Assessment of inspiration and technical quality in anteroposterior thoracic radiographs using machine learning.

INTRODUCTION: Chest radiographs are the most performed radiographic procedure, but suboptimal technical factors can impact clinical interpretation. A deep learning model was developed to assess technical and inspiratory adequacy of anteroposterior chest radiographs. METHODS: Adult anteroposterior chest radiographs (n = 2375) were assessed for technical adequacy, and if otherwise technically adequate, for adequacy of inspiration. Images were labelled by an experienced radiologist with one of three ground truth labels: inadequate technique (n = 605, 25.5 %), adequate inspiration (n = 900, 37.9 %), and inadequate inspiration (n = 870, 36.6 %). A convolutional neural network was then iteratively trained to predict these labels and evaluated using recall, precision, F1 and micro-F1, and Gradient-weighted Class Activation Mapping analysis on a hold-out test set. Impact of kyphosis on model accuracy was assessed. RESULTS: The model performed best for radiographs with adequate technique, and worst for images with inadequate technique. Recall was highest (89 %) for radiographs with both adequate technique and inspiration, with recall of 81 % for images with adequate technique and inadequate inspiration, and 60 % for images with inadequate technique, although precision was highest (85 %) for this category. Per-class F1 was 80 %, 81 % and 70 % for adequate inspiration, inadequate inspiration, and inadequate technique respectively. Weighted F1 and Micro F1 scores were 78 %. Presence or absence of kyphosis had no significant impact on model accuracy in images with adequate technique. CONCLUSION: This study explores the promising performance of a machine learning algorithm for assessment of inspiratory adequacy and overall technical adequacy for anteroposterior chest radiograph acquisition. IMPLICATIONS FOR PRACTICE: With further refinement, machine learning can contribute to education and quality improvement in radiology departments.

Prevalence of pelvic organ prolapse detected at dynamic MRI in women without history of pelvic floor dysfunction: comparison of two reference lines.

AIM: To retrospectively evaluate the prevalence of pelvic organ prolapse as an incidental finding on dynamic magnetic resonance imaging (MRI) using two different references lines. MATERIALS AND METHODS: Sixty women with symptoms unrelated to pelvic floor dysfunction who underwent MRI including a dynamic sagittal true fast imaging with steady-state free precession (TrueFISP) sequence during straining were identified. Two radiologists in consensus used the pubococcygeal line (PCL) and mid-pubic line (MPL) to diagnose and grade prolapse in all three pelvic compartments. RESULTS: Cystocele was absent, mild, moderate, and severe in 88% (53/60), 7% (4/60), 5% (3/60), and 0% (0/60) of patients, respectively, using PCL, versus 78% (47/60), 13% (8/60), 5% (3/60), and 3% (2/60) of patients, respectively, using MPL. Vaginal prolapse was absent, mild, moderate, and severe in 95% (57/60), 5% (3/60), 0% (0/60), and 0% (0/60) of patients, respectively, using PCL, versus 80% (48/60), 17% (10/60), 3% (2/60), and 0% (0/60) of patients, respectively, using MPL. Rectal descent was absent, mild, moderate, and severe in 63% (38/60), 10% (6/60), 23% (14/60), and 3% (2/60) of patients, respectively, using PCL, versus 43% (26/60), 27% (16/60), 27% (16/60), and 3% (2/60) of patients, respectively, using MPL. No enterocele, peritoneocele, or muscular defect was identified. Two percent (1/60) of patients had mild rectocele, 8% (5/60) had abnormal vesico-urethral angle, and 25% (15/60) had abnormal levator plate angle. CONCLUSION: In asymptomatic women, dynamic MRI identified the greatest degrees of prolapse in the posterior compartment. The MPL consistently yielded greater frequency of prolapse than the PCL. Findings of pelvic organ prolapse may be observed in asymptomatic patients and are of uncertain significance, requiring correlation with clinical and physical examination findings.

Groundwater Ecosystems Vary with Land Use across a Mixed Agricultural Landscape.

