Consultant Radiologist Research Articles

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

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

Concordance and Discordance Between Radiology Residents and Consultant Radiologist Interpretation Of CT Brain

OBJECTIVES The primary objective of this study is to assess the degree of concordance and discordance between the interpretations of computed tomography (CT) brain images by resident and consultant radiologists while emphasizing the critical significance of accurate image interpretation for informed clinical decision-making. METHODOLOGY The evaluation of radiology reports for CT Brain interpretation through a prospective analysis at the Radiology Department of Rehman Medical Institute over two years, from 1st October 2020 to 31st October 2022. A total of 198 patients who underwent cranial CT scans were interpreted by residents (R1, R2, R3, R4). Following this, the consultant radiologists reviewed the images and completed their reports. The reports of the residents and the consultant radiologists were then compared, and concordance was achieved when the residents’ reports were consistent with the final radiologist’s reports. The data collected were recorded in Microsoft Excel. The statistical analysis was performed using SPSS version 22 (IBM Corp., Armonk, NY), and the kappa coefficient was used to determine the level of agreement between residents and consultants.RESULTSAmong the 198 CT Head reports evaluated, 186 of them were in agreement with the final report of the consultant radiologist. Of the correctly diagnosed cases, R1 correctly diagnosed 46 cases, R2 correctly diagnosed 80 cases, R3 correctly diagnosed 54 cases, and R4 correctly diagnosed 6 cases. Our study achieved a percentage agreement of 93.93, with a Cohen's kappa coefficient of 0.8.CONCLUSIONThe overall concordance rate between residents and consultant radiologists was 93.93%, with a kappa coefficient 0.8. This high kappa coefficient indicates strong agreement between the two groups.

FREQUENCY OF RECURRENCE OF PARAUMBILICAL HERNIA AFTER MESH REPAIR

Para-umbilical hernia is a common abdominal wall defect, and mesh repair is widely used to reduce recurrence rates. However, recurrence remains challenging in clinical practice, especially after elective mesh repair procedures like the Onlay technique. Objective: To determine the frequency of recurrence of para-umbilical hernia following mesh repair using the Onlay technique. Methods: This cross-sectional study was conducted in the Department of Surgery, SMBBMC, Lyari, Karachi, from March 1, 2024, to August 30, 2024, following ethical approval from the institutional review board. A total of 125 patients, aged 18-65 years, were diagnosed with para-umbilical hernia via clinical examination and abdominal ultrasound and undergoing elective mesh repair (Onlay technique) were included through non-probability consecutive sampling. After informed consent was obtained, data on age, BMI, smoking status, diabetes (fasting blood sugar >126 mg/dl or use of antidiabetic drugs), and hernia size (assessed by a consultant radiologist via ultrasound) were documented. Statistical analysis evaluated the recurrence rate and its association with clinical variables. Results: The average age of the participants was 48.68 ± 14.4 years, with a male predominance (55%). The overall recurrence rate following mesh repair was 52%. Stratification of recurrence based on age, gender, BMI, smoking status, and diabetes history revealed no statistically significant associations with the recurrence rate. Conclusion: The recurrence rate of para-umbilical hernia following mesh repair with the Onlay technique was high, at 52%, notably higher than that reported in the existing literature. Further research is needed to identify potential factors contributing to this elevated recurrence rate.

SP5.1 - The importance of weekly Radiology-General Surgery Multi-Disciplinary Meetings (MDMs) in the management of Emergency General Surgery (EGS) patients

