Implementation of Structured Radiology Reports Tran, Leanne, JD, MD; Wadhwa, Anupma, MD; Mann, Erika, MD
Journal of the American College of Radiology,
03/2016, Letnik:
13, Številka:
3
Journal Article
Toxic megacolon (TMC) denotes a rare clinical syndrome accompanied by colonic dilatation, and is a serious complication of inflammatory bowel disease (IBD). This study assessed the clinical and ...radiologic characteristics of TMC in children with IBD.
A systematic search identified patients with IBD-associated TMC and matched them by age to controls with ulcerative colitis without evidence of TMC. Clinical characteristics and outcomes were compared with conditional logistic regression. Abdominal X-rays were interpreted by two blinded radiologists and findings were compared with controls.
Ten children with TMC (median age 12.6 7.3-15.5 yr) were matched with 20 controls (median age 12.8 6.8-15.2 yr). Altered level of consciousness and hypotension were rare in children with TMC. Fever (P= 0.005), tachycardia (P= 0.0001), dehydration (P= 0.01), and electrolyte abnormalities (P= 0.0002) were more common in children with TMC than controls. Air-fluid levels (P= 0.005), intestinal thickening (P= 0.006), and abnormal colonic haustra (P= 0.012) were more commonly seen on X-rays of TMC cases. Transverse colon luminal diameter >or=56 mm was strongly suggestive of TMC (sensitivity 90%, specificity 90%, area under the ROC curve 0.91). No child with TMC died and 70% required colectomy during admission. Two of the three with intact colons at discharge required second-line therapy during the subsequent year.
Colonic dilatation >or=56 mm in children with IBD strongly suggests TMC, if clinical signs are present. Mental alteration and hypotension may be less common in children than in adults. TMC in children with IBD is associated with poor outcome, with a high rate of corticosteroid failure.
Most of the common skeletal dysplasias have some manifestation in the hand. Many have characteristic findings in the hand that lead to the diagnosis. Hand bones are also affected in many systemic ...hematologic and metabolic conditions. The diagnosis can be clinched on a single hand radiograph if characteristic findings are present. This pictorial essay illustrates characteristic findings of 20 common conditions including bone dysplasias and metabolic and hematologic abnormalities on a single hand radiograph. It also includes some common hand abnormalities without systemic skeletal abnormalities.
We report the imaging findings in a case of acute right-sided diverticulitis in a 13-year-old boy. Based on this diagnosis the patient was successfully treated conservatively with intravenous ...antibiotics. This entity should be considered in patients with right lower quadrant pain and a sonographically normal appendix, particularly in those of Asian or Pacific descent.
The need to demonstrate the impact of academic libraries has fueled a culture of assessment within libraries, with librarians seeking to evaluate and improve a range of library services. This study ...seeks to both engage with that culture and to provide reflection on one assessment approach. Using feedback gathered from student evaluation assessments of one-shot library instruction sessions, the authors use a reflective practice and qualitative approach to discuss the assessment, its questions, and the responses received. The authors conclude with a series of reflection questions for librarians to ask themselves as they create and review student evaluation forms.
In this column, an academic library's web team shares their experience of managing a website redesign while also navigating institutional changes and branding requirements. They detail the obstacles ...and challenges that needed to be managed in order to build a new website with limited staff and technological resources to better meet the needs of library users.
Purpose Voiding cystourethrogram involves radiation exposure and is invasive. Several guidelines, including the 2011 AAP (American Academy of Pediatrics) guidelines, no longer recommend routine ...voiding cystourethrogram after the initial urinary tract infection in children. The recent trend in voiding cystourethrogram use remains largely unknown. We examined practice patterns of voiding cystourethrogram use and explored the impact of these guidelines in a single payer system in the past 8 years. Materials and Methods We identified all voiding cystourethrograms performed at a large pediatric referral center between January 2008 and December 2015. Patients 2 to 24 months old who underwent an initial voiding cystourethrogram for the diagnosis of a urinary tract infection in the first 6 months of 2009 and 2014 were identified. Medical records were retrospectively reviewed. Results During the study period 8,422 voiding cystourethrograms were performed and the annual number declined over time. In the pre-AAP and post-AAP cohorts 233 and 95 initial voiding cystourethrograms were performed, respectively. While there was no statistically significant difference in the vesicoureteral reflux detection rate between 2009 and 2014 (37.3% vs 43.0%, p = 0.45), there was a threefold increase in high grade vesicoureteral reflux in 2014 (2.6% vs 8.4%, p = 0.03). Conclusions A clear trend toward fewer voiding cystourethrograms was noted at our institution. This decrease started before 2011 and cannot be attributed to the AAP guidelines alone. While most detected vesicoureteral reflux remains low grade, there was a greater detection rate of high grade vesicoureteral reflux in 2014 compared to 2009. This may reflect a favorable impact of a more selective approach to obtaining voiding cystourethrograms.
