Bilateral Comparison of Anterior Shoulder Position in Elite Tennis Players.

Background: In elite tennis players, musculoskeletal adaptations in the dominant upper extremity have been reported for range of motion, strength, and scapular biomechanics. In addition to scapular dysfunction, tightness and inflexibility of the pectoral musculature have been identified as risk factors for the development of overuse shoulder injury in overhead athletes. Hypothesis: Differences in anterior shoulder position will be identified between the dominant and non-dominant extremity in elite tennis players. The purpose of this study was to examine bilateral differences in anterior shoulder posture measured using a double square in elite tennis players without shoulder injury. Study Design: Descriptive Laboratory Study. Methods: Three hundred and six uninjured elite tennis players were measured in the supine position using a double square method to measure anterior shoulder position. The distance from the surface of the table to the anterior most position of the shoulder (in millimeters) was measured bilaterally and compared. A dependent t-test was used to test for significant differences in anterior shoulder position between the dominant and non-dominant extremity. Results: One hundred thirty-three males and 173 females were included in this study with a mean age of 16.58 years. The mean difference between extremities indicates increased anterior shoulder positioning on the dominant shoulder of 7.65 mm in females, and 8.72 in males. Significantly greater (p<.001) anterior shoulder position measures were documented on the dominant shoulder as compared to the non-dominant shoulder. Conclusions: The results of this study showed significantly (p<.001) greater anterior shoulder position on the dominant extremity of elite male and female tennis players. The differences of 7-8mm between extremities has clinical application for interpreting anterior shoulder position test results in this population. Level of Evidence: 3.

Multi-Center Follow-up Study to Develop a Classification System Which Differentiates Mucinous Cystic Neoplasm of the Liver and Benign Hepatic Cyst Using Machine Learning.

RATIONALE AND OBJECTIVES: To date, no clinically useful classification system has been developed for reliably differentiating mucinous cystic neoplasm (MCN) from a benign hepatic cyst (BHC) in the liver. The objective was to use machine learning and a multi-center study design to develop and assess the performance of a novel classification system for predicting whether a hepatic cystic lesion represents MCN or BHC. MATERIALS AND METHODS: A multi-center cohort study identified 154 surgically resected hepatic cystic lesions in 154 subjects which were pathologic confirmed as MCN (43) or BHC (111). Readers at each institution recorded seven pre-determined imaging features previously identified as potential differentiating features from prior publications. The contribution of each of these features to differentiating MCN from BHC was assessed by machine learning to develop an optimal classification system. RESULTS: Although several of the assessed imaging features demonstrated statistical significance, only 3 imaging features were found by machine learning to significantly contribute to a potential classification system: (1) solid enhancing nodule (2) all septations arising from an external macro-lobulation (3) whether the lesion was solitary or one of multiple cystic liver lesions. The optimal classification system had only four categories and correctly identified 144/154 lesion (93.5%). CONCLUSION: This multi-center follow-up study was able to use machine learning to develop a highly accurate classification system for differentiation of hepatic MCN from BHC, which could be readily applied to clinical practice.

Non-contrast and portal venous phase computed tomography in breast cancer hepatic metastases: comparison of tumor measurements and impact on response assessment.

BACKGROUND: For many common malignancies, including breast cancer, evaluation for metastatic disease using multiphase computed tomography (CT) has fallen out of favor and been replaced by studies performed only in the portal venous phase. However, differences in tumor vascularity could produce differences in appearance on post-contrast imaging. PURPOSE: To assess non-contrast phase and portal venous phase computed tomography in detection and measurement of hepatic metastases from breast carcinoma. MATERIALS AND METHODS: A total of 75 CT scans from 52 breast cancer patients were independently assessed by three body imagers for lesion presence, number and size. Readers randomly assessed portal venous phase or combined phase images at one session with cross-over reads performed four to six weeks later. RESULTS: In the 58% of cases where index lesions measured larger on combined phase, the mean difference in lesion size was 5.7 mm. In this group, combined phase reads demonstrated an 8.4 mm increase in sum of largest diameters, and a mean percentage sum of largest diameters increase of 19% compared to portal venous phase-only reads. CONCLUSION: Addition of non-contrast phase images results in increased index lesion size in most patients with hepatic metastases from breast cancer. If only the portal venous phase is utilized, there is potential for incorrectly diagnosing disease progression on follow-up due to underestimation of lesion size.

Added value of iodine-specific imaging and virtual non-contrast imaging for gastrointestinal assessment using dual-energy computed tomography.

