4D Flow cardiovascular magnetic resonance consensus statement: 2023 update

Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 '4D Flow CMR Consensus Statement'. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards

Die Arbeits- und Weiterbildungssituation junger Ärztinnen und Ärzte in Deutschland – eine zusammenfassende Analyse von Befragungsergebnissen aus sechs Fachrichtungen

Objective The working and training conditions of young physicians in Germany have changed over the last few years, as a result of far-reaching changes in the healthcare system. Therefore, Germany-wide surveys among young physicians of several disciplines were evaluated in a pooled analysis, in order to obtain a current interdisciplinary impression of conflicts in their daily work. Material and methods Data from web-based surveys from residents training in six disciplines were analyzed together retrospectively. One focus was a gratification crises model for the assessment of psychosocial workload. Results Data on 4041 participants were evaluated. In day-today work, young physicians were burdened with a high proportion of tasks that were not directly medical. Instruments of good subspecialty training, such as training contracts, curricula and regular feedback were associated with a lower psychosocial workload, which was generally significant among the participants. An economic influence on medical-professional decisions was subjectively clearly present among the participants. Conclusion Many young doctors find the current work and training conditions in the medical work environment unsatisfactory. This might have consequences not only for the doctors themselves, but also for the patients they care for. A healthy work environment with health professionals in good health is therefore crucial and should be in everyone's interest

Heating of an Aortic Stent for Coarctation Treatment During Magnetic Particle Imaging and Magnetic Resonance Imaging—A Comparative In Vitro Study

Purpose!#!To evaluate heating of a redilatable stent for the treatment of aortic coarctation in neonates and small children in the new imaging modality magnetic particle imaging and established magnetic resonance imaging.!##!Materials and methods!#!The cobalt-chromium stent (BabyStent, OSYPKA AG, Rheinfelden, Germany) has a stent design which allows for redilatation and adjustment of the diameter from 6 to 16 mm for a use in aortic coarctation. The stent loses its radial integrity while opening at predetermined breaking points at a diameter of 14 mm or 16 mm, respectively. We measured the temperature increase in the stent at different diameters during 7-min magnetic particle imaging and magnetic resonance imaging scans with fiber optic thermometers under static conditions surrounded by air. In magnetic particle imaging, stents with diameters from 6 to 16 mm were tested while in magnetic resonance imaging only stents with diameters of 6 mm and 14 mm were investigated exemplarily.!##!Result!#!In magnetic particle imaging, the measured temperature differences increased up to 4.7 K with growing diameters, whereas the opened stents with discontinuous struts at 14 and 16 mm showed only minimal heating of max. 0.5 K. In contrast to magnetic particle imaging, our measurements showed no heating of the stents during magnetic resonance imaging under identical conditions.!##!Conclusion!#!The BabyStent did show only slight heating in magnetic particle imaging and no detectable temperature increase in magnetic resonance imaging

Repeatability and reproducibility of various 4D Flow MRI postprocessing software programs in a multi-software and multi-vendor cross-over comparison study

Abstract Background Different software programs are available for the evaluation of 4D Flow cardiovascular magnetic resonance (CMR). A good agreement of the results between programs is a prerequisite for the acceptance of the method. Therefore, the goal was to compare quantitative results from a cross-over comparison in individuals examined on two scanners of different vendors analyzed with four postprocessing software packages. Methods Eight healthy subjects (27 ± 3 years, 3 women) were each examined on two 3T CMR systems (Ingenia, Philips Healthcare; MAGNETOM Skyra, Siemens Healthineers) with a standardized 4D Flow CMR sequence. Six manually placed aortic contours were evaluated with Caas (Pie Medical Imaging, SW-A), cvi42 (Circle Cardiovascular Imaging, SW-B), GTFlow (GyroTools, SW-C), and MevisFlow (Fraunhofer Institute MEVIS, SW-D) to analyze seven clinically used parameters including stroke volume, peak flow, peak velocity, and area as well as typically scientifically used wall shear stress values. Statistical analysis of inter- and intrareader variability, inter-software and inter-scanner comparison included calculation of absolute and relative error (ER), intraclass correlation coefficient (ICC), Bland–Altman analysis, and equivalence testing based on the assumption that inter-software differences needed to be within 80% of the range of intrareader differences. Results SW-A and SW-C were the only software programs showing agreement for stroke volume (ICC = 0.96; ER = 3 ± 8%), peak flow (ICC: 0.97; ER = −1 ± 7%), and area (ICC = 0.81; ER = 2 ± 22%). Results from SW-A/D and SW-C/D were equivalent only for area and peak flow. Other software pairs did not yield equivalent results for routinely used clinical parameters. Especially peak maximum velocity yielded poor agreement (ICC ≤ 0.4) between all software packages except SW-A/D that showed good agreement (ICC = 0.80). Inter- and intrareader consistency for clinically used parameters was best for SW-A and SW-D (ICC = 0.56–97) and worst for SW-B (ICC = -0.01–0.71). Of note, inter-scanner differences per individual tended to be smaller than inter-software differences. Conclusions Of all tested software programs, only SW-A and SW-C can be used equivalently for determination of stroke volume, peak flow, and vessel area. Irrespective of the applied software and scanner, high intra- and interreader variability for all parameters have to be taken into account before introducing 4D Flow CMR in clinical routine. Especially in multicenter clinical trials a single image evaluation software should be applied

Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society

Zusammenfassung Ziel Eine qualitativ hochwertige Weiterbildung ist Grundlage fur eine hohe Arbeitszufriedenheit und eine exzellente Patientenversorgung in der Radiologie. Ziel dieser Umfrage war es, den aktuellen Stand der Arbeitsbedingungen von arzten in der Weiterbildung Radiologie in Deutschland zu erfassen und einen Fokus auf die Teilaspekte Weiterbildung sowie psychosoziale Arbeitsbelastung zu legen. Die Beschreibung des Ist-Zustandes soll helfen, mogliche Problemfelder zu identifizieren und Verbesserungsansatze zu entwickeln. Material und Methoden Anfang 2018 wurde ein elektronischer Fragebogen uber die Deutsche Rontgengesellschaft (DRG) e. V., die Konferenz der Lehrstuhlinhaber fur Radiologie (KLR), das Chefarztforum der DRG (CAFRAD) und das Forum Niedergelassener Radiologen (FUNRAD) an radiologische Weiterbildungsassistenten verschickt. Der Fragebogen deckte mit 63 Fragen 7 wesentliche Themenfelder arztlicher Arbeits- und Weiterbildungsbedingungen ab. Um eine facherubergreifende Vergleichbarkeit zu sichern, wurden Fragen von bisherigen Erhebungen unter arzten in Weiterbildung anderer Fachrichtungen ubernommen. Ergebnisse 643 arzte haben die Umfrage begonnen. 501 (78 %) Fragebogen wurden vollstandig bearbeitet und in die endgultige Analyse einbezogen. 65 % der Befragten waren mit ihrer derzeitigen beruflichen Situation zufrieden. Gleichzeitig wurden Defizite besonders in Bezug auf die Vereinbarkeit von Familie und Beruf sowie die Moglichkeit zu wissenschaftlichem Arbeiten deutlich. Nur 36 % der Teilnehmer mit Kindern waren zufrieden mit der Vereinbarkeit von Familie und Beruf an ihrem Arbeitsplatz. Nur 31 % der wissenschaftlich Tatigen waren zufrieden mit ihren Forschungsbedingungen. Zudem war die psychosoziale Arbeitsbelastung unter den befragten arzten stark ausgepragt. Schlussfolgerung Die Arbeitszufriedenheit ist unter radiologischen Assistenzarzten im Vergleich zu anderen Fachrichtungen hoch. Dennoch scheinen auf Basis dieser Erhebung Anpassungen der Arbeits- und Weiterbildungsbedingungen in der Radiologie erforderlich, um die Gesundheit der betroffenen arzte zu erhalten, die Motivation fur wissenschaftliches Arbeiten zu fordern und die Entwicklungsmoglichkeiten insbesondere von Frauen durch eine bessere Vereinbarkeit von Familie und Beruf aufzuwerten. Die vorliegende Umfrage zeigt Strategien und Fuhrungsinstrumente auf, mit denen dies erreicht werden kann. Kernaussagen: arzte in radiologischer Weiterbildung ... sind zufrieden mit ihrer beruflichen Situation. stehen unter hoher psychosozialer Arbeitsbelastung. bewerten die Vereinbarkeit von Familie und Beruf als verbesserungsbedurftig. sind an Forschung interessiert, bewerten die Forschungsbedingungen aber als unzureichend. Zitierweise Oechtering TH, Panagiotopoulos N, Volker M et al. Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. Fortschr Rontgenstr 2020; 192: 458 - 47

4D Flow cardiovascular magnetic resonance consensus statement: 2023 update

Abstract Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 ‘4D Flow CMR Consensus Statement’. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards