The Roles of Ovarian-Adnexal Reporting and Data System US and Ovarian-Adnexal Reporting and Data System MRI in the Evaluation of Adnexal Lesions.

The Ovarian-Adnexal Reporting and Data System (O-RADS) is an evidence-based clinical support system for ovarian and adnexal lesion assessment in women of average risk. The system has both US and MRI components with separate but complementary lexicons and assessment categories to assign the risk of malignancy. US is an appropriate initial imaging modality, and O-RADS US can accurately help to characterize most adnexal lesions. MRI is a valuable adjunct imaging tool to US, and O-RADS MRI can help to both confirm a benign diagnosis and accurately stratify lesions that are at risk for malignancy. This article will review the O-RADS US and MRI systems, highlight their similarities and differences, and provide an overview of the interplay between the systems. When used together, the O-RADS US and MRI systems can help to accurately diagnose benign lesions, assess the risk of malignancy in lesions suspicious for malignancy, and triage patients for optimal management.

Three octave visible to mid-infrared supercontinuum generation seeded by multimode silica fiber pumped at 1064†nm.

Hyperspectral spectroscopy requires light sources with wide spectral ranges from the visible to the mid-infrared. Here, we demonstrate the first fiber-based mid-infrared supercontinuum covering three octaves of frequency by leveraging 1-µm laser technology. The process consists in spectral broadening of a 1064-nm pump toward 0.48-2.5 µm in a graded-index multimode fiber, followed by a fluoro-indate fiber used to reach deeper into the near infrared (4.3 µm). Finally, an arsenic selenide chalcogenide fiber allows us to reach the 6-µm wavelength region, providing a 0.75-6-µm supercontinuum. We illustrate the potential of this light source by recording mid-infrared absorption spectra of organic compounds.

Tunable four-wave mixing enabled by a self-phase modulation of chirped pulses.

We experimentally demonstrate how a concatenation of the standard and microstructure fiber segments permits adjusting the four-wave mixing sideband position over a large spectral range by varying the chirp of an input pulsed pump at a fixed wavelength in the presence of a self-phase modulation. The blue- and redshifted sidebands can stand aside over ∼200 nm and ∼450 nm from the pump, respectively, which agrees well with the numerical simulations. We validate our approach by showing the feasibility of CARS imaging.

Observation of Light Thermalization to Negative-Temperature Rayleigh-Jeans Equilibrium States in Multimode Optical Fibers.

Although the temperature of a thermodynamic system is usually believed to be a positive quantity, under particular conditions, negative-temperature equilibrium states are also possible. Negative-temperature equilibriums have been observed with spin systems, cold atoms in optical lattices, and two-dimensional quantum superfluids. Here we report the observation of Rayleigh-Jeans thermalization of light waves to negative-temperature equilibrium states. The optical wave relaxes to the equilibrium state through its propagation in a multimode optical fiber-i.e., in a conservative Hamiltonian system. The bounded energy spectrum of the optical fiber enables negative-temperature equilibriums with high energy levels (high-order fiber modes) more populated than low energy levels (low-order modes). Our experiments show that negative-temperature speckle beams are featured, in average, by a nonmonotonic radial intensity profile. The experimental results are in quantitative agreement with the Rayleigh-Jeans theory without free parameters. Bringing negative temperatures to the field of optics opens the door to the investigation of fundamental issues of negative-temperature states in a flexible experimental environment.

Placenta Accreta Spectrum Disorders: Update and Pictorial Review of the SAR-ESUR Joint Consensus Statement for MRI.

Placenta accreta spectrum (PAS) disorders are a major cause of maternal morbidity and mortality and are increasing in incidence owing to a rising rate of cesarean delivery. US is the primary imaging tool for evaluation of PAS disorders, which are most often diagnosed during routine early second-trimester US to assess fetal anatomy. MRI serves as a complementary modality, providing value when the diagnosis is equivocal at US and evaluating the extent and topography of myoinvasion for surgical planning in severe cases. While the definitive diagnosis is established by a combined clinical and histopathologic classification at delivery, accurate antenatal diagnosis and multidisciplinary management are critical to guide treatment and ensure optimal outcomes for these patients. Many MRI features of PAS disorders have been described in the literature. To standardize assessment at MRI, the Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) released a joint consensus statement to provide guidance for image acquisition, image interpretation, and reporting of PAS disorders. The authors review the role of imaging in diagnosis of PAS disorders, describe the SAR-ESUR consensus statement with a pictorial review of the seven major MRI features recommended for use in diagnosis of PAS disorders, and discuss management of these patients. Familiarity with the spectrum of MRI findings of PAS disorders will provide the radiologist with the tools needed to more accurately diagnose this disease and make a greater impact on the care of these patients. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Jha and Lyell in this issue.

