Learning how to perform ultrasound-guided interventions with and without augmented reality visualization: a randomized study

OBJECTIVES Augmented reality (AR), which entails overlay of in situ images onto the anatomy, may be a promising technique for assisting image-guided interventions. The purpose of this study was to investigate and compare the learning experience and performance of untrained operators in puncture of soft tissue lesions, when using AR ultrasound (AR US) compared with standard US (sUS). METHODS Forty-four medical students (28 women, 16 men) who had completed a basic US course, but had no experience with AR US, were asked to perform US-guided biopsies with both sUS and AR US, with a randomized selection of the initial modality. The experimental setup aimed to simulate biopsies of superficial soft tissue lesions, such as for example breast masses in clinical practice, by use of a turkey breast containing olives. Time to puncture(s) and success (yes/no) of the biopsies was documented. All participants completed questionnaires about their coordinative skills and their experience during the training. RESULTS Despite having no experience with the AR technique, time to puncture did not differ significantly between AR US and sUS (median [range]: 17.0 s [6-60] and 14.5 s [5-41], p = 0.16), nor were there any gender-related differences (p = 0.22 and p = 0.50). AR US was considered by 79.5% of the operators to be the more enjoyable means of learning and performing US-guided biopsies. Further, a more favorable learning curve was achieved using AR US. CONCLUSIONS Students considered AR US to be the preferable and more enjoyable modality for learning how to obtain soft tissue biopsies; however, they did not perform the biopsies faster than when using sUS. KEY POINTS • Performance of standard and augmented reality US-guided biopsies was comparable • A more favorable learning curve was achieved using augmented reality US. • Augmented reality US was the preferred technique and was considered more enjoyable

Women in radiology: gender diversity is not a metric-it is a tool for excellence.

Women in Focus: Be Inspired was a unique programme held at the 2019 European Congress of Radiology that was structured to address a range of topics related to gender and healthcare, including leadership, mentoring and the generational progression of women in medicine. In most countries, women constitute substantially fewer than half of radiologists in academia or private practice despite frequently accounting for at least half of medical school enrolees. Furthermore, the proportion of women decreases at higher academic ranks and levels of leadership, a phenomenon which has been referred to as a "leaky pipeline". Gender diversity in the radiologic workplace, including in academic and leadership positions, is important for the present and future success of the field. It is a tool for excellence that helps to optimize patient care and research; moreover, it is essential to overcome the current shortage of radiologists. This article reviews the current state of gender diversity in academic and leadership positions in radiology internationally and explores a wide range of potential reasons for gender disparities, including the lack of role models and mentorship, unconscious bias and generational changes in attitudes about the desirability of leadership positions. Strategies for both individuals and institutions to proactively increase the representation of women in academic and leadership positions are suggested. KEY POINTS: • Gender-diverse teams perform better. Thus, gender diversity throughout the radiologic workplace, including in leadership positions, is important for the current and future success of the field. • Though women now make up roughly half of medical students, they remain underrepresented among radiology trainees, faculty and leaders. • Factors leading to the gender gap in academia and leadership positions in Radiology include a lack of role models and mentors, unconscious biases, other societal barriers and generational changes

USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumors: preliminary results

The aim of this study was to assess nodal enhancement with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) during preoperative staging of gynecological pelvic tumors within the same imaging session for the primary tumor. Pelvic MRI was performed 18-28h after intravenous infusion of USPIO (Combidex/Sinerem, 2.6mg Fe/kg body weight) in 13 women (mean age 51 years) scheduled for surgery for biopsy proven (n=11) or clinically suspected (n=2) uterine carcinoma. Axial T1-weighted spin-echo (SE), T2-weighted fast SE (FSE; with fat saturation), fast spoiled gradient-recalled (FSPGR) echo, sagittal and oblique T2-weighted FSE sequences were acquired on a 1.5-T system. Lymph nodes were prospectively staged using standard criteria, i.e., size and shape, as well as USPIO enhancement. Results were correlated with histology findings. MRI correctly staged all primary uterine tumors. In one case, the preoperative diagnosis of stage IV switched the therapeutic approach to radiochemotherapy. Ninety-one (86 benign, 5 malignant) of the histologically characterized nodes could be correlated with their MRI counterparts. One node was false positive; three micrometastases greater than 5mm and one 5-mm metastasis were missed. On a nodal basis, the sensitivity score was 0.33 and the specificity score, 0.99. On a patient basis, the sensitivity score was 0.25 and the specificity score, 0.80. Our preliminary results indicate that USPIO-enhanced pelvic MRI for preoperative nodal assessment is feasible within one imaging session for primary tumors and that it has a high specificity. However, the low sensitivity in the present study is a limitation for the clinical application of this techniqu

