Diagnosis Research Articles

Fine Needle Aspiration Cytology of Ovarian Tumors With Histopathological Correlation: A Revisit to Borderline Category

Abstract Background: Borderline ovarian tumors (BOTs) comprise 15%–20% of all ovarian epithelial malignancies. The majority of them are serous tumors followed by mucinous tumors. Pre-operative cytological diagnosis plays an important role with histopathology being the gold standard. The present study aimed to assess the sensitivity, specificity, and diagnostic accuracy of cytology in the diagnosis of epithelial ovarian tumors with special emphasis on the cytologically borderline category. Materials and Methods: The present study was conducted in our institute over five years from January 2017 to December 2022. This was a retrospective study and included 92 patients with ovarian masses who were subjected to ultrasound-guided fine needle aspiration (FNA) as a preliminary diagnostic procedure. Cytology smears were examined and categorized as benign, borderline, and malignant. The sensitivity, specificity, and diagnostic accuracy were assessed considering histopathology as the gold standard. Results: In the present study, 92 ovarian FNA cytology were performed. Aspirates were adequate in all but 10 cases. Out of 82 cases, 75 were epithelial tumors. Twelve cases of BOTs were compiled and cytological findings were assessed. Conclusion: To conclude, diagnosis of BOTs on cytology is difficult, however, aspiration from multiple sites from the lesion, critical cytomorphological assessment, and cell-block preparation with immunocytochemistry/immunohistochemistry can overcome the pitfalls.

Validating ICD-10 Diagnosis Codes for Guillain-Barré Syndrome in Taiwan's National Health Insurance Claims Database.

To validate the International Classification of Diseases, 10th Revision (ICD-10) codes for Guillain-Barré syndrome (GBS) in Taiwan's insurance claims database. We identified adult patients hospitalized at any Chang Gung Memorial Foundation branch hospital between January 1st, 2017, and December 31st, 2022, with ICD-10 code G61.0 in any of the five discharge diagnosis positions, indicating possible Guillain-Barré syndrome. We then validated the possible GBS diagnosis using data from electronic medical records of the identified patients, based on the diagnostic criteria established by the National Institute of Neurological Disorders and Stroke. We determined the positive predictive values (PPV) of various operational definitions, including the position (primary or other) where the code was recorded in the discharge diagnosis, nerve conduction study (NCS) claims, and / or specific GBS treatments. The final validation cohort of 484 patients with ICD-10 code for GBS in the discharge diagnosis was found to include 368 true GBS patients. Identifying inpatients using only the ICD-10 code for GBS in any of the five positions for discharge diagnosis yielded a PPV of 76.0%. With more restrictive definitions (primary diagnosis only, or requiring additional claims for NCS and/or treatments), the PPV tended to increase, but with fewer true GBS patients identified. Using ICD-10 GBS code in the primary diagnosis plus NCS and treatment claims yielded the highest PPV (98.3%); however, 140 (38.0%) of the true GBS patients were missed using this definition. In contrast, using the ICD-10 GBS code in any position, plus claims for NCS, achieved a relatively good PPV (85.8%) with minimal loss of true GBS patients (13, ie, 3.5%). In Taiwan's NHI claims data, identifying true GBS patients using only the ICD-10 code yielded a PPV of 76.0%; however, adding claims for diagnostic procedure and GBS treatment increased the PPV to 98.3%.

The 2023 National Proficiency Test for molecular detection of shrimp infectious myonecrosis virus (IMNV) in China

Infectious myonecrosis virus (IMNV), an emerging virus that can cause severe viral disease in penaeid shrimp, was first confirmed to have spread to China in 2020. In order to standardize diagnostic procedures and reliable detection capability, and to evaluate the performances of aquatic clinical diagnostic laboratories, the competent authority has launched a proficiency test (PT) scheme for the molecular detection of IMNV in China from the year of 2023. In the ring test of IMNV-PT 2023, five tissue samples containing different concentrations of IMNV were provided as a panel of test samples. A total of 68 laboratories participated in the PT test of qualitative and quantitative analysis of the five samples using standard molecular assays. The results showed that 92.65 % (63/68) of the participants correctly reported all samples in the panel using Real-time reverse transcription PCR and 62 participants achieved satisfactory results, one participant using conventional PCR and four participants had not completed the test. Out of the 62 participants in the z-scores analysis, 88.71 % (55/62) achieved acceptable ZB-scores, with two outlier laboratories and five laboratories being questionable. Additionally, 98.39 % (61/62) achieved ZW-scores, with only one laboratory being questionable. Furthermore, the national PT conducted in the present study proved to be an effective tool for evaluating laboratory performance in IMNV molecular testing. This assessment can aid in improving the capabilities of IMNV molecular testing of the participating laboratories, and also provided technical supporting to enhance the national response to IMN outbreaks.

