International pharmacy students' perceptions towards artificial intelligence in medicine-A multinational, multicentre cross-sectional study.

AIMS: To explore international undergraduate pharmacy students' views on integrating artificial intelligence (AI) into pharmacy education and practice. METHODS: This cross-sectional institutional review board-approved multinational, multicentre study comprised an anonymous online survey of 14 multiple-choice items to assess pharmacy students' preferences for AI events in the pharmacy curriculum, the current state of AI education, and students' AI knowledge and attitudes towards using AI in the pharmacy profession, supplemented by 8 demographic queries. Subgroup analyses were performed considering sex, study year, tech-savviness, and prior AI knowledge and AI events in the curriculum using the Mann-Whitney U-test. Variances were reported for responses in Likert scale format. RESULTS: The survey gathered 387 pharmacy student opinions across 16 faculties and 12 countries. Students showed predominantly positive attitudes towards AI in medicine (58%, n = 225) and expressed a strong desire for more AI education (72%, n = 276). However, they reported limited general knowledge of AI (63%, n = 242) and felt inadequately prepared to use AI in their future careers (51%, n = 197). Male students showed more positive attitudes towards increasing efficiency through AI (P = .011), while tech-savvy and advanced-year students expressed heightened concerns about potential legal and ethical issues related to AI (P < .001/P = .025, respectively). Students who had AI courses as part of their studies reported better AI knowledge (P < .001) and felt more prepared to apply it professionally (P < .001). CONCLUSIONS: Our findings underline the generally positive attitude of international pharmacy students towards AI application in medicine and highlight the necessity for a greater emphasis on AI education within pharmacy curricula.

Can optimized model-based iterative reconstruction improve the contrast of liver lesions in CT?

BACKGROUND: Computed tomography is a standard imaging procedure for the detection of liver lesions, such as metastases, which can often be small and poorly contrasted, and therefore hard to detect. Advances in image reconstruction have shown promise in reducing image noise and improving low-contrast detectability. PURPOSE: To examine a novel, specialized, model-based iterative reconstruction (MBIR) technique for improved low-contrast liver lesion detection. MATERIAL AND METHODS: Patient images with reported poorly contrasted focal liver lesions were retrospectively reconstructed with the low-contrast attenuating algorithm (FIRST-LCD) from primary raw data. Liver-to-lesion contrast, signal-to-noise, and contrast-to-noise ratios for background and liver noise for each lesion were compared for all three FIRST-LCD presets with the established hybrid iterative reconstruction method (AIDR-3D). An additional visual conspicuity score was given by two experienced radiologists for each lesion. RESULTS: A total of 82 lesions in 57 examinations were included in the analysis. All three FIRST-LCD algorithms provided statistically significant increases in liver-to-lesion contrast, with FIRSTMILD showing the largest increase (40.47 HU in AIDR-3D; 45.84 HU in FIRSTMILD; P < 0.001). Substantial improvement was shown in contrast-to-noise metrics. Visual analysis of the lesions shows decreased lesion visibility with all FIRST methods in comparison to AIDR-3D, with FIRSTSTR showing the closest results (P < 0.001). CONCLUSION: Objective image metrics show promise for MBIR methods in improving the detectability of low-contrast liver lesions; however, subjective image quality may be perceived as inferior. Further improvements are necessary to enhance image quality and lesion detection.

Comparison of a High-Pitch Non-ECG-Gated and a Prospective ECG-Gated Protocol for Preprocedural Computed Tomography Imaging Before TAVI/TAVR.

PURPOSE: Preprocedural computed tomography (CT) imaging before transcatheter aortic valve implantation/replacement (TAVI/TAVR) requires high diagnostic accuracy without motion artifacts. The aim of this retrospective study is to compare the image quality of a high-pitch non-electrocardiography (ECG)-gated CT protocol used in patients with atrial tachyarrhythmias with a prospectively ECG-gated CT protocol used in patients with sinus rhythm. MATERIALS AND METHODS: We retrospectively included 108 patients who underwent preprocedural CT imaging before TAVI/TAVR. 52 patients with sinus rhythm were imaged using a prospectively ECG-gated protocol (Group A), and 56 patients with atrial tachyarrhythmias were imaged using the high-pitch non-ECG-gated protocol (Group B). Image quality was rated subjectively by two experienced radiologists and assessed by objective parameters including radiation dose, image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) at the levels of the aortic root and abdominal aorta. RESULTS: Subjective image quality was equally good with both CT protocols, and interrater agreement was substantial in both groups but tended to be higher in Group B at the level of the aortic root (Group A: κw = 0.644, Group B: κw = 0.741). With the high-pitch non-ECG-gated CT protocol, image noise was significantly increased (p = 0.001), whereas the SNR, CNR, and radiation dose were significantly decreased (p = 0.002, p = 0.003, and p < 0.001, respectively) at the level of the aortic root compared to the prospectively ECG-gated CT protocol. CONCLUSION: The high-pitch non-ECG-gated protocol yields images with similar subjective image quality compared with the prospectively ECG-gated CT protocol and allows motion-free assessment of the aortic root for accurate TAVI/TAVR planning. The high-pitch non-ECG-gated protocol may be used as an alternative for preprocedural CT imaging in patients with atrial tachyarrhythmias. KEY POINTS: · In patients with atrial tachyarrhythmias, a high-pitch non-ECG-gated CT protocol achieves similar subjective image quality compared to a prospective ECG-gated CT protocol.. · At the level of the aortic root, image noise is significantly increased, whereas SNR and CNR are significantly decreased using the high-pitch non-ECG-gated protocol.. · Radiation dose is reduced by 55 % using the high-pitch non-ECG-gated protocol.. CITATION FORMAT: · Shnayien S, Beetz N, Bressem KK et al. Comparison of a High-Pitch Non-ECG-Gated and a Prospective ECG-Gated Protocol for Preprocedural Computed Tomography Imaging Before TAVI/TAVR. Fortschr Röntgenstr 2023; 195: 139 - 147.

