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Abdominal and pelvic hemorrhage may be secondary to a number of causes and is often a medical emergency. Patient presentation ranges from obvious trauma with evidence of hemodynamic instability to vague symptoms. CT has become the imaging modality of choice for identifying abdominopelvic hemorrhage. Recognizing acute hemorrhage as well as identifying its location and severity are key to expediting management. In the Emergency Department, ultrasound often used in the initial evaluation of trauma patients, but is not sensitive for subtle bleeds or injuries. CT is the best first-line imaging tool to identify abdominal hemorrhage and, compared with angiography, has been shown to be superior in detecting intra-abdominal bleeding, especially when the bleeding rate is low. Depending on location and etiology, abdominopelvic hemorrhage may have a characteristic appearance, such as the “sentinel clot” sign associated with blunt trauma to the solid organs or the “triangle sign” of a mesenteric bleed. The following pictorial essay reviews CT technique, study interpretation, and interpretative pearls and pitfalls in the recognition of acute abdominopelvic hemorrhage.

Background Cachexia is a major cause of morbidity in pancreatic ductal adenocarcinoma (PDAC) patients. Our purpose was to understand the impact of PDAC‐induced cachexia on brain metabolism in PDAC xenograft studies, to gain new insights into the causes of cachexia‐induced morbidity. Changes in mouse and human plasma metabolites were characterized to identify underlying causes of brain metabolic changes. Methods We quantified metabolites, detected with high‐resolution 1H magnetic resonance spectroscopy, in the brain and plasma of normal mice (n = 10) and mice bearing cachexia (n = 10) or non‐cachexia (n = 9) inducing PDAC xenografts as well as in human plasma obtained from normal individuals (n = 24) and from individuals with benign pancreatic disease (n = 20) and PDAC (n = 20). Statistical significance was defined as a P value ≤0.05. Results The brain metabolic signature of cachexia‐inducing PDAC was characterized by a significant depletion of choline of −27% and −21% as well as increases of glutamine of 13% and 9% and formate of 21% and 14%, relative to normal controls and non‐cachectic tumour‐bearing mice, respectively. Good to moderate correlations with percent weight change were found for choline (r = 0.70), glutamine (r = −0.58), and formate (r = −0.43). Significant choline depletion of −38% and −30%, relative to normal controls and non‐cachectic tumour‐bearing mice, respectively, detected in the plasma of cachectic mice likely contributed to decreased brain choline in cachectic mice. Similarly, relative to normal controls and patients with benign disease, choline levels in human plasma samples of PDAC patients were significantly lower by −12% and −20% respectively. A comparison of plasma metabolites from PDAC patients with and without weight loss identified significant changes in glutamine metabolism. Conclusions Disturbances in metabolites of the choline/cholinergic and glutamine/glutamate/glutamatergic neurotransmitter pathways may contribute to morbidity. Metabolic normalization may provide strategies to reduce morbidity. The human plasma metabolite changes observed may lead to the development of companion diagnostic markers to detect PDAC and PDAC‐induced cachexia.

Purpose The purpose of this study was to report procedures developed to annotate abdominal computed tomography (CT) images from subjects without pancreatic disease that will be used as the input for deep convolutional neural networks (DNN) for development of deep learning algorithms for automatic recognition of a normal pancreas. Materials and methods Dual-phase contrast-enhanced volumetric CT acquired from 2005 to 2009 from potential kidney donors were retrospectively assessed. Four trained human annotators manually and sequentially annotated 22 structures in each datasets, then expert radiologists confirmed the annotation. For efficient annotation and data management, a commercial software package that supports three-dimensional segmentation was used. Results A total of 1150 dual-phase CT datasets from 575 subjects were annotated. There were 229 men and 346 women (mean age: 45 ± 12 years; range: 18–79 years). The mean intra-observer intra-subject dual-phase CT volume difference of all annotated structures was 4.27 mL (7.65%). The deep network prediction for multi-organ segmentation showed high fidelity with 89.4% and 1.29 mm in terms of mean Dice similarity coefficients and mean surface distances, respectively. Conclusions A reliable data collection/annotation process for abdominal structures was developed. This process can be used to generate large datasets appropriate for deep learning.

