RRIMS: Radiation Risk In Mammography Screening - model evaluation.

OBJECTIVE: The Radiation Risk In Mammography Screening (RRIMS) model was introduced as a novel tool to help females accurately calculate their lifetime mean glandular dose (MGD) and estimate their population-level risk of radiation-induced breast cancer incidence and mortality. METHODS: The model's accuracy was evaluated by comparing the received MGD of 317 women who had undergone a total of 733 visits across one to four rounds of screening. This was achieved by comparing the RRIMS predicted dose values with the same examination dose calculated manually by hand. Qualitative and quantitative statistical analyses were performed to assess the percentage difference (% diff) or agreement between the two values. RESULTS: Qualitative statistical analysis using the Bland-Altman plots demonstrated a statistically significant bias for the % diff between the manually calculated and RRIMS predicted dose values, where the mean (bias) was -2.02% with an upper and lower limit of agreement of 40.24% and -44.27%, respectively. Quantitative statistical analysis revealed an intraclass correlation coefficient (ICC, 3,1) of 0.64 (p-value < 0.001) and a Kendall's W of 0.83 (p-value < 0.001). CONCLUSION: The results indicate a statistically significant and reasonably good level of agreement between the manually calculated vs RRIMS predicted dose values. This work was focused on one of the major mammography equipment manufacturers that is Hologic, however there is potential for a multivendor applicability study of this model with future iterations. This will further improve upon this innovative dose and risk prediction tool that can empower healthcare professionals when making informed decisions and enhance patient care. ADVANCES IN KNOWLEDGE: This paper assesses the precision of the dose and risk model that our team has previously established. The results bring us one step closer to providing females and clinicians with a useful tool that can help explain and contextualise the benefits and risks associated with screening mammography.

Investigating the impact of cognitive biases in radiologists' image interpretation: A scoping review.

RATIONALE AND OBJECTIVE: Image interpretation is a fundamental aspect of radiology. The treatment and management of patients relies on accurate and timely imaging diagnosis. However, errors in radiological reports can negatively impact on patient health outcomes. These misdiagnoses can be caused by several different errors, but cognitive biases account for 74 % of all image interpretation errors. There are many biases that can impact on a radiologist's perception and cognitive processes. Several recent narrative reviews have discussed these cognitive biases and have offered possible strategies to mitigate their effects. However, these strategies remain untested. Therefore, the purpose of this scoping review is to evaluate the current knowledge on the extent that cognitive biases impact on medical image interpretation. MATERIAL AND METHODS: Scopus and Medline Databases were searched using relevant keywords to identify papers published between 2012 and 2022. A subsequent hand search of the narrative reviews was also performed. All studies collected were screened and assessed against the inclusion and exclusion criteria. RESULTS: Twenty-four publications were included and categorised into five main themes: satisfaction of search, availability bias, hindsight bias, framing bias and other biases. From these studies, there were mixed results regarding the impact of cognitive biases, highlighting the need for further investigation in this area. Moreover, the limited and untested debiasing methods offered by a minority of the publications and narrative reviews also suggests the need for further research. The potential of role of artificial intelligence is also highlighted to further assist radiologists in identifying and mitigating these cognitive biases. CONCLUSION: Cognitive biases can impact radiologists' image interpretation, however the effectiveness of debiasing strategies remain largely untested.

Incidence, mortality, survival, and disease burden of breast cancer in China compared to other developed countries.

Breast cancer was the most diagnosed malignant neoplasm and the second leading cause of cancer mortality among Chinese females in 2020. Increased risk factors and widespread adoption of westernized lifestyles have resulted in an upward trend in the occurrence of breast cancer. Up to date knowledge on the incidence, mortality, survival, and burden of breast cancer is essential for optimized cancer prevention and control. To better understand the status of breast cancer in China, this narrative literature review collected data from multiple sources, including studies obtained from the PubMed database and text references, national annual cancer report, government cancer database, Global Cancer Statistics 2020, and Global Burden of Disease study (2019). This review provides an overview of the incidence, mortality, and survival rates of breast cancer, as well as a summary of disability-adjusted life years associated with breast cancer in China from 1990 to 2019, with comparisons to Japan, South Korea, Australia and the United States.

