Inexperienced Readers Research Articles

The invisible opponent: a hidden discussion in a linguistic popular science article

This article is devoted to the description of the linguistic means by which the author of a popular science article introduces into it the position of an “inexperienced reader”. Six popular science articles on linguistic topics were used as a source of material for the research. With the methods of studies of reference, semantic syntax and poetics of a literary text, the techniques of introducing an ordinary worldview of the “invisible opponent” of the author-scientist (or a knowledgeable journalist) were analyzed, in which the author represents a potential inexperienced reader of the article. As a result of the study, it was found that the authors use various means of implicitness, including presuppositions, implicit change of point of view, games with the reference of pronouns and nouns, in order to solve a complex collision of the “addressee factor”: criticizing the views that form the reader's everyday picture of the world, do not present explicit the reader himself as his opponent.

Semi-automated Analysis of Ventilation-Perfusion Single-Photon Emission Tomography in the Diagnosis of Pulmonary Embolism - Does it add extra value?

Diagnosis of pulmonary embolism using V/P-SPECT may include the application of advanced image-processing techniques to identify V/P-mismatches. Aim of this study was to evaluate the benefit in clinical decision making in the diagnosis of pulmonary embolism.by whether adding to conventional reading a software that automatically calculates and visualizes the ventilation/perfusion-quotient pixel by pixel. 63 consecutive patients with a clinical suspicion of PE who underwent V/P-SPECT were included in this retrospective study. Images were randomly ordered both for standard as well as for software-assisted reading using V/P-quotients. Studies were read independently by 2 experienced and 2 inexperienced raters. Diagnostic performance and observer agreement of all readers and both reading methods were determined. Expert observers consistently achieved a high diagnostic accuracy both in conventional as well as in software-assisted reporting (sensitivity: 0.94 vs. 0.94, specificity: 0.96vs. 0.97, LR+: 17.32 vs. 28.86, LR- stayed constant at 0.06). For inexperienced readers, diagnostic performance improved: sensitivity raised from 0.74 to 0.85 and specificity from 0.86 to 0.95, LR+ raised from 5.20 to 15.69, LR- decreased from 0.31 to 0.16. Inter-rater reliability (Fleiss' κ) improved from 0.63 to 0.86 by using V/P quotient. Benefit from a software-tool that calculates V/P-ratio automatically is only small when used by experienced physicians If inexperienced readers use the software, the diagnostic accuracy increases. Images generated by automated calculation of V/P-mismatches are easy to read and their use might help to standardize and objectify interpretation of V/P-SPECT in the diagnosis of PE.

Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI.

Background Improving the differentiation of uterine sarcomas from atypical leiomyomas remains a clinical challenge and is needed to avoid inappropriate surgery. Purpose To develop a diagnostic algorithm including diffusion-weighted MRI criteria to differentiate malignant uterine sarcomas from benign atypical leiomyomas. Materials and Methods This case-control retrospective study identified women with an atypical uterine mass at MRI between January 2000 and April 2017, with surgery or MRI follow-up after 1 year or longer. A diagnostic algorithm including T2-weighted MRI and diffusion-weighted imaging (DWI) signal and apparent diffusion coefficient (ADC) values was developed to predict for sarcoma. The training set consisted of 51 sarcomas and 105 leiomyomas. Two external validation sets were used to evaluate interreader reproducibility (16 sarcomas; 26 leiomyomas) and impact of reader experience (29 sarcomas; 30 leiomyomas). Wilson confidence intervals (CIs) were calculated for sensitivity and specificity. Results Evaluated were 156 women (median age, 50 years; interquartile range, 44-63 years). Predictive MRI criteria for malignancy were enlarged lymph nodes or peritoneal implants, high DWI signal greater than that in endometrium, and ADC less than or equal to 0.905 × 10-3 mm2/sec. Conversely, a global or focal area of low T2 signal intensity and a low or an intermediate DWI signal less than that in endometrium or lymph nodes allowed readers to confidently diagnose as benign a uterine mass demonstrating one or more of these signs (P < .001) in 100% cases in all three data sets. The sensitivities and specificities of the algorithm for diagnosis of malignancy were 98% (50 of 51 masses; 95% CI: 90%, 100%) and 94% (99 of 105 masses; 95% CI: 88%, 98%) in the training set; 88% (14 of 16 masses; 95% CI: 64%, 97%) and 100% (26 of 26 masses; 95% CI: 87%, 100%) in the validation set; and 83% (24 of 29 masses; 95% CI: 65%, 92%) and 97% (29 of 30 masses; 95% CI: 83%, 99%) for the less experienced reader, respectively. Conclusion A diagnostic algorithm with predictive features including lymphadenopathy, high diffusion-weighted imaging signal with reference to endometrium, and low apparent diffusion coefficient enabled differentiation of malignant sarcomas from atypical leiomyomas, and it may assist inexperienced readers. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Méndez in this issue.

