Virtual reality and cardiac anatomy: Exploring immersive three-dimensional cardiac imaging, a pilot study in undergraduate medical anatomy education.

Cardiac anatomy can be challenging to grasp because of its complex three-dimensional nature and remains one of the most challenging topics to teach. In light of some exciting technological advances in the field of virtual reality (VR), we sought to test the viability and the assess efficacy of this computer-generated model for the purposes of teaching cardiac anatomy. Before learning cardiac anatomy, first-year undergraduate medical students participated in an anatomically correct VR simulation of the heart. Students were randomly distributed into control and variable groups. Each student completed a pre-intervention quiz, consisting of 10 multiple choice questions with 5 conventional cardiac anatomy questions and 5 visual-spatial (VS) questions. The control group continued to independent study, whereas the variable group subjects were exposed to a 30-min immersive cardiac VR experience. At the end of the intervention, both the groups underwent a separate post-intervention 10-question quiz. Forty-two students participated in the cardiac VR experiment, separated into 14 control and 28 variable subjects. They scored 50.9% on average on the pre-intervention quiz (SD = 16.5) and 70.2% on the post-intervention quiz (SD = 18.7). Compared to the control group, the students exposed to VR scored 21.4% higher in conventional content (P = 0.004), 26.4% higher in VS content (P < 0.001), and 23.9% higher overall (P < 0.001). VR offers an anatomically correct and immersive VS environment that permits learner to interact three-dimensionally with the heart's anatomy. This study demonstrates the viability and the effectiveness of VR in teaching cardiac anatomy. Clin. Anat. 32:238-243, 2019. © 2018 Wiley Periodicals, Inc.

Management of EGFR-mutated non-small-cell lung cancer: practical implications from a clinical and pathology perspective.

Starting in the early 2000s, non-small-cell lung cancer (nsclc) subtypes have evolved from being histologically described to molecularly defined. Management of lung adenocarcinomas now generally requires multiple molecular tests at baseline to define the optimal treatment strategy. More recently, second biopsies performed at progression in patients treated with tyrosine kinase inhibitors (tkis) have further defined the continued use of molecularly targeted therapy. In the present article, we focus on one molecular subtype: EGFR-mutated nsclc. For that patient population, multiple lines of tki therapy are now available either clinically or in clinical trials. Each line of treatment is guided by the specific mutations (for example, L858R, T790M, C797S) identified in EGFR. We first describe the various mechanisms of acquired resistance to EGFR tki treatment. We then focus on strategies that clinicians and pathologists can both use during tissue acquisition and handling to optimize patient results. We also discuss future directions for the molecular characterization of lung cancers with driver mutations, including liquid biopsies. Finally, we provide an algorithm to guide treating physicians managing patients with EGFR-mutated nsclc. The same framework can also be applied to other molecularly defined nsclc subgroups as resistance patterns are elucidated and additional lines of treatment are developed.

Post-mortem computed tomography ventilation; simulating breath holding.

Whilst the literature continues to report on advances in the use of post-mortem computed tomography (PMCT), particularly in relation to post-mortem angiography, there are few papers published that address the diagnostic problems related to post-mortem changes in the lungs and ventilation. We present a development of previous methods to achieve ventilated PMCT (VPMCT). We successfully introduced a supraglottic airway in 17/18 cases without causing overt damage, despite rigor mortis. Using a clinical portable ventilator, we delivered continuous positive airway pressure to mimic clinical breath-hold inspiratory scans. This caused significant lung expansion and a reduction in lung density and visible normal post-mortem changes. All thoracic pathology identified at autopsy, including pneumonia, was diagnosed on VPMCT in this small series. This technique provides a rapid form of VPMCT, which can be used in both permanent and temporary mortuaries, allowing for the post-mortem radiological comparison of pre-ventilation and post-ventilation images mimicking expiratory and inspiratory phases. We believe that it will enhance the diagnostic ability of PMCT in relation to lung pathology.

Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging.

The use of post-mortem imaging is expanding throughout the world with increasing use of advanced imaging techniques, such as contrast-enhanced CT and MRI. The questions asked of post-mortem imaging are complex and can be very different, for example for natural sudden death investigation will focus on the cause, whereas for trauma the cause of death is often clear, but injury patterns may be very revealing in investigating the background to the incident. Post-mortem imaging is different to clinical imaging regarding both the appearance of pathology and the information required, but there is much to learn from many years of clinical research in the use of these techniques. Furthermore, it is possible that post-mortem imaging research could be used not only for investigating the cause of death but also as a model to conduct clinically relevant research. This article reviews challenges to the development of post-mortem imaging for trauma, identification and cardiorespiratory death, and how they may be influenced by current clinical thinking and practice.

