Diagnostic Imaging Research Articles

A Case Report of Aberrant Origin of the Right Coronary Artery from thePulmonary Artery in an Adult Male: The Role of Multi-modality Imaging

Background: The normal anatomy of the coronary arteries consists of the right coronary artery and the left main coronary artery, which originate from the right and left sinuses of Valsalva in the aortic root separately. In general, congenital anomalies of the coronary artery are uncommon in adults. The ectopic origin of a coronary artery from the pulmonary trunk is part of a group of infrequent coronary artery anomalies. The Anomalous origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) is thought to be an extremely rare congenital coronary artery anomaly. Most of our knowledge and experience about this congenital coronary malformation is derived from published case reports and series. Case Presentation: We have, herein, reported the case of a 68-year-old male who was discovered to have ARCAPA after he presented to our center with chest pain. The patient underwent multiple invasive and non-invasive diagnostic imaging modalities, including an echocardiogram, a coronary angiogram, a multislice-gated coronary computed tomographic angiogram, and stress perfusion cardiovascular magnetic resonance imaging. The clinical decision was to continue with conservative non-surgical management along with close follow-up. Conclusion: The ARCAPA anomaly is considered to be one of the rare congenital coronary artery variances that can be discovered in late adulthood as a patient may remain asymptomatic for many decades.

Retrospective Review of Patients Presenting for Daytime, Evening, Weekday, and Weekend Breast Cancer Screening and Diagnostic Imaging Appointments

Retrospective Review of Patients Presenting for Daytime, Evening, Weekday, and Weekend Breast Cancer Screening and Diagnostic Imaging Appointments

To reject, or to accept? A study on radiographers’ perspectives on diagnostic radiographs

IntroductionThe overall reject rate (RR) of our newly set up Radiology department was an average of 14%, higher than the recommended 8% target and 10% threshold set by the American Association of Physicists in Medicine (AAPM). An analysis done to identify potential causes of a high RR suggested that radiographers might have been rejecting images of diagnostic value. A lack of consistency in the definition of a diagnostic value image amongst radiographers may be a possible cause in the higher overall RR. This study aims to investigate potential discrepancies among radiographers in defining a diagnostic radiograph. MethodsAn online survey composed of an image bank with a questionnaire was created, participants grade each image as either accepted or rejected. Fleiss Kappa was used to determine the level of agreement between the radiographers in accepting or rejecting the images in the image bank. ResultsTwenty radiographers with varying years of experience participated in this study. There was fair agreement amongst the radiographers’ judgements, k=.277 (95% CI, .277 to .278), p < .005. Individual kappa for the “Accept” and “Reject” categories were both 0.277. There is no significant difference in the agreement level across the junior (k=.278), intermediate (k=.371) and senior (k=.275) radiographers. ConclusionThe result suggests that there is discrepancy in the radiographers’ definition of a diagnostic radiograph and this misalignment of radiographers’ perception might be one of the underlying causes of high RR. Implications for practiceThis study has provided the researchers with a better insight on the underlying cause of the department high RR. By calibrating the radiographers’ definition of a diagnostic radiograph, it will help realign the radiographer's agreement on when a radiograph should be rejected. This will reduce the overall RR and patient's overall dose. A lower RR translates to a more efficient turnaround time in General Radiography services, ensuring quality service is provided without further strain on our limited resources.

Machine learning-based estimation of patient body weight from radiation dose metrics in computed tomography.

