Teleworking beyond teleradiology: managing radiology departments during the COVID-19 outbreak.

Teleradiology solutions are playing an essential role during the COVID-19 outbreak. Activity at radiology departments must be maintained and adapted to this new situation beyond teleradiology. Teleworking should be extended to the rest of non-medical radiology department areas. A comprehensive perspective based on our own experience during the COVID-19 outbreak has been performed highlighting the value of teleworking for almost all areas implied in the workflow of radiology departments beyond radiologists. Personal and technical requirements for successfully adapting to this new scenario are discussed including the opportunities that this unprecedent situation is bringing for reorganizing workflow and developing new projects. KEY POINTS: • Teleradiology solutions are playing an essential role during the COVID-19 outbreak. • Teleworking should be extended to the rest of non-medical radiology department areas whenever possible.

Effect of Virtual Monoenergetic Images From Spectral Detector Computed Tomography on Coronary Calcium Blooming.

OBJECTIVE: The aim of this study was to investigate the quantitative and qualitative effects of virtual monoenergetic images (VMI) by spectral detector computed tomography (SDCT) on calcium blooming in coronary computed tomography angiography. METHODS: Coronary computed tomography angiography using SDCT was performed on 42 patients with coronary artery calcifications. Stenosis grading by diameter and area of calcified plaques and free lumen using VMI from 70 to 140 keV was performed and compared with measurements by conventional images. In addition, interobserver reliability and subjective image quality were assessed by 2 experienced readers. RESULTS: A total of 61 coronary arteries were evaluated. Stenosis grading by diameter and area showed significant incremental decrease, from 48.86% to 22.82% and from 41.18% to 11.33%, respectively, with increasing VMI (P < 0.05). Interobserver reliability was excellent (intraclass correlation coefficient >0.99). Overall image quality was best at 80 keV. CONCLUSIONS: Calcium blooming significantly decreases at higher monoenergetic levels from SDCT, increasing luminal dimensions and decreasing stenotic grading, with best overall subjective image quality using 80-keV VMI.

Magnetic resonance enterography/enteroclysis in acquired small bowel diverticulitis and small bowel diverticulosis.

PURPOSE: Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and diverticulitis in MRE. METHODS: This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation. RESULTS: Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation. CONCLUSION: SB diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis. KEY POINTS: • Small bowel diverticulosis and diverticulitis is rare and often missed in imaging • Acquired small bowel diverticula are variable in size and number • Small bowel diverticulitis demonstrates characteristic features on MR enterography/enteroclysis • A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula.

Initial experience of MR/PET in a clinical cancer center.

Magentic Resonance/positron emission tomography (PET) has been introduced recently for imaging of clinical patients. This hybrid imaging technology combines the inherent strengths of MRI with its high soft-tissue contrast and biological sequences with the inherent strengths of PET, enabling imaging of metabolism with a high sensitivity. In this article, we describe the initial experience of MR/PET in a clinical cancer center along with a review of the literature. For establishing MR/PET in a clinical setting, technical challenges, such as attenuation correction and organizational challenges, such as workflow and reimbursement, have to be overcome. The most promising initial results of MR/PET have been achieved in anatomical areas where high soft-tissue and contrast resolution is of benefit. Head and neck cancer and pelvic imaging are potential applications of this hybrid imaging technology. In the pediatric population, MR/PET can decrease the lifetime radiation dose. MR/PET protocols tailored to different types of malignancies need to be developed. After the initial exploration phase, large multicenter trials are warranted to determine clinical indications for this exciting hybrid imaging technology and thereby opening new horizons in molecular imaging.

Predictive value of pattern classification 24 hours after radiofrequency ablation of liver metastases on CT and positron emission tomography/CT.

