Research Output by Medical Doctors After PhD Graduation in Radiology:17-Year Experience From the Netherlands

RATIONALE AND OBJECTIVES: To determine the frequency and predictors of lack of research output by medical doctors after PhD graduation in radiology. MATERIALS AND METHODS: This study included all 272 PhD theses by medical doctors in the Netherlands between 2000 and 2016, with radiology as the field of research of the primary doctoral supervisor. Post-PhD research output was considered lacking if no original research, systematic review, or meta-analysis was published as first, second, or last author in the post-PhD period. RESULTS: The percentage of PhD graduates without research output was 41.9% (78/186) at 5 years, 28.6% (24/84) at 10 years, and 16.1% (5/31) at 15 years in the post-PhD period. On univariate Cox regression analysis, only female gender emerged as a significant predictor of a lack of research output in the post-PhD period (odds ratio: 1.456, 95% confidence interval: 1.023-2.073, p = 0.038). PhD student's age, being a radiologist or not before PhD graduation, the radiologic subspecialty topic of the PhD thesis, the H-index of the primary doctoral supervisor, the institution at which the PhD was performed, and the number of publications in the PhD period, were not significantly associated with lack of post-PhD research output. CONCLUSION: A considerable proportion of medical doctors has no active research output after obtaining a PhD degree in radiology, and this should be taken into account when relying on PhD programs to replenish the physician-scientist workforce. Females appear to be more prone to lack active research output, and this should be addressed by the scientific community and society

Carbon footprint of the RSNA annual meeting

Purpose: To determine the airplane travel-related carbon footprint of the Radiological Society of North America (RSNA) annual meeting, the associated health burden, and the costs to offset these greenhouse gas emissions (i.e. compensation of emissions by funding an equivalent CO2 saving elsewhere). Methods: The RSNA's website was used to determine the reported country of origin of attendees to the 2017 meeting that took place in Chicago from November 26 to December 1. It was assumed that attendees had traveled from the airport nearest to the largest city in their country or state to Chicago's O'Hare international airport. The total amount of air travel-related CO2-equivalent emission (based on round-trip economy class travel), the imposed health burden in terms of disability-adjusted life years (DALYs) in the global population, the total CO2 offsets costs, and the CO2 offsets costs per DALY were calculated. Results: The calculated airplane travel-related CO2-equivalent emissions of 11,223 attendees from the United States and 10,684 attendees from other countries were 7,067,618 kg and 32,438,420 kg, totaling 39,506,038 kg. This caused an estimated 51.4-79.0 DALYs. The calculated amount of Total CO2 offset costs were calculated to be $474,072, which corresponds to$6,001-9,223 per DALY averted. Conclusions: The airplane travel-related carbon footprint of the RSNA annual meeting and the associated disease burden are relevant, and potential attendees and organizers should take measures to overcome this undesired side effect. Offsetting this carbon footprint is cost-effective and this initiative should be taken by the radiological community

Dealing with a soft tissue lesion that is scheduled for CT-guided biopsy and that has decreased in size on preprocedural planning CT

On planning CT before CT-guided biopsy, the target lesion may have de size compared to previous imaging. Radiologists frequently face the dilemma of whether to biopsy these shrinking lesions or not. There is currently a lack of literature on how often such a situation is encountered in clinical practice, how it is dealt with, and if the perceived lesion size reduction always implies benignancy. This information would be valuable to develop evidence-based strategies for this specific clinical situation. We aimed to determine the frequency, radiologist's management, and nature of r with size reduction on prebiopsy planning CT. In this retrospective study, we found that the incidence of lesions with size reduction on prebiopsy planning CT was 1.00% (11/1103). Biopsy was refrained from In most cases (9/11). Eight lesions proved to be benign, one malignant, one harboured both benign and malignant pathology, and one lesion remained of unclear nature. Soft tissue lesions with size reduction on prebiopsy planning CT are encountered infrequently and are usually not biopsied. Although most of these lesions are benign, lesion size reduction does not exclude malignancy. Therefore, clinical and imaging follow-up should be considered mandatory when biopsy is cancelled.</p

Clinical and FDG-PET/CT Suspicion of Malignant Disease:Is Biopsy Confirmation Still Necessary?