Shadows and signals: a brief history of medical imaging

Abstract Medical imaging is a revolutionary field that has transformed healthcare, providing clinicians with the ability to view the inside of the body without invasive procedures. This overview traces the evolution of the major medical imaging modalities from their inception to the advanced technologies used today. Starting with the serendipitous discovery of X-rays by Wilhelm Conrad Röntgen in 1895 the subsequent developments in various imaging modalities including fluoroscopy, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine and ultrasound imaging are chronicled. The technological breakthroughs, pioneering scientists and clinicians involved, and the significant impact of these advancements on diagnostic medicine are discussed. Additionally the integration of digital imaging, artificial intelligence (AI) and machine learning technologies into medical imaging is considered together with their potential to revolutionise diagnostic procedures, enhance patient care and streamline healthcare delivery.

Determinants of Cormack–Lehane grading for glottic exposure in microlaryngeal surgery in Middle Delta Egyptian patients

BackgroundLaryngoscopy is a diagnostic procedure utilized in critical care to examine and visualize the larynx through the diversion of upper airway structures. Its primary functions are airway management and tracheal intubation. The objective of this study was to detect the predictors of laryngeal exposure during microlaryngeal surgery (MLS).MethodsAn analytical cross-sectional study was conducted on a consecutive sample of 100 patients presenting laryngeal lesions that were trans-orally microsurgeries to treat various glottic diseases (biopsies revealed 68% benign lesions such as vocal fold polyps, cysts, and nodules, and 32% glottic masses) and prepared for MLS.ResultsThis study included 100 patients presenting laryngeal lesions from both sexes with the age of 47.0 ± 14.7 years, in multivariate logistic regression analysis, all these parameters were significant predictors for Cormack–Lehane and Italian Grading (P < 0.05). Body mass index (BMI) (OR = 3.449, 95% CI = 2.463–8.187), mandibular protrusion test (OR = 2.981, 95% CI = 1.922–4.044), mento-sternal length (OR = 3.722, 95% CI = 1.980–7.794), and atlanto-occipital joint (AOJ) extension (OR = 1.572, 95% CI = 1.865–4.263). Cormack–Lehane and Italian Grading was significantly associated with BMI, mandibular protrusion test, Mallampati Index, mento-thyroid, mento-sternal length, and AOJ extension, it increased with BMI of > 35, with more protruded mandible (class C), higher Mallampati Index (class III) and shorter mento-sternal distance (≤ 12.5 cm).ConclusionsDuring microlaryngeal surgery, BMI, mandibular protrusion test, Mallampati Index, mento sternal and AOJ extension were significant predictors of Cormack–Lehane and Italian Grading which makes it easier for laryngeal exposure.

Clinical case of 45,X/46,XY mosaic male with ejaculatory disorder associated with seminal vesicle dysplasia: a case report

Abstract Introduction 45,X/46,XY mosaicism is a rare anomaly in sexual differentiation, presenting with diverse phenotypes and often leading to infertility due to abnormal gonadal development. Aims This report aims to present a case study of a 45,X/46,XY mosaic male patient with an ejaculatory disorder attributed to seminal vesicle dysplasia. Methods In this case study, diagnostic procedures encompassed blood tests, semen analysis, chromosomal examination, and imaging studies to assess gonadal morphology. Treatment strategies included attempted varicocelectomy, pharmacological intervention with amoxapine, and surgical testicular sperm extraction. Additionally, the patient underwent assisted reproductive techniques, specifically intracytoplasmic sperm injection (ICSI), to facilitate pregnancy for his wife. Results A 32-year-old man could not ejaculate, with post-orgasmic urinalysis revealing minimal sperm presence. Chromosomal analysis confirmed 45,X/46,XY mosaicism. Despite undergoing microsurgical varicocelectomy for clinical varicocele and receiving tricyclic antidepressants, no improvement in semen volume occurred. Imaging studies indicated ejaculatory disorder due to prostate and seminal vesicle aplasia. Consequently, surgical retrieval of testicular sperm was performed, leading to successful pregnancy via ICSI for his wife. Conclusion Our approach has effectively addressed ejaculatory disorder in 45,X/46,XY mosaic men, resulting in successful pregnancy.

