Comparison of Commercial AI Software Performance for Radiograph Lung Nodule Detection and Bone Age Prediction.

Background Multiple commercial artificial intelligence (AI) products exist for assessing radiographs; however, comparable performance data for these algorithms are limited. Purpose To perform an independent, stand-alone validation of commercially available AI products for bone age prediction based on hand radiographs and lung nodule detection on chest radiographs. Materials and Methods This retrospective study was carried out as part of Project AIR. Nine of 17 eligible AI products were validated on data from seven Dutch hospitals. For bone age prediction, the root mean square error (RMSE) and Pearson correlation coefficient were computed. The reference standard was set by three to five expert readers. For lung nodule detection, the area under the receiver operating characteristic curve (AUC) was computed. The reference standard was set by a chest radiologist based on CT. Randomized subsets of hand (n = 95) and chest (n = 140) radiographs were read by 14 and 17 human readers, respectively, with varying experience. Results Two bone age prediction algorithms were tested on hand radiographs (from January 2017 to January 2022) in 326 patients (mean age, 10 years ± 4 [SD]; 173 female patients) and correlated strongly with the reference standard (r = 0.99; P < .001 for both). No difference in RMSE was observed between algorithms (0.63 years [95% CI: 0.58, 0.69] and 0.57 years [95% CI: 0.52, 0.61]) and readers (0.68 years [95% CI: 0.64, 0.73]). Seven lung nodule detection algorithms were validated on chest radiographs (from January 2012 to May 2022) in 386 patients (mean age, 64 years ± 11; 223 male patients). Compared with readers (mean AUC, 0.81 [95% CI: 0.77, 0.85]), four algorithms performed better (AUC range, 0.86-0.93; P value range, <.001 to .04). Conclusions Compared with human readers, four AI algorithms for detecting lung nodules on chest radiographs showed improved performance, whereas the remaining algorithms tested showed no evidence of a difference in performance. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Omoumi and Richiardi in this issue.

Clinical use of artificial intelligence products for radiology in the Netherlands between 2020 and 2022.

OBJECTIVES: To map the clinical use of CE-marked artificial intelligence (AI)-based software in radiology departments in the Netherlands (n = 69) between 2020 and 2022. MATERIALS AND METHODS: Our AI network (one radiologist or AI representative per Dutch hospital organization) received a questionnaire each spring from 2020 to 2022 about AI product usage, financing, and obstacles to adoption. Products that were not listed on www.AIforRadiology.com by July 2022 were excluded from the analysis. RESULTS: The number of respondents was 43 in 2020, 36 in 2021, and 33 in 2022. The number of departments using AI has been growing steadily (2020: 14, 2021: 19, 2022: 23). The diversity (2020: 7, 2021: 18, 2022: 34) and the number of total implementations (2020: 19, 2021: 38, 2022: 68) has rapidly increased. Seven implementations were discontinued in 2022. Four hospital organizations said to use an AI platform or marketplace for the deployment of AI solutions. AI is mostly used to support chest CT (17), neuro CT (17), and musculoskeletal radiograph (12) analysis. The budget for AI was reserved in 13 of the responding centers in both 2021 and 2022. The most important obstacles to the adoption of AI remained costs and IT integration. Of the respondents, 28% stated that the implemented AI products realized health improvement and 32% assumed both health improvement and cost savings. CONCLUSION: The adoption of AI products in radiology departments in the Netherlands is showing common signs of a developing market. The major obstacles to reaching widespread adoption are a lack of financial resources and IT integration difficulties. CLINICAL RELEVANCE STATEMENT: The clinical impact of AI starts with its adoption in daily clinical practice. Increased transparency around AI products being adopted, implementation obstacles, and impact may inspire increased collaboration and improved decision-making around the implementation and financing of AI products. KEY POINTS: • The adoption of artificial intelligence products for radiology has steadily increased since 2020 to at least a third of the centers using AI in clinical practice in the Netherlands in 2022. • The main areas in which artificial intelligence products are used are lung nodule detection on CT, aided stroke diagnosis, and bone age prediction. • The majority of respondents experienced added value (decreased costs and/or improved outcomes) from using artificial intelligence-based software; however, major obstacles to adoption remain the costs and IT-related difficulties.

