Issue Of Radiology Research Articles

The usefulness of transesophageal echocardiography in the staging of locally advanced lung cancer

The pre-operative staging of locally advanced non-small cell lung cancer (NSCLC) is an important clinical and radiological issue. Computed tomography (CT) scan cannot always provide sufficient information about resectability and some patients may undergo unnecessary thoracotomy. The purpose of this study was to evaluate the utility of transesophageal echocardiography (TEE) in distinguishing T3 from T4 lesions in patients with lung cancer possibly involving cardiovascular structures and to compare its findings with those of computed tomography and, whenever possible, of surgical samples. Between January 1998 and December 2001, sixteen patients were referred to our pulmonology unit for evaluation of locally advanced NSCLC possibly involving the heart or great vessels. All patients underwent mediastinal staging with both contrast enhancement CT scan and TEE. The mediastinal staging by CT scan classified eleven patients as T4N0M0 and five patients as T3N0M0. TEE suggested mediastinal extension of the tumour in nine out of sixteen patients, who were eventually classified as T4; the remaining seven patients had no mediastinal involvement according to TEE and were therefore classified as T3. The pathologic staging confirmed clinical TEE staging in all of the ten patients who subsequently underwent surgery. The remaining six patients were excluded from surgery either because of major coexistent illnesses or because refused to be operated on. TEE is a useful diagnostic tool in the staging of patients with locally advanced NSCLC which suspect involvement of heart and/or great vessels.

National Alliance for Radiation Readiness: Leveraging Partnerships to Increase Preparedness.

The National Alliance for Radiation Readiness (NARR) is an alliance of 16 national member organizations that have banded together to serve as the collective "voice of health" in radiological preparedness through: • participation in national dialogues on radiological emergency issues; • provision of thoughtful feedback on documents, policies, and guidelines; and • convening of partners to raise awareness of and resolve radiological emergency issues. NARR benefits from the intersection and interaction of public health, radiation control, healthcare, and emergency management professionals--all with an interest in bolstering the nation's preparedness for a radiological or nuclear incident. NARR is able to provide a unique perspective on radiological and nuclear preparedness by creating multi-disciplinary workgroups to develop guidance, recommendations, and provide subject matter feedback. NARR aims to build response and recovery capacity and capabilities by supporting the sharing of resources and tools, including technical methods and information through the development of an online clearinghouse. NARR also aims to identify and disseminate best practices, as well as define and educate on the roles and responsibilities of local, state, and federal government and the numerous agencies involved with the response to a radiological emergency.

Medicolegal-Malpractice and Ethical Issues in Radiology. Judging the Competency of a Radiologist Colleague.

Medicolegal-Malpractice and Ethical Issues in Radiology. Judging the Competency of a Radiologist Colleague.

Abdominal Radiology: a new name for an evolutionary change

This first issue of Abdominal Radiology marks the continued evolution of the Journal to meet the professional needs of the Abdominal Radiologist. With this change in title from Abdominal Imaging, the inclusion and welcoming of interventional radiology manuscripts into the Journal is formalized. Many abdominal radiologists have had an active interventional practice for years, but without a central academic home for their education and publications. As the official journal of the Society of Abdominal Radiologists (SAR) that is inclusive of interventional radiologists, it is only fitting to expand the vision of the journal to include these important components of our practice. Readers should look for a growing presence of interventional articles in the future, and authors should consider sending us their interventional manuscripts for consideration. Beginning in 2016, Abdominal Radiology will become a monthly publication, secondary to your strong support of submitting many high quality manuscripts for consideration. Please continue to send us your best work. Original articles that advance the science and have wide readership appeal will continue to be encouraged and are the centerpiece of Journal activity. Special focus sections, review articles, classics in Radiology, and practice related articles will also continue. Continuing medical education (CME) credits with self assessment (SA) will be offered with each issue—allowing our readers to record credit for their educational effort and learning in support of maintenance of certification. We will strive to continue to earn the respect of our international readers as we have now affiliated with the Asian Society of Abdominal Radiology (ASAR) and the European Society of Gastrointestinal Radiology. We strive to increase international contributions and collaboration. A special thanks to the enormous volunteer efforts that makes this Journal possible. An army of associate editors, reviewers and editorial board members around the world are all working hard to find the best articles, and to ensure the scientific integrity of these publications. These individuals truly value learning, science, and selfless dedication to the cause of advancing patient care. I am indebted to all of them. I hope you will find professional satisfaction and assistance as you become regular monthly readers of this new Journal. I would welcome your input and suggestions as we continue to strive for ongoing improvements. Editor-in-Chief

