Interrater Agreement of BT-RADS for Evaluation of Follow-Up MRI in Treated Primary Brain Tumor Patients.

BACKGROUND AND PURPOSE: The Brain Tumor Reporting and Data System (BT-RADS) is a structured radiology reporting algorithm that was introduced to provide uniformity in post-treatment primary brain tumor follow-up and reporting, but its interrater reliability (IRR) assessment has not been widely studied. Our goal is to evaluate the IRR among neuroradiologists and radiology residents in the use of BT-RADS. MATERIALS AND METHODS: This retrospective study reviewed 103 consecutive MR studies in 98 adult patients previously diagnosed with and treated for primary brain tumor (January 2019 to February 2019). Six readers with varied experience (4 neuroradiologists and 2 radiology residents) independently evaluated each case and assigned a BT-RADS score. Readers were blinded to the original score reports and the reports from other readers. Cases in which at least one neuroradiologist scored differently were subjected to consensus scoring. After the study, a post-hoc reference score was also assigned by 2 readers using future imaging and clinical information previously unavailable to readers. The interrater reliabilities were assessed using Gwet's AC2 index with ordinal weights and percent agreement. RESULTS: Of the 98 patients evaluated (median age, 53 years; interquartile range, 41-66 years), 53% were males. The most common tumor type was astrocytoma (77%) of which 56% were grade 4 glioblastoma. Gwet's index for interrater reliability among all six readers was 0.83 (95% CI: 0.78, 0.87). The Gwet's index for the neuroradiologists' group (0.84 [95% CI: 0.79, 0.89]) was not statistically different from that for the residents' group (0.79 [95% CI: 0.72, 0.86]) (χ2 = 0.85; p = 0.36). All four neuroradiologists agreed on the same BT-RADS score in 57 of the 103 studies, three neuroradiologists agreed in 21 of the 103 studies, and two neuroradiologists agreed in 21 of the 103 studies. Percent agreement between neuroradiologist blinded scores and post-hoc reference scores ranged from 41%-52%. CONCLUSIONS: A very good interrater agreement was found when tumor reports were interpreted by independent blinded readers using BT-RADS criteria. Further study is needed to determine if this high overall agreement can translate into greater consistency in clinical care. ABBREVIATIONS: BI-RADS = Breast Imaging Reporting and Data System; BT-RADS = Brain Tumor Reporting and Data System; IQR = interquartile range; IRR = interrater reliability; NI-RADS = Neck Imaging Reporting and Data System.

Consulting in the dark: Robert Hamilton (1749-1830) and the importance of 'tenderness' towards patients.

Robert Hamilton (1749-1830) was born in Coleraine, Ireland, attended medical school in Edinburgh, Scotland, served in the British army and practised in South-East England. In order to differentiate him from his contemporary and namesake, Hamilton is identified by having worked in Ipswich, Suffolk and Colchester, Essex. This submission considers Hamilton's biography, his 1787 book on the British regimental surgeon and his ideas therein about professionalism. Central to his concept of professionalism is 'tenderness', a notion that broadly equates to empathy. He notes that tenderness brings improvement in clinical outcome and he has the foresight to recognise nurses as key to such care. The authors explore the concept of 'consulting in the dark', i.e. without access to clinical investigations. This is exemplified by doctors of the eighteenth century and earlier. Today general practitioners must still be comfortable 'consulting in the dark', e.g. when attending a patient's home. Hamilton's biography offers a further example of 'consulting in the dark': In later life, he lost his vision but continued to practise successfully. Central to his gift of consulting 'in the dark' was likely to be 'tenderness' for his patients, expressed through language and gentle touch. Hamilton's entreaty for 'tenderness' contrasts with modern medical education where reliance upon clinical tests, technology and pharmacology risksblinding young doctors towards patients and their lives.

Dr. Russell Davies (1914-1991): Pioneer of theatre recovery and of anaesthetics in Yugoslavia.

Dr. Russell Davies is a largely forgotten pioneer of both post-operative theatre recovery but also a key figure in the establishment of anaesthetics services in Yugoslavia in the late 1940s. Davies spent the majority of his career working as an anaesthetist at Queen Victoria Hospital, East Grinstead, Sussex, England, later being promoted to the head anaesthetist role. Davies set up one of the first recovery wards in the United Kingdom at Queen Victoria Hospital, the ward being named after him in 1989. Here he became a founding member of the Guinea Pig Club, alongside Dr. Archibald McIndoe. The Guinea Pig Club was founded in 1941 to support airmen in the Second World War undergoing plastic surgery at Queen Victoria Hospital. Davies was crucial to the pastoral care of the Club, providing clinical care and guiding members over access to pensions they would have previously been denied. Little is recognised of Davies's achievement of establishing anaesthetics services in Yugoslavia. Davies and his contributions have been largely overlooked. Davies should be considered one of the foremost British anaesthetists of the 20th century.

Diagnostic Excellence in Pediatric Spine Imaging: Using Contextualized Imaging Protocols.

