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The Sexual Health And Peer Education (SHAPE) program implemented in middle schools in Oklahoma County utilizes a hybrid adult and peer educator model to deliver sexual health programming. While peer educators have been incorporated into school-based sexual health programs in the past, this program is unique in its approach to preparing and engaging peer educators. Researchers synthesized data from interviews with program implementers and focus group discussions with teenage peer educators and middle school students who recently participated in the program to understand the process elements that contribute to the benefit of the SHAPE program model. Interviews with program implementers described the thorough peer educator recruitment and training process. Teenage peer educators felt well-prepared to deliver lessons, and through this program, they developed leadership skills, confidence, and grew personally. Middle school students revealed that peer educators were relatable and provided a positive experience where they could engage and ask questions. The application of a hybrid adult and teenage peer educator model proved useful for delivering sexual health topics and benefited students and teenage peer educators. This study's findings highlight elements that can be utilized in future sexual health programming to prepare and engage teenage peer educators in more meaningful ways.

Abstract Background Implementing the JCI Accreditation process as an organizational culture may face resistance. However, the skepticism and involvement of different hospital sectors (medical, nursing, paramedical, and administrative/logistic) in the process may vary. Conducting organizational change needs tools to decrease resistance. Objectives To investigate the attitudes, cultural norms, and satisfaction of the different sectors regarding the accreditation process, and to suggest ways to integrate the process as part of the organizational culture. Materials and methods A cross-sectional survey was conducted among 462 respondents (187 nurses, 95 physicians, 92 administrative, 88 paramedical) at Rambam Health Care Campus, a tertiary hospital in Israel. The hospital employees' attitudes, cultural norms, and satisfaction were assessed. ANOVA tests were used to examine the differences among the different sectors. The association between the satisfaction from the process and the preferred type of training was examined using Pearson's correlation coefficient. Results Significant differences were found among the sectors in the scores related to attitude, cultural norms, and satisfaction from the accreditation process (F (3, 456) = 17.95, p

Abstract Background During the COVID-19 outbreak, (March 1 - June 15, 2020) citizens expressed sympathy and gratitude towards medical staff through the media, while the entire hospital staff faced the same danger of infection as other citizens. This might have made hospital staff develop sympathy, understanding for the patients` and family’s needs, and a better communication. Objectives To investigate if there is a relation between the mutual change in attitude between citizens and hospital staff during the first COVID-19 outbreak, and the incidence of violence cases. Materials and methods This is a cross sectional study conducted at Rambam Medical Center (RMC) in Israel. The data about the number of violence cases were collected from the security department, and the data about hospital wards activity were collected from the hospital Business Intelligence (BI) software. The number of violence cases in relation to the number of Emergency Department (ED) visits, admissions to hospital wards, and length of stay (LOS) were compared during the COVID-19 outbreak to the corresponding period in 2019 using the T- test. The difference in the incidence of violence between general population and people with a psychiatric or social disorder (like drug abuse and criminal background) in both periods were also compared using the Fisher exact test. Results During the first COVID-19 outbreak, there were 6 violence cases against medical staff out of 24,740 visits to the ED, vs. 21 cases out of 30,759 visits during the same periods in 2019 (P

Even though birds are some of the most common road-killed animals, it remains to be determined whether avian roadkills are related to breeding numbers and breeding success, mainly due to a lack of study areas that monitor breeding populations and roadkills. We studied whether barn owl breeding numbers and breeding success are related to roadkills. We monitored yearly barn owl breeding numbers (2174 breeding attempts and 1682 adults ringed) and breeding success (9380 nestlings ringed) and monitored 95 km of roads weekly for roadkills from 2009 to 2017 in the Beit Shean and Emek Yizreel Valleys, Israel. During the study period, we documented 1073 road-killed barn owls, of which 328 were ring recoveries. The highest mortality occurred between July to September, coinciding with the barn owl post-fledging period. The number of breeding pairs and the number of nestlings ringed were positively related to the total number of barn owl roadkill, the proportion of roadkill ring recoveries, and the proportion of ring recovered roadkills in the first year of their life. First-year owls represent the majority of ringed owls, accounting for 64.6%, while adult owls compose 35.4%. Notably, a substantial fraction of adult ring recoveries, encompassing 67.2%, may pertain to floaters since we did not observe these individuals as breeding adults. Even though more females were found as roadkill ring recoveries, the proportion of male/female ring recoveries from roadkills was similar to that of adults ringed at the nest boxes. This study is the first that shows that barn owl roadkills are density-dependent and demonstrate the importance of monitoring breeding and population numbers in roadkill studies.