Background: Biopsy of F-18-fluoro-2-deoxy-D-glucose (FDG)-avid lesions suspected for malignancy remains an invasive procedure associated with a variety of risks. It is still unclear if the positive predictive value (PPV) of positron emission tomography (PET)/computed tomography (CT) is sufficiently high to avoid tissue sampling. Therefore, the purpose of this study was to determine the PPV of F-18-FDG-PET/CT for malignancy in patients with a clinical suspicion of active malignant disease. Methods: This single-center retrospective study included 83 patients who had undergone FDG-PET/CT within 60 days before CT- or ultrasonography-guided tissue sampling and whose request form for CT- or US-guided tissue sampling requested mutation analyses. The latter implies a high clinical suspicion of active malignant disease. The nature of each biopsied lesion was determined based on the results of the pathological analysis and/or clinical and imaging follow-up of at least 12 months. Results: In total, eighty-eight FDG-avid lesions were biopsied. The PPV of FDG-PET/CT for malignancy was 98.9% (95% CI: 93.8-99.8%). For patients with an oncological history, the PPV was 98.7% (95% CI: 92.9-99.8%), and for patients with no oncological history, the PPV was 100% (95% CI: 74.1-100.0%). There was no significant difference between the PPV of the group with and without an oncological history (p = 0.71). In two cases, an unsuspected malignancy was diagnosed. Conclusion: Although the PPV of FDG-PET/CT for malignancy in patients with a clinical suspicion of active malignant disease is high, biopsy remains recommended to avoid inappropriate patient management due the non-negligible chance of dealing with FDG-avid benign disease or unexpected malignancies

Potential Causes of False-Negative Interpretations in 68Ga-PSMA PET/CT for the Detection of Local and Recurrent Prostate Cancer:An Underexposed Issue

68Ga-PSMA PET/CT has emerged as a highly promising diagnostic method for the evaluation of prostate cancer. Although it is increasingly recognized that its specificity is imperfect, data on false-negatives in the prostate have been underreported. We present 3 cases with false-negatives for local (recurrent) prostate cancer on 68Ga-PSMA PET/CT, using multiparametric MRI and histopathology as reference standard. Metal artifact of prostate gold markers placed for external beam radiation therapy, low level of PSMA uptake, and bladder spillover are potential causes of misinterpretation. Awareness of these diagnostic pitfalls may improve 68Ga-PSMA PET/CT interpretation

Quality of Multicenter Studies Using MRI Radiomics for Diagnosing Clinically Significant Prostate Cancer:A Systematic Review

Background: Reproducibility and generalization are major challenges for clinically significant prostate cancer modeling using MRI radiomics. Multicenter data seem indispensable to deal with these challenges, but the quality of such studies is currently unknown. The aim of this study was to systematically review the quality of multicenter studies on MRI radiomics for diagnosing clinically significant PCa. Methods: This systematic review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Multicenter studies investigating the value of MRI radiomics for the diagnosis of clinically significant prostate cancer were included. Quality was assessed using the checklist for artificial intelligence in medical imaging (CLAIM) and the radiomics quality score (RQS). CLAIM consisted of 42 equally important items referencing different elements of good practice AI in medical imaging. RQS consisted of 36 points awarded over 16 items related to good practice radiomics. Final CLAIM and RQS scores were percentage-based, allowing for a total quality score consisting of the average of CLAIM and RQS. Results: Four studies were included. The average total CLAIM score was 74.6% and the average RQS was 52.8%. The corresponding average total quality score (CLAIM + RQS) was 63.7%. Conclusions: A very small number of multicenter radiomics PCa classification studies have been performed with the existing studies being of bad or average quality. Good multicenter studies might increase by encouraging preferably prospective data sharing and paying extra care to documentation in regards to reproducibility and clinical utility

Unread Second-Opinion Radiology Reports:A Potential Waste of Health Care Resources

OBJECTIVE. The purpose of this study was to investigate how frequently second-opinion radiology reports are not read by clinicians and to identify reasons why reports are not read. MATERIALS AND METHODS. This retrospective study included 4696 consecutive second-opinion reports of external imaging examinations that were authorized by subspecialty radiologists at a tertiary care institution over a 1-year period. RESULTS. Of 4696 second-opinion reports, 537 were not read by a clinician, corresponding to a frequency of 11.4% (95% CI, 10.6-12.3%). On multivariate logistic regression analysis, five variables were significantly and independently associated with the second-opinion report not being read: Inpatient status (odds ratio [OR], 163.26; p < 0.001), sonography as the imaging modality (OR, 5.07; p = 0.014), surgery (OR, 0.18; p < 0.001) or neurology (OR, 2.82; p < 0.001) as the requesting clinician's specialty, and interventional radiology as the subspecialty of the radiologist who authorized the second-opinion report (OR, 3.52; p = 0.047). We found no significant independent associations between the clinician not reading the secondopinion report and patient age, patient sex, or time between submission of the second-opinion request and finalization of the report. CONCLUSION. A considerable proportion of second-opinion reports are not read by clinicians, which represents an appreciable but potentially reversible waste of health care resources. The reasons why clinicians do not read reports need to be investigated in future studies. If subspecialty radiologists and clinicians take the proven determinants into account, the amount of second-opinion readings with limited additional clinical value may be reduced

