Imaging Procedures Research Articles

Abstract LB097: Sensitive detection of central nervous system tumors using a sequencing based cerebrospinal fluid test

Abstract The current approach to diagnosing and monitoring tumors of the central nervous system relies almost exclusively on radiographic imaging and neurosurgical procedures. Cerebrospinal fluid (CSF) is appealing for diagnosis because it is already part of the standard of care for the diagnosis or management of several types of CNS disease, including cancer, and the tumor DNA is more highly concentrated inside the blood brain barrier than in plasma or other bodily fluids. Even though cytology is widely used, sensitivity remains low ranging from 2% to 50%, depending on cancer type. We report an analytic technique that efficiently introduces identical molecular barcodes to both strands of CSF template DNA molecules for the identification of cancer specific somatic mutations and copy number alterations. We apply this approach to 126 CSF samples obtained from individuals with known primary or metastatic tumors involving the brain and 36 CSF samples obtained from individuals with non-neoplastic neurological conditions such as multiple sclerosis and another neurologic conditions. We correctly detect 91% of cancers at a specificity of 94.5%. In cases (n=20) where standard of care cytology was available, cytology detected 25% of cancers while our molecular assay detected 90%. Our approach has the capacity to be used in combination with other clinical, radiologic, and laboratory-based data to inform the diagnosis and management of patients with suspected cancers of the brain. Positives n= Sensitivity GBM 42 46 91.3% Lymphoma 22 24 91.7% Medulloblastoma 14 16 87.5% Metastases 37 40 92.5% Citation Format: Christopher B. Douville, Chetan Bettegowda. Sensitive detection of central nervous system tumors using a sequencing based cerebrospinal fluid test [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB097.

Towards the establishment of national diagnostic reference levels for abdomen, KUB, and lumbar spine x-ray examinations in Sri Lanka: a multi-centric study

Diagnostic reference levels (DRLs) and achievable doses (ADs) provide guidance to optimise radiation doses for patients undergoing medical imaging procedures. This multi-centre study aimed to compare institutional DRLs (IDRLs) across hospitals, propose ADs and multi-centric DRLs (MCDRLs) for four common x-ray examinations in Sri Lanka, and assess the potential for dose reduction. A prospective cross-sectional study of 894 adult patients referred for abdomen anteroposterior (AP), kidney-ureter-bladder (KUB) AP, lumbar spine AP, and lumbar spine lateral (LAT) x-ray examinations was conducted. Patient demographic information (age, sex, weight, BMI) and exposure parameters (tube voltage, tube current-exposure time product) were collected. Patient dose indicators were measured in terms of kerma-area product (PKA) using a PKA meter. IDRLs, ADs, and MCDRLs were calculated following the International Commission on Radiological Protection guidelines, with ADs and MCDRLs defined as the 50th and 75th percentiles of the median PKA distributions, respectively. IDRL ranges varied considerably across hospitals: 1.42–2.42 Gy cm2 for abdomen AP, 1.51–2.86 Gy cm2 for KUB AP, 0.83–1.65 Gy cm2 for lumbar spine AP, and 1.76–4.10 Gy cm2 for lumbar spine LAT. The proposed ADs were 1.82 Gy cm2 (abdomen AP), 2.03 Gy cm2 (KUB AP), 1.27 Gy cm2 (lumbar spine AP), and 2.21 Gy cm2 (lumbar spine LAT). MCDRLs were 2.24 Gy cm2 (abdomen AP), 2.40 Gy cm2 (KUB AP), 1.43 Gy cm2 (lumbar spine AP), and 2.38 Gy cm2 (lumbar spine LAT). Substantial intra- and inter-hospital variations in PKA were observed for all four examinations. Although ADs and MCDRLs in Sri Lanka were comparable to those in the existing literature, the identified intra- and inter-hospital variations underscore the need for dose reduction without compromising diagnostic information. Hospitals with high IDRLs are recommended to review and optimise their practices. These MCDRLs serve as preliminary national DRLs, guiding dose optimisation efforts by medical professionals and policymakers.

