Blended learning of radiology improves medical students’ performance, satisfaction, and engagement

Purpose To evaluate the impact of blended learning using a combination of educational resources (flipped classroom and short videos) on medical students’ (MSs) for radiology learning. Material and methods A cohort of 353 MSs from 2015 to 2018 was prospectively evaluated. MSs were assigned to four groups (high, high-intermediate, low-intermediate, and low achievers) based on their results to a 20-MCQs performance evaluation referred to as the pretest. MSs had then free access to a self-paced course totalizing 61 videos based on abdominal imaging over a period of 3 months. Performance was evaluated using the change between posttest (the same 20 MCQs as pretest) and pretest results. Satisfaction was measured using a satisfaction survey with directed and spontaneous feedbacks. Engagement was graded according to audience retention and attendance on a web content management system. Results Performance change between pre and posttest was significantly different between the four categories (ANOVA, P = 10−9): low pretest achievers demonstrated the highest improvement (mean ± SD, + 11.3 ± 22.8 points) while high pretest achievers showed a decrease in their posttest score (mean ± SD, − 3.6 ± 19 points). Directed feedback collected from 73.3% of participants showed a 99% of overall satisfaction. Spontaneous feedback showed that the concept of “pleasure in learning” was the most cited advantage, followed by “flexibility.” Engagement increased over years and the number of views increased of 2.47-fold in 2 years. Conclusion Learning formats including new pedagogical concepts as blended learning, and current technologies allow improvement in medical student’s performance, satisfaction, and engagement

Joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards on recommended use of [18F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors version 1.0

PURPOSE: The goal of this guideline/procedure standard is to assist nuclear medicine physicians, other nuclear medicine professionals, oncologists or other medical specialists for recommended use of [ METHODS: In a cooperative effort between the EANM, the SNMMI and the ANZSNM, clinical indications, recommended imaging procedures and reporting standards have been agreed upon and summarized in this joint guideline/procedure standard. CONCLUSIONS: The field of immuno-oncology is rapidly evolving, and this guideline/procedure standard should not be seen as definitive, but rather as a guidance document standardizing the use and interpretation of [ PREAMBLE: The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association founded in 1985 to facilitate worldwide communication among individuals pursuing clinical and academic excellence in nuclear medicine. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote science, technology and practical application of nuclear medicine. The Australian and New Zealand Society of Nuclear Medicine (ANZSNM), founded in 1969, represents the major professional society fostering the technical and professional development of nuclear medicine practice across Australia and New Zealand. It promotes excellence in the nuclear medicine profession through education, research and a commitment to the highest professional standards. EANM, SNMMI and ANZSNM members are physicians, technologists, physicists and scientists specialized in the research and clinical practice of nuclear medicine. All three societies will periodically put forth new standards/guidelines for nuclear medicine practice to help advance the science of nuclear medicine and improve service to patients. Existing standards/guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each standard/guideline, representing a policy statement by the EANM/SNMMI/ANZSNM, has undergone a thorough consensus process, entailing extensive review. These societies recognize that the safe and effective use of diagnostic nuclear medicine imaging requires particular training and skills, as described in each document. These standards/guidelines are educational tools designed to assist practitioners in providing appropriate and effective nuclear medicine care for patients. These guidelines are consensus documents based on current knowledge. They are not intended to be inflexible rules or requirements of practice, nor should they be used to establish a legal standard of care. For these reasons and those set forth below, the EANM, SNMMI and ANZSNM caution against the use of these standards/guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals considering the unique circumstances of each case. Thus, there is no implication that an action differing from what is laid out in the guidelines/procedure standards, standing alone, is below standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the standards/guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources or advances in knowledge or technology subsequent to publication of the guidelines/procedure standards. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible for general guidelines to consistently allow for an accurate diagnosis to be reached or a particular treatment response to be predicted. Therefore, it should be recognized that adherence to these standards/ guidelines will not ensure a successful outcome. All that should be expected is that practitioners follow a reasonable course of action, based on their level of training, current knowledge, clinical practice guidelines, available resources and the needs/context of the patient being treated. The sole purpose of these guidelines is to assist practitioners in achieving this objective. The present guideline/procedure standard was developed collaboratively by the EANM, the SNMMI and the ANZSNM, with the support of international experts in the field. They summarize also the views of the Oncology and Theranostics and the Inflammation and Infection Committees of the EANM, as well as the procedure standards committee of the SNMMI, and reflect recommendations for which the EANM and SNMMI cannot be held responsible. The recommendations should be taken into the context of good practice of nuclear medicine and do not substitute for national and international legal or regulatory provisions

