Analysis of Longitudinal Assessment: Role of Radiology Online Longitudinal Assessment-Type Questions.

OBJECTIVE: The purpose of this investigation was to assess gaps in radiologists' medical knowledge using abdominal subspecialty online longitudinal assessment (OLA)-type questions. Secondarily, we evaluated what question-centric factors influenced radiologists to pursue self-directed additional reading on topics presented. METHODS: A prospective OLA-type test was distributed nationally to radiologists over a 4-month period. Questions were divided into multiple groupings, including arising from three different time periods of literature (≤5 years, 6-15 years, and >20 years), relating to common versus uncommon modalities, and guideline-based versus knowledge-based characterization. After each question, participants rated their confidence in diagnosis and perceived question relevance. Answers were provided, and links to answer explanations and references were provided and tracked. A series of regression models were used to test potential predictors of correct response, participant confidence, and perceived question relevance. RESULTS: In all, 119 participants initiated the survey, with 100 answering at least one of the questions. Participants had significantly lower perceived relevance (mean: 51.3, 59.2, and 62.1 for topics ≤5 years old, 6-15 years old, and >20 years old, respectively; P < .001) and confidence (mean: 48.4, 57.8, and 63.4, respectively; P < .001) with questions on newer literature compared with older literature. Participants were significantly more likely to read question explanations for questions on common modalities compared with uncommon (46% versus 40%; P = .005) and on guideline-based questions compared with knowledge-based questions (49% versus 43%; P = .01). DISCUSSION: OLA-type questions function by identifying areas in which radiologists lack knowledge or confidence and highlight areas in which participants have interest in further education.

Exploring the potential for online data sources to enhance species threat mapping through the case study of global bat exploitation.

Expanding digital data sources, including social media and online news, provide a low-cost way to examine human-nature interactions, such as wildlife exploitation. However, the extent to which using such data sources can expand or bias understanding of the distribution and intensity of threats has not been comprehensively assessed. To address this gap, we quantified the geographical and temporal distribution of online sources documenting the hunting and trapping, consumption, or trade of bats (Chiroptera) and compared these with the distribution of studies obtained from a systematic literature search and species listed as threatened by exploitation on the International Union for Conservation of Nature Red List. Online records were collected using automated searches of Facebook, Twitter, Google, and Bing and were filtered using machine classification. This yielded 953 relevant social media posts and web pages, encompassing 1099 unique records of bat exploitation from 84 countries. Although the number of records per country was significantly predicted by the number of academic studies per country, online records provided additional locations and more recent records of bat exploitation, including 22 countries not present in academic literature. This demonstrates the value of online resources in providing more complete geographical representation. However, confounding variables can bias the analysis of spatiotemporal trends. Online bat exploitation records showed peaks in 2020 and 2014, after accounting for increases in internet users through time. The second of these peaks could be attributed to the COVID-19 outbreak, and speculation about the role of bats in its epidemiology, rather than to true changes in exploitation. Overall, our results showed that data from online sources provide additional knowledge on the global extent of wildlife exploitation, which could be used to identify early warnings of emerging threats and pinpoint locations for further research.

Sondeo del potencial de las fuentes virtuales de datos para mejorar el mapeo de amenazas para las especies por medio del estudio de caso de la explotación mundial de murciélagos Resumen La expansión de las fuentes virtuales, incluidas las redes sociales y las noticias en línea, proporciona una forma asequible de analizar las interacciones entre el humano y la naturaleza, como la explotación de fauna. Sin embargo, no se ha analizado por completo el rango al que dichas fuentes pueden expandir o sesgar el conocimiento de la distribución e intensidad de las amenazas. Para abordar este vacío cuantificamos la distribución geográfica y temporal de las fuentes virtuales que documentan la caza, captura, consumo o mercado de murciélagos (Chiroptera) y las comparamos con la distribución de los estudios obtenidos de una búsqueda sistemática en la literatura y con las especies catalogadas como amenazadas por la explotación según la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza. Recolectamos los registros virtuales por medio de búsquedas automatizadas en Facebook, Twitter, Google y Bing y después las filtramos con clasificaciones automatizadas. Esto arrojó 953 publicaciones relevantes en redes sociales y sitios web que englobaban 1099 registros únicos de la explotación de murciélagos en 84 países. Aunque pronosticamos de forma significativa el número de registros por país con el número de estudios académicos por país, los registros virtuales proporcionaron localidades adicionales y registros más recientes de la explotación de murciélagos, incluyendo a 22 países que no se encuentran en la literatura académica. Lo anterior demuestra el valor que tienen los recursos en línea para proporcionar una representación geográfica más completa. Sin embargo, las variables confusas pueden sesgar el análisis de las tendencias espaciotemporales. Los registros virtuales de la explotación de murciélagos mostraron picos en 2020 y en 2014, esto después de considerar el incremento de usuarios de internet con el tiempo. El segundo pico podría atribuirse al brote de COVID-19 y la especulación en torno al papel que tenían los murciélagos en su epidemiología y no tanto a un verdadero cambio en la explotación. En general, nuestros resultados mostraron que los datos de las fuentes virtuales proporcionan conocimiento adicional sobre el alcance mundial de la explotación de fauna, el cual podría usarse para identificar señales tempranas de amenazas emergentes y ubicar localidades para su mayor investigación.

