Individual Readers Research Articles

Diagnostic performance of radiologists in distinguishing post-COVID-19 residual abnormalities from interstitial lung abnormalities

Abstract Objective Distinguishing post-COVID-19 residual abnormalities from interstitial lung abnormalities (ILA) on CT can be challenging if clinical information is limited. This study aimed to evaluate the diagnostic performance of radiologists in distinguishing post-COVID-19 residual abnormalities from ILA. Methods This multi-reader, multi-case study included 60 age- and sex-matched subjects with chest CT scans. There were 40 cases of ILA (20 fibrotic and 20 non-fibrotic) and 20 cases of post-COVID-19 residual abnormalities. Fifteen radiologists from multiple nations with varying levels of experience independently rated suspicion scores on a 5-point scale to distinguish post-COVID-19 residual abnormalities from fibrotic ILA or non-fibrotic ILA. Interobserver agreement was assessed using the weighted κ value, and the scores of individual readers were compared with the consensus of all readers. Receiver operating characteristic curve analysis was conducted to evaluate the diagnostic performance of suspicion scores for distinguishing post-COVID-19 residual abnormalities from ILA and for differentiating post-COVID-19 residual abnormalities from both fibrotic and non-fibrotic ILA. Results Radiologists’ diagnostic performance for distinguishing post-COVID-19 residual abnormalities from ILA was good (area under the receiver operating characteristic curve (AUC) range, 0.67–0.92; median AUC, 0.85) with moderate agreement (κ = 0.56). The diagnostic performance for distinguishing post-COVID-19 residual abnormalities from non-fibrotic ILA was lower than that from fibrotic ILA (median AUC = 0.89 vs. AUC = 0.80, p = 0.003). Conclusion Radiologists demonstrated good diagnostic performance and moderate agreement in distinguishing post-COVID-19 residual abnormalities from ILA, but careful attention is needed to avoid misdiagnosing them as non-fibrotic ILA. Key Points QuestionHow good are radiologists at differentiating interstitial lung abnormalities (ILA) from changes related to COVID-19 infection? FindingsRadiologists had a median AUC of 0.85 in distinguishing post-COVID-19 abnormalities from ILA with moderate agreement (κ = 0.56). Clinical relevanceRadiologists showed good diagnostic performance and moderate agreement in distinguishing post-COVID-19 residual abnormalities from ILA; nonetheless, caution is needed in distinguishing residual abnormalities from non-fibrotic ILA.

[89Zr]Zr-girentuximab for PET–CT imaging of clear-cell renal cell carcinoma: a prospective, open-label, multicentre, phase 3 trial

With limitations of conventional imaging and biopsy, accurate, non-invasive techniques to detect clear-cell renal cell carcinoma in patients with renal masses remain an unmet need. 89Zr-labelled monoclonal antibody ([89Zr]Zr-girentuximab) has high affinity for carbonic anhydrase 9, a tumour antigen highly expressed in clear-cell renal cell carcinoma. We aimed to evaluate [89Zr]Zr-girentuximab PET-CT imaging for detection and characterisation of clear-cell renal cell carcinoma. ZIRCON was a prospective, open-label, multicentre, phase 3 trial conducted at 36 research hospitals and practices across nine countries (the USA, Australia, Canada, the UK, Türkiye, Belgium, the Netherlands, Spain, and France). Patients aged 18 years or older with an indeterminate renal mass 7 cm or smaller (cT1) suspicious for clear-cell renal cell carcinoma and scheduled for nephrectomy received a single dose of [89Zr]Zr-girentuximab (37 MBq ±10%; 10 mg girentuximab) intravenously followed by abdominal PET-CT imaging 5 days (±2 days) later. Surgery was performed no later than 90 days after administration of [89Zr]Zr-girentuximab. Blinded central review, conducted by three independent readers, determined the histology from surgical samples. The coprimary endpoints, determined for each individual reader, were the sensitivity and specificity of [89Zr]Zr-girentuximab PET-CT imaging to detect clear-cell renal cell carcinoma, with histopathological confirmation as standard of truth. Analyses were on the full analysis set of patients, defined as patients who had evaluable PET-CT imaging and a confirmed histopathological diagnosis. The trial is registered with ClinicalTrials.gov, NCT03849118, and EUDRA Clinical Trials Register, 2018-002773-21, and is closed to enrolment. Between Aug 14, 2019, and July 8, 2022, 371 patients were screened for eligibility, 332 of whom were enrolled. 300 patients received [89Zr]Zr-girentuximab (214 [71%] male and 86 [29%] female). 284 (95%) evaluable patients were included in the primary analysis. The mean sensitivity was 85·5% (95% CI 81·5-89·6) and mean specificity was 87·0% (81·0-93·1). No safety signals were observed. Most adverse events were not or were unlikely to be related to [89Zr]Zr-girentuximab, with most (193 [74%] of 261 events) occurring during or after surgery. The most common grade 3 or worse adverse events were post-procedural haemorrhage (in six [2%] of 261 patients), urinary retention (three [1%]), and hypertension (three [1%]). In 25 (8%) of 300 patients, 52 serious adverse events were reported, of which 51 (98%) occurred after surgery. There were no treatment-related deaths. Our results suggest that [89Zr]Zr-girentuximab PET-CT has a favourable safety profile and is a highly accurate, non-invasive imaging modality for the detection and characterisation of clear-cell renal cell carcinoma, which has the potential to be practice changing. Telix Pharmaceuticals.

