Radiology Commons^™

Telehealth In Emergency Medicine Residency Training: A Model Curriculum, Laura Oh, Rahul Bhat, Michael J Carr, Aditi U Joshi, Bruce M Lo, Ashley C Rider, Lulu Wang, Michael C Wadman, Samuel D Luber

Faculty, Staff and Student Publications

Emergency physicians are well‐positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train …

Impact Of Chatgpt And Large Language Models On Radiology Education: Association Of Academic Radiology-Radiology Research Alliance Task Force White Paper, David H. Ballard, Alexander Antigua-Made, Emily Barre, Elizabeth Edney, Emile B. Gordon, Linda Kelahan, Taha Lodhi, Jonathan G. Martin, Melis Ozkan, Kevin Serdynski, Bradley Spieler, Daphne Zhu, Scott J. Adams

School of Medicine Faculty Publications

Generative artificial intelligence, including large language models (LLMs), holds immense potential to enhance healthcare, medical education, and health research. Recognizing the transformative opportunities and potential risks afforded by LLMs, the Association of Academic Radiology-Radiology Research Alliance convened a task force to explore the promise and pitfalls of using LLMs such as ChatGPT in radiology. This white paper explores the impact of LLMs on radiology education, highlighting their potential to enrich curriculum development, teaching and learning, and learner assessment. Despite these advantages, the implementation of LLMs presents challenges, including limits on accuracy and transparency, the risk of misinformation, data privacy issues, …

Development Of A New Peyronie’S Disease Self-Assessment Screening App, Gregory A Broderick, Jesse N Mills, Lisa Bathish, Christopher Davis, Mohit Khera

Faculty, Staff and Students Publications

Peyronie's disease (PD) is an underdiagnosed and undertreated fibroproliferative disorder associated with the formation of plaques that results in penile curvature and discourages some men from seeking medical consultation. The PD self-assessment app, a digital application (app), was developed to increase PD awareness, provide men with a self-screening and educational tool for PD, and help eliminate barriers to seeking consultation with a physician. Prior to deployment, 4 board-certified urologists provided qualitative reviews on the app's usability and utility as a screening tool. The PD self-assessment app features a questionnaire that addresses penile curvature, challenges with penetration, partner distress, and the …

Fragile Foundations: Unravelling Osteogenesis Imperfecta, From The Womb To The Afterlife, Santosh Rai, Shreya Matele Dr., Sharada Rai Dr., Urvi Ahlawat, Sunita Hegde Dr., Arvind Natarajan Dr.

Manipal Journal of Medical Sciences

Abstract: We report the case of a 36-year-old multiparous woman whose routine antenatal ultrasound at 28 weeks gestation raised suspicion of severe skeletal dysplasia. At 38 weeks, she presented with decreased fetal movements, and intrauterine fetal demise was confirmed. An emergency cesarean section revealed a stillborn fetus with craniofacial deformities, large head with soft scalp bones, and blackish skin discoloration.

Post-mortem imaging, including CT and X-ray, showed severe skeletal abnormalities, including pneumocephalus, pneumothorax, wormian skull bones, extensive demineralization, spina bifida, and multiple fractures with bowing of long bones. Based on antenatal ultrasound and postnatal radiological findings, a diagnosis of …

Association Between Various Types Of Corticosteroids And Mortality For Severe Community-Acquired Pneumonia In Adults: A Systematic Review And Network Meta-Analysis, Peng Wang, Jun Wan, Qiaoyu You, Yuxin Zheng, Wenhao Xu, Jialing He, Liyuan Peng, Cuyubamba Dominguez Jorge Luis, Yuning Feng, Ping Xu, Xinrong Li, Weelic Chong, Yang Hai, Lu Jia, Fang Fang, Yu Zhang

Department of Medical Oncology Faculty Papers

OBJECTIVE: This study aims to conduct a systematic review and network meta-analysis to evaluate the efficacy and safety of specific corticosteroids, including but not limited to hydrocortisone, methylprednisolone, prednisolone, and dexamethasone, in the treatment of severe community-acquired pneumonia (SCAP). Efficacy will be assessed using specific outcomes, such as 30-day mortality and the requirement for mechanical ventilation. Safety evaluations will include adverse events like gastrointestinal bleeding and healthcare-associated infections. The study seeks to address the gaps identified in the latest guidelines regarding the optimal use of different corticosteroid types and to provide recommendations for clinical practice.

