Diagnostic Radiology - Science topic

Response:

Thank you, Begaiym Kulbaeva and Rajkumar Couppoussamy, for your thoughtful contributions. I completely agree that while AI can significantly reduce the time required for repetitive tasks like determining bone age or identifying anomalies in diagnostic imaging, the nuanced interpretation of these findings requires the contextual understanding and expertise of a trained radiologist.

AI excels in pattern recognition, but it lacks the ability to fully grasp the complex interplay of factors that influence radiographic findings, such as patient history, clinical presentation, and potential co-morbidities. As Rajkumar aptly pointed out, AI should serve as an adjunct rather than a replacement for radiologists, augmenting their capabilities and enabling them to focus more on the interpretive and consultative aspects of patient care.

One promising avenue I’ve seen in AI-assisted diagnostics is its ability to flag potential abnormalities for further review, effectively acting as a “second set of eyes.” This is particularly impactful in high-volume clinical settings, where time and accuracy are critical. However, integrating AI into the diagnostic workflow demands that we maintain a human-centered approach, ensuring that the technology enhances, rather than diminishes, the role of radiologists in patient care.

I’d be interested to hear your thoughts on how we can strike the right balance between leveraging AI for efficiency and maintaining the essential human oversight required for accurate and compassionate diagnostics.

Steven Henderson

I like your "Future trends in health professions education" chapter because the education of a healthcare professional is of foremost relevance in his or her functioning as that professional. And the future should rely on the past to mold the techniques in schooling. I wish you success in your chapter-writing as some of my published papers have been referenced in chapters in books. Good luck!

I am NOT a doctor but as compter science professional, little more AI provided detail:

In cases where there is nodular peritoneal thickening, ovarian cancer, and ascites, the source of ascites can be the result of various factors, including the presence of cancer cells in the peritoneal cavity.

CA-125 is a tumor marker that is often elevated in cases of ovarian cancer, although it can also be elevated in other conditions. The presence of high CA-125 levels, along with the imaging findings of nodular peritoneal thickening, suggests the possibility of peritoneal serosal carcinoma, which is a type of cancer that affects the lining of the abdominal cavity (peritoneum). Ovarian cancer can sometimes spread to the peritoneum, leading to peritoneal serosal carcinoma.

Ascites refers to the accumulation of fluid in the abdominal cavity. In the context of ovarian cancer, ascites can occur due to several reasons, including:

1. Peritoneal involvement: Cancer cells can spread to the peritoneum, leading to inflammation and the production of fluid.

2. Impaired lymphatic drainage: The presence of cancer can disrupt the normal flow of lymphatic fluid, leading to its accumulation in the abdomen.

3. Liver involvement: Advanced ovarian cancer can involve the liver, leading to impaired liver function and fluid accumulation.

Surgery, as you mentioned, is often a crucial component of the treatment plan for ovarian cancer. The specific surgical procedures performed can vary depending on the individual case, but they may include removal of the ovaries (oophorectomy), peritoneal biopsy, and collection of various samples for histological examination. These procedures aim to obtain a definitive diagnosis, determine the extent of the disease, and guide further treatment decisions.

Please consult qualified healthcare professionals who can provide personalized advice and guidance based on the specific details of your best friend's mother's case. They will be able to provide the most accurate information and help determine the most appropriate course of action.

Hope it helps

I will be waiting for radiologist answers, but I will add; are old densities have same chance to disappear as the rather recent densities?

Dear Wellington Pinheiro Dos Santos, I am now dealing with a book chapter dealing polymeric nanoparticles (PN) for solid cancer drug delivery. During my bibliographic processing I found appreciable bibliographic material on the same PN used in cancer diagnosis for image contrast mainly. However, in the recommended parts of your Book no one is concerned by this aspect. So, what do you think, if you think this is feasable I Can be in charge of that. Kindest Regards

Ma be these links will help you: (i) https://www.nature.com/articles/sdata20194 (ii) https://www.fips.fi/dataset.php.

My suggestion would be to forget for a moment the terms sensitivity, specificity, PPV, and NPV because they can be quite confusing when dealing with more than one type of condition. Instead, focus on the value of the test that you want to measure, i.e. which test is preferable over another test with different test characteristics?

For that you need to put a value on each possible test result. You can approach it in either way: as positive contribution to a patient's health or as 'cost' due to an erroneous test results. Both these approaches should result in the same preference. It is probably easiest to approach is from the cost side:

- What is the disadvantage of getting a positive test result if you don't have meningitis?