New Normative Values for the German Short Version of the Resilience Scale (RS-13)

In a representative survey conducted in Germany, normative values for the German short version of the RS-13 resilience scale were updated and compared with the data from a previous representative survey conducted in 2001. In a representative study conducted by the social science research institute USUMA GmbH in 2021, people aged 16 to 95 years (N=2,505) were randomly selected and interviewed by telephone. Data were compared to representative data collected in 2001 (N=2,045), and the influence of demographic variables on resilience was examined. The internal consistency of the RS-13 was α=0.92. Current norm data of the RS-13, differentiated by gender and age, were generated. Access to these data is provided by an online tool, which can be used for the norm-oriented interpretation of individual resilience values (http://rs13.shinyapps.io/RS13). In the current 2021 sample, the mean resilience score was significantly higher than in 2001 (d=0.28, 95% CI [0.22-0.34]). Age was significantly negatively associated with resilience, education and net household income showed a significant negative correlation. The RS-13 has good psychometric properties. Providing updated normative values of the RS-13 is justified due to the significantly higher scores in 2021 compared to 2001. The updated normative values allow for the comparison of future data with those of the German general population. In addition, the online tool can be used for the norm-oriented interpretation of individual resilience scores as part of diagnostic procedures. The RS-13 is a reliable, valid and economical instrument for assessing resilience in its theoretical understanding of a stable personality trait. Future studies investigating resilience should consider age, education and income as relevant influencing variables.

Importance of Copy Number Variant Analysis in Patients with Monogenic Kidney Diseases: Insights from 8 Years of Experience in an Expert Centre's Genome Diagnostic Laboratory

Importance of Copy Number Variant Analysis in Patients with Monogenic Kidney Diseases: Insights from 8 Years of Experience in an Expert Centre's Genome Diagnostic Laboratory

A rare case of tetanus with early manifestation of apnea but without trismus

BackgroundTetanus is a life-threatening disease caused by tetanus neurotoxin (TeNT) produced by Clostridium tetani. Early symptoms of tetanus are trismus and muscle stiffness, both caused by spasticity. TeNT mainly exerts its effect by impairment of inhibitory neurons in the spine and brainstem, resulting in the hyperactivity of motor neurons, which causes spasticity and muscle spasms. Apnea is not a symptom that is predicted to occur in the early stages. Case ReportWe present a rare case of severe tetanus with an early manifestation of apnea but without trismus. We believe that apnea was caused by spasms of the intercostal muscles and its early manifestation was due to a high load of TeNT, considering that the speed of disease progression is related to disease severity. We hypothesize that the absence of trismus was also due to a high load of TeNT, exerting toxic effect at the neuromuscular junction and causing flaccid paralysis of the massetersWhy Should an Emergency Physician Be Aware of This?:Since there is no diagnostic laboratory test for tetanus, emergency physicians must be well aware of symptoms that may or may not appear in tetanus. Tetanus should be considered as a differential diagnosis for patients arriving at the emergency department with apnea as an early symptom. The absence of trismus should not rule out the possibility of tetanus.

Clinical features of tularemia in cats: a retrospective study from 2000 to 2021.