Contains fulltext : 220761.pdf (Publisher’s version ) (Open Access) Rationale: The decades-long progression of chronic obstructive pulmonary disease (COPD) renders identifying different trajectories of disease progression challenging.Objectives: To identify subtypes of patients with COPD with distinct longitudinal progression patterns using a novel machine-learning tool called "Subtype and Stage Inference" (SuStaIn) and to evaluate the utility of SuStaIn for patient stratification in COPD.Methods: We applied SuStaIn to cross-sectional computed tomography imaging markers in 3,698 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-4 patients and 3,479 controls from the COPDGene (COPD Genetic Epidemiology) study to identify subtypes of patients with COPD. We confirmed the identified subtypes and progression patterns using ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) data. We assessed the utility of SuStaIn for patient stratification by comparing SuStaIn subtypes and stages at baseline with longitudinal follow-up data.Measurements and Main Results: We identified two trajectories of disease progression in COPD: a "Tissue-->Airway" subtype (n = 2,354, 70.4%), in which small airway dysfunction and emphysema precede large airway wall abnormalities, and an "Airway-->Tissue" subtype (n = 988, 29.6%), in which large airway wall abnormalities precede emphysema and small airway dysfunction. Subtypes were reproducible in ECLIPSE. Baseline stage in both subtypes correlated with future FEV1/FVC decline (r = -0.16 [P < 0.001] in the Tissue-->Airway group; r = -0.14 [P = 0.011] in the Airway-->Tissue group). SuStaIn placed 30% of smokers with normal lung function at elevated stages, suggesting imaging changes consistent with early COPD. Individuals with early changes were 2.5 times more likely to meet COPD diagnostic criteria at follow-up.Conclusions: We demonstrate two distinct patterns of disease progression in COPD using SuStaIn, likely representing different endotypes. One third of healthy smokers have detectable imaging changes, suggesting a new biomarker of "early COPD."

Rationale and Objectives The role of a radiologist has expanded beyond the tripartite mission of patient care, education, and research to include cross-specialty consultation for patient management, innovative solutions to improve health-care quality and safety, device design, and policy advocacy. As such, radiology residency programs should incorporate formalized training to prepare residents for these various professional roles. Materials and Methods Since the 2015–2016 academic year, five training tracks focused on noninterpretative skills have been integrated into our residency training program: Clinician Educator, Quality Improvement, Entrepreneurship/Innovation, Health Policy Advocacy, and High-Value Care. Each track is longitudinal, with a set of requirements throughout the residents' training necessary to achieve certification at graduation. Results To date nine residents have participated in the programs, including two who received distinction in two separate tracks. Residents in each of the tracks have implemented successful initiatives related to the focus area. As such, these tracks enrich training by ensuring that residents make meaningful contributions to the department and institution during their training and disseminate successful initiatives through presentation at national meetings and publications. Conclusion The duration of a radiology residency and resources available in an academic center provide opportunities for residency program directors to advance residents' skills in important noninterpretative components of radiology practice. Regardless of whether residents pursue academic medicine or private practice, these skills are necessary for graduates to become valuable members of a radiology practice and serve as national leaders in the field of radiology.

Background and purposeIt is increasingly recognized that time is one of the key determinants in acute stroke outcome when interventional stroke therapy is applied. With increasing device efficacy and understanding of imaging triage options, reducing pre-treatment time loss may be a critical component of improving interventional stroke outcomes for the population at large. Time sensitive procedures such as organ harvest have transported physicians to the patient site to improve time to procedure. Applying this same principle to interventional stroke management may be a valid paradigm.MethodsPrevious logistical deliberation with hospital and Medevac companies was carried out to provide the rationale and funding for helicopter transfer of a neurointerventionalist to an in-network hospital with an on-site angiographic suite. An appropriate patient with large vessel occlusion and an NIH Stroke Scale score >8 was identified. MRI was performed, then the Medevac transport system was activated and the intervention was carried out. Times were collected during the case and assessed for time efficiency.ResultsThe proof of concept case was identified and Medevac was consulted at 12:13 after verifying that no in-house emergencies would prevent physician departure. Weather clearance was obtained and stroke intervention confirmed as a go at 12:24. Groin puncture occurred at 13:07 and the intervention was completed at 13:41. The total time from decision-to-treat to groin puncture was 43 min and groin closure was completed at 77 min from decision-to-treat.ConclusionsThis proof of concept case is presented for logistical, financial and use-case analysis. As it is a first case, times can likely be improved. We assert that this model may be another option in the spoke-and-hub design of stroke systems of care.

