Improving cardiovascular magnetic resonance access in low- and middle-income countries for cardiomyopathy assessment: rapid cardiovascular magnetic resonance.

AIMS: To evaluate the impact of a simplified, rapid cardiovascular magnetic resonance (CMR) protocol embedded in care and supported by a partner education programme on the management of cardiomyopathy (CMP) in low- and middle-income countries (LMICs). METHODS AND RESULTS: Rapid CMR focused particularly on CMP was implemented in 11 centres, 7 cities, 5 countries, and 3 continents linked to training courses for local professionals. Patients were followed up for 24 months to assess impact. The rate of subsequent adoption was tracked. Five CMR conferences were delivered (920 attendees-potential referrers, radiographers, reporting cardiologists, or radiologists) and five new centres starting CMR. Six hundred and one patients were scanned. Cardiovascular magnetic resonance indications were 24% non-contrast T2* scans [myocardial iron overload (MIO)] and 72% suspected/known cardiomyopathies (including ischaemic and viability). Ninety-eighty per cent of studies were of diagnostic quality. The average scan time was 22 ± 6 min (contrast) and 12 ± 4 min (non-contrast), a potential cost/throughput reduction of between 30 and 60%. Cardiovascular magnetic resonance findings impacted management in 62%, including a new diagnosis in 22% and MIO detected in 30% of non-contrast scans. Nine centres continued using rapid CMR 2 years later (typically 1-2 days per week, 30 min slots). CONCLUSIONS: Rapid CMR of diagnostic quality can be delivered using available technology in LMICs. When embedded in care and a training programme, costs are lower, care is improved, and services can be sustained over time.

Noninvasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in low-middle income countries.

Introduction: Cardiac Magnetic Resonance (CMR) is a crucial diagnostic imaging test that redefines diagnosis and enables targeted therapies, but the access to CMR is limited in low-middle Income Countries (LMICs) even though cardiovascular disease is an emergent primary cause of mortality in LMICs. New abbreviated CMR protocols can be less expensive, faster, whilst maintaining accuracy, potentially leading to a higher utilization in LMICs.Areas covered: This article will review cardiovascular disease in LMICs and the current role of CMR in cardiac diagnosis and enable targeted therapy, discussing the main obstacles to prevent the adoption of CMR in LMICs. We will then review the potential utility of abbreviated, cost-effective CMR protocols to improve cardiac diagnosis and care, the clinical indications of the exam, current evidence and future directions.Expert opinion: Rapid CMR protocols, provided that they are utilized in potentially high yield cases, could reduce cost and increase effectiveness. The adoption of these protocols, their integration into care pathways, and prioritizing key treatable diagnoses can potentially improve patient care. Several LMIC countries are now pioneering these approaches and the application of rapid CMR protocols appears to have a bright future if delivered effectively.

Abbreviated magnetic resonance imaging in breast cancer: A systematic review of literature.

BACKGROUND: : magnetic resonance imaging (MRI) has been increasingly used to study breast cancer for screening high-risk cases, pre-operative staging, and problem-solving because of its high sensitivity. However, its cost-effectiveness is still debated. Thus, the concept of abbreviated MRI (ABB-MRI) protocols was proposed as a possible solution for reducing MRI costs. PURPOSE: : to investigate the role of the abbreviated MRI protocols in detecting and staging breast cancer. METHODS: : a systematic search of the literature was carried out in the bibliographic databases: Scopus, PubMed, Medline, and Science Direct. RESULTS: : forty-one articles were included, which described results of the assessment of fifty-three abbreviated protocols for screening, staging, recurrence assessing, and problem-solving or clarification. CONCLUSIONS: : the use of ABB-MRI protocols allows reducing the acquisition and reading times, maintaining a high concordance with the final interpretation, in comparison to a complete protocol. However, larger prospective and multicentre trials are necessary to validate the performance in specific clinical environments.

Dose dependence of accelerated repopulation in head and neck cancer: Supporting evidence and clinical implications.

