An image guided robot only becomes fully useful with integrated software leveraging image fusion. Image fusion is the process of registering and superimposing imaging data in the same coordinate space and can be helpful to image-guided robotic interventions. Effective percutaneous robotic procedures can utilize real-time image guidance and navigation which are powered by fusion technologies. By integrating information from multiple imaging modalities, fusion technologies provide insights into anatomic features and procedural targets that may not be apparent through traditional positional tracking or single-modality imaging. Current robots available for interventions highlight different approaches to utilizing real-time fusion and procedure planning. As robotics become increasingly integrated into interventional radiology clinical practice, the continued innovation and adoption of fusion-based approaches will enable more seamless use of this technology, offering the potential for improved safety, standardization, and clinical efficacy. This review explores key techniques in image fusion and highlights the integration of fusion and robotics towards the goal of optimized and automated interventional procedures.

Introduction: Delayed bleeding is a potentially serious complication after partial nephrectomy (PN), with reported rates of 1%-2%. Patients with multiple renal tumors, including those with hereditary forms of kidney cancer, are often managed with resection of multiple tumors in a single kidney which may increase the risk of delayed bleeding, though outcomes have not previously been reported specifically in this population. The objective of this study was to evaluate the incidence and timing of delayed bleeding as well as the impact of intervention on renal functional outcomes in a cohort primarily made up of patients at risk for bilateral, multifocal renal tumors. Methods: A retrospective review of a prospectively maintained database of patients with known or suspected predisposition to bilateral, multifocal renal tumors who underwent PN from 2003 to 2023 was conducted. Patients who presented with delayed bleeding were identified. Patients with delayed bleeding were compared to those without. Comparative statistics and univariate logistic regression were used to determine potential risk factors for delayed bleeding. Results: A total of 1256 PN were performed during the study period. Angiographic evidence of pseudoaneurysm, AV fistula and/or extravasation occurred in 24 cases (1.9%). Of these, 21 were symptomatic presenting with gross hematuria in 13 (54.2%), decreasing hemoglobin in 4(16.7%), flank pain in 2(8.3%), and mental status change in 2 (8.3%), while 3 patients were asymptomatic. Median number of resected tumors was 5 (IQR 2-8). All patients underwent angiogram with super-selective embolization. Median time to bleed event was 13.5 days (IQR 7-22). Factors associated with delayed bleeding included open approach (OR 2.2, IQR(1.06-5.46), P = 0.04 and left-sided surgery (OR 4.93, IQR(1.67-14.5), P = 0.004. Selective embolization had little impact on ultimate renal functional outcomes, with a median change of 11% from the baseline eGFR after partial nephrectomy and embolization. One patient required total nephrectomy for refractory bleeding after embolization. Conclusions: Delayed bleeding after PN in a cohort of patients with multifocal tumors is an infrequent event, with similar rates to single tumor series. Patients should be counseled regarding timing and symptoms of delayed bleeding and multidisciplinary management with interventional radiology is critical for timely diagnosis and treatment. (c) 2024 Published by Elsevier Inc.

Purpose To develop and evaluate a smartphone augmented reality (AR) system for a large 50-mm liver tumor ablation with treatment planning for composite overlapping ablation zones. Materials and Methods A smartphone AR application was developed to display tumor, probe, projected probe paths, ablated zones, and real-time percentage of the ablated target tumor volume. Fiducial markers were attached to phantoms and an ablation probe hub for tracking. The system was evaluated with tissue-mimicking thermochromic phantoms and gel phantoms. Four interventional radiologists performed 2 trials each of 3 probe insertions per trial using AR guidance versus computed tomography (CT) guidance approaches in 2 gel phantoms. Insertion points and optimal probe paths were predetermined. On Gel Phantom 2, serial ablated zones were saved and continuously displayed after each probe placement/adjustment, enabling feedback and iterative planning. The percentages of tumor ablated for AR guidance versus CT guidance, and with versus without display of recorded ablated zones, were compared among interventional radiologists with pairwise t-tests. Results The means of percentages of tumor ablated for CT freehand and AR guidance were 36% ± 7 and 47% ± 4 (P = .004), respectively. The mean composite percentages of tumor ablated for AR guidance were 43% ± 1 (without) and 50% ± 2 (with display of ablation zone) (P = .033). There was no strong correlation between AR-guided percentage of ablation and years of experience (r < 0.5), whereas there was a strong correlation between CT-guided percentage of ablation and years of experience (r > 0.9). Conclusions A smartphone AR guidance system for dynamic iterative large liver tumor ablation was accurate, performed better than conventional CT guidance, especially for less experienced interventional radiologists, and enhanced more standardized performance across experience levels for ablation of a 50-mm tumor.

