From Data to Value: How Artificial Intelligence Augments the Radiology Business to Create Value.

The radiology practice has access to a wealth of data in the radiologist information system, dictation reports, and electronic health records. Although many artificial intelligence applications in radiology have focused on computer vision and the interpretive use cases, many opportunities exist to enhance the radiologist's value proposition through business analytics. This article explores how AI lends an analytical lens to the radiology practice to create value.

Radiomic features from MRI distinguish myxomas from myxofibrosarcomas.

BACKGROUND: Myxoid tumors pose diagnostic challenges for radiologists and pathologists. All myxoid tumors can be differentiated from each other using fluorescent in-situ hybridization (FISH) or immunohistochemical markers, except for myxomas and myxofibrosarcomas. Myxomas and myxofibrosarcomas are rare tumors. Myxomas are benign and histologically bland, whereas myxofibrosarcomas are malignant and histologically heterogenous. Because of the histological heterogeneity, low grade myxofibrosarcomas may be mistaken for myxomas on core needle biopsies. We evaluated the performance of T1-weighted signal intensity (T1SI), tumor volume, and radiomic features extracted from magnetic resonance imaging (MRI) to differentiate myxomas from myxofibrosarcomas. METHODS: The MRIs of 56 patients (29 with myxomas, 27 with myxofibrosarcomas) were analyzed. We extracted 89 radiomic features. Random forests based classifiers using the T1SI, volume features, and radiomic features were used to differentiate myxomas from myxofibrosarcomas. The classifiers were validated using a leave-one-out cross-validation. The performances of the classifiers were then compared. RESULTS: Myxomas had lower normalized T1SI than myxofibrosaromas (p = 0.006) and the AUC using the T1SI was 0.713. However, the classification model using radiomic features had an AUC of 0.885 (accuracy = 0.839, sensitivity = 0.852, specificity = 0.828), and outperformed the classification models using T1SI (AUC = 0.713) and tumor volume (AUC = 0.838). The classification model using radiomic features was significantly better than the classifier using T1SI values (p = 0.039). CONCLUSIONS: Myxofibrosarcomas are on average higher in T1-weighted signal intensity than myxomas. Myxofibrosarcomas are larger and have shape differences compared to myxomas. Radiomic features performed best for differentiating myxomas from myxofibrosarcomas compared to T1-weighted signal intensity and tumor volume features.

Integrating Wikipedia Articles and Images into an Information Resource for Radiology Patients.

Wikipedia-an open-access online encyclopedia-contains a large number of medically relevant articles and images that may help supplement glossaries of radiology terms. We sought to determine the extent to which concepts from a large online radiology glossary developed as part of the Patient-Oriented Radiology Reporter (PORTER) initiative could be mapped to relevant Wikipedia web pages and images using automated or semi-automated approaches. The glossary included 4090 concepts with their definitions; the concept's preferred name and lexical variants, such as plurals, adjectival forms, synonyms, and abbreviations, yielded a total of 13,030 terms. Of the 4090 concepts, 3063 (74.9%) had a corresponding English-language Wikipedia page identified by automated search with subsequent manual review. We applied the MediaWiki application programming interface (API) to generate web-service calls to identify the images from each concept's corresponding Wikipedia page; three reviewers selected relevant images to associate with the glossary's concepts. Licensing terms for the images were reviewed. For 800 randomly sampled concepts that had associated Wikipedia pages, 362 distinct images were identified from the MediaWiki library and matched to 404 concepts (51%). Three images (1%) had unspecified licensing terms; the rest were in the public domain or available via a Creative Commons license. Wikipedia and the MediaWiki library offer a large collection of medical articles and images that can be incorporated into an online lay-language glossary of radiology terms though a semi-automated approach.

Congenital absence of the bilateral long heads of the biceps brachii tendons in a patient with Silver-Russell syndrome.

