Deep learning-based automated detection and segmentation of bone and traumatic bone marrow lesions from MRI following an acute ACL tear.

INTRODUCTION: Traumatic bone marrow lesions (BML) are frequently identified on knee MRI scans in patients following an acute full-thickness, complete ACL tear. BMLs coincide with regions of elevated localized bone loss, and studies suggest these may act as a precursor to the development of post-traumatic osteoarthritis. This study addresses the labour-intensive manual assessment of BMLs by using a 3D U-Net for automated identification and segmentation from MRI scans. METHODS: A multi-task learning approach was used to segment both bone and BML from T2 fat-suppressed (FS) fast spin echo (FSE) MRI sequences for BML assessment. Training and testing utilized datasets from individuals with complete ACL tears, employing a five-fold cross-validation approach and pre-processing involved image intensity normalization and data augmentation. A post-processing algorithm was developed to improve segmentation and remove outliers. Training and testing datasets were acquired from different studies with similar imaging protocol to assess the model's performance robustness across different populations and acquisition conditions. RESULTS: The 3D U-Net model exhibited effectiveness in semantic segmentation, while post-processing enhanced segmentation accuracy and precision through morphological operations. The trained model with post-processing achieved a Dice similarity coefficient (DSC) of 0.75 ± 0.08 (mean ± std) and a precision of 0.87 ± 0.07 for BML segmentation on testing data. Additionally, the trained model with post-processing achieved a DSC of 0.93 ± 0.02 and a precision of 0.92 ± 0.02 for bone segmentation on testing data. This demonstrates the approach's high accuracy for capturing true positives and effectively minimizing false positives in the identification and segmentation of bone structures. CONCLUSION: Automated segmentation methods are a valuable tool for clinicians and researchers, streamlining the assessment of BMLs and allowing for longitudinal assessments. This study presents a model with promising clinical efficacy and provides a quantitative approach for bone-related pathology research and diagnostics.

Postural control during gait termination and prehension.

BACKGROUND: Challenges to postural stability emerge in the transition from locomotion to a standing posture as during gait termination, often accompanied by another task (e.g., opening a door), which may complicate control. However, less is known about postural control during terminating gait while engaged in a secondary manual task. RESEARCH QUESTION: What are the changes in postural control when terminating gait with and without a prehension task? METHODS: In a cross-sectional design, 15 healthy young adults (M=8, F=7; 27±2 years; 69±13 kg; 171±8 cm) underwent both a single task gait termination (GTO) and dual task (gait termination plus reaching; GTR). Postural Time-to-Contact (TtC) was measured using Center of Pressure (CoP) and the sternum position in anterior-posterior (AP) and medial-lateral (ML) directions over two different phases: preparatory phase and stabilization phase. Five successful trials were recorded to obtain a mean TtC. For statistical analysis of TtC, a two-tailed paired t-test was used (p =.05) as normality was satisfied. RESULTS: For the preparatory phase, there were no differences for the CoP, but TtC of the sternum position in AP was shorter in GTR than GTO (p =.001). Meanwhile, for the stabilization phase, TtCs of both the CoP and sternum position were longer in GTR in both AP and ML directions (p's <.001). SIGNIFICANCE: We suggest that for the preparatory phase, the shorter TtC of the sternum position with intact TtC of the CoP in GTR indicates that healthy young individuals are flexible, in that they smoothly integrate CoP control with the upper body demands required to also perform the prehension task. Meanwhile, for the stabilization phase, the longer TtC in dual termination and prehension task indicates that the perturbation imposed by the prehension movement did not result in reduced stabilization when returning to an upright posture.

SSR white paper: guidelines for utilization and performance of direct MR arthrography.

OBJECTIVE: Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS: The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS: Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION: Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.

Detection of fungi in the airways of horses according to the sample site: a methodological study.