Nephrolithiasis in Renal Tubular Acidosis: Pathophysiology, Diagnosis, and Management Strategies

Renal tubular acidosis (RTA) encompasses a group of disorders characterized by impaired kidney acid-base regulation, resulting in metabolic acidosis. Nephrolithiasis, the formation of kidney stones, represents a significant complication of RTA. Despite its clinical importance, the relationship between RTA and nephrolithiasis remains complex and poorly understood. This review provides a comprehensive overview of nephrolithiasis in RTA, focusing on its pathophysiology, diagnostic challenges, and management strategies. Mechanisms underlying kidney stone formation in RTA, including altered urinary pH, electrolyte abnormalities, and mineral metabolism disturbances, are explored in detail. Clinical manifestations and diagnostic considerations specific to nephrolithiasis in RTA patients are discussed, emphasizing the importance of a comprehensive metabolic evaluation and imaging procedures for accurate diagnosis. Current therapeutic approaches for treating kidney stones in RTA patients, including dietary modifications, pharmacological interventions, and surgical interventions, are reviewed. By elucidating the intricate interplay between RTA and nephrolithiasis, this review aims to enhance clinical understanding and guide optimal management strategies for patients with this challenging renal disorder.

Neuroscientific results of experimental studies on the control of acute pain with hypnosis and suggested analgesia.

This narrative review summarizes a representative collection of electrophysiological and imaging studies on the neural processes and brain sources underlying hypnotic trance and the effects of hypnotic suggestions on the processing of experimentally induced painful events. It complements several reviews on the effect of hypnosis on brain processes and structures of chronic pain processing. Based on a summary of previous findings on the neuronal processing of experimentally applied pain stimuli and their effects on neuronal brain structures in healthy subjects, three neurophysiological methods are then presented that examine which of these neuronal processes and structures get demonstrably altered by hypnosis and can thus be interpreted as neuronal signatures of the effect of analgesic suggestions: (A) On a more global neuronal level, these are electrical processes of the brain that can be recorded from the cranial surface of the brain with magnetoencephalography (MEG) and electroencephalography (EEG). (B) On a second level, so-called evoked (EPs) or event-related potentials (ERPs) are discussed, which represent a subset of the brain electrical parameters of the EEG. (C) Thirdly, imaging procedures are summarized that focus on brain structures involved in the processing of pain states and belong to the main imaging procedures of magnetic resonance imaging (MRI/fMRI) and positron emission tomography (PET). Finally, these different approaches are summarized in a discussion, and some research and methodological suggestions are made as to how this research could be improved in the future.

(Uro)genital developmental disorders

Congenital anomalies of the urogenital tract are common, whereas isolated developmental disorders of the genital organs are rare and varied. The type and timing of imaging to characterize these developmental disorders and the planning of any treatment are the subject of discussion. The aim of this article is to provide a brief overview of embryology, diagnostic procedures, and examples of findings. The primary procedure for imaging the genitals is sonography, which must be performed with appropriate empathy. In addition to the genitals, the general situation of the kidneys and urinary tract should be examined, as urogenital malformations are often combined. Dedicated magnetic resonance imaging (MRI) is indicated as advanced imaging in interdisciplinary consultations. Invasive procedures, such as genitography combined with micturition cystourethrography (MCU) using X‑rays or contrast-enhanced sonography, are rarely required. Computed tomography (CT) or excretory urography play no role. Imaging plays an important role in the assessment of genital anomalies. Knowledge of embryology facilitates anatomical understanding and the assessment of pathologies.

Molecular analysis using SalvGlandDx improves risk of malignancy estimation and diagnosis of salivary gland cytopathology: An exploratory multicenter study.

Diagnosis of salivary gland neoplasms is challenging, especially on cytological specimens acquired by fine-needle aspiration. The recently implemented standardized Milan system for reporting salivary gland cytopathology provides an estimated risk of malignancy (ROM); yet, for two of the categories, the diagnosis of the lesion remains unclear. However, a precise diagnosis is desirable for optimal patient management, including planning of surgery and imaging procedures. Cytological specimens (n=106) were subjected to molecular analysis using the SalvGlandDx panel. The risk of malignancy was calculated for each detected alteration based on the diagnosis of the resection specimen. By taking into account the molecular alterations, their associated ROM, the clinical and cytological features, and the current literature, the Milan category was evaluated. Of n=63 technically valid cases, 76% revealed a molecular alteration. A total of 94% of these molecularly altered cases could be assigned to a different Milan category when additionally taking molecular results into account. In only 2% of the salivary gland neoplasms of uncertain malignant potential, in which a molecular alteration was detected, the classification remained salivary gland neoplasms of uncertain malignant potential. Molecular analysis of cytological specimens provides a benefit in classifying salivary gland neoplasms on fine-needle aspiration. It can improve the ROM estimation and thus help to assign cases of formerly unknown malignant potential to clearly benign or malignant categories.

