Level Of Confidence In Diagnosis Research Articles

Additional Non-contrast CT to Portal Venous Phase is not Relevant for Patients referred for Colonic Diverticulitis or Sigmoiditis Suspicion.

To evaluate the usefulness of unenhanced CT added to the portal venous phase in the diagnostic accuracy of acute colonic diverticulitis/sigmoiditis. Between January 1st and December 31st, 2020, all consecutive adult patients referred to the radiology department for clinical suspicion of acute colonic diverticulitis/sigmoiditis were retrospectively screened. To be included, patients must have undergone a CT with both unenhanced (UCT) and contrast-enhanced portal venous phase CT (CECT). CT examinations were assessed for features of diverticulitis, complications, differential diagnosis and incidental findings using UCT + CECT association, medical management, and follow-up as the reference. Radiation doses were recorded on our image archiving system and assessed. Of the 114 patients included (mean age was 67±18 years; 60% were female), 46 had acute colonic diverticulitis/sigmoiditis. No diagnosis of sigmoiditis/diverticulitis, complication or differential diagnosis was missed with the CECT alone. Apart from diverticulitis, only one 2 mm meatal urinary microlithiasis was missed with no impact on patient management. The confidence level in diagnosis was not increased by UCT. The average DLP of CECT was 450 mGy.cm, and 382 mGy.cm for UCT. The use of a single-phase CECT acquisition allowed a reduction of 45.9% of the irradiation. Unenhanced CT is not necessary for patients addressed with clinical suspicion of acute colonic diverticulitis/sigmoiditis, and CECT alone protocol must be used.

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

Brain magnetic resonance imaging surface-based analysis and cortical thickness measurement in relapsing remission multiple sclerosis

BackgroundDamage occurs in the brain tissue in MS which appears normal on standard conventional imaging (normal appearing brain tissue). This slow, evolving damage can be monitored by nonconventional advanced MR imaging techniques. New techniques for the measurement of cortical thickness have been validated against histological analysis and manual measurements. The aim of our study was to study the role of MRI surface-based analysis and cortical thickness measurement in the evaluation of patients with Relapsing Remitting Multiple Sclerosis and to detect if there is localized rather than generalized cortical atrophy in Multiple Sclerosis patients and correlating these findings with clinical data.Results30 patients and 30 healthy control were included in this study and they were subjected to cortical thickness analysis using MRI. The patients in our study showed decreased thickness of the precentral, paracentral, postcentral, posterior cingulate cortices and mean cortical thickness in both hemispheres when compared with the normal control group. Statistical analysis was significant (P value < 0.05) for the precentral, paracentral, postcentral, posterior cingulate cortices and mean cortical thickness in both hemispheres. On the other hand, statistical analysis was not significant (P value > 0.05) for other cortices. There was a significant negative correlation between the precentral, paracentral, postcentral, posterior cingulate cortices and mean cortical thickness in both hemispheres and EDSS scores with correlation coefficients ranging from − 0.9878 to − 0.7977.ConclusionsMRI and post-processing segmentation analysis for cortical thickness is non-invasive imaging techniques that can increase the level of diagnostic confidence in diagnosis of MS patients and should be included as routine modality when evaluating patients with MS.

Addressing the Diagnostic Miscommunication in Pathology

The pathology report serves as a crucial communication tool among a number of stakeholders. It can sometimes be challenging to understand. A communication barrier exists among pathologists, other clinicians, and patients when interpreting the pathology report, leaving both clinicians and patients less empowered when making treatment decisions. Miscommunication can lead to delays in treatment or other costly medical interventions. In this review, we highlight miscommunication in pathology reporting and provide potential solutions to improve communication. Up to one-third of clinicians do not always understand pathology reports. Several causes of report misinterpretation include the use of pathology-specific jargon, different versions of staging or grading systems, and expressions indicative of uncertainty in the pathologist's report. Active communication has proven to be crucial between the clinician and the pathologist to clarify different aspects of the pathology report. Direct communication between pathologists and patients is evolving, with promising success in proof-of-principle studies. Special attention needs to be paid to avoiding inaccuracy while trying to simplify the pathology report. There is a need for active and adequate communication among pathologists, other clinicians, and patients. Clarity and consistency in reporting, quantifying the level of confidence in diagnosis, and avoiding misnomers are key steps toward improving communications.

