Radiological Tools Research Articles

Clinical and radiological assessment of joints in people with haemophilia in Assam, Northeast India: a cross-sectional study

Abstract Background Despite the availability of factor replacement therapy, including prophylaxis, to treat and prevent bleeding, haemophilic arthropathy continues to be the most common complication of haemophilia and significantly impairs the quality of life in people with haemophilia (PwH). Regular periodic assessment of joint status in PwH is essential to identify early arthropathic changes and prevent the development or progression of haemophilic arthropathy. Kinematic and kinetic assessment are preferable and MRI is the gold standard for diagnosing haemophilic arthropathy, but availability is limited in developing countries. HJHS and ultrasound in conjunction with HEAD-US have been shown to effective in assessing changes indicating arthropathy. Aim This study is designed to identify which radiological assessment tool(s) works best when integrated with clinical assessment tools to examine joint health in PwH, with the aim of establishing a cheap, effective, multimodal approach to joint assessment in clinical practice in low resource settings which can then help to guide treatment. Methods A cross-sectional observational study was carried out among PwH attending a clinic in the department of medicine at Assam Medical College and Hospital, Northeast India, over a one-year time period. The elbow, knee and ankle joints of participants were assessed clinically and functionally using HJHS and FISH and radiologically by Pettersson (X-ray) and HEAD-US (ultrasound) scoring. The resulting data was analysed statistically to ascertain correlation between these parameters. Results Sixty-seven PwH were enrolled in the study, with a mean age of 21.69±8.24 years (median 21 years); 38 (57.72%) had severe factor deficiency. The majority (71.70%) presented with joint bleeds; 40 (59.70%) had the knee as a target joint, followed by the elbow (11; 16.41%) and ankle (6; 8.95%). Mean ABR (annual bleed rate), AJBR (annual joint bleed rate) and ATJBR (annual target joint bleed rate) values had a positive correlation with increased severity of factor deficiency (p <0.001). FISH score increased with factor activity level; HJHS, HEAD-US and Pettersson scores decreased with factor activity level. Significant positive correlation was established between Pettersson score, age and ABR. The degree of association was greatest between HJHS and HEAD-US at 60.62%; between HJHS and Pettersson it was 57.74%. Statistically significant negative correlation was established between FISH and HEAD-US. Conclusion A combined multimodal approach using the HJHS, FISH and HEAD-US scoring systems can provide a cheap, quick, more reliable and accurate option for assessing haemophilic joints, with minimal inter and intra observer reliability. This can support the optimisation of management of joint damage in PwH in resource-constrained settings.

68Ga-PSMA PET-CT and PSMA score affecting therapeutic decision-making in high-risk prostatic carcinoma.

This research study was conducted to evaluate the impact of (68Ga)-tagged prostatic-specific membrane antigen (68Ga-PSMA) positron emission tomography and computed tomography (PET-CT), compare its role with conventional radiology in early staging of high-risk prostate cancer, and calculate the PSMA score evaluating its usefulness in 68Ga-PSMA PET-CT reporting in our patient population. 68Ga-PSMA PET-CT of 65 high-risk cases of prostate cancer was performed for staging purpo-ses. Any change in disease stage was noted after 68Ga-PSMA PET-CT findings and PSMA score leading to a change in the management plan. Change in disease stage post-PSMA imaging was seen in 39% cases, high PSMA score (03) was noted in > 80% of upstaged cases, while low score (0) and (1) was seen in 65% and 35% down-staged individuals, respectively. Change in therapeutic decision-making was observed in 32% (21) of patients. 68Ga-PSMA PET-CT scans have a significant influence on the planned clinical management of high-risk prostate cancer patients; hence, they can be utilized as a replacement for radiological imaging tools, particularly in the detection of pelvic nodal and distant metastatic disease. PSMA score can be considered as an effective tool in standardized reporting of 68Ga-PSMA imaging.