Changes in surface land use may threaten groundwater quality and ecosystem integrity, particularly in shallow aquifers where links between groundwater and surface activities are most intimate. In this study we examine the response of groundwater ecosystem to agricultural land uses in the shallow alluvial aquifer of the Gwydir River valley, New South Wales, Australia. We compared groundwater quality and microbial and stygofauna assemblages among sites under irrigated cropping, non-irrigated cropping and grazing land uses. Stygofauna abundance and richness was greatest at irrigated sites, with the composition of the assemblage suggestive of disturbance. Microbial assemblages and water quality also varied with land use. Our study demonstrates significant differences in the composition of groundwater ecosystems in areas with different surface land use, and highlights the utility of groundwater biota for biomonitoring, particularly in agricultural landscapes.

Assessing the chronic toxicity of atrazine, permethrin, and chlorothalonil to the cladoceran Ceriodaphnia cf. dubia in laboratory and natural river water.

The majority of ecotoxicological data are generated from standard laboratory-based experiments with organisms exposed in nonflowing systems using highly purified water, which contains very low amounts of dissolved organic matter and suspended particulates. However, such experimental conditions are not ecologically relevant. Thus, there is a need to develop more realistic approaches to determining toxicity, including both lethal and sublethal effects. This research provides information on the effect of natural water constituents, such as suspended particulates and dissolved organic matter, in river water (RW) on the chronic toxicity (7-day reproductive impairment) of the pesticides atrazine, chlorothalonil, and permethrin to the freshwater cladoceran Ceriodaphnia cf. dubia. Standard bioassays were conducted under standard laboratory and more environmentally realistic conditions (using RW). The 7-day IC25 (reproduction impairment) values of atrazine, chlorothalonil, and permethrin to C. cf. dubia ranged from 862.4 to >1000, 51.3 to 66.4, and 0.19 to 0.23 µg/L, respectively. Using the Globally Harmonized System of Classification and Labelling of Chemicals, atrazine is classified as moderately to highly toxic, whereas permethrin and chlorothalonil were both highly toxic. The presence of dissolved organic matter and suspended particles in natural RW did not significantly (p > 0.05) change the toxicity of any of the pesticides to C. cf. dubia compared with that tested in laboratory water (LW). For the tested pesticides, toxicity testing in LW provided an adequate estimate of the hazard posed.

Impact of delay after biopsy and post-biopsy haemorrhage on prostate cancer tumour detection using multi-parametric MRI: a multi-reader study.

AIM: To assess impact of haemorrhage and delay after biopsy on prostate tumour detection using multi-parametric (MP) magnetic resonance imaging (MRI) assessment. MATERIALS AND METHODS: Forty-four patients underwent prostate MRI at 1.5 T using a pelvic phased-array coil, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging, before prostatectomy. Three radiologists independently reviewed images during four sessions [T2WI, DWI, DCE, and all parameters combined (MP-MRI)] to assess for tumour in each sextant. In a separate session, readers reviewed T1WI to score the extent of haemorrhage per sextant. Accuracy was assessed using logistic regression for correlated data. RESULTS: There was no significant difference in accuracy between readers for any session (p ≥ 0.166), and results were averaged across the three readers for remaining comparisons. Accuracy was significantly greater for MP-MRI than for any parameter alone (p ≤ 0.020). For T2WI alone, there was a trend toward decreased sensitivity in sextants with extensive haemorrhage (p = 0.072). However, accuracy, sensitivity, and specificity were otherwise similar for sextants with and without extensive haemorrhage for all sessions (p = 0.192-0.934). No session showed a significant improvement in accuracy, sensitivity, or specificity in cases with delay after biopsy of over 4 weeks compared with shorter delay. CONCLUSION: Extensive haemorrhage and short delay after biopsy did not negatively impact accuracy for tumour detection using MP-MRI. Further studies using MP-MRI protocols and interpretation schemes from other institutions are required to confirm these observations.

A comparison of mixture toxicity assessment: examining the chronic toxicity of atrazine, permethrin and chlorothalonil in mixtures to Ceriodaphnia cf. dubia.