P084 EDS ECHO: virtual case based learning in the assessment and management of Ehlers-Danlos syndrome and hypermobility spectrum disorders

Abstract Background/Aims The Ehlers-Danlos Society is an affiliate of Project ECHO, a non-profit organisation supporting health professionals manage their patients through telehealth case-based learning. To increase access to expert advice and learning, in 2019 the Ehlers-Danlos Society introduced EDS ECHO, a series of programmes for health professionals supporting them in learning and sharing knowledge in the management of Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD). Programmes run from the UK, USA, and Australia; participants and experts joining from all over the world, and, from multiple specialties. This study explores participant perceptions of a 9-session programme covering all aspects of diagnosis and management in EDS and HSD, and, their co-morbidities. Each session is 90 minutes long, providing a total of 13.5 hours of learning. All materials are made available for review. The programme is repeated throughout the year. Methods The study had IRB approval from Penn State, USA. At the beginning of each 9-session programme, participants were invited to join the study. Using REDCap, a series of questions surveyed the participants confidence in managing patients with EDS or HSD; and, re-explored this at 6 months following completion of the programme. In addition, participants were surveyed for their perceptions of the value of the programme. Results 185 of 237 eligible participants completed the baseline and 6-month follow-up survey. At baseline 17%, 47%, and 36% reported their levels of confidence in diagnosing EDS or HSD as either low, moderate, or high respectively. The most reported motivations for joining the programme were: to increase knowledge (90% of responders), access experts (71%), and, increase confidence in managing EDS and HSD (68%). At 6-month follow-up 80-95% of participants reported positive experiences across the various fields of enquiry. With regard to increasing level of knowledge 46% reported a 'slight' increase and 46% a 'great' increase. Levels of confidence in diagnosis and management had risen 'slightly' in 54% and 'greatly' in 40% of participants. 78% of participants reported an overall increase in their interest in EDS and HSD. Conclusion The Project ECHO model of 'all teach all learn', case-based learning, and use of telehealth technology is well-established in supporting healthcare professionals managing patients across the breadth of Medicine. EDS ECHO follows these principles and practices, providing a series of programmes aligned to the multiple disciplines that manage people with EDS and HSD. For the majority of participants their perception was that the EDS ECHO 9-week program increased their knowledge and confidence in assessing and managing EDS and HSD. Further analysis will explore themes for developing the program, and how changes in confidence are influenced by baseline perceptions. In addition, a study is underway to explore perceptions of care among patients of participants in the EDS ECHO programme. Disclosure A. Hakim: Consultancies; The Ehlers-Danlos Society. J. Schubart: Grants/research support; The Ehlers-Danlos Society. C. Francomano: Grants/research support; The Ehlers-Danlos Society. R. Bascom: None. L. Bloom: Corporate appointments; The Ehlers-Danlos Society.

Antimicrobial Evaluation for Novel Solution of Iron Oxide Nanoparticles Functionalized with Glycine and Coated by Chitosan as Root Canal Final Irrigation