Low-dose pulsed vs standard pulsed fluoroscopy during ERCP to reduce radiation without change in image quality: Prospective randomized study.

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) poses the risk of radiation exposure (RE) to patients and staff and increases the risk of adverse biological effects such as cataracts, sterility, and cancer. Newer fluoroscopy equipment (C-Arm) provides options to limit radiation in the form of lower radiation dose and frame rate or time-limited "pulsed" settings. However, the impact of lower settings on image quality has not been assessed, and no standard protocol exists for fluoroscopy settings used during ERCP. Patients and methods This was a single-center, double-blind, prospective randomized study of consecutive adult patients undergoing standard-of-care ERCP at a tertiary academic medical center. Patients were randomized into two groups: 1) standard-dose pulsed and 2) low-dose pulsed. Pulsed mode (8 fps) was defined as x-ray exposure either in the manufacturer standard-dose or low-dose settings limited to 3 seconds each time the foot-operated switch was depressed. Results Seventy-eight patients undergoing ERCP were enrolled and randomized. No difference in age, gender, or body mass index was found between the two groups. No significant difference in image quality was found between standard-dose and low-dose fluoroscopy P = 0.925). The low-dose group was exposed to significantly less radiation when compared with standard-dose P < 0.05). Fluoroscopy time (minutes) was similar in both groups (2.0 vs 1.9), further suggesting that group assignment had no impact on image quality or procedure time. Conclusions Low-dose pulsed fluoroscopy is a reliable method that substantially reduces radiation without compromising image quality or affecting procedure or fluoroscopy times. This underscores the need for standardization in ERCP fluoroscopy settings to limit radiation exposure.

The Role of Radionuclide Imaging in Brain Death Diagnosis.

Brain death is defined as the complete and irreversible cessation of the entire brain function, including the brainstem. For the most part, the diagnosis is clinical, and ancillary testing is only needed when clinical criteria are not satisfied. Differences exist in brain death diagnosis policy in the confirmation of brain death with ancillary testing and the particular test used. Demonstration of the absence of cerebral circulation is a reliable indicator of brain death. Currently, there are no agreed-on universal criteria for ancillary imaging investigation. However, several guidelines and meta-analyses have referred to radionuclide imaging as the most reliable, accurate, and validated ancillary imaging procedure in the confirmation of brain death. Whenever available, lipophilic agents should be preferred using tomographic imaging in all or as needed. False results may occur because of slight temporal delays in flow-function interaction, and such findings may carry prognostic information. Detectable cerebral circulation in the clinical presence of brain death most probably indicates that the process of dying is not yet complete. The results of radionuclide studies may also suggest that the loss of viability in a significant proportion of brain tissue is not compatible with life.

Impact of COVID-19 Pandemic on Radiology Department Employees and Trainees in Al-Qassim, 2021.

Objectives This study aimed to assess the impact of the COVID-19 pandemic on radiology department employees and trainees. It also compared the impact of COVID-19 to the pre-COVID-19 era in the Al-Qassim region. Methods This was a quantitative observational analytical cross-sectional study conducted in the largest government hospitals under the Ministry of Health (MOH) in Al-Qassim. A pre-determined questionnaire was distributed among radiology staff that included demographic characteristics, the impact of the COVID-19 pandemic among radiology staff, the behavior of staff related to COVID-19 infection, and the assessment of mental health using the patient health questionnaire (PHQ-9). Results Eighty-four radiology staff were recruited (64.3% males vs 35.7% females). Of these, 66.7% were trainees and the rest were employees (33.3%). Of the trainees,32.1% and 42.9% thought that elective imaging, procedures, and outpatient/clinic exposures were reduced during the pandemic, and 37.5% indicated that their training had been affected negatively. The prevalence of depression among radiology staff was 36.9%. The prevalence of depression was substantially higher among radiology trainees (p=0.038), those who were not infected with COVID-16 (p=0.041), and those who indicated that their studying time increased at the time of the pandemic (p=0.047). However, after conducting multivariate regression analysis, these variables did not seem to have significantly affected depression (p>0.05). Conclusion Training and medical education have been affected negatively because of the outbreak. Studying time and research activities of employees and trainees slowed down, which could be critical to their careers. Trainees complained about the significant reduction in their exposure to clinics and imaging procedures. Therefore, a method to safeguard the well-being of employees and trainees in the radiology department is necessary to limit the impact of such pandemics.

