Impact of Body Mass Index on Perioperative Complications and Oncologic Outcomes in Patients Undergoing Thermal Ablation for Renal Cell Carcinoma.

PURPOSE: To determine effect of body mass index (BMI) on safety and cancer-related outcomes of thermal ablation for renal cell carcinoma (RRC). MATERIALS AND METHODS: This retrospective study evaluated 427 patients (287 men and 140 women; mean [SD] age, 72 [12] y) who were treated with thermal ablation for RCC between October 2006 and December 2017. Patients were stratified by BMI into 3 categories: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Of 427 patients, 71 (16%) were normal weight, 157 (37%) were overweight, and 199 (47%) were obese. Complication rates, local recurrence, and residual disease were compared in the 3 cohorts. RESULTS: No differences in technical success between normal-weight, overweight, and obese patients were identified (P = .72). Primary technique efficacy rates for normal-weight, overweight, and obese patients were 91%, 94%, and 93% (P = .71). There was no significant difference in RCC specific-free survival, disease-free survival, and metastasis-free survival between obese, overweight, and normal-weight groups (P = .72, P = .43, P = .99). Complication rates between the 3 cohorts were similar (normal weight 4%, overweight 2%, obese 3%; P = .71). CONCLUSIONS: CT-guided renal ablation is safe, feasible, and effective regardless of BMI.

Thermal Ablation, Embolization, and Selective Internal Radiation Therapy Combined with Checkpoint Inhibitor Cancer Immunotherapy: Safety Analysis.

PURPOSE: To describe interventional oncology therapies combined with immune checkpoint inhibitor (ICI) therapy targeting the programmed death 1 pathway in patients with different neoplasms. MATERIALS AND METHODS: This was a retrospective cohort study of patients who underwent tumor-directed thermal ablation, embolization, or selective internal radiation therapy (SIRT) between January 1, 2011, and May 1, 2019, and received anti-programmed death 1/PD-L1 agents ≤ 90 days before or ≤ 30 days after the interventional procedure. Immune-related adverse events (irAEs) and procedural complications ≤ 90 days after the procedure were graded according to the Common Terminology Criteria for Adverse Events version 5.0. The study included 65 eligible patients (49% female; age 63 years ± 11.1). The most common tumors were metastatic melanoma (n = 28) and non-small cell lung cancer (NSCLC) (n = 12). Patients underwent 78 procedures (12 patients underwent > 1 procedure), most frequently SIRT (35.9%) and cryoablation (28.2%). The most common target organs were liver (46.2%), bone (24.4%), and lung (9.0%). Most patients received ICI monotherapy with pembrolizumab (n = 30), nivolumab (n = 22), and atezolizumab (n = 6); 7 patients received ipilimumab and nivolumab. RESULTS: Seven (10.8%) patients experienced an irAE (71.4% grade 1-2), mostly affecting the skin. Median time to irAE was 33 days (interquartile range, 19-38 days). Five irAEs occurred in patients with melanoma, and no irAEs occurred in patients with NSCLC. Management required corticosteroids (n = 3) and immunotherapy discontinuation (n = 1); all irAEs resolved to grade ≤ 1. There were 4 intraprocedural and 32 postprocedural complications (77.8% grade < 3). No grade 5 irAEs and/or procedural complications occurred. CONCLUSIONS: No unmanageable or unanticipated toxicities occurred within 90 days after interventional oncology therapies combined with ICIs.

Thermal Ablation of Renal Cell Carcinoma in Patients With Morbid Obesity: Assessment of Technique, Safety, and Oncologic Outcomes.