Presentation of pharmacological content in crime novels between 1890 and 2023.

As there is lack of research on how drugs are presented in crime literature, we read nearly 25,000 pages of crime literature written between 1890 and 2023 to provide an overview on the pharmacological content in this genre. Correct presentation of pharmacological information decreased over time. Misconceptions about certain substances, especially narcotics and anesthetics appear in many of the analyzed examples. Also, in comparison with crime TV series, books are inferior in providing the reader with additional information and pharmacological plausibility. This especially applies for the newer books which contained less additional information than the older ones. In contrast, somebooks educate their readers. Newer books show a greater variety of substances also introducing recentlydeveloped drugs or new ways of application. On the contrary, older books stick to a small selection of well-known substances during that time, especially metals like arsenic and toxins like strychnine. Gender involvement in poisoning is not realistically presented in the novels. Male victims are overrepresented compared to reality. Also, the etiology is commonly presented incorrectly. Poisoning by accident or for suicidal purposes are rarely presented in the novels, despite their significance in reality. Overall, crime novels educate but also misinform their readers. We discuss the consequences of our findings for the individual reader and public health.

Modeling Radiologists' Assessments to Explore Pairing Strategies for Optimized Double Reading of Screening Mammograms.

To develop a model that simulates radiologist assessments and use it to explore whether pairing readers based on their individual performance characteristics could optimize screening performance. Logistic regression models were designed and used to model individual radiologist assessments. For model evaluation, model-predicted individual performance metrics and paired disagreement rates were compared against the observed data using Pearson correlation coefficients. The logistic regression models were subsequently used to simulate different screening programs with reader pairing based on individual true-positive rates (TPR) and/or false-positive rates (FPR). For this, retrospective results from breast cancer screening programs employing double reading in Sweden, England, and Norway were used. Outcomes of random pairing were compared against those composed of readers with similar and opposite TPRs/FPRs, with positive assessments defined by either reader flagging an examination as abnormal. The analysis data sets consisted of 936,621 (Sweden), 435,281 (England), and 1,820,053 (Norway) examinations. There was good agreement between the model-predicted and observed radiologists' TPR and FPR (r ≥ 0.969). Model-predicted negative-case disagreement rates showed high correlations (r ≥ 0.709), whereas positive-case disagreement rates had lower correlation levels due to sparse data (r ≥ 0.532). Pairing radiologists with similar FPR characteristics (Sweden: 4.50% [95% confidence interval: 4.46%-4.54%], England: 5.51% [5.47%-5.56%], Norway: 8.03% [7.99%-8.07%]) resulted in significantly lower FPR than with random pairing (Sweden: 4.74% [4.70%-4.78%], England: 5.76% [5.71%-5.80%], Norway: 8.30% [8.26%-8.34%]), reducing examinations sent to consensus/arbitration while the TPR did not change significantly. Other pairing strategies resulted in equal or worse performance than random pairing. Logistic regression models accurately predicted screening mammography assessments and helped explore different radiologist pairing strategies. Pairing readers with similar modeled FPR characteristics reduced the number of examinations unnecessarily sent to consensus/arbitration without significantly compromising the TPR. A logistic-regression model can be derived that accurately predicts individual and paired reader performance during mammography screening reading.Pairing screening mammography radiologists with similar false-positive characteristics reduced false-positive rates with no significant loss in true positives and may reduce the number of examinations unnecessarily sent to consensus/arbitration.

