Transcending Language Barriers: Can ChatGPT Be the Key to Enhancing Multilingual Accessibility in Healthcare?

OBJECTIVE: To explore the capabilities of ChatGPT for the purpose of simplifying and translating radiology reports into Spanish, Hindi, and Russian languages, with comparisons to its performance in simplifying to the English language. METHODS: 50 deidentified abdomen-pelvis CT reports were fed to ChatGPT (4.0), instructing it to simplify and translate the report. The processed reports were rated on factual correctness (I), potential harmful errors (II), completeness (III), and explanation of medical terms (IV). The translated versions were also rated on the quality of translation (V). The scores in each category were compared between the translated versions and each translated version was compared with the English version in the first four categories. The original reports and the simplified English reports were rated on the Flesch Reading Ease Score (FRES) and the Flesch Kincaid Grade Level (FKRL). RESULTS: The Spanish translation outperformed the Hindi and Russian version significantly in categories I and III (p<0.05). All translated versions performed significantly worse compared to the English version in category IV (p<0.001). Notably, the Hindi translated version performed significantly worse in all 4 categories (p<0.05). The Russian translated version was also significantly worse in category III (p<0.05). In the first three categories, the Spanish translation, and the Russian translation in the first two categories demonstrated no statistically significant difference from the English version. No statistically significant difference was observed in the FRES and FKRL of the simplified English reports. Typographical errors in the original reports negatively affected the translation. CONCLUSION: ChatGPT demonstrates potential ability in translating reports and communicating pertinent clinical information with limited errors. More training and tailoring are required for languages that are not as commonly used in medical literature. LLMs can be used for translating and simplifying radiology reports, potentially improving access to healthcare, and helping reduce healthcare costs.

Gallstones Detection on Dual-Energy Computerized Tomography-Is It Ready for Real-World Use? A Retrospective Observational Study.

AIMS: The aims of the study are to evaluate the performance of dual-energy computed tomography (DECT) imaging in the detection of noncalcified gallstones (GSs) and to assess its performance relative to transabdominal ultrasound (US) in identifying cholelithiasis. METHOD: This study is a retrospective review of radiology records and images to find all patients who had both US and DECT scans within a 6-month period and were found to have GSs. Patients who did not have GSs on US served as the control group. The CT scans were reviewed by 4 radiologists who did not have access to the US results when assessing the presence or absence of GSs on the DECT scans. In case of any discrepancies among the radiologists, the majority opinion was considered. If there was a split opinion, a fifth reviewer was consulted. The data were analyzed to calculate sensitivity, specificity, positive and negative predictive values, as well as overall accuracy and to evaluate interreader variability. The absolute Hounsfield unit (HU) differences of the GSs and bile were compared between polychromatic (PC), virtual noncontrast (VNC), and virtual monochromatic (VMC) images. RESULTS: Considering at least 3-reader agreement, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were found to be 92%, 96%, 96%, 92%, and 94%, respectively. Individual reader sensitivity varied between 87% and 92%. There was good interobserver agreement with a Fleiss' kappa of 0.76. Quantification of the whole data set showed that no significant difference was observed in the HU values for the stones between the PC images and the VNC images. A significant increase was observed on the 50-keV VMC images compared with the PC and VNC images. In the study group, 17% stones were visualized only on the VNC or/and 50-keV VMC images, and not on the PC images. On quantitative analysis of these cases, there was a significant increase of HU in the VNC images as compared with PC images and a significant decrease of HU in the 50-keV VMC images as compared with PC images. CONCLUSIONS: Low-keV images increase stone-bile contrast. Evaluation of cholelithiasis using VNC and 50-keV VMC images demonstrated a 14% increase in sensitivity relative to conventional CT.

Mitral Annular Disjunction: Review of an Increasingly Recognized Mitral Valve Entity.

