Aberrant arc between the common hepatic artery and a replaced right hepatic artery resulting in misperfusion in a patient with a hepatic arterial infusion pump.

Hepatic arterial infusion pumps are increasingly utilized as an option for liver directed therapy in the treatment of metastatic colorectal carcinoma. After skeletonization of the hepatic artery through the ligation of extra-hepatic branches, these pumps are implanted surgically with their tip placed in the common hepatic artery. Subsequently, a nuclear medicine pump study is performed to ensure homogeneous perfusion of the liver and detect any extrahepatic perfusion. We report a peripheral arc between the superior mesenteric artery and celiac axis, which caused misperfusion on the SPECT nuclear medicine scan.

FDG altered biodistribution in white adipose tissue, a rare entity: case report and review of the literature.

PURPOSE: Altered 18F-fluorodeoxyglucose (FDG) biodistribution due to patient factors such as exercise and inadequate fasting are well established causes of limited diagnostic efficacy. In addition, medications such as G-CSF are known to affect uptake of FDG by bone marrow and spleen. In this study, we present a case of increased white adipose uptake in a pediatric lymphoma patient who recently received high dose dexamethasone and review the relevant literature regarding this rare and poorly understood pattern of altered FDG biodistribution. METHODS: A 14-year-old male patient diagnosed with B-cell lymphoblastic lymphoma underwent FDG-PET/CT for restaging shortly after completing an induction chemotherapy regimen. Images revealed diffuse FDG uptake localizing to white adipose tissue, attributed to the 29-day course of dexamethasone which was completed two days prior. A diagnostically adequate study with relative normalization of FDG biodistribution was obtained seven days later. RESULTS: In our review of the literature, diffuse FDG uptake by white fat is a rare occurrence and has only been reported by a few case reports and early observational studies. In addition to patients receiving corticosteroids, other cases of medication-induced adipose remodeling such as patients receiving highly active antiretroviral therapy have been documented with similar patterns of increased white adipose tissue activity. CONCLUSION: Corticosteroid-induced white fat uptake of FDG is a rare phenomenon that can limit diagnostic accuracy of FDG-PET/CT and necessitate repeat imaging. Current evidence suggests that a wait period of at least one week after discontinuation of corticosteroids is sufficient to allow for decreased white fat uptake and increased diagnostic accuracy.

Educating Radiology Stakeholders on Relevant Health Issues and Terminology Regarding LGBTQIA+ Patients in 2023.

RATIONALE AND OBJECTIVES: Over 20% of the Lesbian, Gay, Bisexual, Queer or Questioning, Intersex, Asexual or Ally, and more (LGBTQIA+) community reports experiencing discrimination upon accessing health care, causing many to defer access to care and resulting in poorer outcomes. While members of this community routinely undergo imaging studies, little formal education exists within the field of radiology to review the unique health care needs of this population and the specific relevance to imaging, in addition to actionable methods to promote inclusion. MATERIALS AND METHODS: A 1-hour educational conference was held for a cohort of radiology resident physicians at our institution, in which topics including LGBTQIA+ health care disparities, clinical nuances relevant to the field of radiology, and actionable suggestions that both academic and private-practice centers can adopt to foster inclusion were presented. All attendees were required to complete a 12-question, multiple-choice preconference and postconference examination. RESULTS: Median prelecture and postlecture quiz scores for four first-year radiology residents were 29% and 75%, for two second-year radiology residents were 29% and 63%, for two third-year radiology residents were 17% and 71%, and for three fourth-year radiology residents were 42% and 80%. CONCLUSION: Multiple areas of opportunity to foster LGBTQIA+ inclusion at the provider and administration levels currently exist throughout the field of radiology. A radiology-focused education module regarding clinical nuances, health care inequities, and ways to foster an inclusive environment with the LGBTQIA+ community is an effective way to promote learner knowledge.

ACR-ACNM-ASTRO-SNMMI Practice Parameter for Lutetium-177 (Lu-177) DOTATATE Therapy.

OBJECTIVES: This practice parameter (PP) for Lutetium-177 (Lu-177) DOTATATE peptide receptor radionuclide therapy (PRRT) aims to guide authorized users in selection of appropriate adult candidates with gastroeneropancreatic neuroendocrine tumors (GEP-NETs) from foregut, midgut, and hindgut. The essential selection criteria include somatostatin receptor-positive GEP-NETs, which are usually inoperable and progressed despite standard therapy. Lu-177 DOTATATE is a radiopharmaceutical with high avidity for somatostatin receptors that are overexpressed by these tumors. This document ensures safe handling of Lu-177 DOTATATE by the authorized users and safe management of affected patients. METHODS: The document was developed according to the systematic process developed by the American College of Radiology (ACR) and described on the ACR Web site (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards). The PP development was led by 2 ACR Committees on Practice Parameters (Nuclear Medicine and Molecular Imaging and Radiation Oncology) collaboratively with the American College of Nuclear Medicine, American Society of Radiation Oncology, and Society of Nuclear Medicine and Molecular Imaging. RESULTS: The Lu-177 DOTATATE PP reviewed pharmacology, indications, adverse effects, personnel qualifications, and required clinical evaluation before starting the treatment, as well as the recommended posttherapy monitoring, quality assurance, documentation, and appropriate radiation safety instructions provided in written form and explained to the patients. CONCLUSIONS: Lu-177 DOTATATE is available for therapy of inoperable and/or advanced GEP-NETs when conventional therapy had failed. It can reduce tumor size, improve symptoms, and increase the progression free survival. The PP document provides clinical guidance for authorized users to assure an appropriate, consistent, and safe practice of Lu-177 DOTATATE.

