Are we aware of radiation: A study about necessity of diagnostic X-ray exposure.

BACKGROUND: Total exposure to ionizing radiation has nearly doubled in the last two decades. This increase is primarily due to increased computed tomography (CT) exposure. Concerns have been raised about the risks associated with patients' exposure to medical imaging radiation, which can increase a person's lifetime risk of developing cancer. Preventing unnecessary examinations becomes critical at this point. To avoid unnecessary examinations, it is necessary to understand the demanding process. AIM: To ascertain clinicians' awareness of and reasons for requesting a CT examination. METHODS: We developed an online questionnaire that included 20 questions about clinicians' awareness of radiation safety and their reasons for requesting a CT examination, as well as demographic information such as age, gender, and year of medical practice experience. Additionally, we asked participants the number of CT scans requested in a month, the patients' questions and approaches about the imaging method, the effect of the patient's previous imaging history on the current imaging request, whether they believed that they had sufficient information about radiation doses, and whether they requested CT without an indication. We administered the questionnaire to clinicians from a variety of different professions in four different cities. RESULTS: A total of 195 clinicians participated. Internal medicine specialists were the most crowded group (38/195, 19.5%). Mean age of the population was 33.66 ± 5.92 years. Mean year of experience was 9.01 ± 5.96. Mean number of requested CT scans in a month was 36.88 ± 5.86. Forty-five (23.1%) participants stated that they requested CT scans without clinical indication. The most common reasons for CT scan requests were work load, fear of malpractice, and patient demand/insistence. CONCLUSION: CT scan requests are influenced by a variety of factors, both internal and external to the doctors and patients. Raising awareness of radiation safety and reducing fear of malpractice by limiting the number of patients per physician may result in a reduction in unnecessary CT examinations and ionizing radiation exposure.

Dynamic contrast-enhanced breast magnetic resonance imaging findings that affect the magnetic resonance-directed ultrasound correlation of non-mass enhancement lesions: a single-center retrospective study.

OBJECTIVE: Our single-center retrospective study aimed to evaluate the relationship between magnetic resonance (MR)-directed ultrasound (MDUS) detectability and MRI findings of non-mass enhancement (NME) lesions, regarding the morphologic and enhancement features, the distance from the skin and nipple, and the presence of concomitant landmarks. METHODS: A total of 350 MRI-detected NME lesions that were determined between January 2015 and May 2019 and subsequently underwent MDUS were analyzed. The MRI findings, biopsy results, and follow-up outcomes of lesions were recorded. The correlation between the MRI findings of the lesions and MDUS detectability was analyzed. RESULTS: 114 (32.6%) of the 350 lesions had a counterpart in the MDUS. Respectively, 66 (37.9%), 38 (43.2%) and 59 (38.3%) of the lesions detected in MDUS were larger than 20 mm in size, with a distance of less than 20 mm to the nipple and 15 mm to the skin. The lesion size and lesion distance to the nipple and skin were significantly associated with a ultrasound correlate (p < 0.05). The MDUS detection rate was significantly higher in NME lesions with MR findings including diffuse distribution (p < 0.001), clustered-ring enhancement pattern (p < 0.001), washout kinetic curve (p = 0.006), and MR-BIRADS category 5 (p < 0.001). Multivariate logistic regression showed that only the clustered-ring enhancement pattern was significantly associated with an MDUS correlation (p < 0.001). CONCLUSION: Statistically significant correlations were found between the size, distance to the nipple and skin, distribution pattern, enhancement pattern and kinetic curve of the NME lesions on MRI and ultrasound detectability. ADVANCES IN KNOWLEDGE: We found that clustered-ring enhancement patterns were significantly more frequent in MR-directed ultrasound detectable lesions.

Comparison of the Magnetic Resonance Imaging Findings of Paget's Disease of the Breast and Malignant Tumor Invasion of the Nipple-Areola Complex.

OBJECTIVE: We aimed to investigate the distinction between Paget's disease of the breast (PDB) and malignant tumor invasion of nipple-areolar complex (MTION) with Magnetic resonance imaging (MRI) findings without the need for skin punch biopsy. MATERIALS AND METHODS: MRI findings of 16 patients with pathologically proven PDB and 11 patients with pathologically proven MTION were reviewed retrospectively. MRI images were assessed for nipple morphological changes; areolar-periareolar skin changes; thickness, classification, and kinetic characteristics of the nipple-areolar complex (NAC) enhancement; morphological pattern, size, and pathological diagnosis of concomitant malignant lesions; kinetic characteristics of the concomitant malignant lesions enhancement; continuity of enhancement between the nipple and closest concomitant malignant lesion; similarity of enhancement kinetics of the NAC and concomitant malignant lesions; and nipple-to-malignant lesion distance in both patient groups. RESULTS: Areolar-periareolar skin thickening was statistically different between the patient groups. Enhancement kinetic pattern was classified as persistent in four patients with MTION and plateau in seven patients with PDB. Moreover, NAC enhancement kinetic characteristics were statistically different between the groups. Invasive ductal carcinoma was detected in three patients with PDB and five patients with MTION. A statistically significant difference in malignant lesion pathological types was detected between the patient groups. CONCLUSION: The significant MRI findings in patients with MTION diagnosed as invasive ductal carcinoma were areolar-periareolar skin thickening and asymmetric NAC enhancement with persistent kinetics pattern. In patients diagnosed with ductal carcinoma in situ, a plateau pattern of asymmetric NAC enhancement without any areolar-periareolar skin changes on MRI may indicate PDB.

