[18F]fluorodeoxyglucose positron emission tomography/computed tomography in combination with clinical data in predicting overall survival in non-small-cell lung cancer patients: A retrospective study.

INTRODUCTION: Positron emission tomography/computed tomography (PET/CT) has an established role in evaluating patients with lung cancer. The aim of this work was to assess the predictive capability of [18F]Fluorodeoxyglucose ([18F]FDG) PET/CT parameters on overall survival (OS) in lung cancer patients using an artificial neural network (ANN) in parallel with conventional statistical analysis. METHODS: Retrospective analysis was performed on a group of 165 lung cancer patients (98M, 67F). PET features associated with the primary tumor: maximum and mean standardized uptake value (SUVmax, SUVmean), total lesion glycolysis (TLG) metabolic tumor volume (MTV) and area under the curve-cumulative SUV histogram (AUC-CSH) and metastatic lesions (SUVmaxtotal, SUVmeantotal, TLGtotal, and MTVtotal) were evaluated. In parallel with conventional statistical analysis (Chi-Square analysis for nominal data, Student's t test for continuous data), the data was evaluated using an ANN. There were 97 input variables in 165 patients using a binary classification of either below, or greater than/equal to median survival post primary diagnosis. Additionally, phantom study was performed to assess the most optimal contouring method. RESULTS: Males had statistically higher SUVmax (mean: 10.7 vs 8.9; p = 0.020), MTV (mean: 66.5 cm3 vs. 21.5 cm3; p = 0.001), TLG (mean 404.7 vs. 115.0; p = 0.003), TLGtotal (mean: 946.7 vs. 433.3; p = 0.014) and MTVtotal (mean: 242.0 cm3 vs. 103.7 cm3; p = 0.027) than females. The ANN after training and validation was optimised with a final architecture of 4 scaling layer inputs (TLGtotal, SUVmaxtotal, SUVmeantotal and disease stage) and receiving operator characteristic (ROC) analysis demonstrated an AUC of 0.764 (sensitivity of 92.3%, specificity of 57.1%). CONCLUSION: Conventional statistical analysis and the ANN provided concordant findings in relation to variables that predict decreased survival. The ANN provided a weighted algorithm of the 4 key features to predict decreased survival. IMPLICATION FOR PRACTICE: Identification of parameters which can predict survival in lung cancer patients might be helpful in choosing the group of patients who require closer look during the follow-up.

What supports and services post COVID-19 do children with disabilities and their parents need and want, now and into the future?

Introduction: Children and youth with disabilities and special healthcare needs, and their families, have been uniquely affected by the COVID-19 pandemic. However, the voices of children themselves are still not well represented in the existing literature. Methods: This qualitative descriptive study used a combination of visual methods and interviews to learn about the experiences of Canadian children with disabilities (n=18) and their parents (n=14) during the COVID pandemic and into the post-pandemic period. Data collection was carried out between January and July 2023. The aim was to identify the supports and services children and families need at present and moving forward. Results: Families' pandemic experiences were complex and nuanced. For many, the pandemic complicated and disrupted everyday activities and supports. These disruptions were largely buffered by parents. However, some families also identified unexpected benefits. Key themes pertaining to present and future needs included the need for services that are flexible; consistent; conducive to relationship-building; comprehensive; coordinated across sectors; and designed to support the needs of the whole family. Discussion: Implications for policy and practice are outlined.

The potential role of artificial intelligence in sustainability of nuclear medicine.

BACKGROUND: Strategies targeted at the five pillars of sustainability (social, human, economic, ecological and environmental) can be used to improve sustainability of clinical or research practices in nuclear medicine. KEY FINDINGS: While the core principle of sustainability is ensuring depletion does not exceed regeneration, this manuscript considers the balance of benefits and detriments of artificial intelligence (AI) technologies across the five pillars of sustainability. Specifically, innovations such as AI, generative AI and digital twins could enhance sustainability. While AI has the potential to address social asymmetry and inequity to drive the social and human pillars of sustainability, there is potential for widening the equity gap. AI augmentation and generative AI present economic and environmental sustainability opportunities. Deep digital twins offers clinical and research benefits in economic, ecological and environmental sustainability pillars. CONCLUSION: AI, digital twins and generative AI offer potential benefits to sustainability in nuclear medicine. Despite the benefits, caution is advised because these technologies confront a number of challenges that could potentially threaten sustainability. IMPLICATIONS FOR PRACTICE: AI presents opportunities for improving sustainability of nuclear medicine practice although caution is recommended to avoid unintentional undermining of sustainability across the five pillars.

