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Messages - Lilly Kauffman

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2
Q&A: Why the public should not worry about radiation contamination when bodies are cremated

Mahadevappa Mahesh, MS, PhD

When JAMA published a research letter detailing radiation contamination in a crematorium, it gained considerable attention from both the mainstream media and the general public. Hoping to ease potential concerns before things grew out of hand, the American Association of Physicists in Medicine (AAPM) and American College of Radiology (ACR) published a joint statement emphasizing that the use of radiopharmaceuticals in healthcare is routine and has been proven to be safe.

Mahadevappa Mahesh, MS, PhD, chief physicist for Johns Hopkins Hospital in Baltimore, Maryland, spoke with Radiology Business to provide additional information about this subject. Mahesh is a representative of both organizations behind the joint statement, serving as treasurer of the AAPM and chair of the ACR Commission on Medical Physics. He is also the president of the Maryland Radiological Society.

Link: https://www.radiologybusiness.com/topics/care-delivery/radiation-contamination-cremation-bodies-aapm-acr

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3
CME / NASHVILLE: Hot Topics in Body CT Scanning: What You Need to Know
« on: March 07, 2019, 10:52:24 am »
Click here to register: https://hopkinscme.cloud-cme.com/default.aspx?P=5&EID=16734

Hot Topics in Body CT Scanning: What You Need to Know

When: Friday, May 17, 2019 - Sunday, May 19, 2019
Where: Gaylord Hotel and Convention Center, Nashville, TN
Overview: The rapid evolution of multidetector CT (MDCT) has impacted all aspects of patient diagnosis from cardiac imaging to vascular imaging to hepatic imaging. The development of these new scanners requires a close look at all aspects of our CT programs ranging from our scan protocols, to contrast injection to the use of oral contrast. The new clinical applications require a better understanding of our scanners as the “room for error” has decreased with scanners routinely acquiring datasets in under 10 seconds. New applications have evolved from coronary CTA to virtual colonoscopy to dual energy imaging, to name a few. Classic applications like imaging the liver, kidneys or pancreas have changed with the role of multiphase acquisition and post processing techniques becoming more critical. This has been both a time of change and a time of excitement. This meeting will provide the attendee with an improved understanding of the role of MDCT today and will help them improve their practice skills and knowledge base. Whether it is designing new scan protocols or learning new skill sets, this meeting will be a catalyst for increasing your core competencies through a series of lectures and hands-on training over a four-day period. The goal of the meeting is to improve your ability to do the best studies possible for optimal patient care in your own practice.

Click here for more information: https://hopkinscme.cloud-cme.com/default.aspx?P=5&EID=16734

RSVP to the Facebook event here: https://www.facebook.com/events/537935686717390/

4
Lectures & Quizzes / CT and the Pregnant Patient
« on: March 05, 2019, 02:49:11 pm »
The issues surrounding CT and the pregnant patient are often asked about and it's an important topic to be versed in for imaging.

View the lecture on the pregnant patient here: https://ctisus.com/responsive/media/2019/03/04/ct-and-the-pregnant-patient

5
Lectures & Quizzes / March 2019 Quiz
« on: March 05, 2019, 02:47:29 pm »
The march 2019 quiz is up!

https://ctisus.com/responsive/learning/quiz

How many did you get right?  What were the hardest/easiest questions?

6
Texture Analysis of Imaging: What Radiologists Need to Know.

AJR Am J Roentgenol. 2019 Mar;212(3):520-528. doi: 10.2214/AJR.18.20624. Epub 2019 Jan 15.
Varghese BA1, Cen SY1, Hwang DH1, Duddalwar VA1.

Abstract
OBJECTIVE: Radiologic texture is the variation in image intensities within an image and is an important part of radiomics. The objective of this article is to discuss some parameters that affect the performance of texture metrics and propose recommendations that can guide both the design and evaluation of future radiomics studies.

CONCLUSION: A variety of texture-extraction techniques are used to assess clinical imaging data. Currently, no consensus exists regarding workflow, including acquisition, extraction, or reporting of variable settings leading to poor reproducibility.

DOI: https://doi.org/10.2214/AJR.18.20624

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7
Using a Deep Learning Network to Diagnose Congestive Heart Failure.

Long H. Ngo

Medical imaging technologies such as radiography, US, CT, and, increasingly, MRI are indispensable in the screening and diagnosis of diseases of the heart, lungs, bones, and other organs. Chest radiography to detect congestive heart failure (CHF) and related complications is one of the most common radiologic procedures performed in the United States. A positive screening result for CHF at chest radiography may be followed by serum B-type natriuretic peptide (BNP) assessment to help confirm the diagnosis. The diagnostic accuracy of BNP in the detection of CHF is excellent, with a sensitivity above 95%. However, BNP testing is not performed for all patients, the laboratory test is expensive, and the final result may be delayed if an off-site laboratory is used. In the absence of BNP data, what is the loss in diagnostic accuracy of using just the chest radiograph? Is there a data-driven solution to compensate for this loss?