Numerous studies have shown that adherence to reporting guidelines is suboptimal.
To evaluate whether asking peer reviewers to check if specific reporting guideline items were adequately reported ...would improve adherence to reporting guidelines in published articles.
Two parallel-group, superiority randomized trials were performed using manuscripts submitted to 7 biomedical journals (5 from the BMJ Publishing Group and 2 from the Public Library of Science) as the unit of randomization, with peer reviewers allocated to the intervention or control group.
The first trial (CONSORT-PR) focused on manuscripts that presented randomized clinical trial (RCT) results and reported following the Consolidated Standards of Reporting Trials (CONSORT) guideline, and the second trial (SPIRIT-PR) focused on manuscripts that presented RCT protocols and reported following the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guideline. The CONSORT-PR trial included manuscripts that described RCT primary results (submitted July 2019 to July 2021). The SPIRIT-PR trial included manuscripts that contained RCT protocols (submitted June 2020 to May 2021). Manuscripts in both trials were randomized (1:1) to the intervention or control group; the control group received usual journal practice. In the intervention group of both trials, peer reviewers received an email from the journal that asked them to check whether the 10 most important and poorly reported CONSORT (for CONSORT-PR) or SPIRIT (for SPIRIT-PR) items were adequately reported in the manuscript. Peer reviewers and authors were not informed of the purpose of the study, and outcome assessors were blinded.
The difference in the mean proportion of adequately reported 10 CONSORT or SPIRIT items between the intervention and control groups in published articles.
In the CONSORT-PR trial, 510 manuscripts were randomized. Of those, 243 were published (122 in the intervention group and 121 in the control group). A mean proportion of 69.3% (95% CI, 66.0%-72.7%) of the 10 CONSORT items were adequately reported in the intervention group and 66.6% (95% CI, 62.5%-70.7%) in the control group (mean difference, 2.7%; 95% CI, -2.6% to 8.0%). In the SPIRIT-PR trial, of the 244 randomized manuscripts, 178 were published (90 in the intervention group and 88 in the control group). A mean proportion of 46.1% (95% CI, 41.8%-50.4%) of the 10 SPIRIT items were adequately reported in the intervention group and 45.6% (95% CI, 41.7% to 49.4%) in the control group (mean difference, 0.5%; 95% CI, -5.2% to 6.3%).
These 2 randomized trials found that it was not useful to implement the tested intervention to increase reporting completeness in published articles. Other interventions should be assessed and considered in the future.
ClinicalTrials.gov Identifiers: NCT05820971 (CONSORT-PR) and NCT05820984 (SPIRIT-PR).
Background
Magnetic resonance imaging enhanced by hepatocyte-specific contrast media has been found useful to characterize liver lesions in adults and children.
Objective
To present our experience ...with gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for evaluation of focal liver lesions in children.
Materials and methods
We retrospectively reviewed gadobenate-dimeglumine-enhanced MR images obtained for evaluation of suspected hepatic lesions in 30 children. Signal characteristics on various sequences including 45- to 60-min hepatobiliary phase images were noted by two radiologists. Chart review identified relevant clinical details including history of cancer treatment, available pathology and stability of lesion size on follow-up imaging.
Results
Of the 30 children who had gadobenate-enhanced MRI, 26 showed focal lesions. Diagnoses in 26 children were focal nodular hyperplasia (FNH) in 15, hemangiomas in 3, regenerating nodules in 3, focal fatty infiltration in 2, indeterminate lesions in 3, and one patient each with adenomas, hepatoblastoma and metastasis. Two patients had multiple diagnoses. All FNH lesions (39), all regenerative nodules (19) and an indeterminate lesion were iso- or hyperintense on hepatobiliary-phase images while all other lesions (28) were hypointense to hepatic parenchyma. The average follow-up period was 21.7 months.
Conclusion
Our experience with gadobenate-enhanced MRI indicates potential utility of gadobenate in the evaluation of pediatric hepatic lesions in differentiating FNH and regenerating nodules from other lesions.
