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Accurate effect estimates are needed to inform input parameters of health economic models. Central-line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) are different definitions used for central-line bloodstream infections and may represent dissimilar patients, but previous meta-analyses did not differentiate between CLABSIs/CRBSIs. To determine outcome effect estimates in CLABSI and CRBSI patients, compared to uninfected patients. PubMed, Embase, and CINAHL were searched from January 2000 to March 2024 for full-text studies reporting all-cause mortality and/or hospital length of stay (LOS) in adult inpatients with and without CLABSI/CRBSI. Two investigators independently reviewed all potentially relevant studies and performed data extraction. Odds ratio for mortality and mean difference in LOS were pooled using random-effects models. Risk of study bias was assessed using ROBINS-E. Thirty-six studies were included. Sixteen CLABSI and 12 CRBSI studies reported mortality. The mortality odds ratios of CLABSIs and CRBSIs, compared to uninfected patients, were 3.19 (95% CI: 2.44, 4.16; I 2 = 49%) and 2.47 (95% CI: 1.51, 4.02; I 2 = 82%), respectively. Twelve CLABSI and eight CRBSI studies reported hospital LOS; only three CLABSI studies and two CRBSI studies accounted for the time-dependent nature of CLABSIs/CRBSIs. The mean differences in LOS for CLABSIs and CRBSIs compared to uninfected patients were 16.14 days (95% CI: 9.27, 23.01; I 2 = 91%) and 16.26 days (95% CI: 10.19, 22.33; I 2 = 66%), respectively. CLABSIs and CRBSIs increase mortality risk and hospital LOS. Few published studies accounted for the time-dependent nature of CLABSIs/CRBSIs, which can result in overestimation of excess hospital LOS. [ABSTRACT FROM AUTHOR]

Purpose To investigate Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) approximations of target lesion tumor burden by comparing categorical treatment response according to conventional RECIST versus actual tumor volume measurements of RECIST target lesions. Materials and Methods This is a retrospective cohort study of individuals with metastatic renal cell carcinoma enrolled in a clinical trial (from 2003 to 2017) and includes individuals who underwent baseline and at least one follow-up chest, abdominal, and pelvic CT study and with at least one target lesion. Target lesion volume was assessed by (a) Vmodel, a spherical model of conventional RECIST 1.1, which was extrapolated from RECIST diameter, and (b) Vactual, manually contoured volume. Volumetric responses were determined by the sum of target lesion volumes (Vmodel-sum TL and Vactual-sum TL, respectively). Categorical volumetric thresholds were extrapolated from RECIST. McNemar tests were used to compare categorical volume responses. Results Target lesions were assessed at baseline (638 participants), week 9 (593 participants), and week 17 (508 participants). Vmodel-sum TL classified more participants as having progressive disease (PD), compared with Vactual-sum TL at week 9 (52 vs 31 participants) and week 17 (57 vs 39 participants), with significant overall response discordance (P < .001). At week 9, 25 (48%) of 52 participants labeled with PD by Vmodel-sum TL were classified as having stable disease by Vactual-sum TL. Conclusion A model of RECIST 1.1 based on a single diameter measurement more frequently classified PD compared with response assessment by actual measured tumor volume. Keywords: Urinary, Kidney, Metastases, Oncology, Tumor Response, Volume Analysis, Outcomes Analysis ClinicalTrials.gov registration no. NCT01865747 © RSNA, 2023 Supplemental material is available for this article.

Objective: Surgical mortality has traditionally been assessed at arbitrary intervals out to 1 year, without an agreed optimum time point. The aim of our study was to investigate the time-varying risk of death after lobectomy to determine the optimum period to evaluate surgical mortality rate after lobectomy for lung cancer. Methods: We performed a retrospective study of patients undergoing lobectomy for lung cancer at our institution from 2015 to 2022. Parametric survival models were assessed and compared with a nonparametric kernel estimate. The hazard function was plotted over time according to the best-fit statistical distribution. The time points at which instantaneous hazard rate peaked and stabilized in the 1-year period after surgery were then determined. Results: During the study period, 2284 patients underwent lobectomy for lung cancer. Cumulative mortality at 30, 90, and 180 days was 1.3%, 2.9%, and 4.9%, respectively. Log-logistic distribution showed the best fit compared with other statistical distribution, indicated by the lowest Akaike information criteria value. The instantaneous hazard rate was greatest during the immediate postoperative period (0.129; 95% confidence interval, 0.087-0.183) and diminishes rapidly within the first 30 days after surgery. Instantaneous hazard rate continued to decrease past 90 days and stabilized only at approximately 180 days. Conclusions: In-hospital mortality is the optimal follow-up period that captures the early-phase hazard during the immediate postoperative period after lobectomy. Thirty-day mortality is not synonymous to “early mortality,” as instantaneous hazard rate remains elevated well past the 90-day time point and only stabilizes at approximately 180 days after lobectomy.

Background: The reported success rate of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) differs by the cause of bleeding; in some reports, UAE shows less successful results in patients with placenta accreta spectrum (PAS). Purpose: To evaluate the outcome of UAE for treating PPH associated with PAS. Material and Methods: From September 2011 to September 2021, 227 patients (mean age = 34.67±4.06 years; age range = 19–47 years) underwent UAE for managing intractable PPH. Patients were divided into two groups: those with PAS (n = 46) and those without PAS (n = 181). Delivery details, embolization details, and procedure-related outcomes were compared between the two groups. P values <0.05 were considered statistically significant. Results: The technical success rate was 96.9% (n = 222) and the clinical success rate was 93.8% (n = 215). There were no significant differences in outcome of UAE between the two patient groups. The technical success rate was 95.7% (n = 44) in patients with PAS and 98.3% (n = 178) in patients without PAS (P = 0.267). The clinical success rate was 91.3% (n = 42) in patients with PAS and 95.6% (n = 173) in patients without PAS (P = 0.269). There were 24 cases of immediate complications, including pelvic pain (n = 20), urticaria (n = 3), and puncture site hematoma (n = 1). No major complication was reported. Conclusion: UAE is a safe and effective method to control intractable PPH for patients with or without PAS. [ABSTRACT FROM AUTHOR]

Background Endovascular intervention of femoropopliteal chronic total occlusions (CTOs) is technically more complex. However, there is lack of comparative analysis between CTO and non‐CTO femoropopliteal interventions. Methods and Results We report procedural details and outcomes of patients treated for femoropopliteal CTO and non‐CTO lesions in the XLPAD (Excellence in Peripheral Artery Disease) registry (NCT01904851) between 2006 and 2019. Primary outcomes were procedural success and 1‐year major adverse limb events, a composite of all‐cause death, target limb revascularization, or major amputation. Analysis included 2895 patients (CTO: n=1516 patients; non‐CTO: n=1379 patients) with 3658 lesions (CTO: n=1998 lesions; non‐CTO: n=1660 lesions). Conventional balloon angioplasty (20.86% versus 33.48%, P

• What is currently known about this topic?. • Trauma is a leading cause of pediatric mortality worldwide. Comparisons among international trauma systems are limited. • What new information is contained in this article?. • Risk-adjusted odds of pediatric injury mortality in India are over 22 times that of the US, with relative odds highest among less severely injured children. These findings suggest that targeted, low-fidelity interventions could substantially improve outcomes. There is a paucity of research comparing pediatric risk-adjusted trauma mortality between high-income and low- and middle-income countries. This limits identification of populations and injury patterns for targeted interventions. We aim to compare independent predictors of pediatric trauma mortality between India and the United States (US). A retrospective cohort study was conducted for pediatric patients (age <18 years) in India's Towards Improved Trauma Care Outcomes (TITCO) project database and the US National Trauma Data Bank (NTDB) from 2013 to 2015. Demographic, injury, physiologic, anatomic and outcome data were analyzed. Multivariable regressions were used to determine independent predictors of mortality. 126,678 pediatric trauma patients were included (India 3,373; US 123,305). Pediatric patients in India were on average significantly younger, with a higher median injury severity score (ISS), had lower systolic blood pressure, and suffered a higher case fatality rate (13.0% vs. 1.0%). When controlling for demographic, mechanism, physiologic, and anatomic injury characteristics, sustaining an injury in India was the strongest predictor of mortality (OR 22.70, 95% CI 18.70–27.56). On subgroup analysis, the highest relative odds of mortality in India was seen in children with lower injury and physiologic severity. Risk-adjusted pediatric trauma-related mortality is significantly higher in India compared to the US. The comparative odds of mortality are highest among children with lower injury and physiologic severity. This suggests that low-cost targeted interventions focused on standard timely trauma care, protocols, training and early imaging could improve pediatric injury mortality in India. Retrospective Prognosis Study II [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose To assess the prognostic value of a deep learning-based chest radiographic age (hereafter, CXR-Age) model in a large external test cohort of Asian individuals. Materials and Methods This single-center, retrospective study included chest radiographs from consecutive, asymptomatic Asian individuals aged 50-80 years who underwent health checkups between January 2004 and June 2018. This study performed a dedicated external test of a previously developed CXR-Age model, which predicts an age adjusted based on the risk of all-cause mortality. Adjusted hazard ratios (HRs) of CXR-Age for all-cause, cardiovascular, lung cancer, and respiratory disease mortality were assessed using multivariable Cox or Fine-Gray models, and their added values were evaluated by likelihood ratio tests. Results A total of 36 924 individuals (mean chronological age, 58 years ± 7 [SD]; CXR-Age, 60 years ± 5; 22 352 male) were included. During a median follow-up of 11.0 years, 1250 individuals (3.4%) died, including 153 cardiovascular (0.4%), 166 lung cancer (0.4%), and 98 respiratory (0.3%) deaths. CXR-Age was a significant risk factor for all-cause (adjusted HR at chronological age of 50 years, 1.03; at 60 years, 1.05; at 70 years, 1.07), cardiovascular (adjusted HR, 1.11), lung cancer (adjusted HR for individuals who formerly smoked, 1.12; for those who currently smoke, 1.05), and respiratory disease (adjusted HR, 1.12) mortality ( P < .05 for all). The likelihood ratio test demonstrated added prognostic value of CXR-Age to clinical factors, including chronological age for all outcomes ( P < .001 for all). Conclusion Deep learning-based chest radiographic age was associated with various survival outcomes and had added value to clinical factors in asymptomatic Asian individuals, suggesting its generalizability. Keywords: Conventional Radiography, Thorax, Heart, Lung, Mediastinum, Outcomes Analysis, Quantification, Prognosis, Convolutional Neural Network (CNN) Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Adams and Bressem in this issue.

