Miracle-dz/UniFAR-FTUs huggingface dataset:
Designing a safer radiology department.

OBJECTIVE Patients presume safety in radiologic services, but the potential to do harm exists in every area of imaging. Radiology department personnel need to understand basic regulatory requirements for safety and how to promote and improve safety in the future. CONCLUSION This article reviews key safety metrics that we think are relevant to radiology and discusses how to define the measures and how we are attempting to translate the metrics into a culture of safety.
When to give blood

With increased public awareness of the risks of blood transfusion and the decreased availability of blood products, the decision to transfuse a patient should be considered carefully. Most patients require a blood transfusion when haemoglobin levels fall below 8 g=dl or when there is greater than 30% loss of blood volume. However, the main indication for transfusing a patient is to increase their oxygen-carrying capacity and through invasive monitoring provide evidence of inadequate tissue oxygenation. Blood transfusions should be based on the patient’s risks of developing complications of inadequate oxygenation rather than on a single haemoglobin ‘trigger’.
Diagnosis of vascular cognitive impairment: recommendations of the scientific department of cognitive neurology and aging of the Brazilian Academy of Neurology

ABSTRACT Since the publication of the latest recommendations for the diagnosis and treatment of Vascular Dementia by the Brazilian Academy of Neurology in 2011, significant advances on the terminology and diagnostic criteria have been made. This manuscript is the result of a consensus among experts appointed by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2020-2022). We aimed to update practical recommendations for the identification, classification, and diagnosis of Vascular Cognitive Impairment (VCI). Searches were performed in the MEDLINE, Scopus, Scielo, and LILACS databases. This guideline provides a comprehensive review and then synthesizes the main practical guidelines for the diagnosis of VCI not only for neurologists but also for other professionals involved in the assessment and care of patients with VCI, considering the different levels of health care (primary, secondary and tertiary) in Brazil.
Atypical metastases from prostate cancer: 10-year experience at a single institution.

OBJECTIVE The purpose of the study was to retrospectively review the frequency, sites, and patterns of atypical metastases from prostate cancer and to determine whether any correlation exists between the atypical sites and biochemical or histologic variables. MATERIALS AND METHODS All available imaging studies of 620 consecutive patients with biopsy-proven prostate carcinoma seen at our institute between 1999 and 2009 were reviewed. Eighty-two patients (mean age, 72 years; age range, 58-87 years) with atypical sites of metastases were identified. Patients were separated into groups on the basis of the presence or absence of concurrent osseous metastasis and high or low Gleason grade, and metastatic patterns were compared using the Fisher exact test. The maximum prostate-specific antigen (PSA) level for each patient was recorded and correlated with metastatic pattern using the Mann-Whitney test. RESULTS The most frequent sites of atypical metastases were the lungs and pleura (40%, 33/82), liver (37%, 30/82), supradiaphragmatic lymph nodes (34%, 28/82), and adrenal glands (15%, 12/82). Supradiaphragmatic lymphadenopathy was more common in patients with osseous metastases (45%, 25/56) than in patients without concurrent osseous involvement (12%, 3/26; p < 0.05). There was no significant correlation between the other atypical metastatic sites and osseous metastases. Abdominal visceral metastasis occurred more frequently in patients with a high Gleason grade (25/43, 58%) than in patients with a low Gleason grade (9/29, 31%; p < 0.05). There was no significant correlation between metastatic pattern and PSA level. CONCLUSION The lungs and pleura, liver, supradiaphragmatic lymph nodes, and adrenal glands are the most common extranodal metastatic sites of prostate cancer. Supradiaphragmatic lymphadenopathy was strongly associated with concurrent osseous metastases.
Variant arteries at the base of the brain

Abnormalities of the important arteries at the base of brain can lead to serious clinical conditions like stroke or other functional deficits. We report here a variant pattern of arteries seen at the base of the brain. The left internal carotid artery was slightly larger than the right and it terminated by dividing into anterior and middle cerebral arteries. It gave an abnormally large posterior communicating artery, which was almost equal in size to that of the middle cerebral artery. This posterior communicating artery replaced the distal part of the left posterior cerebral artery. The proximal part of the left posterior cerebral artery was very small. There were two anterior communicating arteries. The left vertebral artery was larger than the right vertebral artery. The knowledge of these anomalous arteries may be useful for radiologists, neurosurgeons and clinicians in general.
AN ADAPTIVE BAYESIAN APPROACH TO JOINTLY MODELING RESPONSE AND TOXICITY IN PHASE I DOSE-FINDING TRIALS