The oxygen deficient mesopelagic layer (ODL) off Peru has concentrations below 5 μmol O2 kg–1 and is delimited by a shallow upper oxycline with strong vertical gradient and a more gradual lower oxycline (lOx). Some regions show a narrow band of slightly increased oxygen concentrations within the ODL, an intermediate oxygen layer (iO2). CTD, oxygen and lowered Acoustic Doppler Current Profiler (LADCP, 300 kHz) profiles were taken on the shelf edge and outside down to mostly 2000 m. We evaluate here the acoustic volume backscatter strength of the LADCP signal representing organisms of about 5 mm size. Dominant features of the backscatter profiles were a minimum backscatter strength within the ODL, and just below the lOx a marked backscatter increase reaching a maximum at less than 3.0 μmol O2 kg–1. Below this maximum, the acoustic backscatter strength gradually decreased down to 1000 m below the lOx. The backscatter strength also increased at the iO2 in parallel to the oxygen concentration perturbations marking the iO2. These stable backscatter features were independent of the time of day and the organisms represented by the backscatter had to be adapted to live in this microaerobic environment. During daylight, these stable structures were overlapped by migrating backscatter peaks. Outstanding features of the stable backscatter were that at very low oxygen concentrations, the volume backscatter was linearly related to the oxygen concentration, reaching half peak maximum at less than 2.0 μmol O2 kg–1 below the lOx, and the depth-integrated backscatter of the peak below the lOx was higher than the integral above the Ox. Both features suggest that sufficient organic material produced at the surface reaches to below the ODL to sustain the major fraction of the volume backscatter-producing organisms in the water column. These organisms are adapted to the microaerobic environment so they can position themselves close to the lower oxycline to take advantage of the organic particles sinking out of the ODL.

The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 represents an update on the scheme used for colorectal and extracolonic findings at CTC. The update provides useful insights gained since the implementation of the original system in 2005. Increased experience has demonstrated confusion on how to classify the mass-like appearance of the colon consisting of soft tissue attenuation that occurs in segments with acute or chronic diverticulitis. Therefore, the update introduces a new subcategory, C2b, specifically for mass-like diverticular strictures, which are likely benign. Additionally, the update simplifies extracolonic classification by combining E1 and E2 categories into an updated extracolonic category of E1/E2 since, irrespective of whether a finding is considered a normal variant (category E1) or an otherwise clinically unimportant finding (category E2), no additional follow-up is required. This simplifies and streamlines the classification into one category, which results in the same management recommendation., (© RSNA, 2024 See also the editorial by Taylor in this issue.)

Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery.  HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees.  The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Simultaneous interpretation is a complex task that is assumed to be associated with a high workload. To corroborate this association, we measured workload during three tasks of increasing complexity: listening, shadowing, and interpreting, using electroencephalography and self-assessments in four groups of participants with varying experience in simultaneous interpretation. The self-assessment data showed that professional interpreters perceived the most workload-inducing condition, namely the interpreting task, as less demanding compared to the less experienced participants. This higher subjectively perceived workload in non-interpreters was paralleled by increasing frontal theta power values from listening to interpreting, whereas such a modulation was less pronounced in professional interpreters. Furthermore, regarding both workload measures, trainee interpreters were situated between professional interpreters and non-interpreters. Since the non-interpreters demonstrated high proficiencies and exposure in their second language, too, our findings provide evidence for an influence of interpretation training on experienced workload during simultaneous interpretation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