The objectives of this study were to describe the clinical features of cats diagnosed with tularemia, and to compare the clinical features of cats with and without tularemia and identify characteristics increasing the likelihood of a tularemia diagnosis. Diagnostic laboratory data and medical records were retrospectively reviewed of cats tested for tularemia between 2000 and 2021. Clinical features including signalment, presenting complaint(s), physical examination findings and clinicopathologic data were described for cats with tularemia diagnosed by culture and/or PCR. Clinical features were also compared between PCR+ vs PCR- cats and logistic regression was used to identify features that predicted PCR+ status. A total of 18 cats were diagnosed with tularemia. The affected cats had a mean age of 5.8 ± 4.9 years, with a slight male predominance. Most were domestic shorthair cats and had outdoor access. Common presenting complaints included lethargy and anorexia, while physical examination findings frequently revealed fever, peripheral lymphadenomegaly and oral ulcers. Laboratory findings varied, with notable abnormalities including neutrophilic inflammation observed on cytology and widespread acute systemic pathologic changes in necropsy results. Leukopenia and neutropenia were more common in PCR+ vs PCR- cats, and these factors were 7.4 times (confidence interval [CI] 1.2-62.3) and 10.0 times (CI 1.4-83.2) more likely to occur in PCR+ vs PCR- cats, respectively. There were no significant differences between the groups in other parameters including anemia, thrombocytopenia, band neutrophilia and hyperbilirubinemia. This study provides a more comprehensive description of tularemia in cats than has been available to date. In particular, leukopenia and neutropenia are significantly associated with tularemia-positive cats. These clinical features should be considered and raise suspicion for tularemia in cats. These findings may be valuable for the timely diagnosis, treatment and prevention of tularemia outbreaks in cats and humans.

Tritrichomonas foetus testing in bulls.

To provide a video tutorial on how to perform preputial scraping for the testing of Tritrichomonas foetus in bulls. Postpubertal bulls. A preputial scraping device is inserted in the prepuce, and back-and-forth scraping movements are made to collect smegma and T foetus organisms. The sample is placed in an appropriate media and prepared for shipment to the diagnostic laboratory. Preputial sampling is an effective method for diagnosing T foetus in infected bulls. Bulls are the primary carriers of T foetus, a protozoan parasite responsible for bovine trichomoniasis. By sampling and testing bulls, veterinarians can identify infected animals and implement control measures to prevent the spread of the disease within herds. Trichomoniasis can lead to significant reproductive problems in cattle, including infertility, embryonic death, and abortions. Sampling bulls allows for the detection of infection, enabling prompt intervention to protect the reproductive health of the entire herd. Trichomoniasis outbreaks can result in substantial economic losses for cattle producers due to reduced conception rates, increased calving intervals, and decreased calf crops. Sampling bulls helps to mitigate these losses by identifying and removing infected animals from the breeding pool, thereby minimizing the spread of the disease and its associated reproductive inefficiencies. In many regions, T foetus testing in bulls is a regulatory requirement for cattle movement and trade. Sampling bulls and obtaining negative test results are often necessary for obtaining health certificates and complying with interstate or international movement regulations.

Overview of the early campaign diagnostics for the SPARC tokamak (invited).

The SPARC tokamak is a high-field, Bt0 ∼12T, medium-sized, R0 = 1.85m, tokamak that is presently under construction in Devens, MA, led by Commonwealth Fusion Systems. It will be used to de-risk the high-field tokamak path to a fusion power plant and demonstrate the commercial viability of fusion energy. SPARC's first campaign plan is to achieve Qfus > 1 using an ICRF-heated, <10MW, high current, Ip ∼ 8.5 MA, L-mode fueled by D-T gas injection, and its second campaign will investigate H-mode operations in D-D. To facilitate plasma control and scientific learning, a targeted set of ∼50 plasma diagnostics are being designed and built for operation during these campaigns. While nearly all diagnostics are based on established techniques, the pace of deployment, relative to the first plasma, and the harshness of the thermal, electromagnetic, and radiation environment are unprecedented for medium-sized tokamaks. An overview of the SPARC diagnostic set is given, providing context to further details communicated by the SPARC team in companion publications that are system-specific. The system engineering philosophy for SPARC diagnostics is outlined, and the design and engineering verification process for components inside and outside the primary vacuum boundary are described. Diagnostics are mounted directly to the vacuum vessel as well as housed within a series of eight midplane and 24 off-midplane replaceable port plugs. With limited exceptions, signal conditioning, digitization electronics and cameras as well as lasers and microwave sources are localized to a series of five Diagnostic Lab spaces, totaling ∼350m2, located >15m from the center of the tokamak, on the other side of a 2.4m concrete shielding wall. A series of 31 large-scale penetrations have been included in the SPARC Tokamak Hall to facilitate integration of early campaign diagnostics and to provide upgradability.