BACKGROUND AND PURPOSE: Accelerated repopulation (AR) can compromise tumor control after conventional radiotherapy for fast-growing tumors. Standard AR models assume it begins at a fixed time, with repopulation rates independent of the number of clonogens killed. We investigate the validity and significance of an alternative model where onset-time and rate of AR depend on the number of clonogens killed, and thus on dose and dose-fractionation. MATERIALS AND METHODS: We analyzed tumor control (TCP) from randomized trials for head and neck cancer (HNC, 7283 patients), featuring wide ranges of doses, times, and fractionation-schemes. We used the linear-quadratic model with the standard dose-independent AR model, or with an alternative dose-dependent model, where AR onset and rate depend on clonogen killing. RESULTS: The alternative dose-dependent model of AR provides significantly-improved descriptions of a wide range of randomized clinical data, relative to the standard dose-independent model. This preferred model predicts that, for currently-used HNC fractionation schemes, the last 5 fractions do not increase TCP, but simply compensate for increased accelerated repopulation. CONCLUSIONS: The preferred dose-dependent AR model predicts that, for standard fractionation schemes currently used to treat HNC, the final week (5 fractions) could be eliminated without compromising TCP, but resulting in significantly decreased late sequelae due to the lower overall dose.

Acurácia do protocolo abreviado de colangioressonância magnética no diagnóstico de coledocolitíase / Accuracy of abbreviated protocol of magnetic resonance cholangio-pancreatography in the diagnosis of choledocholithiasis

ABSTRACT Background: Abbreviated magnetic resonance imaging protocols have emerged to reduce the examination time of the long protocols eliminating unnecessary pulse sequences to answer a targeted clinical question, without compromising diagnostic information. Objective: The objective of this study was to evaluate the diagnostic accuracy of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol in patients with suspected choledocholithiasis. Methods: This retrospective study evaluated patients (ages 10 + years) that performed consecutive MRCP examination from October 2019 to June 2020, with the clinical suspicion of choledocholithiasis. Readers first evaluated the biliary tree using a four-sequence A-MRCP protocol and later reviewed the entire conventional eleven-sequence MRCP. Presence of choledocholithiasis, stone size, common bile duct caliber, and additional findings were evaluated. Results: A total of 148 patients with MRCP were included (62.8% female, mean 50.9 years). The prevalence of choledocholithiasis was 32.2%. The accuracy of the abbreviated MRCP protocol for choledocholithiasis was 98.7%. There was no difference between the performance of the abbreviated and conventional MRCP image sets for detection of choledocholithiasis (kappa=0.970), with a sensitivity of 98% and a specificity of 99%. There was excellent inter-reader agreement evaluating for choledocholithiasis on both imaging sets of MRCP protocols (kappa values were 0.970). Conclusion: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides similar diagnostic over the conventional MRCP protocol, offering potential for decreased scanning time and improved patient tolerability.

RESUMO Contexto: Protocolos abreviados de ressonância magnética (RM) surgiram a fim de reduzir o tempo de exame, eliminando sequências de pulso desnecessárias para responder a uma questão clínica específica, sem comprometer o diagnóstico. Objetivo: O objetivo do estudo foi avaliar a acurácia diagnóstica de um protocolo abreviado de colangiopancreatografia por ressonância magnética (colangioRM) em pacientes com suspeita de coledocolitíase. Métodos Estudo retrospectivo, com pacientes acima de 10 anos que realizaram exame de colangioRM, entre outubro de 2019 a junho de 2020, com suspeita clínica de coledocolitíase. Os observadores, radiologistas especialistas, primeiro avaliaram a árvore biliar usando um protocolo abreviado de colangioRM composto por quatro sequências de pulso e, posteriormente, revisaram o protocolo convencional de colangioRM de 11 sequências. A presença de coledocolitíase, o tamanho do cálculo, o calibre do ducto hepático comum e achados adicionais foram avaliados. Resultados Um total de 148 pacientes foram incluídos, sendo 62,8% do sexo feminino, com média de 50,9 anos de idade. A prevalência de coledocolitíase foi de 32,2%. A acurácia do protocolo abreviado de colangioRM para coledocolitíase foi de 98,7%. Não houve diferença entre o desempenho dos protocolos abreviado e convencional de colangioRM para a detecção de coledocolitíase (k=0,970), com uma sensibilidade de 98% e uma especificidade de 99%. Além disso, observou-se excelente concordância entre observadores na avaliação de coledocolitíase em ambos os protocolos de colangioRM (k=0,925). Conclusão O protocolo abreviado de colangioRM apresentou excelente acurácia para o diagnóstico de coledocolitíase quando comparado ao protocolo convencional.