Percutaneous Image-Guided Cryoablation of Endophytic Renal Cell Carcinoma.

PURPOSE: Endophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study. MATERIALS AND METHODS: Patients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC. RESULTS: Fifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications. CONCLUSION: This study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up. LEVEL OF EVIDENCE 3: Retrospective cohort study.

Radiographers' role in justification of medical imaging examinations.

INTRODUCTION: Justification is one of the fundamental principles in radiation protection and according to the ICRP, justification means that any decision that alters the radiation exposure situation should do more good than harm. The purpose of this study was to explore diagnostic radiographers' attitude towards their role in justification, and to assess the perceived need for justification discussions with peers and the ability to reject unjustified referrals during day, evening, and night shifts. METHODS: This study was conducted in Norway and Denmark. A questionnaire was developed in Norwegian and translated into Danish, and two experienced radiographers assessed content validity. A secure online data capture solution was used, and the questionnaire was distributed to radiographers working in clinical settings in March and April 2022 (n = 1215). RESULTS: A total of 202 radiographers were included in the study, 93 from Norway and 109 from Denmark, respectively. Seventy-nine per cent of the radiographers reported that they had a duty to assess justification and 86 % did so daily. Their role in justification assessment was reported as relatively important, where CT and MRI had significantly different results than the total respondents. Radiologists were designated as being most responsible in the assessment, closely followed by referring doctors and radiographers. The most important criterion for justification assessment was the referring doctor's clinical assessment. The need to confer was highest during daytime when there were also more opportunities to confer. CONCLUSION: The need to discuss justification of examinations is greater during daytime when access to radiologists is also high, while both access and need are low during night shifts. Further research is needed to explain the latter finding. Radiographers who engage in daily justification assessments, and perceive it as a duty, find justification important and report having sufficient knowledge to carry out these assessments.

CT triage for lung malignancy: coronal multiplanar reformation versus images in three orthogonal planes.

BACKGROUND: Generation of multiplanar reformation (MPR) images has become automatic on most modern computed tomography (CT) scanners, potentially increasing the workload of the reporting radiologists. It is not always clear if this increases diagnostic performance in all clinical tasks. PURPOSE: To assess detection performance using only coronal multiplanar reformations (MPR) when triaging patients for lung malignancies with CT compared to images in three orthogonal planes, and to evaluate performance comparison of novice and experienced readers. MATERIAL AND METHODS: Retrospective study of 63 patients with suspicion of lung cancer, scanned on 64-slice multidetector computed tomography (MDCT) with images reconstructed in three planes. Coronal images were presented to four readers, two novice and two experienced. Readers decided whether the patients were suspicious for malignant disease, and indicated their confidence on a five-point scale. Sensitivity and specificity on per-patient basis was calculated with regards to a reference standard of histological diagnosis, and compared with the original report using McNemar's test. Receiver operating characteristic (ROC) curves were plotted to compare the performance of the four readers, using the area under the curve (AUC) as figure of merit. RESULTS: No statistically significant difference of sensitivity and specificity was found for any of the readers when compared to the original reports. ROC analysis yielded AUCs in the range of 0.92-0.93 for all readers with no significant difference. Inter-rater agreement was substantial (kappa = 0.72). CONCLUSION: Sensitivity and specificity were comparable to diagnosis using images in three planes. No significant difference was found between experienced and novice readers.