Comparison of image quality assessments between interventional radiographers and interventional radiologists using digital subtraction angiography.

Purpose: The aim of our study was to compare the image quality assessments of vascular anatomy between interventional radiographers and interventional radiologists using digital subtraction angiography (DSA) runs acquired during an interventional radiology procedure. Approach: Visual grading characteristics (VGC) analysis was used to assess image quality by comparing two groups of images, where one group consisted of procedures in which radiation dose was optimized (group A, n = 10 ) and one group where dose optimization was not performed (group B, n = 10 ). The radiation dose parameters were optimized based on theoretical and empirical evidence to achieve radiation dose reductions during uterine artery embolization procedures. The two observer groups comprised of interventional radiologists ( n = 4 ) and interventional radiographers ( n = 4 ). Each observer rated the image quality of 20 DSA runs using a five-point rating scale. Results: The VGC analysis produced an area under the VGC curve ( AUC VGC ) of 0.55 for interventional radiographers ( P = 0.61 ) and AUCVGC of 0.52 for interventional radiologists ( P = 0.83 ). The optimization of radiation dose parameters demonstrated a reduction in kerma-area product by 35% ( P = 0.026 , d = 0.5 ) and reference air kerma (Ka, r ) by 43% ( P = 0.042 , d = 0.5 ) between group A and group B. Conclusions: VGC analysis indicated that the image quality assessments of interventional radiographers were comparable with interventional radiologists, where a reduction in radiation dose revealed no effect on both observer groups regarding their image quality assessment of vascular anatomy.

Panoramic radiographs and dental patients with Down syndrome: A scoping review.

INTRODUCTION: Life expectancy for people with Down syndrome (DS) has increased to 60 years, although poor oral health affects their quality of life. Panoramic radiographs (PRs) are usually well-tolerated by people with DS and can provide valuable diagnostic data for treatment planning and research. Methods A scoping review of peer-reviewed articles published between 1971and 2021 was conducted in accordance with the PRISMA extension for scoping reviews to determine the scope of use of PRs for people with DS. RESULTS: 937 papers were screened, and 52 papers were included and charted into seven categories in this review. A high prevalence of tooth agenesis (TA) and other anomalies were reported in 45% of papers. Severe periodontal disease was considered characteristic of DS in the 1970s-80s and the benefit of time-consuming treatment was questioned. Since 2000 case reports illustrate that improved oral care, orthodontic treatment, and dental implants under local or general anaesthetic can improve the quality of life for people with DS. CONCLUSION: PRs play an important role in the diagnosis of anomalies, periodontal disease, and implant planning for patients with DS. This review highlights the gaps in research of caries, pathology, TMJ, systemic disease indicators, and guidelines for dentists. Systematic PR viewing, with a knowledge of characteristic features of DS, will assist diagnosis of pathology and improve comprehensive dental care treatment planning for children and adults with DS.

Panoramic radiography and patients with disability: a new simple breathing technique to reduce common airspace error.

Patients with intellectual disabilities often fail to follow traditional tongue position instructions for panoramic radiographs resulting in missed pathology or unnecessary further radiation. This simple breathing technique is a new clinical instruction method for panoramic radiography developed to reduce the most common patient position error: patient failure to hold the tongue to the roof of the mouth. The technique is suitable for all patients including young patients and those with intellectual disabilities. The simple breathing technique uses 'tell-show-do' communication methods and does not mention the tongue but utilises the known tongue positions that occur during breathing and swallowing. This simple breathing technique instruction for panoramic radiography uses a demonstration of 'breathe-in, breathe-out, swallow, lips closed and hold still' to reduce the intensity of both the palatoglossal and pharyngeal airspaces on panoramic radiographs. This method, referred in this article as the simple breathing technique, can improve the diagnostic potential of panoramic radiographs and can be used with young children and patients with intellectual disabilities, and this slow breathing technique can help them further relax.