Nanomaterials Based on 2,7,12,17-Tetra-tert-butyl-5,10,15,20-tetraaza-21H,23H-porphine Exhibiting Bifunctional Sensitivity for Monitoring Chloramphenicol and Co2.

Monitoring antibiotic retention in human body fluids after treatment and controlling heavy metal content in water are important requirements for a healthy society. Therefore, the approach proposed in this study is based on developing new optical sensors using porphyrin or its bifunctional hybrid materials made with AuNPs to accomplish the accurate detection of chloramphenicol and cobalt. To produce the new optical chloramphenicol sensors, 2,7,12,17-tetra-tert-butyl-5,10,15,20-tetraaza-21H,23H-porphine (TBAP) was used, both alone in an acid medium and as a hybrid material with AuNPs in a water-DMSO acidified environment. The same hybrid material in the unchanged water-DMSO medium was the sensing material used for Co2+ monitoring. The best results of the hybrid materials were explained by the synergistic effects between the TBAP azaporphyrin and AuNPs. Chloramphenicol was accurately detected in the range of concentrations between 3.58 × 10-6 M and 3.37 × 10-5 M, and the same hybrid material quantified Co2+ in the concentration range of 8.92 × 10-5 M-1.77 × 10-4 M. In addition, we proved that AuNPs can be used for the detection of azaporphyrin (from 2.66 × 10-5 M to 3.29 × 10-4 M), making them a useful tool to monitor porphyrin retention after cancer imaging procedures or in porphyria disease. In conclusion, we harnessed the multifunctionality of this azaporphyrin and of its newly obtained AuNP plasmonic hybrids to detect chloramphenicol and Co2+ quickly, simply, and with high precision.

CT Urology에서 가돌리늄 조영제 제거를 위한 이중에너지 CT의 Virtual Non-Contrast 기술의 평가

Residual gadolinium contrast agents in the urinary tract following MRI contrast-enhanced examinations often presents as elevated Hounsfield Unit (HU) values on CT scans, impeding the efficacy of CT urology procedures. This study aims to explore the feasibility of addressing this challenge through the application of the Dual-Energy Computed Tomography (DECT) Virtual Non-Contrast (VNC) technique across various energy levels. HU values of residual gadolinium contrast agent in the renal pelvis and ureter were measured in patients who underwent MRI contrast-enhanced examinations followed by non-contrast CT chest examinations. Subsequently, gadolinium contrast agent mixtures, such as Max, Mean, and Min Mixtures, were created and scanned together with normal saline using DECT at various energy levels. Additionally, an iodine mixture and a virtual stone representing urolithiasis were fabricated and evaluated. The results demonstrated a significant reduction in contrast enhancement of gadolinium contrast agent with DECT VNC at 70 kV and Sn150 kV. The Min Mixture closely resembled normal saline in both HU and Contrast-to-Noise Ratio (CNR), facilitating the differentiation between iodine contrast agent and virtual urolithiasis. Therefore, utilizing DECT VNC after a 1-hour and 30-minute interval following MRI contrast-enhanced examinations effectively eliminates gadolinium contrast agents, improving the efficacy of CT Urology imaging procedures.

