Patient-centered radiology: a roadmap for outpatient imaging.

Creating a patient-centered experience is becoming increasingly important for radiology departments around the world. The goal of patient-centered radiology is to ensure that radiology services are sensitive to patients' needs and desires. This article provides a framework for addressing the patient's experience by dividing their imaging journey into three distinct time periods: pre-exam, day of exam, and post-exam. Each time period has aspects that can contribute to patient anxiety. Although there are components of the patient journey that are common in all regions of the world, there are also unique features that vary by location. This paper highlights innovative solutions from different parts of the world that have been introduced in each of these time periods to create a more patient-centered experience. CLINICAL RELEVANCE STATEMENT: Adopting innovative solutions that help patients understand their imaging journey and decrease their anxiety about undergoing an imaging examination are important steps in creating a patient centered imaging experience. KEY POINTS: • Patients often experience anxiety during their imaging journey and decreasing this anxiety is an important component of patient centered imaging. • The patient imaging journey can be divided into three distinct time periods: pre-exam, day of exam, and post-exam. • Although components of the imaging journey are common, there are local differences in different regions of the world that need to be considered when constructing a patient centered experience.

Progressive pulmonary fibrosis: an expert group consensus statement.

This expert group consensus statement emphasises the need for standardising the definition of progressive fibrosing interstitial lung diseases (F-ILDs), with an accurate initial diagnosis being of paramount importance in ensuring appropriate initial management. Equally, case-by-case decisions on monitoring and management are essential, given the varying presentations of F-ILDs and the varying rates of progression. The value of diagnostic tests in risk stratification at presentation and, separately, the importance of a logical monitoring strategy, tailored to manage the risk of progression, are also stressed. The term "progressive pulmonary fibrosis" (PPF) exactly describes the entity that clinicians often face in practice. The importance of using antifibrotic therapy early in PPF (once initial management has failed to prevent progression) is increasingly supported by evidence. Artificial intelligence software for high-resolution computed tomography analysis, although an exciting tool for the future, awaits validation. Guidance is provided on pulmonary rehabilitation, oxygen and the use of non-invasive ventilation focused specifically on the needs of ILD patients with progressive disease. PPF should be differentiated from acute deterioration due to drug-induced lung toxicity or other forms of acute exacerbations. Referral criteria for a lung transplant are discussed and applied to patient needs in severe diseases where transplantation is not realistic, either due to access limitations or transplantation contraindications. In conclusion, expert group consensus guidance is provided on the diagnosis, treatment and monitoring of F-ILDs with specific focus on the recognition of PPF and the management of pulmonary fibrosis progressing despite initial management.

Thoracic splenosis: A curious case of thoracic masses.

An asymptomatic patient from another country, with a past history of an abdominal gunshot wound and splenic rupture, treated 20 years ago, presented with thoracic masses. It was possible to make the diagnosis of thoracic splenosis, after reviewing the history, the imaging findings and the final histopathology report, without subjecting the patient to surgery.

Cardiac MRI for Iron Overload in pediatric thalassemia patients- Right Age to Start in a Resource Constrained Environment.

The aim of this article is to assess the prevalence and severity of myocardial iron overload in thalassemia patients who present for the first time for cardiac MRI and to define the right age to start screening, in a resource-constrained environment. All MRI scans done at our institute for myocardial iron overload assessment in thalassemia patients, between 2015 and 2018 were analysed. Patients up to the age of 30 years were included. There were a total of 600 patients, (Age group between 2 and 30 years). All these scans were retrospectively analysed and severity of myocardial iron overload was categorized as normal, mild, moderate and severe based on the bright blood T2* equivalent values at 1.5 T. Overall prevalence of myocardial iron overload was 32.3%, while the prevalence of myocardial iron overload in patients in the age group 0-10 was 10.2%.There were 40 patients in the age group 0-6 years, of whom, only 2 had myocardial iron overload. In patients less than or equal to 6 years of age, the number of patients with iron overload was very small and this may be used to decide the optimal age for scanning.

Long-term, real world experience of ventricular tachycardia and granulomatous cardiomyopathy.

