Experienced Physicians Research Articles

Multiple large language models versus experienced physicians in diagnosing challenging cases with gastrointestinal symptoms

Abstract Faced with challenging cases, doctors are increasingly seeking diagnostic advice from large language models (LLMs). This study aims to compare the ability of LLMs and human physicians to diagnose challenging cases. An offline dataset of 67 challenging cases with primary gastrointestinal symptoms was used to solicit possible diagnoses from seven LLMs and 22 gastroenterologists. The diagnoses by Claude 3.5 Sonnet covered the highest proportion (95% confidence interval [CI]) of instructive diagnoses (76.1%, [70.6%–80.9%]), significantly surpassing all the gastroenterologists (p < 0.05 for all). Claude 3.5 Sonnet achieved a significantly higher coverage rate (95% CI) than that of the gastroenterologists using search engines or other traditional resource (76.1% [70.6%–80.9%] vs. 45.5% [40.7%-50.4%], p < 0.001). The study highlights that advanced LLMs may assist gastroenterologists with instructive, time-saving, and cost-effective diagnostic scopes in challenging cases.

Electronic Health Record Use Patterns Among Well-Being Survey Responders and Nonresponders: Longitudinal Observational Study

Abstract Background Physician surveys provide indispensable insights into physician experience, but the question of whether responders are representative can limit confidence in conclusions. Ubiquitously collected electronic health record (EHR) use data may improve understanding of the experiences of survey nonresponders in relation to responders, providing clues regarding their well-being. Objective The aim of the study was to identify EHR use measures corresponding with physician survey responses and examine methods to estimate population-level survey results among physicians. Methods This longitudinal observational study was conducted from 2019 through 2020 among academic and community primary care physicians. We quantified EHR use using vendor-derived and investigator-derived measures, quantified burnout symptoms using emotional exhaustion and interpersonal disengagement subscales of the Stanford Professional Fulfillment Index, and used an ensemble of response propensity-weighted penalized linear regressions to develop a burnout symptom prediction model. Results Among 697 surveys from 477 physicians with a response rate of 80.5% (697/866), always responders were similar to nonresponders in gender (204/340, 60% vs 38/66, 58% women; P=.78) and age (median 50, IQR 40‐60 years vs median 50, IQR 37.5‐57.5 years; P=.88) but with higher clinical workload (median 121.5, IQR 58.5‐184 vs median 34.5, IQR 0‐115 appointments; P<.001), efficiency (median 5.2, IQR 4.0-6.2 vs median 4.3, IQR 0‐5.6; P<.001), and proficiency (median 7.0, IQR 5.4‐8.5 vs median 3.1, IQR 0‐6.3; P<.001). Survey response status prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.88 (95% CI 0.77-0.91). Burnout symptom prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.63 (95% CI 0.57-0.70). The predicted burnout prevalence among nonresponders was 52%, higher than the observed prevalence of 28% among responders, resulting in an estimated population burnout prevalence of 31%. Conclusions EHR use measures showed limited utility for predicting burnout symptoms but allowed discrimination between responders and nonresponders. These measures may enable qualitative interpretations of the effects of nonresponders and may inform survey response maximization efforts.

Evaluating the learning curve for flexible ureteroscopic thulium fiber laser lithotripsy using CUSUM analysis.

Effective training methods and learning curve (LC) assessment are crucial for more difficult endoscopic procedures. The present study sought to assess the LC of ureteral flexible scopes for thulium fiber laser (TFL) lithotripsy and determine the effectiveness of using a porcine kidney model in training modality, to inform future training. Postgraduate medical students without experience in ureteroscopy were recruited, and surgical data were collected from 10 consecutive flexible ureteroscopic (fURS) lithotripsy procedures performed on our homemade porcine kidney training model. Cumulative sum (CUSUM) analysis and pooled mean CUSUM curves were applied to determine the LC turning points (TPs), and pre-LC and post-LC data were compared with that of an experienced attending physician. Data from 110 surgeries were included in the analysis. The mean number of surgical units to overcome the LC for the duration of fURS TFL lithotripsy was 4. The operation time, number of tissue damage, and number of central visual shifts were significantly lower in students after the TP than before. No statistically significant difference in operation time was found between the students after the LC (817.50 [703.75-964.75]) and the surgeon group (732.50 [51.00-822.25]). Overcoming the LC of fURS TFL lithotripsy requires four surgeries, and the developed ex vivo porcine kidney is a conveniently accessible and effective clinical training model.