ACR-ACNM-ASTRO-SNMMI Practice Parameter for Lutetium-177 (Lu-177) DOTATATE Therapy.

OBJECTIVES: This practice parameter (PP) for Lutetium-177 (Lu-177) DOTATATE peptide receptor radionuclide therapy (PRRT) aims to guide authorized users in selection of appropriate adult candidates with gastroeneropancreatic neuroendocrine tumors (GEP-NETs) from foregut, midgut, and hindgut. The essential selection criteria include somatostatin receptor-positive GEP-NETs, which are usually inoperable and progressed despite standard therapy. Lu-177 DOTATATE is a radiopharmaceutical with high avidity for somatostatin receptors that are overexpressed by these tumors. This document ensures safe handling of Lu-177 DOTATATE by the authorized users and safe management of affected patients. METHODS: The document was developed according to the systematic process developed by the American College of Radiology (ACR) and described on the ACR Web site (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards). The PP development was led by 2 ACR Committees on Practice Parameters (Nuclear Medicine and Molecular Imaging and Radiation Oncology) collaboratively with the American College of Nuclear Medicine, American Society of Radiation Oncology, and Society of Nuclear Medicine and Molecular Imaging. RESULTS: The Lu-177 DOTATATE PP reviewed pharmacology, indications, adverse effects, personnel qualifications, and required clinical evaluation before starting the treatment, as well as the recommended posttherapy monitoring, quality assurance, documentation, and appropriate radiation safety instructions provided in written form and explained to the patients. CONCLUSIONS: Lu-177 DOTATATE is available for therapy of inoperable and/or advanced GEP-NETs when conventional therapy had failed. It can reduce tumor size, improve symptoms, and increase the progression free survival. The PP document provides clinical guidance for authorized users to assure an appropriate, consistent, and safe practice of Lu-177 DOTATATE.

Endothelial response to overnight corneal reshaping.

PURPOSE: To discuss corneal endothelial structure during different environments. Little information has been available on the structure of the corneal endothelium during overnight corneal reshaping. METHOD: Patients were selected to represent different environments of contact lens wearing to contrast them to patients who changed their environment from contact lens use to overnight corneal reshaping. RESULTS: There were no apparent ill effects to the corneal endothelium from overnight corneal reshaping. CONCLUSIONS: Corneal endothelial polymegathism and pleomorphism can decrease with properly prescribed and monitored overnight corneal reshaping lenses over some standard contact lenses.

Preliminary interpretations of after-hours CT and sonography by radiology residents versus final interpretations by body imaging radiologists at a level 1 trauma center.

OBJECTIVE: At many academic institutions, preliminary interpretations of CT scans and sonograms obtained after regular hours of operation are performed by radiology residents, with attending radiologists reviewing the interpretations the next morning. We sought to determine the rate of discrepancy between residents' interpretations of imaging studies and the final interpretations performed by an attending body imaging radiologist as well as any resulting clinical consequences stemming from the discrepancies. Therefore, we reviewed 928 CT and sonographic images that had been obtained after hours at a level 1 trauma center during a 6-month period. MATERIALS AND METHODS: Any discrepancies between the preliminary and final interpretations were judged as either major (i.e., necessitating an urgent change in treatment) or minor errors. We conducted patient follow-up via a retrospective review of the medical charts to determine whether any of the discrepancies led to additional imaging, an increase in patient morbidity, an extension of a hospital stay, or a change in treatment. RESULTS: The overall discrepancy rate in interpretations rendered by the residents and those performed by the attending radiologist was 3.8%, with most of these discrepancies (86%) judged to be minor. If we combined the data for body CT scans and sonograms, the rate of minor discrepancies was 3.2%, and the rate of major discrepancies was 0.5%. If we considered only body CT data in the evaluation, the overall discrepancy rate increased to 6.4%, with a 5.4% rate of minor discrepancies and a 1.0% rate of major discrepancies. CONCLUSION: Our evaluation of discrepancy rates was unusual in that we included interpretations of sonograms, on which residents and the attending radiologist had a higher rate of agreement (99.5%). Because of the high agreement in the interpretation of sonograms, the overall discrepancy rate was 3.8%. However, if only body CT scan interpretations were evaluated, our results were closer to the rates reported in previously published studies. Major discrepancies led to a change in patient treatment but did not lead to any increase in patient morbidity or to any quantifiable increase in the length of the hospital stay.