- What are the respective disadvantages of getting a negative test result if you do have either of the three types of meningitis? I assume that those three disadvantages are not of equal value because otherwise you would not need to bother with the different types of meningitis

Generally the disadvantage of a false negative is much larger than of a false positive, therefore your evaluation should reflect that you are willing to tolerate more than 1 false positive if that is needed for finding 1 more true positive.

Health economists tend to estimate preference through QALYs. Maybe you have a better way to determine the relative value of the four different types of test errors in your example.

An ultrasound image has poor resolution because the speed of sound varies by less than 10% and the speckle noise but with the new technologies overcome this problem

regards

If you have access to all DICOM images in file system use a command line tool that dumps the information your interested in from all files (e.g. write a script that uses the command line tool).

If the DICOM images are stored in a PACS or any other kind of DICOM network node you have to transfer them first to your local hard drive and proceed as described above.

If you want to develop an application that does the above look for a DICOM library that fits your programming language and needs.

Did this get published? Am I to understand that the wound trajectory is almost vertical? If so, we may have another "Space Bullet" which is a low velocity bullet and can travel alone the path of least resistance, thus dissecting a path along tissue planes, and may miss major structures as it does not follow a straight line. This should be visualized well on a 3-D CT scan. You can read the full-text on "Spent Bullets" here on RG; which explains the research on a large series of the first published cases. Thank you for your support, Gary Ordog, MD

No of course because of the radiation hazards

The principal reason is that the difference in position causes different amounts of magnification of cardiac size. With a PA chest x-ray, the heart is close to the image receptor, and magnification is minimal. With an AP chest x-ray, the heart is further from the image receptor, and appears larger on the image. When evaluating the possible presence of cardiomegaly, only a PA view should be used.

i found that MRI siemens standart protocols is out of good imaging. This is may be my fail in understanding but nothing helps. so I hope edx format will help me.

Ask them what about IR is less appealing to them; what has deflated their interest in IR; many times a particular instructor or professor can be harder than the IR resident anticipated. Getting to the basis of their thought process regarding seeing themselves in IR often will be a key to helping them in their decision making.

Dennis

Dennis Mazur

A good lecture session for half a day or one day should be informative.

e. We won’t have an IR residency.

A medical or surgical rotation should include students on rounds with the team to see all radiographs (interventional or non-interventional) taken on each day of the medical student rotation on any service where radiographs are taken.

The radiologist should begin questioning of the interpretation of the radiographs with the medical student going first.

Dennis

Dennis Mazur

Colonoscopy when performed by experienced operators has no major complications. Its usefulness exceeds by far any major risk.

agreed with Hayder

Thank you sir, please are there empirical evidence from published data? Please. @ Joseph Zira Dlama

@Wolfgang Reichl: Hi, gradient in which direction? X ,Y or both?

there is a good database with ground truth provided by SIIT biomedical unit , Thammasat university, Thailand 

Daryoush,

You are correct in stating that it is the ratio of the mass energy absorption coefficients.  You can look at a lot of these values at the NIST web site:

Look at Table 3 for elements and Table 4 for compounds and mixtures including some standard tissues.

this is so easy to answer in hindsight with the retrospectoscope. Or even better on a desk running analysis on a population based retrospective study....however in real life where physicians must decide, in broad day light or night alike; some times under time pressure, some times biased by a recent case, sometimes afraid of medicolegal implications ....it becomes harder to only order the best exam

off course there will be overuse, how else can one be sure that all necessary examinations have been carried out... 

and yes it is frustrating that we have examinations and time and effort spend when in hindsight it could have been done without... however ...better safe than sorry and first don't harm are still relevant 

In case of suspicion Crohn , we prefer, the first one, US study of the last ileal loop (SICUS). The RMN secondarily . If your service does not have a sonographer delicate, resonanc, with the study of the loops, is indicated .

Dear Sergio Faermann 

Thanks for your response. you are right two accelerators are not same and of course we can not remove FF, I like to comprise some simulation code , however for validation of each Linac I need PDD and profile measuring data. So for this data, we are able to compare two code which are validated by same measuring.

by the way, thanks for your attention.

beast regards

I concur with everyone's contribution and I hereby commend your effort.

