Radiology Centers Research Articles

Early and long-term outcomes of treatment in patients with medulloblastoma

To compare the modes of craniospinal irradiation (CSI) and to determine possible factors improving the outcome in patients with medulloblastoma. The study included 92 patients with medulloblastoma who were treated at the Russian Research Radiology Center between 2008 and 2019. Mean age of patients was 12 years. Classical morphological variant of medulloblastoma prevailed (48.4%). After surgery, 78 patients underwent radiotherapy (CSI + full-volume «boost» on the tumor site). Standard risk patients received CSI in a reduced dose after tumor resection. Weekly modification of radiotherapy with vincristine was performed in 73 (79.3%) patients. We significantly (p<0.05) determined the total focal doses for CSI in patients with medulloblastoma. Total resection of posterior cranial fossa tumor improved relapse-free survival by several times. Complete CSI up to total dose of 36/54 Gy ensures the most positive effect compared to irradiation in reduced dose. Relapse-free survival significantly depends on total focal dose of CSI. Single focal dose, chemotherapeutic modification of radiotherapy and M-stage had no significant effect on relapse-free survival. Perhaps, this is due to small sample size.

Dose-area-product (DAP) modelling of Siemens Max-series X-ray digital radiography (DR) systems

PurposeTo develop a dose-area-product (DAP) model of Siemens Max-series x-ray digital radiography (DR) systems for pre-exposure DAP estimation. Methods and materialsSeries of commissioning exposures were taken with varying x-ray tube voltage (kVp), and milliampere-second (mAs) and imaging protocols (thorax PA, pelvis and knee) on a Fusion Max and Ysio Max unit respectively. Correlations of dose-area-product (DAP) values with kVp and mAs were analyzed, and a quasi-linear model were proposed as DAP(mAs, kVp) = a∙mAs∙kVp + b∙kVp, which was validated on commissioning data. Then, the DAP estimation models were verified with clinical data from four radiology centers, and relative errors between model estimates and measurements were analyzed. ResultsField size, mAs and kVp are found to be the key factors that influence DAP values, which exhibit significant linear-correlations both with kVp and mAs. The model parameters (a, b) on Fusion and Ysio units are not equal, which indicates slight difference in imaging chains. The validation results show that the proposed DAP estimation model can well depict the DAP dependence on kVp and mAs on both units. In preliminary clinical verification, relative errors between model estimates and measurements are significantly correlated to field-size deviations. ConclusionsWhile the model parameters are field-size dependent, the proposed model framework exhibits great viability on DAP estimation on both Fusion Max and Ysio Max units, and may contribute in pre-exposure imaging parameter fine-tuning on Max-series DR units.

Development and strengthening of the nuclear and radiation safety infrastructure for nuclear power program of Bangladesh

Bangladesh, as a newcomer country, is expecting to start her nuclear power journey by 2022. Due to evident reasons, newcomer nuclear countries face several key challenges concerning the development of national nuclear safety infrastructure. The paper investigates the status of the 7 key safety infrastructure issues out of the 19 and readiness of the supportive organizations, laboratories, and workforces following the International Atomic energy Agency’s status evaluation guide at milestone 3 and foreign countries’ practice. Much progress has been achieved at phase 3 regarding the establishments of a few Acts, a regulator, and an operator. However, comprehensive regulatory frameworks, skilled workforces, establishments of a few supportive organizations, and laboratories for managing environmental radioactivity, radiological accidents, and radioactive wastes are yet to ready. Several suggestions are made for establishing and expediting radiation monitoring laboratories, a radiological emergency management center, a radioactive waste management company, and technical support organizations for the safety infrastructure. To avoid perceived risks, policymakers and competent authorities need to emphasize creating an optimized safety infrastructure before commissioning and operating the 1stnuclear power plant safely, securely, and cost-sustainably.