Abdominal Cocoon Syndrome (ACS) or Idiopathic Sclerosing Peritonitis: An Extremely Rare Cause of Intestinal Obstruction

Introduction: Abdominal cocoon syndrome is an extremely rare cause of intestinal obstruction in which loops of small bowel are encapsulated by a fibro-collagenous membrane. This condition is also known in the literature as sclerosing peritonitis, and in the majority of cases, it has no known cause. The majority of patients exhibit long-standing signs and symptoms of partial intestinal obstruction. Presentation of case: A 15-year-old female patient presented with complete intestinal obstruction with no known co-morbidity and no history of prior laparotomy. Intraoperatively, the entire small bowel was found to be encapsulated by a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesions with appendicectomy done at the same time. Discussion: Most patients with abdominal cocoon syndrome present with features of recurrent acute or chronic small bowel obstruction secondary to kinking and/or compression of the intestines within the constricting cocoon. An abdominal mass may also be present due to an encapsulated cluster of dilated small bowel loops. Conclusions: Abdominal cocoon is a rare condition causing intestinal obstruction, and diagnosis requires a high index of suspicion because of the non-specific clinical picture. Contrast-enhanced CT-scan (CT) of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Peritoneal sac excision and adhesiolysis is the treatment, and the outcome is usually satisfactory.

Cocaine-Filled Capsule Detected after Firearm Injury: A Case Report

Emergency departments are facing increasing drug-related health problems with difficult medicolegal and social consequences. A 25-year-old male with no past medical history arrived at our emergency department. He was brought to the emergency room of our hospital by the security forces, as he suffered a gunshot wound while traveling to a place. The cocaine-filled capsule was seen on plain abdominal film. The plain abdominal film is the most commonly used radiological tool to detect 2-8 cm drug-filled packages within the gastrointestinal tract of body packers. In a study that analyzed the role of drugs in firearm deaths in New York between 1990 and 1998, more than half of firearm deaths had positive drug toxicology. Physicians working in the emergency unit should be prepared for secondary diagnoses. In addition, different examination and imaging findings should be kept in mind in suspicious cases.

Advancements and Applications of Radiological Tools in Forensic Investigations

Advancements and Applications of Radiological Tools in Forensic Investigations

Determining and Validating Population Differences in Magnetic Resonance Angiography Using Sparse Representation.

Identifying population differences can serve as an insightful tool for diagnostic radiology. To do so, a reliable preprocessing framework and data representation are vital. We build a machine learning model to visualize gender differences in the circle of Willis (CoW), an integral part of the brain's vasculature. We start with a dataset of 570 individuals and process them for analysis using 389 for the final analysis. We find statistical differences between male and female patients in one image plane and visualize where they are. We can see differences between the right and left-hand sides of the brain confirmed using Support Vector Machines (SVM). This process can be applied to detect population variations in the vasculature automatically. It can guide debugging and inferring complex machine learning algorithms such as SVM and deep learning models.

A Systematic Literature Review on Applications of GAN-Synthesized Images for Brain MRI

With the advances in brain imaging, magnetic resonance imaging (MRI) is evolving as a popular radiological tool in clinical diagnosis. Deep learning (DL) methods can detect abnormalities in brain images without an extensive manual feature extraction process. Generative adversarial network (GAN)-synthesized images have many applications in this field besides augmentation, such as image translation, registration, super-resolution, denoising, motion correction, segmentation, reconstruction, and contrast enhancement. The existing literature was reviewed systematically to understand the role of GAN-synthesized dummy images in brain disease diagnosis. Web of Science and Scopus databases were extensively searched to find relevant studies from the last 6 years to write this systematic literature review (SLR). Predefined inclusion and exclusion criteria helped in filtering the search results. Data extraction is based on related research questions (RQ). This SLR identifies various loss functions used in the above applications and software to process brain MRIs. A comparative study of existing evaluation metrics for GAN-synthesized images helps choose the proper metric for an application. GAN-synthesized images will have a crucial role in the clinical sector in the coming years, and this paper gives a baseline for other researchers in the field.

Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review.

