Multicentre external validation of a commercial artificial intelligence software to analyse chest radiographs in health screening environments with low disease prevalence.

OBJECTIVES: To externally validate the performance of a commercial AI software program for interpreting CXRs in a large, consecutive, real-world cohort from primary healthcare centres. METHODS: A total of 3047 CXRs were collected from two primary healthcare centres, characterised by low disease prevalence, between January and December 2018. All CXRs were labelled as normal or abnormal according to CT findings. Four radiology residents read all CXRs twice with and without AI assistance. The performances of the AI and readers with and without AI assistance were measured in terms of area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. RESULTS: The prevalence of clinically significant lesions was 2.2% (68 of 3047). The AUROC, sensitivity, and specificity of the AI were 0.648 (95% confidence interval [CI] 0.630-0.665), 35.3% (CI, 24.7-47.8), and 94.2% (CI, 93.3-95.0), respectively. AI detected 12 of 41 pneumonia, 3 of 5 tuberculosis, and 9 of 22 tumours. AI-undetected lesions tended to be smaller than true-positive lesions. The readers' AUROCs ranged from 0.534-0.676 without AI and 0.571-0.688 with AI (all p values < 0.05). For all readers, the mean reading time was 2.96-10.27 s longer with AI assistance (all p values < 0.05). CONCLUSIONS: The performance of commercial AI in these high-volume, low-prevalence settings was poorer than expected, although it modestly boosted the performance of less-experienced readers. The technical prowess of AI demonstrated in experimental settings and approved by regulatory bodies may not directly translate to real-world practice, especially where the demand for AI assistance is highest. KEY POINTS: • This study shows the limited applicability of commercial AI software for detecting abnormalities in CXRs in a health screening population. • When using AI software in a specific clinical setting that differs from the training setting, it is necessary to adjust the threshold or perform additional training with such data that reflects this environment well. • Prospective test accuracy studies, randomised controlled trials, or cohort studies are needed to examine AI software to be implemented in real clinical practice.

Feasibility of UTE-MRI-based radiomics model for prediction of histopathologic subtype of lung adenocarcinoma: in comparison with CT-based radiomics model.

OBJECTIVES: To assess the feasibility of the UTE-MRI radiomic model in predicting the micropapillary and/or solid (MP/S) patterns of surgically resected lung adenocarcinoma. MATERIALS AND METHODS: We prospectively enrolled 74 lesions from 71 patients who underwent UTE-MRI and CT before curative surgery for early lung adenocarcinoma. For conventional radiologic analysis, we analyzed the longest lesion diameter and lesion characteristics at both UTE-MRI and CT. Radiomic features were extracted from the volume of interest of the lesions and Rad-scores were generated using the least absolute shrinkage and selection operator with fivefold cross-validation. Six models were constructed by combining the conventional radiologic model, UTE-MRI Rad-score, and CT Rad-score. The areas under the curves (AUCs) of each model were compared using the DeLong method. Early recurrence after curative surgery was analyzed, and Kaplan-Meier survival analysis was performed. RESULTS: Twenty-four lesions were MP/S-positive, and 50 were MP/S-negative. The longitudinal size showed a small systematic difference between UTE-MRI and CT, with fair intermodality agreement of lesion characteristic (kappa = 0.535). The Rad-scores of the UTE-MRI and CT demonstrated AUCs of 0.84 and 0.841, respectively (p = 0.98). Among the six models, mixed conventional, UTE-MRI, and CT Rad-score model showed the highest diagnostic performance (AUC = 0.879). In the survival analysis, the high- and low-risk groups were successfully divided by the Rad-score in UTE-MRI (p = 0.01) and CT (p < 0.01). CONCLUSION: UTE-MRI radiomic model predicting MP/S positivity is feasible compared with the CT radiomic model. Also, it was associated with early recurrence in the survival analysis. CLINICAL RELEVANCE STATEMENT: A radiomic model utilizing UTE-MRI, which does not present a radiation hazard, was able to successfully predict the histopathologic subtype of lung adenocarcinoma, and it was associated with the patient's recurrence-free survival. KEY POINTS: • No studies have reported the ultrashort echo time (UTE)-MRI-based radiomic model for lung adenocarcinoma. • The UTE-MRI Rad-score showed comparable diagnostic performance with CT Rad-score for predicting micropapillary and/or solid histopathologic pattern. • UTE-MRI is feasible not only for conventional radiologic analysis, but also for radiomics analysis.

