Mark Rodrigues

Radiology smartphone applications; current provision and cautions

ObjectivesMedical smartphone applications are increasingly popular amongst doctors. However, the quality of their content is variable. We assessed contemporary radiology-related smartphone applications, focussing on the level of advertised medical involvement in application development.MethodsSix major application stores were searched between 18-30 June 2012 using the terms radiology, radiation, x-ray(s), computed tomography/CT, magnetic resonance imaging/MRI, ultrasound, nuclear medicine, fluoroscopy and mammography/mammogram. Application ratings, cost and medical input in development were recorded.Results321 applications were identified. One hundred fifty-eight were teaching and 96 “reference”. Three of the 29 DICOM viewing applications had FDA approval for primary diagnosis, while 62xa0% stated they should not be used for primary diagnosis; 24xa0% of applications stated named medical professional involvement, 12xa0% had unnamed medical involvement and 4xa0% acknowledged guidelines or papers; 42xa0% did not disclose authorship.ConclusionsA large variety of radiology-related smartphone applications are available with many potential benefits. Advertised medical involvement in application design is variable, making assessment of their accuracy difficult prior to purchase. Additional measures are required to ensure the accuracy of such applications. The limitations of image interpretation using smartphones are a major drawback of DICOM viewing applications. Further research into the accuracy of primary diagnosis using such applications is needed.Main Messages• A large variety of radiology smartphone applications are available with many potential benefits• Variable medical involvement in application design limits assessment of accuracy before purchase• Limitations of image interpretation using smartphones are a drawback of DICOM viewing applications• Further work on the accuracy of primary diagnosis using these DICOM viewing applications is needed

Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial

IntroductionCT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke.MethodsWe selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel (>5xa0years experience reading CTA) and seven radiology trainees (<2xa0years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff’s-alpha (K-alpha).ResultsAmong experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alphau2009=u20090.70) and with an angiography assessment scale (K-alphau2009=u20090.60–0.66). There was less agreement for grades of collateral supply (K-alphau2009=u20090.56) or for identification of a perfusion defect on CTA-SI (K-alphau2009=u20090.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alphau2009=u20090.33–0.72).ConclusionFor most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best.

Developing junior doctor-delivered teaching

Background:u2002 There are increasing opportunities for junior doctors to deliver teaching as well as formally develop teaching skills. Near‐peer teaching (NPT) programmes, like that established in South‐East Scotland, not only provide additional learning opportunities for students but also have potential benefits for the teachers.

Incidental meandering right pulmonary vein, literature review and proposed nomenclature revision

We report a case of an anomalous pulmonary vein on chest X-ray resembling a scimitar sign in an 80-year-old female undergoing investigation of syncope. Multislice computed tomography (CT) with multiplanar reformatting and maximum intensity projections demonstrated an aberrant right inferior pulmonary vein coursing inferomedially towards the diaphragm before turning superiorly and draining normally into the left atrium. The diagnosis of an incidental meandering right pulmonary vein was established. The case is used to review the literature on this rare pulmonary anomaly, including pathogenesis, its relationship with scimitar syndrome and scimitar variant, and diagnosis, with an emphasis on the role modern CT techniques can play in non-invasive diagnosis. A revision to the nomenclature of pulmonary vascular anomalies is proposed to help reduce confusion in the literature.