Prise de décision individualisée en immuno-oncologie guidée par l'intelligence artificielle et l'analyse du phénotype tumoral en imagerie médicale

Les immunothérapies ciblant les voies du récepteur de la mort cellulaire programmée 1 et de son ligand (anti-PD(L)1) se sont révélées être un traitement efficace pour de nombreux cancers. Le traitement par anti-PD(L)1 constitue un changement de paradigme en oncologie puisque son activité repose sur la restauration d'une réponse efficace des cellules T antitumorales. Deux raisons principales expliquent la nécessité d’identifier des biomarqueurs permettant de prédire la survie et l'efficacité anticancéreuse des anti-PD(L)1. Premièrement, un excès de décès a été observé dans le groupe expérimental d’essais de phase III randomisés comparant les immunothérapies anti-PD(L)1 à la chimiothérapie. Parmi les hypothèses controversées pouvant expliquer cette observation, le manque d'efficacité de l'anti-PD(L)1 chez les patients atteints d'une maladie à croissance rapide (appelés "progresseurs rapides") par rapport à un effet paradoxal de l'accélération de la maladie sous immunothérapie (dits "hyperprogresseurs") sont souvent mentionnés. Deuxièmement, les critères de réponse en imagerie jouent un rôle essentiel dans la prise en charge des patients cancéreux et définissent une "stratégie attentiste" pour les patients avec une maladie évolutive en imagerie. Le mécanisme d’action distinct des anti-PD(L)1, qui restaurent la capacité anti-tumorale du système immunitaire, conduisent à la survenue de profils de réponse non conventionnels tels que la pseudoprogression, l’hyperprogression, l’effet abscopal et les toxicités liées au système immunitaire. Nous avons tiré parti de l’apprentissage automatique pour confronter différents facteurs pronostiques / prédictifs et identifier les biomarqueurs d'imagerie associés à la mort prématurée sous immunothérapie anti-PD(L)1. Nous avons exploité des données transcriptomiques pour déterminer les voies biologiques liées à ces facteurs pronostiques / prédictifs. Nos résultats démontrent qu'un sous-ensemble limité de biomarqueurs d'imagerie peut prévoir la survie globale des patients. La classification de ces biomarqueurs d'imagerie en caractéristiques distinctives fournit une structure conceptuelle et une cohérence logique délimitant les interconnexions entre eux. Ces caractéristiques distinctives peuvent être comprises comme des circuits physiologiques distincts perturbées par le cancer et liés à une survie plus courte : organotropisme hépatique, charge tumorale élevée, hétérogénéité importante dans la vascularisation ou le métabolisme de la tumeur, infiltration le long des bordures de la tumeur, irrégularité de la forme tumorale, forte consommation de glucose, sarcopénie, et métabolisme élevé de la moelle osseuse. En utilisant l’apprentissage automatique, nous avons démontré que l’augmentation de la lactate déshydrogénase sérique et la présence de métastases hépatiques au scanner étaient deux facteurs indépendants de décès prématuré après l’initiation du traitement anti-PD(L)1. L'analyse transcriptomique a identifié des voies de signalisations susceptibles de donner lieu à de nouveaux traitements, et d'améliorer l'efficacité des anti-PD(L)1. Dans une perspective plus large, cela démontre la nécessité de continuer à développer une technologie d'imagerie de pointe pour améliorer la surveillance des patients atteints de cancer traités avec des immunothérapeutiques. Cela implique l'analyse et la liaison des données en pathologie, en oncologie, en radiologie et en médecine nucléaire, ainsi que la capacité de travailler avec de larges ensembles de données. Par conséquent, il est nécessaire de développer des programmes de radiomique pour développer des outils prédictifs utiles au diagnostic, à l'évaluation et à la gestion de tous les types de patients cancéreux. En conclusion, les approches de médecine de précision axées sur la radiomique pourraient améliorer la vie des patients cancéreux traités par immunothérapie anticancéreuse.Immunotherapies targeting the programmed cell death receptor-1 and ligand-1 pathways (anti-PD(L)1) have emerged as an effective treatment for a variety of cancers. Anti-PD(L)1 is a paradigm shift in the treatment of cancers since its activity relies on restoring an efficient anti-tumor T-cell response. Two main reasons explain the need to investigate biomarkers forecasting survival and predicting the anti-cancer efficacy of anti-PD(L)1. First, an excess of death has been observed in the experimental arm of randomized phase III trials comparing anti-PD(L)1 immunotherapies to chemotherapy for multiple cancers. Among the controversial hypotheses that would explain this observation are frequently mentioned the lack of effectiveness of anti-PD(L)1 in patients with a fast-growing disease (so-called "fast progressors") vs. a paradoxical effect of disease acceleration under immunotherapy (so-called "hyperprogressors"). Second, imaging response criteria play a pivotal role in guiding cancer patient management and define a "wait and see strategy" for patients treated with anti-PD(L)1 in monotherapy with progressive disease. The distinct mechanisms of anti-PD(L)1, which restore the immune system's anti-tumor capacity, leads to unconventional immune-related phenomena. From a medical imaging standpoint, it translates into pseudoprogression, hyperprogression, abscopal effect, and immune-related adverse events. We leveraged machine learning approaches to challenge the prognostic/predictive factors and identify which imaging biomarkers are associated with early death upon anti-PD(L)1 immunotherapy. We mined transcriptomic data to determine the biological pathways related to these prognostic/predictive factors. Our results demonstrate that a limited subset of imaging biomarkers can forecast overall survival. The classification of these imaging biomarkers into distinct hallmarks provides a conceptual structure and logical coherence delineating the interconnections between them. These hallmarks can be understood as distinct physiological circuits disrupted by cancer that are linked to shorter survival: liver organotropism, high tumor burden, high heterogeneity in tumor vascularity or metabolism, infiltration along tumor boundaries, irregularity in tumor shape, high glucose consumption, sarcopenia, and high bone marrow metabolism. Using machine-learning, we demonstrated that increased baseline serum lactate dehydrogenase and the presence of liver metastasis on CT-scan are two independent drivers of premature death after anti-PD(L)1 initiation. Transcriptomic analysis identified actionable pathways amenable to novel treatments, which could improve anti-PD(L)1 efficacy. From a broader perspective, this demonstrates the need to continue to develop advanced imaging technology to enhance the monitoring of cancer patients treated with immunotherapeutics. This involves analyzing and linking data in pathology, oncology, and radiology, and the ability to work with extensive datasets. Therefore, there is a need to develop comprehensive programs of radiomics for predictive tools that benefit diagnosis, assessment, and management of all types of cancer patients. In conclusion, radiomics driven precision medicine approaches could improve the lives of cancer patients treated with cancer immunotherapy