Visceral adipose tissue volume effect in Crohn's disease using reduced exposure CT enterography.

PURPOSE: The purpose of this investigation was to assess the effect of visceral adipose tissue volume (VA) on reader efficacy in diagnosing and characterizing small bowel Crohn's disease using lower exposure CT enterography (CTE). Secondarily, we investigated the effect of lower exposure and VA on reader diagnostic confidence. METHODS: Prospective paired investigation of 256 CTE, 129 with Crohn's disease, were reconstructed at 100% and simulated 50% and 30% exposure. The senior author provided the disease classification for the 129 patients with Crohn's disease. Patient VA was measured, and exams were evaluated by six readers for presence or absence of Crohn's disease and phenotype using a 0-10-point scale. Logistic regression models assessed the effect of VA on sensitivity and specificity. RESULTS: The effect of VA on sensitivity was significantly reduced at 30% exposure (odds radio [OR]: 1.00) compared to 100% exposure (OR: 1.12) (p = 0.048). There was no statistically significant difference among the exposures with respect to the effect of visceral fat on specificity (p = 0.159). The study readers' probability of agreement with the senior author on disease classification was 60%, 56%, and 53% at 100%, 50%, and 30% exposure, respectively (p = 0.004). When detecting low severity Crohn's disease, readers' mean sensitivity was 83%, 75%, and 74% at 100%, 50%, and 30% exposure, respectively (p = 0.002). In low severity disease, sensitivity also tended to increase as visceral fat increased (ORs per 1000 cm3 increase in visceral fat: 1.32, 1.31, and 1.18, p = 0.010, 0.016, and 0.100, at 100%, 50%, and 30% exposure). CONCLUSIONS: While the interaction is complex, VA plays a role in detecting and characterizing small bowel Crohn's disease when exposure is altered, particularly in low severity disease.

Imaging of Uterine Transplantation.

Uterus transplantation (UTx) is a novel procedure being studied as a treatment of absolute uterine factor infertility. Imaging plays an important role throughout the life cycle of a uterus transplant. In this review, we will first describe the surgical technique of UTx. The article will then focus on the importance of imaging in the evaluation of potential recipients and donors and during the immediate post-surgical time course as graft viability is established. Imaging as part of including in vitro fertilization, pregnancy, and complications will also be discussed.

Effect of obesity on ability to lower exposure for detection of low-attenuation liver lesions.

PURPOSE: The purpose of this study was to assess the effect of obesity and iterative reconstruction on the ability to reduce exposure by studying the accuracy for detection of low-contrast low-attenuation (LCLA) liver lesions on computed tomography (CT) using a phantom model. METHODS: A phantom with four unique LCLA liver lesions (5- to 15-mm spheres, -24 to -6 HU relative to 90-HU background) was scanned without ("thin" phantom) and with ("obese" phantom) a 5-cm thick fat-attenuation ring at 150 mAs (thin phantom) and 450 mAs (obese phantom) standard exposures and at 33% and 67% exposure reductions. Images were reconstructed using standard filtered back projection (FBP) and with iterative reconstruction (Adaptive Model-Based Iterative Reconstruction strength 3, ADMIRE). A noninferiority analysis of lesion detection was performed. RESULTS: Mean area under the curve (AUC) values for lesion detection were significantly higher for the thin phantom than for the obese phantom regardless of exposure level (P < 0.05) for both FBP and ADMIRE. At 33% exposure reduction, AUC was noninferior for both FBP and ADMIRE strength 3 (P < 0.0001). At 67% exposure reduction, AUC remained noninferior for the thin phantom (P < 0.0035), but was no longer noninferior for the obese phantom (P ≥ 0.7353). There were no statistically significant differences in AUC between FBP and ADMIRE at any exposure level for either phantom. CONCLUSIONS: Accuracy for lesion detection was not only significantly lower in the obese phantom at all relative exposures, but detection accuracy decreased sooner while reducing the exposure in the obese phantom. There was no significant difference in lesion detection between FBP and ADMIRE at equivalent exposure levels for either phantom.