With the worldwide increase in people speaking more than one language, a better understanding of the behavioural and neural mechanisms governing lexical selection, lexical access in multiple languages and code switching has attracted widespread interest from several disciplines. Previous studies documented higher costs when processing a non-native (L2) than a native (L1) language or when switching from L2 to L1. However, studies on auditory language reception are still scarce and did not take into account the degree of switching experience. Accordingly, in the present study, we combined behavioural and electrophysiological measurements to assess lexical access in L1 and L2 as well as code switching in professional simultaneous interpreters, trainee interpreters, foreign language teachers and Anglistics students, while the participants performed a bilingual auditory lexical decision task. The purpose of this study was to expand the knowledge on code switching in auditory language processing and examine whether the degree of simultaneous interpretation experience might reduce switching costs. As a main result, we revealed that L2 compared to L1 trials, as well as switch compared to non-switch trials, generally resulted in lower accuracies, longer reaction times and increased N400 amplitudes in all groups of participants. Otherwise, we did not reveal any influence of switching direction and interpretation expertise on N400 parameters. Taken together, these results suggest that a late age of L2 acquisition leads to switching costs, irrespective of proficiency level. Furthermore, we provided first evidence that simultaneous interpretation training does not diminish switching costs, at least when focusing on lexical access., (© 2022 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Purpose: CT colonography (CTC) is growing in its utilization as a nationally approved colorectal cancer screening test. After colonic polyps, lipomas are the second most common colonic lesions and their accurate and rapid recognition are important., Methods: This retrospective Institutional Review Board approved study was performed at two large academic university-based institutions. 1044 patients underwent CTC at Institution A from 2010 to 2018 and 1094 patients underwent CTC at Institution B from 2003 to 2015. All CTC examinations with at least one colonic lipoma in their report were evaluated by a fellowship-trained abdominal imaging radiologist. 47 CTC examinations containing 59 colonic lipomas were detected and included. Segmental location, sessile versus pedunculated morphology, multiplicity, average attenuation, and largest lesion diameter were evaluated. A review of the current literature on colonic lipomas is entailed., Results: The overall incidence of colonic lipoma was 2.2% in women and 2.3% in men. Mean age for detection of colonic lipomas on CTC was 66.9 years. Segmental locations of colonic lipomas include ascending colon (39%), transverse colon (19%), ileocecal valve (12%), cecum (12%), descending colon (10%), and rectosigmoid (8%). 9% of colonic lipomas were multiple, 42% were pedunculated, and 58% were sessile. The mean (range) size of detected lipomas was 19 (6-59) mm. The mean (range) attenuation was - 132 (- 41 to - 258) HU., Conclusion: Most colonic lipomas are located in the ascending colon. Although they are typically solitary, just under 10% are multiple, and although they are most often sessile, slightly under half are pedunculated mimicking polyps. CTC detects smaller lipomas than optical colonoscopy., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Epigastric pain can have multiple etiologies including myocardial infarction, pancreatitis, acute aortic syndromes, gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, and hiatal hernia. This document focuses on the scenarios in which epigastric pain is accompanied by symptoms such as heartburn, regurgitation, dysphagia, nausea, vomiting, and hematemesis, which raise suspicion for gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, or hiatal hernia. Although endoscopy may be the test of choice for diagnosing these entities, patients may present with nonspecific or overlapping symptoms, necessitating the use of imaging prior to or instead of endoscopy. The utility of fluoroscopic imaging, CT, MRI, and FDG-PET for these indications are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2021 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Pelvic floor dysfunction is a relatively common but often complex condition, presenting with a variety of clinical symptoms, especially when it involves multiple compartments. Clinical exam alone is often inadequate and requires a complementary imaging study. Magnetic resonance defecography (MRD) is an excellent noninvasive diagnostic study with its multiplanar capability, lack of ionizing radiation and excellent soft tissue resolution. It can identify both anatomic and functional abnormalities in the pelvic floor and specifically excels in its ability to simultaneously detect multicompartmental pathology and help with vital pre-operative assessment. This manuscript reviews the relevant anatomical landmarks, describes the optimal technique, highlights an approach to the interpretation of MRD, and provides an overview of the various pelvic floor disorders in the different anatomical compartments.