Managing juvenile idiopathic arthritis within the context of their life: What we learnt from children and youth living with juvenile idiopathic arthritis and their parents.

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and causes short- and long-term disability. Optimal management requires pharmacologic and non-pharmacologic interventions. Few studies have explored the youth and family experience of the management of JIA. This study's objective was to explore the management experience of youth with JIA and their parents. METHODS: This qualitative study used semi-structured interviews with youth 12-18 years of age with JIA receiving biological medication and parents of children with JIA on biological medication. Participants were recruited in clinics using convenience sampling. A thematic analysis approach was employed for data analysis. RESULTS: Nine youth and 14 parents participated. Four themes were identified that encompassed an overarching theme of participants managing JIA within the context of their life: aspects of life affected by JIA and its management, lived experience with JIA management, medication decision-making, and involvement in decision-making. Juvenile idiopathic arthritis management is situated within the context of their life but is normally (outside acute events) not central. CONCLUSION: Two dimensions were added to those in the literature: parents' overall approaches to health and the sense of urgency surrounding decision-making. Our findings reinforce the importance of person- and family-centred care in paediatric rheumatology. That is, identifying what matters most to youth and their parents given their current life circumstances to provide a foundation for discussions of how they want to manage their JIA.

ChatGPT in medical imaging higher education.

INTRODUCTION: Academic integrity among radiographers and nuclear medicine technologists/scientists in both higher education and scientific writing has been challenged by advances in artificial intelligence (AI). The recent release of ChatGPT, a chatbot powered by GPT-3.5 capable of producing accurate and human-like responses to questions in real-time, has redefined the boundaries of academic and scientific writing. These boundaries require objective evaluation. METHOD: ChatGPT was tested against six subjects across the first three years of the medical radiation science undergraduate course for both exams (n = 6) and written assignment tasks (n = 3). ChatGPT submissions were marked against standardised rubrics and results compared to student cohorts. Submissions were also evaluated by Turnitin for similarity and AI scores. RESULTS: ChatGPT powered by GPT-3.5 performed below the average student performance in all written tasks with an increasing disparity as subjects advanced. ChatGPT performed better than the average student in foundation or general subject examinations where shallow responses meet learning outcomes. For discipline specific subjects, ChatGPT lacked the depth, breadth, and currency of insight to provide pass level answers. CONCLUSION: ChatGPT simultaneously poses a risk to academic integrity in writing and assessment while affording a tool for enhanced learning environments. These risks and benefits are likely to be restricted to learning outcomes of lower taxonomies. Both risks and benefits are likely to be constrained by higher order taxonomies. IMPLICATIONS FOR PRACTICE: ChatGPT powered by GPT3.5 has limited capacity to support student cheating, introduces errors and fabricated information, and is readily identified by software as AI generated. Lack of depth of insight and appropriateness for professional communication also limits capacity as a learning enhancement tool.

Practical learning through radiation physics problem solving.

INTRODUCTION: The identification of unknown radionuclides is an authentic practical activity for students that provides the foundations for clinical problem solving, especially in the storage and management of radioactive waste. As different radionuclides have different half-lives, some of which are quite long, the storage of waste material has to accommodate the longest of these. Cross contamination requires a method of identifying the radionuclide samples in a mixed sample to safely and appropriately manage disposal. Similarly, identifying a single unknown sample of a radionuclide allows correct handling and disposal. METHODS: Performing a systematic investigation of the physical properties of unknown radioactive samples is a rich learning opportunity to instil understanding of important physics principles among students in nuclear medicine. RESULTS: This manuscript outlines an investigation developed that would allow students to identify single unknown radionuclides based on physical properties and identify the constituent radionuclides of a mixed sample using some additional mathematical curve stripping. CONCLUSION: The processes and solutions are provided with real data and this practical activity can be replicated by students generating their own data. IMPLICATIONS FOR PRACTICE: This paper provides a template and analysis/interpretation guideline for educators and clinicians to deepen understanding of foundation physics. Enhanced and deeper understanding are a vehicle for improved problem solving in clinical and research practice.

Value of SPECT/CT in the diagnosis of avascular necrosis of the head of femur: A meta-analysis.

