ACR Appropriateness Criteria® Osteoporosis and Bone Mineral Density: 2022 Update.

Osteoporosis constitutes a significant public health risk. An estimated 10.2 million adults in the United States >50 years of age have osteoporosis, a systemic condition that weakens the bones increasing the susceptibility for fractures. Approximately one-half of women and nearly one-third of men >50 years of age will sustain an osteoporotic fracture. These fractures are associated with a decrease in quality of life, diminished physical function, and reduced independence. Dual-energy X-ray absorptiometry (DXA) is the primary imaging modality used to screen for osteoporosis in women >65 years of age and men >70 years of age. DXA may be used in patients <65 years of age to evaluate bone mass density if there are additional risk factors. In certain situations, vertebral fracture assessment and trabecular bone score may further predict fracture risk, particularly in patients who are not yet osteoporotic but are in the range of osteopenia. Quantitative CT is useful in patients with advanced degenerative changes in the spine. Given the proven efficacy of pharmacologic therapy, the role of imaging to appropriately identify and monitor high-risk individuals is critical in substantially reducing osteoporosis-associated morbidity and mortality, and reducing the considerable cost to the health care system. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Multifunctional chitosan ferrogels for targeted cancer therapy by on-demand magnetically triggered drug delivery and hyperthermia.

A facile method for the synthesis of chitosan ferrogels for magnetically triggered drug release and hyperthermia treatment is presented. The glyoxal crosslinked, dried ferrogels (magnetic bioaerogels) have been characterized by FTIR, XRD, TGA and VSM analyses and they possess unique characteristics such as high porosity, ultra-low density and superparamagnetism (Ms up to 56 emu g-1). In addition, they present high drug (Doxorubicin, DOX) loading efficiency (~40 %), tumor-specific pH-responsive swelling, excellent biodegradation, remotely switchable drug release and high magnetic hyperthermia potential (42 °C within 4 min). Almost complete degradation of the ferrogels occurs in 3 months under physiological conditions (pH = 7.4), while the tumor-specific microenvironment (pH = 5.6) accelerates the degradation rate, where it occurs in ~8 weeks. Furthermore, an enhancement in drug release (by 30 %) was observed in 60 min, when subjected to a magnetic field of 50 mT. Excellent biocompatibility and promising cell-material interactions have been exhibited by the ferrogels, substantiated by MTT assay, cytoskeleton staining and confocal imaging. The viability has been drastically reduced for DOX-loaded samples due to the action of the released drug; validating the efficacy of DOX loaded ferrogels. The system presented, therefore, holds multi-functionalities enabling smart cancer treatment.

Communication and Team Interactions to Improve Patient Experiences, Quality of Care, and Throughput in MRI.

Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients' awareness of what to expect during MRI and therefore mitigate anticipatory anxiety. Some patient interaction strategies to promote relaxation or calming effects are also discussed. Staff teamwork and staff training in communication and interpersonal skills are also described, along with literature evidence of effectiveness with respect to patient satisfaction and productivity endpoints. Attention to how radiologists, nurses, technologists, and other members of the radiology team interact with patients before or during the MRI scan could improve patients' motivation and ability to cooperate with the MRI scanning process as well as their subjective perceptions of the quality of their care. The topics discussed in this article are relevant not only to MRI operations but also to other clinical settings in which patient anxiety or motion represent impediments to optimal workflow.