Assessing Authorship Rates over Time in Original Radiologic Research Publications.

Background Previous studies have shown an increase in the number of authors on radiologic articles between 1950 and 2013, but the cause is unclear. Purpose To determine whether authorship rate in radiologic and general medical literature has continued to increase and to assess study variables associated with increased author numbers. Materials and Methods PubMed/Medline was searched for articles published between January 1998 and October 2022 in general radiology and general medical journals with the top five highest current impact factors. Generalized linear regression analysis was used to calculate adjusted incidence rate ratios (IRRs) for the numbers of authors. Wald tests assessed the associations between study variables and the numbers of authors per article. Combined mixed-effects regression analysis was performed to compare general medicine and radiology journals. Results There were 3381 original radiologic research articles that were analyzed. Authorship rate increased between 1998 (median, six authors; IQR, 4) and 2022 (median, 11 authors; IQR, 8). Later publication year was associated with more authors per article (IRR, 1.02; 95% CI: 1.01, 1.02; P < .001) after adjusting for publishing journal, continent of origin of first author, number of countries involved, PubMed/Medline original article type, study design, number of disciplines involved, multicenter or single-center study, reporting of a priori power calculation, reporting of obtaining informed consent, study sample size, and number of article pages. There were 1250 general medicine original research articles that were analyzed. Later publication year was also associated with more authors after adjustment for the study variables (IRR, 1.04; 95% CI: 1.03, 1.05; P < .001). There was a stronger increase in authorship by publication year for general medicine journals compared with radiology journals (IRR, 1.02; 95% CI: 1.01, 1.02; P < .001). Conclusion An increase in authorship rate was observed in the radiologic and general medical literature between 1998 and 2022, and the number of authors per article was independently associated with later year of publication. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Arrivé in this issue.

Erosive hand osteoarthritis and sarcopenia: data from Osteoarthritis Initiative cohort.

OBJECTIVES: There is no evidence linking specific osteoarthritis (OA) types, such as erosive hand OA (EHOA), with distant generalised changes in muscle composition (sarcopenia), which can potentially be modified. This study pioneers the exploration of the association between EHOA and sarcopenia, both of which are predominantly observed in the older adults. METHODS: Using the Osteoarthritis Initiative cohort, we selected hand OA (modified Kellgren and Lawrence (grade ≥2 in ≥1 hand joint) participants with radiographic central erosions in ≥1 joints (EHOA group) and propensity score-matched hand OA participants with no erosion (non-EHOA group). MRI biomarkers of thigh muscles were measured at baseline, year 2 and year 4 using a validated deep-learning algorithm. To adjust for 'local' effects of coexisting knee OA (KOA), participants were further stratified according to presence of radiographic KOA. The outcomes were the differences between EHOA and non-EHOA groups in the 4-year rate of change for both intramuscular adipose tissue (intra-MAT) deposition and contractile (non-fat) area of thigh muscles. RESULTS: After adjusting for potential confounders, 844 thighs were included (211 EHOA:633 non-EHOA; 67.1±7.5 years, female/male:2.9). Multilevel mixed-effect regression models showed that EHOA is associated a different 4-year rate of change in intra-MAT deposition (estimate, 95% CI: 71.5 mm2/4 years, 27.9 to 115.1) and contractile area (estimate, 95% CI: -1.8%/4 years, -2.6 to -1.0) of the Quadriceps. Stratified analyses showed that EHOA presence is associated with adverse changes in thigh muscle quality only in participants without KOA. CONCLUSIONS: EHOA is associated with longitudinal worsening of thigh muscle composition only in participants without concomitant KOA. Further research is needed to understand the systemic factors linking EHOA and sarcopenia, which unlike EHOA is modifiable through specific interventions.

Diagnostic radiology and its future: what do clinicians need and think?