The aim of this study was to assess the feasibility of quantifying morphologic changes in tumors during immunotherapy, as a reflection of response or survival. A retrospective single-center analysis was performed in patients with unresectable liver cancer previously enrolled in clinical trials combining immunotherapy (tremelimumab ± durvalumab) and locoregional treatment (either ablation or transarterial chemoembolization). Conventional response (RECIST 1.1) was assessed at 6-month follow-up. For morphologic assessment, the largest target lesion was manually segmented on axial slices in two dimensions using contrast-enhanced CT. Solidity and circularity of tumors were calculated at baseline, 3-month follow-up, and at 6-months follow-up. Survival analysis was performed. From the 68 patients enrolled in clinical trials, 28 did not have target lesions separate from lesions treated by locoregional therapies, and 3 had no follow-up imaging. Thirty-seven patients (9 with biliary cancer and 28 with hepatocellular carcinoma) were included. Shape features and shape variation were not correlated with RECIST 1.1 status at 6-month follow-up. However, patients with low solidity tumors at 6-month follow-up showed poorer prognosis compared with patients with high solidity tumors at 6-month follow-up (p = 0.01). Solidity variation analysis confirmed that a decrease of tumor solidity at 6-month follow-up was associated with poorer prognosis (p = 0.01). No association was found between shape features at baseline or shape features at 3-month follow-up with overall survival. Evolution and variation of tumor morphology during treatment may reflect or correlate with outcomes and contribute toward adapted response criteria.

Despite advancements in precision and efficacy of microwave ablation for tumor management, accurately predicting ablation zone geometry and minimum ablation margin remains a major challenge. This pilot study seeks to elucidate the influence of probe configuration on the morphometry of resulting ablation zones using tissue mimicking thermochromic phantoms. In-vitro results from 12 ablations were analyzed: a single probe ablation (n=1) and dual probe ablations (n=11). Angles and separations greatly influenced ablation zone morphometry. In dual-probe ablations, probe tip separation and angle of offset were positively correlated with ablation zone volume, length, and cross-sectional circularity. IR ablation planning is currently suboptimal, as it often relies upon cognitive registration. Even treatment planning software creates virtual composite ablation volumes based upon data from theoretical ablations in single, idealized configurations and settings. These findings draw attention to a need for improved ablation zone prediction and planning, which might impact efficiency, safety, cost, and outcomes.

Targeting accuracy determines outcomes for percutaneous needle interventions. Augmented reality (AR) in IR may improve procedural guidance and facilitate access to complex locations. This study aimed to evaluate percutaneous needle placement accuracy using a goggle-based AR system compared to an ultrasound (US)-based fusion navigation system. Six interventional radiologists performed 24 independent needle placements in an anthropomorphic phantom (CIRS 057A) in four needle guidance cohorts (n = 6 each): (1) US-based fusion, (2) goggle-based AR with stereoscopically projected anatomy (AR-overlay), (3) goggle AR without the projection (AR-plain), and (4) CT-guided freehand. US-based fusion included US/CT registration with electromagnetic (EM) needle, transducer, and patient tracking. For AR-overlay, US, EM-tracked needle, stereoscopic anatomical structures and targets were superimposed over the phantom. Needle placement accuracy (distance from needle tip to target center), placement time (from skin puncture to final position), and procedure time (time to completion) were measured. Mean needle placement accuracy using US-based fusion, AR-overlay, AR-plain, and freehand was 4.5 ± 1.7 mm, 7.0 ± 4.7 mm, 4.7 ± 1.7 mm, and 9.2 ± 5.8 mm, respectively. AR-plain demonstrated comparable accuracy to US-based fusion (p = 0.7) and AR-overlay (p = 0.06). Excluding two outliers, AR-overlay accuracy became 5.9 ± 2.6 mm. US-based fusion had the highest mean placement time (44.3 ± 27.7 s) compared to all navigation cohorts (p < 0.001). Longest procedure times were recorded with AR-overlay (34 ± 10.2 min) compared to AR-plain (22.7 ± 8.6 min, p = 0.09), US-based fusion (19.5 ± 5.6 min, p = 0.02), and freehand (14.8 ± 1.6 min, p = 0.002). Goggle-based AR showed no difference in needle placement accuracy compared to the commercially available US-based fusion navigation platform. Differences in accuracy and procedure times were apparent with different display modes (with/without stereoscopic projections). The AR-based projection of the US and needle trajectory over the body may be a helpful tool to enhance visuospatial orientation. Thus, this study refines the potential role of AR for needle placements, which may serve as a catalyst for informed implementation of AR techniques in IR.