DOI: https://doi.org/10.1148/radiol.2018182341

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8
Journal Club / Current Update on Desmoid Fibromatosis.
« on: February 21, 2019, 02:42:46 pm »
Current Update on Desmoid Fibromatosis.

J Comput Assist Tomogr. 2019 Jan/Feb;43(1):29-38. doi: 10.1097/RCT.0000000000000790.
Ganeshan D1, Amini B2, Nikolaidis P3, Assing M4, Vikram R2.

Abstract
OBJECTIVE: The purpose of this article is to review the etiopathogenesis, molecular cytogenetics, histopathology, clinical features, and multimodality imaging features of desmoid fibromatosis. Recent advances in the management of desmoid fibromatosis will also be discussed.

CONCLUSIONS: Desmoid fibromatosis is a rare soft tissue neoplasm with a high incidence of local recurrence. Imaging plays an important role in the diagnosis and management of this disease.

DOI: https://doi.org/10.1097/RCT.0000000000000790

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9
Connective Tissue Disorders in Childhood: Are They All the Same?

Radiographics. 2019 Jan-Feb;39(1):229-250. doi: 10.1148/rg.2019180078.
Navallas M1, Inarejos Clemente EJ1, Iglesias E1, Rebollo-Polo M1, Antón J1, Navarro OM1.

Abstract
Systemic connective tissue disorders are characterized by the presence of autoantibodies and multiorgan system involvement. Juvenile systemic lupus erythematosus with or without associated antiphospholipid syndrome; juvenile dermatomyositis; sclerodermiform syndromes, including systemic and localized sclerodermas and eosinophilic fasciitis; mixed connective tissue disease; and Sjögren syndrome are the disorders that affect children most frequently. Diagnosis is difficult, because the clinical presentation of patients is diverse, from mild to severe disease. In addition, all organs may be affected. However, a variety of imaging techniques are now available to investigate rheumatic disease in children. These imaging modalities offer the potential for earlier diagnosis and improved assessment of therapeutic response. This article reviews the main connective tissue disorders that affect children, highlighting their key imaging features on images acquired with different diagnostic imaging modalities and correlating these features with clinical and pathologic findings, when available. ©RSNA, 2019.

DOI: https://doi.org/10.1148/rg.2019180078

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10
Journal Club / Imaging of Unusual Renal Tumors.
« on: February 08, 2019, 09:46:33 am »
Imaging of Unusual Renal Tumors.

Curr Urol Rep. 2019 Jan 21;20(1):5. doi: 10.1007/s11934-019-0867-7.
Castillo RP1, Santoscoy JF2, Pisani L1, Madrazo BL1, Casillas VJ1.

Abstract
PURPOSE OF REVIEW: Renal masses are a wide entity and a common finding in clinical practice. Detection of these masses has increased in the last years, yet mortality rates have slightly decreased.

RECENT FINDINGS: According to the World Health Organization classification, there are 8 types, 51 subtypes, and a lot more subsequent subclassifications of renal tumors. Histopathological analysis should always be assessed for final diagnosis of theses tumors. However, imaging can be an important diagnostic guidance. The most common diagnoses of renal tumor are clear cell carcinoma, papillary renal cell carcinoma, angiomyolipoma, and transitional cell carcinoma. Nonetheless, a considerable variety of particular tumors can arise from the kidney, challenging the expertise of radiologists and urologists on this subject. The awareness of these unusual entities is vital for professionals working at a complex medical facility with greater volume of patients. We hereby present uncommon renal tumors and its pathological and radiological features.

DOI: https://doi.org/10.1007/s11934-019-0867-7

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11
CTisus News / HAPPY BIRTHDAY!!
« on: February 05, 2019, 12:23:38 pm »
Today is CTisus's 20th birthday!!

Thank you everyone for supporting us over the past two decades.  We look forward to continuing several more years of radiology and CT education!


12
Artificial Intelligence in Breast Imaging: Potentials and Limitations.

AJR Am J Roentgenol. 2019 Feb;212(2):293-299. doi: 10.2214/AJR.18.20532. Epub 2018 Nov 13.
Mendelson EB1.

Abstract
OBJECTIVE: The purpose of this article is to discuss potential applications of artificial intelligence (AI) in breast imaging and limitations that may slow or prevent its adoption.