Background: This study aims to evaluate the antibacterial activity of chitosan-coated iron oxide nanoparticles (Chi-IONP) by agar direct diffusion method and determine the minimum inhibitory concentration and minimum bactericidal concentration (MIC/MBC) of this nano-solution against E.faecalis, S.mutans and Candida albicans the three oral microorganisms commonly isolated from endodontic infections. Methods: The nanoparticles solution was prepared by functionalizing the 8nm iron oxide nanoparticles with glycine and coating them by chitosan dissolved in 0.25% v/v acetic acid. E.faecalis, S.mutans and candida albicans were isolated and identified with Vitek 2 system. Agar diffusion method was used to test three groups of materials, NaOCl 5.25% serve as positive control, 0.25% Acetic acid as negative control and Chi-IONP as experimental material. Broth microdilution method used to determine the MIC/MBC of the experimental material. Statistical analysis used: Statistical analysis was conducted by independent variables t-test performed by using IBM-SPSS program version 22. Result: The used microbial isolates were confirmed with Vitek 2 system with excellent confidence level of diagnosis. Chi-IONP showed antifungal activity higher than NaOCl 5.25%, and comparable effect to NaOCl 5.25% against E.faecalis and S.mutans. The negative group showed no effect on the tested microorganisms. The MIC/MBC were determined as following 125/250 µg/ml for E.faecalis, 250/ 500 µg/ml for S.mutans and the MIC/MFC was 62.5/ 125 µg/ml for C.albicans. Conclusion: Chi-IONP was a powerful antimicrobial agent against the tested microorganisms, and this test results shows antifungal activity of Chi-IONP higher than NaOCl 5.25% and comparable antibacterial effect to NaOCl 5.25%.

Categorization of Diabetic Retinopathy using Deep Learning Techniques

Diabetic retinopathy is a disease that infects the vision of human eyes suffering from diabetes. It affects the blood vessels of soft tissues at retina, which is located at the backside of the eyes. This disease is evaluated by the physicians based on the retinal images of patients. Detection of the disease initiates human-intensive work for medical practitioners with monetary expenses also. Recent research works have identified that the use of deep learning methods for automatic detection of diabetic retinopathy helps the experts to make quick decision about the patient’s health conditions. In this paper, automated detection of diabetic retinopathy using deep belief networks has been presented which process the retinal images of patients and provides accurate diagnosis of categories of diabetic retinopathy. The proposed method has been trained and tested with Convolutional Neural Networks and Deep Belief Networks. The confidence level of diagnosis is computed and 94.69% with 96.01% are achieved in the detection of Proliferative diabetic retinopathy using CNN and DBN based on the features of data.

Evaluating the Quality of Rigid Optic Videolaryngoscopy Image Taken Through Dental Protection Cap and Its Feasibility as Additional Barrier Method Against COVID-19

Videolaryngoscopy screening is essential to help assessing human larynx. The use of 70° optical fiber in association with image recording by analog or digital cameras is one of the methods adopted to perform this examination. Endoscopic exams can contaminate the equipment with several microorganisms. The pandemic caused by the new coronavirus reinforces the importance of developing efficient barrier methods to be adopted in videolaryngoscopy procedures. Although dental intraoral camera covers are a barrier method authorized by Brazilian health organs, it has not yet been used in videolaryngoscopy examinations. The aim of the current longitudinal, individualized, single-blind, prospective, self-controlled, and accurate study is to evaluate the quality of images generated through, and confidence level of, diagnosis based on videolaryngoscopy performed with intraoral dental camera equipped with disposable protection cap and connected to 70° rigid laryngoscope in vocally healthy individuals. Videolaryngoscopy examinations based on 70° rigid optics were performed in 13 euphonic and asymptomatic volunteers at an otorhinolaryngology specialist clinic; only 1 patient was excluded from the study. Images were taken with, and without, disposable intraoral dental camera protection cap; high-grade disinfection protocol was applied between examinations. Recorded videos were randomly distributed in a single-blind manner in order to be evaluated by four otorhinolaryngologists, who answered a questionnaire comprising three questions. Statistical analysis was used to compare groups – which were defined by the use, or not, of protection cap – based on Wilcoxon nonparametric test. Statistical significance was set at 5% with 95% confidence interval. There was no statistically significant difference in image quality between examinations performed with, and without, protection cap (P= 0.646) or in the diagnosis confidence level of examinations performed with, or without, the barrier method. The use of disposable protection cap on intraoral dental camera did not significantly change the quality of images taken through videolaryngoscopy performed with 70° rigid optics in vocally healthy patients.

Teaching Psychiatric Emergencies Using Simulation: an Experience During the Boot Camp.

