Radiology Commons^™

Feasibility Of Diffusion And Probabilistic White Matter Analysis In Patients Implanted With A Deep Brain Stimulator., J. Muller, M. Alizadeh, L. Li, S. Thalheimer, C. Matias, M. Tantawi, J. Miao, M. D. Silverman, V. Zhang, G. Yun, V. Romo, F. B. Mohamed, C. Wu

Department of Neurosurgery Faculty Papers

Deep brain stimulation (DBS) for Parkinson's disease (PD) is an established advanced therapy that produces therapeutic effects through high frequency stimulation. Although this therapeutic option leads to improved clinical outcomes, the mechanisms of the underlying efficacy of this treatment are not well understood. Therefore, investigation of DBS and its postoperative effects on brain architecture is of great interest. Diffusion weighted imaging (DWI) is an advanced imaging technique, which has the ability to estimate the structure of white matter fibers; however, clinical application of DWI after DBS implantation is challenging due to the strong susceptibility artifacts caused by implanted devices. This …

Outpatient Facility-Based Order Variation In Combined Imaging., Adam C. Powell, Yan Wang, Gary L. Smith, James W. Long, Uday U. Deshmukh, David P. Friedman, Christopher G. Roth, Baskaran Sundaram

Department of Radiology Faculty Papers

OBJECTIVE: Combined computed tomography (CT) occurs when one anatomical area is simultaneously imaged both without and with contrast, or two overlapping anatomical areas are imaged concurrently. While this has been studied in a Traditional Medicare population, it has not been studied in other populations subject to prior authorization. This study explores between-facility variation in ordering and receiving orders to render combined CT in a mixed commercial and Medicare Advantage population.

METHODS: Orders for CT abdomen (without/with contrast), CT thorax (without/with contrast), and concurrent CT brain and sinus authorized by a prior authorization company from 2013-2017, pertaining to patients with commercial …

Cmut/Cmos-Based Butterfly Iq – A Portable Personal Sonoscope, Joyce Liu, Ba, Jiajun Xu, Md, Flemming Forsberg, Phd, Faium, Ji-Bin Liu, Md

Department of Radiology Faculty Papers

With the development of bioengineering technologies, medical ultrasound systems have evolved and advanced over the years, including the transition of ultrasound machines from analog devices to digital systems and improvements in transducer assembly from piezoelectric ceramics to single crystals. In the past several years, the further miniaturization of ultrasound units has become possible with the advancement of computer chip manufacturing and production. Most recently, a new handheld ultrasound system has been developed by the startup company Butterfly Network, using an innovative CMUT/CMOS-based probe technique. This paper will review the history, technology and features of this new device, as well as …

Clinical Value Of Ultrasonography For Monitoring Angular Pregnancy In First-Trimester, Yanhua Zhen, Md, Xuefeng Lu, Md, Chenyu Wang, Md, Huixia Li, Md, Ji-Bin Liu, Md

Department of Radiology Faculty Papers

Objective: To explore the clinical value of ultrasonography for early detection and monitoring of angular pregnancy during the first-trimester.

Methods: For this retrospective study, we enrolled 23 patients with asymptomatic angular pregnancy who were diagnosed by ultrasound at early pregnancy and who underwent ultrasound follow-up to determine its clinical outcome. An ultrasound unit E8 (GE Healthcare, Milwaukee, WI) associated with a 5-9 MHz convex array transvaginal probe was used to image the gestational sac by both two-dimensional and three-dimensional modes. Transvaginal sonographic observation included the location, size, and shape of the gestational sac, as well as the relationship between the …

Applications In Molecular Ultrasound Imaging: Present And Future, Vishal Thumar, Md, Ji-Bin Liu, Md, John Eisenbrey, Phd

Department of Radiology Faculty Papers

Molecular ultrasound imaging or targeted contrast-enhanced ultrasound (CEUS) is a relatively new technique that has varied applications to augment both diagnostics and therapeutics. Ultrasound contrast agents are conjugated to ligands that bind with specific biomarkers in the areas of interest which can then be quantified using ultrasound technology. This technique has numerous clinical applications including studying pathophysiology of disease, improving diagnostic sensitivity and specificity, and improving localized drug delivery. This technology, most notably, has proven useful in numerous oncologic and cardiovascular applications. Given ultrasound’s advantages over other radiographic studies including its low cost, lack of ionizing radiation, portability, ability to …