Fungal detection in equine airways may be performed on either tracheal wash (TW) or bronchoalveolar lavage fluid (BALF) by either cytology or culture. However, method comparisons are sparse. Our objective was to determine the prevalence of fungi in airways of horses according to the sample site and laboratory methodology. Sixty-two adult horses, investigated in the field or referred for respiratory disease, were included. Tracheal wash, and BALF collected separately from both lungs, were collected using a videoendoscope. Fungi were detected in cytologic samples examined by light microscopy, and by fungal culture. Hay was sampled in the field. Prevalence of fungi was of 91.9% in TW and 37.1% in BALF. Fungi were cultured from 82.3% of TW and 20.9% of BALF. Fungal elements were observed cytologically in 69.4% of TW and 22.6% of BALF. In 50% of horses, the same fungi were detected in both TW and hay, but fungi detected in BALF and hay differed in all horses. Poor agreement was found for the detection of fungi between TW and BALF and between fungal culture and cytologic examination (Cohen's kappa coefficient (κ) < 0.20). Moderate agreement was found between cytologic examination of left and right lungs (κ = 0.47). The prevalence of fungi detected cytologically on pooled BALF was significantly different (p = 0.023) than on combined left and right BALF. Fungi were more prevalent in the TW than BALF, and results suggest that hay might not be the primary source of fungi of the lower respiratory tract of horses.

Changes to balance dynamics following a high-intensity run are associated with future injury occurrence in recreational runners.

Background: Fatigue is associated with increased injury risk along with changes in balance control and task performance. Musculoskeletal injury rates in runners are high and often result from an inability to adapt to the demands of exercise and a breakdown in the interaction among different biological systems. This study aimed to investigate whether changes in balance dynamics during a single-leg squat task following a high-intensity run could distinguish groups of recreational runners who did and did not sustain a running-related injury within 6 months. Methods: Thirty-one healthy recreational runners completed 60 s of single-leg squat before and after a high-intensity run. Six months after the assessment, this cohort was separated into two groups of 13 matched individuals with one group reporting injury within this period and the other not. Task performance was assessed by the number of repetitions, cycle time, amplitude, and speed. To evaluate balance dynamics, the regularity and temporal correlation structure of the center of mass (CoM) displacements in the transverse plane was analyzed. The interaction between groups (injury, non-injured) and time (pre, post) was assessed through a two-way ANOVA. Additionally, a one-way ANOVA investigated the percent change difference of each group across time. Results: The injured group presented more regular (reduced entropy; 15.6%) and diffusive (increased short-term persistence correlation; 5.6%) CoM displacements after a high-intensity run. No changes were observed in the non-injured group. The within-subject percent change was more sensitive in demonstrating the effects of fatigue and distinguishing the groups, compared to group absolute values. No differences were observed in task performance. Discussion: Runners who were injured in the future demonstrate changes in balance dynamics compared to runners who remain injury-free after fatigue. The single-leg squat test adopted appears to be a potential screening protocol that provides valuable information about balance dynamics for identifying a diminished ability to respond to training and exercise.

Impaired foot vibration sensitivity is related to altered plantar pressures during walking in people with multiple sclerosis.

BACKGROUND: Balance and mobility impairment are two of the most common and debilitating symptoms among people with multiple sclerosis (MS). Somatosensory symptoms, including reduced plantar cutaneous sensation, have been identified in this cohort. Given the importance of the somatosensory system in gait, it is likely that impaired plantar sensation may play a role in the walking adaptations commonly observed in people with MS, including decreased stride length and increased stride width and dual support time, often described as a cautious gait strategy. Understanding the contributions of plantar sensation to these alterations may provide targets for interventions that seek to improve sensory feedback and normalize gait patterns. This cross-sectional study determined whether individuals with MS who demonstrate reduced sensitivity of the plantar surfaces also demonstrate altered plantar pressure distributions during walking compared to a control cohort. METHODS: Twenty individuals with MS and twenty age- and sex-matched control participants walked barefoot at preferred and three matched speeds. Participants walked across a walkway with an embedded pressure plate used to quantify pressures within ten plantar zones. In addition, vibration perception thresholds were assessed at four sites on the plantar surface. RESULTS: Individuals with MS demonstrated increased peak total plantar pressures compared to control participants, that increased with walking speed. For the MS group, plantar pressures were higher on the less sensitive foot, although pressures on both feet exceeded those of the control cohort. Positive correlations between vibration perception threshold and peak total pressure were evident, although generally stronger in the MS cohort. CONCLUSION: A relationship between plantar vibration sensitivity and pressure could indicate that individuals with MS seek to increase plantar sensory feedback during walking. However, because proprioception may also be impaired, increased plantar pressure could result from inaccurate foot placement. Interventions targeting improved somatosensation may have the potential to normalize gait patterns and should be investigated.

