Deep Learning for Pneumothorax Detection on Chest Radiograph: A Diagnostic Test Accuracy Systematic Review and Meta Analysis.

BACKGROUND: Pneumothorax is a common acute presentation in healthcare settings. A chest radiograph (CXR) is often necessary to make the diagnosis, and minimizing the time between presentation and diagnosis is critical to deliver optimal treatment. Deep learning (DL) algorithms have been developed to rapidly identify pathologic findings on various imaging modalities. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the overall performance of studies utilizing DL algorithms to detect pneumothorax on CXR. METHODS: A study protocol was created and registered a priori (PROSPERO CRD42023391375). The search strategy included studies published up until January 10, 2023. Inclusion criteria were studies that used adult patients, utilized computer-aided detection of pneumothorax on CXR, dataset was evaluated by a qualified physician, and sufficient data was present to create a 2 × 2 contingency table. Risk of bias was assessed using the QUADAS-2 tool. Bivariate random effects meta-analyses and meta-regression modeling were performed. RESULTS: Twenty-three studies were selected, including 34 011 patients and 34 075 CXRs. The pooled sensitivity and specificity were 87% (95% confidence interval, 81%, 92%) and 95% (95% confidence interval, 92%, 97%), respectively. The study design, use of an institutional/public data set and risk of bias had no significant effect on the sensitivity and specificity of pneumothorax detection. CONCLUSIONS: The relatively high sensitivity and specificity of pneumothorax detection by deep-learning showcases the vast potential for implementation in clinical settings to both augment the workflow of radiologists and assist in more rapid diagnoses and subsequent patient treatment.

Bowel Emergencies in Patients With Cancer.

Cancer is the second most common cause of death worldwide. Bowel emergencies in patients with cancer are becoming increasingly more prevalent due to advances in cancer therapy and longer overall patient survival. When these patients present acutely, they are often frail and may have pre-existing co-morbidities. This article discusses the imaging features of bowel emergencies commonly encountered in oncological patients in clinical practice. These include chemotherapy related colitis, neutropenia enterocolitis and typhlitis, toxic megacolon, bowel perforation, malignant bowel obstruction and gastrointestinal haemorrhage. The radiologist plays a key role in identifying these oncological emergencies and guiding further management.

Abdominal Emergencies in Cancer Patients.

Abdominal emergencies in cancer patients encompass a wide spectrum of oncologic conditions caused directly by malignancies, paraneoplastic syndromes, reactions to the chemotherapy or often represent the first clinical manifestation of an unknown malignancy. Not rarely, clinical symptoms are the tip of an iceberg. In this scenario, the radiologist is asked to exclude the cause responsible for the patient's symptoms, to suggest the best way to manage and to rule out the underlying malignancy. In this article, we discuss some of the most common abdominal oncological emergencies that may be encountered in an emergency department.

Current Status of Burnout in Canadian Radiology.

Burnout is a healthcare concern affecting physicians around the world. Physicians experiencing burnout tend to display signs of emotional exhaustion, depersonalization, and low personal accomplishment. Ongoing burnout trends have posed numerous challenges to Canadian physicians, notwithstanding the added complexity of the COVID-19 pandemic's impact in recent years. In particular, Canadian radiologists frequently reported experiencing high rates of burnout. This review aims to examine prominent factors affecting burnout in Canadian radiologists and summarize the impact of recent trends. In doing so, the overall wellbeing of Canadian radiologists can be assessed, and strategies for improvement can be discussed as the Canadian healthcare system prepares for new challenges of increasing demand and pressures.

The Role of Twitter in Radiology Medical Education and Research: A Review of Current Practices and Drawbacks.

The trends in society have provided favourable conditions for the rapid growth of radiology on social media, specifically there has been an expanding presence on Twitter. Currently, simple searches on Twitter yield a plethora of radiology education resources, that may be suited for medical students, residents or practicing radiologists. Educators have many tools at their disposal to deliver effective teaching. Over time, strategies such as including images and scrollable stacks often are more successful at gaining popularity or clicks online. Journals and authors can use Twitter to promote their new scientific work and potentially reach audiences they couldn't have prior. Attendees at conferences can get involved in the conversation by tweeting about the meeting and engaging with other attendees with mutual interests. Interested medical students, residents and even practicing radiologists can use Twitter as a means of networking and connecting with other scholars all around the globe. Within its glory, Twitter does carry some drawbacks including privacy concerns, equality, and risk of misinformation. Above all, the future of Twitter is bright and promising for all who are currently on it and plan to use it for their education, research, or professional advancement.

Barriers to Screening At-risk Populations in Canada.