Purpose: For pelvic and abdominal treatments, excess dose to the bowel can result in acute toxicities. Current estimates of bowel toxicity are based on pre‐treatment dose‐volume histogram data. However, the actual dose the bowel receives depends on interfraction variations, such as patient anatomy changes. We propose a method to model bowel toxicities, incorporating in vivo patient information using transit electronic portal imaging device (EPID) images. Methods and materials: For 63 patients treated to the lower thorax, abdomen, or pelvis on the Varian Halcyon, weekly chart review was performed to obtain incidences of grade 2 or higher toxicity, RTOG scale. Twenty patients presented with acute gastrointestinal (GI) toxicity. All patients were treated with conventional fractionation. For each treatment plan, the absolute volume dose‐volume histogram of the bowel was exported and analyzed. Additionally, for each fraction of treatment, in vivo EPID images were collected and used to estimate the change in radiation transmission during the course of treatment. A logistic model was used to test correlations between acute GI toxicity and bowel dosimetric parameters as well as metrics obtained from in vivo image measurements. After performing the fit to the in vivo EPID data, the bootstrap resampling method was used to create confidence intervals. In vivo EPID image metrics from an additional 42 patients treated to the lower thorax, abdomen, or pelvis were used to validate the logistic model fit. Results: The incidence of toxicity versus the volume of 40 Gy to the bowel space was fitted with a logistic function, which was superior to an average model (p < 0.0001) and agrees with previously published models. For the initial in vivo EPID data, the incidence of toxicity versus the sum of in vivo transmission measurements showed marginal significance after 15 fractions (p = 0.10) of treatment and a significance of p = 0.038 is seen at the 20th fraction, when compared to an average model. For the validation data set, the logistic model of the in vivo transmission measurement after 20 fractions was superior to the average model (p = 0.043), with the model falling within the 68% confidence interval of the fit of the initial data set. Conclusions: Dose‐volume constraints to reduce the incidence of acute GI toxicity have been validated. The presented novel EPID transmission‐based metric can be used to identify GI toxicity as patients progress through treatment. [ABSTRACT FROM AUTHOR]

Abstract Background The prognosis for nonmetastatic, primary pancreatic squamous cell carcinoma (SCC) is thought to be poor compared with adenocarcinoma (AC); however, this is based on limited data. Additionally, the optimal definitive treatment strategy for nonmetastatic pancreatic SCC is unknown. Methods We analyzed patients with nonmetastatic pancreatic cancer using the National Cancer Database for patients diagnosed from 2006 to 2014. Patients were analyzed according to histology—only AC, adenosquamous carcinoma (A‐SCC), and SCC were included. The primary endpoint was overall survival (OS) from the time of diagnosis. Results A total of 94 928 cases were included; 94 016 AC, 757 A‐SCC, and 155 SCC. Median OS was lower for SCC (8.67 months), compared to AC (13.93 months) and A‐SCC (12.71 months, P

Background: Prophylactic use of inferior vena cava filters to prevent pulmonary embolism in trauma is controversial. The practice varies between hospitals and countries, in part due to conflicting evidence and guidelines. Purpose: To compare the effects of pulmonary embolism, deep venous thrombosis and mortality in two hospitals using prophylactic inferior vena cava filter placement or prophylactic anticoagulation alone. Material and Methods: Patients presenting with severe trauma were recruited from two level-1 trauma centres between January 2008 and December 2013. Recruited patients from an US hospital having prophylactic inferior vena cava filter inserted were compared to a Scandinavian hospital using prophylactic anticoagulation alone. Inclusion criteria were age >15 years, Injury Severity Score >15 and survival >24 h after hospital admission. Patients with venous thromboembolism diagnosed prior to inferior vena cava filter placement were excluded. A Cox proportional hazard regression model was used with adjustment for immortal time bias and predictor variables. Results: In total, 951 patients were reviewed, 282 from an US hospital having inferior vena cava filters placed and 669 from a Scandinavian hospital without inferior vena cava filters. The mean age was 45.9 vs. 47.4 years and the mean Injury Severity Score was 29.8 vs. 25.9, respectively. Inferior vena cava filter placement was not associated with the hazard of pulmonary embolism (Hazard ratio=0.43; 95% confidence interval (CI) 0.12, 1.45; P=0.17) or mortality (Hazard ratio=1.16; 95% CI 0.70, 1.95; P=0.56). However, an increased rate of deep venous thrombosis was observed with inferior vena cava filters in place (Hazard ratio=3.75; 95% CI 1.68, 8.36; P=0.001). Conclusion: In severely injured trauma patients, prophylactic inferior vena cava filter placement was not associated with pulmonary embolism or mortality. However, inferior vena cava filters were associated with increased rate of deep venous thrombosis. [ABSTRACT FROM AUTHOR]

Purpose To examine the clinical feasibility of workstation-based CT fractional flow reserve (CT-FFR) for coronary artery disease (CAD) evaluation during preprocedural planning in patients undergoing transcatheter aortic valve replacement (TAVR). Materials and Methods In this retrospective single-center study, 434 patients scheduled for TAVR between 2018 and 2020 were screened for study inclusion; a relevant proportion of patients (35.0% [152 of 434]) was not suitable for evaluation due to insufficient imaging properties. A total of 112 patients (mean age, 82.1 years ± 6.7 [SD]; 58 [52%] men) were included in the study. Invasive angiography findings, coronary CT angiography results, and Agatston score were acquired and compared with on-site CT-FFR computation for evaluation of CAD and prediction of major adverse cardiovascular events (MACE) within a 24-month follow-up. Results Hemodynamic relevant CAD, as suggested by CT-FFR of 0.80 or less, was found in 41 of 70 (59%) patients with stenosis of 50% or more. MACE occurred in 23 of 112 (20.5%) patients, from which 14 of 23 had stenoses with CT-FFR of 0.80 or less (hazard ratio [HR], 3.33; 95% CI: 1.56, 7.10; P = .002). CT-FFR remained a significant predictor of MACE after inclusion in a multivariable model with relevant covariables (HR, 2.89; 95% CI: 1.22, 6.86; P = .02). An Agatston score of 1000 Agatston units or more (HR, 2.25; 95% CI: 0.98, 5.21; P = .06) and stenoses of 50% or more determined via invasive angiography (HR, 0.94; 95% CI: 0.41, 2.17; P = .88) were not significant predictors of MACE. Conclusion Compared with conventional CAD markers, CT-FFR better predicted adverse outcomes after TAVR. A relevant portion of the screened cohort, however, was not suitable for CT-based CAD evaluation. Keywords: CT, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Coronary Arteries, Outcomes Analysis © RSNA, 2024 See also the commentary by Weir-McCall and Pugliese in this issue.

Background: The prognosis for nonmetastatic, primary pancreatic squamous cell carcinoma (SCC) is thought to be poor compared with adenocarcinoma (AC); however, this is based on limited data. Additionally, the optimal definitive treatment strategy for nonmetastatic pancreatic SCC is unknown. Methods: We analyzed patients with nonmetastatic pancreatic cancer using the National Cancer Database for patients diagnosed from 2006 to 2014. Patients were analyzed according to histology—only AC, adenosquamous carcinoma (A‐SCC), and SCC were included. The primary endpoint was overall survival (OS) from the time of diagnosis. Results: A total of 94 928 cases were included; 94 016 AC, 757 A‐SCC, and 155 SCC. Median OS was lower for SCC (8.67 months), compared to AC (13.93 months) and A‐SCC (12.71 months, P <.001). SCC was resected less often (25.5% vs 46.7% and 74.5%). On subgroup analysis of patients with pancreatic SCC, factors on multivariate analysis associated with improved survival included surgery (HR 0.19, P <.001), and chemotherapy (HR 0.22, P =.01). In 38 patients with SCC undergoing surgical resection, median OS improved (MS = 6.8 months without surgery vs 21.3 months with surgery, P <.001). Conclusions: Nonmetastatic pancreatic SCC presents with more advanced disease, which is less often surgically resected or treated with any definitive local therapy. In contrast, AC and A‐SCC behave more similarly and have higher surgical resection rates and improved survival. In patients with nonmetastatic SCC of the pancreas, surgical resection provides the most significant survival benefit, with systemic chemotherapy providing a less significant benefit, and localized radiation providing no statistical benefit for any subgroup. [ABSTRACT FROM AUTHOR]