The Belmont Report (1979) presents ethical principles governing clinical research: respect for persons, beneficence, and justice. This dissertation attempts to improve beneficence, in particular, in early stage clinical trials, in three directions. First, we develop a "dose-choice control panel" (DCCP) computer program. Inputs are complete population information and patient utilities. DCCP produces optimal dose assignment decisions, and helps users to explore how the population parameters and utilities affect the dose recommendation.Second, we present a new adaptive Bayesian method for dose-finding in phase I clinical trials based on both response and toxicity. Although clinical responses are rare in cancer trials, biological responses may be common and may help decide how aggressive a phase I escalation should be. The model assumes that response and toxicity events happen depending on respective dose thresholds for the individual, assuming that the thresholds jointly follow a bivariate log-normal distribution or a mixture. The design utilizes prior information about the population threshold distribution as well as accumulated data. The next dose is assigned to maximize expected utility integrated over the current posterior distribution. The design is evaluated in a setting inspired by the Gleevec story, with population parameters equaling estimates from early Gleevec trials. This exercise provides evidence for the value of the use of the proposed design for future clinical trials. Third, we propose an adaptive Bayesian design based on a hierarchical pharmacokinetics/pharmacodynamic (PK/PD) model, incorporating prior knowledge and/or patient-specific measurements related to PK/PD processes. Because genetic variations or drug co-administration can lead to huge inter-individual differences in drug efficacy and toxicity, it is desirable to individualize chemotherapy dosage. Those factors influencing drug metabolism and clearance are expected to affect all PD processes downstream, leading to efficacy and toxicity outcomes, while other genetic variations or drug co-administration may affect only one PD process. Application of the design to the Gleevec and Irinotecan settings is encouraging with regard to patient protection and accuracy of estimates. This work could improve public health by providing more accurate answers quicker, and by encouraging accrual through explicit consideration of what is best for each individual patient.
What a differential a virus makes: a practical approach to thoracic imaging findings in the context of HIV infection--part 2, extrapulmonary findings, chronic lung disease, and immune reconstitution syndrome.

OBJECTIVE The Centers for Disease Control and Prevention reported more than one million people with HIV infection in the United States in 2006, an increase of 11% over 3 years. Worldwide, nearly 34 million people are infected with HIV. Pulmonary disease accounts for 30-40% of acute hospitalizations of HIV-seropositive patients, underscoring the importance of understanding the range of cardiothoracic imaging findings associated with HIV infection. This article will cover extrapulmonary thoracic diseases, chronic lung diseases, and immune reconstitution inflammatory syndrome in HIV-infected patients. Our approach is focused on the radiologist's perspective by recognizing and categorizing key imaging findings to generate a differential diagnosis. The differential diagnosis can be further refined by incorporating clinical data, such as patient demographics, CD4 count, and presenting symptoms. In addition, with prolonged survival of HIV-infected patients in the era of highly active antiretroviral therapy, radiologists can also benefit from awareness of imaging features of a myriad of chronic cardiopulmonary diseases in this patient population. Finally, the change of imaging findings and clinical status in response to treatment provides important diagnostic information, such as in immune reconstitution syndrome. CONCLUSION Developing a practical approach to key cardiothoracic imaging findings in HIV-infected patients will aid the radiologist in generating a clinically relevant differential diagnosis and interpretation, thereby improving patient care.
Tumor response on CT following hypofractionated stereotactic ablative body radiotherapy for small hypervascular hepatocellular carcinoma with cirrhosis.

