Implementation of Korean Clinical Imaging Guidelines: A Mobile App-Based Decision Support System

OBJECTIVE: The aims of this study were to develop a mobile app-based clinical decision support system (CDSS) for implementation of Korean clinical imaging guidelines (K-CIGs) and to assess future developments therein. MATERIALS AND METHODS: K-CIGs were implemented in the form of a web-based application (http://cdss.or.kr/). The app containing K-CIGs consists of 53 information databases, including 10 medical subspecialties and 119 guidelines, developed by the Korean Society of Radiology (KSR) between 2015 and 2017. An email survey consisting of 18 questions on the implementation of K-CIGs and the mobile app-based CDSS was distributed to 43 members of the guideline working group (expert members of the KSR and Korean Academy of Oral and Maxillofacial Radiology) and 23 members of the consultant group (clinical experts belonging to related medical societies) to gauge opinion on the future developmental direction of K-CIGs. RESULTS: The web-based mobile app can be downloaded from the Google Play Store. Detailed information on the grade of recommendation, evidence level, and radiation dose for each imaging modality in the K-CIGs can be accessed via the home page and side menus. In total, 32 of the 66 experts contacted completed the survey (response rate, 45%). Twenty-four of the 32 respondents were from the working group and eight were from the consulting group. Most (93.8%) of the respondents agreed on the need for ongoing development and implementation of K-CIGs. CONCLUSION: This study describes the mobile app-based CDSS designed for implementation of K-CIGs in Korea. The results will allow physicians to have easy access to the K-CIGs and encourage appropriate use of imaging modalities.

Imaging In Oral Cancers – A Practical Approach.

Imaging techniques have become an important element in the field of oral oncology. Continued research has led to technical progress in the existing modalities and addition of newer, exiting and highly accurate techniques. Although this is a boon, it has created differences of opinion regarding the ideal choice of imaging techniques. Inappropriate choice of imaging modality can result in delay in diagnosis and treatment thereby inducing more suffering for the patients. This problem is more so with imaging of oral cancers and responsible decisions of oral clinicians and radiologists is of paramount importance. In developing nations, problem is compounded by various other factors like affordability, availability and awareness. Thus, an imaging protocol needs to be devised that helps a clinician choose the best imaging modality for a particular clinical situation. This review illustrates the imaging protocol in the form of a decision tree, describes the various imaging techniques, their utility in evaluation of oral cancers and practical problems associated with these techniques.

Dynamic Anatomy of Aortic Root and Its Potential Role in TAVR Prostheses Further Development and Modification.

Aortic stenosis (AS) is the most common valvular disorder. Surgical aortic valve replacement is the definitive therapy for patients with severe AS. In the last years transcatheter aortic valve replacement (TAVR) has been developed as an alternative to surgical aortic valve replacement with promising results. Despite being less invasive than open-chest aortic valve replacement, good outcome and effectiveness of TAVR procedure, it remains associated with the potential for serious complications and short-time durability. Today there are two TAVR prostheses that have CE marks and FDA approved: Edwards Valves and CoreValve. Besides there are many other newly developed TAVR prostheses on the stage of clinical trials. However, no one of them had been developed on the base of data for dynamic anatomy of human aortic root because of the lack of appropriate imaging modality. Today, different two-dimensional (2D) and three-dimensional (3D) imaging techniques are used for aortic root examination. But no one of them has been accepted as a “gold standard” imaging modality for assessment of dynamic anatomy of aortic root. The existing imaging modalities such as transthoracic echocardiography, transesophageal echocardiography, angiography, CT and MRI scans provide tangential cut plane view which did not reflect the real sizes of the annulus and other aortic root rings and structures. Obtained with these modalities images did not reflect the changes of the size and shapes of the anatomic structures of aortic root during the different phase of cardiac cycles either. Today there are strict needs for imaging modality which could assist in assessment of dynamic aortic root to push the TAVR prosthesis design and modification on new level.

