Picture Archiving Research Articles

A Workflow-Efficient Approach to Pre- and Post-Operative Assessment of Weightbearing Three-Dimensional Knee Kinematics.

Knee kinematics during daily activities reflect disease severity pre-operatively and are associated with clinical outcomes after total knee arthroplasty (TKA). It is widely believed that measured kinematics would be useful for preoperative planning and postoperative assessment. Despite decades-long interest in measuring three-dimensional (3D) knee kinematics, no methods are available for routine, practical clinical examinations. We report a clinically practical method utilizing machine-learning-enhanced software and upgraded C-arm fluoroscopy for the accurate and time-efficient measurement of pre-TKA and post-TKA 3D dynamic knee kinematics. Using a common C-arm with an upgraded detector and software, we performed an 8-second horizontal sweeping pulsed fluoroscopic scan of the weight-bearing knee joint. The patient's knee was then imaged using pulsed C-arm fluoroscopy while performing standing, kneeling, squatting, stair, chair, and gait motion activities. We used limited-arc cone-beam reconstruction methods to create 3D models of the femur and tibia/fibula bones with implants, which can then be used to perform model-image registration to quantify the 3D knee kinematics. The proposed protocol can be accomplished by an individual radiology technician in ten minutes and does not require additional equipment beyond a step and stool. The image analysis can be performed by a computer onboard the upgraded c-arm or in the cloud, before loading the examination results into the Picture Archiving and Communication System (PACS) and Electronic Medical Record (EMR) systems. Weight-bearing kinematics affect knee function pre-TKA and post-TKA. It has long been exclusively the domain of researchers to make such measurements. We present an approach that leverages common, but digitally upgraded, imaging hardware and software to implement an efficient examination protocol for accurately assessing 3D knee kinematics. With these capabilities, it will be possible to include dynamic 3D knee kinematics as a component of the routine clinical workup for patients who have diseased or replaced knees.

Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction

To analyse patients with recurrent atlanto-axial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. This retrospective study was conducted in a tertiary care center, which included 20 patients who failed atlanto-axial surgery from January 2013 to June December 2021. They were evaluated using X-ray, computed tomography, and magnetic resonance imaging examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/C1 and C2. The mean change in modified Japanese Orthopaedic Association Scores and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, Pvalue 0.002 and-0.15 ± 0.27, P value 0.046, respectively). On similar paths, the mean change in modified Japanese Orthopaedic Association Scores and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, P value < 0.001 and-1.2 ± 0.11, Pvalue < 0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%), and poor choice of graft (100%) were the leading causes of failure of index surgery. The best candidates who can benefit after redo surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.

A comparison of MRI and intraoperative measurements to determine interspinous spacer device size.

To determine whether preoperative magnetic resonance imaging (MRI) can reliably determine intraoperative measurements in the Vertiflex Interspinous Spacer (ISS) procedure. Patients who underwent Vertiflex ISS with Lumbar Spinal Stenosis (LSS) and a preoperative MRI available in picture archiving and communication system (PACS) between January 2013 to February 2023 were identified retrospectively from the University of Chicago Medical Center Database. An experienced board-certified pain specialist and well-trained 2nd-year medical student independently performed measurements of the interspinous space where Vertiflex ISSs of various sizes are inserted. MRI measurements were taken blinded to intraoperative measurement and ISS implant size used in the procedure. Pearson's correlation, paired T-test, intraclass correlation coefficients (ICC), absolute agreement, and 2-way random effects model were used to determine the relationships between MRI, intraoperative measurement, and ISS size. A total of 79 patients who underwent the Vertiflex ISS procedure were included in the study. Median Vertiflex ISS size was 10 mm (10-12), mean intraoperative measurement was 11.40 mm (±1.23), and mean MRI measurement was 11.24 mm (±1.44). Mean differences were not significant in intraoperative and MRI measurements (p = 0.271). Pearson's correlation between ISS size and intraoperative measurement was 0.807 (p < 0.001), representing the current best practice model. Pearson's correlation was 0.668 (p < 0.001) between MRI measurement and ISS size and 0.542 (p < 0.001) between MRI and intraoperative measurement. ICC showed good agreement and moderate reliability (0.698) between intraoperative and MRI measurements. Observer interrater ICC agreement of the MRI interspinous space measurement was 0.95 (p < 0.001). Measuring interspinous space on MRI yielded, on average, a value smaller than the intraoperative measurement in Vertiflex ISS procedures, but the mean differences were not significant. Good agreement and moderate reliability were found between observer MRI and surgeon intraoperative measurements, suggesting MRI can evaluate the intraoperative space for the Vertiflex ISS procedure. Preoperative MRI measurement may help decrease complications by aiding in surgical decision-making through providing a reference for intraoperative measurements. Further prospective study is necessary to determine if preoperative MRI measurement can predict and potentially replace the need for intraoperative measurement.