100 kVp Low-Tube Voltage Abdominal CT in Adults: Radiation Dose Reduction and Image Quality Comparison of 120 kVp Abdominal CT

Recently, reducing radiation dose to all body parts of children and adults has been a paramount issue in diagnostic radiology (1). Among various techniques used to reduce radiation dose, lowering peak tube voltage has been a clear trend because radiation dose changes approximately with the square of tube potential (2-5). Lowering peak tube voltage provides improved contrast enhancement of iodine-containing vascular and parenchymal organs because it provides a greater photoelectric effect with decreased Compton scattering (6, 7). Inevitably, lowering peak tube voltage can lead to greater image noise and poor image quality, thus resulting in decreased diagnostic accuracy. This prevented clinical implementation of techniques for lowering peak tube voltage in the past, particularly in abdominal CT application (8). However, a new algorithm for concurrently adjusting the high-output tube current known as automatic tube current modulation (ATCM) can counterbalance greater image 100 kVp Low-Tube Voltage Abdominal CT in Adults: Radiation Dose Reduction and Image Quality Comparison of 120 kVp Abdominal CT 성인에서 100 kVp와 120 kVp 관접압을 이용한 복부 전산화단층촬영의 방사선량 감소와 영상의 질 비교

Imaging of the lingual thyroid: Case report and management

Lingual thyroid is a rare developmental abnormality characterized by the failure of the thyroid gland, or remnants, to descend from anywhere along its embryologic path of origin at the foramen cecum to its normal eutopic pretracheal position. Awareness of the anatomic course of the embryologic thyroid primordium and typical and atypical locations of ectopic thyroid tissue may aid in diagnosis. The reported incidence of lingual thyroid is 1 in 100,000, and it is more common in females, with a female:male ratio ranging between 3:1 and 7:1. Lingual thyroid located at the base of tongue often present with hypothyroidism, usually asymptomatic but may cause dysphonia, dysphagia, upper airway obstruction, and hemorrhage. In the current case report, we present the imaging characteristics of lingual thyroid occurring in a 12-year-old female patient. Partial endoscopic removal of lingual thyroid was performed, followed by substitutive exogenous thyroid hormone therapy. The purpose of this article is to discuss the radiological characteristics and therapeutic issues in the management of lingual thyroid.

Features Advances to Automatically Find Images for Application to Clinical Decision Support

Filtering through ever increasing sources of information to find relevant information for clinical decisions is a challenging task for clinicians. In biomedical publications, there are a variety of items that can provide evidence to aid the decision making process. One example is illustration image analysis and classification, which has been used to characterize and distinguish specific image modalities; this capability in turn has been used to assist in the evidence gathering process. This paper examines clinical decision support applications and extends previous research for illustration modality discrimination analysis. Specifically, we compared global, HSV histogram-based, and Gabor filter-based features to histogram-based features for modality classification on a set of 12,056 images from 2004-2006 biomedical publication issues of Radiology and RadioGraphics that were manually annotated by modality (radiological, photo, etc.). Using a nearest neighbor classifier, we obtained average modality discrimination results as high as 99.98% using correlated features computed from Gabor filter spectral coefficients. These experimental results indicate that image features, particularly correlation-based features, can provide modality discrimination useful for clinical decision support applications

Pulmonary function tests and computed tomography lung attenuation in chronic obstructive pulmonary disease.

