Radiological Tools Research Articles

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.

Cutoff values of body fat composition to predict metabolic risk factors with normal waist circumference in Asian Indian population.

The aim of the study is to see if visceral fat volume (VFV), subcutaneous fat volume (SFV), and visceral-subcutaneous fat ratio (VSR) can be used to detect metabolically obese normal weight individuals in Asian Indian population. This is a single center prospective cross-sectional study and 80 cases having either hypertension, diabetes, or hyperlipidemia with normal waist circumference and 80 controls having normal metabolic parameters with normal waist circumference were evaluated. Visceral and subcutaneous fat volumes and visceral to subcutaneous fat ratios were determined by computed tomography (CT) at L4-L5 level with a slice thickness of 5 mm. Visceral fat volume, subcutaneous fat volume, and VSR are significantly higher in patients with metabolic risk factors as compared to those without risk factors. Volume of subcutaneous fat is significantly higher in females as compared to males. VSR is higher in males in our study. The cutoff values for VFV, SFV, and VSR to predict at least one metabolic syndrome are 8.5 cm3, 15.7 cm3, and 0.61 in males and 7.0 cm3, 16.5 cm3, and 0.44 in females. For individuals with normal waist circumference, VFV, SFV, and VSR can effectively predict the presence of one metabolic risk factor. • Visceral fat volume, subcutaneous fat volume, and visceral-subcutaneous fat ratio can predict individuals at risk of metabolic syndrome having normal waist circumference. • Higher VSR in Indian population is due to low reservoir of primary adipose tissue fat compartment which leads to diversion of adipocytes into the secondary adipose tissue fat compartment. • This data can be used as a screening tool in preventive radiology for identifying individuals at risk of developing metabolic syndrome.

The burden of T. solium cysticercosis and selected neuropsychiatric disorders in Mocuba district, Zambézia province, Mozambique.

Taenia solium (neuro-)cysticercosis, a neglected tropical disease, can be associated with epileptic seizures and other neuropsychiatric (= neurological and psychiatric) disorders. This study aimed to evaluate the association of T. solium cysticercosis with selected neuropsychiatric disorders and/or symptoms (chronic headache, epileptic seizures/epilepsy and psychosis) in Mocuba district, Mozambique. Between March and May 2018, a cross-sectional study was conducted among 1,086 participants aged 2 years or above in Mocuba district, Zambézia province, central Mozambique, to assess the seroprevalence of human cysticercosis and risk factors for infection, as well as to explore its relation to selected neuropsychiatric disorders. Socio-demographic and clinical data were collected from each participant using a modified questionnaire designed by the Cysticercosis Working Group for Eastern and Southern Africa. Additionally, neuropsychiatric disorders, such as chronic headache, epileptic seizures/epilepsy and psychosis were assessed using four vignettes. T. solium antigen and cysticercosis IgG in serum were detected using both T. solium antigen B158/B60 enzyme linked immunosorbent assay (ELISA) and LDBIO Cysticercosis Western Blot, respectively. Overall, 112/1,086 participants (10.3%) were sero-positive for T. solium antigen or antibodies. Prevalence of antibodies (6.6%; n = 72) was higher than of antigens (4.9%; n = 54). In the questionnaires, 530 (49.5%) of participants reported chronic headache, 293 (27%) had generalized epileptic seizures, 188 (18%) focal seizures and 183 (18.3%) psychosis. We found a statistically significant association between seropositivity for T. solium and chronic headache (p = 0.013). Additionally, increasing age (p = 0.03) was associated with Ag-ELISA seropositivity. Our study revealed that in Mocuba, T. solium cysticercosis is prevalent and associated with self-reported chronic headache. Additionally, in the study setting, the seroprevalence of cysticercosis increased with age. However, it is not associated with other neuropsychiatric disorders such epileptic seizures/epilepsy and psychosis. Future studies are needed to confirm the high burden of neuropsychiatric disorders and their possible etiology, including neurocysticercosis, using additional serological, molecular biological and radiological diagnostic tools, as well as in-depth clinical examinations.