High Interobserver Agreement for the Standardized Reporting System SSTR-RADS 1.0 on Somatostatin Receptor PET/CT.

Recently, a standardized framework system for interpreting somatostatin receptor (SSTR)-targeted PET/CT, termed the SSTR reporting and data system (RADS) 1.0, was introduced, providing reliable standards and criteria for SSTR-targeted imaging. We determined the interobserver reliability of SSTR-RADS for interpretation of 68Ga-DOTATOC PET/CT scans in a multicentric, randomized setting. Methods: A set of 51 randomized 68Ga-DOTATOC PET/CT scans was independently assessed by 4 masked readers with different levels of experience (2 experienced readers and 2 inexperienced readers) trained on the SSTR-RADS 1.0 criteria (based on a 5-point scale from 1 [definitively benign] to 5 [high certainty that neuroendocrine neoplasia is present]). For each scan, SSTR-RADS scores were assigned to a maximum of 5 target lesions (TLs). An overall scan impression based on SSTR-RADS was indicated, and interobserver agreement rates on a TL-based, on an organ-based, and on an overall SSTR-RADS score-based level were computed. The readers were also asked to decide whether peptide receptor radionuclide therapy (PRRT) should be considered on the basis of the assigned RADS scores. Results: Among the selected TLs, 153 were chosen by at least 2 readers (all 4 readers selected the same TLs in 58 of 153 [37.9%] instances). The interobserver agreement for SSTR-RADS scoring among identical TLs was good (intraclass correlation coefficient [ICC] ≥ 0.73 for 4, 3, and 2 identical TLs). For lymph node and liver lesions, excellent interobserver agreement rates were derived (ICC, 0.91 and 0.77, respectively). Moreover, the interobserver agreement for an overall scan impression based on SSTR-RADS was excellent (ICC, 0.88). The SSTR-RADS-based decision to use PRRT also demonstrated excellent agreement, with an ICC of 0.80. No significant differences between experienced and inexperienced readers for an overall scan impression and TL-based SSTR-RADS scoring were observed (P ≥ 0.18), thereby suggesting that SSTR-RADS seems to be readily applicable even for less experienced readers. Conclusion: SSTR-RADS-guided assessment demonstrated a high concordance rate, even among readers with different levels of experience, supporting the adoption of SSTR-RADS for trials, clinical routine, or outcome studies.

VI-RADS: Multiinstitutional Multireader Diagnostic Accuracy and Interobserver Agreement Study