BACKGROUND:The four co-circulating and immunologically interactive dengue virus serotypes (DENV1-4) pose a unique challenge to vaccine design because sub-protective immunity can increase the risk of severe dengue disease. Existing dengue vaccines have lower efficacy in DENV seronegative individuals but higher efficacy in DENV exposed individuals. There is an urgent need to identify immunological measures that are strongly associated with protection against viral replication and disease following sequential exposure to distinct serotypes.METHODS/DESIGN:This is a phase 1 trial wherein healthy adults with neutralizing antibodies to zero (seronegative), one non-DENV3 (heterotypic), or more than one (polytypic) DENV serotype will be vaccinated with the live attenuated DENV3 monovalent vaccine rDEN3Δ30/31-7164. We will examine how pre-vaccine host immunity influences the safety and immunogenicity of DENV3 vaccination in a non-endemic population. We hypothesize that the vaccine will be safe and well tolerated, and all groups will have a significant increase in the DENV1-4 neutralizing antibody geometric mean titer between days 0 and 28. Compared to the seronegative group, the polytypic group will have lower mean peak vaccine viremia, due to protection conferred by prior DENV exposure, while the heterotypic group will have higher mean peak viremia, due to mild enhancement. Secondary and exploratory endpoints include characterizing serological, innate, and adaptive cell responses; evaluating proviral or antiviral contributions of DENV-infected cells; and immunologically profiling the transcriptome, surface proteins, and B and T cell receptor sequences and affinities of single cells in both peripheral blood and draining lymph nodes sampled via serial image-guided fine needle aspiration.DISCUSSION:This trial will compare the immune responses after primary, secondary, and tertiary DENV exposure in naturally infected humans living in non-endemic areas. By evaluating dengue vaccines in a new population and modeling the induction of cross-serotypic immunity, this work may inform vaccine evaluation and broaden potential target populations.TRIAL REGISTRATION:NCT05691530 registered on January 20, 2023.

Across a wide range of medical specialties, registries have served as valuable sources of data for quality improvement, research, and payment policy programs. The Society of Interventional Radiology first began its national registry program in 2015 (1) based on standardized procedure report data (2) using the American College of Radiology’s (ACR) National Radiology Data Registry platform. Here, the initial registry findings from a retrospective analysis of the limited, deidentified dataset provided by the ACR are summarized.

Registry data are being increasingly used to establish treatment guidelines, set benchmarks, allocate resources, and make payment decisions. Although many registries rely on manual data entry, the Society of Interventional Radiology (SIR) is using automated data extraction for its VIRTEX registry. This process relies on participants using consistent terminology with highly structured data in physician-developed standardized reports (SR). To better understand barriers to adoption, a survey was sent to 3,178 SIR members. Responses were obtained from 451 interventional radiology practitioners (14.2%) from 92 unique academic and 151 unique private practices. Of these, 75% used structured reports and 32% used the SIR SR. The most common barriers to the use of these reports include SR length (35% of respondents), lack of awareness about the SR (31%), and lack of agreement on adoption within practices (27%). The results demonstrated insights regarding barriers in the use and/or adoption of SR and potential solutions.

Although systemic immunotherapy has achieved durable responses and improved survival for certain patients and cancer types, low response rates and immune system-related systemic toxicities limit its overall impact. Intratumoral (intralesional) delivery of immunotherapy is a promising technique to combat mechanisms of tumor immune suppression within the tumor microenvironment and reduce systemic drug exposure and associated side effects. However, intratumoral injections are prone to variable tumor drug distribution and leakage into surrounding tissues, which can compromise efficacy and contribute to toxicity. Controlled release drug delivery systems such as in situ-forming hydrogels are promising vehicles for addressing these challenges by providing improved spatio-temporal control of locally administered immunotherapies with the goal of promoting systemic tumor-specific immune responses and abscopal effects. In this review we will discuss concepts, applications, and challenges in local delivery of immunotherapy using controlled release drug delivery systems with a focus on intratumorally injected hydrogel-based drug carriers.

Quality improvement (QI) initiatives have benefited patients as well as the broader practice of medicine. Large-scale QI has been facilitated by multi-institutional data registries, many of which were formed out of national or international medical society initiatives. With broad participation, QI registries have provided benefits that include but are not limited to establishing treatment guidelines, facilitating research related to uncommon procedures and conditions, and demonstrating the fiscal and clinical value of procedures for both medical providers and health systems. Because of the benefits offered by these databases, Society of Interventional Radiology (SIR) and SIR Foundation have committed to the development of an interventional radiology (IR) clinical data registry known as VIRTEX. A large IR database with participation from a multitude of practice environments has the potential to have a significant positive impact on the specialty through data-driven advances in patient safety and outcomes, clinical research, and reimbursement. This article reviews the current landscape of societal QI programs, presents a vision for a large-scale IR clinical data registry supported by SIR, and discusses the anticipated results that such a framework can produce.

