Quality Improvement Report: The Sliding Sign Initiative-Facilitating Earlier Detection of Deep Endometriosis in an Academic US Department.

A delayed diagnosis of endometriosis can significantly impact a patient's quality of life. To facilitate an earlier diagnosis, we implemented a modified pelvic US protocol that included use of the dynamic sliding sign (SS) maneuver to screen at-risk populations. The aim of this initiative was to improve both SS maneuver performance and SS reporting consistency to 80% and determine the number of new endometriosis cases identified after US.

Deep Learning Based Shear Wave Detection and Segmentation Tool for Use in Point-of-Care for Chronic Liver Disease Assessments.

Objective: As metabolic dysfunction-associated steatotic liver disease (MASLD) becomes more prevalent worldwide, it is imperative to create more accurate technologies that make it easy to assess the liver in a point-of-care setting. The aim of this study is to test the performance of a new software tool implemented in Velacur (Sonic Incytes), a liver stiffness and ultrasound attenuation measurement device, on patients with MASLD. This tool employs a deep learning-based method to detect and segment shear waves in the liver tissue for subsequent analysis to improve tissue characterization for patient diagnosis.

Cost-Effectiveness of the ACR TIRADS Compared to the ATA 2015 Risk Stratification Systems in the Evaluation of Incidental Thyroid Nodules.

Rationale And Objectives: Thyroid nodules are a common incidental imaging finding and prone to overdiagnosis. Several risk stratification systems have been developed to reduce unnecessary work-up, with two of the most utilized including the American Thyroid Association 2015 (ATA2015) and the newer American College of Radiology Thyroid Imaging, Reporting and Data System (TIRADS) guidelines. The purpose of this study is to evaluate the cost-effectiveness of the ATA2015 versus the TIRADS guidelines in the management of incidental thyroid nodules.

Velacur ACE outperforms FibroScan CAP for diagnosis of MASLD.

Background: As the prevalence of metabolic dysfunction-associated steatotic liver disease increases, it is imperative to have noninvasive alternatives to liver biopsy. Velacur offers a non-invasive, point-of-care ultrasound-based method for the assessment of liver stiffness and attenuation. The aim of this study was to perform a head-to-head comparison of liver stiffness and liver fat determined by Velacur and FibroScan using MRI-based measurements as the reference standard.

A qualitative study of childhood cancer families' post-treatment needs and the impact of a community-based organization in a rural, socioeconomically disadvantaged, majority Hispanic/Latino region.

Background: Individual- and population-level socioeconomic disadvantages contribute to unequal outcomes among childhood cancer survivors. Reducing health disparities requires understanding experiences of survivors from historically marginalized communities, including those with non-English language preference.

Procedure: We partnered with a community-based organization (CBO) serving families of children with cancer in a rural region in California with low socioeconomic status and majority Hispanic/Latino (H/L) residents.

Bi-parametric prostate MRI with a recall system for contrast enhanced imaging: Improving accessibility while maintaining quality.

Purpose: To review the efficacy of a recall system for bi-parametric non-contrast prostate MRI (bp-MRI).

Methods: A bi-parametric protocol was instituted in July 2020 for all patients who had a prostate MRI requested, excluding those after treatment of prostate cancer, patients with hip prosthesis or pacemaker, and those who lived out-of-town. The protocol consisted of tri-planar T2-weighted and diffusion weighted images (DWI) (b = 50, 800 s/mm for ADC map; b = 1,500 s/mm acquired separately) in accordance with the Prostate Imaging Reporting & Data system (PI-RADS) v2.

Evaluating Epidemiologic Trends and Variations in NICU Admissions in California, 2008 to 2018.

Objective: Previous research suggests increasing numbers of and variation in NICU admissions. We explored whether these trends were reflected in California by examining NICU admissions and birth data in aggregate and among patient and hospital subpopulations more susceptible to variations in care.

Methods: In this retrospective cohort study, we evaluated NICU utilization between 2008 and 2018 for all live births at hospitals that provide data to the California Perinatal Quality Care Collaborative.

"My Home Away From Home": Community Support for International Pediatric and Young Adult Patients and Their Families in End-of-Life Care and Bereavement.

Foreign national patients and families can face life-limiting illness and end-of-life care far from home; this palliative need has not been well described. We present a case of a 20-year-old Ugandan patient diagnosed with metastatic alveolar rhabdomyosarcoma who presented to a pediatric academic medical center in California. Despite treatment, her disease progressed and she was unable to return to Uganda due to symptom burden.

Cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors: the role of a community-based organization and the social determinants of health.

Purpose: Adherence to survivorship care is suboptimal among pediatric and adolescent/young adult (AYA) cancer survivors. We evaluated predictors of cancer center-based follow-up among pediatric/AYA cancer survivors, with an emphasis on social determinants of health (SDOH).

Methods: This retrospective cohort study used electronic health record data at an academic medical center to identify patients aged 0-29 years at last cancer treatment who completed treatment 2010-2019.

Current Practice Patterns, Challenges, and Need for Education in Performing and Reporting Advanced Pelvic US and MRI to Investigate Endometriosis: A Survey by the Canadian Association of Radiologists Endometriosis Working Group.

The Canadian Association of Radiologists (CAR) Endometriosis Working Group developed a national survey to evaluate current practice patterns associated with imaging endometriosis using advanced pelvic ultrasound and MRI to inform forthcoming clinical practice guidelines for endometriosis imaging. The anonymous survey consisted of 36 questions and was distributed electronically to CAR members. The survey contained a mix of multiple choice, Likert scale and open-ended questions intended to collect information about training and certification, current practices and protocols associated with imaging endometriosis, opportunities for quality improvement and continuing professional development.

