Radiology Centers Research Articles

What Women Want: Real Time Results for Screening Mammography in the Era of Value-Based Care | A Single Institution Experience During the COVID-19 SARS-COV2 Pandemic

Objective: Direct radiologist to patient communication has been linked to higher levels of patient satisfaction, compliance, and overall treatment outcomes. Recent studies examining patient expectations in breast imaging indicate that 90% of women prefer result communication and review of imaging directly from their radiologist. Though the primary components of diagnostic breast imaging are patient centered, supplemental data suggests that screening mammography result consultation may represent an additional opportunity for engagement in the new era of patient-experience driven care. The primary aim of our study was to examine patient preferences for receiving real time screening mammography result communication (RTRC) and characteristics that may influence their willingness to participate. Material and Methods: This quality-improvement based, IRB-approved, study was performed at three community-based academic breast radiology centers in a large metropolitan area between October 5, 2020, and January 2, 2021. Female patients presenting for screening mammography were invited to opt in for RTRC and/or participate in an electronic, HIPAA-compliant, simple survey that could be completed on the personal subject’s phone or tablet. Subjects opting in for RTRC were invited to wait in a consultation room during staff radiologist review. Once interpreted, the radiologist would discuss the results and next step recommendations with the patient. Self-reported patient demographic characteristics and RTRC preferences by age, race, ethnicity, level of education, household income, prior personal or family history of breast cancer, active (non-breast) cancer history and prior history of abnormal mammogram were assessed by categorical variable analysis using Chi-squared tests. A p-value <0.05 was determined to be statistically significant. Results: 1714 screening mammograms were performed across our three community-based breast imaging centers and 11% (186/1714) of women completed the survey during the study timeframe. White women (92%) were statistically more likely to opt in for RTRC when compared with non-white (80%) counterparts (p=.026). Patients with a personal history (p=0.001) or family history (p=0.006) of breast cancer were statistically more likely to opt in for RTRC when compared with other cohorts. A positive correlation was observed between prior history of abnormal mammogram and preference for receiving RTRC (93%) but did not achieve statistical significance (p=.082). There was no correlation observed between RTRC preference and an active (non-breast) cancer diagnosis (p=0.415). Conclusion: Our study confirms previous data suggesting that patients vastly prefer direct verbal communication ahead of written letter result notification. Our study also suggests that screening mammography RTRC may be of particular interest in patients with higher (personal or familial) risk for developing breast cancer. While this service may operationally add demand on radiologist-patient face time and cost to care delivery, an awareness of patient preferences and cohorts that may find value in this service option can be prioritized to optimize both patient experience and clinical workflow. Additional studies are warranted to further validate which practice models would achieve most benefit from this tailored service offering.

Evaluation of the position of the mental foramen in panoramic radiographs in a radiological center, Lima 2022

Evaluation of the position of the mental foramen in panoramic radiographs in a radiological center, Lima 2022

Functional forms of socio-territorial inequities in breast cancer screening – A French cross-sectional study using hierarchical generalised additive models

To reduce the breast cancer burden, the French National Organised Breast Cancer Screening Programme (FNOBCSP) was implemented in 2004. The recommended participation rate has never been achieved and socio-territorial inequities in participation have been reported on several occasions. We investigated the functional forms and consistency of the relationships between neighbourhood deprivation, travel time to the nearest accredited radiology centre and screening uptake. We used two-level hierarchical generalised additive models in 8 types of territories classified by socio-demographic and economic factors. The first level was 368,201 women aged 50–72 invited to the 2013–2014 screening campaign in metropolitan France. They were nested in 41 départements, the level of organisation of the FNOBCSP. The effect of travel time showed two main patterns: it was either linear (with participation decreasing as travel time increased) or participation first increased with increasing travel time to a peak around 5–15 min and decreased afterward. In nearly all types and départements, the probability of participation decreased linearly with increasing deprivation. Territorial inequities in participation were more context-dependent and complex than social inequities. Inequities in participation represent a loss of opportunity for individuals who already have the worst cancer outcomes. Evidence-based public health policies are needed to increase the effectiveness and equity of breast cancer screening.