Pesticides predominantly occur in aquatic ecosystems as mixtures of varying complexity, yet relatively few studies have examined the toxicity of pesticide mixtures. Atrazine, chlorothalonil and permethrin are widely used pesticides that have different modes of action. This study examined the chronic toxicities (7-d reproductive impairment) of these pesticides in binary and ternary mixtures to the freshwater cladoceran Ceriodaphnia cf. dubia. The toxicity of the mixtures was compared to that predicted by the independent action (IA) model for mixtures, as this is the most appropriate model for chemicals with different modes of action. Following this they were compared to the toxicity predicted by the concentration addition (CA) model for mixtures. According to the IA model, the toxicity of the chlorothalonil plus atrazine mixture conformed to antagonism, while that of chlorothalonil and permethrin conformed to synergism. The toxicity of the atrazine and permethrin mixture as well as the ternary mixture conformed to IA implying there was either no interaction between the components of these mixtures and/or in the case of the ternary mixture the interactions cancelled each other out to result in IA. The synergistic and antagonistic mixtures deviated from IA by factors greater than 3 and less than 2.5, respectively. When the toxicity of the mixtures was compared to the predictions of the CA model, the binary mixture of chlorothalonil plus atrazine, permethrin plus atrazine and the ternary mixture all conformed to antagonism, while the binary mixture of chlorothalonil plus permethrin conformed to CA. Using the CA model provided estimates of mixture toxicity that did not markedly underestimate the measured toxicity, unlike the IA model, and therefore the CA model is the most suitable to use in ecological risk assessments of these pesticides.

3D time-resolved MR angiography (MRA) of the carotid arteries with time-resolved imaging with stochastic trajectories: comparison with 3D contrast-enhanced Bolus-Chase MRA and 3D time-of-flight MRA.

BACKGROUND AND PURPOSE: Time-resolved MR angiography (MRA) offers the combined advantage of large anatomic coverage and hemodynamic flow information. We applied parallel imaging and time-resolved imaging with stochastic trajectories (TWIST), which uses a spiral trajectory to undersample k-space, to perform time-resolved MRA of the extracranial internal carotid arteries and compare it to time-of-flight (TOF) and high-resolution contrast-enhanced (HR) MRA. MATERIALS AND METHODS: A retrospective review of 31 patients who underwent carotid MRA at 1.5T using TOF, time-resolved and HR MRA was performed. Images were evaluated for the presence and degree of ICA stenosis, reader confidence, and number of pure arterial frames attained with the TWIST technique. RESULTS: With a consensus interpretation of all sequences as the reference standard, accuracy for identifying stenosis was 90.3% for TWIST MRA, compared with 96.0% and 88.7% for HR MRA and TOF MRA, respectively. HR MRA was significantly more accurate than the other techniques (P < .05). TWIST MRA yielded datasets with high in-plane spatial resolution and distinct arterial and venous phases. It provided dynamic information not otherwise available. Mean diagnostic confidence was satisfactory or greater for TWIST in all patients. CONCLUSION: The TWIST technique consistently obtained pure arterial phase images while providing dynamic information. It is rapid, uses a low dose of contrast, and may be useful in specific circumstances, such as in the acute stroke setting. However, it does not yet have spatial resolution comparable with standard contrast-enhanced MRA.

Comparison of the fate and toxicity of chlorpyrifos--laboratory versus a coastal mesocosm system.

The widespread use of chlorpyrifos for pest control in urban and rural environments poses a risk of contamination to aquatic environments via runoff, spray drift or spillage. The aim of this study was to assess the fate of chlorpyrifos and its toxicity to common freshwater invertebrates in the laboratory and in stream mesocosms. Chlorpyrifos was rapidly lost from the test systems but the rates of loss varied considerably, such that losses in the mesocosms could not be reliably predicted from the static laboratory studies. This was likely due to the mass transport of chlorpyrifos from the mesocosm via stream flow. Chlorpyrifos was acutely toxic to all invertebrates tested with the cladoceran species (laboratory 48h LC(50) values 0.07-0.10 microg L(-1)) being most sensitive. Despite the differences in the dynamics of chlorpyrifos in the laboratory and mesocosm systems, the sensitivities of the mayfly Atalophlebia australis and the cladoceran Simocephalus vetulus were similar in the 2 systems.

Iliocaval arteriovenous fistula presenting with multiple organ failure.

Iliac arteriovenous fistulas are an uncommon condition, which may be spontaneous or traumatic in nature. Such fistulas classically present with a triad of high-output cardiac failure, pulsatile abdominal mass with a bruit and unilateral leg ischaemia or venous congestion. We describe a case of an iliocaval fistula secondary to rupture of a common iliac artery aneurysm, with an unusual presentation of multiple organ failure, masquerading as sepsis. We describe the CT findings of iliocaval fistula, which was the means of diagnosis in this study.