Utility of fast MRIs in pediatric elbow injuries

BackgroundPediatric elbow trauma presents a diagnostic challenge for clinicians. Radiographs may be insufficient in assessing the radiocapitellar alignment and advanced imaging or invasive procedures such as an intraoperative arthrogram may be indicated. The purpose of this study is to describe the application and utility of fast magnetic resonance imaging (MRI) in the diagnosis and management of traumatic elbow injuries in pediatric patients. MethodsWe reviewed pediatric patients who underwent a fast MRI of the elbow between 2014-2022. A fast MRI was defined as an MRI using rapid sequences, accelerated conventional sequences, or fewer conventional sequences than a standard exam. Imaging for chronic or non-traumatic injuries was excluded. We identified patient demographics, MRI scan times, and clinical course. ResultsTwenty-three patients (8 females and 15 males) with fast elbow MRI scans were identified. The mean age was 5 years (range 2-12 years, SD 2 years). All patients had radiographs and four had CT scans prior to MRI. The average scanning time was 14 minutes (SD 6 minutes). Only one patient required anesthesia. Twenty of the 23 patients had a fracture identified on elbow radiographs and 8 were Monteggia fracture-dislocations. Nine of these patients demonstrated subluxation of the radiocapitellar joint requiring operative management in 8 patients, and one additional patient underwent surgery for displaced radial neck fracture. Three patients sustained an elbow dislocation without fracture identified on radiographs; of these, one had persistent radiocapitellar subluxation on MRI requiring surgical management. A total of 13 patients (56.5%) did not require operative management based on fast MRI findings. Outcome data was available for 22 patients with mean follow up was 23.6 months. One patient had residual pain and 8 had some range of motion limitation at final follow-up. All patients had reduced elbow joint on follow-up radiographs. ConclusionsFast MRIs can assist with the clinical evaluation of acute elbow injury in pediatric patients with equivocal radiographic findings and particularly in those with possible radiocapitellar subluxation/dislocation. This novel imaging technique has the potential to change clinical management, decrease the need for unnecessary procedures, and prevent complications of missed injuries.

A generic time-frequency analysis-based signal processing and imaging approach for air-coupled ultrasonic testing

The utilization of air-coupled ultrasonic technology is crucial for examining objects that are challenging to establish contact with or cannot endure coupling. Nevertheless, air-coupled ultrasonic is susceptible to various factors such as impedance mismatch, sound wave attenuation, and environmental noise, consequently leading to a diminished signal-to-noise ratio of the received signal. This reduction in signal quality amplifies the complexity of analysis and imaging processes. In this study, a generic air-coupled ultrasonic signal processing and imaging procedure for ultrasonic inspection is proposed, which capitalizes on time-frequency analysis. This methodology attains a heightened level of stability and superior signal-to-noise ratio imaging through a series of procedural steps, encompassing feature extraction, denoising, and the reconstruction of the A-scan signals. The efficacy of the proposed approach is quantitatively assessed in terms of signal-to-noise ratio, probability of detection, robustness, and generality. This innovative method presents a newfangled resolution for automated air-coupled ultrasonic testing.

Design and validation of algorithms to identify venous thromboembolism in the French National Healthcare Database.

This paper aims to introduce an algorithm designed to identify Venous Thromboembolism (VTE) in the French National Healthcare Database (SNDS) and to estimate its positive predictive value. A case-identifying algorithm was designed using SNDS inpatient and outpatient encounters, including hospital stays with discharge diagnoses, imaging procedures and drugs dispensed, of French patients aged at least 18 years old to whom baricitinib or Tumor Necrosis Factor Inhibitors (TNFi) were dispensed between September 1, 2017, and December 31, 2018. An intra-database validation study was then conducted, drawing 150 cases identified as VTE by the algorithm and requesting four vascular specialists to assess them. Patient profiles used to conduct the case adjudication were reconstituted from de-identified pooled and formatted SNDS data (i.e., reconstituted electronic health records-rEHR) with a 6-month look-back period prior to the supposed VTE onset and a 12-month follow-up period after. The positive predictive value (PPV) with its 95% confidence interval (95% CI) was calculated as the number of expert-confirmed VTE divided by the number of algorithm-identified VTE. The PPV and its 95% CI were then recomputed among the same patient set initially drawn, once the VTE-identifying algorithm was updated based on expert recommendation. For the 150 patients identified with the first VTE-identifying algorithm, the adjudication committee confirmed 92 cases, resulting in a PPV of 61% (95% CI = [54-69]). The final VTE-identifying algorithm including expert suggestions showed a PPV of 92% (95% CI = [86-98]) with a total of 87 algorithm-identified cases, including 80 retrieved from the 92 confirmed by experts. The identification of VTE in the SNDS is possible with a good PPV.

Prelacrimal recess approach for maxillary sinus inverted papilloma: a 15-year experience from a single center.