. Role Of PET/CT in Assessment Of Post Interventional Treatment of Hepatocellular Carcinoma

Purpose: to highlight the role of PET/CT in evaluation of post interventional treatment (radiofrequency ablation & TACE) of hepatocellular carcinoma. Background: Hepatocellular carcinoma (HCC) is one of the major causes of mortality among patients with cirrhosis. It represents about 11.85% of the malignancies of all GIT organs and 1.78% of the total malignancies among Egyptians. Patients and methods: From February 2018 to November 2019, twenty five patients (20 males and 5 females, their age ranged from 44 to 75 years with mean age of 60.60 ± 7.35 years) were referred to the radiology unit with hepatocellular carcinoma and had underwent TACE ( 2 patients had history of combined TACE and RFA procedures ). 18F-FDG PET/CT and triphasic CT examinations were conducted in a private radiology center in Cairo for all patients using combined PET-CT machine (Philips intgenuity TF PET/CT 128 slices). Results:PET/CT showed true positive results in 20 patients, true negative results in 3 patients, false negative results at one patient and false positive results at one patient. In our study, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 18F -FDG PET/CT were 95.24%, 75%, 95.24%, 75% and 92% respectively. Conclusion:PET/CT showed higher accuracy in assessment of the intervention bed without affection by lipiodol artifact as well as detection of extra hepatic spread of HCC in single whole body examination which is crucial for patients preparing for liver transplantation and differentiation between benign and malignant portal vein thrombosis.

Cervical cancer in women of the Far Eastern Federal District (morbidity and mortality)

Objective: to analyze the incidence and mortality of cervical cancer in the Far Eastern Federal district (FEFD) in 2008–2018.Materials and methods. To assess the incidence and mortality of cervical cancer among women residing in FEFD, we used annual reports of P. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiology Center, Ministry of Health of Russia, for 2008–2018. We evaluated extensive and standardized parameters (per 100,000 population; 0/0000) calculated using the direct method (world standard). The prognosis was based on the 11-year dynamics of the incidence and mortality; regression coefficients were calculated using the standard method. Data analysis was performed using the Statistica 8.0 and Microsoft Excel 2003 software with a significance level of p £0.05. We evaluated the incidence and mortality of cervical cancer among women of FEFD registered between 2008 and 2018: during a 5-year period (2008–2012) and a 6-year period (2013–2018) for the whole region, as well as for individual administrative territories.Results. We found that the incidence of cervical cancer in FEFD was higher than its national incidence (14.3 ± 0.10/0000) and was steadily increasing in all administrative centers of FEFD. The highest incidence was observed in Zabaikalsky Krai (32.6 ± 1.90/0000, which is 2.3 times higher than national incidence). The quickest growth of cervical cancer incidence was registered in the Republic of Buryatia (69.6 %; growth rate 6.5 % (p £0.05)). This territory was also characterized by the highest mortality (11.4 ± 0.50/0000, which is 2.2 times higher than national mortality (5.3 ± 0.20/0000) (p &lt;0.01)).Conclusions. The analysis of the cervical cancer incidence and mortality in FEFD demonstrated their steady increase, which makes the issues of disease prevention and early diagnosis highly relevant and indicates a clear need to activate vaccination and screening programs.

Prevalence and Distribution of the Middle Mesial Canal in Mandibular First Molar Teeth of the Kerman Population: A CBCT Study.

Purpose Missed additional canals are one of the most important reasons for RCT failures in molar teeth. This study aimed to determine the prevalence and distribution of middle mesial canals in mandibular first molars of the Kerman population. Materials and Methods A retrospective study was performed on de-identified cone beam image sets from 3 private radiology centers in Kerman. A total of 100 mandibular first molars from 62 patients (mean age 32 years) were included. Information regarding the patient's age and gender, the location of teeth, and the presence or absence of a MMC and also a second distal canal in MMC cases was recorded in an Excel table. Data were analyzed using SPSS software (IBM-USA). Results The overall prevalence of MMCs in the mandibular first molars was 8.1% (10.0% in females and 6.3% in males). More cases of MMCs were seen on the right side (12.2%) than the left side (3.4%). One case of bilateral MMCs combined with bilateral second distal canals in the mandibular first molars was seen in a 26-year-old female. A further case of bilateral MMCs was found in a 32-year-old male but with single-canal distal roots on both sides. Conclusion The overall prevalence of MMCs in the Kerman population (8.1%) is at the lower end of the reported range of the international literature (0.26% to 53.8%). In the cohort examined in this study, mid mesial canals were more prevalent in females and on the right side. There was no definite relationship between MMCs and second distal canals in the mandibular first molar teeth in the same subject. MMCs may be unilateral or bilateral. Careful exploration of the pulpal floor between canal orifices is essential to prevent missing the MMC, as this would cause undesirable clinical outcomes.

