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OBJECTIVE We aimed to investigate the perception of radiation oncologists about artificial intelligence (AI), their current use of AI in clinical practice, and their expectations, concerns, and wishes in terms of the future of radiation oncology (RO) in the era of AI. METHODS An electronic survey was created. RESULTS A total of 108 radiation oncologists participated. One-fourth (24.3%) rated their knowledge of AI as very poor. The majority (94%) reported that they need training about AI. Most respondents (62.6%) indicated that they had never used any AI application. Nearly 90% reported that the introduction of AI would improve RO. Image analysis and target definition were identified as key benefits of AI in RO by 84% of respondents. The medical liability due to machine error and black box uncertainties was the greatest concerns. The need for clinical validation of AI applications, development of ethical frameworks, and medicolegal guidelines was identified as priorities before the implementation of AI in RO by 86%, 78%, and 68%, respectively. CONCLUSION There was a big gap in knowledge within our RO community. The enthusiasm to learn was high. AI applications have not been imposed much in clinical routine. Mostly, the participants felt optimistic about the introduction of AI. The top areas where AI was thought to be most useful in RO were reliant on imaging. The respondents were mostly concerned about the medical liability. [ABSTRACT FROM AUTHOR]

Aim of the study: There is a paradigm shift in the management of gastric varices with the availability of endoscopic ultrasound and radiologic interventions. The optimal choice of intervention remains a dilemma for most treating physicians. Material and methods: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and Science-Direct for studies comparing endoscopic glue injection, endoscopic thrombin injection (THB), variceal band ligation, EUS-guided coiling, EUS-guided glue injection, EUS-guided coiling with glue (EUS-C+G), balloon occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS) for gastric varices in adults. The data on four outcomes - obliteration of varices, rebleeding, adverse effects, and mortality - were pooled using a random-effects model. Treatment estimates were calculated as odds ratios (ORs) along with their 95% confidence interval (CI). The relative ranking of interventions for various outcomes was calculated as their surface under the cumulative ranking curve (SUCRA). Results: We identified 34 studies (10 randomized controlled trials, 24 non-randomized trials) with 2783 patients. Based on SUCRA plots, BRTO (SUCRA 95.1) had the highest rate of variceal obliteration followed by EUS-C+G (SUCRA 80.9). The risk of rebleeding was lowest with BRTO (SUCRA 85.1) followed by EUS-C+G (SUCRA 78.8). Moderate-severe adverse effects were least likely with THB (SUCRA 92.5) and highest with TIPS (SUCRA 3.7). In terms of mortality, EUS-C+G (73.5) had the lowest probability of overall mortality followed by TIPS (69.1). Conclusions: In this network meta-analysis, we found BRTO and EUS-guided therapies to be superior to endoscopic glue injection. However, the level of evidence remains low. [ABSTRACT FROM AUTHOR]

Tibiotalocalcaneal (TTC) arthrodesis is considered a salvage procedure for either complex deformity or arthritis about the hindfoot, and can be performed via fibula-resection (FR) or fibula-sparing (FS) approaches. The primary aim of this study was to investigate differences in outcomes in FR versus FS TTC arthrodeses. This was a retrospective cohort study reviewing outcomes of TTC arthrodesis at a single institution. Patients who underwent a TTC arthrodesis from 2005 to 2017 and had minimum two-year follow-up were included. Preoperative diagnosis, pre- and post-operative radiographic coronal alignment, fixation methods, and complications were compared between groups. 107 patients (110 ankles) underwent TTC arthrodesis, with a mean age of 57.0 years (sd, 14.0 years). The mean clinical follow-up was 50.7 months (range, 24–146) and mean radiographic follow-up was 45.8 months (range, 6–146 months). Pre-operative diagnoses included arthritis (N = 40), prior non-union (N = 21), Charcot neuro-arthropathy (N = 15), failed total ankle arthroplasty (N = 15) and avascular necrosis of the talus (N = 19). Sixty-nine ankles comprised the FS group and 41 comprised the FR group. There was no significant difference in the non-union rate between groups (29% FR vs 38% FS, p = 0.37), complication rate (59% FR vs 64% FS, p = 0.59), or post-operative coronal standing radiographic alignment (89.6 degrees FR, 90.5 degrees FS, p = 0.26). Logistic regression analyses demonstrated a pre-operative diagnosis of failed TAA was associated with post-operative nonunion (OR:3.41,CI:1.13–11.04,p = 0.03). Pre-operative indication for TTC arthrodesis of arthritis alone was associated with a decreased risk of non-union (OR:0.27,CI:0.11–0.62,p = 0.002). TTC arthrodesis is a successful surgical option for complex hindfoot deformity, arthritis, and limb salvage regardless of surgical approach. We did not detect a difference in the union rate, incidence of complications, or coronal plane radiographic alignment in fibula-sparing versus fibula-resection constructs. Patients with a pre-operative indication for surgery of arthritis may be at decreased risk of developing non-union. III – Retrospective cohort study [ABSTRACT FROM AUTHOR]

The aim of the present review was to analyze the available evidence in the literature on the clinical and radiological outcomes of multilayered biomimetic scaffolds in the treatment of osteochondral lesions of the talus (OLTs). A systematic search was performed in three databases to identify clinical trials, where the multilayered biomimetic scaffolds were used for the treatment of OLTs. The PRISMA guidelines were followed. Qualitative analysis of the relevant data of the included studies was executed. The methodological quality of the analyzed studies was assessed with a modified Coleman Methodology Score (CMS). A total of 10 studies with 87 patients were included in the analysis. Only three multilayered biomimetic scaffolds have been investigated in clinical trials for the treatment of OLTs. The worst clinical and radiological outcomes, as well as safety profile were observed for the TruFit scaffold (Smith & Nephew, Andover, MA, USA), which had already been withdrawn from the market. The other two scaffolds (MaioRegen, Finceramica, Italy; Agili-C, Cartiheal, Israel) performed significantly better in the majority of the reviewed studies, especially in the clinical aspect. The radiological findings, the improvements of MOCART scores, the completeness of lesions' fill, and the structure of regenerated tissue were much more inconsistent. Two of the multilayered biomimetic scaffolds demonstrated an adequate potential in the treatment of complex OLTs. However, limited studies availability and their low level of medical evidence request further high-level investigations before the clinical decision making for such scaffolds in the treatment of OLTs can be defined. [ABSTRACT FROM AUTHOR]