Abstract Aims Most patients in Emergency-General-Surgery (EGS) require radiological investigations as part of their management plan. However, unlike cancer services where structured multi-disciplinary-meetings (MDMs) form an integral part of patient management, MDMs are not commonly practised in EGS. Our aim is to identify if having a weekly Radiology-General Surgery-MDM leads to better outcome in management of EGS patients. Methods A prospective study involving weekly 1-hour MDM focusing on Radiology and General Surgery was conducted from May to November 2023. These sessions were led by consultant radiologists where discussions amongst general surgical consultants and junior doctors took place. Factors taken into consideration were clinical presentation, original scan report, any missed findings on imaging and any changes to the initial management plan. Results A total of 85 cases were discussed during the study period, majority were initially reported by the out-of-hours radiologists. Out of those, 40 (47%) had changes to the management plan as well as missed findings that were noted as a result of Radiology-GeneralSurgery-MDM. Informal feedback gathered from junior doctors who attended revealed a significant impact in their knowledge on interpreting radiological scans in EGS. Conclusion Weekly Radiology-GeneralSurgery-MDMs for EGS-admissions have seen to improve overall patient outcome as a result of having a second opinion and recommending change in management plan in significant proportion of patients. It also had a positive impact on learning the clinical correlation of radiological-scans by junior-doctors who regularly attended these meetings.

ThP6.4 - Psoas Sarcopaenia as a Predictor of Mortality in Patients Over 65 with PR Bleeding: A Retrospective Case Controlled Study

Abstract Aims Sarcopaenia has been examined as a predictor for functional baseline and frailty in surgical patients and may predict mortality. The hypothesis of this study is that sarcopaenia is associated with increased risk of death after per rectal (PR) bleeding. Methods Patients over 65 who were admitted between January 2017 and December 2022, having had an episode of PR bleeding, that underwent cross sectional imaging were identified from the Southern health and social care trust database. Cross sectional imaging was accessed via PACS and total psoas area (TPA) calculated at the third lumbar vertebra by a radiology trainee and validated by a consultant radiologist. Clinical, mortality and demographic data was obtained from Northern Ireland Electronic Care Record (NIECR). Psoas muscle index (PMI) was then calculated by TPA and standardising for height in mm2/m2. Sarcopaenia was defined as PMI male < 545 mm2/m2 female < 385 mm2/m2. Results 77 Patients were included in this study. Patients were excluded based on the ability to standardise TPA for height. 27% (n 21) of patients were identified as sarcopaenic, 66% (n 14) of these patients have died. The median PMI showed differences between female mortality (490.44 mm2/m2) and non-mortality (559.49 mm2/m2) groups. Male patients also showed lower median PMI between mortality (599.79 mm2/m2) and non-mortality (643.05 mm2/m2 ) groups. Conclusions Sarcopaenia as a predictor for frailty is an important risk factor for all-cause mortality in PR bleeding. Cross-sectional imaging provides an opportunity to quantify risk as well as investigate aetiology for PR bleeding. Although radiation risk and cost effectiveness may limit use, it should be considered when imaging is available.

EP392 - Different modalities used in the investigation of anorectal lesions: a case report and discussion

Abstract Introduction Endoanal ultrasound scan (EAUS) /MRI rectum followed by early open/endoscopic, resection/biopsy for histology are important to plan management of all anorectal lesions. Here, we report an incidentally found inter-sphincteric lesion investigated with both EAUS and MRI scans, followed by excision. Case report A 55-year-old patient presented with post-menopausal bleeding and was investigated with an MRI pelvis which confirmed the causative subserosal fibroid. An incidental 15x12 mm focal soft tissue lesion at 2 o’clock between the internal and external anal canal sphincters was also picked up by the consultant GI radiologist. Her colonoscopy was normal but her digital rectal examination revealed a palpable submucosal elongated pea shaped lump at 2 o’clock. A lower GI specialist nurse performed an EAUS which suggested the lesion to be at 10 o’clock. At examination under anaesthetic (EUA), the mass in the inter-sphincter anal canal was confirmed at 2 o’clock, and excised after careful dissection from its intersphincteric location; histology confirmed a leiomyoma. The patient recovered well from the procedure. Discussion MRI and endoanal ultrasound are key imaging modalities in the diagnosis of rectal masses. EAUS provides more accurate assessment of depth of tumour invasion compared to MRI, and its relation to the anal sphincters; however, the scans are highly operator-dependent, as we found, and need to be interpreted with the benefit of clinical examination. Conclusion MRI and EAUS are complimentary in investigating rectal masses; however clinical examination, (especially under anaesthetic), as well as histology, gives the best information to plan subsequent management of common and unusual lesions (such as this) in the anorectum.