OBJECTIVE The purpose of this study is to evaluate the CT appearances of tumor responses following hypofractionated stereotactic ablative body radiotherapy for small hypervascular hepatocellular carcinomas (HCCs) and to assess the relationship between tumor responses and local control. MATERIALS AND METHODS Among 277 HCC tumors treated with stereotactic ablative body radiotherapy (35 or 40 Gy per five fractions), we selected enhanced lesions on arterial phase CT performed before stereotactic ablative body radiotherapy. Radiographic findings after stereotactic ablative body radiotherapy were evaluated during a 2-year follow-up period with the modified Response Evaluation Criteria in Solid Tumors. Local control and survival rates were calculated with the Kaplan-Meier method. RESULTS Forty-two tumors with a median size of 2.1 cm (range, 1.0-3.8 cm) were selected with a median follow-up of 23.3 months (range, 9-56 months). Local recurrence was observed in two tumors after achieving a complete response (CR). The 2-year local control rate was 97%, and the overall survival rate was 81%. CR increased from 10 (24%) to 28 (67%) to 30 (71%) tumors at 3, 6, and 12 months after stereotactic ablative body radiotherapy. Overall CR at maximum follow-up was 39 tumors (93%), yet three enhanced tumors persisted for more than 2 years. The median time to achieve CR was 5.9 months (range, 1.2-34.2 months). CONCLUSION The CR rate in hypervascular HCCs after hypofractionated stereotactic ablative body radiotherapy increased during the 2-year follow-up period. Cautious and continuous observation until tumor regrowth is considered relevant to evaluate a true effect of this treatment. Further studies for the optimal evaluation of treatment outcome after stereotactic ablative body radiotherapy are warranted.
A Model-Based Method for Assessing Insulin Sensitivity From the Oral Glucose Tolerance Test

OBJECTIVE —Available insulin sensitivity (IS) methods based on the oral glucose tolerance test (OGTT) are empirical. We used a glucose-insulin model to derive an OGTT-based IS (oral glucose insulin sensitivity [OGIS]) index, which predicts glucose clearance in a glucose clamp. We validated OGIS against clamp data. RESEARCH DESIGN AND METHODS —OGIS requires glucose and insulin concentrations from a 75-g OGTT at 0, 2, and 3 h (3-h OGTT) or at 0, 1.5, and 2 h (2-h OGTT). The formula includes six constants optimized to match the clamp results. For this purpose, 15 lean nondiabetic subjects (BMI 2 ), 38 obese nondiabetic subjects (BMI > 25 kg/m 2 ), and 38 subjects with type 2 diabetes randomly underwent an OGTT and a 120 mU · min − 1 · m − 2 insulin infusion euglycemic clamp. Glucose clearance (Cl CLAMP ), calculated as the ratio of glucose infusion to concentration during the last hour of the clamp, was compared with OGIS. OGIS was also tested on an independent group of 13 subjects with impaired glucose tolerance (IGT). RESULTS —OGIS and Cl CLAMP were correlated in the whole group ( R = 0.77, P R = 0.59; obese: R = 0.73; type 2 diabetes: R = 0.49; P R = 0.65, P CLAMP were similar (coefficients of variation: OGIS 7.1%, Cl CLAMP 6.4%). OGIS was as effective as Cl CLAMP in discriminating between groups (for OGIS, lean vs. obese: 440 ± 16 vs. 362 ± 11 ml · min − 1 · m − 2 , P P P CLAMP ). The relationships between IS and BMI, fasting plasma insulin, and insulin secretion (calculated from the OGTT insulin concentration) were examined. OGIS yielded results similar to Cl CLAMP and fully consistent with established physiological principles. The performance of the index for the 3-h and 2-h OGTT was similar. CONCLUSIONS —OGIS is an index of IS in good agreement with the clamp. Because of its simplicity (only three blood samples required), this method has potential use for clinical investigation including large-scale epidemiological studies.
LICHEN PLANUS MIMICKING SYPHILIS II PAPULES - A CASE STUDY

Lichen planus is a chronic mucocutaneous disease of immunological basis, and of unknown etiology. Women with oral lichen planus may have concomitant manifestations in vulvovaginal areas. A case of vaginal lichen planus is presented with special emphasis on its clinical and microscopic characteristics. Multiple violaceous flat papules over vagina and oral single violaceous plaque associated with mild discomfort was treated with methyl prednisolone and topical steroid. Nail lesions were treated with clonestasol propionate with salicylic acid, which resulted in a favourable outcome.
Image quality assessment of standard- and low-dose chest CT using filtered back projection, adaptive statistical iterative reconstruction, and novel model-based iterative reconstruction algorithms.