The purpose of this study is to prepare fourth-year medical students to recognize psychiatric emergencies using simulation technology. The learning experience is accomplished during the boot camp activity designed to train fourth-year medical students in different competencies before transitioning to residency. Ninety-eight fourth-year medical students at Paul L. Foster School of Medicine participated in the boot camp during the 2018-2019 academic year. The participation of the Department of Psychiatry was for a total of four full days divided into 3-h morning and 3-h afternoon sessions with the average of four students per hour per session. The use of high-fidelity simulation and standardized patients to recreate two different clinical scenarios representing acute psychiatric emergencies, followed by structured debriefing, was implemented. Pre- and post-qualitative surveys, which were electronically available via Qualtrics, intended to assess the effectiveness of the curriculum and course teaching modalities during the boot camp. All participants reported improvement on levels of confidence in diagnosis and management of psychiatric emergencies compared with baseline. Overall a statistically significant increase in the Likert score was noted in the post-survey analysis. Teaching psychiatric emergencies utilizing high-fidelity simulation and standardized patient encounters improved student confidence in several competencies. The increase in student confidence can potentially help the learner in transitioning better to residency.

Can Cone-beam Computed Tomography Change Endodontists' Level of Confidence in Diagnosis and Treatment Planning? A Before and After Study

IntroductionThis study evaluated the influence of cone-beam computed tomography (CBCT) on endodondists' level of confidence in their diagnosis of endodontic cases and their treatment plans. MethodsTwenty clinical cases with periapical radiographs and small-volume CBCT scans were classified according to the American Association of Endodontists guidelines. Information was provided on patient clinical history, and both extraoral and intraoral examinations were simulated. Fifteen endodontists filled out 2 questionnaires. In the first (Q1), the clinical description and a periapical radiograph were presented, followed by the questions. Thirty days later, they answered a second questionnaire (Q2) containing the same clinical description and CBCT. Their confidence in diagnosis and treatment planning was analyzed before and after receiving the tomographic images. Responses were recorded on a 5-point Likert scale, and the Wilcoxon test was used to investigate before and after levels of confidence in diagnosis and treatment planning. ResultsThe CBCT images influenced confidence in diagnosis and treatment planning of endodontic cases classified as complex (Wilcoxon test; P ≤ .05). There was a substantial change in the treatment planned in both moderate and complex cases after CBCT. Case complexity did not affect the participants' decision to request complementary information through CBCT. ConclusionsIn complex cases, CBCT increased endodontists' confidence to diagnose and plan treatment, when compared with periapical radiographs. Endodontists tended to recommend intervention when periapical images were supplemented with CBCT. CBCT proved to be an imaging method that influences endodontists' preoperative evaluation and treatment choice.

Relationship between interictal epileptiform discharges under medetomidine sedation and clinical seizures in canine idiopathic epilepsy

BackgroundElectroencephalography (EEG) is required for the diagnosis of canine idiopathic epilepsy as a highest confidence level of diagnosis by the International Veterinary Epilepsy Task Force; however, EEG is seldom used...

Development of Mathematical Model of Two-Contour Tomography Scanner: New Possibilities in Scanning

The actuality of the present research consists in the fact that equipotential surfaces defined by a standard one-contour tomography scanner are algebraic surfaces which are complicated for calculations. In particular, the latter surfaces fail to constant spheres among equipotential surfaces prescribed by such a device. This obstacle is convenient for analytical calculations. Calculation made by the reading devices are diminished because the final results become more exact and not purely numerical. This is especially important in medical research where the confidence level of diagnosis influences strongly to patient state evaluation.

Safer Attitude to Risky Decision-Making in Premanifest Huntington's Disease Subjects.

Huntington’s disease (HD) is an inherited neurodegenerative disorder characterized by involuntary, jerky movements, incoordination, behavioral changes and subtle executive and cognitive impairment starting before motor symptoms. Our study aimed to assess the risky decision-making process in premanifest (pre) HD subjects, by means Game of Dice Task (GDT). As dependent variables, several GDT outcomes have been taken into consideration. We recruited 30 subjects (15 females) with preHD (i.e., Diagnosis Confidence Level < 4; Total Motor Score < 10), and 21 age, gender and education matched neurologically normal subjects (11 females). GDT is a computer-guided task where subjects are invited to watch the digits on which to bet and to evaluate the related potential risk to win or loss. Our results showed that decision and feedback times were longer in preHD than in neurologically normal group in both disadvantageous and advantageous choices. PreHD subjects provided a greater number of “safe” strategies, taken with longer decision-making time than neurologically normal subjects, showing a reduced propensity to risk. Such behavior, characterized by increased slowness in acting and providing answers, might contribute to delineate a behavioral and cognitive profile in preHD.