TREATMENT OF &lt;em&gt;BRAF&lt;/em&gt;&lt;sup&gt;V600E&lt;/sup&gt; POSITIVE ANAPLASTIC THYROID CARCINOMA: CASE REPORT

Anaplastic thyroid cancer is one of the most aggressive and fatal human carcinomas. A significant experience in using various kinase inhibitors for anaplastic thyroid cancer therapy has been accumulated worldwide. The most encouraging results were obtained after using a combination of b-Raf and MEK kinase inhibitors (vemurafenib/dabrafenib and trametinib/cobimetinib, respectively) for the treatment of the unresectable BRAF V600E -positive anaplastic thyroid cancer. This drug combination makes it possible to perform surgery followed by chemoradiotherapy and other targeted therapies. Here we report a clinical case of anaplastic thyroid cancer in a 69-year-old woman, who was treated with neoadjuvant targeted therapy. The treatment was carried out on the basis of three medical institutions: the National Medical Research Radiological Centre (Moscow), the N.I. Pirogov Clinic of Advanced Medical Technologies (St. Petersburg) and the Endocrinology Research Center (Moscow). Since there is still no universal protocol for treating ATC patients, and only palliative therapy is used in most cases, we emphasized on diagnostic and treatment errors of this disease. Special attention was paid to the importance of using molecular diagnostics and modern medical imaging technologies.

Selective permeation of Ag+ ions from pyrosulfite solution through Nano-Emulsion Liquid Membrane (NELM) containing CYANEX 925 as carrier

A designed Nano-Emulsion Liquid Membrane (NELM) particles containing CYANEX 925 in kerosene as carrier, KSCN (potassium thiocyante) as internal stripping phase and span 80 as surfactant was prepared and used for the extraction of 9.27 × 10−4 M Ag+ from pyrosulfite (Na2S2O5) solution. The parameters affecting the liquid-liquid extraction of Ag+ such as [CYANEX925], [pyrosulfite] and temperature were separately investigated. Ammonium hydroxide and thiourea with different concentrations were used to enhance the extraction efficiency of Ag+. The batch results indicate that the addition of ammonium hydroxide as complexing agent increased the extraction efficiency of Ag+ with CYANEX 925 from Na2S2O5 solution (up to E% = 75) while the addition of thiourea inhibited and strongly decrease the extraction process (E% = 25). The emulsion membrane was prepared and the NELM particles were characterized using dynamic light scattering (DLS) which indicated that the obtained nanoparticles have an average particle size of 29.9 nm. The studied fundamental parameters affecting the emulsion liquid membrane stability indicated that the optimum conditions were: emulsification speed = 8500 rpm, emulsification time = 10 min, stirring speed = 400 rpm, Span 80 = 3.5 % (w/v), organic: internal phase = 1:1, ELM: aqueous phase = 1:10 and permeation time = 10 min. The chemical permeation rate was found to be independent of [KSCN] in the internal phase and also of [Ag+] concentration in the aqueous feed solution. The demulsification of silver ions permeated through the NELM was achieved with 1 M NaBH4. An application on the selective recovery of silver ions from leached pyrosulfite solution of X-ray films wasted from radiology centers was carried out using the prepared NELM containing CYANEX 925 as carrier.

