Radiology Training Research Articles

Arthroscopic Inlay Suprapectoral versus Mini-Open Onlay Subpectoral Biceps Tenodesis: A Prospective, Randomized Analysis of Clinical Outcomes and Ultrasound-Assessed Structural Integrity.

Surgical techniques for biceps tenodesis vary in approach, fixation strategy, and anatomic location without clear superior technique for this common procedure. The purpose of this study was to prospectively evaluate a randomized cohort of patients undergoing arthroscopic suprapectoral (ASBT) with interference screw fixation using an inlay technique versus mini-open subpectoral (MOBT) with a unicortical button implant using an onlay technique with regards to 1) clinical outcome measures and 2) structural healing as evaluated by ultrasound. From May 2017 to April 2021, patients undergoing biceps tenodesis were preoperatively randomized to either ASBT or MOBT. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analogue Scale (VAS) scores were recorded at baseline, three months, and two years postoperatively. The integrity of the biceps tendon at the tenodesis site was independently examined via ultrasound by a musculoskeletal trained radiologist at three months and two years postoperatively. T-tests were performed for continuous variables, while Chi squared tests were performed for categorical variables. A total of 52 patients (24 ASBT, 28 MOBT) were randomized and completed follow-up. At baseline, three months, and two years postoperatively, the mean ASES, SANE and VAS scores were not statistically different between ASBT and MOBT. At the three-month postoperative ultrasound, 23/24 (96%) of the ASBT patients and 26/28 (93%) of the MOBT patients were noted to have a clearly intact biceps tenodesis. At two years, all biceps tenodesis regardless of group were noted to be intact and healed, including all three shoulders whose ultrasound noted a questionably intact repair without significant retraction of the tendon at prior three-month ultrasound evaluation. This study demonstrates similar clinical outcomes at two year follow-up between ASBT and MOBT. Both groups demonstrated improvement that exceeded the reported patient acceptable symptom state (PASS) and minimal clinically important difference (MCID). Ultrasound showed excellent structural healing rates for both inlay and onlay biceps tenodesis techniques. Level II; Randomized Controlled Trial; Treatment Study.

Results of a Global Survey on the State of Interventional Radiology 2024.

To understand the state of IR practice and education worldwide and identify factors impacting access to IR services. A Society of Interventional Radiology (SIR) approved anonymous survey was created to gather demographics, regional IR practice and education characteristics, and challenges impacting local IR development. The survey was distributed to members of global IR societies and shared on social media from 6/2022 to 9/2023. Of 1263 respondents, 987 provided specialty affiliations, including 811 interventional radiologists (IRs), 85 diagnostic radiologists (DRs), and 91 IR/DRs. 260 identified as attending/consultants, 185 residents/fellows, 12 medical students, and 7 technologists/nurses. IR awareness was the greatest reported need globally. Education, patient referrals, and training were also common needs. When compared to North American training programs, there were significant shortages of dedicated IR training programs in Africa (OR=0.06, p<0.001), Asia (OR=0.50, p=0.004), Europe (OR=0.12, p<0.001), and Oceania (OR=0.12, p<0.001). Significant shortage of any IR exposure during radiology training was observed in Africa (OR=0.31, p<0.001), Asia (OR=0.16, p<0.001), and South America (OR=0.14, p<0.001). Additional challenges included awareness and support in the hospital setting and competition with other specialties. Compared to respondents from North America, the top three actions recommended to provide the most significant relative impact included establishing IR training programs, providing access to online education, and holding multidisciplinary conferences. This survey established the universal needs to increase patient awareness about IR and improve dedicated IR training programs. The results can help guide organizational and societal efforts to improve access to IR services worldwide.

Top 10 Most-feared Diagnostic Errors for Radiology Trainees in Pediatric Neuroradiology Emergencies.

Top 10 Most-feared Diagnostic Errors for Radiology Trainees in Pediatric Neuroradiology Emergencies.

