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Hepatorenal index (HRI) has been shown to be an effective, noninvasive ultrasound tool to screen patients for those with or without >5% hepatic steatosis. Objective: The aim of this study was to further refine this HRI tool in order to stratify patients according to their degree of liver steatosis and give direction as to which patients should undergo random liver biopsy. Methods: We conducted a retrospective review of 267 consecutive patients from 2015 to 2017 who had abdominal ultrasounds and a subsequent random liver biopsy within one month. The HRI was calculated and compared with the percent steatosis as assessed by histology. Results: An HRI of ≤1.17 corresponds with >95% positive predictive value of ≤5% steatosis. Between HRI values 1.18 and 1.39, performance of steatosis prediction is mixed. However, for values 1.37. An HRI of ≥1.4 corresponds with >95% positive predictive value of ≥10% steatosis. Conclusion: HRI is an accurate noninvasive tool to quantify degree of steatosis and guide who should undergo random liver biopsy, potentially significantly reducing the total number of necessary liver biopsies.

These are summarized in Table 1 and below; additional details and supporting sources may be found in Chapters 2 through 7: Health physics: The health physics workforce is currently deemed adequate to meet routine needs, except those likely to be associated with a major radiological incident. 8.2 IMPLICATIONS FOR FUTURE INADEQUACIES IN THE WORKFORCE Implications for workforce shortages are detailed in Chapters 2-7, and are summarized below. 8.3 PROFESSION-SPECIFIC CONCERNS REGARDING ADEQUACY OF THE WORKFORCE IN THE FUTURE The teams identified several profession-specific concerns regarding the future workforces, which are summarized here and detailed in Chapters 2 through 7. Keywords: professional radiation workforce EN professional radiation workforce 1 6 6 01/31/23 20221202 NES 221202 8.1 CURRENT STATUS AND FUTURE OUTLOOK OF THE WORKFORCE IN THE UNITED STATES Each team consisted of subject matter experts in the respective profession; they considered data from the literature and other sources, such as surveys conducted by, and membership trends in, relevant professional societies. [Extracted from the article]

This section focuses on the professional workforce comprised of the primary medical specialties that utilize ionizing radiation in their practices. Those discussed include the specialties of radiology and radiation oncology, as well as the subspecialties of radiology, namely diagnostic radiology, interventional radiology, nuclear radiology, and nuclear medicine. These professionals provide essential health care services, for example, the interpretation of imaging studies, the provision of interventional procedures, radionuclide therapeutic treatments, and radiation therapy. In addition, they may be called on to function as part of a radiologic emergency response team to care for potentially exposed persons following radiation events, for example, detonation of a nuclear weapon, nuclear power plant accidents, and transportation incidents. For these reasons, maintenance of an adequate workforce in each of these professions is essential to meeting the nation's future needs. Currently, there is a shortage for all physicians in the medical radiology workforce. [ABSTRACT FROM AUTHOR]

Keywords: health physics; workforce EN health physics workforce 1 9 9 01/31/23 20221202 NES 221202 2.1 INTRODUCTION Health physics is an applied science field focused on the protection of workers, patients, the general public, and the environment from ionizing and nonionizing radiation sources. The NRC also offers 27 online and classroom radiation safety and health physics courses for staff employed by the NRC and NRC Agreement States. These include classes in radiation physics, radiation biology, radiation detection and measurements with laboratory experience, internal and external radiation dosimetry, principles of radiation safety and health physics, and contemporary issues in health physics. The RSO is responsible for overseeing and ensuring the safe operation of a hospital's radiation protection program, including managing the radiation protection program; identifying radiation protection problems and stopping unsafe activities; initiating, recommending, or providing corrective actions; verifying implementation of corrective actions; and ensuring compliance with federal and state regulations for safety and security. [Extracted from the article]

In the literature, it has repeatedly been stated that the introduction of hepatospecific contrast agents in Magnetic Resonance Imaging prolongs the acquisition time due to the hepatobiliary phase, normally acquired 15–20 min after injection. Many efforts have been made to shorten the time-consuming protocols, and it was demonstrated that T2-Weighted Images (T2WI) and Diffusion-Weighted Images (DWI) acquired after Gd-EOB-DTPA show a comparable diagnostic capability to pre-contrast T2WI and DWI in the detection and characterization of hepatic tumors. Therefore, T2WI and DWI are usually acquired after the acquisition of vascular phases, in the dead time until the acquisition of the hepatobiliary phase. Unfortunately, contrast agents, especially Gd-EOB-DTPA, reduce the hydrogen nuclei's relaxation time and modify signal intensity. We report a case in which, due to these limitations of the acquisition protocol, two hemangiomas showed an inhomogeneous, low signal on T2WI and DWI that was not visible in a follow-up scan a few days later. In conclusion, when liver lesions of unknown nature must be characterized, and there is a lack of previous radiological investigations, it could be useful to acquire pre-contrast T2WI and DWI to avoid diagnostic confusion, especially in non-tertiary centers. [ABSTRACT FROM AUTHOR]