Ultrasound-guided forearm selective nerve block: A bright future on the horizon

Objective: In light of the advancement of modern medicine, anesthesiologists and surgeons are increasingly prioritizing patient comfort in diagnostic and therapeutic procedures. A growing body of research revolves around the utilization of ultrasound-guided forearm selective nerve blocks for surgeries involving the distal upper limb. This review aims to provide an overview of regional anesthesia techniques in forearm, hand, and wrist surgeries, laying a theoretical foundation for the prospects of ultrasound-guided forearm selective nerve blocks in optimizing comfort during diagnostic and therapeutic procedures. Methods: A retrospective review of literature sourced from the PubMed database was conducted to comprehensively evaluate and elucidate the advantages and drawbacks of ultrasound-guided forearm selective nerve blocks, brachial plexus blocks, Bier blocks, and wrist blocks. Additionally, a summary was provided regarding the selection of local anesthetics for ultrasound-guided forearm selective nerve blocks. Results: Overall, ultrasound-guided forearm selective nerve block techniques exhibit several advantages over Bier’s block, brachial plexus block, and wrist block for the majority of forearm, wrist, and hand surgeries. These advantages include reduced anesthesia-related time, prolonged duration of analgesia, and minimal impairment of upper extremity motor function. Consequently, these techniques enhance surgical safety and facilitate postoperative recovery. Furthermore, the addition of dexmedetomidine or dexamethasone to ultrasound-guided selective nerve blocks of the forearm could extend the duration of analgesia. Conclusion: Ultrasound-guided forearm selective nerve block is a straightforward and conducive anesthesia method for distal upper limb surgeries, aligning with the principles of fast surgical recovery and enhanced patient comfort during diagnostic and therapeutic procedures. Given its manifold benefits, widespread promotion and adoption of this technique in clinical practice are warranted.

Resilience in Healthcare: A Hospital-based Investigation of Breast Cancer Diagnostics Amid the Pandemic in Indonesia

Background: Widespread disruptions in healthcare services have occurred due to ongoing challenges during the pandemic. The tremendous impacts have struck countries with limited resources, greater distances of geographical access to healthcare services, and a shortage of healthcare personnel. Long delay of diagnosis and disruption in patient care affects the long-term prognosis of breast cancer. This study was conducted to investigate the effects of the COVID-19 pandemic and government-mandated social restrictions on the provision of diagnostic services for breast cancer patients in a tertiary referral hospital. The study aimed to explore how travel restrictions and patients' apprehension about COVID-19 exposure have contributed to notable declines in diagnostic and treatment procedures for breast cancer within this healthcare setting. Methods: This study was retrospective design and used a hospital registry to collect information on demographics, imaging, and pathology from January 2018 to September 2021. Breast ultrasound (US) and mammography data were collected from the Picture Archiving and Communication System (PACS), while pathology data were collected from e-medical records. The descriptive statistics of the annual total volume of imaging and pathological examinations were interpreted and statistics were only calculated for diagnostics mammography. Results: Between 2018 and 2021, the volume of monthly breast sonograms drastically decreased by 65% in 2020 and 2021 during the pandemic, while mammography significantly reduced by more than 40% from the 2019 levels. Breast US and mammography procedures were significantly lower during the first and second waves of the pandemic in March until May 2020 and June until September 2021, respectively. Although the proportion of breast ultrasound-guided fine-needle aspiration biopsy (FNAB) increased year by year, the number of FNAB for primary breast lesions significantly decreased by 84% in 2020 and 2021. Conclusions: We observed significant decreases in diagnostic procedures for breast cancer. Reconfiguration of breast cancer care scheduling is required to accommodate the potential for increased hospital visits after the travel restrictions.