Currently, precise patient body weight (BW) at the time of diagnostic imaging cannot always be used for radiation dose management. Various methods have been explored to address this issue, including the application of deep learning to medical imaging and BW estimation using scan parameters. This study develops and evaluates machine learning-based BW prediction models using 11 features related to radiation dose obtained from computed tomography (CT) scans. A dataset was obtained from 3996 patients who underwent positron emission tomography CT scans, and training and test sets were established. Dose metrics and descriptive data were automatically calculated from the CT images or obtained from Digital Imaging and Communications in Medicine metadata. Seven machine-learning models and three simple regression models were employed to predict BW using features such as effective diameter (ED), water equivalent diameter (WED), and mean milliampere-seconds. The mean absolute error (MAE) and correlation coefficient between the estimated BW and the actual BW obtained from each BW prediction model were calculated. Our results found that the highest accuracy was obtained using a light gradient-boosting machine model, which had an MAE of 1.99kg and a strong positive correlation between estimated and actual BW (ρ=0.972). The model demonstrated significant predictive power, with 73% of patients falling within a±5% error range. WED emerged as the most relevant dose metric for BW estimation, followed by ED and sex. The proposed machine-learning approach is superior to existing methods, with high accuracy and applicability to radiation dose management. The model's reliance on universal dose metrics that are accessible through radiation dose management software enhances its practicality. In conclusion, this study presents a robust approach for BW estimation based on CT imaging that can potentially improve radiation dose management practices in clinical settings.

Self-Reported Management of Inflammatory Breast Cancer Among the American Society of Breast Surgeons Membership: Consensus and Opportunities.

Inflammatory breast cancer (IBC) is rare and biologically aggressive. We sought to assess diagnostic and management strategies among the American Society of Breast Surgeons (ASBrS) membership. An anonymous survey was distributed to ASBrS members from March to May 2023. The survey included questions about respondents' demographics and information related to stage III and IV IBC management. Agreement was defined as a shared response by >80% of respondents. In areas of disagreement, responses were stratified by years in practice, fellowship training, and annual IBC patient volume. The survey was administered to 2337 members with 399 (17.1%) completing all questions and defining the study cohort. Distribution of years in practice was 26.0% 0-10 years, 26.6% 11-20 years and 47.4% > 20 years. Overall, 51.2% reported surgical oncology or breast fellowship training, 69.2% maintain a breast-only practice, and 73.5% treat < 5 IBC cases/year. Agreement was identified in diagnostic imaging, trimodal therapy, and mastectomy with wide skin excision for stage III IBC. Lack of agreement was identified in surgical management of the axilla; respondents with < 10 years in practice or fellowship training were more likely to perform axillary dissection for cN0-N2 stage III IBC. Locoregional management of stage IV IBC was variable. Among ASBrS members, there is consensus in diagnostic evaluation, treatment sequencing and surgical approach to the breast in stage III IBC. Differences exist in surgical management of the cN0-2 axilla with uptake of de-escalation strategies. Clinical trials are needed to evaluate oncologic safety of de-escalation in this high-risk population.

Helmet Radio Frequency Phased Array Applicators Enhance Thermal Magnetic Resonance of Brain Tumors.

Thermal Magnetic Resonance (ThermalMR) integrates Magnetic Resonance Imaging (MRI) diagnostics and targeted radio-frequency (RF) heating in a single theranostic device. The requirements for MRI (magnetic field) and targeted RF heating (electric field) govern the design of ThermalMR applicators. We hypothesize that helmet RF applicators (HPA) improve the efficacy of ThermalMR of brain tumors versus an annular phased RF array (APA). An HPA was designed using eight broadband self-grounded bow-tie (SGBT) antennae plus two SGBTs placed on top of the head. An APA of 10 equally spaced SGBTs was used as a reference. Electromagnetic field (EMF) simulations were performed for a test object (phantom) and a human head model. For a clinical scenario, the head model was modified with a tumor volume obtained from a patient with glioblastoma multiforme. To assess performance, we introduced multi-target evaluation (MTE) to ensure whole-brain slice accessibility. We implemented time multiplexed vector field shaping to optimize RF excitation. Our EMF and temperature simulations demonstrate that the HPA improves performance criteria critical to MRI and enhances targeted RF and temperature focusing versus the APA. Our findings are a foundation for the experimental implementation and application of a HPA en route to ThermalMR of brain tumors.

Comparison between BIRAD Scores and Histological features in Diagnosis of Breast Neoplasia at Warith International Cancer Institution.