P885: PROSPECTIVE ASSESSMENT OF MYELOMA TUMOUR BURDEN AND BONE DISEASE USING DW-MRI AND EXPLORATORY BONE BIOMARKERS

Background: Key clinical priorities for multiple myeloma (MM) are to reduce tumour burden and complications, of which lytic bone disease is the major cause of morbidity. To guide treatment, there is a pressing need for biomarkers that can accurately quantify MM tumour burden and associated bone disease. To this end, Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) and bone turnover markers are promising radiological and serum metrics, respectively, although their clinical value in prospective assessment is unclear. Aims: LOOMIS was a single-centre observational cohort study that evaluated the relative merits of DW-MRI and bone turnover markers in prospectively assessing tumour burden and bone disease when added to standard clinical assessment, in patients with MM and monoclonal gammopathy of undetermined significance (MGUS). Methods: A total of 67 patients were enrolled (14 newly diagnosed MM, 12 relapsed MM, 15 smouldering MM, 14 MGUS and 12 healthy volunteers) between March 2018 and March 2020. At baseline (and 6-month follow-up for MM/MGUS), participants had a DW-MRI scan and serum measurements of established (P1NP, CTX-1, ALP) and exploratory (DKK1, sclerostin, RANKL:OPG ratio) bone turnover markers. MM/MGUS patients additionally had standard myeloma bloods and Dual-Energy X-ray Absorptiometry (DXA) at each visit, as correlates of tumour burden and bone loss. DW-MRI scans were double reported by expert Radiologists for Apparent Diffusion Coefficient (ADC) measurements of lytic bone lesion(s), and Myeloma Response Assessment and Diagnosis System (MY-RADS) Response Assessment Category (RAC) scoring. Patients were classified by International Myeloma Working Group (IMWG) response criteria as a clinical correlate of therapy response. Results: On assessment of baseline tumour burden, there was no correlation between single lesion DW-MRI ADC and serum paraprotein [p>0.05]; however, there was moderate positive correlation between serum DKK1 and serum paraprotein [r=0.39, p=0.04]. At follow-up, radiological MY-RADS RAC scoring correlated with conventional IMWG response criteria [p=0.015]; additionally, longitudinal relative change in serum DKK1 differed between IMWG-defined therapy responders (37% decrease) and non-responders (15% increase) [p<0.01]. On baseline assessment of bone loss, there was moderate positive correlation between serum sclerostin and DXA bone mineral density at femoral neck [r=0.40, p<0.01] and lumbar spine [r=0.54, p<0.001]. At follow-up, there was a moderate negative correlation between longitudinal % change in the RANKL:OPG ratio and % change in DXA bone mineral density at femoral neck [r= -0.45, p<0.01]. Summary/Conclusion: Our prospective trial validates DW-MRI-based MY-RADS RAC scoring as a qualitative radiological tool to assess therapy response. Whilst previous work has supported single lytic lesion ADC measurements as a correlate of tumour volume, we did not find this; small sample size and prior chemotherapy in our study may have limited our ability to detect this. In comparison, serum bone turnover markers such as DKK1 may provide a more global measure to quantify myeloma burden both at baseline diagnosis and longitudinally with therapy. Additionally, our data highlight serum sclerostin and RANKL:OPG ratio as potential biomarkers to assess and monitor bone loss. Overall, our study highlights emerging radiological and serum biomarkers of tumour burden and associated bone loss in MM and MGUS, which merit further exploration alongside uniformly treated cohorts, to better understand their clinical utility.

Association between Mesenchymal Stem Cells and COVID-19 Therapy: Systematic Review and Current Trends.

Background The novel coronavirus first emerged in Wuhan, China, and quickly spread across the globe, spanning various countries and resulting in a worldwide pandemic by the end of December 2019. Given the current advances in treatments available for COVID-19, mesenchymal stem cell (MSC) therapy seems to be a prospective option for management of ARDS observed in COVID-19 patients. This present study is aimed at exploring the therapeutic potential and safety of using MSC obtained by isolation from health cord tissues in the treatment of patients with COVID-19. Methods A systematic search was done based on the guidelines of the PRISMA 2020 statement. A literature search was executed using controlled vocabulary and indexing of trials to evaluate all the relevant studies involving the use of medical subject headings (MeSH) in electronic databases like PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov up to 31 December 2021. The protocol was registered in the PROSPERO register with ID CRD42022301666. Findings. After screening finally, 22 remaining articles were included in this systematic review. The studies revealed that MSC exosomes are found to be superior to MSC alone in terms of safety owing to being smaller with a lesser immunological response which leads to free movement in blood capillaries without clumping and also cannot further divide, thus reducing the oncogenic potential of MSC-derived exosomes as compared to MSC only. The studies demonstrated that the lungs healed with the use of exosomes compared to how they presented initially at the hospital. MSCs are found to increase the angiogenesis process and alveolar reepithelization, reducing markers like TNF alpha, TGF beta, and COL I and III, reducing the growth of myofibroblasts and increasing survivability of endothelium leading to attenuated pulmonary fibrosis and even reversing them. Interpretation. We can conclude that the use of mesenchymal stem cells or their derived exosomes is safe and well-tolerated in patients with COVID-19. It improves different parameters of oxygenation and helps in the healing of the lungs. The viral load along with different inflammatory cells and biomarkers of inflammation tend to decrease. Chest X-ray, CT scan, and different radiological tools are used to show improvement and reduced ongoing destructive processes.