Mitral annular disjunction (MAD) refers to atrial displacement of the hinge point of the mitral valve annulus from the ventricular myocardium. MAD leads to paradoxical expansion of the annulus in systole and may often be associated with mitral valve prolapse (MVP), leaflet degeneration, myocardial and papillary muscle fibrosis, and, potentially, malignant cardiac arrhythmias. Patients with MAD and MVP may present similarly, and MAD is potentially the missing link in explaining why some patients with MVP experience adverse outcomes. Patients with a 5 mm or longer MAD distance have an elevated risk of malignant cardiac arrhythmia compared with those with a shorter MAD distance. Evaluation for MAD is an important component of cardiac imaging, especially in patients with MVP and unexplained cardiac arrhythmias. Cardiac MRI is an important diagnostic tool that aids in recognizing and quantifying MAD, MVP, and fibrosis in the papillary muscle and myocardium, which may predict and help improve outcomes following electrophysiology procedures and mitral valve surgery. This article reviews the history, pathophysiology, controversy, prevalence, clinical implications, and imaging considerations of MAD, focusing on cardiac MRI. Keywords: MR-Dynamic Contrast Enhanced, Cardiac, Mitral Valve, Mitral Annular Disjunction, Mitral Valve Prolapse, Floppy Mitral Valve, Cardiac MRI, Arrhythmia, Sudden Cardiac Death, Barlow Valve © RSNA, 2023.

Comprehensive Imaging Review of Pleural Fistulas from Diagnosis to Management.

Pleural fistula is an abnormal communication between the pleural cavity and an adjacent structure. The interplay of anatomic and physiologic factors including proximity to various intrathoracic structures, deep pleural recesses, and negative pleural pressures makes the pleura an easy victim of fistulization. Iatrogenic creation followed by necrotizing infections and malignancies are the most common causes. While the overall incidence and size of postsurgical pleural fistulas are decreasing with increased adoption of vascularized flaps for high-risk resections, the smaller fistulas that develop in the setting of post-radiation therapy changes, with necrotizing infections in immunosuppressed patients, and with use of newer antiangiogenic chemotherapies can be challenging to visualize directly. Imaging signs in clinical practice are often subtle and indirect. Multimodality imaging and biochemical pleural fluid analysis can offer important adjunctive information when a diagnosis is only suggested with the first imaging study. Certain pleural fistulas are inconsequential, some spontaneously close with or without diversion of flow or use of positive-pressure ventilation, while others carry a higher risk of complications or recurrence. Estimated fistula size, factors that impair healing, and the possibility of diversion are important considerations when deciding between endoscopic or surgical closure. The authors have tailored this article for a general imager or clinical practitioner and review 10 types of pleural fistulas, ranging from routine to rare, with regard to their etiology, pathophysiology, clinical cues, imaging features, nuances of pleural fluid analysis, and management options available today. ©RSNA, 2022.

Solid Primary Retroperitoneal Masses in Adults: An Imaging Approach.

Mass lesions in the retroperitoneal space may be primary or secondary. Primary retroperitoneal mass lesions are relatively uncommon as compared to pathology that arises secondarily from retroperitoneal organs. These may be solid or cystic lesions. The overlapping imaging features of various solid primary retroperitoneal tumors make the diagnosis difficult, and hence, histopathology remains the mainstay of diagnosis. This paper provides a brief review of the anatomy of the retroperitoneal space and provides an algorithmic approach based on cross-sectional imaging techniques to narrow down the differential diagnosis of solid primary retroperitoneal masses encountered in the adult population.

Qualitative and Quantitative MRI Techniques for the Evaluation of Musculoskeletal Neoplasms.

Musculoskeletal neoplasms include tumors arising from bone, cartilage, muscles, tendons, nerves, and synovium. After initial screening radiographs, magnetic resonance (MR) imaging is the mainstay of management, and its role continues to increase in both pre- and post-operative evaluations. This article presents a review of the available qualitative and quantitative MR techniques for evaluating musculoskeletal neoplasms, including conventional and advanced imaging techniques such as diffusion-weighted and diffusion-tensor imaging, chemical shift and Dixon imaging, dynamic contrast-enhanced MRI, neurography, and spectroscopy. After reading the article, radiologists and oncologists will be able to apply these principles in their practices to benefit patients with musculoskeletal neoplasms.

Interobserver Agreement Between Primary Sonographers and Secondary Overreaders for Screening and Surveillance Liver Ultrasounds Using Ultrasound Liver Imaging Reporting and Data System.