Evaluation of fully automated commercial software for Agatston calcium scoring on non-ECG-gated low-dose chest CT with different slice thickness.

OBJECTIVES: To evaluate commercial deep learning-based software for fully automated coronary artery calcium (CAC) scoring on non-electrocardiogram (ECG)-gated low-dose CT (LDCT) with different slice thicknesses compared with manual ECG-gated calcium-scoring CT (CSCT). METHODS: This retrospective study included 567 patients who underwent both LDCT and CSCT. All LDCT images were reconstructed with a 2.5-mm slice thickness (LDCT2.5-mm), and 453 LDCT scans were reconstructed with a 1.0-mm slice thickness (LDCT1.0-mm). Automated CAC scoring was performed on CSCT (CSCTauto), LDCT1.0-mm, and LDCT2.5-mm images. The reliability of CSCTauto, LDCT1.0-mm, and LDCT2.5-mm was compared with manual CSCT scoring (CSCTmanual) using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Agreement, in CAC severity category, was analyzed using weighted kappa statistics. Diagnostic performance at various Agatston score cutoffs was also calculated. RESULTS: CSCTauto, LDCT1.0-mm, and LDCT2.5-mm demonstrated excellent agreement with CSCTmanual (ICC [95% confidence interval, CI]: 1.000 [1.000, 1.000], 0.937 [0.917, 0.952], and 0.955 [0.946, 0.963], respectively). The mean difference with 95% limits of agreement was lower with LDCT1.0-mm than with LDCT2.5-mm (19.94 [95% CI, -244.0, 283.9] vs. 45.26 [-248.2, 338.7]). Regarding CAC severity, LDCT1.0-mm achieved almost perfect agreement, and LDCT2.5-mm achieved substantial agreement (kappa [95% CI]: 0.809 [0.776, 0.838], 0.776 [0.740, 0.809], respectively). Diagnostic performance for detecting Agatston score ≥ 400 was also higher with LDCT1.0-mm than with LDCT2.5-mm (F1 score, 0.929 vs. 0.855). CONCLUSIONS: Fully automated CAC-scoring software with both CSCT and LDCT yielded excellent reliability and agreement with CSCTmanual. LDCT1.0-mm yielded more accurate Agatston scoring than LDCT2.5-mm using fully automated commercial software. KEY POINTS: • Total Agatston scores and all vessels of CSCTauto, LDCT1.0-mm, and LDCT2.5-mm demonstrated excellent agreement with CSCTmanual (all ICC > 0.85). • The diagnostic performance for detecting all Agatston score cutoffs was better with LDCT1.0-mm than with LDCT2.5-mm. • This automated software yielded a lower degree of underestimation compared with methods described in previous studies, and the degree of underestimation was lower with LDCT1.0-mm than with LDCT2.5-mm.

Two Years of Experience and Methodology of Korean COVID-19 Living Clinical Practice Guideline Development.

BACKGROUND: In Korea, during the early phase of the coronavirus disease 2019 (COVID-19) pandemic, we responded to the uncertainty of treatments under various conditions, consistently playing catch up with the speed of evidence updates. Therefore, there was high demand for national-level evidence-based clinical practice guidelines for clinicians in a timely manner. We developed evidence-based and updated living recommendations for clinicians through a transparent development process and multidisciplinary expert collaboration. METHODS: The National Evidence-based Healthcare Collaborating Agency (NECA) and the Korean Academy of Medical Sciences (KAMS) collaborated to develop trustworthy Korean living guidelines. The NECA-supported methodological sections and 8 professional medical societies of the KAMS worked with clinical experts, and 31 clinicians were involved annually. We developed a total of 35 clinical questions, including medications, respiratory/critical care, pediatric care, emergency care, diagnostic tests, and radiological examinations. RESULTS: An evidence-based search for treatments began in March 2021 and monthly updates were performed. It was expanded to other areas, and the search interval was organized by a steering committee owing to priority changes. Evidence synthesis and recommendation review was performed by researchers, and living recommendations were updated within 3-4 months. CONCLUSION: We provided timely recommendations on living schemes and disseminated them to the public, policymakers and various stakeholders using webpages and social media. Although the output was successful, there were some limitations. The rigor of development issues, urgent timelines for public dissemination, education for new developers, and spread of several new COVID-19 variants have worked as barriers. Therefore, we must prepare systematic processes and funding for future pandemics.