OBJECTIVE. The objective of our study was to determine the utility of radiomics features in differentiating CT cases of pancreatic ductal adenocarcinoma (PDAC) from normal pancreas. MATERIALS AND METHODS. In this retrospective case-control study, 190 patients with PDAC (97 men, 93 women; mean age ± SD, 66 ± 9 years) from 2012 to 2017 and 190 healthy potential renal donors (96 men, 94 women; mean age ± SD, 52 ± 8 years) without known pancreatic disease from 2005 to 2009 were identified from radiology and pathology databases. The 3D volume of the pancreas was manually segmented from the preoperative CT scans by four trained researchers and verified by three abdominal radiologists. Four hundred seventy-eight radiomics features were extracted to express the phenotype of the pancreas. Forty features were selected for analysis because of redundancy of computed features. The dataset was divided into 255 training cases (125 normal control cases and 130 PDAC cases) and 125 validation cases (65 normal control cases and 60 PDAC cases). A random forest classifier was used for binary classification of PDAC versus normal pancreas of control cases. Accuracy, sensitivity, and specificity were calculated. RESULTS. Mean tumor size was 4.1 ± 1.7 (SD) cm. The overall accuracy of the random forest binary classification was 99.2% (124/125), and AUC was 99.9%. All PDAC cases (60/60) were correctly classified. One case from a renal donor was misclassified as PDAC (1/65). The sensitivity was 100%, and specificity was 98.5%. CONCLUSION. Radiomics features extracted from whole pancreas can be used to differentiate between CT cases from patients with PDAC and healthy control subjects with normal pancreas.

We report a case of a 20-year-old patient who sustained a mutilating crush injury to the left-hand index and ring finger volar surface measuring 5 × 6 cm from the distal end of the proximal phalanx to the fingertips. After thorough debridement and stabilization of the skeletal injury, a radial forearm fascia only free flap measuring 6 × 7 cm was used to resurface the distal soft tissue volar defect of two adjacent fingers. Digital nerve grafting was also required, and this was done using autologous nerve graft from the lateral antebrachial cutaneous nerve. This thin fascia only flap allows for stable soft tissue coverage and provides a gliding surface for the underlying tendons. The neosyndactylized digits were safely divided at 3-month follow-up, and excellent functional and aesthetic results were achieved. The radial forearm fascia is a thin, durable, and pliable tissue that is based on the radial artery as a vascular pedicle. We consider this free fascial flap as a valuable option for coverage of multiple complex distal digit injuries using a single flap and highly recommend its use.

The purpose of this study was to determine the prevalence of nonpolypoid adenomas and the sensitivity of CT colonography (CTC) in their detection by use of the restricted criteria of height-to-width ratio50% and height elevation≤3 mm.In the National CT Colonography Trial (American College of Radiology Imaging Network protocol 6664), a cohort of 2531 participants without symptoms underwent CTC and screening colonoscopy. The CTC examinations were interpreted with both 2D and 3D techniques. Nonpolypoid adenomatous polyps identified with CTC or colonoscopy were retrospectively reviewed to determine which polyps met the restricted criteria. The prevalence of nonpolypoid adenomas and the prospective sensitivity of CTC were determined. Descriptive statistics were used to report the prevalence, size, and histologic features. The sensitivities (with 95% CIs) for nonpolypoid and polypoid lesions were compared by two-sided Z test for independent binomial proportions.The retrospective review confirmed 21 nonpolypoid adenomas, yielding a prevalence of 0.83% (21 of 2531 participants). Eight (38.1%) were advanced adenomas, many (50% [4/8]) only because of large size (≥10 mm). The overall per polyp sensitivity of CTC (combined 2D and 3D interpretation) for detecting nonpolypoid adenomas≥5 mm (n=21) was 0.76; ≥6 mm (n=16), 0.75; and ≥10 mm (n=5), 0.80. These values were not statistically different from the sensitivity of detecting polypoid adenomas (p0.37).In this large screening population, nonpolypoid adenomas had a very low prevalence (1%), and advanced pathologic features were uncommon in polyps10 mm in diameter. Most nonpolypoid adenomas are technically visible at CTC. The prospective sensitivity is similar to that for polypoid adenomas when the interpretation combines both 2D and 3D review.