Optimizing the integration of family physicians into cancer survivorship care in the BC Interior: a mixed methods study of physicians' opinions and experiences.

With cancer diagnoses increasing worldwide and the number of cancer survivors rising, family physicians are being increasingly relied upon to provide post-cancer treatment care and/or survivorship care. This mixed-method study explores and evaluates barriers and facilitators to optimizing family physician-led survivorship care in the largely rural Interior of British Columbia (BC), Canada. A mixed-method approach consisting of quantitative surveys and qualitative interviews was utilized to explore family physician and oncologist perspectives on the current state of survivorship care for breast, lung, prostate, and colorectal cancers within the BC Interior. Concerns about family physician knowledge in some aspects of survivorship care were identified by both groups, with mixed responses regarding geographical factors, resources, and communication networks. Success was dependent on information from oncologists with more common cancer sites fitting the model better. There was significant concern for individuals with no family physician. Five frequently discussed facilitators were identified: (1) providing accessible survivorship guidelines, (2) standardized discharge summaries (i.e., survivorship care plans), (3) clear points-of-contact at cancer care centers, (4) more educational opportunities, and (5) compatible electronic supports between care providers. Overall, the model of family physician-led survivorship care was supported by family physicians and oncologists within the BC Interior, although success was dependent on several factors. Identifying the perspectives of physicians directly involved in the survivorship care pathway will be instrumental in developing and implementing solutions that will succeed within the BC Interior and similar regions.Implication toforCancer SurvivorsWe hope that the improvements to interprofessional cooperation driven by our research mayimprove the quality and continuity of care received by cancer survivors in British Columbia and beyond. IMPLICATION TO CANCER SURVIVORS: We hope that the improvements to interprofessional cooperation driven by our research may improve the qualityand continuity of care received by cancer survivors in British Columbia and beyond.

Safety and Feasibility of 3D Intracardiac Echocardiography in Guiding Left AtrialAppendage Occlusion With WATCHMAN FLX.

Intracardiac echocardiography (ICE) is an alternative to transesophageal echocardiography to guide left atrial appendage occlusion (LAAO). However, 2-dimensional ICE has important limitations that hinder its adoption in routine practice. This prospective multicenter study (NCT04569734) investigated the feasibility and safety of ICE-guided LAAO with Watchman FLX using a novel 3-dimensional ICE catheter (VeriSight Pro, Philips). A total of 100 patients undergoing LAAO with the Watchman FLX device were recruited. All cases were performed under moderate sedation. A simplified 2 orthogonal view ICE imaging protocol was adopted to assess PASS (position, anchoring, sizing, and sealing) criteria. The feasibility endpoint was successful implantation of the FLX device and adequate seal (peri-device leak<5mm) at 45days. The safety endpoint was the incidence of major complications at 7 and 45days. Physician experience and imaging quality scores were collected (1=lowest, 5=highest). The mean age was 77.0±8.1years, and 39 (39%) were women. CHA2DS2-VASc score was 4.8±1.5 and HAS-BLED score was 3.2±1.1. Total procedural time was 54±25minutes. Mean contrast volume was 41±46ml, with no contrast used in 16 patients. The feasibility endpoint was achieved in 95 patients (95%); 4 patients were not implanted due to unsuitable anatomy, and 1 patient had a leak >5mm at 45days. There was 1 periprocedural stroke and 2 gastrointestinal bleeds requiring transfusion at 7days with no other major complications. Physicians' rating of overall ICE imaging quality was 4.6±0.6. The novel 3-dimensional ICE VeriSight Pro Probe can safely and effectively guide LAAO with Watchman FLX using a simplified imaging protocol.

Experiences of Lesbian, Gay, Bisexual, Transgender, and Queer Cardiology Physicians and Fellows in Training.