PURPOSE: To assess a classification scheme for predicting local tumor progression (LTP) after radiofrequency (RF) ablation of liver metastases, using predefined patterns on contrast-enhanced computed tomography (CT) and positron emission tomography (PET) combined with CT (PET/CT) acquired 24 hours after RF ablation. MATERIALS AND METHODS: There were 45 metastases in 20 patients treated. After 24 hours, imaging of the ablation zones was performed with contrast-enhanced PET/CT. Three independent radiologists prospectively assessed contrast-enhanced CT and combined PET/CT images to identify three patterns: pattern I, no tissue enhancement or fluorodeoxyglucose uptake between the ablation zone and the liver parenchyma; pattern II, a rimlike pattern; and pattern III, a peripheral nodule. PET/CT images obtained after 8-10 weeks were evaluated for LTP. The patterns were analyzed for their sensitivity, specificity, positive predictive value, and negative predictive value for predicting LTP. RESULTS: Pattern I was most frequently observed (81% for contrast-enhanced CT and 61% for PET/CT) as well as for ablation zones that showed LTP (52% and 37%, respectively). Conversely, pattern II was observed for tumors that were completely ablated (6% and 29%, respectively). Patterns II and III together had the highest sensitivity for predicting LTP (48% and 63%, respectively); pattern III had the highest specificity (94% and 95%, respectively). For nodular patterns, test characteristics were better for PET/CT compared with contrast-enhanced CT, but the difference was not significant. Nodular patterns > 1 cm achieved high positive predictive value (both 100%). CONCLUSIONS: Inflammation and hyperemia can hinder interpretation on imaging 24 hours after RF ablation, especially on PET/CT. Nodular patterns around the ablation zone on early contrast-enhanced CT and PET/CT have a high predictive value for LTP and should be taken into account for disease management.

The cost of doing business in academic radiology departments.

This study identifies the major sources of overhead fees/costs and subsidies in academic radiology departments (ARDs) in the US and determines the differences between them based on geographic location or the size of their affiliated hospital. ARDs in the Northeast had the highest level of financial support from their affiliated hospitals when compared to those in the South/Southwest; however, a greater number of Midwest ARDs receive high levels of funding for teaching from their medical schools when compared to the northeast. Significantly fewer ARDs affiliated with hospitals of less than 200 beds receive subsidies for their activities when compared to those affiliated with larger hospitals. Differences in levels of overhead costs/ subsidies available to ARDs are associated with either geographic location or the size of the affiliated hospital. The reasons for these differences may be related to a variety of legal, contractual, or fiscal factors. Investigation of existing geographic and affiliate size fiscal differences and their causes by ARDs may be of benefit.

The 2022 AUR Academic Radiology and Industry Leaders Roundtable.

The Association of University Radiologists (AUR) convened its sixth annual Academic-Industry Roundtable in a hybrid fashion in March 2022, with academic radiology and radiology industry leaders gathered in person and via remote videoconference. The open discussion centered around on challenges facing radiology and specifically focused on the people in our field, including patients, radiologists, and radiology staff. Participants identified numerous opportunities for industry and radiology departments to collaborate to improve equitable access to healthcare, communication with patients, use of appropriate imaging, and the state of the radiology workforce.

A history of radiologic pathology correlation at the Armed Forces Institute of Pathology and its evolution into the American Institute for Radiologic Pathology.

The evolution of the Armed Forces Institute of Pathology (AFIP) has played an important role in the history of pathology education and in radiologic pathology correlation in the United States. From its humble beginnings as a museum, showcasing dried and varnished morbid specimens--human relics of the Civil War, the institute became a leader in pathology. Later, it became a center of instruction for radiology residents seeking to understand the pathologic findings that underlay the radiologic appearance of disease. Images were gathered by the AFIP and the American Registry of Pathology (ARP) and have been used in research and education in radiology and other fields (ophthalmology, otalaryngology, dermatology, obstetrics and gynecology, and surgery). Despite the contributions of the AFIP, the ARP, and the Radiologic Pathology Correlation Course, high-ranking members of the military and the federal government frowned on a military-owned educational system that also served civilians. Although support from the radiology community dissuaded military officers and federal officials from taking action against the participation of civilians, the 2005 Base Realignment and Closure (BRAC) provisions mandated the disestablishment of the AFIP, forcing the redistribution of some of its resources to other military-only organizations and disbanding other AFIP functions. To ensure that the correlation course, known to radiology residents as the "rad-path" course, was not a casualty of the BRAC, the American College of Radiology (ACR) and leaders of the AFIP and ARP agreed that the ACR should continue this vital educational endeavor. In January 2011, the American Institute for Radiologic Pathology of the ACR debuted and successfully instructed 268 radiology residents, including 40 international residents. The faculty and staff, who had been part of the course at the AFIP, continue to help enrich and improve the course established by their predecessors.