Stroke Evaluation in the Interventional Suite Using Dual-Layer Detector Cone-Beam CT: aFirst-in-human Prospective Cohort Study (the Next GenerationX-ray Imaging System Trial).

Cone-beam CT in the interventional suite could be an alternative to CT to shorten door-to-thrombectomy time. However, image quality in cone-beam CT is limited by artifacts and poor differentiation between gray and white matter. This study compared non-contrast brain dual-layer cone-beam CT in the interventional suite to reference standard CT in stroke patients. Aprospective single-center study enrolled consecutive participants with ischemic or hemorrhagic stroke. The hemorrhage detection accuracy, per-region ASPECTS accuracy and subjective image quality (Likert scales for gray-white matter differentiation, structure perception and artifacts) were assessed by three neuroradiologists blinded to clinical data on dual-layer cone-beam CT 75 keV monoenergetic images compared to CT. Objective image quality was assessed by region-of-interest metrics. Non-inferiority for hemorrhage detection and ASPECTS accuracy was determined by the exact binomial test with aone-sided lower performance boundary prospectively set to 80% (98.75% CI). 27participants were included (74years ± 9; 19female) in the hyperacute or acute stroke phase. One reader missed asmall bleeding, but all hemorrhages were detected in the majority analysis (100% accuracy, CI lower boundary 86%, p = 0.002). ASPECTS majority analysis showed 90% accuracy (CI lower boundary 85%, p < 0.001). Sensitivity was 66% (individual readers 67%, 69%, and 76%), specificity was 97% (97%, 96%, 89%). Subjective and objective image quality were inferior to CT. In asmall single-center cohort, dual-layer cone-beam CT showed non-inferior hemorrhage detection and ASPECTS accuracy to CT. Despite inferior image quality, the technique may be useful for stroke evaluation in the interventional suite. NCT04571099 (clinicaltrials.gov). Prospectively registered 2020-09-04.

Recall Laterality and Bilaterality: Possible New Screening Mammography Quality Metrics

Purpose: Current screening mammography quality metrics are important and helpful, but do not address all quality concerns. An individual screening mammography reader may be systematically insensitive to findings present in the breast of one side, laterality bias, evidenced by left versus right difference in advised immediate recalls. Current metrics are not designed to detect laterality bias. Whether a reader exhibits laterality bias, or what an appropriate ratio/range of bilateral versus unilateral recalls should be, have never been discussed in medical literature. Methods: As a trainee quality project, five attending (‘consultant’ in Europe) radiologists’ screening mammography reports over 2 years at an academically affiliated, public hospital were tallied with regard to laterality of recommended recall, and with respect to unilateral versus bilateral recalls advised. The chi-square (χ²) statistic was applied to reports advising unilateral recall. Findings: No group laterality bias was discovered. One radiologist (the most experienced) evidenced a consistent laterality bias over 2 years (p=0.07) against left-breast findings. Of reports recommending recall, the radiologists’ single-year range for recall regarding both breasts was 10.2–23.3%; for both years combined, the individual radiologists ranged from 13.6–17.9%. The group, 2-year mean recommending bilateral recall was 16.5%. Conclusion: A radiologist may exhibit laterality bias, favoring detection of findings in one breast over the other, a concern never before considered. Audit to discern such bias leads simultaneously to assessment of bilateral recall bias. Possible causes of these biases are discussed, and research regarding them as possible quality metrics is encouraged.