Dual-energy computed tomography (DECT) has become increasingly available and can be readily incorporated into clinical practice. Although DECT can provide a wide variety of spectral imaging reconstructions, most clinically valuable information is available from a limited number of standard image reconstructions including virtual non-contrast and iodine overlay. The combination of these standard reconstructions can be used for specific diagnostic tasks that provide added value over traditional CT protocols. In this pictorial essay, the added value of these standard reconstructed images will be demonstrated by case examples for diseases specifically related to the gastrointestinal system.

Structural and functional comparison of Saccharomonospora azurea strains in terms of primycin producing ability.

Emerging and re-emerging microbial pathogens, together with their rapid evolution and adaptation against antibiotics, highlight the importance not only of screening for new antimicrobial agents, but also for deepening knowledge about existing antibiotics. Primycin is a large 36-membered non-polyene macrolide lactone exclusively produced by Saccharomonospora azurea. This study provides information about strain dependent primycin production ability in conjunction with the structural, functional and comparative genomic examinations. Comparison of high- and low-primycin producer strains, transcriptomic analysis identified a total of 686 differentially expressed genes (DEGs), classified into diverse Cluster of Orthologous Groups. Among them, genes related to fatty acid synthesis, self-resistance, regulation of secondary metabolism and agmatinase encoding gene responsible for catalyze conversion between guanidino/amino forms of primycin were discussed. Based on in silico data mining methods, we were able to identify DEGs whose altered expression provide a good starting point for the optimization of fermentation processes, in order to perform targeted strain improvement and rational drug design.

Combined Qualitative and Quantitative Assessment of Low-Attenuation Renal Lesions Improves Identification of Renal Malignancy on Noncontrast Computed Tomography.

OBJECTIVE: The objective of this study was to assess renal lesions measuring less than 20 Hounsfield units (HU) on noncontrast computed tomography (NCT). METHODS: Twenty-one (18.1%) of 116 consecutive pathologically proven renal cell carcinomas measured less than 20 HU on NCT and were compared with 40 confirmed benign cysts also measuring less than 20 HU. All lesions were assessed qualitatively (heterogeneous or homogenous) by 3 blinded readers and quantitatively with commercially available textural analysis software. Finally, a combined assessment was performed. RESULTS: Qualitative assessment performed well (sensitivity, 76%-90%; specificity, 70%-88%). Quantitative assessment revealed mean positive pixels as having the highest performance (area under the curve, 0.912; sensitivity, 90%; specificity, 80% at a cutoff value of 21). The combined assessment, using the mean positive pixel cutoff, improved the sensitivity (reader 1, 100%; reader 2, 95%; and reader 3, 95%). CONCLUSION: Qualitative and quantitative assessments have relatively good performance, but the combination can nearly eliminate renal cell carcinomas being missed on NCT.

Benefits of Integrated RIS/PACS/Reporting Due to Automatic Population of Templated Reports.

With integration of the Radiological Information Systems (RIS), Picture Archiving and Communication systems (PACS), and reporting systems, patient identifiers and examination information can automatically map into examination reports. There are many potential benefits of report automation to radiologists including improvements in efficiency, accuracy, and fatigue. In this article we describe a 2 part study, with the first part being an anonymous survey of radiologists concerning report automation. A total of 13 staff radiologists and 9 radiology residents at a single institution completed an anonymous survey. Respondents were asked if automatic population of examination description, comparison examination data, indications, computed tomography dose, technique, and copy to physician data saved time, decreased fatigue, and increased accuracy. Respondents were asked if a "copy findings" function saved time. The second objective part of the study was a mock examination experiment to assess time savings of report automation and to assess error rates. Of all, 9 radiologists were asked to dictate fields for 8 mock examinations. Subjects were timed and reporting errors monitored. Estimated daily time savings and error rates were calculated assuming a mix of 80 studies. A total of 95% surveyed responded that report automation saved time; 91% that report automation improved accuracy of dictations; 82% that report automation decreased fatigue. Furthermore, 83% of copy finding function users reported time savings. Average time to dictate these prepopulated fields was 51 seconds per study. Average error rate per report was 0.86, with an average of 0.26 errors remaining uncorrected upon report completion. Estimated average time per day saved per radiologist from report automation was 68 minutes. Estimated average corrected errors was 48 per day. Estimated average uncorrected or missed errors was 21 per day. These estimated benefits from report automation result from tight integration of RIS, PACS, and reporting systems.

Impact of low-kVp scan technique on oral contrast density at abdominopelvic CT.