BACKGROUND. Obesity is a worldwide problem that impacts patient health as well as the morbidity associated with surgical procedures. Thus, patients with morbid obesity may not be suitable candidates for curative surgery. For this patient population, thermal ablation may be an effective alternative to nephrectomy. OBJECTIVE. The purpose of this study was to determine the feasibility, oncologic outcomes, and survival of patients with morbid obesity and renal cell carcinoma treated with thermal ablation. MATERIALS AND METHODS. A retrospective analysis was performed of 107 patients treated with CT-guided renal ablation for clinical T1 renal cell carcinoma between February 2005 and December 2017. Patients were stratified into two cohorts on body mass index of ≥ 40 kg/m2 (morbidly obese) and body mass index (weight in kilograms divided by the square of height in meters) of ≥ 40 (morbidly obese) and 18.5-24.9 (normal weight). Anesthetic and radiation dosages, procedure time, residual disease, and local recurrence, and adverse events were analyzed between the two groups. Kaplan-Meier statistics were used to evaluate cancer-related outcomes for each group. RESULTS. Thirty-four patients were morbidly obese, and 73 patients had normal weight. Morbid obesity was associated with longer procedural duration (p = .001), sedative doses (p = .002) and radiation exposure (p = .001) than normal weight. Hematomas were more prevalent in patients with morbid obesity than in those of normal weight (p = .01), but treatment efficacy and local recurrences were comparable with those for normal-weight individuals (p = .81 and p = .12, respectively). Cancer-related outcomes were equivalent between the two groups based on 5 years of imaging observation data. CONCLUSION. CT-guided thermal ablation remains technically feasible, well-tolerated, and effective in patients with morbid obesity and renal cell carcinoma, with the caveat of increased risk of perinephric hematoma, anesthesia dose, and radiation exposure. CLINICAL IMPACT. CT-guided thermal ablation can be considered a safe and effective treatment for renal cell carcinoma in patients with morbid obesity.

Role of Machine Learning and Artificial Intelligence in Interventional Oncology.

PURPOSE OF REVIEW: The purpose of this review is to highlight the current role of machine learning and artificial intelligence and in the field of interventional oncology. RECENT FINDINGS: With advancements in technology, there is a significant amount of research regarding the application of artificial intelligence and machine learning in medicine. Interventional oncology is a field that can benefit greatly from this research through enhanced image analysis and intraprocedural guidance. These software developments can increase detection of cancers through routine screening and improve diagnostic accuracy in classifying tumors. They may also aid in selecting the most effective treatment for the patient by predicting outcomes based on a combination of both clinical and radiologic factors. Furthermore, machine learning and artificial intelligence can advance intraprocedural guidance for the interventional oncologist through more accurate needle tracking and image fusion technology. This minimizes damage to nearby healthy tissue and maximizes treatment of the tumor. While there are several exciting developments, this review also discusses limitations before incorporating machine learning and artificial intelligence in the field of interventional oncology. These include data capture and processing, lack of transparency among developers, validating models, integrating workflow, and ethical challenged. In summary, machine learning and artificial intelligence have the potential to positively impact interventional oncologists and how they provide cancer care treatments.

Percutaneous Cryoablation: Safety and Efficacy for Pain Palliation of Metastases to Pleura and Chest Wall.

PURPOSE: To assess safety and efficacy of percutaneous cryoablation for pain palliation of metastases to pleura and chest wall. MATERIALS AND METHODS: This retrospective single-center cohort study included 22 patients (27% female, mean age 63 y ± 11.4) who underwent 25 cryoablation procedures for pain palliation of 39 symptomatic metastases measuring 5.1 cm ± 1.9 (range, 2.0-8.0 cm) in pleura and chest wall between June 2012 and December 2017. Pain intensity was assessed using a numerical scale (0-10 points). Statistical tests t test, χ2, and Wilcoxon signed rank were performed. RESULTS: Patients were followed for a median of 4.1 months (interquartile range [IQR], 2.3-10.1; range, 0.1-36.7 mo) before death or loss to follow-up. Following cryoablation, pain intensity decreased significantly by a median of 4.5 points (IQR, 2.8-6; range, 0-10 points; P = .0002 points, Wilcoxon signed rank). Pain relief of at least 3 points was documented following 18 of 20 procedures. Pain relief occurred within a median of 1 day following cryoablation (IQR, 1-2; range, 1-4 d) and lasted for a median of 5 weeks (IQR, 3-17; range, 1-34 wk). Systemic opioid requirements decreased in 11 of 22 patients (50%) by an average of 56% ± 34. Difference in morphine milligram equivalents was not significant (P = .73, Wilcoxon signed rank). No procedure-related complications occurred despite previous radiation of 7 tumors. Of 25 procedures, 22 (88%) were performed on an outpatient basis. CONCLUSIONS: Percutaneous cryoablation for metastases to pleura and chest wall can safely provide significant pain relief within days following a single session.