A review of screening mammography: The benefits and radiation risks put into perspective.

INTRODUCTION/BACKGROUND: In medical imaging a benefit to risk analysis is required when justifying or implementing diagnostic procedures. Screening mammography is no exception and in particular concerns around the use of radiation to help diagnose cancer must be addressed. METHODS: The Medline database and various established reports on breast screening and radiological protection were utilised to explore this review. RESULTS/DISCUSSION: The benefit of screening is well argued; the ability to detect and treat breast cancer has led to a 91% 5-year survival rate and 497 deaths prevented from breast cancer amongst 100,000 screened women. Subsequently, screening guidelines by various countries recommend annual, biennial or triennial screening from ages somewhere between 40-74 years. Whilst the literature presents different perspectives on screening younger and older women, the current evidence of benefit for screening women <40 and ≥75 years is currently not strong. The radiation dose and associated risk delivered to each woman for a single examination is dependent upon age, breast density and breast thickness, however the average mean glandular dose is around 2.5-3 mGy, and this would result in 65 induced cancers and 8 deaths per 100,000 women over a screening lifetime from 40-74 years. This results in a ratio of lives saved to deaths from induced cancer of 62:1. CONCLUSION: Therefore, compared to the potential mortality reduction achievable with screening mammography, the risk is small.

RRIMS: Radiation Risk In Mammography Screening - a novel model for predicting the lifetime dose and risk of radiation-induced breast cancer from the first screening visit.

Objectives: Radiation Risk In Mammography Screening (RRIMS) builds on the prototype, formerly known as Breast-iRRISC, to develop a model that aims to establish a dose and risk profile for females by calculating their lifetime mean glandular dose (MGD) for each age of screening between 40 and 75 years, using only the information from her first screening visit. This is then used to allocate her to a dose category and estimate the lifetime risk of radiation-induced breast cancer incidence and mortality for a population of females in that category. Methods: This model training was developed using a large dataset of Hologic images containing a total of 20,232 images from 5,076 visits from 4,154 females. The female's breast characteristics and exposure parameters were extracted from the images to calculate the female's MGD throughout a lifetime of screening from just her first screening visit, using modelling of various parameters and their change through time. Results: This development has ultimately provided a model that uses the female's first screening visit to calculate the received MGD for all ages of potential screening. This has enabled the allocation of females to either a low-, medium-, or high-dose category, ultimately followed by the lifetime effective risk (LER) estimation for any screening attendance pattern. A female in the low-dose category undergoing biennial screening from 50 to 74 years would expect a risk of radiation-induced breast cancer incidence and mortality of 8.64 and 2.61 cases per 100,000 females, respectively. Similarly, a female in the medium- or high-dose category undergoing the same regimen would expect an incidence and mortality risk of 11.76 and 3.55, and 15.08 and 4.55 cases per 100,000 females, respectively. Conclusions: This novel approach of establishing a female's dose profile and lifetime risk from a single visit will further assist females in their informed consent on breast screening attendance and help inform policy-makers when exploring the benefits and drawbacks of various screening patterns and frequencies. Advances in knowledge: RRIMS is a novel tool that enables the assessment of a female's lifetime dose and risk profile using only the information from her first screening visit.

SCREENING MAMMOGRAPHY: DIAGNOSTIC EFFICACY-ISSUES AND CONSIDERATIONS FOR THE 2020S.

Diagnostic efficacy in medical imaging is ultimately a reflection of radiologist performance. This can be influenced by numerous factors, some of which are patient related, such as the physical size and density of the breast, and machine related, where some lesions are difficult to visualise on traditional imaging techniques. Other factors are human reader errors that occur during the diagnostic process, which relate to reader experience and their perceptual and cognitive oversights. Given the large-scale nature of breast cancer screening, even small increases in diagnostic performance equate to large numbers of women saved. It is important to identify the causes of diagnostic errors and how detection efficacy can be improved. This narrative review will therefore explore the various factors that influence mammographic performance and the potential solutions used in an attempt to ameliorate the errors made.