Russell O Bainer,1 Matthew R Trendowski,2 Cheng Cheng,3 Deqing Pei,3 Wenjian Yang,3 Steven W Paugh,4 Kathleen H Goss,5 Andrew D Skol,6 Paul Pavlidis,7 Ching-Hon Pui,4,8 T Conrad Gilliam,1 William E Evans,4,9,* Kenan Onel10–13,* 1Department of Human Genetics, 2Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, IL, 3Department of Biostatistics, 4Hematological Malignancy Program, St Jude Children’s Research Hospital, Memphis, TN, 5University of Chicago Medicine Comprehensive Cancer Center, 6Department of Pediatrics, The University of Chicago, Chicago, IL, USA; 7Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; 8Department of Oncology, 9Department of Pharmaceutical Sciences, St Jude Children’s Research Hospital, Memphis, TN, 10Division of Human Genetics and Genomics, 11Division of Hematology/Oncology and Stem Cell Transplantation, Cohen Children’s Medical Center, New Hyde Park, 12The Feinstein Institute for Medical Research, Manhasset, NY, 13Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA *These authors contributed equally to this work Abstract: Gene signatures have been associated with outcome in pediatric acute lymphoblastic leukemia (ALL) and other malignancies. However, determining the molecular drivers of these expression changes remains challenging. In ALL blasts, the p53 tumor suppressor is the primary regulator of the apoptotic response to genotoxic chemotherapy, which is predictive of outcome. Consequently, we hypothesized that the normal p53-regulated apoptotic response to DNA damage would be altered in ALL and that this alteration would influence drug response and treatment outcome. To test this, we first used global expression profiling in related human B-lineage lymphoblastoid cell lines with either wild type or mutant TP53 to characterize the normal p53-mediated transcriptional response to ionizing radiation (IR) and identified 747 p53-regulated apoptotic target genes. We then sorted these genes into six temporal expression clusters (TECs) based upon differences over time in their IR-induced p53-regulated gene expression patterns, and found that one cluster (TEC1) was associated with multidrug resistance in leukemic blasts in one cohort of children with ALL and was an independent predictor of survival in two others. Therefore, by investigating p53-mediated apoptosis in vitro, we identified a gene signature significantly associated with drug resistance and treatment outcome in ALL. These results suggest that intersecting pathway-derived and clinically derived expression data may be a powerful method to discover driver gene signatures with functional and clinical implications in pediatric ALL and perhaps other cancers as well. Keywords: pediatric acute lymphoblastic leukemia, p53, gene expression signature, outcomes analysis

Pituitary surgery, a critical intervention for various pituitary disorders, has sparked ongoing debates regarding the preference between endoscopic and microscopic transsphenoidal approaches. This systematic review delves into the outcomes associated with these techniques, taking into account the recent advancements in neurosurgery. The minimally invasive nature of endoscopy, providing improved visualization and reduced morbidity, stands in contrast to the well-established track record of the conventional microscopic method. Examining outcomes for disorders such as Cushing's disease and acromegaly, the review synthesizes evidence from Denmark, Bulgaria, and China. Noteworthy advantages of endoscopy encompass higher resection rates, shorter surgery durations, and fewer complications, endorsing its effectiveness in pituitary surgery. While emphasizing the necessity for prospective trials, the review concludes that endoscopic approaches consistently showcase favorable outcomes, influencing the ongoing discourse on the optimal surgical strategies for pituitary disorders., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ashfaq et al.)

Purpose To develop a model integrating radiomics features from cardiac MR cine images with clinical and standard cardiac MRI predictors to identify patients with hypertrophic cardiomyopathy (HCM) at high risk for heart failure (HF). Materials and Methods In this retrospective study, 516 patients with HCM (median age, 51 years [IQR: 40-62]; 367 [71.1%] men) who underwent cardiac MRI from January 2015 to June 2021 were divided into training and validation sets (7:3 ratio). Radiomics features were extracted from cardiac cine images, and radiomics scores were calculated based on reproducible features using the least absolute shrinkage and selection operator Cox regression. Radiomics scores and clinical and standard cardiac MRI predictors that were significantly associated with HF events in univariable Cox regression analysis were incorporated into a multivariable analysis to construct a combined prediction model. Model performance was validated using time-dependent area under the receiver operating characteristic curve (AUC), and the optimal cutoff value of the combined model was determined for patient risk stratification. Results The radiomics score was the strongest predictor for HF events in both univariable (hazard ratio, 10.37; P < .001) and multivariable (hazard ratio, 10.25; P < .001) analyses. The combined model yielded the highest 1- and 3-year AUCs of 0.81 and 0.80, respectively, in the training set and 0.82 and 0.77 in the validation set. Patients stratified as high risk had more than sixfold increased risk of HF events compared with patients at low risk. Conclusion The combined model with radiomics features and clinical and standard cardiac MRI parameters accurately identified patients with HCM at high risk for HF. Keywords: Cardiomyopathies, Outcomes Analysis, Cardiovascular MRI, Hypertrophic Cardiomyopathy, Radiomics, Heart Failure Supplemental material is available for this article . © RSNA, 2024.

Abstract Objective To develop a probability model of matching into a US ophthalmology residency program using San Francisco Matching Program (SF Match) data. Design Retrospective data analysis of de-identified application and matching data. Participants Registrants for the 2013, 2014, and 2015 ophthalmology residency matches conducted by the SF Match. Methods Descriptive statistics of candidates, comparison of continuous and categorical variables between matched and nonmatched candidates, and linear regression modeling were performed. A recursive partitioning method was used to create a probability of matching algorithm. Main Outcome Measures Probability of successfully matching based on quantifiable candidate characteristics. Results Over the 3-year period, 1,959 individuals submitted an average of 64 applications and received a mean of nine interview invitations. The overall match rate was 71%, with 78% matching at one of their top five choices. Successful matches were more likely to occur in US medical school graduates (78% vs 20%, p 48 applications. Probability of matching was “high” (> 80%) among US graduates with a step 1 United States Medical Licensing Examination (USMLE) score >243 (regardless of number of programs applied to), a step 1 USMLE score of 231 to 243 who applied to at least 30 programs, and first-time applicants with a step 1 score >232. No international medical graduates or repeat applicants had a “high” probability of matching. Conclusions Although advice must be individualized for each candidate, applicants for ophthalmology residency who fall into a “high” probability of matching group are likely to be successful with applications to 45 or fewer programs. Applying to 80 or more programs should be considered for international medical graduates and/or applicants who are previously unmatched. Modification of the match application data form may allow more detailed analysis of variables such as Alpha Omega Alpha or Gold Humanism Honor Society membership, research activity, and composite evaluation on a standardized letter of recommendation.

Purpose: To determine the association of myocardial fibrosis and left ventricular (LV) dyssynchrony measured using cardiac MRI with late gadolinium enhancement (LGE) and feature tracking (FT), respectively, with response to cardiac resynchronization therapy (CRT) for nonischemic dilated cardiomyopathy (DCM)., Materials and Methods: This retrospective study included 98 patients (mean age, 59 years ± 10 [SD]; 54 men) who had nonischemic DCM, as assessed with LGE cardiac MRI before CRT. Cardiac MRI FT-derived dyssynchrony was defined as the SD of the time-to-peak strain (TTP-SD) of the LV segments in three directions (longitudinal, radial, and circumferential). CRT response was defined as a 15% increase in LV ejection fraction (LVEF) at echocardiography at 6-month follow-up, and then, long-term cardiovascular events were assessed. The likelihood ratio test was used to evaluate the incremental prognostic value of LGE and dyssynchrony parameters., Results: Seventy-one (72%) patients showed a favorable LVEF response following CRT. LGE presence (odds ratio: 0.14 [95% CI: 0.04, 0.47], P = .002; and hazard ratio: 3.52 [95% CI: 1.37, 9.07], P = .01) and lower circumferential TTP-SD (odds ratio: 1.04 [95% CI: 1.02, 1.07], P = .002; and hazard ratio: 0.98 [95% CI: 0.96, 1.00], P = .03) were independently associated with LVEF nonresponse and long-term outcomes. Combined LGE and circumferential TTP-SD provided the highest discrimination for LVEF nonresponse (area under the receiver operating characteristic curve [AUC]: 0.89 [95% CI: 0.81, 0.94], sensitivity: 84.5% [95% CI: 74.0%, 92.0%], specificity: 85.2% [95% CI: 66.3%, 95.8%]) and long-term outcomes (AUC: 0.84 [95% CI: 0.75, 0.91], sensitivity: 76.9% [95% CI: 56.4%, 91.0%], specificity: 87.0% [95% CI: 76.7%, 93.9%])., Conclusion: Myocardial fibrosis and lower circumferential dyssynchrony assessed with pretherapy cardiac MRI were independently associated with unfavorable LVEF response and long-term events following CRT in patients with nonischemic DCM and may provide incremental value in predicting prognosis. Keywords: MR Imaging, Cardiac, Outcomes Analysis Supplemental material is available for this article . © RSNA, 2023., Competing Interests: Disclosures of conflicts of interest: Y.S. No relevant relationships. X.C. No relevant relationships. K.Y. No relevant relationships. Z.D. No relevant relationships. C.C. No relevant relationships. K.Z. No relevant relationships. H.C. No relevant relationships. K.J. No relevant relationships. M.L. No relevant relationships. S.Z. No relevant relationships., (© 2023 by the Radiological Society of North America, Inc.)