BACKGROUND. The Vesical Imaging Reporting and Data System (VI-RADS), based on multiparametric MRI (mpMRI), was developed to provide accurate information for the diagnosis of muscle-invasive bladder cancer (MIBC). OBJECTIVE. The purpose of our study was to evaluate the interobserver agreement and diagnostic performance of VI-RADS among readers with different levels of experience. METHODS. This retrospective study included 91 consecutive patients who underwent mpMRI before transurethral resection of bladder tumor (TURBT) from July 2010 through August 2018. After attending a training session, seven radiologists (five radiologists experienced in bladder MRI and two inexperienced radiologists) reviewed and scored all MRI examinations according to VI-RADS. The interobserver agreement was assessed by kappa statistics. ROC analysis was used to evaluate the diagnostic performance for MIBC. AUCs were estimated. RESULTS. Among 91 patients (72 men and 19 women; mean age ± SD, 73.2 ± 10.2 years), 48 (52.7%) had MIBC and 43 (47.3%) had non-muscle-invasive bladder cancer. Sixty-eight patients were treated with TURBT, and 23 were treated with radical cystectomy. Interobserver agreement was moderate to substantial (κ = 0.60-0.80) among the experienced readers, substantial (κ = 0.67) between the two inexperienced readers, and moderate to substantial (κ = 0.55-0.75) between the experienced and inexperienced readers. The pooled AUC was 0.88 (range, 0.82-0.91) for experienced readers and 0.84 (range, 0.83-0.85) for inexperienced readers, and 0.87 for all readers. Using a VI-RADS score of 4 or greater as the cutoff value for MIBC, the pooled sensitivity and specificity were 74.1% (range, 66.0-80.9%) and 94.1% (range, 88.6-97.7%) for experienced readers and 63.9% (range, 59.6-68.1%) and 86.4% (range, 84.1-88.6%) for inexperienced readers. Using a VI-RADS score of 3 or greater as the cutoff value, the pooled sensitivity and specificity were 83.4% (range, 80.9-85.1%) and 77.3% (range, 61.4-88.6%) for experienced readers and 82.0% (range, 80.9-83.0%) and 73.9% (range, 72.7-75.0%) for inexperienced readers. CONCLUSION. We observed moderate to substantial interobserver agreement and a pooled AUC of 0.87 among radiologists of different levels of expertise using VI-RADS. CLINICAL IMPACT. VI-RADS could help determine the depth and range of excision in TURBT, decreasing the risk of complications and enhancing the accuracy of pathologic diagnosis.

Added value of color-coded virtual non-calcium dual-energy CT in the detection of acute knee fractures in non-radiology inexpert readers

PurposeTo evaluated the added value of dual-energy CT (DECT) virtual non-calcium (VNCa) protocol on conventional CT in the detection of acute knee fractures in non-radiology inexpert readers. MethodOne hundred fifty-six patients (mean age, 51.97 years; age range, 17–86 years) with knee trauma, who underwent DECT and MRI within 3 days between April 2017 and October 2018, were retrospectively analyzed. Three readers (intern, 1st-year general surgery resident, 1st-year emergency medicine resident) independently analyzed CT alone and then with the additional color-coded DECT VNCa for fractures. A board-certified radiologist, analyzed CT and MRI series to define the reference standard. Sensitivity, specificity, and AUC were compared between the two reading sessions. ResultsFifty-seven patients had acute fractures and 99 had no fractures. Thirteen of 57 fractures were nondisplaced. The additional use of VNCa images significantly increased the mean AUC (reader 1: 0.813 vs. 0.919; reader 2: 0.842 vs. 0.930; reader 3: 0.837 vs. 0.921; P < 0.05). When only nondisplaced fractures included, the mean AUC was more increased in the combined analysis of CT and DECT VNCa (reader 1: 0.521 vs. 0.916; reader 2: 0.542 vs. 0.926; reader 3: 0.575 vs. 0.926; P < .01). Sensitivity increased by 15 %–20 % in total fracture group and by 69 %–77 % in nondisplaced fracture group over that with CT alone when both CT and DECT VNCa were used. Specificity did not differ significantly. ConclusionsThe additional use of color-coded DECT VNCa protocol to conventional CT improved diagnostic performance in detecting acute knee fractures for inexperienced non-radiology readers.

Roundtable: arguments in support of using multi-parametric prostate MRI protocol.

There is increasing evidence to suggest the value of bi-parametric prostate MRI to replace multi-parametric MRI, which includes the dynamic contrast enhancement (DCE) sequence. In this review, we discuss the value of DCE in select scenarios, specifically in resolving equivocal cases, improving the diagnostic accuracy in the inexperienced reader, rescuing exams in the settings of failed T2W and DWI, detecting biochemical recurrence, while imposing minimal to no risk to the patient with respect to IV gadolinium use, specifically group II agents.

The role of EEG in patients with suspected epilepsy.

Despite the advances in imaging, EEG remains a critical test for the diagnosis of epilepsy. Not only can it confirm the diagnosis, but it can also clarify the type of epilepsy. There are many different types of EEG recordings depending on duration, the presence of video, and inpatient or outpatient setting, each with its pros and cons. Interictal epileptiform abnormalities are very specific to epilepsy, but they can be over-interpreted by inexperienced readers. In addition to diagnosis of epilepsy, EEG also has a role in the decision to discontinue treatment in seizure-free patients, and in assessing critically ill patients for possible status epilepticus and encephalopathies. EEG reports should be relatively standardized and clear to the clinician who requested the EEG.

