Search

Introduction: While digital breast tomosynthesis (DBT) has proven to enhance cancer detection and reduce recall rates (RR), its integration into BreastScreen Australia for screening has been limited, in part due to perceived cost implications. This study aims to assess the cost effectiveness of digital mammography (DM) compared with synthesized mammography and DBT (SM + DBT) in a first round screening context for short‐term outcomes. Methods: Clients recalled for nonspecific density (NSD) as a single lesion by both readers at the Northern Sydney Central Coast BreastScreen service in 2019 were included. Prior images were excluded to simulate first‐round screening. Eleven radiologists read DM and synthesized mammography with DBT (SM + DBT) images 4 weeks apart. Recall rates (RR), reading time, and diagnostic parameters were measured, and costs for screen reading and assessment were calculated. Result: Among 65 clients studied, 13 were diagnosed with cancer, with concordant cancer recalls. SM + DBT reduced recall rates (RR), increased reading time, maintained cancer detection sensitivity, and significantly improved other diagnostic parameters, particularly false positive rates. Benign biopsy recalls remained equivalent. While SM + DBT screen reading cost was significantly higher than DM (DM AU$890 ± 186 vs SM + DBT AU$1279 ± 265; P < 0.001), the assessment cost (DM AU$29,504 ± 9427 vs SM + DBT AU$18,021 ± 5606; P < 0.001), and combined screen reading and assessment costs were significantly lower (DM AU$30,394 ± 9508 vs SM + DBT AU$19,300 ± 5721; P = 0.001). SM + DBT screen reading and assessment of 65 patients resulted in noteworthy cost savings (AU$11,094), equivalent to assessing 12 additional clients. Conclusion: In first round screening, DBT yields significant cost savings by effectively reducing unnecessary recalls to assessment while maintaining diagnostic efficacy. [ABSTRACT FROM AUTHOR]

Byline: Darius G. Viskontas, MD, FRCSC (Department of Orthopaedic Surgery, Royal Columbian Hospital, New Westminster, British Columbia, Canada); Bruno M. Giuffre, MB, FRANZCR (Radiology Department, Royal North Shore Hospital, St. [...]