Magnetic Resonance Imaging Liver Segmentation Protocol Enables More Consistent and Robust Annotations, Paving the Way for Advanced Computer-Assisted Analysis

Background/Objectives: Recent advancements in artificial intelligence (AI) have spurred interest in developing computer-assisted analysis for imaging examinations. However, the lack of high-quality datasets remains a significant bottleneck. Labeling instructions are critical for improving dataset quality but are often lacking. This study aimed to establish a liver MRI segmentation protocol and assess its impact on annotation quality and inter-reader agreement. Methods: This retrospective study included 20 patients with chronic liver disease. Manual liver segmentations were performed by a radiologist in training and a radiology technician on T2-weighted imaging (wi) and T1wi at the portal venous phase. Based on the inter-reader discrepancies identified after the first segmentation round, a segmentation protocol was established, guiding the second round of segmentation, resulting in a total of 160 segmentations. The Dice Similarity Coefficient (DSC) assessed inter-reader agreement pre- and post-protocol, with a Wilcoxon signed-rank test for per-volume analysis and an Aligned-Rank Transform (ART) for repeated measures analyses of variance (ANOVA) for per-slice analysis. Slice selection at extreme cranial or caudal liver positions was evaluated using the McNemar test. Results: The per-volume DSC significantly increased after protocol implementation for both T2wi (p &lt; 0.001) and T1wi (p = 0.03). Per-slice DSC also improved significantly for both T2wi and T1wi (p &lt; 0.001). The protocol reduced the number of liver segmentations with a non-annotated slice on T1wi (p = 0.04), but the change was not significant on T2wi (p = 0.16). Conclusions: Establishing a liver MRI segmentation protocol improves annotation robustness and reproducibility, paving the way for advanced computer-assisted analysis. Moreover, segmentation protocols could be extended to other organs and lesions and incorporated into guidelines, thereby expanding the potential applications of AI in daily clinical practice.

RADHawk-an AI-based knowledge recommender to support precision education, improve reporting productivity, and reduce cognitive load.

Using artificial intelligence (AI) to augment knowledge is key to establishing precision education in modern radiology training. Our department has developed a novel AI-derived knowledge recommender, the first reported precision education program in radiology, RADHawk (RH), that augments the training of radiology residents and fellows by pushing personalized and relevant educational content in real-time and in context with the case being interpreted. To assess the impact on trainees of an AI-based knowledge recommender compared to traditional knowledge sourcing for radiology reporting through reporting time, quality, cognitive load, and learning experiences. A mixed methods prospective study allocated trainees to intervention and control groups, working with and without access to RH, respectively. Validated questionnaires and observed and graded simulated picture archiving and communication system (PACS)-based reporting at the start and end of a month's rotation assessed technology acceptance, case report quality, case report time and sourcing time, cognitive load, and attitudes toward modified learning strategies. Non-parametric regression analyses and Mann-Whitney tests were used to compare outcomes between groups, with significance set at P<0.05. The intervention group (n=28) demonstrated astatistically significant reduction in the case report time by -162s per case (95%CI -275.76s to -52.40s) (P-value = 0.002) and an increase of 14% (95%CI 8.1-19.8%) (P-value <0.001) in accuracy scores compared to the control group (n=29) at the end of the rotation. The intervention group also showed lower levels of mental demand (P=0.030) and experienced less effort (P=0.030) and frustration (P=0.030) while reporting. Additionally, >78% of the intervention group gave positive ratings on RH's effectiveness, increase in productivity, job usefulness, and ease of use. Eighty-nine percent of participants in the intervention group requested access to RH for their next rotation. This study demonstrates that RH, as the first reported AI-derived knowledge recommender for radiology education, significantly reduces reporting time and improves reporting accuracy while reducing overall workload and mental demand for radiology trainees. The high acceptance among trainees suggests its potential for supporting self-directed learning. Further testing of a larger external cohort will support more widespread implementation of RH for precision education.

Female Representation in Integrated Interventional Radiology Residency: Trends, Underrepresentation, and Modest Growth Over 5 Years.