Introduction: Accurate evaluation and classification of breast lesions using the Breast Imaging-Reporting and Data System (BIRADS) are crucial for appropriate management and treatment planning of breast cancer. This study explores the relationship between BIRADS scores and histological features in the diagnosis of breast neoplasia at the Warith International Cancer Institution in Karbala, Iraq. Methods: This descriptive study included 520 patients diagnosed with breast neoplasia with a pre-diagnostic malignancy probability (BI-RADS 3, 4, or 5) between June 2023 and June 2024. Based on the diagnostic imaging method, patients were classified into mammography and ultrasonography groups. Clinicopathological factors, including age, BI-RADS categories, and histological findings, were analyzed. Results: Mammogram findings revealed that 63.65% of patients had benign results, while 20.77% had findings indicative of malignancy. Ultrasound findings showed that 71.35% of patients had benign results, and 11.35% had findings suggestive of malignancy. Histological analysis indicated that 23.85% of patients had malignant results, 68.07% had benign findings, and 2.31% showed suspicious results. Patients aged 50 years and above had a significantly higher likelihood of detecting malignant breast lesions through mammography compared to younger patients. At the same time, no significant association was found between age groups and ultrasound findings. Conclusion: Mammography demonstrated high sensitivity and specificity in detecting breast neoplasia, although there were false positives and negatives. Ultrasound screening also effectively detected breast abnormalities, particularly in identifying lesions that required further evaluation. The study highlights the importance of age in influencing breast cancer detection through mammography, with older patients having a higher detection rate than younger patients.

Gold Nanoparticles: An Emerging Novel Technology for Targeted Delivery System for Site-Specific Diseases

Abstract: Gold Nanoparticles (GNPs) have emerged as a novel technology in the field of targeted delivery systems, offering promising solutions for site-specific disease treatment. These nanoparticles possess unique physicochemical properties, such as controlled size, shape, and surface chemistry, which enable precise manipulation for enhanced therapeutic efficacy. The biocompatibility and ease of functionalization of GNPs facilitate the conjugation with various biomolecules, including drugs, peptides, and nucleic acids, thereby improving their targeted delivery capabilities. Recent advancements in nanotechnology have leveraged GNPs for the treatment of a range of diseases, particularly in oncology, cardiology, and neurology. In cancer therapy, GNPs can be engineered to target tumor cells selectively, minimizing damage to healthy tissues and reducing side effects. This is achieved through the conjugation of GNPs with tumor-specific ligands, antibodies, or aptamers, which direct the nanoparticles to malignant cells, allowing for localized drug release and improved therapeutic outcomes. Moreover, GNPs exhibit remarkable potential in diagnostic imaging and photothermal therapy. Their unique optical properties, such as surface plasmon resonance, enable their use as contrast agents in imaging techniques, providing high-resolution and real-time monitoring of disease progression. In photothermal therapy, GNPs convert light energy into heat, effectively destroying targeted cells with minimal invasiveness. The development of GNP-based delivery systems also addresses significant challenges in drug resistance and bioavailability. By overcoming biological barriers and enhancing cellular uptake, GNPs improve the pharmacokinetics and pharmacodynamics of therapeutic agents. However, despite these advancements, the clinical translation of GNPs faces challenges such as potential toxicity, long-term stability, and regulatory hurdles. In conclusion, gold nanoparticles represent a cutting-edge approach in targeted delivery systems, offering significant potential for site-specific disease treatment. Continued research and innovation are essential to overcome existing challenges and fully realize the clinical applications of GNPs, ultimately revolutionizing precision medicine. Gold nanoparticles exhibit unique physicochemical and optical properties. The gold nanoparticles have advanced techniques to cure different chronic diseases. Today, gold nanoparticles are aided by photodynamic therapy and radiation therapy as drug carriers. Due to this, researchers now focus on medical sciences to treat various diseases and therapeutic applications. This review provides all the aspects of gold-based nanoparticles, methods, and their pharmacological benefits in different fields of medical sciences. We also discuss various preparation methods and their advantages in pharmaceutical formulations.

Management of paracondylar process fracture in three horses.