Differentiating pulmonary metastasis from benign lung nodules in thyroid cancer patients using dual-energy CT parameters.

OBJECTIVES: To explore the importance of quantitative characteristics of dual-energy CT (DECT) between pulmonary metastasis and benign lung nodules in thyroid cancer. METHODS: In this retrospective study, we identified 63 patients from our institution's database with pathologically proven thyroid cancer who underwent DECT to assess pulmonary metastasis. Among these patients, 22 had 55 pulmonary metastases, and 41 had 97 benign nodules. If nodules showed increased iodine uptake on I-131 single-photon emission computed tomography-computed tomography or increased size in follow-up CT, they were considered metastatic. We compared the clinical findings and DECT parameters of both groups and performed a receiver operating characteristic analysis to evaluate the optimal cutoff values of the DECT parameters. RESULTS: Patients with metastases were significantly older than patients with benign nodules (p = 0.048). The DECT parameters of the metastatic nodules were significantly higher than those of the benign nodules (iodine concentration [IC], 5.61 ± 2.02 mg/mL vs. 1.61 ± 0.98 mg/mL; normalized IC [NIC], 0.60 ± 0.20 vs. 0.16 ± 0.11; NIC using pulmonary artery [NICPA], 0.60 ± 0.44 vs. 0.15 ± 0.11; slope of the spectral attenuation curves [λHU], 5.18 ± 2.54 vs. 2.12 ± 1.39; and Z-effective value [Zeff], 10.0 ± 0.94 vs. 8.79 ± 0.75; all p < 0.001). In the subgroup analysis according to nodule size, all DECT parameters of the metastatic nodules in all subgroups were significantly higher than those of the benign nodules (all p < 0.05). The cutoff values for IC, NIC, λHU, NICPA, and Zeff for diagnosing metastases were 3.10, 0.29, 3.57, 0.28, and 9.34, respectively (all p < 0.001). CONCLUSIONS: DECT parameters can help to differentiate metastatic and benign lung nodules in thyroid cancer. KEY POINTS: • DECT parameters can help to differentiate metastatic and benign lung nodules in patients with thyroid cancer. • DECT parameters showed a significant difference between benign lung nodules and lung metastases, even for nodules with diameters ≥ 3 mm and < 5 mm. • Among the DECT parameters, the highest diagnostic accuracy for differentiating pulmonary metastases from benign lung nodules was achieved with the NIC and IC, followed by the NICPA and λHU, and their cutoff values were 0.29, 3.10, 0.28, and 3.57, respectively.

Fluorescent and Iodized Emulsion for Preoperative Localization of Pulmonary Nodules.

OBJECTIVE: This study was conducted to develop a fluorescent iodized emulsion comprising indocyanine green (ICG) solution and lipiodol (ethiodized oil) and evaluate its feasibility for use in a clinical setting. BACKGROUND: ICG use for the preoperative localization of pulmonary nodules is limited in terms of penetration depth and diffusion. METHODS: First, fluorescent microscopy was used to investigate the distribution of ICG-lipiodol emulsions prepared using different methods. The emulsions were injected in 15 lung lobes of 3 rabbits under computed tomography fluoroscopy guidance; evaluation with imaging and radiography was conducted after thoracotomy. Subsequently, the emulsions were used to preoperatively localize 29 pulmonary nodules in 24 human subjects, and wedge resections were performed using fluorescent imaging and C-arm fluoroscopy. RESULTS: The optimal emulsion of 10% ICG and 90% lipiodol mixed through 90 passages had even distribution and the highest signal intensity under fluorescent microscopy; it also had the best consistency in the rabbit lungs, which persisted for 24 hours at the injection site. In human subjects, the mean diameter of pulmonary nodules was 0.9 ±â€Š0.4 cm, and depth from the pleura was 1.2 ± 0.8 cm. All emulsion types injected were well localized around the target nodules without any side effects or procedure-related complications. Wedge resection with minimally invasive approach was successful in all pulmonary nodules with a free resection margin. CONCLUSIONS: A fluorescent iodized emulsion prepared by mixing ICG with lipiodol enabled accurate localization and resection of pulmonary nodules.