Artificial Intelligence In Ultrasound Imaging: Current Research And Applications, Shuo Wang, Bs, Ji-Bin Liu, Md, Ziyin Zhu, Md, John Eisenbrey, Phd

Department of Radiology Faculty Papers

Artificial intelligence (AI) is an area of computer science that emphasizes the creation of intelligent software or system based on big data information, machine learning and deep learning technologies. The rapid development of science and technology as well as internet communication has enabled AI and big data to gradually apply to many fields of health care. The modern imaging medicine is one of the first areas that AI can play an important role and applications. As cross-sectional imaging, ultrasound (US) is well suitable for AI technology to standardize imaging protocols and improve diagnostic accuracy. This article reviews current AI technology …

Commentary: Using Directional Deep Brain Stimulation To Co-Activate The Subthalamic Nucleus And Zona Incerta For Overlapping Essential Tremor/Parkinson's Disease Symptoms., Chengyuan Wu, Caio Matias

Department of Radiology Faculty Papers

We have read with interest the article titled “Using Directional Deep Brain Stimulation to Co-activate the Subthalamic Nucleus and Zona Incerta for Overlapping Essential Tremor/Parkinson's Disease Symptoms” by Falconer et al. (1). In this case report, the authors present a patient treated with unilateral left-sided deep brain stimulation (DBS) after medical management alone proved to be ineffective. The stereotactic target was described as being “3 mm lateral to the most lateral point of the red nucleus” at the Bejjani line (2); and implantation of the electrode at this target was confirmed with microelectrode recordings, intraoperative macrostimulation …

A Comparative Study Of Short-Term Efficacy And Safety For Thyroid Micropapillary Carcinoma Patients After Microwave Ablation Or Surgery., Jianming Li, Yujiang Liu, Ji-Bin Liu, Peipei Yang, Xiangdong Hu, Linxue Qian

Department of Radiology Faculty Papers

Background: Although papillary thyroid microcarcinoma (PTMC) has a high incidence and excellent clinical outcome, debate continues as to the therapeutic approach that would be most appropriate after confirming the diagnosis.

Methods: We retrospectively analyzed the medical records of 311 patients with T1aN0M0 PTMC between January 2013 and September 2018. In all, 168 underwent microwave ablation (MWA), and 143 underwent surgery. MWA was performed using extensive ablation with hydrodissection. The surgery comprised thyroid lobectomy (TL) with unilateral central lymph node dissection (CND). We examined clinical outcomes during mean follow-up periods of 824 ± 452 days for the TL group and 753 …

Solutions To Reduce Unnecessary Imaging., David C. Levin, Vijay M. Rao

Department of Radiology Faculty Papers

No abstract provided.

Sternoclavicular Joint Arthropathy Mimicking Radiculopathy In A Patient With Concurrent C4-5 Disc Herniation, Prateek Agarwal, Ab, Nitin Agarwal, Md, David Hansberry, Md, Phd, Neil Majmundar, Md, Ira M. Goldstein, Md

Department of Radiology Faculty Papers

Background

Patients with sternoclavicular joint arthropathy, which can result from septic arthritis, often present with localized sternoclavicular pain as well as shoulder pain. Such pain may be similar to the presenting symptoms of cervical intervertebral disc herniation.

Clinical presentation

A 47-year-old female presented with 1 month of significant pain in the neck as well as right anterior chest and deltoid. The patient was found to have reduced strength in the right deltoid muscle on physical examination. MRI revealed a C4-C5 herniated nucleus pulposus. The patient underwent successful C4-C5 anterior cervical discectomy, but subsequently developed painful swelling in the region of …

Diagnostic Value Of Two Dimensional Shear Wave Elastography Combined With Texture Analysis In Early Liver Fibrosis., Zhao-Cheng Jian, Jin-Feng Long, Yu-Jiang Liu, Xiang-Dong Hu, Ji-Bin Liu, Xian-Quan Shi, Wei-Sheng Li, Lin-Xue Qian

Department of Radiology Faculty Papers

BACKGROUND: Staging diagnosis of liver fibrosis is a prerequisite for timely diagnosis and therapy in patients with chronic hepatitis B. In recent years, ultrasound elastography has become an important method for clinical noninvasive assessment of liver fibrosis stage, but its diagnostic value for early liver fibrosis still needs to be further improved. In this study, the texture analysis was carried out on the basis of two dimensional shear wave elastography (2D-SWE), and the feasibility of 2D-SWE plus texture analysis in the diagnosis of early liver fibrosis was discussed.