OBJECTIVE: To investigate the view of clinicians on diagnostic radiology and its future. METHODS: Corresponding authors who published in the New England Journal of Medicine and the Lancet between 2010 and 2022 were asked to participate in a survey about diagnostic radiology and its future. RESULTS: The 331 participating clinicians gave a median score of 9 on a 0-10 point scale to the value of medical imaging in improving patient-relevant outcomes. 40.6%, 15.1%, 18.9%, and 9.5% of clinicians indicated to interpret more than half of radiography, ultrasonography, CT, and MRI examinations completely by themselves, without consulting a radiologist or reading the radiology report. Two hundred eighty-nine clinicians (87.3%) expected an increase in medical imaging utilization in the coming 10 years, whereas 9 clinicians (2.7%) expected a decrease. The need for diagnostic radiologists in the coming 10 years was expected to increase by 162 clinicians (48.9%), to remain stable by 85 clinicians (25.7%), and to decrease by 47 clinicians (14.2%). Two hundred clinicians (60.4%) expected that artificial intelligence (AI) will not make diagnostic radiologists redundant in the coming 10 years, whereas 54 clinicians (16.3%) thought the opposite. CONCLUSION: Clinicians who published in the New England Journal of Medicine or the Lancet attribute high value to medical imaging. They generally need radiologists for cross-sectional imaging interpretation, but for a considerable proportion of radiographs, their service is not required. Most expect medical imaging utilization and the need for diagnostic radiologists to increase in the foreseeable future, and do not expect AI to make radiologists redundant. CLINICAL RELEVANCE STATEMENT: The views of clinicians on radiology and its future may be used to determine how radiology should be practiced and be further developed. KEY POINTS: • Clinicians generally regard medical imaging as high-value care and expect to use more medical imaging in the future. • Clinicians mainly need radiologists for cross-sectional imaging interpretation while they interpret a substantial proportion of radiographs completely by themselves. • The majority of clinicians expects that the need for diagnostic radiologists will not decrease (half of them even expect that we need more) and does not believe that AI will replace radiologists.

Health Care Industry Payments to Editorial Board Members of Imaging-related Journals.

Background Editorial board members may be biased due to conflicts of interest (COIs). Purpose To investigate the frequency and amount of payments from industry to editorial board members of imaging-related journals and whether they are in agreement with the disclosure status as provided by the journal. Materials and Methods Editorial board members of 15 U.S.-based imaging-related journals who were listed in the Open Payments database (OPD) were included. Payments from industry to editorial board members in the year 2020 were extracted from the OPD and compared with publicly available COI disclosure data as provided by the journals. The Kruskal-Wallis test was used for statistical analysis. Results A total of 519 editorial board members were included, of whom 214 (41%) received industry payment and 305 (59%) did not. Payments to editorial board members by the industry ranged from $12.63 to $404 625.47 (median, $2397.48). Most payments from industry (59%) were ascribed to consulting. Editorial board members of the journals JACC: Cardiovascular Imaging and Journal of Vascular and Interventional Radiology received significantly higher amounts of individual payments from industry than editorial board members of most other journals. Financial COI disclosures were not publicly listed for 413 of the 519 (80%) editorial board members, 169 of whom received payments from industry according to the OPD. Of the 106 editorial board members whose financial COI disclosures were publicly listed, 36 (34%) were discordant with the OPD. Conclusion Payments from industry to Open Payments database-listed editorial board members of imaging-related journals are prevalent. Imaging-related journals often do not report or do not accurately report payments from industry to their editorial board members © RSNA, 2022.

Diagnostic performance of MRI in detecting locally recurrent soft tissue sarcoma: systematic review and meta-analysis.

OBJECTIVE: To systematically review the diagnostic criteria and performance of MRI in detecting locally recurrent soft tissue sarcoma. METHODS: Medline and Embase were searched for original studies on the diagnostic performance of MRI detecting locally recurrent soft tissue sarcoma. Study quality was assessed using QUADAS-2. Sensitivity and specificity were pooled using a bivariate random-effects model. RESULTS: Ten studies were included. There was a high risk of bias with respect to patient selection in 2 studies and a high risk of bias with respect to flow and timing in 8 studies. The presence of a mass yielded a pooled sensitivity of 80.9% and a pooled specificity of 77.0%. Hyperintensity at T2-weighted imaging yielded a pooled sensitivity of 82.4% and a pooled specificity of 11.0%. Hypo- or isointensity at T1-weighted imaging yielded a pooled sensitivity of 82.0% and a pooled specificity of 14.3%. Contrast enhancement images yielded a pooled sensitivity of 95.9% and a pooled specificity of 12.3%. Low signal mass on the apparent diffusion coefficient (ADC) map yielded a pooled sensitivity of 67.5% and a pooled specificity of 95.3%. Early and rapid arterial phase enhancement at dynamic contrast-enhanced (DCE) MRI yielded a pooled sensitivity of 91.3% and a pooled specificity of 84.7%. CONCLUSION: The presence of a mass appears a useful criterion to diagnose locally recurrent soft tissue sarcoma. Signal characteristics at standard T2- and T1-weighted imaging and contrast enhancement seem less useful because they lack specificity. Functional MRI techniques, including DWI with ADC mapping and DCE, may help to make a correct diagnosis. KEY POINTS: • The presence of a mass at MRI appears useful to diagnose locally recurrent soft tissue sarcoma, because both sensitivity and specificity are fairly high. • Signal characteristics at standard T2- and T1-weighted sequences and contrast enhancement suffer from poor specificity. • DWI with ADC mapping and DCE may help to make a correct diagnosis, but further research is needed to better understand the value of these functional MRI techniques.