A Systematic Review for Health Disparities and Inequities in Multiparametric Magnetic Resonance Imaging for Prostate Cancer Diagnosis.

RATIONALE AND OBJECTIVES: Multi-parametric Magnetic Resonance Imaging (mpMRI) is a novel procedure recommended by the American Urological Association for Prostate Cancer (PCa) diagnosis. In radiology, differences in utilization of expensive screening techniques are described but never reviewed for mpMRI. Thus, our article aims at summarizing disparities relating to the expensive yet revolutionary mpMRI in United States men with PCa while highlighting needed research areas. MATERIAL AND METHODS: Eligible articles were gathered via PubMed query, referred publications known to the authors or from the reference lists of the identified publications. We excluded studies that didn't specifically evaluate mpMRI technique, weren't conducted in the United States, or didn't directly assess the relationship between disparities and mpMRI. No date restrictions were applied, resulting articles were published through 2020. RESULTS: Out of 80 publications, 17 were selected. Two unique themes were identified: 1) disparities in mpMRI utilization, and 2) performance. While demographic factors such as race, age and socioeconomic status played a significant role in utilization, mpMRI demonstrated equal and sometimes superior performance in AAs. CONCLUSION: Our findings illustrate the importance of disparity awareness in PCa mpMRI and highlight the need to examine additional mpMRI disparities across other races and social determinants. A new area of inequity in PCa was theoretically illustrated, as lower utilization of mpMRI was detected in a group that could potentially benefit from it the most. Major limitation was the selected search terms. Our review is unique as disparities related to mpMRI were found to be multilayered, affecting utilization and performance. Continued research is needed to discover additional areas in efforts to reduce disparity gaps related to mpMRI and PCa.

Peritoneal sarcomatosis versus peritoneal carcinomatosis: imaging findings at MDCT.

OBJECTIVE: Peritoneal sarcomatosis is an entity analogous to the better known peritoneal carcinomatosis. The purpose of this article is to discuss the imaging findings of peritoneal sarcomatosis versus peritoneal carcinomatosis. CONCLUSION: Sarcomatosis is most commonly seen in gastrointestinal stromal tumor, liposarcoma, and leiomyosarcoma. A few distinguishing features of peritoneal sarcomatosis include heterogeneous bulky masses, hypervascularity with or without hemoperitoneum, and variable presence of ascites.

Recurrent malignant peritoneal mesothelioma: radiological manifestations.

PURPOSE: To describe the CT imaging findings of recurrent malignant peritoneal mesothelioma in patients who underwent debulking surgery. MATERIALS AND METHODS: The history, clinical and laboratory data, and imaging studies of 13 patients with histologically proven diagnosis of Malignant Peritoneal Mesothelioma (MPM) and their recurrence following cytoreductive surgery were reviewed. CT studies were reviewed for presence of ascites, peritoneal, mesenteric and omental involvement, presence of solid abdominal viscera involvement, gastrointestinal involvement, presence and location of enlarged lymph nodes and extra abdominal sites of involvement. RESULTS: The most common finding at recurrence was ascites (n = 6). Peritoneal thickening was seen in five patients, infiltration of the peritoneum resembling omental caking was seen in one patient, and low density implants mimicking pseudomyxoma peritonei was seen in another patient. None of the peritoneal implants showed calcification. Three patients had large discrete soft tissue masses in the omentum and/or peritoneum. Multifocal serosal implants were seen in four patients; one had low grade small bowel obstruction which was managed conservatively. Three patients had evidence of intrathoracic disease seen as soft tissue pericardial mass and malignant pleural effusions. CONCLUSION: CT findings of recurrent MPM resemble primary MPM, metastatic or granulomatous diseases. Radiologist should be aware of its appearance and forms of recurrence which may be seen at extra abdominal sites.

Artificial Intelligence in Radiology: Summary of the AUR Academic Radiology and Industry Leaders Roundtable.