e16110 Background: Biliary tract cancers (BTC) have a dismal prognosis. Recently, standard of care changed by adding durvalumab (D) to chemotherapy after the TOPAZ-1 study demonstrated an extended and durable survival benefit (median OS: 12.8 vs 11.5 months; 24-month OS rate: 23.6% vs 11.5%). Extrapolating from IMbrave150 and HIMALAYA trials in liver cancer, we combined an anti-VEGF monoclonal antibody with the STRIDE regimen (Single Tremelimumab Regular Interval Durvalumab) in advanced BTC. Methods: This is a phase II single center trial of unresectable or metastatic BTC with a safety run-in included (NCT03937830). In schedule A, the first 6 patients (pts) received single dose T 300mg with D 1,150mg flat dose + bevacizumab (B) 7.5mg/kg/dose every 21 days until disease progression or unacceptable toxicity. In schedule B, the next 8 pts did not start B until cycle 2 (C2); all other scheduling and dosing remained the same. Paired tumor tissue and blood were collected before and on treatment for correlative studies. Primary endpoint was 6-month PFS, and secondary endpoints were safety and feasibility, OS, and best ORR according to Response Evaluation Criteria (RECIST 1.1). Results: We enrolled 14 pts as of data cutoff (1/11/23) with 8 patients alive (median follow-up 4.3 mo, 0.7-17.7). Accrual is expected to be completed by June 2023 with 20 evaluable pts; interim analysis presented early due to vital unexpected results with different dosing schedules. Updated data will be presented at ASCO along with 6-month PFS and correlative studies. We treated 6 pts with schedule A and observed ORR 17% (PR x 1, SD x 4, PD x1), mPFS 8.5 mo (96% CI: 1.8 - NE), and mOS not reached (range: 3.0 - 17.7 mo). 50% of pts experienced G3 or G4 immune-related adverse events (irAE), including overlapping myositis-myocarditis-myasthenia gravis syndrome, thyroiditis, colitis, and hepatitis; these pts received systemic steroids and were taken off treatment. irAE occurred early after initiation of treatment with most presenting within 40 days. Based on the high rate of severe irAE, we changed to schedule B and treated 8 pts. We observed ORR 0% (SD x 1, PD x 5, unevaluable x 2), mPFS 2.6 mo (96% CI: 0.9 - 3.9), and mOS 4.7 mo (95% CI: 0.9 - 4.7). There were no G3 or G4 irAE; there was 1 death from tumor-related bleed that occurred prior to restaging in C2 and may have been worsened by bevacizumab. Clinical response appears to diminish with treatment schedule change, albeit small numbers limit interpretation (Cochran-Armitage trend test, p = 0.0671). Conclusions: The combination of anti-VEGF with anti-PDL1 and anti-CTLA4 appears to induce a strong immune response in advanced BTC with more severe and earlier irAE. In contrast, historical data showed limited benefit with D+T alone in BTC. We observed that modifying dosing schedule may impact outcomes by reducing efficacy when the three drugs are not given together. Clinical trial information: NCT03937830 .