Implementing Virtual and Augmented Reality Tools for Radiology Education and Training, Communication, and Clinical Care.

Advances in virtual immersive and augmented reality technology, commercially available for the entertainment and gaming industry, hold potential for education and clinical use in medicine and the field of medical imaging. Radiology departments have begun exploring the use of these technologies to help with radiology education and clinical care. The purpose of this review article is to summarize how three institutions have explored using virtual and augmented reality for radiology.

Radiofrequency Ablation, Cryoablation, and Microwave Ablation for T1a Renal Cell Carcinoma: A Comparative Evaluation of Therapeutic and Renal Function Outcomes.

PURPOSE: To compare the therapeutic and renal function outcomes of radiofrequency (RF) ablation, cryoablation, and microwave (MW) ablation for treatment of T1a renal cell carcinoma (RCC). MATERIALS AND METHODS: A retrospective assessment of 297 patients (mean age 72 years range 24-90 years) with biopsy-proven RCC treated with image-guided percutaneous thermal ablation was performed between October 2006 and December 2016. Mean tumor size was 2.4 cm; mean radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, hilar tumor touching the main renal artery or vein, and location relative to polar lines; Preoperative Aspects and Dimensions Used for an Anatomical; and c-centrality scores were 6.0, 7.0, and 2.8, respectively. Assessments of adverse events, treatment efficacy, and therapeutic outcomes were performed among RF ablation, cryoablation, and MW ablation. The 2-year disease-free, metastatic-free, and cancer-specific survival rates were tabulated. Estimated glomerular filtration rate was used to assess for treatment related changes in renal function. RESULTS: A total of 297 T1aN0M0 biopsy-proven RCCs measuring 1.2-3.9 cm were treated with computed tomography-guided RF ablation (n = 244, 82%), cryoablation (n = 26, 9%), and MW ablation (n = 27, 9%). There were no significant differences in patient demographics among the 3 groups (P = .09). Technical success rates were similar among the 3 treatments (P = .33). Primary efficacy at 1 month postablation was more likely to be achieved with RF ablation and MW ablation than with cryoablation. At 2 years' follow-up, there was no local recurrence, metastatic progression, or RCC-related death observed in the 3 groups. There was no significant change in estimated glomerular filtration rate among the 3 ablation groups compared with baseline at 2-year follow-up (P = .71). CONCLUSION: RF ablation, cryoablation, and MW ablation are equivalent at 2 years for treatment of T1a RCC for therapeutic outcome, stability of renal function, and low adverse event rate.

Dual-Source Dual-Energy CT in Detection and Characterization of Urinary Stones in Patients With Large Body Habitus: Observations in a Large Cohort.