Impact of COVID-19 pandemic on radiographers in the Republic of Cyprus. A questionnaire survey

IntroductionImaging is essential for the initial diagnosis and monitoring of the novel coronavirus, which emerged in Wuhan, China. This study aims to assess the insight of radiographers on how the COVID-19 pandemic has affected their work routine and if protective measures are applied. MethodA prospective observational study was conducted among radiographers registered in the Cyprus Society of Registered Radiologic Technologists & Radiation Therapy Technologists. A questionnaire composed of 28 multiple choice questions was utilised, and the data analysis was performed using SPSS software with the statistical significance assumed as p-value < 0.05. ResultsOut of 350 registered radiographers, 101 responses were received. The results showed that there are statistically significant differences regarding the working hours, the feeling of stress, the work effectiveness, the average examination time, the presence of a protocol used among the different workplaces of the participants; a private radiology centre, a private hospital or a public hospital, with a p-value 0.0022, 0.015, 0.027, 0.001, 0.0001 respectively. Also, statistically significant differences were observed in the decontamination methods used for equipment (p-value 0.007), for air (p-value 0.04) and when decontamination takes place (p-value 0.00032) among the different workplaces of the participants. Nonetheless, the majority of radiographers believe that their workplace is sufficiently provided with PPE, cleaning supplies, equipment, and with cleaning personnel and are optimistic regarding the adequacy of these provisions in the next three months. ConclusionThis study showed that in the Republic of Cyprus, there are protocols regarding protective measures against COVID-19, and the radiographers are adequately trained on how to face an infectious disease outbreak. However, work is needed in order to develop protocols that reassure the safety of patients and medical personnel while managing the excess workload effectively. Implications for practiceThis study indicates the importance of applying protective measures and protocols in the radiology departments in order to minimise the spread of the virus.

Evaluating the Effect of Working in the Dental Radiology Center on Micronucleus Frequency in Buccal Mucosa

Background: The present study aimed to investigate the effect of working in the dental radiology department on the frequency of micronucleus. Results: The mean frequency of micronucleus per cell in the control and case groups was not statistically significant (P = 0.4). In addition, no statistically significant difference was observed in males and females regarding the mean frequency of micronucleus per cell (P = 0.6). Employment background and age had no significant impact on the percentage of micronucleus-containing cells and the mean frequency of micronucleus per cell. Conclusions: Working in a dental radiology center had no impact on the percentage of micronucleuscontaining cells and the mean frequency of micronucleus per cell.

Comparison of mammography results from individual and organized screening for breast cancer

BackgroundIn France, the coexistence of individual screening (IS) and organized screening (OS) for breast cancer induces difficulties for primary care practitioners to position themselves. This study assessed whether the risk of having a mammography with a high risk of malignancy (BI-RADS 4 or 5) was different between patients aged from 50 to 74year performing it as part of an IS or of the OS. MethodThis cross-sectional multicenter study included women aged 50–74, with no personal history of breast cancer, performing mammography in radiology centers in Paris (France). The nature of the screening (OS or IS), breast cancer risk (high risk: BI-RADS 4 or 5), risk factors and clinical breast examination (CBE) abnormalities were collected. Patients in the IS and OS group were matched on age, breast density, history of benign lesions and family history of breast cancer using a propensity score. The association between the nature of screening and the risk of malignancy was evaluated by conditional logistic regression. ResultsAmong 2190 included patients, 77 % performed a mammography with the IS and had more CBE abnormalities (23 % vs 11 %, p<0,001), a history of benign lesion (15 % vs 11 %, p=0.01) and a family history of breast cancer (42 % vs 29 %, p<0,001). After matching 503 OS patients with 941 IS patients, the risk of malignancy and the nature of the screening were not associated (OR=0.72 [0.35–1.47], p=0.50). ConclusionThe risk of malignancy was not different whether the mammography was performed as part of the OS or IS.

CORRIGENDUM TO: TOWARD NATIONAL CT DIAGNOSTIC REFERENCE LEVELS IN THE UNITED ARAB EMIRATES: A MULTICENTER REVIEW OF CT DOSE INDEX AND DOSE LENGTH PRODUCT