MR ERIC BECKER “Treat your customers like family: successful outcomes and kindness can go hand in hand.” When I was younger, my father was in business, and I would frequently accompany him on visits to various customers. Needless to say, I learned more by watching him interact with his customers than I ever did in any classroom or seminar, and the time I spent with my father has had an indelible impact on my own successes as an entrepreneur and investor. Perhaps the most important thing he ever taught me while on those visits was that in order to be successful it was important to treat your customers like family, and if you did that your customers would always be loyal to you and treat you like family. Although this might sound somewhat naive and simplistic in one sense, it proved to be quite true in my father’s case: when his business took a serious turn for the worse and it seemed as if he might have to declare bankruptcy, his customers and friends stood by him and provided their support, enabling the turnaround of his company through a series of loans which he eventually repaid in full. It was his commitment to his

The role of a radiologist has expanded beyond the tripartite mission of patient care, education, and research to include cross-specialty consultation for patient management, innovative solutions to improve health-care quality and safety, device design, and policy advocacy. As such, radiology residency programs should incorporate formalized training to prepare residents for these various professional roles.Since the 2015-2016 academic year, five training tracks focused on noninterpretative skills have been integrated into our residency training program: Clinician Educator, Quality Improvement, Entrepreneurship/Innovation, Health Policy Advocacy, and High-Value Care. Each track is longitudinal, with a set of requirements throughout the residents' training necessary to achieve certification at graduation.To date nine residents have participated in the programs, including two who received distinction in two separate tracks. Residents in each of the tracks have implemented successful initiatives related to the focus area. As such, these tracks enrich training by ensuring that residents make meaningful contributions to the department and institution during their training and disseminate successful initiatives through presentation at national meetings and publications.The duration of a radiology residency and resources available in an academic center provide opportunities for residency program directors to advance residents' skills in important noninterpretative components of radiology practice. Regardless of whether residents pursue academic medicine or private practice, these skills are necessary for graduates to become valuable members of a radiology practice and serve as national leaders in the field of radiology.

RationaleThe demographic, physiological, and computed tomography (CT) features associated with pneumothorax in smokers with and without chronic obstructive pulmonary disease (COPD) are not clearly defined.ObjectivesWe evaluated the hypothesis that pneumothorax in smokers is associated with male sex, tall and thin stature, airflow obstruction, and increased total and subpleural emphysema.MethodsThe study included smokers with and without COPD from the COPDGene Study, with quantitative chest CT analysis. Pleural-based emphysema was assessed on the basis of local histogram measures of emphysema. Pneumothorax history was defined by subject self-report.Measurements and main resultsPneumothorax was reported in 286 (3.2%) of 9,062 participants. In all participants, risk of prior pneumothorax was significantly higher in men (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.08-2.22) and non-Hispanic white subjects (OR, 1.90; 95% CI, 1.34-2.69). Risk of prior pneumothorax was associated with increased percent CT emphysema in all participants and participants with COPD (OR, 1.04 for each 1% increase in emphysema; 95% CI, 1.03-1.06). Increased pleural-based emphysema was independently associated with risk of past pneumothorax in all participants (OR, 1.05 for each 1% increase; 95% CI, 1.01-1.10). In smokers with normal spirometry, risk of past pneumothorax was associated with non-Hispanic white race and lifetime smoking intensity (OR, 1.20 for every 10 pack-years; 95% CI, 1.09-1.33).ConclusionsAmong smokers, pneumothorax is associated with male sex, non-Hispanic white race, and increased percentage of total and subpleural CT emphysema. Pneumothorax was not independently associated with height or lung function, even in participants with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