MR assessment of fetal lung development using lung volumes and signal intensities

The purpose of this study was to evaluate the monitoring and diagnostic potential of MRI in fetal lung development and disease using lung volume and signal intensity changes through gestation. Thirty-five healthy fetuses (22-42weeks) were examined on a 1.5-T MR system using sagittal T2w single-shot fast spin-echo imaging (TR indefinite, TE 90ms, slice thickness/gap 3-5/0mm, FOV 26-40cm, NEX 0.5). Fetal body and lung were segmented manually and volumes calculated. Signal intensities (SI) of fetal lung and three reference values were measured on the section best displaying the lung. Regions of interests were defined by including the maximal organ area possible. The following SI ratios were generated: lung/liver, lung/amniotic fluid, lung/muscle, liver/fluid and liver/muscle. Volumes and ratios were correlated with gestational age. Data from seven fetuses with pulmonary pathology were compared with these normative values. Absolute lung volume varied from 12.3 to 143.5cm3 in correlation with gestational age (P<0.001); lung volume relative to total body volume ranged from 1.6 to 5.0%, decreasing with gestational age (P=0.001). All SI ratios measured were unrelated to gestational age. Diagnoses in the seven abnormal fetuses were hydrothorax (n=2), congenital cystic adenomatoid malformation (n=2), diaphragmatic hernia (n=2) and pulmonary sequestration (n=1); their absolute and relative lung volumes were below normal (P<0.001). The SI ratios did not differ significantly from those in the normal population. Normative MR fetal lung volumes may have important clinical applications in confirming and quantifying intrauterine pulmonary hypoplasia and in complementing ultrasound in the planning of fetal and post-natal surgery. No clinical relevance was found for fetal lung SI value

In vitro blood sample assessment: investigating correlation of laboratory hemoglobin and spectral properties of dual-energy CT measurements (ρ/Z)

Objectives: Our study comprised a single-center retrospective in vitro correlation between spectral properties, namely ρ/Z values, derived from scanning blood samples using dual-energy computed tomography (DECT) with the corresponding laboratory hemoglobin/hematocrit (Hb/Hct) levels and assessed the potential in anemia-detection. Methods: DECT of 813 patient blood samples from 465 women and 348 men was conducted using a standardized scan protocol. Electron density relative to water (ρ or rho), effective atomic number (Z$_{eff}$), and CT attenuation (Hounsfield unit) were measured. Results: Positive correlation with the Hb/Hct was shown for ρ (r-values 0.37–0.49) and attenuation (r-values 0.59–0.83) while no correlation was observed for Z$_{eff}$ (r-values −0.04 to 0.08). Significant differences in attenuation and ρ values were detected for blood samples with and without anemia in both genders (p value < 0.001) with area under the curve ranging from 0.7 to 0.95. Depending on the respective CT parameters, various cutoff values for CT-based anemia detection could be determined. Conclusion: In summary, our study investigated the correlation between DECT measurements and Hb/Hct levels, emphasizing novel aspects of ρ and Z$_{eff}$ values. Assuming that quantitative changes in the number of hemoglobin proteins might alter the mean Z$_{eff}$ values, the results of our study show that there is no measurable correlation on the atomic level using DECT. We established a positive in vitro correlation between Hb/Hct values and ρ. Nevertheless, attenuation emerged as the most strongly correlated parameter with identifiable cutoff values, highlighting its preference for CT-based anemia detection. Clinical relevance statement: By scanning multiple blood samples with dual-energy CT scans and comparing the measurements with standard laboratory blood tests, we were able to underscore the potential of CT-based anemia detection and its advantages in clinical practice. Key Points: ° Prior in vivo studies have found a correlation between aortic blood pool and measured hemoglobin and hematocrit. ° Hemoglobin and hematocrit correlated with electron density relative to water and attenuation but not Z$_{eff}$. ° Dual-energy CT has the potential for additional clinical benefits, such as CT-based anemia detection