Fractures of the paracondylar process of the occipital bone may cause headshaking, neck pain and neurologic deficits. The condition is being recognised more frequently with increasing availability of computed tomography. However, to date only limited information is available as to presentation, treatment, surgical approach and outcome. To describe the clinical signs, imaging findings, treatment, surgical approach and outcome in three horses diagnosed with paracondylar process fracture. Retrospective case series. Clinical records and diagnostic images of affected cases were reviewed. Two cases had ventral nonunion fractures-one of these presented with neck pain, headshaking and behavioural changes, while in the other the fracture was a suspected incidental finding in a case of poor performance. A third case with a more dorsal fracture presented with acute facial nerve paralysis. Diagnosis was by computed tomography in all cases, although imaging of ventral fractures by radiography was found to be feasible. Where clinical signs could be associated confidently with the fracture, conservative management resulted in improvement but not complete resolution. Repeated recurrence of clinical signs after prolonged periods of remission necessitated surgical removal in one case, which was readily accomplished with the aid of ultrasound guidance, and led to rapid resolution of clinical signs without significant post-operative complications. The surgical approach is described. Limited follow-up was available. Paracondylar process fracture should be considered as a differential diagnosis for headshaking, neck pain, poor performance and facial paresis, and is a justification for performing computed tomography in such cases. A multi-disciplinary approach is beneficial due to the potential for orthopaedic, neurologic, ophthalmologic and behavioural clinical signs, with additional need for expertise in diagnostic imaging and pain management. Surgical fragment removal should be considered for ventral fractures.

Evolution and Impact of a Diagnostic Point-of-Care Ultrasound Program in a PICU.

To evaluate the impact of point-of-care ultrasound (POCUS) use on clinicians within a PICU and to assess infrastructural elements of our POCUS program development. Retrospective observational study. Large academic, noncardiac PICU in the United States. Patients in a PICU who had diagnostic POCUS performed. None. Between January 1, 2017, and December 31, 2022, 7201 diagnostic POCUS studies were ordered; 1930 (26.8%) had a quality assurance (QA) record generated in an independent POCUS QA database. The cardiac domain was most frequently imaged (81.0% of ordered studies, 81.2% of reviewed studies). POCUS images changed clinician understanding of pathophysiology in 563 of 1930 cases (29.2%); when this occurred, management was changed in 318 of 563 cases (56.5%). Cardiac POCUS studies altered clinician suspected pathophysiology in 30.1% of cases (472/1568), compared with 21.5% (91/362) in noncardiac studies (p = 0.06). Among cases where POCUS changed clinician understanding, management changed more often following cardiac than noncardiac POCUS (p = 0.02). Clinicians identified a need for cardiology consultation or complete echocardiograms in 294 of 1568 cardiac POCUS studies (18.8%). Orders for POCUS imaging increased by 94.9%, and revenue increased by 159.4%, from initial to final study year. QA database use by both clinicians and reviewers decreased annually as QA processes evolved in the setting of technologic growth and unit expansion. Diagnostic POCUS imaging in the PICU frequently yields information that alters diagnosis and changes management. As PICU POCUS use increased, QA processes evolved resulting in decreased use of our initial QA database. Modifications to QA processes are likely necessary as clinical contexts change over time.

Optimizing computed tomography image reconstruction for focal hepatic lesions: Deep learning image reconstruction vs iterative reconstruction

BackgroundDeep learning image reconstruction (DLIR) is a novel computed tomography (CT) reconstruction technique that minimizes image noise, enhances image quality, and enables radiation dose reduction. This study aims to compare the diagnostic performance of DLIR and iterative reconstruction (IR) in the evaluation of focal hepatic lesions. MethodsWe conducted a retrospective study of 216 focal hepatic lesions in 109 adult participants who underwent abdominal CT scanning at our institution. We used DLIR (low, medium, and high strength) and IR (0 %, 10 %, 20 %, and 30 %) techniques for image reconstruction. Four experienced abdominal radiologists independently evaluated focal hepatic lesions based on five qualitative aspects (lesion detectability, lesion border, diagnostic confidence level, image artifact, and overall image quality). Quantitatively, we measured and compared the level of image noise for each technique at the liver and aorta. ResultsThere were significant differences (p < 0.001) among the seven reconstruction techniques in terms of lesion borders, image artifacts, and overall image quality. Low-strength DLIR (DLIR-L) exhibited the best overall image quality. Although high-strength DLIR (DLIR-H) had the least image noise and fewest artifacts, it also had the lowest scores for lesion borders and overall image quality. Image noise showed a weak to moderate positive correlation with participants’ body mass index and waist circumference. ConclusionsThe optimal-strength DLIR significantly improved overall image quality for evaluating focal hepatic lesions compared to the IR technique. DLIR-L achieved the best overall image quality while maintaining acceptable levels of image noise and quality of lesion borders.

Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study

BackgroundThe percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED).MethodsData were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT.ResultsThe study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases).ConclusionsThis study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.

18F]Flotaza for Aβ Plaque Diagnostic Imaging: Evaluation in Postmortem Human Alzheimer's Disease Brain Hippocampus and PET/CT Imaging in 5xFAD Transgenic Mice.

The diagnostic value of imaging Aβ plaques in Alzheimer's disease (AD) has accelerated the development of fluorine-18 labeled radiotracers with a longer half-life for easier translation to clinical use. We have developed [18F]flotaza, which shows high binding to Aβ plaques in postmortem human AD brain slices with low white matter binding. We report the binding of [18F]flotaza in postmortem AD hippocampus compared to cognitively normal (CN) brains and the evaluation of [18F]flotaza in transgenic 5xFAD mice expressing Aβ plaques. [18F]Flotaza binding was assessed in well-characterized human postmortem brain tissue sections consisting of HP CA1-subiculum (HP CA1-SUB) regions in AD (n = 28; 13 male and 15 female) and CN subjects (n = 32; 16 male and 16 female). Adjacent slices were immunostained with anti-Aβ and analyzed using QuPath. In vitro and in vivo [18F]flotaza PET/CT studies were carried out in 5xFAD mice. Post-mortem human brain slices from all AD subjects were positively IHC stained with anti-Aβ. High [18F]flotaza binding was measured in the HP CA1-SUB grey matter (GM) regions compared to white matter (WM) of AD subjects with GM/WM > 100 in some subjects. The majority of CN subjects had no decipherable binding. Male AD exhibited greater WM than AD females (AD WM♂/WM♀ > 5; p < 0.001) but no difference amongst CN WM. In vitro studies in 5xFAD mice brain slices exhibited high binding [18F]flotaza ratios (>50 versus cerebellum) in the cortex, HP, and thalamus. In vivo, PET [18F]flotaza exhibited binding to Aβ plaques in 5xFAD mice with SUVR~1.4. [18F]Flotaza is a new Aβ plaque PET imaging agent that exhibited high binding to Aβ plaques in postmortem human AD. Along with the promising results in 5xFAD mice, the translation of [18F]flotaza to human PET studies may be worthwhile.

Optimizing GPT-4 Turbo Diagnostic Accuracy in Neuroradiology through Prompt Engineering and Confidence Thresholds.

Integrating large language models (LLMs) such as GPT-4 Turbo into diagnostic imaging faces a significant challenge, with current misdiagnosis rates ranging from 30-50%. This study evaluates how prompt engineering and confidence thresholds can improve diagnostic accuracy in neuroradiology. We analyze 751 neuroradiology cases from the American Journal of Neuroradiology using GPT-4 Turbo with customized prompts to improve diagnostic precision. Initially, GPT-4 Turbo achieved a baseline diagnostic accuracy of 55.1%. By reformatting responses to list five diagnostic candidates and applying a 90% confidence threshold, the highest precision of the diagnosis increased to 72.9%, with the candidate list providing the correct diagnosis at 85.9%, reducing the misdiagnosis rate to 14.1%. However, this threshold reduced the number of cases that responded. Strategic prompt engineering and high confidence thresholds significantly reduce misdiagnoses and improve the precision of the LLM diagnostic in neuroradiology. More research is needed to optimize these approaches for broader clinical implementation, balancing accuracy and utility.