Objective: To describe the radiological characteristics of hepatocellular carcinoma (HCC) lesions that achieved a complete response following drug-eluting bead transarterial chemoembolization (DEB-TACE) preceding liver transplantation. Methods: This single-center case-control study enrolled patients with hepatocellular carcinoma who underwent neoadjuvant DEB-TACE therapy, were followed up with contrast-enhanced magnetic resonance imaging or computed tomography, and were successively evaluated according to the modified Response Evaluation Criteria in Solid Tumors. The HCCs were divided into two groups based on their diameter (Group A: =3cm; Group B: 3cm). Viability was assessed using the Kaplan-Meier method according to tumor size categories. The relationship between tumor variables was analyzed using bivariate Cox regression. Results: Three-hundred and twenty-eight patients with 667 hepatocellular carcinomas who underwent their first DEB-TACE session were enrolled. A total of 105 hepatocellular carcinomas in 59 patients exhibited complete response after the initial DEB-TACE session and were divided into Group A (92 HCCs) and Group B (13 HCCs). The diameter in Group A decreased significantly compared to the pre-procedure size until the second assessment (p<0.001), with no subsequent reduction in diameter, despite maintaining a complete response. In Group B, the reduction in diameter remained significant compared with the initial value until the sixth imaging evaluation (p=0.014). The average reduction was 45.1% for Group B and a maximum of 14.9% in Group A. Conclusion: HCCs >3cm exhibited a greater reduction in size and a longer time to recurrence. HCCs =3cm had a shorter relapse time. The recurrence rates were similar. These findings may aid in planning for liver transplantation. [ABSTRACT FROM AUTHOR]

Copyright of Radiology News Journal / Radiološki Vjesnik is the property of Croatian Association of Radiation Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Radiology News Journal / Radiološki Vjesnik is the property of Croatian Association of Radiation Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The author describes her experience of working in diagnostic radiology, transitioning to interventional radiology and cardiac catheterization laboratory and offers a look on the progress of technological developments. She shares her observations on the work of a special procedures team setting up the sterile field. She discusses the advent of the Siemens MICOR hemodynamic monitoring system, electrophysiology, automated implantable cardiac defibrillator, and extracorporeal membrane oxygenation.

Rathke's cleft cysts (RCC) are rare benign cystic lesions that might present with different imaging features, potentially posing a problem in the radiological diagnosis of cystic sellar lesions. The purpose of this pictorial review is to present an overview of the radioclinical features of RCC through four clinical cases with different radiologic findings confirmed by pathology, as well as reviewing the common differential diagnosis to be considered. The subjects are women, aged 11 to 73 who underwent recent transsphenoidal surgical resection with a postoperative follow-up period of a few months to three years. [ABSTRACT FROM AUTHOR]

On November 18, 2023, the annual meeting of the Belgian Society of Radiology (BSR) will be hosted at the KBC headquarters in Brussels. This year's topic will be "Non-Invasive Cardiovascular Radiology." Together with the Young Radiologist Section (YRS) of the BSR, this event will feature interesting high-quality lectures on a myriad of topics in vascular imaging. [ABSTRACT FROM AUTHOR]

Ewing's sarcoma (ES) is a malignant tumor that arises mainly from bone tissue. Primary extraosseous Ewing sarcoma (EES) is a rare form of the Ewing's sarcoma family of tumor, and pelvic localization is even more unusual, considered to be one of the rarest localizations [1]. We present the case of a seven-year-old boy with persistent abdominal pain. Ultrasound (US), contrast-enhanced computed tomography (CECT), and magnetic resonance imaging (MRI) revealed the presence of a large, solid, and heterogeneous mass in the pelvis. The histological and immunohistochemistry were compatible with pelvic EES. Teaching point: Extraosseous Ewing's sarcoma is a rare pediatric tumoral entity that requires clinician and radiological vigilance and detection. [ABSTRACT FROM AUTHOR]

Teaching Point: Osteoid osteoma is one of the most frequent benign bone tumors; however, when found in the toes it usually presents atypical clinical and radiological features including soft tissue swelling that can lead to misdiagnosis. [ABSTRACT FROM AUTHOR]

Lingual foregut duplication cysts are rare developmental anomalies with varied symptoms, and adenocarcinomas may develop from them. Radiological evaluations, including computed tomography and magnetic resonance imaging, can help diagnose these lesions and determine their extent. Abnormal enhancement should raise the suspicion of malignancy of a lingual foregut duplication cyst. Early detection and complete surgical resection of lingual foregut duplication cysts are necessary to prevent malignant transformations. Complete tumor resection with adjuvant radiotherapy or radiochemotherapy is recommended. The teaching point is that mucinous adenocarcinoma can develop from a lingual foregut duplication cyst, and radiological studies may aid in the diagnosis. Teaching Point: Adenocarcinomas can develop from lingual foregut duplication cysts, which are rare developmental anomalies, and radiologic studies may aid in the diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: Myelination-related MR signal changes in white matter are helpful for assessing normal development in infants and children. A rule-based myelination evaluation workflow regarding signal changes on T1-weighted images (T1WIs) and T2-weighted images (T2WIs) has been widely used in radiology. This study aimed to simulate a rule-based workflow using a stacked deep learning model and evaluate age estimation accuracy. Methods: The age estimation system involved two stacked neural networks: a target network-to extract five myelination-related images from the whole brain, and an age estimation network from extracted T1- and T2WIs separately. A dataset was constructed from 119 children aged below 2 years with two MRI systems. A four-fold cross-validation method was adopted. The correlation coefficient (CC), mean absolute error (MAE), and root mean squared error (RMSE) of the corrected chronological age of full-term birth, as well as the mean difference and the upper and lower limits of 95% agreement, were measured. Generalization performance was assessed using datasets acquired from different MR images. Age estimation was performed in Sturge--Weber syndrome (SWS) cases. Results: There was a strong correlation between estimated age and corrected chronological age (MAE: 0.98 months; RMSE: 1.27 months; and CC: 0.99). The mean difference and standard deviation (SD) were -0.15 and 1.26, respectively, and the upper and lower limits of 95% agreement were 2.33 and -2.63 months. Regarding generalization performance, the performance values on the external dataset were MAE of 1.85 months, RMSE of 2.59 months, and CC of 0.93. Among 13 SWS cases, 7 exceeded the limits of 95% agreement, and a proportional bias of age estimation based on myelination acceleration was exhibited below 12 months of age (P = 0.03). Conclusion: Stacked deep learning models automated the rule-based workflow in radiology and achieved highly accurate age estimation in infants and children up to 2 years of age. [ABSTRACT FROM AUTHOR]

