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Background Patients with Congenital heart disease (CHD) require repetitive imaging of the pulmonary vasculature throughout their life. In this study, we compared a novel Compressed SENSE accelerated (factor 9) electrocardiogram (ECG)- and respiratory-triggered 3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT-non-contrast-enhanced magnetic resonance angiography (modified REACT-non-CE-MRA)) with standard non-ECG-triggered time-resolved 4D CE-MRA for imaging of the pulmonary arteries and veins in patients with CHD. Methods This retrospective analysis of 25 patients (June 2018–April 2019) with known or suspected CHD was independently conducted by two radiologists executing measurements on modified REACT-non-CE-MRA and 4D CE-MRA on seven dedicated points (inner edge): Main pulmonary artery (MPA), right and left pulmonary artery, right superior and inferior pulmonary vein, left superior (LSPV) and inferior pulmonary vein. Image quality for arteries and veins was evaluated on a four-point scale in consensus. Results Twenty-three of the 25 included patients presented a CHD. There was a high interobserver agreement for both methods of imaging at the pulmonary arteries (ICC ≥ 0.96); at the pulmonary veins, modified REACT-non-CE-MRA showed a slightly higher agreement, pronounced at LSPV (ICC 0.946 vs. 0.895). Measurements in 4D CE-MRA showed higher diameter values compared to modified REACT-non-CE-MRA, at the pulmonary arteries reaching significant difference (e.g. MPA: mean 0.408 mm, p  = 0.002). Modified REACT-non-CE-MRA (average acquisition time 07:01 ± 02:44 min) showed significant better image quality than 4D CE-MRA at the pulmonary arteries (3.84 vs. 3.32, p  < 0.001) and veins (3.32 vs. 2.72, p  = 0.015). Conclusions Compressed SENSE accelerated (factor 9) ECG- and respiratory-triggered 3D modified REACT-non-CE-MRA allows for reliable and fast imaging of the pulmonary arteries and veins with higher image quality and slightly higher interobserver agreement than 4D CE-MRA without contrast agent and associated disadvantages. Therefore, it represents a clinically suitable technique for patients requiring repetitive imaging of the pulmonary vasculature, e.g. patients with CHD.

Background Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability. The purpose of this study was to investigate the clinical potential of Compressed SENSE (factor 5) accelerated free-breathing three-dimensional (3D) whole heart LGE with high isotropic spatial resolution (1.4 mm 3 acquired voxel size) compared to standard breath-hold LGE imaging. Methods This was a retrospective, single-center study of 70 consecutive patients (45.8 ± 18.1 years, 27 females; February–November 2019), who were referred for assessment of left ventricular myocardial viability and received free-breathing and breath-hold LGE sequences at 1.5 T in clinical routine. Two radiologists independently evaluated global and segmental LGE in terms of localization and transmural extent. Readers scored scans regarding image quality (IQ), artifacts, and diagnostic confidence (DC) using 5-point scales (1 non-diagnostic—5 excellent/none). Effects of heart rate and body mass index (BMI) on IQ, artifacts, and DC were evaluated with ordinal logistic regression analysis. Results Global LGE (n = 33) was identical for both techniques. Using free-breathing LGE (average scan time: 04:33 ± 01:17 min), readers detected more hyperenhanced lesions (28.2% vs. 23.5%, P < .05) compared to breath-hold LGE (05:15 ± 01:23 min, P = .0104), pronounced at subepicardial localization and for 1–50% of transmural extent. For free-breathing LGE, readers graded scans with good/excellent IQ in 80.0%, with low-impact/no artifacts in 78.6%, and with good/high DC in 82.1% of cases. Elevated BMI was associated with increased artifacts (P = .0012) and decreased IQ (P = .0237). Increased heart rate negatively influenced artifacts (P = .0013) and DC (P = .0479) whereas IQ (P = .3025) was unimpaired. Conclusions In a clinical setting, free-breathing Compressed SENSE accelerated 3D high isotropic spatial resolution whole heart LGE provides good to excellent image quality in 80% of scans independent of heart rate while enabling improved depiction of small and particularly non-ischemic hyperenhanced lesions in a shorter scan time than standard breath-hold LGE.