Diagnostic performance of diffusion-weighted MR neurography as an adjunct to conventional MRI for the assessment of brachial plexus pathology.

OBJECTIVE: To investigate the diagnostic performance of diffusion-weighted (DW) MR neurography as an adjunct to conventional MRI for the assessment of brachial plexus pathology. METHODS: DW MR neurography scans (short tau inversion recovery fat suppression and b-value of 800 s/mm2) of 15 consecutive patients with and 45 randomly selected patients without brachial plexus abnormalities were independently and blindly reviewed by a 5th year radiology resident, a junior neuroradiologist, and a senior neuroradiologist. RESULTS: Median interpretation times ranged between 20 and 30 s. Interobserver agreement was substantial (κ coefficients of 0.715-0.739). For the 5th year radiology resident, sensitivity was 53.3% (95% CI, 30.1-75.2%) and specificity was 100% (95% CI, 92.1-100%). For the junior neuroradiologist, sensitivity was 66.7% (95% CI, 41.7-84.8%) and specificity was 100% (95% CI, 92.1-100%). For the senior neuroradiologist, sensitivity was 73.3% (95% CI, 48.1-89.1%) and specificity was 95.6% (95% CI, 85.2-98.8%). Traumatic injury, metastases, radiation-induced plexopathy, schwannoma, and inflammatory process of unknown cause could be detected by the majority of readers (100% detection rate for each disease entity by at least two readers). Neuralgic amyotrophy, iatrogenic injury after first rib resection, and cervical disc herniation causing root compression were not detected by the majority of readers (0% detection rate for each disease entity by at least two readers). CONCLUSION: DW MR neurography may be a useful adjunct when assessing for brachial plexus abnormalities, because interpretation time is relatively short and the majority of abnormalities can be detected. KEY POINTS: • DW MR neurography interpretation time of the brachial plexus is relatively short (median interpretation times of 20 to 30 s). • Interobserver agreement between three readers with different levels of experience is substantial (κ coefficients of 0.715 to 0.739). • DW MR neurography can detect brachial plexus abnormalities with moderate sensitivity (53.3 to 73.3%) and high specificity (95.6 to 100%).

Artificial intelligence software for diagnosing intracranial arterial occlusion in patients with acute ischemic stroke.

PURPOSE: To evaluate the diagnostic performance of AI software in diagnosing intracranial arterial occlusions in the proximal anterior circulation at CT angiography (CTA) and to compare it to manual reading performed in clinical practice. METHODS: Patients with acute ischemic stroke underwent CTA to detect arterial occlusion in the proximal anterior circulation. Retrospective review of CTA scans by two neuroradiologists served as reference standard. Sensitivity and specificity of AI software (StrokeViewer) were compared to those of manual reading using the McNemar test. The proportions of correctly detected occlusions in the distal internal carotid artery and/or M1 segment of the middle cerebral artery (large vessel occlusion [LVO]) and in the M2 segment of the middle cerebral artery (medium vessel occlusion [MeVO]) were calculated. RESULTS: Of the 474 patients, 75 (15.8%) had an arterial occlusion in the proximal anterior circulation according to the reference standard. Sensitivity of StrokeViewer software was not significantly different compared to that of manual reading (77.3% vs. 78.7%, P = 1.000). Specificity of StrokeViewer software was significantly lower than that of manual reading (88.5% vs. 100%, P < 0.001). StrokeViewer software correctly identified 40 of 42 LVOs (95.2%) and 18 of 33 MeVOs (54.5%). StrokeViewer software detected 8 of 16 (50%) intracranial arterial occlusions which were missed by manual reading. CONCLUSION: The current AI software detected intracranial arterial occlusion with moderate sensitivity and fairly high specificity. The AI software may detect additional occlusions which are missed by manual reading. As such, the use of AI software may be of value in clinical stroke care.

Diagnostic performance of MRI and CT in diagnosing necrotizing soft tissue infection: a systematic review.