OBJECTIVE: The objective of our study was to investigate the impact of large body habitus on dual-energy CT (DECT) image quality and stone characterization. MATERIALS AND METHODS: We retrospectively included 105 consecutive patients with large body habitus (> 90 kg) who underwent stone protocol DECT between 2015 and 2017. The evaluation of DECT datasets was performed for image quality assessment based on European Guidelines on Quality Criteria for Computed Tomography and for determination of stone composition (i.e., uric acid vs non-uric acid). Correlation between DECT characterization and crystallography results was performed when available. The cohort was divided into two groups on the basis of body weight (≤ 104 kg and > 104 kg), and comparisons were made for image quality and stone characterization. RESULTS: One hundred ninety-seven urinary tract calculi (size: mean ± SD, 5.7 ± 5.3 mm; range, 1.4-56 mm) were detected in 73% (79/108) of examinations in 105 patients (weight: mean ± SD, 104.0 ± 12.7 kg; range, 91-163 kg). The overall mean image quality score of blended images and color maps was 3.7 and 3.9, respectively, and the effective dual-energy FOV limitation did not hamper stone characterization. The diagnostic acceptability scores of blended images and color maps were slightly lower in patients weighing > 104 kg than in patients ≤ 104 kg (mean scores [highest score, 4 points]: blended images, 3.62 vs 3.82 [p = 0.0314]; color maps, 3.75 vs 3.98 [p = 0.0034]), but the scores were within acceptable range. Stone characterization as uric acid versus non-uric acid was achieved in 80% (158/197) of calculi (size: mean ± SD, 6.4 ± 5.7 mm; range, 1.6-56 mm), and DECT stone characterization was (95.6%) accurate with reference to crystallography. Twenty percent (39/197) of calculi could not be characterized on DECT, and these calculi were significantly smaller in size (size: mean ± SD, 2.8 ± 1.4 mm; range, 1.4-8.2 mm; p < 0.001) than those that could be characterized. The mean size of uncharacterized calculi was slightly larger in patients weighing > 104 kg (3.3 ± 1.6 mm) than in those weighing ≤ 104 kg (2.2 ± 0.6 mm). CONCLUSION: In patients with large body habitus, dual-source DECT provides acceptable image quality and allows characterization of almost all clinically significant calculi.

Risk Assessment of Chronic Kidney Disease following Microwave Ablation for Stage T1 Renal Cell Carcinoma.

PURPOSE: To assess safety and renal-function outcomes after microwave (MW) ablation of localized stage T1 renal cell carcinoma (RCC). MATERIALS AND METHODS: A retrospective review was conducted of 38 patients (28 men; mean age, 69 y; range, 51-88 y) who underwent computed tomography (CT)-guided MW ablation for stage T1N0M0 RCC. Baseline and follow-up renal function surrogates including creatinine level and estimated glomerular filtration rate (eGFR) were statistically compared. Peri- and postoperative complication rates, technical success, and treatment response were also assessed. RESULTS: A total of 44 biopsy-proven stage T1N0M0 RCCs measuring 1.2-6.9 cm (mean, 2.5 cm) were treated, and renal function was measured 1 mo after treatment. Mean eGFRs were 60 mL/min/1.73 m2 at baseline and 59 mL/min/1.73 m2 at 1 month after ablation. At 1-year and last follow-ups, the means of difference were 3.3% (95% confidence interval, -4.4 to 4.3; P = .99) and 3.3% (95% confidence interval, -4.3 to 4.8; P = .91), respectively. The 2-years freedom from eGFR decrease to < 60 mL/min/1.73 m2 was 2% (P = .91). Among the 5 patients (13%) with preexisting stage 4 chronic kidney disease (CKD; eGFR < 30 mL/min/1.73 m2) before ablation, there was no significant postablative onset of decline or CKD upstaging (P = .001). There were no major complications, and 5 patients (13%) had small asymptomatic perinephric hematomas (Society of Interventional Radiology minor complication, class A/B) that were managed conservatively. CONCLUSIONS: At 2-year follow-up, CT-guided percutaneous MW ablation is safe and well-tolerated and achieves nephron preservation similar to existing ablative modalities.

Local Control and Survival after Image-Guided Percutaneous Ablation of Adrenal Metastases.

