Improving radiologist's ability in identifying particular abnormal lesions on mammograms through training test set with immediate feedback.

It has been shown that there are differences in diagnostic accuracy of cancer detection on mammograms, from below 50% in developing countries to over 80% in developed world. One previous study reported that radiologists from a population in Asia displayed a low mammographic cancer detection of 48% compared with over 80% in developed countries, and more importantly, that most lesions missed by these radiologists were spiculated masses or stellate lesions. The aim of this study was to explore the performance of radiologists after undertaking a training test set which had been designed to improve the capability in detecting a specific type of cancers on mammograms. Twenty-five radiologists read two sets of 60 mammograms in a standardized mammogram reading room. The first test set focused on stellate or spiculated masses. When radiologists completed the first set, the system displayed immediate feedback to the readers comparing their performances in each case with the truth of cancer cases and cancer types so that the readers could identify individual-based errors. Later radiologists were asked to read the second set of mammograms which contained different types of cancers including stellate/spiculated masses, asymmetric density, calcification, discrete mass and architectural distortion. Case sensitivity, lesion sensitivity, specificity, receiver operating characteristics (ROC) and Jackknife alternative free-response receiver operating characteristics (JAFROC) were calculated for each participant and their diagnostic accuracy was compared between two sessions. Results showed significant improvement among radiologists in case sensitivity (+ 11.4%; P < 0.05), lesion sensitivity (+ 18.7%; P < 0.01) and JAFROC (+ 11%; P < 0.01) in the second set compared with the first set. The increase in diagnostic accuracy was also recorded in the detection of stellate/spiculated mass (+ 20.6%; P < 0.05). This indicated that the performance of radiologists in detecting malignant lesions on mammograms can be improved if an appropriate training intervention is applied after the readers' weakness and strength are identified.

Korean Society of Thyroid Radiology Guidelines for the Management of Pediatric Thyroid Nodules: Suitability and Risk Factors.

Background: The guideline for managing pediatric thyroid nodules has not been established. We investigated the appropriateness of the Korean Society of Thyroid Radiology (KSThR) guidelines and the need to consider risk factors for managing pediatric thyroid nodules. Methods: From August 2007 to February 2020, a database of thyroid nodules in patients younger than 19 years who underwent fine-needle aspiration (FNA) was analyzed. Two radiologists retrospectively reviewed ultrasound images to characterize the nodules according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) criteria. Thyroid nodules were divided into benign and malignant nodules. Clinical risk factors were identified, including familial thyroid cancer, history of radiation therapy, and underlying thyroiditis. According to the K-TIRADS categories and the presence of risk factors, malignancy rates were calculated. We compared the diagnostic performance of the original KSThR guidelines and newly suggested criteria for FNA derived by simulation tests with variable size cutoffs in the total study population, a group with risk factors, and a group without risk factors. Results: A total of 107 patients (mean age, 13.9 years; range, 4-18 years; 83 females; 50 patients with risk factors) with 133 nodules (71 benign and 62 malignant) were included. The malignancy rate of thyroid nodules was higher in the group with risk factors (64.0%) than in the group without risk factors (43.9%; p = 0.037). Compared with the KSThR guideline (≥1.0 cm for K-TIRADS 4 and 5), the accuracy was higher (62.4% vs. 56.4%) and the unnecessary biopsy rate was lower (44.0% vs. 47.4%) when the new criteria (≥0.6 cm for K-TIRADS 4 and ≥0.5 cm for K-TIRADS 5) were used in the total study population. In particular, in the group with risk factors, the newly suggested size criteria had a much higher accuracy (73.1% vs. 59.7%) and lower unnecessary biopsy rate (30.4% vs. 35.5%) than the KSThR guideline. Conclusions: For the management of thyroid nodules in children, it is necessary to consider risk factors and adjust the criteria values for FNA. FNA should be considered in children with risk factors for thyroid cancer even if thyroid nodules are small.

Joint Statement of the German Respiratory Society and German Society of Thoracic Surgery in Cooperation with the German Radiological Society: Structural Prerequisites of Centres for Interventional Treatment of Emphysema.