Sono-urethrogram versus conventional urethrogram in the assessment of urethral stricture disease: A prospective comparative study

ObjectiveManagement of urethral stricture disease depends on the location, length of stricture, and associated urethral pathology. These parameters are obtained from preoperative imaging, with conventional urethrogram (retrograde urethrogram and micturating cystourethrogram [RGU/MCU]) being the diagnostic tool of choice despite its many shortcomings. Sono-urethrogram (SUG) is an alternative which addresses most issues of RGU/MCU. Studies comparing RGU/MCU with SUG are limited. With objective of comparing these two imaging modalities in the evaluation of urethral stricture disease, a prospective study was conducted. MethodsFifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in study. SUG was performed by the experienced consultant radiologist who was blinded to the report of RGU/MCU. Findings of RGU/MCU and SUG were compared to intra-operative findings which served as the reference standard. ResultsThe median length of strictures determined intraoperatively was 16.50 mm, by RGU/MCU was 5.85 mm, and by SUG was 13.50 mm. Diagnostic accuracy for determination of stricture location was 93.45% for RGU/MCU and 98.28% for SUG. SUG identified spongiofibrosis in 90.00% of patients with higher accuracy for severe degree of fibrosis. ConclusionsSUG has shown to be more accurate than RGU/MCU for estimation of stricture length and location with added advantage of evaluating spongiofibrosis. Use of SUG in conjunction to RGU/MCU helps in better guidance of stricture management by improving preoperative assessment. Further studies with larger sample size are warranted.

Clinical application of convolutional neural network lung nodule detection software: An Australian quaternary hospital experience.

Early-stage lung cancer diagnosis through detection of nodules on computed tomography (CT) remains integral to patient survivorship, promoting national screening programmes and diagnostic tools using artificial intelligence (AI) convolutional neural networks (CNN); the software of AI-Rad Companion™ (AIRC), capable of self-optimising feature recognition. This study aims to demonstrate the practical value of AI-based lung nodule detection in a clinical setting; a limited body of research. One hundred and eighty-three non-contrast CT chest studies from a single centre were assessed for AIRC software analysis. Prospectively collected data from AIRC detection and characterisation of lung nodules (size: ≥3 mm) were assessed against the reference standard; reported findings of a blinded consultant radiologist. One hundred and sixty-seven CT chest studies were included; 52% indicated for nodule or lung cancer surveillance. Of 289 lung nodules, 219 (75.8%) nodules (mean size: 10.1 mm) were detected by both modalities, 28 (9.7%) were detected by AIRC alone and 42 (14.5%) by radiologist alone. Solid nodules missed by AIRC were larger than those missed by radiologist (11.5 mm vs 4.7 mm, P < 0.001). AIRC software sensitivity was 87.3%, with significant false positive and negative rates demonstrating 12.5% specificity (PPV 0.6, NPV 0.4). In a population of high nodule prevalence, AIRC lung nodule detection software demonstrates sensitivity comparable to that of consultant radiologist. The clinical significance of larger sized nodules missed by AIRC software presents a barrier to current integration in practice. We consider this research highly relevant in providing focus for ongoing software development, potentiating the future success of AI-based tools within diagnostic radiology.

Effect of combined rapid access point-of-care intestinal ultrasound clinic on the management of inflammatory bowel disease

BackgroundIntestinal ultrasound (IUS), although less widely practiced in the UK, offers several advantages in inflammatory bowel disease (IBD), particularly with regard to the accessibility of the test and immediate availability...