Radiation Dose Reduction in Preprocedural CT Imaging for TAVI/TAVR Using a Novel 3-Phase Protocol: A Single Institution's Experience.

PURPOSE: To retrospectively investigate the effectiveness of a novel 3-phase protocol for computed tomography (CT) before transcatheter aortic valve implantation/transcatheter aortic valve replacement (TAVI/TAVR) in terms of radiation dose and image quality. MATERIALS AND METHODS: A total of 107 nonrandomized patients (81 ±â€Š7.4 years) scheduled for TAVI/TAVR underwent preprocedural CT on an 80-row CT scanner. 55 patients underwent a combined ECG-synchronized spiral scan of the chest and non-ECG-synchronized spiral scan of the abdomen/pelvis as recommended by the Society of Cardiovascular Computed Tomography (SCCT). 52 patients underwent an updated 3-phase variable helical pitch (vHP3) protocol combining a non-ECG-synchronized spiral scan of the upper thoracic aperture, followed by a prospective ECG-synchronized spiral scan of the heart, and a non-ECG-synchronized abdominal/pelvic spiral scan. The radiation dose was determined from an automatically generated protocol based on the CT dose index (CTDI). Objective image quality in terms of vessel attenuation and image noise was measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was evaluated using a 4-point scale and compared for interrater agreement using Cohen's weighted kappa coefficient (κw). All data were compared and statistically analyzed. RESULTS: Use of the novel 3-phase vHP3 protocol reduced the dose-length product (DLP) from 1256.58 ±â€Š619.05 mGy*cm to 790.90 ±â€Š238.15 mGy*cm, reducing the effective dose (E) from 21.36 ±â€Š10.52 mSv to 13.44 ±â€Š4.05 mSv and size-specific dose estimates (SSDE) from 20.85 ±â€Š7.29 mGy to 13.84 ± 2.94 mGy (p < 0.001). There were no significant differences in objective and subjective image quality between the two protocols and between the two readers. CONCLUSION: The novel 3-phase vHP3 protocol significantly reduces the radiation dose of preprocedural TAVI/TAVR CT without a loss of image quality. KEY POINTS: · The use of a novel 3-phase protocol for preprocedural TAVI/TAVR CT reduces radiation dose by 37 % compared to a combined ECG-synchronized and non-ECG-synchronized spiral CT protocol.. · Objective image quality remains unaffected as image noise, SNR, and CNR did not differ significantly between the two protocols. The average attenuation of the aortic root and abdominal aorta exceeded 450 HU in both protocols.. · The average subjective image quality ratings were good to excellent for both protocols with almost perfect to substantial interrater agreement.. CITATION FORMAT: · Shnayien S, Bressem KK, Beetz NL et al. Radiation Dose Reduction in Preprocedural CT Imaging for TAVI/TAVR Using a Novel 3-Phase Protocol: A Single Institution's Experience. Fortschr Röntgenstr 2020; 192: 1174 - 1182.

Multipolar RFA of the liver: Influence of intrahepatic vessels on ablation zones and appropriateness of CECT in detecting ablation dimensions - Results of an in-vivo porcine liver model.

BACKGROUND: Radiofrequency ablation (RFA) is an important treatment option for hepatic tumors and metastases. Post-ablation recurrence rates are reported up to 36.5 percent and seem to depend on tumor size, intrahepatic localization of tumors and adjacent hepatic vessels. Multipolar RFA has the potential to overcome/reduce these limitations. Experimental and standardized data on achievable lesion sizes, influence of hepatic vessels and non-invasive evaluation of complete ablation is still insufficient. OBJECTIVES: The aim of this study was to evaluate the influence of intrahepatic vessels on shape and size of multipolar RF-ablation zones in healthy porcine liver and to evaluate the appropriateness of immediate post-ablation contrast-enhanced computed tomography (CECT) in detecting RF-ablation dimensions. MATERIAL AND METHODS: We conducted multipolar RFAs in each of the livers of 10 healthy, narcotized and laparotomized domestic pigs by inserting three parallel probes with a constant probe distance and a constant energy supply. In 4 ablations we interrupted hepatic blood flow using Pringle's maneuver. Immediate post-ablation CECT scans were acquired. After euthanasia the livers were sliced perpendicularly to the probes at the probes' active centers. CECT scans were reconstructed equivalently in order to compare RF-lesion size and shape to the macroscopic sections. RESULTS: In total, 19 RF-lesions were analyzed. Every RF-lesion that was ablated during physiological liver perfusion showed an irregular and cloverleaf-like shape (n = 15). Interrupting the hepatic blood flow during RFA led to well-defined, round and homogeneous ablation zones which were 3.8 times larger compared to RF-lesions ablated during continuous hepatic perfusion (n = 4). We found an excellent correlation between immediate post-ablation CECT slices and macroscopic sections when comparing RF-lesion diameters and area, although CECT tended to overestimate ablation dimensions. CONCLUSIONS: The interruption of hepatic blood flow using Pringle's maneuver during multipolar RFA with three applicators significantly reduces heat sink effects of hepatic vessels and generates large and coherent ablation zones. This approach should be considered in each case of ablation planning adjacent to larger hepatic vessels or when ablating larger tumor volumes. Immediate post-ablation CECT has limited value in detecting incomplete RFA periprocedurally.