patients were men and 24 (22%) were women. Most patients had underlying viral chronic liver disease (73 [66%]) and Barcelona Clinic Liver Cancer stage A hepatocellular carcinoma (61 [55%]), without portal vein thrombosis (87 [78%]). We observed major pathological response in 33 (32%) patients and pathological complete response in 19 (18%) patients. Radiological overall response was associated with major pathological response, with 23 (74%) of 31 patients with radiological response showing major pathological response compared with ten (14%) of 73 patients without radiological response (p<0·0001). However, ten (30%) of 33 major pathological responses were not predicted by radiological response. After a median follow-up of 27·2 months (95% CI 22·3-32·1), median relapse-free survival for the whole cohort was 43·6 months (95% CI 28·3-not evaluable). Relapse-free survival was significantly longer in patients with major pathological response than in those who did not have a major pathological response (not reached [95% CI not evaluable-not evaluable] vs 28·3 months [12·8-43·8]; hazard ratio 0·26 [0·10-0·66]; p=0·0024) and in patients with pathological complete response than in those who did not have a pathological complete response (NR [95% CI not evaluable-not evaluable] vs 32·8 months [15·0-50·5]; 0·19 [0·05-0·78]; p=0·010). Unbiased recursive partitioning of the cohort for the risk of relapse, death, or both identified a threshold of 90% as the optimal cutoff of pathological tumour regression to predict improved relapse-free survival. The extent of tumour regression following neoadjuvant ICI therapy could identify patients with improved relapse-free survival following liver resection. The threshold of at least 90% tumour regression should be validated for its surrogate role for relapse-free survival in phase 3 randomised controlled trials. None.

Diagnostic Accuracy of Screening Contrast-enhanced Mammography for Women with Extremely Dense Breasts at Increased Risk of Breast Cancer.

Background Mammogram interpretation is challenging in female patients with extremely dense breasts (Breast Imaging Reporting and Data System [BI-RADS] category D), who have a higher breast cancer risk. Contrast-enhanced mammography (CEM) has recently emerged as a potential alternative; however, data regarding CEM utility in this subpopulation are limited. Purpose To evaluate the diagnostic performance of CEM for breast cancer screening in female patients with extremely dense breasts. Materials and Methods This retrospective single-institution study included consecutive CEM examinations in asymptomatic female patients with extremely dense breasts performed from December 2012 to March 2022. From CEM examinations, low-energy (LE) images were the equivalent of a two-dimensional full-field digital mammogram. Recombined images highlighting areas of contrast enhancement were constructed using a postprocessing algorithm. The sensitivity and specificity of LE images and CEM images (ie, including both LE and recombined images) were calculated and compared using the McNemar test. Results This study included 1299 screening CEM examinations (609 female patients; mean age, 50 years ± 9 [SD]). Sixteen screen-detected cancers were diagnosed, and two interval cancers occured. Five cancers were depicted at LE imaging and an additional 11 cancers were depicted at CEM (incremental cancer detection rate, 8.7 cancers per 1000 examinations). CEM sensitivity was 88.9% (16 of 18; 95% CI: 65.3, 98.6), which was higher than the LE examination sensitivity of 27.8% (five of 18; 95% CI: 9.7, 53.5) (P = .003). However, there was decreased CEM specificity (88.9%; 1108 of 1246; 95% CI: 87.0, 90.6) compared with LE imaging (specificity, 96.2%; 1199 of 1246; 95% CI: 95.0, 97.2) (P < .001). Compared with specificity at baseline, CEM specificity at follow-up improved to 90.7% (705 of 777; 95% CI: 88.5, 92.7; P = .01). Conclusion Compared with LE imaging, CEM showed higher sensitivity but lower specificity in female patients with extremely dense breasts, although specificity improved at follow-up. © RSNA, 2024 See also the editorial by Lobbes in this issue.