DATA SOURCES: This study conducted …

Coronary Artery Calcification In Rheumatoid Arthritis Patients, Stephanie Nagy, Jordan J. Ditchek, Marc M. Kesselman

HCA-NSU MD Research Day

Objective: To assess the need of coronary artery calcium scoring (CACS) in the standardized management of patients with rheumatoid arthritis (RA) for early identification, prevention of coronary artery obstruction and complications. Background: Worldwide, RA is a leading inflammatory arthropathy. The musculoskeletal impacts of RA are well known; however, the inflammatory nature of the disease extends beyond the joint synovium. The cardiovascular system is the most impacted and the leading cause of death. Recently, CACS has become a popular method to analyze the calcifications within the coronary vessels. Methods: A review was performed using CINHAL, OVID, EMBASE, and Web of Science. …

Beta-Blocker Use In Patients Undergoing Non-Cardiac Surgery: A Systematic Review And Meta-Analysis, Doménica Herrera Hernández, Bárbara Abreu, Tania S. Xiao, Andreina Rojas, Kevin López Romero, Valentina Contreras, Sol Villa Nogueyra, Zulma Sosa, Samantha M. Alvarez, Camila Sánchez Cruz, Ernesto Calderón Martinez

Department of Radiology Faculty Papers

BACKGROUND: The use of beta-blockers in the perioperative period has been widely investigated due to their potential to reduce the risk of major adverse cardiovascular and cerebrovascular events (MACCE) and mortality; yet their overall impact on various postoperative outcomes remains debated. This study constitutes a systematic review and meta-analysis of the impact of beta-blockers on mortality, MI, stroke, and other adverse effects such as hypotension and bradycardia in patients undergoing non-cardiac surgery.

METHODS: A comprehensive systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Searches were performed across PubMed, Cochrane, Web of Science, Scopus, EMBASE, and CINAHL databases; …

Cardiac Arrest Following Svc Intravascular Stenting: A Case Report, Afrah Ali, Shahtaj Shah, Varun Mehta, Lubna Ziauddin, Asma Khan, Sameen Khurshid, Fawaz Ali

Advances in Clinical Medical Research and Healthcare Delivery

Superior vena cava (SVC) syndrome is a known collection of symptoms caused by obstruction of blood flow through the superior vena cava. Symptoms notably seen include difficulty breathing, coughing, hoarse voice, and swelling of the head, neck, and arm. It is most commonly seen secondary to malignancy from tumor infiltration of the vessel wall and is frequently associated with lung cancer due to anatomic location.

Treatment of SVC syndrome largely depends on severity of symptoms. While treatment of underlying cause is considered first line, intravascular stenting is also commonly considered in life threatening cases and for symptomatic relief.

We report …

Assessing Radiology And Radiation Therapy Needs For Cancer Care In Low-And-Middle-Income Countries: Insight From A Global Survey Of Departmental And Institutional Leaders., Stephanie A Parker, Joseph Weygand, Beata Gontova Bernat, Amanda M Jackson, Osama Mawlawi, Izabella Barreto, Yao Hao, Rao Khan, Afua A Yorke, William Swanson, Mohammed Saiful Huq, Eugene Lief, Cesar Della Biancia, Christopher F Njeh, Ahmad Al-Basheer, Oi Wai Chau, Stephen Avery, Wilfred Ngwa, Peter A Sandwall

Oncology Articles

PURPOSE: The global cancer burden and mortality rates are increasing, with significant disparities in access to care in low- and middle-income countries (LMICs). This study aimed to identify radiology and radiation therapy needs in LMICs from the perspective of departmental and institutional leaders.

METHODS AND MATERIALS: A survey was developed and conducted by the American Association of Physicists in Medicine Global Needs Assessment Committee and the American Association of Physicists in Medicine International Council. The survey, organized into 5 sections (Introduction, Infrastructure Needs, Education Needs, Research Needs, and General Information), was open to respondents from March 1, to August 16, …

Pulmonary Artery Stenting In Cancer Patients: A Single-Center Experience, Jay Gupta, Ronak Patel, Neal Patel, David Wynne, Mohammad Ghasemi-Rad

