Improving Automating Quality Control in Radiology: Leveraging Large Language Models to Extract Correlative Findings in Radiology and Operative Reports.

Radiology Imaging plays a pivotal role in medical diagnostics, providing clinicians with insights into patient health and guiding the next steps in treatment. The true value of a radiological image lies in the accuracy of its accompanying report. To ensure the reliability of these reports, they are often cross-referenced with operative findings. The conventional method of manually comparing radiology and operative reports is labor-intensive and demands specialized knowledge. This study explores the potential of a Large Language Model (LLM) to simplify the radiology evaluation process by automatically extracting pertinent details from these reports, focusing especially on the shoulder's primary anatomical structures. A fine-tuned LLM identifies mentions of the supraspinatus tendon, infraspinatus tendon, subscapularis tendon, biceps tendon, and glenoid labrum in lengthy radiology and operative documents. Initial findings emphasize the model's capability to pinpoint relevant data, suggesting a transformative approach to the typical evaluation methods in radiology.

Mammary gland development and EDC-driven cancer susceptibility in mesenchymal ERα-knockout mice.

Development of the mammary gland requires both proper hormone signaling and cross talk between the stroma and epithelium. While estrogen receptor (ERα) expression in the epithelium is essential for normal gland development, the role of this receptor in the stroma is less clear. Moreover, several lines of evidence suggest that mouse phenotypes of in utero exposure to endocrine disruption act through mesenchymal ERα in the developing fetus. We utilized a Twist2-cre mouse line to knock out mesenchymal ERα. Herein, we assessed mammary gland development in the context of mesenchymal ERα deletion. We also tested the effect of in utero bisphenol A (BPA) exposure to alter the tumor susceptibility in the mouse mammary tumor virus-neu (MMTV-neu) breast cancer mouse model. Mesenchymal ERα deletion resulted in altered reproductive tract development and atypical cytology associated with estrous cycling. The mammary gland demonstrated mature epithelial extension unlike complete ERα-knockout mice, but ductal extension was delayed and reduced compared to ERα-competent mice. Using the MMTV-Neu cancer susceptibility model, ERα-intact mice exposed to BPA had reduced tumor-free survival and overall survival compared to BPA-exposed mice having mesenchymal ERα deletion. This difference is specific for BPA exposure as vehicle-treated animals had no difference in tumor development between mice expressing and not expressing mesenchymal ERα. These data demonstrate that mesenchymal ERα expression is not required for ductal extension, nor does it influence cancer risk in this mouse model but does influence the cancer incidence associated with in utero BPA exposure.

Recommended Musculoskeletal and Sports Ultrasound Terminology: A Delphi-Based Consensus Statement.

OBJECTIVES: The current lack of agreement regarding standardized terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice, and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. METHODS: A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus which was defined as group level agreement >80%. RESULTS: Content was organized into seven general topics including: 1) General Definitions, 2) Equipment and Transducer Manipulation, 3) Anatomic and Descriptive Terminology, 4) Pathology, 5) Procedural Terminology, 6) Image Labeling, and 7) Documentation. Terms and definitions which reached consensus agreement are presented herein. CONCLUSIONS: The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients, and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.

Recommended musculoskeletal and sports ultrasound terminology: a Delphi-based consensus statement.

The current lack of agreement regarding standardised terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus, which was defined as group level agreement of >80%. Content was organised into seven general topics including: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labelling and (7) documentation. Terms and definitions which reached consensus agreement are presented herein. The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.

Advanced Musculoskeletal Ultrasound Techniques: What Are the Applications?

OBJECTIVE. The purpose of this article is to cover technical advances in musculo-skeletal ultrasound from the viewpoint of the radiologist. CONCLUSION. Among the advances in musculoskeletal ultrasound that we highlight the use of ultrahigh-frequency transducers to visualize ever-finer anatomic detail, the expanding practical clinical applications for microvascular imaging, and the use of elastography to predict function and, possibly, healing potential.