The number of practicing lesbian, gay, bisexual, transgender, and queer (LGBTQ+) cardiologists is unknown despite diversity initiatives focused on understanding workforce demographics. The aim of this study was to evaluate the prevalence, sources of mistreatment, and measures of wellness among the LGBTQ+cardiology community. An online survey was sent to the American College of Cardiology Fellow in Training and Early Career Professional Listservs and shared on social media sites. The survey included the Short-Negative Acts Questionnaire and LGBTQ+-specific harassment questions. Chi-square analysis and Fisher exact tests were performed to compare responses between LGBTQ+ and non-LGBTQ+respondents. A total of 188 respondents completed the survey (56% Fellow in Training). One-third (33%) identified as LGBTQ+. Gender identity data included: transgender (3%), nonbinary (2%), gender queer (1%), and agender (1%). LGBTQ+physicians were less likely to agree with the statements 'LGBTQ+patients were treated fairly' (40% vs 66%, P<0.001), and 'leadership dealt with people demonstrating poor behavior fairly' (34% vs 51%, P=0.029) compared to heterosexual peers. LGBTQ+physicians were more likely to report gender policing and heterosexist harassment compared to heterosexual peers (P=0.002). The majority of physicians (91%) were satisfied with their decision to become a cardiologist. This current analysis of LGBTQ+cardiologists in the workplace identifies opportunities to address mistreatment impacting the LGBTQ+community. Despite experiencing mistreatment, LGBTQ+cardiologists report high job satisfaction. Further work is necessary to create a safe space and diverse cohort of physicians required to meet the needs of LGBTQ+patients at risk for cardiovascular disease.

P-2027. Care at Home for Remdesivir Treatment of COVID-19: A Mixed Methods Study of Patient and Physician Experiences

Abstract Background Hospital in the home and virtual models of care were rapidly implemented during the COVID-19 pandemic. We sought to assess patient and provider perspectives of care at home integrating a three or five-day remdesivir (RDV) treatment regimen in a large integrated health care system in California.Figure 1.Patient Survey Recruitment Consort Flow Diagrama. Identified as unreachable prior to and during recruitment (deceased, no longer health system members, cognitive impairment, invalid contact information)b. Lost to follow- no response after exhausting all contacts Methods A mixed methods study was conducted to assess patient and physician experiences using an online/telephone survey questionnaire developed based on components of the Health Belief Model and Hospital Consumer Assessment of Healthcare Providers. Patients &amp;gt; 18 years of age who received RDV in the outpatient setting (N=1544) and prescribing physicians (N=406) from December 15, 2020-August 31, 2022 were eligible. Descriptive statistics were used to describe categorical responses. A cross-sectional analysis was performed to identify factors associated with patient adherence defined as taking &amp;gt; 80% of prescribed doses and physician adoption of treatment guidelines. Qualitative data were triangulated to determine whether patient/prescriber perceptions about value were validated by health outcomes measured as reduction of COVID-19 related readmission within 30 days of entry into treatment program.Figure 2.Provider Survey Recruitment Consort Flow Diagrama. No longer health system providersb. Lost to follow-up- no response after exhausting all contacts Results Of 540 patient respondents (response rate: 38%, mean age: 58.4 years (SD 16.2), 55.2% male), the majority was of Hispanic ethnicity (48.4.2%), followed by White (32.3%), and Black (12.6%). Of 140 physician respondents (response rate: 34%, mean age: 46.9 years (SD 8.4), 58% male), the majority was of Asian ethnicity (65.8%), followed by White (23%), and Hispanic (7.1%). Adherence was found in 99% of patients having completed &amp;gt; 80% of RDV doses. Adherent patients reported returning to their own home (95.2%), nurses always listened to them (87%), and high health literacy (65%). Feeling knowledgeable was significantly associated with physician prescribing of new unfamiliar medications while under emergency use authorization. (p=0.0007). Patients (80.3%) reporting “Very Satisfied” with medical follow-up were less frequently readmitted within 30 days. (p=0.045) Conclusion Patients and physicians responded favorably to value-based care at home integrating RDV for treatment of COVID-19. This finding is key to informing future design of alternative modes of health care delivery. Disclosures Julia K. Nguyen, PharmD, Gilead Sciences: Grant/Research Support Rulin C. Hechter, MD, PhD, MS, Gilead Sciences: Grant/Research Support William Towner, MD, GSK: Grant/Research Support|Janssen: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support

Impact of tissue-independent positron range correction on [68Ga]Ga-DOTATOC and [68Ga]Ga-PSMA PET image reconstructions: a patient data study.