Contextual design and selection of MRI protocols is critical for making an accurate diagnosis given the wide variety of clinical indications for spine imaging in children. Here, we describe our pediatric spine imaging protocols in detail, tailored to specific clinical questions.

Sir Benjamin William Rycroft OBE (1902-1967): British ophthalmologist and pioneer in corneal surgery.

An unsung hero of British ophthalmology is the largely forgotten Sir Benjamin Rycroft (1902-1967). This paper will discuss and analyse the undervalued career of this great man. Upon graduating from medical school, Rycroft became a General Practitioner. Rycroft then decided to train to become an ophthalmologist. Rycroft began his ophthalmology career in 1930s London focusing on the new ground-breaking surgery of keratoplasty (corneal grafting) before serving with distinction in the medical corps during the Second World War. He is chiefly remembered for his work after the war at the Queen Victoria Hospital in East Grinstead, Sussex, where he worked with renowned plastics surgeon Archibald McIndoe. During his time, there Rycroft became globally recognised for his skill in keratoplasty and started a campaign which radically changed the legal framework behind organ donation in the UK. Despite few knowing of him today, Rycroft is undoubtedly one of the most influential British ophthalmologists of the past century. He was for decades seen as one of the world's leading practitioners of keratoplasty and established a unit which restored sight to wounded veterans. His greatest achievement lies in his organ donation reform, which started the process of allowing organ donation to be carried out on a nationwide scale for the first time.

A 'worthy disciple of Galen', 'ardent sportsman' and 'expert swordsman': Henry Kipping (1726-1785) apothecary and surgeon at Brighton, England.

Henry Kipping (1726-1785) was an apothecary and surgeon in Brighton, England. Here we present a series of contemporary references to Kipping from newspaper, book, archive and web-based resources. Some relate to his medical practice (resuscitating a 'drowned' elderly physician and a fisherman, bleeding a member of parliament who had fallen from his horse and praising a nostrum for the 'gravel and stone'). Social references include a duel with an army officer whose sword Kipping confiscated. Kipping appears to have been popular, connected with members of Brighton's high society and passionate about traditional past times, e.g. swordsmanship, horse riding and hunting on the Sussex downs. Indeed, Kipping's horse ran in the earliest known horse race in Brighton (1770). He was consulted by notable local residents including the Thrale family of Brighton and Lady Wilhelmina Shelley (the latter evidenced by Kipping partaking in her funeral procession in 1772). Kipping lived and practised at 28 West street, a road most famous for its (now lost) George Inn where King Charles II stayed just prior to his escape to Normandy. Kipping comes across as a colourful and eccentric clinician.

William Attree (died 1846): Royal and army surgeon who underwent amputation of the leg at Brighton, England (1807).

William Attree (1780-1846) came from a prominent family in Brighton, England. He studied medicine at St Thomas' Hospital, London, and there was unwell for nearly 6 months with severe 'spasms' of the hand/arm/chest (1801-1802). Attree qualified Member of the Royal College of Surgeons in 1803 and served as dresser to Sir Astley Paston Cooper (1768-1841). In 1806 Attree is recorded as 'Surgeon and Apothecary' of Prince's street, Westminster. In 1806 Attree's wife died in childbirth and the following year he underwent emergency amputation of the foot in Brighton following a road traffic accident. Attree served as surgeon in the Royal Horse Artillery at Hastings, presumably in a regimental or garrison hospital. He went onto become surgeon to the Sussex County Hospital, Brighton, and Surgeon Extraordinary to two Kings: George IV and William IV. In 1843 Attree was appointed as one of the original 300 Fellows of the Royal College of Surgeons. He died in Sudbury, near Harrow. His son William Hooper Attree (1817-1875) was surgeon to Don Miguel de Braganza, the former King of Portugal. The medical literature appears to lack a history of nineteenth century doctors (especially military surgeons) with physical disability. Attree's biography goes a small way towards developing this field of enquiry.

Trevor Mann (1916-1996): Paediatrician responsible for the development of hospital services for children in Brighton, England.

Trevor Philip Mann (1916-1996) was the first consultant paediatrician at the Royal Alexandra Children's Hospital (RACH) in Brighton, since its foundation in 1881. Here, he was responsible for significant service developments, including establishing a department of paediatric surgery and the first neonatal unit in England outside of London. Mann grew up in South London, and aged 14 had a lengthy admission to hospital with tuberculosis. He studied medicine at St Mary's Hospital, London. During World War II he was a Royal Navy Surgeon-Lieutenant, aboard the Atlantic destroyer, HMS Georgetown, and with the Russian convoys, before completing paediatric training in London. Here, he was involved in treating paediatric tuberculous meningitis; clinical work that formed part of one of the earliest randomised controlled trials. In 1951 Mann moved to the RACH where he researched infantile infectious gastroenteritis and introduced (now commonplace) practices at the hospital, including barrier nursing. He lived in Rottingdean, Sussex, and enjoyed sailing, gardening and wood turning. Mann's impact on paediatric care in Brighton was recognised by the hospital, naming the Trevor Mann Baby Unit in his honour, upon his retirement in 1981. This article seeks to record his contributions and reconnect local clinicians with his memory.