Background Treatment decisions for ascending aortic aneurysms are guided by measurements from CT angiograms. Objective The aim was to evaluate the reproducibility of these measurements by using manual techniques and advanced imaging software. Methods Two radiologists measured maximal ascending aorta diameter on CT angiograms in 30 subjects at 4 separate reading sessions—2 with manual techniques and 2 with semiautomated software analysis. Interobserver and intraobserver variabilities were assessed with Bland-Altman plots and Spearman correlation coefficients. Results Interobserver variability was smaller for the software-assisted method. Limits of agreement for the manual method were −4.2 mm and 9.2 mm compared with −4.0 mm and 4.6 mm for the software-assisted method; coefficients of repeatability were 6.8 mm and 4.3 mm. Intraobserver variability was inconsistent between readers. Strong correlation was found between observers who used both methods ( R 2 = 0.8078–0.9881; P Conclusion The use of an advanced imaging software for measurement of ascending aortic aneurysm reduces interobserver variability.

OBJECTIVE. This article reviews the use of CT urography in diagnosing ureteral transitional cell carcinomas, different CT urography protocols, CT findings suggestive of ureteral malignancy, and the importance of 3D reconstructions. CONCLUSION. The ureters can be problematic to evaluate on CT, partly because of difficulties in obtaining adequate ureteral distention and opacification. Proper diagnosis hinges not only on appropriate interpretation of the axial images but also on the utilization of a 3D technique (volume rendering or maximum intensity projection) as an ancillary tool.

OBJECTIVE. This article reviews several different causes of rectal bleeding and the role of MDCT in diagnosis. CONCLUSION. Although colonoscopy remains the first-line modality for the diagnosis of lower gastrointestinal tract bleeding, colonoscopy may not be possible for unstable patients, and moreover, even for patients who undergo colonoscopy, the examination may still fail to diagnose a cause for bleeding. MDCT with CT angiography and 3D mapping now offers a valuable option for diagnosis, not only for patients whose colonoscopy findings were negative, but also as a first-line screening modality for patients with active bleeding and hemodynamic instability. This article reviews the valuable role of MDCT in the diagnosis of multiple different causes of rectal bleeding, including rectal vascular malformations, rectal varices, ischemic colitis, stercoral colitis, inflammatory bowel disease, radiation proctopathy, infectious colitis, and rectal cancer.

OBJECTIVE. The purpose of this article is to discuss the normal findings and complications after pancreaticoduodenectomy. The Whipple procedure is associated with a set of common complications, including pancreatic fistula, postsurgical hemorrhage, postoperative pancreatitis, portomesenteric venous thrombosis, hepatic infarction, delayed gastric emptying, and anastomotic strictures. CONCLUSION. Appropriate diagnosis of these complications is contingent on an understanding of the surgical anatomy, normal postoperative imaging appearance in both the immediate postoperative and chronic settings, and typical CT appearance of each of these complications.

Medical imaging procedures have become a national target in the campaign to reduce wasteful practices. At a minimum, radiology residency programs must integrate high-value curricula and train residents to practice in accordance with value-based principles and new healthcare policy. A greater portion of radiology resident education needs to be devoted to appropriateness education and consultancy training. Ideally, radiology training programs will instill in residents the importance of embracing the movement and leading the change.

Traumatic hand and digit injuries result in complex challenging wounds that require the need for soft tissue coverage of exposed vital structures at the dorsal and palmar surface of the hand. Thin and supple tissue provides the best coverage for hand and finger defects because these tissues ultimately allow for stable wound coverage and improved range of motion with an acceptable aesthetic result. Given the limited amounts of expendable soft tissue in the distal upper extremity these devastating injuries usually require microvascular free tissue transfers with immediate syndactylization of the affected digits to provide soft tissue coverage. The authors review their experience in treating these complex hand and digit injuries using either free fascia or fasciocutaneous flaps with neosyndactylization of adjacent digits.