The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study

Summary Background Identification of lobar spontaneous intracerebral haemorrhage associated with cerebral amyloid angiopathy (CAA) is important because it is associated with a higher risk of recurrent intracerebral haemorrhage than arteriolosclerosis-associated intracerebral haemorrhage. We aimed to develop a prediction model for the identification of CAA-associated lobar intracerebral haemorrhage using CT features and genotype. Methods We identified adults with first-ever intracerebral haemorrhage diagnosed by CT, who died and underwent research autopsy as part of the Lothian IntraCerebral Haemorrhage, Pathology, Imaging and Neurological Outcome (LINCHPIN) study, a prospective, population-based, inception cohort. We determined APOE genotype and radiologists rated CT imaging appearances. Radiologists were not aware of clinical, genetic, and histopathological features. A neuropathologist rated brain tissue for small vessel diseases, including CAA, and was masked to clinical, radiographic, and genetic features. We used CT and APOE genotype data in a logistic regression model, which we internally validated using bootstrapping, to predict the risk of CAA-associated lobar intracerebral haemorrhage, derive diagnostic criteria, and estimate diagnostic accuracy. Findings Among 110 adults (median age 83 years [IQR 76–87], 49 [45%] men) included in the LINCHPIN study between June 1, 2010 and Feb 10, 2016, intracerebral haemorrhage was lobar in 62 (56%) participants, deep in 41 (37%), and infratentorial in seven (6%). Of the 62 participants with lobar intracerebral haemorrhage, 36 (58%) were associated with moderate or severe CAA compared with 26 (42%) that were associated with absent or mild CAA, and were independently associated with subarachnoid haemorrhage (32 [89%] of 36 vs 11 [42%] of 26; p=0·014), intracerebral haemorrhage with finger-like projections (14 [39%] of 36 vs 0; p=0·043), and APOE ɛ4 possession (18 [50%] of 36 vs 2 [8%] of 26; p=0·0020). A prediction model for CAA-associated lobar intracerebral haemorrhage using these three variables had excellent discrimination (c statistic 0·92, 95% CI 0·86–0·98), confirmed by internal validation. For the rule-out criteria, neither subarachnoid haemorrhage nor APOE ɛ4 possession had 100% sensitivity (95% CI 88–100). For the rule-in criteria, subarachnoid haemorrhage and either APOE ɛ4 possession or finger-like projections had 96% specificity (95% CI 78–100). Interpretation The CT and APOE genotype prediction model for CAA-associated lobar intracerebral haemorrhage shows excellent discrimination in this cohort, but requires external validation. The Edinburgh rule-in and rule-out diagnostic criteria might inform prognostic and therapeutic decisions that depend on identification of CAA-associated lobar intracerebral haemorrhage. Funding UK Medical Research Council, The Stroke Association, and The Wellcome Trust.

Characteristics and trends in publication of scientific papers presented at the European Congress of Radiology: a comparison between 2000 and 2010

AbstractObjectiveTo determine journal publication rates of scientific papers presented orally at the European Congress of Radiology (ECR) 2010, with comparison of country data to ECR 2000.MethodsAll oral presentations from ECR 2010 were evaluated for publication between 2010 and 2014 using the MEDLINE database. Countries, collaborations, subspecialties, modalities and study design were ranked by publication percentage. Chi-square tests were used to compare publication percentages for each category of variables. Hazard ratios (HR) were calculated for each country relative to the host nation, Austria. ECR 2010 country statistics were compared with analogous data from ECR 2000.ResultsIn total, 360/840 abstracts were subsequently published (43xa0%). The author’s country of origin (pu2009=u20090.02), subspecialty (pu2009=u20090.02) and study design (pu2009=u20090.001) were significantly associated with subsequent publication. Switzerland, the Netherlands, France and Germany were among the top six countries by publication percentage in 2000 and 2010. In 2010, Switzerland had the highest publication rate (62xa0%) and HR in comparison to Austria (HR 2.62 [1.31–5.25], pu2009=u20090.01). Three Asian nations increased relative publication rates over the 10-year period.ConclusionSeveral European nations consistently convert relatively high percentages of oral abstracts at ECR into publications, and the influence of Asian countries is increasing.Main Messages• Certain European nations consistently publish high percentages of orally presented abstracts at ECR.n • The influence of several Asian countries on ECR is increasing.n • Country, subspecialty and study design are significantly associated with journal publication.n • Authors collaborating internationally have the highest publication rates and mean impact factors.n • Among all modalities, PET-CT, MRI and CT have the highest publication percentages.