How does artificial intelligence in radiology improve efficiency and health outcomes?

Since the introduction of artificial intelligence (AI) in radiology, the promise has been that it will improve health care and reduce costs. Has AI been able to fulfill that promise? We describe six clinical objectives that can be supported by AI: a more efficient workflow, shortened reading time, a reduction of dose and contrast agents, earlier detection of disease, improved diagnostic accuracy and more personalized diagnostics. We provide examples of use cases including the available scientific evidence for its impact based on a hierarchical model of efficacy. We conclude that the market is still maturing and little is known about the contribution of AI to clinical practice. More real-world monitoring of AI in clinical practice is expected to aid in determining the value of AI and making informed decisions on development, procurement and reimbursement.

Artificial intelligence in radiology: 100 commercially available products and their scientific evidence.

OBJECTIVES: Map the current landscape of commercially available artificial intelligence (AI) software for radiology and review the availability of their scientific evidence. METHODS: We created an online overview of CE-marked AI software products for clinical radiology based on vendor-supplied product specifications ( www.aiforradiology.com ). Characteristics such as modality, subspeciality, main task, regulatory information, deployment, and pricing model were retrieved. We conducted an extensive literature search on the available scientific evidence of these products. Articles were classified according to a hierarchical model of efficacy. RESULTS: The overview included 100 CE-marked AI products from 54 different vendors. For 64/100 products, there was no peer-reviewed evidence of its efficacy. We observed a large heterogeneity in deployment methods, pricing models, and regulatory classes. The evidence of the remaining 36/100 products comprised 237 papers that predominantly (65%) focused on diagnostic accuracy (efficacy level 2). From the 100 products, 18 had evidence that regarded level 3 or higher, validating the (potential) impact on diagnostic thinking, patient outcome, or costs. Half of the available evidence (116/237) were independent and not (co-)funded or (co-)authored by the vendor. CONCLUSIONS: Even though the commercial supply of AI software in radiology already holds 100 CE-marked products, we conclude that the sector is still in its infancy. For 64/100 products, peer-reviewed evidence on its efficacy is lacking. Only 18/100 AI products have demonstrated (potential) clinical impact. KEY POINTS: • Artificial intelligence in radiology is still in its infancy even though already 100 CE-marked AI products are commercially available. • Only 36 out of 100 products have peer-reviewed evidence of which most studies demonstrate lower levels of efficacy. • There is a wide variety in deployment strategies, pricing models, and CE marking class of AI products for radiology.

Trends in frequency and outcome of high-risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study.

Between January 1, 2011, and December 31, 2016, we studied the incidence, management and outcome of high-risk breast lesions in a consecutive series of 376,519 screens of women who received biennial screening mammography. During the 6-year period covered by the study, the proportion of women who underwent core needle biopsy (CNB) after recall remained fairly stable, ranging from 39.2% to 48.1% (mean: 44.2%, 5,212/11,783), whereas the proportion of high-risk lesions at CNB (i.e., flat epithelial atypia, atypical ductal hyperplasia, lobular carcinoma in situ and papillary lesions) gradually increased from 3.2% (25/775) in 2011 to 9.5% (86/901) in 2016 (p < 0.001). The mean proportion of high-risk lesions at CNB that were subsequently treated with diagnostic surgical excision was 51.4% (169/329) and varied between 41.0% and 64.3% through the years, but the excision rate for high-risk lesions per 1,000 screens and per 100 recalls increased from 0.25 (2011) to 0.70 (2016; p < 0.001) and from 0.81 (2011) to 2.50 (2016; p < 0.001), respectively. The proportion of all diagnostic surgical excisions showing in situ or invasive breast cancer was 29.0% (49/169) and varied from 22.2% (8/36) in 2014 to 38.5% (5/13) in 2011. In conclusion, the proportion of high-risk lesions at CNB tripled in a 6-year period, with a concomitant increased excision rate for these lesions. As the proportion of surgical excisions showing in situ or invasive breast cancer did not increase, a rising number of screened women underwent invasive surgical excision with benign outcome.

Dedicated computer-aided detection software for automated 3D breast ultrasound; an efficient tool for the radiologist in supplemental screening of women with dense breasts.