CVD-HNet: Classifying Pneumonia and COVID-19 in Chest X-ray Images Using Deep Network.

The use of computer-assisted analysis to improve image interpretation has been a long-standing challenge in the medical imaging industry. In terms of image comprehension, Continuous advances in AI (Artificial Intelligence), predominantly in DL (Deep Learning) techniques, are supporting in the classification, Detection, and quantification of anomalies in medical images. DL techniques are the most rapidly evolving branch of AI, and it’s recently been successfully pragmatic in a variety of fields, including medicine. This paper provides a classification method for COVID 19 infected X-ray images based on new novel deep CNN model. For COVID19 specified pneumonia analysis, two new customized CNN architectures, CVD-HNet1 (COVID-HybridNetwork1) and CVD-HNet2 (COVID-HybridNetwork2), have been designed. The suggested method utilizes operations based on boundaries and regions, as well as convolution processes, in a systematic manner. In comparison to existing CNNs, the suggested classification method achieves excellent Accuracy 98 percent, F Score 0.99 and MCC 0.97. These results indicate impressive classification accuracy on a limited dataset, with more training examples, much better results can be achieved. Overall, our CVD-HNet model could be a useful tool for radiologists in diagnosing and detecting COVID 19 instances early.

Development and application of an electronic synoptic report for reporting and management of low-dose computed tomography lung cancer screening examination

BackgroundInterpretation of Low Dose CT scans and protocol driven management of findings is a key aspect of lung cancer screening program performance. Reliable and reproducible methods are needed to communicate radiologists’ interpretation to the screening program or clinicians driving management decision.MethodsWe performed an audit of a subset of dictated reports from the PANCAN study to assess for omissions. We developed an electronic synoptic reporting tool for radiologists embedded in a clinical documentation system software. The tool was then used for reporting as part of the Alberta Lung Cancer Screening Study and McGill University Health Centre Pilot Lung Cancer Screening Program.ResultsFifty reports were audited for completeness. At least one omission was noted in 30 (70%) of reports, with a major omission (missing lobe, size, type of nodule in report or actionable incidental finding in recommendation section of report) in 24 (48%). Details of the reporting template and functionality such as automated nodule cancer risk assessment, Lung-RADS category assignment, auto-generated narrative type report as well as personalize participant results letter is provided. A description of the system’s performance in its application in 2815 CT reports is then summarized.ConclusionsWe found that narrative type radiologist reports for lung cancer screening CT examinations frequently lacked specific discrete data elements required for management. We demonstrate the successful implementation of a radiology synoptic reporting system for use in lung cancer screening, and the use of this information to drive program management and communications.

Assessment of Coronary Arteries Calcification in Diabetic Patients by using CT Calcium Score Technique

This study designed to define the role of computed tomography coronary angiography (CTA) in the diagnosis of patients with chest pain and suspected to have coronary artery disease (CAD) by measuring the calcium scoring in the coronary arteries (CAC) in patient with known diabetes and correlate the results with the (CTA) findings and other related variables. A descriptive analytical study for 84 patient with 36 diabetes and 48 patient with diabetes and hypertension examined using multi-detector computed tomography scanner MDCT64-Slice scanner (0.625 mm slices): 64 slice 0.625 mm collimation, table feed 10 mm/rotation, effective tube current 685 mAs at 120 kV. Pitch = 10/40 mm, collimation = 0.25 Average scan time = 5s, to scan the patient with coronary problems, detector array, fan beam shape, CT monitor for controlling scanning and processing. Cardiac trigger monitor with electrode leads (3000 TOSHEIBA) to monitor the heart rate, contrast injector (Medrao Toshiba-2ways) for flush contrast media to patient and VITREA SYSTYM (TOSHIBA) for diagnosis images and reconstruction and volume rendered purposes.(CAC) offers identifying the patients intended to have cardiac events, diagnosis of coronary arteries lesions and characterizing the plaque pattern .It is believable that measurements of calcium score will provide an acknowledged analytical radiological tool for the diagnoses of (CAD).