OBJECTIVE: To systematically review the accuracy of MRI and CT in diagnosing necrotizing soft tissue infection (NSTI). METHODS: MEDLINE and Embase were searched for original studies which reported the diagnostic performance of MRI or CT in detecting NSTI. Individual study quality was assessed using the QUADAS-2 tool. Sensitivity and specificity of MRI and CT were calculated and, if supported by data from at least two studies, pooled using a bivariate random-effects model. RESULTS: Six MRI studies and 7 CT studies were included. There were no major concerns with regard to study quality and applicability. The included studies used multiple diagnostic criteria, with sensitivities and specificities of both MRI and CT ranging between 0 and 100%. T2 hyperintensity of deep fascia was the most commonly used diagnostic MRI criterion (5 studies), yielding a pooled sensitivity of 86.4% (95% confidence interval [CI] 76.1-92.7%) and a pooled specificity of 65.2% (95% CI 35.4-86.6%). Presence of gas was the most commonly used diagnostic CT criterion (3 studies), yielding a pooled sensitivity of 48.6% (95% CI 37.1-60.2%) and a pooled specificity of 93.2% (95% CI 73.3-98.5%). CONCLUSION: T2 hyperintensity of deep fascia at MRI has high sensitivity and moderate specificity in diagnosing NSTI. Presence of gas at CT has low sensitivity but high specificity. A combination of diagnostic criteria may improve diagnostic performance, but this needs further investigation.

CT in necrotizing soft tissue infection: diagnostic criteria and comparison with LRINEC score.

OBJECTIVE: To investigate which computed tomography (CT) criteria are most useful in diagnosing necrotizing soft tissue infection (NSTI) and how CT performs with respect to the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. METHODS: Patients who underwent CT for suspected NSTI were eligible for inclusion. LRINEC score was assessed. CT scans were evaluated for subcutaneous edema, fluid along superficial fascia, fluid along deep fascia, blurring of intermuscular fat planes, fluid collection, and air in the soft tissues. Surgical findings or clinical follow-up served as reference standard. RESULTS: Fourteen patients with NSTI and 34 patients with non-NSTI were included. LRINEC score was significantly higher in patients with NSTI (median of 7.5 vs. 6, p = 0.039). Fluid along the deep fascia was significantly more frequently present in patients with NSTI (46.2% vs. 5.9%, p = 0.001). In multiple logistic regression analysis, presence of fluid along the deep fascia was significantly associated with NSTI (odds ratio [OR] = 10.28, 95% CI: 1.57 to 67.18, p = 0.015), whereas the LRINEC score was not significantly associated with NSTI (OR = 1.27, 95% CI: 0.92 to 1.74, p = 0.146). Using presence of fluid along the deep fascia as diagnostic criterion for NSTI, sensitivity was 46.2% (95% CI, 23.2 to 70.9%) and specificity was 94.1% (95% CI, 80.9 to 98.4%). CONCLUSION: Fluid along the deep fascia was the only CT criterion which was significantly associated with NSTI and appeared more useful than the LRINEC score. In the right clinical setting, presence of this CT finding is highly suggestive for NSTI. Its absence, however, does not rule out NSTI. KEY POINTS: • The presence of fluid along the deep fascia at CT is highly suggestive for NSTI in suspected patients. Its absence, however, does not rule out NSTI. `• The use of fluid along the deep fascia as a criterion appears to be more useful than the LRINEC score in diagnosing NSTI.

Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis.

PURPOSE: To investigate, in a meta-analysis, the frequency of pulmonary embolism (PE) in patients with COVID-19 and whether D-dimer assessment may be useful to select patients for computed tomography pulmonary angiography (CTPA). METHODS: A systematic literature search was performed for original studies which reported the frequency of PE on CTPA in patients with COVID-19. The frequency of PE, the location of PE, and the standardized mean difference (SMD) of D-dimer levels between patients with and without PE were pooled by random effects models. RESULTS: Seventy-one studies were included. Pooled frequencies of PE in patients with COVID-19 at the emergency department (ED), general wards, and intensive care unit (ICU) were 17.9% (95% CI: 12.0-23.8%), 23.9% (95% CI: 15.2-32.7%), and 48.6% (95% CI: 41.0-56.1%), respectively. PE was more commonly located in peripheral than in main pulmonary arteries (pooled frequency of 65.3% [95% CI: 60.0-70.1%] vs. 32.9% [95% CI: 26.7-39.0%]; OR = 3.540 [95% CI: 2.308-5.431%]). Patients with PE had significantly higher D-dimer levels (pooled SMD of 1.096 [95% CI, 0.844-1.349]). D-dimer cutoff levels which have been used to identify patients with PE varied between 1000 and 4800 µg/L. CONCLUSION: The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries, which suggests local thrombosis to play a major role. D-dimer assessment may help to select patients with COVID-19 for CTPA, using D-dimer cutoff levels of at least 1000 µg/L. KEY POINTS: • The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. • PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries. • D-dimer levels are significantly higher in patients with COVID-19 who have PE.