Permit me, to take us back to the question, and summarize the answer. ... " Are there diagnostic radiological features that help to differentiate between KCOT and ameloblastoma? Answer, : There are radiological features that are suggestive of differences between the two and may help to differentiate between KCOT and Ameloblastoma but these are not diagnostic.

You might want to look at the method developed by Walter Huda and me.  Using the free-in-air isocenter kerma, we measured the ratio to organ doses in multiple anthropomorphic phantoms.  Very easy approach to organ dose:

It requires manual set up for each patient, at the moment we do not offer it as a script for running on a larger database yet

Jose,

You're answer depends on the spacing of the elements and the distance from them you are interested in. There will be large pressure fluctuations within the Fresnel zone before a settled Fraunhoffer region emerges. The position of this will depend upon the interactions of the waves from the sources with each other, one of the governing parameters will be your acoustic source spacing. It will be fairly simple to write a model in Matlab to study the relationships yourself using a Rayleigh-Sommerfeld model.

For more information I highly recommend the book "Fundamentals of Ultrasonic Phased Arrays" by Schmerr

Yes of course there are some. Here below is one ref but you could find others easily.

Solid focal liver lesions indeterminate by contrast-enhanced CT or MR imaging: the added diagnostic value of contrast-enhanced ultrasound.

Quaia E.

Abdom Imaging. 2012 Aug;37(4):580-90.

In India, though we have good amount of experts in the domain of radiology, medical physics but are mostly into their private labs as entrepreneurs. They rarely have time to contribute for the research and development in any form.

We use test bolus with ROI in pulmonary trunk and add 2 secs to peak time as delay. Then 30 ml are sufficient for CTPA (on Flash the scan of thorax takes about 3 secs), but aorta is "empty" . However there are plenty of possibilities.  

I googled the probe you use and It seems to be ok for the job you are working on.  Did you use a good transmitting media, I mean ultrasound jel - plenty of it...  You may try to put ex vivo pig hearts in a plastic container filled with ultrasound gel, I have tried plain water for some other experiments, ultrasound gel may even work better.  

You can check my experimental model ( A model for basic ultrasound set-up and training for 3D/4D ultrasound scanning

K E Karaşahin · M Ercan · I Alanbay · U Keskin · M Dede · M C Yenen · I Başer

Ultrasound in Obstetrics and Gynecology 03/2011; 37(3):371-2. )

I believe it will work for you.  Submerge the pig heart  about 4- 5 cm away from the tip of the probe, make sure there is plenty of gel between the heart and the probe.  Try to avoid air bubbles. 

You can also try to fill the plastic cup with jello solution, and observe after it solidifies.  

4 D imaging is real time so you have to be patient, do not move the probe around quickly.  3 D is easier but still requires a stationary probe.  Get a clear 2 D image first.  Then use 3/4 D .

Use small volume or interest for better results (you get higher frequency and better resolution).

Good luck.  

Thank you for your contributions! Yes, the idea is a simple blood test as a guide to apply further evaluation. maybe a good example is HCC-screening using AFP in patients with liver cirrhosis at risk of hepatocellular carcinoma. the key for success is a proper selection of patients with a high pre-test probability.

A short "summary" about drug excretion, also mentioning drug weight and lipophilocity : http://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-excretion 

and for those who want to read more: http://classes.biology.ucsd.edu/bimm118.WI11/PPT%20Lecture%20Notes/Lecture%203.pdf

Interesting and good discussion!

The Cancer Imaging Archive might be worth a try.

Hi,

For this purpose, I think there is what we call kill actor in GATE simulation platform !

Your answer surprises me. With a dose of 80 MBq at rest and a normal collimator, ignoring decay / scatter / attenuation / part of patient outside FOV / geometric efficiency / poor algorithmic efficiecy, your 'true' data compromises at most 6E5 events amidst a lot of noise. Given that likely half the photons are scattered, half are attenuated and three quarters will be outside the field of view and that probably the GP will compromise less than 1.5% of the MIBG uptake within the field of view, I am not convinced that it is at all feasable. 