This multicenter study evaluated computed tomography dose index volume (CTDIvol) and dose length product (DLP) to contribute to establishing computed tomography (CT) national diagnostic reference levels (NDRLs) in the United Arab Emirates (UAE). Data from 240 patients, who underwent CT head, chest, abdomen-pelvis and urography examinations, were analyzed, including patient age, sex and weight, CTDIvol (mGy) and DLP (mGy cm). The proposed DRLs for each examination were calculated as the third quartile. DRLs are proposed using CTDIvol (mGy) and DLP (mGy cm) for CT head (67 and 1189, respectively), chest (8 and 302, respectively), abdomen-pelvis (28 and 1122, respectively) and urography (20 and 714, respectively). These values are comparable with the initial NDRLs and published international DRLs. Baseline values for International Radiology Center (IRC) CT DRLs were calculated on frequently performed CT examinations. Implementation of DRL values improves dose optimization based on procedures, scanner type and patient characteristics while maintaining acceptable image quality and diagnostic confidence.

LOCAL STUDY OF DIAGNOSTIC REFERENCE LEVELS FOR COMPUTED TOMOGRAPHY EXAMINATIONS OF ADULT PATIENTS IN İZMIR, TURKEY.

This study aims to develop local diagnostic reference levels (DRLs) for the most common computed tomography (CT) examinations carried out around Izmir, Turkey. Five common CT examinations (head, neck, chest, abdomen-pelvis (AP), chest-abdomen-pelvis (CAP)) from four different radiology centres have been included in the study. CT dose index-volume (CTDIvol) and dose length product (DLP) values were recorded for 50 patients per exam in each centre. Third quartiles of CTDIvol and DLP values were determined as DRLs and compared with international findings. 51.3% of the patients were male and 48.7% were female, with a mean age of 57 (between 18 and 93). DRLs for CTDIvol were recorded as 70, 16, 15, 23 and 16 for head, neck, chest, AP and CAP examinations, respectively, while the corresponding DLPs were 1385, 604, 567, 998 and 1180mGy.cm. Results are mostly comparable to the latest international data, except for the head examinations, which were observed to slightly exceed the DRLs established by other countries.

Setting Up 3D Printing Services for Orthopaedic Applications: A Step-by-Step Guide and an Overview of 3DBioSphere.

3D printing has widespread applications in orthopaedics including creating biomodels, patient-specific instruments, implants, and developing bioprints. 3DGraphy or printing 3D models enable the surgeon to understand, plan, and simulate different procedures on it. Despite widespread applications in non-healthcare specialties, it has failed to gain traction in healthcare settings. This is perhaps due to perceived capital expenditure cost and the lack of knowledge and skill required to execute the process. This article is written with an aim to provide step-by-step instructions for setting up a cost-efficient 3D printing laboratory in an institution or standalone radiology centre. The article with the help of video modules will explain the key process of segmentation, especially the technique of edge detection and thresholding which are the heart of 3D printing. This is likely to enable the practising orthopaedician and radiologist to set up a 3D printing unit in their departments or even standalone radiology centres at minimal startup costs. This will enable maximal utilisation of this technology that is likely to bring about a paradigm shift in planning, simulation, and execution of complex surgeries.

The Reconnaissance of Iranian Adolescent’s Perceptions of Radiology Imaging Process

Background Since adolescents do not frequently refer to pediatricians or even general practitioners, hospitals and clinical standard systems are not designed to meet their needs. Therefore, the present study aimed to identify adolescent’s views and feelings of the X-ray imaging process, suggest some age-appropriate facilities to respond to their needs to have a good experience of attending to radiology centers and appropriate interactions between middle adolescents and radiographers. Materials and Methods: In this cross-sectional study, 60 adolescents (30 girls and 30 boys) from four secondary schools participated in the study. Their opinions and feelings regarding the waiting room, the imaging room, and their interactions with the radiographers were collected using the completed questionnaire. The questionnaire has been created by the Irish researcher (Davis), and its validity and reliability have been examined. Results: The major complaints of adolescents (36.7%) was the lack of comfortable seats in the waiting room. They preferred watching TV in the waiting room to play music. None of the adolescent girls were nervous in the X-ray room, and 13.3% of boys stated that they were nervous. Twenty-two of the adolescents said the radiographer was quiet. 10% of girls stated that the radiographer was quite rough in dealing with them; however, none of the boys made such a statement. Conclusion Theresults showed that adolescents do not receive optimal care during X-ray imaging. It was suggested that age-appropriate educational posters to be installed on the wall, and television programs to be displayed in the radiology departments, as well as training courses on how to interact with adolescents for radiographers.