Women remain a minority of trainees in interventional radiology (IR) since the residency's inception in 2014. Similar phenomena have been observed in other surgical specialties. Our study aims to quantify changes in female trainee representation in integrated IR over a 5-year period from the 2018-2019 to 2022-2023 academic years and to compare with trends in other specialties. We conducted a retrospective review of survey data collected from the National Graduate Medical Education database. The eight selected specialties, including IR, were chosen due to qualitative similarities with IR training or due to less than 30% female trainee representation in 2018-2019. In these data, gender was categorized as male or female. Percentage of female trainees in each specialty was collected in the study period. Analysis was conducted using analysis of variance, linear regression, and Tukey honest significant difference (P < .05). In the 5-year study period, female representation in integrated IR residency grew by 16.6% at a mean relative growth rate of 4.0% annually. By 2022-2023, integrated vascular surgery residency had the highest female trainee representation (38.4%), whereas integrated IR had the second lowest (22.4%), ahead of orthopedic surgery (20.4%). Despite observed growth, female trainee representation in integrated IR lags behind other procedural and radiology specialties. Our analysis emphasizes the need for continued recruitment of female applicants to bolster gender parity. Supporting known ongoing initiatives like female mentorship programs and developing new strategies to support female interest in IR should be a priority for the field.

Healthcare students’ knowledge and awareness on ionizing radiation and radiation protection

Nurses and healthcare workers are potentially at risk of exposure to ionizing radiation. Awareness of the use and protection of radiation in everyday clinical practice is important for relevant professional groups. In this study, a descriptive cross-sectional study was conducted to determine the level of knowledge of nursing and healthcare students regarding the use of ionizing radiation and protection. The survey questions were asked to 786 students studying at Dicle University between March and April 2024. Chi-square, ANOVA and post-hoc tests were used to evaluate the relationship between students' knowledge level and other parameters. The results of the statistical analysis showed a significant difference for department, grade point average, radiation training, and risk awareness. The correct answer rate for all participants and radiation trainees was found to be 38.6% and 51.6%, respectively. Only 9% of students have good knowledge; it was found that 52% were moderate and 39% were poor. Among all radiological examinations, the proportion of those who thought that magnetic resonance imaging (MRI) and ultrasound imaging contained ionizing radiation was determined as 80.3% and 66%, respectively. The results showed that the students had insufficient knowledge of radiology and radiation protection. Formal training in basic radiology and radiation is recommended in nursing and healthcare programs so that they can work safely in clinics.

Knowledge and Preparedness Regarding Chemical, Biological, Radiological and Nuclear (CBRN) Warfare among Doctors and Medical Students at Combined Military Hospital (CMH) Lahore Medical College

Chemical, biological, radiological and nuclear-related disasters have become increasingly common all around the world. Objectives: To assess the knowledge and preparedness regarding chemical, biological, radiological and nuclear Warfare among Doctors and Medical students at Combined Military Hospital Lahore Medical College. Methods: In this descriptive cross-sectional study, 311 respondents participated from November 2022 to May 2023. Non-probability convenience sampling technique was used. Data were analyzed on SPSS version 26.0. Results: The study revealed a significant knowledge gap regarding chemical, biological, radiological and nuclear warfare. Almost 290 participants had never encountered the term 'chemical, biological, radiological and nuclear' signifying a substantial lack of awareness. Furthermore, a slightly higher knowledge gap was observed among female participants, although this difference did not reach statistical significance (p-value=0.07). Additionally, students in their 3rd, 4th, and final years of medical college demonstrated a more comprehensive understanding of chemical, biological, radiological and nuclear compared to those in their initial years of study (p-value=0.008). Conclusions: It was concluded that there is a significant knowledge gap about chemical, biological, radiological and nuclear Warfare and its management among medical professionals. A very low percentage of professionals were properly trained in chemical, biological, radiological and nuclear emergency management. Respondents stressed the inclusion of chemical, biological, radiological and nuclear emergency management training in the curriculum. These findings suggest that proper provision of knowledge, and training related to these disasters is inevitable for timely management and future risk reduction from such events.

External validation and performance analysis of a deep learning-based model for the detection of intracranial hemorrhage.