Use of a molecular classifier to identify usual interstitial pneumonia in conventional transbronchial lung biopsy samples: a prospective validation study

In the appropriate clinical setting, the diagnosis of idiopathic pulmonary fibrosis (IPF) requires a pattern of usual interstitial pneumonia to be present on high-resolution chest CT (HRCT) or surgical lung biopsy. A molecular usual interstitial pneumonia signature can be identified by a machine learning algorithm in less-invasive transbronchial lung biopsy samples. We report prospective findings for the clinical validity and utility of this molecular test. We prospectively recruited 237 patients for this study from those enrolled in the Bronchial Sample Collection for a Novel Genomic Test (BRAVE) study in 29 US and European sites. Patients were undergoing evaluation for interstitial lung disease and had had samples obtained by clinically indicated surgical or transbronchial biopsy or cryobiopsy for pathology. Histopathological diagnoses were made by experienced pathologists. Available HRCT scans were reviewed centrally. Three to five transbronchial lung biopsy samples were collected from all patients specifically for this study, pooled by patient, and extracted for transcriptomic sequencing. After exclusions, diagnostic histopathology and RNA sequence data from 90 patients were used to train a machine learning algorithm (Envisia Genomic Classifier, Veracyte, San Francisco, CA, USA) to identify a usual interstitial pneumonia pattern. The primary study endpoint was validation of the classifier in 49 patients by comparison with diagnostic histopathology. To assess clinical utility, we compared the agreement and confidence level of diagnosis made by central multidisciplinary teams based on anonymised clinical information and radiology results plus either molecular classifier or histopathology results. The classifier identified usual interstitial pneumonia in transbronchial lung biopsy samples from 49 patients with 88% specificity (95% CI 70-98) and 70% sensitivity (47-87). Among 42 of these patients who had possible or inconsistent usual interstitial pneumonia on HRCT, the classifier showed 81% positive predictive value (95% CI 54-96) for underlying biopsy-proven usual interstitial pneumonia. In the clinical utility analysis, we found 86% agreement (95% CI 78-92) between clinical diagnoses using classifier results and those using histopathology data. Diagnostic confidence was improved by the molecular classifier results compared with histopathology results in 18 with IPF diagnoses (proportion of diagnoses that were confident or provisional with high confidence 89% vs 56%, p=0·0339) and in all 48 patients with non-diagnostic pathology or non-classifiable fibrosis histopathology (63% vs 42%, p=0·0412). The molecular test provided an objective method to aid clinicians and multidisciplinary teams in ascertaining a diagnosis of IPF, particularly for patients without a clear radiological diagnosis, in samples that can be obtained by a less invasive method. Further prospective clinical validation and utility studies are planned. Veracyte.

Imaging of the sacroiliac joints is important for diagnosing early axial spondyloarthritis but not all-decisive.

To evaluate the contribution of the results of sacroiliac imaging to diagnosis and to the level of confidence in diagnosis in patients presenting with chronic back pain (CBP) and suspected of having axial spondyloarthritis (axSpA). Data from 513 patients from the SPondyloArthritisCaughtEarly cohort with CBP (⩾3 months, ⩽2 years, onset <45 years) were analysed after full diagnostic work-up. Rheumatologists were asked not only to provide a diagnosis before and after the imaging results had been provided to them, but also to provide the level of confidence of this diagnosis on an 11-point numerical scale. Before imaging, 317/513 patients were diagnosed with axSpA. Of these patients, 178/317 (56%) did not have signs of sacroiliitis on either MRI or radiography, which led to the rheumatologist refuting the initial diagnosis of axSpA in 81/178 (46%) patients. Of the 196/513 patients without axSpA before imaging, 35/196 (18%) had signs of sacroiliitis on imaging. Subsequently, 28/35 (80%) patients were diagnosed with axSpA. Overall, imaging was incongruent with the diagnosis before imaging in 213 patients. This led to a change in diagnosis in 109/213 (51%), which corresponds to 21% (109/513) of all patients in the cohort. In general, diagnostic confidence increased by having imaging results available (from 6.2 to 7.4, P < 0.001). In patients with CBP suspected of having axSpA, sacroiliac imaging adds to the confidence in the final diagnosis. However, the number of changes in diagnosis suggests that imaging is important but not all-decisive in early axSpA diagnosis.