Cancer screening is invaluable for early detection of disease, including for breast and lung cancer. Through early detection, cancer treatment can be commenced prior to the development of advanced stage disease, significantly reducing morbidity and mortality. However, eligible patients may face barriers when accessing screening services, and some groups may be more disproportionately affected than others. This review aims to describe some of the most prominent barriers that at-risk populations may face when accessing image-based cancer screening services in Canada. Characterizing these barriers would be helpful in determining the best strategies to increase uptake to these screening services and, consequently, improve health equity.

Intra-Specialty Citation Pattern in Radiology and Gastroenterology/Hepatology Journals: A Cross-Specialty Comparison.

Objectives: To investigate intra-specialty citation patterns of radiology articles, compared with another medical specialty: gastroenterology/hepatology. Methods: Four radiology journals (Radiology, European Radiology, Diagnostic and Interventional Imaging, Canadian Association of Radiologists Journal) and four gastroenterology/hepatology journals (Journal of Hepatology, Journal of Gastroenterology, World Journal of Gastroenterology, Journal of Clinical Gastroenterology) with similar Web of Science in-category 2020 IF ranking were selected. The original research, review, letter, and editorial articles published in these journals in 2021 were identified. The average number of intra-specialty citations per article (intra-specialty citation count) and percentage of intra-specialty citations out of total citations per article (intra-specialty citation rate) were compared between radiology and gastroenterology/hepatology articles using Student's t-test. Results: The radiology articles demonstrated a lower total citation count per article (radiology: 29.7 ± .4 (mean ± SEM), n = 2063; gastroenterology/hepatology: 50.1 ± 1.4, n = 1335). The intra-specialty citation count was also lower in radiology articles than gastroenterology/hepatology articles (radiology: 12.9 ± .2, gastroenterology/hepatology: 19.6 ± .7; P < .001), both overall and in all article types. Additionally, the overall intra-specialty citation rate was not significantly different between the two specialties (radiology: 48.8% ± .5%; gastroenterology/hepatology: 47.1 ± .8%; P = .057), although the intra-specialty citation rates were higher in radiology original research and editorial article types. Conclusions: The significantly lower per-article intra-specialty citation counts in all radiology article types, a measurement that directly links to specialty IFs, may contribute to the lower impact factors of radiology journals compared with gastroenterology/hepatology ones.

Pancreatic Cystic Lesions: Review of the Current State of Diagnosis and Surveillance.

Pancreatic cystic lesions (PCLs) are both common and often incidental. These encompass a range of pathologies with varying degrees of concern for malignancy. Although establishing a diagnosis is helpful for determining malignant potential, many PCLs are either too small to characterize or demonstrate nonspecific morphologic features. The most salient modalities involved in diagnosis and surveillance are magnetic resonance imaging, multidetector computerized tomography, and endoscopic ultrasound. Fine needle aspiration has a role in conjunction with molecular markers as a diagnostic tool, particularly for identifying malignant lesions. Although several major consensus guidelines exist internationally, there remains uncertainty in establishing the strength of the association between all PCLs and pancreatic adenocarcinoma, and in showing a benefit from extended periods of imaging surveillance. No consensus exists between the major guidelines, particularly regarding surveillance duration, frequency, or endpoints. This review paper discusses PCL subtypes, diagnosis, and compares the major consensus guidelines with considerations for local adaptability along with questions regarding current and future priorities for research.

Chemotherapy-Induced Toxicities: An Imaging Primer[Formula: see text].

The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ systems. The purpose of this review is to offer a unified resource for general radiologists regarding the imaging appearances of chemotherapy-induced toxicities.

Emergency Radiology: Evolution, Current Status, and Future Directions.

Emergency Radiology is a clinical practice and an academic discipline that has rapidly gained increasing global recognition among radiology and emergency/critical care departments and trauma services around the world. As with other subspecialties, Emergency Radiology practice has a unique scope and purpose and presents with its own unique challenges. There are several advantages of having a dedicated Emergency Radiology section, perhaps most important of which is the broad clinical skillset that Emergency Radiologists are known for. This multi-society paper, representing the views of Emergency Radiology societies in Canada and Europe, outlines several value-oriented contributions of Emergency Radiologists and briefly discusses the current state of Emergency Radiology as a subspecialty.

Influences of the Social Media Continuum Model in Radiology: Theory and Reality.