Adapting a preschool disruptive behavior group for the underserved in pediatric primary care practice.

INTRODUCTION: While behavioral parent training (BPT) is the first line treatment for preschool aged children with disruptive behavior, only a fraction of families receive these therapies. The integration of BPT within the pediatric primary care (PPC) setting is a promising way to address this need, as the PPC setting is the first and only point of contact for most children diagnosed with mental health disorders. We piloted a clinical innovation by implementing an adapted BPT group in an urban, academic, PPC practice, serving a low-income, predominantly Black population. METHOD: Using a formative program development approach and a cultural adaptation framework, structural and cultural adaptations to the program were implemented to increase engagement and adaptability of the group to meet the needs of our PPC population. RESULTS: Learnings indicated that these adaptations were feasible and acceptable to families. Specifically, they were effective in engaging families and transforming the practice of primary care providers. DISCUSSION: Our work offers a case example to guide efforts to thoughtfully and effectively adapt evidence-based interventions for disruptive behavior in primary care settings. These processes provide one strategy to ameliorate behavioral health disparities in diverse, racial/ethnic minority populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Spatiotemporal gait changes in people with multiple sclerosis with different disease progression subtypes.

BACKGROUND: Gait impairment is common in people with multiple sclerosis (MS), but less is known about gait differences between MS disease progression subtypes. The objective here was to examine differences in spatiotemporal gait in MS and between relapsing-remitting and progressive subtypes during the timed-25-ft-walk test. Our specific aims were to investigate (1) spatiotemporal, (2) spatiotemporal variability, and (3) gait modulation differences between healthy controls and MS subtypes at preferred and fast walking speed. METHODS: This study included 27 controls, 18 relapsing-remitting MS, and 13 progressive MS participants. Participants wore six inertial sensors and walked overground without walking aids at preferred and fast-as-possible speeds. FINDINGS: Both MS groups had significantly lower walking speed than controls, with a trend towards lower preferred gait speed in progressive compared to relapsing-remitting MS (ES = 0.502). Although most spatiotemporal gait parameters differed between controls and MS groups, differences were not significant between MS subtypes in these parameters and their variability, with low to moderate effect sizes during preferred and fast walking. Both MS groups showed reduced modulation in gait compared to controls and no significant differences between MS subtypes. INTERPRETATION: Gait in MS is altered compared to controls. Although gait may change with progressive MS, the overall small differences in the gait parameters between the MS subtypes observed in this sample suggests that those with the progressive form of MS who are independently ambulatory and without further clinically meaningful changes in gait speed may not show gait decrements greater than the relapsing-remitting form of the disease.

Angular dynamics in vector coding: a new approach based on angular velocity.

The assessment of coordination variability in multi-joint human movements has traditionally started from angle-angle representations, and then used the angle change between subsequent time points as input for further analysis through vector coding. We propose an improvement to this approach, and suggest employing angular velocities as input data (Velocity Ellipse Method, VEM). We used experimental data and theoretical principles to contrast VEM with an existing standard (Difference Ellipse Method) and discuss its advantages and potential issues. Normalised cross-correlation was used to compare VEM and DEM in 36 angle couplings, from 20 participants running at 12 km/h on a treadmill. The hip flexion/extension-knee flexion/extension data were further investigated to discuss the robustness of the approach to measurement noise and outliers. Although DEM and VEM generally exhibited similar patterns (cross-correlation between 0.851 and 0.999), the variability curves from the two methods were noticeably different in some intervals. Also, using angular velocities as input appeared more robust to potential noise from raw data whilst retaining the following features: (a) more coherent with biomechanical conventions for calculating three-dimensional angular dynamics; (b) still suitable for coordination analysis; and, (c) more easily interpretable by practitioners when represented as relative motion plots.