Automated Integration of AI Results into Radiology Reports Using Common Data Elements.

Integration of artificial intelligence (AI) into radiology practice can create opportunities to improve diagnostic accuracy, workflow efficiency, and patient outcomes. Integration demands the ability to seamlessly incorporate AI-derived measurements into radiology reports. Common data elements (CDEs) define standardized, interoperable units of information. This article describes the application of CDEs as a standardized framework to embed AI-derived results into radiology reports. The authors defined a set of CDEs for measurements of the volume and attenuation of the liver and spleen. An AI system segmented the liver and spleen on non-contrast CT images of the abdomen and pelvis, and it recorded their measurements as CDEs using the Digital Imaging and Communications in Medicine Structured Reporting (DICOM-SR) framework to express the corresponding labels and values. The AI system successfully segmented the liver and spleen in non-contrast CT images and generated measurements of organ volume and attenuation. Automated systems extracted corresponding CDE labels and values from the AI-generated data, incorporated CDE values into the radiology report, and transmitted the generated image series to the Picture Archiving and Communication System (PACS) for storage and display. This study demonstrates the use of radiology CDEs in clinical practice to record and transfer AI-generated data. This approach can improve communication among radiologists and referring providers, harmonize data to enable large-scale research efforts, and enhance the performance of decision support systems. CDEs ensure consistency, interoperability, and clarity in reporting AI findings across diverse healthcare systems.

Insights into VTE risk in trauma patients: an observational study in an Irish trauma patient population.

The rate of VTE in trauma patients varies significantly in the reported literature. We aimed to determine the incidence of VTE in trauma patients in a trauma-receiving hospital over a 7-year period. We sought to evaluate the timing and nature of VTE events and explore the patterns of co-occurrence between PE and DVT, while factoring in clinical care and death outcome. Retrospective review of consecutive trauma patients ≥ 18years admitted between January 2014 and December 2020. Data were extracted from the TARN database, picture archiving and communication system, and hospital records. The primary outcome was VTE incidence. Latent class analysis was used to uncover cross combinations of clinical management and VTE outcomes, yielding subgroups of trauma patients. Subgroups were compared for demographic and clinical characteristics. Seventy-three VTE were observed-incidence of 0.0036 cases/people-year (95% CI 0.0 to 3.69). VTE ( +) group consisted mostly of males (75%), had an advanced age, had higher injury severity scores, and had increased length of stay. Most patients (64%) developed a PE only. Most DVT (64%) were proximal. Two subgroups had a high probability of PE/low probability of DVT and two a high probability of DVT/low-to-moderate probability of PE. Subgroup comparisons showed differences in the clinical characteristics which were statistically inconclusive. This is the largest study of VTE incidence in Irish trauma patients and the first to delineate VTE risk in a trauma population. These findings urge reconsideration of VTE risk in trauma patients and implementation of prevention strategies.

Effectivness of Health Information System Applications: Clinical Information and Diagnosis-Treatment Systems in Turkey

The distinctive quality of the new social structure is that information becomes the only factor of production. In today's organizations, public administrators are directly responsible for applying information to administrative processes. In addition to his managerial responsibilities, a knowledge based organization requires every employee to take responsibility for achieving efficiency. This has increased the importance of information systems in the decision-making process. Information systems consist of computer and communication technology, data base management and model management and include activity processing system, management information system, decision support systems, senior management information system, expert systems and office automation systems. Information systems in the health sector aim at the management and provision of preventive and curative health services. The use of information systems in healthcare has the benefits of increasing service quality, shortening treatment processes, maximizing efficiency of the time, labour and medical devices. The use of information systems for clinical decision making and reducing medical errors in the healthcare industry dates back to the 1960s. Clinical information systems involve processing, storing and re-accessing information that supports patient care in a hospital. Clinical information systems are systems that are directly or indirectly related to patient care. These systems include electronic health-patient records, clinical decision support systems, nurse information systems, patient tracking systems, tele-medicine, case mix and smart card applications. Diagnosis-treatment systems are information-based systems used in the diagnosis and treatment of diseases. It consists of laboratory information systems, picture archiving and communication system, pharmacy information system, radiology information system, nuclear medicine information system. This study aims to evaluate the effectiveness of health information system applications in Turkey. The first part of the study focuses on the concept of information systems and the types of information systems in organization structures. In the second part, clinical information systems and applications for diagnosis-treatment systems in Turkey are examined. Finally, the study evaluates applications in the health sector qualitatively from the new organizational structure, which is formed by information systems.