Optimal Magnetic Resonance Sequence for Assessment of Central Cartilage Tumor Scalloping

Abstract Background Magnetic resonance imaging (MRI) is key in evaluating central cartilage tumors. The BACTIP (Birmingham Atypical Cartilaginous Tumour Imaging Protocol) protocol assesses central cartilage tumor risk based on the tumor size and degree of endosteal scalloping on MRI. It provides a management protocol for assessment, follow-up, or referral of central cartilage tumors. Objective Our study compared four MRI sequences: T1-weighted (T1-w), fluid sensitive (Short Tau Inversion Recovery (STIR)- weighted, STIR-w), and grayscale inversions (T1-w GSI and short tau inversion recovery [STIR] GSI) to see how reliably endosteal scalloping was detected. Materials and Methods Two senior consultant musculoskeletal radiologists with experience reviewed randomly selected 60 representative central cartilage tumor cases with varying degree of endosteal scalloping to reflect a spectrum of BACTIP pathologies. The endosteal scalloping was graded as per the definition of BACTIP A, B, and C. They agreed on a consensus BACTIP grade for each of the 240 key images (60 cases × 4 sequences), which was considered the final “consensus” BACTIP grade. These 240 images were then randomized into a test set and given to two fellowship-trained consultant musculoskeletal radiologists for analysis. They assigned a BACTIP grade to each of the 240 selected images while being blinded to the final “consensus” BACTIP grade. The training set was further subdivided into three groups based on the MR image quality (good quality, average quality, and poor quality) to ascertain if the quality of the acquired images influenced intraobserver and interobserver agreements on the BACTIP grading. The two observers were blinded to the grade assigned to the image quality. Results Linearly weighted kappa analysis was performed to measure the agreement between the BACTIP grading answers by two observers and the “consensus” BACTIP grading answers, as well as the BACTIP grading agreement between the two observers themselves.The analysis revealed that T1-w and STIR-w sequences demonstrated more consistent and higher agreement across different image qualities. However, the T1-w GSI and STIR-w GSI sequences exhibited lower agreement, particularly for poor-quality images. T1-w imaging demonstrated substantial agreement between BACTIP gradings for poor-quality images, suggesting potential resilience of T1-w sequence in challenging imaging conditions. Conclusion T1-w imaging is the best sequence for BACTIP grading of endosteal scalloping, followed by fluid-sensitive STIR sequences.

Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study.

Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar's and the medical student's were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.

Interobserver Agreement and Performance of Concurrent AI Assistance for Radiographic Evaluation of Knee Osteoarthritis.

Background Due to conflicting findings in the literature, there are concerns about a lack of objectivity in grading knee osteoarthritis (KOA) on radiographs. Purpose To examine how artificial intelligence (AI) assistance affects the performance and interobserver agreement of radiologists and orthopedists of various experience levels when evaluating KOA on radiographs according to the established Kellgren-Lawrence (KL) grading system. Materials and Methods In this retrospective observer performance study, consecutive standing knee radiographs from patients with suspected KOA were collected from three participating European centers between April 2019 and May 2022. Each center recruited four readers across radiology and orthopedic surgery at in-training and board-certified experience levels. KL grading (KL-0 = no KOA, KL-4 = severe KOA) on the frontal view was assessed by readers with and without assistance from a commercial AI tool. The majority vote of three musculoskeletal radiology consultants established the reference standard. The ordinal receiver operating characteristic method was used to estimate grading performance. Light kappa was used to estimate interrater agreement, and bootstrapped t statistics were used to compare groups. Results Seventy-five studies were included from each center, totaling 225 studies (mean patient age, 55 years ± 15 [SD]; 113 female patients). The KL grades were KL-0, 24.0% (n = 54); KL-1, 28.0% (n = 63); KL-2, 21.8% (n = 49); KL-3, 18.7% (n = 42); and KL-4, 7.6% (n = 17). Eleven readers completed their readings. Three of the six junior readers showed higher KL grading performance with versus without AI assistance (area under the receiver operating characteristic curve, 0.81 ± 0.017 [SEM] vs 0.88 ± 0.011 [P < .001]; 0.76 ± 0.018 vs 0.86 ± 0.013 [P < .001]; and 0.89 ± 0.011 vs 0.91 ± 0.009 [P = .008]). Interobserver agreement for KL grading among all readers was higher with versus without AI assistance (κ = 0.77 ± 0.018 [SEM] vs 0.85 ± 0.013; P < .001). Board-certified radiologists achieved almost perfect agreement for KL grading when assisted by AI (κ = 0.90 ± 0.01), which was higher than that achieved by the reference readers independently (κ = 0.84 ± 0.017; P = .01). Conclusion AI assistance increased junior readers' radiographic KOA grading performance and increased interobserver agreement for osteoarthritis grading across all readers and experience levels. Published under a CC BY 4.0 license. Supplemental material is available for this article.