The Accuracy of Radiographers Preliminary Image Evaluations of Axial Radiographs: a Prospective Longitudinal Study at Al-Hussein Hospital, Iraq

Introduction: Modern emergency departments are under increasing pressure that can only be alleviated by new approaches to meeting demand. One strategy could be the adoption of radiographer preliminary image evaluations (PIEs), which would significantly reduce the time it takes emergency teams to receive critical imagery results. The aim of this study was to examine the accuracy of radiographers’ interpretations of axial radiographs and the impact a short training program had on their image interpretation skills. Methods: Forty-one radiographers volunteered to participate in the study. From 15 January to 15 April 2023 radiographers produced PIEs for 24 axial radiographs which were compared to the radiology reports for the same images. The accuracy each of the radiographers’ PIEs were categorized as true positive, true negative, false positive and false negative, with numerical scores to enable mean accuracies to be calculated. The radiographers’ accuracy was then reassessed on the same images after they had completed a two-week training program on axial skeletal radiograph interpretation. Results: The study reported that demonstrated that most (TP) radiographer PIEs (M = 5.66, SD = 1.24) were about facial bone fracture. Moreover, this study demonstrated that most (FN/TP) radiographer PIEs (M = 3.83, SD = 1.69) were that cases about inflammatory disease of the axial spine, such as ankylosing spondylitis. In contrast, the most common cases misinterpreted were about cervical spine disorders such as diffuse idiopathic skeletal hyperostosis (DISH) (M = 2.49, SD = 1.36). Years of experience in radiography showed a positive but not statistically significant influence on accuracy. Additionally, post training mean accuracy significantly improved. Conclusion: This study found radiographers provided quite accurate PIEs for facial bone fractures when compared to the full radiology reports of the same images. The findings also highlighted specific pathologies that were frequently misinterpreted. A two-week training program was found to be effective at improving radiographers’ ability to correctly identify and describe abnormalities present in axial radiographs.

Assessment of large-scale imaging practices in patients with acute brain hemorrhage in French emergency departments: Emergency imaging practices in hemorrhagic stroke

ObjectiveIntracerebral hemorrhage (ICH) is a life-threatening condition, where imaging plays a crucial role but remains poorly standardized. Our main objective was to analyze the imaging protocols used during the acute phase of ICH and ascertain the proportion of patients diagnosed with secondary hemorrhage. Patients and methodsA multicenter retrospective observational study was conducted across over 100 French hospitals affiliated with a national tele-imaging network dedicated to emergency imaging. Among patients managed in the “Stroke Alert” pathway for suspected acute stroke from March 2021 to April 2023, those with ICH diagnosed within 24 h of symptoms onset were identified. Their imaging reports were reviewed to identify the imaging modality used and protocols performed and investigate whether a secondary cause was identified. ResultsOf the 18,356 patients included in the ”Stroke Alert” pathway, 662 cerebral hemorrhages were identified (3.6 %). Computed tomography (CT) was the most widely used imaging modality in the acute phase (71.8 % of examinations). Vascular imaging was performed in 78 % of patients with cerebral hemorrhage, most often CT angiography or TOF magnetic resonance angiography. A secondary cause was identified in 8.2 % (54/662) of cerebral hemorrhages, including vascular imaging in the vast majority of cases (92.6 %). ConclusionOptimization and standardization of imaging protocols in the acute phase of ICH is essential to improve the detection of its secondary causes, particularly vascular, requiring urgent treatment. Vascular imaging improves their early detection.

Integrated model of secondary fracture prevention in primary care (INTERCEPT): protocol for a cluster randomised controlled multicentre trial

BackgroundOsteoporotic fractures signal severely compromised bone strength and are associated with a greatly increased risk of refracture. Despite the availability of effective and safe medications that reduce fracture risk, 70–80% of patients are inadequately investigated or treated for osteoporosis following an initial fracture, constituting a significant ‘osteoporosis care gap’. Optimal methods of bridging this gap with primary care at the forefront of secondary fracture prevention remain undetermined. This protocol describes a cluster randomised controlled trial to evaluate the effectiveness of a novel integrated model of secondary fracture prevention and management in primary care.MethodsThe cluster randomised controlled trial involves multiple branches of a community-based radiology provider (CRP), a hospital-based secondary fracture prevention program (SFPP) and numerous primary care practices in metropolitan Sydney that refer to either the CRP or SFPP. Using natural language processing tools, patients diagnosed with a potential osteoporotic fracture will be identified by automatically screening radiology reports generated at the CRP or SFPP. The primary care practices that these patients attend will be randomised (1:1) to either the intervention or usual care. The intervention consists of (i) electronic and fax alerts informing the practice/primary care physician that their patient has been diagnosed with a potential osteoporotic fracture; (ii) provision of osteoporosis management guidelines and (iii) follow-up surveys at 4 weeks and 6 months. Practices in the usual care (control) group will receive no alerts and provide usual care. The primary outcome is the proportion of patients undergoing a bone density scan and/or filling a prescription for osteo-protective pharmacotherapy within 3 months of the initial diagnostic imaging report. Secondary outcomes are the proportion of patients: (i) undergoing an osteoporosis-related blood test within 3 months of the initial diagnostic imaging report; (ii) initiated on a chronic disease management plan within 3 months of the diagnostic report, and (iii) filling a second prescription for osteo-protective pharmacotherapy within 9 months post initial diagnostic imaging report. Outcomes will be obtained through de-identified linked data from Medical Benefits Schedule and Pharmaceutical Benefits Scheme held by the Australian Institute of Health and Welfare.DiscussionThis is the first randomised trial to integrate case-detection of potential osteoporotic fractures in a hospital and community setting with direct alerts to the patient’s primary care provider. This study will determine whether such an intervention is effective in improving investigation and/or treatment rates of osteoporosis in patients with a potential osteoporotic fracture.Trial registrationThis study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000658617p.

Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis.

The Liver Imaging Reporting and Data System (LI-RADS) does not consider factors extrinsic to the observation of interest, such as concurrent LR-5 observations. To evaluate whether the presence of a concurrent LR-5 observation is associated with a difference in the probability that LR-3 or LR-4 observations represent hepatocellular carcinoma (HCC) through an individual participant data (IPD) meta-analysis. Multiple databases were searched from 1/2014 to 2/2023 for studies evaluating the diagnostic accuracy of CT/MRI for HCC using LI-RADS v2014/2017/2018. The search strategy, study selection, and data collection process can be found at https://osf.io/rpg8x . Using a generalized linear mixed model (GLMM), IPD were pooled across studies and modeled simultaneously with a one-stage meta-analysis approach to estimate positive predictive value (PPV) of LR-3 and LR-4 observations without and with concurrent LR-5 for the diagnosis of HCC. Risk of bias was assessed using a composite reference standard and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Twenty-nine studies comprising 2591 observations in 1456 patients (mean age 59years, 1083 [74%] male) were included. 587/1960 (29.9%) LR-3 observations in 1009 patients had concurrent LR-5. The PPV for LR-3 observations with concurrent LR-5 was not significantly different from the PPV without LR-5 (45.4% vs 37.1%, p = 0.63). 264/631 (41.8%) LR-4 observations in 447 patients had concurrent LR-5. The PPV for LR-4 observations with concurrent LR-5 was not significantly different from LR-4 observations without concurrent LR-5 (88.6% vs 69.5%, p = 0.08). A sensitivity analysis for low-risk of bias studies (n = 9) did not differ from the primary analysis. The presence of concurrent LR-5 was not significantly associated with differences in PPV for HCC in LR-3 or LR-4 observations, supporting the current LI-RADS paradigm, wherein the presence of synchronous LR-5 may not alter the categorization of LR-3 and LR-4 observations.

The Accuracy of Radiographers Preliminary Image Evaluations of Axial Radiographs: a Prospective Longitudinal Study at Al-Hussein Hospital, Iraq

Introduction: Modern emergency departments are under increasing pressure that can only be alleviated by new approaches to meeting demand. One strategy could be the adoption of radiographer preliminary image evaluations (PIEs), which would significantly reduce the time it takes emergency teams to receive critical imagery results. The aim of this study was to examine the accuracy of radiographers’ interpretations of axial radiographs and the impact a short training program had on their image interpretation skills. Methods: Forty-one radiographers volunteered to participate in the study. From 15 January to 15 April 2023 radiographers produced PIEs for 24 axial radiographs which were compared to the radiology reports for the same images. The accuracy each of the radiographers’ PIEs were categorized as true positive, true negative, false positive and false negative, with numerical scores to enable mean accuracies to be calculated. The radiographers’ accuracy was then reassessed on the same images after they had completed a two-week training program on axial skeletal radiograph interpretation. Results: The study reported that demonstrated that most (TP) radiographer PIEs (M 66, SD = 1.24) were about facial bone fracture. Moreover, this study demonstrated that most (FN/TP) radiographer PIEs (M = 3.83, SD = 1.69) were that cases about inflammatory disease of the axial spine, such as ankylosing spondylitis. In contrast, the most common cases misinterpreted were about cervical spine disorders such as diffuse idiopathic skeletal hyperostosis (DISH) (M = 2.49, SD = 1.36). Years of experience in radiography showed a positive but not statistically significant influence on accuracy. Additionally, post training mean accuracy significantly improved. Conclusion: This study found radiographers provided quite accurate PIEs for facial bone fractures when compared to the full radiology reports of the same images. The findings also highlighted specific pathologies that were frequently misinterpreted. A two-week training program was found to be effective at improving radiographers’ ability to correctly identify and describe abnormalities present in axial radiographs.