Consequences of differences among readers in age estimations of Baltic cod larvae and early juveniles for growth rate and hatch date analysis. Is more experience always better?

We evaluated the precision (i.e., reproducibility of estimations) and accuracy (i.e., reflection of true age) of ageing larval and early juvenile Baltic cod, Gadus morhua, (4.1–33 mm SL) from sagittae and lapilli by inexperienced and experienced readers and an expert. For all three readers, lapilli provided higher precision and accuracy of age estimates than did sagittae. Moreover, with the used method of unpolished otoliths analysis, lapilli allowed ageing juveniles larger (up to 33 mm SL) than did sagittae (up to approximately 18 mm SL). With regard to the level of experience of the reader ageing larval fish, the highest precision in ageing was achieved by the expert and experienced reader, and the lowest by the inexperienced reader. Interestingly, reader experience was not reflected in the accuracy of estimates as it was higher with the inexperienced reader than with the experienced one. Differences in ageing among readers had significant consequences for growth rate analysis (slope of regression line fitted to SL-at-age data). The results obtained covered a wide range of values, from 0.11 mm day−1 to 0.45 mm day−1 for sagittae and from 0.21 mm day−1 to 0.68 mm day−1 for lapilli. The consequences of ageing error for back-calculated hatching dates were statistically significant as well. It may be therefore recommended to use lapilli for cod larvae and early juveniles ageing. Moreover, it is recommended not to make a quick assumption that ageing done by more experienced reader must provide more accurate results that better reflect true age, even if precision of the increment counts is for the more experienced reader high.

Impact of the Internet Using Experience on the Peculiarities of the Internet Texts Understanding

Objective. The article presents the results of the empirical study of the impact of the Internet using experience on the process of the Internet texts understanding.&#x0D; Materials &amp; Methods. Different theoretical methods and techniques were used for this purpose: deductive and inductive methods, analysis and synthesis, generalization, systematization. Empirical methods were used for this purpose: experiment (semantic and receptive), method of semantic and pragmatic interpretations, content analysis, subjective scaling procedure. Mathematical methods were used: primary statistics, checks on the normal nature of the data distribution, statistical output, taking into account statistical indicators of fashion and the scope of variation. As well as some interpretive methods that are based on specific principles of systemic, activity, cognitive and organizational approaches.&#x0D; Results. The author notes that Internet texts understanding is significantly different from the understanding of oral or written texts, since the Internet text is a pragmatically integral electronic document that constructing of conditionally completed text blocks in the form of «windows», that are opened in separate tabs of the browser, the order that depends on hyperlinks and user behavior. The peculiarities of the Internet texts include enhanced dialogue, divisibility, external informativity, reduced connectivity and comprehension, pragmatic and mostly formal integrity, conditional completeness, complicated structural, as well as hybrid and high degree of permeability, multimedia, presentation, inclination to speech game and collective authorship, saturation with neologisms, emoticons and abbreviations, fragmentation, non-compliance with linguistic norms, and the functioning of a special language etiquette.&#x0D; Conclusions. As a result of empirical research involving 716 respondents from different regions of Ukraine, it was determined that experience has the most significant effect on the understanding process at the reception stage, guiding users' activity and the accuracy of their expectations. Experience contributes to the accuracy of predicting the content of Internet texts by 15,0%. At the stage of interpretation, the adequacy and completeness of Internet texts interpretation with the accumulation of experience is improved by almost 10,0%. However, even experienced users were able to correctly interpret only a quarter of the dominant, while random – only a sixth part. Even less important is the experience and Internet activity at the stage of emotional identification, nor the assessment of comprehension, nor the coherence of emotional attitude is almost independent of the Internet using experience. With the accumulation of experience, users evaluate Internet texts more homogeneously, they are easier to realize their own attitude to the Internet texts, it becomes more consistent, however, they underestimate the complexity of Internet texts more than half of the cases, they are also inclined to share texts on the approval and critical like inexperienced readers.

