Dissemination of endometrial cancer MRI staging guidelines among young radiologists: an ESUR Junior Network survey.

OBJECTIVES: Imaging guidelines could play an important role in the training of radiologists, but the extent of their adoption in residency programs is unclear. With this survey, the European Society of Urogenital Radiology (ESUR) Junior Network aimed to assess the dissemination of the ESUR guidelines on endometrial cancer MRI staging (EC-ESUR guidelines) among young radiologists. METHODS: An online questionnaire targeted to last year radiology residents and radiologists in the first year of their career was designed. It included 24 questions, structured in 4 sections (i.e., background, general, acquisition protocol, interpretation, and reporting). The survey was active between April and May 2022, accepting answers worldwide. Answers were solicited with a social media campaign and with the support of national scientific societies. Subgroup analysis was performed based on variables such as subspecialty of interest and number of EC-ESUR guidelines consultations using the Wilcoxon rank sum test. RESULTS: In total, 118 participants completed the questionnaire, of which 94 (80%) were from Europe and 46 (39%) with a special interest in urogenital radiology. Overall, 68 (58%) stated that the guidelines were not part of their residency teaching programs while 32 (27%) had never even consulted the guidelines. Interest in urogenital radiology as a subspecialty and EC-ESUR guidelines consultations were associated with greater confidence in supervising scan acquisition, interpreting, and reporting EC MRI staging exams. CONCLUSION: Four years after publication, the adoption of EC-ESUR guidelines in residency programs is heterogeneously low. Despite a possible selection bias, our findings indicate that active promotion of EC-ESUR guidelines is required. KEY POINTS: • The adoption of ESUR guidelines on endometrial cancer in radiology residency programs is heterogeneous. • Almost one third of respondents stated they had never even consulted the guidelines. • Confidence toward guidelines was higher in those who were exposed to more endometrial cancer MRI staging scans. • Reading the guidelines was associated with a greater confidence in protocol acquisition, interpretation, and reporting. • Active efforts to promote their dissemination are required.

Endometrial Cancer Staging: Is There Value in ADC?

PURPOSE: To assess the ability of apparent diffusion coefficient (ADC) measurements in predicting the histological grade of endometrial cancer. A secondary goal was to assess the agreement between MRI and surgical staging as an accurate measurement. METHODS: Patients with endometrial cancers diagnosed between 2018-2020 and having received both MRI and surgical staging were retrospectively enrolled. Patients were characterized according to histology, tumor size, FIGO stage (MRI and surgical stage), and functional MRI parameters (DCE and DWI/ADC). Statistical analysis was performed to determine if an association could be identified between ADC variables and histology grade. Secondarily, we assessed the degree of agreement between the MRI and surgical stages according to the FIGO classification. RESULTS: The cohort included 45 women with endometrial cancer. Quantitative analysis of ADC variables did not find a statistically significant association with histological tumor grades. DCE showed higher sensitivity than DWI/ADC in the assessment of myometrial invasion (85.00% versus 65.00%) with the same specificity (80.00%). A good agreement between MRI and histopathology for the FIGO stage was found (kappa of 0.72, p < 0.01). Differences in staging between MRI and surgery were detected in eight cases, which could not be justified by the interval between MRI and surgery. CONCLUSIONS: ADC values were not useful for predicting endometrial cancer grade, despite the good agreement between MRI interpretation and histopathology of endometrial cancer staging at our center.

Cervical cancer recurrence - can we predict the type of recurrence?

PURPOSE: We aimed to identify if there is an association between the severity of cervical cancer at diagnosis and the pattern of recurrence. METHODS: We conducted a retrospective study of recurrent cervical cancers diagnosed between 2016 and 2018. We characterized the cases according to histology, size, FIGO stage (according to 2009 and 2018 FIGO classifications) and nodal involvement at diagnosis, symptoms at the time of recurrence, interval between the end of treatment and recurrence, imaging methods used, and location of the recurrence. Statistical analysis was performed between histology, size, FIGO stage and nodal involvement at diagnosis and time to recurrence and type of recurrence (locoregional versus lymph node, distant or multiple site involvement). RESULTS: We included 48 patients with recurrent cervical cancer. At diagnosis, mean tumor size was 5 cm and 83% of the patients had squamous cell carcinoma. The FIGO stage changed in 43.8% of patients between the 2009 and the 2018 classifications. A mean of 26 months elapsed between the end of treatment and recurrence. Recurrence was symptomatic in 64.6% of patients. Imaging identified recurrence in 97.9% of patients. The most frequent recurrence sites were locoregional and lymph node metastases. We found a statistically significant association between 2009 FIGO stage and time to recurrence (P = 0.030) and lymph node involvement at diagnosis and type of recurrence (P = 0.022). As expected patients with more advanced disease recurred sooner, though this was only observed for the 2009 FIGO classification. Absence of lymph nodes at initial diagnosis was associated with locoregional recurrence, while presence of lymph node involvement was associated with lymph node, distant or multiple site involvement of recurrence. No other significant associations were found. CONCLUSION: In our cohort of recurrent cervical cancer, we found an association between patients without lymph node metastases at initial diagnosis and locoregional recurrence. Further studies are needed in order to evaluate whether this association has predictive value.