The radio anatomical arrangement of nerve roots at L3 level in cauda equina sac is it affected by diseases?

An observational study to discover the common conditions affecting the lumbosacral region that may affect lumbosacral position and tension. All the patients, underwent MRI exaamination (magnetic resonance imaging) in the supine position, were examined by the same consultant radiologist. The article was revised by the institutional ethical approval committee. The position of the nerve roots was observed, and the number of nerve roots was calculated anterior to a line passing between the mid-transvers process of L3(third lumbar vertebra). The number of nerve roots ahead of this line was calculated by the radiologist at the level of the right intervertebral foramen and at the left one. This procedure was applied to the normal group, and 5 common pathological diseases were repeated including single-level lumbar disc prolapse, multiple-disc prolapse, multiple bulge, spinal stenosis and spondylolisthesis (at the level of L45 (fourth to fifth lumbar vertebrae) or L5S1 (fifth lumbar to first sacral vertebrae) being outside the study area, i.e., L3). We noticed significant difference in the number of the nerve roots between the cases with herniated discs, spinal stenosis, and spondylolisthesis with the normal group and the significance was in ascending increment in significance being the highest in cases with spondylolisthesis, and even in the groups of other pathologies which are statistically not significant, we noticed that the significance is proportional to the severity of the disease being the least in single level cases (p 0.427), to be more significant on cases with multiple prolapses(p 0.319) to be more in cases with multiple bulges to start to be statistically significant in herniated, higher significance in cases with spinal stenosis to be the highest in cases with spondylolisthesis.

Awareness of radiation hazards and knowledge of radioprotective measures among radiologists and non-radiology staff: a cross-sectional survey

BackgroundIonizing radiation has become increasingly utilized in medical practice. Consequently, healthcare workers must be aware of radiation hazards and apply the necessary countermeasures to reduce occupational exposure. This study assessed the awareness of radiation hazards and knowledge of radiation protection measures among radiologists and non-radiologists. These findings may improve the application of various safety measures during medical interventions involving radiation.MethodsWe conducted a cross-sectional questionnaire-based study among 200 medical personnel, including consultant surgeons, physicians, radiologists, nurses, and radiographers, across five hospitals in Jordan between November 2022 and February 2023. The questionnaire collected data on demographic characteristics, awareness of radiation hazards, and knowledge of radioprotective techniques.ResultsOverall, the knowledge of radiation protection and awareness of radiation hazards among the participants were poor (51.55% and 37.17%, respectively). No significant difference was detected between the medical disciplines in terms of the level of knowledge of radiation protection; however, radiographers were significantly more aware of radiation hazards.ConclusionsAccording to our findings, medical personnel generally have poor awareness of radiation hazards and radiation protection protocols. However, this understanding can be enhanced through periodic in-service training and regular monitoring of occupational radiation exposure by health professionals.

Machine learning and deep learning for classifying the justification of brain CT referrals.