Atypical femur fractures: a survey of current practices in orthopedic surgery.

We aimed to determine current AFF treatment practices of orthopedic surgeons to inform clinical practice guideline development. A self-administered online survey was developed and sequentially posted on the Orthopaedic Trauma Association (OTA) website from July to August 2015 and the Canadian Orthopaedic Association (COA) website from December 2015 to January 2016. Level of confidence in diagnosis and treatment as well as treatment preferences between respondents who self-identified as trauma surgeons vs. non-trauma surgeons were compared. A total of 172 completed surveys were obtained (OTA, N=100, 58%; COA, N=72, 8%). Seventy-eight percent of respondents had treated ≥1 AFF in the previous 6months. Seventy-six percent reported feeling extremely or very confident in diagnosing AFF (trauma 84% vs. non-trauma surgeons 70%, p=0.04), and 63% reported feeling extremely or very confident in treating AFF (trauma 82%, non-trauma surgeons 50%, p<0.01). Preferred management for complete and symptomatic incomplete AFFs was surgical fixation with a cephalomedullary nail (CMN) by 88 and 79%, respectively, while close follow-up was preferred for asymptomatic incomplete AFFs in 72% of respondents. Trauma surgeons used the CMN more frequently than non-trauma surgeons (90 vs. 76% p=0.03). In patients with bilateral AFFs, with one side surgically treated, 56% were extremely likely to surgically treat the contralateral side, if symptomatic. Most felt guidelines (81%) and educational resources (73%) would be valuable. Current orthopedic treatment practices for AFFs are variable. The results of this survey will inform the development of practice guidelines and educational resources.

Impact of an educational workshop upon psychiatrists' attitudes towards delirium care.

Improving knowledge about delirium care is a key target for health care. We describe the implementation of a four-part workshop focusing upon key aspects of delirium care. Attitudes towards and understanding of delirium diagnosis and management amongst psychiatrists were surveyed before and immediately after an educational workshop. There were 62 participants. Pre-workshop, delirium was rated highly relevant to psychiatry. Overall level of confidence in diagnosis was modest, with the behavioural and psychological symptoms of dementia considered the most challenging differential diagnosis. Only nine participants (15%) correctly identified DSM-5 delirium criteria. Preferred assessment of attention varied with six different approaches endorsed. Confidence was higher for managing hyperactive compared with hypoactive delirium (p&lt;0.001). Pharmacotherapy was more frequently endorsed for hyperactive compared with hypoactive presentations, with haloperidol the most popular agent (p&lt;0.001). A total of 41 (66%) participants completed post-workshop assessments. Post-workshop, there were significant increases to the perceived relevance of delirium (p = 0.003), confidence in overall diagnosis (p&lt;0.001) accuracy of awareness of DSM-5 criteria (p&lt;0.001), and confidence in treating different presentations (p&lt;0.001). The Months Backward Test was the preferred bedside test of attention (38/40 respondents). This interactive educational intervention impacted positively upon knowledge and attitudes amongst psychiatrists towards key aspects of delirium care. Further investigation can examine the impact upon longer term knowledge and behaviour.

Use of digital images to aid in the decision-making for acute upper extremity trauma referral.