Continuous spatial self-cleaning in GRIN multimode fiber for self-referenced multiplex CARS imaging.

We demonstrate how spatial beam self-cleaning and supercontinuum generation in graded-index multimode optical fibers can be directly applied in multiplex coherent anti-Stokes Raman Scattering (M-CARS) spectroscopy. Although supercontinuum generation causes pump depletion mainly in the center of the beam, the partial recovery of the pump brightness due to self-cleaning may enable self-referenced M-CARS, with no additional delay lines to synchronize pump and Stokes waves. As a proof-of-principle, we report examples of imaging of single chemical compounds and polystyrene beads. The new scheme paves the way towards simpler M-CARS systems based on multimode fiber sources.

Three-dimensional simulation of aesthetic outcome from breast-conserving surgery compared with viewing photographs or standard care: randomized clinical trial.

INTRODUCTION: Over half of women with surgically managed breast cancer in the UK undergo breast-conserving treatment (BCT). While photographs are shown prior to reconstructive surgery or complex oncoplastic procedures, standard practice prior to breast conservation is to simply describe the likely aesthetic changes. Patients have expressed the desire for more personalized information about likely appearance after surgery. The hypothesis was that viewing a three-dimensional (3D) simulation improves patients' confidence in knowing their likely aesthetic outcome after surgery. METHODS: A randomized, controlled trial of 117 women planning unilateral BCT was undertaken. The randomization was three-way: standard of care (verbal description alone, control group), viewing two-dimensional (2D) photographs, or viewing a 3D simulation before surgery. The primary endpoint was the comparison between groups' median answer on a visual analogue scale (VAS) for the question administered before surgery: 'How confident are you that you know how your breasts are likely to look after treatment?' RESULTS: The median VAS in the control group was 5.2 (i.q.r. 2.6-7.8); 8.0 (i.q.r. 5.7-8.7) for 2D photography, and 8.9 (i.q.r. 8.2-9.5) for 3D simulation. There was a significant difference between groups (P < 0.010) with post-hoc pairwise comparisons demonstrating a statistically significant difference between 3D simulation and both standard care and viewing 2D photographs (P < 0.010 and P = 0.012, respectively). CONCLUSION: This RCT has demonstrated that women who viewed an individualized 3D simulation of likely aesthetic outcome for BCT were more confident going into surgery than those who received standard care or who were shown 2D photographs of other women. The impact on longer-term satisfaction with outcome remains to be determined.Registration number: NCT03250260 (http://www.clinicaltrials.gov).

Most women with breast cancer are able to have an operation to remove the cancer while preserving the breast ('lumpectomy'). Whilst cancer control is the most important goal, appearance after surgery has been shown to affect long-term quality of life and is considered when planning treatment. Currently, surgeons simply describe the likely changes in appearance and, for more complex procedures, photographs of other women are shown. Patients themselves have indicated they would like more information regarding the likely changes to their breast after treatment. The authors have developed a way to simulate appearance following lumpectomy and radiotherapy using three-dimensional (3D) photographs. The study invited women undergoing lumpectomy to be assigned at random to one of three groups receiving standard care (discussion), a two-dimensional photograph, or the 3D simulation before their operation. The authors have demonstrated that showing a woman her simulation prior to surgery improves confidence going into treatment.

Optimum design of NOLM-driven mode-locked fiber lasers.

Most of the saturable absorbers commonly used to perform mode locking in laser cavities affect the trigger conditions of laser oscillation, which requires manually forcing the laser start-up by various means such as polarization controllers. We present a procedure for designing a laser cavity driven by a nonlinear optical loop mirror, which allows the laser to operate optimally without interfering with the oscillation triggering conditions, thus opening up possibilities for integration of this type of laser.

3D time-domain beam mapping for studying nonlinear dynamics in multimode optical fibers.

Characterization of the complex spatiotemporal dynamics of optical beam propagation in nonlinear multimode fibers requires the development of advanced measurement methods, capable of capturing the real-time evolution of beam images. We present a new space-time mapping technique, permitting the direct detection, with picosecond temporal resolution, of the intensity from repetitive laser pulses over a grid of spatial samples from a magnified image of the output beam. By using this time-resolved mapping, we provide, to the best of our knowledge, the first unambiguous experimental observation of instantaneous intrapulse nonlinear coupling processes among the modes of a graded index fiber.

