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PURPOSE: To evaluate the utility and comparative effectiveness of three five-point qualitative scoring systems for assessing response on PET-CT and MRI imaging individually and in combination, following curative-intent chemoradiotherapy (CRT) in locally advanced cervical cancer (LACC). Their performance in the prediction of subsequent patient outcomes was also assessed; Methods: Ninety-seven patients with histologically confirmed LACC treated with CRT using standard institutional protocols at a single centre who underwent PET-CT and MRI at staging and post treatment were identified retrospectively from an institutional database. The post-CRT imaging studies were independently reviewed, and response assessed using five-point scoring tools for T2WI, DWI, and FDG PET-CT. Patient characteristics, staging, treatment, and follow-up details including progression-free survival (PFS) and overall survival (OS) outcomes were collected. To compare diagnostic performance metrics, a two-proportion z-test was employed. A Kaplan-Meier analysis (Mantel-Cox log-rank) was performed. RESULTS: The T2WI (p < 0.00001, p < 0.00001) and DWI response scores (p < 0.00001, p = 0.0002) had higher specificity and accuracy than the PET-CT. The T2WI score had the highest positive predictive value (PPV), while the negative predictive value (NPV) was consistent across modalities. The combined MR scores maintained high NPV, PPV, specificity, and sensitivity, and the PET/MR consensus scores showed superior diagnostic accuracy and specificity compared to the PET-CT score alone (p = 0.02926, p = 0.0083). The Kaplan-Meier analysis revealed significant differences in the PFS based on the T2WI (p < 0.001), DWI (p < 0.001), combined MR (p = 0.003), and PET-CT/MR consensus scores (p < 0.001) and in the OS for the T2WI (p < 0.001), DWI (p < 0.001), and combined MR scores (p = 0.031) between responders and non-responders. CONCLUSION: Post-CRT response assessment using qualitative MR scoring and/or consensus PET-CT and MRI scoring was a better predictor of outcome compared to PET-CT assessment alone. This requires validation in a larger prospective study but offers the potential to help stratify patient follow-up in the future.
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INTRODUCTION: The role of interventional radiology (IR) in health care is rapidly expanding in the United Kingdom (UK). However, the presence of IR in the current undergraduate curriculum is lacking. PURPOSE: This study investigates the awareness, knowledge and perceptions of IR in undergraduates through the clinical years of medical school to suggest future interventions. METHODS: A total of 360 questionnaires, designed to test undergraduates' knowledge of, and exposure to, IR were distributed over a 14-day period in a UK medical institution. RESULTS: Of the 312 respondents (86.7%), the majority had never formally shadowed a radiologist (65.4%) or encountered teaching from an interventional radiologist (54.5%). Most students (88.5%) felt their knowledge of IR was lower than other specialties. Students' knowledge of IR procedures did not statistically increase through the clinical years. Students were most cognisant of vascular procedures and least aware of IR's role in oncology. Only 10.9% would consider a career in IR, with 39.7% citing the lack of knowledge and 18.6% citing patient contact as the top reasons for this. CONCLUSION: Current students have poor exposure to IR through the undergraduate curriculum. Consequently, there is no increase in knowledge of IR clinical practice through the clinical years. Multi-level interventions, incorporating universities and radiological societies are required to increase undergraduate awareness and promote IR as a career. LEVEL OF EVIDENCE: Level 3, Local non-random sample.
