Ultrasound Workflow in a Pandemic: Lessons Learned from COVID-19.

The 2019 novel coronavirus (COVID-19) pandemic has posed unique, sudden challenges to health care systems. This is true particularly in the context of ultrasound logistics given the risks of inherent prolonged close contact of patients with sonographers and equipment during sonographic image acquisition. We describe the adaptations and modifications in scheduling, workflow, and imaging protocols implemented in our radiology department ultrasound division (a large urban academic center).

Role of hepatic metastatic lesion size on inter-reader reproducibility of CT-based radiomics features.

Objectives: To evaluate the effect of hepatic metastatic lesion size on inter-reader reproducibility of CT-based 2D radiomics imaging features.

Methods: Computerized tomography (CT) scans of 59 liver metastases from 34 patients with colorectal cancer were evaluated. Image segmentation was performed manually by three readers blinded to each other's results.

Rectourethral fistula following SpaceOAR gel placement for prostate cancer radiotherapy: A rare complication.

After undergoing a SpaceOAR® gel placement prior to planned radiotherapy for Gleason 4 + 4 prostate cancer, a 70-year-old male experienced severe right buttock pain and urine passing from his rectum. A colonoscopy and follow-up pelvic MRI demonstrated a large rectourethral fistula. The fistula was treated surgically with a robot-assisted radical prostatectomy, primary rectal repair, omental flap and diverting loop ileostomy.

Body mass index as an indicator of the likelihood of ultrasound visualization of the appendix in pregnant women with suspicion of appendicitis.

Purpose: To determine if clinical characteristics of pregnant women are associated with the likelihood of ultrasound (US) visualization of the appendix in cases where there is a clinical suspicion of appendicitis.

Materials And Methods: A retrospective study of 471 pregnant patients with suspicion of appendicitis from 2009 to 2018 were studied. Patients underwent sonography of the appendix as their initial imaging study.

Dual-energy CT evaluation of gastrointestinal bleeding.

Gastrointestinal bleeding is a common cause for hospital admissions and is an important cause of morbidity and mortality. Although endoscopy is accepted as the standard initial diagnostic modality for the evaluation of gastrointestinal bleeding, multiphasic computed tomography (CT) imaging has become an alternative diagnostic tool. Dual-energy CT with post-processing techniques may have additional advantages over single-energy computed tomography in evaluation of gastrointestinal bleeding.

Esophagogastric Junction Distensibility on Functional Lumen Imaging Probe Topography Predicts Treatment Response in Achalasia-Anatomy Matters!

Introduction: To compare the utility of the distensibility index (DI) on functional lumen imaging probe (FLIP) topography to other esophagogastric junction (EGJ) metrics in assessing treatment response in achalasia in the context of esophageal anatomy.

Methods: We prospectively evaluated 79 patients (at ages 17-81 years; 47% female patients) with achalasia during follow-up after pneumatic dilation, Heller myotomy, or per-oral endoscopic myotomy with timed barium esophagram, high-resolution impedance manometry, and FLIP. Anatomic deformities were identified based on consensus expert opinion.

Comparison of Tin Filter-Based Spectral Shaping CT and Low-Dose Protocol for Detection of Urinary Calculi.

Objective: The purpose of this study was to assess the performance of tin filter-based spectral shaping CT compared with routine low-dose CT for detection of urolithiasis.

Materials And Methods: Unenhanced third-generation dual-source CT scans of 129 consecutively registered patients were retrospectively reviewed: 43 patients underwent CT for detection of renal stones with tin filtration (Sn150 kV); 43 patients underwent a routine low-dose CT protocol at 100 kV; and 43 patients underwent a routine CT protocol with automated tube potential selection (110-120 kV). Image quality was evaluated subjectively and objectively.

Using value-based analysis to influence outcomes in complex surgical systems.

Background: Value-based analysis (VBA) is a management strategy used to determine changes in value (quality/cost) when a usual practice (UP) is replaced by a best practice (BP). Previously validated in clinical initiatives, its usefulness in complex systems is unknown. To answer this question, we used VBA to correct deficiencies in cardiac surgery at Memorial Healthcare System.

Establishment of genetically diverse patient-derived xenografts of colorectal cancer.