A 5-year-old girl with skin hardness and thickening was admitted to our clinic and diagnosed with scleredema of Buschke clinically and histopathologically. Ultraviolet A1 (UVA1) phototherapy at a dose of 30 J/cm2 was planned for 3 days in 1 week. After 45 UVA1 phototherapy sessions (with a cumulative dose of 1350 J/cm²), clinical complete remission was achieved. Ultrasonography revealed improvement in skin thickening, and no recurrence was noted in the 2-year follow-up period. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Actinomycosis is a rare chronic suppurative granulomatous infection of the oropharynx, gastrointestinal, and urogenital tract. Infection most commonly manifests as a cervicofacial disease but less frequently in the thoracic and abdominopelvic region. Hepatic actinomycosis (HA) is rare and usually secondary to abdominal actinomycosis. It can mimic hepatic malignant tumors. There is not enough information in the literature about HA. In this study, radiological and clinical findings of HA cases were investigated. Between January 2013 and February 2021, a total of 12 patients diagnosed with HA were retrospectively analyzed. Significant clinical and laboratory findings and radiological findings related to current pathology were noted. The mean age of the patients ranged from 23 to 75 years (mean age, 52.2 years). There were 7 male and 5 female patients. 85% of these patients had fever, 67% anemia, and 53% weight loss. Peripheral blood leukocytes were increased in all patients. 8 of the patients (66%) had a secondary infection of HA in the lungs, and pelvis organs. Radiologically, they were mostly low-intensity changes (66%), making them easily misdiagnosed as metastatic cancer and primary liver cancer. 17% seen acute bacterial abscess-like changes. A few cases exhibited cystic mass-like changes. In 64% of the patients, a single lesion was found. The right lobe of the liver was the most common infection area. A definitive diagnosis was made by histopathological examination. The diagnosis of primary HA is difficult to diagnose because of the nonspecific clinical and radiological findings. Differential diagnoses should be made with diseases that include both benign and malignant conditions. [ABSTRACT FROM AUTHOR]

Flagging the presence of cardiac devices such as pacemakers before an MRI scan is essential to allow appropriate safety checks. We assess the accuracy with which a machine learning model can classify the presence or absence of a pacemaker on pre-existing chest radiographs. A total of 7973 chest radiographs were collected, 3996 with pacemakers visible and 3977 without. Images were identified from information available on the radiology information system (RIS) and correlated with report text. Manual review of images by two board certified radiologists was performed to ensure correct labeling. The data set was divided into training, validation, and a hold-back test set. The data were used to retrain a pre-trained image classification neural network. Final model performance was assessed on the test set. Accuracy of 99.67% on the test set was achieved. Re-testing the final model on the full training and validation data revealed a few additional misclassified examples which are further analyzed. Neural network image classification could be used to screen for the presence of cardiac devices, in addition to current safety processes, providing notification of device presence in advance of safety questionnaires. Computational power to run the model is low. Further work on misclassified examples could improve accuracy on edge cases. The focus of many healthcare applications of computer vision techniques has been for diagnosis and guiding management. This work illustrates an application of computer vision image classification to enhance current processes and improve patient safety. [ABSTRACT FROM AUTHOR]

Simple Summary: Endometrial cancer (EC) is one of the most common malignant tumors in gynecology. The prognosis of patients with early EC is good; however, high-risk EC patients have a poor prognosis because they have a higher risk of tumor recurrence, lymph node metastasis, and distant tumor spread. At present, there are no structured ultrasound reporting standards for endometrial lesions. The high specificity of serum tumor biomarkers for EC has not been found in current studies. The present results show that the international endometrial tumor analysis (IETA) ultrasonic features combined with gynecologic imaging reporting and data system (GI-RADS) and tumor biomarkers provides a novel, safe, real-time technology for surveillance of EC. This study is clinically significant since it shows that the IETA ultrasonic features combined with the GI-RADS classification system and tumor biomarkers method have good performance in discriminating EC. It has the potential to be used as a screening tool to distinguish the benign and malignant lesions of the uterine cavity or endometrium very well. Objectives: We were the first to combine IETA ultrasonic features with GI-RADS and tumor biomarkers for the surveillance of endometrial carcinoma. The aim was to evaluate the efficacy of single IETA ultrasonography GI-RADS classification and combined tumor biomarkers in differentiating benign and malignant lesions in the uterine cavity and endometrium. Methods: A total of 497 patients with intrauterine and endometrial lesions who had been treated surgically between January 2017 and December 2021 were enrolled; all of them had undergone ultrasound examinations before surgery. We analyzed the correlation between the terms of ultrasonic signs of the uterine cavity and endometrial lesions defined by the expert consensus of IETA and the benign and malignant lesions and then classified these ultrasonic signs by GI-RADS. In addition, the tumor biomarkers CA125, CA15-3, CA19-9 and HE4 were combined by adjusting the classification. The results of the comprehensive analysis were compared with pathological results to analyze their diagnostic efficacy. Results: (1) The statistic analysis confirmed that there were seven independent predictors of malignant lesions, including thickened endometrium (premenopause ≥ 18.5 mm, postmenopause ≥ 15.5 mm), non-uniform endometrial echogenicity (heterogeneous with irregular cysts), endometrial midline appearance (not defined), the endometrial–myometrial junction (interrupted or not defined), intracavitary fluid (ground glass or "mixed" echogenicity), color score (3~4 points) and vascular pattern (focal origin multiple vessels or multifocal origin multiple vessels). (2) In traditional ultrasound GI-RADS (U-T-GI-RADS), if category 4a was taken as the cut-off value of benign and malignant, the diagnostic sensitivity, specificity, PPV, NPV and diagnostic accuracy were 97.2%, 65.2%, 44.0%, 98.8% and 72.2%, respectively, and the area under the ROC curve (AUC) was 0.812. If 4b was taken as the cut-off value, the diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 88.1%, 92.0%, 75.6%, 96.5% and 91.2%, 0.900, respectively. The diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 75.2%, 98.5%, 93.2%, 93.4%, 93.4% and 0.868, respectively, when taking category 5 as the cutoff point. In modified ultrasound GI-RADS (U-M-GI-RADS), if 4a was taken as the cut-off value, The diagnostic efficacy was the same as U-T-GI-RADS. If 4b was taken as the cut-off value, the diagnostic sensitivity, specificity, PPV, NPV, diagnostic accuracy and AUC were 88.1%, 92.3%, 76.2%, 96.5%, 91.3% and 0.902, respectively. If 4c was taken as the cutoff point, the diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 75.2%, 98.7%, 94.3%, 93.4%, 93.6% and 0.870, respectively. The diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 66.1%, 99.7%, 98.6%, 91.3%, 92.4% and 0.829, respectively, if taking category 5 as the cutoff point. (3) In the comprehensive diagnostic method of U-T-GI-RADS combined tumor biomarkers results, the AUC of class 4a, 4b and 5 as the cutoff value was 0.877, 0.888 and 0.738, respectively. The AUC of class 4a, 4b, 4c and 5 as the cutoff value in the comprehensive diagnostic method of U-M-GI-RADS combined tumor biomarkers results was 0.877, 0.888, 0.851 and 0.725, respectively. There was no significant difference in diagnostic efficiency between the two comprehensive diagnostic methods. Conclusions: In this study, no matter which diagnostic method was used, the best cutoff value for predicting malignant EC was ≥GI-RADS 4b. The GI-RADS classification had good performance in discriminating EC. The tumor biomarkers, CA125, CA19-9, CA15-3 and HE4, could improve the diagnostic efficacy for preoperative endometrial carcinoma assessment. [ABSTRACT FROM AUTHOR]