Spontaneous Osteonecrosis of Knee After Arthroscopy Is Not Necessarily Related to the Procedure.

Reports in the literature have suggested a causal relationship between knee arthroscopy and spontaneous osteonecrosis of the knee (SONK). We conducted a study to determine if there are imaging characteristics associated with SONK and if there is a relationship between arthroscopy and SONK. In this retrospective review, we compared preoperative and postoperative findings in 11 patients (12 joints) who developed SONK after arthroscopy with findings in 11 age- and sex-matched controls who did not develop SONK after arthroscopy. There were no significant preoperative radiologic differences between the SONK and control groups. All 12 SONK lesions seen on magnetic resonance imaging were in the medial femoral condyle. Six SONK knees developed the lesion after arthroscopy, and 6 had SONK lesions before arthroscopy. Eleven of the 12 SONK knees had a medial meniscal tear, compared with 8 medial meniscal tears and 3 lateral meniscal tears in the control group. Eight SONK knees and 5 control patients had medial meniscal extrusion of more than 3 mm. A causal relationship between knee arthroscopy and SONK is questionable.

Subchondral insufficiency fractures and spontaneous osteonecrosis of the knee may not be related to osteoporosis.

UNLABELLED: The term insufficiency fracture implies inadequate bone and is applied to some subchondral knee magnetic resonance images. We reviewed bone mineral density, body mass index, meniscal extrusion, comorbidities, and demographics in 32 knee insufficiency fracture patients. Only five were osteoporotic. Meniscal extrusion was predominant. PURPOSE: The literature supports systemic osteoporosis as a risk fracture for spontaneous osteonecrosis of the knee (SONK). SONK is also called a subchondral insufficiency fracture. Recognizing that insufficiency fracture and SONK are related, we designed this retrospective study to determine if knee subchondral insufficiency fractures were associated with osteoporosis based on bone mineral density. METHODS: Based on magnetic resonance imaging findings, 32 patients were diagnosed as having an insufficiency fracture by an orthopaedic surgeon with magnetic resonance imaging confirmation by a musculoskeletal radiologist. We reviewed body mass index, age, sex, comorbidities, demographics, and bone mineral density using both T-scores and Z-scores. RESULTS: The average age was 70, and only five patients were osteoporotic. Twenty-six of the 32 patients were female. The average age-related Z-score was 1 standard deviation above normal. CONCLUSIONS: We conclude that osteoporosis is not the underlying cause of this disorder in the majority of patients.

DNA sequencing versus standard prenatal aneuploidy screening.

BACKGROUND: In high-risk pregnant women, noninvasive prenatal testing with the use of massively parallel sequencing of maternal plasma cell-free DNA (cfDNA testing) accurately detects fetal autosomal aneuploidy. Its performance in low-risk women is unclear. METHODS: At 21 centers in the United States, we collected blood samples from women with singleton pregnancies who were undergoing standard aneuploidy screening (serum biochemical assays with or without nuchal translucency measurement). We performed massively parallel sequencing in a blinded fashion to determine the chromosome dosage for each sample. The primary end point was a comparison of the false positive rates of detection of fetal trisomies 21 and 18 with the use of standard screening and cfDNA testing. Birth outcomes or karyotypes were the reference standard. RESULTS: The primary series included 1914 women (mean age, 29.6 years) with an eligible sample, a singleton fetus without aneuploidy, results from cfDNA testing, and a risk classification based on standard screening. For trisomies 21 and 18, the false positive rates with cfDNA testing were significantly lower than those with standard screening (0.3% vs. 3.6% for trisomy 21, P<0.001; and 0.2% vs. 0.6% for trisomy 18, P=0.03). The use of cfDNA testing detected all cases of aneuploidy (5 for trisomy 21, 2 for trisomy 18, and 1 for trisomy 13; negative predictive value, 100% [95% confidence interval, 99.8 to 100]). The positive predictive values for cfDNA testing versus standard screening were 45.5% versus 4.2% for trisomy 21 and 40.0% versus 8.3% for trisomy 18. CONCLUSIONS: In a general obstetrical population, prenatal testing with the use of cfDNA had significantly lower false positive rates and higher positive predictive values for detection of trisomies 21 and 18 than standard screening. (Funded by Illumina; ClinicalTrials.gov number, NCT01663350.).