Image-Guided Musculoskeletal Interventional Radiology in the Personalised Management of Musculoskeletal Tumours.

Musculoskeletal image-guided interventional radiology plays a key role in diagnosing and treating a range of conditions. Recent advances have yielded a wide variety of procedures that can be applied selectively and enable the personalisation of patient care. This review aims to outline the indications, applications, and techniques of subspecialist musculoskeletal oncology interventional procedures that were used at our tertiary referral centre with a focus on how these may be used to personalise patient management. The applications of a range of diagnostic and therapeutic image-guided interventional procedures including different methods of bone and soft tissue sampling, ablation, and augmentation procedures across different types of patients and pathologies are reviewed. To supplement the reviewed literature, we included our own experience and radiology images retrospectively collected from our Picture Archiving and Communication System (PACS). We demonstrate how the range of musculoskeletal image-guided interventions provide flexibility in the diagnosis and management of different tumours across different patient populations. This study provides the musculoskeletal interventional radiologist with insight into how to appropriately utlilise different techniques to optimise the diagnosis, treatment and palliation of tumours.

Visceral fat as the main tomographic risk factor for COVID-19 mortality.

Obesity is a risk factor for COVID-19 mortality; a BMI >35 increases the risk of death up to 12-fold; two previous studies have examined the association between visceral fat quantified by tomography and the risk of severe COVID-19, but not its association with mortality. Examine whether tomographic findings differentiated data from patients who died of COVID-19 pneumonia from those who survived in a cohort of patients at a tertiary hospital. This was a case-control study (1:1) in which we recruited data from patients at a tertiary care hospital in Mexico. Cases (N = 213) were data from patients with COVID-19 pneumonia discharged due to death, and controls (N = 216) were data from patients discharged due to improvement. All had chest computed tomography (CT) scans in the Picture Archiving and Communication System (PACS) platform. Multivariate analysis was used to identify tomographic variables associated with mortality, and odds ratios were calculated. As tomographic variables, we refer to the total severity score, the total percentage of pulmonary involvement, the pattern of involvement, the location of the lesions, and subcutaneous and visceral fat. A total of 429 sets of data from Mexican patients were analyzed, with an overall age of 57 years (18-93). Sixty-three percent were male, and arterial hypertension was the most common comorbidity in 48.3 %. An odds ratio (OR) of 8.79 (95 % CI 1.44-53.73) was found for visceral fat and mortality; the rest of the tomographic variables did not show a statistically significant association. Visceral fat was the most significant tomographic risk factor for mortality in patients with COVID-19 pneumonia.

Investigation of Road Traffic Accident Trauma Cases: Occurrence and Diagnosis in Jeddah, Saudi Arabia

Objectives: Road traffic accidents (RTAs) are a leading cause of emergency department admissions, and Jeddah City is no exception. In this study, we conducted a comparative analysis of male and female patients who sustained injuries in RTAs, considering factors such as age, site of injury, and the optimal diagnostic modality, computed tomography (CT) or X-ray radiography (XR), depending on the nature of the injury. Methods: Data was collected retrospectively from the Picture Archiving and Communication System (PACS) at the Radiology Department of King Fahad General Hospital (KFGH). Collected data included patient demographics, injury locations, the initial diagnostic modality employed and its findings, and any subsequent diagnostic modality used, if necessary. We investigated the appropriateness of the initial diagnostic modality for each type of injury by comparing the diagnoses obtained from the first modality with those of the second modality. Results: Data from 200 patients (83.5% males; 16.5% females) was collected. Patients were categorized into four age groups: 16–23, 24–30, 31–60, and &gt; 60 year old groups, accounting for 28.5%, 32%, 36%, and 3.5% of patients, respectively. The most common site of injury was polytrauma with 101 cases (50.5%), followed by head and spine injuries in 64 (32%) and 17 cases (8.5%), respectively. Notably, CT was the most commonly used first diagnostic modality, employed in 88.5% of cases, all cases of polytrauma injuries, and the majority of head (93.8%), spinal (56.3%), and facial (71.4%) injuries. Whereas radiography was primarily used for chest, lower, and upper limb injuries. Conclusions: Based on our findings, we recommend CT as the initial diagnostic modality for patients with polytrauma, spinal injuries, and head injuries resulting from RTAs. However, radiography remains a valuable diagnostic tool when transporting patients to a radiology department or for follow-up purposes.