Faculty, Staff and Students Publications

Endovascular stenting of the pulmonary artery treats arterial stenosis from pulmonary hypertension, congenital heart defects, or post-transplant stricture. Patients with malignant extrinsic pulmonary arterial compression, secondary to large mediastinal or pulmonary masses, often present with dyspnea, hypoxemia, and right ventricular failure. Conventional therapies like surgery, chemotherapy, and radiation are often slow and fail to promptly resolve acute symptoms. Balloon angioplasty and stenting have been explored as a rapid treatment to alleviate symptoms of external pulmonary artery compression. Despite its potential, the adoption of this procedure is limited due to risks like stent misplacement, migration, cardiac arrhythmias, and arterial rupture. This …

National Liver Cancer Screening Trial (Tracer) Study Protocol, Amit G Singal, Neehar D Parikh, Fasiha Kanwal, Jorge A Marrero, Sneha Deodhar, Stephanie Page-Lester, Camden Lopez, Ziding Feng, Nabihah Tayob

Faculty, Staff and Students Publications

BACKGROUND: Professional guidelines recommend HCC screening in at-risk patients using semi-annual ultrasound with or without alpha-fetoprotein (AFP); however, this strategy has limited effectiveness due to low adherence and sensitivity. Increasing data support the potential role of blood-based biomarker panels, which could improve both aspects. The biomarker panel GALAD, comprised of sex, age, and 3 blood biomarkers (AFP, AFP-L3, and des-carboxy prothrombin des-carboxy prothrombin), has shown high sensitivity and specificity in biomarker phase II (case-control) and phase III (retrospective cohort) validation studies. However, prospective validation in a large phase IV biomarker clinical utility trial is necessary before its adoption in practice. …

Spontaneous Rupture Of A Splenic Artery Aneurysm With Hemoperitoneum; Case Presentation, Vlad Denis Constantin, Ion Motofei, Gelu Valentin Stefanescu, Adrian Silaghi

Journal of Mind and Medical Sciences

Aneurysms of the splenic artery are relatively rare, being found in patients with portal hypertension, multiparous, atherosclerosis, or in young people with various genetic diseases. In the uncomplicated forms, splenic artery aneurysms are often difficult to diagnose either because of the asymptomatic evolution, or because of the non-specific symptoms. In cases of trauma or large sizes, aneurysms can be complicated by rupture, which can cause hemoperitoneum with the risk of death if specific treatment is not initiated as soon as possible. Depending on the location of the splenic aneurysm, comorbidities, the patient's general condition or life-threatening complications, laparotomy, laparoscopy, endovascular …

The Role Of Computed Tomography And Esophageal Ultrasonography In The Preoperative Evaluation Of Esophageal Cancer Resection, Vasile Cosmin Obleaga, Dan Ionuț Gheonea, Ioana Andreea Gheonea, Cecil Sorin Mirea, Emil Moraru, Mihai Călin Ciorbagiu, Ionică Daniel Vîlcea, Tiberiu Ștefăniță Cojan-Țenea

Journal of Mind and Medical Sciences

Objectives. Esophageal cancer is one of the most aggressive types of cancer, with a 5-year relative survival rate of only 18%-20.5%. Survival is highly dependent on accurate positive diagnosis and staging, in which the imaging modalities available have a primary role. The study is focused on the analysis of the preoperative T and M staging strategy and the reliability of computed tomography and endoscopic esophageal ultrasound in predicting resectability. A second objective was to evaluate the influence of preoperative imaging modalities on decreasing the number of unnecessary thoracotomies and laparotomies. Material and Methods. This study was conducted on a lot …

Magnetic Resonance Used As A Differential Diagnostic Tool Between Inflammatory Cancer Of The Sigmoid And Acute Sigmoid Diverticulitis, Cornel Dragos Cheregi, Teodora Gabriela Alexescu, Andrei Vasile Pascalau, Ovidiu Laurean Pop, Calin Magheru, Ioana Maria Muresan, Nicoleta Ramona Suciu, Maur Sebastian Horgos, Mihai Stefan Muresan

Journal of Mind and Medical Sciences

Sigmoid diverticulitis is a common disease characterized by a well-standardized diagnostic approach and treatment. Colorectal cancer is the third most common malignancy worldwide, irrespective of gender. In 2020, CRC global-related mortality rate was estimated at 935 173 cases, with an incidence of 9.3% in men and 9.5% in women. The diagnosis of acute diverticulitis is always made by performing a contrast-enhanced-computed tomography (CT) of the abdomen. Current diagnosis guidelines do not recommend the use of a magnetic resonance imaging (MRI) for further and more precise assessment of a suspected sigmoid diverticulitis diagnosed by CT. Early lower-gastrointestinal (lower-GI) endoscopy is rarely …