While uncertainty is ubiquitous in medical practice, minimal work to date has been performed to analyze the cause and effect relationship between uncertainty and patient outcomes. In medical imaging practice, uncertainty in the radiology report has been well documented to be a source of clinician dissatisfaction. Before one can effectively create intervention strategies aimed at reducing uncertainty, it must first be better understood through context- and user-specific analysis. One strategy for accomplishing this task is to characterize the source of uncertainty and create user-specific uncertainty profiles which take into account a number of provider-specific variables which may contribute to report uncertainty. The resulting data can in turn be used to create real-time report uncertainty metrics aimed at providing uncertainty analytics at the point of care, for the combined purposes of decision support, improved communication, and enhanced clinical/economic outcomes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to compare perioperative outcomes for total hip arthroplasty (THA) at an orthopedic specialty hospital (OSH) and a general hospital (GH).Methods: A retrospective study of all primary THAs was performed at an OSH and GH in 2014. A cohort of GH patients was manually matched to the OSH by clinical and demographic variables blinded to outcome. These matched groups were then unblinded and compared by length of stay (LOS), 90-day readmissions, mortality, reoperations, and inpatient rehabilitation utilization.Results: The 329 THAs at the OSH were matched with 329 THAs at the GH. Average LOS for THA at the OSH was 1.10 ± 0.51 days compared with 1.27 ± 0.93 (P = .004) at the GH. There were 2 OSH readmissions vs 5 GH readmissions (P = .25). There were 3 OSH reoperations vs 4 GH reoperations (P = .70). There were no mortalities. Three OSH patients used inpatient rehabilitation vs 13 GH patients (P = .011). When GH outlier and rehabilitation patients were excluded, the difference in LOS was not significant (1.08 ± 0.47 vs 1.13 ± 0.55 days; t = 1.331; P = .184). Two OSH patients required transfer to a GH postoperatively (angina and gastrointestinal bleed).Conclusion: This study found that perioperative outcomes for THA were equally good at the OSH and GH. Rehabilitation utilization was higher at the GH. The LOS at both facilities was lower than the national average of 2.9 days. When rehabilitation patients and outliers were excluded, there was no significant difference in LOS between the two. [ABSTRACT FROM AUTHOR]

Objective: Surgical mortality has traditionally been assessed at arbitrary intervals out to 1 year, without an agreed optimum time point. The aim of our study was to investigate the time-varying risk of death after lobectomy to determine the optimum period to evaluate surgical mortality rate after lobectomy for lung cancer., Methods: We performed a retrospective study of patients undergoing lobectomy for lung cancer at our institution from 2015 to 2022. Parametric survival models were assessed and compared with a nonparametric kernel estimate. The hazard function was plotted over time according to the best-fit statistical distribution. The time points at which instantaneous hazard rate peaked and stabilized in the 1-year period after surgery were then determined., Results: During the study period, 2284 patients underwent lobectomy for lung cancer. Cumulative mortality at 30, 90, and 180 days was 1.3%, 2.9%, and 4.9%, respectively. Log-logistic distribution showed the best fit compared with other statistical distribution, indicated by the lowest Akaike information criteria value. The instantaneous hazard rate was greatest during the immediate postoperative period (0.129; 95% confidence interval, 0.087-0.183) and diminishes rapidly within the first 30 days after surgery. Instantaneous hazard rate continued to decrease past 90 days and stabilized only at approximately 180 days., Conclusions: In-hospital mortality is the optimal follow-up period that captures the early-phase hazard during the immediate postoperative period after lobectomy. Thirty-day mortality is not synonymous to "early mortality," as instantaneous hazard rate remains elevated well past the 90-day time point and only stabilizes at approximately 180 days after lobectomy., Competing Interests: E.L. reports personal fees from Covidien, Roche, Lilly Oncology, Boehringer Ingelheim, Medela, Ethicon, AstraZeneca, Beigene, Roche, and BMS; grants and personal fees from ScreenCell; and grants from Clearbridge Biomedics, Illumina, and Guardant Health, outside the submitted work. In addition, E.L. has patents P52435GB and P57988GB issued to Imperial Innovations. E.L. is Chief Investigator for VIOLET NIHR HTA (13/04/03), MARS 2 NIHR HTA (15/188/31), and RAMON NIHR HTA (131306); and founder of My Cancer Companion Healthcare Companion, Ltd. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Crown Copyright © 2023 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.)

Purpose To determine if a radiomics model based on quantitative maps acquired with synthetic MRI (SyMRI) is useful for predicting neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC). Materials and Methods In this prospective study, 181 women diagnosed with stage I-III TNBC were scanned with a SyMRI sequence at baseline and at midtreatment (after four cycles of NAST), producing T1, T2, and proton density (PD) maps. Histopathologic analysis at surgery was used to determine pathologic complete response (pCR) or non-pCR status. From three-dimensional tumor contours drawn on the three maps, 310 histogram and textural features were extracted, resulting in 930 features per scan. Radiomic features were compared between pCR and non-pCR groups by using Wilcoxon rank sum test. To build a multivariable predictive model, logistic regression with elastic net regularization and cross-validation was performed for texture feature selection using 119 participants (median age, 52 years [range, 26-77 years]). An independent testing cohort of 62 participants (median age, 48 years [range, 23-74 years]) was used to evaluate and compare the models by area under the receiver operating characteristic curve (AUC). Results Univariable analysis identified 15 T1, 10 T2, and 12 PD radiomic features at midtreatment that predicted pCR with an AUC greater than 0.70 in both the training and testing cohorts. Multivariable radiomics models of maps acquired at midtreatment demonstrated superior performance over those acquired at baseline, achieving AUCs as high as 0.78 and 0.72 in the training and testing cohorts, respectively. Conclusion SyMRI-based radiomic features acquired at midtreatment are potentially useful for identifying early NAST responders in TNBC. Keywords: MR Imaging, Breast, Outcomes Analysis ClinicalTrials.gov registration no. NCT02276443 Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Houser and Rapelyea in this issue.

Background Endovascular intervention of femoropopliteal chronic total occlusions (CTOs) is technically more complex. However, there is lack of comparative analysis between CTO and non-CTO femoropopliteal interventions. Methods and Results We report procedural details and outcomes of patients treated for femoropopliteal CTO and non-CTO lesions in the XLPAD (Excellence in Peripheral Artery Disease) registry (NCT01904851) between 2006 and 2019. Primary outcomes were procedural success and 1-year major adverse limb events, a composite of all-cause death, target limb revascularization, or major amputation. Analysis included 2895 patients (CTO: n=1516 patients; non-CTO: n=1379 patients) with 3658 lesions (CTO: n=1998 lesions; non-CTO: n=1660 lesions). Conventional balloon angioplasty (20.86% versus 33.48%, P <0.001) or drug-coated balloon angioplasty (1.26% versus 2.93%, P <0.001) were more frequent in the non-CTO group, whereas bare-metal stents (28.09% versus 20.22%, P <0.001) or covered stents (4.08% versus 1.83%, P <0.001) were more frequent in the CTO group. Debulking procedures were more commonly performed in the non-CTO group (41.44% versus 53.13%, P <0.001), despite a similar degree of calcification between the 2 groups. Procedural success was higher in the non-CTO group (90.12% versus 96.79%, P <0.001). Procedural complications were higher in the CTO group (7.21% versus 4.66%, P =0.002), mainly due to excess distal embolization (1.5% versus 0.6%, P =0.015). Adjusted 1-year major adverse limb events were higher in the CTO group (22.47% versus 18.77%, P =0.019), driven mainly by target limb revascularization (19.00% versus 15.34%, P =0.013). Conclusions Procedural success is lower for endovascular treatment of femoropopliteal CTO compared with non-CTO lesions. CTO lesions are associated with higher rates of periprocedural complications and reinterventions after 1 year.

Objective. To quantitatively determine scholarly activity among tenure-track faculty at US departments of pharmacy practice over a 10-year period. Methods. A search of PubMed was performed for articles by department of pharmacy practice tenure track (DPP-TT) faculty from January 1, 2010, through December 31, 2019. DPP-TT faculty working in departments of pharmacy practice were identified through faculty rosters published on the American Association Colleges of Pharmacy website or college or school internet sites. Tenure-track faculty listed as working in a department of pharmacy practice, clinical pharmacy, or pharmacotherapy were included. An objective third party confirmed the data obtained. Each publication was classified by scope (eg, clinical pharmacology, health economics/outcome research, biomedical informatics, basic science, review, editorial/letter, or case report). DPP-TT faculty productivity was calculated by dataset frequency distribution. Descriptive statistics and analysis of variance were used to compare data across demographic strata. Results. One hundred thirty-seven institutions employed 2147 pharmacy practice faculty. These faculty published 20,059 (9.3±16.3/10 years/faculty member) papers. Six institutions had no tenure-track designation. There was a 2.5-fold increase in publication rates from 2010-2019 ( P < 0001). Public vs private schools' productivity was 207.8 vs 69.0 publications per institution, respectively ( P < 001). The ratio of male to female DPP-TT faculty per institution was 62% to 38%, with male faculty publishing an average of 12.1±19.1 each, and female faculty publishing an average of 7.4±13.8 each ( P < 0001). Faculty ranks were 37% assistant professor; 36% associate professor; and 26% professor, with an average of 4.0±7.3, 8.6±12.4, and 17.4±24.6 publications per faculty, respectively. Regionally, US pharmacy practice faculty located in the West produced the most publications, followed by those in the Northeast, South, and Midwest ( P < 0001). Conclusions. These national DPP-TT publication data demonstrate that scholarly productivity increased from 2010 through 2019, across a wide variety of publication scopes., (© 2023 American Association of Colleges of Pharmacy.)