Agenesis of the long head of biceps tendon (LHBT) is a congenital anomaly not commonly reported in the literature, and bilateral absence of the LHBT is even more rare. Most cases of LHBT agenesis are found incidentally at arthroscopy or are diagnosed by magnetic resonance imaging after a history of insidious shoulder pain or anterior shoulder instability. We present the magnetic resonance imaging findings of bilateral congenital absence of the LHBT in a 37-year-old male with Silver-Russell syndrome who presented with progressive, bilateral anterior shoulder pain after failing conservative treatment strategies. This case report describes bilateral agenesis of the LHBT in association with a congenital growth disorder that has not been described previously in the literature. We provide a description of key MR imaging findings to assist in making the diagnosis, along with a discussion of potential differential diagnoses, and a review of the current literature on this topic.

Ethynyldeoxyuridine (EdU) suppresses in vitro population expansion and in vivo tumor progression of human glioblastoma cells.

Thymidine analogs (TAs) are synthetic nucleosides that incorporate into newly synthesized DNA. Halogenated pyrimidines (HPs), such as bromodeoxyuridine (BrdU), are a class of TAs that can be detected with antibodies and are commonly used for birthdating individual cells and for assessing the proliferative index of cell populations. It is well established that HPs can act as radiosensitizers when incorporated into DNA chains, but they are generally believed not to impair normal cell function in the absence of secondary stressors. However, we and others have shown that HP incorporation leads to a sustained suppression of cell cycle progression in mammalian cells, resulting in cellular senescence in somatic cells. In addition, we have shown that HP incorporation results in delayed tumor progression in a syngeneic rat model of glioma. Here we examine ethynyldeoxyuridine (EdU), a newly developed and alkylated TA, for its anti-cancer activity, both in vitro and in vivo. We show that EdU, like HPs, leads to a severe reduction in the proliferation rate of normal and transformed cells in vitro. Unlike HPs, however, EdU incorporation also causes DNA damage resulting in the death of a substantial subset of treated cells. When administered over an extended time as a monotherapy to mice bearing subcutaneous xenografts of human glioblastoma multiforme tumors, EdU significantly reduces tumor volume and increases survival without apparent significant toxicity. These results, combined with the fact that EdU readily crosses the blood-brain barrier, support the continued investigation of EdU as a potential therapy for malignant brain tumors.

Hip Alpha Angle is Associated with Anterior-Superior Labral Tears but not Anterior Labral Tears.

INTRODUCTION: The purpose of this study is to examine the associations between hip and acetabular morphology, clinical and demographic patient factors, and acetabular labral tear location in young adults. MATERIALS AND METHODS: This study was reviewed by the local Institutional Review Board. The hip magnetic resonance imaging arthrograms from 100 young adult patients (aged 18-35 years) who underwent hip arthroscopy within 1 month of the arthrogram were reviewed. Clinical and demographic variables including age, height, weight, body mass index (BMI) and quantitative hip measurements of acetabular anteversion, alpha and beta angles, femoral head extrusion index, lateral center edge angle, acetabular depth-width ratio, Sharp's and Tönnis' angles were measured, and compared based on acetabular tear location. RESULTS: Ninety-six (96%) of patients had arthroscopically confirmed acetabular tears, and 4 (4%) patients had a normal acetabula labrum. Most (85 [88.5%]) patients had tears involving the anterior-superior labrum and another location, 41 (42.7%) patients had tears involving the anterior labrum and another location, and 35 (36.5%) had tears involving the superior-lateral labrum and another location. Tears commonly occurred in more than one location, with 37 (38.5%) patients having tears in both the anterior and anterior-superior labrum; 28 (29.2%) patients with tears in both the anterior-superior and superior-lateral labrum and 11 (11.5%) patients with tears in the anterior and superior-lateral labrum. Patients with isolated tears of the anterior-superior labrum had on average higher alpha angles than patients with isolated tears of the anterior labrum (P = 0.007). In patients with anterior-superior labral tears, increased BMI (P = 0.033), and weight (P = 0.024) were associated with having concomitant tears of the superior-lateral labrum. DISCUSSION: MR arthrograms are 96% sensitive for detecting acetabular labral tears. Acetabular labral tears tend to co-occur in different locations, with anterior and anterior-superior labral tears most commonly co-occurring. Patients with isolated anterior-superior labral tears had on average higher alpha angles than patients with isolated anterior labral tears.