Musculoskeletal soft-tissue infections include a wide range of clinical conditions that are commonly encountered in both emergency departments and non-emergency clinical settings. Since clinical signs, symptoms, and even laboratory tests can be unremarkable or non-specific, imaging plays a key role in many cases. MRI is considered the most comprehensive and sensitive imaging tool available for the assessment of musculoskeletal infections. Ultrasound is a fundamental tool, especially for the evaluation of superficially located diseases and for US-guided interventional procedures, such as biopsy, needle-aspiration, and drainage. Conventional radiographs can be very helpful, especially for the detection of foreign bodies and in cases of infections with delayed diagnosis displaying bone involvement. This review article aims to provide a comprehensive overview of the radiological tools available and the imaging features of the most common musculoskeletal soft-tissue infections, including cellulitis, necrotizing and non-necrotizing fasciitis, foreign bodies, abscess, pyomyositis, infectious tenosynovitis, and bursitis.

Evaluating Changes to the Modified K-Line Using Kinematic MRIs.

Retrospective cross-sectional review of a large database. Little is known regarding extension K-lines for treatment of cervical myelopathy. Therefore, this study seeks to examine differences between K-lines drawn in neutral and extension. The modified K-line is a radiological tool used in surgical planning of the cervical spine. As posterior cervical decompression and fusion often results in patients being fused in a more lordotic position than the preoperative neutral radiograph, a K-line measured in the extension position may offer better utility for these patients. Total of 97 patients were selected with T2-weighted, upright cervical magnetic resonance imaging taken in neutral and extension. For each patient, the K-line was drawn at the mid-sagittal position for both neutral and extension. The distance from the most posterior portion of each disk (between C2 and C7) to the K-line was measured in neutral and extension and the difference was calculated. Paired t test was used to assess significant differences. Across all levels between C2 and C7 there was an increase in the distance between the dorsal aspect of the disk and K-line when comparing neutral and extension radiographs. The average change in difference (extension minus neutral) at each cervical spinal level was 0.9mm (C2-C3), 2.5mm (C3-C4), 2.6mm (C4-C5), 2.0mm (C5-C6), and 0.9mm (C6-C7). A paired t test showed that the K-line increase from neutral to extension was statistically significant across all disk levels ( P <0.001). When positioned in extension, patients experience a significant increase in distance from the dorsal aspect of a disk to the K-line compared to when positioned in neutral, especially between C3 and C6. This is clinically relevant for surgeons considering a posterior cervical decompression and fusion in patients with a negative modified K-line on preoperative magnetic resonance imaging, as these patients may have enough cervical cord drift back when fused in an extended position, maximizing likelihood of improving postoperative DSM functional outcomes.

Ductography and Microdochectomy: the Diagnostic Procedure of Choice Alongside the Conventional Tools for Nipple discharge

Introduction: Nipple discharge is the presenting complaint in 3-10% of all women with breast-related complaints. It causes considerable anxiety in the modern cancer-conscious woman. Breast surgeons frequently use various tools for diagnosing the underlying cause of nipple discharge. A definitive diagnostic approach is crucial for an accurate diagnosis of the aetiology and exclusion of any malignant breast lesion. The objective of this study was to evaluate diagnostic performances of ductography and microdochectomy and compare these with other conventional diagnostic tools. Methods: This retrospective study included 153 female patients presenting with significant nipple discharge to “Breast Care Center” from December 2011 to December 2018. Informed consent was taken from all participants. History, clinical examination, relevant imaging, cytology and histology findings of all the patients were recorded in electronic database. Results: Mean and median age of the cohort were 38.4 years and 35 years respectively. 18 of the 153 patients, had a positive family history for breast cancer which was statistically significant. 3.9% (6/153) patients were eventually diagnosed (cytopathology-1, FNAC-1, ductography-1 &amp; microdochectomy-3) with in situ or invasive malignancies while being evaluated for nipple discharge. Breast ultrasound has sensitivity and specificity of 28.6% (5.1-69.7) &amp; 99.3% (95.7-99.9) respectively at 95% CI in detecting risk lesions. Sensitivity of ductography in detecting risk lesions was 100% (95% CI: 5.4-100) with specificity value of 95.2% (95% CI: 85.8-98.8). Again, microdochectomy has been used as final diagnostic as well as therapeutic tools in the study. Conclusion: Ductography is a noninvasive imaging modality whereas microdochectomy, although invasive, helps reach a definitive tissue diagnosis. Ductography and microdochectomy together can serve as indispensable diagnostic tools alongside the conventional radiological and histological tools. J Bangladesh Coll Phys Surg 2022; 40: 263-269