Background: The primary aim of our study was to assess the correlation between an improved version of the attenuation coefficient available on the Arietta 850 ultrasound system (iATT, Fujifilm Healthcare, Tokyo, Japan) and controlled attenuation parameter (CAP). The secondary aim was to assess whether focusing only on iATT acquisition without following the strict protocol for liver stiffness measurements would affect iATT measurement. Methods: Consecutive individuals were enrolled. Pearson's r was used to test the correlation between ATT and CAP values. The concordance between iATT and CAP was tested using Lin's concordance correlation coefficient (CCC). Results: 354 individuals (203 males, 151 females) were studied. The overall Pearson correlation between CAP and iATT values obtained following or not following the liver stiffness measurement protocol, respectively, were r = 0.73 and r = 0.71. The correlation was affected by the interquartile range/median (IQR/M) of the 10 measurements: it was r = 0.75 for IQR/M ≤ 15% and r = 0.60 for IQR/M > 15%. CCC showed that there was a moderate to good concordance between iATT and CAP values. Conclusion: iATT shows a strong correlation with CAP that does not decrease when the protocol for liver stiffness acquisition is not followed. The correlation between iATT and CAP values is higher when the IQR/M ≤ 15%. [ABSTRACT FROM AUTHOR]

Optimal carotid duplex velocity criteria for defining the severity of carotid in-stent restenosis. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study. In addition, scanning in and through an area of stenosis or suspected stenosis must be adequate to determine the maximal peak systolic velocity and end-diastolic velocity associated with the stenosis and to document disturbances in the waveform distal to the stenosis. The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of clinical practice parameters, and accreditation of practices performing ultrasound examinations. [Extracted from the article]

A radiation workforce of sufficient size and capacity is necessary to meet our nation's current and future needs for energy production, health care, and other vital areas. DATA AVAILABILITY STATEMENT Data sharing is not applicable to this or the accompanying articles since no new data were created or analyzed during the generation of this workforce report. The methods used to prepare this review included surveying relevant information on each workforce, using data from the literature and other resources, such as information from professional societies. [Extracted from the article]

The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of clinical practice parameters, and accreditation of practices performing ultrasound examinations. A renal artery stent evaluation should include recording of peak systolic velocities in the proximal renal artery (if possible), within the stent, and distal to the stent. Color and spectral Doppler evaluation: An analysis of main renal vein and intraparenchymal renal vein waveforms should be performed to evaluate for renal vein stenosis. The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. [Extracted from the article]

We wish to offer support for the recently published International Commission on Radiation Protection's Vancouver Call to Action (Rühm et al. [9]) regarding the radiation protection workforce. Keywords: Radiation protection workforce EN Radiation protection workforce 287 288 2 07/21/23 20230801 NES 230801 Michael A. Noska: Retired. We look to organizations such as the ICRP and other national and international entities to offer clear directives and support to take the necessary steps that will revitalize and sustain the radiation protection workforce. [Extracted from the article]

Objectives: The purpose of this study was to determine the incidences and rates of progression of varying degrees of carotid stenosis that do not require intervention according to the Asymptomatic Carotid Atherosclerosis Study, the European Carotid Surgery Trial, and the North American Symptomatic Carotid Endarterectomy Trial, and from this information, to provide evidence‐based recommendations for follow‐up imaging. Methods: A retrospective review was performed of all carotid ultrasound examinations performed at a single institution from January 1995 through April 2015. Examinations following endarterectomy or stenting were excluded. Stenoses were classified by a modification of the criteria of Bluth et al (Radiographics 1988; 8:487–506). A Kaplan‐Meier survival analysis was performed for stenosis progression and to provide information for follow‐up recommendations. Results: Most of the carotid arteries (91.6%) reviewed for this study showed 1% to 39% stenosis. However, only 6.8% of carotid arteries with 1% to 39% stenosis progressed compared to 38.9% of carotid arteries with 40% to 59% stenosis. A table of evidence‐based follow‐up recommendations is provided for patients with varying levels of stenosis. Conclusions: We provide evidence‐based follow‐up recommendations for patients who have low degrees of carotid stenosis. Different degrees of carotid stenosis progress at different rates and therefore should be followed at different intervals. Additionally, the most patients in our database showed 1% to 39% stenosis and did not have any follow‐up imaging, suggesting that carotid ultrasound may not be overused for low degrees of stenosis. [ABSTRACT FROM AUTHOR]

The article presents the study on the incidence of bullying in healthcare workplace. It states that bullying is more common compared to other industries and has been reported to approach 50 percent. It mentions that educating workforce regarding bullying and mistreatment is the first step in solving the problem.