Breast-iRRISC: a novel model for predicting the individualised lifetime risk of radiation-induced breast cancer from a single screening event.

OBJECTIVES: This work establishes the prototype of a new innovative risk model that aims to evaluate the total risk involved with screening mammography for each individual female. This has been specifically designed to accommodate any combination of lifetime screening regimes, using only the information gathered from a single mammographic examination. METHODS: This model prototype was developed with the aid of a large dataset of images from the Cancer Institute New South Wales (CINSW) with over 30,000 images from over 7000 examinations. Each examination is derived from a separate female. RESULTS: This prototype which we have called Breast Individualised Risk of Radiation-Induced Screening Cancer (Breast-iRRISC) is a novel tool for the assessment of the lifetime risk involved with screening mammography. The results demonstrate the applicability of this approach to the various screening regimes utilised around the globe, in addition to the personalised screening frequency patterns females have undergone and are likely to receive in the future. CONCLUSIONS: This unique tailored approach to risk assessment will further empower females and clinicians towards a more informed clinical decision process regarding future imaging pathways. It will also inform health policy decisions regarding alternate screening durations and intervals. ADVANCES IN KNOWLEDGE: Breast-iRRISC is a novel tool that provides females, clinicians and health policymakers around the globe with the ability to quantify the lifetime risk of radiation-induced breast cancer from screening mammography on an individual level from a single exposure.

Increasing iterative reconstruction strength at low tube voltage in coronary CT angiography protocols using 3D-printed and Catphan® 500 phantoms.

PURPOSE: The purpose of this study was to investigate the effect of increasing iterative reconstruction (IR) algorithm strength at different tube voltages in coronary computed tomography angiography (CCTA) protocols using a three-dimensional (3D)-printed and Catphan® 500 phantoms. METHODS: A 3D-printed cardiac insert and Catphan 500 phantoms were scanned using CCTA protocols at 120 and 100 kVp tube voltages. All CT acquisitions were reconstructed using filtered back projection (FBP) and Adaptive Statistical Iterative Reconstruction (ASIR) algorithm at 40% and 60% strengths. Image quality characteristics such as image noise, signal-noise ratio (SNR), contrast-noise ratio (CNR), high spatial resolution, and low contrast resolution were analyzed. RESULTS: There was no significant difference (P > 0.05) between 120 and 100 kVp measures for image noise for FBP vs ASIR 60% (16.6 ± 3.8 vs 16.7 ± 4.8), SNR of ASIR 40% vs ASIR 60% (27.3 ± 5.4 vs 26.4 ± 4.8), and CNR of FBP vs ASIR 40% (31.3 ± 3.9 vs 30.1 ± 4.3), respectively. Based on the Modulation Transfer Function (MTF) analysis, there was a minimal change of image quality for each tube voltage but increases when higher strengths of ASIR were used. The best measure of low contrast detectability was observed at ASIR 60% at 120 kVp. CONCLUSIONS: Changing the IR strength has yielded different image quality noise characteristics. In this study, the use of 100 kVp and ASIR 60% yielded comparable image quality noise characteristics to the standard CCTA protocols using 120 kVp of ASIR 40%. A combination of 3D-printed and Catphan® 500 phantoms could be used to perform CT dose optimization protocols.

The Effect of Visual Hindsight Bias on Radiologist Perception.