Transjugular Random Renal Biopsy: A Review, Katelyn Gill, Dan F. Laney Iv, Hector Ferral

School of Medicine Faculty Publications

Random renal biopsy is considered the gold standard for the diagnosis of systemic renal disorders. Percutaneous biopsy remains a safe option for most patients; however, the percutaneous approach may be considered too risky in approximately 5-10% of patients. In these high-risk patients, transjugular renal biopsy (TJRB) may represent an underutilized alternative. TJRB is a technically difficult procedure with a learning curve of approximately 10 cases. When performed properly, TJRB is a safe alternative to percutaneous biopsy in patients with renal failure or who are at high risk of bleeding. This article aims to provide a comprehensive review of the indications, …

Pathological Fractures And The Perils Of Purchasing Steroids Online, Danielle C Thor, Valerie Rome

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Exogenous steroids are a staple of modern medicine, with utility in a variety of direct and supplemental treatment modalities. However, all pharmaceuticals are undoubtedly coupled with unique side effect profiles, and steroids are no exception. In the case presented, the assessment and management of a 36-year-old male who inappropriately self-administered high-dose steroids for prolonged periods of time is reviewed. In doing so, attention is drawn to both the impact of glucocorticoid-induced osteoporosis and the greater risk of online availability of these powerful medications.

Personalized Brachytherapy: Applications And Future Directions, Piyush Pathak, Justin J Thomas, Arjit Baghwala, Chengfeng Li, Bin S Teh, Edward B Butler, Andrew M Farach

Faculty, Staff and Students Publications

Brachytherapy offers a highly conformal and adaptive approach to radiation therapy for various oncologic conditions. This review explores the rationale, applications, technological advances, and future directions of personalized brachytherapy. Integration of advanced imaging techniques, 3D-printed applicators, and artificial intelligence are rapidly enhancing brachytherapy delivery and efficiency, while genomic tests and molecular biomarkers are refining patient and dose selection. Emerging research on combining brachytherapy with immunotherapy offers unique synergistic potential, and technologies such as intensity-modulated and shielded brachytherapy applicators present novel opportunities to further optimize dose distributions. Despite these promising advances, the field faces challenges including a need to train more …

Ethical Requirements For Achieving Fairness In Radiology Machine Learning: An Intersectionality And Social Embeddedness Approach, Dessislava S. Fessenko

Journal of Health Ethics

Radiodiagnostics by machine-learning (ML) systems is often perceived as objective and fair. It may, however, exhibit bias towards certain patient sub-groups. The typical reasons for this are the selection of disease features for ML systems to screen, that ML systems learn from human clinical judgements, which are often biased, and that fairness in ML is often inappropriately conceptualized as “equality”. ML systems with such parameters fail to accurately diagnose and address patients’ actual health needs and how they depend on patients’ social identities (i.e. intersectionality) and broader social conditions (i.e. embeddedness). This paper explores the ethical obligations to ensure fairness …

Steatotic Mass Secondary To Heterozygous Hemochromatosis, A Rare Case Of Biliary Obstruction, Saddam Zaidi Md, Cheng-Hung Tai, Joanna Gibson Md, Phd, Caroline Loeser

Posters

Heterozygous Hemochromatosis (HH) is a genetic disorder that increases iron absorption. Carriers of the C282Y HFE gene mutation have a higher risk of developing nonalcoholic fatty liver disease (NAFLD). Research indicates a significant association between liver fat accumulation (steatosis) and fibrosis in HH. This case involves a 31-year-old male with HH and an uncommon biliary obstruction caused by focal fat infiltration.

Evaluating The Impact Of Spot Position Errors On Dose Distribution: A Comparison Between Spot-Scanning Arc Therapy (Sparc) And Intensity-Modulated Proton Therapy (Impt), Peilin Liu, Lewei Zhao, Gang Liu, Xiaoda Cong, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To quantitatively investigate the impact of spot position error (PE) on the dose distribution in (Spot-scanning arc therapy) SPArc plans versus Intensity-Modulated Proton Therapy (IMPT).

Methods:

Four representative disease sites, including brain, lung, liver, and prostate cancers, were retrospectively selected. Spot position errors were simulated during dynamic SPArc treatment delivery. Two types of errors were generated, including randomized error and systematic error. For each random error scenario, they were further examined across four sub-scenarios (25%, 50%, 75%, and 100% of spots affected) at 1 mm and 2 mm deviations.The randomized errors used two categories with and without Gaussian distribution …