AIM: To assess the diagnostic value of 2D-SWE combined with textural analysis …

Monitoring Progression Of Ductal Carcinoma In Situ Using Photoacoustics And Contrast-Enhanced Ultrasound., Ryan Margolis, Corinne Wessner, Maria Stanczak, Ji-Bin Liu, Jingzhi Li, Kibo Nam, Flemming Forsberg, John R. Eisenbrey

Department of Radiology Faculty Papers

Breast cancer is the leading form of cancer in women, accounting for approximately 41,400 deaths in 2018. While a variety of risk factors have been identified, physical exercise has been linked to reducing both the risk and aggressiveness of breast cancer. Within breast cancer, ductal carcinoma in situ (DCIS) is a common finding. However, less than 25% of DCIS tumors actually progress into invasive breast cancer, resulting in overtreatment. This overtreatment is due to a lack of predictive precursors to assess aggressiveness and development of DCIS. We hypothesize that tissue oxygenation and perfusion measured by photoacoustic and contrast-enhanced ultrasound imaging, …

Automation, Regulation, And Collaboration: Threats And Opportunities For Clinical Medical Physics Careers In Diagnostic Imaging And Nuclear Medicine., David W. Jordan, Eric L. Gingold, Ehsan Samei

Department of Radiology Faculty Papers

No abstract provided.

Comparative Effectiveness Of Intensity Modulated Radiation Therapy To 3-Dimensional Conformal Radiation In Locally Advanced Lung Cancer: Pathological And Clinical Outcomes., Sarit Appel, Jair Bar, Alon Ben-Nun, Marina Perelman, Dror Alezra, Damien Urban, Maoz Ben-Ayun, Nir Honig, Efrat Ofek, Tamar Katzman, Amir Onn, Sumit Chatterji, Sergey Dubinski, Lev Tsvang, Shira Felder, Judith Kraitman, Ory Haisraely, Tatiana Rabin Alezra, Sivan Lieberman, Edith M. Marom, Nir Golan, David Simansky, Zvi Symon, Yaacov Richard Lawrence

Department of Radiation Oncology Faculty Papers

OBJECTIVE: Intensity-modulated radiotherapy (IMRT) has better normal-tissue sparing compared with 3-dimensional conformal radiation (3DCRT). We sought to assess the impact of radiation technique on pathological and clinical outcomes in locally advanced non-small cell lung cancer (LANSCLC) treated with a trimodality strategy.

METHODS: Retrospective review of LANSCLC patients treated from August 2012 to August 2018 at Sheba Medical Center, Israel. The trimodality strategy consisted of concomitant chemoradiation to 60 Gray (Gy) followed by completion surgery. The planning target volume (PTV) was defined by co-registered PET/CT. Here we compare the pathological regression, surgical margin status, local control rates (LC), disease free (DFS) …

Process Improvement For Follow-Up Radiology Report Recommendations Of Lung Nodules., Philip S. Lim, Doron Schneider, Jonathan Sternlieb, Michel Taupin, Nicholas Sich, Joan Diaz, Eileen Jameson, Bryan Frambes, Sharon Taylor

Abington Jefferson Health Papers

In the modern healthcare system, there are still wide gaps of communication of imaging results to physician and patient stakeholders and tracking of whether follow-up has occurred. Patients are also unaware of the significance of findings in radiology reports. With the increase in use of cross-sectional imaging such as CT, patients are not only being diagnosed with primary urgent findings but also with incidental findings such as lung nodules; however, they are not being told of their imaging findings nor what actions to take to mitigate their risks. In addition, patients at high risk for developing lung cancer often obtain …

