Radiologists' Expectations of Artificial Intelligence in Pancreatic Cancer Imaging: How Good Is Good Enough?

BACKGROUND: Existing (artificial intelligence [AI]) tools in radiology are modeled without necessarily considering the expectations and experience of the end user-the radiologist. The literature is scarce on the tangible parameters that AI capabilities need to meet for radiologists to consider them useful tools. OBJECTIVE: The purpose of this study is to explore radiologists' attitudes toward AI tools in pancreatic cancer imaging and to quantitatively assess their expectations of these tools. METHODS: A link to the survey was posted on the www.ctisus.com website, advertised in the www.ctisus.com email newsletter, and publicized on LinkedIn, Facebook, and Twitter accounts. This survey asked participants about their demographics, practice, and current attitudes toward AI. They were also asked about their expectations of what constitutes a clinically useful AI tool. The survey consisted of 17 questions, which included 9 multiple choice questions, 2 Likert scale questions, 4 binary (yes/no) questions, 1 rank order question, and 1 free text question. RESULTS: A total of 161 respondents completed the survey, yielding a response rate of 46.3% of the total 348 clicks on the survey link. The minimum acceptable sensitivity of an AI program for the detection of pancreatic cancer chosen by most respondents was either 90% or 95% at a specificity of 95%. The minimum size of pancreatic cancer that most respondents would find an AI useful at detecting was 5 mm. Respondents preferred AI tools that demonstrated greater sensitivity over those with greater specificity. Over half of respondents anticipated incorporating AI tools into their clinical practice within the next 5 years. CONCLUSION: Radiologists are open to the idea of integrating AI-based tools and have high expectations regarding the performance of these tools. Consideration of radiologists' input is important to contextualize expectations and optimize clinical adoption of existing and future AI tools.

Is AI the Ultimate QA?

We are among the many that believe that artificial intelligence will not replace practitioners and is most valuable as an adjunct in diagnostic radiology. We suggest a different approach to utilizing the technology, which may help even radiologists who may be averse to adopting AI. A novel method of leveraging AI combines computer vision and natural language processing to ambiently function in the background, monitoring for critical care gaps. This AI Quality workflow uses a visual classifier to predict the likelihood of a finding of interest, such as a lung nodule, and then leverages natural language processing to review a radiologist's report, identifying discrepancies between imaging and documentation. Comparing artificial intelligence predictions with natural language processing report extractions with artificial intelligence in the background of computer-aided detection decisions may offer numerous potential benefits, including streamlined workflow, improved detection quality, an alternative approach to thinking of AI, and possibly even indemnity against malpractice. Here we consider early indications of the potential of artificial intelligence as the ultimate quality assurance for radiologists.

The first use of artificial intelligence (AI) in the ER: triage not diagnosis.

Predictions related to the impact of AI on radiology as a profession run the gamut from AI putting radiologists out of business to having no effect at all. The use of AI appears to show significant promise in ER triage in the present. We briefly discuss the emerging effectiveness of AI in the ER imaging setting by looking at some of the products approved by the FDA and finding their way into "practice." The FDA approval process to date has focused on applications that affect patient triage and not necessarily ones that have the computer serve as the only or final reader. We describe a select group of applications to provide the reader with a sense of the current state of AI use in the ER setting to assess neurologic, pulmonary, and musculoskeletal trauma indications. In the process, we highlight the benefits of triage staging using AI, such as accelerating diagnosis and optimizing workflow, with few downsides. The ability to triage patients and take care of acute processes such as intracranial bleed, pneumothorax, and pulmonary embolism will largely benefit the health system, improving patient care and reducing costs. These capabilities are all available now. This first wave of AI applications is not replacing radiologists. Rather, the innovative software is improving throughput, contributing to the timeliness in which radiologists can get to read abnormal scans, and possibly enhances radiologists' accuracy. As for what the future holds for the use of AI in radiology, only time will tell.

So You Want to Develop an App for Radiology Education? What You Need to Know to Be Successful.

