Limitations of GPT-3.5 and GPT-4 in Applying Fleischner Society Guidelines to Incidental Lung Nodules.

Purpose: To evaluate the accuracy of GPT-3.5, GPT-4, and a fine-tuned GPT-3.5 model in applying Fleischner Society recommendations to lung nodules. Methods: We generated 10 lung nodule descriptions for each of the 12 nodule categories from the Fleischner Society guidelines, incorporating them into a single fictitious report (n = 120). GPT-3.5 and GPT-4 were prompted to make follow-up recommendations based on the reports. We then incorporated the full guidelines into the prompts and re-submitted them. Finally, we re-submitted the prompts to a fine-tuned GPT-3.5 model. Results were analyzed using binary accuracy analysis in R. Results: GPT-3.5 accuracy in applying Fleischner Society guidelines was 0.058 (95% CI: 0.02, 0.12). GPT-4 accuracy was improved at 0.15 (95% CI: 0.09, 0.23; P = .02 for accuracy comparison). In recommending PET-CT and/or biopsy, both GPT-3.5 and GPT-4 had an F-score of 0.00. After explicitly including the Fleischner Society guidelines in the prompt, GPT-3.5 and GPT-4 significantly improved their accuracy to 0.42 (95% CI: 0.33, 0.51; P < .001) and to 0.66 (95% CI: 0.57, 0.74; P < .001), respectively. GPT-4 remained significantly better than GPT-3.5 (P < .001). The fine-tuned GPT-3.5 model accuracy was 0.46 (95% CI: 0.37, 0.55), not different from the GPT-3.5 model with guidelines included (P = .53). Conclusion: GPT-3.5 and GPT-4 performed poorly in applying widely known guidelines and never correctly recommended biopsy. Flawed knowledge and reasoning both contributed to their poor performance. While GPT-4 was more accurate than GPT-3.5, its inaccuracy rate was unacceptable for clinical practice. These results underscore the limitations of large language models for knowledge and reasoning-based tasks.

Underreported and underrecognized: a comprehensive imaging review of breast injury.

Breast injury is commonly encountered yet it remains significantly underreported. Injury to the breast may arise from either primary mechanisms or secondary or iatrogenic mechanisms. Primary mechanisms of breast injury include blunt force, seat-belt, penetrating, and thermal injury. Secondary or iatrogenic mechanisms of breast injury include breast biopsy or intervention as well as operative intervention and cardiopulmonary resuscitation. The severity of breast injury arising from these mechanisms is broad, ranging from breast contusion to avulsion. Sequelae of breast injury include fat necrosis and Mondor's disease. Radiologists play an integral role in the evaluation and management of breast injury both in the acute and non-acute settings. In the acute setting, radiologists must be able to recognize breast injury arising from primary mechanisms or iatrogenic or secondary mechanisms and to identify rare but potentially life-threatening complications promptly to ensure timely, appropriate management. In the non-acute setting, radiologists must be able to discern the sequalae of breast injury from other processes to prevent potentially unnecessary further evaluation and intervention. Nonetheless, though breast injury is commonly encountered there remain few guidelines and a lack of established recommendations for the evaluation and management of breast injury. We provide a comprehensive multi-modality imaging review of breast injury arising in the acute setting as well as the sequela of breast injury arising in the non-acute setting. Moreover, we provide an overview of the management of breast injury.

Multi-echo GRE imaging of knee cartilage.

PURPOSE: To visualize healthy and abnormal articular cartilage, we investigated the potential of using the 3D multi-echo gradient echo (GRE) signal's magnitude and frequency and maps of T2* relaxation. MATERIALS AND METHODS: After optimizing imaging parameters in five healthy volunteers, 3D multi-echo GRE magnetic resonance (MR) images were acquired at 3T in four patients with chondral damage prior to their arthroscopic surgery. Average magnitude and frequency information was extracted from the GRE images, and T2* maps were generated. Cartilage abnormalities were confirmed after arthroscopy and were graded using the Outerbridge classification scheme. Regions of interest were identified on average magnitude GRE images and compared to arthroscopy. RESULTS: All four patients presented with regions of Outerbridge Grade I and II cartilage damage on arthroscopy. One patient had Grade III changes. Grade I, II, and III changes were detectable on average magnitude and T2* maps, while Grade II and higher changes were also observable on MR frequency maps. For average magnitude images of healthy volunteers, the signal-to-noise ratio of the magnitude image averaged over three echoes was 4.26 ± 0.32, 12.26 ± 1.09, 14.31 ± 1.93, and 13.36 ± 1.13 in bone, femoral, tibial, and patellar cartilage, respectively. CONCLUSION: This proof-of-principle study demonstrates the feasibility of using different imaging contrasts from the 3D multi-echo GRE scan to visualize abnormalities of the articular cartilage. © 2016 International Society for Magnetic Resonance in Medicine Level of Evidence: 1 J. MAGN. RESON. IMAGING 2017;45:1502-1513.

Using Dual-Orthogonal Fluoroscopy and CT to Assess the Relationship Between Knee Morphology and Patellar Kinematics in Patients With Patellofemoral Pain.