Neformalių XX a. pabaigos – XXI a. pradžios Lietuvos jaunimo leidinių – fanzinų – leidybos tendencijos

This article analyzes Lithuanian youth subcultural group publications – fanzines (zines) – which have not yet received broader attention from researchers. Paper fanzines started to be created at the end of the 20th century and became popular in the 1990s, spreading Western culture ideas and changing the political, and socio-cultural environment in Lithuania along with technological copying and reproduction possibilities. Using resources from Lithuania’s Youth Culture Digital Archive “Lithuanian Zine Collection” and additionally collected sources, the article analyzes the trends in the creation and publishing of fanzines. By comparing the publishing similarities and differences of fanzines attributed to different subcultural groups, the aim is to understand the cultural context of these publications, their relationship with readers, and the publishing possibilities of fanzine creators. The study applies descriptive metadata analysis and systematization of fanzines, as well as ethnographic research methods (targeted interview, questionnaire, and qualitative interviews with fanzine authors, publishers, and collectors). The research results showed that in Lithuania, mainly in the 1990s, metal music fanzine authors, unlike punks and science fiction fans, created more publications written in English. Metal music fanzines were characterized by greater volume. Science fiction fans’ publications differed from those of metalheads and punks by a greater number of continuous issues and fewer one-time publications. Authors of fanzines associated with punk ideology mostly chose to independently reproduce publications using a copying machine, while creators of metal music and science fiction fanzines more often used professional printing services. The language used in fanzines and its style helped to form a close relationship with readers, revealed the identity traits of subcultural groups, and helped metal music fanzine authors to integrate into the international fanzine culture context. Seeking independence and individuality, fanzine creators disregarded professional publishing standards. Fanzine publishing depended on individual choice, motivation, creativity, reader interest, and technological possibilities (publication reproduction, layout). Fanzines created in Lithuania became one of the main forms of idea dissemination, creative freedom, and self-expression for alternative youth communication.

Individual differences in word skipping during reading in English as L2.

The Multilingual Eye-movement Corpus (MECO; Siegelman et al., 2022) contains data from unbalanced bilinguals reading in their first language (L1) for a variety of languages and in English as their second language (L2). We analyzed word skipping in L2 on the basis of five predictors consisting of the frequency and length of the word in L2 and three measures of individual differences. Besides the L2 proficiency of the participant, two novel measures were also constructed: the average amount of skipping in L1 across participants per language and whether an individual reader skips words often in their L1 compared with other L1 readers in the same language. Word skipping in L2 increased for short and high-frequency words, for participants with higher L2 proficiency, for readers whose L1 featured relatively high average skipping rates compared with the other languages, and especially for participants who skip more often in L1 than their peers. All three individual differences interacted with word length such that their influence was more pronounced for longer words. Our results show that readers prefer to maintain a certain level of word skipping resembling how they read in L1. Due to lower L2 than L1 proficiency in unbalanced bilinguals, word skipping in L2 would often be based on a comparatively less advanced stage in parafoveal word recognition.

Double reading performance and the impact of adjudication on progression-free survival estimations: Findings from a lung clinical trial.

e23010 Background: The FDA recommends Blinded Independent Central Review (BICR) with double read for clinical trials with imaging. However, inter-reader variability is a concern in these trials. While studies have investigated the variability of RECIST, the primary response criteria, little attention has been given to the optimal association of readers. The evaluation of therapeutic response in phase III trials relies on the Date of first Progressive Disease (DoPD), with the Discrepancy Rate (DR) as the preferred index for measuring inter-reader variability in DoPD evaluation. Another important index measures readers' bias, assessing their tendency to over or under-estimate diagnoses. In cases of discrepancies, a third reader is brought in for adjudication. However, the impact of adjudication on trials' Progression-Free Survival (PFS) is not well-documented. Our study examines the variability in a lung clinical trial using RECIST, analyzing double reading performance, reader association prediction, and the impact of adjudication on PFS estimations. Methods: We retrospectively analyzed five phase III lung clinical trials using the RECIST 1.1 criteria in BICR with double reads. The trials involved 7 readers organized into 11 teams, each reader having participated in multiple trials and performed over 50 reads, resulting in 1017 patients' reviews. Our analysis included: Calculation of DR and bias for each team, and testing the correlation between DR and bias. Computation of the signed bias for each individual reader. Evaluation of a probabilistic model to predict the DR for each team and the bias for each reader. Comparison of PFS between single and double reads after adjudication and endorsement of one of the readings. Results: A multiple comparisons test did not reveal any difference between teams’ DR (Marascuilo test; q &gt; 0.05). The average DR across all teams was 39.9% [95%CI; 37.8; 41.9]. However, we did find significant differences in bias when comparing 9/55 pairs of teams (Marascuilo test; q &lt; 0.05). The range of absolute bias values was 20% to 100%. We did not find a correlation between bias and DR (p = 0.64). Additionally, when comparing the average bias value per reader, no differences were observed (Marascuilo test; q &lt; 0.05). We failed to predict teams DR and readers' bias. The endorsement rate of readers ranged [18%; 82%]. After adjudication, we found that 27% of the PFS were lower than the minimum value obtained from the single readers, in one case 20.6% shorter. Conclusions: Significant readers' bias has a notable impact on double readings, independent of the DR values. The performance of one reader cannot be generalized based on others. Additionally, adjudication significantly affects the PFS of clinical trials. These findings emphasize the importance of considering readers' bias and the potential consequences of adjudication in clinical trial assessments.