Objectives: We sought to assess midterm sonographic findings in patients after stenting for hepatic artery stenosis. Methods: Thirty‐nine hepatic artery stent procedures were performed for hepatic artery stenosis after liver transplantation between September 2009 and December 2013. Thirty cases were technically successful and met the minimum follow‐up time (76 days, defined by earliest diagnosed stenosis). Routine ultrasound surveillance was obtained on all patients, and statistical analysis of the findings in the patency and restenosis groups was performed. Results: Of the 30 cases, restenosis occurred 9 times in 6 patients. Mean follow‐up was 677 days. Mean time to restenosis was 267 days. Five cases (56%) were identified within the first 6 months after stent placement. Four cases (44%) were recognized in the second year after stent placement. Prior to the sonographic diagnosis of restenosis, the mean resistive indices of the main (.64 versus .57, P < .0001), left (.63 versus .54, P < .0001), right anterior (.60 versus .52, P < .0001), and right posterior (.60 versus .53, P = .001) hepatic artery branches differed among patency and restenosis groups, respectively. The mean peak systolic velocity also differed significantly between the 2 groups: 254 cm/sec in patients with eventual restenosis versus 220 cm/sec in patients without restenosis (P = .02). Conclusions: The sonographic evaluation of hepatic artery stenosis remains critical during the first 2 years after stent placement. While the vast majority of patients do not restenose, resistive index and peak systolic velocity differed significantly between the 2 groups and may be prognostic surveillance markers for the development of restenosis. [ABSTRACT FROM AUTHOR]

Presents a case study about the formation of a gastrocolic fistula in Crohn's Disease. Discussion on the case of a 26-year-old woman with a history of inflammatory bowel disease; Result of the diagnosis conducted to the patient; Analysis of the result of the study.

The Certification for Imaging Informatics Professionals (CIIP) program is sponsored by the Society of Imaging Informatics in Medicine and the American Registry of Radiologic Technologists through the American Board of Imaging Informatics. In 2005, a survey was conducted of radiologists, technologists, information technology specialists, corporate information officers, and radiology administrators to identify the competencies and skill set that would define a successful PACS administrator. The CIIP examination was created in 2007 in response to the need for an objective way to test for such competencies, and there have been 767 professionals who have been certified through this program to date. The validity of the psychometric integrity of the examination has been previously established. In order to further understand the impact and future direction of the CIIP certification on diplomats, a survey was conducted in 2010. This paper will discuss the results of the survey. [ABSTRACT FROM AUTHOR]

More than 72 million Americans have hypertension, and the majority of these persons have essential hypertension. However, a significant subset has a secondary cause. The most common cause of secondary hypertension is renal vascular hypertension, of which renal artery stenosis is the leading pathology. Up to 5 percent of all occurrences of hypertension are caused by renal artery stenosis, equating to as many as 3.5 to 4 million occurrences in the United States. Detecting renal artery stenosis is particularly important for ensuring that this potentially curable form of hypertension is identified and treated properly. Duplex Doppler ultrasonography is a good screening test in many patients, but it has limitations in larger persons and can overlook small accessory arteries. For patients with normal renal function but a high clinical index of suspicion for renovascular disease, contrast-enhanced magnetic resonance angiography and computed tomographic angiography are the most accurate imaging tests. For patients with diminished renal function, gadolinium-enhanced contrast magnetic resonance angiography is the best imaging test. However, caution is warranted because exposure to gadolinium contrast agents is associated with nephrogenic systemic fibrosis in patients with renal failure. The American College of Radiology has developed appropriateness criteria for imaging tests related to the diagnosis of renal artery stenosis. This article is a summary of the recommendations, with the advantages and limitations of each test. [ABSTRACT FROM AUTHOR]

Hematuria, symptomatic and incidental, that involves more than three red blood cells per high-power field on two of three properly collected urinalysis specimens warrants some type of imaging to evaluate the upper tracts. Traditionally, excretory urography or the intravenous pyelogram has been the mainstay of the hematuria work-up, but computed tomography urography has more recently been recognized to have significant advantages. Multidetector computed tomography urography, a cross-sectional technique, is less susceptible to overlying bowel gas and more sensitive for detection of small tumors and calculi. Moreover, intravenous- pyelogram--like images can be obtained by using reconstruction techniques. In specific cases, ultrasound examination and magnetic resonance imaging can also be useful, and are particularly helpful in children and pregnant women. Neither modality has the sensitivity of computed tomography for calculi, but small tumors may be visible on magnetic resonance imaging. This article reviews the appropriateness criteria for the various radiologic imaging tests used in the evaluation of hematuria, as proposed by the American College of Radiology. [ABSTRACT FROM AUTHOR]