Background/Objectives: Artificial intelligence (AI) tools for fracture detection in radiographs are increasingly approved for clinical use but remain underutilized. Understanding physician attitudes before implementation is essential for successful integration into emergency care workflows. This study investigates the acceptance of an AI-based fracture detection tool among physicians in emergency care settings, using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Methods: A cross-sectional, pre-implementation survey was conducted among 92 physicians across three hospitals participating in the SMART Fracture Trial (ClinicalTrials.gov: NCT06754137). The questionnaire assessed the four core UTAUT constructs—performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC)—and additional constructs such as attitude toward technology (AT), diagnostic confidence (DC), and workflow efficiency (WE). Responses were collected on a five-point Likert scale. Structural equation modeling (SEM) and confirmatory factor analysis (CFA) were performed to assess predictors of behavioral intention (BI). Results: PE was the strongest predictor of BI (β = 0.5882, p < 0.001), followed by SI (β = 0.391, p < 0.001), FC (β = 0.263, p < 0.001), and EE (β = 0.202, p = 0.001). These constructs explained a substantial proportion of variance in BI. WE received the lowest ratings, while internal consistency for SI and BI was weak. Moderator analyses showed prior AI experience improved EE, whereas more experienced physicians were more skeptical regarding WE and DC. However, none of the moderators significantly influenced BI. Conclusions: Physicians’ intention to use AI fracture detection is primarily influenced by perceived usefulness and ease of use. Implementation strategies should focus on intuitive design, targeted training, and clear communication of clinical benefits. Further research should evaluate post-implementation usage and user satisfaction.

The original publication of this article [1], contained graphical errors in Figs. 1 and 2. This does not impact the display of the mean differences of the Bland-Altman plots. The updated figures (Fig. 1 and Fig. 2) are published in this correction article.

An impressive collection of essays by 21 of English Canada's leading theatre critics provides a cultural history of Canada, and Canadians intense relationship to theatre, from 1829 to 1998, and across the whole country.

Background This study aimed to meta-analyze epidemiological data, revision rates, and incidences of different designs of a single Total Knee Arthroplasty System and compare these factors across different countries. Methods A systematic review was conducted on clinical studies and arthroplasty registries of ATTUNE TKA from 1999 to 2020. The main endpoints analyzed were revision rates and epidemiological data. Results The average age of patients was 67.8 years, with a gender distribution of 60% female and 40% male. The pooled average BMI was 29.4 kg/m 2 . Eight clinical studies showed a pooled revision rate per 100 observed CY of 0.5 (n = 1343 cases). Cumulative revision rates after 1, 3, and 5 years varied among registries, with the Swiss registry having the highest revision data (after 5 years: 6.3%) and the American registry having the lowest revision data (after 5 years: 1.7%). A comparison of the revision rates of mobile bearing and fixed bearing (41,200 cases) as well as cruciate retaining and posterior stabilized (n = 123,361 cases) showed no significant advantage in the first 5 years after implantation. Conclusion In conclusion, pooled data from 41,200 cases of TKA with a single Total Knee Arthroplasty System in two arthroplasty registries revealed that there was no significant difference in revision rates between the mobile bearing and fixed bearing design within the first 5 years after implantation. In addition, a comparison of the revision rates in n = 123,361 cases showed no significant advantage for cruciate retaining or posterior stabilized in the first 5 years after implantation.