Preclinical compounds tested in animal models often show limited efficacy when transitioned into human clinical trials. As a result, many patients are stratified into treatment regimens that have little impact on their disease. In order to create preclinical models that can more accurately predict tumor responses, we established patient-derived xenograft (PDX) models of colorectal cancer (CRC).

Anastomotic leaks: technique and timing of detection.

Background: Despite the proven benefits of laparoscopic colorectal surgery, the rate of anastomotic leaks has not changed. This study looks at the time of presentation of anastomotic leaks between laparoscopic and open colectomies.

Methods: Retrospective chart review was performed between July 2008 and 2012.

Can moral reasoning predict general surgery residents' clinical competence?

Background: When selecting residents for residency programs, there has been little success using standard academic criteria to predict their clinical performance. However, numerous studies in the past have found linkages between the nonstandard variable moral reasoning as measured by the instrument Defining Issues Test (Version 2; DIT-2) and clinical decision making with higher levels of moral reasoning linked to better clinical performance. This study sought to determine whether this important linkage exists in surgery residents.

Minimally invasive colorectal resection is associated with a transient increase in plasma hepatocyte growth factor levels early after surgery for colon cancer.

Introduction: Surgery's impact on blood levels of hepatocyte growth factor (HGF), a potent angiogenic factor, is unknown. Preoperative (PreOp) HGF blood levels are elevated in patients with colorectal cancer (CRC) and correlate with disease stage and prognosis. This study's purpose was to determine plasma HGF levels after minimally invasive colorectal resection (MICR) in patients with CRC.

Minimally invasive colorectal resection for cancer is associated with a short-lived decrease in soluble Tie-2 receptor levels, which may transiently inhibit VEGF-mediated angiogenesis (via altered blood levels of free Ang-1 and Ang-2).

Background: Angiopoetin- (Ang-) 1 inhibits and Ang-2 promotes VEGF-mediated angiogenesis via binding to endothelial cell-bound Tie-2 receptor (Tie-2). After minimally invasive colorectal resection (MICR), Ang-1 levels decrease and Ang-2 levels increase, which may stimulate angiogenesis in wounds and residual tumor foci. Soluble Tie-2 (sTie-2) modulates the effects of free Ang-1 and Ang-2 by binding to them.

Patterns of injury in geriatric falls.

Falls are the most common cause of trauma in the elderly. Data regarding patterns of injury following geriatric falls are scant. We conducted a retrospective review of falls in patients aged 65 years and older seen at a trauma center over a nine year period.

A comparison of laparoscopic, hand-assist and open sigmoid resection in the treatment of diverticular disease.

Background: Laparoscopic colorectal surgery (LAP) has become more prevalent as evidence of its safety and benefits become apparent. However, in difficult cases, hand-assisted instrumentation has facilitated LAP. We examined the impact of hand-assisted laparoscopic surgery (HALS) on the treatment of sigmoid diverticular disease.

Local excision of stratified T1 rectal cancer.

Background: Local excision has been accepted therapy for T1 rectal cancers. A recent study demonstrated that primary tumors with deeper submucosal invasion were associated with a higher rate of lymph node metastases than those with shallow invasion. Our aim was to determine the effect of the depth of submucosal penetration on recurrence and mortality rates following transrectal excision of T1 tumors.

Colonoscopy in the office setting is safe, and financially sound ... for now.

Purpose: In 2000, the Centers for Medicare & Medicaid Services announced a plan to allow for enhanced reimbursement for office endoscopy. This change in reimbursement was phased in during three years. The purpose of this study was to evaluate the fiscal outcomes and quality measures in the first two and a one-half years of performing endoscopy in an office setting under the new Centers for Medicare & Medicaid Services guidelines.

Practice parameters for the surgical treatment of ulcerative colitis.

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus.

Genetic testing for hereditary nonpolyposis colorectal cancer.

Approximately 80 per cent of patients with colorectal cancer have sporadic disease whereas the remaining 20 per cent seem to have a genetic component. Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common autosomal dominant hereditary syndrome predisposing to colorectal cancer. Various methods have been described to screen for HNPCC and to directly test for mismatch repair gene mutations.