BACKGROUND: Granulomatous cardiomyopathy (GCM) is relatively uncommon in patients presenting with ventricular tachycardia (VT). Sarcoidosis and tuberculosis are the most common causes of GCM with VT. The aim of study was to evaluate their clinical characteristics and the long-term outcomes. METHODS: We retrospectively analyzed patients from March 2004 to January 2020, presenting with VT and subsequently diagnosed to have GCM. Patients were divided into three groups (sarcoid, tuberculosis and indeterminate) based on serologic tests, imaging and histopathology. The response to anti-arrhythmic and disease specific therapy on long-term follow-up were analyzed. RESULTS: There were 52 patients, comprising 27 males and 25 females, age 40 ± 10 years. The follow-up period was 5.9 ± 3.9 years. Sarcoidosis was diagnosed in 20 (38%); tuberculosis (TB) in 15(29%) and 17(33%) patients were indeterminate. Left ventricular ejection fraction (LVEF) of the entire cohort was 0.45 ± 0.14. Erythrocyte Sedimentation Rate(ESR) was found to be significantly higher in TB(43.6 ± 18.4) patients vs sarcoid(18.9 ± 6.7)p < 0.0001, but not the indeterminate group (36.2 ± 21.1), p = 0.3. Implantable Cardioverter Defibrillator (ICD) implantation was performed in 12/20(60%) patients in the sarcoid group, in 4/15(27%) patients in the TB group and in 10/17(59%) patients in the indeterminate group. At a mean follow-up of six years, VT recurrences were noted in 6, 2, and 7 patients in the sarcoid, TB and indeterminate groups respectively. CONCLUSION: Despite the advances in diagnostic modalities for tuberculosis and sarcoidosis, in real-world practice, almost one-third of the patients with VT and GCM have uncertain etiology. Long term outcomes of patients presenting with GCM and VT with mild left ventricle dysfunction treated appropriately seems favorable.

Female Representation on Radiology Journal Editorial Boards Around the World: Geographical Differences and Temporal Trends.

RATIONALE AND OBJECTIVES: We examined the status of women's representation on radiology journal editorial boards around the world and evaluated temporal trends in female board representation. MATERIALS AND METHODS: Data on the gender of editorial board members, deputy editors, and editors-in-chief of top general radiology journals from the United States and from five continents outside North America was collected, based on listings in mastheads of each journal at 5-year intervals from 1998 to 2018. Female editorial board representation was compared to female membership in national professional radiology organizations and national physician registries. RESULTS: One of 42 editors-in-chief (2.4%), 24 of 135 deputy editors (17.8%), and 345 of 2545 (13.6%) editorial board members were female for the 20-year period. The overall percentage of female editorial board members increased from 9.7% (41 of 423) in 1998 to 17.0% (97 of 569) in 2018 (p < 0.0001). In 2018, women were less represented on the editorial boards than female professional society membership for all geographic regions except Australia/New Zealand; this difference reached statistical significance in Korea, Brazil, Europe, and China. Female editorial board representation ranged from 11.3% to 33.3%, with no significant difference between the United States (21.5%) and other countries. CONCLUSION: Although the proportion of female editorial board members of radiology journals worldwide has increased over the past two decades, female editorial board composition generally underrepresents the percentage of female radiologists. Editorial board female representation does not differ significantly between the United States and other countries.

Role of MRI in idiopathic inflammatory myopathies: a review article.

Idiopathic inflammatory myopathies are a rare heterogeneous group of chronic, autoimmune conditions characterized by the slow, progressive weakness of the skeletal muscles and inflammatory infiltrates in the muscle tissue. The predominant role of magnetic resonance imaging (MRI) in myositis imaging is to assess disease activity and to identify the target site for biopsy. Its role in phenotyping the disease is less explored. The aim of the present review was to examine the role of MRI in differentiating between the common inflammatory myopathies, i.e. dermatomyositis, polymyositis, and sporadic inclusion body myositis, and to describe the specific spectrum of MRI findings in various inflammatory myopathies.

International survey on residency programs in radiology: similarities and differences among 17 countries.