A standardized approach to evaluation and reporting of synovial histopathology in two surgically induced murine models of osteoarthritis

ObjectiveSynovial pathology has been linked to osteoarthritis (OA) pain in patients. Microscopic grading systems for synovial changes in human OA have been described, but a standardized approach for murine models of OA is needed. We sought to develop a reproducible approach and set of minimum recommendations for reporting of synovial histopathology in mouse models of OA. MethodsCoronal and sagittal sections from male mouse knee joints subjected to destabilization of medial meniscus (DMM) or partial meniscectomy (PMX) were collected as part of other studies. Stains included Hematoxylin and Eosin (H&E), Toluidine Blue (T-Blue) and Safranin O/Fast Green (Saf-O). Four blinded readers graded pathological features (hyperplasia, cellularity, and fibrosis) at specific anatomic locations. Inter-reader agreement of each feature score was determined. ResultsThere was acceptable to very good agreement when using 3-4 individual readers. After DMM and PMX, expected medial predominant changes in hyperplasia and cellularity were observed, with fibrosis noted at 12 weeks post-PMX. Synovial changes were consistent from section to section in the mid-joint area. When comparing stains, H&E and T-blue resulted in better agreement compared to Saf-O stain. ConclusionsTo account for the pathologic and anatomic variability in synovial pathology and allow for a more standardized evaluation that can be compared across studies, we recommend evaluating a minimum set of 3 pathological features at standardized anatomic areas. Further, we suggest reporting individual feature scores separately before relying on a single summed “synovitis” score. H&E or T-blue are preferred, inter-reader agreement for each feature should be considered.

Virginia Woolf’s Common Readers in Paris

In this article, we analyze historical, biographical, geolocational, and book distribution data from the Shakespeare and Company Project to understand Virginia Woolf’s readership in Paris in the 1920s and 1930s. The lending library cards from Sylvia Beach’s archive reveal the names of Woolf’s readers, and include important information about their reading habits and professional lives. The article uses a mixed-methods approach, combining historical and archival research on individual readers with visualizations of demographic, literary, and geographical data. Datasets from the Shakespeare and Company Project provide unique access to the networks of distribution, circulation, and readership that defined Woolf’s literary presence in Paris. These networks, in turn, resonate with Woolf’s own deep interest in her various readerships and publics.

Bacchic Batman?: Batman: Killing Time and Euripides’ Bacchae

ABSTRACT This paper investigates the ways that Tom King’s Batman: Killing Time (2022) blends a telling of Euripides’ Bacchae with the more traditional story of a super-villain bank heist. The heist mobilises characters such as Catwoman and the Riddler against Batman as they try to secure possession of an ancient artefact. This artefact turns out to have ancient Greek provenance and allows King to emphasise how his tale evokes and responds to Euripides’ play. By quoting extensively from the Bacchae and interspersing scenes from the play that resonate with the action in and around Gotham City, King makes the actions of Batman and the supervillains embody the tenets of Classical reception. The shifting interpretations of the characters and the various representations of the ancient artefact reflect the ways that individual readers come to understand a literary or artistic work. The conflict over the artefact mirrors critics’ conflicting interpretations of a text, and Killing Time can be seen as a large-scale interpretation of Euripides’ tragedy. This sequential graphic narrative acts as a creative response to Euripides’ Bacchae and questions that play’s conception of madness, reason, sight, and insight, while fruitfully putting into dialogue the myths of ancient Greece with those of the DC Universe.