The pelvic floor is composed of a network of muscles, ligaments, and fasciae, which provide active and passive support for the pelvic organs. Impairment of these pelvic floor elements can result in a variety of functional abnormalities and single or multicompartment organ prolapse. Knowledge of normal pelvic floor anatomy can aid the radiologist in understanding the complex nature of pelvic floor dysfunction and is important for comprehensive image interpretation. This article provides an overview of normal anatomy of the pelvic floor as seen on magnetic resonance imaging, ultrasound, and fluoroscopic studies performed in the evaluation of pelvic floor function.

Pelvic floor dysfunction is prevalent, with multifactorial causes and variable clinical presentations. Accurate diagnosis and assessment of the involved structures commonly requires a multidisciplinary approach. Imaging is often complementary to clinical assessment, and the most commonly used modalities for pelvic floor imaging include fluoroscopic defecography, magnetic resonance defecography, and pelvic floor ultrasound. This collaboration opinion paper was developed by representatives from multiple specialties involved in care of patients with pelvic floor dysfunction (radiologists, urogynecologists, urologists, and colorectal surgeons). Here, we discuss the utility of imaging techniques in various clinical scenarios, highlighting the perspectives of referring physicians. The final draft was endorsed by the Society of Abdominal Radiology (SAR), American Urogynecologic Society (AUGS), and the American Urological Association (AUA).

Purpose: Some patients with novel coronavirus disease 2019 (COVID-2019) present with abdominal symptoms. Abdominal manifestations of COVID on imaging are not yet established. The goal of this study was to quantify the frequency of positive findings on abdominopelvic CT in COVID-positive patients, and to identify clinical factors associated with positive findings to assist with imaging triage., Materials and Methods: This retrospective study included adult COVID-positive patients with abdominopelvic CT performed within 14 days of their COVID PCR nasal swab assay from 3/1/2020 to 5/1/2020. Clinical CT reports were reviewed for the provided indication and any positive abdominopelvic findings. Demographic and laboratory data closest to the CT date were recorded. Multivariate logistic regression model with binary outcome of having no reported positive abdominopelvic findings was constructed., Results: Of 141 COVID-positive patients having abdominopelvic CT (average age 64 years [± 16], 91 [64%] women), 80 (57%) had positive abdominopelvic findings. Abdominal pain was the most common indication, provided in 54% (43/80) and 74% (45/61) of patients with and without reported positive abdominopelvic findings, respectively (p = 0.015). 70% (98/141) of patients overall had reported findings in the lung bases. Findings either typical or intermediate for COVID were reported in 50% (40/80) and 64% (39/61) of patients with and without positive abdominopelvic findings, respectively (p = 0.099). Of 80 patients with positive abdominopelvic findings, 25 (31%) had an abnormality of gastrointestinal tract, and 14 (18%) had solid organ infarctions or vascular thromboses. In multivariate analysis, age (OR 0.85, p = 0.023), hemoglobin (OR 0.83, p = 0.029) and male gender (OR 2.58, p = 0.032) were independent predictors of positive abdominopelvic findings, adjusted for race and Charlson comorbidity index., Conclusion: Abdominopelvic CT performed on COVID-positive patients yielded a positive finding in 57% of patients. Younger age, male gender, and lower hemoglobin were associated with higher odds of having reportable positive abdominopelvic CT findings.