Frequency-resolved spatial beam mapping in multimode fibers: application to mid-infrared supercontinuum generation.

We present a new, to the best of our knowledge, spatial-spectral mapping technique permitting measurement of the beam intensity at the output of a graded-index multimode fiber (GIMF) with sub-nanometric spectral resolution. We apply this method to visualize the fine structure of the beam shape of a sideband generated at 1870 nm by geometric parametric instability (GPI) in a GIMF. After spatial-spectral characterization, we amplify the GPI sideband with a thulium-doped fiber amplifier to obtain a microjoule-scale picosecond pump whose spectrum is finally broadened in a segment of InF3 optical fiber to achieve a supercontinuum ranging from 1.7 up to 3.4 µm.

Highly efficient few-mode spatial beam self-cleaning at 1.5µm.

We experimentally demonstrate that spatial beam self-cleaning can be highly efficient when obtained with a few-mode excitation in graded-index multimode optical fibers. By using 160 ps long, highly chirped (6 nm bandwidth at -3dB) optical pulses at 1562 nm, we demonstrate a one-decade reduction of the power threshold for spatial beam self-cleaning, with respect to previous experiments using pulses with laser wavelengths at 1030-1064 nm. Self-cleaned beams remain spatio-temporally stable for more than a decade of their peak power variation. The impact of input pulse temporal duration is also studied.

Classical Rayleigh-Jeans Condensation of Light Waves: Observation and Thermodynamic Characterization.

Theoretical studies on wave turbulence predict that a purely classical system of random waves can exhibit a process of condensation, which originates in the singularity of the Rayleigh-Jeans equilibrium distribution. We report the experimental observation of the transition to condensation of classical optical waves propagating in a multimode fiber, i.e., in a conservative Hamiltonian system without thermal heat bath. In contrast to conventional self-organization processes featured by the nonequilibrium formation of nonlinear coherent structures (solitons, vortices,…), here the self-organization originates in the equilibrium Rayleigh-Jeans statistics of classical waves. The experimental results show that the chemical potential reaches the lowest energy level at the transition to condensation, which leads to the macroscopic population of the fundamental mode of the optical fiber. The near-field and far-field measurements of the condensate fraction across the transition to condensation are in quantitative agreement with the Rayleigh-Jeans theory. The thermodynamics of classical wave condensation reveals that the heat capacity takes a constant value in the condensed state and tends to vanish above the transition in the normal state. Our experiments provide the first demonstration of a coherent phenomenon of self-organization that is exclusively driven by optical thermalization toward the Rayleigh-Jeans equilibrium.

Comparison of International Ovarian Tumor Analysis Simple Rules to Society of Radiologists in Ultrasound Guidelines for Detection of Malignancy in Adnexal Cysts.

OBJECTIVE. The purpose of this study was to evaluate the International Ovarian Tumor Analysis (IOTA) simple rules and the Society of Radiologists in Ultrasound (SRU) guidelines for detecting ovarian malignancy in a general population of women presenting to radiology departments with adnexal cystic lesions. MATERIALS AND METHODS. A retrospective multicenter study of ultrasound-detected adnexal cystic lesions with appropriate follow-up was conducted. Lesions were classified into benign, indeterminate, or malignant categories according to criteria based on the IOTA simple rules and the SRU guidelines. The prevalence of nonneoplastic cysts, neoplasms, and malignant tumors was calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, and ROC analysis for the diagnosis of malignancy was performed. RESULTS. A total of 697 women with 764 cystic lesions were included; 85.2% (651/764) of the lesions were nonneoplastic, 12.2% (93/764) were benign neoplasms, and 2.6% (20/764) were malignant neoplasms. Nearly all malignancies were classified into indeterminate and malignant categories. The prevalence of malignancy in the indeterminate category was 4.8% (7/145) (SRU) to 10.7% (7/65) (IOTA) and in the malignant category was 18.1% (13/72) (SRU) to 34.3% (12/35) (IOTA). Only one malignancy was misclassified as benign by the IOTA simple rules. The sensitivity of the IOTA simple rules for malignancy was 90.0%; specificity, 96.5%; PPV, 29.0%; NPV, 99.8%; and accuracy, 96.4%. The corresponding values for the SRU guidelines were 100%, 89.6%, 14.9%, 100%, and 89.8%. In ROC analysis, the IOTA simple rules were slightly more accurate than the SRU guidelines (AUC, 0.9805 versus 0.9713; p = 0.0003). CONCLUSION. Both imaging characterization methods were sensitive for identifying ovarian malignancies, but the PPV was low among women presenting to radiology departments, and the indeterminate classification harbored one-third of the total malignancies. Exploration of varied clinical settings and inclusion of secondary tests may help to refine these systems.