Interventional treatment of emphysema offers a wide range of surgical and endoscopic options for patients with advanced disease. Multidisciplinary collaboration of pulmonology, thoracic surgery, and imaging disciplines in patient selection, therapy, and follow-up ensures treatment quality. The present joint statement describes the required structural and quality prerequisites of treatment centres. This is a translation of the German article "Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Thoraxchirurgie in Kooperation mit der Deutschen Röntgengesellschaft: Strukturvoraussetzungen von Zentren für die interventionelle Emphysemtherapie" Pneumologie. 2020;74:17-23.

LI-RADS in the year 2020 - Are you already using it or still considering? / LI-RADS im Jahr 2020 ­ Nutzt du es schon oder überlegst du noch?

PURPOSE: The working group for gastrointestinal and abdominal imaging within the German Radiological Society performed a nationwide online survey in order to assess the current status regarding the awareness and application of LI-RADS, a classification for evaluation of liver lesions in patients at risk. MATERIALS AND METHODS: Using the website www.deutsches-krankenhausverzeichnis.de a list of hospitals was generated meeting the criteria internal medicine, gastroenterology, general and visceral surgery and radiology (n = 391). Randomly, 102 department directors were contacted, and asked to name one consultant and one resident from their department in order to participate in the survey. 177 potential participants were invited to fill out an approximately 10-minute online survey in the form of 17 questions regarding the awareness and application of LI-RADS. The results of the survey were analyzed by means of descriptive statistics. RESULTS: 77 participants were registered, which corresponds to a response rate of 43.5 %. 47 % of all participants were radiologists, 30 % surgeons and 23 % internal doctors/gastroenterologists, respectively, many with more than 13 years of professional experience (37.2 %). The majority of participants worked in a hospital with a focus (37.2 %) or a university hospital (29.1 %). Even though the majority of participants knows about or has heard of LI-RADS (73.2 %), only a minority uses the classification themselves (26 %) or within the context of tumor boards (19.2 %). CONCLUSION: The results of our survey demonstrate that LI-RADS is relatively known in Germany, the application however quite sparse. This is in contrast to the general desire and endeavor for more standardized reporting in radiology. KEY POINTS: · LI-RADS is not yet broadly implemented in clinical routine in Germany. · The sparse application is in contrast to the general desire for more standardized reporting in radiology. · Interdisciplinary education may support the propagation and use of the LI-RDAS classification. CITATION FORMAT: · Ringe KI, Gut A, Grenacher L et al. LI-RADS in the year 2020 - Are you already using it or still considering? Fortschr Röntgenstr 2021; 193: 186 - 193.

Malignancy risk stratification and FNA recommendations for thyroid nodules: A comparison of ACR TI-RADS, AACE/ACE/AME and ATA guidelines.

OBJECTIVE: To compare diagnostic performance and malignancy risk stratification among guidelines set forth by the American Thyroid Association (ATA) in 2015, the American Association of Clinical Endocrinologists (AACE), the American College of Endocrinology (ACE) and the Association Medici Endocrinologi (AME) in 2016, and the American College of Radiology (ACR) in 2017. METHODS: The retrospective study was approved by the hospital ethics committee, and the informed consent requirement was waived. From October 2015 to March 2016, a total of 230 patients with 230 consecutive thyroid nodules were enrolled in this study. Each nodule was classified by one junior and one senior radiologist separately according to ACR TI-RADS, AACE/ACE/AME and ATA guidelines. The malignancy diagnostic performance and the number of FNA recommendations were pairwise compared among three guidelines using chi-square tests. RESULTS: Of the 230 thyroid nodules, 137 were malignant, and 93 were benign. However, 19.6% of the nodules (45 of 230) did not match any pattern using the ATA guidelines but with a high risk of malignancy (68.9%). The ACR TI-RADS derived the highest diagnostic performance, from both junior radiologist (AUC 0.815) and senior radiologist (AUC 0.864). The ACR guidelines also showed the greatest level of sensitivity (junior: 86.1%, senior: 94.9%), compared with AACE/ACE/AME and ATA guidelines. The number of thyroid nodules recommended to fine-needle aspiration (FNA) was the lowest (37.8%, 40.4%) by ACR TI-RADS, and meanwhile, the malignant detection rate within these nodules was highest (64.4%, 68.8%). CONCLUSIONS: The ACR guidelines present a higher level of diagnostic indicators and may offer a meaningful reduction in FNA recommendations with a higher malignancy detection rate.