Ultrasound-Triggered Antibiotic Release From Peek Clips To Prevent Spinal Fusion Infection: Initial Evaluations., Lauren J. Delaney, Daniel Macdonald, Jay Leung, Keith Fitzgerald, Alex M. Sevit, John R. Eisenbrey, Neil Patel, Flemming Forsberg, Christopher K. Kepler, Taolin Fang, Steven M. Kurtz, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

Despite aggressive peri-operative antibiotic treatments, up to 10% of patients undergoing instrumented spinal surgery develop an infection. Like most implant-associated infections, spinal infections persist through colonization and biofilm formation on spinal instrumentation, which can include metal screws and rods for fixation and an intervertebral cage commonly comprised of polyether ether ketone (PEEK). We have designed a PEEK antibiotic reservoir that would clip to the metal fixation rod and that would achieve slow antibiotic release over several days, followed by a bolus release of antibiotics triggered by ultrasound (US) rupture of a reservoir membrane. We have found using human physiological fluid …

Is Excision Of Radial Scars Identified On Cnb Necessary?, K. Nimtz, K. Hookim, Md, A. Sevrukov, Md, T. Tsangaris, Md, A. Willis, Md, A. Berger, Md, M. Lazar, Md

Phase 1

Introduction: Quantifying the risk of upgrade to malignancy with radial scars has been an ongoing challenge, as the published upgrade rate varies widely from 0-40%, making management strategy controversial. The lack of consensus on optimal management highlights the need for further analysis. We sought to identify our institutional upgrade rate of radial scar identified on core needle biopsy (CNB).

Methods: A retrospective review of pathology and radiology databases was performed to identify radial scars found on CNB. We excluded patients with malignancy associated with radial scar and those who did not undergo surgical excision. The upgrade rates to …

Network Influence Of The Cerebellum For Predicting Dbs Response In Patients With Advanced Parkinson’S Disease, Lucy Li, Jennifer Muller, Sara Thalheimer, Mackenzie D. Silverman, Mahdi Alizadeh, Tsao-Wei Liang, Kelly Layton, Daniel Kremens, Victor Romo, Feroze Mohamed, Chengyuan Wu

Phase 1

Introduction: Deep brain stimulation (DBS) is a treatment option for reducing motor symptoms in patients with Parkinson’s Disease (PD) when first-line medication becomes ineffective. Existing literature has hypothesized that the clinical outcome of DBS may depend on brain connectivity profiles of the stimulation site to distant brain regions. However, the potential of brain connectivity profiles to predict response to DBS in PD remains unclear.

Objective: This study aimed to investigate how changes in structural and functional connectivity may relate to patient response to DBS, through the examination of brain network changes using graph theory.

Methods: Ten patients with advanced PD …

Effect Of Tort Reform On Diagnostic Imaging Rates, Israel Ojalva, Ba, Arthur Hong, Md, Mph

Phase 1

Introduction: Defensive medicine, is defined as “order[ing] tests, procedures, or visits, or avoid certain high-risk patients or procedures, primarily (but not solely) because of concern about malpractice liability.” Nearly all physician who fear malpractice litigation have admitted to practicing some degree of defensive medicine. In response, many states have enacted policy reforms to lighten the threat of malpractice on physicians.

Objective: The most common defensive medicine behavior is ordering diagnostic imaging tests when it is potentially unwarranted. Many states have enacted non-economic damage caps from 2000-2010. We explored if these laws had an impact on the rates of diagnostic imaging …

Adaptive Statistical Iterative Reconstruction-V For Lung Nodule Analysis, Cherry Au, Zhenteng Li, Md, Eric Gingold, Md, Ethan Halpern, Md, Baskaran Sundaram, Md

Phase 1

Introduction: Low-dose CT in lung cancer screening has demonstrated benefits in select patients. As the traditional filtered back projection (FBP) technique is limited by poor image quality, adaptive statistical iterative reconstruction-V (ASIR-V) algorithm has been developed to achieve higher image quality with processing efficiency.

Objective: To investigate the impact of various CT scan parameters on the semi-automated measurement of lung nodules using a Computer Aided Detection (CAD) program.

Methods: This IRB-exempt phantom experiment was conducted with a CT scanner capable of ASIR-V algorithm. Eight lung nodules sized 5-12 mm, of solid or ground glass type, were placed inside a multipurpose …