Experience in using the VI-RADS system in assessing the depth of invasion of bladder tumors

Introduction. Survival rates and treatment algorithms for patients with bladder cancer (BC) depend on the depth of tumor invasion, in particular on the presence of the bladder muscle layer invasion and extraorganic spread. To assess the depth of bladder invasion, the VI-RADS system was developed in 2018, which is based on multiparametric MRI (mpMRI). According to published studies on the VI-RADS effectiveness, there is a high diagnostic accuracy for identifying formations with probable invasion into the muscle layer. The data on BC extraorganic spread are limited and the issue of assessing the sensitivity and specificity of this system requires further study.Aim of the study. To evaluate the diagnostic performance of mpMRI using the VI-RADS system in detecting muscle invasion and BC extraorganic growth.Materials and methods. A prospective study was conducted in the clinics of the National Medical Research Radiological Centre and included 75 patients aged 19 to 85 years, of which 39 (52%) had been newly diagnosed with BC, 36 (48%) had a relapse or continuous tumor growth. All patients underwent pelvic organs mpMRI on a tomograph with a magnetic field induction of 1.5T, followed by transurethral resection (TUR), TUR-biopsy of the bladder or cystectomy no later than 6 weeks after scanning.. The description of the bladder tumor included its measurements, localization and VI-RADS scale assessment. The data obtained by mpMRI were compared with the results of the morphological study using statistical analysis.Results. According to the results of the study, the overall VI-RADS scale sensitivity for categories above 3 (the presence of muscle invasion is equivocal) was 95.15% [90.11%; 99.95%], above 4 (muscle invasion is likely) – 92.59% [82.11%; 97.94%], specificity was determined at the level of 47.62% [25.71%; 70.22%] and 80.95% [58.09%; 94.55%] respectively. When assessing extraorganic spread in 30 patients, the sensitivity was 83.33% [62.62%; 95.26%], specificity – 83.33% [35.88%; 99.58%]. The accuracy and positive predictive value also had high levels from 80 to 95%, in contrast to the negative predictive value (55.56%).Conclusion. The scale for BC invasion depth assessing VI-RADS is characterized by high rates of sensitivity, specificity and accuracy, in particular when used in determining extraorganic spread.

Follow-up after radioiodine remnant ablation in differentiated thyroid cancer: the view of nuclear medicine physician

Timeliness of accurate dynamic observation and a clear understanding of the treatment response guarantees health of patients with differentiated thyroid cancer. Multidimensional approach to evaluation of thyroid-stimulating hormone, tumor markers, ultrasound picture, as well as results of molecular imaging with radioactive iodine is clearly defined in international clinical guidelines. At the A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center for more than 15 years tactics of control exam 6 months after radioactive iodine ablation has been implemented. The aim of the current article is to consider the sequence of diagnostic search for different responses to treatment of differentiated thyroid cancer.

Modern endoscopy in the diagnosis of early esophago-gastric junction cancer

The problem of endoscopic diagnosis of early esophago-gastric junction cancer is one of the most important in modern endoscopy and oncology, since most malignant tumors of the esophagogastric junction are detected at late stage. The 5-year survival rate of such patients remains low. Definition of early esophagogastric junction cancer, resectability criteria, features of the course of the disease at early stage will be considered in this article. It has been proven that NBI-ME and NBI Dual Focus in combination with endosonography are the most accurate in the diagnosis of early esophagogastric junction cancer. The most typical endoscopic features of early esophagogastric junction cancer are discussed in this review. All these methods are applied to the patient in Herzen Moscow Cancer Research Institute, branch of National Medical Research Radiology Center.

Assessing the cost-effectiveness of waiting list reduction strategies for a breast radiology department: a real-life case study

BackgroundA timely diagnosis is essential for improving breast cancer patients’ survival and designing targeted therapeutic plans. For this purpose, the screening timing, as well as the related waiting lists, are decisive. Nonetheless, even in economically advanced countries, breast cancer radiology centres fail in providing effective screening programs. Actually, a careful hospital governance should encourage waiting lists reduction programs, not only for improving patients care, but also for minimizing costs associated with the treatment of advanced cancers. Thus, in this work, we proposed a model to evaluate several scenarios for an optimal distribution of the resources invested in a Department of Breast Radiodiagnosis.Materials and methodsParticularly, we performed a cost-benefit analysis as a technology assessment method to estimate both costs and health effects of the screening program, to maximise both benefits related to the quality of care and resources employed by the Department of Breast Radiodiagnosis of Istituto Tumori “Giovanni Paolo II” of Bari in 2019. Specifically, we determined the Quality-Adjusted Life Year (QALY) for estimating health outcomes, in terms of usefulness of two hypothetical screening strategies with respect to the current one. While the first hypothetical strategy adds one team made up of a doctor, a technician and a nurse, along with an ultrasound and a mammograph, the second one adds two afternoon teams.ResultsThis study showed that the most cost-effective incremental ratio could be achieved by reducing current waiting lists from 32 to 16 months. Finally, our analysis revealed that this strategy would also allow to include more people in the screening programs (60,000 patients in 3 years).