Determining the efficacy of functional liver imaging score (FLIS) obtained from gadoxetic acid-enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Albumin-Bilirubin (ALBI) grade and FLIS.

(1) To evaluate the efficacy of functional liver imaging score (FLIS) in predicting liver function on gadoxetic acid-enhanced MRI in patients with chronic liver disease (CLD) or liver cirrhosis (LC) and its relationship with ALBI grade. (2) To assess the intra-reader reliability and interreader agreement of readers with different levels of experience in abdominal imaging of FLIS. We retrospectively included 131 patients (70 men, 61 women; mean ± SD, 53.7 ± 14.6years) with CLD and LC who underwent GA-enhanced MRI between November 2019 and March 2022. FLIS was assigned as a result of the sum of three hepatobiliary phase (HBP) images features, each scored 0-2: liver parenchymal enhancement, biliary contrast excretion, and portal vein sign. FLIS was calculated using HPB images independently by three radiologists with different experience. In addition, 50 randomly selected patients were reviewed a second time by a reader to assess intra-reader reliability. Patients were divided into the following three groups according to the albumin-bilirubin (ALBI) grade: ALBI grade 1, 2, and 3. We evaluated the correlation between ALBI grade and both FLIS and its parameters using Spearman's rank correlation for each reader. Receiver operating characteristic (ROC) curve analysis was performed to show the optimal cut-off value of FLIS to distinguish between ALBI grades. Intra-reader reliability and inter-reader agreement were evaluated by intraclass correlation coefficient (ICC). FLIS and three FLIS parameters showed very strong correlation with ALBI grade for each readers (r = - 0.843 to 0.976, -0.831 to 0.962, and -0.819 to 0.902, respectively). ROC curve analysis showed that FLIS ≥ 5 was the optimal cutoff for prediction of ALBI grade 1 for each readers (sensitivity, 83.7% to 95.4%; specificity, 82.6% to 87%; accuracy, 88.6% to 93.6% and area under the curve (AUC), 0.882 to 0.917), and FLIS ≤ 3 was the optimal cutoff for distinguish ALBI grade 3 from other grades for each readers (sensitivity, 100%; specificity, 95.2% to 96%; accuracy, 95.4% to 96.2% and AUC, 0.974 to 0.994). Intra-reader reliability (ICC = 0.95; 95% CI 0.93-0.96) and inter-reader agreement (ICC = 0.85 to 0.90; 95% CI 0.82-0.97) for FLIS were excellent. FLIS showed a very correlation with hepatic function level and can stratify the ALBI grades. This feature has demonstrated the potential of FLIS to be excellent radiological tools for predicting of liver function of CLD and LC patients in clinical practice. Also, the excellent agreement of FLIS among readers with different levels of experience indicates that it can be used with high accuracy and reproducibility regardless of experience.

Abstract No. 587 Morbidity and mortality conferencing as a quality assessment tool in interventional radiology: a survey of Society of Interventional Radiology members

Investigate the degree to which morbidity and mortality (M&M) conferencing is utilized in interventional radiology (IR), identify impediments to its adoption, and assess the experience of those using this tool.

Development of an Online Distance Learning Platform Combining Anatomy, Imaging, and Surgical Practice to Support Mastery Learning of the Equine Locomotor Apparatus.

There are many challenges in teaching veterinary anatomy, such as available classroom time, costs, and difficulties accessing animal cadavers, mainly due to animal welfare concerns. Furthermore, veterinary surgeons and radiologists complain that recent graduates lack anatomical knowledge. On the other hand, the current limitations of face-to-face teaching due to the COVID-19 pandemic suggest that the development of online distance education tools is necessary, mainly in specialties that lack this type of material. Teaching platforms promoting the integration of anatomy with other applied disciplines such as imaging and surgery in the horse were not found in the consulted literature. Therefore, this work aimed to develop an online distance education platform for studying the surgical anatomy of a horse's locomotor apparatus as a complementary tool for training students enrolled in undergraduate courses in veterinary surgery. The locomotor apparatus was chosen as the focus as it is the most commonly found in equine surgeries. Anatomical pieces referring to the locomotor apparatus were prepared. These were complemented with material related to diagnostic imaging, surgery videos, theoretical explanations, and an interactive radiological anatomy tool. Finally, all the material was uploaded to a virtual platform accessible via the Internet. The platform is expected to be a tool that helps students in surgical training and prepares them with a better understanding of anatomy and its application in surgery.