CONCLUSION: The algorithms of AI for workflow improvement and outcome analyses are advancing. Using imaging data of high quality and quantity, AI can support breast imagers in diagnosis and patient management, but AI cannot yet be relied on or be responsible for physicians' decisions that may affect survival. Education in AI is urgently needed for physicians.

DOI: https://doi.org/10.2214/AJR.18.20532

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13
Journal Club / How Cognitive Machines Can Augment Medical Imaging.
« on: January 28, 2019, 09:33:34 am »
How Cognitive Machines Can Augment Medical Imaging.

AJR Am J Roentgenol. 2019 Jan;212(1):9-14. doi: 10.2214/AJR.18.19914. Epub 2018 Nov 13.
Miller DD1,2, Brown EW3.

Abstract
OBJECTIVE: Artificial intelligence (AI) neural networks rapidly convert disparate facts and data into highly predictive analytic models. Machine learning maps image-patient phenotype correlations opaque to standard statistics. Deep learning performs accurate image-derived tissue characterization and can generate virtual CT images from MRI datasets. Natural language processing reads medical literature and efficiently reconfigures years of PACS and electronic medical record information.

CONCLUSION: AI logistics solve radiology informatics workflow pain points. Imaging professionals and companies will drive health care AI technology insertion. Data science and computer science will jointly potentiate the impact of AI applications for medical imaging.

DOI: https://doi.org/10.2214/AJR.18.19914

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14
Journal Club / CT derived FFR: "The Game Changer?" revisited.
« on: January 18, 2019, 12:07:26 pm »
CT derived FFR: "The Game Changer?" revisited.

J Cardiovasc Comput Tomogr. 2018 Nov - Dec;12(6):447-449. doi: 10.1016/j.jcct.2018.08.006.
Hecht HS1.

Introduction

The practice of cardiology has been revolutionized by the emergence of coronary computed tomographic angiography (CTA) as a major addition to the armamentarium for the evaluation of coronary artery disease. In an extraordinarily short time span, the CTA literature has been populated with studies documenting accuracy superior to the most commonly utilized functional testing modalities of treadmill testing, stress echocardiography (SE) and SPECT myocardial perfusion imaging (MPI) for the identification of invasive coronary angiographic (ICA) stenoses >50%.1, 2, 3 Recognizing that ICA stenosis correlates inadequately with invasive fractional flow reserve (IFFR) and is not the appropriate gold standard, CTA has also been correlated with IFFR, with similar superiority in sensitivity to the standard modalities but lower specificity. The less often utilized and more expensive positron emission tomography (PET) and magnetic resonance imaging (MRI) stress testing have sensitivities similar to CTA but superior specificities.4, 5, 6, 7

In addition, studies have documented the better prognostic value of CTA compared to SE and MPI,8 as well as superior outcomes in chest pain patients without established CAD randomized to CTA versus the standard modalities,9, 10, 11, 12 despite the relatively poor specificity using the IFFR gold standard. The reasons for the low specificity of CTA are multiple: Firstly, as with ICA, there is an imperfect correlation of percent stenosis with IFFR. Secondly, the classification by intention to diagnose of heavily calcified or motion artifact degraded segments as “positive” will decrease specificity. Thirdly, visual overestimation of % DS on CTA is undoubtedly as common as it is in invasive angiography.

DOI: https://doi.org/10.1016/j.jcct.2018.08.006

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15
Journal Club / Imaging of acute ischemic stroke
« on: January 16, 2019, 02:55:45 pm »
Imaging of acute ischemic stroke

Rudkin S1, Cerejo R2, Tayal A2, Goldberg MF3.

Abstract

For decades, imaging has been a critical component of the diagnostic evaluation and management of patients suspected of acute ischemic stroke (AIS). With each new advance in the treatment of AIS, the role of imaging has expanded in scope, sophistication, and importance in selecting patients who stand to benefit from potential therapies. Although the field of stroke imaging has been evolving for many years, there have been several major recent changes. Most notably, in late 2017, the window for treatment expanded to 24 h from onset of stroke symptoms in selected patients. Furthermore, for those patients in expanded time windows, guidelines issued in early 2018 now recommend the use of “advanced” imaging techniques in the acute setting, including CT perfusion and MRI, to guide therapeutic decision-making. With these and other changes, the emergency radiologist must be prepared to handle a growing volume and complexity of AIS imaging. This article reviews the various imaging modalities and techniques employed in the imaging of AIS patients, with an emphasis on recommendations from recent randomized controlled trials and national consensus guidelines.

DOI: https://doi.org/10.1007/s10140-018-1623-x

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