Nitrates administered by spray versus tablet: comparison of coronary vasodilation on CT angiography.

OBJECTIVES: To compare the coronary vasodilation effects of spray with those induced by tablet administration in coronary CT angiography (CCTA). METHODS: A total of 2024 patients who underwent CCTA were identified for this retrospective study, including 828 patients with spray (spray group) and 1169 with tablets (tablet group). Of these, 93 patients underwent CCTA at least twice using both spray and tablets. The number of measurable segments and diameters of all 18 segments was measured. The number of measurable segments was compared between groups. RESULTS: No statistically significant differences were evident between these two groups in terms of clinical characteristics. All coronary segments except the ramus intermedius (RI) and left posterior descending artery (L-PDA) were significantly larger in the spray group than in the tablet group (all p < 0.001). In peripheral and branch vessels, as well as in central and main coronary arteries, the diameters were significantly larger in the spray group than in the tablet group (all p < 0.001). Although not always statistically significant, all coronary segments tended to be more measurable on CCTA with spray than with tablet. In the subgroup that underwent CCTA twice using both spray and tablets, all coronary segments except the RI, obtuse marginal artery 2 (OM2), and L-PDA were significantly larger in the spray group than in the tablet group (all p < 0.05). CONCLUSION: Lingual isosorbide dinitrate (ISDN) spray was more efficacious than sublingual nitroglycerin (NTG) tablets in coronary vasodilation for CCTA. Therefore, lingual ISDN spray should be preferred over sublingual NTG tablets for CCTA. KEY POINTS: • Lingual ISDN spray was more efficacious than sublingual NTG tablet for coronary vasodilation in coronary CT angiography, even in elderly patients. • The diameters of all coronary segments except RI and L-PDA were significantly larger, and there were significantly more coronary segments greater than 1.5 mm, except RI and L-PDA, in the spray group than in the tablet group in the whole study group. • Even in peripheral and branch vessels, the diameters of coronary arteries were significantly larger in the spray group than in the tablet group, and they were also larger in elderly patients.

Coronary artery calcium severity grading on non-ECG-gated low-dose chest computed tomography: a multiple-observer study in a nationwide lung cancer screening registry.

OBJECTIVES: To identify the optimal method for evaluation of coronary artery calcium (CAC) severity on non-electrocardiogram-gated low-dose chest computed tomography (LDCT) in a nationwide lung cancer screening registry. METHODS: A total of 256 subjects were retrospectively enrolled from participants of the Korean Lung Cancer Screening (K-LUCAS) project (an LDCT lung cancer screening registry for high-risk individuals). Four board-certified cardiothoracic radiologists independently assessed CAC severity using four different scoring methods (visual assessment, artery-based grading, segment-involvement grading, and segment-based grading) and classified severity for each case using all four methods as none, mild, moderate, or severe. Agreements between the four observers for CAC category classification and between the four different scoring methods for the same observer were assessed by Fleiss kappa statistics. Evaluation time for CAC grading was compared between observers and between grading methods. RESULTS: Interobserver agreement was moderate for visual assessment (Fleiss kappa 0.451) and substantial for the other three methods (Fleiss kappa 0.673-0.704). Agreement between the four grading methods for the same observer was substantial for three observers (Fleiss kappa 0.610-0.705) and moderate for one (Fleiss kappa 0.578). Mean evaluation time differed significantly between methods (visual assessment, 14.3 ± 11.8 s; artery-based grading, 17.6 ± 22.3 s, segment-involvement grading, 19.2 ± 6.8 s; segment-based grading, 34.2 ± 37.4 s; p < 0.01). CONCLUSION: Artery-based grading could be appropriate with substantial interobserver agreement and an acceptable mean evaluation time. KEY POINTS: • CAC severity grading methods on LDCT show moderate to substantial agreements between grading methods and observers. • Artery-based grading could be appropriate with substantial interobserver agreement and a mean evaluation time of 17.6 s. • Visual assessment is disadvantaged by high interobserver variability despite having the shortest evaluation time.

Levels of Extracellular Vesicles in Pulmonary and Peripheral Blood Correlate with Stages of Lung Cancer Patients.