Background: The use of transcatheter aortic valve replacement (TAVR) to treat aortic stenosis in the United States is growing, yet little is known about the variation in procedural outcomes in community practice. We developed a TAVR in-hospital mortality risk model and used it to quantify variation in mortality rates across United States (US) TAVR centers.Methods and Results: We analyzed data from 22 248 TAVR procedures performed at 318 sites participating in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (November 2011 to October 2014). A Bayesian hierarchical model was developed to estimate hospital-specific risk-adjusted mortality rates adjusting for 40 patient baseline factors. A total of 1130 in-hospital deaths (5.1%) were observed. Reliability-adjusted risk-adjusted mortality rate estimates ranged from 3.4% to 7.7% with an interquartile range of 4.8% to 5.4%. A patient's predicted odds of dying was 80% higher if treated by a hospital 1 standard deviation above the mean compared with a hospital 1 standard deviation below the mean (odds ratio =1.8; 95% credible interval, 1.4%-2.2%).Conclusions: Risk modeling of TAVR in-hospital mortality revealed variation in risk-adjusted mortality rates during the US early commercial experience. Transcatheter Valve Therapy Registry analyses using this model will support research, feedback reporting, and the identification of factors associated with quality. [ABSTRACT FROM AUTHOR]

The potential long-term consequences of treatments delaying manifestations of neurodegenerative diseases have not been explored. Using Huntington disease (HD) data and Markov chain Monte Carlo methods, we simulated the effects of therapies with equivalent effects on time to onset of HD and survival with HD. Our results suggest substantial potential trade-offs in effects of these therapies; significant delays in time to onset of HD were accompanied by significant prolongations of survival after onset of HD. Under a variety of assumptions, treatments delaying onset of HD result in some patients likely to have a greater increase in survival with manifest HD compared to delays in time to onset of HD. Our results suggest that future work in HD should be sensitive to the potential existence of such trade-offs and that understanding the preferences of HD patients and the broader HD community will be increasingly important. Future research, trial design, and treatment strategies in HD and other mid-life-onset neurodegenerative disorders should consider the possibility of trade-offs in long-term consequences of disease-modifying treatments. © 2015 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Purpose: To describe the design and methodological approach of a multicenter, retrospective study to externally validate a clinical and imaging-based model for predicting the risk of late adverse events in patients with initially uncomplicated type B aortic dissection (uTBAD)., Materials and Methods: The Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) is a collaboration between 10 academic aortic centers in North America and Europe. Two centers have previously developed and internally validated a recently developed risk prediction model. Clinical and imaging data from eight ROADMAP centers will be used for external validation. Patients with uTBAD who survived the initial hospitalization between January 1, 2001, and December 31, 2013, with follow-up until 2020, will be retrospectively identified. Clinical and imaging data from the index hospitalization and all follow-up encounters will be collected at each center and transferred to the coordinating center for analysis. Baseline and follow-up CT scans will be evaluated by cardiovascular imaging experts using a standardized technique., Results: The primary end point is the occurrence of late adverse events, defined as aneurysm formation (≥6 cm), rapid expansion of the aorta (≥1 cm/y), fatal or nonfatal aortic rupture, new refractory pain, uncontrollable hypertension, and organ or limb malperfusion. The previously derived multivariable model will be externally validated by using Cox proportional hazards regression modeling., Conclusion: This study will show whether a recent clinical and imaging-based risk prediction model for patients with uTBAD can be generalized to a larger population, which is an important step toward individualized risk stratification and therapy. Keywords: CT Angiography, Vascular, Aorta, Dissection, Outcomes Analysis, Aortic Dissection, MRI, TEVAR© RSNA, 2022See also the commentary by Rajiah in this issue., Competing Interests: Disclosures of conflicts of interest: D.M. Research grant from the National Institute of Biomedical Imaging and Bioengineering (no. 5T32EB009035); consulting fees from Segmed; stock or stock options in Segmed; member of Radiology: Cardiothoracic Imaging trainee editorial board. M.J.W. Postdoctoral Fellowship Award (no. 18POST34030192) from the American Heart Association, payments to author’s institution; consulting fees from Segmed; payment from GLG, AlphaInsight, and Guidepoint for expert testimony; leadership or fiduciary role in the Society of Cardiovascular Computed Tomography, unpaid; stock or stock options in Segmed. V.L.T. Shareholder of Segmed stock or stock options. V.H. No relevant relationships. M.C. Postdoctoral Fellowship Award (no. 826389) from the American Heart Association; payment or honoraria from FASTeR as lecturer for research methodology course; owner of stock options in Arterys; employee of Arterys. K.H. Payment or honoraria from Sanofi Genzyme and Amicus for lectures, presentations, speakers bureaus, manuscript writing, or educational events; participation on a Data Safety Monitoring Board or Advisory Board for Sanofi Genzyme; associate editor for Radiology: Cardiothoracic Imaging. M.O. No relevant relationships. D.O.T. No relevant relationships. R.O.A. Consultant for Medtronic and EndoRon; member of the Society for Vascular Surgery (SVS) Diversity Equity and Inclusion Committee and council member of the SVS Young Surgeon Section; shareholder for EndoRon and Voythus. S.H. No relevant relationships. N.S.B. Radiological Society of North America Research Scholar Grant (no. RSCH1801); entitled to royalties related to licensure of intellectual property to Imbio; patents planned, issued, or pending for U.S. patent number 10,896,507, Techniques of Deformation Analysis for Quantification of Vascular Enlargement in Aneurysmal Disease. B.Y. Honoraria from seminar hosted by Medtronic. J.M.L. Honoraria from Cardiovascular Institute of Philadelphia. T.G.G. No relevant relationships. D.P. No relevant relationships. G.F. No relevant relationships. L.L. Participation on the Medtronic Thoracic Hostile Neck Club Advisory Board, Barcelona, December 20, 2021. R.H. No relevant relationships. H.A. No relevant relationships. A.E.S. Member of Radiology: Cardiothoracic Imaging editorial board. E.C. No relevant relationships. S.M.J.v.K. No relevant relationships. G.W.H.S. No relevant relationships. A.M.S. No relevant relationships. K.B. No relevant relationships. D.C.M. No relevant relationships. M.P.F. No relevant relationships. D.F. Deputy editor for Radiology: Cardiothoracic Imaging., (© 2022 by the Radiological Society of North America, Inc.)

The direct anterior approach (DAA) for total hip replacement (THR) is relatively new. It has been proved superior to other techniques concerning early functional outcomes, stability, and earlier recovery. But DAA-THR has a steeper surgical learning curve and, in its original description, needs special operating room equipment. This study aims to present clinical, functional, and radiological outcomes of DAA compared to the posterior approach (PA), performed using a routine operating table and instrumentation sets. Eighty patients undergoing THR were non-randomly allocated prospectively into Group 1 DAA and Group 2 PA. Visual analog scale (VAS) for pain was recorded preoperatively and at 6, 12, 24, 48, and 72 h after the surgery and at 1st and 2nd year postoperatively. Both groups' functional outcomes were evaluated pre-and postoperatively at 1st and 2nd-year follow-up with Harris hip score (HHS) and SF-12. Perioperative parameters like blood loss, length of hospital stay, duration of surgery, postoperative complications, and radiological prosthesis positioning were also compared between the two groups. All patients were comparable according to their baseline demographic characteristics. DAA was found to have significantly better early HHS at one year (p = 0.001) and VAS for hip pain (p < 0.05) at 12, 24, 48, and 72 hrs postoperative period only. Clinical outcomes were comparable at the final follow-up of 2 years. Perioperative variables were also similar except the incision length, length of stay in the hospital, and average time to weight bear without walking aids which were statistically better in DAA than PA group. There was no difference in radiological prosthesis positioning. Postoperative complication rates were also comparable in the two groups. Though technically demanding, DAA provides better early functional outcomes with comparable radiological outcomes and complication rates than the PA. Level of evidence: Non-randomized comparative trial, Level II. [ABSTRACT FROM AUTHOR]

Background: The survival rate of infants with gastroschisis has improved significantly. It is over 90% in developed countries, but 50% in developing countries. This study aimed to investigate the factors improving the survival rate of infants with gastroschisis in developing countries. Methods: Neonates meeting the inclusion criteria, who presented to our center since the establishment of delivery room surgery, were enrolled into this retrospective study. Data were evaluated specifically to determine the role of delivery room surgery in reducing the mortality and morbidity of infants with gastroschisis and to identify factors optimizing the conditions of outborn infants. Results: A total of 64 infants were identified. The overall survival rate of the infants was 60.9%. The survival rate of infants in inborns was 76.5%, and the survival rate of infants in outborns was 43.3%. Infants of the outborn group took more time to reach full enteral feeding, and were more likely to require a prolonged stay in hospital when compared with those of the inborn group. Logistic analysis identified that the surgical technique, the presence of sepsis and intestinal necrosis could be expected to influence the outcome of gastroschisis. Conclusions: The strategy of delivery of patients in a center prepared to perform delivery room closure of gastroschisis appears to improve the survival of patients with gastroschisis. Further reduction in mortality rates will depend on improved conditions of outborn infants. [ABSTRACT FROM AUTHOR]

