Medical Specialties Commons^™

Urinary Bladder Metastasis From Breast Cancer: A Rare Cause Of Hematuria, Samuel Gitau, Allan Njau, Sitna Mwanzi

Imaging & Diagnostic Radiology, East Africa

Breast cancer is the most common cancer in women globally as well as in Kenya. The most common sites of metastases reported include the bones, liver and lung. Metastasis to the urinary bladder is relatively uncommon with only a few case reports in literature. It can therefore be easily overlooked as a cause of hematuria in these patients. We describe a rare case of a patient with breast cancer who presented with urinary bladder metastasis as a late complication of her illness.

Lung Metastasis Postradioembolization Of Hepatocellular Carcinoma With Tumor In Vein, Harit Kapoor, Sreeja Sanampudi, Joseph W. Owen, Driss Raissi

Radiology Faculty Publications

Transarterial radioembolization (TARE) is one of the few treatment options available for infiltrative hepatocellular carcinoma with tumor in vein. This is backed by the published data showing marginally favorable toxicity profile compared with other locoregional and systemic therapies. Although lung shunt fraction studies are performed to prevent radiation injury to the lungs, TARE-induced embolization/metastasis to the lungs has not been reported before. We report an intriguing case of new lung metastases within 1 month after TARE for infiltrative hepatocellular carcinoma with a tumor in the vein, with only a slightly elevated but acceptable lung shunt fraction. This report brings to …

Diagnostic Accuracy Of Ceus Li-Rads For The Characterization Of Liver Nodules 20 Mm Or Smaller In Patients At Risk For Hepatocellular Carcinoma., Jia-Yan Huang, Jia-Wu Li, Qiang Lu, Yan Luo, Ling Lin, Yu-Jun Shi, Tao Li, Ji-Bin Liu, Andrej Lyshchik

Department of Radiology Faculty Papers

Background: American College of Radiology contrast agent–enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) was developed to improve the accuracy of hepatocellular carcinoma (HCC) diagnosis at contrast agent2enhanced US. However, to the knowledge of the authors, the diagnostic accuracy of the system in characterization of liver nodules 20 mm or smaller has not been fully evaluated.

Purpose: To evaluate the diagnostic accuracy of CEUS LI-RADS in diagnosing HCC in liver nodules 20 mm or smaller in patients at risk for HCC.

Materials and Methods: Between January 2015 and February 2018, consecutive patients at risk for HCC presenting with …

Acoustic Parameters For Optimal Ultrasound-Triggered Release From Novel Spinal Hardware Devices., Lauren J. Delaney, Cemile Basgul, Daniel W Macdonald, Keith Fitzgerald, Noreen J. Hickok, Steven M Kurtz, Flemming Forsberg

Department of Radiology Faculty Papers

Post-operative infection is a catastrophic complication of spinal fusion surgery, with rates as high as 10%, and existing preventative measures (i.e., peri-operative antibiotics) are only partially successful. To combat this clinical problem, we have designed a drug delivery system around polyether ether ketone clips to be used for prophylactic post-surgical release of antibiotics upon application of ultrasound. The overall hypothesis is that antimicrobial release from this system will aggressively combat post-surgical bacterial survival. This study investigated a set of acoustic parameters optimized for in vitro ultrasound-triggered coating rupture and subsequent release of encapsulated prophylactic antibiotics. We determined that a transducer …

Utility Of Ultrasound And Mammography In Detection Of Negative Axillary Nodal Metastasis In Breast Cancer, Anam Khan, Imrana Masroor, Kumail Khandwala, Summar Un-Nisa Abbasi, Muhammad Usman Tariq

Department of Radiology

Objective: The status of axillary lymph nodes is one of the most important prognostic factors in patients with breast cancer. A precise noninvasive evaluation of axillary lymph node status preoperatively, although challenging, is vital for optimization of the treatment plan for patients. The objective of our study was to assess the utility of ultrasound and mammography in detecting the absence of axillary lymph nodal metastasis in patients of breast cancer, taking histopathology as gold standard.
Methods: A cross-sectional study was conducted in the Department of Radiology, Aga Khan University Hospital, Karachi. All female patients between 20 and 95 years of …

Expression Of Cytokines And Chemokines As Predictors Of Stroke Outcomes In Acute Ischemic Stroke, Sarah R. Martha, Qiang Cheng, Justin F. Fraser, Liyu Gong, Lisa A. Collier, Stephanie M. Davis, Doug Lukins, Abdulnasser Alhajeri, Stephen Grupke, Keith R. Pennypacker

