Development and Validation of the Radiology Common Data Model (R-CDM) for the International Standardization of Medical Imaging Data

Purpose@#Digital Imaging and Communications in Medicine (DICOM), a standard file format for medical imaging data, contains metadata describing each file. However, metadata are often incomplete, and there is no standardized format for recording metadata, leading to inefficiency during the metadata-based data retrieval process. Here, we propose a novel standardization method for DICOM metadata termed the Radiology Common Data Model (R-CDM). @*Materials and Methods@#R-CDM was designed to be compatible with Health Level Seven International (HL7)/Fast Healthcare Interoperability Resources (FHIR) and linked with the Observational Medical Outcomes Partnership (OMOP)-CDM to achieve a seamless link between clinical data and medical imaging data. The terminology system was standardized using the RadLex playbook, a comprehensive lexicon of radiology. As a proof of concept, the R-CDM conversion process was conducted with 41.7 TB of data from the Ajou University Hospital. The R-CDM database visualizer was developed to visualize the main characteristics of the R-CDM database. @*Results@#Information from 2801360 cases and 87203226 DICOM files was organized into two tables constituting the R-CDM. Information on imaging device and image resolution was recorded with more than 99.9% accuracy. Furthermore, OMOP-CDM and RCDM were linked to efficiently extract specific types of images from specific patient cohorts. @*Conclusion@#R-CDM standardizes the structure and terminology for recording medical imaging data to eliminate incomplete and unstandardized information. Successful standardization was achieved by the extract, transform, and load process and image classifier. We hope that the R-CDM will contribute to deep learning research in the medical imaging field by enabling the securement of large-scale medical imaging data from multinational institutions.

Combined Radiofrequency Ablation and Double Anti-Angiogenic Protein Therapy to Increase Coagulation Efficacy: An Experimental Study in a Murine Renal Carcinoma Model

OBJECTIVE: To evaluate whether suppression of tumor microvasculature by double anti-angiogenic protein (DAAP) treatment could increase the extent of radiofrequency ablation (RFA)-induced coagulation in a murine renal cell carcinoma model. MATERIALS AND METHODS: Renal cell carcinoma cell lines were implanted subcutaneously into 10 nude mice. Four mice received adenoviral DAAP treatment and 6 mice received sterile 0.9% saline solution as DAAP-untreated group. The effect of DAAP was evaluated according to the vascularity by contrast-enhanced ultrasound (CEUS) using microbubbles. Four DAAP-treated mice and 4 DAAP-untreated mice were then treated with RFA, resulting in 3 groups: no-therapy (n = 2), RFA only (n = 4), and RFA combined with DAAP treatment (n = 4). Immediately after RFA, the size of coagulation necrosis and mitochondrial enzyme activity were compared between the groups using analysis of variance (ANOVA) and post hoc test. RESULTS: The contrast enhancement ratio for tumor vascularization on CEUS was significantly lower in the DAAP treated group than in DAAP-untreated group (30.2 +/- 9.9% vs. 77.4 +/- 17.3%; p = 0.021). After RFA, the mean coagulation diameter was 0 mm for no-therapy group, 6.7 +/- 0.7 mm for the RFA only group and 8.5 +/- 0.4 mm for the RFA with DAAP group (ANOVA, p < 0.001). The area of viable mitochondria within the tumor was 27.9 +/- 3.9% in no-therapy group, 10.3 +/- 4.5% in the RFA only group, and 2.1 +/- 0.7% in the RFA with DAAP group (ANOVA, p < 0.001). CONCLUSION: Our results suggest the potential value of combining RFA with anti-angiogenic therapy.

Cervical and Thoracic Sagittal Curves in Thoracic Adolescent Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: Prospective study OBJECTIVES: To analyze and compare the cervical and thoracic sagittal curves between normal adolescents and patients with thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF THE LITERATURE REVIEW: There are no reports on cervical sagittal curves and its correlation with thoracic sagittal curves in AIS. MATERIALS AND METHODS: The sagittal curves were analyzed in normal adolescents (N-adol group, n=23) and patients with thoracic AIS (AIS group, n=26) who had thoracic curves > or = 45degrees. Lateral standing radiographs of the cervical spine with a elbow straight and the whole spine with the hands on the clavicles were taken. The sagittal curves and balance were measured in the following segments; C2-C7, T2-T5, T5-12, T2-12, T12-S1. Cervical lordosis (C2-C7) was measured in both cervical spine radiographs and whole spine radiographs. RESULTS: In the N-adol group, the cervical lordosis was 9.2+/-14.6degrees in the cervical spine radiographs and -0.6+/-12.9degrees ('-' means kyphosis) in whole spine radiographs. In the AIS group, cervical lordosis was -5.0+/-12.9degrees in the cervical radiographs and -8.1+/-12.7degrees in the whole radiographs. The AIS group had significantly less cervical lordosis than the N-adol group. Thoracic kyphosis of T5-12 and T2-12 was 24.1+/-10.6degrees and 38.9+/-13.1degrees in the N-adol group, respectively, and 17.8+/-9.4degrees and 30.1+/-11.8degrees in the AIS group, respectively. There was a significant difference between the two groups (Ps0.05). In the AIS group, the cervical lordosis measured in the cervical spine radiograph showed a positive correlation with thoracic kyphosis of T2-5 (r=0.50, P=0.009) and T2-12 (r=0.57, P=0.003). CONCLUSIONS: AIS patients had significantly less cervical lordosis and thoracic kyphosis than normal adolescents. Decreased cervical lordosis in AIS had a significant correlation with their relative thoracic hypokyphosis.