Reliability and accuracy of 3-mm and 2-mm maximum intensity projection CT angiography to detect intracranial large vessel occlusion in patients with acute anterior cerebral circulation stroke.

PURPOSE: To evaluate the reliability and accuracy of thick maximum intensity projection (MIP) CTA images to detect large-vessel occlusion (LVO) in the anterior circulation in patients with acute stroke. METHODS: A total of 140 acute stroke patients (41 with and 99 without LVO) were evaluated by two neuroradiologists for LVO using axial 3-mm and 2-mm MIPs. RESULTS: Interobserver agreement was substantial using 3-mm MIPs (ĸ = 0.67) and almost perfect using 2-mm MIPs (ĸ = 0.82). Using 3-mm MIPs, sensitivities were 80.5% and 68.3%, with specificities of 98.0% and 96.0%. Using 2-mm MIPs, sensitivities were 82.9% and 73.2%, with specificities of 98.0% and 99.0%. Sensitivity and specificity of 3 mm and 2 mm MIPs were not statistically significantly different (P ≥ 0.375). The majority of LVOs in the distal intracranial carotid artery, and/or M1-segment were correctly identified: 96.0% (observer 1, 3-mm MIPs), 88.0% (observer 2, 3-mm MIPs), 96.0% (observer 1, 2-mm MIPs), and 96.0% (observer 2, 2 mm MIPs). Using 3-mm MIP images, observers 1 and 2 missed 7/15 (46.7%) and 9/15 (60.0%) of isolated M2-segment occlusions, respectively. Using 2-mm MIP images, observers 1 and 2 missed 5/15 (33.3%) and 6/15 (40.0%) of isolated M2-segment occlusions, respectively. CONCLUSION: Thick (2-3 mm) axial MIPs are not useful to detect proximal LVO in the anterior circulation.

A practical artificial intelligence system to diagnose COVID-19 using computed tomography: A multinational external validation study.

Computed tomography has gained an important role in the early diagnosis of COVID-19 pneumonia. However, the ever-increasing number of patients has overwhelmed radiology departments and has caused a reduction in quality of services. Artificial intelligence (AI) systems are the remedy to the current situation. However, the lack of application in real-world conditions has limited their consideration in clinical settings. This study validated a clinical AI system, COVIDiag, to aid radiologists in accurate and rapid evaluation of COVID-19 cases. 50 COVID-19 and 50 non-COVID-19 pneumonia cases were included from each of five centers: Argentina, Turkey, Iran, Netherlands, and Italy. The Dutch database included only 50 COVID-19 cases. The performance parameters namely sensitivity, specificity, accuracy, and area under the ROC curve (AUC) were computed for each database using COVIDiag model. The most common pattern of involvement among COVID-19 cases in all databases were bilateral involvement of upper and lower lobes with ground-glass opacities. The best sensitivity of 92.0% was recorded for the Italian database. The system achieved an AUC of 0.983, 0.914, 0.910, and 0.882 for Argentina, Turkey, Iran, and Italy, respectively. The model obtained a sensitivity of 86.0% for the Dutch database. COVIDiag model could diagnose COVID-19 pneumonia in all of cohorts with AUC of 0.921 (sensitivity, specificity, and accuracy of 88.8%, 87.0%, and 88.0%, respectively). Our study confirmed the accuracy of our proposed AI model (COVIDiag) in the diagnosis of COVID-19 cases. Furthermore, the system demonstrated consistent optimal diagnostic performance on multinational databases, which is critical to determine the generalizability and objectivity of the proposed COVIDiag model. Our results are significant as they provide real-world evidence regarding the applicability of AI systems in clinical medicine.

Dynamic susceptibility MR perfusion in diagnosing recurrent brain metastases after radiotherapy: A systematic review and meta-analysis.