HomeRadioGraphicsVol. 42, No. 6 PreviousNext Education CornerRG Social Media and Digital InnovationSocial Media Considerations for the Interventional RadiologistMichael T. Kassin1 , Ifechi Ukeh1, Paul M. Bunch, Saher S. SabriMichael T. Kassin1 , Ifechi Ukeh1, Paul M. Bunch, Saher S. SabriAuthor AffiliationsFrom the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Room 1C365, Bethesda, MD 20892 (M.T.K.); Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.); and Department of Radiology, Medstar Georgetown University Hospital, Washington, DC (S.S.S.).Address correspondence to M.K. (email: [email protected]).Michael T. Kassin1 Ifechi Ukeh1Paul M. BunchSaher S. SabriPublished Online:Oct 3 2022https://doi.org/10.1148/rg.220157MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In 1 M.T.K. and I.U. contributed equally to this work.References1. Hage AN, Chick JFB, Jeffers B, Srinivasa RN, Gemmete JJ, Srinivasa RN. #InterventionalRadiology. J Vasc Interv Radiol 2018;29(5):669–675. Crossref, Medline, Google Scholar2. Matalon SA, Kassin MT, Malayeri AA. Precision Twitter: Using Twitter for Professional Advancement. RadioGraphics 2021;41(6):E169–E170. Link, Google Scholar3. Widmer RJ, Mandrekar J, Ward A, et al. Effect of Promotion via Social Media on Access of Articles in an Academic Medical Journal: A Randomized Controlled Trial. Acad Med 2019;94(10):1546–1553. Crossref, Medline, Google Scholar4. Luc JGY, Archer MA, Arora RC, et al. Does Tweeting Improve Citations? One-Year Results From the TSSMN Prospective Randomized Trial. Ann Thorac Surg 2021;111(1):296–300. Crossref, Medline, Google ScholarArticle HistoryReceived: June 23 2022Accepted: June 24 2022Published online: Oct 03 2022Published in print: Oct 2022 FiguresReferencesRelatedDetailsRecommended Articles Social Media Tools for Department and Practice Communication and Branding in the Digital AgeRadioGraphics2018Volume: 38Issue: 6pp. 1773-1785RG TEAM Highlights Importance of Trainee Involvement in RadioGraphicsRadioGraphics2021Volume: 41Issue: 2pp. E60Precision Twitter: Using Twitter for Professional AdvancementRadioGraphics2021Volume: 41Issue: 6pp. E169-E170Running a Radiology Residency Program: Strategies for SuccessRadioGraphics2018Volume: 38Issue: 6pp. 1729-1743Addressing Global Radiology Disparities: Increasing Access to Interventional Radiology EducationRadioGraphics2021Volume: 41Issue: 5pp. E142-E144See More RSNA Education Exhibits A New (Digital) Era in Medical Journalism: Leveraging Social Media and Other Online Tools to Increase Reach and EngagementDigital Posters2022A Guide to Using YouTube Live for Radiology EducationDigital Posters2022Can You Hear Me Now? Implementation of Telemedicine (TM) in an Academic Interventional Radiology (IR) Practice during the COVID-19 PandemicDigital Posters2020 RSNA Case Collection Complicated Breast CystRSNA Case Collection2022 migrated biliary stent and bowel obstructionRSNA Case Collection2021Basilar Tip AnuersymRSNA Case Collection2022 Vol. 42, No. 6 Abbreviations Abbreviations: IR interventional radiology Metrics Altmetric Score PDF download

BACKGROUND:While prostate specific membrane antigen (PSMA) is overexpressed in high-grade prostate cancers, it is also expressed in tumor neovasculature and other malignancies, including hepatocellular carcinoma (HCC). Importantly, no functional imaging for HCC is clinically available, making diagnosis and surveillance following local therapies particularly challenging. 18F-DCFPyL binds with high affinity to PSMA yet clears rapidly from the blood pool. PET imaging with 18F-DCFPyL may represent a new tool for staging, surveillance and assessment of treatment response in HCC. The purpose of this Functional Imaging Liver Cancer (FLIC) trial is to assess the ability of 18F-DCFPyL-PET/CT to detect sites of HCC. METHODS:This is a phase II multi-site prospective imaging trial with a plan to enroll 50 subjects with suspected HCC on standard of care CT or MRI and eligible for standard local treatment. Participants will undergo a baseline 18F-DCFPyL-PET/CT, prior to therapy. Subjects will also be scanned with 18F-FDG-PET/CT within 2 weeks of 18F-DCFPyL-PET/CT. Participants will undergo histopathologic assessment and standard of care local treatment for HCC within a multidisciplinary team context. Participants with histopathologic confirmation of HCC and a positive baseline 18F-DCFPyL-PET/CT will undergo a post-treatment 18F-DCFPyL-PET/CT during the first routine follow-up, typically within 4-8 weeks. Subjects with negative baseline 18F-DCFPyL-PET/CT will not be re-scanned after treatment but will remain in follow-up. Participants will be followed for 5-years to assess for progression-free-survival. The primary endpoint is the positive predictive value of 18F-DCFPyL-PET for HCC as confirmed by histopathology. Secondary endpoints include comparison of 18F-DCFPyL-PET/CT with CT, MRI, and 18F-FDG-PET/CT, and evaluation of the value of 18F-DCFPyL-PET/CT in assessing treatment response following local treatment. Exploratory endpoints include next generation sequencing of tumors, and analysis of extracellular vesicles to identify biomarkers associated with response to therapy. DISCUSSION:This is a prospective imaging trial designed to evaluate whether PSMA-PET/CT imaging with 18F-DCFPyL can detect tumor sites, assess local treatment response in HCC patients, and to eventually determine whether PSMA-PET/CT could improve outcomes of patients with HCC receiving standard of care local therapy. Importantly, this trial may help determine whether PSMA-selective radiopharmaceutical therapies may be beneficial for patients with HCC. CLINICAL TRIAL REGISTRATION:NIH IND#133631. Submission date: 04-07-2021. Safe-to-proceed letter issued by FDA: 05.07.2021. NIH IRB #00080. ClinicalTrials.gov Identifier NCT05009979. Date of Registry: 08-18-2021. Protocol version date: 01-07-2022.