Apple changed the communications landscape with its 2007 introduction of the iPhone. In little more than a decade, most Americans have become smartphone owners. With more than 200,000 applications (apps) for education available in the Apple App Store, we can infer that many smartphone owners use their devices to learn. Several surveys of medical students reveal that apps do indeed enhance clinical knowledge and provide comparable training with textbooks. We launched our first iOS app, the CTisus iQuiz, in 2010 in response to the growing number of portable devices, and with an intention to grow alongside technology. We now have 17 apps available for free on the App Store, and present tips here on how to successfully develop apps for radiology education. Furthermore, we detail the steps necessary to advertise a new app and use analytics to assess how the app is performing. Generating apps for radiology can play an important role in continuing education. As the medical and education fields are integrating increasingly with technology, it is essential that we use technology to reach and interact with its users. Creating iOS applications and using analytics to understand how they meet the goals of the developer can expand the reach of the medical and education communities and render information more accessible on mobile devices on a large scale.

Is a Picture Really Worth More than a Thousand Words? Which Instagram Post Types Elicit the Best Response for Radiology Education.

Since its 2010 launch, Instagram has rapidly risen to become one of the leading social media in the world, with more than one billion monthly users. Within the field of radiology, perhaps because of the image-weighted nature of the platform, several prominent organizations host Instagram accounts, including the Radiological Society of North America, American Roentgen Ray Society, American College of Radiology, and the American Board of Radiology. We started our own Instagram account in January 2016 because of the popularity of this social media platform among medical students. Our website contains over 260,000 images and is aimed at educating physicians, technologists, and nurses around the world on radiology, with an emphasis on body computed tomography. Given our varied selection of radiology resources, we were curious as to which posts perform best on Instagram and set out how to best characterize the interest in these posts. Our results point to an approach that can aid radiology educators who use social media, particularly Instagram, in producing popular content.

Open Label Study Evaluating Efficacy, Safety, and Effects on Perception of Age After Injectable 20 mg/mL Hyaluronic Acid Gel for Volumization of Facial Temples

Objective: To study the safety, efficacy, optimal volume, and longevity of an injectable hyaluronic acid (HA) gel dermal filler to treat facial temporal fossa fat loss. Methods and materials: This open-label, single-site, 12-month study used 20 mg/mL HA gel to correct volume loss in both temples in 30 subjects. Touch-ups were allowed at week 2. At each visit, the investigator completed a Frontal Temporal Fossa Scale and a 7-point satisfaction scale. Subjects completed a 7-point satisfaction scale, Subject Global Aesthetic Improvement Scale (GAIS), and self-perception of age assessment. Photos were taken at each visit. Results: Subjects who returned for the one-month visit (29) achieved a ≥ 1-point improvement on the Temporal Fossa Scale in both temples. At month 12, 98% of the temples maintained a ≥ 1-grade, 18% showed a 3-grade, 34% showed a 2-grade, and 46% showed a 1-grade improvement. All subjects received an average of 1.1 mL per temple. Mild to moderate jaw pain after injections was noted by 40% of patients. The pain was reported to occur during mastication. There was no correlation between the amount of the study device injected and the incidence of jaw pain, which did not occur at the touch-up injections and was self-limited. Injections were well tolerated, and no patients developed vascular compromise, vascular events, or visual disturbances. Conclusion: HA gel (20 mg/mL) is safe and efficacious when used in the facial temporal fossa. The results lasted at least 12 months in 98% of subjects. Most subjects perceived themselves as looking younger than at baseline. J Drugs Dermatol. 2019;18(1):67-74.

What Can Pinterest Do for Radiology?

The rapid growth of social media over the last decade soon convinced businesses including medical practices and academic medical centers to enter the social media fray-for profit, education, and expanding access. Launched in 2010, Pinterest (San Francisco, CA, USA) differed from many of the established social media platforms by presenting collection and curation features based on the sharing of images rather than text. Thus, Pinterest allows users to categorize website links using photos, GIFs, and videos, and catalog them for future consideration, saved on a virtual folder or "pinboard." Facebook, Twitter, and LinkedIn are text-heavy social media platforms that do not allow for significant curating activities. Instagram, the other of the two primary photo-oriented social media giants, was launched the same year as Pinterest. Owned by Facebook, Instagram caters to a more personal experience and mostly relies on mobile technology. Because Pinterest users are mainly focused on finding and collecting other users' content, Pinterest is thought to generate website traffic and is more conducive to use on larger screens. It further distinguishes itself by encouraging appreciation/learning over self-promotion and its range of categories exceeds that of other such sites. Some of the more visually oriented medical specialties (i.e., dermatology, plastic surgery, and radiology) have begun to consider what role, if any, the popular site Pinterest, with more than 250 million monthly users, might play in disseminating healthy messages, reaching patients, and contributing to medical education. We investigated how Pinterest could work for our radiology education mission and then decided to establish a presence on the site to ascertain if creating our own board would have any practical benefits.