Evaluation of medical devices in thoracic radiograms in intensive care unit - time to pay attention! / Avaliação de dispositivos médicos nas radiografias de tórax em unidades de terapia intensiva - tempo de prestar atenção!

OBJECTIVE: To identify and evaluate the correct positioning of the most commonly used medical devices as visualized in thoracic radiograms of patients in the intensive care unit of our center. METHODS: A literature search was conducted for the criteria used to evaluate the correct positioning of medical devices on thoracic radiograms. All the thoracic radiograms performed in the intensive care unit of our center over an 18-month period were analyzed. All admissions in which at least one thoracic radiogram was performed in the intensive care unit and in which at least one medical device was identifiable in the thoracic radiogram were included. One radiogram per admission was selected for analysis. The radiograms were evaluated by an independent observer. RESULTS: Out of the 2,312 thoracic radiograms analyzed, 568 were included in this study. Several medical devices were identified, including monitoring leads, endotracheal and tracheostomy tubes, central venous catheters, pacemakers and prosthetic cardiac valves. Of the central venous catheters that were identified, 33.6% of the subclavian and 23.8% of the jugular were malpositioned. Of the endotracheal tubes, 19.9% were malpositioned, while all the tracheostomy tubes were correctly positioned. CONCLUSION: Malpositioning of central venous catheters and endotracheal tubes is frequently identified in radiograms of patients in an intensive care unit. This is relevant because malpositioned devices may be related to adverse events. In future studies, an association between malpositioning and adverse events should be investigated.

Avaliação de dispositivos médicos nas radiografias de tórax em unidades de terapia intensiva - tempo de prestar atenção! / Evaluation of medical devices in thoracic radiograms in intensive care unit - time to pay attention!

RESUMO Objetivo: Identificar e avaliar o posicionamento correto dos dispositivos médicos mais comumente utilizados, observados nas radiografias de tórax de pacientes durante a permanência em unidade de terapia intensiva de nosso centro. Métodos: Foi realizada uma pesquisa bibliográfica quanto aos critérios utilizados para avaliar o posicionamento correto dos dispositivos médicos nas radiografias de tórax. Avaliamos todas as radiografias de tórax realizadas na unidade de terapia intensiva de nosso centro durante um período de 18 meses. Incluíram-se todas as admissões nas quais foi realizada uma radiografia do tórax na unidade de terapia intensiva, nas quais fosse identificável a presença de pelo menos um dispositivo médico. Para análise, selecionou-se uma radiografia por admissão. As radiografias foram avaliadas por um observador independente. Resultados: De um total de 2.312 radiografias analisadas, 568 foram incluídas neste estudo. Identificaram-se diversos dispositivos médicos, incluindo eletrodos de monitoramento, tubos endotraqueais, cânulas de traqueostomia, cateteres venosos centrais, marca-passos e próteses valvares cardíacas. Dentre os cateteres venosos centrais identificados, 33,6% dos subclávios e 23,8% dos jugulares estavam mal posicionados. Dentre os tubos endotraqueais, 19,9% estavam mal posicionados, enquanto todas as cânulas de traqueostomia tinham posicionamento correto. Conclusão: Frequentemente se identificam, na radiografia de tórax realizada em pacientes na unidade de terapia intensiva, cateteres venosos e tubos endotraqueais mal posicionados. Isso é importante, pois dispositivos mal posicionados podem se relacionar a eventos adversos. Estudos futuros devem investigar possíveis associações entre o mau posicionamento dos dispositivos e eventos adversos.

ABSTRACT Objective: To identify and evaluate the correct positioning of the most commonly used medical devices as visualized in thoracic radiograms of patients in the intensive care unit of our center. Methods: A literature search was conducted for the criteria used to evaluate the correct positioning of medical devices on thoracic radiograms. All the thoracic radiograms performed in the intensive care unit of our center over an 18-month period were analyzed. All admissions in which at least one thoracic radiogram was performed in the intensive care unit and in which at least one medical device was identifiable in the thoracic radiogram were included. One radiogram per admission was selected for analysis. The radiograms were evaluated by an independent observer. Results: Out of the 2,312 thoracic radiograms analyzed, 568 were included in this study. Several medical devices were identified, including monitoring leads, endotracheal and tracheostomy tubes, central venous catheters, pacemakers and prosthetic cardiac valves. Of the central venous catheters that were identified, 33.6% of the subclavian and 23.8% of the jugular were malpositioned. Of the endotracheal tubes, 19.9% were malpositioned, while all the tracheostomy tubes were correctly positioned. Conclusion: Malpositioning of central venous catheters and endotracheal tubes is frequently identified in radiograms of patients in an intensive care unit. This is relevant because malpositioned devices may be related to adverse events. In future studies, an association between malpositioning and adverse events should be investigated.