To compare needle placement performance using an augmented reality (AR) navigation platform implemented on smartphone or smartglasses devices to that of CBCT-guided fluoroscopy in a phantom. An AR application was developed to display a planned percutaneous needle trajectory on the smartphone (iPhone7) and smartglasses (HoloLens1) devices in real time. Two AR-guided needle placement systems and CBCT-guided fluoroscopy with navigation software (XperGuide, Philips) were compared using an anthropomorphic phantom (CIRS, Norfolk, VA). Six interventional radiologists each performed 18 independent needle placements using smartphone (n = 6), smartglasses (n = 6), and XperGuide (n = 6) guidance. Placement error was defined as the distance from the needle tip to the target center. Placement time was recorded. For XperGuide, dose-area product (DAP, mGy*cm2) and fluoroscopy time (sec) were recorded. Statistical comparisons were made using a two-way repeated measures ANOVA. The placement error using the smartphone, smartglasses, or XperGuide was similar (3.98 ± 1.68 mm, 5.18 ± 3.84 mm, 4.13 ± 2.38 mm, respectively, p = 0.11). Compared to CBCT-guided fluoroscopy, the smartphone and smartglasses reduced placement time by 38% (p = 0.02) and 55% (p = 0.001), respectively. The DAP for insertion using XperGuide was 3086 ± 2920 mGy*cm2, and no intra-procedural radiation was required for augmented reality. Smartphone- and smartglasses-based augmented reality reduced needle placement time and radiation exposure while maintaining placement accuracy compared to a clinically validated needle navigation platform.