Evaluation of Pedicle Screw Position on Computerized Tomography Using Three-Dimensional Reconstruction Software.

Background and Objectives: Recent advances in intraoperative navigation systems have improved the accuracy of pedicle screw placement in spine surgery. However, many hospitals have limited access to these advanced technologies due to resource constraints. In such settings, postoperative computed tomography (CT) evaluation remains crucial for assessing screw placement and related potential complications. Metal artifacts in CT scans often compromise the diagnostic accuracy. This study aimed to develop and validate three-dimensional (3-D) reconstruction software to enhance screw localization accuracy and facilitate its practical clinical application. Materials and Methods: This study included two phases: 3-D software development utilizing specific threshold values of Hounsfield units for titanium screws followed by internal validation. For validation, fifty pedicle screws were inserted into porcine lumbar vertebrae with random violation (superior, inferior, medial, or lateral). Three fellowship-trained surgeons evaluated screw positions using both conventional CT bone window settings and the developed software. Additional clinical validation involving 386 pedicle screws from cervical to lumbar spine was performed by two surgeons. Results: The software demonstrated significantly higher specificity (83% vs. 63%) and positive predictive value (96% vs. 91%) compared to conventional CT bone window settings, while maintaining 100% sensitivity and negative predictive value. Interobserver reliability was excellent for both methods (0.961 for bone window vs. 0.990 for software). In clinical validation, the software showed superior intraobserver (0.83 vs. 0.74) and interobserver reliability (0.855 vs. 0.513) compared to picture archiving and communication system (PACS) workstation evaluation. Conclusions: The developed software provides improved accuracy and reliability in pedicle screw position evaluation through distinct screw outline visualization and metal artifact reduction. Its equipment-independent nature and cost-effectiveness make it particularly valuable for clinical implementation.

RADHawk-an AI-based knowledge recommender to support precision education, improve reporting productivity, and reduce cognitive load.

Using artificial intelligence (AI) to augment knowledge is key to establishing precision education in modern radiology training. Our department has developed a novel AI-derived knowledge recommender, the first reported precision education program in radiology, RADHawk (RH), that augments the training of radiology residents and fellows by pushing personalized and relevant educational content in real-time and in context with the case being interpreted. To assess the impact on trainees of an AI-based knowledge recommender compared to traditional knowledge sourcing for radiology reporting through reporting time, quality, cognitive load, and learning experiences. A mixed methods prospective study allocated trainees to intervention and control groups, working with and without access to RH, respectively. Validated questionnaires and observed and graded simulated picture archiving and communication system (PACS)-based reporting at the start and end of a month's rotation assessed technology acceptance, case report quality, case report time and sourcing time, cognitive load, and attitudes toward modified learning strategies. Non-parametric regression analyses and Mann-Whitney tests were used to compare outcomes between groups, with significance set at P<0.05. The intervention group (n=28) demonstrated astatistically significant reduction in the case report time by -162s per case (95%CI -275.76s to -52.40s) (P-value = 0.002) and an increase of 14% (95%CI 8.1-19.8%) (P-value <0.001) in accuracy scores compared to the control group (n=29) at the end of the rotation. The intervention group also showed lower levels of mental demand (P=0.030) and experienced less effort (P=0.030) and frustration (P=0.030) while reporting. Additionally, >78% of the intervention group gave positive ratings on RH's effectiveness, increase in productivity, job usefulness, and ease of use. Eighty-nine percent of participants in the intervention group requested access to RH for their next rotation. This study demonstrates that RH, as the first reported AI-derived knowledge recommender for radiology education, significantly reduces reporting time and improves reporting accuracy while reducing overall workload and mental demand for radiology trainees. The high acceptance among trainees suggests its potential for supporting self-directed learning. Further testing of a larger external cohort will support more widespread implementation of RH for precision education.

