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5. Overview for developing Delphi-based interdisciplinary consensus statements on imaging: pros and cons

Author

Dietrich Tobias Johannes, Mascarenhas Vasco V., Cerezal Luis, Afonso P. Diana, and Sudoł-Szopińska Iwona

Subjects
imaging, delphi survey, interdisciplinary, consensus statements, Medicine (General), R5-920, Medical technology, R855-855.5
Abstract

This review paper offers a concise guide on how to execute Delphi-based interdisciplinary consensus statements on imaging. Fundamental to the Delphi methodology are several core principles. First, an initial key element is the selection of experts, known as panelists. Second is the principle of anonymity among participants, ensuring that no single individual or group applies excessive influence over others. Third, the methodology involves iterative rounds where statements are presented repeatedly, allowing for controlled feedback. Lastly, after each round, participants are given insight into the collective panel’s previous responses. This knowledge enables them to potentially reconsider and adjust their positions in subsequent rounds, driving towards the group consensus. These principles emphasize the critical role of statistical group responses and the structured interaction inherent in the Delphi approach. Looking at the broader process, the development of Delphi-based interdisciplinary consensus statements on imaging unfolds through several stages. It begins with identifying the research field or the consensus statements in question. This is followed by undertaking comprehensive literature research. Subsequently, pertinent questions and their corresponding statements are crafted. The process then moves on to administering anonymous, iterative questionnaire rounds. Feedback, both on an individual and collective level, is provided between the rounds. The process culminates in the summarization and reporting of the finalized Delphi-based interdisciplinary consensus statements on imaging.

Published
2024
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9. Interdisciplinary consensus statements on imaging of DRUJ instability and TFCC injuries

Author

Cerezal, Luis, del Piñal, Francisco, Atzei, Andrea, Schmitt, Rainer, Becce, Fabio, Klich, Maciej, Bień, Maciej, de Jonge, Milko C., Teh, James, Boutin, Robert Downey, Toms, Andoni Paul, Omoumi, Patrick, Fritz, Jan, Bazzocchi, Alberto, Shahabpour, Maryam, Zanetti, Marco, Llopis, Eva, Blum, Alain, Lalam, Radhesh Krishna, Reto, Sutter, Afonso, P. Diana, Mascarenhas, Vasco V., Cotten, Anne, Drapé, Jean-Luc, Bierry, Guillaume, Pracoń, Grzegorz, Dalili, Danoob, Mespreuve, Marc, Garcia-Elias, Marc, Bain, Gregory Ian, Mathoulin, Christophe L., Van Overstraeten, Luc, Szabo, Robert M., Camus, Emmanuel J., Luchetti, Riccardo, Chojnowski, Adrian Julian, Gruenert, Joerg G., Czarnecki, Piotr, Corella, Fernando, Nagy, Ladislav, Yamamoto, Michiro, Golubev, Igor O., van Schoonhoven, Jörg, Goehtz, Florian, Sudoł-Szopińska, Iwona, and Dietrich, Tobias Johannes

Published
2023
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10. Interdisciplinary consensus statements on imaging of scapholunate joint instability

Author

Dietrich, Tobias Johannes, Toms, Andoni Paul, Cerezal, Luis, Omoumi, Patrick, Boutin, Robert Downey, Fritz, Jan, Schmitt, Rainer, Shahabpour, Maryam, Becce, Fabio, Cotten, Anne, Blum, Alain, Zanetti, Marco, Llopis, Eva, Bień, Maciej, Lalam, Radhesh Krishna, Afonso, P Diana, Mascarenhas, Vasco V, Sutter, Reto, Teh, James, Pracoń, Grzegorz, de Jonge, Milko C, Drapé, Jean-Luc, Mespreuve, Marc, Bazzocchi, Alberto, Bierry, Guillaume, Dalili, Danoob, Garcia-Elias, Marc, Atzei, Andrea, Bain, Gregory Ian, Mathoulin, Christophe L, del Piñal, Francisco, Van Overstraeten, Luc, Szabo, Robert M, Camus, Emmanuel J, Luchetti, Riccardo, Chojnowski, Adrian Julian, Grünert, Jörg G, Czarnecki, Piotr, Corella, Fernando, Nagy, Ladislav, Yamamoto, Michiro, Golubev, Igor O, van Schoonhoven, Jörg, Goehtz, Florian, Klich, Maciej, and Sudoł-Szopińska, Iwona

Subjects
Biomedical Imaging, Clinical Research, Bioengineering, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Musculoskeletal, Arthrography, Consensus, Humans, Joint Instability, Ligaments, Articular, Wrist Injuries, Wrist Joint, Wrist injuries, Joint instability, Diagnostic imaging, Guidelines, Surveys and questionnaires, Clinical Sciences, Nuclear Medicine & Medical Imaging
Abstract

ObjectivesThe purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.MethodsNineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of '0', '5' and '10' reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of '8' or higher for 80% or more of the panellists.ResultsTen of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.ConclusionsDelphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.Key points• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.