HomeRadioGraphicsVol. 41, No. 6 PreviousNext Education CornerFree AccessRG Social Media and Digital InnovationPrecision Twitter: Using Twitter for Professional AdvancementShanna A. Matalon , Michael T. Kassin, Ashkan A. MalayeriShanna A. Matalon , Michael T. Kassin, Ashkan A. MalayeriAuthor AffiliationsFrom the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (S.A.M.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (M.T.K., A.A.M.).Address correspondence to S.A.M. (e-mail: [email protected]).Shanna A. Matalon Michael T. KassinAshkan A. MalayeriPublished Online:Oct 1 2021https://doi.org/10.1148/rg.2021210193MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In IntroductionAs of April 2021, Twitter boasted 199 million daily active users, many of whom are medical professionals, including radiologists. While some radiologists have Twitter accounts for personal use only, many have public profiles and use them to develop their professional identity. In the past several years, the radiology Twitter community has grown tremendously, with increasing activity not only by individual radiologists but also by professional societies such as the Radiological Society of North America (@RSNA), radiology departments and practices, radiology training programs, and even radiology journals, including this one (@RadioGraphics and @RadG_Editor) (1).It can be easy to feel overwhelmed by the vastness of the radiology Twitter universe. If you need a beginner’s guide to Twitter, be sure to see the starter’s guide by Miles and Patel (2). While many use Twitter professionally, time spent on Twitter is usually not compensated by one’s employer and must done in one’s scarce free time. To optimize use, we propose the concept of precision Twitter, to tailor one’s use to optimize goals of professional advancement.Major themes of professional uses of Twitter that we discuss here are (a) medical education, (b) networking, and (c) personal branding and self-promotion. We review ways that radiologists can effectively use Twitter to accomplish these specific professional goals.Goal 1: Medical EducationLearningThis aspect of Twitter may be especially appealing to medical students and radiology trainees but can be used by all radiologists in their pursuit of continued medical education. By searching the hashtag #FOAMed (Free Open Access Medical Education), one comes upon thousands of medical education tweets. To filter by radiology-specific educational posts, use the hashtag #FOAMRad in the search bar. Tweets specifically geared toward medical students and radiology trainees often include the hashtags #futureradres, #radres, #iradres, and/or #radfellows. One can then filter the search results by top posts or most recent posts. It is important to keep in mind that tweets are not peer reviewed or even vetted for content, so it is imperative to stay vigilant regarding the credibility and accuracy of Twitter educational posts.Most society annual meetings and imaging journals now have a hashtag that can be used to learn about hot topics and highlights of sessions or new issues. The RadioGraphics Social Media and Digital Innovation (SMDI) team now shares short educational content based on the articles from each issue, easily found by searching the hashtag #RGphx and by following the @RadG_Editor account (1).TeachingThose with a passion for medical education can use Twitter to share their expertise with this community and promote their brand as medical educators. The target audience of such posts can range from medical students to radiology trainees to practicing radiologists and even patients. By optimizing the 280-character limit per tweet, one can share bite-sized pearls of wisdom or create a thread of multiple tweets on a specific topic, known as a tweetorial. Up to one GIF file or four photographs can be uploaded to share videos or static images. By strategically using the aforementioned radiology education hashtags and tagging other users who may be interested in your content (or who may retweet to amplify your post), radiologists can reach a large global audience and optimize engagement. One great aspect of Twitter is that it can be used to engage and ask questions to generate an educational dialogue that can occur almost in real time.If sharing patient cases, it is important to ensure that cases are fully anonymized to avoid violating patient privacy and confidentiality. It is also important to consider your respective institution’s social media policy and remain in compliance.Goal 2: NetworkingTwitter levels the medical hierarchy and allows interactions among medical professionals of all ranks and geographic locations like never before. There are many ways to engage with those in the #RadTwitter community, ranging from liking, retweeting or commenting on others’ posts, direct messaging another user, and participating in tweet chats (themed Twitter conversations occurring on a specific date and time, usually associated with a hashtag to follow to participate). By connecting over such content, people with shared interests can develop virtual professional relationships that can lead to collaboration on academic projects or educational initiatives. These Twitter-made connections have even led to a recent journal article highlighting the benefits of Twitter for medical students (3).Twitter’s networking capabilities have been more valuable than ever since the start of the Covid-19 pandemic. This has been especially relevant for trainee recruitment and job hiring searches, which were almost entirely virtual throughout 2020 and much of 2021. In addition to sharing information and connecting programs and jobs with candidates, a robust mentorship and coaching network has also evolved on the platform. It has become a place to recognize others’ accomplishments, share advice and resources, and even arrange for mock interviews for the 2020 residency recruitment season (3–5). Radiologists have likely been hired or selected for residency based on initially seeing a user’s Twitter activity.Goal 3: Personal Branding and Self-PromotionA well-considered Twitter “handle” (username) and profile is the first step to developing a digital professional identity. A unique but easily remembered and identifiable handle will make it simple for others to recognize and find. Choosing proper profile and background pictures in line with your desired messaging is an important step in gaining recognition. The 160-character “bio” should be optimized to paint a picture of professional interests, using related hashtags and handles. Using both hashtags and handles in the bio will enhance the visibility and searchability of one’s profile. Some opt to also include personal details such as nonmedical hobbies and interests.Once a user has identified a Twitter niche, they can focus their Twitter activity on related topics. For example, someone interested in medical education may retweet posts from the Harvard Macy Institute (@HarvardMacy) or participate in #MedEdChat tweet chats. Interactions such as these allow someone to expand their professional network, amplify their accomplishments, and develop a reputation as an expert in the field (6).In our ever-shrinking world, Twitter is an ideal venue for radiologists to learn new things, educate others, foster new relationships with peers, and disseminate their academic work in their quest for professional advancement.All authors have disclosed no relevant relationships.References1. Tomblinson CM, Jaswal S, Bunch PM. Social Media and Digital Innovation: An Expanding Frontier for Journal Engagement. RadioGraphics 2021;41(4):E103–E104. Link, Google Scholar2. Miles RC, Patel AK. The Radiology Twitterverse: A Starter’s Guide to Utilization and Success. J Am Coll Radiol 2019;16(9 Pt A):1225–1231. Crossref, Medline, Google Scholar3. Shah N, Nguyen JK, Heitkamp DE, Patel AK, Gupta Y. Dear Medical Students: It’s Time to Join the #Twitterverse. J Am Coll Radiol 2021;18(2):309–311. Crossref, Medline, Google Scholar4. @futureradres (n.d.) Tweets [Twitter Profile]. https://twitter.com/futureradres. Accessed June 29, 2021. Google Scholar5. McLuckey MN, Gold JA, O’Glasser AY, Hingle S, Spencer A, Fick LB. Harnessing the Power of Medical Twitter for Mentorship. J Grad Med Educ 2020;12(5):535–538. Crossref, Medline, Google Scholar6. Spieler B, Ballard DH, Mazaheri P, et al. Social Media in Radiology: Overview and Usefulness of Online Professional #SoMe Profiles. Acad Radiol 2021;28(4):526–539. Crossref, Medline, Google ScholarArticle HistoryReceived: July 07 2021Accepted: July 09 2021Published online: Oct 01 2021Published in print: Oct 2021 FiguresReferencesRelatedDetailsCited ByTransition to Practice: Finding Your NichePaul M. Bunch, Courtney M. Tomblinson, 9 March 2023 | RadioGraphics, Vol. 43, No. 4The growing role of social media for research and education in radiologyAlexPozdnyakov, MostafaAlabousi, Michael N.Patlas2023 | Diagnostic and Interventional ImagingSocial Media Considerations for the Interventional RadiologistMichael T. Kassin, Ifechi Ukeh, Paul M. Bunch, Saher S. Sabri, 3 October 2022 | RadioGraphics, Vol. 42, No. 6Enhancing Residency Recruitment through Social MediaShanna A. Matalon, Tatiana Kelil, Sandeep S. 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Background: Woodchucks chronically infected with woodchuck hepatitis virus (WHV), which resembles human hepatitis B virus, develop spontaneous hepatic tumors and may be an important biological and immunological model for human HCC. Nonetheless, this model requires further validation to fully realize its translational potential. Methods: Woodchucks infected at birth with WHV that had developed HCC (n=12) were studied. Computed tomography, ultrasound, and magnetic resonance imaging were performed under anesthesia. LI-RADS scoring and correlative histologic analysis of sectioned tissues were performed. For immune characterization of tumors, CD3 (T cells), CD4 (T helpers), NCAM (Natural killers), FOXP3 (T-regulatory), PDL-1 (inhibitory checkpoint protein), and the human hepatocellular carcinoma (HCC) biomarker alpha-fetoprotein (AFP) immunohistochemical stains were performed. Results: Forty tumors were identified on imaging of which 29 were confirmed to be HCC with 26 categorized as LR-4 or 5. The remainder of the tumors had benign histology including basophilic foci, adenoma, and lipidosis as well as pre-malignant dysplastic foci. LR-4 and LR-5 lesions showed high sensitivity (90%) and specificity (100%) for malignant and pre-malignant tumors. Natural killers count was found to be 2-5 times lower in tumors relative to normal parenchyma while other immune cells were located in the periphery of tumors. Tumors expressed AFP and did not express PD-L1. Conclusion: Woodchucks chronically infected with WHV developed diverse hepatic tumor types with diagnostic imaging, pathology, and immune patterns comparable to that in humans. This unique animal model may provide a valuable tool for translation and validation of novel image-guided and immune-therapeutic investigations.