Simple Summary: Grey scale ultrasound assessment is primarily used in the differential diagnosis of thyroid nodules. However, in recent years the assessment of tissue elasticity using shear wave elastography (SWE) has been suggested to have additional diagnostic value in thyroid cancer diagnosis. The aim of the present study was to evaluate the diagnostic efficiency of SWE in combination with grey scale ultrasound malignancy risk-stratification based on the European (EU) thyroid management guideline based on nodule size stratifications and indeterminate cytology status. We established that the combined approach had high diagnostic efficacy in differentiating malignant and benign nodules > 1 cm. However, in nodules with indeterminate cytology the approach highly discriminated benign nodules but resulted in low sensitivity which was indicative of an undesirable high false negative rate. The combination of SWE and the EU guideline is therefore most useful when evaluating non-micro-nodules based on size. Although multimodal ultrasound approaches have been suggested to potentially improve the diagnosis of thyroid cancer; the diagnostic utility of the combination of SWE and malignancy-risk stratification systems remains vague due to the lack of standardized criteria. The purpose of the study was to assess the diagnostic value of the combination of grey scale ultrasound assessment using EU TIRADS and shear wave elastography. 121 patients (126 nodules–81 benign; 45 malignant) underwent grey scale ultrasound and SWE imaging of nodules between 0.5 cm and 5 cm prior to biopsy and/or surgery. Nodules were analyzed based on size stratifications: <1 cm (n = 43); 1–2 cm (n = 52) and >2 cm (n = 31) and equivocal cytology status (n = 52), and diagnostic performance assessments were conducted. The combination of EU TIRADS with SWE using the SD parameter; maintained a high sensitivity and significantly improved the specificity of sole EU TIRADS for nodules 1–2 cm (SEN: 72.2% vs. 88.9%, p > 0.05; SPEC: 76.5% vs. 55.9%, p < 0.01) and >2 cm (SEN: 71.4% vs. 85.7%, p > 0.05; SPEC: 95.8% vs. 62.5%, p < 0.01). For cytologically-equivocal nodules; the combination with the SWE minimum parameter resulted in a significant reduction in sensitivity with increased specificity (SEN: 60% vs. 80%; SPEC: 83.4% vs. 37.8%; all p < 0.05). SWE in combination with EU TIRADS is diagnostically efficient in discriminating nodules > 1 cm but is not ideal for discriminating cytologically-equivocal nodules. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is a viral disease that causes life-threatening health problems during acute illness, causing a pandemic and millions of deaths. Although computed tomography (CT) was used as a diagnostic tool for COVID-19 in the early period of the pandemic due to the inaccessibility or long duration of the polymerase chain reaction tests, current studies have revealed that CT scan should not be used to diagnose COVID-19. However, radiologic findings are vital in assessing pneumonia severity and investigating complications in patients with COVID-19. Long-term symptoms, also known as long COVID, in people recovering from COVID-19 affect patients' quality of life and cause global health problems. Herein, we aimed to summarize the lessons learned in COVID-19 pneumonia, the challenges in diagnosing the disease and complications, and the prospects for future studies. [ABSTRACT FROM AUTHOR]

PURPOSE The study aimed to evaluate the performance of radiology residents (RRs) when using a dedicated structured report (SR) template for chest high-resolution computed tomography (HRCT) in patients with suspected connective tissue disease-interstitial lung disease (CTD-ILD), compared to the traditional narrative report (NR). METHODS We retrospectively evaluated 50 HRCT exams in patients with suspected CTD-ILD. A chestdevoted radiologist reported all HRCT exams as the reference standard, pointing out pulmonary fibrosis findings (i.e., honeycombing, traction bronchiectasis, reticulation, and volume loss), the presence and pattern of ILD, and possible other diagnoses. We divided 4 RRs into 2 groups according to their expertise level. In each group, RRs reported all HRCT examinations alternatively with NR or SR, noting each report's reporting time. The Cohen's Kappa, Wilcoxon, and McNemar tests were used for statistical analysis. RESULTS Regarding the pulmonary fibrosis findings, we found higher agreement between RRs and the reference standard reader when using SR than NR, regardless of their expertise level, except for volume loss. RRs' accuracy for "other diagnosis" was higher when using SR than NR, moving from 0.48 to 0.66 in the novel group (P = .035) and from 0.44 to 0.80 in the expertise group (P < .001). No differences in accuracy were found between ILD presence and ILD pattern. The reporting time was significantly lower (P = .001) when using SR than NR. CONCLUSION SR is of value in increasing the reporting of critical chest HRCT findings in the complex CTD-ILD scenario and should be used early and systematically during residency. [ABSTRACT FROM AUTHOR]

