Percutaneous Core Biopsy Devices: A Detailed Review and Comparison of Different Needle Designs.

Percutaneous core-needle biopsy (PCNB) plays a growing and essential role in many medical specialties. Proper and effective use of various PCNB devices requires basic understanding of how they function. Current literature lacks a detailed overview and illustration of needle function and design differences, a potentially valuable reference for users ranging from early trainees to experts who are less familiar with certain devices.

Imaging AI in Practice: A Demonstration of Future Workflow Using Integration Standards.

Artificial intelligence (AI) tools are rapidly being developed for radiology and other clinical areas. These tools have the potential to dramatically change clinical practice; however, for these tools to be usable and function as intended, they must be integrated into existing radiology systems. In a collaborative effort between the Radiological Society of North America, radiologists, and imaging-focused vendors, the Imaging AI in Practice (IAIP) demonstrations were developed to show how AI tools can generate, consume, and present results throughout the radiology workflow in a simulated clinical environment.

CT Esophagography for Evaluation of Esophageal Perforation.

Esophageal emergencies such as rupture or postoperative leak are uncommon but may be life threatening when they occur. Delay in their diagnosis and treatment may significantly increase morbidity and mortality. Causes of esophageal injury include iatrogenic (including esophagogastroduodenoscopy and stent placement), foreign body ingestion, blunt or penetrating trauma to the chest or abdomen, and forceful retching, also called Boerhaave syndrome.

Atherosclerotic Plaque Burden on Abdominal CT: Automated Assessment With Deep Learning on Noncontrast and Contrast-enhanced Scans.

Background: Abdominal aortic atherosclerotic plaque burden may have clinical significance but manual measurement is time-consuming and impractical.

Purpose: To perform external validation on an automated atherosclerotic plaque detector for noncontrast and postcontrast abdominal CT.

Materials And Methods: The training data consisted of 114 noncontrast CT scans and 23 postcontrast CT urography scans.

Structured Reporting in Ultrasound.

Structured reporting of ultrasound examinations can add value throughout the imaging chain. Reports may be created in a more efficient manner, with increased accuracy and clarity. Communication with referring providers and patients may be improved.

CT automated exposure control using a generalized detectability index.

Purpose: Identifying an appropriate tube current setting can be challenging when using iterative reconstruction due to the varying relationship between spatial resolution, contrast, noise, and dose across different algorithms. This study developed and investigated the application of a generalized detectability index ( ) to determine the noise parameter to input to existing automated exposure control (AEC) systems to provide consistent image quality (IQ) across different reconstruction approaches.

Methods: This study proposes a task-based automated exposure control (AEC) method using a generalized detectability index ( ).

Does Nonenhanced CT-based Quantification of Abdominal Aortic Calcification Outperform the Framingham Risk Score in Predicting Cardiovascular Events in Asymptomatic Adults?

Purpose To determine if abdominal aortic calcification (AAC) at CT predicts cardiovascular events independent of Framingham risk score (FRS). Materials and Methods For this retrospective study, electronic health records for 829 asymptomatic patients (mean age, 57.9 years; 451 women, 378 men) who underwent nonenhanced CT colonography screening between April 2004 and March 2005 were reviewed for subsequent cardiovascular events; mean follow-up interval was 11.

Semiautomated System for Nonurgent, Clinically Significant Pathology Results.

Background: Failure of timely test result follow-up has consequences including delayed diagnosis and treatment, added costs, and potential patient harm. Closed-loop communication is key to ensure clinically significant test results (CSTRs) are acknowledged and acted upon appropriately. A previous implementation of the Alert Notification of Critical Results (ANCR) system to facilitate closed-loop communication of imaging CSTRs yielded improved communication of critical radiology results and enhanced adherence to institutional CSTR policies.

Characterizing indeterminate liver lesions in patients with localized pancreatic cancer at the time of diagnosis.

Background: In patients with newly diagnosed pancreatic cancer, the classification of indeterminate liver lesions is an unanswered clinical dilemma as misclassification of these lesions can impact the assignment of clinical stage and subsequent treatment planning. Our objective was to design a standardized classification system to more accurately define the risk of malignancy in indeterminate liver lesions.

Methods: In this retrospective study, patients with localized, non-metastatic pancreatic cancer were identified and pre-treatment computed tomography (CT) scans were evaluated for the presence or absence of liver lesions.

Renal cancer at unenhanced CT: imaging features, detection rates, and outcomes.

Purpose: To describe and quantify the rate of detection of renal cancer on unenhanced CT.

Methods: This retrospective, HIPAA-compliant study was approved by the Institutional Review Board. Electronic health records for all patients who underwent unenhanced abdominal CT at our institution between 2000 and 2005 were reviewed to identify patients subsequently diagnosed with renal cancer during a follow-up period of up to 12 years.

Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis.

Introduction: Optimal critical test result communication is a Joint Commission national patient safety goal and requires documentation of closed-loop communication among care providers in the medical record. Electronic alert notification systems can facilitate an auditable process for creating alerts for transmission and acknowledgement of critical test results. We evaluated the impact of a patient safety initiative with an alert notification system on reducing critical results lacking documented communication, and assessed potential overuse of the alerting system for communicating results.

Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up?

Objective: To assess whether integrating critical result management software--Alert Notification of Critical Results (ANCR)--with an electronic health record (EHR)-based results management application impacts closed-loop communication and follow-up of nonurgent, clinically significant radiology results by primary care providers (PCPs).