The future of radiology and radiologists: AI is pivotal but not the only change afoot.

Uncertainty regarding the future of radiologists is largely driven by the emergence of artificial intelligence (AI). If AI succeeds, will radiologists continue to monopolize imaging services? As AI accuracy progresses with alacrity, radiology reads will be excellent. Some articles show that AI can make non-radiologists experts. However, eminent figures within AI development have expressed concerns over its possible adverse uses. Bad actors, not bad AI, may account for a future in which AI is not as successful as we might hope and, as some fear, even pernicious. More relevant to current predictions over the course of AI in medicine, and radiology in particular, is how the evolution of AI is often seen in a vacuum. We cannot predict the future with certainty. But as we contemplate the potential impact of AI in radiology, we should remember that radiology does not exist in a vacuum; while AI is changing, so is everything else. The medical system, not to mention the world's population, has been severely impacted by the global COVID-19 pandemic and numerous experts expect future worldwide pandemics. We cannot predict the condition of the healthcare system in two decades but may assume that radiology will likely remain critical in any future medical practice. For now, we should responsibly use all tools at our disposal (including AI) to make ourselves as indispensable as possible. Our best chances of remaining relevant and instrumental to patient care will likely hinge on our ability to lead the changes rather than be passively impacted by them.

Solitary plasmacytoma of the pancreas: A rare case report.

A plasmacytoma is a cancerous growth of abnormal plasma cells that arise within osseous or soft tissue structures. In soft tissue structures, plasmacytomas can present as solitary or multiple masses in the absence of systemic involvement. Solitary plasmacytomas can be subcategorized as extramedullary plasmacytoma (derived from plasma cells located in soft tissues) or osseous plasmacytoma (derived from plasma cells located in the bone marrow). Infrequently, these tumors can arise as extramedullary lesions from the pancreas and present similarly to other tumors, such as pancreatic neuroendocrine tumors (PNETs). In this article, we report the case of a 62-year-old male with a diagnosis of solitary plasmacytoma of the pancreas. We focus on optimizing diagnosis and management through the application of radiological imaging modalities, specifically computed tomography (CT) scans and positron emission tomography-computed tomography (PET-CT) scans.

Lessons learned from rebranding a radiology education facebook page.

OBJECTIVE: In May 2009, we created a Facebook page for radiology education. While we shared a host of learning materials such as case images, quiz questions, and medical illustrations, we also posted world news, music, and memes. In February 2023, we eliminated everything from the site not related to radiology education. Our aim was to determine how focusing on radiology education alone would affect audience growth for our Facebook page. MATERIALS AND METHODS: We exported our Facebook post data for the dates March 1, 2023 through February 29, 2024, to represent the full calendar year after we revised our content presentation, which we compared to data from November 1, 2020 to October 31, 2021. The mean and standard deviation for each post type's reach for 2023/24 were analyzed and compared against the 2020/21 statistics, and Wilcoxon rank sum tests were used to obtain p-values. Linear regressions for each year were performed to understand the relationship between reach and engagement. RESULTS: A total of 4,270 posts were included in our new analysis. Our average number of posts per day decreased from 24.8 to 11.71, reducing by more than half the amount of content shared to our social media page. Our posts had a mean overall reach of 4,660-compared to 1,743 in 2021 (p=0.0000). There was a statistically significant increase in reach for posts on artificial intelligence, case images, medical illustrations, pearls, quiz images, quiz videos, slideshow images, and both types of instructional videos (p<0.005). For both 2021 and 2024, the linear regression slopes were positive (y=0.0687x-65.0279 and y=0.006334x+21.3425, respectively). CONCLUSIONS: Facebook and other social media have been found to be helpful sources for radiology education. Our experience and statistics with radiology education via social media may help other radiology educators better curate their own pages. To optimize experiences for students, professionals, and other users, and to reach more people, we found that providing readily accessible radiology education is preferred to the social aspects of social media.

Primary diffuse large B-cell lymphoma of the cecum.