PURPOSE We aimed to establish a liver function evaluation model by combining multiparametric magnetic resonance imaging (MRI) with liver volume (LV) and further verify the effectiveness of the model to evaluate liver function. METHODS This retrospective study included 101 consecutive cirrhosis patients (69 cases for modeling group and 32 cases for validation group) who underwent gadoxetic acid-enhanced MRI. Five signal intensity parameters were obtained by measuring the signal intensities of the liver, spleen, and erector spinae before and 20 minutes after gadoxetic acid disodium enhancement. The diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were obtained from intravoxel incoherent motion diffusion-weighted imaging. The LV parameters (Vliver, Vspleen, and Vliver/Vspleen) were obtained using 3-dimensional image generation software. The most effective parameter was selected from each of the 3 methods, and a multivariate regression model for liver function evaluation was established and validated. RESULTS In the modeling group, relative enhancement (RE), D*, and Vliver/Vspleen showed significant differences among the different liver function groups (P < .001). Receiver operating characteristic analysis showed that these parameters had the highest area under the curve (AUC) values for distinguishing Child-Pugh A from Child-Pugh B and C groups (0.917, 0.929, and 0.885, respectively). The following liver function model was obtained by multivariate regression analysis: F(x) = 3.96 - 1.243 (RE) - 0.034 (D*) - 0.080 (Vliver/Vspleen) (R2 = 0.811, P < .001). In the patients with cirrhosis, the F(x) of Child-Pugh A, B, and C were 1.16 ± 0.44, 1.95 ± 0.29, and 2.79 ± 0.38, respectively. In the validation group, the AUC for F(x) to distinguish Child-Pugh A from Child-Pugh B and C was 0.973. CONCLUSION Combining multiparametric MRI with LV effectively distinguished patients with different Child-Pugh grades. This model could hence be useful as a novel radiological marker to estimate the liver function. [ABSTRACT FROM AUTHOR]

PURPOSE Nonclinical factors and cognitive biases have been shown to significantly affect clinical decision making. In this study, we aimed to identify clinical and environmental factors that might influence the decision to approve or reject image-guided radiation therapy (IGRT) images in a large multisite institution. METHODS We identified all IGRT image approval and rejection decisions recorded within an electronic imaging system from July 1, 2016, to June 30, 2018. For each decision, we tabulated the following parameters: the attending physician of the patient, the physician reviewing the image, total images reviewed by the physician that day, time of day, day of week, treatment site, and imaging modality (kilovoltage or cone beam computed tomography [CBCT]). We created a binary multivariable logistic regression model to identify factors associated with IGRT image rejection. RESULTS Overall, of 51,797 total image records evaluated, 881 (1.70%) were rejected and 50,916 (98.30%) were approved. Univariable analysis revealed that images reviewed by physicians with high rejection rates (odds ratio [OR], 3.16; P, .001) and by physicians reviewing fewer IGRT images (OR, 0.99; P 5 .024), images from various anatomic sites (particularly skin, breast, and head and neck), and CBCT imaging compared with kilovoltage imaging (OR, 1.49; P, .001) were associated with the increased rate of rejection. On multivariable analysis, images reviewed by physicians with high rejection rates (OR, 3.28; P, .001), images from specific anatomic sites including breast (P, .001), and CBCT imaging (P, .001) persisted as independent predictors of image rejection. CONCLUSION These data provide important insight into the clinical, cognitive, and environmental factors that might influence the routine clinical decision of IGRT image approval. Recognition of these factors may not only improve the quality of individual decisions but also identify opportunities for systems-based quality improvement in IGRT. [ABSTRACT FROM AUTHOR]

Case-Based Reasoning models are one of the most used reasoning paradigms in expert-knowledge-driven areas. One of the most prominent fields of use of these systems is the medical sector, where explainable models are required. However, these models are considerably reliant on user input and the introduction of relevant curated data. Deep learning approaches offer an analogous solution, where user input is not required. This paper proposes a hybrid Case-Based Reasoning, Deep Learning framework for medical-related applications, focusing on the generation of medical reports. The proposal combines the explainability and user-focused approach of case-based reasoning models with the deep learning techniques performance. Moreover, the framework is fully modular to fit a wide variety of tasks and data, such as real-time sensor captured data, images, or text, to name a few. An implementation of the proposed framework focusing on radiology report generation assistance is provided. This implementation is used to evaluate the proposal, showing that it can provide meaningful and accurate corrections, even when the amount of information available is minimal. Additional tests on the optimization degree of the case base are also performed, evidencing how the proposed framework can optimize this base to achieve optimal performance.

Redefine the role of Radiation Therapists (RTs) by discussing considerations and steps required to incorporate medical directives into their practice within the scope of advanced practice. The focus is to empower RTs to redefine the traditional role of RTs by authorization to perform specific clinical tasks and decision making traditionally reserved for Radiation Oncologists (ROs). This transformative step is directed towards enhancing patient care, increasing efficiency in clinical care and treatment delivery, and advancing the professional scope of RTs. The implementation process commenced with a thorough analysis of existing clinical workflows and the CAMRT's Advanced Practice Radiation Therapist (APRT) competency profile to identify tasks suitable for delegation to RTs under medical directives. This was followed by discussion with ROs, clinical educators and the Medical Advisory Committee. An intensive training program was tailored to equip the APRT with the requisite skills and knowledge for their expanded role. The execution phase saw the APRT assuming responsibilities such as conducting patient assessments, informing patients of their imaging results, obtaining consent and engaging in critical decision making within established guidelines. Continuing monitoring and evaluation were integral to the process and feedback from all stakeholders was obtained. The introduction of medical directives for RTs presents several benefits. Patients benefit from decreased waiting times and enhanced interaction with their care providers, potentially leading to higher satisfaction levels. RTs experience professional growth and diversification of their roles, contributing to increased job satisfaction. The healthcare system as a whole may see optimized workflows and better resource management. However, this initiative also faces challenges. These include ensuring RTs receive comprehensive training for their new responsibilities, maintaining clear legal and professional boundaries, and addressing potential conflicts within the multidisciplinary team. To navigate these challenges, a structured training approach, distinct role definitions, and continuous support from ROs are essential. The implementation of medical directives for RTs marks a significant milestone in the evolution of radiation therapy. Other professions have noted that the increased autonomy improves patient care by ensuring quicker and more efficient treatment, particularly in urgent situations. It also alleviates physicians' workload, allowing them to focus on more complex cases. It fosters professional growth and job satisfaction and contributes to more streamlined healthcare delivery. The long-term implications of this initiative are expected to be transformative for the radiation therapy field. It positions RTs as more integral and autonomous members of the oncology care team, potentially leading to overall improvements in patient care. This initiative serves as a model for other institutions aiming to expand the role of RTs, advocating for a more collaborative, efficient, and patient-focused approach in radiation therapy. [ABSTRACT FROM AUTHOR]