INTRODUCTION: Patellofemoral pain (PFP) is one of the most common knee overuse injuries, with studies suggesting PFP as a precursor for early knee osteoarthritis. The etiology of PFP is multi-factorial; however, patellar mal-tracking has been regarded as a primary mechanism. Details of this multi-factorial mechanism have been unclear because of the limitations in evaluating in-vivo, three-dimensional (3D) patellofemoral joint movement during dynamic activities accurately. Alternatively, studies have demonstrated the high accuracy and repeatability of dual fluoroscopy and CT/MRI for measuring knee joint motion. OBJECTIVE: This study uses dual fluoroscopy and CT to investigate the associations between joint morphology and patellar kinematics in healthy controls and subjects with PFP. METHODS: Eight PFP females (29.7±10.6 years) and 10 healthy females (25.0±7.7 years) were recruited and screened by a sports medicine physician. CT imaging was performed on participants in a supine with the knee extended, and ankle and hip in neutral alignment. Dual-orthogonal fluoroscopy measured patellar movement while participants performed a lunge task. A calibration algorithm was used to register the 3D CT model to 2D fluoroscopy image to calculate the relative position and angles of the patella based on the clinical definition of patellar motion. Measures of patellar and trochlear morphology were generated and correlated to kinematic data. RESULTS AND CONCLUSION: There was a significant difference in the patellar-to-trochlear width ratio; however, no other significant differences in CT morphology measurements were present between groups. For PFP patients in the weight-bearing extended position, there was a moderate positive correlation between the patellar-to-trochlear width ratio and medial-lateral patellar shift (τ = 0.643, p = 0.026). Healthy controls in this position demonstrated a moderate positive correlation between the lateral-trochlear inclination angle and medial-lateral patellar shift (τ = 0.600, p = 0.016) and moderate negative correlation between medial trochlear inclination angle and medial-lateral patellar shift (τ = -0.511, p = 0.040). The findings suggest that, for this cohort, there is correlation between morphology and patellar kinematics. Passive and active stabilizers likely have a role in mal-tracking.

Gender Differences in Academic Rank, Leadership, and Awards Among NIH Grant Recipients in Diagnostic Radiology.

Objective: Females have been traditionally underrepresented in academia across multiple medical specialties, including radiology. The present study investigated primary investigators (PIs) who received National Institutes of Health (NIH) radiology funding between 2016 and 2019 to establish if there was a correlation between NIH grants, gender, academic rank, first and second tier leadership positions, geographic location, and professional awards. Materials and Methods: Funding information was obtained from the NIH Research Portfolio Online Reporting Tools Expenditure and Results (RePORTER) website for 2016-2019. Information for each PI was obtained from academic institutional websites, LinkedIn, and Doximity. Mann-Whitney U tests and chi-square analyses were performed to compare and determine associations between gender and the stated variables of interest. Results: Of the 805 radiology PIs included in this study, 78% were male. There was a significant association of gender with the attainment of the highest academic rank (p = 0.026), with females occupied more of the assistant professor ranks (M:F = 1:1.5) and less of the professor ranks (F:M = 1:1.2). Between genders, there was no significant difference in first and second tier leadership positions (p = 0.497, p = 0.116), and postgraduate honors and awards (p = 0.149). The greatest proportion of grants was awarded in the setting of sole male PIs (55%) and the least proportion of grants were awarded when the contact PI and other project leader were female (1%). Conclusion: Despite having similar academic credentials, including number of leadership positions and postgraduate honors and awards, female radiology PIs who have received NIH grants continue to be underrepresented in higher academic ranks.

Gender Differences Among Academic Radiation Oncology National Institutes of Health (NIH) Funding Recipients.

Purpose The purpose of our study was to evaluate National Institutes of Health (NIH) funding recipients between 2016 and 2019 to determine if there was an association between gender, research productivity, academic rank, leadership positions, and post-graduate awards. Materials and Methods The NIH Research Portfolio Online Reporting Tools Expenditure and Results (RePORTER) website was used to retrieve data for grants in Radiation Oncology from 2016-2019. Demographics and profiles of awardees were retrieved from institutional websites, LinkedIn, and Doximity. Publication metrics were collected through the Scopus database. Mann-Whitney U tests and chi-square analyses were performed to compare and determine associations between gender and other variables.  Results Three hundred and forty radiation oncology principal investigators (PIs) were included in this study, of whom 76% were men. Of the 776 total NIH grants awarded, 62% of the grants had a sole male PI and 1% had two or more PIs in which the contact PI and co-PI were women. Between the genders of PIs in this sample, there was no significant difference in highest academic rank, leadership positions (i.e., chair, director, founder, president, and other), and post-graduate honors and awards. Total publications, years of active research, h-index, and m-index were higher amongst men in the professor category but were largely similar between genders in the associate and assistant professor categories. Conclusions The results demonstrate that most NIH grants in radiation oncology were awarded to men. Strategies that increase women in radiation oncology (RO), as well as those that increase NIH grants amongst women may also increase the prevalence of women in senior academic ranks and leadership positions.

Invasive melanoma in a 5-year-old Canadian patient: A case report.

Atypical Spitzoid lesions pose a distinct challenge in classification as they may comprise a mixture of both classic benign nevus and cutaneous melanoma characteristics. Immunostaining and molecular analysis, such as comparative genomic hybridization, can assist in narrowing the differential diagnosis. We present a case of a 5-year-old male with an atypical Spitzoid lesion on his back. Initial histopathology revealed a relatively symmetric lesion with mitotic figures and poor maturation of melanocytes with descent into the dermis. Immunohistochemistry demonstrated a loss of p16, and array comparative genomic hybridization revealed a loss of chromosome 9, supporting a diagnosis of invasive melanoma arising in conjunction with a remnant of a conventional melanocytic nevus. This case is the first in Canada to demonstrate the use of array comparative genomic hybridization for diagnosing melanoma in a young paediatric patient.