The AUR Academic Radiology and Industry Leaders Roundtable was organized as an open discussion between academic leaders of top US academic radiology departments and industry leaders from top companies that provide equipment and services to radiology, including manufacturers, pharmaceutical companies, software developers and electronic medical record (EMR) providers. The format was that of a structured brainstorming session with pre-selected discussion topics. This roundtable was instrumental in widening perspectives and providing insights into the challenges and opportunities for our specialty, such as in the case of Artificial Intelligence (AI).

Evaluation of low-density neutral oral contrast material in PET/CT for tumor imaging: results of a randomized clinical trial.

OBJECTIVE: The objective of this study was to determine the impact on image quality and risks in terms of artifacts and side effects of a low-density barium-based suspension as oral contrast material for CT during PET/CT examinations of an oncologic patient population. SUBJECTS AND METHODS: Eighty-five patients (51 men and 34 women; mean age, 53 years; age range, 21-87 years) were prospectively randomized to receive either 0.1% barium sulfate oral suspension or no oral contrast material during PET/CT. Patients in the oral contrast group were given 1,350 mL over 60-75 minutes. The (18)F-FDG PET component of each examination was reviewed for the presence of artifacts by two nuclear medicine physicians and was classified as adequate (no presence of artifactual focal FDG uptake attributed to attenuation-correction errors) or inadequate (focal uptake in attenuation-correction PET images with no corresponding uptake in non-attenuation-corrected PET images). Two radiologists reviewed the CT studies and scored the degree of bowel opacification using a 5-point scale, ranging from 0 for no opacification (i.e., not possible to delineate the bowel structures from the surrounding tissues) to 4 for excellent opacification (i.e., bowel structure identifiable and bowel wall clearly visible). The attenuation values (in Hounsfield units) were recorded in the stomach, duodenum, mid jejunum, and terminal ileum for quantitative analysis. Interobserver variability was assessed using kappa coefficients. RESULTS: None of the patients who received oral contrast material experienced side effects. All 85 PET examinations were considered adequate with no observable artifacts. The mean bowel opacification scores of the oral contrast group (2.59 and 2.93) as evaluated by radiologists 1 and 2, respectively, were significantly higher (p < 0.01) than those of the control group (1.55 and 1.59). The level of attenuation achieved in the contrast group was significantly higher than in the control group. The interobserver variability was moderate (kappa = 0.32). CONCLUSION: The use of low-density neutral oral contrast material for CT during combined FDG PET/CT studies significantly improves visualization of the bowel structures compared with no contrast material without causing side effects or clinically detectable errors in the attenuation correction of the FDG PET study.

Use of 3.0-T MR imaging for evaluation of the abdomen.

The most important advantage of 3.0-T magnetic resonance (MR) imaging systems is their increased signal-to-noise ratio (SNR) compared with 1.5-T systems. The higher SNR can be used to shorten acquisition time, achieve higher spatial resolution, or a combination of the two, thereby improving image quality and clinical diagnosis. In fact, 3.0-T MR imaging systems have already proved superior to 1.5-T systems in neuroradiologic and musculoskeletal applications. In the abdomen, 3.0-T MR imaging is uniquely beneficial for techniques such as enhanced and nonenhanced hepatic imaging, diffusion-weighted imaging, angiography, MR pancreatography, and colonography. Admittedly, 3.0-T abdominal imaging has important technical limitations, such as standing wave artifact, chemical shift artifact, susceptibility artifact, and safety issues such as increased energy deposition within the patient's body. Furthermore, 3.0-T abdominal MR imaging is still in the early stages of development and requires substantial modifications of the pulse sequences and hardware components used for 1.5-T imaging. Nevertheless, the ability to obtain physiologic and functional information within reasonably short acquisition times with 3.0-T abdominal MR imaging bodies well for the future of this imaging technique.

Depiction of normal gastrointestinal anatomy with MDCT: comparison of low- and high-attenuation oral contrast media.

