Real-time PACS-integrated longitudinal brain metastasis tracking tool provides comprehensive assessment of treatment response to radiosurgery.

Background: Treatment of brain metastases can be tailored to individual lesions with treatments such as stereotactic radiosurgery. Accurate surveillance of lesions is a prerequisite but challenging in patients with multiple lesions and prior imaging studies, in a process that is laborious and time consuming. We aimed to longitudinally track several lesions using a PACS-integrated lesion tracking tool (LTT) to evaluate the efficiency of a PACS-integrated lesion tracking workflow, and characterize the prevalence of heterogenous response (HeR) to treatment after Gamma Knife (GK). Methods: We selected a group of brain metastases patients treated with GK at our institution. We used a PACS-integrated LTT to track the treatment response of each lesion after first GK intervention to maximally seven diagnostic follow-up scans. We evaluated the efficiency of this tool by comparing the number of clicks necessary to complete this task with and without the tool and examined the prevalence of HeR in treatment. Results: A cohort of eighty patients was selected and 494 lesions were measured and tracked longitudinally for a mean follow-up time of 374 days after first GK. Use of LTT significantly decreased number of necessary clicks. 81.7% of patients had HeR to treatment at the end of follow-up. The prevalence increased with increasing number of lesions. Conclusions: Lesions in a single patient often differ in their response to treatment, highlighting the importance of individual lesion size assessments for further treatment planning. PACS-integrated lesion tracking enables efficient lesion surveillance workflow and specific and objective result reports to treating clinicians.

The impact of COVID-19 quarantine efforts on emergency radiology and trauma cases.

OBJECTIVE: Amidst COVID-19 pandemic, many states have issued stay at home advisories and non-essential business closures to limit public exposure. During this "quarantine" period, it is important to understand the volume and types of emergency/trauma radiology cases to better prepare for the continuing and future pandemics. This study demonstrates new trends in pathologies and an overall increase in positive exams. METHODS: A retrospective review of emergency department's imaging during the initial two weeks of this state's quarantine period, 3/23/2020-4/5/2020 was compared to similar dates of the previous year ("pre-quarantine" period), 3/25/2019-4/7/2019. One thousand emergency radiology and 991 trauma cases were evaluated. Of the emergency radiology cases 500 studies from each period were assessed, and from the trauma cases, 783 cases from pre-quarantine and 315 from the quarantine period were examined. Chi-square analysis was performed to assess for statistical significance. RESULTS: Overall there were 43.0% fewer emergency radiology studies performed during the quarantine period (n = 4530) compared to pre-quarantine period (n = 2585). Additionally, the number of positive cases was significantly higher (P = 0.0001) during the quarantine period (43.0%) compared to the pre-quarantine period (30.2%). Several trends in types of trauma were observed, including a significant increase in domestic violence during the quarantine period (P = 0.0081). DISCUSSION: Different volumes and types of emergency/trauma imaging cases were observed during the recent quarantine period. Findings may assist emergency radiology departments to plan for future pandemics or COVID-19 resurgences by offering evidence of the types and volume of emergency radiology cases one might expect.

Creating a Radiology Call Center Hotline and "HOT" Sites: Centralizing Radiology Questions and Cohorting Out-patient Care During the COVID-19 Pandemic.

INTRODUCTION: Amidst COVID-19 crisis, confusion exists over current radiology operations due to influx of new data and new protocols. In order to decrease confusion and reduce imaging facility related COVID-19 transmissions, we created a dedicated radiology COVID-19 call center and dedicated out-patient COVID-19 imaging sites (referred to "HOT" sites). MATERIALS AND METHODS: We created a central radiology call center hotline, staffed by our radiology technologists, to answer all radiology questions related to COVID-19 and help with scheduling exams. All out-patient x-ray exams became mandatory to schedule through the call center so proper COVID-19 screening could occur. If positive for COVID-19 symptoms, they are sent to "HOT" sites. Various statistical analyses were performed. RESULTS: A total of 2548 calls were received over 7 weeks with linear increase in calls during this period (R 2 = 0.17, P = 0.003). Most common reasons for calling were related to scheduling (n = 2336, 92%) and radiology operations (n = 145, 6%). At our main "HOT" site, from a total of 371 separate patient encounters by date of study, 72 patient encounters (19%) were COVID-19 positive at time of exam. DISCUSSION: This project provides efficient and reassuring radiology operations during an emergency situation by providing a single reliable point of contact and a source of truth for all facets of radiology. In doing so, we facilitate high quality patient centered care while protecting the health of our patients and staff.