With the increasing prevalence and complexity of re-irradiation cases, there is a need for comprehensive policies and procedures to ensure optimal patient outcomes and minimize risk. A critical incident involving re-irradiation was reported to Ontario Health-Cancer Care Ontario (OH-CCO) which prompted a review of re-irradiation practices across radiation treatment facilities. The aim of the OH-CCO Re-Irradiation Symposium Webinar was to explore re-irradiation incidents and lessons learned and current re-irradiation practices and processes across the province with the goal of knowledge transfer exchange and best practice sharing. In the context of this webinar, re-irradiation was defined as delivery of a new course of radiation therapy to a previously irradiated volume where there is overlap or potential overlap between the two plans. Prior to the webinar, a pre-meeting survey was circulated to the radiation therapy managers at each of Ontario's radiation treatment facilities. The managers were asked to coordinate one submission per centre in collaboration with the inter-professional team. The survey included questions on re-irradiation policy, gathering radiation treatment history and combining previous and current plans. A 100% response rate (n=15) was achieved. The OH-CCO Re-Irradiation Symposium webinar was held in June 2023. The webinar included an overview of the epidemiology of re-irradiation, a review of the pre-meeting survey results, a summary of the Radiation Incident Safety Committee (RISC) analysis of re-irradiation incidents reported to the National System for Incident Reporting-Radiation Treatment (NSIR-RT), a presentation of a critical incident involving re-irradiation and the resulting quality care review recommendations, and a showcase of re-irradiation processes and learnings from three radiation treatment facilities. The webinar also included four discussion periods where participants could ask questions and share their experiences and challenges with re-irradiation processes. A showing of the recorded webinar was hosted in November 2023 for those unable to attend the live event. The benefits of the webinar included bringing representatives from all radiation treatment facilities to participate in knowledge transfer exchange and best practice sharing, as well as increasing awareness of variation in current re-irradiation processes and challenges with creating or updating these processes. 93% of radiation treatment facilities indicated during the pre-meeting survey that they would be interested in sharing their re-irradiation policy/process with other facilities highlighting an appetite for continued collaboration amongst facilities. The main challenge of the webinar was the size of the group and the virtual setting, which made participation in discussion more difficult and limited the interaction among attendees. Over 180 participants attended the live webinar and/or the showing of the recording. There was representation from each of Ontario's radiation treatment facilities including participants from multiple areas of the multidisciplinary team (i.e. radiation oncologists, medical physicists, clinical specialist radiation therapists, radiation therapists, dosimetrists, clinical educators, radiation nurses, management, students etc.). Opportunities for continued collaboration and best practice sharing have stemmed from this webinar. Suggestions for future symposia topics were raised by the participants; these will be explored by the OH-CCO team. Work is underway to collect re-irradiation policies/processes from each of Ontario's radiation treatment facilities with the goal of developing a recommendation document to support creating or updating these processes to improve their effectiveness. There has also been interest in forming a provincial re-irradiation working group to establish provincial guidelines and promote consensus on re-irradiation practices both clinically and logistically. [ABSTRACT FROM AUTHOR]

Adaptive radiation therapy is a novel treatment technique that has been recently adopted at our institution. While standard radiation therapy treatment is delivered solely by radiation therapists, adaptive radiation therapy requires a multidisciplinary model for a patient's daily treatment. We developed role definitions and a workflow that allows Radiation Therapists, Radiation Oncologists and Medical Physicists to provide seamless and efficient delivery of adaptive radiation therapy to patients at our institution. Four team members were identified as essential in providing adaptive radiation therapy. These roles include, a Radiation Oncologist, a Medical Physicist and two Radiation Therapists. The two Radiation Therapists (RTT) are identified as RTT1 and RTT2. RTT1 and RTT2 are responsible for acquiring cone beam computed tomography (CBCT) images, assessment of CBCT and delivery of the radiation treatment. The adaptive therapy specific responsibilities of RTT1 are contouring the influencing organs at risk, confirmation of the selected plan name and verification of monitor units if the adapted plan is chosen. RTT2 is responsible for transcribing any information related to the contouring of anatomy and plan selection as noted by team members. The Radiation Oncologist is responsible for contouring the influencing target structures as well as, verifying derived targets volumes and plan selection. The Medical Physicist is responsible for providing an independent dose quality assurance of the selected plan during the adaptive process. Multiple mock treatment sessions were performed with all team members present prior to go-live of our adaptive treatment process. This allowed team members to refine the workflow and create workstations within the treatment console, enabling us to identify any issues or challenges and adjust as needed. The benefit of performing multiple mock treatment sessions allowed team members to refine and become familiar with their role and improve workflow. This also provided a better understanding of individual responsibilities of the multi-disciplinary team enabling a collaborative and efficient working environment. The main challenge was ensuring that all team members were available to participate in treatment mock sessions to become familiar with the workflow. Also, due to the limited size of the treatment console remodeling of the workstations needed to occur as well as procurement of new equipment. Performing the mock treatment sessions allowed each team member to become familiar with their part in the overall workflow, make adjustments based on identified challenges and create a smooth and efficient treatment process. As a result, each team member felt confident when treating the first adaptive patient. [ABSTRACT FROM AUTHOR]