Published
2021

12. Diagnostic imaging strategies of acute intracerebral hemorrhage in European academic hospitals—a decision-making analysis

Author

Putora, Paul Martin, Almeida, Gonçalo G., Wildermuth, Simon, Weber, Johannes, Dietrich, Tobias, Vernooij, Meike W., van Doormaal, Pieter Jan, Smagge, Lucas, Zeleňák, Kamil, Krainik, Alexandre, Bonneville, Fabrice, van Den Hauwe, Luc, Möhlenbruch, Markus, Bruno, Federico, Ramgren, Birgitta, Ramos-González, Ana, Schellhorn, Till, Waelti, Stephan, and Fischer, Tim

Published
2023
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16. Comparison of temporal evolution of computed tomography imaging features in COVID-19 and influenza infections in a multicenter cohort study

Author

Fischer, Tim, El Baz, Yassir, Scanferla, Giulia, Graf, Nicole, Waldeck, Frederike, Kleger, Gian-Reto, Frauenfelder, Thomas, Bremerich, Jens, Kobbe, Sabine Schmidt, Pagani, Jean-Luc, Schindera, Sebastian, Conen, Anna, Wildermuth, Simon, Leschka, Sebastian, Strahm, Carol, Waelti, Stephan, Dietrich, Tobias Johannes, and Albrich, Werner C.

Published
2022
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19. Postoperative Imaging of Joints in the Sportive Patient

Author

Graf, Dimitri Nicolas, Dietrich, Tobias Johannes, Kauczor, Hans-Ulrich, Series Editor, Parizel, Paul M., Series Editor, Peh, Wilfred C. G., Series Editor, Brady, Luther W., Honorary Editor, Lu, Jiade J., Series Editor, Vanhoenacker, Filip M., editor, Maas, Mario, editor, and Gielen, Jan L.M.A., editor

Published
2021
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20. The Lisbon Agreement on femoroacetabular impingement imaging—part 2: general issues, parameters, and reporting

Author

Mascarenhas, Vasco V., Castro, Miguel O., Afonso, P. Diana, Rego, Paulo, Dienst, Michael, Sutter, Reto, Schmaranzer, Florian, Sconfienza, Luca, Kassarjian, Ara, Ayeni, Olufemi R., Beaulé, Paul E., Dantas, Pedro, Lalam, Radhesh, Weber, Marc-André, Vanhoenacker, Filip M., Dietrich, Tobias Johannes, Jans, Lennart, Robinson, Philip, Karantanas, Apostolos H., Sudoł-Szopińska, Iwona, Anderson, Suzanne, Noebauer-Huhmann, Iris, Marin-Peña, Oliver, Collado, Diego, Tey-Pons, Marc, Schmaranzer, Ehrenfried, Padron, Mario, Kramer, Josef, Zingg, Patrick O., De Maeseneer, Michel, and Llopis, Eva

Published
2021
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21. The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 3: imaging techniques

Author

Castro, Miguel O., Mascarenhas, Vasco V., Afonso, P. Diana, Rego, Paulo, Schmaranzer, Florian, Sutter, Reto, Kassarjian, Ara, Sconfienza, Luca, Dienst, Michael, Ayeni, Olufemi R., Beaulé, Paul E., Dantas, Pedro, Lalam, Radhesh, Weber, Marc-André, Vanhoenacker, Filip M., Dietrich, Tobias Johannes, Jans, Lennart, Robinson, Philip, Karantanas, Apostolos H., Sudoł-Szopińska, Iwona, Anderson, Suzanne, Noebauer-Huhmann, Iris, Marin-Peña, Oliver, Collado, Diego, Tey-Pons, Marc, Schmaranzer, Ehrenfried, Padron, Mario, Kramer, Josef, Zingg, Patrick O., De Maeseneer, Michel, and Llopis, Eva

Published
2021
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22. Prospective measurement of the width of cerebrospinal fluid spaces by cranial ultrasound in neurologically healthy children aged 0-19 months