Machine learning and radiomics analysis by computed tomography in colorectal liver metastases patients for RAS mutational status prediction.

To assess the efficacy of machine learning and radiomics analysis by computed tomography (CT) in presurgical setting, to predict RAS mutational status in colorectal liver metastases. Patient selection in a retrospective study was carried out from January 2018 to May 2021 considering the following inclusion criteria: patients subjected to surgical resection for liver metastases; proven pathological liver metastases; patients subjected to enhanced CT examination in the presurgical setting with a good quality of images; and RAS assessment as standard reference. A total of 851 radiomics features were extracted using the PyRadiomics Python package from the Slicer 3D image computing platform after slice-by-slice segmentation on CT portal phase by two expert radiologists of each individual liver metastasis performed first independently by the individual reader and then in consensus. Balancing technique was performed, and inter- and intraclass correlation coefficients were calculated to assess the between-observer and within-observer reproducibility of features. Receiver operating characteristics (ROC) analysis with the calculation of area under the ROC curve (AUC), sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), negative predictive value (NPV) and accuracy (ACC) were assessed for each parameter. Linear and non-logistic regression model (LRM and NLRM) and different machine learning-based classifiers were considered. Moreover, features selection was performed before and after a normalized procedure using two different methods (3-sigma and z-score). Seventy-seven liver metastases in 28 patients with a mean age of 60years (range 40-80years) were analyzed. The best predictors, at univariate analysis for both normalized procedures, were original_shape_Maximum2DDiameter and wavelet_HLL_glcm_InverseVariance that reached an accuracy of 80%, an AUC ≥ 0.75, a sensitivity ≥ 80% and a specificity ≥ 70% (p value < < 0.01). However, a multivariate analysis significantly increased the accuracy in RAS prediction when a linear regression model (LRM) was used. The best performance was obtained using a LRM combining linearly 12 robust features after a z-score normalization procedure: AUC of 0.953, accuracy 98%, sensitivity 96%, specificity of 100%, PPV 100% and NPV 96% (p value < < 0.01). No statistically significant increase was obtained considering the tested machine learning both without normalization and with normalization methods. Normalized approach in CT radiomics analysis allows to predict RAS mutational status in colorectal liver metastases patients.

A Deconstructionist Reading of The Waste Land

The Waste Land offers no hope for redemption or salvation. The poem's ending is ambiguous and inconclusive, and it is unclear whether the Fisher King, who is a symbol of fertility and renewal, is able to heal the wasteland. The meaning of the Waste Land is up to the individual reader to decide. The poem's deconstructionist elements allow it to be interpreted in many different ways, and each reader will come away with their own unique understanding of the poem.

Impact of an AI software on the diagnostic performance and reading time for the detection of cerebral aneurysms on time of flight MR-angiography

PurposeTo evaluate the impact of an AI-based software trained to detect cerebral aneurysms on TOF-MRA on the diagnostic performance and reading times across readers with varying experience levels.MethodsOne hundred eighty-six MRI studies were reviewed by six readers to detect cerebral aneurysms. Initially, readings were assisted by the CNN-based software mdbrain. After 6 weeks, a second reading was conducted without software assistance. The results were compared to the consensus reading of two neuroradiological specialists and sensitivity (lesion and patient level), specificity (patient level), and false positives per case were calculated for the group of all readers, for the subgroup of physicians, and for each individual reader. Also, reading times for each reader were measured.ResultsThe dataset contained 54 aneurysms. The readers had no experience (three medical students), 2 years experience (resident in neuroradiology), 6 years experience (radiologist), and 12 years (neuroradiologist). Significant improvements of overall specificity and the overall number of false positives per case were observed in the reading with AI support. For the physicians, we found significant improvements of sensitivity on lesion and patient level and false positives per case. Four readers experienced reduced reading times with the software, while two encountered increased times.ConclusionIn the reading with the AI-based software, we observed significant improvements in terms of specificity and false positives per case for the group of all readers and significant improvements of sensitivity and false positives per case for the physicians. Further studies are needed to investigate the effects of the AI-based software in a prospective setting.