INTRODUCTION: To evaluate the diagnostic value of single photon emission computed tomography/computed tomography (SPECT/CT) in patients with avascular necrosis (AVN) of the femoral head. METHODS: A search of the databases PubMed, ScienceDirect, and Google Scholar was undertaken using targeted index word. Studies satisfying inclusions and exclusions criteria were identified and additional related literature sources were considered. Analysis included pooled sensitivity and specificity, odds ratio (OR), and receiver operating characteristic (ROC) analysis. RESULTS: Seven studies were identified that specifically related to the diagnostic accuracy of SPECT/CT in the detection or characterisation of AVN of the femoral head. These were included in the meta-analysis. The pooled sensitivity and specificity were 94% (95% confidence interval of 87-97%) and 75% (95% confidence interval of 68-81%) respectively, the OR was 44.5 (with a 95% confidence interval of 18.2-108.6), and the area under the SROC was 93.73% (with a 95% confidence interval of 89.2%-98.3%). CONCLUSION: This meta-analysis provides strong evidence of the high diagnostic efficacy of SPECT/CT in the evaluation of AVN of the femoral head. IMPLICATIONS FOR PRACTICE: In the absence of or contraindication to MRI, SPECT/CT is able to provide a suitable alternative for diagnosis of AVN of the head of femur.

A muggles guide to deep learning wizardry.

OBJECTIVES: Growing interest in the applications of artificial intelligence (AI) and, in particular, deep learning (DL) in nuclear medicine and radiology partitions the professional community. At one end of the spectrum are our expert DL wizards developing potion-like code and waving the DL capabilities like a wand across our professions. On the opposite side of the spectrum are our muggle colleagues who lack the wizardry of DL and may be largely oblivious to the entire magical realm. KEY FINDINGS: As crafted by Arthur C Clark, any sufficiently advanced technology is indistinguishable from magic. DL is not only an important technology in the future of medical imaging, but its application lives in the capabilities of medical imaging technologists. This may be incidental through application of techniques at the patient interface, through role expansion in data curation and management, or as active members of DL projects and development. Understanding the rudimentary principles of DL is emerging as requisite in medical imaging. CONCLUSION: AI and DL are valuable tools in advancing capabilities and outcomes in medical imaging. A working knowledge of the technology and techniques is important and achievable for the medical imaging technologist even when capability in application of DL to research and clinical practice is not within one's interests or scope of practice. IMPLICATIONS FOR PRACTICE: While there is no requisite for all of the professional community to be tutored in the wizardry of DL, there are benefits for the profession and our patients for all to have a rudimentary understanding of the language and landscape. The breadth of DL literature assumes a level of understanding not evident for the bulk of our professions. This manuscript provides a simplified primer on DL with the aim of arming the muggles among us with sufficient insight to navigate the magical realm of DL without transferring any wizardry capability itself.

Topical sensor metrics for 18F-FDG positron emission tomography dose extravasation.

INTRODUCTION: Extravasation or partial extravasation of the positron emission tomography (PET) tracer negatively effects image quality in PET and the accuracy of the standard uptake value (SUV). A commercially available topical sensor has been validated using a number of metrics to characterise injection quality. This evaluation explores contributing factors for extravasation and refines metrics to predict extravasation based on the time-activity-curves (TAC) of the topical sensor device. METHODS: A multi-site, multi-national pooling of 18F FDG PET/CT data was undertaken with 863 patients from 6 sites in the USA and 2 sites in Australia. A number of dose migration metrics determined with topical application of Lara sensors were retrospectively analysed using conventional statistical analysis. Deeper insights into the complex relationship between variables was further explored using an artificial neural network. RESULTS: Extravasation was independently predicted by the time taken for the injection sensor counts to reach double the counts of the reference sensor (tc50), the normalised difference between injection and reference sensors counts at 4 min post injection (ndAvgN), or the ratio of injection sensor counts to reference sensor counts at the end of data collection (CEnd ratio). The algorithm developed using the artificial neural network produced 100% sensitivity and 100% specificity against grounded truth for detecting extravasation by weighting and scaling these 3 key metrics; CEnd ratio, ndAvgN and tc50. CONCLUSION: Partial extravasation of a PET dose is readily detected and differentiated using TAC metrics and these metrics could provide deeper insight into the impact of partial extravasation on image quality or quantitation. Further validation of key metrics developed in this study are recommended in a larger and more diverse cohort. IMPLICATIONS FOR PRACTICE: Partial extravasation undermines image quality and accuracy of quantitation, impacting efficacy of outcomes for patients. Characterisation of extravasation informs decision making to optimise protocol and procedure, enhancing patient outcomes. Awareness provides the opportunity for education and training to minimise impact. The information can be used to drive policy and regulations to support improved techniques in practice.

Indwelling pleural catheters: an overview and real-life experience.

