Radiology Commons^™

Interventional Radiology's Exploration Into Artificial Intelligence, Raymond Nguyen

Master's Projects and Capstones

Background: Artificial intelligence (AI) has become more prominent in our daily lives in recent years. This includes various aspects of healthcare. Interventional radiology (IR) is one of these specialties that has taken strides in understanding how AI can be leveraged for patient care. This literature review aims to understand what areas will be most impacted by AI in IR and how it will influence both the patient and interventional radiologist.

Methods: Twenty-six publications from 2019-2024 were selected from PubMed and Scopus. Publications were sourced through a combination of keywords, subject headings (MeSH terms), and citation searching.

Results: This literature review …

Clinical And Radiographic Outcomes After Mechanical Thrombectomy In Medium-Vessel Posterior Cerebral Artery Occlusions: Subgroup Analysis From Star, Eyad Almallouhi, Matthew C Findlay, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Amir Shaban, Nitin Goyal, Shinichi Yoshimura, Hugo Cuellar, Brian Howard, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam Polifka, Fazeel Siddiqui, Joshua Osbun, Roberto Crosa, Charles Matouk, Min S Park, Michael R Levitt, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Peter Kan, Reade De Leacy, Shakeel Chowdhry, David J Altschul, Alejandro Spiotta, Ramesh Grandhi

Faculty, Staff and Students Publications

BACKGROUND: Whereas mechanical thrombectomy (MT) has become standard-of-care treatment for patients with salvageable brain tissue after acute stroke caused by large-vessel occlusions, the results of MT in patients with medium-vessel occlusions (MEVOs), particularly in the posterior cerebral artery (PCA), are not well known.

METHODS: Using data from the international Stroke Thrombectomy and Aneurysm Registry (STAR), we assessed presenting characteristics and clinical outcomes for patients who underwent MT for primary occlusions in the P2 PCA segment. As a subanalysis, we compared the PCA MeVO outcomes with STAR's anterior circulation MeVO outcomes, namely middle cerebral artery (MCA) M2 and M3 segments.

RESULTS: …

Assessing The Concomitant Presentation Of Acl And Anterolateral Ligament Injuries, Kiang Huang, Katherine Quesada-Tibbetts, Leela Prakash, Neelesh Prakash

Radiology Student Publications

Anterior cruciate ligament (ACL) injuries severely compromise the quality of life in affected patients, so early detection of concurrent injuries is crucial for quicker rehabilitation and proper surgical treatment. Although injuries to the medial meniscus and medial collateral ligament are frequently linked to damage to the ACL, little is known about other important but underappreciated ligament lesions in individuals with ACL injury. The anterolateral ligament (ALL) is a less well-known lesion that presents tearing injuries in 32%-88% of patients with ACL tears in the same knee, with a higher prevalence in complete ACL tears. Despite their lower occurrence, ALL tears …

Commonly Missed Miscellaneous Ligament Injuries Co-Occurring With Acl Tears On Diagnostic Imaging, Katherine Quesada-Tibbetts, Kian Huang, Mafaz Kattih, Albert Brotgandel, Neelesh Prakash

Radiology Student Publications

Anterior cruciate ligament (ACL) injuries greatly affect patient quality of life, necessitating the early identification of additional injuries for faster recovery and appropriate surgical care. Although injuries to the medial meniscus and medial collateral ligament are commonly linked with ACL injuries, there is less awareness of other significant but less recognized ligament lesions in ACL-deficient patients. These less-common injuries include meniscal ramp lesions and meniscal root tears. Research indicates that concomitant ramp lesions are present in 15%-42% of ACL reconstructions, lateral meniscal root tears in 10%-14%, and medial meniscal root tears in a mere 3%. Despite their lower incidence, meniscal …

The Case For Bisphosphonate Use In Astronauts Flying Long-Duration Missions, Reece Rosenthal, Victor S Schneider, Jeffrey A Jones, Jean D Sibonga

Faculty, Staff and Students Publications

Changes in the structure of bone can occur in space as an adaptive response to microgravity and on Earth due to the adaptive effects to exercise, to the aging of bone cells, or to prolonged disuse. Knowledge of cell-mediated bone remodeling on Earth informs our understanding of bone tissue changes in space and whether these skeletal changes might increase the risk for fractures or premature osteoporosis in astronauts. Comparisons of skeletal health between astronauts and aging humans, however, may be both informative and misleading. Astronauts are screened for a high level of physical fitness and health, are launched with high …