Materials And Methods: This institutional review board-approved study was conducted at a large academic medical center. Postintervention, PCPs could acknowledge nonurgent, clinically significant ANCR-generated alerts ("alerts") within ANCR or the EHR.

Automated critical test result notification system: architecture, design, and assessment of provider satisfaction.

Objective: Communicating critical results of diagnostic imaging procedures is a national patient safety goal. The purposes of this study were to describe the system architecture and design of Alert Notification of Critical Results (ANCR), an automated system designed to facilitate communication of critical imaging results between care providers; to report providers' satisfaction with ANCR; and to compare radiologists' and ordering providers' attitudes toward ANCR.

Materials And Methods: The design decisions made for each step in the alert communication process, which includes user authentication, alert creation, alert communication, alert acknowledgment and management, alert reminder and escalation, and alert documentation, are described.

Journal club: Requiring clinical justification to override repeat imaging decision support: impact on CT use.

Objective: The purpose of this study was to determine the impact of requiring clinical justification to override decision support alerts on repeat use of CT.

Subjects And Methods: This before and after intervention study was conducted at a 793-bed tertiary hospital with computerized physician order entry and clinical decision support systems. When a CT order is placed, decision support alerts the orderer if the patient's same body part has undergone CT within the past 90 days.

Four-year impact of an alert notification system on closed-loop communication of critical test results.

Objective: One of the patient safety goals proposed by the Joint Commission urges hospitals to develop a policy for communicating critical test results and to measure adherence to that policy. We evaluated the impact of an alert notification system on policy adherence for communicating critical imaging test results to referring providers and assessed system adoption over the first 4 years after implementation.

Materials And Methods: This study was performed in a 753-bed academic medical center.

Simple cyst-appearing renal masses at unenhanced CT: can they be presumed to be benign?

Purpose: To determine renal cancer incidence in simple cyst-appearing renal masses detected at unenhanced computed tomography (CT).

Materials And Methods: Institutional review board approval and an informed consent waiver for this retrospective HIPAA-compliant study were obtained. Patients who had renal masses with homogeneous water attenuation, hairline-thin smooth walls, and no calcifications or septations were identified by applying a validated natural language processing algorithm to radiology reports for 15 695 unique patients who underwent unenhanced abdominal CT at our institution between 2000 and 2005.

Renal cell carcinoma: attenuation values on unenhanced CT.

Objective: The purpose of this study is to analyze the attenuation values of pathologically proven renal cell carcinomas (RCCs) on unenhanced CT and to determine the range of values wherein malignancy should be considered.

Materials And Methods: A retrospective review was performed of 189 consecutive patients with 193 pathologically proven RCCs 1 cm or larger on unenhanced CT. For each RCC, attenuation values were assessed throughout the tumor by continuous sampling with a 25-100-mm(2) region of interest (ROI), avoiding foci of calcification and peritumoral volume averaging.

Visceral adiposity and hepatic steatosis at abdominal CT: association with the metabolic syndrome.

Objective: Visceral adiposity and hepatic steatosis may correlate with the metabolic syndrome but are not currently among the diagnostic criteria. We evaluated these features at unenhanced MDCT.

Materials And Methods: Semiautomated measurements of subcutaneous fat area, visceral fat area, and visceral fat percentage were obtained at the umbilical level at unenhanced MDCT of 474 adults (217 men, 257 women; mean age, 58.

Incidental finding of renal masses at unenhanced CT: prevalence and analysis of features for guiding management.

Objective: The purposes of this study were to investigate the frequency and clinical relevance of the incidental finding of renal masses at low-dose unenhanced CT and to analyze the results for features that can be used to guide evaluation.

Materials And Methods: Images from unenhanced CT colonographic examinations of 3001 consecutively registered adults without symptoms (1667 women, 1334 men; mean age, 57 years) were retrospectively reviewed for the presence of cystic and solid renal masses 1 cm in diameter or larger. An index mass, that is, the most complex or concerning, in each patient was assessed for size, mean attenuation, and morphologic features.

Coagulation concepts update.

Objective: Since the previous comprehensive radiology review on coagulation concepts that was done in 1990, many studies have been published in the medical and surgical literature that can guide the approach of a radiology practice. The purpose of this article is to provide an analysis of these works, updating the radiologist on proper use and interpretation of coagulation assessment tools, medications that modify the hemostatic system, and the use of transfusions prior to interventions.

Conclusion: The basic tools for coagulation assessment have not changed; however, results from subspecialty research have suggested ways in which the use of these tools can be modified and streamlined to safely reduce time and expense for the patient and the health care system.

Lytic metastases in thoracolumbar spine: computer-aided detection at CT--preliminary study.

Purpose: To evaluate the sensitivity of a computer-aided detection (CAD) system for detection of lytic thoracolumbar spinal lesions at body CT, with results of manual lesion segmentation as the reference standard.

Materials And Methods: The study was HIPAA compliant and institutional review board approved; the institutional review board waived the need for informed consent. The CAD system segments the spine on CT images and searches for detections that match size, shape, location, and attenuation criteria.

Revisiting oral barium sulfate contrast agents.

Oral contrast agents used during CT colonography (CTC) are valuable and may reduce false positive and false negative detections due to stool and residual fluid. Electronic cleansing algorithms are feasible, and oral contrast agents can eliminate the CTC requirement for a clean colon. Recent work shows oral contrast frequently adheres to polyps, with a preference for those with villous histology, a characteristic of advanced polyps.