We aimed to investigate the external validation and performance of an FDA-approved deep learning model in labeling intracranial hemorrhage (ICH) cases on a real-world heterogeneous clinical dataset. Furthermore, we delved deeper into evaluating how patients' risk factors influenced the model's performance and gathered feedback on satisfaction from radiologists of varying ranks. This prospective IRB approved study included 5600 non-contrast CT scans of the head in various clinical settings, that is, emergency, inpatient, and outpatient units. The patients' risk factors were collected and tested for impacting the performance of DL model utilizing univariate and multivariate regression analyses. The performance of DL model was contrasted to the radiologists' interpretation to determine the presence or absence of ICH with subsequent classification into subcategories of ICH. Key metrics, including accuracy, sensitivity, specificity, positive predictive value, and negative predictive value, were calculated. Receiver operating characteristics curve, along with the area under the curve, were determined. Additionally, a questionnaire was conducted with radiologists of varying ranks to assess their experience with the model. The model exhibited outstanding performance, achieving a high sensitivity of 89% and specificity of 96%. Additional performance metrics, including positive predictive value (82%), negative predictive value (97%), and overall accuracy (94%), underscore its robust capabilities. The area under the ROC curve further demonstrated the model's efficacy, reaching 0.954. Multivariate logistic regression revealed statistical significance for age, sex, history of trauma, operative intervention, HTN, and smoking. Our study highlights the satisfactory performance of the DL model on a diverse real-world dataset, garnering positive feedback from radiology trainees.

Use of Multiparametric and Biparametric Magnetic Resonance Imaging in Bladder Cancer Staging: Prospective Observational Study and Analysis of Radiologist Learning Curve.

Background: Nowadays, thanks to the introduction of the VI-RADS scoring system, mpMRI has shown promising results in pre-TURBT assessment of muscular invasiveness of BCa, even if its application in everyday practice is still limited. This might be due to a lack in the literature about the learning curve of radiologists and about the characteristics of the exam. With the aim to reduce scan time and patient discomfort while maintaining diagnostic accuracy, bpMRI has been introduced as a possible alternative to mpMRI in this group of patients. This study reports a single-center experience using mpMRI and the VI-RADS scoring system to differentiate NMIBC from MIBC. The primary aim of the study is to assess diagnostic accuracy of mpMRI using the VI-RADS scoring system. The secondary aim is to evaluate the learning curve of an experienced mpMRI radiologist. Additionally, we perform a retrospective assessment of the same group of patients evaluating only DWIs and T2-weighted images, as they underwent bpMRI, to compare the performance of mpMRI and bpMRI. Materials and Methods: From 11/2021 to 11/2023, patients with suspected newly diagnosed BCa were enrolled in this prospective study. All patients underwent mpMRI prior to TURBT in a highly specialized radiology center for MRI. According to VI-RADS, a cutoff of ≥3 was assumed to define MIBC. Histological TURBT reports were compared with preoperative VI-RADS scores to assess the accuracy of mpMRI in discriminating between NMIBC and MIBC. Furthermore, to assess the learning curve of the reading radiologist we analyzed the rate of patients correctly classified as MIBC at MRI. Finally, we evaluated the performance of a hypothetic biparametric MRI in classifying our cohort according to VI-RADS score and compared it with mpMRI performance by using DeLong's test. Data analysis was performed using Jamovi software v.2.3 and R software v.4.2.1. Results: A total of 133 patients were enrolled. mpMRI showed sensitivity and specificity of 86% (95% confidence interval [CI]: 64-97) and 95% (95% CI: 89-98), respectively. The learning curve analysis of the reading radiologist showed that the rate of patients correctly classified as MIBC rapidly increases reaching its plateau after 40 cases. The hypothetic bpMRI showed a sensitivity of 76% (95% CI: 53-92) and a specificity of 93% (95% CI: 86-97), with no significant difference with mpMRI performance (p = 0.10). Conclusions: Our study confirms the effectiveness of MRI, particularly with the VI-RADS scoring system, in differentiating NMIBC from MIBC. The learning curve analysis underscores the importance of radiologist training in optimizing diagnostic accuracy. Future research should focus on enhancing the sensitivity of bpMRI and further validating these findings in larger and multicentric studies.

Misdiagnosis in breast imaging: a statement paper from European Society Breast Imaging (EUSOBI)-Part 2: Main causes of errors in breast imaging and recommendations from European Society of Breast Imaging to limit misdiagnosis.