Determining baseline radiation levels in marine biota – A comparison of SE Queensland commercial species

Limited data exists on the contribution to radiological dose to members of the public from ingestion of radioactivity in seafood in the Australian diet. There is also a lack of data available to assess the radiological dose to marine fauna in Australian waters. Natural and anthropogenic radionuclides and trace metals were measured in the edible flesh of prawns to determine the radiological dose to humans. The remaining tissues were combined and analysed to enable uptake and environmental radiological doses to be assessed. Although in international studies, the edible flesh is generally measured to determine radiation dose or ingestion of trace metals, the effects of preparation and cooking techniques are rarely assessed. In this study, cooking and preparation techniques that may influence the radiological dose to humans were assessed. Eggs were also removed from a selected number of samples to assess the potential dose in sensitive developmental tissues and possible implications for environmental effects. Order of magnitude differences in 210Po activity concentrations and Cd concentrations were observed between whole animals and the edible flesh of Australian caught King (Melicertus spp.) and Tiger (Penaeus spp.) prawns, with the hepatopancreas primarily responsible for this difference. Most 210Po was unsupported by 210Pb and activity concentrations of all other radionuclides measured (137Cs, 210Pb, 226Ra, 232Th, and 238U) were very low. The major contribution to radiation dose via the ingestion pathway and to the organism itself was from 210Po. Cooking techniques that may lead to leaching of 210Po from the hepatopancreas could substantially increase the radiological dose from ingestion of this isotope. Organism dose estimates using different input assumptions in the radiological assessment tool “ERICA”, including site-specific tissue activity concentrations with site- or region-specific media concentrations, were compared with ERICA default distribution coefficients (Kd) and concentration ratios.

Angiosarcoma of the lungs, liver, and bones in a 27-year-old male patient

Angiosarcoma is a rare (from 1% to 2% of all soft tissue sarcomas), highly aggressive endothelial tumor that may affect any organ. The prognosis for the disease is poor, particularly if it is metastatic by the time of diagnosis. The etiology is unclear; however, there are definite risk factors including chronic lymphedema, radiation therapy, familial syndromes, and exposure to environmental chemical toxins and foreign bodies. Although the final diagnosis is histopathological, radiological tools such as ultrasound, CT, and MRI are still necessary to determine the stage of cancer. Treatment includes surgery, chemotherapy, and radiation therapy. Chemotherapy is the main treatment strategy for metastatic angiosarcoma, however, the toxicity level of frequently used agents is high. The research focuses on targeted medicines and immunotherapy as potential therapeutic options. We present a case of angiosarcoma in a young man without chronic illnesses with metastatic spread to the lungs, liver, and bones at the time of diagnosis

Radiation dose assessment in multiple injured patients using whole-body computed tomography

IntroductionWhole-body computed tomography (WBCT) is still debatable and a source of excessive radiation exposure when screening individuals with suspected blunt multiple trauma. ObjectiveThis study aims to develop institutional Diagnostic Reference Level's (DRL) value and estimate effective organ doses for poly-trauma patients who underwent WBCT examination. MethodRetrospective analysis for patients undergone WBCT scans after being traumatized and admitted to the emergency room. Effective and organ dose estimated for 78 patients. Sequence parameters and CT indices were retrieved from the CT system. Data analysis was done using SPSS 20.0 (SPSS Inc, Chicago, IL, USA). Results84.3% of the patients were male, while 15.7% were female. 88% of the patients had a road traffic accident, and the rest fell from height. The effective dose was estimated as 34.5–35.3 mSv in males and females, respectively, while the organ doses ranged from 10.2 to 63.7 mGy. ConclusionWBCT is a standard diagnostic radiological tool for urgent evaluation of patients with serious trauma. However, WBCT scanning comes with significant radiation exposure and the risk of developing cancer. Therefore, the WBCT should be clinically justified, and dosage reduction measures should be applied.