An Interesting Case Of Wunderlich Syndrome And Page Kidney, Megan Worthington, Nicholaus Monsma, Raj Pyne

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of Wunderlich Syndrome and Page Kidney, a rarely reported combination. Wunderlich Syndrome, characterized by spontaneous renal hemorrhage without a history of trauma, is typically associated with Lenk’s triad of flank pain, mass, and hypovolemia. Page Kidney induced hypertension, a rare condition resulting from external renal compression associated with renin-mediated mechanisms. Our case demonstrates the importance in quick recognition and treatment as blood pressure changes can be fast and dramatic. Our case also has the added dimension of renin measurements. After the patients hypertension developed, his initial renin levels were within normal range, but they later showed …

Case Report Of Unilateral Dysphagia In The Context Of A Classical Type Of Eagle Syndrome, Ryan Tam, Stephen D. Howard, Timothy Ehmann, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

A patient presents with unilateral, right-sided dysphagia and generalized facial symptoms following past surgical history of tonsillectomy that is consistent with an underdiagnosis of Eagle Syndrome. The elongation of the styloid process likely impinged on the glossopharyngeal and vagus nerves resulting in symptoms. Given the lack of recognition of the disease, this case report describes the presentation of Eagle Syndrome to encourage physicians to consider this disease as part of a broader differential diagnosis.

Renal Mass Imaging Modalities: Does Body Mass Index (Bmi) Matter?, Young Son, Mark E Quiring, Raeann M Dalton, Brian Thomas, Noah Davidson, Dayna Devincentz, Collin Payne, Sahil H Parikh, Benjamin A Fink, Thomas Mueller, Gordon Brown

Rowan-Virtua School of Osteopathic Medicine Departmental Research

PURPOSE: Accurate measurement of renal mass size is crucial in the management of renal cancer. With the burdensome cost of imaging yet its need for management, a better understanding of the variability among patients when determining mass size remains of urgent importance. Current guidelines on optimal imaging are limited, especially with respect to body mass index (BMI). The aim of this study is to discern which modalities accurately measure renal mass size and whether BMI influences such accuracy.

METHODS: A multi-institutional chart review was performed for adult patients undergoing partial or radical nephrectomy between 2018 and 2021, with 236 patients …

Parameter Estimation For Stroke Patients Using Brain Ct Perfusion Imaging With Deep Temporal Convolutional Neural Network, Shake Ibna Abir

Masters Theses & Specialist Projects

Acute ischemic stroke, caused by cerebral artery blockage, is a leading cause of long-term disability and mortality. Effective management relies on accurate, timely assessments from neuroimaging data. Computed tomography perfusion (CTP) imaging is crucial in evaluating stroke patients, offering detailed maps of cerebral perfusion to identify irreversibly damaged tissue and at-risk areas. This detailed assessment is essential for informed therapeutic decisions.

Key perfusion parameters derived from CTP imaging, including cerebral blood volume (CBV), cerebral blood flow (CBF), time to peak (TTP), and mean transit time (MTT), are crucial for understanding the extent and nature of cerebral ischemia, providing valuable insights …

Checklist For Reproducibility Of Deep Learning In Medical Imaging, Mana Moassefi, Yashbir Singh, Gian Marco Conte, Bardia Khosravi, Pouria Rouzrokh, Sanaz Vahdati, Nabile Safdar, Linda Moy, Felipe Kitamura, Amilcare Gentili, Paras Lakhani, Nina Kottler, Safwan Halabi, Joseph Yacoub, Yuankai Hou, Khaled Younis, Bradley Erickson, Elizabeth Krupinski, Shahriar Faghani

Department of Radiology Faculty Papers

The application of deep learning (DL) in medicine introduces transformative tools with the potential to enhance prognosis, diagnosis, and treatment planning. However, ensuring transparent documentation is essential for researchers to enhance reproducibility and refine techniques. Our study addresses the unique challenges presented by DL in medical imaging by developing a comprehensive checklist using the Delphi method to enhance reproducibility and reliability in this dynamic field. We compiled a preliminary checklist based on a comprehensive review of existing checklists and relevant literature. A panel of 11 experts in medical imaging and DL assessed these items using Likert scales, with two survey …

Image-Guided Aspiration Of A Cystic Mediastinal Teratoma: A Case Report And Literature Review, Craig R Kym, Anoop P Ayyappan, Babith J Mankidy, Mohammad Ghasemi-Rad