Cone-Beam Computed Tomography Assessment of Quality of Endodontic Treatment and Prevalence of Procedural Errors in Mandibular Molars.

This study assessed the quality of endodontic treatment and the prevalence of procedural errors in permanent mandibular molars using cone-beam computed tomography (CBCT). This cross-sectional study was conducted on 328 CBCT scans (182 females and 146 males) of endodontically treated mandibular molars retrieved from the archives of two radiology centers in Ardabil city, Iran, in 2019. Mandibular molars were evaluated on sagittal, coronal, and axial sections regarding obturation length, obturation density (voids), missed canals, broken instruments, apical perforation, strip perforation, ledge formation, transportation, root fracture, root resorption, and periapical lesions by a senior dental student under the supervision of an oral and maxillofacial radiologist and an endodontist. Differences between the frequency of procedural errors and tooth type and gender were analyzed by the chi-square test. The frequency of underfilling, missed canals, overfilling, voids, apical perforation, transportation, ledge formation, broken instruments, root fracture, strip perforation, root resorption, and periapical lesions was 34.8%, 17.4%, 16.8%, 14.3%, 7.3%, 6.1%, 4.3%, 3%, 1.2%, 0.6%, 5.5%, and 46%, respectively. The frequency of root fracture was significantly higher in females than in males (P < 0.05). The prevalence of underfilling was the highest in right second molars (47.2%), followed by right first molars, left second molars, and left first molars (P < 0.005). The frequency of transportation was maximum in right first molars (10%), followed by right second molars, left first molars, and left second molars (P < 0.04). Underfilling, missed canals, and overfilling were the most prevalent procedural errors in mandibular molars in our study population.

Retroperitoneoscopic access in organ-preserving treatment of renal cell carcinoma

Background. Renal cell carcinoma is one of the most common urologic cancers. Due to development of modern diagnostic methods, kidney tumors are often diagnosed at early stages (cT1a-T1b). The golden standard of treatment of localized renal cell carcinoma is tumor resection. In retroperitoneoscopic access, the time to artery access is decreased, the risk of intra- and postoperative complications is reduced. Retroperitoneal access is preferable for tumors located on the lateral or posterior kidney surface.Aim. To analyze the results of treatment of patients after retroperitoneoscopic kidney resection.Materials and methods. Between 2018 and 2021, at the A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Radiological Center 47 retroperitoneoscopic kidney resections were performed (29 (61.7 %) in men, 18 (38.3 %) in women) due to stage cT1aN0M0 renal cell carcinoma. Retrospective analysis of demographic data, comorbid status, tumor characteristics, operative time, blood loss volume, frequency and severity of complications per the Clavien-Dindo classification was performed. Complexity of resection was evaluated using the R.E.N.A.L. scale.Results. Mean patient age was 63 (38-79) years, body mass index was 29.9 (22-39) kg/m2. Tumor of the left kidney was diagnosed in 24 (51.0 %) cases, of the right kidney - in 22 (46.8 %) cases, bilateral lesions - in 1 (2.2 %) case. Mean tumor size was 22.4 (11-39) mm. Resection had low complexity in 35 (74.5 %) cases, intermediate complexity in 12 (25.5 %) cases. Mean operative time was 156 (80-280) minutes, mean warm ischemia time was 19 (7-32) minutes, number of resections with zero ischemia was 15 (31.9 %), mean blood loss volume was 53 (10-300) mL, number of resections without renal parenchyma suturing was 10 (21.3 %). Mean hospitalization time after surgery was 5 days. Postoperative complications were observed in 4 (8.5 %) cases: bleeding (severity grade II per the Clavien-Dindo classification) in 1 (2.1 %) case, postoperative infectious complications (severity grade II) - in 2 (4.2 %) cases, subcutaneous hematoma (severity grade I) - in 1 (2.1 %) case.Conclusion. Retroperitoneoscopic access is effective and safe. This is confirmed by low frequency and severity of postoperative complications. This access allows to reduce hospitalization time and pain management medication which accelerates patient mobilization and recovery. Comparative analysis shows that retroperitoneoscopic kidney resection has the same effectiveness as laparoscopic resection.