Follow-up of women with breast cancer: comparison between MRI and FDG PET

Abstract.: The aim of this study was to compare MRI of the breast with 18F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET) in patients with suspected local or regional breast cancer recurrence or suspected contralateral breast cancer. Thirty-two patients (mean age 57.2years, age range 32-76years) with suspected loco-regional recurrence (n=19), chest wall recurrence (n=5), and suspected secondary tumor of the contralateral breast (n=8) underwent MRI of the breast and FDG PET of the whole body and breast region. Cytology/histology (n=17) or a clinical follow-up examination (n=15) with additional imaging served as the standard of reference. A McNemar test was performed to compare PET and MRI, and kappa was determined to quantify agreement of both methods. Sensitivity was 79 and 100%, specificity was 94 and 72%, and accuracy was 88 and 84% for MRI and PET, respectively. Additional metastases outside the field of view of MRI were found in PET in 5 patients. In this study both imaging methods had comparable accuracy. The detection of distant metastases with whole-body PET imaging can influence patient managemen

Advanced Diffusion-Weighted Imaging Sequences for Breast MRI: Comprehensive Comparison of Improved Sequences and Ultra-High B-Values to Identify the Optimal Combination

This study investigated the image quality and choice of ultra-high b-value of two DWI breast-MRI research applications. The study cohort comprised 40 patients (20 malignant lesions). In addition to s-DWI with two m-b-values (b50 and b800) and three e-b-values (e-b1500, e-b2000, and e-b2500), z-DWI and IR m-b1500 DWI were applied. z-DWI was acquired with the same measured b-values and e-b-values as the standard sequence. For IR m-b1500 DWI, b50 and b1500 were measured, and e-b2000 and e-b2500 were mathematically extrapolated. Three readers used Likert scales to independently analyze all ultra-high b-values (b1500-b2500) for each DWI with regards to scan preference and image quality. ADC values were measured in all 20 lesions. z-DWI was the most preferred (54%), followed by IR m-b1500 DWI (46%). b1500 was significantly preferred over b2000 for z-DWI and IR m-b1500 DWI (p = 0.001 and p = 0.002, respectively). Lesion detection was not significantly different among sequences or b-values (p = 0.174). There were no significant differences in measured ADC values within lesions between s-DWI (ADC: 0.97 [±0.09] × 10$^{-3}$ mm$^{2}$/s) and z-DWI (ADC: 0.99 [±0.11] × 10$^{-3}$ mm$^{2}$/s; p = 1.000). However, there was a trend toward lower values in IR m-b1500 DWI (ADC: 0.80 [±0.06] × 10$^{-3}$ mm$^{2}$/s) than in s-DWI (p = 0.090) and z-DWI (p = 0.110). Overall, image quality was superior and there were fewer image artifacts when using the advanced sequences (z-DWI + IR m-b1500 DWI) compared with s-DWI. Considering scan preferences, we found that the optimal combination was z-DWI with a calculated b1500, especially regarding examination time

Imaging of Pulmonary Infection

The spectrum of organisms known to cause respiratory infections is broad and constantly increasing as new pathogens are identified, and an increasing number of patients have impaired immunity due to disease or medications. The radiographic manifestations of a given organism may be variable depending on the immunologic status of the patient and the presence of pre- or coexisting lung disease. Moreover, the clinical data and radiographic findings often fail to lead to a definitive diagnosis of pneumonia because there are an extensive number of noninfectious processes associated with febrile pneumonitis. This chapter describes and illustrates the characteristic imaging manifestations of the most common community- acquired pneumonias, nosocomial pneumonias, and the various infections seen in both immunocompetent and immunocompromised patients