Radiologic Findings of a Rare Subtype of Invasive Breast Cancer with Poor Prognosis: Metaplastic Carcinoma of the Breast.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the mammographic, sonographic and MRI findings of metaplastic breast carcinoma. METHODS: In this retrospective review study, we analyzed the medical files of 9600 patients who were treated for invasive breast cancers. Clinical information, histopathologic and radiologic findings of 65 patients were included in this study. All existing radiologic images and medical reports were reviewed retrospectively. Thirty-three patients had MG, 58 patients had US and 7 patients had MRI imaging results. RESULTS: Mammographically, the most frequent presentations of MPBC were round shape, microlobulated margin and high density masses. Calcifications with or without masses were not a frequent finding. The most common sonographic findings were round shape, partially indistinct angular margin, hypoechoic and heterogeneous echo patterns and no posterior feature masses. All lesions were presented as masses rather than non-mass enhancements on magnetic resonance imaging. Features of masses had more malignant feature on MRI than other modalities in all 7 patients. CONCLUSION: Metaplastic breast carcinoma is one of the rarest poorly differentiated invasive breast carcinomas. Interestingly, these aggressive tumors demonstrate benign or moderately malign features on imaging methods. This appearance of MPBC can cause it to be misdiagnosed as a benign breast lesion especially in young women. MPBC should be kept in mind in the differential diagnosis of large palpable breast masses. Therefore, follow-up at short intervals and/or multimodality imaging studies which include breast MRI are important for the diagnosis of MPBC.

Multifocal tumoral calcinosis in a 4-year-old girl.

PATIENT: Female, 4 FINAL DIAGNOSIS: Tumoral calcinosis Symptoms: Hard immobile mass Medication: - Clinical Procedure: - Specialty: Surgery. OBJECTIVE: Congenital defects. BACKGROUND: Tumoral calcinosis is an uncommon condition associated with the deposition of painless calcific masses. It is more common in childhood or early adolescence of African-American females. CASE REPORT: We present a case of a 4-year-old girl with tumoral calcinosis treated surgically. The case is rather rare in terms of the age of the patient and the localization of the masses (gluteal site). In our patient, the biochemical findings were normal, except for hyperphosphatemia and elevated alkaline phosphatase. CONCLUSIONS: Total excision appears to lead to a good clinical outcome and a low incidence of local relapse.

Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents.

THE AIMS OF OUR STUDY WERE: (1) to evaluate the frequency of asymptomatic fatty liver disease (FLD) using both Doppler and B-mode ultrasound (US) in overweight and obese adolescents; (2) to compare metabolic findings of fatty liver (FL) assessed by two methods; and (3) to evaluate metabolic predictors of FL shown by these methods. Fifty-nine overweight and obese adolescents aged between 9.0 and 17.0 years and 41 non-obese healthy adolescents were included in this study. B-mode and right hepatic vein Doppler ultrasonography (US) were performed and anthropometric indices, lipid profiles, and adiponectin levels were evaluated in all adolescents. HDL-C levels were significantly lower in patients with FL detected by Doppler US compared to patients without FL (p < 0.05). HDL-C levels were inversely correlated with presence of FL assessed by two methods (r = -0.285, p = 0.004; r = -0.328, p = 0.001, respectively) and adiponectin levels were correlated with presence of FL only detected by B-mode US (r = -0.263, p = 0.008). Adiponectin levels were significantly lower in patients with FL than those without FL assessed by B-Mode US (p = 0.049). Multiple regression analysis revealed that HDL-C levels was the most important predictor of FL assessed by Doppler US (p = 0.027), while body mass index was the determinant of FL assessed by two methods (p < 0.001) in asymptomatic overweight and obese adolescents. It was found that FLD, identified by both B-mode and Doppler US, is seen frequently in asymptomatic overweight and obese adolescents. Elevated BMI is associated with increased risk of FL assessed by two ultrasonographic methods. When using Doppler US, low HDL-C levels can be used as a good predictor for presence of FLD in overweight and obese adolescents.