Faculty, Staff and Students Publications

A 51-year-old male presented to our tertiary referral hospital with progressive shortness of breath and orthopnea. A computed tomography (CT) of the chest was performed that showed a large cystic middle mediastinal mass. Magnetic resonance imaging (MRI) of the chest demonstrated a large, well-circumscribed, T2-hyperintense cystic middle mediastinal mass resulting in significant compression of the trachea, brachiocephalic artery, superior vena cava, and azygos vein. The patient subsequently developed a right hemispheric stroke due to compression of the brachiocephalic artery and was too clinically unstable to undergo or definitive operative management of the mediastinal cyst. Percutaneous CT-guided aspiration of the cystic …

Comparison Of Open Thoracoabdominal Repair For Chronic Aortic Dissections And Aneurysms, Ian O Cook, Susan Y Green, Kimberly R Rebello, Qianzi Zhang, Veronica A Glover, Rodrigo Zea-Vera, Marc R Moon, Scott A Lemaire, Joseph S Coselli

Faculty, Staff and Students Publications

Objective: Aortic dissection is common in patients undergoing open surgical repair of thoracoabdominal aortic aneurysms (TAAAs). Most often, dissection is chronic and is associated with progressive aortic dilatation. Because contemporary outcomes in chronic dissection are not clearly understood, we compared patient characteristics and outcomes after open TAAA repair between patients with chronic dissection and those with non-dissection aneurysm.

Methods: We retrospectively analyzed data from 3470 open TAAA repairs performed in a single practice. Operations were for non-dissection aneurysm in 2351 (67.8%) and chronic dissection in 1119 (32.2%). Outcomes included operative mortality and adverse events, a composite variable comprising operative death …

Interpretation Models For Prostate Lesion: Detecting, Explaining, And Understanding., Mehmet Akif Gulum

Electronic Theses and Dissertations

Prostate cancer is a major public health concern, affecting millions of men worldwide. While early detection and treatment of prostate cancer is critical for improving patient outcomes, the detection of prostate lesions is even more important for timely intervention and management of the disease. Prostate lesions are abnormal growths or lumps within the prostate gland, which may or may not be cancerous. The timely detection and accurate diagnosis of prostate lesions is crucial for effective treatment and management of the disease. In recent years, deep learning models have shown promise in accurately detecting and characterizing prostate lesions using advanced imaging …

Estimation Of The Optimal Radiotherapy Utilization Rate For Childhood Neuroblastoma, Azumi Fukushima, Varsha Hande, Katherine Wakeham, Michael Barton, Mohamed Zaghloul, Daniel Moreira, Nickhill Bhakta, Kathy Pritchard-Jones, Bilal Mazhar Qureshi, Michael Sullivan

Haematology and Oncology, East Africa

Background and purpose: The optimal utilization rate of radiotherapy (oRUR) serves as a benchmark for assessing service demand and improving access to cancer care. While it is estimated that approximately 50 % of adult cancer patients require external beam radiotherapy during their treatment, there is a scarcity of data regarding the optimal use of radiotherapy in pediatric cancer. In this study, we adopted an established method and developed a model to estimate the oRUR in childhood neuroblastoma.

Materials and methods: We developed a decision tree model to calculate the oRUR using indications for radiotherapy and corresponding epidemiological data collected through …

Analyzing The Relationship Between Dose And Geometric Agreement Metrics For Auto-Contouring In Head And Neck Normal Tissues, Barbara Marquez, Zachary T Wooten, Ramon M Salazar, Christine B Peterson, David T Fuentes, T J Whitaker, Anuja Jhingran, Julianne Pollard-Larkin, Surendra Prajapati, Beth Beadle, Carlos E Cardenas, Tucker J Netherton, Laurence E Court

Faculty, Staff and Student Publications

This study aimed to determine the relationship between geometric and dosimetric agreement metrics in head and neck (H&N) cancer radiotherapy plans. A total 287 plans were retrospectively analyzed, comparing auto-contoured and clinically used contours using a Dice similarity coefficient (DSC), surface DSC (sDSC), and Hausdorff distance (HD). Organs-at-risk (OARs) with ≥200 cGy dose differences from the clinical contour in terms of Dmax (D0.01cc) and Dmean were further examined against proximity to the planning target volume (PTV). A secondary set of 91 plans from multiple institutions validated these findings. For 4995 contour pairs across 19 OARs, 90% had a DSC, sDSC, …

Ruptured Infectious Pseudoaneurysm Of The Common Carotid Artery In A 14-Year-Old Girl. Management In The Dr Congo, Alphonse Nzomvuama, Jean Jacques Kalongo, Blondel Bayenekene, Stéphane Yanda, M. Jacques Nsuami