BACKGROUND: The extracellular vesicle (EV) concentration is known to be higher in cancer patients than in healthy individuals. Herein, we report that EV levels differ in the tumor-draining pulmonary vein blood and the peripheral blood of animal models and human subjects at different pathological stages of lung cancer. METHODS: Ten rabbits and 40 humans formed the study cohorts. Blood was collected from the peripheral vein of members of all groups. Pulmonary blood was collected intraoperatively from all groups except for the healthy human controls. Quantitative analysis of EV levels was performed using a nanoparticle tracking assay, a CD63 enzyme-linked immunosorbent assay, and western blotting. RESULTS: The EV levels in the peripheral blood of animals and patients with lung cancer were higher than those in the peripheral blood of healthy controls (p < 0.01 and p < 0.001, respectively). Moreover, for both animals and patients with lung cancer, the EV levels in the pulmonary blood were significantly higher than those in the preoperative peripheral blood (p < 0.01 and p < 0.0001, respectively). In patients, the pathological stages of lung cancer showed a higher correlation with the pulmonary EV levels than the peripheral EV levels. CONCLUSIONS: EV levels increased with increasing lung cancer grade, and this trend was more prominent in the pulmonary blood than in the peripheral blood.

Developing evidence-based clinical imaging guidelines of justification for radiographic examination after dental implant installation.

BACKGROUND: This study aimed to develop evidence-based clinical imaging guidelines to assess the proper implant location following implant surgery and identify potential complications during follow-up. METHODS: The guideline development process employed an adaptation methodology in accordance with the Korean clinical imaging guidelines (K-CIG). Core (Ovid-Medline, Ovid-Embase, National Guideline Clearinghouse, and Guideline International Network) and domestic databases (KoreaMed, KMbase, and KoMGI) were searched used to retrieve guidelines, and two reviewers analyzed the retrieved articles. The articles were included in this review using well-established inclusion criteria. RESULTS: Our online search identified 66 articles, of which 3 were selected for the development of the guidelines. Consequently, based on these three guidelines, we formulated distinct recommendations regarding the appropriate imaging modalities that should be used following implant placement. CONCLUSIONS: Conventional imaging (e.g., periapical or panoramic radiography) should be the first choice for assessing the implant following its placement and osseointegration. The metal artifacts in Cone Beam Computed Tomography (CBCT) should be considered. However, CBCT is recommended for patients with sensory abnormalities following dental implant surgery to evaluate and identify the underlying cause of implant complications and to determine the appropriate treatment.

Comparison of tissue tracking assessment by cardiovascular magnetic resonance for cardiac amyloidosis and hypertrophic cardiomyopathy.

BACKGROUND: Administration of gadolinium-contrast can cause problems in cardiac amyloidosis (CA) patients with impaired renal function. PURPOSE: To compare patterns of cardiovascular magnetic resonance tissue tracking (CMR-TT) for CA and hypertrophic cardiomyopathy (HCM) and to assess the feasibility of CMR-TT to distinguish between these diseases without administration of gadolinium-contrast. MATERIAL AND METHODS: Included were 54 patients with biopsy-proven CA, 40 patients with HCM, and 30 healthy people. We calculated strain ratio of apex to base (SRAB) in the left ventricle (LV) using radial (R), circumferential (C), and longitudinal (L) strain from CMR-TT. The LV ejection fraction (LVEF) and the ratio of septal to posterior wall at basal level were also calculated. Late gadolinium enhancement (LGE) image analysis was performed for differential diagnosis. Area under the receiver operating characteristic curve (AUC) comparisons were used. RESULTS: All SRAB values were significantly different between CA and HCM (all P < 0.001). AUC values for parameters were 0.806 for LVEF, 0.815 for ratio of wall thickness, 0.944 for the LGE pattern, 0.898 for SRABR, 0.880 for SRABC, and 0.805 for SRABL. AUCs for the LGE pattern were significantly higher than for LVEF, ratio of wall thickness and SRABL (all P < 0.008). No significant differences were seen between AUCs for the LGE pattern, SRABR, and SRABC (all P > 0.109). CONCLUSION: SRABR and SRABC were reliable parameters for distinguishing between CA and HCM.

Is the epicardial adipose tissue area on non-ECG gated low-dose chest CT useful for predicting coronary atherosclerosis in an asymptomatic population considered for lung cancer screening?