Social media utilization has been growing exponentially worldwide and has created a thriving venue for radiologists and the profession of radiology to engage in on both the academic and social levels. The aim of this article is to conduct updated literature review and address a gap in the literature by introducing a simple classification for social media utilization and a new theoretical model to outline the role and potential value of social media in the realm of radiology. We propose classifying social media through usage-driven and access-driven indices. Furthermore, we discuss the interdependency of radiologists, other physicians and non-physician stakeholders, scientific journals, conferences/meetings and the general public in an integrated social media continuum model. With the ongoing sub-specialization of radiology, social media helps mitigate the physical barriers of making connections with peers and audiences which would have otherwise been unfeasible. The constant evolution and diversification of social media platforms necessitates a novel approach to better understand its role through a radiological lens. With the looming fear of 'ancillary service' labelling, social media could be the golden plate to halt the path towards commoditization of radiology.

The practice of emergency radiology throughout Europe: a survey from the European Society of Emergency Radiology on volume, staffing, equipment, and scheduling.

OBJECTIVES: To obtain information from radiology departments throughout Europe regarding the practice of emergency radiology METHODS: A survey which comprised of 24 questions was developed and made available online. The questionnaire was sent to 1097 chairs of radiology departments throughout Europe using the ESR database. All data were collected and analyzed using IBM SPSS Statistics software, version 20 (IBM). RESULTS: A total of 1097 radiologists were asked to participate, 109 responded to our survey. The response rate was 10%. From our survey, 71.6% of the hospitals had more than 500 beds. Ninety-eight percent of hospitals have an active teaching affiliation. In large trauma centers, emergency radiology was considered a dedicated section. Fifty-three percent of institutions have dedicated emergency radiology sections. Less than 30% had all imaging modalities available. Seventy-nine percent of institutions have 24/7 coverage by staff radiologists. Emergency radiologists interpret cross-sectional body imaging, US scans, and basic CT/MRI neuroimaging in more than 50% of responding institutions. Cardiac imaging examinations/procedures are usually performed by cardiologist in 53% of institutions, while non-cardiac vascular procedures are largely performed and interpreted by interventional radiologists. Most people consider the European Diploma in Emergency Radiology an essential tool to advance the education and the dissemination of information within the specialty of emergency radiology. CONCLUSION: Emergency radiologists have an active role in the emergency medical team. Indeed, based upon our survey, they have to interact with emergency physicians and surgeons in the management of critically ill patients. A broad skillset from ultrasonography and basic neuroimaging is required. KEY POINTS: • At most major trauma centers in Europe, emergency imaging is currently performed by all radiologists in specific units who are designated in the emergency department. • Radiologists in the emergency section at present have a broad skillset, which includes cross-sectional body imaging, ultrasonography, and basic neuroimaging of the brain and spine. • A dedicated curriculum that certifies a subspecialty in emergency radiology with a diploma offered by the European Society of Emergency Radiology demonstrates a great interest by the vast majority of the respondents.

Use of Enteric Contrast Material for Abdominopelvic CT in Penetrating Traumatic Injury in Adults: Comparison of Diagnostic Accuracy Systematic Review and Meta-Analysis.

BACKGROUND. Scarce evidence exists on the diagnostic benefit of enteric contrast administration for abdominopelvic CT performed in the setting of penetrating trauma. OBJECTIVE. The purpose of this systematic review and meta-analysis is to compare the diagnostic accuracy of CT using enteric contrast material with that of CT not using enteric contrast material in penetrating traumatic abdominopelvic injury in adults. EVIDENCE ACQUISITION. A protocol was registered a priori (PROSPERO CRD42019139613). MEDLINE and EMBASE databases were searched until June 25, 2019. Studies were included that evaluated the diagnostic accuracy of abdominopelvic CT either with or without enteric (oral and/or rectal) contrast material in patients presenting with penetrating traumatic injury. Relevant study data metrics and risk of bias were assessed. Bivariate random-effects meta-analyses and meta-regression modeling were performed to assess and compare diagnostic accuracies. EVIDENCE SYNTHESIS. From an initial sample of 829 studies, 12 studies were included that reported on 1287 patients with penetrating injury (389 with confirmed bowel, mesenteric, or other abdominopelvic organ injury). The enteric contrast material group (seven studies; 506 patients; 124 patients with confirmed penetrating injury) showed a sensitivity of 83.8% (95% CI, 73.7-90.5%) and specificity of 93.8% (95% CI, 83.6-97.8%). The group without enteric contrast administration (six studies; 781 patients; 265 patients with confirmed penetrating injury) showed a sensitivity of 93.0% (95% CI, 86.8-96.4%) and a specificity of 90.3% (95% CI, 81.4-95.2%). No statistically significant difference was identified for sensitivity (p = .07) or specificity (p = .37) between the groups with and without enteric contrast material according to meta-regression. Nine of 12 studies showed risk of bias in at least one QUADAS-2 domain (most frequently limited reporting of blinding of radiologists or lack of blinding of radiologists, insufficient clinical follow-up for the reference standard, and limited reporting of sampling methods). CONCLUSION. The use of enteric contrast material for CT does not provide a significant diagnostic benefit for penetrating traumatic injury. CLINICAL IMPACT. Eliminating enteric contrast administration for CT in penetrating traumatic injury can prevent delays in imaging and surgery and reduce cost.