DEPENDENCE OF THE SPECIFICITY OF INTERNET TEXT UNDERSTANDING ON DEVELOPMENT OF THINKING-SPEECH ABILITIES

The article presents the empirical study of the influence of thinking and speech development on the results of Internet texts understanding. Different&nbsp;theoretical methods and techniques were used&nbsp;for this purpose: deductive&nbsp;and&nbsp;inductive methods, analysis and synthesis, generalization, systematization.&nbsp; The following empirical methods were used&nbsp;for this purpose:&nbsp; experiment (semantic and receptive), the method of semantic and pragmatic interpretations, content analysis, and the subjective scaling procedure. The following mathematical methods were used: primary statistics, checks on the data distribution normality, the statistical output, taking into account statistical mode and variation. Some&nbsp;interpretive methods&nbsp;based on specific principles of the systemic, activity, cognitive and organizational approaches were used also. The empirical research involved 716 respondents from different regions of Ukraine, ant it revealed that thinking and speech development influences most significantly on the understanding process at the reception stage; here users' activities are guided and their expectation accuracy is determined. The results achieved by readers with highly developed thinking-speech abilities are better by 18-22% at this stage. At the stage of interpretation, the adequacy and completeness of Internet text interpretations are improved by almost 10% with the experience accumulation. At the stage of emotional identification, there is a direct correlation between the understanding adequacy and thinking-speech development, but it is much weaker (only 6%). Instead, there is a clear dependence between emotional attitude awareness and thinking-speech development at this stage, this correlation is 17%. The users with highly developed thinking-speech abilities evaluate Internet texts more homogeneously, they are better and more consistently understand their own attitudes to Internet texts. However, like inexperienced readers, they underestimate the complexity of Internet texts in more than half of the cases, they are also inclined to divide texts on approved and criticised. &nbsp

Time-saving polyp detection in colon capsule endoscopy: evaluation of a novel software algorithm.

Colon capsule endoscopy (CCE) is a reliable method to detect colonic polyps in the well-prepared colon. As CCE evaluation can be time consuming, a new software algorithm might aid in reducing evaluation time. The aim of the study was to evaluate whether it is feasible to reliably detect colon polyps in CCE videos with a new software algorithm the "collage mode" (Rapid 8 Software, Covidien/Medtronic®). Twenty-nine CCE videos were randomly presented to three experienced and to three inexperienced investigators. Videos were evaluated by applying the collage mode. Investigation time was documented and the results (≥one polyp vs. no polyp) were compared with the findings of two highly experienced central readers who read the CCE videos in the standard mode beforehand. It took a median time of 9.8, 3.5, and 7.5 vs. 4.3, 4.6 and 12.5min for experienced vs. inexperienced investigators to review the CCE videos. For detecting ≥one polyp vs. no polyp, sensitivity of 93.3%, 73.3%, and 93.3% was observed for the experienced and sensitivity of 46.7%, 33.3%, and 93.3% for the inexperienced CCE readers. Collage mode might allow for a quick review of CCE videos with a high polyp detection rate for experienced CCE readers. Future prospective studies should include CCE collage mode for rapid polyp detection to further prove the feasibility of practical colon polyp detection by CCE and possibly support the role of CCE as a screening tool in CRC prevention.

Evaluation of the effect of computer aided diagnosis system on breast ultrasound for inexperienced radiologists in describing and determining breast lesions.