Toxicity and bioavailability of atrazine and molinate to the freshwater fish (Melanotenia fluviatilis) under laboratory and simulated field conditions.

Acute (96 h) semi-static toxicity tests were conducted by exposing the freshwater fish, Melanotenia fluviatilis, to atrazine and molinate in laboratory and river water both with and without sediment. The 96-h EC50 (imbalance) values of atrazine to M. fluviatilis ranged from 5.6 to 10.4 mg L(-1) while the corresponding values for molinate ranged from 7.9 to 14.8 mg L(-1), respectively. Atrazine was classed as having moderate toxicity while molinate had low to moderate toxicity to M. fluviatilis. Neither the presence of river water nor sediment significantly (P<0.05) reduced the bioavailability of either herbicide to M. fluviatilis. A series of other studies by the authors have found that sediment significantly (P<0.05) reduced the bioavailability of these two chemicals to a variety of organisms. Reasons for sediment having no effect for this species were examined. This lack of effect by sediment is most likely due to the relative rates of absorption into the fish and adsorption onto the sediment. However, contributions to this outcome by resuspended sediment, contaminated food and a combined effect of the herbicides and sediment could not be excluded.

Endovascular treatment of arterial mesenteric ischaemia: a retrospective review.

Mesenteric ischaemia is a condition that has traditionally been managed surgically. It poses a challenging diagnostic and therapeutic problem, particularly in the acute setting. We review a small series of eight patients managed with endovascular techniques for either acute or chronic mesenteric ischaemia at The Royal Melbourne Hospital, from 1997 to 2002. We describe our results and relate these to the recent published literature regarding endovascular and surgical management of mesenteric ischaemia. Our experience confirms the valuable contribution of angioplasty and stenting in chronic mesenteric ischaemia, which compares favourably with surgery with regards to complication rates and mortality. We suggest the need for further studies to compare the long-term efficacy of endovascular techniques compared with surgery in the management of chronic mesenteric ischaemia. Furthermore, we demonstrate a role for endovascular management in acute mesenteric ischaemia, in the appropriate clinical setting.

Effect of river water, sediment and time on the toxicity and bioavailability of molinate to the marine bacterium Vibrio fischeri (Microtox).

The toxicity and bioavailability of molinate to Vibrio fischeri (Microtox((R))) were determined in both laboratory and river water in the absence and presence of sediment after 0, 24, 48, 72 and 96-h exposure. The bioavailability of molinate, expressed as 5min EC50s (bioluminescence) and their fiducial limits calculated using initial measured concentrations, to V. fischeri in laboratory water in the absence and presence of sediment ranged from 1.8 (1.7-2.1) to 3.6 (3.5-3.7) mgL(-1) and 1.3 (1.2-1.4) to 4.2 (3.5-4.5) mgL(-1), respectively. The corresponding values in river water and river water plus sediment were 1.7 (1.6-1.8) to 3.8 (3.6-4.1) and 1.3 (1.3-1.4) to 4.6 (4.2-4.9) mgL(-1), respectively. River water did not significantly (P>0.05) reduce the bioavailability of molinate to V. fischeri compared to that of laboratory water. However, the presence of sediment significantly (P<0.05) reduced the bioavailability of molinate to V. fischeri in both waters. The exposure time also significantly (P<0.05) reduced the bioavailability of molinate to V. fischeri in both waters in the presence and absence of sediment. The type of water did not significantly (P>0.05) affect the loss of molinate during the 96-h exposure period. However, the presence of sediment significantly (P<0.01) increased the loss of molinate from the test solutions, probably by binding to the sediment particles. Exposure period and concentration levels significantly (P<0.05) affected the loss of the herbicides over the 96h.

The development of marine Toxicity Identification Evaluation (TIE) procedures using the unicellular alga Nitzschia closterium.