Institute for Biomedical Informatics Faculty Publications

Introduction: Ischemic stroke remains one of the most debilitating diseases and is the fifth leading cause of death in the US. The ability to predict stroke outcomes within the acute period of stroke would be essential for care planning and rehabilitation. The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC; clinicaltrials.gov NCT03153683) study collects arterial blood immediately distal and proximal to the intracranial thrombus at the time of mechanical thrombectomy. These blood samples are an innovative resource in evaluating acute gene expression changes at the time of ischemic stroke. The purpose of this study was to identify inflammatory genes and …

Lead X-Ray Vests: Pros And Cons In Dental Radiography And Patient Education On Radiographic Technology, Kayla D. Oakley, Emily Deker

Dental Hygiene Student Scholarship

Problem: There is a greater need to emphasize and educate patients and providers about radiologic advancements and patient exposure. The tradition of placing lead x-ray vests on patients for all radiographs is no longer a necessity. Without the explanation of why lead aprons are no longer needed, unnecessary steps for the provider and potential harm to the patient could be caused.

Methods: This review of literature was assembled by analyzing data from primary and secondary sources through online databases. The most recent research on the risks and benefits of the use of lead x-ray vests towards patients in …

Covid-19 And The Radiology Match: A Residency Program's Survival Guide To The Virtual Interview Season, Jk Nguyen, N Shah, De Heitkamp, Y Gupta

Journal Articles

No abstract provided.

Impact Of The Coronavirus Disease 2019 (Covid-19) Pandemic On Imaging Case Volumes, J J. Naidich, A Boltyenkov, J J. Wang, J Chusid, D Hughes, Pc Sanelli

Journal Articles

No abstract provided.

The Role Of Chest Imaging In Patient Management During The Covid-19 Pandemic: A Multinational Consensus Statement From The Fleischner Society., Gd Rubin, Cj Ryerson, Lb Haramati, N Sverzellati, Jp Kanne, S Raoof, Nw Schluger, A Volpi, J-J Yim, L Richeldi, +15 Additional Authors

Journal Articles

No abstract provided.

Coronavirus Disease 2019 (Covid-19) Pandemic Shifts Inpatient Imaging Utilization., Jj Naidich, A Boltyenkov, Jj Wang, J Chusid, D Hughes, Pc Sanelli

Journal Articles

No abstract provided.

Multisystem Imaging Manifestations Of Covid-19, Part 2: From Cardiac Complications To Pediatric Manifestations., M. V. Revzin, S. Raza, N. C. Srivastava, R. Warshawsky, C. D'Agostino, A. Malhotra, A. S. Bader, R. D. Patel, K. Chen, C. C. Kyriakakos, J. S. Pellerito

Journal Articles

Infection with severe acute respiratory syndrome coronavirus 2 results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. COVID-19 has been reported in most countries, and as of August 15, 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. Although COVID-19 predominantly affects the respiratory system, it has become apparent that many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease and its related complications, and proper utilization …

Multisystem Imaging Manifestations Of Covid-19, Part 1: Viral Pathogenesis And Pulmonary And Vascular System Complications, M. V. Revzin, S. Raza, R. Warshawsky, C. D’Agostino, N. C. Srivastava, A. S. Bader, R. D. Patel, K. Chen, C. Kyriakakos, J. S. Pellerito, +1 Additional Author

Journal Articles

© RSNA, 2020. Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. The infection has been reported in most countries around the world. As of August 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19–associated deaths. It has become appar-ent that although COVID-19 predominantly affects the respiratory system, many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease, as …

Abdominal Pelvic Ct Findings Compared Between Covid-19 Positive And Covid-19 Negative Patients In The Emergency Department Setting, S. A. Funt, S. L. Cohen, J. J. Wang, P. C. Sanelli, M. A. Barish

Journal Articles

© 2020, Springer Science+Business Media, LLC, part of Springer Nature. Purpose: Manifestations of COVID-19 are primarily respiratory based, however, gastrointestinal symptoms are now recognized as an important component of the disease. The purpose of this study is to evaluate differences in abdominal pelvic CT findings in the emergency department by COVID-19 test result. Methods: This retrospective study identified patients tested by PCR for COVID-19 infection who underwent abdominal pelvic CT scan in the ED across an academic health system from March 15 to April 15, 2020. Radiology reports were reviewed for the presence of ground glass opacity in the lungs …

Challenges In The Interpretation And Application Of Typical Imaging Features Of Covid-19., Mm Hammer, Ca Raptis, Ts Henry, A Shah, S Bhalla, Md Hope

Journal Articles

No abstract provided.