Thickness of Facial Soft Tissue in Adult Patients with Class I, II and III Skeletal Patterns in Digital lateral Cephalometery

Introduction: Understanding the variations in the thickness of facial soft tissue is important in forensic medicine, dentistry, and plastic surgery. This study aimed to evaluate the thickness of the facial soft tissue in adolescents with different maxillary skeletal patterns and compare them between both sexes, by using digital lateral cephalometric radiographs. Methods: 97 patients over 18 years of age referring to a private radiology center for digital lateral cephalometric radiographs participated in this study. Standard digital lateral cephalometric radiographs of patients were categorized based on the ANB angle to three Skeletal jaw classes ( I, II, and III). Then, in each of the lateral cephalometric radiographs, the Soft tissue landmarks including glabella, nasion, subnasale, labrale superius, stomion, labrale inferius, labiomental, pogonion, menton, and the vertical distance of each landmark to the bone surface were determined. Soft tissue thickness landmarks at each site were measured separately in males and females and in three different skeletal class groups. Statistical analysis of multivariate multiplicative variance was used to compare the data. Results: The results of the study showed that soft tissue thickness in Glabella and Labiomental points were not significantly different between men and women (P-value >0.05). Other landmarks in men were significantly higher than women(P-value<0.05). As for the relationship between soft tissue thickness and skeletal classes, subnasale, labrale superius, stomion, labrale inferius had significant association with skeletal classification (P-value<0.05). Conclusion: These findings point to the importance of sex and cranial morphology in soft facial tissues for accurate facial reconstruction

Ultrasound Role in Management of Female Infertility

Abstract Background: Investigation of the probable causes of female infertility is complex and in many instances a compli-cated process. Aim of Study: To discuss the role of ultrasound in detection of causes of female infertility (including those disorders of cervix, ovaries, fallopian tube and uterus) illustrated by few cases. Patients and Methods: This cross sectional study was conducted on thirty female patients seeking fertility at Itay scan private radiology center, Itay Elbaroud and Al Dlangat General Hospitals, during the period from January 2018 to January 2020. All patients were subjected to examination using (GE healthcare Voluson P8 and Toshiba Nemio 30 and Medison Sono Ace R3) Ultrasound Machines. Results: Uterine abnormalities represent about 60%, cervical abnormalities represent 3.3% and ovarian abnormal-ities represent 23.3%, while tubal abnormalities represent 13.3% of the study group. Mean age of uterine abnormalities is about 30.5 years old, cervical abnormalities about 26 years old, ovarian abnormalities about 26 years old while mean age of tubal abnormalities is 30.5 years old in the study group. In most cases of female infertility in our study, ultrasound has been of great value: e.g. uterine malformations (sub septate and bicornuate uterus), endometrial abnormalities (endometrial polyp and focal endometrial hyperplasia), myometrial diseases (fibroids and uterine adenomyosis), tubal abnormalities (in-cluding hydrosalpinx and endometriosis), ovarian functional abnormalities (polycystic ovary) and cervical abnormalities (cervical masses). Conclusion: Ultrasound is a reliable tool in the diagnosis of many anatomical causes of female infertility and is com-parable to gold standard investigations in many circumstances, so we recommend it as primary investigation modality that could be complemented by other tools e.g. MRI, HSG, and laparoscopy when needed.

Teknik modifikasi ekstraoral radiografi Newman dan Friedman sebagai alternatif radiografi intraoral periapikal pada masa pandemi COVID-19

Objectives: This review is aimed to propose a method that could be an alternative in taking intra-oral radiographs during the COVID-19 pandemic. &#x0D; Literature Review: The COVID-19 pandemic is the most concerning health problem in the world today. The transmission of COVID-19 is through direct or close contact with infected secretions or aerosol droplets. Individuals with COVID-19 may be asymptomatic or presymptomatic (20%-86% of all infections). Thus, patients with undiagnosed COVID-19 can come to dental clinics and Oral and Maxillofacial Radiology centers anytime. The Oral and Maxillofacial Radiology centers from dental clinics can be a source of transmission of COVID-19 to operator and dental patients. In extraoral radiography modification technique of Newman and Friedman, the sensor is placed on the cheek outside of the oral mucosa, so that the sensor does not contact the mucosal fluid from the patient. &#x0D; Conclusion: Newman and Friedman's extraoral radiography modification techniques can be use as an alternatives to periapical intraoral radiographs to minimize the transmission of COVID-19.