Readability of radiology reports: implications for patient-centered care.

INTRODUCTION: Radiology reports, although written primarily for healthcare providers, are read increasingly by patients and their family. This study sought to assess the readability of radiology reports. MATERIALS AND METHODS: From 108,228 consecutive radiology reports from a large US health system, we excluded duplicate reports, reports of research exams, and reports with missing data. For each report, we measured the numbers of words and sentences, and computed a "reading grade level" (RGL) as the mean of three readability indices: Flesch-Kincaid Grade Level, Gunning Fog index, and Simple Measure of Gobbledygook. Analysis of variance (ANOVA) evaluated the effects of modality, patient setting, examination urgency, and combinations thereof on RGL. RESULTS: The 97,052 reports in the study cohort had a mean (±standard deviation) of 17.6 ±â€¯12.8 sentences and 203 ±â€¯161 words. Patient setting, modality, and examination urgency all had significant independent effects on RGL (all with p < 0.001). There were 4094 reports (4.2%) at a reading grade level of 8 or lower. CONCLUSION: Radiology reports often contain complex concepts and polysyllabic terms unfamiliar to lay readers. Only 4% of all radiology reports in our sample were readable at the 8th grade level, which is the reading level of the average US adult. Although radiology reports are written for physicians and other healthcare providers, radiologists might explore using simpler, more structured language to address the goals of patient-centered care.

Coverage and Readability of Information Resources to Help Patients Understand Radiology Reports.

BACKGROUND: Radiology reports can be difficult for a layperson to understand. MedlinePlus, a patient-oriented reference from the National Library of Medicine, may offer limited coverage of radiology report concepts. RadLex provides an extensive radiology vocabulary but may be ill suited to help patients understand radiology reports. We compared MedlinePlus, RadLex, and the PORTER (Patient-Oriented Radiology Reporter) lay-language radiology glossary for their coverage of radiology reports and for the readability of their definitions. METHODS: We tallied how frequently terms from MedlinePlus (975 concepts), RadLex (46,433 concepts), and PORTER (3,734 concepts) were found in 10,000 radiology reports sampled randomly from a large academic health system. We also compared the readability of MedlinePlus, RadLex, and PORTER definitions. RESULTS: The mean number of terms matched per radiology report was 3.8 for MedlinePlus, 40.7 for RadLex, and 42.0 for PORTER. RadLex and PORTER offered significantly greater coverage than MedlinePlus (P < .0001); there was no significant difference between RadLex and PORTER. Median readability score (grade level) of definitions was 10.1 for MedlinePlus, 12.6 for RadLex, and 4.1 for PORTER. CONCLUSIONS: The PORTER glossary matched significantly more terms in radiology reports than MedlinePlus and had similar performance to RadLex, even though RadLex had 12 times as many concepts. Only 8% of RadLex terms offered definitions, and most had readability above the 12th-grade reading level, making them incomprehensible to the average US adult. PORTER's glossary definitions were readable by a lay audience. A lay-language radiology glossary may help patients better understand their radiology reports.

Osteosarcoma of the Foot.

A 40-year-old man presented with a large and painful right foot mass. The patient reported a history of a recurrent right foot mass treated elsewhere with 3 prior surgical excisions.

Polyostotic fibrous dysplasia.

An 18-year-old man was referred to the authors' institution's thoracic cancer specialists for further consultation after abnormal findings were seen on chest radiograph.

Pediatric interventional radiology and dose-reduction techniques.

The pediatric interventional radiology community has worked diligently in recent years through education and the use of technology to incorporate numerous dose-reduction strategies. This article seeks to describe different strategies where we can significantly lower the dose to the pediatric patient undergoing a diagnostic or therapeutic image-guided procedure and, subsequently, lower the dose several fold to the staff and ourselves in the process. These strategies start with patient selection, dose awareness and monitoring, shielding, fluoroscopic techniques, and collimation. Advanced features such as cone-beam technology, dose-reduction image processing algorithms, overlay road mapping, and volumetric cross-sectional hybrid imaging are also discussed.