Pearls and Pitfalls in Neck Imaging.

This article highlights some pearls and pitfalls encountered in neck imaging. It first covers normal anatomic structures that can be mistaken for pathology. Pathologic entities that can share similar imaging appearances are subsequently discussed. The article later touches on several essential anatomic distinctions. Finally, the selection of appropriate imaging modalities for certain clinical indications is discussed.

An Artificial Intelligence-Based Chest X-ray Model on Human Nodule Detection Accuracy From a Multicenter Study.

Importance: Most early lung cancers present as pulmonary nodules on imaging, but these can be easily missed on chest radiographs. Objective: To assess if a novel artificial intelligence (AI) algorithm can help detect pulmonary nodules on radiographs at different levels of detection difficulty. Design, Setting, and Participants: This diagnostic study included 100 posteroanterior chest radiograph images taken between 2000 and 2010 of adult patients from an ambulatory health care center in Germany and a lung image database in the US. Included images were selected to represent nodules with different levels of detection difficulties (from easy to difficult), and comprised both normal and nonnormal control. Exposures: All images were processed with a novel AI algorithm, the AI Rad Companion Chest X-ray. Two thoracic radiologists established the ground truth and 9 test radiologists from Germany and the US independently reviewed all images in 2 sessions (unaided and AI-aided mode) with at least a 1-month washout period. Main Outcomes and Measures: Each test radiologist recorded the presence of 5 findings (pulmonary nodules, atelectasis, consolidation, pneumothorax, and pleural effusion) and their level of confidence for detecting the individual finding on a scale of 1 to 10 (1 representing lowest confidence; 10, highest confidence). The analyzed metrics for nodules included sensitivity, specificity, accuracy, and receiver operating characteristics curve area under the curve (AUC). Results: Images from 100 patients were included, with a mean (SD) age of 55 (20) years and including 64 men and 36 women. Mean detection accuracy across the 9 radiologists improved by 6.4% (95% CI, 2.3% to 10.6%) with AI-aided interpretation compared with unaided interpretation. Partial AUCs within the effective interval range of 0 to 0.2 false positive rate improved by 5.6% (95% CI, -1.4% to 12.0%) with AI-aided interpretation. Junior radiologists saw greater improvement in sensitivity for nodule detection with AI-aided interpretation as compared with their senior counterparts (12%; 95% CI, 4% to 19% vs 9%; 95% CI, 1% to 17%) while senior radiologists experienced similar improvement in specificity (4%; 95% CI, -2% to 9%) as compared with junior radiologists (4%; 95% CI, -3% to 5%). Conclusions and Relevance: In this diagnostic study, an AI algorithm was associated with improved detection of pulmonary nodules on chest radiographs compared with unaided interpretation for different levels of detection difficulty and for readers with different experience.

Detection of Extrapulmonary Malignancy During Lung Cancer Screening: 5-Year Analysis at a Tertiary Hospital.

PURPOSE: The aims of this study were to determine the prevalence and outcomes of extrapulmonary malignancies identified on lung cancer screening (LCS) and to determine the cost associated with the investigation of these lesions. METHODS: This retrospective study included 7,414 low-dose CT studies performed between June 2014 and December 2019 on 4,160 patients as part of an established LCS program. Patients with indeterminate extrapulmonary lesions were identified, and the diagnostic workup, management, and outcomes of the lesions were determined. Costs related to diagnostic evaluation were estimated using 2020 total facility relative value units and the 2020 Medicare conversion factor. Out-of-pocket costs were extracted from billing records. RESULTS: There were 20 extrapulmonary malignancies among 241 reported lesions in 225 patients (mean age, 66.1 ± 6.4 years; 109 men, 116 women). The prevalence of extrapulmonary malignancy was 20 of 4,160 (0.48%). Early-stage cancers were detected in 13 of 20 (65%). No cancer-specific mortality was observed. The predictive value for malignancy varied by organ (P = .03) and was highest in the chest wall and axilla (36.4%), followed by bone (25%). The average cost on the basis of Medicare reimbursement for diagnosis of an extrapulmonary malignancy on LCS was $1,316.03 ($6.33 per participant and $109.21 per indeterminate incidental lesion). Most patients (203 of 225 [90.2%]) did not have out-of-pocket costs related to diagnostic workup. In those who did, the median cost was $160.60 (range, $75-$606.76). CONCLUSIONS: Low-dose CT for LCS detects extrapulmonary malignancy with high predictive value for certain locations. There is cost associated in the workup related to these incidental lesions, but most malignancies are detected at early stages and have good outcomes.