OBJECTS: The purpose was to determine whether the epicardial adipose tissue (EAT) area on low-dose chest CT (LDCT) could be used to predict coronary atherosclerosis in an asymptomatic population considered for lung cancer screening. METHODS: Subjects aged 55-80 years with smoking history who underwent both LDCT and coronary CT angiography (CCTA) were retrospectively enrolled. Correlation between the EAT volume in CCTA and EAT area in LDCT was evaluated. Coronary risk factors including the body surface area (BSA) indexed EAT area were compared between coronary plaque negative and positive groups. Significant factors for predicting coronary atherosclerosis were analyzed with logistic regression analysis. Receiver-operating characteristic curve analysis was performed to determine the cutoff value. RESULTS: A total of 438 subjects were enrolled, including 299 subjects with coronary atherosclerosis. There was a good correlation between the EAT volume in CCTA and EAT area in LDCT (ρ = 0.712, p < 0.001). There were significant differences in age, systolic blood pressure, all BSA indexed EAT area, sex, and hypertension between plaque negative and positive groups. In multivariate logistic regression for the BSA indexed EAT area in LDCT at the RCA level, sex (OR: 11.168, 95% CI: 2.107-59.201, p = 0.005), systolic blood pressure (OR: 1.021, 95% CI: 1.005-1.036, p = 0.009), hypertension (OR: 1.723, 95% CI: 1.103-2.753, p = 0.017), and EAT area (OR: 1.273, 95% CI: 1.154-1.405, p < 0.001) were significant. The area under the curve of the BSA indexed EAT area in LDCT at the RCA level for coronary atherosclerosis was 0.657, and the cut-off value was 7.66 cm2/m2. CONCLUSION: The EAT area in LDCT could be used to predict coronary atherosclerosis in an asymptomatic population considered for lung cancer screening. KEY POINTS: • To quantify EAT, the EAT area in LDCT can be used instead of the EAT volume in CCTA. • The EAT area measured in LDCT can be used as a predictor of coronary artery disease. • The extensive CAD group tended to have a greater EAT area than the non-extensive CAD group.

Changes in Left Atrial Transport Function in Patients Who Maintained Sinus Rhythm After Successful Radiofrequency Catheter Ablation for Atrial Fibrillation: A 1-Year Follow-Up Multislice Computed Tomography Study.

BACKGROUND: Functional remodeling of left atrium (LA) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has not been fully elucidated. This study aimed to determine the impact of RFCA on LA transport function in patients who maintained sinus rhythm (SR) after AF ablation. METHODS AND RESULTS: A total of 96 patients (paroxysmal AF [PAF] = 52) who maintained SR during 1 year after AF ablation were enrolled. Multislice computed tomography was performed to determine LA volume (LAV) and LA emptying fraction (LAEF) at pre-RFCA and 1-year post-RFCA. Creatine kinase-MB (CK-MB) and troponin-T levels were analyzed 1-day post-RFCA. At 1-year post-RFCA, mean LAV and LAEF decreased in overall patients. Based on LAEF change (ΔLAEF) cutoff of 5.0%, LAEF reduced in 41 patients (worsened group) and improved or showed no change in 55 patients (preserved group). Compared with preserved group, worsened group had a higher proportion of PAF, higher levels of CK-MB and troponin-T, and additional LA ablation. ΔLAEF was inversely correlated with CK-MB and troponin-T levels. Subgroup analysis showed that LAEF significantly decreased in PAF patients who underwent additional LA ablation. Multivariate analysis revealed that high baseline LAEF and additional LA ablation were independent predictors for worsened LAEF. CONCLUSIONS: Although SR was maintained for 1 year after AF ablation, LAEF as well as LAV decreased. The extent of LAEF deterioration was significantly associated with the amount of iatrogenic myocardial damage. Our data indicate that extensive atrial ablation may lead to LA functional deterioration, especially in patients with PAF.

Radiation Doses of Various CT Protocols: a Multicenter Longitudinal Observation Study.