ABSTRACT: The authors aim to identify if primary sonographers and secondary reviewers, both radiologists and sonographers, are likely to assign the same Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) scores for liver surveillance ultrasounds. Institutional review board approval was obtained. Sonographers were familiarized with US LI-RADS via radiologist-led lectures. Three sonographers prospectively scored 170 screening examinations using US LI-RADS recommendations. Scans were retrospectively rescored by a fourth sonographer and a radiologist, both of whom were blinded to the original scores. Results were analyzed with weighted and nonweighted Cohen kappa statistical analysis methods. There was near-perfect agreement between primary and secondary sonographers and primary sonographer and radiologist (kappa of 0.87 and 0.92, respectively) for US LI-RADS category (cat) scores. However, only substantial and moderate agreements were noted for visualization (vis) scores between primary and secondary sonographers and primary sonographer and radiologist (weighted kappa of 0.73 and 0.48, respectively). There was vis score disagreement between the primary sonographer and radiologist in 60 (35.3%) cases. In 35 (20%) cases, the radiologist assigned a lower/more conservative vis score. There was vis score disagreement between the primary and secondary reviewing sonographers in 30 (17.6%) cases. In 12 (7%) cases, the secondary sonographer assigned a more conservative vis score. Although a good degree of concordance was noted between the groups, radiologists will need to generate their own US LI-RADS scoring to accurately reflect their impression and appropriately steer management.

Anterior cruciate ligament reconstruction related complications: 2D and 3D high-resolution magnetic resonance imaging evaluation.

Anterior cruciate ligament (ACL) injury is a common indication for sports-related major surgery and accounts for a large proportion of ligamentous injuries in athletes. The advancements in 2D and 3D MR imaging have provided considerable potential for a one-stop shop radiation-free assessment with an all-in-one modality examination of the knee, for both soft-tissue and bone evaluations. This article reviews ACL injuries and types of surgical managements with illustrative examples using high resolution 2D and 3D MR imaging. Various complications of ACL reconstruction procedures are highlighted with a focus on the use of advanced MR imaging and relevant arthroscopic correlations.

Massive fusiform superior vena cava aneurysm in a 47-year-old complicated by pulmonary embolism: A case report and review of literature.

Superior vena cava (SVC) aneurysms are a rare occurrence. Given the rarity of SVC aneurysms and their propensity to be overlooked or misinterpreted on imaging, it is essential to be familiar with their appearance for accurate diagnosis, and to minimize thromboembolic risk, complications from rupture and mass effect. This report of a case of a massive fusiform SVC aneurysm that presented with pulmonary thrombo-embolism highlights the nuances of making an imaging diagnosis of SVC aneurysm and reviews the reported cases of fusiform SVC aneurysms that were diagnosed beyond childhood.

Correlation of placental MR imaging signs and pathologic diagnosis of placenta accreta spectrum: Retrospective single center case series.

INTRODUCTION: Alongside initial screening obstetric US, use of placental MRI has been increasing in the last few decades to aid with antenatal diagnosis and delivery planning in Placenta Accreta Spectrum (PAS). The aim of this study was to determine if the MRI pathophysiological sign subcategories described in the current literature can predict the severity of pathologic diagnosis. METHODS: Institutional imaging records were reviewed for placental MRIs performed for suspicion of PAS in the last decade. Electronic health records were searched for patient history and pathology. The 59 MRI studies were reviewed using the 11 MRI signs described by the SAR and ESUR joint consensus statement. Further breakdown of the signs was divided by underlying pathophysiologic subcategories including gross morphologic, interface and tissue architecture signs. RESULTS: Pathologic diagnosis yielded 34 cases: accreta 4/34, incerta 14/34, percreta 10/34 and normal 6/34. Of the accreta cases all of them demonstrated at least two interface and half of the cases had tissue architecture signs, 13/14 increta cases demonstrated interface signs and 12/14 demonstrated tissue architecture signs, 9/10 percreta cases had two interface and at least six demonstrated three tissue architecture signs. Statistical analysis showed significant difference between pathologic diagnosis and the number of positive interface signs with p = 0.02. DISCUSSION: Interface signs were the most objective and sensitive MRI subcategory. Statistical analysis determined there was a significant difference between PAS diagnosis and number of interface signs present. This subcategory has the most overlap with classic US signs which are traditionally used before MRI referral.