Review of three magnetic resonance arthrography related infections.

We report three cases of intra-articular infection which followed injection for magnetic resonance arthrography. In an effort to reduce the risk of arthrogram related infection, representatives from radiology, infectious disease medicine, and microbiology departments convened to analyze the contributing factors. The proposed source was oral contamination from barium swallow studies which preceded the arthrogram injections in the same room. We propose safety measures to reduce incidence of arthrogram related infections.

Ultrasound of the postoperative hip.

Imaging of the postoperative hip with ultrasound can be difficult and challenging. The primary role of ultrasound is to help determine whether or not there is infection. It is difficult at times to differentiate between complex fluid and synovium. Whether fluid is infected or not cannot be determined by ultrasound criteria and aspiration, and laboratory analysis is required. Particle disease and infection cannot be reliably differentiated by ultrasound criteria. In the setting of possible infection, any fluid collection/s around the hip should be treated with suspicion and, if possible, aspirated. The importance of sending part of the aspirated fluid for cell count is stressed; aspirated synovial fluid with a cell count >3000 white blood cells per milliliter of aspirated synovial fluid when combined with an elevated erythrocyte sedimentation rate and C-reactive protein level is highly predictive of infection.

Apophyseal injuries of the lesser tuberosity in adolescents: a series of five cases.

An isolated avulsion fracture of the lesser tuberosity is an uncommon injury. We present five cases in adolescent athletes which demonstrate the radiographic, ultrasound, and MR appearances of this injury. Clinically and radiologically, the diagnosis can be difficult. In a setting of trauma, careful review of the imaging studies can lead to early diagnosis and appropriate treatment.

Radiographic and CT evaluation of recombinant human bone morphogenetic protein-2-assisted spinal interbody fusion.

OBJECTIVE: Bone morphogenetic proteins BMPs, when used in spinal fusion, hasten healing and initiate distinct imaging features. We undertook a study to record and analyze the radiographic and CT changes after the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in spinal fusion surgery. MATERIALS AND METHODS: This study included 95 patients who underwent spinal interbody fusion using rhBMP-2. The lumbar spine fusion cohort consisted of 23 patients who underwent anterior lumbar interbody fusion, 36 patients who underwent transforaminal lumbar interbody fusion, and two patients who underwent posterior lumbar interbody fusion. The remaining 34 patients underwent anterior cervical decompression and fusion. RESULTS: A polyetheretherketone cage was used as an interbody spacer in 59 patients (82 levels) and an allograft bone was the spacer in 36 patients (55 levels). Patients were evaluated 2 and 6 weeks after the procedure and then 3, 6, 12, and 24 months after the procedure. All patients underwent radiography at every follow-up visit, and CT evaluation was performed in 32 patients. CONCLUSION: Features observed on imaging that we attributed to the use of rhBMP-2 included an enhanced fusion rate and an increased incidence of prevertebral soft-tissue swelling in patients who underwent cervical fusion. Endplate resorption was observed in 100% of patients who underwent cervical fusion and in 82% of the lumbar levels. Subsidence of the cage resulting in narrowing of the disk space was seen in more than 50% of cases. Cage migration and heterotopic bone formation in the spinal canal and neural foramen occurred maximally in the lumbar spine of patients in whom a polyetheretherketone cage was placed using a transforaminal approach.

Musculoskeletal ultrasound: elbow imaging and procedures.