PURPOSE: To evaluate local control and survival after image-guided ablation of adrenal gland metastases. MATERIALS AND METHODS: Image-guided ablations of adrenal metastases measuring < 5 cm performed at 2 academic medical centers between July 2002 and June 2016 were analyzed. There were 51 procedures performed on 46 tumors (mean diameter 2.8 cm ± 1.1; range, 0.7-4.9 cm) in 38 patients (mean age 66 y; range, 41-80 y) with renal cell carcinoma (n = 17 patients; 45%), non-small cell lung cancer (n = 10 patients; 26%), and other primary malignancies (n = 11 patients; 29%). Treatment modalities included cryoablation (n = 30 procedures; 59%), radiofrequency ablation (n = 12 procedures; 24%) and microwave ablation (n = 9 procedures; 18%). Technical success, primary and secondary efficacy, local progression rate, local progression-free survival, and overall survival were assessed. Mean follow-up was 37 months (range, 2-128 months). Statistical analysis was performed with univariate Cox hazards regression and Kaplan-Meier analyses. RESULTS: Technical success, primary efficacy, and secondary efficacy were 96%, 72%, and 76%. Local progression rate during all follow-up was 25%. Local tumor progression-free survival at 1, 3, and 5 years was 82%, 69%, and 55%. Overall survival at 1, 3, and 5 years was 82%, 44%, and 34%. In 16 patients with isolated adrenal metastasis, median disease-free survival was 8 months; 4 patients had no evidence of disease during follow-up. Lung cancer was associated with decreased survival (hazard ratio 4.41, P = .002). CONCLUSIONS: Image-guided ablation can achieve local control for adrenal metastases < 5 cm.

Percutaneous Image-Guided Thermal Ablation for Multifocal Renal Cell Carcinoma: 10-Year Experience at a Single Center.

OBJECTIVE: The objective of our study was to assess the technical success, safety, and oncologic and renal function outcomes of CT-guided percutaneous thermal ablation for synchronous multiple renal masses in a single session. MATERIALS AND METHODS: A retrospective analysis of 23 patients (16 men and 7 women; median age, 70 years) with biopsy-proven multifocal renal cell carcinoma (RCC) masses treated with radiofrequency ablation (RFA), cryoablation, or microwave ablation (MWA) was performed. Preablation, postablation, and follow-up serum blood urea nitrogen, creatinine, and estimated glomerular filtration rate (GFR) levels were recorded to evaluate the stability of renal function. Technical success, complications, treatment response, oncologic outcome, and overall survival were assessed. RESULTS: Biopsy-proven RCCs were treated in 23 patients. Median tumor size was 2.3 cm (range, 1.0-4.0 cm). The mean RENAL (radius, exophytic vs endophytic properties, nearness of tumor to the collecting system or sinus, anterior vs posterior, location relative to polar lines) nephrometry score was 6.3 (range, 4.0-10.0); mean PADUA (preoperative aspects and dimensions used for anatomical) score, 7.8 (range, 6.0-11.0); and mean centrality index (C-index), 3.1 (range, 0.7-6.8). The mean ablation time was 23 minutes (range, 3-24 minutes). Technical success was achieved for 100% of tumors. Of the 49 complications, nine (18%) were classified as Clavien-Dindo grade I complications. Complete response was achieved in 41 of the 49 (84%) tumors. Local progression-free, RCC-specific disease-free, and overall survival rates during the imaging follow-up time (mean, 3.1 years; range, 0.1-9.6 years) were 96% (22/23), 100% (23/23), and 91% (21/23), respectively. CONCLUSION: CT-guided percutaneous thermal ablation is a safe, effective, and durable treatment intervention for multifocal renal masses.

Successful CT guided cryoablation of phosphaturic mesenchymal tumor in the soft tissues causing tumor-induced osteomalacia: a case report.

We report the case of a 25-year-old male patient with tumor-induced osteomalacia from a 1.8-cm phosphaturic mesenchymal tumor in the right distal thigh, who was treated at our institution with a single session of CT-guided cryoablation in December 2015, which resulted in biochemical and clinical resolution. We present the clinical history, physical examination, biochemistry, functional imaging, anatomic characterization, and follow-up for clinical outcome. The response to treatment was documented in terms of normalization of serum fibroblastic growth factor 23 (FGF23) and phosphorous levels, symptomatic improvement, as well as normalization of bone mineralization on femur radiographs 3 months after the procedure. Although the first-line treatment for phosphaturic mesenchymal tumor-induced osteomalacia is wide surgical excision, CT-guided cryoablation widens the array of treatment options, especially in those patients who decline surgery or who are otherwise poor surgical candidates.

CT-Guided Percutaneous Microwave Ablation of Tumors in the Hepatic Dome: Assessment of Efficacy and Safety.