To train the machine and deeplearning models to automate the justification analysis of radiology referrals in accordance with iGuide categorisation, and to determine if prediction models can generalise across multiple clinical sites and outperform human experts. Adult brain computed tomography (CT) referrals from scans performed in three CT centres in Ireland in 2020 and 2021 were retrospectively collected. Two radiographers analysed the justification of 3000 randomly selected referrals using iGuide, with two consultant radiologists analysing the referrals with disagreement. Insufficient or duplicate referrals were discarded. The inter-rater agreement among radiographers and consultants was computed. A random split (4:1) was performed to apply machine learning (ML) and deeplearning (DL) techniques to unstructured clinical indications to automate retrospective justification auditing with multi-class classification. The accuracy and macro-averaged F1 score of the best-performing classifier of each type on the training set were computed on the test set. 42 referrals were ignored. 1909 (64.5%) referrals were justified, 811 (27.4%) were potentially justified, and 238 (8.1%) were unjustified. The agreement between radiographers (κ = 0.268) was lower than radiologists (κ = 0.460). The best-performing ML model was the bag-of-words-based gradient-boosting classifier achieving a 94.4% accuracy and a macro F1 of 0.94. DL models were inferior, with bi-directional long short-term memory achieving 92.3% accuracy, a macro F1 of 0.92, and outperforming multilayer perceptrons. Interpreting unstructured clinical indications is challenging necessitating clinical decision support. ML and DL can generalise across multiple clinical sites, outperform human experts, and be used as an artificial intelligence-based iGuide interpreter when retrospectively vetting radiology referrals. Healthcare vendors and clinical sites should consider developing and utilising artificial intelligence-enabled systems for justifying medical exposures. This would enable better implementation of imaging referral guidelines in clinical practices and reduce population dose burden, CT waiting lists, and wasteful use of resources. Significant variations exist among human experts in interpreting unstructured clinical indications/patient presentations. Machine and deep learning can automate the justification analysis of radiology referrals according to iGuide categorisation. Machine and deep learning can improve retrospective and prospective justification auditingfor better implementation of imaging referral guidelines.

Etiology and Diagnostic Challenges of Ulnar Wrist Pain in Pediatric and Adolescent Patients

Diagnosing the cause of ulnar-sided wrist pain can be difficult in the pediatric and adolescent age group. While frequently used, the diagnostic accuracy of magnetic resonance image (MRI), as compared with intraoperative arthroscopic findings, is not well-described in this population. This study aimed to determine concordance rates between magnetic resonance and arthroscopic findings depending on the specific ulnar wrist pathology. A retrospective review was performed to identify pediatric and adolescent patients who underwent operative treatment of ulnar wrist pain between 2004 and 2021. Patients were included in the analysis if they were <18 years of age, complained of ulnar-sided wrist pain, underwent MRI of the affected wrist with an available report interpreted by a consultant radiologist, and had a diagnostic arthroscopy procedure within one year of imaging. Ulnar pathologies analyzed included triangular fibrocartilage (TFCC) tears, ulnotriquetral (UT) ligament tears, lunotriquetral ligament abnormalities, and ulnocarpal impaction. A total of 40 patients with a mean age of 15-years-old (range 11 to 17) were included in the analysis. Twenty-four were female, and approximately half had their dominant extremity affected. Most had a history of antecedent trauma (n= 34, 85%), but only 15/40 (38%) had a history of fracture. The mean duration of symptoms prior to presentation was six months (standard deviation, 7). The most common etiologies were Palmer 1B TFCC tears (n= 27, 68%) followed by UT split tears (n= 11, 28%). MRI overall demonstrated high specificity (82% to 94%), but low sensitivity (14% to 71%) for ulnar-sided wrist conditions. Accuracy varied between 70% and 83% depending on the specific injury. While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy. Surgeons should have a high degree of suspicion for TFCC-related pathology in the setting of positive provocative clinical examination despite negative MRI findings in young patients. Diagnostic IIb.