Elbow injuries, both acute and chronic sports-related cases, have increased over the last decade. With one in every four members of a household participating in sports, both clinics and radiology departments are seeing more patients with elbow pain. High-resolution ultrasound is well suited for evaluating the elbow. Ultrasound is growing in popularity and fast becoming another modality that the radiologist can use to help diagnose elbow pathology. With advancing transducer technology and accessibility, ultrasound offers focused and real-time high-resolution imaging of tendons, ligaments, and nerve structures. Its advantages include the use of safe nonionizing radiation, accessibility, and cost effectiveness. Another unique advantage is its ability for dynamic assessment of tendon and ligament structures such as in cases of partial tears of the medial ulnar collateral ligament or ulnar nerve dislocation. It is also easy to assess the contralateral side as a control. Ultrasound is also useful in therapeutic guided injections for its multiplanar capability and clear visualization of major vessels and nerves. We discuss the unique application of ultrasound in evaluating common elbow pathology and in advanced ultrasound-guided treatments such as dextrose prolotherapy and platelet-rich plasma.

Sequence effects in the Go/NoGo task: inhibition and facilitation.

Facilitation and inhibition are asymmetric aspects of attention that differentially affect response times (RTs), accuracy and neuroelectric activity in many experimental tasks. Both vary as a function of stimulus context, with stimulus repetitions, for example, often resulting in facilitation in terms of speed, accuracy or reduced neural activity. Although inhibition has been extensively studied in the Go/NoGo task, facilitation has been overlooked. Twenty healthy adults performed an adapted Go/NoGo task which manipulated levels of facilitation and inhibition. Event-related potential (ERP) and behavioural measures were averaged according to preceding stimulus sequences. Established Go/NoGo effects for N2 and P3 components were replicated. Behavioural and ERP measures, however, showed strong sequence effects. Correlates of facilitation included reduced P1 and N1 latencies, and topographic effects in P1, to Go stimulus repetitions. Manipulations of inhibitory load through increasing Go before NoGo stimuli resulted in incremental increases in N1, P2 and N2 latencies. Several additional ERP and RT measures showed quadratic effects, with indications of facilitation or inhibition which reversed towards the end of longer stimulus trains. The results suggest that both facilitatory and inhibitory processes underlie performance in the Go/NoGo task. As Go stimuli are typically more frequently repeated than NoGo stimuli, the two processes may be confounded when sequence effects are not considered. Additionally, analysing stimuli by context indicates that the timing of the Go-P3 latency is closely related to responses, and the prolongation of N1, P2 and N2 with increasing difficulty of inhibition supports a possible relation of these components to inhibition.

Complications in the use of rhBMP-2 in PEEK cages for interbody spinal fusions.

STUDY DESIGN: All patients of spinal interbody fusion using polyetheretherketone (PEEK) cages and recombinant human bone morphogenetic protein (rhBMP)-2 performed over a 16-month period were reviewed. OBJECTIVE: To determine the suitability of PEEK cages when used in conjunction with rhBMP-2 in interbody spinal fusion. SUMMARY OF BACKGROUND DATA: Bone morphogenetic proteins are increasingly being used in spinal fusion to promote osteogenesis. PEEK is a semicrystalline aromatic polymer that is used as a structural spacer to maintain the disc and foraminal height. Their use has led to increased and predictable rates of fusion. However, not many reports of the adverse effects of their use are available. METHODS: Fifty-nine consecutive patients of interbody spinal fusion in the cervical or lumbar spine using a PEEK cage and rhBMP-2 were followed for an average of 26 months after surgery. A clinical examination and a record of Oswestry Disability Index, Visual Analog Scale for pain, and a pain diagram were performed preoperatively and at every follow-up visit. All patients had plain radiographs carried out to assess fusion. Ten patients of lumbar spine fusion were additionally evaluated with a computed tomography scan. RESULTS: All cases demonstrated an appreciable amount of new bone formation by 6 to 9 months in the cervical spine and by 9 to 12 months in the lumbar spine. End plate resorption was visible radiologically in all cervical spine fusions and majority of lumbar fusions. Cage migration was observed to occur maximally in patients with transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. Disc space subsidence was seen in both cervical and lumbar arthrodesis with the latter showing a lesser incidence, but with a greater degree of collapse. CONCLUSIONS: PEEK cages and rhBMP-2 when used in spinal fusion give consistently good fusion rates. However, the early role of BMP in the resorptive phase may cause loosening, cage migration, and subsidence.

Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial.

OBJECTIVE: The objective of this study was to determine whether patients' families' violence-prevention behaviors would be affected by their primary care practitioner's use of a violence-prevention clinical intervention during the routine well-child examination. METHODS: In this cluster-randomized, controlled trial (2002-2006), 137 Pediatric Research in Office Settings practices were randomly assigned and initiated patient recruitment for either an office-based violence-prevention intervention or a control group (educational handout on literacy promotion provided). Primary caregivers of children who were aged 2 to 11 years and presented for a well-child visit were surveyed at baseline and 1 and 6 months. Practitioners were trained to (1) review a parent previsit summary regarding patient-family behavior and parental concern about media use, discipline strategies, and children's exposure to firearms, (2) counsel using brief principles of motivational interviewing, (3) identify and provide local agency resources for anger and behavior management when indicated, and (4) instruct patient-families on use of tangible tools (minute timers to monitor media time/timeouts and firearm cable locks to store firearms more safely where children live or play). Main outcomes were change over time in self-reported media use <120 minutes per day, use of timeouts, and use of firearm cable locks. RESULTS: Generalized estimating equation analysis revealed a significant effect at 6 months for decreased media use and safer firearm storage. The intervention group compared with the control group showed an increase in limiting media use to <120 minutes per day. There was no significant effect for timeout use. There was a substantial increase in storing firearms with cable locks for the intervention group versus a decrease for the control group. CONCLUSIONS: This randomized, controlled trial demonstrated decreased media exposure and increased safe firearm storage as a result of a brief office-based violence-prevention approach.

Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up.

OBJECTIVE: The purpose of this study was to determine if a correlation exists between magnetic resonance imaging (MRI) findings of bone marrow edema (BME) in osteoarthrosis (OA) of the knee joint and need for total knee arthroplasty (TKA) within a follow-up period of 3 years. MATERIALS AND METHODS: The entire database of knee MR studies over a 3-year period was used to select individuals with knee OA. A chart review was conducted to identify and include only those who had a 3-year follow-up appointment from the time of the initial MR study. There were 25 patients in the OA-only group (four men and 21 women; age range, 28-75; average age, 49.3 years). The OA and BME group had 48 patients (23 men and 25 women; average age, 55.5 years). The MRs were reviewed and interpreted by a musculoskeletal radiologist and were classified into one of four patterns of BME: none, focal, global, or cystic pattern. Meniscal tear and degree of cartilage loss were also assessed. RESULTS: Subjects who had BME of any pattern type were 8.95 times as likely to progress rapidly to a TKA when compared to subjects with no BME (p = 0.016). Subjects with a global pattern of BME were 5.45 times as likely to have a TKA compared to subjects with focal, cyst, or no BME (p < 0.05). Subjects with a global edema pattern were 13.04 times as likely to have a TKA than subjects with no marrow edema in the knee (p < 0.01). There was no correlation of TKA with meniscal tear or cartilage loss. The group of subjects who had a TKA were 12.6 years older than those who did not have a TKA (p < 0.001). However, the BME results were still significant after accounting for the age difference. CONCLUSION: Our classification of patterns into global, focal, cystic, and absence of BME is an attempt to further define edema in osteoarthrosis and how it relates to clinical progression. Patients with BME and OA have an increased risk of TKA as opposed to OA and no marrow edema. The BME pattern with the worst prognosis for the knee is the global pattern.