PURPOSE: To assess quantitative and qualitative effects of kVp on oral contrast density. MATERIALS AND METHODS: Three readers retrospectively reviewed 100 CT scans performed at a range of high- and low-energy settings, independently determining their preferred window and level settings for evaluation of the oral-contrast-opacified bowel. Contrast density was also assessed quantitatively in the stomach, jejunum, and ileum. Subsequently, a range of oral contrast dilutions were imaged at varying kVp's in a commercially available CIRS tissue equivalent phantom model. RESULTS: In the retrospective patient study, mean oral contrast density increased significantly in the ileum compared to the jejunum (455.2 and 308.8 HU, respectively, p < 0.01). Similar findings were seen in patients regardless of patients' weight. Mean oral contrast density was higher on lower-energy scans, requiring more window/level adjustment. An oral contrast iodine concentration of 5.82-7.77 mg I/mL most closely approximated a target oral contrast density of 200 HU. CONCLUSIONS: Oral contrast density is strongly influenced by kVp, supporting use of more dilute oral contrast when using lower-kVp techniques.

Acute Appendicitis Involving a De Garengeot Hernia.

We present a case of appendicitis within a De Garengeot hernia. The patient presented to the emergency department with 4 days of worsening abdominal pain. Computed tomography examination revealed an inflamed appendix within a femoral hernia. The patient underwent appendectomy and repair of the femoral defect. Pathological examination was consistent with acute appendicitis. De Garengeot hernia is a rare phenomenon, with less than 5% of femoral hernias containing the appendix and 0.08% to 0.13% containing an incarcerated acute appendicitis.

Metrix Matrix: A Cloud-Based System for Tracking Non-Relative Value Unit Value-Added Work Metrics.

PURPOSE: In the era of value-based medicine, it will become increasingly important for radiologists to provide metrics that demonstrate their value beyond clinical productivity. In this article the authors describe their institution's development of an easy-to-use system for tracking value-added but non-relative value unit (RVU)-based activities. METHODS: Metrix Matrix is an efficient cloud-based system for tracking value-added work. A password-protected home page contains links to web-based forms created using Google Forms, with collected data populating Google Sheets spreadsheets. Value-added work metrics selected for tracking included interdisciplinary conferences, hospital committee meetings, consulting on nonbilled outside studies, and practice-based quality improvement. Over a period of 4 months, value-added work data were collected for all clinical attending faculty members in a university-based radiology department (n = 39). Time required for data entry was analyzed for 2 faculty members over the same time period. RESULTS: Thirty-nine faculty members (equivalent to 36.4 full-time equivalents) reported a total of 1,223.5 hours of value-added work time (VAWT). A formula was used to calculate "value-added RVUs" (vRVUs) from VAWT. VAWT amounted to 5,793.6 vRVUs or 6.0% of total work performed (vRVUs plus work RVUs [wRVUs]). Were vRVUs considered equivalent to wRVUs for staffing purposes, this would require an additional 2.3 full-time equivalents, on the basis of average wRVU calculations. Mean data entry time was 56.1 seconds per day per faculty member. CONCLUSIONS: As health care reimbursement evolves with an emphasis on value-based medicine, it is imperative that radiologists demonstrate the value they add to patient care beyond wRVUs. This free and easy-to-use cloud-based system allows the efficient quantification of value-added work activities.

Differentiating biliary cystadenomas from benign hepatic cysts: Preliminary analysis of new predictive imaging features.

OBJECTIVE: To identify performance of imaging features in differentiating hepatic cysts from biliary cystadenomas of the liver. METHODS: 25 pathologically confirmed hepatic cystic lesions (hepatic cysts or biliary cystadenomas) were evaluated retrospectively and predetermined imaging features assessed for performance in differentiation. RESULTS: Any septation which arose from a cyst wall without external indentation had a very high association with biliary cystadenoma, while the presence of a thick septation had only a moderate association. CONCLUSIONS: The relationship between septations and the wall of the cystic lesion performed better than previously reported features including thick septations.

Use of nutritional supplements and ergogenic aids in professional tennis players.