BACKGROUND: Indwelling pleural catheters (IPCs) are most frequently used in those with malignant pleural effusions, although their use is expanding to patients with non-malignant diseases. AIM: To provide an overview of IPCs and highlight how, when and why they can be used including our own real-life experience. DESIGN: Data were collected retrospectively from a large tertiary centre for all individuals who received an IPC between June 2010 and February 2018 inclusive. The data collected included gender, age, origin of malignancy, number of drains prior to IPC, whether they had received pleurodesis prior to IPC, presence of a trapped lung, date of insertion, documented complications, overall outcome and date of death. RESULTS: A total of 68 patients received an IPC, the majority were female (n = 38, 57%) with an overall median age of 68 years (range 40-90 years). The most common site of cancer origin was lung (n = 33, 49%) followed by pleura (n = 10, 15%) and breast (n = 9, 13%). The median survival of all patients was 141 days (IQR 26-181). Sixteen percent (n = 11) of patients underwent a spontaneous pleurodesis resulting in their IPC being removed. Only three individuals had a complication (4.4%). CONCLUSIONS: IPC insertion is a safe procedure and represents an exciting and expanding field in the management of pleural disease. Further longitudinal studies are required to fully delineate their place in the management of both malignant and benign effusions.

The management of chronic cough.

Chronic cough is a common presentation to primary care and constitutes a significant volume of referrals to secondary care. It affects around 10% of the adult population and has a plethora of respiratory and non-respiratory causes. It can have a significant impact on the quality of life of affected individuals. In many patients, minimal baseline investigations lead to an easily identifiable and treatable cause. In others, no cause can be identified even after extensive investigations in specialized cough clinics. This evidence-based review article outlines the approach to the adult patient presenting with chronic cough and focuses upon current management strategies in those with chronic idiopathic cough. It includes results from trials of speech and language therapies, and the emerging concept of chronic idiopathic cough as a neuropathic disorder with its own bespoke approach to management including the use of neuromodulatory agents.

Paper versus electronic feedback in high stakes assessment.

Tablet computers have emerged as increasingly useful tools in medical education, particularly for assessment. However, it is not fully established whether tablet computers influence the quality and/or quantity of feedback provided in high stakes assessments. It is also unclear how electronically-recorded feedback relates to student performance. Our primary aim was to determine whether differences existed in feedback depending on the tool used to record it. METHODS: We compared quantitative and qualitative feedback between paper-scoring sheets versus iPads™ across two consecutive years of a final year MBChB (UK medical degree) Objective Structured Clinical Examination. Quality of comments (using a validated five-point rating scale), number of examiner comments and number of words were compared across both methods of recording assessment performance using chi-squared analysis and independent t-test. We also explored relationships between student performance (checklist and global scoring) and feedback. RESULTS: Data from 190 students (2850 paper scored interactions) in 2015 and 193 (2895 iPad™ scored interactions) in 2016 were analysed. Overall, a greater number of comments were given with iPad™ compared to written (42% versus 20%; p < 0.001) but the quality of feedback did not differ significantly. For both written and electronic feedback, students with low global scores were more likely to receive comments (p < 0.001). CONCLUSION: The use of iPads™ in high stakes assessment increases the quantity of feedback compared to traditional paper scoring sheets. The quantity and quality of feedback for poorer performing candidates (by global score) were also better with iPad™ feedback.

The Scottish Academic Foundation Year Programme: what, why and how?

The Foundation Programme is well established in the UK and serves as the generic training scheme into which newly qualified doctors enter after gaining a medical degree. Although individual programmes have many differences, the range of competencies needing to be fulfilled to progress is uniform across Scotland and the rest of the UK. Some final year medical undergraduates may apply for the Academic Foundation Programme; this is designed to facilitate exposure to academic medicine over and above the clinical experience offered to Foundation Year doctors. This paper describes characteristics of the Academic Foundation Programme in general, with a particular focus on Scotland, which is one Foundation School.

Characteristics of high- and low-risk individuals in the PRIORITY study: urinary proteomics and mineralocorticoid receptor antagonism for prevention of diabetic nephropathy in Type 2 diabetes.