Although usually not a first-line imaging modality in the setting of acute pelvic pain, magnetic resonance imaging (MRI) is able to depict and characterize a wide range gynecologic diagnoses with high accuracy. Lack of ionizing radiation renders MRI particularly useful for assessment of pregnant women and children. Furthermore, inherent high soft-tissue resolution of MRI allows accurate diagnosis without intravenous contrast use, which is advantageous for patients with renal insufficiency and pregnant patients. Familiarity with the typical MRI appearance of various acute gynecologic conditions helps establish the correct diagnosis. This article reviews the common MRI findings of acute gynecologic processes, in both pregnant and nonpregnant patients. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1291-1309., (© 2019 International Society for Magnetic Resonance in Medicine.)

Pancreatic cancer is an aggressive disease with rising incidence and high mortality despite advances in imaging and therapeutic options. Surgical resection is currently the only curative treatment, with expanding roles for adjuvant and neoadjuvant chemoradiation. Accurate detection, staging, and post-treatment monitoring of pancreatic cancer are critical to improving survival and imaging plays a central role in the multidisciplinary approach to this disease. This article will provide a broad overview of the imaging and management of pancreatic cancer with a focus on diagnosis and staging, operative and nonoperative treatments, and post-therapeutic appearances after surgery and chemoradiation therapy., (Copyright © 2019. Published by Elsevier Inc.)

The purpose of this study was to assess the concordance in categorization and radiologic T staging using Liver Imaging Reporting and Data System (LI-RADS, LR) version 2017 (v2017), version 2018 (v2018), and the Organ Procurement and Transplantation Network (OPTN) criteria. All magnetic resonance imaging and computed tomography reports using a standardized LI-RADS macro between April 2015 and March 2018 were identified retrospectively. The major features (size, arterial phase hyperenhancement, washout, enhancing capsule, or threshold growth) were extracted from the report for each LR-3, LR-4, and LR-5 observation. Each observation was assigned a new category based on LI-RADS v2017, v2018, and OPTN criteria. Radiologic T stage was calculated based on the size and number of LR-5 or OPTN class 5 observations. Categories and T stages assigned by each system were compared descriptively. There were 398 patients (66.6% male; mean age, 63.4 years) with 641 observations (median size, 14 mm) who were included. A total of 73/182 (40.1%) observations categorized LR-4 by LI-RADS v2017 were up-categorized to LR-5 by LI-RADS v2018 due to changes in the LR-5 criteria, and 4/196 (2.0%) observations categorized as LR-5 by LI-RADS v2017 were down-categorized to LR-4 by LI-RADS v2018 due to changes in the threshold growth definition. The T stage was higher by LI-RADS v2018 than LI-RADS v2017 in 49/398 (12.3%) patients. Compared with the OPTN stage, 12/398 (3.0%) patients were upstaged by LI-RADS v2017 and 60/398 (15.1%) by LI-RADS v2018. Of 101 patients, 5 (5.0%) patients with T2 stage based on LI-RADS v2017 and 10/102 (9.8%) patients with T2 stage based on LI-RADS v2018 did not meet the T2 criteria based on the OPTN criteria. Of the 98 patients with a T2 stage based on OPTN criteria, 2 (2.0%) had a T stage ≥3 based on LI-RADS v2017 and 6 (6.1%) had a T stage ≥3 based on LI-RADS v2018., (Copyright © 2019 by the American Association for the Study of Liver Diseases.)

The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal sphincter complex is an integral part of the coordinated effort of defecation. As imaging plays an important role in assessment of pathologic conditions involving the anal region, understanding the normal anatomy of the anal sphincter complex is important for correct image interpretation and accurate diagnosis. This review discusses the anatomy and function of the anal sphincter complex, important technical considerations for MRI, and various inflammatory, infectious, and neoplastic processes, as well as pathologic structural conditions that affect the anal region. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1018-1032., (© 2019 International Society for Magnetic Resonance in Medicine.)