Letter from Colonel C. U. Dercle, France, to Mrs. Gorgas, August 10, 1920

The William Crawford Gorgas Papers include material created by and written about Gorgas, as well as material created by Gorgas' family members. His diaries and journals illuminate his life and work for the U.S. Army as a surgeon and span the years he worked in Cuba and Panama. The collection includes official reports and other documents Gorgas wrote and collected, as well as articles and other publications written about Gorgas and his work in sanitation and disease prevention, particularly yellow fever. Correspondence, articles, and other items document the numerous awards and tributes Gorgas received during his life and memorials after his death in 1920. In addition to William Crawford Gorgas material, the collection includes other material belonging to Gorgas family members including Marie Gorgas and their daughter, Aileen Gorgas Wrightson. In 1924, his widow Marie Gorgas published William Crawford Gorgas: His Life and Work. This collection includes manuscripts, galley proofs, and published versions of her work

Future role of [18F]-FDG PET/CT in patients with bladder cancer in the new era of neoadjuvant immunotherapy?

International audienceComment on: [18F]Fluoro-Deoxy-Glucose positron emission tomography to evaluate lymph node involvement in patients with muscle-invasive bladder cancer receiving neoadjuvant pembrolizumab. Marandino L, Capozza A, Bandini M, Raggi D, Farè E, Pederzoli F, Gallina A, Capitanio U, Bianchi M, Gandaglia G, Fossati N, Colecchia M, Giannatempo P, Serafini G, Padovano B, Salonia A, Briganti A, Montorsi F, Alessi A, Necchi A. Urol Oncol. 2021 Apr;39(4):235.e15-235.e21. doi: 10.1016/j.urolonc.2020.09.035. Epub 2020 Oct 16. PMID: 3307110

Utility of Routine Preoperative F-18-Fluorodeoxyglucose Positron Emission Tomography/Computerized Tomography in Identifying Pathological Lymph Node Metastases at Radical Cystectomy. Letter

International audienc