A pilot study for a non-invasive system for detection of malignancy in canine subcutaneous and cutaneous masses using machine learning.

Introduction: Early diagnosis of cancer enhances treatment planning and improves prognosis. Many masses presenting to veterinary clinics are difficult to diagnose without using invasive, time-consuming, and costly tests. Our objective was to perform a preliminary proof-of-concept for the HT Vista device, a novel artificial intelligence-based thermal imaging system, developed and designed to differentiate benign from malignant, cutaneous and subcutaneous masses in dogs. Methods: Forty-five dogs with a total of 69 masses were recruited. Each mass was clipped and heated by the HT Vista device. The heat emitted by the mass and its adjacent healthy tissue was automatically recorded using a built-in thermal camera. The thermal data from both areas were subsequently analyzed using an Artificial Intelligence algorithm. Cytology and/or biopsy results were later compared to the results obtained from the HT Vista system and used to train the algorithm. Validation was done using a "Leave One Out" cross-validation to determine the algorithm's performance. Results: The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the system were 90%, 93%, 88%, 83%, and 95%, respectively for all masses. Conclusion: We propose that this novel system, with further development, could be used to provide a decision-support tool enabling clinicians to differentiate between benign lesions and those requiring additional diagnostics. Our study also provides a proof-of-concept for ongoing prospective trials for cancer diagnosis using advanced thermodynamics and machine learning procedures in companion dogs.

Nationwide community based emergency centers reveal scale of hand trauma.

INTRODUCTION: This study describes the characteristics of hand trauma treated in community-based emergency centers (CBECs) in Israel. It was hypothesized that the rate of hand trauma, as well as patient and injury characteristics, would differ from a recent study of patients treated in hospital emergency departments (EDs) in Jerusalem. METHODS: Data on all hand injury patients treated at any of the CBECs belonging to a large nationwide chain in 2017 were retrieved from the electronic medical records of the treatment centers, including demographic and clinical characteristics. RESULTS: Over the course of 2017, 53,574 individuals were treated for forearm, wrist and hand injuries (35% of all trauma patients treated during this period). The majority of the patients were male (62%). Contusions and fractures were common (80%) with a minority of lacerations (10%). Crush injuries and amputations were rare. Dog bites accounted for 1.5% of the injuries under the age of 10. Females were treated more with painkillers and opioids, especially over the age of 65, with variability between centers. Although the rate of fractures was similar between teens and the elderly, the elderly were treated with immobilization less frequently, and were referred to EDs for further care. Hospital referral rates differed significantly between centers. DISCUSSION: A higher rate of hand trauma was found in the CBECs in comparison to the hospital ED report (35% vs. 20% of all trauma patients, respectively). Patients treated at the CBECs, in comparison to the ED, were less often male, less often young adults, and differed in terms of type of injury. In the CBECs there were more contusions, as well as fewer lacerations and open wound injuries. In contrast, dog bites in children were found to be much more prevalent than previously reported. Hospital referral indications, the use of immobilization and pain management were found to vary according to age, gender and treatment center. Due to the high rate of hand trauma in CBECs, specific protocols are needed for these patients. The use of opioids should be specifically addressed, considering recent changes in treatment protocols. Thus, the prevalence and characteristics of hand trauma may be biased in studies based on hospital records.

[Outcome of a residency program in radiology for immigrants and other physicians by Maccabi Healthcare Services].

BACKGROUND: Maccabi Healthcare Services has more than 20 Diagnostic Imaging Clinics in Israel, and many radiologists are needed to perform and interpret the imaging studies. There was a shortage of radiologists willing to work full-time in these clinics. In the late 1980s and early 1990s a large number of immigrants arrived in Israel, some of them radiologists, who were looking for a position at Maccabi. However, their training was inadequate for the needs of modern radiology. Therefore, a program in radiology was initiated to support a number of these physicians to complete additional training in radiology, a process that would facilitate their employment as radiologists for Maccabi Healthcare Services. OBJECTIVES: To support several years of residency in radiology for immigrants and other physicians who would, on completion of their residency, work as radiologists for Maccabi Healthcare Services. METHODS: A total of 21 physicians entered the program, 16 women and 5 men, including 11 physicians from the former Soviet Union. They started their training in various academic hospitals during the years 1991-1997. A questionnaire regarding the program was completed by the residents and the chairmen of the relevant departments were interviewed. RESULTS: All physicians except one, who left the country for medical reasons, have as of now successfully completed their residency, and are employed as radiologists in Maccabi. One candidate received a grant for one year of residency abroad, and has been employed by Maccabi since completing her residency. CONCLUSION: The program can be termed a success, as all the parties concerned--residents, Maccabi Healthcare Services and the participating hospitals, profited from the arrangement.