Persistent air leak treated by autologous blood patch pleurodesis: the role of CT-guided small-bore chest tube insertion.

Autologous blood patch pleurodesis (ABPP) offers an alternative to surgery when conservative management is ineffective for treating a persistent air leak (PAL). In the traditional technique, autologous venous blood is introduced into the affected pleural cavity via a blindly inserted large-bore surgical chest tube. Herein, we present a case of an 18 year old male with a PAL following video assisted thorascopic bleb resection and talc pleurodesis who underwent successful ABPP using a small-bore pigtail catheter placed under computed tomography (CT) guidance. As compared to the traditional technique, this approach may potentially offer several advantages, such as more precise chest tube placement over the air leak site and reduced pain with chest tube insertion. Although image-guided chest tube insertion is a commonly performed procedure, its use for the specific indication in this patient's case has not been described in the literature, to the best of our knowledge.

Clinical significance of incidentally discovered renal cysts in pediatric patients.

PURPOSE: To determine the clinical significance of incidentally discovered renal cysts in pediatric patients and identify imaging predictors of autosomal dominant polycystic kidney disease (ADPKD). METHODS: A retrospective search of radiology reports from 2000 to 2016 was performed to identify patients < 18 years old with an imaging exam identifying at least one renal cyst and a ≥ 1-year follow-up renal imaging exam for cyst evaluation and/or diagnosis of ADPKD. Cysts with clear solid mass components were excluded. RESULTS: 84 pediatric patients with renal cysts were identified (mean age, 9.5 years), including 76 patients with incidentally discovered cysts and 8 patients with cysts identified from screening for ADPKD family history. Among the incidentally discovered cyst group, 7.9% were found to have ADPKD compared with 100% of patients with cysts and ADPKD family history. Maximum cyst diameter was significantly increased in patients with ADPKD compared to patients without ADPKD (22.0 mm vs 12.7 mm; P < 0.001, Fisher's Exact test). Multiple cysts or bilateral cysts were imaging features associated with a significantly higher (P < 0.01) incidence of ADPKD, both for the entire study population and the incidentally discovered cyst group. An increase in cyst size on the follow-up study was associated with higher incidence of ADPKD (P < 0.05). No malignancies were identified. CONCLUSIONS: Incidentally discovered renal cysts in pediatric patients are associated with a small but non-zero risk of ADPKD. Among cyst characteristics, bilaterality, multiplicity, large size, and increased size on follow-up imaging were associated with a statistically significant elevation of ADPKD risk, and should prompt diagnostic evaluation.

Osteopoikilosis Demonstrating Multiple Joint Involvement in an Adult Male: An Incidental Radiographic Finding.

Osteopoikilosis is a rare condition that is characterized by multiple small non-aggressive appearing sclerotic foci in a periarticular distribution. Typically, it does not cause any symptoms and is diagnosed incidentally on imaging studies done for other reasons. We present a case of osteopoikilosis in a 37-year-old male, which was diagnosed incidentally on radiographs.

Satisfaction with Healthcare Received at an Interprofessional Student-run Free Clinic: Invested in Training the Next Generation of Healthcare Professionals.