Hi Shakardokht,

I don't have any experience with dosimetry in diagnostic radiology but I have been doing radiotherapy in vivo dosimetry (TLDs and GaF film) for a while now.  Narayan's work is really intra cavitory dosimetry, which, these days is not performed regularly as modern planning systems can predict/estimate the doses to OARs quite accurately. I have found eye lens dosimetry to be the most challenging one. In vivo dosimetry in this case uses surrogates on the skin to estimate dose to lens at depth. The other issue the uncertainty in dose estimation using TLDs due to the angular dependence of TLDs. Not sure if a phantom exists where one could place TLDs in place of lens and then performs dosimetry by putting TLDs on the skin and comparing the doses from on the skin TLDs to the TLDs placed inside the phantom where the lens is located. The other anatomical areas where in vivo can be challenging are the nose and ear, especially when MV electron are used to treat skin tumours in these areas. The issues to consider here are the electron backscatter, uneven surface and the lack of tissue. There probably are other areas/issues such as dosimeter preparation readout etc. which can also be challenging.

Cheers

Vinod 

The CR systems uses a log amplifier. There is one advantage as this roughly corrects the signal to be proportional to the density of everything in the beam i.e. inverting the effect of the exponential absorption properties. This is useful to know if you are looking at a raw clinical image (with linear LUT), it can be easier to view after applying a log transform to the images.

There is more and I am stretching my brain for this one, but there are some advantages in terms of noise for log amplifiers. I think linear amplifiers are used for DR as log amplifiers would amplify the electronic noise in low signal regions - this is not an issue for CR as there is negligible electronic noise.

Either way the images are generally presented to the reader with a sigmoid look up table.

If  many  radiological  accessories  are  made  of  lead, that  presupposes  that  contact  with   it  is  not  harmful  in  its  basic  solid  form. The  harm  documented  in  literature  is  from  inhalation  as  powder  or    ingestion  when  dissolved  in  a  solvent.

The  question  also  arises  as  to  how  lead  from  radiological  practice  can  accumulate  to  such  a level  as  to  constitute  an   environmental  hazard.  It  is  not  a   use-and-dispose  consumable  by  the  way  but  made  to  last  ad  infinitum  unless  its  integrity  is  compromised. In  developing  countries  it  would  be  rare  to  see  any  disposal  of  lead-based  radiological  materials  aside  distorted  grid  and  compromised  lead  aprons.  And  even  then,  where  will  the  quantity  that  can  constitute   a  serious  environmental  hazard  be  found? Only  in  metallurgical  companies  that  handle  lead. It  is  the  scrap  metal  from  such  places  that  we  should  worry  about  more.

It  is  my  opinion  that  that  lead  can  be  disposed  normally  in  a  garbage  heap  as  long  as  it  is  not  close  to  a  drinking  water  source. It  can  also  be  buried  deep  down  in  the  soil. Nevertheless, this   calls  for  a  research  to  know  how  it  is  being  disposed  and  the  immediate  and  eventual  environmental  impact  of  non-recycling  in  ones  immediate  environment.

Chapter 9 of Physics in Nuclear Medicine by Simon R. Cherry, James A. Sorenson, Michael E. Phelps discusses counting statistics in some depth. You can preview the book on Google books to see if it the correct content for you.

A review article by E. Gordon DePuey, "Advances in SPECT camera software and

hardware: Currently available and new on the horizon" discusses advances in software that enables lower counts to be used, such as iterative reconstruction, resolution recovery and noise compensation...

I hope this information is useful

I don't know what anti-concentration means, but diffusion of contrast agents is a 3D phenomenon. Angio X-ray images are 2D conical projections of a 3D scene. A pixelvalue in such an X-ray image is the result of the electron-density of all tissue in the path of a beamlet plus some scatter.

So, I would say: doing some diffusion-based modelling in 3D is valid, but in 2D projections it is not valid.

It should be: Nominelle Anodeneingangsleistung

Yup, thats exactly the practice in Malaysia, a film badge dosimeter worn by every employee at the radiology department and we are given 14 days of extra leave compared to others who work in other departments. The badges are collected by the radiation supervisor.

It's likely to be a toxic extrapontin demyelination case. The history of the patient also suggest primarely this diagnosis.

These are small caliber arteries and the examination does not necessarily focus on them. Nitroglycerin spayed sublingually can help achieve vasodilatation before angiographic images are taken.