RATIONALE AND OBJECTIVES: To measure the effect of visual hindsight bias on radiologists' perception during chest radiograph pulmonary nodule detection. MATERIALS AND METHODS: This was a prospective multi-observer study to assess the effect of hindsight bias on radiologists' perception. Sixteen radiologists were asked to interpret 15 postero-anterior chest images containing a solitary lung nodule each consisting of 25 incremental levels of blur. Participants were requested initially to detect the nodule by reducing the blur of the images (foresight). They were then asked to increase the blur until the identified nodule was undetectable (hindsight). Participants then repeated the experiment, after being informed of the potential effects of hindsight bias and asked to counteract these effects. Participants were divided into two groups (experienced and less experienced) and the nodules were given different conspicuity ratings to determine the effect of expertise and task difficulty. Eye tracking technology was also utilised to capture visual search. RESULTS: Wilcoxon analysis demonstrated significant differences between foresight and hindsight values of the radiologists (p = 0.02). However, after being informed of hindsight bias, these differences were no longer significant (p = 0.97). Friedman analysis also determined overall significance in the hindsight ratios between nodule conspicuities for both phases (phase 1: p = 0.02; phase 2: p = 0.02). There was no significance difference between the experienced and less experienced groups. CONCLUSION: This study demonstrated that radiologists exhibit hindsight bias but appeared to be able to compensate for this phenomenon once its effects were considered. Also, visual hindsight bias appears to be affected by task difficulty with a greater effect occurring with less conspicuous nodules.

Mammographic density and cancer detection: does digital imaging challenge our current understanding?

RATIONALE AND OBJECTIVES: To investigate the impact of breast density on the performance of radiologists when mammograms are digitally acquired and displayed. MATERIALS AND METHODS: A total of 150 craniocaudal digital mammograms including 75 cases with cancer were examined by 14 radiologists divided into two groups: those who read more (six) and less (eight) than 2000 mammograms per year. Cases were classified as low or high mammographic density. For both types of cases, detection of cancers within and outside the dense fibroglandular tissue was investigated. The performance of radiologist was measured using jack-knife free-response receiver operating characteristic (JAFROC) figure of merit (FOM). RESULTS: Radiologists with over 2000 annual reads had significantly higher JAFROC FOM (P = .03) for high (0.76) mammographic density compared to low (0.70) mammographic density cases. When lesions overlaid the fibroglandular tissue, cases with high mammographic density compared to low mammographic density displayed increased location sensitivity for all radiologists (P = .03) and for those radiologists reading more than 2000 mammograms annually (P = .04), whereas JAFROC FOMs increased for all radiologists (P = .05). No significant changes were observed when the lesion was outside the fibroglandular region. CONCLUSIONS: Increased mammographic density improves the performance of experienced radiologists when using digital mammograms. This finding, which does not align with those previously reported for film screen systems, may be because of windowing/leveling opportunities available with digital images.

Can prevalence expectations drive radiologists' behavior?

RATIONALE AND OBJECTIVES: To measure the effect of explicit prevalence expectation on the performance of experienced radiologists during image interpretation of pulmonary lesions on chest radiographs. MATERIALS AND METHODS: Each of 22 experienced radiologists was allocated to one of three groups to interpret a set of 30 (15 abnormal) posteroanterior chest images on two occasions to decide if pulmonary lesions were present. Before each viewing, the radiologists were told that the images contained a specific number of abnormal images: group 1, 9 versus 15; group 2, 22 versus 15; and group 3, not told versus 15, respectively. Eye position metrics and receiver operating characteristics confidence ratings were compared for normal and abnormal images. An analysis of false-positive and false-negative decisions was also performed. RESULTS: For normal images, at higher prevalence expectation, significant increases were noted for duration of image scrutiny (group 1: P = .0004; group 2: P = .007; and group 3: P = .003) and number of fixations per image (group 1: P = .0006; group 2: P = .0004; and group 3: P = .0001). Also for normal images, group 1 demonstrated a significant increase (P = .038) in average confidence ratings when prevalence expectation increased. For abnormal images, at higher prevalence expectation, significant increases were noted for duration of image scrutiny in group 1 (P = .005) and number of fixations per image in group 1 (P = .01) and group 2 (P = .003). CONCLUSIONS: Confidence ratings and visual search of the expert radiologists appear to be affected by changing prevalence expectations. The impact of prevalence expectation appears to be more apparent for normal images.