Unicellular algae are highly sensitive to a wide range of toxicants and have been used extensively in ecotoxicological testing. This, along with their ability to grow in very small test volumes over short test durations, make them ideal test organisms for use in Toxicity Identification Evaluations (TIEs). Despite this, microalgae have not previously been used in marine TIE studies. In this study, the marine diatom Nitzschia closterium was shown to be a highly suitable test organism after modification of the standard test protocol to reduce test volumes to 6 mL and test duration to 48 h. The alga was tolerant to the chemicals used in phase I of the standard USEPA TIE protocol, and physical TIE manipulations had no effect on algal growth. The cation exchange procedure, however, inhibited algal growth, while the anion exchange procedure stimulated growth, making these two procedures unsuitable for use with this species. Of the buffers trialed for the graduated pH procedure, 0.01 M PIPES buffer was found to be suitable for buffering at pH 7 because it maintained the required pH over the duration of the test and did not affect the growth or sensitivity of the algae to one reference toxicant (copper). A trial TIE on a secondary-treated sewage effluent for discharge into coastal waters showed that the developed protocols could successfully be used to identify ammonia as the major toxicant in the effluent.

The toxicity and bioavailability of atrazine and molinate to Chironomus tepperi larvae in laboratory and river water in the presence and absence of sediment.

Acute (10 day) semi-static toxicity tests in which the midge, Chironomus tepperi, were exposed to atrazine and molinate were conducted in laboratory water and in river water, in the absence and presence of sediment. The bioavailability measured as median lethal concentrations (LC50) and 95% fiducial limits (FLs) of atrazine to C. tepperi in laboratory water in the absence and presence of sediment were 16.6 (14.3-19.4) and 21.0 (18.2-24.1) mg l(-1), respectively while the corresponding values in river water were 16.7 (14.7-19.0) and 22.7 (20.3-25.4) mg l(-1), respectively. For molinate, the LC50 and FL values in laboratory water in the absence and presence of sediment were 8.8 (6.8-11.4) and 14.3 (12.4-16.4) mg l(-1), respectively and the corresponding values in river water were 9.3 (7.6-11.3) and 14.5 (12.4-16.9) mg l(-1), respectively. Atrazine has low toxicity (LC50 > 10 mg l(-1)) while molinate has moderate toxicity (1 mg l(-1) < LC50 < 10 mg l(-1)) to C. tepperi. River water did not significantly (P > 0.05) reduce the bioavailability of either chemical to C. tepperi. However, the presence of sediment did significantly (P < 0.05) reduce the bioavailability of both atrazine and molinate to C. tepperi.

Toxicity and bioavailability of atrazine and molinate to the freshwater shrimp (Paratya australiensis) under laboratory and simulated field conditions.

Acute (96-h) semistatic toxicity tests were conducted by exposing the freshwater shrimp, Paratya australiensis, to atrazine and molinate in laboratory water and in river water both with and without sediment. The median lethal concentrations (LC50) and 95% fiducial limits of atrazine for P. australiensis in laboratory water in the absence and presence of sediment were 9.9 (8.6-11.5) and 6.8 (5.4-8.5)mg/L, respectively, while the corresponding values in river water were 9.8 (8.5-11.2) and 6.5 (5.4-7.8)mg/L, respectively. For molinate, the LC50 values in laboratory water in the absence and presence of sediment were 9.2 (7.0-12.1) and 9.0 (6.8-12.0)mg/L, respectively and the corresponding values in river water were 8.7 (6.4-11.8) and 8.2 (6.6-10.2)mg/L, respectively. Neither the river water nor the presence of sediment significantly (P<0.05) reduced the bioavailability of either chemical to P. australiensis. This was unexpected, as studies with other aquatic organisms have shown that sediment significantly reduced the bioavailability of these chemicals.

Angioplasty and stenting of the superior mesenteric artery in acute mesenteric ischaemia.

Acute mesenteric ischaemia is a challenging diagnostic problem with a very high mortality. Traditionally, laparotomy is required for definitive management. We describe a successful case of angioplasty and stenting of the superior mesenteric artery in a surgically unfit patient. We recommend that stenting be considered only in situations where the diagnosis has been made prior to bowel infarction, and if the patient poses a poor operative risk.

Toxicity of atrazine and molinate to the cladoceran Daphnia carinata and the effect of river water and bottom sediment on their bioavailability.