t e t t C e t e o i t m f t t t i e m INTRODUCTION Internet use for medical information seeking and continuing medical education has become an integral component of medical education. The iPad, Apple’s latest mobile hand-held computing device (Apple Computer, Cupertino, California), has great potential for educational use because of the perfect compromise between transportability and screen size. It is lighter and smaller than a laptop but has a similar screen size of 768 1,024 pixels. Aditional advantages over computer lapops include the iPad’s touch screen nd lack of a default orientation (porrait vs landscape) [1]. The iPad is already extremely popuar, with current estimates that 25 illion have been sold [2]. With repect to physician use, survey data reeals that iPadsareusedby30%ofdocors for a range of clinical purposes, ncluding medical record access, radioogic study review, and patient comunication. An additional 28% of the octors surveyed reported that they inend to purchase iPads in the next 6 onths [3]. Reports in the literature escribe clinical uses, including the reiew of radiologic studies in intensive areunits andoperating rooms[4,5], as ell as access to patient data and comunication between physicians [4]. hedevice’smobilitymakes it anexcelent resource for education as well, with ne advantage being that once downoaded, a highly interactive application app)maynotrequireInternetaccess to unction. Recognizing this potential, we deeloped an educational app for body T imaging, CTisus iQuiz: The HD dition, which has currently been ownloaded by 7,500 users in 1 ear. This is a free offline iPad applicaion designed to test students’ knowldge of body CT as well as to increase heir understanding of many of the pahologies that can be diagnosed with Tscanning. Itprovidesaneasy-to-use nvironment, which combines images, ext, andsoundtoenhance the learning xperience (Figure 1). On the basis of ur experience creating and distributng CTisus iQuiz: The HD Edition, his paper reviews the process of subitting an app to the Apple App Store or acceptance and distribution. Rather han focusingonthecontentandstrucure of an app for medical education, he purpose of this paper is to instruct nterested developers on the steps necssary to successfully develop and subit an app to the App Store.

Recent software developments enable interactive, real-time axial, 2D and 3D CT display on an iPad by cloud computing from a server for remote rendering. The purpose of this study was to compare radiologists' interpretative performance on the iPad to interpretation on the conventional picture archive and communication system (PACS). Fifty de-identified contrast-enhanced CT exams performed for suspected pulmonary embolism were compiled as an educational tool to prepare our residents for night call. Two junior radiology attendings blindly interpreted the cases twice, one reader used the PACS first, and the other interpreted on the iPad first. After an interval of at least 2 weeks, the cases were reinterpreted in different order using the other display technique. Sensitivity, specificity, and accuracy for identification of pulmonary embolism were compared for each interpretation method. Pulmonary embolism was present in 25 patients, ranging from main pulmonary artery to subsegmental thrombi. Both readers interpreted 98 % of cases correctly regardless of display platform. There was no significant difference in sensitivity (98 vs 100 %, p = 1.0), specificity (98 vs 96 %, p = 1.0), or accuracy (98 vs 98 %, p = 1.0) for interpretation with the iPad vs the PACS, respectively. CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists' availability for consultation and expedite emergency patient management.

BACKGROUND The inner thigh skin and fat based on the transverse upper gracilis musculocutaneous flap blood supply provide an autologous donor area with qualities favorable to microvascular breast reconstruction. The flap can be shaped to mimic a mastectomy specimen, providing excellent contour and projection, and has a consistent blood supply. The characteristics and skin color of the flap allow for immediate nipple-areola complex reconstruction in skin-sparing mastectomy. METHODS From 2004 to 2007, the authors performed 32 free inner thigh flap microvascular breast reconstructions after mastectomy for breast cancer in 20 patients, in both delayed and immediate settings. RESULTS All flaps survived without any soft-tissue loss or fat necrosis. Complications were a single take-back for venous thrombosis with salvage, donor-site skin breakdown in eight flaps, and five seromas. There was no functional loss at the donor site, and all patients resumed normal activity. CONCLUSIONS Transverse upper gracilis musculocutaneous flap microvascular breast reconstruction is an excellent option for patients who desire autologous reconstruction and who do not have adequate abdominal donor tissue or who do not desire abdominal scarring. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

