Journal highlights

The following are highlights from the current issues of RSNA’s peer-reviewed journals.

radiology

Potential Effect of the Protecting Access to Medicare Act on Use of Advanced Diagnostic Imaging in the Emergency Department: An Analysis of the National Hospital Ambulatory Care Survey

Passed by the U.S. Congress in 2014, the Protecting Access to Medicare Act (PAMA) specifies the implementation of clinical decision support (CDS) systems for advanced imaging during emergency department (EDs) visits.

PAMA requires the Centers for Medicare and Medicaid Services (CMS) to establish the Appropriate Use Program for CDS systems, to be implemented by January 2020 across U.S. health systems that serve Medicare beneficiaries.

CMS has declared that CDS systems must cover advanced imaging associated with eight priority clinical areas (PCAs), including coronary artery disease, suggestive pulmonary embolism, headache, hip pain, low back pain, shoulder pain, cancer of the lung and cervical or neck pain.

Provider reimbursement hinges on compliance. In an online article in Radiology, Jahan Fahimi, MD, MPH, University of California, San Francisco, and colleagues performed a cross-sectional analysis of ED visits to identify visits related to these eight clinical conditions and estimate the volume of advanced imaging that would require use of CDS to achieve PAMA compliance in the ED.

“Whether PAMA will actually improve imaging appropriateness, given the limitations of the current generation of electronic health records and CDS technologies, is unknown,” the authors write.

For the results and more details of the study, go to RSNA.org/Radiology.

Ai

Quantitative Analysis of Neural Foramina in the Lumbar Spine: An Imaging Informatics and Machine Learning Study

Neural foramina are critical structures in the spine that contain exiting nerve roots. Narrowing of these foramina leads to compression of nerve roots, which results in the clinical syndrome of radiculopathy.

Radiologists evaluate radiculopathy using MRI and interpret these studies and label each foramen as mild, moderately or severely narrowed or stenosed. These interpretations are critical as they ultimately drive treatment and surgical decisions. However, this practice has been shown to be highly subjective with significant interrater variability. Moreover, physicians do not currently have a standardized quantitative definition of what a “normal” lumbar neural foraminal area is. Without a proper understanding of what normal is, the variability and subjectivity of abnormal becomes even greater.

In an online article in Radiology: Artificial Intelligence (RSNA.org/AI), Bilwaj Gaonkar, PhD, of the University of California, Los Angeles, and colleagues validated a proposed automated machine learning (ML) method for the delineation of neural foramina on digital MRI.

Researchers used the ML method to measure foraminal areas in asymptomatic patients and used these measurements to test the hypothesis that these areas change significantly with age, sex and height.

“We have used artificial intelligence to take the first steps toward establishing a normative model for characterization of areas of lumbar neural foramina on MR images. We believe this ability can provide much needed standardization to the field and facilitate objective evaluations of neural foramina in future radiologic reporting,” the authors write.

RadioGraphics

Functional MR Neurography in Evaluation of Peripheral Nerve Trauma and Postsurgical Assessment

Evaluation of peripheral nerve trauma and its postsurgical outcome has typically been performed using ultrasound (US) and MRI. However, MRI and US do not provide pathophysiologic information, which can be useful for clinicians and surgeons in global assessment of peripheral nerve injury severity and the patient’s prognosis.

In recent years, there has been increased interest in functional MR neurography, based on diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI), to provide pathophysiologic information on healthy and diseased peripheral nerves.

In an article published online in RadioGraphics, Teodoro Martín Noguerol, MD, SERCOSA, Health Time, Jaén, Spain, and colleagues review the physical basis and technical aspects of functional MR neurography using DWI, and especially DTI, for evaluation of peripheral nerve trauma, with focus on the added value of using functional MR neurography for surgical treatment selection and monitoring.

“Familiarity with peripheral nerve surgery indications and surgical techniques is essential for radiologists to accurately interpret morphologic and functional MR neurography studies,” the authors write.

Read the full article at RSNA.org/RadioGraphics.