An evaluation of AI generated literature reviews in musculoskeletal radiology

PurposeThe use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be avoided by using programmes trained for a more specific scope. In this study we compared the performance of a new AI tool (the-literature.com) to the latest version OpenAI's ChatGPT (GPT-4) in summarizing topics that the authors have significantly contributed to. MethodsThe AI tools were asked to produce a literature review on 7 topics. These were selected based on the research topics that the authors were intimately familiar with and have contributed to through their own publications. The output produced by the AI tools were graded on a 1–5 Likert scale for accuracy, comprehensiveness, and relevance by two fellowship trained consultant radiologists. ResultsThe-literature.com produced 3 excellent summaries, 3 very poor summaries not relevant to the prompt, and one summary, which was relevant but did not include all relevant papers. All of the summaries produced by GPT-4 were relevant, but fewer relevant papers were identified. The average Likert rating was for the-literature was 2.88 and 3.86 for GPT-4. There was good agreement between the ratings of both radiologists (ICC = 0.883). ConclusionSummaries produced by AI in its current state require careful human validation. GPT-4 on average provides higher quality summaries. Neither tool can reliably identify all relevant publications.

HIGH ANKLE SPRAINS WITH SYNDESMOSIS INSTABILITY: TIME TO MRI MATTERS

IntroductionEarly clinical examination combined with MRI following a high ankle sprain allows accurate diagnosis of syndesmosis instability. However, patients often present late, and for chronic injuries clinical assessment is less reliable. Furthermore, in many centres MRI may be not be readily available. The aims of the current study were to define MRI characteristics associated with syndesmosis instability, and to determine whether MRI patterns differed according to time from injury.MethodsRetrospectively, patients with an unstable ligamentous syndesmosis injury requiring fixation were identified from the logbooks of two fellowship trained foot and ankle surgeons over a five-year period. After exclusion criteria (fibula fracture or absence of an MRI report by a consultant radiologist), 164 patients (mean age 30.7) were available. Associations between MRI characteristics and time to MRI were examined using Pearson's chi-square tests or Fisher's exact tests (significance set at p&lt; 0.05).ResultsOverall, 100% of scans detected a syndesmosis injury if performed acutely (within 6 weeks of injury), falling to 83% if performed after 12 weeks (p=0.001). In the acute group, 93.5% of patients had evidence of at least one of either PITFL injury (78.7%), posterior malleolus bone oedema (60.2%), or a posterior malleolus fracture (15.7%). In 20% of patients with a posterior malleolus bone bruise or fracture, the PITFL was reported as normal. The incidence of posterior malleolus bone bruising and fracture did not significantly differ according to time.ConclusionFor unstable ligamentous syndesmosis injuries, MRI becomes less sensitive over time. Importantly, posterior malleolus bone oedema or fracture may be the only evidence of a posterior injury. Failure to recognise instability may lead to inappropriate management of the patient, long term pain and arthritis. We therefore advocate early MRI as it becomes more difficult to ‘grade’ the injury if delayed.

P072 The management of hand osteoarthritis in the NHS: a national UK clinician-based study

Abstract Background/Aims Hand Osteoarthritis (HOA) is a condition causing significant pain and disability in those affected. Treatments include pharmacological/non-pharmacological approaches, including splinting, pain management with non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroid (ICS) injections and surgery. There may be variability in ICS use, since few trials have compared efficacy of ICS over placebo. We conducted a UK-wide study of practising clinicians regarding their management of HOA. Methods An online survey was conducted from September 2022 - May 2023. Practising clinicians who are members of their respective societies were contacted by email. Participants provided information about their job role, region of work, nature of their clinical practice, subtypes of HOA managed and preferred management options. Results A total of 132 complete responses were obtained from the survey. Responding clinicians included Consultant Rheumatologists (43.2%), Consultant Hand Surgeons (34.8%), Rheumatology Specialist Nurses (6.1%), Rheumatology trainees (7.4%), Occupational Therapists (4.6%), Consultant Radiologists (1.5%), Physiotherapists (0.8%), General Practitioners (0.8%) and Physician Associates (0.8%). Responses were obtained from London (25%), South East (12.9%), South West (4.5%), East of England (6.8%), Midlands (12.1%), North West (3.8%), North East (3.8%), Yorkshire and the Humber (28%), Scotland (0.8%) and Wales (2.3%). There were 48.5% of respondents working in tertiary care services, 37.1% in district general hospitals, 13.6% across multiple sites in secondary care and 0.8% in primary care. Ninety-eight per cent of responders were seeing patients with HOA and the most common number of patients seen with HOA was 1-10 per month, reported by 40.3% of respondents. The most common type of HOA observed was first CMC joint or DIP/PIP joint involvement (more than 50%), with a lower proportion for erosive HOA (up to 10%). More than 90% of respondents reported that NSAIDs/hand therapy/intra-articular steroid injections/surgery were the treatments most likely to be offered. Eighty per cent of respondents reported an awareness of splinting, 31% were aware of taping. Regarding ICS, 62.9% performed ICS injections and 37.1% preferred injections under ultrasound (US) guidance. Reasons for preferring injections in clinic included time taken for US guided injections due to pressure on radiology services. Some clinicians preferred US guided confirmation of inflammation before proceeding to injection. Conclusion We obtained a high response rate from clinicians managing HOA. The most common HOA subtype observed was the first CMC, PIP/DIP joints. Recent EULAR (European Alliance of Associations for Rheumatology) recommendations state that ‘intra-articular injections of glucocorticoids should not generally be used in hand OA’, but can be considered in patients with painful PIP/DIP joints. We found high use of ICS injections as an adjunct to other therapies. Injection in clinic was preferred due to pressures on Radiology services. Our data suggest a higher use of ICS in clinical practice in comparison with published guideline recommendations. Disclosure N. Sofat: None. L. Ahmed: None. A. Radulovic: None. S. Cerovac: None. S. Umarji: None.