Atrazine and molinate are widely used herbicides and concern has been raised about their potential deleterious impacts on aquatic ecosystems. Although there have been some studies on the toxicity of herbicides to aquatic organisms using laboratory or natural water, information on the effect of sediments, suspended particulates, and dissolved organic matter on their bioavailability is quite limited. This study aims to provide toxicity data that considers these factors and the effect that these factors have on bioavailability. In this study, the toxicity of the test chemicals was calculated following the Organisation for Economic Co-operation and Development (OECD) methods, whereas change in bioavailability was measured using EC50 values based on measured initial concentrations of the test chemicals. The acute (48-h) static toxicity of atrazine and molinate to the freshwater cladoceran Daphnia carinata was determined in cladoceran water and river water in the absence and presence of sediment. The 48-h EC50 (immobilization) values of atrazine to D. carinata ranged from 22.4 to 26.7 mg/L, while the corresponding values for molinate ranged from 18.3 to 33.6 mg/L, respectively. Both chemicals were classed as having low acute toxicity to D. carinata. The presence of dissolved organic matter and suspended particles in river water did not significantly (p > 0.05) reduce the bioavailability (measured as toxicity) of atrazine to D. carinata compared to that tested in cladoceran water. The presence of sediment, however, significantly (p < 0.05) reduced the bioavailability (48-h EC50) of atrazine in cladoceran water, from 24.6 to 30.7 mg/L, and in river water, from 22.4 to 31.0 mg/L. Similarly, the presence of sediment in cladoceran water, significantly (p < 0.05) reduced the bioavailability (48-h EC50) of molinate, from 26.6 to 46.4 mg/L, and in river water, from 22.5 to 45.6 mg/L.

Experimental study of blood lead kinetics in estuarine crocodiles (Crocodylus porosus) exposed to ingested lead shot.

A previous study of lead (Pb) contamination in estuarine crocodiles (Crocodylus porosus) in Kakadu National Park, Australia, found elevated Pb levels in bone and flesh from individuals caught in habitats where hunting with lead ammunition had occurred. Lead shot was suspected as the potential source of Pb in these animals. An investigation was designed to determine if crocodiles are capable of retaining and dissolving lead shot in their stomachs and absorbing the ionic Pb into the blood. Four of the six juvenile crocodiles (C. porosus) used in the experiment were fed an initial dose of five or ten lead shot each. Most of the lead shot were retained in the stomach over the 20-week experimental period, as confirmed by stomach lavage and radiography of the stomach region. From 13 to 30% of the original weight of individual lead shot had been eroded in that time. In vitro experiments confirmed that lead shot could be dissolved under conditions simulating those known for the crocodilian stomach. Blood Pb concentrations increased by an order of magnitude within a week after dosing three crocodiles with five lead shot each, and then attained steady-state equilibrium 5-20 weeks after dosing, with blood Pb steady-state levels ranging from 278 to 363 microg/dL. The blood Pb concentration-time curves in these crocodiles followed a one-compartment model with first-order loss kinetics that yielded an apparent biological half-life for Pb in blood of about 3.4 days. Throughout the experiment, the crocodiles remained in apparent good physical condition and displayed no clinical signs of Pb toxicosis. These observations, together with the very high blood Pb levels that were sustained for several months, suggest that crocodilians may possess a relatively high degree of resistance to Pb toxicity.

Assessment of metal toxicity in sediment pore water from Lake Macquarie, Australia.

Recent investigations into the level of heavy metal enrichment in the sediments of Lake Macquarie have indicated that significant contamination has occurred over the past 100 years, with elevated levels of lead, zinc, cadmium, copper, and selenium being observed in most parts of the lake. Pore water extracted from sediments showing the greatest contamination by these metals exhibited toxicity to the larval development of the sea urchin Heliocidaris tuberculata. However, an analysis of pore water metal concentrations revealed that the concentrations of these metals were too low to cause toxicity. Rather, pore water toxicity was highly correlated with manganese for the majority of sites sampled; subsequent spiking experiments confirmed manganese as a cause of toxicity. Current levels of manganese in the sediments of Lake Macquarie have arisen from natural sources and are not the result of anthropogenic activities. These results reiterate the importance of identifying the causes of toxicity in assessments of sediment contamination, particularly when testing sediment pore waters using sensitive early life stages.