INTRODUCTION: Nutritional supplements and ergogenic aids (NS&EA) are used between training/matches with the goal of enhancing tennis performance. Scientific literature about prevalence and use of NS&EA in professional tennis players is scarce. OBJECTIVE: The aim of the study was to describe the NS&EA used by professional tennis players during a season. METHODS: Using a validated self-administered questionnaire, 62 professional male and 9 professional female tennis players (11% in their gender specific top 100 tennis world ranking (i.e.,ATP/WTA)) registered all the used NS&EA. RESULTS: Eighty-one percent of the participants declared taking at least one NS&EA. Strength and conditioning trainers (S&C) and tennis coaches were the professionals who recommended most of the NS&EA in the players outside the TOP-100 (OT100; 50.7% and 39.1%, respectively). However, sports nutritionist were the principal advisors in the top-100 tennis players (T100; 62.5%). Sports drinks were the NS&EA most commonly used by all participants (81.7%). T100 participants used caffeine (p = 0.042), creatine (p = 0.001), iron (p = 0.013) and CHO-protein mix (p = 0.033) significantly more frequently that OT100 players. CONCLUSIONS: There is a high prevalence of NS&EA use among professional tennis players independently of their tennis ranking position. However, T100 tennis player have an increased use of certain substances such us caffeine, creatine, iron and CHO-Protein mix. For the rest of the studied NS&EA the use was similar between T100 and OT100 players. It is possible that the differences in NS&EA use between groups could be related to the different professionals on charge of nutritional advice in T100 vs OT100.

Use of nutritional supplements and ergogenic aids in professional tennis players / Uso de suplementos nutricionales y ayudas ergogénicas en jugadores profesionales de tenis

Introduction: Nutritional supplements and ergogenic aids (NS&EA) are used between training/matches with the goal of enhancing tennis performance. Scientific literature about prevalence and use of NS&EA in professional tennis players is scarce. Objective: The aim of the study was to describe the NS&EA used by professional tennis players during a season. Methods: Using a validated self-administered questionnaire, 62 professional male and 9 professional female tennis players (11% in their gender specific top 100 tennis world ranking (i.e., ATP/WTA)) registered all the used NS&EA. Results: Eighty-one percent of the participants declared taking at least one NS&EA. Strength and conditioning trainers (S&C) and tennis coaches were the professionals who recommended most of the NS&EA in the players outside the TOP-100 (OT100; 50.7% and 39.1%, respectively). However, sports nutritionist were the principal advisors in the top-100 tennis players (T100; 62.5%). Sports drinks were the NS&EA most commonly used by all participants (81.7%). T100 participants used caffeine (p = 0.042), creatine (p = 0.001), iron (p = 0.013) and CHO-protein mix (p = 0.033) significantly more frequently that OT100 players. Conclusions: There is a high prevalence of NS&EA use among professional tennis players independently of their tennis ranking position. However, T100 tennis player have an increased use of certain substances such us caffeine, creatine, iron and CHO-Protein mix. For the rest of the studied NS&EA the use was similar between T100 and OT100 players. It is possible that the differences in NS&EA use between groups could be related to the different professionals on charge of nutritional advice in T100 vs OT100 (AU)

Introducción: los suplementos nutricionales/ayudas ergogénicas (NS&EA) son utilizados en los entrenamientos/partidos de tenis con el objetivo de mejorar el rendimiento. Sin embargo, la literatura científica se encuentras escasos documentos científicos sobre el uso de estas sustancias en tenistas profesionales. Objetivo: describir el uso de NS&EA utilizados por tenistas profesionales durante una temporada. Métodos: se utilizó un cuestionario validado y se evaluó a 62 tenistas profesionales hombres y 9 mujeres (11% entre los 100 mejores del mundo). Resultados: el 81% de los participantes toman al menos un NS&EA. Los preparadores físicos (S&C) y entrenadores de tenis fueron los profesionales preferidos para recomendar NS&EA entre los jugadores fuera del TOP-100 (OT100, 50,7% y 39,1%, respectivamente). Sin embargo, los nutricionistas deportivos fueron los principales asesores de los jugadores entre los 100 mejores del mundo (T100, 62,5%). Las bebidas deportivas fueron los NS&EA más utilizados entre todos los participantes (81,7%). Los tenistas T100 utilizaron cafeína (p = 0,042), creatina (p = 0,001), hierro (p = 0.013) y mezcla de CHO-proteína (p = 0,033) significativamente más frecuentemente que los jugadores OT100. Conclusiones: existe una gran prevalencia de uso de NS&EA entre los tenistas profesionales. Además, los T100 presentan un mayor uso de ciertas sustancias tales como cafeína, creatina, hierro y CHO-proteína. Para el resto de los NS&EA estudiados, el uso fue similar entre los jugadores T100 y OT100. Finalmente, las diferencias en el uso de NS&EA entre grupos pudieran estar relacionadas con los diferentes profesionales escogidos para el asesoramiento nutricional en T100 vs. OT100 (AU)

Correlate: A PACS- and EHR-integrated Tool Leveraging Natural Language Processing to Provide Automated Clinical Follow-up.