Postural Complexity during Listening in Young and Middle-Aged Adults.

Postural behavior has traditionally been studied using linear assessments of stability (e.g., center of pressure ellipse area). While these assessments may provide valuable information, they neglect the nonlinear nature of the postural system and often lead to the conflation of variability with pathology. Moreover, assessing postural behavior in isolation or under otherwise unrealistic conditions may obscure the natural dynamics of the postural system. Alternatively, assessing postural complexity during ecologically valid tasks (e.g., conversing with others) may provide unique insight into the natural dynamics of the postural system across a wide array of temporal scales. Here, we assess postural complexity using Multiscale Sample Entropy in young and middle-aged adults during a listening task of varying degrees of difficulty. It was found that middle-aged adults exhibited greater postural complexity than did young adults, and that this age-related difference in postural complexity increased as a function of task difficulty. These results are inconsistent with the notion that aging is universally associated with a loss of complexity, and instead support the notion that age-related differences in complexity are task dependent.

Diagnostic accuracy of a dual-energy computed tomography-based post-processing method for imaging bone marrow edema following an acute ligamentous knee injury.

OBJECTIVE: This study evaluated the ability of a custom dual-energy CT (DECT) post-processing material decomposition method to image bone marrow edema after acute knee injury. Using an independent validation cohort, the DECT method was compared to gold-standard, fluid-sensitive MRI. By including both quantitative voxel-by-voxel validation outcomes and semi-quantitative radiologist scoring-based assessment of diagnostic accuracy, we aimed to provide insight into the relationship between quantitative metrics and the clinical utility of imaging methods. MATERIALS AND METHODS: Images from 35 participants with acute anterior cruciate ligament injuries were analyzed. DECT material composition was applied to identify bone marrow edema, and the DECT result was quantitatively compared to gold-standard, registered fluid-sensitive MRI on a per-voxel basis. In addition, two blinded readers rated edema presence in both DECT and fluid-sensitive MR images for evaluation of diagnostic accuracy. RESULTS: Semi-quantitative assessment indicated sensitivity of 0.67 and 0.74 for the two readers, respectively, at the tibia and 0.55 and 0.57 at the femur, and specificity of 0.87 and 0.89 for the two readers at the tibia and 0.58 and 0.89 at the femur. Quantitative assessment of edema segmentation accuracy demonstrated mean dice coefficients of 0.40 and 0.16 at the tibia and femur, respectively. CONCLUSION: The custom post-processing-based DECT method showed similar diagnostic accuracy to a previous study that assessed edema associated with ligamentous knee injury using a CT manufacturer-provided, built-in edema imaging application. Quantitative outcome measures were more stringent than semi-quantitative scoring methods, accounting for the low mean dice coefficient scores.

Independent changes in bone mineralized and marrow soft tissues following acute knee injury require dual-energy or high-resolution computed tomography for accurate assessment of bone mineral density and stiffness.