BACKGROUND: The diagnostic performance of dynamic susceptibility contrast (DSC) MR perfusion in discriminating treatment-related changes from recurrence in irradiated brain metastases is currently not completely clear. PURPOSE: To systematically review the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy. STUDY TYPE: Systematic review and meta-analysis. SUBJECTS: MEDLINE and Embase were searched for original studies investigating the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy. Ten studies, comprising a total of more than 271 metastases, were included. FIELD STRENGTH/SEQUENCE: 1.5T or 3.0T, DSC MR perfusion. ASSESSMENT: Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool. STATISTICAL TESTS: Sensitivity and specificity were pooled with a bivariate random-effects model. Heterogeneity was assessed by a chi-squared test. Potential sources for heterogeneity were explored by subgroup analyses. RESULTS: In seven studies the diagnostic criterion was not prespecified. In eight studies it was unclear whether the reference standard was interpreted blindly. In seven studies it was unclear whether DSC MR perfusion results influenced which reference standard was used. Pooled sensitivity and specificity were 81.6% (95% confidence interval [CI]: 70.6%, 89.1%) and 80.6% (95% CI: 64.2%, 90.6%), respectively. There was significant heterogeneity in both sensitivity (P = 0.005) and specificity (P < 0.001). There were no significant differences in relative diagnostic odds ratio according to publication year, country of origin, study size, and DSC MR perfusion interpretation method (visual analysis of cerebral blood volume [CBV] map vs. relative CBV measurement) (P > 0.2). Due to insufficiently detailed reporting, it was not possible to investigate the influence of primary tumor origin on accuracy. DATA CONCLUSION: Our results suggest that the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy is fairly high. However, these findings should be interpreted with caution because of methodological quality concerns and heterogeneity between studies. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:524-534.

Medical disciplinary jurisprudence in alleged malpractice in radiology: 10-year Dutch experience.

PURPOSE: To systematically investigate the frequency and types of allegations related to radiology practice handled by the Dutch Medical Disciplinary Court in the past 10 years. METHODS: The Dutch Medical Disciplinary Court database was searched for verdicts concerning radiology practice between 2010 and 2019. The association between the number of verdicts and time (years) was assessed by Spearman's rho. Other data were summarized using descriptive statistics. RESULTS: There were 48 verdicts (mean 4.8 per year). There was no significant association between the number of verdicts and time (Spearman's rho < 0.001, p = 0.99). Most allegations were in breast imaging and musculoskeletal radiology (each 18.8%), followed by interventional radiology, head and neck imaging, and abdominal imaging (each 12.5%), neuroradiology and vascular imaging (each 10.4%), and chest imaging (4.2%). There were 46 allegations against radiologists (95.8%) and 2 against residents (4.2%). The most common allegation (37.5%) was error in diagnosis. In 20.8% of verdicts, the allegation was judged (partially) founded; disciplinary measures were warnings (n = 8) and reprimands (n = 2). An appeal was submitted by the patient in 11 cases and by the radiologist in 3 cases. All appeals by patients were rejected, whereas 2 of the 3 appeals by radiologists were granted and previously imposed disciplinary measures were reversed. CONCLUSION: Allegations against radiologists at the Dutch Medical Disciplinary Court are relatively few, their number has remained stable over the past 10 years, and a minority were judged to be (partially) founded. We can learn from the cases presented in this article, which may improve patient care. KEY POINTS: • The frequency of allegations against radiologists at the Dutch Medical Disciplinary Court is relatively low and has not exhibited any temporal change over the past 10 years. • These allegations reflect patient dissatisfaction, but this infrequently equals malpractice. • Knowledge of the circumstances under which these allegations have arisen may improve patient care.

Citation advantage for open access articles in European Radiology.

OBJECTIVE: To investigate whether there is a difference in citation rate between open access and subscription access articles in the field of radiology. METHODS: This study included consecutive original articles published online in European Radiology. Pearson χ2, Fisher's exact, and Mann-Whitney U tests were used to assess for any differences between open access and subscription access articles. Linear regression analysis was performed to determine the association between open access publishing and citation rate, adjusted for continent of origin, subspeciality, study findings in article title, number of authors, number of references, length of the article, and number of days the article has been online. In a secondary analysis, we determined the association between open access and number of downloads and shares. RESULTS: A total of 500 original studies, of which 86 (17.2%) were open access and 414 (82.8%) were subscription access articles, were included. Articles from Europe or North America were significantly more frequently published open access (p = 0.024 and p = 0.001), while articles with corresponding authors from Asia were significantly less frequently published open access (p < 0.001). In adjusted linear regression analysis, open access articles were significantly more frequently cited (beta coefficient = 3.588, 95% confidence interval [CI] 0.668 to 6.508, p = 0.016), downloaded (beta coefficient = 759.801, 95% CI 630.917 to 888.685, p < 0.001), and shared (beta coefficient = 0.748, 95% CI 0.124 to 1.372, p = 0.019) than subscription access articles (beta coefficient = 3.94, 95% confidence interval 1.44 to 6.44, p = 0.002). CONCLUSION: Open access publishing is independently associated with an increased citation, download, and share rate in the field of radiology. KEY POINTS: • A minority of articles are currently published open access in European Radiology. • European and North American authors tend to publish more open access articles than Asian authors. • Open access publishing seems to offer an independent advantage in terms of citation, download, and share rate.