Efficacy of avelumab in the treatment of oncourological malignances. Results of registration studies and own experience

Background. In the JAVELIN Bladder 100 trial, 1st line maintenance with avelumab in combination with best supportive care significantly increased (9.2 months) overall survival compared to best supportive care in patients with locally advanced or metastatic urothelial cancer without progression after 1st line platinum-based chemotherapy: 29.7 months versus 20.5 months, respectively. Trial results led to inclusion of avelumab into the international guidelines as a standard of care with the highest level of evidence. Combined therapy with avelumab + axitinib in patients with previously untreated metastatic renal cell carcinoma showed higher progression-free survival and objective response rate compared to sunitinib in all IMDC (International Metastatic Renal Cancer Database Consortium) groups. Avelumab + axitinib is one of the immuno-oncology combinations with proven effectiveness for progression-free survival and objective response rate.Aim. To evaluate the effectiveness of avelumab in treatment of oncological urological diseases in routine clinical practice. Materials and methods. At the N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - branch of the National Medical Research Radiology Center, 12 patients with locally advanced inoperable and metastatic urothelial cancer without progression after 1st line platinum-based chemotherapy in combination with gemcitabine received maintenance avelumab therapy. Median follow-up was 10 months. Primary endpoints were overall survival from the start of avelumab maintenance therapy and safety.Combined therapy with avelumab + axitinib was administered in 18 patients with metastatic renal cell carcinoma. Median follow-up was 9 (3-16) months. Overall survival, progression-free survival, response rate and safety in the overall population and according to IMDC groups were evaluated.Results. At data cut-off (March 2023) with median follow-up of 10 months, overall survival was 100 %, progression-free survival was 66.7 % (among patients who received more than 3 infusions - 100 %). Progression-free survival was higher in patients with tumors of the lower urinary tract compared to upper (72.5 % versus 60 %), complete response to induction platinum-based chemotherapy compared to partial response and stable disease (100 % versus 66.7 %) and presence of metastases in the lymph nodes only compared to visceral and bone metastases (100 % versus 66.7 %). Adverse events were observed in 4 (66.7 %) patients.Among 18 patients who received avelumab + axitinib, complete response was observed in 2 (11.1 %) patients, partial response in 6 (33.3 %) patients, stable disease in 9 (50 %) patients, disease progression in 1 (5.6 %) patient. Response to therapy was observed in patients of all prognosis groups; for large (&gt;5 cm) metastases in the lungs, soft tissues, lymph nodes and bones response was observed 3 months after treatment start. Overall survival for this follow-up duration was 100 %, progression-free survival was 96.4 ± 11.2 %. Adverse events were observed in 8 (44.4 %) patients, and in 6 (75 %) of them they were grade I—II and did not require infusion regimen correction or axitinib dose reduction.Conclusion. Avelumab maintenance therapy in the 1st line is the standard of care for patients with locally advanced and metastatic urothelial cancer without disease progression during 1st line platinum-based chemotherapy. Maintenance therapy allows to achieve better overall survival and progression-free survival irrespective of the choice of platinum regimen (cisplatin or carboplatin), response to platinum-based chemotherapy, number of chemotherapy cycles, tumor localization and advancement.Experience of the N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology confirms results of the JAVELIN Bladder 100 trial on the effectiveness of avelumab maintenance therapy in routine clinical practice. Combination drug therapy with avelumab and axitinib in patients with metastatic renal cell carcinoma is an effective and safe treatment method which allows to achieve fast objective response and has good tolerability in patients irrespective of IMDC group or metastasis location. Effectiveness and favorable safety profile of avelumab + axitinib combination were proven in the context of routine clinical practice.

Hungarian Fine-to-Coarse Aggregate, a Possible Constituent of Near-Vessel Structural Concrete of Nuclear Power Plants.

Significant gravel mines, representative of four regions of Hungary (northeast, central, northwest, and southwest) were systematically sampled to characterize their sand and pebbles as potential constituents of nuclear-grade concrete. The samples were analysed for their elemental compositions as a function of the mining locality and grain size, using two complementary neutron-based analytical techniques, prompt gamma activation analysis (PGAA) and neutron activation analysis (NAA). The combined analysis resulted in reliable mass fractions for over thirty elements that could be used to assess the radiation shielding and activation properties of the resulting concrete, essential in nuclear applications, by means of computer simulations. The studied aggregates are proven to be appropriate constituents for biological shielding at radiological centres, NPPs, and at nuclear research installations, even in mixed neutron/gamma radiation fields. The elemental compositions also revealed geochemical differences between the sedimentologically different regions.