To investigate the effect of a computer-aided diagnosis (CAD) system on breast ultrasound (US) for inexperienced radiologists in describing and determining breast lesions. Between October 2015 to January 2017, 500 suspicious or probable benign lesions in 413 patients were reviewed. Five experienced readers retrospectively reviewed for each of 100 lesions according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and category, with CAD system (S-detectTM). The readers then made final decisions by combining CAD results to their US results. Using the nested experiment design, five inexperienced readers were asked to select the appropriate BI-RADS lexicons, categories, CAD results, and combination results for each of the 100 lesions, retrospectively. Diagnostic performance of experienced and inexperienced radiologists and CAD were assessed. For each case, agreements in the lexicons and categories were analyzed among the experienced reader, inexperienced reader and CAD. Indicators of the diagnostic performance for breast malignancy of the experienced group (AUC=0.83, 95%CI [0.80, 0.86]) were similar or higher than those of CAD (AUC = 0.79, 95%CI[0.74, 0.83], p=0.101), except for specificity. Conversely, indicators of diagnostic performance of inexperienced group (AUC=0.65, 95%CI[0.58, 0.71]) did not differ from or were lower than those of CAD(AUC=0.73, 95%CI[0.67, 0.78], p=0.013). Also, the diagnostic performance of the inexperienced group after combination with the CAD result was significantly improved (0.71, 95% CI [0.65, 0.77], p=0.001), whereas that of the experienced group did not change after combination with the CAD result, except for specificity and positive predictive value (PPV). Kappa values for the agreement of the categorization between CAD and each radiologist group were increased after applying the CAD result to their result of general US. Especially, the increase of the Kappa value was higher in the inexperienced group than in the experienced group. Also, for all the lexicons, the Kappa values between the experienced group and CAD were higher than those between the inexperienced group and CAD. By using the CAD system for classification of breast lesions, diagnostic performance of the inexperienced radiologists for malignancy was significantly improved, and better agreement was observed in lexicons between the experienced group and CAD than between the inexperienced group and CAD. CAD may be beneficial and educational for the inexperienced group.

The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas.

ObjectiveSince the first introduction of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score, significant progress has been made with regard to surgical treatment options for cartilage defects, as well as magnetic resonance imaging (MRI) of such defects. Thus, the aim of this study was to introduce the MOCART 2.0 knee score — an incremental update on the original MOCART score — that incorporates this progression.Materials and MethodsThe volume of cartilage defect filling is now assessed in 25% increments, with hypertrophic filling of up to 150% receiving the same scoring as complete repair. Integration now assesses only the integration to neighboring native cartilage, and the severity of surface irregularities is assessed in reference to cartilage repair length rather than depth. The signal intensity of the repair tissue differentiates normal signal, minor abnormal, or severely abnormal signal alterations. The assessment of the variables “subchondral lamina,” “adhesions,” and “synovitis” was removed and the points were reallocated to the new variable “bony defect or bony overgrowth.” The variable “subchondral bone” was renamed to “subchondral changes” and assesses minor and severe edema-like marrow signal, as well as subchondral cysts or osteonecrosis-like signal. Overall, a MOCART 2.0 knee score ranging from 0 to 100 points may be reached. Four independent readers (two expert readers and two radiology residents with limited experience) assessed the 3 T MRI examinations of 24 patients, who had undergone cartilage repair of a femoral cartilage defect using the new MOCART 2.0 knee score. One of the expert readers and both inexperienced readers performed two readings, separated by a four-week interval. For the inexperienced readers, the first reading was based on the evaluation sheet only. For the second reading, a newly introduced atlas was used as an additional reference. Intrarater and interrater reliability was assessed using intraclass correlation coefficients (ICCs) and weighted kappa statistics. ICCs were interpreted according to Koo and Li; weighted kappa statistics were interpreted according to the criteria of Landis and Koch.ResultsThe overall intrarater (ICC = 0.88, P < 0.001) as well as the interrater (ICC = 0.84, P < 0.001) reliability of the expert readers was almost perfect. Based on the evaluation sheet of the MOCART 2.0 knee score, the overall interrater reliability of the inexperienced readers was poor (ICC = 0.34, P < 0.019) and improved to moderate (ICC = 0.59, P = 0.001) with the use of the atlas.ConclusionsThe MOCART 2.0 knee score was updated to account for changes in the past decade and demonstrates almost perfect interrater and intrarater reliability in expert readers. In inexperienced readers, use of the atlas may improve interrater reliability and, thus, increase the comparability of results across studies.

Can acoustic structural quantification be used to characterize the ultrasound echotexture of the peripheral zone of breast lesions?

