Technology trends and applications of deep learning in ultrasonography: image quality enhancement, diagnostic support, and improving workflow efficiency

In this review of the most recent applications of deep learning to ultrasound imaging, the architectures of deep learning networks are briefly explained for the medical imaging applications of classification, detection, segmentation, and generation. Ultrasonography applications for image processing and diagnosis are then reviewed and summarized, along with some representative imaging studies of the breast, thyroid, heart, kidney, liver, and fetal head. Efforts towards workflow enhancement are also reviewed, with an emphasis on view recognition, scanning guide, image quality assessment, and quantification and measurement. Finally some future prospects are presented regarding image quality enhancement, diagnostic support, and improvements in workflow efficiency, along with remarks on hurdles, benefits, and necessary collaborations.

Mesenchymal chondrosarcoma in the maxillary gingiva of a Maltese dog: a case report

A 13-year-old castrated male Maltese dog was presented to a local animal hospital with an oral hemorrhage. An intraoral examination revealed an irregular proliferated lobular mass at the right side of the maxillary gingiva and hard palate. A surgically excised mass was requested for a histopathology examination. Histopathologically, the neoplastic foci were composed of biphasic morphologic patterns, such as primitive mesenchymal tissue and mature or immature cartilage tissue. Immunohistochemically, most of the neoplastic cells forming cartilaginous islands tested positive for S-100; the surrounding mesenchymal cells tested positive for vimentin. This paper describes a rare case of mesenchymal chondrosarcoma in the maxillary gingiva of a Maltese dog.

An Analysis on the Effect of the Increase in the Fee of Magnetic Resonance Imaging Deciphering of the External Hospital: Focusing on the Brain Magnetic Resonance Imaging / 보건행정학회지

Background@#In 2018, the government increased the fee for the magnetic resonance imaging (MRI) image deciphering services of the external hospital to discourage the redundant MRI scan and to induce appropriate use of the MRI services. It is important to evaluate the effect of the policy to provide the basis for establishing other MRI-related policies. @*Methods@#The healthcare data of the patients who had brain MRI scans were organized by episode and analyzed using the panel study in order to find out the effect of the MRI-related policy on the substitution effect and the medical expenses. @*Results@#As a result of the increase in the fee of deciphering the MRI image, there has been an uplift in deciphering the MRI scan of the external hospital. It implies that more hospitals chose to use the MRI scan taken by other clinics or hospitals, rather than the MRI scan taken at their own facilities. @*Conclusion@#The research results imply that a policy that facilitates the exchange of the medical image data between the hospitals is needed in order to establish an efficient management system of the healthcare resources. Such improvement is expected to reduce the social cost and contribute to the stability in the finance of national health insurance.

The Value of Elastic Modulus Index as a Novel Surrogate Marker for Cardiovascular Risk Stratification by Dimensional Speckle-Tracking Carotid Ultrasonography

BACKGROUND: Carotid intima media thickness (CIMT) and the presence of carotid plaque have been used for risk stratification of cardiovascular disease (CVD). To date, however, the association between multi-directional functional properties of carotid artery and CVD has not been fully elucidated. We sought to explore the multi-directional mechanics of the carotid artery in relation to cardiovascular risk. METHODS: Four hundred one patients who underwent carotid ultrasound were enrolled between January 2010 and April 2013. A high risk of CVD was defined as more than 20% of 10-year risk based on the Framingham risk score. Using a speckle-tracking technique, the longitudinal and radial movements were analyzed in the B-mode images. Peak longitudinal and radial displacements, strain and strain rate were also measured. Beta stiffness and elastic modulus index were calculated from the radial measurements. RESULTS: Of the overall sample, 13% (52) of patients comprised the high-risk group. In multivariate logistic regression, CIMT and elastic modulus index were independently associated with a high-risk of CVD {odds ratio (OR): 1.810 [95% confidence interval (CI) 1.249–2.622] and OR: 1.767 (95% CI: 1.177–2.652); p = 0.002, 0.006, respectively}. The combination of CIMT and elastic modulus index correlated with a high-risk of CVD more so than CIMT alone. CONCLUSION: The elastic modulus index of the carotid artery might serve as a novel surrogate marker of high-risk CVD. Measurement of the multi-directional mechanics of the carotid artery using the speckle tracking technique has potential for providing further information over conventional B-mode ultrasound for stratification of CVD risk.