Towards transcervical ultrasound image guidance for transoral robotic surgery.

Purpose: Trans-oral robotic surgery (TORS) using the da Vinci surgical robot is a new minimally-invasive surgery method to treat oropharyngeal tumors, but it is a challenging operation. Augmented reality (AR) based on intra-operative ultrasound (US) has the potential to enhance the visualization of the anatomy and cancerous tumors to provide additional tools for decision-making in surgery.

Methods: We propose a US-guided AR system for TORS, with the transducer placed on the neck for a transcervical view.

An evaluation of the contribution of routine ultrasound when performed with multiphase CT in renal donor imaging assessment.

Objectives: We sought to examine the contribution of routine ultrasound when performed with computed tomography in identifying exclusion criteria in potential living kidney donors.

Methods: We performed a 10-year retrospective cohort study including all cases of potential renal donors at our center. For each case, the donor workup ultrasound (US) and multiphase computed tomography (MPCT) original reports and imaging were reviewed by a fellowship-trained abdominal radiologist in consultation with a transplant urologist and placed into one of 3 groups: (1) no significant US contribution, (2) US was useful to characterize an incidental finding (either US exclusive or US aided in CT interpretation) but did not impact donor eligibility, and (3) an US exclusive finding contributed to donor exclusion.

DNA methylation-based classification of glioneuronal tumours synergises with histology and radiology to refine accurate molecular stratification.

Aims: Glioneuronal tumours (GNTs) are poorly distinguished by their histology and lack robust diagnostic indicators. Previously, we showed that common GNTs comprise two molecularly distinct groups, correlating poorly with histology. To refine diagnosis, we constructed a methylation-based model for GNT classification, subsequently evaluating standards for molecular stratification by methylation, histology and radiology.

What's new in the hot gallbladder: the evolving radiologic diagnosis and management of acute cholecystitis.

Acute cholecystitis (AC) is a common condition and its incidence is rising. New technologies have advanced the imaging diagnosis of AC, providing more structural and functional information as well as allowing the radiologist to distinguish AC from mimics and identify complications from both the disease and its management. Dual energy CT aids in detecting gallstones and gallbladder wall enhancement, which helps to diagnose AC and identify its complications.

Evaluating Care in Safety Net Hospitals: Clinical Outcomes and Neonatal Intensive Care Unit Quality of Care in California.

Objectives: To examine the characteristics of safety net (sn) and non-sn neonatal intensive care units (NICUs) in California and evaluate whether the site of care is associated with clinical outcomes.

Study Design: This population-based retrospective cohort study of 34 snNICUs and 104 non-snNICUs included 22 081 infants born between 2014 and 2018 with a birth weight of 401-1500 g or gestational age of 22-29 weeks. Quality of care as measured by the Baby-MONITOR score and rates of survival without major morbidity were compared between snNICUs and non-snNICUs.

How is mobile health technology transforming physician-nurse collaboration?

The integration of mobile health technologies in medical practice has the potential to promote in-person, high-quality care. We examine the impact of Voalte, a healthcare-specific mobile application, on bedside rounding and care coordination. A cross-sectional survey was conducted on 71 medical ward-based nurses from a quaternary-care academic centre, capturing 183 rounding events.

A randomized study of a best practice alert for platelet transfusions.

Background And Objectives: Inappropriate platelet transfusions represent an opportunity for improvements in patient care. Use of a best practice alert (BPA) as clinical decision support (CDS) for red cell transfusions has successfully reduced unnecessary red blood cell (RBC) transfusions in prior studies. We studied the impact of a platelet transfusion BPA with visibility randomized by patient chart.

Three-Dimensional Multi-Frequency Shear Wave Absolute Vibro-Elastography (3D S-WAVE) With a Matrix Array Transducer: Implementation and Preliminary In Vivo Study of the Liver.

Magnetic resonance elastography (MRE) is commonly regarded as the imaging-based gold-standard for liver fibrosis staging, comparable to biopsy. While ultrasound-based elastography methods for liver fibrosis staging have been developed, they are confined to a 1D or a 2D region of interest and to a limited depth. 3D Shear Wave Absolute Vibro-Elastography (S-WAVE) is a steady-state, external excitation, volumetric elastography technique that is similar to MRE, but has the additional advantage of multi-frequency excitation.

Increased Stiffness Inhibits Invadopodia Formation and Cell Migration in 3D.

Cancer cells typically invade through basement membranes (BMs) at key points during metastasis, including primary tumor invasion, intravasation, and extravasation. Cells extend invadopodia protrusions to create channels in the nanoporous BM through which they can invade, either via proteolytic degradation or mechanical force. Increased matrix stiffness can promote cancer progression, and two-dimensional (2D) culture studies indicate that increased stiffness promotes invadopodia degradation activity.

Osmotic Dilator Intra-Abdominal Perforation: A Case Report.

Background: This report describes an unusual case of a retained hygroscopic osmotic dilator following second trimester dilation and evacuation.

Case: A 24-year-old woman presented for elective pregnancy termination at 16 weeks gestational age. A cervical osmotic dilator could not be retrieved and fractured on attempted removal.

Autonomic Dysreflexia in Patients With Spinal Cord Injury: What the Radiologist Needs to Know.

Autonomic dysreflexia (AD) is a potentially life-threatening condition that occurs in patients with cervical and high thoracic spinal cord injury (SCI). AD is not completely understood and has a high incidence that increases proportional to the level and severity of the SCI. The signs and symptoms can vary, but severe hypertension is a dominant feature and may be fatal.