What Is the Suitable Wide Cage Size for Stand-alone LLIF in Asian Population: A Computed Tomography Scan–Based Study of a Dimension of Lumbar Endplate

Abstract Objective The objective of this study is to establish a precise database detailing the width of vertebral endplates, the depth of vertebral endplates (anterior–posterior [A-P] width), and the height of intervertebral discs within the lumbar spine of the Asian population. Materials and Methods The stand-alone lateral lumbar interbody fusion (LLIF) procedure is increasingly popular for minimally invasive spine surgery and has demonstrated effectiveness in treating various spinal pathologies. Previous studies have indicated that the use of a 26-mm wide cage in stand-alone LLIF can significantly decrease the incidence of cage subsidence. However, most of these studies were conducted on the Caucasian population, which has a larger anatomical structure compared with the Asian population. Consequently, the appropriate wide cage size suitable for stand-alone LLIF in the Asian population has not been previously explored. Ninety-one computed tomography (CT) images were obtained from patients who presented with back pain and had negative imaging results between 2017 and 2021. These images were analyzed using the Picture Archiving Communication System to assess the vertebral body's topography. The analysis involved measuring the vertebral endplate width, vertebral endplate depth (A-P width), and intervertebral disc height. Results The findings of this study reveal that there is a noticeable increase in the overall width, depth, and intervertebral disc height of the lumbar vertebrae from the upper to the lower regions. Additionally, the morphometric attributes of the lumbar vertebrae observed in this study closely resemble those of Caucasian subjects. Conclusion The morphometric measurements of the lumbar vertebrae in the Asian population closely resemble those of Caucasian subjects. As a result, it is suggested that a 26-mm wide cage may be a suitable option for stand-alone LLIF in the Asian population.

A Comparative Study Between Posterolateral Lumbar Fusion and Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Spondylolisthesis.

Introduction Degenerative spondylolisthesis (DS) is a degenerative condition characterized by subluxation of one vertebral body anterior to the adjacent inferior vertebral body with an intact pars. Conservative treatment approaches, such as steroid injections and physical therapy, may work well at first, but in resistant situations, surgery is frequently necessary. Posterolateral lumbar fusion (PLF) has been widely used, but transforaminal lumbar interbody fusion (TLIF) offers theoretical advantages such as improved alignment and enhanced fusion rates. Methods This retrospective study examined patients with DS who underwent PLF or TLIF at R.L. Jalappa Hospital and Research Centre, Kolar, Karnataka, India, between January 2020 and January 2024. The inclusion criteria were planned one- or two-level fusion DS resistant to conservative treatment and at least one year of follow-up. Patients with prior lumbar fusion or uncontrolled comorbidities were not included. Details were taken from medical records and Picture Archiving and Communication System (PACS), and SPSS Version 22 was used for analysis. Continuous variables were compared using t-tests or Mann-Whitney U tests, and categorical variables were compared using chi-square tests. The non-inferiority of TLIF to PLF was assessed with predefined margins. The study included 56 patients (28 in each group), with outcomes measured via visual analogue scale (VAS), 12-Item Short Form Survey (SF-12) scores, and radiological outcomes. The threshold for clinical significance was p < 0.05. Results This research compared TLIF and PLF in a total of 56 DS patients. Demographic data, operative details, and pre-surgical parameters showed no significant differences. Clinical outcomes revealed comparable improvements in scores for leg and back pain (p > 0.05). SF-12 Physical Component Summary (PCS) scores were significantly higher post-surgery in the TLIF group (42.4 ± 5.1) compared to the PLF group (37.9 ± 4.5) (p = 0.01). Radiologically, the slippage was significantly lower in the TLIF cohort (2.1 ± 1.02) compared to the PLF cohort (3.1 ± 1.9) (p = 0.01). Both anterior and posterior disc heights were substantially increased in the TLIF group (11.3 ± 1.6 vs. 9.3 ± 1.5 in PLF unit, p < 0.01) compared to the PLF group (1.7 ± 0.9 vs. 0.8 ± 0.4, p < 0.01). There were no discernible variations in lumbar lordosis, sacral slope, or changes in the tilt of the pelvis. TLIF demonstrated better radiographic improvements but had clinical outcomes similar to those of PLF. Conclusion TLIF demonstrated superior radiographic improvements, particularly in disc height and slippage reduction, while clinical outcomes were comparable between TLIF and PLF, suggesting that both are effective options for managing DS.