Preauthorization of CT and MRI examinations: assessment of a managed care preauthorization program based on the ACR Appropriateness Criteria and the Royal College of Radiology guidelines.

PURPOSE: To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) utilization patterns before and after the implementation of a preauthorization program based on the ACR Appropriateness Criteria((R)) and the guidelines of the Royal College of Radiologists. MATERIALS AND METHODS: All CT and MRI requests received at the preauthorization center and CT and MRI examinations actually performed were identified by our health care service's centralized computerized database between January 1, 2000, and December 31, 2003. The obligatory preauthorization of CT and MRI requests was established for CT in September 2001 and for MRI in February 2002. All ambulatory CT and MRI examination requests sent for approval during the study period by most of our health care physicians were included in the study. The preauthorization program model is presented, and multiple parameters were evaluated from January 2000 to December 2003, before and after preauthorization was established. RESULTS: Before preauthorization was required, the CT and MRI utilization rates were constantly increasing by 20% and 5% per year for CT and MRI, respectively. After preauthorization was implemented, CT and MRI annual performance rates decreased from 25.9 and 7 examinations per 1,000, respectively, in 2000 to 17.3 and 5.6 examinations per 1,000, respectively, in 2003. The decreases in the utilization of MRI and CT imaging between 2001 and 2003 were 9% (12,129 compared with 11,070 MRI examinations) and 33% (81,223 compared with 57,204 CT examinations), respectively, resulting in substantial, statistically significant cost savings. The deferral rate ranged from 7.5% to 12.2% (mean = 9.8%) for CT and 13.9% to 21.4% (mean = 17%) for MRI. Deferred cases in CT were most commonly in neuroradiology, musculoskeletal radiology, and CT angiography (ranges of deferred cases 9% to 12%, 11% to 12%, and 10% to 12%, respectively). Deferred cases in MRI were most commonly in abdominal and chest radiology (ranges of deferred cases 32% to 37% and 20% to 31%, respectively). Computed tomography was more commonly utilized inappropriately by pediatric professions, and MRI was more commonly utilized inappropriately by medical subspecialty professions. CONCLUSION: Preauthorization of CT and MRI requests results in a substantial decrease in utilization of these modalities with reduction in imaging costs.

Mesenteric lymphadenopathy in children examined by US for chronic and/or recurrent abdominal pain.

BACKGROUND: Children with recurrent abdominal pain often undergo US to confirm or exclude organic disease. OBJECTIVE: To assess the prevalence of mesenteric lymphadenopathy on US in these children. MATERIALS AND METHODS: We prospectively studied 189 children with recurrent abdominal pain with US of the abdomen, using graded compression. The results were compared with 73 children in a control group. The children in both groups were divided into three age groups. The size, number, morphology and location of mesenteric lymph nodes were noted, as well as additional findings. Pediatricians followed the patients from 3 months to 1 year, and a repeat US study was done in 30 children. RESULTS: Mesenteric lymphadenopathy was present in 116 of 189 children (61.4%), with the greatest prevalence in boys in the younger age groups. The location of the nodes was mainly in the right lower quadrant. In the control group, 7 of 73 children had mesenteric lymphadenopathy, a significantly lower prevalence than in the study group ( P<0.001). Additional findings, apart from lymphadenopathy, were present in 27 (14.2%) of the 189 children in the study group, and in 5 (6.8%) of the 73 children in the control group. CONCLUSION: Mesenteric lymphadenopathy is a common, and often the only abnormal, finding on US in children with recurrent abdominal pain.