•Autosegmentation of target volumes for prostate radiation have high utility in routine practice.•Autosegmentation yields a median time savings of 12 min (30%) compared to historic controls.•Most ...(65%) autosegmented cases required no more than minor edits.•Added path length is supported as a clinically meaningful quantitative metric.
Artificial intelligence advances have stimulated a new generation of autosegmentation, however clinical evaluations of these algorithms are lacking. This study assesses the clinical utility of deep learning-based autosegmentation for MR-based prostate radiotherapy planning.
Data was collected prospectively for patients undergoing prostate-only radiation at our institution from June to December 2019. Geometric indices (volumetric Dice-Sørensen Coefficient, VDSC; surface Dice-Sørensen Coefficient, SDSC; added path length, APL) compared automated to final contours. Physicians reported contouring time and rated autocontours on 3-point protocol deviation scales. Descriptive statistics and univariable analyses evaluated relationships between the aforementioned metrics.
Among 173 patients, 85% received SBRT. The CTV was available for 167 (97%) with median VDSC, SDSC, and APL for CTV (prostate and SV) 0.89 (IQR 0.83–0.95), 0.91 (IQR 0.75–0.96), and 1801 mm (IQR 1140–2703), respectively. Physicians completed surveys for 43/55 patients (RR 78%). 33% of autocontours (14/43) required major “clinically significant” edits. Physicians spent a median of 28 min contouring (IQR 20–30), representing a 12-minute (30%) time savings compared to historic controls (median 40, IQR 25–68, n = 21, p < 0.01). Geometric indices correlated weakly with contouring time, and had no relationship with quality scores.
Deep learning-based autosegmentation was implemented successfully and improved efficiency. Major “clinically significant” edits are uncommon and do not correlate with geometric indices. APL was supported as a clinically meaningful quantitative metric. Efforts are needed to educate and generate consensus among physicians, and develop mechanisms to flag cases for quality assurance.
The purpose of this study is to investigate the factors influencing the licensure examination performance of Radiologic Technology (RT) graduates in a private higher education institution (HEI) in ...Northern Mindanao, Philippines. A retrospective study was conducted in which the academic records of 181 RT graduates in HEI under study who took the licensure examination during the 2015-2019 period, were analyzed. Nine academic and non-academic factors were examined, and their impact on the licensure examination performance was tested using simple and multiple linear regression analyses. Results revealed that Student Internship Grade (SIG), College Admission Test (CAT), and Terminal Competency Assessment (TCA) scores were the significant factors affecting the licensure examination performance of the RT graduates. This study concludes the need for the administrators and educators of HEI under study to be aware of the role that SIG, CAT, and TCA play in the licensure examination. These factors should be included in the college admission and retention policies, as well as in the formulation of education intervention programs, in order to improve RT graduates’ performance in the licensure examination.
Objectives
To assess percent of patients undergoing multiple CT exams that leads to cumulative effective dose (CED) of ≥ 100 mSv and determine their age distribution.
Methods
Data was retrieved ...retrospectively from established radiation dose monitoring systems by setting the threshold value of 100 mSv at four institutions covering 324 hospitals. The number of patients with CED ≥ 100 mSv only from recurrent CT exams during a feasible time period between 1 and 5 years was identified. Age and gender distribution of these patients were assessed to identify the magnitude of patients in the relatively lower age group of ≤ 50 years.
Results
Of the 2.5 million (2,504,585) patients who underwent 4.8 million (4,819,661) CT exams during the period of between 1 and 5 years, a total of 33,407 (1.33%) patients received a CED of ≥ 100 mSv with an overall median CED of 130.3 mSv and maximum of 1185 mSv. Although the vast majority (72–86%) of patients are > 50 years of age, nearly 20% (13.4 to 28%) are ≤ 50 years. The minimum time to accrue 100 mSv was a single day at all four institutions, an unreported finding to date.
Conclusions
We are in an unprecedented era, where patients undergoing multiple CT exams and receiving CED ≥ 100 mSv are not uncommon. While underscoring the need for imaging appropriateness, the consideration of the number and percent of patients with high exposures and related clinical necessities creates an urgent need for the industry to develop CT scanners and protocols with sub-mSv radiation dose, a goal that has been lingering.
Key Points
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We are in an era where patients undergoing multiple CT exams during a short span of 1 to 5 years are not uncommon and a sizable fraction among them are below 50 years of age.
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This leads to cumulative radiation dose to individual patients at which radiation effects are of real concern.
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There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering.
Liver diseases, a wide spectrum of pathologies from inflammation to neoplasm, have become an increasingly significant health problem worldwide. Noninvasive imaging plays a critical role in the ...clinical workflow of liver diseases, but conventional imaging assessment may provide limited information. Accurate detection, characterization and monitoring remain challenging. With progress in quantitative imaging analysis techniques, radiomics emerged as an efficient tool that shows promise to aid in personalized diagnosis and treatment decision‐making. Radiomics could reflect the heterogeneity of liver lesions via extracting high‐throughput and high‐dimensional features from multi‐modality imaging. Machine learning algorithms are then used to construct clinical target‐oriented imaging biomarkers to assist disease management. Here, we review the methodological process in liver disease radiomics studies in a stepwise fashion from data acquisition and curation, region of interest segmentation, liver‐specific feature extraction, to task‐oriented modelling. Furthermore, the applications of radiomics in liver diseases are outlined in aspects of diagnosis and staging, evaluation of liver tumour biological behaviours, and prognosis according to different disease type. Finally, we discuss the current limitations of radiomics in liver disease studies and explore its future opportunities.