OBJECTIVES: To determine the effect of computer-aided-detection (CAD) software for automated breast ultrasound (ABUS) on reading time (RT) and performance in screening for breast cancer. MATERIAL AND METHODS: Unilateral ABUS examinations of 120 women with dense breasts were randomly selected from a multi-institutional archive of cases including 30 malignant (20/30 mammography-occult), 30 benign, and 60 normal cases with histopathological verification or ≥ 2 years of negative follow-up. Eight radiologists read once with (CAD-ABUS) and once without CAD (ABUS) with > 8 weeks between reading sessions. Readers provided a BI-RADS score and a level of suspiciousness (0-100). RT, sensitivity, specificity, PPV and area under the curve (AUC) were compared. RESULTS: Average RT was significantly shorter using CAD-ABUS (133.4 s/case, 95% CI 129.2-137.6) compared with ABUS (158.3 s/case, 95% CI 153.0-163.3) (p < 0.001). Sensitivity was 0.84 for CAD-ABUS (95% CI 0.79-0.89) and ABUS (95% CI 0.78-0.88) (p = 0.90). Three out of eight readers showed significantly higher specificity using CAD. Pooled specificity (0.71, 95% CI 0.68-0.75 vs. 0.67, 95% CI 0.64-0.70, p = 0.08) and PPV (0.50, 95% CI 0.45-0.55 vs. 0.44, 95% CI 0.39-0.49, p = 0.07) were higher in CAD-ABUS vs. ABUS, respectively, albeit not significantly. Pooled AUC for CAD-ABUS was comparable with ABUS (0.82 vs. 0.83, p = 0.53, respectively). CONCLUSION: CAD software for ABUS may decrease the time needed to screen for breast cancer without compromising the screening performance of radiologists. KEY POINTS: • ABUS with CAD software may speed up reading time without compromising radiologists' accuracy. • CAD software for ABUS might prevent non-detection of malignant breast lesions by radiologists. • Radiologists reading ABUS with CAD software might improve their specificity without losing sensitivity.

Surveillance of Women with the BRCA1 or BRCA2 Mutation by Using Biannual Automated Breast US, MR Imaging, and Mammography.

Purpose To evaluate a multimodal surveillance regimen including yearly full-field digital (FFD) mammography, dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) imaging, and biannual automated breast (AB) ultrasonography (US) in women with BRCA1 and BRCA2 mutations. Materials and Methods This prospective multicenter trial enrolled 296 carriers of the BRCA mutation (153 BRCA1 and 128 BRCA2 carriers, and 15 women with first-degree untested relatives) between September 2010 and November 2012, with follow-up until November 2015. Participants underwent 2 years of intensified surveillance including biannual AB US, and routine yearly DCE MR imaging and FFD mammography. The surveillance performance for each modality and possible combinations were determined. Results Breast cancer was screening-detected in 16 women (age range, 33-58 years). Three interval cancers were detected by self-examination, all in carriers of the BRCA1 mutation under age 43 years. One cancer was detected in a carrier of the BRCA1 mutation with a palpable abnormality in the contralateral breast. One incidental breast cancer was detected in a prophylactic mastectomy specimen. Respectively, sensitivity of DCE MR imaging, FFD mammography, and AB US was 68.1% (14 of 21; 95% confidence interval [CI]: 42.9%, 85.8%), 37.2% (eight of 21; 95% CI: 19.8%, 58.7%), and 32.1% (seven of 21; 95% CI: 16.1%, 53.8%); specificity was 95.0% (643 of 682; 95% CI: 92.7%, 96.5%), 98.1% (638 of 652; 95% CI: 96.7%, 98.9%), and 95.1% (1030 of 1088; 95% CI: 93.5%, 96.3%); cancer detection rate was 2.0% (14 of 702), 1.2% (eight of 671), and 1.0% (seven of 711) per 100 women-years; and positive predictive value was 25.2% (14 of 54), 33.7% (nine of 23), and 9.5% (seven of 68). DCE MR imaging and FFD mammography combined yielded the highest sensitivity of 76.3% (16 of 21; 95% CI: 53.8%, 89.9%) and specificity of 93.6% (643 of 691; 95% CI: 91.3%, 95.3%). AB US did not depict additional cancers. FFD mammography yielded no additional cancers in women younger than 43 years, the mean age at diagnosis. In carriers of the BRCA2 mutation, sensitivity of FFD mammography with DCE MR imaging surveillance was 90.9% (10 of 11; 95% CI: 72.7%, 100%) and 60.0% (six of 10; 95% CI: 30.0%, 90.0%) in carriers of the BRCA1 mutation because of the high interval cancer rate in carriers of the BRCA1 mutation. Conclusion AB US may not be of added value to yearly FFD mammography and DCE MR imaging surveillance of carriers of the BRCA mutation. Study results suggest that carriers of the BRCA mutation younger than 40 years may not benefit from FFD mammography surveillance in addition to DCE MR imaging. © RSNA, 2017 Online supplemental material is available for this article.