The positron range effect can impair PET image quality of Gallium-68 (68Ga). A positron range correction (PRC) can be applied to reduce this effect. In this study, the effect ofa tissue-independent PRC for 68Ga was investigated on patient data. PET/CT data (40 patients: [68Ga]Ga-DOTATOC or [68Ga]Ga-PSMA) were reconstructed using Q.Clear reconstruction algorithm. Two reconstructions were performed per patient, Q.Clear with and without PRC. SUVmax and contrast-to-noise ratio (CNR) values per lesion were compared between PRC and non-PRC images. Five experienced nuclear medicine physicians reviewed the images and chose the preferred reconstruction based on the image quality, lesion detectability, and diagnostic confidence. A total of 155 lesions were identified. The PRC resulted in statistically significant increase of the SUVmax and CNR for soft tissue lesions (6.4%, p < 0.001; 8.6%, p < 0.001), bone lesions (14.6%, p < 0.001; 12.5%, p < 0.001), and lung lesions (3.6%, p = 0.010; 6.3%, p = 0.001). This effect was most prominent in small lesions (SUVmax: 12.0%, p < 0.001, and CNR: 13.0%, p < 0.001). Similar or better image quality, lesion detectability, and diagnostic confidence was achieved in PRC images compared to the non-PRC images as those assessed by the expert readers. A tissue-independent PRC increased the SUVmax and CNR in soft tissue, bone, and lung lesions with a larger effect for the small lesions. Visual assessment demonstrated similar or better image quality, lesion detectability, and diagnostic confidence in PRC images compared to the non-PRC images.

A phenotype-based AI pipeline outperforms human experts in differentially diagnosing rare diseases using EHRs

Rare diseases, affecting ~350 million people worldwide, pose significant challenges in clinical diagnosis due to the lack of experienced physicians and the complexity of differentiating between numerous rare diseases. To address these challenges, we introduce PhenoBrain, a fully automated artificial intelligence pipeline. PhenoBrain utilizes a BERT-based natural language processing model to extract phenotypes from clinical texts in EHRs and employs five new diagnostic models for differential diagnoses of rare diseases. The AI system was developed and evaluated on diverse, multi-country rare disease datasets, comprising 2271 cases with 431 rare diseases. In 1936 test cases, PhenoBrain achieved an average predicted top-3 recall of 0.513 and a top-10 recall of 0.654, surpassing 13 leading prediction methods. In a human-computer study with 75 cases, PhenoBrain exhibited exceptional performance with a top-3 recall of 0.613 and a top-10 recall of 0.813, surpassing the performance of 50 specialist physicians and large language models like ChatGPT and GPT-4. Combining PhenoBrain’s predictions with specialists increased the top-3 recall to 0.768, demonstrating its potential to enhance diagnostic accuracy in clinical workflows.

An Exploration of the Contemporary U.S. Academic Physician Experience with the Formal Rationalization of Health Care

It has been over three decades since it was predicted that the processes of formal rationalization would lead to dire consequences for all physicians. Prompted by a social concern about elevated burnout rates in U.S. physicians, there have been some investigations about organizational influences on their work lives. However, these studies have not used formal rationalization as a conceptual framework. This exploratory study was undertaken to examine the work lives of a group of academic physicians in the United States using McDonaldization thesis features as the organizing framework. Eighteen academic physicians were recruited from a single academic medical center in the United States. Focus groups were conducted by a physician and a medical sociologist, and the transcripts analyzed. Academic physicians could identify programs consistent with the McDonaldization of health care and reacted variably to them. The features were found to interact in differing ways with control over work being superordinate to the other three features. There was evidence for the consequence of irrationality in that inefficiency was increased and the quality of the patient interaction reduced. Physicians’ reactions to overall changes to their work are variable ranging from distress to varying degrees of acceptance.

Trends in Neurosurgeons Signing Medicare Opt-Out Affidavits.