OBJECTIVE The purpose of this article is to compare image quality between filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), and model-based iterative reconstruction (MBIR) at standard dose and two preselected low-dose scans. SUBJECTS AND METHODS Thirty patients (16 men and 14 women; mean age, 67 years) were prospectively recruited. Patients underwent three scans (one standard-dose scan and two low-dose scans at noise indexes [NIs] of 33, 60, and 70, respectively). All three scans were reconstructed with FBP, ASIR, and MBIR. Objective and subjective image qualities were compared. Dose-length products and effective doses for each scans were recorded. Mean image noise and attenuation values were compared between different reconstruction algorithms using repeated-measures analysis of variance and paired Student t tests. The interobserver variation between the two radiologists for subjective image quality and lesion assessment was estimated by using weighted kappa statistics. RESULTS Objective image analysis supports significant noise reduction with low-dose scans using the MBIR technique (p < 0.05). There was no significant change in mean CT numbers between different reconstructions (p > 0.05). Subjective analysis reveals no significant difference between image quality and diagnostic confidence between low-dose MBIR scans compared with standard-dose scans reconstructed using ASIR (p > 0.05). Average effective doses were 3.7, 1.2, and 0.9 mSv for standard scans at NIs of 33, 60, and 70, respectively. CONCLUSION MBIR shows superior noise reduction and improved image quality. Substantial dose reduction can be achieved by increasing the NI parameters as tested in this study without affecting image quality and diagnostic confidence.
Development of a novel breast MRI phantom for quality control.

OBJECTIVE Many indications for breast MRI exist. MRI screening can identify preinvasive breast cancer in women at high risk and in that regard is superior to mammography and ultrasound. Quality control standards exist for mammography and breast ultra-sound screening with phantoms designed specifically for this purpose. Given the growing importance of breast MRI, we propose the development of a breast MRI phantom for quality control purposes. MATERIALS AND METHODS A breast phantom with dual cavities containing water and fat was developed. A resolution plate inside the phantom contains various shapes ranging in size from 1 to 20 mm. Twenty studies of the phantom were performed with a 1.5-T system. STIR, T1-weighted fat-suppressed, and T2-weighted sequences were completed. Relaxation times of water and fat, number of step shapes resolved on STIR and T2-weighted images, number of circles resolved on T2-weighted images, and the diameter of a 20-mm circle on T1-weighted fat-suppressed images were recorded. RESULTS On STIR images the TR of fat was 238.70±96.31 ms and of water was 1231.92±399.14 ms. On T2-weighted images the TR of fat was 778.73±62.60 ms and of water was 1737.60±121.63 ms. On STIR images, steps 3 mm and larger were visualized in 95% of instances. On T2-weighted images steps 3 mm and larger were seen in all instances. Measurements of a 20-mm circle were 19±0.3 mm. CONCLUSION The proposed breast MRI phantom can be used to obtain reproducible measurements and allows implementation of quality control measures for a modality that is being increasingly used.
Radiation dose in cardiac imaging: how should it affect clinical decisions?

OBJECTIVE The purpose of this article is to discuss whether and how the risks of exposure to ionizing radiation should affect clinical decision making in patients with known or suspected cardiovascular disease. CONCLUSION Although the prevalence of cardiovascular disease and frequency of diagnostic testing has risen dramatically, cardiovascular mortality has declined. Earlier and more accurate detection of cardiovascular disease may play an important role. Concerns regarding excessive radiation exposure from cardiovascular imaging have been raised. Efforts to reduce exposure have included selection of appropriate patients for cardiovascular testing, technologic advances, educational resources, and a directed patient-centered approach to testing.
Challenges and limitations of quantifying brain connectivity in vivo with diffusion MRI

This article addresses whether or not diffusion MRI, a noninvasive technique that probes the microstructural aspects of tissue, can be used to quantify the white matter connectivity of the human brain in vivo. It begins by studying the motivation, that is, the increasing trend to look at ‘functional connectivity’ in the brain, which implies that the brain operates as a distributed network of active locations. A brief summary of diffusion MRI and fiber tracking is given and the early applications of diffusion MRI to study connectivity are reviewed. A close and critical inspection is then made of the limitations inherent in these different approaches, challenging the notion that it is possible to quantify brain connectivity in vivo with diffusion MRI. Finally, steps toward improving quantification of connectivity, by integrating information from other techniques, are suggested.
Comparison of real-time elastography and multiparametric MRI for prostate cancer detection: a whole-mount step-section analysis.