PURPOSE: To evaluate the technique, efficacy, safety, and clinical outcomes of CT-guided microwave ablation of tumors in the hepatic dome. MATERIALS AND METHODS: Retrospective review was conducted of 46 consecutive patients (31 men and 15 women; mean age, 64 y) treated with CT-guided microwave ablation for hepatic-dome tumors between June 2011 and December 2014. Baseline demographics of sex, tumor diagnosis, tumor location, tumor size, and technical details were recorded. Technical success was evaluated. Treatment response was assessed per European Association for the Study of the Liver criteria. Overall success and overall survival were calculated, and complications were recorded. RESULTS: Forty-eight tumors were treated. Tumor locations included segments VIII (n = 32), VII (n = 10), and VIa (n = 6). Mean tumor size was 2.4 cm (range, 0.9-5.2 cm). Thirty-four tumors (70%) were treated following creation of artificial ascites with 0.9% normal saline solution (mean volume, 1,237 mL; range, 300-3,000 mL). The technical success rate was 100%, and the complete response rate was 94%. Overall survival rate was 73.9% over 24.7 months of follow-up. There were no major complications. Two patients experienced small, asymptomatic pneumothoraces that were aspirated at the time of the procedure and required no further treatment. CONCLUSIONS: CT-guided microwave ablation of tumors in the hepatic dome is associated with a high technical success rate, high complete response rate, and low complication rate.

Catecholamine Surge during Image-Guided Ablation of Adrenal Gland Metastases: Predictors, Consequences, and Recommendations for Management.

PURPOSE: To identify retrospectively predictors of catecholamine surge during image-guided ablation of metastases to the adrenal gland. MATERIALS AND METHODS: Between 2001 and 2014, 57 patients (39 men, 18 women; mean age, 65 y ± 10; age range, 41-81 y) at two academic medical centers underwent ablation of 64 metastatic adrenal tumors from renal cell carcinoma (n = 27), lung cancer (n = 23), melanoma (n = 4), colorectal cancer (n = 3), and other tumors (n = 7). Tumors measured 0.7-11.3 cm (mean, 4 cm ± 2.5). Modalities included cryoablation (n = 38), radiofrequency (RF) ablation (n = 20), RF ablation with injection of dehydrated ethanol (n = 10), and microwave ablation (n = 4). Fisher exact test, univariate, and multivariate logistical regression analysis was used to evaluate factors predicting hypertensive crisis (HC). RESULTS: HC occurred in 31 sessions (43%). Ventricular tachycardia (n = 1), atrial fibrillation (n = 2), and troponin leak (n = 4) developed during HC episodes. HC was significantly associated with maximum tumor diameter ≤ 4.5 cm (odds ratio [OR], 26.36; 95% confidence interval [CI], 5.26-131.99; P < .0001) and visualization of normal adrenal tissue on CT or MR imaging before the procedure (OR, 8.38; 95% CI, 2.67-25.33; P < .0001). No HC occurred during ablation of metastases in previously irradiated or ablated adrenal glands. CONCLUSIONS: Patients at high risk of catecholamine surge during ablation of non-hormonally active adrenal metastases can be identified by the presence of normal adrenal tissue and tumor diameter ≤ 4.5 cm on pre-procedure CT or MR imaging.

Prospective trial with optical molecular imaging for percutaneous interventions in focal hepatic lesions.