Purpose: To study the ability and accuracy of sonography to visualize carotid artery stents and assess criteria for carotid artery stent stenosis. Methods: Duplex Doppler sonographic examinations were performed on 143 patients in whom 158 carotid artery stents were placed. Follow-up sonography to evaluate 24 of these stents within 24 h of stent placement was compared with post-procedure angiography. Another 23 stents were evaluated with sonography and with follow-up angiography more than 24 h after the procedure. The remainder of the 111 stents were evaluated exclusively with sonography after stent placement. Sonography was used to evaluate stent visibility, stent-media separation, and degree of stent stenosis. Results: Wallstents were the best-visualized stents and Acculink the worst, but the differences were not statistically significant. Of 4 patients with stent-media separation >3 mm, 2 (50%) developed stenosis (40%-59%) at 6 and 12 months from stent placement. The other 2 stents with stent-media separation had not developed stenosis at 6 months' follow-up. A comparison of angiography and sonography performed on the date of stent placement revealed 19 true-negative sonography studies, 4 false-positive studies, 1 true-positive study, and no false-negative studies. A comparison of follow-up angiograms performed more than 24 h after the procedure with follow-up sonography revealed 17 true-negative studies, 1 false-positive study, 5 true-positive studies, and no false-negative studies. Conclusions: Sonography allows accurate evaluation of stent placement within the vessel and visualization of stent-media distance. Stent-media separation may be an early detection sign for stent stenosis development. Velocity criteria developed for non-stented vessels, when applied to stented vessels, correlate well with angiographic findings. Doppler velocity measurements when compared with visible stent assessment may reduce false-positives. [ABSTRACT FROM AUTHOR]

A retrospective study of 152 ileostomates with inflammatory bowel disease (IBD) revealed that 16 patients (10.5 per cent) had diagnoses of cholelithiasis before, at the time of, or after having ileostomies. Of the remaining patients, 69 were followed for possible cholelithiasis, most of those with sonographic examination. Sixteen of this latter group of patients (23.2 per cent) were found to have cholelithiasis, usually in an asymptomatic stage. Among women over 50 years old, seven of 11 (63.6 per cent) had gallstones. Due to this high prevalence of cholelithiasis, gallbladder imaging is recommended as a part of the preoperative workup and follow-up of ileostomates. Prophylactic cholecystectomy may be carefully considered in female patients with IBD at the time of proctocolectomy. [ABSTRACT FROM AUTHOR]

By paying careful attention to technique, two identifiable patterns of small bowel pathology can be seen. These patterns, the pseudokidney sign and tubular sonolucent masses occur in both benign and malignant disease. For the pseudokidney sign to be present, lesions can occur either on a mucosal or serosal surface and extend toward the opposite surface to cause thickening of the bowel wall. Barium studies can be negative and yet a bowel lesion can indeed be present. The most important criteria for identification of these lesions is the continued presence of these masses with real-time. In the absence of real-time, repeat examinations at different times should prove these masses persistent. When these masses are identified, the examiner should carefully examine the patient to be certain that no other evidence of abnormality can be seen and to exclude the possibility of metastatic spread of disease. In those patients in which a pseudokidney Is seen, the examiner should be certain that both kidneys are in normal position and that the mass is not an ectopic kidney. With the more frequent use of ultrasound as a screening tool, the identification of bowel lesions with sonography can help the clinician rapidly determine the correct diagnosis and thus save the patient considerable time and money by avoiding unnecessary diagnostic tests. [ABSTRACT FROM AUTHOR]

Hepatorenal index (HRI) has been shown to be an effective, noninvasive ultrasound tool to screen patients for those with or without >5% hepatic steatosis. Objective: The aim of this study was to further refine this HRI tool in order to stratify patients according to their degree of liver steatosis and give direction as to which patients should undergo random liver biopsy. Methods: We conducted a retrospective review of 267 consecutive patients from 2015 to 2017 who had abdominal ultrasounds and a subsequent random liver biopsy within one month. The HRI was calculated and compared with the percent steatosis as assessed by histology. Results: An HRI of ≤1.17 corresponds with >95% positive predictive value of ≤5% steatosis. Between HRI values 1.18 and 1.39, performance of steatosis prediction is mixed. However, for values <1.37 there is an increased likelihood of steatosis ≤5% and likewise the opposite for values >1.37. An HRI of ≥1.4 corresponds with >95% positive predictive value of ≥10% steatosis. Conclusion: HRI is an accurate noninvasive tool to quantify degree of steatosis and guide who should undergo random liver biopsy, potentially significantly reducing the total number of necessary liver biopsies. [ABSTRACT FROM AUTHOR]

A case is described in which digital pelvic real-time ultrasound evaluation was used in order to determine the proper placement of a catheter for abscess drainage. This is the first description of utilizing this new technique as an adjunct to a surgical procedure. [ABSTRACT FROM AUTHOR]