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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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

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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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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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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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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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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