School of Medicine Faculty Publications

The infectious pseudoaneurysm of the common carotid artery is a rare observation in children. We present a case of ruptured infectious common carotid aneurysm in a 14-year-old girl managed in the Democratic Republic of Congo. We performed an arterial reconstruction with a saphenous vein patch. Post-operative course was simple. The patient was discharged from the hospital at post-operative day 15. She was doing well and had returned to school. Rupture of an infectious pseudoaneurysm of the common carotid artery constitutes a serious, life-threatening accident. As we have shown in this case report, its management with successful results is indeed possible, …

Multidisciplinary Approach To Diagnostic Radiology Education: A Novel Educational Intervention For Turkish Medical Students, Parth Patel, Emre Altınmakas, Görkem Ayas, Rachel Stanietzky, Madeline L. Stewart, Abdelrahman Elshikh, Disha Ram, Hrishika Bhosale, Mohamed Eltaher, Serageldin Kamel, Munevver N. Duran, Umut Yücel, Mohamed Badawy, Scott Rohren, Khaled M. Elsayes

School of Medicine Faculty Publications

Teleconferencing can facilitate a multidisciplinary approach to teaching radiology to medical students. This study aimed to determine whether an online learning approach enables students to appreciate the interrelated roles of radiology and other specialties during the management of different medical cases. Turkish medical students attended five 60-90-minute online lectures delivered by radiologists and other specialists from the United States and Canada through Zoom meetings between November 2020 and January 2021. Student ambassadors from their respective Turkish medical schools recruited their classmates with guidance from the course director. Students took a pretest and posttest to assess the knowledge imparted from each …

Spinal Cord Watershed Infarction After Surgery, Gia Nguyen, Giang-Kim Nguyen, Fanny Emilia Morón

Faculty, Staff and Students Publications

Spinal cord watershed infarction is a rare phenomenon due to the rich collateral blood supply to the organ. It often occurs in elderly patients with preexisting atherosclerotic disease in the setting of global hypoperfusion, such as thoracoabdominal surgery, dissection, coagulopathies, or idiopathic. We present a case of spinal cord infarction (SCI) in both longitudinal and transverse watershed areas as a complication of postoperative blood loss. In addition, we demonstrate the imaging evolution of spinal cord infarct in the subacute phase with peripheral enhancement due to the breakdown of the blood-spinal cord barrier.

Jacc: Advances Expert Panel Perspective: Shared Decision-Making In Multidisciplinary Team-Based Cardiovascular Care, Elizabeth M Perpetua, Roseanne Palmer, Viet T Le, Sana M Al-Khatib, Craig J Beavers, Joshua A Beckman, Biykem Bozkurt, Megan Coylewright, Caroline Lloyd Doherty, Kimberly A Guibone, Marian Hawkey, Patricia A Keegan, James N Kirkpatrick, Jessica Laperle, Sandra B Lauck, Glenn Levine, Brian R Lindman, Michael J Mack, Andrea L Price, Susan Strong, Janet F Wyman, Quentin R Youmans, Martha Gulati

Faculty, Staff and Students Publications

Shared decision-making (SDM) and multidisciplinary team-based care delivery are recommended across several cardiology clinical practice guidelines. However, evidence for benefit and guidance on implementation are limited. Informed consent, the use of patient decision aids, or the documentation of these elements for governmental or societal agencies may be conflated as SDM. SDM is a bidirectional exchange between experts: patients are the experts on their goals, values, and preferences, and clinicians provide their expertise on clinical factors. In this Expert Panel perspective, we review the current state of SDM in team-based cardiovascular care and propose best practice recommendations for multidisciplinary team implementation …

Intratumoral Injection Of Immunotherapeutics: State Of The Art And Future Directions, Rahul A Sheth, Eric Wehrenberg-Klee, Sapna P Patel, Kristy K Brock, Nicos Fotiadis, Thierry De Baère

Faculty, Staff and Student Publications

Systemic immunotherapies have led to tremendous progress across the cancer landscape. However, several challenges exist, potentially limiting their efficacy in the treatment of solid tumors. Direct intratumoral injection can increase the therapeutic index of immunotherapies while overcoming many of the barriers associated with systemic administration, including limited bioavailability to tumors and potential systemic safety concerns. However, challenges remain, including the lack of standardized approaches for administration, issues relating to effective drug delivery, logistical hurdles, and safety concerns specific to this mode of administration. This article reviews the biologic rationale for the localized injection of immunotherapeutic agents into tumors. It also …