Chronic tubal pregnancy diagnosed at cesarean delivery in infertile woman conceived after ovulation induction by clomiphene citrate and human menopausal gonadotropin / 대한산부인과학회지

Preoperative diagnosis of heterotopic pregnancy is difficult, especially when ectopic component is chronic and the precise effect of chronic tubal pregnancy on coexisting intra-uterine pregnancy or ongoing pregnancy rates is not known. We present the case of heterotopic pregnancy with a chronic tubal pregnancy incidentally diagnosed during term cesarean delivery in infertile woman conceived after ovulation induction using sequential clomiphene citrate and human menopausal gonadotropin, and timed coitus. Chronic tubal pregnancy might not affect the intrauterine gestation or the mother negatively in non-ruptured cases.

Chronic tubal pregnancy diagnosed at cesarean delivery in infertile woman conceived after ovulation induction by clomiphene citrate and human menopausal gonadotropin / 대한산부인과학회지

Preoperative diagnosis of heterotopic pregnancy is difficult, especially when ectopic component is chronic and the precise effect of chronic tubal pregnancy on coexisting intra-uterine pregnancy or ongoing pregnancy rates is not known. We present the case of heterotopic pregnancy with a chronic tubal pregnancy incidentally diagnosed during term cesarean delivery in infertile woman conceived after ovulation induction using sequential clomiphene citrate and human menopausal gonadotropin, and timed coitus. Chronic tubal pregnancy might not affect the intrauterine gestation or the mother negatively in non-ruptured cases.

A case of chorioangioma of placenta complicated by fetal anemia and fetal hydrops / 대한산부인과학회지

Benign chorioangioma of the placenta is the most common primary tumor of the placenta similar to hamartoma. Most small-sized tumors do not make any clinical problem, but uncommon large tumors (>5 cm in diameter) may produce both maternal and fetal complications, such as polyhydramnios, preterm labor, fetal hydrops, microangiopathic hemolytic anemia, disseminated intravascular coagulation, intrauterine growth restriction, preeclampsia and placental abruption. In this respect, the diagnosis and management of chorioangioma and its complication should be done appropriately. We report a case of chorioangioma presenting with polyhydramnios, preterm labor, fetal anemia and fetal hydrops, diagnosed by antenatal ultrasonography and postnatal placental histologic examination, and live born baby with the brief review of the literature related to this type of tumor.

Conformity of the LCP-DF (Locking Compression Plate-Distal Femur) in Korean Adult Femur: A Cadaver Study

PURPOSE: To evaluate the conformity of the anatomically pre-shaped LCP-DF to the femurs of the Korean adult. MATERIALS AND METHODS: 67 adult femur obtained from the Korean adult cadaver were used. An eleven-hole LCP-DF was applied to the lateral surface of the distal femur according to the contour. Then the distance from the inner surface of the plate to the cortex was measured at the sites of mismatch. The angle between the distal most screw and the articular surface was measured. RESULTS: Mismatch was found at the level of proximal 4~5 holes of the plate with an average distance of 9.58 mm (0~18) at the tip of the plate. Otherwise, the overall conformity of the LCP-DF was excellent. The distal most screws are positioned such that the joint line is 3 degrees of valgus to this screw in average (range 0~18). CONCLUSION: It may be necessary to consider to bend the plate in case of mismatch at the tip especially for the plate longer than 9-hole plate. The angular relation between the distal most screw and the joint line can assist the judgement for the coronal plane alignment.

A Case of Vaginal Tuberculosis presenting as Vaginal Cyst / 대한산부인과학회지

A rare case of vaginal tuberculosis is reported. A 42-year-old woman referred to our hospital for surgical treatment of a cystocele presented with vaginal mass for 2 months. Pelvic examination revealed a cystic mass at anterior vagianl wall. Her initial diagnosis was urethral diverticulum. Surgical excision was performed and pathological analysis of the specimen revealed tuberculosis. She was treated with antituberculous drugs. We emphasize the need to maintain a high index of suspicion and to biopsy any suspicious vaginal lesion in the diagnosis of vaginal tuberculosis.