The neural and cognitive basis of expository text comprehension

As science and technology rapidly progress, it becomes increasingly important to understand how individuals comprehend expository technical texts that explain these advances. This study examined differences in individual readers’ technical comprehension performance and differences among texts, using functional brain imaging to measure regional brain activity while students read passages on technical topics and then took a comprehension test. Better comprehension of the technical passages was related to higher activation in regions of the left inferior frontal gyrus, left superior parietal lobe, bilateral dorsolateral prefrontal cortex, and bilateral hippocampus. These areas are associated with the construction of a mental model of the passage and with the integration of new and prior knowledge in memory. Poorer comprehension of the passages was related to greater activation of the ventromedial prefrontal cortex and the precuneus, areas involved in autobiographical and episodic memory retrieval. More comprehensible passages elicited more brain activation associated with establishing links among different types of information in the text and activation associated with establishing conceptual coherence within the text representation. These findings converge with previous behavioral research in their implications for teaching technical learners to become better comprehenders and for improving the structure of instructional texts, to facilitate scientific and technological comprehension.

Interpretation of Complete Tumor Response on MRI Following Chemoradiotherapy of Rectal Cancer: Inter-Reader Agreement and Associated Factors in Multi-Center Clinical Practice.

To measure inter-reader agreement and identify associated factors in interpreting complete response (CR) on magnetic resonance imaging (MRI) following chemoradiotherapy (CRT) for rectal cancer. This retrospective study involved 10 readers from seven hospitals with experience of 80-10210 cases, and 149 patients who underwent surgery after CRT for rectal cancer. Using MRI-based tumor regression grading (mrTRG) and methods employed in daily practice, the readers independently assessed mrTRG, CR on T2-weighted images (T2WI) denoted as mrCRT2W, and CR on all images including diffusion-weighted images (DWI) denoted as mrCRoverall. The readers described their interpretation patterns and how they utilized DWI. Inter-reader agreement was measured using multi-rater kappa, and associated factors were analyzed using multivariable regression. Correlation between sensitivity and specificity of each reader was analyzed using Spearman coefficient. The mrCRT2W and mrCRoverall rates varied widely among the readers, ranging 18.8%-40.3% and 18.1%-34.9%, respectively. Nine readers used DWI as a supplement sequence, which modified interpretations on T2WI in 2.7% of cases (36/1341 [149 patients × 9 readers]) and mostly (33/36) changed mrCRT2W to non-mrCRoverall. The kappa values for mrTRG, mrCRT2W, and mrCRoverall were 0.56 (95% confidence interval: 0.49, 0.62), 0.55 (0.52, 0.57), and 0.54 (0.51, 0.57), respectively. No use of rectal gel, larger initial tumor size, and higher initial cT stage exhibited significant association with a higher inter-reader agreement for assessing mrCRoverall (P ≤ 0.042). Strong negative correlations were observed between the sensitivity and specificity of individual readers (coefficient, -0.718 to -0.963; P ≤ 0.019). Inter-reader agreement was moderate for assessing CR on post-CRT MRI. Readers' varying standards on MRI interpretation (i.e., threshold effect), along with the use of rectal gel, initial tumor size, and initial cT stage, were significant factors associated with inter-reader agreement.

Civic Fictions: Modelling book-reader interactions in the Age of Revolution

This article describes a new, database-linking project, Civic Fictions, based at Radboud University (The Netherlands), and funded by the Dutch Research Council (NWO), that seeks to develop digital tools to address a series of questions that have long been fundamental to literary studies, and to book history and 18th-century studies more specifically. Is it possible to model the effects that books had on real readers in the past? How can we understand such book–reader interactions using both existing and new bibliographic data collections? How might prosopographical, longitudinal studies focusing on readers supplement or enrich quantitative bibliographic sources on books? Can this enrichment offer us insights into the long-term reading habits of book readers, owners or borrowers? And can we then extrapolate the impact of books onto the various social networks in which these readers participated throughout their lives?&amp;nbsp;Building on the European Research Council-funded MEDIATE database, and creating an ecosystem of linked databases, Civic Fictions seeks to empirically test various modern theories about fiction’s supposed ability to foster empathy, work through trauma and build community during the Age of Revolution (c. 1760–1830). In doing so, it addresses a major challenge in book history, the lack of comprehensive reader-reception data like ego-documents, by using large-scale data on the circulation of books among identifiable, individual readers as a reader-reception source. Thus, the project links book ownership (private library catalogues, bookseller’s archives), borrowing practices (library lending-records) and other sources to individual actors and larger (socio-economic, professional, gender, etc.) groupings. Coupling data on ownership to longitudinal studies of book owners’ lives and societal interventions, it thereby aims to reveal macro-patterns allowing historians to infer how works of fiction might historically have moved readers.

