Anatomic Considerations for Injection of the Lateral Atlanto-Axial Joint.

OBJECTIVE: We aimed to define the potential complications of intra-articular steroid injections into the lateral C1-2 articulations and safety margins to the relevant structures. METHODS: A total of 488 contrast-enhanced computed tomography angiogram (CTA) "arch to vertex" studies were retrospectively reviewed for theoretical intersection of the vertebral artery or thecal sac and distance of the named structures from the anticipated/theoretical trajectory of injection into the lateral C1-C2 joint. RESULTS: Patients were 60.4±15.8 years old and 55.5% male. In total, seven vertebral arteries and 11 thecal sac theoretical intersections were found. In cases without a direct intersection, the distance from the trajectory (range) was 0.71±0.18 (0.22-1.44) cm to the vertebral artery and 0.6±0.22 (0.14-1.8) cm to the thecal sac. CONCLUSIONS: Although injection of steroid into the lateral C1-C2 articulation for pain management has historically been reported to carry risk of severe complications due to close proximity and location variability of surrounding structures, our study quantifies the potential risk of such injections. Further, our analysis suggests that preprocedural imaging should be considered.

Radial artery aneurysm secondary to dynamic entrapment by extensor pollicis longus tendon: a case of snapping thumb.

Aneurysms of the distal radial artery at the level of the wrist are rare. Most reported cases are posttraumatic, either from iatrogenic arterial puncture for radial arterial access or from a penetrating injury. Other causes include infection and connective tissue disorders. Early diagnosis is important to avoid the potential complications of thrombus formation, distal digital ischemia, and rupture. Evaluation of the radial artery is typically performed using non-invasive modalities like ultrasonography, computed tomographic angiography (CTA), and magnetic resonance angiography (MRA). Invasive angiography can also be performed, particularly if minimally invasive treatment options are being considered. We report a case of a 35-year-old male mechanic who presented with pain at the base of the left thumb dorsally, with reproducible painful snapping on dynamic exam. Ultrasound demonstrated a fusiform aneurysm of the radial artery. At the level of the aneurysm, there was dynamic entrapment of the artery between the extensor pollicis longus (EPL) tendon and the underlying trapezium. The patient's symptoms improved with conservative management and avoidance of the snapping-producing maneuvers. To our knowledge, this is the first published case of snapping at the base of the thumb resulting in repetitive entrapment of the radial artery by the EPL tendon captured on dynamic ultrasound examination.

The Competency of Emergency Medicine Residents in Interpreting Hand X-rays Across the Three Major Regions of Saudi Arabia.

Background Interpreting hand X-rays is crucial for emergency medicine residents to accurately diagnose traumatic injuries and conditions affecting the hand. This study aimed to assess the competency of emergency medicine residents in interpreting hand X-rays across three major regions in Saudi Arabia. Methodology We conducted a cross-sectional study involving 100 emergency medicine residents from the Central, Eastern, and Western regions of Saudi Arabia. Participants were presented with 10 clinical case scenarios each accompanied by hand X-rays and were asked to provide their interpretations. Assessment scores were calculated based on the proportion of correct answers for each case. Results Half of the participants (50 residents) fell within the age range of 25 to 27 years, with 61 male and 39 female participants, respectively. Residents in the third year of training (R3) exhibited the highest mean score of 74.83% ± 20.46%. Participants using desktops to view the images achieved the highest mean score of 75% ± 10.49% compared to those using smartphones or tablets. Significant associations were found between age (F = 4.072, p = 0.020), training level (F = 3.161, p = 0.028), and choice of viewing device (F = 7.811, p = 0.001) and assessment scores. Conclusions Our study highlighted that emergency medicine residents in Saudi Arabia demonstrate competent proficiency in interpreting hand X-rays, with higher competency observed among senior residents (R3 and R4), those aged 28 to 30 years, and those using desktops for image viewing.

Cutting Edge to Cutting Time: Can ChatGPT Improve the Radiologist's Reporting?

Radiology-structured reports (SR) have many advantages over free text (FT), but the wide implementation of SR is still lagging. A powerful tool such as GPT-4 can address this issue. We aim to employ a web-based reporting tool powered by GPT-4 capable of converting FT to SR and then evaluate its impact on reporting time and report quality. Thirty abdominopelvic CT scans were reported by two radiologists across two sessions (15 scans each): a control session using traditional reporting methods and an AI-assisted session employing a GPT-4-powered web application to structure free text into structured reports. For each radiologist, the output included 15 control finalized reports, 15 AI-assisted pre-edits, and 15 post-edit finalized reports. Reporting turnaround times were assessed, including total reporting time (TRT) and case reporting time (TATc). Quality assessments were conducted by two blinded radiologists. TRT and TATc have decreased with the use of the AI-assisted reporting tool, although statistically not significant (p-value > 0.05). Mean TATc for RAD-1 decreased from 00:20:08 to 00:16:30 (hours:minutes:seconds) and TRT decreased from 05:02:00 to 04:08:00. Mean TATc for RAD-2 decreased from 00:12:04 to 00:10:04 and TRT decreased from 03:01:00 to 02:31:00. Quality scores of the finalized reports with and without AI-assistance were comparable with no significant differences. Adjusting the AI-assisted TATc by removing the editing time showed statistically significant results compared to the control for both radiologists (p-value < 0.05). The AI-assisted reporting tool can generate SR while reducing TRT and TATc without sacrificing report quality. Editing time is a potential area for further improvement.

Use of rituximab in idiopathic retroperitoneal fibrosis.

BACKGROUND: Retroperitoneal fibrosis (RPF) is characterized by the proliferation of fibrous tissue in the retroperitoneum. The majority of RPF cases are due to idiopathic or IgG4-related disease. Recent studies on IgG4-related disease have shown rituximab to be an effective treatment. The current first-line treatment for idiopathic RPF (iRPF) is glucocorticoid therapy. Relapse rates vary widely in the literature, and DMARDs remain poorly studied. We sought to evaluate the efficacy of rituximab in idiopathic RPF by quantifying changes in iRPF diameter on imaging pre- and post-rituximab therapy and response by lab parameters in 10 iRPF patients. METHODS: We selected 10 patients diagnosed with iRPF and previously treated with rituximab (1000 mg) in two doses approximately 2 weeks apart. Pre- and post-therapy contrast enhanced cross-sectional abdomen and pelvis imaging were compared. In all patients, the thickest portion of the peri-aortic disease was measured in the axial and coronal planes. The presence of acute or long standing back pressure related renal findings were documented. Details of clinical visits including patient demographics and laboratory evaluations were collected pre- and post-therapy. Statistical analysis was performed using a Wilcoxon signed rank test. RESULTS: The RPF diameter around the aorta before and after therapy decreased from a mean of 15.9 ± 4.9 mm to 10.6 ± 6.1 mm, respectively (p < 0.01). The craniocaudal iRPF mean length decreased from 108.6 mm ± 40.4 mm to 90.6 mm ± 45.9 mm (p = 0.02). CONCLUSION: A comparison of pre and post-rituximab imaging studies revealed a statistically significant decrease in iRPF diameter following treatment with rituximab.