Implementation of a High-Risk Breast Clinic for Comprehensive Care of Women With Elevated Breast Cancer Risk Identified by Risk Assessment Models in the Community.

Many radiology centers perform risk assessment at time of screening mammography. The Massachusetts General Hospital North Shore Cancer Center (MGHNS) developed a nurse practitioner (NP)-led high-risk breast clinic (HRBC) to provide comprehensive care for patients with elevated breast cancer risk by a validated tool. Patient and administrative data from the MGHNS HRBC was collected to evaluate clinical and implementation outcomes. We compared patients from the HRBC with those identified as having ≥ 20% lifetime risk at 5 community imaging centers. From March 2018 to February 2019, 318 patients were seen in the HRBC; 264 (83%) had ≥ 20% lifetime risk, 13 (4%) had prior atypia/lobular carcinoma in situ, 9 (3%) had ≥ 1.7% 5-year risk, and 32 (10%) had no indication of elevated risk. Genetic testing was recommended for 159 patients (50%); 33 (21%) completed testing with 1 mutation identified. Chemoprevention was discussed with 99 patients (31%); 9 (9%) initiated treatment. Screening magnetic resonance imaging (MRI) was recommended for 284 patients (89%); 184 (65%) had MRI performed with 2 mammographically occult cancers identified. During this time period, 215,112 patients had risk assessment performed at time of breast imaging; of these, 1,170 were found to have ≥ 20% lifetime risk. Compared with those identified as high risk in the community, patients seen in the HRBC were more likely to be white (94.3% v 85.4%; P < .001) and have a family history of ovarian cancer (16.4% v 9.4%; P < .001). We demonstrate the feasibility of an NP-led HRBC. Follow-through of recommendations by patients was highest for screening MRI; use of genetic testing and chemoprevention was lower than anticipated. In our community, uptake of the HRBC by referring providers remains a barrier, with only a minority of identified high-risk patients assessed in our clinic.

Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study

The study aimed to validate admission clinical and radiographic features of pediatric patients with traumatic epidural hematoma (EDH) that lead to safe observation. A Level I trauma center radiology and electronic medical record databases were retrospectively queried for pediatric patients with EDH on CT scan between 1/1/2016 and 10/1/2016. Patient imaging, treatment and outcome variables were abstracted. Characteristics of the cohort were compared to an external cohort used to develop prediction rules for surgical intervention. External validity of the prediction rules was assessed. 195 eligible subjects were included in the study, 37 of which failed observation and required surgery while 158 underwent successful observation. The surgical cohort had significantly thicker (p < .001) and higher volume (p < .001) EDH, increased midline shift (p < .001) and higher likelihood of mass effect (p < .001). There was significantly higher residual neurologic deficit rate (54% vs 23%, p < .001) and hospital mortality (5% vs 0%, p = .035) amongst the surgical group. There were significant differences in patient demographic, clinical and imaging characteristics between the internal and external cohorts. The predictive rules externally developed yielded positive predictive value of 97.7% (95% CI = 93.3-99.5%), negative predictive value of 24.5% (95% CI = 16.2-34.4%), specificity of 88.5% (95% CI = 69.9-97.6%), and sensitivity of 63.8% (95% CI = 56.6-70.5%) for successful observation. The current study validates previously developed prediction rules for safe observation of pediatric EDH in a cohort with distinct characteristics from the external cohort. Specifically, patients with no mass effect, EDH volume <15 ml and no neurological deficits are less likely to fail observation. The current study validates prediction rules for safe observation of pediatric EDH in a distinct pediatric cohort that provides further support to conservative management in these circumstances.