Pulmonary complications in the non-HIV immunocompromised patient.

The incidence of non-HIV immunocompromised patients is increasing. This is primarily due to improved immunosuppressive regimes for autoimmune diseases and also increases in stem cell transplantation. Pulmonary complications are a major cause of morbidity and mortality in these patients. Imaging is frequently used to assess these complications and to streamline therapies, as microbiological and/or pathological diagnosis can often be difficult, invasive, or protracted. This review provides the reader with a structured approach to interpret the imaging findings and differentiate between different infective and non-infective complications in these patients.

Non-invasive imaging in coronary artery disease including anatomical and functional evaluation of ischaemia and viability assessment.

Coronary artery disease has an important impact on the morbidity and mortality statistics and health economics worldwide. Diagnosis of coronary artery disease is important in risk stratification and guides further management. Invasive coronary angiography is the traditional method of imaging the coronary arteries and remains the gold standard. It detects luminal stenosis but provides little information about the vessel wall or plaques. Besides, not all anatomical lesions are functionally significant. This has lent itself to a wide variety of imaging techniques to identify and assess a flow-limiting stenosis. The approach to diagnosis of coronary artery disease is broadly based on anatomical and functional imaging. Coronary CT and MRI of coronary arteries provide an anatomical assessment of coronary stenosis. Coronary calcium score and coronary CT assess subclinical atherosclerosis by assessing the atherosclerotic plaque burden. The haemodynamic significance of a coronary artery stenosis can be assessed by stress radioisotope studies, stress echocardiography and stress MRI. The more recent literature also focuses on plaque assessment and identification of plaques that are likely to give rise to an acute coronary syndrome. There is an explosion of literature on the merits and limitations of the different imaging modalities. This review article will provide an overview of all the imaging modalities in the diagnosis of coronary artery disease.

Cardiovascular magnetic resonance imaging in the assessment of carcinoid heart disease.

Carcinoid disease arises from a low-grade neuroendocrine tumour derived from serotonin-producing enterochromaffin cells. It is the most common tumour affecting the small bowel. The majority of patients who progress to carcinoid syndrome develop cardiac disease selectively involving the right side of the heart, whereas left heart disease is unusual. The most common cause of death is dilatation and dysfunction of the right ventricle. Right ventricular dysfunction is largely secondary to pathological endocardial fibrosis of the tricuspid and pulmonary valves, presenting with regurgitation and stenosis. Average survival falls to only 11 months with the onset of symptoms, but recent evidence suggests that survival can be improved by early surgery in selected individuals. This article reviews the particular role that cardiovascular magnetic resonance imaging has in the management of carcinoid heart disease.

MR staging in carcinoma of the endometrium and carcinoma of the cervix.

This study aimed to evaluate MR as an imaging modality for the assessment of myometrial and cervical invasion in endometrial carcinoma and for the assessment of parametrial and lymph node involvement in cervical carcinoma. Twenty-eight patients with a preoperative histological diagnosis of endometrial carcinoma/cervical carcinoma were included in the study. The findings were compared with the surgical staging and the histopathological report of the hysterectomy specimen. Accuracy in detecting myometrial and cervical involvement in patients with endometrial carcinoma was 78% for both. Accuracy in detecting parametrial and lymph node involvement in patients with cervical carcinoma was 71% and 86% respectively. MR is a reliable method for preoperative assessment of endometrial and cervical carcinoma. It helps decide operability, the type of operation and aids in the selection of patients who need to be considered for specialist referral to a gynaecologist oncologist.

Postgraduate journal club as a means of promoting evidence-based obstetrics and gynaecology.

We assessed the feasibility of a new educational programme to teach critical appraisal of the medical literature to postgraduate trainees. The new programme used a journal club format where selection of topics and articles was driven by clinical problems arising in day-to-day practice. Papers were appraised critically according to validated guidelines using computer software for appraisal, electronic storage and retrieval. Over the initial 4-month period the journal club produced 17 critically appraised topics, two of which were published in peer-reviewed journals. During the study, trainees' reading time improved from a median of 2.0 hours (range 1-5 hours) to 3.5 hours (range 2-8 hours) (P = 0.026) and their knowledge scores improved from a mean of 50.8 (SD 4.0) to 62.9 (SD 4.3) (P = 0.003). We conclude that a journal club supported by electronic means of critical appraisal and dissemination of appraised information can be used to encourage the practice of evidence-based medicine.