When found in the cecum or rectosigmoid junction, primary colorectal B-cell lymphoma is a rare malignant non-Hodgkin's lymphoma often associated with an unfavorable prognosis. Due to the nonspecific clinical symptoms, these uncommon tumors are often left undefined or misdiagnosed, resulting in delays in treatment and adverse patient outcomes. Contrast-enhanced computed tomography is the most commonly used medical imaging process for primary colorectal lymphoma, but due to the rarity of this disorder, accurate imaging diagnosis remains a clinical challenge. In this article, we report the case of a 70-year-old male who was diagnosed with primary B-cell lymphoma of the cecum. We focus on improving diagnosis through the utilization of radiological imaging modalities, particularly computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18-F-FDG PET/CT). While imaging modalities are important in recognizing colonic lymphomas, there are no pathognomonic imaging features for lymphoma; therefore, biopsy remains necessary for diagnostic confirmation.

Gastrointestinal basidiobolomycosis masquerading as cancer.

Gastrointestinal basidiobolomycosis is an unusual fungal infection caused by Basidiobolus ranarum, a saprophytic fungus primarily found in soil and decaying vegetables. Basidiobolomycosis typically presents as a chronic subcutaneous swelling and rarely infects the gastrointestinal tract. Thus, the infrequency of gastrointestinal infections, along with nonspecific clinical symptoms, often results in misdiagnosed cases and delays in treatment. In this article, we report the case of a 68-year-old male with gastrointestinal basidiobolomycosis masquerading as metastatic cancer. We focus on the use of radiological imaging modalities and histopathological analysis to optimize the diagnosis and treatment of this rare gastrointestinal infection.

Metastatic sclerosing epithelioid fibrosarcoma.

Sclerosing epithelioid fibrosarcoma is a rare fibrosarcoma variant in which more than half of patients experience local recurrence or metastatic spread. In the current literature, there is limited and nonspecific imaging data, contributing to frequent misdiagnosis and delays in treatment intervention. Given the poor prognosis associated with this malignancy and the high probability of metastases, accurate and prompt diagnoses are critical. In this article, we report the case of a 27-year-old female diagnosed with metastatic sclerosing epithelioid fibrosarcoma following the discovery of a growing palpable mass on her right gluteus maximus muscle. We focus on the use of radiological imaging modalities in optimizing diagnosis and correlate our imaging and pathological findings.

An incidental large adrenal schwannoma: A case report.

Adrenal schwannoma is a rare tumor of Schwann cell origin that represents less than 0.2% of all adrenal tumors. These typically benign tumors are most often found in the head, neck, and limbs. However, schwannomas can also rarely occur rarely in the adrenal gland within the retroperitoneal cavity. In the adrenal gland, these tumors arise from the medulla and are difficult to diagnose, often misdiagnosed as other benign or malignant entities. In this article, we report the case of a 43-year-old female with a large left adrenal mass revealed by biopsy to be a schwannoma. We focus on the use of radiological imaging modalities and immunohistochemical analysis to optimize diagnosis and treatment intervention of this rare tumor.

Primary renal liposarcoma simulating angiomyolipoma.

Liposarcomas are infrequent malignant tumors of mesenchymal origin most commonly seen in the extremities. Although infrequent, these can develop as primary lesions in the soft tissue of the kidney, making them difficult to diagnose through imaging modalities alone. Primary renal liposarcomas are associated with poor prognoses, increasing the importance of timely and accurate diagnosis. In extremely rare instances, the tumor can arise directly from the fat in the epicenter of the kidney, disguised as an angiomyolipoma. In this article, we report the case of a 54-year-old female who was diagnosed with a well-differentiated liposarcoma of the kidney and underwent radical nephrectomy. Our objective is to evaluate unique radiological imaging findings and correlate with histopathological analysis to optimize diagnosis.

Social Media Usage for Radiology Education: A One-Month 2022 Global Survey.