PURPOSE: To demonstrate the clinical translation of optical molecular imaging (OMI) for the localization of focal hepatic lesions during percutaneous hepatic interventions. MATERIALS AND METHODS: Institutional review board approval was obtained for this prospective, single-center, HIPAA-compliant trial. Patients who were suspected of having hepatocellular carcinoma or liver metastases from colorectal cancer and were scheduled for percutaneous liver biopsy or thermal ablation were eligible for this study. Patients (n = 5) received 0.5 mg per kilogram of body weight of indocyanine green (ICG) intravenously 24 hours prior to their scheduled procedure in this study. Intraprocedurally, a handheld device composed of an endoscope that fits coaxially through a standard 17-gauge introducer needle was advanced into the liver, and real-time measurements of ICG fluorescence were obtained. A point-of-care fluorescence imaging system was used to image ICG fluorescence in biopsy samples. Target-to-background ratios (TBRs) were calculated by dividing the mean fluorescence intensity in the lesion by the mean fluorescence intensity in the adjacent liver parenchyma. The reference standard for determination of proper needle positioning in patients undergoing biopsy was final pathologic analysis of biopsy specimens or follow-up imaging. RESULTS: Intraprocedural OMI was successfully performed in six lesions (two lesions in patient 3) in five patients. The median size of the targeted lesions was 16 mm (range, 10-21 mm). Four of five biopsies (80%) yielded an accurate pathologic diagnosis, and one biopsy specimen showed benign liver parenchyma; both ablated lesions showed no residual disease 1 month after the procedure. The median overall added procedure time to perform OMI was 2 minutes. ICG was found to localize with TBRs greater than 2.0 (median, 7.9; range, 2.4-13.4) in all target lesions. No trial-related adverse events were reported. CONCLUSION: The clinical translation of OMI to percutaneous hepatic interventions was demonstrated.

Impact of Dose-Modified Protocols on Radiation Doses in Patients Undergoing CT Examinations following Image-Guided Catheter Placement.

PURPOSE: To investigate the impact of dose-modified (DM) scan protocols on decreasing radiation exposure from computed tomography (CT) scans obtained following image-guided catheter procedures. MATERIALS AND METHODS: In this retrospective analysis, between December 2012 and June 2014, 192 patients (mean age, 60.7 y; 102 men) who underwent abdomen/pelvis CT examinations for catheter placement follow-up were included. The standard-dose (SD) baseline CT parameters included tube potential of 120 kVp, tube current of 75-550 mA, and noise index (NI) of 18-22. Weight-based scan parameters applied for follow-up CT were based on two reconstruction algorithms: filtered back projection (FBP; 120 kVp, 75-350 mA, NI = 30) and iterative reconstruction technique (IRT; 100/120 kVp, 75-250/350 mA, NI = 35). Two readers reviewed image quality (IQ) of follow-up and baseline CT examinations for 22 randomly sampled patients. Radiation doses were retrieved by dose monitoring software. RESULTS: Compared with baseline, DM follow-up CT protocols enabled substantial (62.4%) dose reductions (mean CT dose indexes: 4.1 mGy at follow-up, 10.9 mGy at baseline; P < .0001). Doses were significantly lower for IRT follow-up CT examinations compared with FBP (mean CT dose indexes: IRT, 3.6 mGy; FBP, 4.6 mGy; P < .05). In 47 patients with more than one follow-up CT examination (mean, 3.1 examinations per patient; range, 2-6), the observed cumulative radiation dose (CRD) was 42.1% lower than the expected CRD (observed, 1,437.9 mGy·cm; expected, 2,483.6 mGy·cm; P < .0001). Subjective IQ scores were acceptable for follow-up CT examinations (follow-up, 3.6; baseline, 4; P < .05). CONCLUSIONS: DM CT examinations enable substantial dose reduction (62.4%) for each follow-up examination compared with SD baseline scans, without any IQ concerns. Use of IRT decreases dose by an additional 22%. The CRD is lowered by 42% in patients undergoing multiple DM follow-up CT examinations.

Virtual reading room for diagnostic radiology.