Breast cancer is one of the leading causes of negligence claims in radiology. The objective of this document is to describe the specific main causes of errors in breast imaging and provide European Society of Breast Imaging (EUSOBI) recommendations to try to minimize these. Technical failures represent 17% of all mammographic diagnostic negligence claims. Mammography quality control protocol and dedicated training for technologists and radiologists are essential. Lack of consideration of the clinical context is a second critical issue, as a clinical abnormality is found in 80% of malpractice claims. EUSOBI emphasizes the importance of communication and clinical examination before the diagnostic investigation. Detection errors or misapplications of the lexicon or Breast Imaging Reporting Data System (BI-RADS) score account for 5% of malpractice claims and should be reduced by limiting radiologists' distraction or fatigue, and being aware of satisfaction of search errors and the importance of a personal systematic review. Errors related to pathological concordance and MDT review can be limited by the use of markers after biopsy and the use of standardized reports, which can aid communication with other specialities. Finally, errors related to tumor or patient factors should be discussed, considering the use of contrast-enhanced mammography and magnetic resonance imaging. Several factors are responsible for misdiagnosis in breast cancer, including errors in the practice of the technician and/or radiologist (technical failures, lack of consideration of the clinical context, incorrect application of the BI-RADS score, false reassurances), lack of communication with other specialists or with the patient, and the type of tumor and breast parenchyma. Question What factors most contribute to and what implications stem from misdiagnosis in breast imaging? Findings Ongoing training and education for radiologists and other healthcare providers, as well as interdisciplinary collaboration and communication is paramount. Clinical relevance Misdiagnosis in breast imaging can have significant implications for patients, healthcare providers, and the entire healthcare system.

Misdiagnosis in breast imaging: a statement paper from European Society Breast Imaging (EUSOBI)-Part 1: The role of common errors in radiology in missed breast cancer and implications of misdiagnosis.

Misdiagnosis in breast imaging can have significant implications for patients, healthcare providers, and the healthcare system as a whole. Some of the potential implications of misdiagnosis in breast imaging include delayed diagnosis or false reassurance, which can result in a delay in treatment and potentially a worse prognosis. Misdiagnosis can also lead to unnecessary procedures, which can cause physical discomfort, anxiety, and emotional distress for patients, as well as increased healthcare costs. All these events can erode patient trust in the healthcare system and in individual healthcare providers. This can have negative implications for patient compliance with screening and treatment recommendations, as well as overall health outcomes. Moreover, misdiagnosis can also result in legal consequences for healthcare providers, including medical malpractice lawsuits and disciplinary action by licensing boards. To minimize the risk of misdiagnosis in breast imaging, it is important for healthcare providers to use appropriate imaging techniques and interpret images accurately and consistently. This requires ongoing training and education for radiologists and other healthcare providers, as well as collaboration and communication among healthcare providers to ensure that patients receive appropriate and timely care. If a misdiagnosis does occur, it is important for healthcare providers to communicate with patients and provide appropriate follow-up care to minimize the potential implications of the misdiagnosis. This may include repeat imaging, additional biopsies or other procedures, and referral to specialists for further evaluation and management. Question What factors most contribute to and what implications stem from misdiagnosis in breast imaging? Findings Ongoing training and education for radiologists and other healthcare providers, as well as interdisciplinary collaboration and communication, is paramount. Clinical relevance Misdiagnosis in breast imaging can have significant implications for patients, healthcare providers, and the entire healthcare system.

Scarcity of Women in Interventional Radiology in SubSaharan Africa: Survey and Insights

Purpose: Globally, women are underrepresented in Interventional Radiology (IR) and calls have been made to increase gender equity. In sub-Saharan Africa specifically, IR is a rapidly emerging field. However, concerns have been raised about the lack of women in IR in the region. The purpose of this study was to assess the state of women in IR in sub-Saharan Africa, with attention to their training experiences, and perceived barriers, to identify opportunities to increase gender equity. Methods: We distributed a survey to all identifiable female IR physicians and trainees in sub-Saharan Africa (SSA). The survey included questions on demographics, training experiences, barriers faced professionally, and suggestions for encouraging more women in Africa to pursue IR. Results: Eight women in IR in SSA were identified, six of whom responded to the survey (75% response rate). Commonly cited perceived barriers include lack of training opportunities, gender underrepresentation and societal expectations. Suggestions for increasing women's participation in IR can be increased by creating more training opportunities in Africa, including gender-specific opportunities, integrating IR into diagnostic radiology training programs, developing mentoring programs, and concerted efforts by professional societies to establish dedicated committees, scholarships and sponsorship of women. Conclusions: While interventional radiologists are few in SSA, gender disparities already exist. As increasing the number of IR physicians in low resource areas is essential to addressing health disparities, and women in IR frequently treat women's health conditions, including maternal mortality, building physician capacity in a gender-sensitive manner is essential.