Synthetic 2D Mammography Versus Standard 2D Digital Mammography: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis.

BACKGROUND. The use of synthetic 2D mammography (SM) with digital breast tomosynthesis (DBT) in place of standard 2D digital mammography (DM) may reduce radiation dose without sacrificing accuracy. OBJECTIVE. The purpose of our study was to compare the diagnostic accuracy of SM, DM, SM with DBT, and DM with DBT for breast cancer detection. EVIDENCE ACQUISITION. A search of MEDLINE, Embase, and Cochrane databases was performed for relevant articles published up to September 11, 2019. Studies included compared the diagnostic accuracy of SM versus DM and SM plus DBT versus DM plus DBT for breast cancer detection. Relevant study data metrics and risk of bias were assessed. A bivariate random-effects meta-analysis and meta-regression were performed to assess diagnostic accuracy (PROSPERO CRD42020150737). EVIDENCE SYNTHESIS. Thirteen studies reporting on 201,304 patients (7252 patients with breast cancer) were included. The SM group (six studies: 20,728 patients, 724 with breast cancer) had 75% sensitivity (95% CI, 67-82%) and 92% specificity (95% CI, 85-96%). The DM group (nine studies: 52,082 patients, 2249 patients with breast cancer) had 73% sensitivity (95% CI, 65-80%) and 88% specificity (95% CI, 77-94%). The SM plus DBT group (10 studies, 64,224 patients, 2149 with breast cancer) had 85% sensitivity (95% CI, 80-89%) and 93% specificity (95% CI, 86-96%). The DM plus DBT group (nine studies, 64,270 patients, 2130 with breast cancer) had 84% sensitivity (95% CI, 80-88%) and 91% specificity (95% CI, 83-95%). Meta-regression models did not reveal significant differences in accuracy between the SM and DM groups (p = .25-.77). CONCLUSION. SM and SM plus DBT showed comparable diagnostic accuracy to DM and DM plus DBT, respectively. CLINICAL IMPACT. The findings support the implementation of SM in place of standard DM for mammographic imaging of the breasts. This may lead to an overall reduction in radiation exposure.

CT of Penetrating Abdominopelvic Trauma.

Penetrating abdominopelvic trauma usually results from abdominal cavity violation from a firearm injury or a stab wound and is a leading cause of morbidity and mortality from traumatic injuries. Penetrating trauma can have subtle or complex imaging findings, posing a diagnostic challenge for radiologists. Contrast-enhanced CT is the modality of choice for evaluating penetrating injuries, with good sensitivity and specificity for solid-organ and hollow viscus injuries. Familiarity with the projectile kinetics of penetrating injuries is an important skill set for radiologists and aids in the diagnosis of both overt and subtle injuries. CT trajectography is a useful tool in CT interpretation that allows the identification of subtle injuries from the transfer of kinetic injury from the projectile to surrounding tissue. In CT trajectography, after the entry and exit wounds are delineated, the two points can be connected by placing cross-cursors and swiveling the cut planes obliquely in orthogonal planes to obtain a double-oblique orientation to visualize the wound track in profile. The path of the projectile and its ensuing damage is not always straight, and the imaging characteristics of free fluid of different attenuation in the abdomen (including hemoperitoneum) can support the diagnosis of visceral and vascular injuries. In addition, CT is increasingly used for evaluation of patients after damage control surgery and helps guide the management of injuries that were overlooked at surgery. An invited commentary by Paes and Munera is available online. Online supplemental material is available for this article. ©RSNA, 2021.

Role of MRI in early follow-up of patients with solid organ injuries: How and why we do it?

Trauma represents one of the most common causes of death or permanent disability in the population below 50 years. At present, non-operative treatment is the commonly adopted strategy in hemodynamically stable patients with solid organ injuries, when there are not concomitant bowel and mesenteric injuries requiring a prompt surgical approach, but it may require multiple imaging follow-up examinations, especially in the case of major injuries. No data are available about magnetic resonance imaging utilization in the early follow-up of trauma patients with solid organ injuries, particularly in liver and spleen trauma. We report our preliminary experience in this field.

Etiology of Burnout in Canadian Radiologists and Trainees.