Emerging concerns regarding the hazard from medical radiation including CT examinations has been suggested. The purpose of this study was to observe the longitudinal changes of CT radiation doses of various CT protocols and to estimate the long-term efforts of supervising radiologists to reduce medical radiation. Radiation dose data from 11 representative CT protocols were collected from 12 hospitals. Attending radiologists had collected CT radiation dose data in two time points, 2007 and 2010. They collected the volume CT dose index (CTDIvol) of each phase, number of phases, dose length product (DLP) of each phase, and types of scanned CT machines. From the collected data, total DLP and effective dose (ED) were calculated. CTDIvol, total DLP, and ED of 2007 and 2010 were compared according to CT protocols, CT machine type, and hospital. During the three years, CTDIvol had significantly decreased, except for dynamic CT of the liver. Total DLP and ED were significantly decreased in all 11 protocols. The decrement was more evident in newer CT scanners. However, there was substantial variability of changes of ED during the three years according to hospitals. Although there was variability according to protocols, machines, and hospital, CT radiation doses were decreased during the 3 years. This study showed the effects of decreased CT radiation dose by efforts of radiologists and medical society.

Imaging Guidelines for Enhancing Justifications for Radiologic Studies.

Justification in the field of radiology refers to the appropriate use of radiologic imaging modalities, and may be achieved by establishing clinical imaging guidelines (CIGs). Recently, CIGs have been shown to be useful in selecting the proper medical imaging modality, resulting in the reduction of inappropriate radiologic examinations, thereby enhancing justifications. However, the development of CIGs is both time-consuming and difficult as the methodology of evidence-based medicine should be adhered to. Thus, although the radiologic societies in developed countries such as the United Kingdom and USA are already developing and implementing CIGs in their clinical practices, CIGs are not yet readily available in many other countries owing to differences in medical circumstances and resources. In this review, we assess the role and limitations of CIGs by examining the current status of CIGs in developed countries, and also describe the specific efforts made to establish CIGs in Korea.

Needlescopic resection of small and superficial pulmonary nodule after computed tomographic fluoroscopy-guided dual localization with radiotracer and hookwire.

PURPOSE: The aim of this study was to evaluate the feasibility of a needlescopic resection for small and superficial pulmonary nodules after dual localization with radiotracer and hookwire. METHODS: Computed tomography (CT) fluoroscopy-guided dual marking with hookwire and (99m)Tc-phytate was performed on 36 small and superficial pulmonary nodules of 34 patients, just before the needlescopic procedure. This method was carried out through one introducer needle, after an initial single puncture. After detection of the hookwire-marked site through needlescopy, the precise lesion was confirmed using a thoracoscopic gamma probe by calculating the highest radioactivity. The pulmonary nodule was resected and diagnosed by pathologic examination. RESULTS: The mean size of the nodules was 12.5 ± 5.4 mm (range 3-20), and their mean distance from the pleural surface was 5.6 ± 5.8 mm (range 0-18.7). The time of the dual localization procedure was 10.8 ± 3.6 min (range 5-18). Pneumothorax was developed in 6 of 34 patients (17.6 %) after preoperative localization, but did not require any treatment. Seven hookwires dislodged during the operation. Nevertheless, radiotracer markings detected on a gamma probe guided a successful wedge resection without difficulty in all seven cases. All nodules were successfully resected under needlescopy, except conversion to the 5-mm-sized thoracoscopy in four patients due to pleural adhesion. CONCLUSIONS: Dual marking with radiotracer and hookwire under CT fluoroscopy is a safe and not time-consuming procedure, and has made needlescopy-assisted lung resection for small and superficial nodules or ground-glass opacity lesions easier, more convenient, and less hazardous.

Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study.

OBJECTIVES: The purpose of this study was to evaluate the diagnostic performance of chest radiography (CXR), chest digital tomosynthesis (DT) and low dose multidetector computed tomography (LDCT) for the detection of small pulmonary ground-glass opacity (GGO) nodules, using an anthropomorphic chest phantom. METHODS: Artificial pulmonary nodules were placed in a phantom and a total of 40 samples of different nodule settings underwent CXR, DT and LDCT. The images were randomly read by three experienced chest radiologists. Free-response receiver-operating characteristics (FROC) were used. RESULTS: The figures of merit for the FROC curves averaged for the three observers were 0.41, 0.37 and 0.76 for CXR, DT and LDCT, respectively. FROC analyses revealed significantly better performance of LDCT over CXR or DT for the detection of GGO nodules (P < 0.05). The difference in detectability between CXR and DT was not statistically significant (P = 0.73). CONCLUSION: The diagnostic performance of DT for the detection of pulmonary small GGO nodules was not significantly different from that of CXR, but LDCT performed significantly better than both CXR and DT. DT is not a suitable alternative to CT for small GGO nodule detection, and LDCT remains the method of choice for this purpose. KEY POINTS: For GGO nodule detection, DT was not significantly different from CXR. DT is not a suitable alternative to CT for GGO nodule detection. LDCT is the method of choice for GGO nodule detection.