This large retrospective, single-center, follow-up study investigated the endoscopic prelacrimal recess approach (PLRA) for treating maxillary sinus inverted papilloma (MSIP). Between January 2007 and November 2022, patients with MSIP treated with PLRA were enrolled. Data on clinical manifestations, imaging, and surgical procedures were collected. The visual analog scale (VAS) scores for maxillofacial numbness and nasal symptoms and the SNOT-22 nasal symptom scores were statistically analyzed. Of 122 patients (68 males and 54 females) enrolled in the study, with a mean age of 50.75 ± 12.84years (26-80years), 111 patients underwent PLRA, nine underwent modified PLRA, one converted to an endoscopic medial maxillectomy (EMM), and one to an endoscopic modified Denker's approach. The average follow-up was 86.60 (13-192) months, the recurrence rate was 3.28%, and 29 patients (23.77%) complained of maxillofacial numbness one month postoperatively, which disappeared in most cases one year after surgery. Five patients (4.10%) experienced mild numbness at the end of the follow-up period. Maxillary sinus ostium contracture or atresia occurred in two cases (1.64%). After surgery, the VAS nasal symptom scores improved significantly (P < 0.001). SNOT-22 indicated that the most common postoperative symptom was thick nasal discharge. PLRA is a flexible first-choice surgical treatment for maxillary sinus inverted papilloma and can be modified according to the extent of the lesion, the surgeon's experience and technique, and surgical instruments. That can help achieve complete resection and reduce recurrence and surgical complications. Upper teeth numbness, the most common postoperative complication, tends to disappear after 1year.

Pediatric hospital utilization for patients with avoidant restrictive food intake disorder

BackgroundAvoidant restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder added to the DSM-5 in 2013 and ICD-10 in 2018. Few studies have examined hospital utilization for patients with ARFID specifically, and none to date have used large administrative cohorts. We examined inpatient admission volume over time and hospital utilization and 30-day readmissions for patients with ARFID at pediatric hospitals in the United States.MethodsUsing data from the Pediatric Health Information System (PHIS), we identified inpatient admissions for patients with ARFID (by principal International Classification of Diseases, 10th Revision, ICD-10 diagnosis code) discharged October 2017–June 2022. We examined the change over time in ARFID volume and associations between patient-level factors (e.g., sociodemographic characteristics, co-morbid conditions including anxiety and depressive disorders and malnutrition), hospital ARFID volume, and hospital utilization including length of stay (LOS), costs, use of enteral tube feeding or GI imaging during admission, and 30-day readmissions. Adjusted regression models were used to examine associations between sociodemographic and clinical factors on LOS, costs, and 30-day readmissions.ResultsInpatient ARFID volume across n = 44 pediatric hospitals has increased over time (β = 0.36 per month; 95% CI 0.26–0.46; p < 0.001). Among N = 1288 inpatient admissions for patients with ARFID, median LOS was 7 days (IQR = 8) with median costs of $16,583 (IQR = $18,115). LOS and costs were highest in hospitals with higher volumes of ARFID patients. Younger age, co-morbid conditions, enteral feeding, and GI imaging were also associated with LOS. 8.5% of patients were readmitted within 30 days. In adjusted models, there were differences in the likelihood of readmission by age, insurance, malnutrition diagnosis at index visit, and GI imaging procedures during index visit.ConclusionsOur results indicate that the volume of inpatient admissions for patients with ARFID has increased at pediatric hospitals in the U.S. since ARFID was added to ICD-10. Inpatient stays for ARFID are long and costly and associated with readmissions. It is important to identify effective and efficient treatment strategies for ARFID in the future.

ROLE AND EVOLUTION OF COMPUTER VISION IN MEDICINE

As the technologies evolve, they become more and more applicable to such fields as medicine and sciences. This article explores the transformative role of computer vision in modern medicine. It delves into the evolution and diverse applications of computer vision technology, highlighting its profound impact on medical imaging, diagnostics, and surgical procedures. Through advanced imaging techniques and machine learning algorithms, computer vision enhances diagnostic accuracy, facilitates surgical navigation, and enables real-time analysis of medical data. The article discusses key insights from industry experts and showcases notable advancements in disease detection, foreign body identification, and injury estimation. Moreover, it emphasizes the potential of computer vision to revolutionize healthcare delivery by improving patient outcomes, streamlining workflows, and enhancing clinical decision-making.