E011 Magnetic resonance imaging in axial spondyloarthritis: usage, reporting times and scanning times - a service evaluation in a large tertiary centre

Abstract Background/Aims Rapid access to magnetic resonance imaging (MRI) of the spine and sacroiliac joints is essential for the timely diagnosis of axial spondyloarthritis (axSpA). A recent NASS/BRITSpA national FOI survey highlighted deteriorating waiting times to access MRI for the assessment of inflammatory back pain in the UK, with only 73% of Trusts reporting access within 8 weeks, compared to 90% in 2017. In addition, NHS England and the Royal College of Radiologists have recently published a target of 28 days for turn-around time (TAT) for a verified report to be provided after image acquisition in any circumstance. Aims: To evaluate the usage of MRI performed under the “inflammatory back pain protocol” at a large tertiary centre, including the time from MRI request to scan being performed, TAT for reporting and whether this has changed over time. Methods A service evaluation audit was conducted at Leeds Teaching Hospitals Trust (LTHT). MRIs of the spine and sacroiliac joints requested between December 2021 and May 2023 under the local “inflammatory back pain protocol” were identified by the radiology department. Data extracted from medical records included: indication for MRI request, time elapsed from request to scan, and from scan to verified report. Results A total of 668 MRI requests were identified. The commonest reason for MRI request was to aid the diagnosis of axSpA 75% (n = 501); followed by disease activity monitoring in established axSpA (16.7%, n = 111) and assessment of axial involvement in peripheral psoriatic arthritis, i.e. diagnosis of axPsA (8.5% n = 57 scans). The majority (92%) had a request to scan time of 8 weeks, with a TAT to report of 4 weeks (77%). However, a greater delay in TAT to verified report was seen from December 2022 to May 2023 with &amp;lt;45% of reports issued within 28 days, despite no change in scanning time. Causes identified were related to local workforce issues including delays in appointing new radiographers and radiology consultants. Conclusion The main reason for request of an MRI under the inflammatory back pain protocol at LTHT is to support making a diagnosis of axSpA. A significant number of patients were scanned for treatment monitoring and to diagnose axial psoriatic arthritis, although data on the utility of MRI for these indications are limited. Whilst nearly all patients were scanned within 2 months at all time periods, the TAT to report has significantly deteriorated since December 2022 in our region, due to workforce issues. Further understanding of the impact of workforce factors on service delivery in rheumatology is required. Disclosure J. Weddell: None. R. Shah: None. P. Robinson: None. A. Barr: None. C. Vandevelde: None. J. Freeston: None. D. McGonagle: None. H. Marzo-Ortega: None.