Recurrent of mesenteric cyst in young boy : a case report

Mesenteric cyst is a rare, intra-abdominal lesion that is often overlooked. Its clinical symptoms might be variable, depending on the size of the cyst and the age of the patient. Radiological examination tools, from plain x-ray to CT scan and MRI, are essential to establish its diagnosis and to plan further treatment. We reported a case of 16 years old boy who came to our hospital with complaint of enlarged stomach who was diagnosed with mesenteric cyst

Demystifying the CT Radiation Dose Sheet.

The radiation dose sheet generated by the CT scanner is a form that displays important information about an examination. It functions as a road map for the examination, detailing what CT examinations were performed and what parameters were used to perform them. One essential element of the radiation dose sheet, the volume CT dose index (CTDIvol), is a commonly used radiation dose index that is displayed on most CT scanners. The CTDIvol is used for quality control and is helpful for comparing the radiation output among different protocols and different scanners. The dose-length product (DLP) is a radiation dose index that builds on the CTDIvol by incorporation of the scan length. The DLP is combined with a conversion coefficient and used to determine the effective dose from the CT examination. Determining the effective dose is a way to estimate the whole-body radiation dose, even if the CT examination is confined to a smaller part of the body. In addition to these values, other data about the study from the CT scanner manufacturer, including the tube voltage and tube current-time product, usually are displayed on CT scanners. These values are major determinants of the image quality and radiation dose. The radiation dose sheet is a useful tool for radiologists, technologists, and physicists, allowing them to comprehend the technical details of a CT examination. The authors describe the components of the radiation dose sheet, the relationships of these components with one another, and the contributions of these components to the radiation dose. ©RSNA, 2022.

MRI and Its Implications in Dentistry

Magnetic Resonance imaging (MRI) has become one of the most powerful diagnostic tools in radiology and diagnostic sciences. It is non-invasive and non-ionizing and the images are highly sensitive and specific with excellent soft tissue contrast. It gives excellent images of anatomic structures differing in proton density and other tissue characteristics. It can be used to assess intracranial and extracranial lesions particularly those involving the soft tissues.&#x0D; MRI has the shortcoming of being prone to magnetic susceptibility difference artefacts, caused by the presence of metallic materials such as dental restorative materials, implants and orthodontic appliances. All substances when placed in a magnetic field are magnetized to a degree which varies according to their magnetic susceptibility. Non precious dental alloys have the potential of causing image deformation or image voids. &#x0D; Dentists are not the only professionals implanting metal devices. Heart pacemakers and defibrillators, aneurysm clips, cochlear implants, insulin pumps, vascular stents and artificial joints are widely used in various branches of medicine. In some cases, it is not possible to carry out MRI due to extensive dental hardware with a high ferromagnetic content. Severe image distortion or an inability to perform the MRI scan due to dental restorations is a rare problem, but cannot be completely eliminated. This article has been written to educate the dentists on the implications of metallic dental restorations on MRI scans.&#x0D; Keywords: Magnetic resonance imaging, MRI, Dentistry, Dental materials, artefact, artifacts.

Dual energy CT applications in oncological imaging

Cancer is the second leading cause of death in the United States, killing more than 600.000 people each year.1 Despite several screening programs available, cancer diagnosis is often made incidentally during imaging studies performed for other reasons. Once the diagnosis is made, treatment assessment and surveillance of these patients heavily rely on radiological tools. Computed tomography (CT) in particular is one of the most commonly ordered modalities due to wide availability even in the most remote locations, and fast results. However, conventional CT often cannot definitively characterize a neoplastic lesion unless it was tailored toward answering a specific question. Furthermore, characterizing small lesions can be difficult with CT. An innovative technique called dual-energy CT (DECT) offers solutions to some of the challenges of conventional CT in oncological imaging.

Optimization of CT protocol in polytrauma patients: an update.