Multiple Sclerosis-Minimizing Errors in Radiological Diagnosis.

BACKGROUND: Multiple sclerosis is a chronic demyelinating disorder with a myriad of imaging and clinical features that overlap with number of other neurological conditions. Incorrect diagnosis poses a significant risk to patients, it may lead to delays in management, increased morbidity, and also adds to the financial cost. OBJECTIVE: The aim of this study was to highlight strategies for the efficient differentiation of multiple sclerosis from other diseases which may masquerade as MS clinico-radiologically. MATERIAL AND METHODS: A systematic literature review was conducted through online databases including PubMed and Medline. Relevant publications on radiological aspects of multiple sclerosis, white matter diseases and mimickers of Multiple sclerosis were included in the analysis. RESULTS: Common mimickers of MS include small vessel disease, acute disseminated encephalomyelitis, neuromyelitis optica, anti-MOG encephalomyelitis, vasculitis, and CADASIL. Contrast-enhanced MRI study performed using MS protocol on high strength MRI system evaluated following a structured protocol along with clinical correlation is effective in differentiating MS from its mimickers. CONCLUSIONS: Contrast-enhanced MRI performed on a high strength scanner using MS protocol with structured protocol for evaluation along, with a better collaboration between radiologists and clinicians may help in minimizing errors in diagnosis of multiple sclerosis.

Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings.

Bone sclerosis is a focal, multifocal, or diffuse increase in the density of the bone matrix on radiographs or computed tomography (CT) imaging. This radiological finding can be caused by a broad spectrum of diseases, such as congenital and developmental disorders, depositional disorders, and metabolic diseases. The differential diagnosis can be effectively narrowed by an astute radiologist in the light of the clinical picture and typical findings on imaging. Some of these lesions are rare and have been described as case reports and series in the literature. This article aims to collate the clinical-radiologic findings of non-infectious and non-neoplastic causes of bone sclerosis with relevant imaging illustrations.

An unusual case with a missing parotid gland: A case report.

Unilateral or bilateral agenesis of the parotid gland is an uncommon condition with unclear aetiology. Only 22 cases of unilateral salivary agenesis have been reported excluding the present case. We present a case of a 4-year-old female child who presented with complaints of slight discoloration of her tongue and was referred for MRI to rule out any vascular malformation. Imaging revealed a complete absence of the right parotid gland. Hypertrophy of the sublingual gland and hypoplasia of the parotid gland on the opposite side was also noted, an unusual finding as the contralateral parotid showed compensatory hypertrophy in the other reported cases.

Repair of Achilles tendon ruptures with peroneus brevis tendon augmentation.

PURPOSE: To report 22 patients who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation. METHODS: Records of 6 women and 19 men aged 21 to 42 (mean, 28) years who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation were reviewed. All the wounds were transverse/oblique, minimally contaminated, and could be closed primarily. Patients were evaluated at months 3, 9, and 12, using the Foot and Ankle Outcome Score (FAOS) questionnaire. RESULTS: Of the 22 patients, 3 developed superficial skin complications that healed gradually, and 2 developed a superficial discharging sinus and underwent minor debridement. No patient had a re-rupture of the Achilles tendon. At the one-year follow-up, all patients achieved good functional outcome in terms of the FAOS. CONCLUSION: Repair of Achilles tendon ruptures with peroneus brevis tendon augmentation achieved good functional outcome.

Unusual presentation of altered bone metabolism with long-term antiepileptic therapy: pathological fracture of neck of femur due to brown tumor at calcer.

The antiepileptic drugs are known to alter the bone metabolism and result in various range of pathological conditions (osteoporosis, osteomalacia, vitamin D deficiency, secondary hyperparathyroidism). These clinical conditions developed either due to direct effect of these therapeutic agents on bone or due to alteration in the homeostasis of other regulators of bone metabolism like serum calcium, vitamin D, and parathyroid hormone. Long-term therapy with antiepileptic agents results in higher incidence of pathological fracture, which is a consequence of either osteoporotic or osteomalasic (secondary to vitamin D deficiency) changes in bone produced by these drugs. Secondary hyperparathyroidism due to vitamin D deficiency following long-term polytherapy of antiepileptic drug ultimately leading to development of brown tumor and pathological fracture is very unusual.