Significance of Incidental Thyroid Findings in a Large Community‐based Lung Cancer Screening Cohort

ObjectivesInvestigate incidental findings of neck pathology on lung cancer screening computer tomography scans and determine clinical relevance in a population of heavy smokers.MethodsA retrospective chart review was conducted utilizing a database of patients who underwent a chest computed tomography (CT) through a robust community‐based hospital lung cancer screening program in 2019 and 2020. Demographics, medical history, imaging reports, and any pathology results were analyzed.ResultsA total of 1738 patients received a lung screening scan during the study period. The median age of the patient population was 64 (range: 50–79), 886 (51%) were male, and 1599 (92%) were Caucasian. Ninety‐four (5.4%) were found to have neck findings on their CT report, including thyroid nodules, calcifications, heterogeneity or enlargements, pathologic appearing lymph nodes, or parathyroids. Forty‐two patients had evidence of follow‐up for their thyroid findings, and three of these ultimately underwent surgical intervention.ConclusionThe results of our study demonstrate that lung cancer screening chest scans can discover clinically relevant findings in the neck. The risks and benefits of screening needs to be thoroughly evaluated. Given the relatively low incidence of findings in this population, a prospective study in conjunction with screening questionnaire for symptoms may increase the yield of incidental findings.Level of Evidence3 Laryngoscope, 2024

Abstract C016: Optical Techniques to Democratize Intravital Quantification of Metabolic Heterogeneity

Abstract Since metabolic and vascular adaptations are essential for tumor cell survival, a technique capable of tracking metabolic heterogeneity at both the bulk tumor and cellular scales over extended timelines is necessary. To address this technological need, we have developed a multi-scale optical microscope relying on exogenous fluorescent reporters for dynamic spatiotemporal imaging of major metabolic pathways in vivo. This microscope utilizes a low-cost CMOS detector and LEDs for excitation to enable fluorescence microscopy in resource-limited settings. Here, we implement our system to assess changes in bulk tumor and cellular metabolic heterogeneity as vasculature is perturbed. 4T1 breast tumor-bearing mice were treated with combretastatin A-1 (a vascular disruptor), implanted with window chambers, and temporally imaged (n=5/group). Fluorescence imaging and Gabor filter/Djikstra segmentation approaches enabled metabolic and vascular analyses, respectively. We demonstrated the system’s ability to acquire co-registered images of vasculature, morphology, and distinct metabolic endpoints reporting on glucose uptake, fatty acid uptake, and mitochondrial metabolism at both wide-field and high resolutions. At 12 hours post-treatment, the tumors’ metabolism shifted from mitochondrial respiration to glycolysis in avascular regions. Further, we report a higher average vascular density in untreated versus treated mice at 108 hours post-treatment (p&amp;lt;0.05, Kolmogorov-Smirnov test). On exploring the relationship between metabolic activity and vasculature, regions with high local tortuosity in the untreated group exhibited a higher reliance on fatty acid uptake than high tortuosity regions in the treatment group, indicating these cells’ reliance on fatty acids within a complex vascular network. Our multiplexed imaging strategy enables the quantification of tumor metabolism and vasculature over multiple length scales, which could be leveraged to study adaptations following clinical therapies. Citation Format: Enakshi Sunassee. Optical Techniques to Democratize Intravital Quantification of Metabolic Heterogeneity [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C016.