Imaging features of intracerebral hemorrhage with cerebral amyloid angiopathy: Systematic review and meta-analysis

Background We sought to summarize Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) features of intracerebral hemorrhage (ICH) associated with cerebral amyloid angiopathy (CAA) in published observational radio-pathological studies. Methods In November 2016, two authors searched OVID Medline (1946-), Embase (1974-) and relevant bibliographies for studies of imaging features of lobar or cerebellar ICH with pathologically proven CAA (“CAA-associated ICH”). Two authors assessed studies’ diagnostic test accuracy methodology and independently extracted data. Results We identified 22 studies (21 cases series and one cross-sectional study with controls) of CT features in 297 adults, two cross-sectional studies of MRI features in 81 adults and one study which reported both CT and MRI features in 22 adults. Methods of CAA assessment varied, and rating of imaging features was not masked to pathology. The most frequently reported CT features of CAA-associated ICH in 21 case series were: subarachnoid extension (pooled proportion 82%, 95% CI 69–93%, I2 = 51%, 12 studies) and an irregular ICH border (64%, 95% CI 32–91%, I2 = 85%, five studies). CAA-associated ICH was more likely to be multiple on CT than non-CAA ICH in one cross-sectional study (CAA-associated ICH 7/41 vs. non-CAA ICH 0/42; χ2 = 7.8, p = 0.005). Superficial siderosis on MRI was present in 52% of CAA-associated ICH (95% CI 39–65%, I2 = 35%, 3 studies). Conclusions Subarachnoid extension and an irregular ICH border are common imaging features of CAA-associated ICH, but methodologically rigorous diagnostic test accuracy studies are required to determine the sensitivity and specificity of these features.

Right abdominal mass in a 2 year-old child

The authors report a case of a wandering spleen presenting as a right lower quadrant abdominal mass, 2 years post a transabdominal left diaphragmatic hernia repair in a 2-year-old child with a congenital diaphragmatic hernia. The wandering spleen was fixed laparoscopically in an extraperitoneal pouch.

Clostridium difficile knowledge in healthcare workers: conclusions in the absence of broader evaluation

A validated, knowledge-based questionnaire tool could provide the means for identification of risk factors associated with poor levels of knowledge, assist in targeting educational interventions, and provide measurable data on the impact of educational interventions. n nUnfortunately, Aroori et al. failed to examine if data resulting from the questionnaire could discriminate populations with known differing levels of knowledge or if conclusions were valid in repeated sampling of healthcare worker populations elsewhere. Additionally, the questionnaire provides no clear conclusion/definition of what is an adequate level of knowledge, i.e. does anything less than 100% correct response deem a healthcare worker as possessing a lack of knowledge? n nPreviously, we assessed methicillin resistant Staphylococcus aureus knowledge in healthcare workers, both in a surgical trainee1 and wider healthcare worker population in repeated sampling. We found questionnaire statements on policy could be UK-region specific and that knowledge levels needed to be judged against a broader healthcare worker population context. In addition, even populations with assumed high levels of knowledge (infection control nurses) did not achieve 100% correct answers.2 n nUntil further validation, it is difficult to support the conclusions that the study findings are indeed ‘valid’ in reference to a presumed ‘significant lack of knowledge’ in wider consultant and nursing staff populations.3 This questionnaire can only ultimately comment on a local population, sampled at a specific time, and does not adequately define an appropriate level of knowledge.

Potential benefits of student- and junior doctor-led textbooks

IntroductionMedical textbooks are an important teaching supplement. Few have junior doctors or medical students (‘juniors’) as primary contributors. However, the strengths of junior-led face-to-face teaching are now well-established, and we hypothesized that similar advantages would be transferrable to a textbook setting.MethodsJuniors were approached to contribute to an independently published medical textbook, with senior clinicians recruited in parallel to ensure factual accuracy. Juniors directed every aspect of textbook writing and the production process. The published book stressed that it was an open collaboration with readers, inviting them to get in touch to evaluate the text and suggest ideas for new titles.ResultsOf 75 respondents, 93u2009% awarded the first textbook in the series 4 or 5 out of 5 for overall quality. Five other titles have been released, with seven more in development. Over 100 juniors are currently involved, with two students progressing from reviewers to editors after less than a year of mentorship.ConclusionJuniors can be a motivated, dynamic, innovative group, capable of significant contributions to the medical textbook literature. This initiative has generated a sustainable infrastructure to facilitate junior-led publishing, and has the capacity for expansion to accommodate new initiatives and ideas.