OBJECTIVE: With the initiative of the ACR International Economics Committee, a multinational survey was conducted to evaluate radiology residency programs around the world. METHODS: A 31-question survey was developed. It included: economic issues, program size and length, resident's activities during daytime and call, academic aspects including syllabus and examinations. Data was tabulated using the forementioned thematic framework and was qualitatively analyzed. RESULTS: Responses were received from all 17 countries that were invited to participate (France, Netherlands, Israel, UK, Russia, USA, Japan, India, Germany, Canada, Turkey, Croatia, Serbia, Italy, Ireland, Hungary, and Greece). Residency length varied between 2 and 5 years. The certificate of residency completion is provided by a local hospital [4/17 (23%)], University [6/17 (36%)], National Board [6/17 (36%)], and Ministry of Health [1/17 (6%)]. There was variability among the number of residency programs and residents per program ranging from 15 to 300 programs per nation with a 1-700 residents in each one respectively. Salaries varied significantly and ranged from 8000 to 75,000 USD equivalent. Exams are an integral part of training in all surveyed countries. Length of call varied between 5 and 26 h and the number of monthly calls ranged from 3 to 6. The future of radiology was judged as growing in [12/17 (70%)] countries and stagnant in [5/17 (30%)] countries. DISCUSSION: Radiology residency programs worldwide have many similarities. The differences are in the structure of the residency programs. Stagnation and uncertainties need to be addressed to ensure the continued development of the next generation of radiologists. SUMMARY STATEMENT: There are many similarities in the academic aims and approach to education and training of radiology residency programs worldwide. The differences are in the structure of the residency programs and payments to individual residents.

An International Survey of Quality and Safety Programs in Radiology.

PURPOSE: The aim of this study was to determine the status of radiology quality improvement programs in a variety of selected nations worldwide. METHODS: A survey was developed by select members of the International Economics Committee of the American College of Radiology on quality programs and was distributed to committee members. Members responded on behalf of their country. The 51-question survey asked about 12 different quality initiatives which were grouped into 4 themes: departments, users, equipment, and outcomes. Respondents reported whether a designated type of quality initiative was used in their country and answered subsequent questions further characterizing it. RESULTS: The response rate was 100% and represented Australia, Canada, China, England, France, Germany, India, Israel, Japan, the Netherlands, Russia, and the United States. The most frequently reported quality initiatives were imaging appropriateness (91.7%) and disease registries (91.7%), followed by key performance indicators (83.3%) and morbidity and mortality rounds (83.3%). Peer review, equipment accreditation, radiation dose monitoring, and structured reporting were reported by 75.0% of respondents, followed by 58.3% of respondents for quality audits and critical incident reporting. The least frequently reported initiatives included Lean/Kaizen exercises and physician performance assessments, implemented by 25.0% of respondents. CONCLUSION: There is considerable diversity in the quality programs used throughout the world, despite some influence by national and international organizations, from whom further guidance could increase uniformity and optimize patient care in radiology.

Vaping associated lung injury (EVALI) as an organizing pneumonia pattern- A case report.

Electronic cigarettes use or vaping is popular but has not been proven to be an innocuous substitute for traditional smoking. Several patterns of vaping-associated lung injuries have been reported. We report a case of a 43-year-old female patient, who presented with productive cough and an organizing pneumonia pattern on computed tomography (CT) scan. Recognizing the various CT scan patterns of vaping-associated lung injury is important to make a diagnosis because the cessation of vaping is an important step in the treatment.

The role of HRCT in Tropical Pulmonary Eosinophilia.

PURPOSE: To determine the pattern of pulmonary involvement in clinically confirmed patients of tropical pulmonary eosinophilia (TPE). METHOD: An observational study on 13 patients with clinically confirmed TPE was performed to determine the CT scan appearances. RESULTS: The predominant CT scan finding is the presence widespread ill-defined bronchocentric nodules, which need to be differentiated from other conditions. CONCLUSION: The pattern of lung involvement on a CT scan can give a clue to the diagnosis of TPE in the correct clinical context. Radiologists in tropical countries should have a high index of suspicion for this diagnosis when reading scans showing widespread ill-defined bronchocentric nodules.