Uncollected Solid Waste Detection and Reporting Using Machine-learning and Geotagging

Uncollected solid waste has become an ever-growing threat to our livelihoods, posing many problems that span health risks, environmental pollution, and unpleasant aesthetics. Traditional methods of reporting uncollected solid waste have proven ineffective and we struggle to keep pace in addressing the growing volumes of waste. This study focused on developing a solid waste detection and reporting system based on machine learning and geotagging. The developed system sought to enable solid waste management entities to obtain verified solid waste reports and accurate location details of the uncollected waste instances. A ResNet model was trained on commonly used solid waste image datasets from online sources. The model achieved a provisional accuracy beforescore of seventy percent (70%) though this statistic can be improved by adjusting model parameters. A rapid iterative design approach was employed to facilitate the development of the crowdsourcing app. This enabled the researchers to swiftly build, evaluate, and refine functional prototypes of the system before finalization. The resulting system receives solid waste images together with their location data and verifies the correct image reports using the trained model, before finally visualizing the reports on a map. Overall, the system provides a platform for the general public to collaborate with solid waste management bodies in combatting uncollected solid waste. In the future, the system may be diversified to allow reporting other amenity issues besides uncollected solid waste.

Usefulness of Combined Advanced Dynamic Contrast-Enhanced and Diffusion-Weighted MRI Over Ultrasonography in Differentiating Cancer From Benign Lesions in Dense Breasts.

Aim To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in characterizing suspicious lesions in dense breasts compared to ultrasonography (USG). Materials and methods Eighty-two consecutive female patients with suspicious lesions in dense breast parenchyma showing the American College of Radiology Breast Imaging Reporting And Data System (ACR BI-RADS) c/d composition on mammography underwent USG, where 63 lesions of 63 patients were suspicious. They underwent multiparametric MRI, followed by histopathological evaluation (HPE) of the lesions.Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of USG and MRI in lesion characterization and the combined accuracy of DCE-MRI with DWI.The receiver operating characteristic (ROC) curve analysis provided the cut-off for the apparent diffusion coefficient (ADC) value. Results The sensitivity, specificity, and accuracy of USG were 91.7%, 63%, and 79.4%, respectively. Kinetic curve analysis on DCE-MRI showed a type I curve only in benign lesions. Malignant lesions predominantly showed a type III curve.The sensitivity, specificity, and accuracy of DCE-MRI were 95.8%, 78.5%, and 85.7%, respectively.The optimum cut-off ADC value was 1.05x10-3 mm2/s with sensitivity, specificity, and accuracy of 83.3 % each.The specificity and accuracy of combined DCE-MRI with DWI were 94.4% and 88.1%, respectively. Conclusion Advanced MRI, including a combination of DCE-MRI kinetics and DWI, would be more effective and accurate for lesion characterization in dense breasts and act as a superior problem-solving tool compared to USG in differentiating carcinoma from benign lesions.

A natural language processing-informed adrenal gland incidentaloma clinic improves guideline-based care.

Adrenal gland incidentalomas (AGIs) are found in up to 5% of cross-sectional images. However, rates of guideline-based workup for AGIs are notoriously low. We sought to determine if a natural language processing (NLP)-informed AGI clinic could improve the rates of indicated biochemical evaluation and adrenal-specific imaging. An NLP algorithm was created to detect clinically significant adrenal nodules from radiology reports of cross-sectional images at an academic institution. The NLP algorithm was applied to scans occurring between June 2020 and July 2021 to form a baseline cohort. The NLP algorithm was re-applied to scans from August 2021 to February 2023 and identified patients were invited to join an outpatient clinic dedicated to AGIs. Patients evaluated in the clinic from March 2022 to February 2023 were included in the intervention cohort. Statistical analysis utilized chi-square, t-test, and a multivariable logistic regression. The baseline and intervention cohorts included 1784 and 322 unique patients, respectively. Patients in the intervention cohort were more likely to be female (59% vs. 51%, p=0.01), be younger (60±13.1 vs. 64±13.2years, p<0.001), have smaller nodules (1.7cm, IQR 1.4-2.1 vs. 1.8cm, IQR 1.4-2.5cm, p=0.017), have had biochemical workup (99% vs. 13%, p<0.001), and have had adrenal-specific imaging (40% vs. 11%, p<0.001). In a multivariable analysis, intervention cohort patients were significantly more likely to have had biochemical workup (odds ratio ,OR 1209, confidence interval ,CI 434-5117, p<0.001) and adrenal-specific imaging (OR 8.89, CI 6.42-12.4, p<0.001). The implementation of an NLP-informed AGI clinic was associated with a seven-fold increase in biochemical workup and a three-fold increase in adrenal-specific imaging in participating patients.