Optimal Levels of Isoeffective Doses for Two Fractionation Modes in Glioblastoma

Purpose: Determination of the optimal level of a/b for the calculation of isoeffective doses in glioblastoma.&#x0D; Material and methods: Two fractionation modes were studied in 141 patients with primary glioblastoma (GBM). Fractionation with the prescribed dose of 2 and 3 Gy was used alternately (a study involving a pairwise selection strategy). In addition, 34 GBM patients treated in the pilot study of the National Medical Research Radiological Centre earlier were added to the database, the total number of patients was 175 people.&#x0D; Results: As of December 2022, 134 (76.6 %) of 175 treated patients had a fatal outcome. In the range of values of the coefficient a/b from 5.0 to 10.0, the indicator a/b=7.5 turned out to be the most informative. According to the criterion of overall survival, a favorable level of isoeffective dose exceeds 59.5 Gy.&#x0D; The median overall survival in the group with an isoeffective dose of &gt;=59.5 Gy was 22.3 months (95 % Cl: 17.7–26.9), in the group with a lower dose level – 10.3 months (p&lt;0.0001).&#x0D; According to monovariate analysis at an isoeffective dose of &gt;=59.5 Gy for fractionation regimens with a prescribed dose of 2 and 3 Gy, survival rates were almost identical (p=0.745). There were no differences in overall survival in the groups with prescribed doses of 2 and 3 Gy, taking into account the use of temozolomide on the background of radiation therapy (OR=1,087; p=0.677).&#x0D; In the older age group, a/b= 7.5 should be used to determine the level of isoeffective dose. The median overall survival with an isoeffective dose of &gt;=59.5 Gy was 20.57 months (n=98; 95 % Cl: 17.7–23.4), with a lower dose level – 6.35 months (n=24; p&lt;0.0001). In persons younger than 50 years of age, a decrease in the a/b coefficient should be expected.&#x0D; Conclusion: From our point of view, the obtained data on the equivalence of regimens with a prescribed dose of 2 and 3 Gy indicate the correct choice of the level of a/b in glioblastoma and the selection of the minimum level of isoeffective dose (59.5 Gy) according to the criterion of overall survival.

Influence of Homogeneous Dose Distribution Inside the Cancer Target on Local Control in Glioblastomas

Purpose: Assessment of the effect of homogeneous distribution inside the radiation target on local control in glioblastoma.&#x0D; Material and methods: In patients under the age of 50, fractionation with the prescribed dose of 2 and 3 Gy was alternately used: the first patient was prescribed a regimen with a dose of 3 Gy, the next – with a dose of 2 Gy (a study involving a pairwise selection strategy). The same approach is used for the older age group (50 years and more). A total of 141 patients had morphologically confirmed glioblastoma (grade 4). 10 patients who had not completed a full course of radiation therapy were excluded. Additionally, 27 patients with GBM were added, treated in the experimental study of National Medical Research Radiological Centre without methodological features. In total, 158 patients were included in the study. 74 patients were treated with the prescribed dose of 2 Gy, 84 had a dose of 3 Gy.&#x0D; Results: The median homogeneity index in our study was 7.5 (95% Cl: 6,7-8,3). The minimum HI indicator was at the level of 2.5, the maximum – 36.9. We managed to identify the most informative level of the homogeneity index according to the criterion of local control. The median disease-free survival in the group with HI&gt;=8.5 was 7.9 months (n=62; 95 % Cl: 1.6-14.2), in the group with a lower level of homogeneity - 5.4 months (n=96; p=0.024). The significance of the highlighted HI range depended on the fractionation mode used. The median relapse–free survival with fractionation of 3 Gy in the group with HI&gt;=8.5 was 12.7 months (n=38), in the group with a lower level of homogeneity - 8.3 months (n=46; p=0.020). In the group with fractionation regime of 2 Gy: 6.4 and 3.8 months, respectively (n=24/50; p=0.336). The median overall survival in the group with HI&gt;=8.5 was 27.2 months, in the group with a lower level of homogeneity – 21.2 months (p=0.904).&#x0D; Conclusion: The level of homogeneity has no significance according to the criterion of overall survival. Despite the fact that this predictor is of value only in scientific terms, the fact of its influence on local control allows to continue research in this direction. This primarily concerns the fractionation regimen with a prescribed dose of 3 Gy.

PD22-07 A MULTICENTER STUDY PRESENTING AN EXPLAINABLE AI APPROACH TO AUTOMATIC SEGMENTATION OF RENAL TUMORS ON COMPUTED TOMOGRAPHY