Funding of Radiology Research: Frequency and Association With Citation Rate.

OBJECTIVE. The purpose of this study is to investigate the frequency of funded research published in major radiology journals and to determine whether funding is associated with the article citation rate. MATERIALS AND METHODS. A total of 600 consecutive original research articles published in three journals-AJR, Radiology, and European Radiology-were included. Linear regression analysis was performed to determine the association between research funding and the article citation rate, as adjusted for journal, continent of origin of the first author, subspecialty, study findings included in the article title, number of authors, immediate open access publication, and time since publication online. RESULTS. Funding was declared for 286 of 600 included articles (47.7%). Sources of funding were as follows: federal sponsorship (29.4%), a nonprofit foundation (16.4%), both federal sponsorship and a nonprofit foundation (16.1%), private industry (10.1%), intramural institutional research funding (9.8%), and other funding sources (18.2%). Articles with first authors whose continent of origin was Europe (p < 0.001), vascular and interventional radiology articles (p < 0.001), and articles published in AJR (p < 0.001) were significantly more frequently unfunded than funded. Articles published in Radiology were significantly more frequently funded (p < 0.001). The citation rate was not significantly different between funded and unfunded articles (p = 0.166). In adjusted linear regression analysis, funding was not significantly associated with the citation rate (ß coefficient, -0.31; 95% CI, -3.27 to 2.66; p = 0.838). CONCLUSION. Almost half of the research articles published in major radiology journals declared funding, a proportion that has increased compared with findings from previous studies (17% of articles in a study from 1994 and 26.9% of articles in a study of literature published between 2001 and 2010). Most funded articles received support from federal sponsors or nonprofit foundations, whereas only a minority of funded articles were supported by private industry. Funding was not associated with a higher citation rate.

Systematic Review and Meta-Analysis on the Value of Chest CT in the Diagnosis of Coronavirus Disease (COVID-19): Sol Scientiae, Illustra Nos.

OBJECTIVE. The purpose of this article is to systematically review and meta-analyze the diagnostic accuracy of chest CT in detecting coronavirus disease (COVID-19). MATERIALS AND METHODS. MEDLINE was systematically searched for publications on the diagnostic performance of chest CT in detecting COVID-19. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Meta-analysis was performed using a bivariate random-effects model. RESULTS. Six studies were included, comprising 1431 patients. All six studies included patients at high risk of COVID-19, and five studies explicitly reported that they included only symptomatic patients. Mean prevalence of COVID-19 was 47.9% (range, 27.6-85.4%). High or potential risk of bias was present throughout all QUADAS-2 domains in all six studies. Sensitivity ranged from 92.9% to 97.0%, and specificity ranged from 25.0% to 71.9%, with pooled estimates of 94.6% (95% CI, 91.9-96.4%) and 46.0% (95% CI, 31.9-60.7%), respectively. The included studies were statistically homogeneous in their estimates of sensitivity (p = 0.578) and statistically heterogeneous in their estimates of specificity (p < 0.001). CONCLUSION. Diagnostic accuracy studies on chest CT in COVID-19 suffer from methodologic quality issues. Chest CT appears to have a relatively high sensitivity in symptomatic patients at high risk of COVID-19, but it cannot exclude COVID-19. Specificity is poor. These data, along with other local factors such as COVID-19 prevalence, available real-time reverse transcriptase-polymerase chain reaction tests, staff, hospital, and CT scanning capacity, can be useful to healthcare professionals and policy makers to decide on the utility of chest CT for COVID-19 detection in the hospital setting.

Chest CT in COVID-19: What the Radiologist Needs to Know.