Artificial Intelligence Applications in Medical Mycology: Current and Future

The application of artificial intelligence (AI) in the medical mycology field represents a new era in the diagnosis and management of fungal infections. AI technologies, particularly machine learning (ML) and deep learning (DL) methods, enhance diagnostic accuracy by leveraging large datasets and complex algorithms. This review examines current applications of AI in laboratory and clinical settings for fungal diagnostics. In the laboratory, AI models analyze microscopic images from potassium hydroxide (KOH) examinations, fungal culture tests, and histopathologic slides, which improves the detection rates of fungal pathogens significantly. In the clinical setting, AI assists the diagnosis of fungal infections using medical images, exhibiting high efficacy in binary classification tasks. However, challenges include small sample sizes, class imbalances, reliance on expert-labeled data, and the black box nature of AI models. Explainable AI offers potential solutions by providing human-comprehensible insights into AI decisionmaking processes. In addition, human-computer collaboration can enhance diagnostic accuracy, particularly for less experienced clinicians. The development of generative AI models, e.g., large language models and multimodal AI, promises to create extensive datasets and integrate various data sources for comprehensive diagnostics. Addressing these limitations through prospective clinical validation and continuous feedback will be essential for realizing the full potential of AI in medical mycology.

Explainable AI (XAI) in healthcare: Enhancing trust and transparency in critical decision-making

The integration of artificial intelligence (AI) in healthcare is revolutionizing diagnostic and treatment procedures, offering unprecedented accuracy and efficiency. However, the opacity of many advanced AI models, often described as "black boxes," creates challenges in adoption due to concerns around trust, transparency, and interpretability, particularly in high-stakes environments like healthcare. Explainable AI (XAI) addresses these concerns by providing a framework that not only achieves high performance but also offers insight into how decisions are made. This research explores the application of XAI techniques in healthcare, focusing on critical areas such as disease diagnostics, predictive analytics, and personalized treatment recommendations. The study will analyse various XAI methods, including model-agnostic approaches (LIME, SHAP), interpretable deep learning models, and domain-specific applications of XAI. It also evaluates the ethical implications, such as accountability and bias mitigation, and how XAI can foster collaboration between clinicians and AI systems. Ultimately, the goal is to create AI systems that are both powerful and trustworthy, promoting broader adoption in the healthcare sector while ensuring ethical and safe outcomes for patients.

Evaluation of intravenous Acepromazine-Butorphanol-Propofol anaesthesia on Canine serum biochemistry

In order to increase accuracy and ensure safety during surgical procedures, anaesthesia is a necessary precondition for most diagnostic and surgical procedures in humans and animals. This study was designed to determine the changes in serum biochemical parameters following Acepromazine-Butorphanol-Propofol (ABP-combination) and propofol alone (PRO alone) anaesthesia in dogs. Ten (10) apparently healthy dogs with mean age of 1.59±0.77 years and a mean body weight of 15.5±1.96 kg were obtained from live dog market in Maiduguri, North-eastern Nigeria. The dogs were divided randomly into two groups, ABP-combination and PRO-alone groups. Following premedication with Acepromazine at 0.02mg/kg and Butorphanol at 0.05mg/kg iv., 4mg/kg Propofol was used to induce total intravenous anaesthesia (TIVA) after five minutes of premedication in ABP-combination group, while PRO-alone at 6mg/kg was used to induce anaesthesia without premedication in PRO-alone group. Creatinine (sCr), Alanine aminotransferase (ALT) and Blood urea nitrogen (BUN) were determined using standard laboratory procedures. The ALT, sCr and BUN showed no difference (p&gt;0.05) within the group but were significantly (p&lt;0.05) different between the groups. The levels of Alanine aminotransferase in both ABP and PRO treatments showed significant difference (p&lt;0.05) at 10minutes, 1hour, 6hrs and 24hours. Significant difference (p&lt;0.05) was observed in sCr levels between the two treatments, at 10minutes, 1hour and 6hours respectively. Blood urea nitrogen in both treatments differed (p&lt;0.05) significantly at 6hours and 24hours post anaesthesia. The results of this study showed that ABP-combination following TIVA provides transient non-significant (p&gt;0.05) effect on serum biochemical parameters. Therefore, the combination of ABP can be used during surgical procedures in dog.

Artificial intelligence for automatic and objective assessment of competencies in flexible bronchoscopy.