Dedicated software to harmonize the follow-up of oncological patients

To test and evaluate a sofware dedicated to the follow-up of oncological CT scans for potential use in the Radiology department. In this retrospective study, 37 oncological patients with baseline and follow-up CT scans were reinterpreted using a dedicated software. Baseline CT scans were chosen from the imaging reports available in our PACS (picture archiving and communicatin systems). Follow-up interpretations were independently assessed with the software. We evaluated the target lesion sums and the tumor response based on RECIST 1.1 (Response Evaluation Criteria in Solid Tumors). There was no significant difference in the target lesion sums and the tumor response assessments between the PACS data and the imaging software. There was no over or underestimation of the disease with the software. There was a sigificant deviation (progression versus stability) in three cases. For two patients, this difference was related to the evaluation of the response of non-target lesions. The difference in the third patient was due to comparison with a previous CT scan than to the baseline exam. There was a miscalculation in 13 % of the reports and in 28 % of the cases the examination was compared to the previous CT scan. Finally, the tumor response was not detailed in 43 % of the follow-up reports. The use of dedicated oncology monitoring software could help in reducing intepretation time and in limiting human errors.

Comparison of multi-phase contrast-enhanced T1-weighted volumetric interpolated breath-hold examination and fat-suppressed T2-weighted combined with diffusion-weighted magnetic resonance imaging in anal fistula evaluation.

Anal fistula is a common anorectal disorder that significantly diminishes the quality of life for affected patients. Accurate preoperative evaluation of the fistula's traits is essential for customizing surgical strategies, improving patient outcomes, and reducing the likelihood of the disease returning. This study aimed to evaluate the diagnostic accuracy of multi-phase contrast-enhanced fat-suppressed T1-weighted imaging using three-dimensional gradient echo sequence volumetric interpolated breath-hold examination (CE-FS-T1-3D-VIBE) and fat-suppressed T2-weighted imaging combined with diffusion-weighted imaging (FS-T2WI-DWI) sequence in delineating the characteristics of anal fistulas. A case-control study of 168 patients with anal fistula was conducted through the picture archiving and communication systems (PACS; diagnostic imaging workstation). Imaging evaluations were performed using both multi-phase CE-FS-T1-3D-VIBE and FS-T2WI-DWI imaging on a Siemens 3.0T magnetic resonance imaging system (Skyra 3.0T superconducting type). The efficacy of each imaging modality in depicting the clarity, number, and positioning of the internal openings, as well as the identification of primary and secondary fistulas and abscesses, was independently evaluated in a blinded manner by two senior diagnostic radiologists, each with over a decade of experience. Statistical analyses were performed using χ2 test. Comparative analysis of the FS-T2WI-DWI and multi-phase CE-FS-T1-3D-VIBE sequences for diagnosing internal and primary fistula tract clarity demonstrated a significant superiority of the multi-phase CE-FS-T1-3D-VIBE sequence in delineating internal clarity (P=0.013) and primary fistula tract clarity (P<0.001). The multi-phase CE-FS-T1-3D-VIBE sequence demonstrated superior accuracy over the FS-T2WI-DWI sequence in depicting localization of internal openings [86.31% vs. 77.38%, 95% confidence interval (CI): 0.307-0.959, P=0.034], as well as delineation of the secondary tracts (88.69% vs. 80.95%, 95% CI: 0.293-1.001, P=0.048). Despite the increased accuracy of the multi-phase CE-FS-T1-3D-VIBE sequence, no difference was observed between the two imaging techniques regarding the accuracy in determining the number of internal openings, the quantity of primary fistulas, and the classification of anal fistulas. This study elucidates that the multi-phase CE-FS-T1-3D-VIBE imaging sequence potentially represents a more effective noninvasive alternative for the precise evaluation of the positioning and clarity of the internal opening, as well as the delineation of primary and secondary fistula tracts in anal fistula patients, compared to the FS-T2WI-DWI sequence. This enhanced diagnostic capability underscores the utility of multi-phase CE-FS-T1-3D-VIBE in improving the clinical management of anal fistulas.

Transaxillary access for PDA Stenting in Neonates with Duct-Dependent Cyanotic Congenital Heart: A Retrospective Study