In recent decades, many physicians have chosen to opt out of Medicare, allowing them to set their own pricing models for their patients. Characterization of Medicare opt-outs has not been thoroughly studied in any surgical specialty, including Neurosurgery. Our study characterizes the factors that may influence a neurosurgeon's decision to opt out of Medicare acceptance and contextualizes them both within the field and across various surgical specialties. Retrospective cross-sectional analysis using Centers for Medicare and Medicaid Services (CMS) data on starting date of physician opting out as well as geographic state of practice for neurosurgeons and other specialty surgeons. Additional parameters were collected from publicly available profiles of neurosurgeons regarding medical school graduation year, subspecialty, and type of practice. 63 neurosurgeons opted out of Medicare. The rate of Medicare opt-outs was highest for Neurosurgery during 2023, while for most other surgical specialties it was highest between the years 2015 and 2017. 54.0% of opt-out neurosurgeons were exclusively private practice physicians. Most were spine (66.7%) or general neurosurgeons (20.6%). Most Medicare non-participating neurosurgeons chose to opt out in their mid-career compared to early or late career. A higher number of these neurosurgeons were located in Alaska, Iowa, California, Connecticut, Florida, and New Jersey. The circumstances influencing a neurosurgeon's decision to opt out of Medicare acceptance are multifaceted, and our findings suggest that physician experience, specialty, location, and practice structure may all play roles and should be further investigated.

Evaluating script concordance tests (SCTs) through the lens of Bayesian reasoning: Enhancing assessment in medical education.

Script Concordance Tests (SCTs) represent an innovative assessment method which have been introduced in the 2024 French National Ranking Examinations (EDN). These tests compare a student's clinical reasoning with that of a panel of experts under conditions of uncertainty. Typically, the question involves the impact of new information on an initially proposed hypothesis, with answers given on a Likert scale. This article aims to didactically illustrate how SCTs are consistent with probabilistic reasoning as modeled by Bayes' theorem. In addition, by comparing SCT writing guidelines with Bayesian reasoning concepts, several ambiguities were identified: (1) What stage of clinical reasoning do SCTs evaluate? (2) What are the appropriate labels for Likert scale responses? (3) Does the expert panel provide a relevant reference for SCTs? Currently, many of these questions remain unanswered in the literature, with recent data suggesting that experienced physicians' responses to SCTs are often biased. Beyond their use as an assessment tool in the EDN, SCTs offer a valuable opportunity to develop and deepen the teaching of probabilistic reasoning in medical education and serve as a potential area of research to improve clinical practice.

Automated Detection of Cancer-Suspicious Findings in Japanese Radiology Reports with Natural Language Processing: A Multicenter Study.

Missed critical imaging findings, particularly those indicating cancer, are a common issue that can result in delays in patient follow-up and treatment. To address this, we developed a rule-based natural language processing (NLP) algorithm to detect cancer-suspicious findings from Japanese radiology reports. The dataset used consisted of chest and abdomen CT reports from six institutions. Reports from our institution were used for algorithm development and internal evaluation, while reports from the other five institutions were used for external evaluation. To create the gold standard, reports were annotated by two experienced physicians. Data were statistically analyzed using precision, recall and F1 score with 1000 bootstrap iterations. BERT was used as a baseline deep learning model, and its performance was compared with the proposed rule-based method. At the report level of detection, the overall precision, recall, and F-1 score were 0.886, 0.886, and 0.883, respectively, for the rule-based algorithm, which were higher than those of the deep learning algorithm (0.851, 0.679, and 0.733). The overall results include both internal and external validation data. For the internal validation set, the precision, recall, and F-1 score were 0.929, 0.929, and 0.927, respectively. For the external validation set, the precision, recall, and F-1 score were 0.875, 0.879, and 0.873, demonstrating generalizability. In conclusion, we show the rule-based NLP algorithm exhibited a high performance in detecting cancer-suspicious findings from multi-institutional CT reports.

Model of the Venous System for Training Endovascular Treatment in Interventional Neuroradiology

Background: Endovascular treatment of venous disease is introducing new therapeutic options in neuroradiology. These procedures are technically challenging and require extensive physician training. Currently, training is mainly conducted on animal models, which presents drawbacks such as ethical concerns and anatomical differences from human vascular architecture. There is no training model that simulates treating intracranial venous disease using original instruments in a real angiography suite. Methods: This work presents the development of a venous system model for endovascular training simulations for integration into the existing Hamburg ANatomical NEurointerventional Simulator (HANNES) for arterial interventions. Results: The manufacturing process established at HANNES and the material used for the arterial vascular models were successfully transferred to the larger 3D-printed vein models. The application test was conducted in a real angiography suite with original instruments by an experienced neurointerventional physician to evaluate the system in terms of geometric mapping, flow, haptics and probing. Conclusion: This newly developed model provides a first approach to simulate an endovascular intervention in the venous system within the HANNES environment. Future expansions might include specific treatment simulations for conditions such as arteriovenous malformations, dural arteriovenous fistulas, sinus vein thrombosis and hydrocephalus.