Bronchoscopy is a challenging technical procedure, and assessment of competence currently relies on expert raters. Human rating is time consuming and prone to rater bias. The aim of this study was to evaluate if a bronchial segment identification system based on artificial intelligence (AI) could automatically, instantly, and objectively assess competencies in flexible bronchoscopy in a valid way. Participants were recruited at the Clinical Skills Zone of the European Respiratory Society Annual Conference in Milan, 9th-13th September 2023. The participants performed one full diagnostic bronchoscopy in a simulated setting and were rated immediately by the AI according to its four outcome measures: diagnostic completeness (DC), structured progress (SP), procedure time (PT), and mean intersegmental time (MIT). The procedures were video-recorded and rated after the conference by two blinded, expert raters using a previously validated assessment tool with nine items regarding anatomy and dexterity. Fifty-two participants from six different continents were included. All four outcome measures of the AI correlated significantly with the experts' anatomy-ratings (Pearson's correlation coefficient, P value): DC (r=0.47, P<0.001), SP (r=0.57, P<0.001), PT (r=-0.32, P=0.02), and MIT (r=-0.55, P<0.001) and also with the experts' dexterity-ratings: DC (r=0.38, P=0.006), SP (r=0.53, P<0.001), PT (r=-0.34, P=0.014), and MIT (r=-0.47, P<0.001). The study provides initial validity evidence for AI-based immediate and automatic assessment of anatomical and navigational competencies in flexible bronchoscopy. SP provided stronger correlations with human experts' ratings than the traditional DC.

Environmental and patient safety: Advances in radiological techniques to reduce radiation exposure

The growing concern for environmental and patient safety in medical imaging has driven significant advancements in radiological techniques aimed at reducing radiation exposure. This review explores these developments, emphasizing the dual focus on minimizing harm to patients and addressing the broader environmental impact of radiological practices. Recent innovations include the optimization of imaging protocols, the introduction of low-dose imaging technologies, and the integration of advanced software algorithms that enhance image quality while reducing the need for higher radiation doses. The implementation of iterative reconstruction techniques, for instance, has allowed for significant dose reductions in computed tomography (CT) scans without compromising diagnostic accuracy. Additionally, the use of alternative imaging modalities such as magnetic resonance imaging (MRI) and ultrasound, which do not involve ionizing radiation, is increasingly recommended where clinically appropriate, further mitigating radiation risks. Furthermore, the shift towards personalized imaging protocols, where radiation doses are adjusted based on individual patient characteristics, marks a critical advance in patient safety. This approach not only reduces unnecessary exposure but also enhances the overall effectiveness of diagnostic procedures. Environmental safety considerations have also led to the development of more sustainable radiological practices, including the safe disposal of radioactive materials and the reduction of energy consumption in imaging facilities. These efforts are aligned with broader healthcare initiatives to lower the carbon footprint of medical practices. The advancements in radiological techniques to reduce radiation exposure reflect a growing commitment to patient-centered care and environmental stewardship in healthcare. As technology continues to evolve, ongoing research and collaboration between medical professionals, physicists, and environmental scientists will be crucial in furthering these goals. By continuing to innovate and implement safer radiological practices, the medical community can significantly mitigate the risks associated with radiation exposure, ensuring better health outcomes for patients and reducing the environmental impact of radiological services.

Bronchial washing fluid sequencing is useful in the diagnosis of lung cancer with necrotic tumor

BackgroundEarly-stage lung cancers detected by low-dose computed tomography (CT) often require confirmation through invasive procedures due to the absence of endobronchial lesions. This study assesses the diagnostic utility of bronchial washing fluid (BW) sequencing, a less invasive alternative, aiming to identify patient characteristics most suited for this approach. MethodsFrom June 2017 to March 2018, we conducted a prospective cohort study by enrolling patients with incidental lung lesions suspected of early-stage lung cancer at two independent hospitals, and 114 were diagnosed with lung cancer while 50 were diagnosed with benign lesions. BW sequencing was performed using a targeted gene panel, and the clinical characteristics of patients detected with cancer through sequencing were identified. ResultsMalignant cells were detected in 33 patients (28.9 %) through BW cytology. By applying specificity-focused mutation criteria, BW sequencing classified 42 patients (36.8 %) as having cancer. Among the cancer patients who were BW sequencing positive and BW cytology negative, 15 patients (75.0 %) showed necrosis on CT. The sensitivity of BW sequencing was particularly enhanced in patients with necrotic tumors, reaching 75 %. ConclusionsBW sequencing presents a viable, non-invasive diagnostic option for early-stage lung cancer, especially valuable in patients with necrotic lesions. By potentially reducing the reliance on more invasive diagnostic procedures, this method could streamline clinical workflows, decrease patient burden, and improve overall diagnostic efficiency.