Prostate cancer is the most common malignancy and the third most common cause of death in Canadian men. In light of evolving diagnostic pathways for prostate cancer and the increased use of MRI, which now includes its use in men prior to biopsy, the Canadian Association of Radiologists established a Prostate MRI Working Group to produce a white paper to provide recommendations on establishing and maintaining a Prostate MRI Programme in the context of the Canadian healthcare system. The recommendations, which are based on available scientific evidence and/or expert consensus, are intended to maintain quality in image acquisition, interpretation, reporting and targeted biopsy to ensure optimal patient care. The paper covers technique, reporting, quality assurance and targeted biopsy considerations and includes appendices detailing suggested reporting templates, quality assessment tools and sample image acquisition protocols relevant to the Canadian healthcare context.

Question: A 40-year-old woman, G2P0 at 11+6 gestational age, presented to the emergency department with a 1-week history of severe nausea and bilious vomiting with an inability to tolerate oral intake. She had been treated in the emergency department on 2 prior occasions for similar symptoms with intravenous (IV) fluids and anti-emetics. The patient had a history of achalasia diagnosed at the age of 34. She was initially managed conservatively but underwent a Heller myotomy and Dor fundoplication in September 2012 owing to worsening dysphagia. Two weeks postoperatively, she experienced intermittent dysphagia felt to be secondary to the fundoplication. This was treated with pneumatic balloon dilation with good effect. She underwent a second dilation in January 2013 for recurrent dysphagia and had been free of symptoms since that time. She was admitted to the gynecology service and treatment for hyperemesis gravidarum was initiated with IV fluids and anti-emetics. The gastroenterology service was consulted on admission for possible upper gastrointestinal (GI) bleeding in the context of coffee ground emesis. Her hemoglobin remained stable and she was conservatively managed with IV proton pump inhibitor for a possible Mallory-Weiss tear. Physical examination on presentation was unremarkable. On admission day 3, she began to complain of dysphagia. She developed nonbilious regurgitation of oral intake and an inability to manage secretions. This was accompanied by right upper quadrant and epigastric pain. She underwent a gastroscopy with an intention of performing pneumatic dilation for possible recurrent achalasia. Gastroscopy revealed a massively dilated esophagus with copious retained secretions and absence of peristaltic contractions. Within the distal esophagus, there was a large, round intraluminal esophageal mass that was compressible with biopsy forceps (Figure A). The 9.2-mm scope was easily passed through the gastroesophageal junction without resistance. Retroflexed view of the fundus and cardia revealed a tight gastroesophageal junction felt to be reflective of the previous fundoplication. A nasojejunal feeding tube was placed endoscopically for nutritional support. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. A computed tomography scan of the thorax was arranged to further characterize the esophageal lesion, which demonstrated retrograde gastroesophageal intussusception (RGEI) with a large portion of the gastric fundus and body as well as omental fat intussuscepted into the dilated distal esophagus (Figure B, C). Because of the lack of improvement in her symptoms and based on the computed tomography finding, the patient underwent laparoscopic repair of the RGEI. A large portion of the stomach was found incarcerated in the distal esophagus, which was laparoscopically reduced followed by a redo fundoplication and anterior gastropexy. A small distal esophageal perforation was also repaired. The patient made an uneventful postoperative recovery with complete resolution of her dysphagia. She was tolerating a regular diet at the time of discharge. RGEI is an extremely rare condition that occurs when there is retrograde prolapse of all stomach layers (mucosa, muscularis, and serosa) into the esophagus, usually as a result of severe vomiting/retching in the context of an incompetent gastroesophageal sphincter mechanism.1Ujiki M.B. Hirano I. Blum M.G. Retrograde gastric intussusception after myotomy for achalasia.Ann Thorac Surg. 2006; 81: 1134-1136Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar This is distinguished from the considerably more common phenomenon of gastric prolapse, which involves invagination of only the mucosal layer. Increased intra-abdominal pressure such as that related to vomiting in pregnancy with hyperemesis gravidarum, eating disorders, gastric outlet obstruction, and even physical exertion increase the risk of developing RGEI.2Gowen G.F. Stoldt H.S. Rosato F.E. Five risk factors identify patients with gastroesophageal intussusception.Arch Surg. 1999; 134: 1394-1397Crossref PubMed Scopus (22) Google Scholar Hiatal hernias and increased gastric mobility owing to laxity of gastric attachments or previous surgeries resulting in the absence of gastric attachments also are significant risk factors.2Gowen G.F. Stoldt H.S. Rosato F.E. Five risk factors identify patients with gastroesophageal intussusception.Arch Surg. 1999; 134: 1394-1397Crossref PubMed Scopus (22) Google Scholar, 3Lukish J.R. Eichelberger M.R. Henry L. et al.Gastroesophageal intussusception: a new cause of acute esophageal obstruction in children.J Pediatr Surg. 2004; 39: 1125-1127Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Four cases of RGEI have been reported previously in patients with achalasia after myotomy and fundoplication.1Ujiki M.B. Hirano I. Blum M.G. Retrograde gastric intussusception after myotomy for achalasia.Ann Thorac Surg. 2006; 81: 1134-1136Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar This patient had several unique factors that likely led to the development of RGEI, including a massively dilated esophagus, incompetent gastroesophageal sphincter owing to previous myotomy and dilation, excessive gastric mobility owing to previous surgical intervention, and persistent violent vomiting and retching in pregnancy.