Colostomies are commonly created in conjunction with colorectal surgery performed for both malignant and benign indications. Familiarity with the different types of colostomies and their normal imaging appearance will improve radiologic detection and characterization of colostomy complications. The radiologist plays a large role in assessment of colostomy patients either via fluoroscopic technique or multidetector computed tomography (CT) in order to help identify ostomy complications or to aid the surgeon prior to colostomy reversal. In this article, we will review: (1) the types of colostomies and indications for their creation; (2) the proper radiographic technique of ostomy evaluation; and (3) the potential complications of colostomies and their imaging manifestations., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Pelvic floor dysfunction encompasses a spectrum of functional disorders that result from impairment of the ligaments, fasciae, and muscles supporting the pelvic organs. It is a prevalent disorder that carries a lifetime risk over 10% for undergoing a surgical repair. Pelvic floor weakness presents as a wide range of symptoms, including pain, pelvic pressure or bulging, urinary and fecal incontinence, constipation, and sexual dysfunction. A correct diagnosis by clinical examination alone can be challenging, particularly in cases involving multiple compartments. Magnetic resonance imaging (MRI) allows noninvasive, radiation-free, high soft-tissue resolution evaluation of all three pelvic compartments, and has proved a reliable technique for accurate diagnosis of pelvic floor dysfunction. MR defecography with steady-state sequences allows detailed anatomic and functional evaluation of the pelvic floor. This article provides an overview of normal anatomy and function of the pelvic floor and discusses a practical approach to the evaluation of imaging findings of pelvic floor relaxation, pelvic organ prolapse, fecal incontinence, and obstructed defecation., Level of Evidence: 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1155-1170., (© 2018 International Society for Magnetic Resonance in Medicine.)

Purpose: The goal of this study was to compare agreement between computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of the major Liver Imaging Reporting and Data System (LI-RADS) features used in assessment of hepatocellular carcinoma: arterial phase hyperenhancement (APHE), portal venous phase washout (WO), capsule appearance (capsule), and largest diameter (diameter)., Methods: Patients with liver protocol CT and gadoxetate-enhanced MRI within 1 month of each other and at least 1 discrete untreated liver lesion were included. Two readers independently reviewed hepatic arterial phase and portal venous phase of each lesion on both CT and MRI, presented at random. The APHE, WO, capsule, and diameter were assessed for each lesion on CT and MRI. The LI-RADS category was assigned based on the recorded major features. Interobserver agreements between the readers for both imaging modalities and for each of the major features were assessed using κ statistics. Agreement between CT and MRI for each reader and for each feature was assessed using κ statistics. Agreement was interpreted based on κ as follows: 0.20 or less, slight agreement; 0.21 to 0.40, fair agreement; 0.41 to 0.60, moderate agreement; 0.61 to 0.80, substantial agreement; and 0.81 to 1.00, almost perfect agreement. Intraclass correlation coefficient was used to assess concordance of diameter measurements., Results: There were 42 patients (mean age, 62.2 ± 7.0 years; 33 men [78.6%]) with 50 lesions. On CT, the interobserver agreement between the readers was almost perfect for APHE (κ = 0.85), WO (κ = 0.83), and capsule (κ = 0.86). On MRI, the interobserver agreement between the readers was almost perfect for APHE (κ = 0.86) and WO (κ = 0.83) and moderate for capsule (κ = 0.59). Intraclass correlation coefficient for diameter measurement was 0.99 for CT and 0.98 for MRI. For reader 1, the agreement between CT and MRI was fair for APHE (κ = 0.39) and capsule (κ = 0.26) and moderate for WO (κ = 0.49). For reader 2, the agreement between CT and MRI was moderate for APHE (κ = 0.43) and capsule (κ = 0.43) and fair (κ = 0.38) for WO. Agreement between readers for final LI-RADS category was substantial for CT (κ = 0.79) and moderate for MRI (κ = 0.60). Agreement for final LI-RADS categories between MRI and CT was fair for both reader 1 (κ = 0.33) and reader 2 (κ = 0.39)., Conclusions: Interobserver agreement for the major LI-RADS features varies from moderate to almost perfect, for both CT and MRI. However, the agreement between CT and MRI for each of the major LI-RADS features is poor, ranging from fair to moderate. This poor agreement contributes to substantial differences between final LI-RADS category assigned on CT versus MRI.