Background: Duct-dependent cyanotic congenital heart is a critical heart disease in infants. In neonates, patients with obstructing native ductus arteriosus may need palliative stenting to maintain adequate blood flow during the transition period. These babies are similar to ductal-dependent lesions but require patent ductus arteriosus (PDA) flow for their transition from fetal to neonatal circulation. PDA stenting is a well-recognized palliative for duct-dependent cyanotic congenital heart in neonates. Objectives: The study highlights the clinical utilities of transaxillary access for PDA stenting in neonates with duct-dependent cyanotic congenital heart Methods: The study aimed to evaluate the effectiveness of transaxillary access for direct stenting and stent placement in neonates with stable duct-dependent congenital heart disease and cyanosis due to non-obstructive arterial duct. The study involved a retrospective approach, using existing data and focusing on acute interventional procedure success with transaxillary access. Secondary endpoints included successful weaning from access to surgical conduit, cannula removal, antegrade flow reduction if connected to BDG, need and success rate of transaxillary plug insertion, and major and minor complications associated with AXA. The study design allowed for a comprehensive evaluation of the feasibility of this technique and its potential benefits and drawbacks. Data was collected from electronic medical records, Picture Archiving and Communication System, and the electronic database of the Intensive Care Unit of a hospital between 2016 and 2021. The study aimed to evaluate the risk-benefit of performing DDC in neonates through the AS in a new cohort of patients in the future. Results: This retrospective study examined the management of cyanotic congenital heart disease in 36 neonates, with eight cases involving elbow neoaortic utilization and 28 having a PDA diameter less than 1 mm. In seven cases, a 4-Fr angiographic pigtail was inserted retrograde to image the PDA, which was then accessed by navigating a 4-Fr JB1 catheter from the cannulation site. A portable X-ray unit was used exclusively to position these catheters and wires during the procedures under C-arm guidance. Diagnostic catheter removals were managed differently in this study, following the same principles used for sheath extractions in 29 retrospective and prospective presentations. The study reported on the procedural outcomes for transaxillary access and PDA stenting in neonates with duct-dependent cyanotic congenital heart disease. The study found no specific demographic or additional pre-procedural risk factors that would affect the results of the study. Conclusion: Transaxillary PDA stenting is a safe method for treating duct-dependent hypoxic congenital hearts in neonates, but has limitations like limited use, long transcatheter treatment periods, and anesthesia risks. It's recommended for developing countries with limited access to advanced care. The study improved palliative PDA stenting standard in CCTGA patients with complex congenital heart disease. Recommendations include insertion of a transaxillary sheath, support, and arterial access under ultrasound guidance.

Intervention design for artificial intelligence-enabled macular service implementation: a primary qualitative study

BackgroundNeovascular age-related macular degeneration (nAMD) is one of the largest single-disease contributors to hospital outpatient appointments. Challenges in finding the clinical capacity to meet this demand can lead to sight-threatening delays in the macular services that provide treatment. Clinical artificial intelligence (AI) technologies pose one opportunity to rebalance demand and capacity in macular services. However, there is a lack of evidence to guide early-adopters seeking to use AI as a solution to demand-capacity imbalance. This study aims to provide guidance for these early adopters on how AI-enabled macular services may best be implemented by exploring what will influence the outcome of AI implementation and why.MethodsThirty-six semi-structured interviews were conducted with participants. Data were analysed with the Nonadoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework to identify factors likely to influence implementation outcomes. These factors and the primary data then underwent a secondary analysis using the Fit between Individuals, Technology and Task (FITT) framework to propose an actionable intervention.ResultsnAMD treatment should be initiated at face-to-face appointments with clinicians who recommend year-long periods of AI-enabled scheduling of treatments. This aims to maintain or enhance the quality of patient communication, whilst reducing consultation frequency. Appropriately trained photographers should take on the additional roles of inputting retinal imaging into the AI device and overseeing its communication to clinical colleagues, while ophthalmologists assume clinical oversight and consultation roles. Interoperability to facilitate this intervention would best be served by imaging equipment that can send images to the cloud securely for analysis by AI tools. Picture Archiving and Communication Software (PACS) should have the capability to output directly into electronic medical records (EMR) familiar to clinical and administrative staff.ConclusionThere are many enablers to implementation and few of the remaining barriers relate directly to the AI technology itself. The proposed intervention requires local tailoring and prospective evaluation but can support early adopters in optimising the chances of success from initial efforts to implement AI-enabled macular services.Protocol registrationHogg HDJ, Brittain K, Teare D, Talks J, Balaskas K, Keane P, Maniatopoulos G. Safety and efficacy of an artificial intelligence-enabled decision tool for treatment decisions in neovascular age-related macular degeneration and an exploration of clinical pathway integration and implementation: protocol for a multi-methods validation study. BMJ Open. 2023 Feb 1;13(2):e069443. https://doi.org/10.1136/bmjopen-2022-069443. PMID: 36725098; PMCID: PMC9896175.

Anatomy and Pathologies of the Spinous Process.