The Prevalence of Psychiatric Disorders Among Elective Plastic Surgery Patients.

Purpose: Psychiatric disorder is one of the predictors of poor outcome in cosmetic plastic surgery patients. A US study in 1960 showed that 72.4% of 98 cosmetic plastic surgery patients had a psychiatric disorder. In our study, we predict that the prevalence of psychiatric disorders will be statistically significant among patients seeking elective plastic surgery in comparison with the general US population. Methods: We conducted a retrospective review study of 1000 adult patients seeking elective plastic surgery at The University of Kansas Medical Center Plastic Surgery Department from 2011 to 2016. Results: From 1000 patients seeking elective plastic surgery procedure, 441 (44.1%) patients have or had a history of psychiatric disorder. Most common psychiatric disorders were major depressive disorder (n = 223; 50.6%) and generalized anxiety disorder (n = 145; 32.9%). Conclusion: Our study indicates that psychiatric disorders are prevalent in patients seeking elective plastic surgery at our institution. Anxiety and depression were the most common diagnoses, and this is possibly due to these being the most common psychiatric disorders in the US population. Results highlight the importance of provider vigilance for psychiatric patients seeking elective plastic surgery.

Case report: interventional radiology's potential role for in vitro fertilization post ovarian transposition and pelvic radiation.

INTRODUCTION: Ovarian transposition is a procedure that can help preserve fertility for female patients requiring radiation in the abdominopelvic region. However, the displacement of ovaries from its original anatomic location can make oocyte retrieval challenging. CASE PRESENTATION: A 24-year-old nulligravid patient recently diagnosed with colorectal carcinoma [CRC] underwent ovarian transposition prior to radiation. After radiation and chemotherapy, she began in vitro fertilization [IVF] by reproductive endocrinology and infertility physicians. Right ovary demonstrated nonviability due to failed transposition and radiation. Left ovarian oocytes were not able to be harvested due to risk of left kidney puncture via transvaginal ultrasound [TVUS]. Interventional Radiology [IR] was involved and performed a transabdominal ultrasound guided egg retrieval which led to successful IVF. CONCLUSION: This case highlights the utility of IR-assisted transabdominal ultrasound approach for oocyte retrieval in patients with history of ovarian transposition.

Upregulation of chondroitin 6-sulphotransferase-1 facilitates Schwann cell migration during axonal growth.

Cell migration is central to development and post-traumatic regeneration. The differential increase in 6-sulphated chondroitins during axonal growth in both crushed sciatic nerves and brain development suggests that chondroitin 6-sulphotransferase-1 (C6ST-1) is a key enzyme that mediates cell migration in the process. We have cloned the cDNA of the C6ST-1 gene (C6st1) (GenBank accession number AF178689) from crushed sciatic nerves of adult rats and produced ribonucleotide probes accordingly to track signs of 6-sulphated chondroitins at the site of injury. We found C6st1 mRNA expression in Schwann cells emigrating from explants of both sciatic nerve segments and embryonic dorsal root ganglia. Immunocytochemistry indicated pericellular 6-sulphated chondroitin products around C6ST-1-expressing frontier cells. Motility analysis of frontier cells in cultures subjected to staged treatment with chondroitinase ABC indicated that freshly produced 6-sulphated chondroitin moieties facilitated Schwann cell motility, unlike restrictions resulting from proteoglycan interaction with matrix components. Sciatic nerve crush provided further evidence of in vivo upregulation of the C6ST-1 gene in mobile Schwann cells that guided axonal regrowth 1-14 days post crush; downregulation then accompanied declining mobility of Schwann cells as they engaged in the myelination of re-growing axons. These findings are the first to identify upregulated C6st1 gene expression correlating with the motility of Schwann cells that guide growing axons through both developmental and injured environments.