In 2007 a new model of care was piloted in Ontario, Canada that incorporated an advanced practiced radiation therapist, entitled 'clinical specialist radiation therapist' (CSRT), into the care team. The CSRT is a registered radiation therapist (MRT(T)) that has additional education and training that allows the CSRT to work autonomously for specific duties within their areas of expertise. CSRTs can focus their efforts on variety of sites/specialties however; the most common area of focus is on palliative radiation therapy (RT). Palliative CSRTs (pCSRT) have shown to expedite care, provide timesaving's for radiation oncologists (RO's), enhance access to care and increase patient satisfaction. pCSRT role was established within our center in October 2022. To help identify areas for pCSRT involvement, the plan-do-study-act (PDSA) model was used. The PDSA model is an iterative process that aims to identify areas for improvement and provide an adaptable process to provide thoughtful results. A survey to identify areas of improvement for palliative RT was sent out to MRT(T)s in late October 2022. One major theme identified from respondents was the necessity for upfront pain control for patients receiving palliative RT. Preliminary audits of boney metastatic cases treated with RT from January 2023-March 2023 identify approximately 23% of patients having documented uncontrolled pain during course of RT, with 31% of patients complaining of uncontrolled pain requiring subcutaneous analgesic injection while on treatment. This project aims evaluate pCSRT impact on patient reported pain scores. The secondary objectives are to determine if the incorporation of pCSRT decreases the need for subcutaneous analgesic injection due to pain crisis at treatment. pCSRT to complete pre-CT simulation assessments from June 13, 2023 to Oct 18 2023. Assessments were limited to outpatients receiving palliative RT to boney metastatic sites and excluded inpatients as well as those who received multisite RT that incorporated lesions outside of the bone. Due to unplanned code grey downtime within our institution from Oct 20, 2023 to Jan 4, 2024, patients who were assessed prior by pCSRT but treatment was not initiated until during Cyberattack were not included. Pre-CT simulation assessment includes: • Pain assessment with patient reported pain score (scale 0-10) • Address outstanding questions regarding RT • Review side effects – most importantly pain flare • Review timeline of potential pain relief • Discuss pre-medication prior to RT Action taken from Pre-CT simulation assessment includes: • Contacting MRP for adjustment on analgesic routine • Expedite RT • Referral to supportive services including palliative/hospice pCSRT contact patient via telephone prior to initial palliative RT, phone conservation includes: • Pain assessment with patient reported pain score (scale 0-10) • Address any outstanding questions regarding RT • Provide reminder regarding pre-medication prior to RT pCSRT not only provided assistance with symptomatic pain control but also expedited treatment delivery, consolidated treatments to decrease patient time on treatment delivery table and improve patient access to care. Of the patients who were assessed prior to CT simulation and reported pain score (n=41), ∼5% (n=2) required sub-cutaneous analgesic injection during RT course delivery and ∼2% (n=1) of patients reported uncontrolled pain during course of RT. 68% (n=28) received pre-treatment phone call from pCSRT with reported pain score, 5% (n=2) received pre-treatment phone call from pCSRT with no reported pain score, 17% (n=7) received XRT less than 3 business days from CT Simulation with assistance of pCSRT with no pre-treatment phone call, and 10% (n=4) did not receive a pre-treatment phone call from pCSRT. Those who received pre-CT assessment and pre-treatment phone calls with reported pain scales from 0-10 (n=28) analyzed. A paired sample t-test was conducted to compare patient reported pain scores following pCSRT pain assessment. There was a significant difference in patient reported pain scores at pre-CT assessment (M=5.5, SD=3.29) and pre-treatment phone call (M=4.77, SD=2.58), t(26)=1.43, p=0.165. Results suggest that pCSRT pain assessments do affect patient reported pain scores for the better. pCSRT are shown to enhance access to care, expedite care, and increase patient satisfaction. pCSRT pre-CT pain assessments are shown to not only improve patient symptoms but also expedite treatment, assist in patient navigation and provide cost savings to departments by decreasing sub-cutaneous analgesic administration within the department. [ABSTRACT FROM AUTHOR]

OBJECTIVES: CMS created the Oncology Care Model (OCM) to increase the delivery of cost-efficient cancer care, but in linking medical oncologist compensation to total costs of care, the model also prompted concerns about reductions in radiation therapy utilization. We compare practices that participated in the model with those that did not through its launch to estimate whether radiation therapy utilization was reduced under the OCM. STUDY DESIGN: Retrospective analysis of a secondary claims-based data set. METHODS: We used 5 years of reimbursement claims data from a large community oncology network in which approximately half of the practices participated in the OCM to measure the relative change in utilization following OCM participation compared with practices that did not participate in the OCM. We evaluated use of radiation therapy for all cancer diagnoses and, more specifically, bone metastases, lung cancer, and breast cancer to assess whether effects varied by setting using 3 quasi-experimental estimation techniques (difference-in-differences, event study, and triple differences regressions). RESULTS: We found no evidence of reductions in radiation therapy utilization associated with the OCM between participant and nonparticipant practices in any of the specifications or subpopulations analyzed. CONCLUSIONS: Despite the potential incentives for medical oncologists to reduce radiation therapy utilization, we found no evidence that such reduction occurred. [ABSTRACT FROM AUTHOR]

Narrowband UVB (NB-UVB) has been shown to be effective for the treatment of early mycosis fungoides (MF) in light-skinned patients, but the effect of NB-UVB on patients with darker skin phototypes needs further investigation. The aim of this study was to evaluate the effect of NB-UVB in the treatment of early-stage MF in Iranian patients. In this retrospective study, 24 patients with the diagnosis of early MF (9 stage AI, 15 stage IB) were enrolled. All patients were treated with NB-UVB phototherapy 2-3 times weekly. After achieving complete response, a maintenance treatment was recommended. The response rate, side effects, and recurrence rate in the follow-up period were assessed. The follow-up period was ranged 6 to 24 months. Ten patients (41.7%) had complete remission after a mean number of 42.9 treatment and mean cumulative dose of 58.11 J/cm2. Twelve patients (50%) had partial response, and 2 patients (8.3%) had no response. After discontinuation of maintenance treatment, 4 of 10 patients (40%) with complete remission relapsed within a mean of 5 months. Side effects were limited to erythema (12.5%) and hyperpigmentation (4%). NB-UVB is a safe and effective method for the treatment of early MF, but it seems that more treatment sessions and higher doses of NB-UVB are required for darker skin phototypes. [ABSTRACT FROM AUTHOR]

Simple Summary: The tumor suppressor gene TP53 is conserved from nematode to human. In humans the TP53 gene is found mutated in a majority of cancers and therefore, the p53-induced cell death pathway is dysfunctional. As such, it is of the utmost importance to determine mechanisms and models to test for ways to induce p53-independent cancer cell death. The small, transparent, nematode C. elegans is a whole animal with a germline stem cell tumor model that presents such an opportunity. We used this model with a well-studied p53 mutant that increases germline tumor size to test for ways to induce p53-independent cell death. Herein, we report that two p53-independent death inducers, a nucleoside analogue and a PARP inhibitor, are capable of inducing C. elegans germline tumor cell death. This suggests new targeted drugs can be tested in this model for p53-independent cancer cell killing. The TP53 gene is mutated in over 50% of human cancers, and the C. elegansp53-1(cep-1) gene encodes the ortholog CEP-1. CEP-1 is activated by ultraviolet type C (UVC)-induced DNA damage and activates genes that induce germline apoptosis. UVC treatment of gain-of-function glp-1(ar202gf)/Notch tumorous animals reduces germline stem cell numbers (and overall tumor size), while UVC treatment of double-mutant cep-1/p53(gk138);glp-1/Notch(ar202gf) increases DNA damage adducts and stem cell tumor volume. We compared UVC-induced mitotic stem cell death and animal lifespans for the two different C. elegans tumorous strains. C. elegans stem cell compartment death has never been observed, and we used engulfed small stem cells, notable by green fluorescent puncta, to count cell death events. We found UVC treatment of glp-1(ar202gf) animals increased stem cell death and increased lifespan. However, UVC treatment of double-mutant cep-1/p53(gk138);glp-1/Notch(ar202gf) animals decreased stem cell death, increased tumor volume, and decreased animal lifespan. There are pharmacological agents that induce p53-independent cell death of human cells in culture; and two notable protocols are the PARP-trapping agents of temozolomide plus talazoparib and the nucleoside analogue 8-amino-adenosine. It is important to determine ways to rapidly test for pharmacological agents able to induce p53-independent cell death. We tested feeding cep-1/p53(gk138);glp-1/Notch(ar202gf) nematodes with either 8-amino-adenosine or temozolomide plus talazoparib and found both were able to decrease tumor volume. This is the first comparison for p53-independent responses in cep-1/p53(gk138);glp-1/Notch(ar202gf) animals and showed UVC DNA damage increased tumor volume and decreased lifespan while PARP inhibition decreased tumor volume. [ABSTRACT FROM AUTHOR]

