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The Good Ol' Days?
Another academic year has begun and, I have to be honest, I worry about those transitioning from training to practice. Writing down those impressions and moving to the next case, knowing that an attending radiologist would not review those images for 6-12 hours and that the care team would act on our interpretation, was terrifying and nearly impossible. [...]pressures are even more immense for rapid radiology interpretations, and images per study have increased exponentially. Or maybe demands on radiology have increased such that even the most experienced and capable (including folks far faster and more knowledgeable than I am) feel overwhelmed. Sharon Breske is certainly not new to the Anderson Publishing family as she has been the outstanding managing editor of our sibling publication, Applied Radiation Oncology (ARO), for many years.
Journal Article
ChatGPT makes medicine easy to swallow: an exploratory case study on simplified radiology reports
Objectives
To assess the quality of simplified radiology reports generated with the large language model (LLM) ChatGPT and to discuss challenges and chances of ChatGPT-like LLMs for medical text simplification.
Methods
In this exploratory case study, a radiologist created three fictitious radiology reports which we simplified by prompting ChatGPT with “Explain this medical report to a child using simple language.” In a questionnaire, we tasked 15 radiologists to rate the quality of the simplified radiology reports with respect to their factual correctness, completeness, and potential harm for patients. We used Likert scale analysis and inductive free-text categorization to assess the quality of the simplified reports.
Results
Most radiologists agreed that the simplified reports were factually correct, complete, and not potentially harmful to the patient. Nevertheless, instances of incorrect statements, missed relevant medical information, and potentially harmful passages were reported.
Conclusion
While we see a need for further adaption to the medical field, the initial insights of this study indicate a tremendous potential in using LLMs like ChatGPT to improve patient-centered care in radiology and other medical domains.
Clinical relevance statement
Patients have started to use ChatGPT to simplify and explain their medical reports, which is expected to affect patient-doctor interaction. This phenomenon raises several opportunities and challenges for clinical routine.
Key Points
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Patients have started to use ChatGPT to simplify their medical reports, but their quality was unknown.
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In a questionnaire, most participating radiologists overall asserted good quality to radiology reports simplified with ChatGPT. However, they also highlighted a notable presence of errors, potentially leading patients to draw harmful conclusions.
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Large language models such as ChatGPT have vast potential to enhance patient-centered care in radiology and other medical domains. To realize this potential while minimizing harm, they need supervision by medical experts and adaption to the medical field.
Graphical Abstract
Journal Article
Transjugular Intrahepatic Portosystemic Shunt (TIPS) Check and Revision in a Freestanding Outpatient Facility: Safety and Efficacy
Aim This study aims to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) check and revision procedures performed in a freestanding interventional radiology (IR) outpatient facility. Methodology A total of 40 patients (male 31:female 9, median age 60 years old) underwent a TIPS check and/or revision at a freestanding IR outpatient facility between 2009 and 2017. Procedures were performed using a mobile C-arm unit under intravenous (IV) moderate sedation, with the patient discharged home on the same day. The decision to perform a TIPS check was based on abnormal surveillance ultrasound findings or the recurrence of portal hypertension symptoms. TIPS were revised if the patient was found to have angiographic stenosis, elevated portosystemic gradients, or recurrent symptoms. TIPS were revised with balloon angioplasty and/or bare metal stent placement. Results Revision was attempted in 34 cases, and 6 were found to not require a revision. The average time to revision was 19 months (range 0.6-99 months). Of the 40 patients, 24 (60%) underwent a TIPS check and/or revision due to findings from surveillance ultrasound, while 16 (40%) underwent a check or revision due to a recurrence of symptoms. Of the 34 TIPS revisions, 28 (83%) involved angioplasty alone, 5 (15%) were stent-assisted, and 1 failed due to unsuccessful cannulation. The overall technical success rate for performing the revisions was 94% (32/34). The one-year patency rate was approximately 57%. The mean fluoroscopy time was 16.1 minutes (range: 3.7-52.5 minutes). Post-procedural recovery time was minimal, averaging one to two hours. No major complications were observed (0%, 0/40). One patient (2.5%, 1/40) experienced a minor complication (access site hematoma), and two patients were hospitalized within 30 days for reasons unrelated to the procedure. Conclusions TIPS revision can be performed successfully and safely in an outpatient facility.
Journal Article
The Top 100 Most Cited Articles on Musculoskeletal Radiology: A Bibliometric Analysis
The number of citations an article receives is reflective of its impact on the scientific community. The top 100 most cited articles were identified using the Web of Science database. Data relating to the publication year, publishing journal, number of citations, primary institution, journal impact factor, authorship, country of origin, radiological modality, and keywords were collected. In the top 100 list, the number of citations per article ranged from 149 to 709 (median 208; mean 240). Per article, the average number of citations per year ranged from five to 60 (median 12; mean 26). The United States was the most common country of origin (n=74). The journal with the greatest number of articles was Radiology (n=34). The University of California contributed the most articles (n=11). This study presents a detailed analysis of the top 100 most cited articles published in musculoskeletal radiology. It affords clinicians and researchers an understanding of the characteristics of the current most influential research papers in this field. It also highlights research trends and areas that may benefit from further research.