New Frontier: Role of the Radiologist in Uterine Transplantation.

Uterine transplantation (UT) is a novel treatment for absolute uterine factor infertility (AUFI) that is currently being performed under experimental protocols in multiple medical centers worldwide. At the time of this publication, there have been at least 10 live births by women with a transplanted uterus. As successful outcomes from this innovative procedure increase, it is likely that more centers will perform UT. Imaging is performed in multiple steps of the UT process, including preoperative imaging of potential donors and recipients, posttransplant surveillance, and monitoring of pregnancy. Fetal imaging is performed by maternal-fetal medicine professionals, but most imaging examinations in UT are performed by radiologists. Given the significant role of imaging in this groundbreaking surgery, radiologists must be familiar with the causes of AUFI and the role of imaging in establishing this diagnosis. Radiologists working in medical centers where UT is performed should understand the role of imaging in preoperative planning and postoperative surveillance. While data regarding complications of UT are preliminary at best, radiologists must be aware of the risk of vascular compromise and graft failure and their imaging features. The authors provide a brief history of UT and define the radiologist's role in pre- and postoperative imaging assessments.©RSNA, 2019.

Digital Breast Tomosynthesis: Cost-Effectiveness of Using Private and Medicare Insurance in Community-Based Health Care Facilities.

OBJECTIVE: The purpose of this study was to determine whether digital breast tomosynthesis (DBT) is a cost-effective alternative to full-field digital mammography (FFDM) for both Medicare and privately insured patients undergoing screening mammography. MATERIALS AND METHODS: A retrospective data analysis was performed between July 15, 2013, and July 14, 2014, with data on women presenting for screening mammography that included any additional radiologic workup (n = 6319). Patients chose to undergo DBT or FFDM on the basis of personal preference, physician suggestion, and cost difference. The summation of findings over the 1-year period were used to calculate recall rates, cancer detection rates, and billing costs for a regional private insurer and Medicare. RESULTS: Data from the 6319 patients who participated were divided: 3655 patients underwent DBT, and 2664 underwent FFDM during the year of screening. Private insurance billing cost $2.9 million, and Medicare cost $1.2 million for screening, follow-up imaging, and radiologic procedures. Per-person costs were approximately $40 higher for the DBT group using both forms of insurance. However, cost per cancer detected was lower in the DBT group for both private and governmental insurance, leading to potentially $3.7 million and $899,000 saved per 100 cancers found. After standardization of the difference in cancer detection rates between the two groups, DBT was a cost-equivalent alternative to FFDM for private insurance billing but was a cost-inefficient alternative with respect to Medicare costs. CONCLUSION: In a community-based setting, DBT is a cost-equivalent or potentially cost-effective alternative to FFDM and has the capacity for improving cancer detection and recall rates.

Safety and efficiency of emergency department interrogation of cardiac devices.

OBJECTIVE: Patients with implanted cardiac devices may wait extended periods for interrogation in emergency departments (EDs). Our purpose was to determine if device interrogation could be done safely and faster by ED staff. METHODS: Prospective randomized, standard therapy controlled, trial of ED staff device interrogation vs. standard process (SP), with 30-day follow-up. Eligibility criteria: ED presentation with a self-report of a potential device related complaint, with signed informed consent. SP interrogation was by company representative or hospital employee. RESULTS: Of 60 patients, 42 (70%) were male, all were white, with a median (interquartile range) age of 71 (64 to 82) years. No patient was lost to follow up. Of all patients, 32 (53%) were enrolled during business hours. The overall median (interquartile range) ED vs. SP time to interrogation was 98.5 (40 to 260) vs. 166.5 (64 to 412) minutes (P=0.013). While ED and SP interrogation times were similar during business hours, 102 (59 to 138) vs. 105 (64 to 172) minutes (P=0.62), ED interrogation times were shorter vs. SP during non-business hours; 97 (60 to 126) vs. 225 (144 to 412) minutes, P=0.002, respectively. There was no difference in ED length of stay between the ED and SP interrogation, 249 (153 to 390) vs. 246 (143 to 333) minutes (P=0.71), regardless of time of presentation. No patient in any cohort suffered an unplanned medical contact or post-discharge adverse device related event. CONCLUSION: ED staff cardiac device interrogations are faster, and with similar 30-day outcomes, as compared to SP.