Objectives
To have a global picture of the recurrent use of CT imaging to a level where cumulative effective dose (CED) to individual patients may be exceeding 100 mSv at which organ doses typically ...are in a range at which radiation effects are of concern
Methods
The IAEA convened a meeting in 2019 with participants from 26 countries, representatives of various organizations, and experts in radiology, medical physics, radiation biology, and epidemiology. Participants were asked to collect data prior to the meeting on cumulative radiation doses to assess the magnitude of patients above a defined level of CED.
Results
It was observed that the number of patients with CED ≥ 100 mSv is much larger than previously known or anticipated. Studies were presented in the meeting with data from about 3.2 million patients who underwent imaging procedures over periods of between 1 and 5 years in different hospitals. It is probable that an additional 0.9 million patients reach the CED ≥ 100 mSv every year globally.
Conclusions
There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients. The actions include development of appropriateness criteria/referral guidelines by professional societies for patients who require recurrent imaging studies, development of CT machines with lower radiation dose than today by manufacturers, and development of policies by risk management organizations to enhance patient radiation safety. Alert values for cumulative radiation exposures of patients should be set up and introduced in dose monitoring systems.
Key Points
• Recurrent radiological imaging procedures leading to high radiation dose to patients are more common than ever before.
• Tracking of radiation exposure of individual patients provides useful information on cumulative radiation dose.
• There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients.
Introduction: The evaluation of the total spine by magnetic resonance imaging in a T2-weighted single sequence using Software Composing previous planning, called panoramic, would be beneficial in the ...study of lumbosacral spine for the additional information that could be obtained. Objective: To analyze the application of T2 panoramic sequence for magnetic resonance imaging of the lumbosacral segment. Methods: Retrospective and cross-sectional study executed with 186 cases selected by stratified probability sampling, between 18 and 60 years old, using a form consisted of a general sheet and an analytical sheet obtained from the request for radiological study and the examination itself. Results: Of the total, 80.1% were in the adult stage of life, and 53.8% were female, and 52.7% had the suspicion of herniated disc as a specific diagnostic presumption. Degenerative pathologies were mainly presented, with 93%, having herniated discs as the most frequent with 57%, which included extruded, protruded and migrated hernias with 40.6%, 37.9% and 21.5 % respectively. Likewise, it was verified with hypothesis test that this acquisition allows to localize 50% more findings in contrast to the usual examination, defining that this sequence should be applied because it localizes findings in a greater number in comparison to the lumbosacral selective examination. Conclusions: In general, it was defined that the application of this panoramic T2 sequence is more usefulness for a better evaluation, because it achieves greater findings, resulting as main pathologies in lumbosacral, cervical and dorsal segments those of a degenerative type, standing out the herniated discs.
Objective
To determine percent of patients without malignancy and ≤ 40 years of age with high cumulative radiation doses through recurrent CT exams and assess imaging appropriateness.
Methods
From ...the cohort of patients who received cumulative effective dose (CED) of ≥ 100 mSv over a 5-year period, a sub-set was identified with non-malignant disease. The top 50 clinical indications leading to multiple CTs were determined. Clinical decision support (CDS) system scores were analyzed using a widely adopted standard of 1–3 (red) as “not usually appropriate,” 4–6 (yellow) “may or may not be appropriate,” and 7–9 (green) “usually appropriate.” Clinicians reviewed patient records to assess compliance with appropriate use criteria (AUC).
Results
9.6% of patients in our series were with non-malignant conditions and 1.4% with age ≤ 40 years. CDS scores (rounded) were 2% red, 38% yellow, 27% green, and 33% unscored CTs. Clinical society guidelines for CT exams, wherever available, were followed in 87.5 to 100% of cases. AUCs were not available for several clinical indications as also referral guidelines for serial CT imaging. More than half of CT exams were unrelated to follow-up of a primary chronic disease.
Conclusions
We are faced with a situation wherein patients in age ≤ 40 years require or are thought to require many CT exams over the course of a few years but the radiation risk creates concern. There is a fair number of conditions for which AUC are not available. Suggested solutions include development of CT scanners with lesser radiation dose and further development of appropriateness criteria.
Key Points
We are faced with a situation wherein patients in age group 0–40 years and with non-malignant diagnosis require or are thought to require many CT exams over the course of a few years.
More than half of CT exams were unrelated to follow-up of a primary chronic disease.
Imaging guidelines and appropriateness use criteria are not available for many conditions. Wherever available, they are for initial work-up and diagnosis and there is a lack of guidance on serial CT imaging.
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