P397 Influence of underlying conditions on disease presentation and diagnostic strategy during pulmonary mucormycosis: Anational study of 114 cases

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesPulmonary mucormycosis (PM) is a life-threatening invasive fungal infection mostly affecting immunocompromised patients. We aimed to study the influence of underlying conditions on disease presentation and diagnostic strategy during PM.MethodsAll PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to EORTC/MSG 2019 criteria with the addition of diabetes and traumatism as host factors and positive serum or tissue PCR as mycological evidence. Thoracic CT scans were reviewed centrally.ResultsAmong 114 cases of PM, 52 (46%) were proven and 62 (54%) were probable, including 12 cases with a positive serum qPCR as the sole mycological criterion. Hematological malignancy was the most common risk factor (49%), followed by allogeneic hematopoietic stem-cell transplantation (21%), and solid organ transplantation (SOT, 17%). Fever was the first symptom for 66% patients and was more frequent in patients with neutropenia than in those without (97% vs 52%, P <.01). A total of 46 (40%) patients had a disseminated infection, which was more frequently reported in neutropenic patients (50% vs 25%, P <.01). Main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Sinusitis was present in 13% of cases.Chest radiological presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (26%), halo sign (24%), vascular abnormalities (26%), and excavation (23%). The excavation was more frequently reported in SOT patients (64%, P <.01) compared with other groups. Vascular involvement was associated with reversed halo sign and Rhizomucor infection. Neutropenic patients presented more frequently than non-neutropenic patients with ground-glass opacities (75 vs 49%, P = .01), halo sign (32% vs 10%, P = .02), and reversed halo sign (35 vs 10%, P <.01).A total of 83 (73%) patients had a positive fungal culture from any type of respiratory sample. Serum qPCR was positive for 42/53 patients (79%) and respiratory fluid qPCR for 16/21 (76%) patients. In neutropenic patients, BAL culture was less often positive (30% vs 66%, P <.01), and serum qPCR was more frequently positive (91% vs 62%, P = .02). A transthoracic lung biopsy was contributive in 8/11 (73%) patients with negative bronchoalveolar lavage (BAL). Serum qPCR was more frequently positive in patients with the main lesion of >3 cm in diameter (91% vs 62%, P = .02). Rhizomucor spp. Was identified in 31 patients (32%), Rhizopus spp. In 29 patients (30%), Lichtheimia spp. In 24 patients (25%), Mucor spp. In 10 patients (10%) and Cunninghamella spp. In 4 patients (4%). Neutropenic patients were more frequently infected with Rhizomucor (43% vs 13%, P <.01) and less frequently with Rhizopus (17% vs 50%, P <.01). Histopathological specimens were available for 48 patients (42%) and revealed Mucorales hyphae in 85% of cases. Patients with a disseminated infection and neutropenia presented more often with angioinvasion than patients with localized disease (50% vs 9%, P <.01 and 38% vs 13%, P = .10). Overall, 90-day mortality was 59%.ConclusionUnderlying conditions significantly influenced clinical and radiological presentation and diagnostic tools’ contribution. Neutropenic patients present more frequently with dissemination, fever, reversed halo sign, pathological angioinvasion, the negativity of BAL culture, the positivity of serum qPCR, and Rhizomucor infection.

Proposed Questions to Assess the Extent of Knowledge in Understanding the Radiology Report Language.

Radiotherapy and diagnostic imaging play a significant role in medical care. The amount of patient participation and communication can be increased by helping patients understand radiology reports. There is insufficient information on how to measure a patient’s knowledge of a written radiology report. The goal of this study is to design a tool that will measure patient literacy of radiology reports. A radiological literacy tool was created and evaluated as part of the project. There were two groups of patients: control and intervention. A sample radiological report was provided to each group for reading. After reading the report, the groups were quizzed to see how well they understood the report. The participants answered the questions and the correlation between the understanding of the radiology report and the radiology report literacy questions was calculated. The correlations between radiology report literacy questions and radiology report understanding for the intervention and control groups were 0.522, p < 0.001, and 0.536, p < 0.001, respectively. Our radiology literacy tool demonstrated a good ability to measure the awareness of radiology report understanding (area under the receiver operator curve in control group (95% CI: 0.77 (0.71–0.81)) and intervention group (95% CI: 0.79 (0.74–0.84))). We successfully designed a tool that can measure the radiology literacy of patients. This tool is one of the first to measure the level of patient knowledge in the field of radiology understanding.