The implementation of electronic medical records (EMR) systems was mandated by the U.S. federal government in large part due to research indicating that difficulty accessing clinical data was one of the most common causes of preventable deaths. Several assumptions were implicit in this mandate, including the assumption that the implementation of EMR would indeed improve clinicians’ access to clinical data, that implementation of EMR would pose little to no risk to patients, and that the clinical benefit of improved access to clinical data would outweigh any risks that might arise. As detailed in this review, both formal research and extensive experiential observation have called all three assumptions into question. Specifically, as detailed below, there is clear evidence that EMR systems are associated with multiple specific risks to patients, whereas few, if any, scientifically rigorous outcomes-based studies have demonstrated that the potential benefits of EMR outweigh the known risks. In addition, there is currently little to no scientifically rigorous evidence that EMR systems constitute a cost-effective methodology for improving patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To develop a multimodal machine learning-based pipeline to predict patient-specific risk of dislocation following primary total hip arthroplasty (THA)., Materials and Methods: This study retrospectively evaluated 17 073 patients who underwent primary THA between 1998 and 2018. A test set of 1718 patients was held out. A hybrid network of EfficientNet-B4 and Swin-B transformer was developed to classify patients according to 5-year dislocation outcomes from preoperative anteroposterior pelvic radiographs and clinical characteristics (demographics, comorbidities, and surgical characteristics). The most informative imaging features, extracted by the mentioned model, were selected and concatenated with clinical features. A collection of these features was then used to train a multimodal survival XGBoost model to predict the individualized hazard of dislocation within 5 years. C index was used to evaluate the multimodal survival model on the test set and compare it with another clinical-only model trained only on clinical data. Shapley additive explanation values were used for model explanation., Results: The study sample had a median age of 65 years (IQR: 18 years; 52.1% [8889] women) with a 5-year dislocation incidence of 2%. On the holdout test set, the clinical-only model achieved a C index of 0.64 (95% CI: 0.60, 0.68). The addition of imaging features boosted multimodal model performance to a C index of 0.74 (95% CI: 0.69, 0.78; P = .02)., Conclusion: Due to its discrimination ability and explainability, this risk calculator can be a potential powerful dislocation risk stratification and THA planning tool. Keywords: Conventional Radiography, Surgery, Skeletal-Appendicular, Hip, Outcomes Analysis, Supervised Learning, Convolutional Neural Network (CNN), Gradient Boosting Machines (GBM) Supplemental material is available for this article. © RSNA, 2022., Competing Interests: Disclosures of conflicts of interest: B.K. No relevant relationships. P.R. No relevant relationships. H.M.K. National Institutes of Health (NIH) grants. D.R.L. No relevant relationships. Q.J.J. No relevant relationships. S.F. No relevant relationships. W.K.K. NIH funds for research paid to institution; author provides statistical analyses to Data Safety Monitoring Boards; mutual funds or similar. B.J.E. Chair of Research Committee for Society for Imaging Informatics in Medicine; consultant to the editor for Radiology: Artificial Intelligence. R.J.S. Royalties or licenses from Zimmer Biomet, OrthAlign, and Link Orthopedics; consulting fees from Think Surgical and OrthAlign; patent planned, issued, or pending with Zimmer Biomet; leadership or fiduciary role with the American Association of Hip and Knee Surgeons, Muller Foundation, and the Academic Network of Conservational Hip Outomes Research; receipt of equipment, materials, drugs, medical writing, gifts, or other services from Springer. M.J.T. No relevant relationships. C.C.W. No relevant relationships., (© 2022 by the Radiological Society of North America, Inc.)

Purpose To determine the effectiveness of MR angiography for pulmonary embolism (MRA-PE) in symptomatic patients. Materials and Methods We retrospectively reviewed all patients whom were evaluated for possible pulmonary embolism (PE) using MRA-PE. A 3-month and 1-year from MRA-PE electronic medical record (EMR) review was performed. Evidence for venous thromboembolism (VTE) (or death from PE) within the year of follow-up was the outcome surrogate for this study. Results There were 190 MRA-PE exams performed with 97.4% (185/190) of diagnostic quality. There were 148 patients (120 F: 28 M) that had both a diagnostic MRA-PE exam and 1 complete year of EMR follow-up. There were 167 patients (137 F: 30 M) with 3 months or greater follow-up. We found 83% (139/167) and 81% (120/148) MRA-PE exams negative for PE at 3 months and 1 year, respectively. Positive exams for PE were seen in 14% (23/167). During the 1-year follow-up period, five patients (false negative) were diagnosed with DVT (5/148 = 3.4 %), and one of these patients also experienced a non-life-threatening PE. The negative predictive value (NPV) for MRA-PE was 97% (92-99; 95% CI) at 3 months and 96% (90-98; 95% CI) with 1 year of follow-up. Conclusion The NPV of MRA-PE, when used for the primary diagnosis of pulmonary embolism in symptomatic patients, were found to be similar to the published values for CTA-PE. In addition, the technical success rate and safety of MRA-PE were excellent. J. Magn. Reson. Imaging 2013;38:914-925. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Purpose: To train a deep natural language processing (NLP) model, using data mined structured oncology reports (SOR), for rapid tumor response category (TRC) classification from free-text oncology reports (FTOR) and to compare its performance with human readers and conventional NLP algorithms., Materials and Methods: In this retrospective study, databases of three independent radiology departments were queried for SOR and FTOR dated from March 2018 to August 2021. An automated data mining and curation pipeline was developed to extract Response Evaluation Criteria in Solid Tumors-related TRCs for SOR for ground truth definition. The deep NLP bidirectional encoder representations from transformers (BERT) model and three feature-rich algorithms were trained on SOR to predict TRCs in FTOR. Models' F1 scores were compared against scores of radiologists, medical students, and radiology technologist students. Lexical and semantic analyses were conducted to investigate human and model performance on FTOR., Results: Oncologic findings and TRCs were accurately mined from 9653 of 12 833 (75.2%) queried SOR, yielding oncology reports from 10 455 patients (mean age, 60 years ± 14 [SD]; 5303 women) who met inclusion criteria. On 802 FTOR in the test set, BERT achieved better TRC classification results (F1, 0.70; 95% CI: 0.68, 0.73) than the best-performing reference linear support vector classifier (F1, 0.63; 95% CI: 0.61, 0.66) and technologist students (F1, 0.65; 95% CI: 0.63, 0.67), had similar performance to medical students (F1, 0.73; 95% CI: 0.72, 0.75), but was inferior to radiologists (F1, 0.79; 95% CI: 0.78, 0.81). Lexical complexity and semantic ambiguities in FTOR influenced human and model performance, revealing maximum F1 score drops of -0.17 and -0.19, respectively., Conclusion: The developed deep NLP model reached the performance level of medical students but not radiologists in curating oncologic outcomes from radiology FTOR. Keywords: Neural Networks, Computer Applications-Detection/Diagnosis, Oncology, Research Design, Staging, Tumor Response, Comparative Studies, Decision Analysis, Experimental Investigations, Observer Performance, Outcomes Analysis Supplemental material is available for this article. © RSNA, 2022., Competing Interests: Disclosures of conflicts of interest: M.A.F. No relevant relationships. K.K. No relevant relationships. A.B. No relevant relationships. M.M. No relevant relationships. M.S. No relevant relationships. M.K. No relevant relationships. G.K. No relevant relationships. J.S. No relevant relationships. C.P.H. No relevant relationships. H.P.S. No relevant relationships. K.M.H. No relevant relationships. T.F.W. No relevant relationships. J.K. No relevant relationships., (© 2022 by the Radiological Society of North America, Inc.)