PURPOSE:To characterize the hepatic and abdominal angiographic anatomy of woodchucks and vascular changes associated with hepatocellular carcinoma (HCC). MATERIALS AND METHODS:Twenty-nine woodchucks (23 with viral-associated HCC, 6 without) underwent multiphasic computed tomography (CT). Fourteen woodchucks (8 with HCC) also underwent diagnostic angiography. Hepatic arterial diameters were measured on the CT scans. Woodchucks were divided into 3 groups: non-tumor-bearing, largest tumor supplied by the right hepatic artery (RHA), and largest tumor supplied by the left hepatic artery (LHA). Statistical analysis with a repeated measures model was performed to determine the effects of tumor location (right, left), vessel measured (RHA, LHA), and interaction between the 2 on vessel diameter. Lobar arteries supplying HCC were compared with those that did not. RESULTS:CT anatomy and normal and variant vascular anatomy were defined. In woodchucks with HCC, LHA and RHA supplying tumors had mean diameters of 2.0 mm ± 0.3 and 1.6 mm ± 0.3 versus 1.5 mm ± 0.3 and 1.1 mm ± 0.2 for non-tumor-supplying arteries (P = .0002 and P < .0001), respectively. Lobar arteries supplying tumors were similarly ectatic. The right lateral lobe artery had the most profound increase in the mean diameter when supplying tumors, measuring 1.7 mm ± 0.1 versus 1.0 mm ± 0.1 in the non-tumor-supplying artery (P < .0001). There were no differences in the diameters of the aorta and celiac, common, and proper hepatic arteries between tumor- and non-tumor-bearing woodchucks. An angiographic atlas of the abdominal vessels was generated. CONCLUSIONS:HCC tumoral vasculature in woodchucks was ectatic compared with normal vasculature. This phenomenon recapitulates human HCC and may facilitate investigation of transcatheter and drug delivery therapies in an HCC animal model.

A better understanding of temporal relationships between chest CT and labs may provide a reference for disease severity over the disease course. Generalized curves of lung opacity volume and density over time can be used as standardized references from well before symptoms develop to over a month after recovery, when residual lung opacities remain. 739 patients with COVID-19 underwent CT and RT-PCR in an outbreak setting between January 21st and April 12th, 2020. 29 of 739 patients had serial exams (121 CTs and 279 laboratory measurements) over 50 ± 16 days, with an average of 4.2 sequential CTs each. Sequential volumes of total lung, overall opacity and opacity subtypes (ground glass opacity [GGO] and consolidation) were extracted using deep learning and manual segmentation. Generalized temporal curves of CT and laboratory measurements were correlated. Lung opacities appeared 3.4 ± 2.2 days prior to symptom onset. Opacity peaked 1 day after symptom onset. GGO onset was earlier and resolved later than consolidation. Lactate dehydrogenase, and C-reactive protein peaked earlier than procalcitonin and leukopenia. The temporal relationships of quantitative CT features and clinical labs have distinctive patterns and peaks in relation to symptom onset, which may inform early clinical course in patients with mild COVID-19 pneumonia, or may shed light upon chronic lung effects or mechanisms of medical countermeasures in clinical trials.