Purpose: To assess the impact of a Liver Imaging Reporting and Data System (LI-RADS) structured template on quality of reports for hepatocellular carcinoma (HCC)., Materials and Methods: A departmental structured LI-RADS template was adopted in April 2015. CT and MRI reports from September 2014 to February 2016 with probable or definite HCC were reviewed. Reporting of the following was recorded for each lesion and compared between template and free-text reports: (1) LI-RADS category, (2) Couinaud segment, and (3) unequivocal description of presence or absence of major LI-RADS HCC features: arterial phase hyperenhancement, "washout," diameter, threshold growth, and "capsule.", Results: There were 306 definite or probable HCCs, 125 (40.8%) reported with free text and 181 (59.2%) with the template. LI-RADS category was reported in 23 of 125 (18.4%) HCCs with free text and in 178 of 181 (98.3%) HCCs with the template (P < .001). Couinaud segment was reported in 102 of 125 (81.6%) HCCs with free text and in 181 of 181 (100%) HCCs with the template (P < .001). Diameter was reported in 118 of 125 (94.4%) HCCs with free text and in 181 of 181 (100%) HCCs with the template (P = .001). Threshold growth was reported in 36 of 125 (28.8%) HCCs with free text and in 169 of 181 (93.4%) HCCs with the template (P < .001). Arterial phase hyperenhancement was reported in 101 of 125 (80.8%) HCCs with free text and in 177 of 181 (97.8%) HCCs with the template (P < .001). Washout was reported in 93 of 125 (74.4%) HCCs with free text and in 178 of 181 (98.3%) HCCs with the template (P < .001). Capsule was reported in 24 of 125 (19.2%) HCCs with free text and in 176 of 181 (97.2%) HCCs with the template (P < .001)., Conclusions: Use of structured LI-RADS template resulted in more comprehensive and consistent reporting of major HCC features and LI-RADS category compared with free-text reporting., (Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: Liver Imaging Reporting and Data System (LI-RADS) uses major features (arterial phase hyperenhancement [APHE], "washout" [WO], "capsule," diameter, threshold growth [TG]) to codify probability of hepatocellular carcinoma for each observation. This study assessed the effect of removing TG as a major feature on LI-RADS categorization., Materials and Methods: In this HIPAA-compliant, IRB-approved study, all MR and CT clinical reports containing a standardized LI-RADS v2014 template between 4/15-1/17 were retrospectively reviewed for each LR-3, LR-4, and LR-5 reported observation. Two LI-RADS categories were then assigned: one using all LI-RADS major features and one after removing TG as a major feature. The two categories were compared descriptively., Results: The study included 265 patients (172 [65%] male, mean age 63 [±10] years) with 489 observations (median diameter 14 mm, IQR 10-20 mm), of which 345 (71%) had APHE, 307 (63%) had WO, 86 (18%) had "capsule," and 72 (15%) had TG. Of 86 observations with TG, 47 (65%) were new observations ≥10 mm, 14 (19%) had diameter increase ≥50% in ≤6 months, and 11 (15%) had diameter increase ≥100% in >6 months. Using all major features, 214/489 (44%) observations were LR-3, 129/489 (26%) were LR-4, and 146/489 (30%) were LR-5. After removing TG, 237/489 (48%) were LR-3, 119/489 (24%) were LR-4, and 133 (27%) were LR-5. Removing TG caused a category downgrade for 35/489 (7%, 95% CI 5-10) observations, including 13/146 (9%, 95% CI 3-14) LR-5 observations., Conclusion: 9% of LR-5 observations would be downgraded without TG.