Musculoskeletal injuries often induce local accumulation of blood and/or fluid within the bone marrow, which is detected on medical imaging as edema-like marrow signal intensities (EMSI). In addition to its biological effects on post-injury recovery, the displacement of low-attenuating, largely adipocytic marrow by EMSI may introduce errors into quantitative computed tomography (QCT) measurements of bone mineral density (vBMD) and resulting bone stiffness estimates from image-based finite element (FE) analysis. We aimed to investigate the impact of post-injury changes in marrow soft tissue composition on CT-based bone measurements by applying CT imaging at multiple spatial resolutions. To do so, dual energy QCT (DECT) material decomposition was used to detect EMSI in the tibiae of nineteen participants with a recent anterior cruciate ligament tear. We then measured bone density and FE-based apparent modulus within the EMSI region and in a matched volume in the uninjured contralateral knee. Three measurement methods were applied: 1.) standard, QCT density calibration and density-based FEM; 2.) a DECT density calibration that provides density measurements adjusted for marrow soft tissues; and 3.) high-resolution peripheral QCT (HR-pQCT) density and microFE analyses. When measured using standard, single-energy QCT, vBMD and apparent modulus were elevated in the EMSI compared to the contralateral. After adjusting for marrow soft tissue composition using DECT, these measurements were no longer different between the two regions. By allowing for high-resolution, localized density analysis, HR-pQCT indicated that trabecular tissue mineral density was 9 mgHA/cm3 lower, while density of marrow soft tissues was 18 mgHA/cm3 higher, in the EMSI than the contralateral region, suggesting that EMSI have opposite effects on the measured density of trabecular bone and the underlying soft marrow. Thus, after an acute injury, altered composition of marrow soft tissues may artificially inflate overall measurements of bone density and apparent modulus obtained using standard QCT. This can be corrected by accounting for marrow soft tissue attenuation, either by using DECT-based density calibration or HR-pQCT microFE and measurements of local density of trabeculae.

Stable Coordination Variability in Overground Walking and Running at Preferred and Fixed Speeds.

Coordination variability (CV) is commonly analyzed to understand dynamical qualities of human locomotion. The purpose of this study was to develop guidelines for the number of trials required to inform the calculation of a stable mean lower limb CV during overground locomotion. Three-dimensional lower limb kinematics were captured for 10 recreational runners performing 20 trials each of preferred and fixed speed walking and running. Stance phase CV was calculated for 9 segment and joint couplings using a modified vector coding technique. The number of trials required to achieve a CV mean within 10% of 20 strides average was determined for each coupling and individual. The statistical outputs of mode (walking vs running) and speed (preferred vs fixed) were compared when informed by differing numbers of trials. A minimum of 11 trials were required for stable mean stance phase CV. With fewer than 11 trials, CV was underestimated and led to an oversight of significant differences between mode and speed. Future overground locomotion CV research in healthy populations using a vector coding approach should use 11 trials as a standard minimum. Researchers should be aware of the notable consequences of an insufficient number of trials for overall study findings.

Non-ambulatory measures of lower extremity sensorimotor function are associated with walking function in Multiple Sclerosis.

BACKGROUND: Disease progression of multiple sclerosis (MS) is often monitored by ambulatory measures, but how non-ambulatory sensorimotor measures differentially associate to walking measures in MS subtypes is unknown. We determined whether there are characteristic differences between relapsing-remitting MS (RRMS), progressive MS (PMS), and non-MS controls in lower extremity sensorimotor function and clinical walking tasks and the sensorimotor associations with walking function in each group. METHODS: 18 RRMS, 13 PMS and 28 non-MS control participants were evaluated in their plantar cutaneous sensitivity (vibration perception threshold, Volts), proprioception during ankle joint position-matching (|∆°| in dorsiflexion), motor coordination (rapid foot-tap count/10 s), and walking function with three tests: Timed 25-foot walk (T25FW) at preferred and fast speeds (s), and timed-up-and-go (TUG, s). RESULTS: Foot-tapping (p = 0.039, Mean difference (MD)= 5.65 taps) and plantar cutaneous sensation (p = 0.026, MD= -10.30 V) differed between the MS subtypes. For the RRMS group faster walking was related to better proprioceptive function (preferred T25FW: p = 0.019, Root mean square error (RMSE)=1.94; fast T25FW: p = 0.004, RMSE=1.65; TUG: p = 0.001, RMSE=2.12) and foot-tap performance (preferred T25FW: p = 0.033, RMSE = 2.74; fast T25FW: p = 0.010, RMSE=2.02). These associations were not observed in the PMS group. CONCLUSIONS: Foot-tap performance and plantar cutaneous sensitivity but not ankle proprioception differed between MS subtypes. Lower walking performance was associated with lower foot-tapping and plantar cutaneous sensitivity in the RRMS but not the PMS group. This result suggests a change in the relationship of lower extremity sensorimotor function to walking performance in the PMS subtype.