Characterizing Physician and WIC Staff Experiences During the 2022 Infant Formula Shortage in Oregon.

Characterizing Physician and WIC Staff Experiences During the 2022 Infant Formula Shortage in Oregon.

Gender differences in self-reported participation in ultrasound-guided procedures: a retrospective analysis.

Across multiple procedural specialties, female trainees tend to perform fewer procedures and receive less autonomy than their male counterparts. However, there is currently no data on procedure contribution levels for radiology trainees. To evaluate whether there was a difference in the degree of reported participation in ultrasound-guided procedures between male and female trainees at our institution. This retrospective study assessed for differences in the reported level of participation between male and female trainees in ultrasound (US) guided paracentesis and thoracentesis. We performed a radiology information system (RIS) search of US guided procedures performed on adult patients from 7/1/2018 to 2/29/2024. Trainee participation levels in the procedures were determined per available reports and classified into independently performed, assisted, or observed. We evaluated the differential reporting of procedure contributions for male and female trainees based on observed vs. expected frequencies, as well as the effect of the trainees' and supervising physicians' gender and experience level on these contributions. A total of 189 trainees (52 female, 137 male) and 58 supervising physicians (18 female and 40 male) were included. The study evaluated 4156 reports, which showed no difference in the percentage of independently completed procedures (females 80.9% vs. 81.9%, X2 (1, N = 4156) = 0.494, p = 0.48) except when supervised by junior physicians less than 2 years out of training (females 81.0% vs. 86.5%, X2 (1, N = 1908) = 8.19, p = 0.0042). However, female trainees were more likely than male trainees to report observing procedures (females 9.2% vs. 5.2%, X2 (1, N = 4156) = 21.1, p < 0.00001) rather than actively participating in procedures despite a similar training level; this difference was not observed when supervising physicians were females. Female radiology trainees report a similar percentage of independently performed procedures but a lower rate of active participation than male trainees.

A fusion model of manually extracted visual features and deep learning features for rebleeding risk stratification in peptic ulcers.

We propose a multi-feature fusion model based on manually extracted features and deep learning features from endoscopic images for grading rebleeding risk of peptic ulcers. Based on the endoscopic appearance of peptic ulcers, color features were extracted to distinguish active bleeding (Forrest I) from non-bleeding ulcers (Forrest II and III). The edge and texture features were used to describe the morphology and appearance of the ulcers in different grades. By integrating deep features extracted from a deep learning network with manually extracted visual features, a multi-feature representation of endoscopic images was created to predict the risk of rebleeding of peptic ulcers. In a dataset consisting of 3573 images from 708 patients with Forrest classification, the proposed multi-feature fusion model achieved an accuracy of 74.94% in the 6-level rebleeding risk classification task, outperforming the experienced physicians who had a classification accuracy of 59.9% (P<0.05). The F1 scores of the model for identifying Forrest Ib, IIa, and III ulcers were 90.16%, 75.44%, and 77.13%, respectively, demonstrating particularly good performance of the model for Forrest Ib ulcers. Compared with the first model for peptic ulcer rebleeding classification, the proposed model had improved F1 scores by 5.8%. In the simplified 3-level risk (high-risk, low-risk, and non-endoscopic treatment) classification task, the model achieved F1 scores of 93.74%, 81.30%, and 73.59%, respectively. The proposed multi-feature fusion model integrating deep features from CNNs with manually extracted visual features effectively improves the accuracy of rebleeding risk classification for peptic ulcers, thus providing an efficient diagnostic tool for clinical assessment of rebleeding risks of peptic ulcers.

Democratization in abdominal ablation therapies: The impact of percutaneous robotic assistance on accuracy-A systematic review.