Interobserver agreement for the Vesical Imaging-Reporting and Data System (VI-RADS) in differentiating non-muscle-invasive and muscle-invasive urinary bladder tumors

BackgroundBladder cancer is the most common tumor of the genitourinary tract. Transitional cell carcinoma is divided into two categories: non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). In spite of the high recurrence rate, NMIBC has good prognosis, while MIBC has poor prognosis due to local organ invasion and metastases. Mp-MRI shows better tumor detection and staging. The aim of this study is to validate VI-RADS in detecting MIBC and assessing interobserver agreement and impact of reader's experience.ResultsAt cutoff value of VI-RADS score ≥ 3, the VI-RADS showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 96.8%,83.3%, 93.8%, 90.9%, and 93%, respectively, for reader 1, 93.5%, 91.7%, 84.6%, and 93% for reader 2, and 96.8%,83.3%, 93.8%, 90.9%, and 93% for reader 3. The interobserver agreement between individual readers was excellent among the three readers.ConclusionsVesical imaging-reporting and data system (VI-RADS) is a good method showing satisfactory sensitivity, specificity, and diagnostic value for detecting detrusor muscle invasion.

Artificial intelligence-based analyses of varus leg alignment and after high tibial osteotomy show high accuracy and reproducibility

PurposeThe aim of this study was to investigate the performance of an artificial intelligence (AI)-based software for fully automated analysis of leg alignment pre- and postoperatively after high tibial osteotomy (HTO) on long-leg radiographs (LLRs).MethodsLong-leg radiographs of 95 patients with varus malalignment that underwent medial open-wedge HTO were analyzed pre- and postoperatively. Three investigators and an AI software using deep learning algorithms (LAMA™, ImageBiopsy Lab, Vienna, Austria) evaluated the hip–knee–ankle angle (HKA), mechanical axis deviation (MAD), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA), and mechanical lateral distal femoral angle (mLDFA). All measurements were performed twice and the performance of the AI software was compared with individual human readers using a Bayesian mixed model. In addition, the inter-observer intraclass correlation coefficient (ICC) for inter-observer reliability was evaluated by comparing measurements from manual readers. The intra-reader variability for manual measurements and the AI-based software was evaluated using the intra-observer ICC.ResultsInitial varus malalignment was corrected to slight valgus alignment after HTO. Measured by the AI algorithm and manually HKA (5.36° ± 3.03° and 5.47° ± 2.90° to − 0.70 ± 2.34 and − 0.54 ± 2.31), MAD (19.38 mm ± 11.39 mm and 20.17 mm ± 10.99 mm to − 2.68 ± 8.75 and − 2.10 ± 8.61) and MPTA (86.29° ± 2.42° and 86.08° ± 2.34° to 91.6 ± 3.0 and 91.81 ± 2.54) changed significantly from pre- to postoperative, while JLCA and mLDFA were not altered. The fully automated AI-based analyses showed no significant differences for all measurements compared with manual reads neither in native preoperative radiographs nor postoperatively after HTO. Mean absolute differences between the AI-based software and mean manual observer measurements were 0.5° or less for all measurements. Inter-observer ICCs for manual measurements were good to excellent for all measurements, except for JLCA, which showed moderate inter-observer ICCs. Intra-observer ICCs for manual measurements were excellent for all measurements, except for JLCA and for MPTA postoperatively. For the AI-aided analyses, repeated measurements showed entirely consistent results for all measurements with an intra-observer ICC of 1.0.ConclusionsThe AI-based software can provide fully automated analyses of native long-leg radiographs in patients with varus malalignment and after HTO with great accuracy and reproducibility and could support clinical workflows.Level of evidenceDiagnostic study, Level III.