Purpose: To evaluate the value of using left ventricular (LV) long-axis shortening (LAS) derived from coronary CT angiography (CCTA) to predict mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR)., Materials and Methods: Patients with severe AS who underwent CCTA for preprocedural TAVR planning between September 2014 and December 2019 were included in this retrospective study. CCTA covered the whole cardiac cycle in 10% increments. Image series reconstructed at end systole and end diastole were used to measure LV-LAS. All-cause mortality within 24 months of follow-up after TAVR was recorded. Cox regression analysis was performed, and hazard ratios (HRs) are presented with 95% CIs. The C index was used to evaluate model performance, and the likelihood ratio χ 2 test was performed to compare nested models., Results: The study included 175 patients (median age, 79 years [IQR, 73-85 years]; 92 men). The mortality rate was 22% (38 of 175). When adjusting for predictive clinical confounders, it was found that LV-LAS could be used independently to predict mortality (adjusted HR, 2.83 [95% CI: 1.13, 7.07]; P = .03). In another model using the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), LV-LAS remained significant (adjusted HR, 3.38 [95 CI: 1.48, 7.72]; P = .004), and its use improved the predictive value of the STS-PROM, increasing the STS-PROM C index from 0.64 to 0.71 (χ 2 = 29.9 vs 19.7, P = .001). In a subanalysis of patients with a normal LV ejection fraction (LVEF), the significance of LV-LAS persisted (adjusted HR, 3.98 [95 CI: 1.56, 10.17]; P = .004)., Conclusion: LV-LAS can be used independently to predict mortality in patients undergoing TAVR, including those with a normal LVEF. Keywords: CT Angiography, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Outcomes Analysis, Cardiomyopathies, Left Ventricle, Aortic Valve Supplemental material is available for this article. © RSNA, 2022See also the commentary by Everett and Leipsic in this issue., Competing Interests: Disclosures of conflicts of interest: G.J.A. Recently approved as a member of the trainee editorial board for Radiology: Cardiothoracic Imaging, but was not a trainee editorial board member at the time of the writing of this article. J.A.D. No relevant relationships. U.J.S. Consultant for and/or receives research support from Bayer, Bracco, Elucid Bioimaging, Guerbet, HeartFlow, and Siemens Healthcare; editor-in-chief of Journal of Thoracic Imaging; member of Radiology: Cardiothoracic Imaging editorial board. L.C. No relevant relationships. N.P. No relevant relationships. B.Y. No relevant relationships. V.B. No relevant relationships. A.L.E. Leadership or fiduciary role in Women in Cardiothoracic Surgery Committee of EACTS and Nachwuchskommission Herzchirurgie DGTHG. F.S. No relevant relationships. J.R.B. No relevant relationships. R.B. Research support from Siemens Healthineers, paid to institution; honoraria from Siemens Healthineers, paid to author; meeting travel support from Siemens Healthineers. A.V.S. Grants or contracts from Siemens, paid to institution; consulting fees from Bayer and Elucid Bioimaging, paid to author. T.E. Speaker honoraria from Siemens Healthineers; travel support from Siemens Healthineers; participation on advisory board for Siemens Healthineers; member of Clinical Practice Committee, Society of Magnetic Resonance Imaging., (© 2022 by the Radiological Society of North America, Inc.)

Spinal deformity in neurofibromatosis, when associated with dystrophic change, is a major treatment challenge. Early anterior and posterior spinal fusion is the accepted treatment plan for severe progressive kyphoscoliosis. Resection of the vertebral body as an additional step in correction and fusion has not been previously investigated. Information on the functional status of the neurofibromatous curves is also scarce in the literature. The purpose of this study is to report an experience with corpectomy and circumferential fusion in dystrophic spines of neurofibromatosis. Among 16 patients with dystrophic spinal curves, nine cases who had undergone anterior and posterior fusion with 6.7 years (range 2–11.9) average follow-up were evaluated clinically, radiographically, and functionally (SRS-22). Nine cases with a mean age of 11.8 years (range 7.8–17) at surgery consisted of seven kyphoscoliotic patients, who had received one or two levels of cord decompression and corpectomy, and two cases of scoliosis with hypokyphosis. Surgery improved the mean preoperative scoliosis of 87 (range 60–110) and local kyphosis of 69.3° (range 50–100) to 49 (range 15–85) and 49° (range 35–70), respectively. Loss of correction of 5° in the scoliosis and 13° in the kyphosis angles was observed in the final follow-up. One surgery resulted in an immediate postoperative mortality. Fusion was achieved in all cases. The average SRS-22 score of 4.1 (range 3–4.6) was obtained. Simultaneous anterior and posterior fusion with corpectomy for dystrophic neurofibromatous spinal deformities is associated with a high fusion rate, good correction, and also good functional outcome. [ABSTRACT FROM AUTHOR]

Objectives: To assess national outcomes of carotid artery stenting (CAS) with respect to hospital and practitioner volume. Methods: The 2005 to 2006 Nationwide Inpatient Sample (NIS) was used to assess CAS with respect to hospital volume, physician volume, and associated complications. Results: Eighteen thousand five hundred ninety-nine CAS interventions were identified. The top 25% was used to define high-volume hospitals (>60 CAS/2 years) and practitioners (>30 CAS/2 years). The stroke rate after CAS was significantly different between low- and high-volume hospitals (2.35% vs 1.78%, respectively; P = .0206). The stroke rate after CAS was also significantly different between low- and high-volume practitioners (2.19% vs 1.51%, P = .0243). Hospital resource use varied significantly between low- and high-volume hospitals (length of stay [LOS]: 1.64 ± 2.10 vs 1.45 ± 11.21, P = .0006; total charges: $32 261 ± 20 562 vs $30 131 ± 19 592, P = .0047) and practitioners (LOS: 1.70±2.14 vs 1.36±1.36; P < .0001; total charges: $33 762±21 081 vs $23 957±19 713; P < .0001). Conclusions: This analysis demonstrates that hospital and physician volume are associated with outcomes and utilization after CAS. High-volume hospitals and practitioners were associated with lower procedure stroke rates and decreased hospital resource utilization. [ABSTRACT FROM AUTHOR]

Background: With an aging population, more patients might be treated for atherosclerotic renal artery stenosis (ARAS). The goal of this treatment is to achieve a dialysis-free life or a well-controlled blood pressure with reduced risks of cardiovascular complications. Purpose: To analyze the clinical outcome of percutaneous transluminal renal artery angioplasty without stenting (PTRA) or with stenting (PTRS) for ARAS at one center. Material and Methods: The study group comprised 152 patients who underwent 203 PTRA/PTRS. All had hypertension, and 45% had azotemia. A retrospective collection of baseline and postprocedural number of antihypertensive drugs, blood pressure, and serum creatinine were analyzed during a follow-up of 3-18 months. Results: Technical success rate was 95%, and clinical benefit was seen in 63% of patients. Complications included a 30-day mortality rate of 1.5%, a total complication rate of 35%, and major adverse events in 13%. The major adverse events were highly related to azotemia. Major adverse events within 30 days, with permanent disability, were seen in 5% and almost exclusively in patients with moderate or severe renal impairment. A subgroup analysis of 28 patients with renal duplex resistive index (RI) pre-PTRA/S and 6 months' follow-up showed a benefit of PTRA/PTRS in 17 (68%) of the 25 patients with RI <80 and in all three (100%) of the patients with RI ≥80. Conclusion: Endovascular treatment of ARAS has an excellent technical success rate, with a clinical improvement rate of >60%. However, it is associated with a considerable complication rate. Serious complications are seen mainly in azotemic patients. Predictors of clinical response could not be identified. Renal duplex RI is questioned as a predictor of clinical outcome. [ABSTRACT FROM AUTHOR]

Abstract: Background and context: Satisfaction is a key indicator of how health care has met patient expectations. Purpose: To examine relationship between clinical and functional outcome and patient satisfaction. Study design/setting: Prospective analysis of outcomes. Patient sample: A total of 428 patients undergoing cervical spine surgery consecutively enrolled at 23 nationwide sites. Outcome measures: Cervical Spine Outcomes Questionnaire (CSOQ). Methods: We used the CSOQ to evaluate 428 patients undergoing cervical spine surgery at 23 nationwide sites. Satisfaction was assessed at 3 months by self-report. Clinical improvement was defined at 3 months as decreased postoperative CSOQ domain scores. Principal components analysis (PCA) was used to demonstrate adherence of the CSOQ to domains of clinical and functional recovery and to identify items measuring patient satisfaction. Psychometric properties of items measuring patient satisfaction were examined. The association between patient satisfaction and 3 month clinical and functional outcome was tested. Results: On repeat administration in a subset of 50 patients, these four items demonstrated good test-retest reliability (Cronbach''s α=0.784). PCA extracted factors adhering to the domain structure of the CSOQ. A unique factor was characterized by the following: recommend to friend (loading=0.658), compare favorably with others (loading=0.525) and with expectations (loading=0.701), and show overall satisfaction (loading=0.513). Structural equation models revealed influence of CSOQ domain scores and socioeconomic status on patient satisfaction. All reported comparisons were significant at p<.001. Conclusions: Satisfaction is unobservable, but can be assessed through self-report. Clinical improvement, especially in neck pain, after surgery is associated with improved patient satisfaction. [Copyright &y& Elsevier]