Markers of good performance in mammography depend on number of annual readings.

PURPOSE: To explore relationships between reader performance and reader characteristics in mammography for specific radiologist groupings on the basis of annual number of readings. MATERIALS AND METHODS: The institutional review board approved the study and waived the need for patient consent to use all images. Readers gave informed consent. One hundred sixteen radiologists independently reviewed 60 mammographic cases: 20 cases with cancer and 40 cases with normal findings. Readers located any visualized cancer, and levels of confidence were scored from 1 to 5. A jackknifing free response operating characteristic (JAFROC) method was used, and figures of merit along with sensitivity and specificity were correlated with reader characteristics by using Spearman techniques and standard multiple regressions. RESULTS: Reader performance was positively correlated with number of years since qualification as a radiologist (P ≤ .01), number of years reading mammograms (P ≤ .03), and number of readings per year (P ≤ .0001). The number of years since qualification as a radiologist (P ≤ .004) and number of years of reading mammograms (P ≤ .002) were negatively related to JAFROC values for radiologists with annual volumes of less than 1000 mammographic readings. For individuals with more than 5000 mammographic readings per year, JAFROC values were positively related to the number of years that the reader was qualified as a radiologist (P ≤ .01), number of years of reading mammograms (P ≤ .002), and number of hours per week of reading mammograms (P ≤ .003). Number of mammographic readings per year was positively related with JAFROC scores for readers with an annual volume between 1000 and 5000 readings (P ≤ .03). Differences in JAFROC scores appear to be more related to specificity than location sensitivity, with the former demonstrating significant relationships with four of the five characteristics analyzed, whereas no relationships were shown for the latter. CONCLUSION: Radiologists' determinants of performance are associated with annual reading volumes. Ability to recognize normal images is a discriminating factor in individuals with a high volume of mammographic readings.

Screening mammography: test set data can reasonably describe actual clinical reporting.

PURPOSE: To establish the extent to which test set reading can represent actual clinical reporting in screening mammography. MATERIALS AND METHODS: Institutional ethics approval was granted, and informed consent was obtained from each participating screen reader. The need for informed consent with respect to the use of patient materials was waived. Two hundred mammographic examinations were selected from examinations reported by 10 individual expert screen readers, resulting in 10 reader-specific test sets. Data generated from actual clinical reports were compared with three test set conditions: clinical test set reading with prior images, laboratory test set reading with prior images, and laboratory test set reading without prior images. A further set of five expert screen readers was asked to interpret a common set of images in two identical test set conditions to establish a baseline for intraobserver variability. Confidence scores (from 1 to 4) were assigned to the respective decisions made by readers. Region-of-interest (ROI) figures of merit (FOMs) and side-specific sensitivity and specificity were described for the actual clinical reporting of each reader-specific test set and were compared with those for the three test set conditions. Agreement between pairs of readings was performed by using the Kendall coefficient of concordance. RESULTS: Moderate or acceptable levels of agreement were evident (W = 0.69-0.73, P < .01) when describing group performance between actual clinical reporting and test set conditions that were reasonably close to the established baseline (W = 0.77, P < .01) and were lowest when prior images were excluded. Higher median values for ROI FOMs were demonstrated for the test set conditions than for the actual clinical reporting values; this was possibly linked to changes in sensitivity. CONCLUSION: Reasonable levels of agreement between actual clinical reporting and test set conditions can be achieved, although inflated sensitivity may be evident with test set conditions.

Quantitative measures confirm the inverse relationship between lesion spiculation and detection of breast masses.