Introduction: Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected, patients are managed with immobilisation. Although scaphoid fractures may be difficult to diagnose on plain radiography, sometimes for months after injury, ongoing radiographic surveillance is preferred due to its low upfront cost. Patients in immobilising casts for long periods experience significant personal and social ramifications such as difficulty working and self‐caring. This study examines whether cross‐sectional imaging by computed tomography (CT) or magnetic resonance imaging (MRI) is quicker than serial X‐ray surveillance at allowing a scaphoid fracture to be either excluded or confirmed. Methods: A retrospective record review was performed of the 1709 patients who presented to Royal North Shore Hospital in 2015 with wrist injuries, finding 104 patients clinically suspicious for a fractured scaphoid. Results: All patients were examined by X‐ray during their initial hospital presentation, providing 33.7% of final diagnoses in 0.6 ± 1.7 days. However, if initial X‐ray proved inconclusive, subsequent serial X‐ray surveillance made a final diagnosis after a mean of 24.1 ± 17.2 days, with some being immobilised for up to 67 days before diagnosis. Cross‐sectional imaging significantly reduced diagnosis time to 9.8 ± 5.8 days (P = 0.0016), with a maximum immobilisation time of 24 days. Conclusion: Cross‐sectional imaging allows for faster scaphoid fracture diagnosis than X‐ray. We propose a protocol for scaphoid fracture diagnosis wherein patients undergo two episodes of X‐ray separated by 7 days, followed by a single MRI if clinical suspicion remains, minimising unnecessary immobilisation. Delayed scaphoid fracture diagnosis is a cause of significant inconvenience to patients. This paper highlights the need for a scaphoid fracture diagnosis protocol, with patients being made to wait in immobilising casts for up to 67 days without a definitive diagnosis if X‐ray alone is used. When cross‐sectional imaging techniques are applied, a final diagnosis is reached much more rapidly, reducing the incidence of unnecessary wrist immobilisation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Magnetic resonance imaging (MRI) accuracy after neoadjuvant systemic therapy (NST) for breast cancer varies according to hormone receptor (HR), human epidermal growth factor receptor type‐2 (HER2) subtype and Ki‐67 proliferation index. Whether MRI accuracy varies by genomic signatures is unknown. We examined the accuracy of MRI in the NEONAB trial ( Clinicaltrials.gov #: NCT01830244). Aim: To examine the accuracy of MRI to predict pathological response to neoadjuvant therapy for breast cancer in the NEONAB trial. Methods: Patients with stages II–III breast cancer received sequential epirubicin, cyclophosphamide and nab‐paclitaxel and trastuzumab if they were HER2+. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to assess the utility of preoperative MRI to predict pathological complete response (pCR). Bland‐Altman plots were used to assess agreement between MRI and pathological assessment of residual disease. Results: MRI correctly predicted pCR in 64.1% of the cohort. Sensitivity and specificity were 52% and 78%, respectively; PPV 73% and NPV 58%. MRI predicted pCR most accurately in HER2‐positive patients; sensitivity 58%, specificity 100%, PPV 100% and NPV 38%. MRI had higher PPV and NPV in tumours with Ki‐67 ≥ 15% than tumours with Ki‐67 < 15%, 75% versus 50% and 57.5% versus 50%, respectively. In this study, MRI underestimated residual tumour size by 1.65 mm (limits of agreement: 43.07–39.77 mm). Conclusions: MRI appears more accurate for predicting pCR in HER2+ disease than other subtypes and in cancers with Ki‐67 ≥ 15% compared to those with Ki‐67 < 15%. Accuracy of MRI in our HR+, RS ≥ 25 cohort is comparable to previous reports of unselected HR+ disease. MRI post‐NST should be interpreted in conjunction with HER2 status and Ki‐67 index of the primary. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is the most common joint disorder and a leading cause of disability. Due to an aging population and increasing obesity, the incidence of OA is rising. The etiology of OA is multifactorial and complex; thus prevention of OA remains challenging. Risk factors can be divided into person-level factors such as age, sex, obesity, genetics, race/ethnicity, and diet, and joint-level factors including injury, malalignment, and abnormal loading of the joints. This review provides a brief overview of the person-level risk factors and a more in-depth analysis of those at the joint level. It is only through an improved understanding of risk factors for the disease that we may be able to intervene meaningfully and prevent its occurrence. [ABSTRACT FROM AUTHOR]

SUMMARY Pneumothoraces in supine patients may be evidenced by many signs - some specific, if uncommon. Occasionally, the normal distribution of intrapleural air is altered. Confirmatory views may be necessary and the supine oblique is an underused but useful film. ABSTRACT The radiological signs of a supine pneumothorax, the factors modifying these signs and useful confirmatory views are presented. Common signs include lower zone lucency, a deep lateral sulcus, a visible anterior costophrenic sulcus and paramediastinal or paradiaphrag-matic air. Specific but uncommon signs are interlobar air and a change in appearance of epicardial fat pads. The signs may be modified - especially by pleural adhesions. An oblique beam view with the patient supine may be very useful to confirm a pneumothorax. [ABSTRACT FROM AUTHOR]

SUMMARY Seven cases of renal oncocytoma are reported. Angiography may be suggestive. Percutaneous biopsy is not recommended. In certain situations, partial nephrectomy may be possible. Pathological assessment of the whole tumour is essential for confident diagnosis. ABSTRACT Oncocytomas are benign renal tumours, difficult to differentiate from Grawitz tumours. Seven cases are presented and the clinical and radiological features are reviewed. The angiographic features are occasionally helpful but are nonspecific. Percutaneous biopsy may be misleading. In certain situations partial nephrectomy is possible. [ABSTRACT FROM AUTHOR]