OBJECTIVE: To create our own survey to identify the most recent ways in which the global radiology community is using social media specifically for radiology education. MATERIALS AND METHODS: We created a 30-question survey on SurveyMonkey, promoted it on our CTisus Facebook, Twitter, YouTube, LinkedIn, as well as Reddit accounts, and to our newsletter subscribers, sharing it from March 15 to April 5, 2022. The survey requested demographic information, and asked respondents to clarify their role in radiology and how they participated in each social media platform for radiology education. RESULTS: We received 254 responses, of which 253 specified their role in radiology: 40.71% were radiologists (n = 103); 24.90% were radiologic technologists (n = 63); 17.79% were residents in radiology (n = 45); and 16.60% engaged in other radiology professions (n = 42). In total, 65 countries were represented (n = 250). Individuals aged 25-34 (n = 89) represented the most popular age group, followed by those aged 35-44 (n = 47), then 45-54 (n = 36). As a combined group, 80.71% said they use social media "every day" or "a few times a week" (n = 205). YouTube was the most popular social media platform for radiology education (n = 180), followed by Instagram (n = 156) and Facebook (n = 110). In terms of goals for radiology education on social media, most answered "to learn more in radiology" (n = 217), with "to keep myself updated on current events in radiology" (n = 162), and "to participate in radiology discussions with colleagues" (n = 67) also well represented. Almost 3 quarters of respondents felt that social media was "extremely useful" or "very useful" for radiology education (n = 187). Approximately half of respondents said they "learn much more from social media" or "learn a bit more from social media" over traditional resources such as textbooks and medical journals (n = 126). CONCLUSION: Our results suggest that the global radiology community finds education via social media to be useful, and often partakes in such education. It also highlights which social media are relevant for current radiology education and which are not. We anticipate returning to this survey approximately every 2 years to examine how the landscape of social media continues to change in the world of radiology education.

Radiation-induced osteosarcoma of the chest wall after treatment for unresectable thymoma.

Secondary osteosarcoma is a rare complication of radiation therapy for a primary tumor. Here we report a unique presentation of radiation-induced osteosarcoma of the chest wall after radiation treatment for thymoma. This patient underwent multiple imaging studies, including magnetic resonance imaging and computed tomography with cinematic rendering. Diagnosis of osteosarcoma was confirmed through imaging features and histology. Several surgical procedures were performed to evaluate and attempt resection of the tumor, but ultimately the tumor location and involvement prevented adequate resection and chemotherapy was initiated. This case highlights the importance of identifying clear cumulative dose thresholds for radiation therapy and rare complications of radiotherapy.

3D CT cinematic rendering of pediatric thoracic vascular anomalies.

Thoracic vascular anomalies in the pediatric population are a heterogeneous group of diseases, with varied clinical presentations and imaging findings. High-resolution computed tomography is widely available and has become a standard part of the workup of these patients, often with three dimensional images. Cinematic rendering is a novel 3D visualization technique that utilizes a new, complex global lighting model to create photorealistic images with enhanced anatomic detail. The purpose of this pictorial review is to highlight the advantages of cinematic rendering compared to standard 2D computed tomography and traditional volume-rendered 3D images in the evaluation of thoracic vascular anomalies. Although cinematic rendering remains a new visualization technique under continued study, the improved anatomic detail and photorealistic quality of these images may be advantageous for surgical planning in cases of complex vascular abnormalities. Cinematic rendering may also help improve communication among clinicians, trainees, and patients and their families.

Solving Problems Due to Hurricane Maria and COVID-19: CT Trends in Puerto Rico Before, During, and Beyond Public Health Crises.

Our objective was to evaluate the impact of recent public health crises on radiology CT services in Puerto Rico. We gathered and analyzed CT statistics from 2 of Puerto Rico's major private hospital groups and obtained monthly data from January 2016 to March 2021. We quantified short- and long-term impacts of Hurricane Maria (September 2016-August 2017, September 2017-August 2018, September 2018-August 2019) and COVID-19 (April 2019-March 2020, April 2020-March 2021) by calculating month-to-month and year-to-year percentage differences for each hospital and all hospitals combined for the dates leading up to, in the immediate aftermath, and following these major events. Despite short-term effects throughout September from Hurricane Maria, there were no noticeable year-to-year differences in the total number of CT studies performed. Both March and April 2020 highlighted the instantaneous impact caused by COVID-19; these months contributed less than 6% of the total yearly scans performed between April 2019 and March 2020 and April 2020-March 2021 for all the hospitals individually. Hurricane Maria exerted a short-term impact on CT studies performed throughout September 2017. COVID-19 also demonstrated immediate yet prolonged effects on the number of CT studies performed with all 3 hospitals reporting decreases between a full pandemic year and the year prior. Our results support fortifying medical and societal infrastructure to better prepare for future natural and public health disasters, particularly in Puerto Rico and similarly resourced areas, to maintain steady, if somewhat diminished, radiology services such as CT for regular and emergency purposes.