Comparison of the Effectiveness of Traditional Motorized Traction and Non-surgical Spinal Decompression Therapy Added to Conventional Physiotherapy for Treatment of Chronic Low Back Pain.

There are a limited number of studies comparing traditional motorized traction and non-surgical spinal decompression with other treatment options such as conventional motor traction in the treatment of low back pain caused by lumbar discopathy. This retrospective study aimed to compare the effectiveness of these treatments. The retrospective data of patients diagnosed with lumbar discopathy who underwent physical therapy in our clinic were reviewed. Demographic data, duration of their symptoms, physical examination findings, lumbosacral magnetic resonance imaging (MRI) reports, method and duration of treatment, and visual analog scale (VAS) and Oswestry Disability Index (ODI) results were recorded. A total of 160 patients met the inclusion criteria. Their mean age was 44.6±12.4 (range 21-65) years, 57.5% (n=92) were female, and 42.5% (n=68) were male. There were no differences between the conventional physiotherapy, motorized traction, and spinal decompression groups in terms of age, duration of symptoms, and the number of sessions (p>0.05). In all three groups, the mean scores of VAS and ODI were significantly decreased in the pre-and post-treatment comparisons (p<0.005). The rates of change in VAS and ODI were higher in the traction group and spinal decompression group compared to the conventional treatment (p<0.005). In patients with subacute and chronic lumbardiscopathies, motorized traction and spinal decompression treatments added to conventional treatment were found to be more effective than conventional treatment alone. The results of spinal decompression and conventional motorized traction treatments appear to be similar.

Diagnostic Capability of Ultrasonography in Evaluating Peripheral Nerve Injuries of the Brachial Plexus.

The purpose of this study is to determine the diagnostic capability of ultrasonography (US) in patients with suspected brachial plexus injury (BPI) to the terminal nerves by comparing physical examination (PE) findings with US, electromyography (EMG), and magnetic resonance imaging (MRI) reports. All patients at a single institution who underwent US for peripheral nerve injury of the brachial plexus and terminal nerves resulting in sensory-motor deficits from October 1, 2017 to October 31, 2023 were identified. A retrospective chart review was performed. Each PE, US, EMG, and MRI reports were given an overall rating: "normal" or "abnormal." Terminal nerves (musculocutaneous, axillary, radial, ulnar, medial) were individually assessed as "normal" or "abnormal." The interobserver agreement between reports was calculated using Cohen kappa. Specificity and sensitivity analyses were performed to determine diagnostic accuracy and were reported with 95% confidence intervals (CI). A total of 120 patients were included. Most injuries were traumatic in nature (78.8%) and were low-energy (53.8%). When each imaging modality was compared with the PE findings, EMG had the highest interobserver agreement (Cohen kappa = 0.18), followed by US (Cohen kappa = 0.10), and last MRI (Cohen kappa = 0.07). The US had the highest sensitivity (0.92, CI = 0.85, 0.96) among the 3 imaging modalities (Table 2). On US, the ulnar nerve was most commonly abnormal (n = 84, 70.0%). Ultrasonography serves as a useful adjunct in the workup of patients with suspected peripheral BPI and is reliable in localizing the pathology of injured terminal nerves in the brachial plexus.

Digital remote monitoring of chronic retinal conditions-A clinical future tool? : Remote monitoring of chronic retinal conditions

In view of the predicted increase in incidence and prevalence of chronic retinal diseases and undersupply of care in the population, telemedicine could contribute to reducing access barriers to healthcare and improving the results of treatment. A literature review on remote monitoring of chronic retinal diseases was carried out. The medical literature was searched for publications on remote monitoring of chronic retinal diseases. The results were compiled in anarrative overview. The four main topics in the literature are: validation studies, implementation strategies, acceptance/target group analyses and health economic analyses. Remote monitoring systems are based on visual function tests, imaging or patient reports and have been particularly investigated in age-related macular degeneration (AMD) and diabetic eye disease (DED). Studies indicate positive effects regarding an optimization of clinical care and afavorable safety profile but randomized controlled trials are lacking for the majority of monitoring tools. Remote monitoring could complement existing care structures for patients with chronic retinal diseases, especially AMD and DED. Promising systems are based on hyperacuity or optical coherence tomography, while patient-reported data are not commonly used; however, there is currently insufficient evidence justifying the use of remote monitoring systems in chronic retinal diseases in Europe and more research on the validation of remote monitoring systems is needed.