Trends and patterns of computed tomography scan use among children in The Netherlands: 1990-2012.

OBJECTIVE: To evaluate trends and patterns in CT usage among children (aged 0-17 years) in The Netherlands during the period 1990-2012. METHODS: Lists of electronically archived paediatric CT scans were requested from the Radiology Information Systems (RIS) of Dutch hospitals which reported >10 paediatric CT scans annually in a survey conducted in 2010. Data included patient identification, birth date, gender, scan date and body part scanned. For non-participating hospitals and for years prior to electronic archiving in some participating hospitals, data were imputed by calendar year and hospital type (academic, general with <500 beds, general with ≥ 500 beds). RESULTS: Based on 236,066 CT scans among 146,368 patients performed between 1990 and 2012, estimated annual numbers of paediatric CT scans in The Netherlands increased from 7,731 in 1990 to 26,023 in 2012. More than 70 % of all scans were of the head and neck. During the last decade, substantial increases of more than 5 % per year were observed in general hospitals with fewer than 500 beds and among children aged 10 years or older. CONCLUSION: The estimated number of paediatric CT scans has more than tripled in The Netherlands during the last two decades. KEY POINTS: • Paediatric CT in The Netherlands has tripled during the last two decades. • The number of paediatric CTs increased through 2012 in general hospitals. • Paediatric CTs continued to increase among children aged 10 years or older.

Tourniquet Does Not Affect Long-term Outcomes in Minor Hand Surgery: A Randomized Controlled Trial.

Surgeons often prefer to use a tourniquet during minor procedures, such as carpal tunnel release (CTR) or trigger finger release (TFR). Besides the possible discomfort for the patient, the effect of tourniquet use on long-term results and complications is unknown. Our primary aim was to compare the patient-reported outcomes 1 year after CTR or TFR under local anesthesia with or without tourniquet. Secondary outcomes included satisfaction, sonographically estimated scar tissue thickness after CTR' and postoperative complications. Methods: Between May 2019 and May 2020, 163 patients planned for open CTR or TFR under local anesthesia were included. Before surgery, and at 3, 6, and 12 months postoperatively, Quick Disabilities of the Arm, Shoulder and Hand and Boston Carpal Tunnel questionnaires were administered, and complications were noted. At 6 months postoperatively, an ultrasound was conducted to determine the thickness of scar tissue in the region of median nerve. Results: A total of 142 patients (51 men [38%]) were included. The Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Boston Carpal Tunnel Questionnaire scores improved significantly in both groups during follow-up, wherein most improvements were seen in the first 3 months. No difference in clinical outcome and scar tissue formation was found between the two groups after 12 months. The complication rate was comparable between both groups. Thirty-two (24%) patients had at least one complication, none needed surgical interventions, and no recurrent symptoms were seen. Conclusions: Our study shows similar long-term clinical outcomes, formation of scar tissue, and complication rates for patients undergoing CTR or TFR with or without a tourniquet. Tourniquet usage should be based on shared decision-making.

Complications of percutaneous transhepatic cholangiography and biliary drainage, a multicenter observational study.