AIM: To compare clinical baseline data in individuals with Type 2 diabetes and normoalbuminuria, who are at high or low risk of diabetic kidney disease based on the urinary proteomics classifier CKD273. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled international multicentre clinical trial and observational study in participants with Type 2 diabetes and normoalbuminuria, stratified into high- or low-risk groups based on CKD273 score. Clinical baseline data for the whole cohort and stratified by risk groups are reported. The associations between CKD273 and traditional risk factors for diabetic kidney disease were evaluated using univariate and logistic regression analysis. RESULTS: A total of 1777 participants from 15 centres were included, with 12.3% of these having a high-risk proteomic pattern. Participants in the high-risk group (n=218), were more likely to be men, were older, had longer diabetes duration, a lower estimated GFR and a higher urinary albumin:creatinine ratio than those in the low-risk group (n=1559, P<0.02). Numerical differences were small and univariate regression analyses showed weak associations (R2 < 0.04) of CKD273 with each baseline variable. In a logistic regression model including clinical variables known to be associated with diabetic kidney disease, estimated GFR, gender, log urinary albumin:creatinine ratio and use of renin-angiotensin system-blocking agents remained significant determinants of the CKD273 high-risk group: area under the curve 0.72 (95% CI 0.68-0.75; P<0.01). CONCLUSIONS: In this population of individuals with Type 2 diabetes and normoalbuminuria, traditional diabetic kidney disease risk factors differed slightly between participants at high risk and those at low risk of diabetic kidney disease, based on CKD273. These data suggest that CKD273 may provide additional prognostic information over and above the variables routinely available in the clinic. Testing the added value will be subject to our ongoing study. (European Union Clinical Trials Register: EudraCT 2012-000452-34 and Clinicaltrials.gov: NCT02040441).

Twitter journal clubs and continuing professional development: An analysis of a #MedRadJClub tweet chat.

INTRODUCTION: Online Twitter journal clubs are a recent and popular innovation with the potential to increase research awareness and inform practice. The medical radiation sciences' MedRadJournalClub (MJRC) is a Twitter-based event that attracts a global group of participants at the monthly chats. An analysis of a recent MedRadJournalClub discussion evaluated the perceived benefits and limitations of medical radiation practitioners participating in an online journal club. METHODS: The February 2017 chat used for analysis was based on the Journal of Medical Imaging and Radiation Sciences article by Currie et al. "Twitter Journal Club in Medical Radiation Science" that examines the educational theory behind learning and evidencing professional development through MRJC and social media. The data consisted of chat tweets which were collated using the Twitter advanced search function using the #medradjclub. An initial reviewed was performed to exclude irrelevant content. A second review was then undertaken to categorize the main theme of the tweet. The data were then subjected to thematic analysis which yielded seven different categories. RESULTS: The main benefits included global access due to the online nature of MRJC that has facilitated networking and collaboration. Open access to recently published research was another key benefit. The character limitation of a tweet was the most common constraint, and the dynamic nature of the twitter conversation requires multi-tasking that may be difficult. CONCLUSION: Our analysis indicated that participants use MedRadJournalClub as a source of continuing professional development with some evidence that this is directly informing clinical and educational practice.

The relationship between health eating and overweight/obesity in Canada: cross-sectional study using the CCHS.

Objective: The relationship between Canada's Food Guide (CFG) adherence and overweight/obesity at the population level is unknown. Our objective was to explore the association between overweight/obesity and CFG adherence in Canada. Methods: Using 24-h dietary recall data from the Canadian Community Health Survey (CCHS), we conducted a cross-sectional analysis of Canadians' consumption of four predefined food types from CFG (grain products, vegetables and fruit, milk and alternatives, meat and alternatives). Respondents aged 18 to 65 years with measured BMI were included. The total number of servings in each food group was compared with the number of recommended servings in CFG to determine adherence. Linear regression was used to explore the association between overweight/obesity and CFG adherence. Results: Participants who met the minimum servings in vegetables and fruit had a lower measured BMI. Also, participants who met the minimum servings in meat and alternatives had a higher measured BMI. These associations were observed for the sample as a whole and for those with overweight/obesity, and, for meat and alternatives, among women. Conclusion: There is evidence that following the CFG recommendation is associated with measured BMI, for some food groups. This relationship needs to be validated using longitudinal data.

Tablet computers in assessing performance in a high stakes exam: opinion matters.

Background Tablet computers have emerged as a tool to capture, process and store data in examinations, yet evidence relating to their acceptability and usefulness in assessment is limited. Methods We performed an observational study to explore opinions and attitudes relating to tablet computer use in recording performance in a final year objective structured clinical examination at a single UK medical school. Examiners completed a short questionnaire encompassing background, forced-choice and open questions. Forced choice questions were analysed using descriptive statistics and open questions by framework analysis. Results Ninety-two (97% response rate) examiners completed the questionnaire of whom 85% had previous use of tablet computers. Ninety per cent felt checklist mark allocation was 'very/quite easy', while approximately half considered recording 'free-type' comments was 'easy/very easy'. Greater overall efficiency of marking and resource savings were considered the main advantages of tablet computers, while concerns relating to technological failure and ability to record free type comments were raised. Discussion In a context where examiners were familiar with tablet computers, they were preferred to paper checklists, although concerns were raised. This study adds to the limited literature underpinning the use of electronic devices as acceptable tools in objective structured clinical examinations.