Virtual Chest Radiographs Developed From Computed Tomography Images for Differentiating Central Venous Versus Misplaced Arterial Lines and for Training Radiologists

Objective Radiographic findings to identify central venous catheter misplacement in the arteries, which can cause lethal complications, have not been fully evaluated, and its training is difficult because it is rare. The purpose of this study is to clarify radiographic findings for differentiating central venous and misplaced arterial lines using virtual chest radiographs and elucidate their usefulness in training radiologists. Methods This retrospective study included 150 patients (mean age, 67 [SD, ±12] years; 97 men) who underwent colon cancer surgery between January 2018 and December 2020. Virtual chest radiographs, including 6 oblique projections at 5° intervals, were developed from the computed tomography images using ray-sum reconstruction. Virtual venous and arterial lines were drawn from the right neck to the superior vena cava and aorta, respectively. Diagnostic abilities, including area under the curve (AUC) analysis of the 7 proposed radiographic findings for differentiating these lines in 100 patients, were evaluated. The diagnostic performance, including AUC analysis by 5 radiologists in the other 50 patients, was compared before and after disclosing these results to the radiologists. Results The findings of crossing over the right paratracheal stripe and running along the paracaval line showed the highest AUC for indicating arterial and venous lines in the frontal, right anterior oblique 15°, and left anterior oblique 15° projections (AUC = 0.992, 0.991, and 0.979, and 1.000, 0.994, and 0.998, respectively). The diagnostic performance of the radiologists improved after informing them of these results (AUC, 0.982–0.999 to 0.993–1.000 [P = 0.145–1.000] for the frontal projections and 0.932–0.970 to 0.967–0.995 [P = 0.075–0.150] for the oblique projections). Conclusions Virtual chest radiographs created from computed tomography images were useful for clarifying radiographic findings for differentiating central venous and misplaced arterial lines and for training radiologists.

Enhancing Lung and Breast Cancer Screening with Advanced AI and Image Processing Techniques

This research investigates the application of CNNs for diagnostics improvements in lung and breast cancers based on AI image classification approaches. Using the datasets with 15,000 images describing lung cancer and 10,000 images describing cases of breast cancer, the models showed high performance: 90% for lung cancer and 99% for breast cancer classification. The descriptive analysis pointed out different features in imaging, such as dense tissue structure and irregular cell patterns; the models successfully identified these. The findings underlined the vital role that AI could play in assisting radiologists by delivering preliminary analysis, triaging high-risk cases, and leading to early cancer detection. Essential challenges were highlighted: ethical considerations concerning patients' privacy and AI algorithms' transparency. The limitation of the dataset diversity resulted in the conclusion that only broader data can ensure good generalization in various clinical settings. They recommended integrating the AI tool with clinical workflow and also called for training radiologists for effectiveness. Future research directions include real-time imaging and patient data integration for comprehensive diagnostic support and multi-modal approaches that combine imaging with genomics for more precise predictions. This leads to a more personalized cancer diagnosis and treatment plan, thus ultimately improving the results of the patients. This research, therefore, underlines the transformative capabilities of AI and image processing in modernizing cancer screening and diagnostics toward more accurate and efficient healthcare practices.

Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology.