Author

Fandak, Jozef; https://orcid.org/0000-0002-4659-0005, Markart, Stefan; https://orcid.org/0000-0002-3220-3545, Willems, Erik P; https://orcid.org/0000-0001-7555-3484, Wildermuth, Simon; https://orcid.org/0000-0002-3278-4335, Frauenfelder, Thomas, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Dietrich, Tobias J; https://orcid.org/0000-0003-2979-6471, Waelti, Stephan L; https://orcid.org/0000-0003-4175-0476, Fandak, Jozef; https://orcid.org/0000-0002-4659-0005, Markart, Stefan; https://orcid.org/0000-0002-3220-3545, Willems, Erik P; https://orcid.org/0000-0001-7555-3484, Wildermuth, Simon; https://orcid.org/0000-0002-3278-4335, Frauenfelder, Thomas, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Dietrich, Tobias J; https://orcid.org/0000-0003-2979-6471, and Waelti, Stephan L; https://orcid.org/0000-0003-4175-0476

Abstract

BACKGROUND Ultrasound (US) is often the first method used to look for brain or cerebrospinal fluid (CSF) space pathologies. Knowledge of normal CSF width values is essential. Most of the available US normative values were established over 20 years ago, were obtained with older equipment, and cover only part of the age spectrum that can be examined by cranial US. This prospective study aimed to determine the normative values of the widths of the subarachnoid and internal CSF spaces (craniocortical, minimal and maximal interhemispheric, interventricular, and frontal horn) for high-resolution linear US probes in neurologically healthy infants and children aged 0-19 months and assess whether subdural fluid collections can be delineated. METHODS Two radiologists measured the width of the CSF spaces with a conventional linear probe and an ultralight hockey-stick probe in neurologically healthy children not referred for cranial or spinal US. RESULTS This study included 359 neurologically healthy children (n$_{boys}$ = 178, 49.6%; n$_{girls}$ = 181, 50.4%) with a median age of 46.0 days and a range of 1-599 days. We constructed prediction plots, including the 5th, 50th, and 95th percentiles, and an interactive spreadsheet to calculate normative values for individual patients. The measurements of the two probes and the left and right sides did not differ, eliminating the need for separate normative values. No subdural fluid collection was detected. CONCLUSION Normative values for the widths of the subarachnoid space and the internal CSF spaces are useful for evaluating intracranial pathology, especially when determining whether an increase in the subarachnoid space width is abnormal.

Published
2024

24. The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 1: overview

Author

Mascarenhas, Vasco V., Castro, Miguel O., Rego, Paulo A., Sutter, Reto, Sconfienza, Luca Maria, Kassarjian, Ara, Schmaranzer, Florian, Ayeni, Olufemi R., Dietrich, Tobias Johannes, Robinson, Philip, Weber, Marc-André, Beaulé, Paul E., Dienst, Michael, Jans, Lennart, Lalam, Radhesh, Karantanas, Apostolos H., Sudoł-Szopińska, Iwona, Anderson, Suzanne, Noebauer-Huhmann, Iris, Vanhoenacker, Filip M., Dantas, Pedro, Marin-Peña, Oliver, Collado, Diego, Tey-Pons, Marc, Schmaranzer, Ehrenfried, Llopis, Eva, Padron, Mario, Kramer, Josef, Zingg, Patrick O., De Maeseneer, Michel, and Afonso, P. Diana

Published
2020
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35. Correction to: The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 1: overview

Author

Mascarenhas, Vasco V., Castro, Miguel O., Rego, Paulo A., Sutter, Reto, Sconfienza, Luca Maria, Kassarjian, Ara, Schmaranzer, Florian, Ayeni, Olufemi R., Dietrich, Tobias Johannes, Robinson, Philip, Weber, Marc-André, Beaulé, Paul E., Dienst, Michael, Jans, Lennart, Lalam, Radhesh, Karantanas, Apostolos H., Sudoł-Szopińska, Iwona, Anderson, Suzanne, Noebauer-Huhmann, Iris, Vanhoenacker, Filip M., Dantas, Pedro, Marin-Peña, Oliver, Collado, Diego, Tey-Pons, Marc, Schmaranzer, Ehrenfried, Llopis, Eva, Padron, Mario, Kramer, Josef, Zingg, Patrick O., De Maeseneer, Michel, and Afonso, P. Diana

Published
2020
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49. Ultra-low-dose computed tomography for torsion measurements of the lower extremities in children and adolescents