RG
Postsurgical evaluation of neurorrhaphy, performed with an epineural and perineural nylon suture, after left median nerve section in a 43-year-old woman. Eight months after surgery, the patient underwent a morphologic and functional MR neurography study. Sagittal SPAIR PD-weighted image (left) shows continuity of the median nerve (arrow). Overlay of 3D DTI neurographic reconstruction and SPAIR PD-weighted image (right) shows not only morphologic but also functional recovery of nerve continuity. The 3D reconstruction was produced by drawing only one region of interest at the level of the nerve suture (arrow) to obtain the entire nerve path.
Martín Noguerol et al, RadioGraphics 2019;39;2 ©RSNA 2019

Bluemke  RadiologyPodcastLogo_new

Listen to Radiology Editor David A. Bluemke, MD, PhD, discuss this month’s research you need to know.   Podcasts summarize the importance and context of selected recent articles. Subscribe today at RSNA.org/Radiology-Podcasts and never miss a single episode.

  • “Robotic versus Freehand Needle Positioning in CT-guided Ablation of Liver Tumors: A Randomized Controlled Trial,” Heerink WJ, et al.
  • “Dual-Energy CT-derived Iodine Maps: Use in Assessing Pleural Carcinomatosis,” Lennartz S, et al.
  • “Ultra-Low-Dose 18F-Florbetaben Amyloid PET Imaging Using Deep Learning with Multi-Contrast MRI Inputs,” Chen KT, et al.
Klein  RadioGraphicsPodcastLogo_new

Listen to RadioGraphics Editor Jeffrey S. Klein, MD, and authors discuss the following articles from recent issues of RadioGraphics at RSNA.org/RG-Podcasts.

  • “Uncommon Intraluminal Tumors of the Gallbladder and Biliary Tract: Spectrum of Imaging Appearances,” Chatterjee A, et al.
  • “Recognizing Radiation Therapy–related Complications in the Chest,” Benveniste MF, et al.

Audio summary podcasts (also available on iTunes and Google Play) include these studies:

  • “MRI Evaluation of the Response of Rectal Cancer to Neoadjuvant Chemoradiation Therapy,” Kalisz KR, et al.
  • “Expected and Unexpected Imaging Findings after 90Y Transarterial Radioembolization for Liver Tumors,” Spina JC, et al.
  • “Calcifications at Digital Breast Tomosynthesis: Imaging Features and Biopsy Techniques,” Horvat JV, et al.

Radiology: Cardiothoracic Imaging Launches in Late April

Later this month, members can read the first issue of Radiology: Cardiothoracic Imaging, one of RSNA’s three new online journals. The journal will emphasize research advances and technical developments in medical imaging that drive cardiothoracic medicine.

RSNA members receive a complimentary subscription to the bi-monthly publication as a member benefit.

To read the journal and learn about submitting original research and editorials, visit RSNA.org/Cardiothoracic-Imaging.

Submissions are currently being accepted for Radiology: Imaging Cancer, which will launch in late 2019. The journal is seeking submissions that cover the best clinical and translational cancer imaging studies across organ systems and modalities, including leading-edge technological developments.

To submit a manuscript for Radiology: Imaging Cancer, visit RSNA.org/Imaging-Cancer.

Access CME/SA-CME Opportunities Available in RadioGraphics

Every other month, RadioGraphics offers more than a dozen opportunities to earn continuing medical education credits (CME) that qualify for AMA PRA Category 1 Credit™. These online activities can also be applied toward the ABR MOC Self-Assessment (SA-CME) Requirement.

Each issue of RadioGraphics features 15 to 20 practice-focused articles spanning the full spectrum of radiologic subspecialties.

Topics covered include diagnostic imaging techniques, imaging features of a disease, radiologic-pathologic correlation, practice policy and quality initiatives, imaging physics and informatics.

Your RSNA membership includes free access to RadioGraphics. To view the current issue, visit RSNA.org/RadioGraphics, or to directly access the CME activities, visit RSNA.org/learning-center-rg.