In the August 2015 issue of Radiology, Paoletti et al. reported the results of a study showing lack of linear correlation between pulmonary function tests (PFT) and lung attenuation on computed tomography (CT) in 132 patients with chronic obstructive pulmonary disease (COPD) (1). PFT were assessed according to the recommended and standardized procedures and measurements (2-4). Lung attenuation was measured with CT densitometry which unfortunately is not a standardized procedure both on the side of acquisition technique and on the side of image processing and measurements (5). In particular CT densitometry implies scanning the patient lying supine while she/he maintains breath-hold at end inspiration or expiration. Variables on the acquisition side include the inspiratory or expiratory lung volumes reached by the patient, number and collimation of sections, radiation dose and scanner calibration. Variables on the image processing and measurements side include application of reconstruction filters, automatic or semiautomatic segmentation of the lungs, correction for lung volume, automatic creation of histograms of density distribution and choice of measurement parameters to describe lung structural or functional status. Currently the main indications of lung CT densitometry in COPD include differentiation of emphysema and chronic bronchitis components in the single patient (alone or in combination with airways measurements) (6), monitoring progression of smoke-related pulmonary emphysema (7) and to be used as surrogate marker in trials assessing replacement therapy in alfa1-deficiency emphysema (8).

Emergency Radiology goes international

With this issue of Emergency Radiology, we introduce an important new relationship for our journal. We announce that, in addition to our sponsoring organization, the American Society of Emergency Radiology (ASER), Emergency Radiology is now the official journal of the Society for Emergency Radiology-India. This is an exciting affiliation for our journal. As international collaborations have increased, our journal will benefit from a more global exposure and from additional subscribers. The Society for Emergency Radiology-India is a relatively new society with approximately 200 members, with plans to grow to a membership over 1000. This affiliation has come to fruition from the support of the leadership of our journal, ASER, and from Dr. Anjali Agrawal, an organizingmember of the Society for Emergency Radiology-India, an ASER member, and a member of our Editorial Board. This affiliation will increase Emergency Radiology’s influence in India where expertise and research in radiology is burgeoning. This is a geographic area of rapid growth in the subspecialty practice of emergency radiology. This affiliation will lead to increased number and diversity of submissions and thus improve the significance of our journal. This will increase our understanding of medical journalism and emergency radiology issues in this important part of the world. In addition to our new journal cover, there will be some journal enhancements related to this affiliation. With upcoming issues, the following changes will take place:

Medicolegal-Malpractice and Ethical Issues in Radiology.

Medicolegal-Malpractice and Ethical Issues in Radiology.

Ghost Tumors of the Central Nervous System: Definition, Clinical Implications, and Proposal of Classification

A ghost tumor (GhT) is a space-occupying lesion with radiologic features consistent with the diagnosis of tumor that on further investigation is revealed not to be a tumor, although definitions in the literature are inconsistent, and the incidence of GhT remains undefined. A review of the pertinent literature was performed to identify pediatric patients in whom a misleading initial diagnosis of space-occupying lesion was described. Analysis of the differentiating features of the final diagnosis and related clinical and radiologic issues was performed. GhT may be categorized as follows: GhT I, lesions spontaneously disappearing during follow-up, also known as "vanishing tumors"; GhT II, nonneoplastic space-occupying lesions showing a tumor appearance, also known as "tumor-like lesions"; GhT III, anatomic variants of normal structures mimicking a tumor, also defined as "false tumors." The most deceptive conditions and critical points in the differential diagnosis of these cases were discussed. GhT is an entity with significant implications in regard to treatment and outcome. In this context, the integration of clinical and radiologic clues is crucial for a careful differential diagnosis and a consistent diagnostic approach, which is necessary for adequate decision making regarding management. A thorough radiologic work-up is mandatory. Atypical radiologic images should raise a high level of suspicion, including incidental lesions, which are encountered with increasing frequency in daily practice as a result of greater access to radiologic examinations, increasing sensitivity of imaging, and the impact of defensive medicine. A wait-and-see policy should be considered whenever indicated.