Author

Waelti, Stephan; https://orcid.org/0000-0003-4175-0476, Fischer, Tim, Griessinger, Jennifer, Cip, Johannes, Dietrich, Tobias Johannes, Ditchfield, Michael, Allmendinger, Thomas, Messerli, Michael, Markart, Stefan, Waelti, Stephan; https://orcid.org/0000-0003-4175-0476, Fischer, Tim, Griessinger, Jennifer, Cip, Johannes, Dietrich, Tobias Johannes, Ditchfield, Michael, Allmendinger, Thomas, Messerli, Michael, and Markart, Stefan

Abstract

BACKGROUND Quantifying femoral and tibial torsion is crucial in the preoperative planning for derotation surgery in children and adolescents. The use of an ultra-low-dose computed tomography (CT) protocol might be possible for modern CT scanners and suitable for reliable torsion measurements even though the bones are not completely ossified. METHODS This is a retrospective review of 77 children/adolescents (mean age 12.7 years) who underwent a lower extremity CT for torsion measurements on a 64-slice scanner. A stepwise dose reduction (70%, 50%, 30% of the original dose) was simulated. Torsion measurements were performed on all image datasets, and image noise, interrater agreement and subjective image quality were evaluated. Effective radiation dose of each original scan was estimated. As proof of concept, 24 children were scanned with an ultra-low-dose protocol, adapted from the 30% dose simulation, and the intra-class correlation coefficient (ICC) was determined. Ethics approval and informed consent were given. RESULTS Torsion measurements at the simulated 30% dose level had equivalent interrater agreement compared to the 100% dose level (ICC ≥ 0.99 for all locations and dose levels). Image quality of almost all datasets was rated excellent, regardless of dose. The mean sum of the effective dose of the total torsion measurement was reduced by simulation from 0.460/0.490 mSv (boys/girls) at 100% dose to 0.138/0.147 mSv at 30%. The ICC of the proof-of-concept group was as good as that of the simulated 30% dose level. CONCLUSION Pediatric torsion measurements of the lower extremities can be performed using an ultra-low-dose protocol without compromising diagnostic confidence.

Published
2022

50. Short tau inversion recovery (STIR) after intravenous contrast agent administration obscures bone marrow edema-like signal on forefoot MRI

Author

Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Baz, Yassir El, Waelti, Stephan; https://orcid.org/0000-0003-4175-0476, Wildermuth, Simon; https://orcid.org/0000-0002-3278-4335, Leschka, Sebastian; https://orcid.org/0000-0002-7973-0203, Güsewell, Sabine; https://orcid.org/0000-0001-8442-8888, Dietrich, Tobias Johannes; https://orcid.org/0000-0003-2979-6471, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Baz, Yassir El, Waelti, Stephan; https://orcid.org/0000-0003-4175-0476, Wildermuth, Simon; https://orcid.org/0000-0002-3278-4335, Leschka, Sebastian; https://orcid.org/0000-0002-7973-0203, Güsewell, Sabine; https://orcid.org/0000-0001-8442-8888, and Dietrich, Tobias Johannes; https://orcid.org/0000-0003-2979-6471

Abstract

Objective: Short tau or short TI inversion recovery (STIR) MRI sequences are considered a robust fat suppression technique. However, STIR also suppresses signals from other tissues with similar T1 relaxation times. This study investigates the in vivo effect of intravenous gadolinium-based T1-shortening contrast agent on STIR signal. Materials and methods: Institutional board approval and informed consent was obtained. MRI examinations (1.5-T or 3-T) of 31 prospectively included patients were analyzed by two readers. Signal intensity of degenerative bone marrow edema-like signal at the Lisfranc joint on precontrast STIR images and on STIR images acquired after intravenous contrast agent administration (gadoteric acid, gadolinium: 0.5 mmol/ml, 15 ml) was measured. The medial cuneiform bone without observable bone marrow edema-like signal was considered a healthy tissue and served as a reference. Relative changes in signal intensity between precontrast and postcontrast images were calculated for the two tissues. Wilcoxon signed-rank test served for statistical analyses. Results: In bone marrow edema-like signal, both readers observed a median signal change of -35% (interquartile range (IQR) 24) and -34% (IQR 21), respectively, on postcontrast STIR images compared to precontrast STIR. In healthy tissue, the signal remained constant on postcontrast STIR images (median change -2%, IQR 15, and 0%, IQR 17) respectively. For both readers, postcontrast signal change in bone marrow edema-like signal differed from that in healthy tissue (p < 0.001). Conclusion: Intravenous gadolinium-based contrast agent causes a significant reduction of signal intensity in bone marrow edema-like signal on routine STIR images. Thus, pathological MRI findings may be obscured. Keywords: Bone marrow edema-like signal; Contrast media; Foot; Magnetic resonance imaging

Published
2022

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