Journal Article
A Rare Case of Lipoid Proteinosis in a Patient Presenting With Seizures: A Case Report and Literature Review
Lipoid proteinosis is a rare genetic disorder affecting the skin, mucous membranes, and central nervous system. Here, we present the case of a 35-year-old female who presented with two episodes of seizures followed by loss of consciousness and injury to the nose. A CT scan and MRI of the brain revealed small symmetrical calcifications in the bilateral medial temporal lobes, a finding highly suggestive of lipoid proteinosis. This case highlights the neurological manifestations of lipoid proteinosis, an extremely rare autosomal recessive disorder, and emphasizes the importance of neuroimaging in its diagnosis.
Journal Article
Diagnostic Accuracy of Cranial Ultrasound for the Detection of Intracranial Hemorrhage in Preterm Neonates Using Magnetic Resonance Imaging As the Gold Standard
Background and objective Intracranial hemorrhage (ICH) and white-matter damage are the main brain injuries in preterm infants. Magnetic resonance imaging (MRI) is the best way to examine cerebral bleeding. The evidence on cranial ultrasound diagnostic accuracy in neonates is limited in Pakistani publications, which show variability in evidence, necessitating the present study. The aim is to find out the diagnostic accuracy of cranial ultrasound for detecting ICH in preterm neonates, taking MRI as the gold standard. Methodology A cross-sectional study was carried out in the Department of Radiology, The Children's Hospital, Lahore, Pakistan, from June 19, 2018 to December 18, 2018. The study involved 103 preterm neonates of both genders aged between 1 and 27 days and presenting with suspicion of ICH. The cranial ultrasound with MRI (gold standard) was used to diagnose ICH, and the results of the cranial ultrasound were assessed accordingly. The diagnostic performance of ultrasound was estimated using parameters, e.g., sensitivity, specificity, accuracy, and positive and negative predictive values. The p < 0.05 was taken as statistically significant. Results The neonates had a mean age of 9.9 ± 6.6 days. There were 53 (51.5%) male and 50 (48.5%) female neonates. The cranial ultrasound diagnosed ICH in 39 (37.9%) neonates, which is confirmed by MRI as the gold standard. Cranial ultrasound had 100.0% sensitivity, 90.62% specificity, 94.17% accuracy, 86.67% positive predictive value, and 100.0% negative predictive value for detecting ICH in preterm neonates. Similar diagnostic performance was seen across age and gender groups (p > 0.05). Conclusion Cranial ultrasound was 100% sensitive, 90.6% specific, and 94.2% accurate in identifying cerebral bleeding in preterm neonates. The noninvasive, ionizing radiation-free nature and availability at the bedside of cranial ultrasound make it a promising future modality.
Journal Article
Managing Epiglottitis in Adults: A Comprehensive Case Study
Epiglottitis is an inflammatory condition involving the epiglottis and surrounding tissues. While it can develop at any age, it was traditionally more common in children, largely due to infections with
type B (Hib). Since the introduction of the Hib vaccine, the incidence in children has significantly decreased, while cases in adults have become more prevalent. We present here the case of a 44-year-old male who presented to the emergency department with a one-day history of throat pain. He reported throat discomfort and pain exacerbated by swallowing and phonation that began one day prior after taking a dose of azithromycin. X-ray and CT imaging revealed inflammation and swelling of the epiglottis (thumbprint sign) with near-complete airway obstruction. Despite the absence of severe respiratory distress, the patient was intubated, differing from recommendations in previous studies. This case emphasizes the importance of developing standardized treatment protocols for acute epiglottitis in adults, particularly regarding airway management and minimizing unnecessary imaging.
Journal Article
A Case of Amyand's Hernia
Inguinal hernias are the most prevalent type of abdominal wall hernia. While many cases are uncomplicated, some variant forms can pose a heightened risk of severe complications. We report the case of a 46-year-old male who arrived at the emergency department with a two-day history of diffuse abdominal pain, with an otherwise negative review of systems, an unremarkable medical and surgical history, and normal laboratory results. The physical examination revealed a palpable, non-reducible mass in the right groin, raising suspicion of an inguinal hernia. A CT scan of the abdomen and pelvis was conducted, confirming Amyand's hernia, characterized by the presence of the vermiform appendix within the hernia sac in the dilated right inguinal canal. Amyand's hernia is a rare and clinically challenging condition to diagnose because its symptoms are nonspecific and often resemble those of other inguinal hernias. Delayed diagnosis can heighten the risk of complications, including inflammation, infection, perforation, and acute appendicitis. Mortality rates for Amyand's hernias have been reported to be between 14% and 30%, primarily due to complications associated with infections, especially peritoneal sepsis. Prompt diagnosis and treatment of Amyand's hernia, usually involving surgical hernia repair and an appendectomy if appendicitis is present, are highly effective in preventing potentially life-threatening complications. Despite their rarity, the difficult nature of the diagnosis and the associated high mortality rate underscore the importance of considering Amyand's hernia as a serious differential diagnosis.
Journal Article