Purpose: To assess relationship between pancreatic cysts (PC) and pancreatic ductal adenocarcinoma (PDAC) and to compare imaging features of PC in subjects who develop PDAC and those who do not., Material and Methods: This case-control IRB-approved HIPAA-compliant study included patients with PDAC (cases) and lung cancer (controls), diagnosed between 1/1/05-1/1/14. The most recent abdominal CT/MR of each patient done >6months prior to cancer diagnosis date was reviewed by radiologist blinded to case/control status. Presence of PC, number and size of largest PC, presence of main pancreatic duct (MPD) dilatation (MPD >3mm) were recorded. Simple PC was defined as lack of calcifications, septations and enhancement. Logistic regression models with binary outcome of PDAC were constructed., Results: There were 88 cases and 273 controls with mean ages of 69.6 years (±10.3) and 69.8 years (±12.0), respectively (p=0.864). PC were present in 21.6% (19/88) cases and in 9.2% (25/273) controls (p=0.002). The OR of PC for development of PDAC was 2.83, adjusting for age, sex and race (p=0.001). Mean PC size was 14.8mm (±8.7) in cases and 7.6mm (±8.0) in controls (p=0.007). PC were solitary in 6 (31.6%) of 19 cases and 21 (84.0%) of 25 controls (p=0.001). There was no significant difference in proportions of simple cysts or MPD dilatation between cases and controls. Multiple PC had 8.2 times increased odds of PDAC compared with solitary PC, adjusting for cyst size (p=0.007)., Conclusion: Multiple PC are associated with 8.2 times higher odds of PDAC compared with solitary PC., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To assess the relationship between imaging follow-up and all-cause mortality in subjects ≥65 years with and without incidental pancreatic cysts (IPC)., Methods and Materials: Patients ≥65 years with abdominal CT/MR 11/1/01-11/1/11 were included. IPC group included subjects with IPC on CT/MR report; No-IPC group was 3:1 frequency-matched on age decade, imaging modality and year of initial study from the pool without reported IPC. Demographics, date of last encounter, date of death, Charlson scores within 3 months before initial CT/MR and number of abdominal CTs and MRs performed after initial study were recorded. Logistic regression models with binary outcomes of death and having post-index imaging were constructed. Models were adjusted for age, race, sex, Charlson score and follow-up time. Subgroups were created based on interactions between variables., Results: There were 1320 subjects in IPC group and 3805 in No-IPC group, with mean ages 79.1 (±8.0) and 78.8 (±8.0) years, respectively (p=0.293), and median follow-up times of 3.1 (IQR 0.74-5.26) and 3.0 (0.36-5.23) years, respectively (p=0.009). Adjusted odds ratios of post-index imaging for IPC were 2.18 (p<0.001) in subgroup<84years and follow-up <4years, 3.37 (p<0.001) in subgroup <84 years and follow-up ≥4 years, and 1.20 (p=0.201) in subgroup ≥84 years. Number of follow-up CTs and MRs was not independently associated with decreased odds of death in any subgroup., Conclusion: Older subjects with IPC are more likely to undergo imaging follow-up compared to subjects without IPC, yet increasing number of follow-up studies does not decrease the odds of death., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

We report the magnetic resonance (MR) findings of sarcoma botryoides in two young pediatric patients with this tumor. There has been very little literature regarding the MR appearance of this subtype of rhabdomyosarcoma. In both cases, the tumor was vaginal in origin, as would be expected in this age group. We found areas of bright T2 signal within these lesions, intermixed with areas of lower T2-signal tissue, which showed considerable enhancement. These imaging findings are reflective of the histologic architecture of these lesions, which are composed of separate myxoid and subepithelial cellular zones. In both cases, the extent of the tumor and lack of local invasion or metastatic disease were confirmed surgically, and both patients have undergone multiple postoperative MR studies that have shown lack of residual, recurrent, or metastatic disease., (Copyright (c) 2009 Wiley-Liss, Inc.)