The past decade has seen sweeping changes to radiologic practice. Year-on-year increases in CT utilization [ 1 Hess E.P. Haas L.R. Shah N.D. Stroebel R.J. Denham C.R. Swensen S.J. Trends in computed tomography utilization rates: a longitudinal practice-based study. J Patient Saf. 2014; 10: 52-58 Crossref PubMed Scopus (57) Google Scholar , 2 Sun Z. Ng K.H. Vijayananthan A. Is utilisation of computed tomography justified in clinical practice? Part I: application in the emergency department. Singapore Med J. 2010; 51: 200-206 PubMed Google Scholar ] and the introduction of teleradiology [ 3 Krestin G.P. Commoditization in radiology: threat or opportunity?. Radiology. 2010; 256: 338-342 Crossref PubMed Scopus (21) Google Scholar ] have inexorably shifted practice toward rapid reporting of cross-sectional imaging. An unintended effect of these changes has been a perceptible reduction in patient contact, with radiologists becoming increasingly remote from patient care [ 4 Maynard C.D. Radiologists: physicians or expert image interpreters?. Radiology. 2008; 248: 333-336 Crossref PubMed Scopus (24) Google Scholar , 5 Glazer G.M. Ruiz-Wibbelsmann J.A. The invisible radiologist. Radiology. 2011; 258: 18-22 Crossref PubMed Scopus (97) Google Scholar ] and feeling personally detached from patients [ 6 Alderson P.O. Customer service and satisfaction in radiology. AJR Am J Roentgenol. 2000; 175: 319-323 Crossref PubMed Scopus (29) Google Scholar ].

PURPOSE:The purpose of this study is to determine whether study quality and completeness of reporting of systematic reviews (SR) and meta-analyses (MA) published in high impact factor (IF) radiology journals is associated with citation rates.METHODS:All SR and MA published in English between Jan 2007-Dec 2011, in radiology journals with an IF >2.75, were identified on Ovid MEDLINE. The Assessing the Methodologic Quality of Systematic Reviews (AMSTAR) checklist for study quality, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for study completeness, was applied to each SR & MA. Each SR & MA was then searched in Google Scholar to yield a citation rate. Spearman correlation coefficients were used to assess the relationship between AMSTAR and PRISMA results with citation rate. Multivariate analyses were performed to account for the effect of journal IF and journal 5-year IF on correlation with citation rate. Values were reported as medians with interquartile range (IQR) provided.RESULTS:129 studies from 11 journals were included (50 SR and 79 MA). Median AMSTAR result was 8.0/11 (IQR: 5-9) and median PRISMA result was 23.0/27 (IQR: 21-25). The median citation rate for SR & MA was 0.73 citations/month post-publication (IQR: 0.40-1.17). There was a positive correlation between both AMSTAR and PRISMA results and SR & MA citation rate; ρ=0.323 (P=0.0002) and ρ=0.327 (P=0.0002) respectively. Positive correlation persisted for AMSTAR and PRISMA results after journal IF was partialed out; ρ=0.243 (P=0.006) and ρ=0.256 (P=0.004), and after journal 5-year IF was partialed out; ρ=0.235 (P=0.008) and ρ=0.243 (P=0.006) respectively.CONCLUSION:There is a positive correlation between the quality and the completeness of a reported SR or MA with citation rate which persists when adjusted for journal IF and journal 5-year IF.