You have accessJournal of UrologyCME1 Apr 2023PD22-07 A MULTICENTER STUDY PRESENTING AN EXPLAINABLE AI APPROACH TO AUTOMATIC SEGMENTATION OF RENAL TUMORS ON COMPUTED TOMOGRAPHY Annemarie Uhlig, Sophie Bachanek, Paul Romario Würzberg, Manuel Nietert, Lutz Trojan, Joachim Lotz, and Johannes Uhlig Annemarie UhligAnnemarie Uhlig More articles by this author , Sophie BachanekSophie Bachanek More articles by this author , Paul Romario WürzbergPaul Romario Würzberg More articles by this author , Manuel NietertManuel Nietert More articles by this author , Lutz TrojanLutz Trojan More articles by this author , Joachim LotzJoachim Lotz More articles by this author , and Johannes UhligJohannes Uhlig More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003295.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Automatic segmentation of renal tumors is a cornerstone for Artificial Intelligence (AI) based tumor diagnostics. This study presents an automatic segmentation algorithm and visualization method using CT-studies from renal tumor patients recruited in a multicenter setting. METHODS: Renal tumor patients diagnosed between 2018 and 2021 were retrospectively assessed for this study. Inclusion criteria were CT-imaging of renal tumors in corticomedullary (CM) or nephrogenic (NG) contrast media phase. Patients aged <18years, and those with cystic or infiltrative renal tumors (i.e. lymphomas) were excluded. Manual segmentation of the renal tumors was performed by a GU-radiologist on all axial CT slices. A convolutional neural network (UNET) was trained based on the radiologists´ manual segmentations. In an independent validation dataset, the accuracy of the UNETs predictions of renal tumor contours was compared to the references standard of manual segmentations and quantified using the DICE score. RESULTS: A total of n=394/ n=350 patients with renal tumors imaged in CM /NG phase, respectively, were included (median age 66y; 35% female; median tumor diameter 5.4cm). CT-studies from >20 radiological imaging centers were included with different imaging protocols and slice thickness. The UNET was trained on n=316 CM and n=294 NG contrast phase patients (n=7019 / n=6859 separate CT images). In the independent validation dataset (n=78 / n=56 patients with 1713 / 1298 CT images), the UNET achieved a DICE score of 0.88 and 0.90 for the corticomedullary and nephrogenic CM phase, respectively. The UNET predictions were visualized using a tile-based approach with color-coding and contour-lines that could be overlaid on CT-images to depict varying levels of prediction confidence. CONCLUSIONS: A UNET AI-approach yields a robust automatic delineation of renal tumors on CT-images acquired in clinical routine, irrespective of the contrast media phase. Using color-coding and contour-lines that could be overlaid on original CT-images provides an explainable approach to the UNETs predictions and might improve AI-acceptance in clinical practice. Source of Funding: This study received funding by the 2022 ESR Research Seed Grant. The 2022 ESR Research Seed Grants were kindly supported by an unrestricted, non-exclusive grant from GE Healthcare © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e667 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Annemarie Uhlig More articles by this author Sophie Bachanek More articles by this author Paul Romario Würzberg More articles by this author Manuel Nietert More articles by this author Lutz Trojan More articles by this author Joachim Lotz More articles by this author Johannes Uhlig More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of the pharyngeal airway in snoring and non-snoring patients based on the lateral cephalometric study: A case-control study.

Normal airways are a key factor during the craniofacial growth of the young. Therefore, sleep-disordered breathing (SDB) without treatment can have harmful consequences for development and health. This study aimed to evaluate the cephalometric characteristics in non-snoring individuals and snoring subjects, and investigate differences in the pharyngeal airway space between the 2 groups. This case-control study included 70 patients aged over 18 years, selected from a radiology center. The patients were divided into 2 groups: case (35 patients with a history of habitual snoring); and control (35 healthy patients). The Berlin sleep questionnaire was administered to the parents of the patients. The nasopharyngeal airway was measured according to the analysis of Linder-Aronson (1970), and 4 indices were measured and analyzed in each of the lateral cephalometric radiographs. No statistically significant differences were observed in the pharyngeal measurements between the 2 groups, although all means in the control group were higher than in the experimental group. However, there was a significant relationship between gender and the Ba-S-PNS and PNS-AD2 indices. Although the patients with nocturnal snoring had smaller airway dimensions, their pharyngeal measurements were not significantly different from the control group.

Evaluation of patient radiation doses using DAP meter in diagnostic radiology procedures in Birjand, Iran