RATIONALE AND OBJECTIVE: To assess the perceptions of radiology staff regarding the role of virtual reality technology in diagnostic radiology after using a virtual reality (VR) headset METHODS: Participants completed a pre-study questionnaire assessing their familiarity with VR technology and its potential role in radiology. Using a VR headset, participants entered a simulated reading room (SieVRt, Luxsonic Technologies) with three large virtual monitors. They were able to view plain radiographs, ultrasound, CT, and MRI images and pull up and compare multiple images simultaneously. They then completed a post-study questionnaire to re-assess their perception about the role of VR technology for diagnostic radiology. RESULTS: Fifteen participants were enrolled, with 33.3 % attendings, 40 % fellows, and 26.7 % residents. Pre-study, 60 % reported they were "not familiar" with VR technology and 66.7 % had never used it. On a 1 to 5 scale, the median perceived likelihood of VR having a role in radiology significantly increased from 3 (IQR 2-3) pre-study to 4 (IQR 4-4) post-study; p = 0.014. Image contrast and resolution were adequate according to most participants, with 53.3 % strongly agreeing and 33.3 % agreeing. The headset was comfortable for 73.3 % and did not induce nausea in any participant. Confidence in VR technology improved after using the headset for 80 %. According to 80 %, future VR technology could replace a PACS workstation. DISCUSSION: Radiologists' perception regarding the role of virtual reality in diagnostic interpretation improves after a hands-on trial of the technology, and VR has the potential to replace a traditional workstation in certain situations.

Retrieval of a Greenfield Inferior Vena Cava Filter Indwelling for 29 Years.

Inferior vena cava (IVC) filters are used to prevent fatal and nonfatal pulmonary embolism in patients who otherwise cannot receive anticoagulation for venous thrombosis. While generally safe and effective, complications can arise, especially after prolonged implantation. Timely retrieval is essential once the indication for insertion has resolved. However, encountering patients with long-standing embedded filters is not uncommon. This case report discusses the successful retrieval of a permanent Greenfield IVC filter after 29 years.

CASCADE: Context-Aware Data-Driven AI for Streamlined Multidisciplinary Tumor Board Recommendations in Oncology.

This study addresses the potential of machine learning in predicting treatment recommendations for patients with hepatocellular carcinoma (HCC). Using an IRB-approved retrospective study of patients discussed at a multidisciplinary tumor board, clinical and imaging variables were extracted and used in a gradient-boosting machine learning algorithm, XGBoost. The algorithm's performance was assessed using confusion matrix metrics and the area under the Receiver Operating Characteristics (ROC) curve. The study included 140 patients (mean age 67.7 ± 8.9 years), and the algorithm was found to be predictive of all eight treatment recommendations made by the board. The model's predictions were more accurate than those based on published therapeutic guidelines by ESMO and NCCN. The study concludes that a machine learning model incorporating clinical and imaging variables can predict treatment recommendations made by an expert multidisciplinary tumor board, potentially aiding clinical decision-making in settings lacking subspecialty expertise.

A Novel Design-Thinking, Hospital Innovation Core Certificate Curriculum for Radiologists and Trainees: Creation, Implementation, and Multiyear Results.

RATIONALE AND OBJECTIVES: Innovation is a crucial skill for physicians and researchers, yet traditional medical education does not provide instruction or experience to cultivate an innovative mindset. This study evaluates the effectiveness of a novel course implemented in an academic radiology department training program over a 5-year period designed to educate future radiologists on the fundamentals of medical innovation. MATERIALS AND METHODS: A pre- and post-course survey and examination were administered to residents who participated in the innovation course (MESH Core) from 2018 to 2022. Respondents were first evaluated on their subjective comfort level, understanding, and beliefs on innovation-related topics using a 5-point Likert-scale survey. Respondents were also administered a 21-question multiple-choice exam to test their objective knowledge of innovation-related topics. RESULTS: Thirty-eight residents participated in the survey (response rate 95%). Resident understanding, comfort and belief regarding innovation-related topics improved significantly (P < .0001) on all nine Likert-scale questions after the course. After the course, a significant majority of residents either agreed or strongly agreed that technological innovation should be a core competency for the residency curriculum, and that a workshop to prototype their ideas would be beneficial. Performance on the course exam showed significant improvement (48% vs 86%, P < .0001). The overall course experience was rated 5 out of 5 by all participants. CONCLUSION: MESH Core demonstrates long-term success in educating future radiologists on the basic concepts of medical technological innovation. Years later, residents used the knowledge and experience gained from MESH Core to successfully pursue their own inventions and innovative projects. This innovation model may serve as an approach for other institutions to implement training in this domain.