HomeRadiologyVol. 272, No. 1 PreviousNext CommunicationsLetters to the EditorAssociation of Study Quality with Completeness of ReportingMatthew McInnes , Adam S. TunisMatthew McInnes , Adam S. TunisAuthor AffiliationsDepartment of Medical Imaging, Ottawa Hospital, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9e-mail: [email protected]Matthew McInnes Adam S. TunisPublished Online:Jul 1 2014https://doi.org/10.1148/radiol.14140830MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In References1. Tunis AS, McInnes MD, Hanna R, Esmail K. Association of study quality with completeness of reporting: have completeness of reporting and quality of systematic reviews and meta-analyses in major radiology journals changed since publication of the PRISMA statement? Radiology 2013;269(2):413–426. Link, Google Scholar2. Schlattmann P, Schuetz GM, Dewey M. Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis. Eur Radiol 2011;21(9):1904–1913. Crossref, Medline, Google ScholarArticle HistoryPublished online: July 2014Published in print: July 2014 FiguresReferencesRelatedDetailsRecommended Articles CT Colonography for Early Detection of Peritoneal Metastasis in Patients with Gastric CancerRadiology: Imaging Cancer2022Volume: 4Issue: 2Effect of Shift, Schedule, and Volume on Interpretive Accuracy: A Retrospective Analysis of 2.9 Million Radiologic ExaminationsRadiology2017Volume: 287Issue: 1pp. 205-212Imaging Non-traumatic Abdominal Emergencies in Pediatric PatientsRadiology2017Volume: 285Issue: 1pp. 34-35MRI and Patients with Non–MRI-conditional Cardiac Devices: Further Evidence of SafetyRadiology2020Volume: 295Issue: 2pp. 314-315The Cases for and against Artificial Intelligence in the Medical School CurriculumRadiology: Artificial Intelligence2022Volume: 4Issue: 5See More RSNA Education Exhibits Most Common Gastrointestinal Post-surgical Anatomy on CT: A Pictorial Review. Radiologists- Don´t Be AfraidDigital Posters2022How Does AI Reconstruct 3D Intestinal Structures Of Ileus And Intestinal Obstruction Cases From 3D CT? - Toward AI-based Emergency Diagnostic Assistance Of Intestinal DiseasesDigital Posters2021Hepatocellular Carcinoma: A Primer for ResidentsDigital Posters2022 RSNA Case Collection Hoffa fat pad herniationRSNA Case Collection2022LI-RADS 4 RSNA Case Collection2021Sister Mary Joseph NoduleRSNA Case Collection2021 Vol. 272, No. 1 Metrics Altmetric Score PDF download

Purpose: To evaluate whether completeness of reporting of systematic reviews and meta-analyses in major radiology journals has changed since publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement; a secondary objective is to evaluate whether completeness of reporting (ie, PRISMA) is associated with study quality (ie, Assessing the Methodological Quality of Systematic Reviews [AMSTAR]).Materials and Methods: Systematic reviews and meta-analyses published in major radiology journals between January 2007 and December 2011 were identified by searching MEDLINE with the modified Montori method. Studies were reviewed independently by two investigators and assessed for adherence to the AMSTAR and PRISMA checklists. The average results were analyzed to assess for change in mean score before and after PRISMA publication and to assess results over time; a Pearson correlation coefficient was calculated to assess for any association between PRISMA and AMSTAR results.Results: Included were 130 studies from 11 journals. Average PRISMA and AMSTAR results were 21.8 of 27 and 7.2 of 11, respectively. The average result was higher after publication of PRISMA, and PRISMA-reported items were 22.6 of 27 after publication of PRISMA versus 20.9 of 27 before publication of PRISMA; AMSTAR results were 7.7 of 11 after publication of PRISMA versus 6.7 of 11 before publication of PRISMA. There was a strong positive correlation (r = 0.86) between the PRISMA and AMSTAR results. There was high variability between journals. Radiology had the highest PRISMA reported items (24.7 of 27), and American Journal of Neuroradiology had the lowest (19.6 of 27). Two major areas for improvement include study protocol registration and assessment of risk of bias across studies (ie, publication bias).Conclusion: In major radiology journal studies, there was modest improvement in completeness of reporting of systematic reviews and meta-analyses, assessed by PRISMA, which was strongly associated with higher study quality, assessed by AMSTAR. (C) RSNA, 2013