Advances in medical technology have revolutionized minimally invasive procedures. This study aims to determine the status of intra-abdominal ablation therapies, focusing on outcomes regarding technique improvement and benefits related to the learning curve. A systematic search in four databases was performed in March 2024 to identify relevant studies. Endpoints included targeting accuracy, organ efficacy, safety, outcomes and technical advantages regardless of physician experience. A total of 40 studies were included. The robotic technique demonstrated significantly higher accuracy (median 1.75mm) compared to the freehand technique (median 4.50mm) (p < 0.05). RFA and MWA were the most frequently used ablation techniques, reaching a rate of 52.5% and liver was the main target organ in 77.5% of the studies. Subgroup analysis showed a median tumor size of 2.30cm, 1.40mm for the readjustments and 3.30mm for accuracy in the freehand technique. For robotic approach, the median tumor size was 1.95cm, readjustments were 0.55mm, and accuracy was 1.85mm, and no statistical difference was identified. Severe adverse events were lower with the robotic approach, and improvement in the learning curve was observed among novice physicians. Robotic-assisted ablation techniques improve accuracy and efficacy compared to freehand techniques and are easier for novices to use. This technology allows novices to achieve similar outcomes to experts, contributing to the democratization of ablation techniques. Nevertheless, more clinical trials and standardized studies are necessary to validate these findings and enable the integration of robotic systems into routine practice.

Peripheral neuropathy: from guidelines to clinical practise.

Chemotherapy-induced peripheral neuropathy (CIPN) is a substantial adverse effect of anticancer therapy. No effective preventive strategies are established in clinical routine, although some forms of cryotherapy or compression therapy seem to be promising. CIPN is difficult to grade objectively and has mostly relied on a clinician- or patient-based rating that is subjective and not easily reproducible. Recent preclinical and clinical studies showed an indicative hint of serum neurofilaments for axonal damage as a biomarker and might be introduced in clinical practice in the future. Axonal degeneration in toxic neuropathy is triggered by molecular pathways including SARM1. Presence of certain genotypes predispose for developing severe vincristine neuropathy. Still, treatment of CIPN is focused on treating neuropathic pain primarily based on physicians experience. A positive effect of membrane stabilizers such as gabapentinoids could not be shown in a systematic review mostly due to inconsistent study populations. In the treatment and prevention of functional disability, physical exercise including sensorimotor-training and whole-body vibration seems promising. More research is needed on quantification of biomarkers indicative for axonal degeneration prior to CIPN symptom expression. All these recent findings should support the health-care team for a patient centred treatment approach.

Borderline Findings in O-(2-[18F]-Fluoroethyl)-l-Tyrosine PET of Patients with Suspected Glioma Relapse: Role in Clinical Practice.

One of the most common clinical indications for amino acid PET using the tracer O-(2-[18F]-fluoroethyl)-l-tyrosine (18F-FET) is the differentiation of tumor relapse from treatment-related changes in patients with gliomas. A subset of patients may present with an uptake of 18F-FET close to recommended threshold values. The goal of this study was to investigate the frequency of borderline cases and the role of quantitative 18F-FET PET parameters in this situation. Methods: We retrospectively identified 439 patients with pretreated gliomas who underwent 18F-FET PET for suspected tumor relapse and in whom the final diagnoses were confirmed by histopathology (n = 175) or clinical course (n = 264). Two experienced nuclear medicine physicians, masked to the final diagnoses, evaluated visually the PET scans by consensus. The findings were classified into 3 categories: clearly positive findings, borderline findings, or clearly negative findings. The diagnostic performance of established 18F-FET PET parameters (i.e., tumor-to-brain ratio [TBR], time-to-peak ratio, slope, intercept) was evaluated separately for these 3 groups using receiver operating characteristics analyses. Results: In the visual analysis, 18F-FET uptake was classified as clearly negative in 67 patients (15%), clearly positive in 234 patients (53%), and borderline in 136 patients (31%), with averaged mean TBR values of 1.5, 2.3, and 1.9, respectively. Receiver operating characteristics analysis showed a high accuracy for TBR values in patients rated as clearly positive or negative in visual rating (area under curve [AUC], 0.84-0.86), whereas the diagnostic performance of TBR values in borderline cases according to visual analysis was significantly lower (AUC, <0.60). Using TBR values ± 10% above or below the cutoff values increased the AUC by approximately 10% (AUC, 0.82-0.84). Conclusion: A considerable number of patients may present with borderline findings in 18F-FET PET. In these patients, quantitative parameters should be used with caution for decision-making. The use of TBR values above or below the range of the cutoff values ±10% may increase the reliability of quantitative parameters to differentiate between tumor relapse and treatment-related changes.