To compare a novel Compressed SENSE accelerated ECG- and respiratory-triggered flow-independent 3D isotropic Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT) with standard non-ECG-triggered 3D contrast-enhanced magnetic resonance angiography (CE-MRA) for imaging of the thoracic aorta in patients with connective tissue diseases (CTD) or other aortic diseases using manual and semiautomatic measurement approaches. This retrospective, single-center analysis of 30 patients (June–December 2018) was conducted by two radiologists, who independently measured aortic diameters on modified REACT and CE-MRA using manual (Multiplanar-Reconstruction) and semiautomatic (Advanced Vessel Analysis) measurement tools on seven levels (inner edge): Aortic annulus and sinus, sinotubular junction, mid- and high-ascending aorta, aortic isthmus, and descending aorta. Bland–Altman analysis was conducted to evaluate differences between the mean values of aortic width and ICCs were calculated to assess interobserver agreement. For each level, image quality was evaluated on a four-point scale in consensus with Wilcoxon matched-pair test used to evaluate for differences between both MRA techniques. Additionally, evaluation time for each measurement technique was noted, which was compared applying one-way ANOVA. When comparing both imaging and measurement methods, CE-MRA (mean difference 0.24 ± 0.27 mm) and the AVA-tool (− 0.21 ± 0.15 mm) yielded higher differences compared to modified REACT (− 0.11 ± 0.11 mm) and the MPR-tool (0.07 ± 0.21 mm) for all measurement levels combined without yielding clinical significance. There was an excellent interobserver agreement between modified REACT and CE-MRA using both tools of measurement (ICC > 0.9). Modified REACT (average acquisition time 06:34 ± 01:36 min) provided better image quality from aortic annulus to mid-ascending aorta (p < 0.05), whereas at distal measurement levels, no significant differences were noted. Regarding time requirement, no statistical significance was found between both measurement techniques (p = 0.08). As a novel non-CE-MRA technique, modified REACT allows for fast imaging of the thoracic aorta with higher image quality in the proximal aorta than CE-MRA enabling a reliable measurement of vessel dimensions without the need for contrast agent. Thus, it represents a clinically suitable alternative for patients requiring repetitive imaging. Manual and semiautomatic measurement approaches provided comparable results without significant difference in time need.

ObjectivesPeritoneal carcinomatosis (PC) is a prognostically relevant metastatic disease which may be difficult to depict in postoperative patients, particularly in early stages. This study aimed to determine whether PC could be diagnosed more accurately when using a combination of spectral detector CT (SDCT)-derived conventional images (CI) and iodine overlay images (IO) compared with CI only.MethodsThirty patients with PC and 30 patients with benign peritoneal alterations (BPA) who underwent portal-venous abdominal SDCT were included. Four radiologists determined the presence/absence of PC for each patient and assessed lesion conspicuity, diagnostic certainty, and image quality using 5-point Likert scales. Subjective assessment was conducted in two sessions comprising solely CI and CI/IO between which a latency of 6 weeks was set. Iodine uptake and HU attenuation were determined ROI-based to analyze quantitative differentiation of PC/BPA.ResultsSpecificity for PC was significantly higher when using CI/IO compared with using CI only (0.86 vs. 0.78, p ≤ 0.05), while sensitivity was comparable (0.79 vs. 0.81, p = 1). In postoperative patients, the increase in specificity was the highest (0.93 vs. 0.80, p ≤ 0.05). Lesion conspicuity was rated higher in CI/IO (4 (3–5)) compared with that in CI only (3 (3–4); p ≤ 0.05). Diagnostic certainty was comparable (both 4 (3–5); p = 0.5). CI/IO received the highest rating for overall image quality and assessability (CI/IO 5 (4–5) vs. CI 4 (4–4) vs. IO 4 (3–4); p ≤ 0.05). Area under the receiver operating characteristics curve (AUC) for quantitative differentiation between PC and BPA was higher for iodine (AUCIodine = 0.95, AUCHU = 0.90).ConclusionsCompared with CI, combination of CI/IO improves specificity in the assessment of peritoneal carcinomatosis at comparable sensitivity, particularly in postoperative patients.Key Points• Combination of iodine overlays and conventional images improves specificity when assessing patients with peritoneal carcinomatosis at comparable sensitivity.• Particularly in postsurgical patients, iodine overlays could help to avoid false-positive diagnosis of peritoneal disease.• Iodine overlays alone provided inferior image quality and assessability than conventional images, while the combination of both received the highest ratings. Iodine overlays should therefore be used in addition to and not as a substitute for conventional images.

Serious theatre criticism did not begin to emerge in cities such as Toronto and Halifax until the late 1820s because the infrequency of theatrical performances in colonial Canada did not warrant it.

Herman Arthur Voaden, playwright, director, educator, editor (b at London, Ont 19 Jan 1903; d in Toronto 27 June 1991).