Evidence for myocardial CT perfusion imaging in the diagnosis of hemodynamically significant coronary artery disease.

This editorial discusses a recent paper published in the August issue of Radiology about the diagnostic value of myocardial computer tomography (CT) perfusion imaging in the detection of hemodynamically significant coronary stenosis when compared to single-photon emission CT (SPECT) imaging based on a secondary analysis of CORE320 study. Three aspects including high diagnostic sensitivity of CT perfusion imaging, moderate specificity of SPECT imaging and lack of use of attenuation correction in SPECT imaging have been discussed with reference to the current literature, and some suggestions have been highlighted for future studies to improve the diagnostic performance of CT perfusion and SPECT imaging in the diagnostic evaluation of coronary artery disease.

Radiology’sLegacy: Rummaging through the Attic

Early articles in Radiology are based on conventional radiography and provide the foundation for both the way we think about extracting diagnostically important information from images and the spectacular technologic achievements in the decades that followed; therefore, we decided to include in this issue of Radiology a pictorial essay of select figures and our thoughts on the articles themselves to give a taste of the beginnings of so many of our current imaging and research activities.

The Comprehensive AOCMF Classification System: Radiological Issues and Systematic Approach.

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) classification system with increasing level of complexity and details. The basic level 1 system differentiates fracture location in the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94); the levels 2 and 3 focus on defining fracture location and morphology within more detailed regions and subregions. Correct imaging acquisition, systematic analysis, and interpretation according to the anatomic and surgical relevant structures in the CMF regions are essential for an accurate, reproducible, and comprehensive diagnosis of CMF fractures using that system. Basic principles for radiographic diagnosis are based on conventional plain films, multidetector computed tomography, and magnetic resonance imaging. In this tutorial, the radiological issues according to each level of the classification are described.

CT imaging in a large part of the world: what we know and what we can learn.

This paper describes how cooperation among international organizations, as modeled in Europe, can work to improve imaging safety and standards for children throughout the world. This is demonstrated in the mechanisms employed in a large-scale multi-national study on CT imaging safety practices described elsewhere in this issue of Pediatric Radiology. Here we learn approaches through which CT safety standards have been achieved and the international resources available to help in standardizing safety practices in medical imaging. There are unique strengths of the approach in Europe, which has mandatory requirements on member states to facilitate strengthening of radiation protection. Most countries have national regulatory mechanisms for radiation protection in medicine. International organizations play a significant role in supporting projects in lower-resource countries such that a large proportion of radiologic professionals in low-resource countries are trained through assistance by these organizations. Many of these international organizations make it possible for professionals worldwide to download free training material. Collaboration among international organizations and the Image Gently campaign toward consensus with regard to radiation protection can go further than individual opinions in promoting a higher standard of radiation protection around the world.

Medicolegal—Malpractice and Ethical Issues in Radiology

Medicolegal—Malpractice and Ethical Issues in Radiology

Behind the numbers: inverse probability weighting.

Inverse probability weighting is a propensity score-based technique that can be used to compensate for imbalance in study groups. It is an alternative to regression-based adjustment of the outcomes. It has advantages over matching of cases on the basis of propensity scores when there are more than two groups to compare, when finding matches results in insufficient sample sizes, or when the data are censored. However, it can create artificial imbalance unless it is applied carefully. In this article, an introduction to inverse probability weighting is provided by using the Yang et al study published in this issue of Radiology as an example.

Medicolegal—Malpractice and Ethical Issues in Radiology.

Medicolegal—Malpractice and Ethical Issues in Radiology.

Medicolegal—Malpractice and Ethical Issues in Radiology

Medicolegal—Malpractice and Ethical Issues in RadiologyCommunicating Significant but Not Urgent or Critical FindingsLeonard Berlin1,2Audio Available | Share

Medicolegal—Malpractice and Ethical Issues in Radiology

Medicolegal—Malpractice and Ethical Issues in Radiology