Most medical schools in the United States have an associated student-run free clinic (SRFC) providing medical care to the underserved population around the campus. SRFCs provide students with opportunities to practice history-taking and diagnosis skills. There have been a few studies that have evaluated patient satisfaction within SRFCs; however, these studies report limited aspects of care within these clinics. This study hopes to determine the levels of satisfaction with clinical staff and operations and to ensure that the medical needs of patients are being met. Results showed that 91% of the patients were satisfied or very satisfied with their overall clinic experience. The highest scoring parameters were "courtesy/respect of staff", "availability of free or affordable medications", and "doctor's knowledge". Overall, the patients are satisfied with the staff, care, and availability of medicine provided by the Keeping Neighbors in Good Health Through Service (KNIGHTS) clinic. Most patients enjoy participating in the training and education of future physicians and would recommend this clinic to a friend or family member. The lowest satisfaction rates were associated with length of visit and wait time. In the future, SRFCs should work together to assess patient satisfaction in the clinics, identify problem areas, and develop generalizable interventions for improvement.

The use of ocular ultrasound to diagnose retinal detachment: a case demonstrating the sonographic findings.

Retinal detachment is an ophthalmologic emergency that requires immediate medical attention as it can potentially lead to permanent vision loss. The gold standard for diagnosing retinal detachment is dilated funduscopic exam. However, when this exam is not feasible such as in an emergency room setting or if visualization of the posterior portion of the eye is not possible due to vitreous hemorrhage or dense cataracts, ocular ultrasound provides a readily available and effective alternative. We present the sonographic appearance of chronic retinal detachment in a 24-year-old female with a longstanding history of poorly controlled type 1 diabetes who could not undergo dilated funduscopic exam due to intra-ocular hemorrhage. While retinal detachment is more likely to be detected by radiologists on computed tomography (CT) or magnetic resonance imaging (MRI), radiologists should be aware of the ultrasound findings as well, especially as it becomes a more frequently utilized method for diagnosing retinal detachment in an emergency room setting.

Low-Intensity Pulsed Ultrasound Therapy for a Symptomatic Persistent Olecranon Physis in an Adolescent Baseball Pitcher.

A 15-year-old competitive right-handed high school baseball pitcher experienced an acute onset of right elbow pain when throwing. He initially treated it conservatively with rest alone for 3 months, but on return to throwing, he was still experiencing pain. Radiographs revealed that he had a persistent olecranon physis. He proceeded with a trial of low-intensity pulsed ultrasound therapy and attained radiographic evidence of bony union at 7 months postinjury, thus avoiding surgical intervention. He returned to pitching competitively 9 months after injury without elbow pain. This is the first reported case of using ultrasound bone stimulation for treatment of a symptomatic persistent olecranon physis in a baseball pitcher.

Real-Time Electronic Dashboard Technology and Its Use to Improve Pediatric Radiology Workflow.

The purpose of our study was to create a real-time electronic dashboard in the pediatric radiology reading room providing a visual display of updated information regarding scheduled and in-progress radiology examinations that could help radiologists to improve clinical workflow and efficiency. To accomplish this, a script was set up to automatically send real-time HL7 messages from the radiology information system (Epic Systems, Verona, WI) to an Iguana Interface engine, with relevant data regarding examinations stored in an SQL Server database for visual display on the dashboard. Implementation of an electronic dashboard in the reading room of a pediatric radiology academic practice has led to several improvements in clinical workflow, including decreasing the time interval for radiologist protocol entry for computed tomography or magnetic resonance imaging examinations as well as fewer telephone calls related to unprotocoled examinations. Other advantages include enhanced ability of radiologists to anticipate and attend to examinations requiring radiologist monitoring or scanning, as well as to work with technologists and operations managers to optimize scheduling in radiology resources. We foresee increased utilization of electronic dashboard technology in the future as a method to improve radiology workflow and quality of patient care.

Assessing the effectiveness of knowledge-based interventions in increasing skin cancer awareness, knowledge, and protective behaviors in skin of color populations.

Skin of color (SOC) populations (ie, blacks, Hispanics, Asians) are at a notably higher risk for mortality from skin cancers such as melanoma than white individuals. In this article, we seek to answer the following question: Do knowledge-based interventions increase skin cancer awareness among SOC patients? Following an extensive literature search, a total of 4 articles were analyzed and discussed in this review.