Management of interstitial lung diseases: A consensus statement of the Indian Chest Society (ICS) and National College of Chest Physicians (NCCP).

BACKGROUND: Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed. METHODS: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions. RESULTS: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD. CONCLUSION: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias.

Pulmonary manifestations of lymphoma: A pictorial essay.

Lymphomatous involvement of the lungs manifests in an infinite number of ways. Often there is a considerable overlap of the patterns of manifestations which comes as a diagnostic challenge to the radiologist. We retrospectively reviewed the pulmonary manifestations of biopsy proven cases of primary or secondary non-Hodgkin's lymphoma or Hodgkin's lymphoma. The patterns of lung involvement were then classified into broad categories which included large masses, mass like consolidation, nodules with or without cavitation, ground glass and lymphangitis/ perilymphatic pattern. This article illustrates the spectrum of CT manifestations of lung involvement in non-Hodgkin's lymphoma as well as Hodgkin's lymphoma.

Applications of dual energy CT in clinical practice: A pictorial essay.

In dual-energy CT (DECT), two different x-ray spectra are used to acquire two image datasets of the same region, to allow the analysis of energy-dependent changes in the attenuation of different materials. Each type of material demonstrates a relatively specific change in attenuation between images obtained with a high-energy spectrum and those obtained with a low-energy spectrum. Based on the relatively specific change in attenuation with two different energies, material composition information can be obtained to allow tissue characterization. The DECT ability of material differentiation allows bone removal in various CT angiography studies and bone marrow edema depiction, while with material optimization, metal artefacts can be significantly reduced to almost nil. DECT allows material separation to differentiate uric acid crystals from calcium to determine the composition of urinary calculi and to diagnose gout. Using the DECT ability of material decomposition, iodine maps can be generated, which are useful in the evaluation of any enhancing lesion in the body without the need to obtain a plain scan and allow perfusion maps to be created in cases of pulmonary thromboembolism.

Fibroma of the patellar tendon sheath-a rare case in a young boy.

Fibroma of the tendon sheath is a rare benign fibrocollagenous soft tissue tumor, arising predominantly from the synovium of tendon sheath. Fibromas occur most commonly in relation to the tendons of the fingers, hand, and the wrist. Fibromas related to large joints are rather rare and though amongst the large joints, the knee is a common site. Fibromas of the patellar tendon sheath, specifically, are very rare. To the best of our knowledge, only three cases of fibromas arising from the patellar tendon sheath have been reported in the relevant English medical literature. Herein we describe the fourth biopsy-proven case of fibroma of patellar tendon sheath in a 6-year-old boy.

Role of the weight-bearing cone-beam CT in evaluation of flatfoot deformity.

INTRODUCTION: Till date, weight-bearing radiographs have been the cornerstone for planning surgeries on flatfoot. The technique, however, has limitations due to the superimposition of the bones and the lack of reproducibility. Weight-bearing CT with its unique design overcomes these limitations and enables cross-sectional imaging of the foot to be done in the natural weight-bearing position. In this paper, we report our initial experience in weight-bearing cross-sectional imaging of the foot for assessment of flatfoot deformity. MATERIALS AND METHODS: Around 19 known cases of flatfoot were scanned on the weight-bearing CT. Each foot was then assessed for the various angles and also for the presence/absence of extra-articular talocalcaneal impingement and subfibular impingement. Other associated abnormalities like secondary osteoarthritic changes, were also noted. RESULTS: The Meary, as well as the calcaneal angles, were abnormal, in all but one separate foot. Forefoot abduction was seen in 7 of the 19 feet. The hind foot valgus angle was greater than 10° in all patients. Extra-articular talocalcaneal impingement was seen in 13 of 19 feet. Secondary osteoarthritic changes were seen in 14 feet. CONCLUSION: Weight-bearing CT scan is a very useful technique for evaluation of flatfoot and associated complications. It overcomes the limitations of the radiographs by providing multiplanar three-dimensional assessment of the foot in the natural weight-bearing position and at the same time being easily reproducible and consistent for the measurements around the foot. The definite advantage over the conventional cross-sectional scanners is the weight-bearing capability.