Artificial intelligence for radiological paediatric fracture assessment: a systematic review

BACKGROUND: Majority of research and commercial efforts have focussed on use of artificial intelligence (AI) for fracture detection in adults, despite the greater long-term clinical and medicolegal implications of missed fractures in children. The objective of this study was to assess the available literature regarding diagnostic performance of AI tools for paediatric fracture assessment on imaging, and where available, how this compares with the performance of human readers. MATERIALS AND METHODS: MEDLINE, Embase and Cochrane Library databases were queried for studies published between 1 January 2011 and 2021 using terms related to 'fracture', 'artificial intelligence', 'imaging' and 'children'. Risk of bias was assessed using a modified QUADAS-2 tool. Descriptive statistics for diagnostic accuracies were collated. RESULTS: Nine eligible articles from 362 publications were included, with most (8/9) evaluating fracture detection on radiographs, with the elbow being the most common body part. Nearly all articles used data derived from a single institution, and used deep learning methodology with only a few (2/9) performing external validation. Accuracy rates generated by AI ranged from 88.8 to 97.9%. In two of the three articles where AI performance was compared to human readers, sensitivity rates for AI were marginally higher, but this was not statistically significant. CONCLUSIONS: Wide heterogeneity in the literature with limited information on algorithm performance on external datasets makes it difficult to understand how such tools may generalise to a wider paediatric population. Further research using a multicentric dataset with real-world evaluation would help to better understand the impact of these tools

Doing it for the kids?: The discursive construction of the teenager and teenage sexuality in E4’s Skins

The teen series is often regarded by television scholars as an inherently American genre. Indeed, the genre is marked by US constructs, such as the cheerleader, jock, homecoming dance and prom and, in turn, teen television scholarship has focused almost exclusively on US texts. However, more recent years have seen the emergence of British teen drama series, most notably Skins (E4, 2007-), which has been so successful that it has spawned an (albeit short-lived) US version which aired on MTV. In an attempt to redress the dearth of academic study of British teen dramas, this article explores Skins in more detail. Journalistic discourse on the programme has frequently emphasised the series' nihilism in contrast to the didacticism that characterises its US generic counterparts, which the series' creators justify by claims for its authenticity. This article moves beyond the authentic/inauthentic debate to explore instead the discursive construction of the teenager and teenage sexuality in the specific context of broadcasting in the UK. Thus, after situating Skins in relation to the history of youth programming in Britain and, specifically, on Channel 4, the article will explore issue-led storylines involving teenage sexuality in more detail. It will argue that despite the programme's nihilistic ethos, Skins is underpinned by more conservative ideologies, particularly regarding the depiction of gender and sexuality. In turn, this ambivalence makes it difficult to discern the programme's ideological stance on sexual issues

Stresses and strains on the human fetal skeleton during development

Mechanical forces generated by fetal kicks and movements result in stimulation of the fetal skeleton in the form of stress and strain. This stimulation is known to be critical for prenatal musculoskeletal development; indeed, abnormal or absent movements have been implicated in multiple congenital disorders. However, the mechanical stress and strain experienced by the developing human skeleton in utero have never before been characterized. Here, we quantify the biomechanics of fetal movements during the second half of gestation by modelling fetal movements captured using novel cine-magnetic resonance imaging technology. By tracking these movements, quantifying fetal kick and muscle forces, and applying them to three-dimensional geometries of the fetal skeleton, we test the hypothesis that stress and strain change over ontogeny. We find that fetal kick force increases significantly from 20 to 30 weeks' gestation, before decreasing towards term. However, stress and strain in the fetal skeleton rises significantly over the latter half of gestation. This increasing trend with gestational age is important because changes in fetal movement patterns in late pregnancy have been linked to poor fetal outcomes and musculoskeletal malformations. This research represents the first quantification of kick force and mechanical stress and strain due to fetal movements in the human skeleton in utero, thus advancing our understanding of the biomechanical environment of the uterus. Further, by revealing a potential link between fetal biomechanics and skeletal malformations, our work will stimulate future research in tissue engineering and mechanobiology

Controversies in epilepsy: Debates held during the Fourth International Workshop on Seizure Prediction