Background: It has been suggested that no upper limit of the fluid amount drained is necessary when performing ultrasound-guided thoracentesis, but the risk of pneumothorax when large amounts of fluid are drained has not been studied in detail. Purpose: To study the amount of drained fluid at ultrasound-guided thoracentesis and the subsequent risk of pneumothorax. Material and Methods: Prospectively collected information on all ultrasound-guided thoracenteses performed at a county hospital between 2004 and 2006 was evaluated. In total, 735 thoracenteses in 471 patients were included. Chest radiographs performed within 14 days after thoracentesis were identified to obtain cases of pneumothorax and cases treated with tube thoracostomy. Data were analyzed by logistic regression. The study was approved by the regional research ethics committee. Results: There was a steep increase in risk for pneumothorax when large amounts of fluid were drained. Compared to a thoracentesis of 0.8-1.2 l, drainage of 1.8-2.2 l was associated with a more than threefold increase in risk for pneumothorax (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.28-11.2), and after drainage of 2.3 l or more, the increase in risk was almost sixfold (OR 5.7, 95% CI 1.30-24.7). The association between the amount drained and the risk of pneumothorax was even more pronounced for pneumothoraces requiring tube thoracostomy (P for trend <0.0001). Nine of 11 tube thoracostomies occurred after thoracenteses of 1.8 l or more. Conclusion: Our study suggests that drainage of large amounts of fluid at ultrasound-guided thoracentesis is a risk factor for pneumothorax. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with locally-advanced head and neck squamous cell carcinoma (HNSCC) have variable responses to (chemo)radiotherapy. A reliable early prediction of outcomes allows for enhancing treatment efficacy and follow-up monitoring. Early tumoral changes can be captured by functional imaging (DWI/IVIM/DCE/18F-FDG-PET-CT) parameters, which allow for the construction of accurate patient-specific prognostic models for locoregional recurrence-free survival, distant metastasis-free survival and overall survival. We also present clinical applicable risk stratification in high/medium/low risks for these patient outcomes. This can enable personalized treatment (adaptation) management early on during treatment, improve counseling and enhance patient-specific post-therapy monitoring. Background: Patients with locally-advanced head and neck squamous cell carcinoma (HNSCC) have variable responses to (chemo)radiotherapy. A reliable prediction of outcomes allows for enhancing treatment efficacy and follow-up monitoring. Methods: Fifty-seven histopathologically-proven HNSCC patients with curative (chemo)radiotherapy were prospectively included. All patients had an MRI (DW,-IVIM, DCE-MRI) and 18F-FDG-PET/CT before and 10 days after start-treatment (intratreatment). Primary tumor functional imaging parameters were extracted. Univariate and multivariate analysis were performed to construct prognostic models and risk stratification for 2 year locoregional recurrence-free survival (LRFFS), distant metastasis-free survival (DMFS) and overall survival (OS). Model performance was measured by the cross-validated area under the receiver operating characteristic curve (AUC). Results: The best LRFFS model contained the pretreatment imaging parameters ADC_kurtosis, Kep and SUV_peak, and intratreatment imaging parameters change (Δ) Δ-ADC_skewness, Δ-f, Δ-SUV_peak and Δ-total lesion glycolysis (TLG) (AUC = 0.81). Clinical parameters did not enhance LRFFS prediction. The best DMFS model contained pretreatment ADC_kurtosis and SUV_peak (AUC = 0.88). The best OS model contained gender, HPV-status, N-stage, pretreatment ADC_skewness, D, f, metabolic-active tumor volume (MATV), SUV_mean and SUV_peak (AUC = 0.82). Risk stratification in high/medium/low risk was significantly prognostic for LRFFS (p = 0.002), DMFS (p < 0.001) and OS (p = 0.003). Conclusions: Intratreatment functional imaging parameters capture early tumoral changes that only provide prognostic information regarding LRFFS. The best LRFFS model consisted of pretreatment, intratreatment and Δ functional imaging parameters; the DMFS model consisted of only pretreatment functional imaging parameters, and the OS model consisted ofHPV-status, gender and only pretreatment functional imaging parameters. Accurate clinically applicable risk stratification calculators can enable personalized treatment (adaptation) management, early on during treatment, improve counseling and enhance patient-specific post-therapy monitoring. [ABSTRACT FROM AUTHOR]

Biliary atresia is a complex disorder dependent on multidisciplinary management. A series of comprehensive national audits in the United Kingdom and France exposed a clear relationship between center volume and clinical outcomes. Different models were adopted in each country in an attempt to improve results. In the United Kingdom, the management of biliary atresia was centralized to three specialist units in 1999, whereas in France, a strategy of decentralized management with closer inter-unit cooperation was adopted in 1997. Both policy changes led to improved outcomes for infants with biliary atresia, but only centralization improved the overall results of Kasai portoenterostomy. Other countries have adopted alternative systems of audit based on voluntary registries, but the impact of these on clinical outcomes at a national level remains unknown. The utility of monitoring tools in assessing performance in biliary atresia, the importance of risk stratification, and the need for standardized definitions of outcome are highlighted. [Copyright &y& Elsevier]

Necrotizing enterocolitis (NEC) remains a major cause of morbidity and death in neonates. The 30% to 50% mortality rate for NEC with perforation has not changed appreciably in the past 30 years. The critical relevant outcomes following NEC include survival, gastrointestinal function, and neurodevelopmental status. In each of these areas, initial anecdotal and case-series analysis has been followed by studies using more sophisticated methods of analysis. The single most important predictor of outcome, besides gestational age, is whether or not the disease has progressed to the point requiring surgical intervention. Patients with NEC requiring operation have a high mortality. Moreover, the vast majority of morbidity following NEC occurs in the patients who survive following operation. The purpose of this review is to examine the evolution of evidence regarding outcomes for patients with NEC and to provide an update on our current state of knowledge. [Copyright &y& Elsevier]

This study compared case volume and operative mortality from surgery for colorectal cancer in England derived from Hospital Episode Statistics (HES) with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) colorectal cancer database. Data extracted from HES records for 2001–2002 for patients undergoing one of seven procedures for colorectal cancer were compared with those from the ACPGBI database. The primary endpoint was a 30-day post-operative mortality. 16,346 patients from HES were compared with 7,635 from the ACPGBI database. For trusts with patients in both databases, HES reported 12% more procedures than ACPGBI (7,516 vs 6,617). Records of anterior resection revealed reasonable agreement between HES and the ACPGBI databases (difference, 2%). By trust, the overall correlation between the reported procedures was 0.660. Reported crude mortality was inconsistent between the databases, with mortality from abdominoperineal excision of rectum showing the poorest correlation ( r = 0.253). Overall, agreement between reported caseload and mortality was reasonable at a national, but not hospital, level. Investigation of differences between the two databases at unit level may help to detect under reporting of cases. The combination of data from both sources could be used to develop an enhanced system for monitoring outcomes from colorectal surgery in England. [ABSTRACT FROM AUTHOR]

The technical nature of radiotherapy requires different data collection strategies for outcomes reporting than those required for most other disciplines in clinical medicine. To correlate advances in radiotherapy technology with treatment outcomes, it is necessary to integrate a given radiotherapy outcomes-study database with the record-and-verify database and with the global hospital database. The authors review the recent development of each of these categories of databases from the vantage point of radiotherapy. Their goal was to integrate these 3 databases for outcomes analyses in radiotherapy at their institution; this process involved (1) the construction of an interface between the record-and-verify database and the outcomes-study database and (2) the use of a bioinformatics database linking the outcomes-study database and the global hospital database. This bioinformatics database was successfully queried in a manner that allowed streamlining data flow of relevance to radiotherapy outcomes studies. Future directions of the application of this integration are discussed. [Copyright &y& Elsevier]

Introduction: For liver transplant candidates with hepatocellular carcinoma (HCC), the ability of neoadjuvant transarterial chemoembolization (TACE) to improve outcomes remains unproven. The objective of our study was to determine if there was a specific time interval where neoadjuvant TACE would decrease the number of HCC patients removed from the pretransplant waitlist.Materials and Methods: A decision model was developed to simulate a randomized trial of neoadjuvant treatment with TACE vs. no TACE in 600 virtual patients with HCC and cirrhosis. Transition probabilities for TACE morbidity (1 +/- 1%), TACE response rates (30 +/- 20%), and disease progression (7 +/- 7% per month) were assigned by systematic review of the literature (18 reports). Sensitivity analyses were performed to determine time thresholds where TACE would decrease the number of delisted patients.Results: TACE treatment had statistical benefit at waitlist time breakpoints of 4 and 9 months (P < 0.05). When waitlist times were less than 4 months, waitlist attrition was similar (20% vs. 34%, P = 0.08). When waitlist times exceed 9 months, waitlist dropout rates re-equilibrated (33% vs. 46%, P = 0.06). Review of the current literature determined that only those studies reporting on patients with waitlist times between 4 and 9 months found a benefit to neoadjuvant TACE.Conclusions: This analysis indicates that the benefit of neoadjuvant TACE may be limited to those patients transplanted from 4 to 9 months from first TACE. These data may help transplant programs to tailor TACE treatments based on predicted waitlist times to achieve optimal resource utilization and improved organ allocation efficiency. [ABSTRACT FROM AUTHOR]

The article analyzes the responsiveness of Scoliosis Research Society (SRS)-22 instrument to change in adult scoliosis patients with primary spinal deformity surgery. A multicenter prospective series of patients were administered SRS-22, Oswestry Disability Index (ODI) and Short Form-12(SF-12) questionnaires. Based on the results, the greatest responsiveness to change was demonstrated by the SRS self-image domain followed by SRS total.

Assessment of peer-reviewed literature and personal experience with publications and grant organization.This is an analysis of the current status of evidence-based medicine for primary adult spinal deformity to answer the question of whether surgical treatment benefits patients.A limited number of evidence-based studies have been performed for primary adult scoliosis and spinal deformity surgery. None of these studies is ideal.This is an assessment of current literature and study group methodology in an attempt to provide an evidence-based medicine approach for the study of primary presentation adult scoliosis and related spinal deformity.Many reasonable studies exist; however, there are no current definitive studies that answer the question posed above. There are many obstacles, both financial and organizational, to producing an “ideal” study. Most smaller studies suggest that surgical treatment of primary adult scoliosis benefits the patient. However, there is no multicenter prospective randomized study to answer this question.A multicenter funded study is needed to answer appropriate questions. [ABSTRACT FROM AUTHOR]

The article looks at the comparison between the Scoliosis Research Society-22r (SRS-22r) patient questionnaire and the Child Health Questionnaire-CF87 (CHQ-CF87) patient questionnaire for adolescent spinal malformation. These assessment tools are part of the health-related quality-of-life (HRQL) questionnaires and both were evaluated for their reliability and validity.