[The new radiation protection legislation-part 1 : Modifications in radiology for the workflow in clinical routine]. / Die neue Strahlenschutzgesetzgebung ­ Teil 1 : Änderungen für die arbeitstägliche Routine in der Radiologie.

BACKGROUND: On 31 December 2018, the new Radiation Protection Regulation came into effect in Germany and made the new Radiation Protection Act more concrete. The old Radiation Protection Regulation and X­ray Regulation have thereby been replaced. OBJECTIVES: The substantial modifications regarding the practical daily routine in radiology are summarized. METHODS: Modifications and innovations of the New Radiation Protection Act and Regulation compared to the old Radiation Protection Regulation and X­ray Regulation and accordances were evaluated. Thereby the main focus was in the relevance for workflow in clinical routine. RESULTS AND CONCLUSION: The new legislation contains a number of regulations that provide crucial tools for implementation of radiation protection, quality assurance, and dose optimization. However, this also requires additional time and personnel.

[Interdisciplinary tumor boards in the radiological routine : Current situation based on an online survey in Germany]. / Interdisziplinäre Tumorkonferenzen in der radiologischen Routine : Statuserhebung basierend auf einer Online-Befragung in Deutschland.

PURPOSE: Interdisciplinary tumor boards are periodical conferences, where optimal individual therapy plans are developed among medical experts with different specializations. The presence of a board-certified radiologist is medically indispensable in almost all relevant boards. In order to systematically evaluate the current workload for radiologists caused by these boards, we evaluated the current situation within German radiology to obtain numbers for future personnel planning. MATERIALS AND METHODS: We performed an online survey. We invited all 33 German university chairmen and 50 randomly selected head physicians of radiology at level 3 hospitals to participate. RESULTS: We had a participation rate of 79% (26/33) at university hospitals and 56% (28/50) at of level 3 non-university hospitals. The average total number of tumor boards was 3.3/day or 16.7/week at university hospitals and 2.6/day or 13/week at level 3 non-university hospitals. We calculated an average time considering preparation and execution as well as the average number of boards of 33.1 h/week for university hospitals and 18.2 h/week for level 3 hospitals. This results in a 78.8% workload for a board-certified radiologist at a university hospital (regular weekly work time 42 h) and 45.5% work load for level 3 hospitals (regular weekly work time 40 h). CONCLUSION: "Speaking radiology" as in interdisciplinary tumor boards represents a fundamental matter of course in radiology. The active participation in boards accomplished by radiologists improves evidence-based patient care. However, given the prevailing scarcity of resources in medicine, the data collected here regarding personnel costs for clinical radiology for participation in tumor boards must be taken into account in future discussions on personnel compensation.

The impact of the novel coronavirus on trauma and orthopaedics in the UK.

At first glance, the novel coronavirus pandemic and orthopaedic surgery appear separate entities. Orthopaedic surgeons are not generally considered front-line staff in terms of the treatment of the disease that the novel coronavirus causes compared with anaesthetic and medical colleagues. However, the impact that the novel coronavirus is likely to have on the musculoskeletal injury burden and the morbidity associated with chronic musculoskeletal disease is significant. This article summarises the strategies currently being developed for the remodelling of orthopaedic services in the UK and the emergency British Orthopaedic Association Standards for Trauma and Orthopaedic guidelines released on 24 March 2020 in managing urgent orthopaedic patients during the novel coronavirus pandemic.

Updated Australian diagnostic reference levels for adult CT.