Debates on six controversial topics were held during the Fourth International Workshop on Seizure Prediction (IWSP4) convened in Kansas City, KS, USA, July 4–7, 2009. The topics were (1) Ictogenesis: Focus versus Network? (2) Spikes and Seizures: Step-relatives or Siblings? (3) Ictogenesis: A Result of Hyposynchrony? (4) Can Focal Seizures Be Caused by Excessive Inhibition? (5) Do High-Frequency Oscillations Provide Relevant Independent Information? (6) Phase Synchronization: Is It Worthwhile as Measured? This article, written by the IWSP4 organizing committee and the debaters, summarizes the arguments presented during the debates

High resolution isotropic diffusion imaging in post-mortem neonates:a feasibility study

OBJECTIVE: To investigate the potential of advanced diffusion imaging in Post-Mortem MRI (PMMR) at 3T.  Methods: We acquired PMMR brain and body imaging in 12 neonates, mean gestational age 33.4 weeks (range 29-37 weeks) at 3T and 1.5T. Head and body diffusion imaging at 1.5T using bipolar diffusion encoding and single-shot echo-planar imaging (EPI) for acquisition (TE 96ms; TR 2700ms; voxel size 1.8x1.8mm in-plane with slice thickness 5mm; b values of 500 and 1000 s/mm2 applied in three orthogonal directions; total acquisition time 2:12). A whole-body 3T diffusion imaging protocol using monopolar diffusion encoding and simultaneous multi-slice EPI acquisition with gradients applied in 12 uniformly distributed directions were obtained (TE 53.4ms; TR 5600ms; 1.8mm isotropic; multi-band factor 2; b-values of 250, 750, 1250 and 1750 s/mm2; acquisition time 2:09 for a single b-value,).  Results: There was significant improvement in image quality in multiband, multi-slice diffusion PMMR protocol. On visual assessment of image quality, 1.5T DWI scored poorly (mean 2.4 SD ± 0.47), and all 3T b values individually scored significantly higher (p < 0.001) apart from b = 250 which was not significantly different. CONCLUSION: Recent advances in diffusion sequences and hardware utilising higher field strengths and gradient performance allows whole-body diffusion PMMR imaging at high resolution with improved image quality compared to the current clinical approach. Advances in knowledge: We have demonstrated feasibility of a multi-slice, multi-band quantitative diffusion imaging sequence in the perinatal post-mortem setting. This will allow more detailed and quantitative clinical PMMR investigations using diffusion MRI in the future

Perinatal post mortem ultrasound (PMUS): a practical approach

Abstract Declining rates of consent for standard perinatal autopsy has led to a rise in interest for postmortem imaging as an alternative, non-invasive method for investigation of childhood and perinatal deaths. Whilst much interest has focussed on cross-sectional techniques such as postmortem CT (PMCT) or MRI (PMMR), other modalities including postmortem ultrasound (PMUS) have been shown to have reasonable diagnostic accuracy rates, with the added benefit of being more readily accessible and affordable. There is little published information or formal guidance available on preparation for postmortem perinatal ultrasound, views to be obtained and differentiating normal postmortem change from potential abnormalities. This article will focus on the role of perinatal postmortem ultrasound as an alternative imaging method for non-invasive autopsy, with emphasis on imaging technique, practical considerations and commonly encountered case examples

Artificial intelligence reporting guidelines: what the pediatric radiologist needs to know

There has been an exponential rise in artificial intelligence (AI) research in imaging in recent years. While the dissemination of study data that has the potential to improve clinical practice is welcomed, the level of detail included in early AI research reporting has been highly variable and inconsistent, particularly when compared to more traditional clinical research. However, inclusion checklists are now commonly available and accessible to those writing or reviewing clinical research papers. AI-specific reporting guidelines also exist and include distinct requirements, but these can be daunting for radiologists new to the field. Given that pediatric radiology is a specialty faced with workforce shortages and an ever-increasing workload, AI could help by offering solutions to time-consuming tasks, thereby improving workflow efficiency and democratizing access to specialist opinion. As a result, pediatric radiologists are expected to be increasingly leading and contributing to AI imaging research, and researchers and clinicians alike should feel confident that the findings reported are presented in a transparent way, with sufficient detail to understand how they apply to wider clinical practice. In this review, we describe two of the most clinically relevant and available reporting guidelines to help increase awareness and engage the pediatric radiologist in conducting AI imaging research. This guide should also be useful for those reading and reviewing AI imaging research and as a checklist with examples of what to expect