OBJECTIVE: To identify specific mammographic appearances that reduce the mammographic detection of breast cancer. MATERIALS AND METHODS: This study received institutional board review approval and all readers gave informed consent. A set of 60 mammograms each consisting of craniocaudal and mediolateral oblique projections were presented to 129 mammogram Breastscreen readers. The images consisted of 20 positive cases with single and multicentric masses in 16 and 4 cases, respectively (resulting in a total of 24 cancers), and readers were asked to identify and locate the lesions. Each lesion was then ranked according to a detectability rating (ie, the number of observers who correctly located the lesion divided by the total number of observers), and this was correlated with breast density, lesion size, and various descriptors of lesion shape and texture. RESULTS: Negative and positive correlations between lesion detection and density (r = -0.64, P = .007) and size (r = 0.65, P = .005), respectively, were demonstrated. In terms of lesion size and shape, there were significant correlations between the probability of detection and area (r = 0.43, P = .04), perimeter (r = 0.66, P = .0004), lesion elongation (r = 0.49, P = .02), and lesion nonspiculation (r = 0.78, P < .0001). CONCLUSIONS: The results of this study have identified specific lesion characteristics associated with shape that may contribute to reduced cancer detection. Mammographic sensitivity may be adversely affected without appropriate attention to spiculation.

Breast screen new South wales generally demonstrates good radiologic viewing conditions.

This study measured reading workstation monitors and the viewing environment currently available within BreastScreen New South Wales (BSNSW) centres to determine levels of adherence to national and international guidelines. Thirteen workstations from four BSNSW service centres were assessed using the American Association of Physicists in Medicine Task Group 18 Quality Control test pattern. Reading workstation monitor performance and ambient light levels when interpreting screening mammographic images were assessed using spectroradiometer CS-2000 and chroma meter CL-200. Overall, radiologic monitors within BSNSW were operating at good acceptable levels. Some non-adherence to published guidelines included the percentage difference in maximum luminance between pairs of primary monitors at individual workstations (61.5 % or 30.8 % of workstations depending on specific guidelines), maximum luminance (23.1 % of workstations), luminance non-uniformity (11.5 % of workstations) and minimum luminance (3.8 % of workstations). A number of ambient light measurements did not comply with the only available evidence-based guideline relevant to the methodology used in this study. Larger ambient light variations across sites are shown when monitors were switched off, suggesting that differences in ambient lighting between sites can be masked when a standard mammogram is displayed for photometric measurements. Overall, BSNSW demonstrated good adherence to available guidelines, although some non-compliance has been shown. Recently updated United Kingdom and Australian guidelines should help reduce confusion generated by the plethora and sometimes dated nature of currently available recommendations.

Use of (99m)Tc 2-methoxyisobutyl isonitrile in minimally invasive radioguided surgery in patients with primary hyperparathyroidism: A narrative review of the current literature.

The use of technetium-99m 2-methoxyisobutyl isonitrile ((99m)Tc MIBI) for assistance in minimally invasive radioguided surgery (MIRS) is growing in popularity as a safe, effective, and proficient technique used for parathyroidectomy in primary hyperparathyroidism (PHPT) treatment. Previously, the preferred treatment for PHPT was bilateral neck exploration (BNE), a very invasive, costly, and lengthy procedure. However, as a large majority (80-85% of cases of PHPT) are attributed to a single parathyroid adenoma (PA), a simpler more direct technique such as MIRS is a far better option. The following article is an exploration of the current literature concerning varied protocols utilizing (99m)Tc MIBI for assistance in MIRS for patients undergoing treatment of PHPT. This technique boasts many advantageous outcomes for patients suffering from PHPT. These include a reduction in cost, operating time, and patient recovery; less evidence of post-surgical hypocalcaemia, less pain, and complications; superior cosmetic results; same-day discharge; and the possibility of local anaesthesia which is particularly beneficial in elderly patients. Better outcomes for patients with deep or ectopic PAs, reduced intra-operative complications, and improved cosmetic outcomes for patients who have previously undergone thyroid and/or parathyroid surgery are also advantageous. Of the literature reviewed it was also found that no patients suffered any major surgical complications such as laryngeal nerve palsy or permanent hypoparathyroidism using (99m)Tc MIBI for assistance in MIRS.