INTRODUCTION: In 2018, ARPANSA published updated national DRLs for adult CT, which were first published in 2012, and augmented the national DRL categories. This paper presents the updated national DRLs and describes the process by which they were produced. METHODS: Examine patient survey data submitted to the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) National Diagnostic Reference Level Service (NDRLS). Determine the quartiles of the distributions of median survey dose metrics with categorisation by procedure type. Engage a liaison panel representing the radiology professions to review procedure categories and recommend revised national DRLs. The revised NDRL procedure categories are: head (non-contrast brain (trauma/headache)), cervical spine (Non-contrast (trauma)), soft-tissue neck (post-contrast (oncology)), chest (post-contrast (oncology)), abdomen-pelvis (post-contrast (oncology)), kidney-ureter-bladder (non-contrast (suspected renal colic)), chest-abdomen-pelvis (post-contrast (oncology)) and lumbar spine (non-contrast (degenerative pain)). RESULTS: The existing six procedure categories were revised and refined. Updated Australian national diagnostic reference levels for adult CT were recommended and endorsed for eight procedure categories: head (52 mGy/880 mGycm), cervical spine (23 mGy/470 mGycm),soft-tissue neck (17 mGy/450 mGycm), chest (10 mGy/390 mGycm), abdomen-pelvis (13 mGy/600 mGycm), kidney-ureter-bladder (13 mGy/600 mGycm), chest-abdomen-pelvis (11 mGy/940 mGycm) and lumbar spine (26 mGy/670 mGycm). The updated national DRLs are between 12 and 26% lower than the previous DRLs for dose-length product and between 13 and 63% lower for volume computed tomography dose index. CONCLUSIONS: Australian national DRLs for adult CT have been reviewed and revised. The revised national DRLs are lower, better reflecting current practice among imaging facilities in Australia. The revised Australian national DRLs are similar to those in other developed countries.

FMEA-guided transition from microSelectron to Flexitron for HDR brachytherapy.

PURPOSE: To utilize failure mode and effects analysis (FMEA) to effectively direct the transition from the Elekta microSelectron to the Flexitron high dose-rate afterloader system. MATERIALS AND METHODS: Our FMEA was performed in two stages. In the first stage, the lead brachytherapy physicists used FMEA to guide the brainstorming sessions and to identify vulnerabilities during this transition. The second stage of FMEA was carried out 2 months after the clinical release of the Flexitron system. The process map was examined again to further refine and improve the entire process. RESULTS: In the first-stage FMEA, 81 process steps were identified. Moreover, 80 failure modes and their categorized causes were recognized. Checklists and data books containing the corresponding applicator information were verified and updated. Next, based on outcomes of our first-stage FMEA, we chose to implement the commissioning process in two phases. The second stage of FMEA identified error-prone steps in our newly updated processes. This second stage of analysis resulted in the development of new tools and checklist items. CONCLUSIONS: The two-stage FMEA approach successfully directed the transition to the Flexitron system by identifying the necessary changes in the checklists and workflows for all applicators utilized in our clinic. It also led to the decision to use a two-phase commissioning approach. This allowed for minimization clinical downtime, avoidance of an extra source change, and facilitation of efficient staff training. Additionally, multiple project-level failures were discovered. Our experience and outcomes from this FMEA-guided transition should provide valuable information to the brachytherapy community.

A practical and adaptive approach to lung cancer screening: a review of international evidence and position on CT lung cancer screening in the Singaporean population by the College of Radiologists Singapore.

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.

Preparing for Artificial Intelligence: Systems-Level Implications for the Medical Imaging and Radiation Therapy Professions.

Innovations in artificial intelligence (AI) are driving a new industrial revolution, and as a result, the medical radiation sciences is experiencing transformational, open, beneficial, yet disruptive changes. Many studies have already been published on specific frontline examples where AI will improve cancer care, but discussions of how AI will change the medical radiation sciences and its associated professions at the systems level have been comparatively sparse. In this article, the system-level implications of AI on the medical radiation sciences are discussed, and recommendations are made on how professionals in this field may need to adapt in preparation for a future where AI will be an integral part of the health care system at all levels.

Artificial Intelligence and the Medical Radiation Profession: How Our Advocacy Must Inform Future Practice.

There is no escaping the fact that academics are devoting unrelenting attention to the impact artificial intelligence will have on health care. Radiological and radiation oncology organizations worldwide are devoting their time and resources to ensure their members are both informed and prepared for the inevitable changes to the respective professions. This commentary provides an overview of how artificial intelligence will affect medical radiation professions of both diagnostic and radiation therapy streams. It outlines how these professions can play an active role in ensuring optimal outcomes for the well-being of both the workforce and the patients.