Unearthing a provincial medical school and its students - A history of the 1834 'School of Practical Medicine and Surgery' at the Sussex County Hospital, Brighton, England.

The 19th century was a period of rapid change in English medical education. Little is known about the important contribution of smaller, hospital-based, provincial medical schools which sprang up to provide important practical training opportunities for students, typically as a foundation for further training and examination in London. One such example is the 1834 Brighton 'School of Practical Medicine and Surgery', which was based at the Sussex County Hospital and recognised by the Royal College of Surgeons and Worshipful Society of Apothecaries. Unlike many other 19th century medical schools, the history of the Brighton school is largely undocumented. Although it remained dependent upon London through the 'College and Hall' examination system, this article shows that the school's pragmatic and adaptive educational approach allowed it to play an important role in educating future doctors in Brighton from 1834 into at least the early 20th century.

'Disciples of Aesclepius': Glimpses into lives of the 'Gentlemen of the Faculty' of medicine in Brighton, England 1800-1809.

Here we present newspaper accounts from the Sussex Advertiser to consider hitherto largely unknown Brighton doctors active between 1800 and 1809. This body of physicians, surgeons and apothecaries comprised Brighton's 'Gentlemen of the [medical] Faculty', whom the newspaper also dubbed the 'Disciples of Aesclepius'. Members are considered under three broad categories. First, are Brighton-based clinicians (Mr Barratt, Mr Bond, Charles Bankhead, Thomas Guy, John Hall, John Newton, Benjamin Scutt and Sir Matthew Tierney). Second are London clinicians, probably in attendance to the Prince of Wales (John Hunter and Thomas Keate), More widely, two dentists (Dr Durlacher and Mr Bew) and two Royal Navy surgeons (Robert Chambers and Thomas Thong) also recorded at Brighton are considered. Other aspects of medical life are described: recruiting an apprentice, anatomy training at Joshua Brooke's London museum, midwifery, a description of a surgeon's bag and the last reference to the Royal Sussex Jennerian Society (which disappears from the newspaper record in 1807). Clinical cases described include: resuscitation from near-drowning, post-mortem examinations, death from the 'gravel and stone' and accounts of suicide. The primary sources presented in this paper offer rare glimpses into medical life in Brighton at the very start of the nineteenth century.

Ultrasound-Guided Retroclavicular Approach to the Infraclavicular Region (RAPTIR) Brachial Plexus Block for Anterior Shoulder Reduction.

BACKGROUND: Shoulder dislocations are a common presenting injury to the emergency department (ED), with anterior dislocations comprising the majority of these cases. Some patients may tolerate gentle manipulation and reduction, but many require analgesia of some type. Oral or parenteral pain medication is often used alone or in combination with procedural sedation if gentle manipulation fails to achieve reduction. Recently, this treatment algorithm has grown to include regional anesthesia as a mode of analgesia for reduction of shoulder dislocations in the form of brachial plexus blocks. It has been well described that the interscalene and supraclavicular approach to the brachial plexus can be used to assist in reduction of anterior shoulder dislocations; however, there has yet to be any published literature regarding the use of ultrasound-guided retroclavicular approach to the infraclavicular region (RAPTIR) brachial plexus blocks for shoulder reduction. CASE REPORT: We describe three patients who presented to the ED with anterior shoulder dislocations. The RAPTIR block was performed, provided effective analgesia, and facilitated successful shoulder reduction in all three patients.Why Should an Emergency Physician Be Aware of This? The RAPTIR nerve block is a safe and effective option for analgesia in the patient with an anterior shoulder dislocation. It may have advantages over other brachial nerve blocks and avoids the risks and disadvantages of procedural sedation and opioids.

Robert Henderson: Scottish doctor who was appointed Physician to the Forces (1795) and practised at Brighton, England.

Robert Henderson was a Scottish physician who qualified Doctor of Medicine at Aberdeen in 1786. By 1792, Henderson was working in Brighton on the south coast of England. He was admitted Licentiate of the College of Physicians of London in 1793. At Brighton he probably worked as a parish doctor. In 1795 Henderson was appointed Physician to the Forces and probably served as a garrison doctor. In Brighton, he is noted as an advocate of chalybeate water therapy (i.e. mineral spring water containing iron salts). Henderson undertook basic experiments into the chemistry of mineral water and a few, very brief, clinical observations may be his. In Henderson's time, the chalybeate in question was part of the 'Wick estate' to the North West of Brighton. Today the site of the spring is located within St Ann's Well Gardens, Hove and this article briefly considers its history. Circumstances link Henderson to Sir Lucas Pepys MD (1742-1830), physician-general to the army and closely associated with both the College of Physicians and the town of Brighton. Henderson died in Brighton on the 3rd April 1808. Henderson's daughter Sophia Janet married Captain William John Thompson Hood who served at Trafalgar aged eleven.