Interventional oncology (IO) employs various techniques to enable minimally invasive, image-guided treatment of tumor diseases with both curative and palliative goals. Additionally, it significantly contributes to managing tumor-related and perioperative complications, offering diverse supportive procedures for patients at all stages of their diseases. The execution of IO procedures places unique demands on the equipment, personnel, and structural organization of radiological clinics, necessitating specific expertise from interventional radiologists.This position paper aims to comprehensively outline the multifaceted aspects of IO and discuss the requisite criteria for hospitals, radiological clinics, and interventional radiologists (IRs). Furthermore, it underscores overarching considerations of quality assurance that clinics and professional societies should prioritize.The requirements for hospitals, radiological clinics, and IRs are varied and demand not only a high level of proficiency in performing IO procedures but also in-depth knowledge of the differential therapy for various tumor diseases. This expertise is essential for effectively serving as clinical partners in the interdisciplinary treatment of oncologic patients. Additionally, a thorough understanding and safe handling of ionizing radiation technologies, along with proficiency in radiation protection methods, which are fundamental aspects of radiological specialist training, is crucial for ensuring the safety of IO procedures for both patients and staff. The Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have long-established dedicated quality management programs, accrediting radiology clinics and certifying IRs. These initiatives aim to uphold the highest standards of care and meet the quality expectations set by politics in healthcare system, particularly in the realm of interventional radiology. · The various procedures in the field of interventional oncology (IO) are complex medical interventions that require not only the most advanced technical equipment but also adequate human resources, particularly specialized expertise in interventional radiology, diagnostic imaging, oncology, and radiation protection.. · This expertise is an integral part of the specialized medical training in radiology and is certified by professional societies such as the German Society for Interventional Radiology (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).. · Professional societies like DeGIR, CIRSE, and the American Society of Interventional Radiology (SIR) establish the necessary quality assurance framework for comprehensive, high-quality IO therapy through quality assurance (QA) registries, standard operating procedure (SOP) documents, and participation in guideline development.. · Currently, radiology is the only discipline that provides physicians with the theoretical and practical knowledge, skills, and competencies required to perform the demanding procedures in the field of IO through specialized training programs and tailored certification processes.. · Isfort P, Sommer CM, Bruners P et al. Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology. Fortschr Röntgenstr 2024; DOI 10.1055/a-2373-1013.

Quantification of pulmonary edema using automated lung segmentation on computed tomography in mechanically ventilated patients with acute respiratory distress syndrome

BackgroundQuantification of pulmonary edema in patients with acute respiratory distress syndrome (ARDS) by chest computed tomography (CT) scan has not been validated in routine diagnostics due to its complexity and time-consuming nature. Therefore, the single-indicator transpulmonary thermodilution (TPTD) technique to measure extravascular lung water (EVLW) has been used in the clinical setting. Advances in artificial intelligence (AI) have now enabled CT images of inhomogeneous lungs to be segmented automatically by an intensive care physician with no prior radiology training within a relatively short time. Nevertheless, there is a paucity of data validating the quantification of pulmonary edema using automated lung segmentation on CT compared with TPTD.MethodsA retrospective study (January 2016 to December 2021) analyzed patients with ARDS, admitted to the intensive care unit of the Department of Anesthesiology and Critical Care Medicine, University Hospital Mannheim, who underwent a chest CT scan and hemodynamic monitoring using TPTD at the same time. Pulmonary edema was estimated using manually and automated lung segmentation on CT and then compared to the pulmonary edema calculated from EVLW determined using TPTD.Results145 comparative measurements of pulmonary edema with TPTD and CT were included in the study. Estimating pulmonary edema using either automated lung segmentation on CT or TPTD showed a low bias overall (− 104 ml) but wide levels of agreement (upper: 936 ml, lower: − 1144 ml). In 13% of the analyzed CT scans, the agreement between the segmentation of the AI algorithm and a dedicated investigator was poor. Manual segmentation and automated segmentation adjusted for contrast agent did not improve the agreement levels.ConclusionsAutomated lung segmentation on CT can be considered an unbiased but imprecise measurement of pulmonary edema in mechanically ventilated patients with ARDS.

Influence of clinical experience in detecting calcifications of the head and neck region on panoramic radiographs: an app-based evaluation.