Thromboembolic Complications Of Covid-19, L. W. Mui, J. F. Lau, J. F. Lau, H. K. Lee

Journal Articles

© 2020, American Society of Emergency Radiology. The symptomology of patients afflicted with novel 2019 coronavirus disease (SARS-CoV-2 or COVID-19) has varied greatly, ranging from the asymptomatic state to debilitating hypoxemic respiratory failure caused by severe atypical viral pneumonia. Patients may also develop a hyper-inflammatory state that can lead to multi-organ failure. It has become increasingly apparent that, as part of the hyper-inflammatory state, COVID-19 infection increases susceptibility to systemic thromboembolic complications that can contribute to rapid clinical deterioration or demise. This article aims to review imaging features of various systemic thrombotic complications in six patients with moderate to severe …

A Role For Ct In Covid-19? What Data Really Tell Us So Far, Md Hope, Ca Raptis, A Shah, Mm Hammer, Ts Henry

Journal Articles

No abstract provided.

Initial Impact Of Coronavirus Disease 2019 (Covid-19) On Radiology Practices: An Acr/Rbma Survey., A. Malhotra, X. Wu, H. B. Fleishon, R. Duszak, E. Silva, G. B. Mcginty, C. Bender, B. Williams, J. J. Naidich, P. C. Sanelli, +3 Additional Authors

Journal Articles

PURPOSE:The coronavirus disease 2019 (COVID-19) pandemic affected radiology practices in many ways. The aim of this survey was to estimate declines in imaging volumes and financial impact across different practice settings during April 2020. METHODS:The survey, comprising 48 questions, was conducted among members of the ACR and the Radiology Business Management Association during May 2020. Survey questions focused on practice demographics, volumes, financials, personnel and Northwell Health adjustments, and anticipation of recovery. RESULTS:During April 2020, nearly all radiology practices reported substantial (56.4%-63.7%) declines in imaging volumes, with outpatient imaging volumes most severely affected. Mean gross charges declined by 50.1% to …

Initial Impact Of Covid-19 On Radiology Practices: An Acr/Rbma Survey, A. Malhotra, X. Wu, H. B. Fleishon, R. Duszak, E. Silva, G. B. Mcginty, C. Bender, B. Williams, J. J. Naidich, P. C. Sanelli, +3 Additional Authors

Journal Articles

© 2020 American College of Radiology Purpose: The coronavirus disease 2019 (COVID-19) pandemic affected radiology practices in many ways. The aim of this survey was to estimate declines in imaging volumes and financial impact across different practice settings during April 2020. Methods: The survey, comprising 48 questions, was conducted among members of the ACR and the Radiology Business Management Association during May 2020. Survey questions focused on practice demographics, volumes, financials, personnel and Northwell Health adjustments, and anticipation of recovery. Results: During April 2020, nearly all radiology practices reported substantial (56.4%-63.7%) declines in imaging volumes, with outpatient imaging volumes most …

Covid-19 Impact On Well-Being And Education In Radiology Residencies: A Survey Of The Association Of Program Directors In Radiology, Jb Robbins, E England, Md Patel, Cm Debenedectis, Ds Sarkany, De Heitkamp, Jm Milburn, V Kalia, K Ali, Sg Jordan, +4 Additional Authors

Journal Articles

No abstract provided.

Radiology Residency Program Management In The Covid Era - Strategy And Reality, E England, A Kanfi, C Flink, A Vagal, D Sarkany, Md Patel, J Milburn, S Chadalavada, S Jordan

Journal Articles

No abstract provided.

Cerebral Venous Thrombosis: A Typical Presentation Of Covid-19 In The Young, De Klein, R Libman, C Kirsch, R Arora

Journal Articles

No abstract provided.

What Is Scannable? An Mri Safety Guide, Michael Burcescu, Ravi Patel, Robert Hessemer, Peter Lore, Sriharsha Kota, Guarav Kumar

West Florida Division GME Research Day 2020

Supernumerary MRI protocols and recommendations exist to guide physicians at the forefront of patient care. While urgent imaging may be necessary for critical patients, inadvertent imaging of implantable devices can incur serious morbidity and mortality[11]. The American College of Radiology published a 30-page manual in 2013[1] on MRI safe practices and releases yearly updates with critical information separately[2]. There is increased utilization of advanced imaging modalities, especially among academic institutions[3]. Physicians are hard pressed to maximize efficiency; uncertainty delays imaging. Moreover, inappropriate orders delay appropriate management. We present pertinent and often questioned considerations in a comprehensible format along with devices …

Assessment Of Dobhoff Tube Malposition On Radiographs Using Deep Learning, Kevin George, Paras Lakhani, Md

Phase 1

Introduction: Dobhoff tubes (DHT) are narrow-bore flexible devices that deliver enteral nutrition for critically ill patients. Tracheobronchial insertion of DHTs presents a significant risk for pulmonary complications. Thus, DHT insertion requires radiologist confirmation of correct placement with chest x-ray (CXR), increasing clinical delays. To address this, we demonstrate the novel application of Deep Convolutional Neural Networks (DCNNs) to automatically and accurately identify DHTs in CXRs in real time.