A comparision of three imaging modalities in image-guided radiotherapy / 中华放射医学与防护杂志

Objective To investigate and analyze the positioning accuracy of three imaging modalities utilized in image-guided radiotherapy (IGRT):electronic portal imaging device ( EPID),kV portal image (kV planar) and the kV cone beam computed tomography (CBCT).Methods 25 groups of setup errors were simulated on the phantom images through treatment planning system. Digitally reconstructed radiographs (DRRs) were constructed from the CT data which were subsequently used as references to register the EPID and kV planar images acquired at the original position.In addition,the reconstructed 3D-CT images were used to register the CBCT images.Finally,the setup errors using several registration methods were measured to investigate and compare the accuracies of the three imaging modalities used for patient setup.Results 675 groups of residual errors were analyzed.All combinations of imaging modalities and registration method were found to be accurate.The mean residual errors in three directions were less than 1 mm.The method based on grey value match of CBCT images was found as the most accurate with an uncertainty below 0.1 mm.When the manual match was used,the performance of kV planar was more accurate than that of EPID (residual error ＜ 0.65 mm).If automatic registration was applied,kV planar generated similar results as EPID did. Conclusions The three available imaging modalities and their corresponding registration methods are all competent for the clinical application of IGRT in our department.Considering the image quality,radiation dose and the accuracy of registration,CBCT has the priority on 1GRT followed by the kV planar.

In Vivo Non Invasive Molecular Imaging for Immune Cell Tracking in Small Animals

Clinical and preclinical in vivo immune cell imaging approaches have been used to study immune cell proliferation, apoptosis and interaction at the microscopic (intra-vital imaging) and macroscopic (whole-body imaging) level by use of ex vivo or in vivo labeling method. A series of imaging techniques ranging from non-radiation based techniques such as optical imaging, MRI, and ultrasound to radiation based CT/nuclear imaging can be used for in vivo immune cell tracking. These imaging modalities highlight the intrinsic behavior of different immune cell populations in physiological context. Fluorescent, radioactive or paramagnetic probes can be used in direct labeling protocols to monitor the specific cell population. Reporter genes can also be used for genetic, indirect labeling protocols to track the fate of a given cell subpopulation in vivo. In this review, we summarized several methods dealing with dendritic cell, macrophage, and T lymphocyte specifically labeled for different macroscopic wholebody imaging techniques both for the study of their physiological function and in the context of immunotherapy to exploit imaging-derived information and immune-based treatments.

In Vivo Non Invasive Molecular Imaging for Immune Cell Tracking in Small Animals

Clinical and preclinical in vivo immune cell imaging approaches have been used to study immune cell proliferation, apoptosis and interaction at the microscopic (intra-vital imaging) and macroscopic (whole-body imaging) level by use of ex vivo or in vivo labeling method. A series of imaging techniques ranging from non-radiation based techniques such as optical imaging, MRI, and ultrasound to radiation based CT/nuclear imaging can be used for in vivo immune cell tracking. These imaging modalities highlight the intrinsic behavior of different immune cell populations in physiological context. Fluorescent, radioactive or paramagnetic probes can be used in direct labeling protocols to monitor the specific cell population. Reporter genes can also be used for genetic, indirect labeling protocols to track the fate of a given cell subpopulation in vivo. In this review, we summarized several methods dealing with dendritic cell, macrophage, and T lymphocyte specifically labeled for different macroscopic wholebody imaging techniques both for the study of their physiological function and in the context of immunotherapy to exploit imaging-derived information and immune-based treatments.

Malignant Fibrous Histiocytoma in the Infratemporal Fossa / 대한구강악안면방사선학회지

Malignant fibrous histiocytoma is one of the most common soft tissue sarcomas in late adult life, but its incidence in oral and maxillofacial region is extremely rare. We report a case of malignant fibrous histiocytoma which occurred in the infratemporal fossa. Conventional radiograph of this case showed an ill-defined radiolucent lesion in the alveolar bone of the right maxillary first molar area, the lateral wall of the maxillary sinus, and the ascending ramus of mandible. MRI demonstrated well defined mass of intermediate signal intensitiy in T1 weighted images but T2 weighted images showed two distinctive regions of different characteristics. Infratemporal portion of the lesion was of hyperintense signal but under that region, the signal intensity decreased clearly, which might mean this case composed of two different subtypes, though it couldn't be confirmed by histopathological examination. Biopsy was taken in the only soft tissue of the maxillary posterior alveolar region and confirmed the lesion as the storiform-pleomorphic type of malignant fibrous histiocytoma. Histopathological subtype was well consistent with the relatively aggressive imaging findings of that region. We expect more detailed analysis of the nature of malignant fibrous histiocytoma with improvement of the imaging modality and the identification of the relationship between diagnostic imaging and histopathologic findings.