BackgroundThe concept of diagnostic reference level (DRL) is considered a regular method to optimize radiation protection in diagnostic imaging system. The objective of implementing a reference level for dose is to produce high-quality images by applying a minimum dose of radiation based on the As Low As Reasonably Achievable (ALARA) principle. Therefore, this study aimed to evaluate the status of radiation protection in diagnostic radiology wards of educational hospitals affiliated with Birjand University of Medical Sciences.MethodsThis study was performed during a period of 11-months in the radiology center of the teaching hospital of Birjand University of Medical Sciences. The studied population included 477 patients who were referred to as clinically indicated x-ray radiography. In order to calculate local DRLs, dose area product (DAP) was measured by a DAP-meter (KERMAX-plus SPD, model 120–131 HS) for 11 devices at educational hospitals affiliated with Birjand University of Medical Sciences. The local DRL values was calculated as 75% of the mean DAP distribution for a specific patient trial at each center.ResultsDAP for Chest PA examination was gained to be in the range from 0.12 Gy.cm2 to 0.42 Gy.cm2 with an average value of 0.23 Gy.cm2 which is above the value of the reference level (0.12 Gy.cm2) for Chest PA. For Chest lateral the observed DAP was found to be in the range from 0.18 Gy.cm2 to 1.48 Gy.cm2 with an average value of 0.65 Gy.cm2 and are therefore twice the reference value (0.3 Gy.cm2). The higher DRL values (average = 2.73) are for lumbar spine lateral radiography. It is observed that the DRL values of chest PA, abdomen AP and Lumbar spine AP are much lower with the earlier studies.ConclusionsThe DRLs helps in understanding the current practices in radiographic examinations. Comparison with other hospitals, the scope of dose optimization and ultimately patient dose reduction in hospitals affiliated with Birjand University of Medical Sciences needs further investigation.

French survey of sedation practices for pediatric magnetic resonance and computed tomography imaging.

Pediatric magnetic resonance imaging (MRI) and computed tompgraphy (CT) require patient immobility and therefore often require sedation or general anesthesia of patients. Consensus on these procedures is lacking in France. Thus, the aim of this study was to describe the current sedation practices for pediatric MRI and CTin France. From January 2019 to December 2019, an online questionnaire was delivered by electronic mail to a representative radiologist in 60 pediatric radiology centers registered by the French-speaking pediatric and prenatal imaging society. Questions included protocols, drugs used, monitoring and side effects. Representatives of 40 of the 60 (67%) radiology centers responded to the survey. Among them, 31 performed sedation including 17 (55%) centers where radiologists performed sedation without anesthesiologists present during the procedure. The premedication drugs were hydroxyzine (n = 8, 80%) and melatonin (n = 2, 20%), Sedation drugs used for children ages0 to 6years old were pentobarbital (n = 9, 60%), midazolam (n = 2, 13%), chloral hydrate (n = 2, 13%), diazepam (n = 1, 6.5%) and chlorpromazine (n = 1, 6.5%). A written sedation protocol was available in 10/17 (59%) centers. In 6/17 (35%) centers, no monitoring was used during the procedures. Blood pressure monitoring and capnography were rarely used (< 10%) and post-sedation monitoring was heterogeneous. No life-threatening adverse effect was reported, but 6 centers reported at least one incident per year. For half of the responding radiology centers, radiologists performed sedation alone in agreement with the local anesthesiology team. Sedation procedures and monitoring were heterogenous among centers. Adjustment and harmonization of the practices according to the capacity of each center may be useful.

Cone beam computed tomography (CBCT) referrals in paediatric patients: A 24-month retrospective study in two radiological centers in Campinas, Brazil.

To evaluate the CBCT referrals in paediatric patients over a 24-month period. A retrospective study was conducted in two radiological centers in Campinas, Brazil. Patients were divided into three age groups: G1: age under 10years, G2: age between 10 and 12years, and G3: age over 12years. The following data were collected: patients' age and sex, localisation, reasons for referral and dental specialty responsible for the request of CBCT exams. Data from 367 patients were assessed. CBCT was used more frequently in the Group 3 (58.9%). There was significant association between the region of the exam and age group (P < 0.05), with a higher percentage of exams in the maxilla for the age over 12years (35.6%) than that of up to 10years (50.9%) and between 10 and 12years (51.1%). Alterations were observed in 79.3% of the exams and 47.4% showed impacted teeth with significant association with the increase in age group (P < 0.05). Of the total number of exams, (55.3%) were requested in Orthodontics followed by Oral Surgery (30.0%) and Paediatric Dentistry (9.5%). It can be concluded that CBCT exams were indicated frequently for the age over 12years. The presence of impacted teeth represented the main reason for referrals and Orthodontics was the dental specialty that indicated CBCT with higher frequency.