BACKGROUND:Besides mammography, breast ultrasound is the most important imaging modality for women with suspected breast cancer. New software tools bear high potential for improved detectability and specification of malignant breast lesions.OBJECTIVE:To compare the halo depicted around malignant breast lesions by ultrasound using Acoustic Structure Quantification (ASQ) of raw image data with the echogenic rim seen in B-mode ultrasound.METHODS:This retrospective study included 37 women for whom conventional B-mode ultrasound of the breast and ASQ were available as well as histopathology findings for comparison. Software tools were used to measure the halo area or echogenic rim and tumor area and calculate halo-to-lesion ratios for the two ultrasound modes. Six inexperienced readers characterized the breast lesions based on this information. Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were determined. ANOVA, the Wilcoxon test, and ROC curve analysis were performed.RESULTS:There was a linear relationship between ASQ-based and B-mode-based halo-to-lesion ratios; however, a systematic error was also noted. ASQ-derived ratios tended to be higher for breast lesions with lymphangioinvasion (p = 0.051, n.s.) and higher N-stages (p > 0.925, n.s.), while there was no correlation with other markers. Because of the significantly greater conspicuity of peritumoral halos in the ASQ mode, inexperienced readers achieved greater sensitivity (78% vs. 74%) and specificity (75% vs. 71%) and higher NPVs (75% vs. 71%) and PPVs (78% vs. 74%) compared with B-mode images. Greater halo conspicuity affected the identification of malignant lesions with both modes; ASQ was found to be particularly well suited (FBimage (1,100) = 19.253, p < 0.001; FASQ (1,100) = 52.338, p < 0.001). The inexperienced readers were significantly more confident about their diagnosis using the ASQ maps (z = –3.023, p = 0.003).CONCLUSIONS:We conclude that the halo in ASQ and the echogenic rim in B-mode ultrasound are attributable to different morphologic correlates. ASQ improves diagnostic accuracy and confidence of inexperienced examiners because of improved halo visibility.

The role of MRI-derived depth of invasion in staging oral tongue squamous cell carcinoma: inter-reader and radiological-pathological agreement.

Background The 8th edition of tumor, node, metastasis (TNM) classification incorporates depth of invasion evaluation in the staging of oral cavity squamous cell carcinoma, since it is a predictor of nodal metastasis and an independent prognostic factor. Although the histopathological definition of depth of invasion is clear, an accurate method for its radiological assessment has not yet been validated. Purpose To investigate the role of MRI-derived depth of invasion evaluation in staging oral tongue squamous cell carcinoma and to assess the inter-reader agreement and the radiological–pathological correlation. Material and Methods We retrospectively reviewed 43 patients with oral tongue squamous cell carcinoma who underwent preoperative MRI. The MRI-derived depth of invasion was measured by two radiologists, each with a different degree of experience in head and neck imaging. The pathological depth of invasion was recorded from histopathological reports. The inter-reader and the radiological–histopathological correlations for the depth of invasion were evaluated with Bland–Altman plots, the intraclass correlation coefficients (ICC), and the paired samples test; agreements for T staging were assessed using the Kappa coefficient. Results Inter-reader reliability was excellent for the MRI-derived depth of invasion (ICC = 0.91), very good between MRI-derived depth of invasion and pathological depth of invasion (ICC = 0.89 for the experienced reader, 0.86 for the inexperienced reader). Both readers reached a good agreement regarding T staging (kappa value = 0.70). Furthermore, the agreement between radiological and pathological T staging was good (kappa value = 0.74 for the experienced reader, 0.60 for the inexperienced reader). Conclusion MRI-derived depth of invasion should be measured in the pretreatment assessment of oral tongue squamous cell carcinoma as it has an excellent inter-reader reliability and nearly excellent radiological–pathological correlation.

Artifacts That Can Be Misinterpreted as Interictal Discharges.

It is presumed that the EEG records only cerebral activity. However, frequently it can include other electrical activities, referred to as noise or artifact, which are not of cerebral origin. In the last few decades, evolution in digital technology has greatly improved the ability to record and display interpretable EEG. With the widespread availability of prolonged EEG recording, new artifacts have been described. The addition of concomitant video with audio during recordings has allowed in most instances to determine the source of certain artifacts. One of the challenges of interpreting EEGs consists of identifying artifacts correctly. Some of the EEG artifacts are so distinctive in appearance that the experienced reader can readily identify them. It is not uncommon for normal EEGs to be overinterpreted, especially by inexperienced readers. Failing to identify artifacts correctly can lead to "over reading" a study and doing so can result in misdiagnosis of epilepsy. This in turn can result in inappropriate treatments that ultimately can have serious clinical implications. This review will provide a description of the most commonly encountered artifacts that mimic spike or sharp waves, also referred to as interictal epileptiform discharges. In addition, we will describe troubleshooting approaches to eliminate these artifacts whenever possible. Artifacts that mimic ictal discharges will be reviewed in a different section.