PURPOSE: To compare low- and high-attenuation oral contrast media for depiction of normal gastrointestinal anatomy with multidetector-row computed tomography (MDCT). MATERIALS AND METHODS: A prospective, randomized study of 90 consecutive patients without known or suspected gastrointestinal disease was conducted after the approval of our Institutional Review Board. All patients underwent IV contrast-enhanced abdominal and pelvic CT scans after oral administration of 900 ml of either low- or high-attenuation barium sulphate suspension. Using a five-point scale, two radiologists independently graded distention and wall visualization of stomach, duodenum, jejunum, and ileum. The degree of distention and wall visualization was compared using Mann-Whitney U-test. RESULTS: Duodenal, jejunal and ileal distention (p<0.05, <0.001, <0.001, respectively) and wall visualization (p<0.05, <0.01, <0.05, respectively) scores with low-attenuation contrast medium were significantly higher than those with high-attenuation barium sulphate preparation, for reader 1. Duodenal and jejunal wall visualization scores with low-attenuation contrast medium (p<0.05, <0.01, respectively) were significantly higher than those with high-attenuation contrast medium, for reader 2. Interobserver agreement was fair to good for both distention (kappa-range: 0.41-0.74) and wall visualization (kappa-range: 0.48-0.71). CONCLUSION: MDCT with low-attenuation contrast medium provides distention and wall visualization of the GI tract that is equal or better than high-attenuation contrast medium.

Role of FDG-PET/MRI, FDG-PET/CT, and Dynamic Susceptibility Contrast Perfusion MRI in Differentiating Radiation Necrosis from Tumor Recurrence in Glioblastomas.

BACKGROUND AND PURPOSE: To compare the utility of quantitative PET/MRI, dynamic susceptibility contrast (DSC) perfusion MRI (pMRI), and PET/CT in differentiating radiation necrosis (RN) from tumor recurrence (TR) in patients with treated glioblastoma multiforme (GBM). METHODS: The study included 24 patients with GBM treated with surgery, radiotherapy, and temozolomide who presented with progression on imaging follow-up. All patients underwent PET/MRI and pMRI during a single examination. Additionally, 19 of 24 patients underwent PET/CT on the same day. Diagnosis was established by pathology in 17 of 24 and by clinical/radiologic consensus in 7 of 24. For the quantitative PET/MRI and PET/CT analysis, a region of interest (ROI) was drawn around each lesion and within the contralateral white matter. Lesion to contralateral white matter ratios for relative maximum, mean, and median were calculated. For pMRI, lesion ROI was drawn on the cerebral blood volume (CBV) maps and histogram metrics were calculated. Diagnostic performance for each metric was assessed using receiver operating characteristic curve analysis and area under curve (AUC) was calculated. RESULTS: In 24 patients, 28 lesions were identified. For PET/MRI, relative mean ≥ 1.31 resulted in AUC of .94 with both sensitivity and negative predictive values (NPVs) of 100%. For pMRI, CBV max ≥3.32 yielded an AUC of .94 with both sensitivity and NPV measuring 100%. The joint model utilizing r-mean (PET/MRI) and CBV mode (pMRI) resulted in AUC of 1.0. CONCLUSION: Our study demonstrates that quantitative PET/MRI parameters in combination with DSC pMRI provide the best diagnostic utility in distinguishing RN from TR in treated GBMs.

Molecular imaging programs in the United States: results of a national survey.

RATIONALE AND OBJECTIVES: We sought to identify and describe the characteristics of molecular imaging (MI) programs in the United States and to determine the factors considered critical for their future. MATERIALS AND METHODS: In a cross-sectional study, a validated survey was sent to members of the Society of Chairmen in Academic Radiology Departments (SCARD) in the United States, and 26 variables were studied. RESULTS: The response rate was 40.3%; 67.9% of the departments surveyed have an MI program. The main focus of 47.4% of departments is oncology. The number of radiologists working for the department was the only variable found to be significantly positively correlated with (1) number of researchers in the MI program, (2) number of MI modalities available, (3) total number of grants, and (4) having ongoing MI clinical trials. These four variables plus the number of federal grants and the space used by MI programs were independent of the geographical region, hospital size (number of beds), and department size (number of radiological examinations per year). All the MI programs received grants during 2005. Only 16.1% have no alliances with industry. Among all the departments, 82% identified staff training and recruitment as the keys for success; 78.57% considered oncology the most important future application of MI and cancer management the hospital service most affected by MI. CONCLUSION: MI programs are starting to be more widespread throughout the United States, and the trend is for more academic radiology departments to become engaged in MI activities; their development is independent of department characteristics. Radiology departments strongly agreed about the key components for success of MI initiatives and the areas that will be most affected by MI applications.