Chest CT has a potential role in the diagnosis, detection of complications, and prognostication of coronavirus disease 2019 (COVID-19). Implementation of appropriate precautionary safety measures, chest CT protocol optimization, and a standardized reporting system based on the pulmonary findings in this disease will enhance the clinical utility of chest CT. However, chest CT examinations may lead to both false-negative and false-positive results. Furthermore, the added value of chest CT in diagnostic decision making is dependent on several dynamic variables, most notably available resources (real-time reverse transcription-polymerase chain reaction [RT-PCR] tests, personal protective equipment, CT scanners, hospital and radiology personnel availability, and isolation room capacity) and the prevalence of both COVID-19 and other diseases with overlapping manifestations at chest CT. Chest CT is valuable to detect both alternative diagnoses and complications of COVID-19 (acute respiratory distress syndrome, pulmonary embolism, and heart failure), while its role for prognostication requires further investigation. The authors describe imaging and managing care of patients with COVID-19, with topics including (a) chest CT protocol, (b) chest CT findings of COVID-19 and its complications, (c) the diagnostic accuracy of chest CT and its role in diagnostic decision making and prognostication, and (d) reporting and communicating chest CT findings. The authors also review other specific topics, including the pathophysiology and clinical manifestations of COVID-19, the World Health Organization case definition, the value of performing RT-PCR tests, and the radiology department and personnel impact related to performing chest CT in COVID-19. ©RSNA, 2020.

Radiology workload in clinical implementation of thrombectomy for acute ischemic stroke: experience from The Netherlands.

PURPOSE: To investigate the number of acute stroke patients undergoing CT angiography (CTA) for suspected large vessel occlusion (LVO) and those eligible for thrombectomy in relation to the population. METHODS: Consecutive patients in a Western population who underwent CTA for suspected LVO of the proximal anterior circulation between January and August 2019 were included. The date and time of CTA and the number of patients eligible for thrombectomy were assessed. Our hospital's service area population was estimated using the Central Bureau for Statistics data. One-way analysis of variance with post-hoc tests and chi-squared tests were used for statistical analyses. RESULTS: Of 520 patients (49% males, mean age of 72 years) undergoing CTA, 84 (16.2%) were eligible for thrombectomy. Our hospital's service area population was estimated at 420,000. Therefore, 3.6 CTA scans were performed and 0.6 patients were eligible for thrombectomy per 100,000 people per week. The number of patients undergoing CTA and the number of patients eligible for thrombectomy both did not significantly differ between any days of the week (P > 0.05). A total of 236 (45%) and 284 patients (55%) underwent CTA during office and on-call hours, respectively. The percentage of patients eligible for thrombectomy did not significantly differ between office and on-call hours (P = 0.834). CONCLUSION: Our study estimated the number of stroke patients undergoing CTA for suspected LVO and those eligible for thrombectomy in relation to the population. Numbers were essentially the same throughout the week, and during office and on-call hours. Our data can be used to make adequate staffing plans.

Whole-body MRI for preventive health screening: A systematic review of the literature.

BACKGROUND: The yield of whole-body MRI for preventive health screening is currently not completely clear. PURPOSE: To systematically review the prevalence of whole-body MRI findings in asymptomatic subjects. STUDY TYPE: Systematic review and meta-analysis. SUBJECTS: MEDLINE and Embase were searched for original studies reporting whole-body MRI findings in asymptomatic adults without known disease, syndrome, or genetic mutation. Twelve studies, comprising 5373 asymptomatic subjects, were included. FIELD STRENGTH/SEQUENCE: 1.5T or 3.0T, whole-body MRI. ASSESSMENT: The whole-body MRI literature findings were extracted and reviewed by two radiologists in consensus for designation as either critical or indeterminate incidental finding. STATISTICAL TESTS: Data were pooled using a random effects model on the assumption that most subjects had ≤1 critical or indeterminate incidental finding. Heterogeneity was assessed by the I2 statistic. RESULTS: Pooled prevalences of critical and indeterminate incidental findings together and separately were 32.1% (95% confidence interval [CI]: 18.3%, 50.1%), 13.4% (95% CI: 9.0%, 19.5%), and 13.9% (95% CI: 5.4%, 31.3%), respectively. There was substantial between-study heterogeneity (I2 = 95.6-99.1). Pooled prevalence of critical and indeterminate incidental findings together was significantly higher in studies that included (cardio)vascular and/or colon MRI compared with studies that did not (49.7% [95% CI, 26.7%, 72.9%] vs. 23.0% [95% CI, 5.5%, 60.3%], P < 0.001). Pooled proportion of reported verified critical and indeterminate incidental findings was 12.6% (95% CI: 3.2%, 38.8%). Six studies reported false-positive findings, yielding a pooled proportion of 16.0% (95% CI: 1.9%, 65.8%). None of the included studies reported long-term (>5-year) verification of negative findings. Only one study reported false-negative findings, with a proportion of 2.0%. DATA CONCLUSION: Prevalence of critical and indeterminate incidental whole-body MRI findings in asymptomatic subjects is overall substantial and with variability dependent to some degree on the protocol. Verification data are lacking. The proportion of false-positive findings appears to be substantial. LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1489-1503.