Diagnostic accuracy and added value of dual-energy subtraction radiography compared to standard conventional radiography using computed tomography as standard of reference

PURPOSE: To retrospectively evaluate diagnostic performance of dual-energy subtraction radiography (DESR) for interpretation of chest radiographs compared to conventional radiography (CR) using computed tomography (CT) as standard of reference. MATERIAL AND METHODS: A total of 199 patients (75 female, median age 67) were included in this institutional review board (IRB)-approved clinical trial. All patients were scanned in posteroanterior and lateral direction with dual-shot DE-technique. Chest CT was performed within ±72 hours. The system provides three types of images: bone weighted-image, soft tissue weighted-image, herein termed as DESR-images, and a standard image, termed CR-image (marked as CR-image). Images were evaluated by two radiologists for presence of inserted life support lines, pneumothorax, pleural effusion, infectious consolidation, interstitial lung changes, tumor, skeletal alterations, soft tissue alterations, aortic or tracheal calcification and pleural thickening. Inter-observer agreement between readers and diagnostic performance were calculated. McNemar's test was used to test for significant differences. RESULTS: Mean inter-observer agreement throughout the investigated parameters was higher in DESR images compared to CR-images (kDESR = 0.935 vs. kCR = 0.858). DESR images provided significantly increased sensitivity compared to CR-images for the detection of infectious consolidations (42% vs. 62%), tumor (46% vs. 57%), interstitial lung changes (69% vs. 87%) and aortic or tracheal calcification (25 vs. 73%) (p<0.05). There were no significant differences in sensitivity for the detection of inserted life support lines, pneumothorax, pleural effusion, skeletal alterations, soft tissue alterations or pleural thickening (p>0.05). CONCLUSION: DESR increases significantly the sensibility without affecting the specificity evaluating chest radiographs, with emphasis on the detection of interstitial lung diseases

Electroconvulsive therapy in a patient with hypertrophic cardiomyopathy: A case report

The use of electroconvulsive therapy (ECT) in patients with underlying cardiac disease like hypertrophic cardiomyopathy (HCM) remains without satisfactory clinical guidelines. We provide a case report of successful application of ECT in a 43-year-old patient with bipolar disorder and comorbid HCM, including detailed diagnostic information and outlining key clinical considerations

Machine learning in cardiovascular radiology:ESCR position statement on design requirements, quality assessment, current applications, opportunities, and challenges

Machine learning offers great opportunities to streamline and improve clinical care from the perspective of cardiac imagers, patients, and the industry and is a very active scientific research field. In light of these advances, the European Society of Cardiovascular Radiology (ESCR), a non-profit medical society dedicated to advancing cardiovascular radiology, has assembled a position statement regarding the use of machine learning (ML) in cardiovascular imaging. The purpose of this statement is to provide guidance on requirements for successful development and implementation of ML applications in cardiovascular imaging. In particular, recommendations on how to adequately design ML studies and how to report and interpret their results are provided. Finally, we identify opportunities and challenges ahead. While the focus of this position statement is ML development in cardiovascular imaging, most considerations are relevant to ML in radiology in general. KEY POINTS: • Development and clinical implementation of machine learning in cardiovascular imaging is a multidisciplinary pursuit. • Based on existing study quality standard frameworks such as SPIRIT and STARD, we propose a list of quality criteria for ML studies in radiology. • The cardiovascular imaging research community should strive for the compilation of multicenter datasets for the development, evaluation, and benchmarking of ML algorithms

Diagnostic accuracy and added value of dual-energy subtraction radiography compared to standard conventional radiography using computed tomography as standard of reference