ANATOMICAL PATTERN COURSE OF MANDIBULAR CANAL AND ITS FORAMINA LOCATION ON SAMPLE OF YEMENI PATIENTS USING CONE BEAM COMPUTED TOMOGRAPHY

Background and aim: Failure of inferior dental anesthesia, increased sensorineural disturbances, and postoperative bleeding in the mandibular canal region has amplified the demand for preoperative planning and appropriate evaluation to prevent these complications. The aim of the study was to reveal the locations and anatomical course pattern of the mandibular canal, as well as the cross-sectional diameter and positions of the mandibular and mental foramina, between a sample of Yemeni patients. Material and methods: A retrospective descriptive cross sectional study was performed to evaluate 165 CBCT images taken from the archives of Diagnostic Radiology Centers in Sana'a City, using EZ3D plus software. Data were retrieved from February 2017 to January 2021. Recorded data were collected, tabulated and statistically analyzed by SPSS (version 24). Results: The mean diameter of the mandibular foramen vertical and horizontal were measured to be 4.15±0.84 mm and 3.46±0.71 mm, respectively. The mandibular foramen was located approximately 2.87 mm above the midpoint of vertical ramus and 3.0 mm behind the midpoint horizontally. The mean diameters of the vertical and horizontal mental foramen were measured to be 3.46±0.78 mm, 3.54±1.5 mm, respectively. The mental foramen was located approximately in the middle of the mandibular body vertically. The most common anteroposterior position for the mental foramen was A (HP3) between the first and second premolars of the mandible (50.6%). The most common superior- inferior position for the mental foramen was (VP3) below the level of the root apices of the first and second mandibular premolars (62.2%). The inferio-superior position of the mandibular canal showed that the superior measurements ranged from 12.3-14.4 mm. Conclusion: This CBCT study reveals differences in the position of the mandibular canal course and the location of the mandibular and mental foramina among Yemeni patients. Therefore, careful evaluation and planning using cone-beam CT before any surgical intervention in the mandibular canal area is highly recommended to avoid unwanted complications among Yemeni patients. Peer Review History: Received: 20 December 2022; Revised: 24 January 2023; Accepted: 5 March 2023, Available online: 15 March 2023 Academic Editor: Prof. Dr. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Dr. Amany Mohamed Alboghdadly, Princess Nourah bint abdulrahman university, Riyadh, amalbgadley@pnu.edu.sa Similar Articles: RADIOGRAPHIC ASSESSMENT OF THE COURSE AND VISIBILITY OF THE MANDIBULAR CANAL BY PANORAMIC RADIOGRAPHY PREVALENCE OF PREMATURE LOSS OF PRIMARY TEETH AT THE AGE OF 6-10 YEARS IN SANA'A CITY, YEMEN

Proton beam therapy in repeat irradiation of recurrent head and neck tumors: analysis of short-term results

Introduction. Recurrence of head and neck tumors occurs in 50 % of cases and usually has locoregional character. Due to the characteristics of dose distribution, proton beam therapy is a promising treatment option for patients with recurrences of tumors in this location who previously underwent radiation therapy.Aim. To evaluate the effectiveness and tolerability of repeat irradiation using active scanning proton beam therapy in patients with recurrent head and neck tumors who previously underwent radiation therapy.Materials and methods. Between November of 2015 and December of 2020, 40 patients with locoregional recurrence of head and neck tumors underwent treatment using active scanning proton beam therapy at the A. F . Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center. Median cumulative dose of primary irradiation was 64.5 Gy. Median time between primary and repeat irradiation was 35.7 months, mean irradiated volume of the repeat course was 94.5 cm3. Proton beam therapy was performed using standard mode (2 isoGy) and accelerated hypofractionation (2.4 isoGy / 3 isoGy) with mean equivalent cumulative dose of 56.4 Gy (α / β = 10). Radiation toxicity was evaluated using the Radiation Therapy Oncology Group European (RTOG) / Organization for Research and Treatment of Cancer (EORTC) scale.Results. Treatment response was achieved in 34 (85 %) patients: in 17 (42.5 %) patients, stable disease was observed; in 10 (25 %) patients, partial response was observed; and in 7 (17.5 %) patients, complete response was observed. In 6 (15 %) cases, disease progression was diagnosed at first follow-up examination. One- and two-year locoregional control, progression-free survival and overall survival were 58.4 / 19.8; 44.5 / 19.8 and 82.3 / 38.8 % respectively with median follow-up duration of 14.2 months. Median survival was 19.5 months. Grade III and above early radiation toxicity was observed in 3 (7.5 %) patients. In total, 6 (15 %) cases of grade III complications and 2 (5 %) episodes of carotid artery rupture leading to death were observed. Overall frequency of complications of grade III and higher was 20 %.Conclusion. Repeat irradiation using proton beam therapy can be considered an effective and safe treatment method for patients with recurrent head and neck tumors. Dosimetric and radiobiological benefits of proton beams allow to achieve balance between high doses and radiation exposure in previously irradiated tissues.