The Safety and Cosmetic Effect of Immediate Latissimus Dorsi Flap Reconstruction after Breast Conserving Surgery / 한국유방암학회지

PURPOSE: Oncoplastic breast conserving surgery is a new concept in breast cancer surgery. We performed immediate latissimus dorsi flap reconstruction after breast conserving surgery (BCS) to get an adequate resection margin and a good cosmetic results. The aim of this study is to evaluate the effect of immediate latissimus dorsi flap reconstruction after BCS. METHODS: From January to December, 2007, we performed BCS and immediate latissimus dosi myocutaneous flap reconstruction for 44 breast cancer patients. We evaluated the status of the post operative resection margin, the complications and the cosmetic results. The cosmetic results were evaluated with paying particular attention to the symmetry of the breasts, the breast shape, the location of the nipple and the post-operative scar by a three person panel that consisted of one doctor and two nurses. RESULTS: Reoperation was performed in 3 patients out of 44 (6.8%) because of positive resection margin. Flap complications didn't occurred and donor-site complications such as seroma occurred in only 3 cases. The mean score for the overall cosmetic outcome by the panel was 7.03 (SD=1.36) out of 10 and the cosmesis was deemed to be fair for 52% and, good for 48%. The mean subjective score by the patients was 6.5 (SD=2.29) out of 10 and the cosmesis was deemed to be poor for 14%, fair for 46% and, good for 40%. The most influential factors for the overall cosmetic results were breast symmetry and shape, and the breast scar in descending order (p<0.05). CONCLUSION: BCS with immediate latissimus dorsi flap reconstruction allows an adequate resection margin and good cosmetic results without serious complications.

Clinical Outcome after Breast Conserving Surgery and Radiation Therapy for Early Breast Cancer / 대한방사선종양학회지

PURPOSE: This study was performed to evaluate the disease-free survival and risk factors of recurrence in early breast cancer patients who have undergone breast conserving surgery and radiation therapy. MATERIALS AND METHODS: From March 1997 to December 2002, 77 breast cancer patients who underwent breast conserving surgery and radiation therapy were reviewed retrospectively. The median follow-up time was 58.4 months (range 43.8~129.4 months) and the mean subject age was 41 years. The frequency distribution of the different T stages, based on the tumor characteristics was 38 (49.3%) for T1, 28 (36.3%) for T2, 3 for T3, 7 for Tis and 1 for an unidentified sized tumor. In addition, 52 patients (67.5%) did not have axillary lymph metastasis, whereas 14 patients (18.1%) had 1~3 lymph node metastases and 3 (0.03%) had more than 4 lymph node metastases. The resection margin was negative in 59 patients, close (< or =2 mm) in 15, and positive in 4. All patients received radiation therapy at the intact breast using tangential fields with a subsequent electron beam boost to the tumor bed at a total dose ranging from 59.4 Gy to 66.4 Gy. Patients with more than four positive axillary lymph nodes received radiation therapy (41.4~60.4 Gy) at the axillary and supraclavicular area. Chemotherapy was administered in 59 patients and tamoxifen or fareston was administered in 29 patients. RESULTS: The 5 year overall survival and disease-free survival rates were 98.08% and 93.49%, respectively. Of the 77 patients, a total of 4 relapses (5.2%), including 1 isolated supraclavicular relapse, 1 supraclavicular relapse with synchronous multiple distant relapses, and 2 distant relapses were observed. No cases of local breast relapses were observed. Lymph node metastasis or number of metastatic lymph nodes was not found to be statistically related with a relapse (p=0.3289) nor disease-free survival (p=0.1430). Patients with positive margins had a significantly shorter disease-free survival period (p<0.0001) and higher relapse rates (p=0.0507). However, patients with close margins were at equal risk of relapse and disease-free survival as with negative margins (p=1.000). Patients younger than 40 years of age had higher relapse rates (9.3% vs. 0%) and lower disease-free survival periods, but the difference was not statistically significant (p=0.1255). The relapse rates for patients with tumors was 14% for tumor stage T2, compared to 0% for tumor stage T1 tumors (p=0.0284). A univariate analysis found that disease-free survival and relapse rates, T stage, positive resection margin and mutation of p53 were significant factors for clinical outcome. CONCLUSION: The results of this study have shown that breast conservation surgery and radiation therapy in early breast cancer patients has proven to be a safe treatment modality with a low relapse rate and high disease-free survival rate. The patients with a positive margin, T2 stage, and mutation of p53 are associated with statistically higher relapse rates and lower disease-free survival.