PURPOSE: To retrospectively evaluate diagnostic performance of dual-energy subtraction radiography (DESR) for interpretation of chest radiographs compared to conventional radiography (CR) using computed tomography (CT) as standard of reference. MATERIAL AND METHODS: A total of 199 patients (75 female, median age 67) were included in this institutional review board (IRB)-approved clinical trial. All patients were scanned in posteroanterior and lateral direction with dual-shot DE-technique. Chest CT was performed within ±72 hours. The system provides three types of images: bone weighted-image, soft tissue weighted-image, herein termed as DESR-images, and a standard image, termed CR-image (marked as CR-image). Images were evaluated by two radiologists for presence of inserted life support lines, pneumothorax, pleural effusion, infectious consolidation, interstitial lung changes, tumor, skeletal alterations, soft tissue alterations, aortic or tracheal calcification and pleural thickening. Inter-observer agreement between readers and diagnostic performance were calculated. McNemar's test was used to test for significant differences. RESULTS: Mean inter-observer agreement throughout the investigated parameters was higher in DESR images compared to CR-images (kDESR = 0.935 vs. kCR = 0.858). DESR images provided significantly increased sensitivity compared to CR-images for the detection of infectious consolidations (42% vs. 62%), tumor (46% vs. 57%), interstitial lung changes (69% vs. 87%) and aortic or tracheal calcification (25 vs. 73%) (p0.05). CONCLUSION: DESR increases significantly the sensibility without affecting the specificity evaluating chest radiographs, with emphasis on the detection of interstitial lung diseases

Small Beetle, Large-scale Drivers: How Regional and Landscape Factors Affect Outbreaks of the European Spruce Bark Beetle

Unprecedented bark beetle outbreaks have been observed for a variety of forest ecosystems recently, and damage is expected to further intensify as a consequence of climate change. In Central Europe, the response of ecosystem management to increasing infestation risk has hitherto focused largely on the stand level, while the contingency of outbreak dynamics on large‐scale drivers remains poorly understood. To investigate how factors beyond the local scale contribute to the infestation risk from Ips typographus (Col., Scol.), we analysed drivers across seven orders of magnitude in scale (from 103 to 1010 m²) over a 23‐year period, focusing on the Bavarian Forest National Park. Time‐discrete hazard modelling was used to account for local factors and temporal dependencies. Subsequently, beta regression was applied to determine the influence of regional and landscape factors, the latter characterized by means of graph theory. We found that in addition to stand variables, large‐scale drivers also strongly influenced bark beetle infestation risk. Outbreak waves were closely related to landscape‐scale connectedness of both host and beetle populations as well as to regional bark beetle infestation levels. Furthermore, regional summer drought was identified as an important trigger for infestation pulses. Large‐scale synchrony and connectivity are thus key drivers of the recently observed bark beetle outbreak in the area. Synthesis and applications. Our multiscale analysis provides evidence that the risk for biotic disturbances is highly dependent on drivers beyond the control of traditional stand‐scale management. This finding highlights the importance of fostering the ability to cope with and recover from disturbance. It furthermore suggests that a stronger consideration of landscape and regional processes is needed to address changing disturbance regimes in ecosystem management

Sensitivity and specificity in detection of interstitial lung changes in detail.

<p>Sensitivity and specificity in detection of interstitial lung changes in detail.</p

Sensitivity and Specificity in detection of pathologic lung changes and inserted life support lines.

<p>Sensitivity and Specificity in detection of pathologic lung changes and inserted life support lines.</p

Patient characteristics.

<p>Patient characteristics.</p

Inter-reader agreement in detection of pathologic lung changes and inserted life support lines.

<p>Inter-reader agreement in detection of pathologic lung changes and inserted life support lines.</p

Lung mass on different imaging modalities.

<p>61 year old female patient showing a focal increase in density in the left upper lobe in the CR image (a). This focal increase in density is not visible on the bone image (b) while it is clearly depicted by the soft tissue image (c) and therefore is primarily suspicious for a soft tissue mass in the left upper lobe. CT (d) confirms the presence of a soft tissue mass in the left upper lobe adjacent to the aortic arch suspicious for a bronchus carcinoma.</p