El novel sujeto lector ante el texto académico: El difícil paso de la comprensión general a la especializada

The academic text is a conventionally structured and scientifically oriented community product that makes use of a specific set of concepts and vocabulary. This paper aims to establish that, due to such characteristics, academic texts present difficulties for the inexperienced reader as they require specialized reading comprehension. To achieve its goal, this paper presents the results of a diagnostic instrument of freshperson’s reading competence level. The test was conducted on 733 new students from the Universidad Icesi in Cali, Colombia, during the first semester of 2017. Based on the discourse analysis and text-linguistics approach, the test was about an explanatory-argumentative text. On a second stage, the paper reviews the characteristics of the academic texts that difficult the reading comprehension by those who are newly integrated into the university. Finally, a series of learning objectives to be included in different courses is proposed in order to support the students’ achievement of specialized reading comprehension.

Nonconvulsive Status Epilepticus: Validating the Salzburg Criteria Against an Expert EEG Examiner.

Rapid and correct diagnosis of nonconvulsive status epilepticus (NCSE) is crucial for optimal treatment. However, electroencephalographic diagnosis can be challenging. Salzburg Consensus Criteria (SCC) have been proposed to facilitate correct diagnosis, but their validity needs to be further established. We retrospectively reanalyzed the first EEG in adult patients (n = 284) referred under the suspicion of NCSE at our institution in 2014. Nonconvulsive status epilepticus or possible NCSE was diagnosed according to the SCC by an examiner specifically trained in SCC and was compared with the original diagnosis made by an expert EEG examiner, which in this context served as the reference standard, to assess the validity of the criteria. Furthermore, the clinical outcome for patients not diagnosed using SCC (false-negatives) was examined. Nonconvulsive status epilepticus or possible NCSE was diagnosed in 40 patients by the inexperienced reader using the SCC, blinded to other clinical data, and in 47 patients by the experienced reader, not blinded to the clinical data, who did not use SCC. There were eight false-negatives, one false-positive, 39 true-positives, and 236 true-negatives. Concordance between SCC and the reference standard was high (k = 0.88 [95% confidence interval, 0.80 to 0.96]). Four of the eight false-negatives suffered from anoxic encephalopathy. The remainder had a history of epilepsy and returned to preictal functional state. The SCC for NCSE implemented by an inexperienced EEG reader, blinded to all other data, yielded results highly concordant with the evaluation of EEG by an experienced reader. False-negative diagnoses were associated with postictal states or anoxic encephalopathy.

Texture analysis of myocardial infarction in CT: Comparison with visual analysis and impact of iterative reconstruction

ObjectivesTo compare texture analysis (TA) with subjective visual diagnosis of myocardial infarction (MI) in cardiac computed tomography (CT) and to evaluate the impact of iterative reconstruction (IR). MethodsTen patients (4 women, mean age 68 ± 11 years) with confirmed chronic MI and 20 controls (8 women, mean age 52 ± 11 years) with no cardiac abnormality underwent contrast-enhanced cardiac CT with the same protocol. Images were reconstructed with filtered back projection (FBP) and with advanced modeled IR at strength levels 3–5. Subjective diagnosis of MI was made by three independent, blinded readers with different experience levels. Classification of MI was performed using machine learning–based decision tree models for the entire data set and after splitting into training and test data to avoid overfitting. ResultsSubjective visual analysis for diagnosis of MI showed excellent intrareader (kappa: 0.93) but poor interreader agreement (kappa: 0.3), with variable performance at different image reconstructions. TA showed high performance for all image reconstructions (correct classifications: 94%–97%, areas under the curve: 0.94–0.99). After splitting into training and test data, overall lower performances were observed, with best results for IR at level 5 (correct classifications: 73%, area under the curve: 0.65). ConclusionsAs compared with subjective, nonreliable visual analysis of inexperienced readers, TA enables objective and reproducible diagnosis of chronic MI in cardiac CT with higher accuracy. IR has a considerable impact on both subjective and objective image analysis.