Methods: 141 de-identified HIPAA compliant frontal view chest radiographs containing DHTs in various positions were obtained. The DHTs were first manually segmented and verified by a board certified radiologist. Images were split …

3d Convolutional Neural Networks For The Diagnosis Of 6 Unique Pathologies On Head Ct, Travis Clarke, Paras Lakhani, Md

Phase 1

Introduction: Head CT scans are a standard first-line tool used by physicians in the diagnosis of neurological pathologies. Recently, the development of deep learning models such as convolutional neural networks (CNNs) has allowed the rapid identification of bleeds and other pathologies on CT scans. This study aims to show that by training 3D CNNs with a larger, curated dataset, a more comprehensive list of potential diagnoses can be included in the detailed model.

Methods: A retrospective study was performed using a dataset of 66,000 head CT studies from the Thomas Jefferson University health system. Studies were acquired using a natural …

Automated Assessment Of Cardiothoracic Ratios On Chest Radiographs Using Deep Learning, Varun Danda, Paras Lakhani, Md

Phase 1

Introduction: The cardiothoracic ratio (CTR) is a quantitative measure of cardiac size that can measured from chest radiography (CXR). Although radiologists using digital workstations possess the ability to calculate CTR, clinical demands prevent calculation for every case. In this study, the efficacy of a deep convolutional neural network (dCNN) to assess CTR was evaluated.

Methods: 611 HIPAA-compliant de-identified CXRs were obtained from [institution blinded] and public databases. Using ImageJ, a board-certified radiologist (reader #1) and a medical student (reader #2), measured the CTR by marking four pixels on all CXRs: the right- and left-most chest wall, the right- and left-most …

Early Acid/Base And Electrolyte Changes In Permanent Middle Cerebral Artery Occlusion: Aged Male And Female Rats, Sarah R. Martha, Lisa A. Collier, Stephanie M. Davis, Sarah J. Goodwin, David Powell, Doug Lukins, Justin F. Fraser, Keith R. Pennypacker

Neurosurgery Faculty Publications

BACKGROUND: Early changes in acid/base and electrolyte concentrations could provide insights into the development of neuropathology at the onset of stroke. We evaluated associations between acid/base and electrolyte concentrations, and outcomes in permanent middle cerebral artery occlusion (pMCAO) model.

METHODS: 18-month-old male and female Sprague-Dawley rats underwent pMCAO. Pre-, post- (7 min after occlusion), and at 72 hr of pMCAO venous blood samples provided pH, carbon dioxide, oxygen, glucose, hematocrit, hemoglobin, and electrolyte values of ionized calcium, potassium, and sodium. Multiple linear regression determined predictors of infarct and edema volumes from these values, Kaplan-Meier curve analyzed morality between males and …

Effect Of Contrast-Enhanced Echocardiograms On The Prognosis Of Infective Endocarditis, D. Arias, E. Halpern, F. Forsberg, J. R. Eisenbrey

Phase 1

Objective - Infective endocarditis (IE) is an infectious disease of the cardiac valves where bacteria colonize the valves; typically, via the formation of vegetations. Recent research has shown that the microbubbles in a contrast-enhanced ultrasound (CEUS) examination can move and dislodge bacterial vegetations in vitro. This study investigated whether CEUS resulted in faster resolution of IE in vivo by dislodging the vegetations.

Methods - This IRB approved retrospective study reviewed 36 patients who were diagnosed with IE via echocardiography. Data was sourced from patients within the Jefferson University Hospital’s Cardiology EMR system by searching for contrast and vegetation from …

Discordance Between Breast Imaging And Histopathology Findings After Ultrasound Guided Core Needle Biopsy, Margaret Mutinda Mwania

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Breast cancer is the most prevalent cancer among women worldwide with an estimated global incidence of 11.6%. According to the GLOBOCAN factsheet, in 2018 breast cancer incidence in Kenya was 40.3 per 100,000. Early detection and diagnosis of breast cancer has been shown to reduce mortality and increase years of life gained. Breast lesion diagnosis is heavily based on imaging and pathology and typically findings are reported independent of one another. Correlation of imaging findings and pathology after biopsy is found to be of critical importance in detecting possible sampling error, concordance versus discordance, recommend appropriate management and thus …

Challenges In Medical Journalism: Reflections From The Year Past, Saba Sohail

Department of Radiology

No abstract provided.