Digital panoramic radiographs (DPRs) are used in dental practice as the first diagnostic tool for the initial detection of head and neck regions soft-tissue calcifications. The aim of this study was to use a self-developed application (App) to evaluate the ability of dental students at different levels of training to examine known DPRs with different soft-tissue calcification. A total of known 100 DPRs with (n=50) and without (n=50) calcification were independently evaluated by four groups: preclinical, first clinical and last clinical dental students, and dentists with less than or equal to 1 year of professional experience in the same time (15min) and examination conditions. Unity software was used to develop the examination App, which allowed to mark areas with calcifications on the DPRs. The data were statistically analyzed between the groups (significance level: P<0.05) for every location, and the detection rate was calculated as a percentage of detected calcifications. Results revealed that the overall detection rate of calcifications in all groups was 29.17%. Dentists exhibited the highest detection rate (36.46%), followed by the last- (29.69%), first- (32.29%), and preclinical (15.10%) students. These findings suggest that clinical experience plays a role in the correct detection of soft-tissue calcifications in DPRs. However, deficiencies in radiological training during dental education may contribute to diagnostic errors. As these can become life-threatening risks, the results highlight the need for early training in the dental curriculum to improve diagnostic performance and minimize possible diagnostic errors.

Gender and Ethnicity Bias of Text-to-Image Generative Artificial Intelligence in Medical Imaging, Part 2: Analysis of DALL-E 3.

Disparity among gender and ethnicity remains an issue across medicine and health science. Only 26%-35% of trainee radiologists are female, despite more than 50% of medical students' being female. Similar gender disparities are evident across the medical imaging professions. Generative artificial intelligence text-to-image production could reinforce or amplify gender biases. Methods: In March 2024, DALL-E 3 was utilized via GPT-4 to generate a series of individual and group images of medical imaging professionals: radiologist, nuclear medicine physician, radiographer, nuclear medicine technologist, medical physicist, radiopharmacist, and medical imaging nurse. Multiple iterations of images were generated using a variety of prompts. Collectively, 120 images were produced for evaluation of 524 characters. All images were independently analyzed by 3 expert reviewers from medical imaging professions for apparent gender and skin tone. Results: Collectively (individual and group images), 57.4% (n = 301) of medical imaging professionals were depicted as male, 42.4% (n = 222) as female, and 91.2% (n = 478) as having a light skin tone. The male gender representation was 65% for radiologists, 62% for nuclear medicine physicians, 52% for radiographers, 56% for nuclear medicine technologists, 62% for medical physicists, 53% for radiopharmacists, and 26% for medical imaging nurses. For all professions, this overrepresents men compared with women. There was no representation of persons with a disability. Conclusion: This evaluation reveals a significant overrepresentation of the male gender associated with generative artificial intelligence text-to-image production using DALL-E 3 across the medical imaging professions. Generated images have a disproportionately high representation of white men, which is not representative of the diversity of the medical imaging professions.

A 360-degree evaluation of the professionalism and communication skills of technologists working in the radiology department of a public sector tertiary care hospital in Karachi, Pakistan

BackgroundRadiologic technologists (RTs) are at the forefront of radiology departments and require optimal skills to demonstrate professionalism and effective provider–patient communication. Hence, the objective of this study was to determine the reliability of 360-degree evaluation as a feedback tool to improve competencies in this crucial workforce.MethodsA planned 360-degree evaluation was conducted using a 10-item tool to evaluate communication skills and professionalism among radiological technologists working at Dow University Hospital, Karachi. In total, 311 evaluations of fifteen radiological technologists were conducted while performing various diagnostic radiology procedures at the radiology department of Dow University Hospital. The data were analysed using SPSS version 26 to compute the evaluation scores and the reliability of 360-degree evaluation.ResultsA total of 311 RT-patient interactions were recorded over 48 days, with scores from all three raters. The evaluation tool was found to have good internal consistency for patients, faculty, and RT, with Cronbach’s alpha values of 0.89, 087, and 0.74, respectively. The study found an intraclass correlation of 0.66 (95% CI; 0.58–0.72), showing moderate reliability of the 360-degree evaluation across different raters.ConclusionWe conclude that 360-degree evaluation is a valid and reliable tool for determining the professionalism and communication skills of radiologic technologists and should be incorporated into training programs for formative and summative assessments. However, large-scale multicenter studies are crucial for generalizing these findings and incorporating 360 evaluations in radiological technologist training programs for formative and summative assessments.