Below is the answer to another question that I gave a while ago, and you should find it helpful:

It is worth adding something to the second part of your question. As you know there are no safe radiation doses (in theory at least). So the objective of shielding is to to ensure that the doses outside the shielded area do not exceed legal limits, or other requirements that may be set nationally. This creates problems in many countries, which do not have their own regulations and tend to follow guidelines available internationally. The most important problem for Engilsh language guidance is that the reccomendations from the US are quite different to those from the EU and the UK. Also, the EC and UK (and many other countries) impose an additional limitation referred to as a Dose Constraint. This is a level used during, for example, the planning of a building to facilitate optimization. Briefly the design levels that tend to be quoted in the US literature are often as high as 50 mSv/y (occupational dose limit). The legal limit often used in EC countries is often as low as 1 mSv/y (public dose limit) and when designing a building this is often reduced further to the design dose constraint of 0.3 mSv/y. All of this is discussed in some detail in the document;

"The Design of Diagnostic Medical Facilities where Ionising Radiation is used."

available for download from my Researchgate page at:

That one is fun! I am assuming that you are referring to the small foramen indicated at the arrow on the segment of your image that I have attached. The superior circle is the optic foramen and the inferior circle is the medial aspect of the superior orbital fissure.

I noticed that the University of Liverpool has a Medical Imaging and Radiotherapy department within the School of Health Sciences. Their Head is Dr. Stuart Mackay. He may be able to connect you to someone that can help you screen your images.

Carla

I must agree with Prasannasrinivas Deshpande, that most often, numerous radiographic clues can be sought on classical 2D images such as:

- lack of discontinuity of the superior "lamina dura" of the mandibular canal

- good visibility of periapical ligament

- partial superposition of roots and mandibular canal (thus excluding the possibility of have the inferior alveolar nerve completely entrapped between 2 fused roots).

Nevertheless, CBCT imaging proves quite useful in assessing somewhat rare anatomical variations of the mandibular nerve, such as the presence of a retromolar nerve and canal, which can have clinical implications such as difficulty in anesthesia of the retromolar trigone or perioperative bleeding due to surgical trauma of the vascular bundle that accompagnies the retromolar nerve.

For further information:

Lizio G, Pelliccioni GA, Ghigi G, et al. Radiographic assessment of the mandibular retromolar canal using cone-beam computed tomography. Acta Odonto Scand 2013 ;71 :650-655.

Von Arx T, Hänni A, Sendi P et al. Radiographic study of the mandibular retromolar canal : an anatomic structure with clinical importance. J Endod 2011 ;37 :1630-5.

You are fully correct. The breast thickness is in cm instead of mm and there is a mistake of a factor 10 in the g-factors. I will try to get this rectified/corrected. Thanks for your feedback.

Ruben van Engen

I do not think that diverticular disease is the only cause of lower gastrointestinal bleeding. In emergancy settings a CT scan may be indicated only after a proctologic examination does not find other source of bleeding (haemorroids, fissures, rectal or anal polyops, solitary ulcer syndrome). Anyway, a successive colonoscopy is mandatory expecially in old patients.

Yes, of course.

I read on the TBSS forum that "though of course we always try to discourage people

from using ANOVA in general" and I read some instructions on the web but it seems that there is a little bit of confusion about this argument.

Great can we exchange emails to start the process

If bone density comes into question from a plain view radiograph, then a follow up, full body dexa scan is ordered (bone density). Follow link for more answers. http://www.osteopenia3.com/dexa-scans.html

This last comment makes a very important point. Even with the best and most careful registration, you still have no way to confirm that voxels are perfectly matched in a normalized brain space. The other option is to work in native space and create your regions using anatomical boundaries within each individual, which can account for individual differences in anatomy. You can then make strong claims that you are looking at the same brain structure, within a certain degree of confidence based on your inter-rater reliability.

For estimating the air kerma (at a given distance, typically 1 meter) you need the specific yield of the X-ray tube (mGy/mAs). The specific yield depends on the tube voltage and the beam filtration, but also on tube age, construction etc. So the best way is to measure the yield curve of your specific tube, see an example in the attachment. Then you can calculate the air kerma as specific yield * mAs.

The general rule of thumb is that if you predicted changes in particular areas before you collected the data, you are justified in reporting uncorrected results. But you must explain your a priori hypothesis. If you didn't have any idea where you would see changes appear in the brain, you must use corrected data. For TBSS presentation, a threshold of p<0.05 corrected is considered acceptable.

Tim

We are at the same point like Peter and his colleagues and evaluate different solutions to get a robust teaching file system up and running.

@Howard: Are there any further resources about the deployment of OsiriX as a teaching file solution?

As concerning my hospital, the main questions asked are: tissue characterization and myocardial anatomy/function.