To evaluate the temporal growth pattern of female radiation/clinical oncologists (FRCOs) and, if applicable, predict the gender neutrality in different countries of South Asia. South Asia is composed of Afghanistan, Bhutan, Maldives, Bangladesh, India, Nepal, Pakistan and Sri Lanka. The growth pattern of FRCOs in the latter five countries having radiation oncology facilities was evaluated from respective national registration data. Based on the average annual differential growth rate, together with the already existing female and male radiation/clinical oncologists (MRCOs), the cumulative numbers of FRCOs and MRCOs were forecasted for the next 10 years. The data regarding FRCOs in a leadership position were also calculated from different sources. The total number of radiation/clinical oncologists in the region was 4074, of which 91.8% were in India, because of its vast population. The overall number of FRCOs and MRCOs stood at 1370 and 2704, with a 1:2 female:male ratio. The average incremental annual growth of FRCOs in India was the highest (12.7 persons/year) and Nepal was the lowest (0.4 persons/year), with no data from Pakistan. If the current growth rate is sustained, Indian gender neutrality will be achieved by 2027–2030. In other countries, gender neutrality is unlikely to be achieved in the near future. With regards to leadership positions, 56–77 radiation oncology departments in India, one each in Bangladesh and Sri Lanka are headed by FRCOs, whereas Nepal and Pakistan have none. With the current growth rate of FRCOs and MRCOs, India will achieve gender parity within a decade; however, the rest of the countries will not achieve this in the near future. Analysis of radiation/clinical oncologists' registration data with their respective national bodies revealed an encouraging growth in the number of FRCOs as against their male counterparts in the last 5 years, compared with previous decades, especially in Bangladesh, Sri Lanka and India. Sri Lanka show high gender neutrality and adopted a multi-tasking and holistic approach of clinical oncology practices as also seen in Scandinavian countries. Such practice may be helpful to improve gender equality in radiation/clinical oncology practice for the other countries in the South Asian region. • An analysis of the woman participants in radiation and clinical oncology. • Analyse the growth characteristics of woman radiation oncologist in south Asia. • Identifies the woman in leadership position (radiation/clinical) oncology. • Include India, Bangladesh, Pakistan, Nepal and Sri Lanka. • Predict the gender neutrality in radiation/clinical oncology for next decade. [ABSTRACT FROM AUTHOR]

Background: In about 80-90 percent of people with rheumatoid arthritis (RA), the hands are affected. causing discomfort, stiffness, deformity, limited range of motion, and muscular weakening that have a significant impact on physical functioning and activities of daily living. The purpose of this study was to assess hand strength in patients with rheumatoid arthritis and see how it correlated with clinical and radiological characteristics. The participants in this study were 50 RA patients as defined by the criteria of ACR/EULAR 2010, another 50 seemingly healthy participants of similar age and sex were used. Hand Strength was assessed using with Jual hand dynamometer and radiological evaluation by Plain hand and wrist radiography were taken (P-A) and lateral. Hand Strength measured with a hand dynamometer was substantially greater in healthy controls. Health assessment questionnaire, score ranged from (0.05) to (4.50) with an average of (1.06 ±0.58). disability of the shoulder, arm and hand score ranged from (5.80) to (85.80) with an average score of (49.25 ±19.28). Cochin Hand Function Scale score among studied RA patients ranged from (0) to (79) with an average of (34.38 ±19.28). Mean HS in right hands were (13.98 vs. 36.34), in left hands were (12.90 vs. 38.22) in RA patients. HS was significantly higher among studied RA patients with no Loco-motor manifestations as compared with RA patients with Loco-motor manifestations in both right and left hands; (p-values= 0.021 & 0.047) in right and left hands respectively. [ABSTRACT FROM AUTHOR]

Background: Cytokine storm causes ARDS, multiple organ failure and post covid-19 pulmonary sequale so anti-inflammatory drugs as tocilizumab and methylprednisolone are widely used to treat covid-19 patients. Methods: prospective observational study on 60 covid-19 patients >18 years old. Diagnosis of covid-19 infection was based on World Health Organization (WHO) criteria and confirmed by nasal and pharyngeal swab for real time reverse transcriptase polymerase chain reaction analysis. 30 hypoxemic covid-19 who received tocilizumab and 30 hypoxemic covid-19 patients who received high dose of methylprednisolone. then Comparison of both groups regarding duration of admission, length of Oxygen need, resolution of CT findings and inflammatory marker levels. Results: There was no significant difference (p-value >0.05) between the two treatment protocols as regards CT findings at time of admission and after a month from discharge. On admission, Higher mean of CRP, D-dimer and a lower mean of procalcitonine were noted among the group treated with Tocilizumab protocol while significantly lower mean of ferritin (p-value <0.05). After one month follow up there was no difference in CRP level between the two groups. Also there was no statistical significant difference between the two groups regarding hospital stay and length of oxygen therapy between the two groups. Conclusion: lower ferritin and higher D-Dimer were noted in tocilizumab treated group while no difference in radiological finding or length of hospital stay between the two groups. [ABSTRACT FROM AUTHOR]

The goal of this study is to evaluate both functional and radiological outcomes in patellar fractures management with both techniques; cannulated screws with tension band and modified tension band wiring. 30 patients, with displaced or mildly comminuted and partial articular patellar fractures, were randomly grouped into two groups, 15 in each group. Group 1: fixed by cannulated screws with tension band and group 2: fixed by modified tension band wiring. By comparison between types of fixation, regarding post-operative complication (loss of knee motion, loss of reduction, delayed or non-union and pain during movement) there was no statistically significant difference between types of fixation, but there was statistically significant increase hardware removal and infection in K-wires method. Cannulated screws with tension band has a better radiological outcomes and better curative effects on patella fracture with low incidence of complications. Modified tension band wiring technique despite being the traditional and most widely accepted method of transverse patella fracture fixation; it has certain distinct disadvantages. [ABSTRACT FROM AUTHOR]