On-call abdominal ultrasonography:the rate of negative examinations and incidentalomas in a European tertiary care center

OBJECTIVES: To determine the proportions of abdominal US examinations during on-call hours that are negative and that contain an incidentaloma, and to explore temporal changes and determinants. METHODS: This study included 1615 US examinations that were done during on-call hours at a tertiary care center between 2005 and 2017. RESULTS: The total proportion of negative US examinations was 49.2% (795/1615). The total proportion of US examinations with an incidentaloma was 8.0% (130/1615). There were no significant temporal changes in either one of these proportions. The likelihood of a negative US examination was significantly higher when requested by anesthesiology [odds ratio (OR) 2.609, P = 0.011], or when the indication for US was focused on gallbladder and biliary ducts (OR 1.556, P = 0.007), transplant (OR 2.371, P = 0.005), trauma (OR 3.274, P < 0.001), or urolithiasis/postrenal obstruction (OR 3.366, P < 0.001). In contrast, US examinations were significantly less likely to be negative when requested by urology (OR 0.423, P = 0.014), or when the indication for US was acute oncology (OR 0.207, P = 0.045) or appendicitis (OR 0.260, P < 0.001). The likelihood of an incidentaloma on US was significantly higher in older patients (OR 1.020 per year of age increase, P < 0.001) or when the liver was evaluated with US (OR 3.522, P < 0.001). DISCUSSION: Nearly 50% of abdominal US examinations during on-call hours are negative, and 8% reveal an incidentaloma. Requesting specialty and indication for US affect the likelihood of a negative examination, and higher patient age and liver evaluations increase the chance of detecting an incidentaloma in this setting. These data may potentially be used to improve clinical reasoning and restrain overutilization of imaging

Recommendations for additional imaging of abdominal imaging examinations:frequency, benefit, and cost

OBJECTIVES: To investigate the frequency, determinants, clinical implications, and costs of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations. METHODS: This retrospective study included 2225 abdominal imaging examinations from outside institutions that were reinterpreted as part of standard clinical care at a tertiary care center in a one-year time frame. RESULTS: Two hundred forty-six RAIs were present in 231 of 2225 reports (10.4%) of secondary abdominal imaging interpretations. Patient age and experience of the radiologist who performed the secondary interpretation were independently significantly associated with the presence of an RAI (both p = 0.002), with odds ratios of 0.99 per year increase in patient age (95% confidence interval [CI], 0.98-1.00) and 1.06 per year increase in experience of the radiologist (95% CI, 1.02-1.10). If followed, RAIs changed clinical management in 31.2%. Total costs of all 246 RAIs, whether performed or not by the referring physicians, amounted to €71,032.21, thus resulting in €31.92 per secondary abdominal imaging interpretation. Total costs of the 140 RAIs that were actually performed by the referring physicians amounted to €42,683.08, resulting in €19.18 per secondary abdominal imaging interpretation. CONCLUSIONS: The frequency of RAIs in reports of secondary interpretations of abdominal imaging examinations (which appear to be affected by patients' age and radiologists' experience) and associated costs are non-negligible. However, RAIs not infrequently change clinical management. The presented data may be helpful to radiology departments and healthcare policy makers to make well-informed decisions on the value and facilitation of the practice of secondary interpretations. KEY POINTS: • Frequency of recommendations for additional imaging (RAIs) in secondary interpretations of abdominal imaging examinations at a tertiary care center is approximately 10.4%. • RAIs appear to be more frequently issued in younger patients and by more experienced radiologists, and if followed by referring clinicians, change clinical management in about one third of cases. • RAI costs per secondary interpretation in the Dutch Healthcare system are €31.92 (considering all RAIs) or €19.18 (considering only those RAIs that are actually performed)