P01.17.A Role of preoperative assessment in predicting tumor induced plasticity in patients with diffuse gliomas

Abstract Background When diffuse gliomas (DG) affect the brain′s potential to reorganize functional networks, patients can exhibit seizures and/or language/cognitive impairment. The tumor-brain interaction and the individual connectomic organization cannot be predicted preoperatively. We aimed to, first, investigate the relationship between preoperative assessment and intraoperative findings of eloquent tumors in 36 DG operated with awake surgery. Second, we also studied possible mechanisms of tumor-induced brain reorganisation in these patients. Material and Methods FLAIR-MRI sequences were used for tumor volume segmentation and the Brain-Grid system (BG). This standardized radiological tool was used as an overlay for infiltration analysis. Neuropsychological (NPS) and/or language preoperative assessments were performed in all patients before the direct cortical/subcortical brain mapping. The distance between eloquent spots and tumor margins was registered and measured on the neuronavigation system. Tumours containing eloquent points within hyperintense area on FLAIR sequences (cortical or subcortical) were considered eloquent. Eloquent points within 5-10 mm from the FLAIR signal margin were considered peritumoral, while beyond 10 mm from the FLAIR signal were considered outside the tumour area. Pre and postoperative images (3 months after the operation) were merged to detect eventual residual tumour. Clinical, radiological, and topographical variables and intraoperative findings were used for correlation and logistic regression analyses. Results 84.6% of our patients displayed neuropsychological symptoms at the preoperative assessment. Eloquent tumors were detected in 75% of the cases. Impaired NPS functions were correlated with more invasive tumors, crucial location (A4C2S2/A3C2S2-voxels, left opercular-insular/sub-insular region) and higher risk of eloquent tumors. Epilepsy was correlated with larger tumor volumes and infiltrated A4C2S2 /A3C2S2 voxels. Language impairment was correlated with infiltrated A3C2S2 voxel. Group comparison between younger and older patients (cut-off at 38 years old based on ROC curves) showed a significative difference in the number of intratumoral cortical eloquent spots (p &amp;lt; .05) and the number of peritumoral cortical eloquent spots (p &amp;lt; .001). Conclusion Preoperative NPS impairment was linked with high risk of eloquent tumors. Epilepsy and language impairment were linked with specific tumor locations while peritumoral cortical eloquent spots reflected an early compensative mechanism with age as possible influencing factor. A systematic integration of extensive cognitive assessment and advanced neuroimaging can improve our comprehension of the connectomic brain organization at the individual scale and lead to a better oncological/functional balance.

Efficacy of a combined tool for stage I non-small cell lung cancer against lymph node metastasis.

In patients with clinical stage I non-small cell lung cancer (NSCLC), the prediction of occult lymph node metastasis (LNM) based on a combination of morphology using high-resolution computed tomography (HRCT) and metabolism using positron emission tomography (PET)-CT is unknown. The present study evaluated the use of predictive radiological tools, chest CT and PET-CT, for occult LNM in patients with clinical stage I NSCLC. The records of patients who underwent lobectomy between July 2014 and November 2021 were retrospectively reviewed. The differences in clinicopathological parameters, including CT and PET, between the LNM and non-LNM groups were assessed. Pure solid tumor was defined as a consolidation-to-tumor ratio of 1. The optimal cut-off value for predictive radiological tools for LNM was assessed according to the area under the receiver operating characteristic (ROC) curve. The present study included 288 patients, of whom 39 (13.5%) had LNM; of these 38 (97.4%) were pure solid type. Larger consolidation size (CS), higher maximal standardized uptake (SUVmax) value and histological type were statistically associated with LNM (all P<0.05). The optimal cutoff values of CS and SUVmax for predicting LNM were 19 mm and 5.5 respectively, as assessed using the area under the ROC curve. The combination of CS ≥19 mm and SUVmax ≥5.5 demonstrated a markedly higher odds ratio (9.184; 95% CI, 4.345-19.407) than each parameter individually. The minimum values of CS and SUVmax associated with LNM were 10 mm and 0.8 respectively. Pure solid formation and CS as morphology and SUVmax as metabolism were useful tools that complemented each other in predicting LNM. The combined method of evaluating SUVmax and CS may identify eligibility for LN dissection. However, considering the minimum values of CS and SUVmax in LNM, it cannot affirm the omission of LN dissection for cases that do not meet the combined criteria using HRCT and PET-CT.