Pulmonary Hypertension in Connective Tissue Diseases Other than Systemic Sclerosis.

Pulmonary hypertension (PH) is a known complication of certain connective tissue diseases (CTDs), with systemic sclerosis (SSc) being the most common in the Western world. However, PH in association with non-SSc CTD such as systemic lupus erythematous, mixed connective tissue disease, and primary Sjögren's syndrome constitutes a distinct subset of patients with inherently different epidemiologic profiles, pathophysiologic mechanisms, clinical features, therapeutic options, and prognostic implications. The purpose of this review is to inform a practical approach for clinicians evaluating patients with non-SSc CTD-associated PH.The development of PH in these patients involves a complex interplay between genetic factors, immune-mediated mechanisms, and endothelial cell dysfunction. Furthermore, the broad spectrum of CTD manifestations can contribute to the development of PH through various pathophysiologic mechanisms, including intrinsic pulmonary arteriolar vasculopathy (pulmonary arterial hypertension, Group 1 PH), left-heart disease (Group 2), chronic lung disease (Group 3), chronic pulmonary artery obstruction (Group 4), and unclear and/or multifactorial mechanisms (Group 5). The importance of diagnosing PH early in symptomatic patients with non-SSc CTD is highlighted, with a review of the relevant biomarkers, imaging, and diagnostic procedures required to establish a diagnosis.Therapeutic strategies for non-SSc PH associated with CTD are explored with an in-depth review of the medical, interventional, and surgical options available to these patients, emphasizing the CTD-specific considerations that guide treatment and aid in prognosis. By identifying gaps in the current literature, we offer insights into future research priorities that may prove valuable for patients with PH associated with non-SSc CTD.

High-resolution computed tomography with scattered X-ray radiation and a single pixel detector

X-ray imaging is a prevalent technique for non-invasively visualizing the interior of the human body and other opaque samples. In most commercial X-ray modalities, an image is formed by measuring the X-rays that pass through the object of interest. However, despite the potential of scattered radiation to provide additional information about the object, it is often disregarded due to its inherent tendency to cause blurring. Consequently, conventional imaging modalities do not measure or utilize these valuable data. In contrast, we propose and experimentally demonstrate a high resolution technique for X-ray computed tomography (CT) that measures scattered radiation by exploiting computational ghost imaging (CGI). We show that the resolution of our method can exceed 500 µm, which is approximately an order of magnitude higher than the typical resolution of X-ray imaging modalities based on scattered radiation. Our research reveals a promising technique for incorporating scattered radiation data in CT scans to improve image contrast and resolution while minimizing radiation exposure for patients. The findings of our study suggest that our technique could represent a significant advancement in the fields of medical and industrial imaging, with the potential to enhance the accuracy and safety of diagnostic imaging procedures.

Does Higher Price Transparency Imply Lower Prices and Less Price Dispersion in Healthcare Markets? An Empirical Analysis of the Effects of Compliance with the Hospital Price Transparency Final Rule in the Greater Los Angeles Area

&lt;p class="MsoNormal" style="margin-top: 12pt; text-align: justify;"&gt;&lt;span lang="EN-US" style="font-family: 'times new roman', times, serif; font-size: 14pt;"&gt;The Hospital Price Transparency Final Rule aims at reducing the cost of healthcare in the United States by making information about the prices of medical services more readily available to market participants. The economic rationale is that higher price transparency should reduce the level and the dispersion of prices by disincentivizing hospitals from charging higher prices than possible. Using data on 3789 prices for three diagnostic imaging procedures and on the compliance with the rule for 86 acute care hospitals in the Greater Los Angeles area, we test the hypothesis that price levels and price dispersion are lower among hospitals that are more compliant. We do not reject this hypothesis, although we do not observe strictly decreasing relationships in all analyses. Prices are lower at hospitals with high or medium compliance than at hospitals with low compliance, but there is not a clear difference between hospitals with high and hospitals with medium compliance. Prices are less dispersed among hospitals with high compliance than among hospitals with low compliance, but the evidence for hospitals with medium compliance is less clear. We conclude that high compliance with the Hospital Price Transparency Final Rule implies lower prices and less price dispersion among hospitals.&lt;/span&gt;&lt;/p&gt;