Purpose The aim of this study was to evaluate for agreement with respect to how radiologists report incidental findings encountered on CT. Methods A multiple-choice survey was designed to query radiologists about how they handle 12 incidental findings on body CT, assuming the patient is a 45-year-old woman with no history of malignancy. Included were a 1-cm thyroid nodule, a 5-mm noncalcified lung nodule, coronary artery calcification, a 2-cm adrenal nodule, a 2-cm pancreatic cyst, a 1-cm enhancing liver lesion, a 2-cm high-density renal cyst, short-segment small bowel intussusception, a 1-cm splenic cyst, focal gallbladder wall calcification, and a 3-cm ovarian cyst in both a premenopausal woman and a postmenopausal woman. Choices ranged from "do not report" to advising interventional procedures tailored to the organ. Surveys were administered to body CT attending radiologists at 3 academic institutions. Results Twenty-seven radiologists completed the survey. The mean experience level was 15.7 years after training. Seventy percent or greater agreement on interpretation was identified for only 6 findings: recommend ultrasound for a 1-cm thyroid nodule, recommend ultrasound for a 3-cm cyst in postmenopausal woman, follow Fleischner Society recommendations for a 5-mm lung nodule, describe only coronary calcification, and describe as likely benign both short-segment small bowel intussusception and a 1-cm splenic cyst. Conclusions Agreement is lacking, both across institutions and within departments, for the management of 6 commonly encountered incidental findings on body CT. Individual departments should develop internal guidelines to ensure consistent recommendations based on existing evidence.

To determine whether the reader's preference for a primary two-dimensional (2D) or three-dimensional (3D) computed tomographic (CT) colonographic interpretation method affects performance when using each technique.In this institutional review board-approved, HIPAA-compliant study, images from 2531 CT colonographic examinations were interpreted by 15 trained radiologists by using colonoscopy as a reference standard. Through a survey at study start, study end, and 6-month intervals, readers were asked whether their interpretive preference in clinical practice was to perform a primary 2D, primary 3D, or both 2D and 3D interpretation. Readers were randomly assigned a primary interpretation method (2D or 3D) for each CT colonographic examination. Sensitivity and specificity of each method (primary 2D or 3D), for detecting polyps of 10 mm or larger and 6 mm or larger, based on interpretive preference were estimated by using resampling methods.Little change was observed in readers' preferences when comparing them at study start and study end, respectively, as follows: primary 2D (eight and seven readers), primary 3D (one and two readers), and both 2D and 3D (six and six readers). Sensitivity and specificity, respectively, for identifying examinations with polyps of 10 mm or larger for readers with a primary 2D preference (n = 1128 examinations) were 0.84 and 0.86, which was not significantly different from 0.84 and 0.83 for readers who preferred 2D and 3D (n = 1025 examinations) or from 0.76 and 0.82 for readers with a primary 3D preference (n = 378 examinations). When performance by using the assigned 2D or 3D method was evaluated on the basis of 2D or 3D preference, there was no difference among those readers by using their preferred versus not preferred method of interpretation. Similarly, no significant difference among readers or preferences was seen when performance was evaluated for detection of polyps of 6 mm or larger.The reader's preference for interpretive method had no effect on CT colonographic performance.

The purpose of our study was to compare the effect of three different full-laxative bowel preparations on patient compliance, residual stool and fluid, reader confidence, and polyp detection at CT colonography (CTC).A total of 2531 patients underwent CTC followed by colonoscopy for the American College of Radiology Imaging Network (ACRIN) National CTC Trial. Of this total, 2525 patients used one of three bowel preparations with bisacodyl tablets and stool and fluid tagging: 4 L of polyethylene glycol (PEG); 90 mL of phosphosoda; or 300 mL of magnesium citrate. Patients reported percent compliance with the bowel preparation and radiologists graded each CTC examination for the amount of residual fluid and stool on a scale from 1 (none) to 4 (nondiagnostic). Reader confidence for true-positive findings was reported on a 5-point scale: 1 (low) to 5 (high). Sensitivity and specificity for detecting polyps ≥ 6 mm and ≥ 1 cm compared with colonoscopy were calculated for each preparation.The most commonly prescribed preparation was phosphosoda (n = 1403) followed by PEG (n = 1020) and magnesium citrate (n = 102). Phosphosoda had the highest patient compliance (p = 0.01), least residual stool (p0.001), and highest reader confidence versus PEG for examinations with polyps (p = 0.06). Magnesium citrate had significantly more residual fluid compared with PEG and phosphosoda (p = 0.006). The sensitivity and specificity for detecting colon polyps ≥ 6 mm and ≥ 1 cm did not differ significantly between preparations.Polyp detection was comparable for all three preparations, although phosphosoda had significantly higher patient compliance and the least residual stool.