A single-incision technique for placement of implantable venous access ports via the axillary vein.

PURPOSE: To evaluate the technical feasibility and safety of a single-incision technique for placement of implantable venous access ports via the axillary vein. MATERIALS AND METHODS: Ports were placed in 216 patients between May and October 2012 using a single-incision technique via the axillary vein. Patients included 112 men and 104 women with a mean age of 58.2 years. After making a single vertical incision without subcutaneous tunneling, ports were placed via the left axillary vein in 172 patients and via the right axillary vein in 44 patients. Axillary vein punctures were directed medially at the incision site under ultrasound guidance. We retrospectively reviewed success rates, technical difficulties, procedure times, and immediate and delayed complications of the procedure. RESULTS: All single-incision port placements were technically successful. Technical difficulties occurring during the procedure included advancement of the wire or catheter into an unintended vein (n = 33), kinking at the cuff-catheter junction (n = 13), bleeding via the puncture tract (n = 5), bending of the peel-away sheath (n = 3), and puncture of the axillary artery (n = 3). All technical problems were overcome with additional manipulation. The only immediate complication was puncture site hematoma in two patients. The mean follow-up period was 165.7 days, and there were no reports of port malfunction. Axillary vein thrombosis was observed in one patient. CONCLUSIONS: The single-incision technique for placing ports via the axillary vein was a feasible and safe procedure with high technical success and low risk of complications.

[Visualization of Borderline Coronary Artery Lesions by CT Angiography and Coronary Artery Disease Reporting and Data System]. / 관상동맥 질환 íŒë ê³¼ 자료 체계와 CT í˜ˆê´€ì¡°ì˜ìˆ ì—ì„œì˜ 경계성 관상동맥 병변.

Coronary artery disease (CAD) narrows vessel lumens at the sites of atherosclerosis, increasing the risk of myocardial ischemia or infarction. Early and accurate diagnosis of CAD is crucial to significantly improve prognosis and management. CT angiography (CTA) is a noninvasive imaging technique that enables assessment of vascular structure and stenosis with high resolution and contrast. Coronary CTA is useful in the diagnosis of CAD. Recently, the CAD-reporting and data system (CAD-RADS), a diagnostic classification system based on coronary CTA, has been developed to improve intervention efficacy in patients suspected of CAD. While the CAD-RAD is based on CTA, it includes borderline categories where interpreting the coronary artery status solely based on CTA findings may be challenging. This review introduces CTA findings that fall within the CAD-RADS categories that necessitate additional tests to decide to perform invasive coronary angiography and discusses appropriate management strategies.

Is a Camera-Type Portable X-Ray Device Clinically Feasible in Chest Imaging?: Image Quality Comparison with Chest Radiographs Taken with Traditional Mobile Digital X-Ray Devices.

Purpose: To evaluate whether the image quality of chest radiographs obtained using a camera-type portable X-ray device is appropriate for clinical practice by comparing them with traditional mobile digital X-ray devices. Materials and Methods: Eighty-six patients who visited our emergency department and underwent endotracheal intubation, central venous catheterization, or nasogastric tube insertion were included in the study. Two radiologists scored images captured with traditional mobile devices before insertion and those captured with camera-type devices after insertion. Identification of the inserted instruments was evaluated on a 5-point scale, and the overall image quality was evaluated on a total of 20 points scale. Results: The identification score of the instruments was 4.67 ± 0.71. The overall image quality score was 19.70 ± 0.72 and 15.02 ± 3.31 (p < 0.001) for the mobile and camera-type devices, respectively. The scores of the camera-type device were significantly lower than those of the mobile device in terms of the detailed items of respiratory motion artifacts, trachea and bronchus, pulmonary vessels, posterior cardiac blood vessels, thoracic intervertebral disc space, subdiaphragmatic vessels, and diaphragm (p = 0.013 for the item of diaphragm, p < 0.001 for the other detailed items). Conclusion: Although caution is required for general diagnostic purposes as image quality degrades, a camera-type device can be used to evaluate the inserted instruments in chest radiographs.