The Fatty Dilemma: A Rare Instance of Extra- and Intravascular Lipoma of the Brachiocephalic Vein

AbstractOftentimes, incidental findings are made on routine diagnostic imaging. An intra- and extravascular lipoma is one example of an important incidental finding. Intravascular lipomas are rare benign vascular tumors that are typically asymptomatic. They are most commonly found in the inferior vena cava but have also been recorded in the superior vena cava, brachiocephalic vein, subclavian vein, internal jugular vein, external jugular vein, and common femoral vein. Here, we presented the case of a 64-year-old female patient with an incidentally discovered intra- and extravascular lipoma affecting the right subclavian and brachiocephalic veins. While benign, intravascular lipoma on imaging can resemble a malignant tumor such as leiomyosarcoma or thrombus. As a result, appropriate identification and classification of this imaging finding is crucial for avoiding an exorbitant and futile workup.

Innovative Approaches to Clinical Diagnosis: Transfer Learning in Facial Image Classification for Celiac Disease Identification

Background: Celiac disease arises from gluten consumption and shares symptoms with other conditions, leading to delayed diagnoses. Untreated celiac disease heightens the risk of autoimmune disorders, neurological issues, and certain cancers like lymphoma while also impacting skin health due to intestinal disruptions. This study uses facial photos to distinguish individuals with celiac disease from those without. Surprisingly, there is a lack of research involving transfer learning for this purpose despite its benefits such as faster training, enhanced performance, and reduced overfitting. While numerous studies exist on endoscopic intestinal photo classification and a few have explored the link between facial morphology measurements and celiac disease, none have concentrated on diagnosing celiac disease through facial photo classification. Methods: This study sought to apply transfer learning techniques with VGG16 to address a gap in research by identifying distinct facial features that differentiate patients with celiac disease from healthy individuals. A dataset containing a total of 200 facial images of adult individuals with and without celiac condition was utilized. Half of the dataset had a ratio of 70% females to 30% males with celiac condition, and the rest had a ratio of 60% females to 40% males without celiac condition. Among those with celiac condition, 28 were newly diagnosed and 72 had been previously diagnosed, with 25 not adhering to a gluten-free diet and 47 partially adhering to such a diet. Results: Utilizing transfer learning, the model achieved a 73% accuracy in classifying the facial images of the patients during testing, with corresponding precision, recall, and F1 score values of 0.54, 0.56, and 0.52, respectively. The training process involved 50,178 parameters, showcasing the model’s efficacy in diagnostic image analysis. Conclusions: The model correctly classified approximately three-quarters of the test images. While this is a reasonable level of accuracy, it also suggests that there is room for improvement as the dataset contains images that are inherently difficult to classify even for humans. Increasing the proportion of newly diagnosed patients in the dataset and expanding the dataset size could notably improve the model’s efficacy. Despite being the first study in this field, further refinement holds promise for the development of a diagnostic tool for celiac disease using transfer learning in medical image analysis, addressing the lack of prior studies in this area.

Imaging and Metabolic Diagnostic Methods in the Stage Assessment of Rectal Cancer.

Rectal cancer (RC) is a prevalent malignancy with significant morbidity and mortality rates. The accurate staging of RC is crucial for optimal treatment planning and patient outcomes. This review aims to summarize the current literature on imaging and metabolic diagnostic methods used in the stage assessment of RC. Various imaging modalities play a pivotal role in the initial evaluation and staging of RC. These include magnetic resonance imaging (MRI), computed tomography (CT), and endorectal ultrasound (ERUS). MRI has emerged as the gold standard for local staging due to its superior soft tissue resolution and ability to assess tumor invasion depth, lymph node involvement, and the presence of extramural vascular invasion. CT imaging provides valuable information about distant metastases and helps determine the feasibility of surgical resection. ERUS aids in assessing tumor depth, perirectal lymph nodes, and sphincter involvement. Understanding the strengths and limitations of each diagnostic modality is essential for accurate staging and treatment decisions in RC. Furthermore, the integration of multiple imaging and metabolic methods, such as PET/CT or PET/MRI, can enhance diagnostic accuracy and provide valuable prognostic information. Thus, a literature review was conducted to investigate and assess the effectiveness and accuracy of diagnostic methods, both imaging and metabolic, in the stage assessment of RC.

68Ga]Ga-Schizokinen, a Potential Radiotracer for Selective Bacterial Infection Imaging.