Wavefront shaping for optimized many-mode Kerr beam self-cleaning in graded-index multimode fiber.

We report experimental results, showing that the Kerr beam self-cleaning of many low-order modes in a graded-index multimode fiber can be controlled thanks to optimized wavefront shaping of the coherent excitation beam. Adaptive profiling of the transverse input phase was utilized for channeling the launched power towards a specific low-order fiber mode, by exploiting nonlinear coupling among all guided modes. Experiments were carried out with 7 ps pulses at 1064 nm injected in a five meters long multimode fiber operating in the normal dispersion regime. Optimized Kerr beam self-cleaning of five different LP modes is reported, with a power threshold that increases with the mode order.

Spatial beam self-cleaning and supercontinuum generation with Yb-doped multimode graded-index fiber taper based on accelerating self-imaging and dissipative landscape.

We experimentally demonstrate spatial beam self-cleaning and supercontinuum generation in a tapered Ytterbium-doped multimode optical fiber with parabolic core refractive index profile when 1064 nm pulsed beams propagate from wider (122 µm) into smaller (37 µm) diameter. In the passive mode, increasing the input beam peak power above 20 kW leads to a bell-shaped output beam profile. In the active configuration, gain from the pump laser diode permits to combine beam self-cleaning with supercontinuum generation between 520-2600 nm. By taper cut-back, we observed that the dissipative landscape, i.e., a non-monotonic variation of the average beam power along the MMF, leads to modal transitions of self-cleaned beams along the taper length.

Hydrodynamic 2D Turbulence and Spatial Beam Condensation in Multimode Optical Fibers.

We show that Kerr beam self-cleaning results from parametric mode mixing instabilities that generate a number of nonlinearly interacting modes with randomized phases-optical wave turbulence, followed by a direct and inverse cascade towards high mode numbers and condensation into the fundamental mode, respectively. This optical self-organization effect is an analogue to wave condensation that is well known in hydrodynamic 2D turbulence.

Interplay of Kerr and Raman beam cleaning with a multimode microstructure fiber.

We experimentally study the competition between Kerr beam self-cleaning and Raman beam cleanup in a multimode air-silica microstructure optical fiber. Kerr beam self-cleaning of the pump is observed for a certain range of input powers only. Stokes Raman beam generation and cleanup lead to both depletion and degradation of beam quality for the pump. The interplay of modal four-wave mixing and Raman scattering in the infrared domain leads to the generation of a multimode supercontinuum ranging from 500 nm up to 1800 nm.

Nonlinear beam self-cleaning in a coupled cavity composite laser based on multimode fiber.

We study a coupled cavity laser configuration where a passively Q-switched Nd:YAG microchip laser is combined with an extended cavity, including a doped multimode fiber. For appropriate coupling levels with the extended cavity, we observed that beam self-cleaning was induced in the multimode fiber thanks to nonlinear modal coupling, leading to a quasi-single mode laser output. In the regime of beam self-cleaning, laser pulse duration was reduced from 525 to 225 ps. We also observed a Q-switched mode-locked operation, where spatial self-cleaning was accompanied by far-detuned nonlinear frequency conversion in the active multimode fiber.

Kerr self-cleaning of pulsed beam in an ytterbium doped multimode fiber.

We experimentally demonstrate that Kerr spatial self-cleaning of a pulsed beam can be obtained in an amplifying multimode optical fiber. An input peak power of 500 W only was sufficient to produce a quasi-single-mode emission from the double-clad ytterbium doped multimode fiber (YMMF) with non-parabolic refractive index profile. We compare the self-cleaning behavior observed in the same fiber with loss and with gain. Laser gain introduces new opportunities to achieve spatial self-cleaning of light in multimode fibers at a relatively low power threshold.

Second harmonic generation in multimode graded-index fibers: spatial beam cleaning and multiple harmonic sideband generation.

We study experimentally and numerically the spectral and spatial dynamics of second harmonic generation in an all-optically poled multimode graded-index fiber. In contrast with poled single-mode fibers, in a multimode graded-index fiber a pump can generate a series of sharp sidebands around its second harmonic (SH) that originate from the sub-millimetric periodic evolution of the intensity at the fundamental frequency. The mutual interaction between the fundamental and its SH may also strongly affect the spatial distribution of guided light for both colors: when increasing the pump power, both fundamental and SH output beams evolve from disordered multimode speckles into two bell-shaped beams.