OBJECTIVES: Over 2500 percutaneous transhepatic cholangiography and biliary drainage (PTCD) procedures are yearly performed in the Netherlands. Most interventions are performed for treatment of biliary obstruction following unsuccessful endoscopic biliary cannulation. Our aim was to evaluate complication rates and risk factors for complications in PTCD patients after failed ERCP. METHODS: We performed an observational study collecting data from a cohort that was subjected to PTCD during a 5-year period in one academic and four teaching hospitals. Primary objective was the development of infectious (sepsis, cholangitis, abscess, or cholecystitis) and non-infectious complications (bile leakage, severe hemorrhage, etc.) and mortality within 30 days of the procedure. Subsequently, risk factors for complications and mortality were analyzed with a multilevel logistic regression analysis. RESULTS: A total of 331 patients underwent PTCD of whom 205 (61.9%) developed PTCD-related complications. Of the 224 patients without a pre-existent infection, 91 (40.6%) developed infectious complications, i.e., cholangitis in 26.3%, sepsis in 24.6%, abscess formation in 2.7%, and cholecystitis in 1.3%. Non-infectious complications developed in 114 of 331 patients (34.4%). 30-day mortality was 17.2% (N = 57). Risk factors for infectious complications included internal drainage and drain obstruction, while multiple re-interventions were a risk factor for non-infectious complications. CONCLUSION: Both infectious and non-infectious complications are frequent after PTCD, most often due to biliary drain obstruction.

Cost-effectiveness of artificial intelligence aided vessel occlusion detection in acute stroke: an early health technology assessment.

BACKGROUND: Limited evidence is available on the clinical impact of artificial intelligence (AI) in radiology. Early health technology assessment (HTA) is a methodology to assess the potential value of an innovation at an early stage. We use early HTA to evaluate the potential value of AI software in radiology. As a use-case, we evaluate the cost-effectiveness of AI software aiding the detection of intracranial large vessel occlusions (LVO) in stroke in comparison to standard care. We used a Markov based model from a societal perspective of the United Kingdom predominantly using stroke registry data complemented with pooled outcome data from large, randomized trials. Different scenarios were explored by varying missed diagnoses of LVOs, AI costs and AI performance. Other input parameters were varied to demonstrate model robustness. Results were reported in expected incremental costs (IC) and effects (IE) expressed in quality adjusted life years (QALYs). RESULTS: Applying the base case assumptions (6% missed diagnoses of LVOs by clinicians, $40 per AI analysis, 50% reduction of missed LVOs by AI), resulted in cost-savings and incremental QALYs over the projected lifetime (IC: - $156, - 0.23%; IE: + 0.01 QALYs, + 0.07%) per suspected ischemic stroke patient. For each yearly cohort of patients in the UK this translates to a total cost saving of $11 million. CONCLUSIONS: AI tools for LVO detection in emergency care have the potential to improve healthcare outcomes and save costs. We demonstrate how early HTA may be applied for the evaluation of clinically applied AI software for radiology.

Intratendinous ganglion of the long head of the biceps tendon: US and MRI features (2010: 9b). Intratendinous ganglion.

We present a case report and literature review of the ultrasound (US) and magentic resonance imaging (MRI) features of an intratendinous ganglion originating from the long head of the biceps tendon. Intratendinous ganglia are very rare entities and intratendinous ganglion of the long head of the biceps tendon has only been described once. To the best of our knowledge, this is the first case report presenting the sonographic features of an intratendinous ganglion originating from the long head of the biceps tendon.

Detection of rotator cuff tears: the value of MRI following ultrasound.

OBJECTIVE: To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and full-thickness rotator cuff tears (RCT). METHODS: In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings. RESULTS: Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5 months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9 partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p = 0.15). CONCLUSIONS: MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant.

Ultrasound detection of rotator cuff tears: observer agreement related to increasing experience.