This study evaluated the use of digital smartphone images in the decision-making for acute upper extremity trauma referrals. Surgeons (n = 15) were presented with ten upper limb trauma scenarios for consideration of immediate transfer. Based on verbal history and with additional images, participants were asked questions regarding diagnosis, injured tissues, recommended management and diagnostic and treatment confidence. Statistical analyses evaluated confidence level changes and relationships between confidence levels and independent variables. Confidence levels for diagnosis and treatment were increased with the provision of smartphone images, and this was statistically significant. The decision to transfer was changed in 22%. The photographs were more useful for amputation versus non-amputation injuries (diagnosis and treatment) and hand versus forearm injuries (diagnosis), and these differences reached statistical significance. Smartphone digital images were shown to be useful for decision-making in acute upper extremity trauma referrals. This improved communication may have implications for health cost savings and patient burden by minimizing unnecessary acute transfers. Diagnostic Level III.

Association Between Confidence Level of Acute Pulmonary Embolism Diagnosis on CTPA images and Clinical Outcomes

The purpose was to evaluate clinical characteristics associated with low confidence in diagnosis of acute pulmonary embolism (PE) as expressed in computed tomography pulmonary angiography (CTPA) reports and to evaluate the effect of confidence level in PE diagnosis on patient clinical outcomes. This study included radiology reports from 1664 consecutive CTPA considered positive for acute PE (8/2003-5/2010). All reports were retrospectively assessed for the level of confidence in diagnosis. Baseline characteristics and outcomes (therapies related to PE and short-term mortality) were compared between high and low confidence groups. Multivariable logistic and Cox regression analyses were used to analyze the relationship between the confidence level and outcomes. One-hundred sixty of 1664 (9.6%) reports had language that reflected a low confidence in PE diagnosis. The low confidence group had smaller (segmental and subsegmental) suspected emboli (prevalence, 72.5% vs. 50.7%; P < .001) and more comorbidities. The low confidence group had a lower likelihood of receiving PE-related therapies (adjusted odds ratio [OR], 0.18; 95% confidence interval, 0.10-031, P < .001), but there was no change in the all-cause and PE-related 30-day and/or 90-day mortality (OR of death for low confidence, 0.81-1.13, P values > .5). Roughly 10% of positive CTPA reports had uncertainty in PE findings, and patients with reports categorized as low confidence had smaller emboli and more comorbidities. Although the low confidence group was less likely to receive PE-related therapies, patients in this group were not associated with higher probability of short-term mortality.

Dual-energy CT increases reader confidence in the detection and diagnosis of hypoattenuating pancreatic lesions.

To prospectively compare detection and reader confidence of pancreatic lesions using a standard multi-detector computed tomography (MDCT) imaging protocol to a dual-energy computed tomography (DECT) imaging protocol with additional virtual non-contrast series. 60 subjects imaged for suspected or known pancreatic lesions were included. Subjects underwent pancreatic MDCT including non-contrast, pancreatic phase, and portal venous phase (PVP). The PVP was performed in dual energy mode. Virtual non-contrast and blended 120 kVp weighted images were created from the DECT data. Overall noise and absolute attenuation differences of pancreatic lesions and normal pancreatic tissue were measured. Images were read by two staff radiologists blinded to the underlying diagnosis. MDCT and DECT scans were reviewed separately to evaluate image quality and level of confidence in diagnosis of a pancreatic lesion. Image quality was ranked excellent for 90 % and 95 % of the 120 kVp studies and 93 % and 95 % of the 100 kVp studies by readers 1 and 2, respectively. VNC was ranked sufficient quality or better by both readers. Average attenuation difference was 74 HU (120 kVp) and 71 HU (100 kVp). Average noise was 11.31 HU (120 kVp) and 15.89 HU (100 kVp). No lesions were missed by either approach. There was increased confidence in diagnostic interpretation in 14 % (± 9 % [95 % CI]) and 9 % (± 7 % [95 % CI]) of DECT scans compared to MDCT. DECT compared to MDCT pancreatic imaging leads to increased reader confidence with identical diagnostic sensitivity for pathologically proven cases. This approach could be implemented as a single phase acquisition study with calculated VNC leading to a significant dose savings to the patient.