OBJECTIVE The purpose of this study was to compare prostate cancer detection rate of real-time elastography (RTE) with that of multiparametric MRI to evaluate the advantages and disadvantages of the two methods. SUBJECTS AND METHODS Thirty-nine patients with biopsy-proven prostate cancer underwent both RTE and multiparametric MRI to localize prostate cancer before radical prostatectomy. RTE was performed to assess prostate tissue elasticity, and hard lesions were considered suspicious for prostate cancer. Multiparametric MRI included T2-weighted MRI, diffusion-weighted MRI (DWI), and contrast-enhanced MRI (CE-MRI) with an endorectal coil at 1.5 T. After radical prostatectomy, whole-mount step sections of the prostate were generated, and the prostate cancer detection rates with both modalities were analyzed for cancer lesions measuring 0.2 cm3 or larger. RESULTS Histopathologic examination revealed 61 cancer lesions. RTE depicted 39 of 50 cancer lesions (78.0%) in the peripheral zone and 2 of 11 (18.2%) in the transitional zone. Multiparametric MRI depicted 45 of 50 cancer lesions (90.0%) in the peripheral zone and 8 of 11 (72.7%) in the transitional zone. Significant differences between the two modalities were found for the transitional zone and anterior part in prostates with volumes greater than 40 cm3 (p<0.05). Detection rates for high-risk prostate cancer (Gleason score≥4 and 3) and cancer lesions with volumes greater than 0.5 cm3 were high for both methods (93.8% and 80.5% for RTE, 87.5% and 92.7% for multiparametric MRI). Volumetric measurements of prostate cancer were more reliable with T2-weighted MRI than with RTE (Spearman rank correlation, 0.72 and 0.46). CONCLUSION RTE and multiparametric MRI depicted high-risk prostate cancer with high sensitivity. However, multiparametric MRI seems to have advantages in tumor volume assessment and for the detection of prostate cancer in the transitional zone and anterior part within prostates larger than 40 cm3.
MRI investigation of radiating pain in the lower limbs: value of an additional sequence dedicated to the lumbosacral plexus and pelvic girdle.

OBJECTIVE In some cases, sciatica-like symptoms radiating through the buttock, anterior thigh, or leg result from spinal root compression in an extraspinal location or from injury to the pelvic girdle. It has been suggested that adding a coronal STIR sequence dedicated to the lumbosacral plexus and pelvis to the routine MRI protocol can provide a good depiction of disorders of this type. MATERIALS AND METHODS Two hundred nine patients with sciatica-like symptoms of suspected lumbar origin were included in the study. Disorders responsible for symptoms involving extraspinal compression of the lumbosacral plexus or pelvic girdle were retrospectively noted and correlated with age, sex, location of pain, referring physician, presence of discoradicular impingement liable to explain symptoms, and history of neoplasia. RESULTS An extraspinal cause of symptoms was depicted in 12 cases (5.7%), including three cases of extraspinal compression and nine differential diagnoses in the pelvic region. Prevalence of an extraspinal cause of pain was significantly correlated with the absence of discoradicular impingement in the spine (p=0.046). A higher prevalence of extraspinal compression of the lumbosacral plexus (p=0.029) was seen in patients 60 years old or older, whereas no other feature was statistically associated with an extraspinal cause of pain. CONCLUSION Because of its short acquisition time and subsequent low cost, the additional coronal STIR sequence should be performed in the routine MRI investigation of sciatica-like symptoms when no discoradicular impingement is seen in the spine to depict an extraspinal cause of symptoms.
Prostaglandin F2α and Labour

Abstract. Serum PGF2α levels during labour and the early post‐partum period have been determined by radioimmunoassay. Random samples from 81 women showed that the highest levels are found in the late first stage of labour with lower levels in the second stage, at delivery and post‐partum. The pattern in seven women who were followed through labour was similar to that seen in random samples and it was found that the change in serum PGF2α levels appears to be related to the stage of cervical dilatation.