OBJECTIVE: Ultrasound of the rotator cuff is considered to be operator-dependent with its accuracy being related to the operator's level of experience. This study was conducted to test the hypothesis that ultrasound performed by operators with different levels of experience will give nonreproducible results. SUBJECTS AND METHODS: Two radiologists, one general radiologist with no experience in musculoskeletal ultrasound and one experienced musculoskeletal radiologist, independently performed ultrasound on 200 shoulders in 183 consecutive patients. Agreement was assessed. Cohen's kappa values with standard errors were calculated. In 71 patients the ultrasound findings could be related to surgical findings. RESULTS: The diagnoses of full-thickness and partial-thickness rotator cuff tears were made with agreements of 98% (κ-value: 0.95 [standard error, 0.03]) and 90% (κ-value: 0.79 [0.05]), respectively. Agreement for full-thickness tears was constant; the agreement for partial-thickness tears improved from 80% to 98% in the last quarter of the study period. Based on the 71 patients who underwent shoulder surgery, sensitivity, specificity, and accuracy for detecting full-thickness tears by the experienced and general radiologists were 94%, 94%, and 94% and 89%, 91%, and 90%, respectively. Sensitivity, specificity, and accuracy for detecting partial-thickness tears by the experienced and general radiologists were 100%, 32%, and 57% and 84%, 35%, and 53%, respectively. CONCLUSION: The hypothesis that ultrasound of the shoulder is operator-dependent and related to experience was refuted. In this study, there was excellent agreement for the detection of rotator cuff tears, which only slightly improved with the increasing experience of the general radiologist. Accuracy of rotator cuff tear detection was high and in accordance with the results in the literature.

Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.

BACKGROUND: Little is known about the efficacy and safety of renal artery stenting in patients with atherosclerotic renal artery stenosis (ARAS) and impaired renal function. OBJECTIVE: To determine the efficacy and safety of stent placement in patients with ARAS and impaired renal function. DESIGN: Randomized clinical trial. Randomization was centralized and computer generated, and allocation was assigned by e-mail. Patients, providers, and persons who assessed outcomes were not blinded to treatment assignment. SETTING: 10 European medical centers. PARTICIPANTS: 140 patients with creatinine clearance less than 80 mL/min per 1.73 m(2) and ARAS of 50% or greater. INTERVENTION: Stent placement and medical treatment (64 patients) or medical treatment only (76 patients). Medical treatment consisted of antihypertensive treatment, a statin, and aspirin. MEASUREMENTS: The primary end point was a 20% or greater decrease in creatinine clearance. Secondary end points included safety and cardiovascular morbidity and mortality. RESULTS: Forty-six of 64 patients assigned to stent placement had the procedure. Ten of the 64 patients (16%) in the stent placement group and 16 patients (22%) in the medication group reached the primary end point (hazard ratio, 0.73 [95% CI, 0.33 to 1.61]). Serious complications occurred in the stent group, including 2 procedure-related deaths (3%), 1 late death secondary to an infected hematoma, and 1 patient who required dialysis secondary to cholesterol embolism. The groups did not differ for other secondary end points. LIMITATION: Many patients were falsely identified as having renal artery stenosis greater than 50% by noninvasive imaging and did not ultimately require stenting. CONCLUSION: Stent placement with medical treatment had no clear effect on progression of impaired renal function but led to a small number of significant procedure-related complications. The study findings favor a conservative approach to patients with ARAS, focused on cardiovascular risk factor management and avoiding stenting.

Unsuspected sonographic findings in patients with posttraumatic shoulder complaints.

PURPOSE: To prospectively assess the frequency of abnormal sonographic findings in patients with posttraumatic shoulder pain and/or disability in whom ultrasound (US) was not considered and to assess the effect of sonographic findings on working diagnosis and therapeutic strategy, to analyze the possible role of US in the diagnostic workup of these patients. METHODS: A survey was performed under general practitioners and orthopedic surgeons. They were requested to refer patients with persistent posttraumatic complaints for an US examination of the shoulder and to fill out a questionnaire concerning working diagnosis and therapy. In 50 patients examinations were performed separately by two radiologists. Findings were confirmed with additional radiographs and/or MRI and/or surgery. Four weeks after the US examination, the survey was repeated to inquire about changes in diagnosis and/or treatment that resulted from US. RESULTS: US showed relevant pathology in 45 (90%) of 50 patients, a proximal humerus fracture in 25 (50%) patients, and a rotator cuff tear in 43 (86%) patients. Twenty-three (92%) fractures were accompanied by a rotator cuff tear, and 23 (54%) rotator cuff tears were accompanied by a fracture. Ten fractures were initially missed radiographically. US findings changed the working diagnosis and therapeutic strategy in 37 (74%) and 26 (52%) patients, respectively. CONCLUSION: In patients with posttraumatic shoulder complaints, US showed a high rate (90%) of relevant pathology. This changed the initial working diagnosis in 74% of the patients and the therapeutic strategy in more than half of the patients. Active referral for US examination may identify these abnormalities in an earlier phase and improve clinical outcome.

Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography.

To assess the variability in accuracy of contrast media introduction, leakage, required time and patient discomfort in four different centres, each using a different image-guided glenohumeral injection technique. Each centre included 25 consecutive patients. The ultrasound-guided anterior (USa) and posterior approach (USp), fluoroscopic-guided anterior (FLa) and posterior (FLp) approach were used. Number of injection attempts, effect of contrast leakage on diagnostic quality, and total room, radiologist and procedure times were measured. Pain was documented with a visual analogue scale (VAS) pain score. Access to the joint was achieved in all patients. A successful first attempt significantly occurred more often with US (94%) than with fluoroscopic guidance (72%). Leakage of contrast medium did not cause interpretative difficulties. With US guidance mean room, procedure and radiologist times were significantly shorter (p < 0.001). The USa approach was rated with the lowest pre- and post-injection VAS scores. The four image-guided injection techniques are successful in injection of contrast material into the glenohumeral joint. US-guided injections and especially the anterior approach are significantly less time consuming, more successful on the first attempt, cause less patient discomfort and obviate the need for radiation and iodine contrast.

Embolization as treatment of choice for bleeding peptic ulcers in high-risk patients.

BACKGROUND/AIM: Peptic ulcers are the most common cause of acute upper gastrointestinal bleedings in the digestive tract. Most patients are poor surgical candidates. The aim was to describe the efficacy of embolization as the treatment of choice for bleeding peptic ulcers in high-risk patients when endoscopic treatment failed. METHODS: All patients who underwent a selective embolization of branches of the superior mesenteric artery and/or branches of the gastroduodenal artery for a bleeding peptic ulcer in the period January 2004 until December 2007 were included in this retrospective descriptive study. We examined the known risk factors for surgery and mortality in upper gastrointestinal bleeding due to peptic ulcers and describe the clinical course and outcome. Primary endpoints were the primary technical success and the clinical success rates. The secondary endpoint was the 30-day mortality. RESULTS: 16 patients were included. All patients had at least two risk factors for surgery and mortality. The clinical success rate was 81% (13/16). The first embolization failed in 3 patients, 1 was successful re-embolized and 2 were operated upon without re-embolization. The primary technical success rate, i.e. bleedings controlled by radiologic intervention, was 88% (14/16). 6 patients died due to non-embolization-related problems; 5 of them developed upper gastrointestinal bleeding during a stay in the hospital. CONCLUSION: Embolization was a successful, minimal invasive alternative for surgical intervention in high-risk patients with upper gastrointestinal bleeding after failure of endoscopic treatment.

Ultrasound of the rotator cuff with MRI and anatomic correlation.

Magnetic resonance imaging and high-resolution ultrasound (US) are frequently used for the detection of rotator cuff tears. The diagnostic yield of US is influenced by several factors as technique, knowledge of the imaging characteristics of anatomic and pathologic findings and of pitfalls. The purpose of this article is to illustrates that the standardized high-resolution US examination of the shoulder covers the entire rotator cuff and correlates with MR imaging and anatomic sections.

Segmentation and three-dimensional reconstruction of lesions using the automated breast volume scanner (ABVS).

BACKGROUND: Ultrasound is an effective tool for breast cancer diagnosis. However, its relatively low image quality makes small lesion analysis challenging. This promotes the development of tools to help clinicians in the diagnosis. METHODS: We propose a method for segmentation and three-dimensional (3D) reconstruction of lesions from ultrasound images acquired using the automated breast volume scanner (ABVS). Segmentation and reconstruction algorithms are applied to obtain the lesion's 3D geometry. A total of 140 artificial lesions with different sizes and shapes are reconstructed in gelatin-based phantoms and biological tissue. Dice similarity coefficient (DSC) is used to evaluate the reconstructed shapes. The algorithm is tested using a human breast phantom and clinical data from six patients. RESULTS: DSC values are 0.86 ± 0.06 and 0.86 ± 0.05 for gelatin-based phantoms and biological tissue, respectively. The results are validated by a specialized clinician. CONCLUSIONS: Evaluation metrics show that the algorithm accurately segments and reconstructs various lesions. Copyright © 2016 John Wiley & Sons, Ltd.