Enhancing Aortic Aneurysm Surveillance: Transformer NLP for Flagging and Measuring in Radiology Reports.

OBJECTIVE: Incidental findings of aortic aneurysms (AAs) often go unreported, and established patients are frequently lost to follow-up. Natural language processing (NLP) offers a promising solution to address these issues. While rule-based NLP methods have shown some success, recent advancements in transformer-based large language models (LLMs) remain underutilized. This study has three aims: (1) to evaluate the effectiveness of our innovative transformer-based NLP pipeline regarding AA detection; (2) to detail the clinical impact by quantifying the number of patients who could benefit from such technology; and (3) to use this information to help coordinate appointments with patients, ensuring proper monitoring and management. METHODS: 3229 radiology reports were divided into three batches with varying class balance. Each entry was processed through our innovative NLP pipeline, where it was fragmented using regular expression (regex) functions to isolate relevant textual segments. These segments were subsequently processed through our "question and find" (Q&F) function, powered by Google's BERT, a well-established transformer LLM. This Q&F function extracted aortic diameter measurements, flagging measurements that exceeded a predefined threshold. Following detection, we conducted comprehensive chart reviews and contacted primary care providers (PCPs) and patients to categorize aneurysms as "known" or "incidental." We also assessed whether patients with known aneurysms were adhering to regular yearly screenings and coordinated follow-up appointments. RESULTS: Evaluation of the three batches showed high F1 scores: 99.4% (95% CI [98.5-100]), 96.7% (95% CI [95.0-98.2]), and 98.9% (95% CI [98.0-99.6]). Overall measurement accuracy was 98.9% (95% CI [97.6-100]), 99.6% (95% CI [99.3-99.9]), and 98.1% (95% CI [96.8-99.4]). Compared to manual chart reviews, the NLP system demonstrated superior accuracy and fewer errors: 12 vs. 22 (p=0.084), 47 vs. 98 (p=0.000021), and 31 vs. 53 (p=0.015). Of the 412 patients investigated, 58 (14.1%) involved incidental findings, 54 patients (15.3%) were lost to follow-up, 39 patients (55.7%) were successfully contacted, and 37 follow-up appointments (12.1%) were successfully coordinated. CONCLUSION: The high-performance metrics from our study demonstrate that transformer-based NLP can enhance aortic aneurysm surveillance. Our subsequent comprehensive patient profiling highlighted the need for such a system as a safety net within the electronic medical record (EMR), systematically reviewing radiology reports to detect incidental findings and patients lost to follow-up. This ensures appropriate referrals and monitoring, improving patient outcomes and healthcare efficiency through timely clinical interventions.

Clinical Impact of Severe Obesity in Patients with Lymphoedema.

OBJECTIVE: With the rate of obesity increasing worldwide, patients with lymphoedema with and without a concomitant diagnosis of severe obesity (SO) were compared in regard to their baseline demographics, health related characteristics, treatment plans, and patient outcomes. METHODS: This was a retrospective observational cohort study. The IBM MarketScan database was examined (2013 - 2019) for patients with a new diagnosis of lymphoedema. Of 60 284 patients with lymphoedema identified, 6 588 had SO defined by a body mass index > 40 kg/m2. The demographics and other characteristics of SO were compared with patients with lymphoedema without SO. RESULTS: SO and lymphoedema diagnosis increased two fold from 2013 to 2019. The lymphoedema SO+ group was younger (57.8 vs. 60.8 years, p < .001) and with a higher proportion of men (37.7% vs. 24.9%, p < .001) than the lymphoedema SO- group. More comorbidities were observed in the lymphoedema SO+ group than the lymphoedema SO- group: diabetes 46.0% vs. 24.9 % (p < .001), heart failure 18.3% vs. 7.4% (p < .001), hypertension 75.0% vs. 47.6% (p < .001), and renal disease 24.8% vs. 11.9% (p < .001). Use of diuretics in the lymphoedema SO+ group was greater: 57.6% vs. 38.0% (p < .001). Patients with lymphoedema SO+ had higher risk of cellulitis: 34.5% vs. 13.5% (p < .001). Specific lymphoedema treatment was given more often to lymphoedema SO-: 66.3% vs. 64.3% (p = .003). This was significant for manual lymphatic drainage (46.6% vs. 40.0%; p < .001) and physical therapy (55.4% vs. 51.6%; p<.001), but not for compression garments (18.2% vs. 17.7%; p = .38). However, more patients with lymphoedema SO+ received pneumatic compression device treatment: 20.9% vs. 13.7% (p < .001). CONCLUSION: There was an increase in SO associated lymphoedema. Patients with lymphoedema SO+ have over a two and half fold increase in cellulitis incidence, with a significant increase in medical resource use and cost. Despite this, patients with lymphoedema and SO receive less specific therapy such as compression, which has proven to reduce cellulitis incidence.

Luminal Changes in Patients with Inferior Vena Cava Filters and Development of Chronic Venous Disease.