It has previously been demonstrated in tissue-mimicking phantoms and in tissue that envelope statistics of US backscatter are affected by changes in the scatterer properties [1–4, 32, 37]. At higher frequencies the wavelength of the US begins to approach the size of cells and cellular components and at this scale the envelope statistics of HFUS backscatter become more sensitive to structural changes within cells. To investigate the relation between the envelope statistics and cell structure, experiments were performed in vitro. The physical meaning of the fit parameters was evaluated by investigating HFUS backscatter from suspensions of various concentrations of two different cell lines of different sizes.

We investigate the use of signal envelope statistics to monitor and quantify structural changes during cell death using an in vitro cell model. Using a f/2.35 transducer (center frequency 20 MHz), ultrasound backscatter data were obtained from pellets of acute myeloid leukemia cells treated with a DNA-intercolating chemotherapy drug, as well as from pellets formed with mixtures of treated and untreated cells. Simulations of signals from pellets of mixtures of cells were generated as a summation of point scatterers. The signal envelope statistics were examined by fitting the Rayleigh and generalized gamma distributions. The fit parameters of the generalized gamma distribution showed sensitivity to structural changes in the cells. The scale parameter showed a 200% increase (p<0.05) between untreated and cells treated for 24 h. The shape parameter showed a 50% increase (p<0.05) over 24 h. Experimental results showed reasonable agreement with simulations. The results indicate that high-frequency ultrasound signal statistics can be used to monitor structural changes within a very low percentage of treated cells in a population, raising the possibility of using this technique in vivo.

During cell death a series of structural changes occur within the cell. We have shown that cell ensembles and tissues undergoing structural changes associated with various cell death pathways can be detected using high-frequency ultrasound. In our effort to better understand the nature of backscatter from collections of cells (which emulate tissues), we have collected raw RF backscatter data from cells of two different sizes in solutions for a series of concentrations or in pellet form. Human acute myeloid leukemia cells (AML-5, ~10µm in diameter) and transformed prostate cells (~25-30µm in diameter) were imaged either in suspension or in pellet form. Images and radiofreqeuncy data were acquired using a VS40B ultrasound instrument (VisualSonics Inc., Toronto, Ont) and 20MHz, 30MHz and 40MHz transducers with -6dB bandwidths approaching 100%. The cells were either imaged in degassed phosphate buffered solution in which their volumetric fraction increased from 0.0025% to 2%, or in pellet form by using a swinging bucket centrifuge. It was found that the backscatter power (as measured by the mid-band fit) increased by ~ 3 dB for both cell types in dilute solutions for which the volumetric concentration was doubled for a specific range of cell concentrations (which was dependent on cell size). In pellet form the backscatter power from the prostate cell pellets was ~12-14dB greater than the AML cell pellets. A comparison of the spectral slopes also strongly suggests a change in the scattering source contributions when the cells are in pellets: the spectral slope was negative for all concentrations for prostate cells imaged at 40MHz, but positive when measured in pellets. This is consistent an increased contribution to the backscatter of smaller sized scatterers (such as the cell nucleus) that manifests itself only when the cells are in pellets but not in solution. These data will be compared to theoretical predictions and their significance discussed.

We investigate the use of signal envelope statistics to monitor the tissue restructuring process during mouse mammary tissue involution. Using an f/3 transducer operating at a centre frequency of 20 MHz, ultrasound backscatter data were collected from mouse mammary tissue following removal of the litter. The signal envelope statistics were examined by fitting the Rayleigh and generalized gamma distributions. The goodness of fit of the distributions was evaluated by the Kolmogorov-Smirnov test. The goodness of fit of the Rayleigh distribution increased to a maximum at day 3 of involution, roughly corresponding to the peak of apoptosis in the tissue. Similarly, the fit parameters of the generalized gamma distribution indicate that at day 3 the distribution is most Rayleigh like. It is believed that the condensation of the nucleus and reorganization of the tissue structure produced these changes in the statistics of the signal envelope. The results demonstrate that high frequency ultrasound signal envelope statistics can be applied to monitor changes to tissue structure in vivo.