Automatic Detection of Periapical Osteolytic Lesions on Cone-beam Computed Tomography Using Deep Convolutional Neuronal Networks

IntroductionCone-beam computed tomography (CBCT) is an essential diagnostic tool in oral radiology. Radiolucent periapical lesions (PALs) represent the most frequent jaw lesions. However, the description, interpretation, and documentation of radiological findings, especially incidental findings, are time-consuming and resource-intensive, requiring a high degree of expertise. To improve quality, dentists may use artificial intelligence in the form of deep learning tools. This study was conducted to develop and validate a deep convolutional neuronal network for the automated detection of osteolytic PALs in CBCT data sets. MethodsCBCT data sets from routine clinical operations (maxilla, mandible, or both) performed from January to October 2020 were retrospectively screened and selected. A 2-step approach was used for automatic PAL detection. First, tooth localization and identification were performed using the SpatialConfiguration-Net based on heatmap regression. Second, binary segmentation of lesions was performed using a modified U-Net architecture. A total of 144 CBCT images were used to train and test the networks. The method was evaluated using the 4-fold cross-validation technique. ResultsThe success detection rate of the tooth localization network ranged between 72.6% and 97.3%, whereas the sensitivity and specificity values of lesion detection were 97.1% and 88.0%, respectively. ConclusionsAlthough PALs showed variations in appearance, size, and shape in the CBCT data set and a high imbalance existed between teeth with and without PALs, the proposed fully automated method provided excellent results compared with related literature.

Surgical management of adhesive small bowel obstruction: Is it still mandatory to wait? – An update

Small bowel obstruction syndromes (SBO) represent one of the main causes of emergency admission for surgical abdominal pain. The 2018 Bologna Guidelines (Ten Broek et al. 2018) recommend non-operative management at the outset if there are no signs of severity; surgery is proposed after 72h for the 20-30% of patients who fail medical management. However, these recommendations were based on old studies published at a time when laparoscopic surgery was not commonplace and when diagnostic capabilities (particularly for establishing etiology) were less developed than they are today. Additionally, the advent and development of laparoscopy and enhanced rehabilitation after surgery have led to a decrease in surgical morbidity. These guidelines are therefore now debated and several recent publications have encouraged urgent or semi-urgent surgical management for patients presenting for SBO in order to reduce morbidity, mortality, duration of hospitalization and costs, and to improve the feasibility of therapeutic laparoscopy. Prompt surgical management could also reduce the risk of recurrent small bowel obstructions. This model for early surgical management probably cannot be applied to all patients. It therefore seems important to select those patients at risk for failure of medical treatment and to identify those in whom the probability of successful laparoscopy is high. New radiological tools should allow better selection in the future. At the present time, the indications for early surgery "within 24h" should be emphasized.

Augmented reality in interventional radiology education: a systematic review of randomized controlled trials.

ABSTRACTBACKGROUND:Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures.OBJECTIVE:To compare AR with other learning methods in interventional radiology.DESIGN AND SETTING:Systematic review of comparative studies on teaching techniques.METHODS:We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model.RESULTS:Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR.CONCLUSION:AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model.SYSTEMATIC REVIEW REGISTRATION NUMBER:DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.