The spinous processes act as a lever for attachments of muscles and ligaments. Spinal imaging is commonly performed as a diagnostic test for pain and radiculopathy. A myriad of incidental or unexpected findings, both potentially asymptomatic and symptomatic, may be encountered during the interpretation of these images, which commonly comprise radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Isolated lesions of the spinous process, although less common, are some of the lesions that may be encountered and can present a diagnostic dilemma. These can range from congenital abnormalities, traumatic lesions, neoplasms and lesions of inflammatory, infective and metabolic aetiology. The literature specifically reviewing these lesions is sparse. The article reviews a range of pathologies affecting the spinous process, along with their pertinent imaging features, based on isolated pathologies of spinous process lesions identified on imaging by the authors at a tertiary orthopaedic centre over a 10-year period. A search on the hospital Picture Archive and Communication System (PACS) and Radiology Information System (RIS) was performed using the keyword "spinous process" and a list of the isolated pathologies of the spinous process based on the imaging reports was compiled for the purpose of this narrative review. It is important that radiologists consider these lesions when they are identified on routine imaging of the spine.

Anatomical Variation of the Olfactory Fossa According to Keros and Yenigun Classifications in Karachi, Pakistan.

The goal of our research is to assess the olfactory fossa anatomical variation through Keros and Yenigun classification by computed tomography (CT) scan of paranasal sinuses (PNS), as in order for surgeons to prevent major complications, they must be familiar with its variations in anatomy during functional endoscopic sinus surgery (FESS) related to anterior ethmoidal artery injury, as its course varies with depth and length of the olfactory fossa. At Karachi's Dow University of Health Sciences (DUHS), retrospective research was carried out. From anterior to posterior, sequential coronal and axial pictures were examined, and the existence and location of further anatomical characteristics were documented. A consultant radiologist used the picture archiving and communication system (PACS) software to do the review. The depth of the olfactory fossa and anterior-posterior length were measured. We utilized OpenEpi version 3 to compute the sample size findings. The estimated sample size was calculated as 249 by taking the prevalence of 63.5% for type 2 Keros classification, with a margin of error of 6% and a confidence level. The median length for the olfactory fossa depth (Keros) for the left and right sides were 6.2 (2.2-10.9) mm and 6.0 (2.8-10.4) mm, respectively. The median anteroposterior length of the cribriform plate (Yenigun) for the left and right sides were 11.4 (6.1-19.2) mm and 11.2 (6.0-18.0) mm, respectively. According to Keros Classification, type 2 was observed as the most prevalent category on the right side for both females and males, with 97/122 (79.5%) and 106/127 (83.5%) individuals, respectively. The chi-square test was applied for the analysis of gender and classification. Keros type 2 was observed to be the most prevalent in both males and females. Similarly, type 2 was also seen to be the most prevalent in the Yenigun classification in both genders. No statistical difference was found in both classifications (p = 0.39). In most of the literature, type 2 has been the most commonly dominated type. The reason seems due to the variation in genes and anatomy of the human PNS. Preoperative planning should take the morphological characteristics of the ethmoidal roof into account. Understanding the ethmoidal roof morphology among populations may be improved by looking at bigger patient groups and meta-analyses that compile different study findings on this topic.

Moyamoya disease and moyamoya syndrome: A case series from multicentre private hospitals in Indonesia

Moyamoya disease (MMD) and moyamoya syndrome (MMS) are considered rare in Indonesia, without any proper epidemiological data backing this claim. Hence, this case series aims to assess all MMD and MMS cases from the perspective of a multicentre private hospital in Indonesia. This is a descriptive analysis using data from the picture archiving and communication system (PACS) from January 2019 to December 2023. The inclusion criteria included all patients who fulfilled the radiological criteria for MMD and/or MMS, while patients who only underwent brain non-contrast computed tomography (CT) scans were excluded. There are 58,905 unique MRI scans from 2019 to 2023. The cohort comprises 8 females and 2 males, with a median age of 37 (7-65) years old. Three cases are probable MMD. with six MMD cases and one MMS case. Therefore, the prevalence rate for the four years is approximately 11.9 cases per 100,000 scans. Out of the confirmed Moya-Moya cases, the majority (4/7) are ischemic subtypes, followed by epileptic (electroencephalography shows slowing brain waves) and TIA in one case each. The most common presenting symptom is weakness in the extremity (N = 7), followed by headache (N = 5). Four patients underwent operative procedures, with three of them being superior temporal artery to middle cerebral artery (STA-MCA) bypass procedures and one of them being encephalo-duro-myo-arterio-pericraniosynangiosis (EDMAPS). The paucity of confirmed cases either points towards the low prevalence of MMD and MMS in Indonesia or the underdiagnosis of these cases.