Gallium-68-labeled siderophores as radiotracers have gained interest for the development of in situ infection-specific imaging diagnostics. Here, we report radiolabeling, in vitro screening, and in vivo pharmacokinetics (PK) of gallium-68-labeled schizokinen ([68Ga]Ga-SKN) as a new potential radiotracer for imaging bacterial infections. We radiolabeled SKN with ≥95% radiochemical purity. Our in vitro studies demonstrated its hydrophilic characteristics, neutral pH stability, and short-term stability in human serum and toward transchelation. In vitro uptake of [68Ga]Ga-SKN by Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and S. epidermidis, but no uptake by Candida glabrata, C. albicans, or Aspergillus fumigatus, demonstrated its specificity to bacterial species. Whole-body [68Ga]Ga-SKN positron emission tomography (PET) combined with computerized tomography (CT) in healthy mice showed rapid renal excretion with no or minimal organ uptake. The subsequent ex vivo biodistribution resembled this fast PK with rapid renal excretion with minimal blood retention and no major organ uptake and showed some dissociation of the tracer in the urine after 60 min postinjection. These findings warrant further evaluation of [68Ga]Ga-SKN as a bacteria-specific radiotracer for infection imaging.

Differences in the clinical management of shoulder pain by physician specialty: data from the 2007–2019 National Ambulatory Medical Care Survey

ObjectivesThe aim of this study was to identify the differences in the clinical management of shoulder pain by primary care physicians (PCPs) and non-primary care physicians (non-PCPs) from the National Ambulatory Medical Care Survey (NAMCS) dataset.MethodsThis cross-sectional study included ambulatory care visits for shoulder pain by using NAMCS data from 2007 to 2019. Descriptive statistics were presented to assess patient-level and visit-level characteristics of the sampled visits. By controlling for patient-level and visit-level covariates, we conducted a multivariable logistic regression to evaluate the influence of primary care physician status on the utilization of health services (pain medications, PT referral, health education/counseling, and diagnostic imaging) for shoulder pain.ResultsThere were 74.43 million ambulatory care visits by adults with shoulder pain during the study period, and nearly one-third of these shoulder visits were made to PCPs. As compared with non-PCPs, PCPs had higher adjusted odds of prescribing narcotic analgesics (adjusted odds ratio [OR] = 1.62, 95% confidence interval [CI]: 1.04–2.51), skeletal muscle relaxants (adjusted OR = 2.71, 95% CI: 1.65–4.45), other pain medications (adjusted OR = 1.87, 95% CI: 1.13–3.07), and lower odds of prescribing PT (adjusted OR = 0.34, 95% CI: 0.21–0.55) and MRI (adjusted OR = 0.46, 95% CI: 0.25–0.84).ConclusionWe observed significant differences in the services ordered or provided by PCPs versus non-PCPs for shoulder pain in ambulatory care settings. These results may reveal the higher reliance of pharmacological approaches, coupled with the potential under-utilization of PT during the ambulatory shoulder care provided by PCPs compared to non-PCPs in the United States.

The Importance of Fetal Echocardiography in the Early Detection and Management of Postnatal Cardiac Anomalies

Congenital heart anomalies are a significant cause of infant morbidity and mortality globally, requiring complex care from the prenatal period through adulthood. Fetal echocardiography stands out as an essential tool for the early diagnosis of these anomalies, allowing for planned therapeutic interventions and reducing the risk of severe complications after birth. The aim of this literature review is to compare neonatal outcomes between cases diagnosed in utero and those not diagnosed in utero, in order to provide solid evidence to improve clinical practices and enhance health outcomes for newborns affected by congenital heart anomalies. Additionally, it aims to promote health education in this region and in the medical field of diagnostic imaging. Studies show that prenatal diagnosis is associated with better neonatal outcomes, including lower morbidity and mortality and a reduction in the need for emergency surgeries. Despite advances in technology, the examination is still not accessible to everyone and is not routinely prescribed, resulting in the detection of heart anomalies only after birth, leading to serious complications. The literature review highlights the importance of multidisciplinary collaboration and the need for health education to improve access to early diagnosis in resource-limited areas. The review demonstrates that fetal echocardiography plays a crucial role in the early identification and effective management of congenital heart anomalies, significantly improving neonatal health outcomes.