Radiologists play a key role in the management of trauma patients. With the improvement of computed tomography (CT), radiologist makes an important contribution to the timely diagnosis of trauma-related findings and the choice of the most suitable treatment, improving patient outcomes. It is important to select the most appropriate imaging technique, which in the trauma patient is CT, and especially the most appropriate CT protocol, to correctly characterize trauma injuries. Currently, there is no agreement on what the optimal protocol is, acquisition times and number of contrast enhanced phases are not standardized. This is a review of the most recent literature on optimizing the CT protocol in polytrauma, with the intent of giving a useful tool for radiologists in the management of trauma patients.

Non-Invasive Diagnosis of Pediatric Intestinal Graft-Versus-Host Disease: A Case Series

Intestinal graft-versus-host disease (I-GvHD) represents a life-threatening complication in allogeneic stem cell transplantation (SCT). Unfortunately, non-invasive validated diagnostic tools to diagnose I-GvHD, evaluate treatment response, and guide the duration of immunosuppression are still lacking. We employed standard ultrasound and power Doppler to diagnose and follow up on pediatric intestinal GvHD. We herein report on three patients, prospectively evaluated among 24 pediatric patients referred to our center for allogeneic SCT. These three patients presented abdominal pain and diarrhea within the first 200 days after transplantation. In the reported cases, we performed small- and large-intestine ultrasound (US) at clinical onset of lower-intestinal symptoms and, when intestinal GvHD was confirmed, at GvHD flares, if any, and at follow-up. US constantly (3/3 patients) revealed increased bowel wall thickening (BWT) with different bowel segments’ involvement from patient to patient. Further, a moderate or strong increased Doppler signaling was seen in 2 out of 3 patients, according to clinical GVHD staging (e.g., the more the increase, the more the staging). Standard sonography corroborated GvHD diagnosis in all patients considered and was able to detect GvHD progression or complete normalization of findings, thus simplifying ensuing clinical decisions. Our report highlights the need to design clinical trials for the validation of non-invasive radiologic tools for diagnosis and follow-up of GvHD, especially in pediatric patients.

Physicians\u2019 preferences and willingness to pay for artificial intelligence-based assistance tools: a discrete choice experiment among german radiologists

BackgroundArtificial Intelligence (AI)-based assistance tools have the potential to improve the quality of healthcare when adopted by providers. This work attempts to elicit preferences and willingness to pay for these tools among German radiologists. The goal was to generate insights for tool providers and policymakers regarding the development and funding of ideally designed and priced tools. Ultimately, healthcare systems can only benefit from quality enhancing AI when provider adoption is considered.MethodsSince there is no established market for AI-based assistance tools in radiology yet, a discrete choice experiment was conducted. Respondents from the two major German professional radiology associations chose between hypothetical tools composed of five attributes and a no-choice option. The attributes included: provider, application, quality impact, time savings and price. A conditional logit model was estimated identifying preferences for attribute levels, the no-choice option, and significant subject-related interaction effects.Results114 respondents were included for analysis of which 46% were already using an AI-based assistance tool. Average adoption probability for an AI-based tool was 81% (95% CI 77.1% − 84.4%). Radiologists preferred a tool that assists in routine diagnostics performing at above-radiologist-level quality and saves 50% in diagnostics time at a price-point of €3 per study. The provider is not a significant factor in the decisions. Time savings were considered more important than quality improvements (i.e., detecting more anomalies).ConclusionsRadiologists are overall willing to invest in AI-based assistance tools. Development, funding, and research regarding these tools should, however, consider providers’ preferences for features of immediate everyday and economic relevance like time savings to optimize adoption.

Minimally Invasive Endoscopic and Surgical Management of Rectal Neoplasia.

Simple SummaryRectal cancer accounts for one-third of colorectal cancer cases annually. It is preventable with early screening and appropriate management of precancerous lesions. Advancements in diagnostic and therapeutic strategies are ongoing and have contributed to improving patient outcomes. In this review, we summarize the available minimally invasive endoscopic and surgical management options of rectal neoplasia. Rectal cancer demonstrates a characteristic natural history in which benign rectal neoplasia precedes malignancy. The worldwide burden of rectal cancer is significant, with rectal cancer accounting for one-third of colorectal cancer cases annually. The importance of early detection and successful management is essential in decreasing its clinical burden. Minimally invasive treatment of rectal neoplasia has evolved over the past several decades, which has led to reduced local recurrence rates and improved survival outcomes. The approach to diagnosis, staging, and selection of appropriate treatment modalities is a multidisciplinary effort combining interventional endoscopy, surgery, and radiology tools. This review examines the currently available minimally invasive endoscopic and surgical management options of rectal neoplasia.