A major challenge for radiologists is obtaining meaningful clinical follow-up information for even a small percentage of cases encountered and dictated. Traditional methods, such as keeping medical record number follow-up lists, discussing cases with rounding clinical teams, and discussing cases at tumor boards, are effective at keeping radiologists informed of clinical outcomes but are time intensive and provide follow-up for a small subset of cases. To this end, the authors developed a picture archiving and communication system-accessible electronic health record (EHR)-integrated program called Correlate, which allows the user to easily enter free-text search queries regarding desired clinical follow-up information, with minimal interruption to the workflow. The program uses natural language processing (NLP) to process the query and parse relevant future clinical data from the EHR. Results are ordered in terms of clinical relevance, and the user is e-mailed a link to results when these are available for viewing. A customizable personal database of queries and results is also maintained for convenient future access. Correlate aids radiologists in efficiently obtaining useful clinical follow-up information that can improve patient care, help keep radiologists integrated with other specialties and referring physicians, and provide valuable experiential learning. The authors briefly review the history of automated clinical follow-up tools and discuss the design and function of the Correlate program, which uses NLP to perform intelligent prospective searches of the EHR. © RSNA, 2017.

Angiographic diagnosis of Meckel's diverticulum in an adult patient with negative scintigraphy.

A Meckel's diverticulum was diagnosed by mesenteric angiography in a 34 year-old patient who presented with hematochezia and dropping hemoglobin. The case demonstrates the challenges often encountered in workup of occult gastrointestinal (GI) bleeding, and shows that angiographic diagnosis of Meckel's diverticulum is possible, even in the absence of angiographic evidence of active extravasation. Our patient had a previous non-diagnostic workup including upper and lower endoscopy, videocapsulography, and Technetium-99m pertechnetate (Tc-99m) scintigraphy. Visceral angiogram demonstrated the presence of a persistent vitelline artery, diagnostic of Meckel's diverticulum. While no active extravasation was seen at the time of the angiogram, operative specimen demonstrated a Meckel's diverticulum with ectopic gastric mucosa and intraluminal hemorrhage.

Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature.

Endometriomas can occur after any surgery where there is endometrial manipulation, and there are a number of reports of endometriomas developing in the abdominal wall at the site of the Pfannenstiel incision following Cesarean-section. Although this is ultimately a histopathologically-confirmed diagnosis, preoperative imaging including ultrasound, computed tomography, and magnetic resonance imaging may be helpful in the diagnosis and assessment. We report a pathology-confirmed case of Cesarean-section endometrioma with a classic, clinical presentation and imaging findings on computed tomography. A comprehensive literature review and discussion of the multi-modality imaging appearance of Cesarean-section endometrioma is also provided.

Proteomic insight into the primycin fermentation process of Saccharomonospora azurea.

Saccharomonospora azurea SZMC 14600 is a member of the family Pseudonocardiaceae exclusively used for industrial scale production of primycin a large 36-membered non-polyene macrolide lactone antibiotic belonging to the polyketide class of natural products. Even though maximum antibiotic yield has been achieved by empirically optimized two-step fermentation process, little is known about the molecular components and mechanisms underlying the efficient antibiotic production. In order to identify differentially expressed proteins (DEPs) between the pre- and main-fermentation stages of primycin, comparative 2D-PAGE experiments were performed. In total, 98 DEP spots were reproducibly detected, out of which four spots were excised from gels, and identified through MALDI-TOF/TOF mass spectrometry. Peptide mass fingerprint analysis revealed peptide matches to HicB antitoxin for the HicAB toxin-antitoxin system (EHK86651), to a nucleoside diphosphate kinase regulator ((Ndk; EHK81899) and two other proteins with unknown function (EHK88946 and EHK86777).

Image toggling saves time in mammography.

When two images are perfectly aligned, even subtle differences are readily detected when the images are "toggled" back and forth in the same location. However, substantial changes between two photographs can be missed if the images are misaligned ("change blindness"). Nevertheless, recent work from our lab, testing nonradiologists, suggests that toggling misaligned photographs leads to superior performance compared to side-by-side viewing (SBS). In order to determine if a benefit of toggling misaligned images may be observed in clinical mammography, we developed an image toggling technique where pairs of new and prior breast imaging exam images could be efficiently toggled back and forth. Twenty-three radiologists read 10 mammograms evenly divided in toggle and SBS modes. The toggle mode led to a 6-s benefit in reaching a decision [[Formula: see text], [Formula: see text]]. The toggle viewing mode also led to a 5% improvement in diagnostic accuracy, though in our small sample this effect was not statistically reliable. Time savings were found even though successive mammograms were not perfectly aligned. Given the ever-increasing caseload for radiologists, this simple manipulation of how the images are viewed could save valuable time in clinical practice, allowing radiologists to read more cases or spend more time on difficult cases.