BACKGROUND: This study aimed to analyze the luminal changes in the iliocaval veins and their effects on the development of signs and symptoms of chronic venous disease manifesting from inferior vena cava (IVC) filter placement. METHODS: This was a retrospective observations study; deidentified patients with an IVC filter placed with subsequent luminal changes were included. All patients had a computerized tomography (CT) scan with or without ultrasound and those who underwent an intervention for the obstruction had also venography and intravascular ultrasound (IVUS). The diameter of IVC and iliac veins was measured from the near wall to the far wall. IVC diameters measured less than 12 mm were considered to be retractions. Signs and symptoms of chronic venous disease were obtained from patient charts and were reported according to the highest CEAP class. The data were analyzed using descriptive statistics, presenting diameter changes as a mean with standard deviation and a range of diameters included. RESULTS: Overall, 76 patients were included in this study, of whom 66 had occlusion of the IVC or the Iliac veins. Luminal changes of the IVC were observed in all patients. A total of 58 patients presented with chronic post-thrombotic changes in both the IVC and iliac veins. There were 4 patients that had a luminal reduction with no filling defects or post-thrombotic changes. Average IVC diameter and iliac vein diameter was measured to be 8.3 ± 1.4 mm and 4.6 ± 1.4 mm, respectively. Patients most frequently presented with extremity swelling, but other signs such as venous ulceration or skin damage were observed. CONCLUSIONS: Permanent luminal changes of the IVC and iliac veins were observed as a result of IVC filter placement and such patients commonly present with signs and symptoms of chronic venous disease. Together, with other known filter complications, these observations add more reasons for a timely retrieval. When such changes occur, patients' appropriate symptoms can be successfully treated. The permanent changes made by filter placement in the IVC and iliac veins further support filter retrieval in a timely fashion. The luminal changes induced by filter placement should be recognized early, particularly in symptomatic patients who can be safely treated with endovenous procedures.

Exploring Barriers Toward Telehealth in an Underserved, Uninsured Patient Population.

Background: Telehealth has untapped potential to improve health care for underserved communities. However, it remains underutilized, limiting opportunities to improve continuity of care and health care outcomes. This pilot study investigates attitudes and barriers to telehealth at Stony Brook HOME, Renaissance School of Medicine's student-run free-health clinic in Suffolk County, NY. Methods: Surveys (n = 100) were electronically administered bimonthly during clinic waiting room time from May 2022 to August 2023 in both English (40%) and Spanish (60%). Surveys collected information on patient demographics, perceived patient barriers and attitudes to telehealth, and technological comfort levels. Results: Most patients were Hispanic/Latino (68%), female (54%), and 40-60 years old (52%). Spanish speakers often come from high social vulnerability regions. English speakers were more likely to own a smartphone, computer, or tablet than Spanish speakers (p = 0.046). English speakers reported higher levels of technological comfort using a smartphone or tablet (p = 0.0033) and using it for their health care (p = 0.03). Finally, 100% of English speakers reported reliable internet access compared to 66.7% of Spanish speakers. Discussion: These results demonstrate that barriers to telehealth are being disproportionately felt by Spanish speakers, thus necessitating survey-directed interventions to address this disparity.

A Review of COVID-19's Impact on Radiology Residents' Academics and Wellness in North America.

BACKGROUND: The COVID-19 pandemic caused major disruptions in radiology departments throughout North America. Radiology residency programs were forced to make dramatic changes to their training programs, which had major impacts on resident academics and wellness. The goal of this review is to evaluate the impact of COVID-19 on radiology residents' academics and wellness in North America, while also identifying effective measures taken by programs to mitigate the effects of the pandemic. METHODS: The search strategy involved database search via PubMed, Embase, and Web of Science with specific key words related to COVID-19, radiology residents, education, wellness, and virtual learning. Studies discussing the education and wellness of radiology residents in North America published after 2020 were included. The data were analyzed using a narrative synthesis approach. RESULTS: The three main domains affected by the pandemic include the residency curriculum, research, and resident wellness. The decline in case volume and diversity of cases had negative overall impact on education of radiology residents, but simulated cases and virtual learning proved its value during the pandemic and may have lasting implications for the postpandemic world. Research initiatives transitioned to a remote format with greater emphasis on quality improvement and COVID-19-related studies. Reduced face-to-face interaction opportunities made it difficult to establish strong and meaningful interpersonal connections and had a negative impact on resident wellness, mentorship, and professional development. Implementing mentorship programs and virtual "town hall meetings" were effective measures to maintain connections during times of social distancing. Finally, the COVID-19 pandemic introduced unprecedented stressors and challenges for radiology residents that negatively impacted their mental health and wellness. Incorporating wellness initiatives such as wellness hours and team-building activities and using social media were helpful in promoting wellness and mental health for radiology residents. CONCLUSION: The COVID-19 pandemic has had a significant impact on the academics and wellness of radiology residents across North America but has taught us many lessons that can help us navigate the ongoing challenges of the pandemic, the postpandemic world, and future pandemics.