A quantitative assessment of dual energy computed tomography-based material decomposition for imaging bone marrow edema associated with acute knee injury.

PURPOSE: This study developed methods to quantify and improve the accuracy of dual-energy CT (DECT)-based bone marrow edema imaging using a clinical CT system. Objectives were: (a) to quantitatively compare DECT with gold-standard, fluid-sensitive MRI for imaging of edema-like marrow signal intensity (EMSI) and (b) to identify image analysis parameters that improve delineation of EMSI associated with acute knee injury on DECT images. METHODS: DECT images from ten participants with acute knee injury were decomposed into estimated fractions of bone, healthy marrow, and edema based on energy-dependent differences in tissue attenuation. Fluid-sensitive MR images were registered to DECT for quantitative, voxel-by-voxel comparison between the two modalities. An optimization scheme was developed to find attenuation coefficients for healthy marrow and edema that improved EMSI delineation, compared to MRI. DECT method accuracy was evaluated by measuring dice coefficients, mutual information, and normalized cross correlation between the DECT result and registered MRI. RESULTS: When applying the optimized three-material decomposition method, dice coefficients for EMSI identified through DECT vs MRI were 0.32 at the tibia and 0.13 at the femur. Optimization of attenuation coefficients improved dice coefficient, mutual information, and cross-correlation between DECT and gold-standard MRI by 48%-107% compared to three-material decomposition using non-optimized parameters, and improved mutual information and cross-correlation by 39%-58% compared to the manufacturer-provided two-material decomposition. CONCLUSIONS: This study quantitatively evaluated the performance of DECT in imaging knee injury-associated EMSI and identified a method to optimize DECT-based visualization of complex tissues (marrow and edema) whose attenuation parameters cannot be easily characterized. Further studies are needed to improve DECT-based EMSI imaging at the femur.

Radiology in the Era of Value-Based Healthcare: A Multi-Society Expert Statement From the ACR, CAR, ESR, IS3R, RANZCR, and RSNA.

BACKGROUND: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. METHODS, FINDINGS AND INTERPRETATION: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.

Radiology in the Era of Value-based Healthcare: A Multi-Society Expert Statement from the ACR, CAR, ESR, IS3R, RANZCR, and RSNA.

Background The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. Methods, findings and interpretation This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined. Published under a CC BY 4.0 license.

Radiology in the Era of Value-Based Healthcare: A Multi Society Expert Statement From the ACR, CAR, ESR, IS3R, RANZCR, and RSNA.

BACKGROUND: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. METHODS, FINDINGS AND INTERPRETATION: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.

The Association of Executive Functioning With Academic, Behavior, and Social Performance Ratings in Children With ADHD.

This study investigated the association of a performance-based measure of executive functioning (EF) with academic, social, and behavioral performance ratings in a convenience sample of 153 children aged 5 to 12 (78% male, 83% Caucasian) diagnosed with attention-deficit/hyperactivity disorder (ADHD). Multivariate regression showed that above and beyond age and ADHD severity, poorer EF performance was uniquely associated with more impairment in reading, written expression, and math by teacher report, and more impairment in the overall school and reading domains by parent report. ADHD symptoms were more strongly associated with ratings of impairment in social relationships, organized peer activities, and classroom behaviors than EF performance. Age did not moderate the findings, but younger children were rated as having more trouble with participation in organized activities by parents, as more likely to disrupt class by teachers, and to have problematic relationships with peers by parents and teachers. EF and academic performance appeared worst in the groups seen as highly symptomatic and impaired by both parents and teachers, and by teachers only. EF deficits may be a specific risk factor for academic impairment in children with ADHD.