PURPOSE: There is worsening of burnout symptoms experienced by radiologists and trainees. We explored potential factors that exacerbate burnout symptoms observed in the Canadian radiological community and currently available protective factors as next steps for establishing viable solutions for burnout. METHODS: An 11-question electronic survey was distributed to Canadian radiologists and trainees through the Canadian Association of Radiologists (CAR). Approval from a local ethics board and the CAR were obtained. The survey contained demographics-related questions as well as questions based on common risk factors for burnout. Qualitative and quantitative analyses were performed. RESULTS: The survey was distributed to 2200 CAR members, and a response rate of 23.3% was achieved. Most radiologists experienced frequent unexpected high workload with no statistically significant difference by the type of practice. Trainees experienced a statistically significantly (P < .0001) higher frequency of on-call shifts compared to staff radiologists. A statistically significant difference (P < .0001) was observed for perceived threats to career longevity dependent on length of career. Although support mechanisms for radiology were perceived as available, survey commentary suggested inefficiency in their usage and lack of prioritization, which was a trend observed across all types of practice. CONCLUSIONS: While there is awareness for radiology needs, changes are required at the workplace level to reduce burnout symptoms at their source. Communication between radiologists and hospital administration, as well as among radiology group members, is key to prioritize radiology needs in our imaging-driven era of health care.

Subspecialty Employment Needs in Academic Radiology Settings Across Canada.

PURPOSE: The purpose of this survey was to identify current and projected subspecialty employment needs across Canadian academic radiology practices. METHODS: An electronic survey was distributed to academic radiology department heads within the faculties of medicine at Canadian universities between September and October 2019. Respondents identified the number of partnership track radiologists hired in the last academic year, the number of fellowship-trained new hires, and the top 3 subspecialties for new and prospective hires. Descriptive statistics were used to summarize the data. RESULTS: Nine academic radiology department heads responded to the survey (75% response rate) with good regional representation across Canada. Ninety-five percent of new hires within the last academic year were subspecialty fellowship trained. The top subspecialties for new hires in the last year were abdominal imaging and interventional neuroradiology, with 77.8% and 44.4% of academic leaders reporting them as one of the top 3 subspecialties, respectively. The top 3 subspecialties for prospective hires in the next academic year included musculoskeletal imaging (n = 6, 66.7%), followed by abdominal imaging (n = 5, 55.6%), with pediatric radiology (n = 3, 33.3%) and cardiothoracic imaging (n = 3, 33.3%) tying for third place. There was some variability in the subspecialty needs for hires between regions. CONCLUSIONS: The survey results provide valuable information about the current and future subspecialty needs of academic radiology practices. The data obtained can provide guidance to trainees regarding fellowship training options that will optimize their future employability.

Female Authorship in Radiology: Trends in the Past Decade in CARJ.

PURPOSE: To identify trends in female authorship in the Canadian Association of Radiologists Journal (CARJ) from 2010 to 2019. METHODS: We retrieved papers published in the CARJ over a 10-year period, and retrospectively reviewed 602 articles. All articles except editorials and advertisements were included. We categorized the names of the first and last position authors as female or male and excluded articles that had at least one author of which gender was not known. We compared the trends in the first and last position authors of the articles from 2010 to 2019. For statistical analysis, logistic regression was performed with reported odds ratios (ORs), and a P value of <.05 was defined as statistically significant. RESULTS: Five hundred thirteen articles met inclusion criteria. Among them, 23 articles with a single author were classified as having only a first author. 39.8% (204/513) of first authors were female and 26.9% (132/490) of last authors were female. There has been an overall temporal increase in the odds of both the first and last author being female in CARJ publications (OR: 1.11, P = .034). Similarly, the odds a CARJ publication's first author being female increased over time (OR: 1.07, P = .033). Female last author did not predict female first author (OR: 1.48, P = .056). There was no association identified between female last author and year of publication (OR: 1.04, P = .225). CONCLUSION: There has been an overall increase in engagement of female authorship in CARJ.

CARJ 2021: Year in Review.

The past year has been one of unprecedented challenge for the modern world and especially the medical profession. This review explores some of the most impactful topics published in the CARJ during the COVID-19 pandemic including physician wellbeing and burnout, patient safety, and technological innovations including dual energy CT, quantitative imaging and ultra-high frequency ultrasound. The impact of the COVID-19 pandemic on trainee education is discussed and evidence-based tips for providing value-added care are reviewed. Patient privacy considerations relevant to the development of artificial intelligence applications for medical imaging are explored. These publications in the CARJ demonstrate that although this year has brought adversity, it has also been a harbinger for new and exciting areas of focus in our field.