Background Multiparametric magnetic resonance imaging (mpMRI) has been increasingly recognised as an important tool in the diagnosis of prostate cancer. PI-RADSv2 guidelines recommend that important clinical information including prostate-specific antigen (PSA) levels, examination findings, and biopsy information should be included in mpMRI requests. PIRADS score and PSA density (PSAD) are both independent predictors for the presence of a clinically significant prostate cancer. Aims This study aims to evaluate the quality of mpMRI requests and reports at our institution in accordance with these parameters. Methods All prostate mpMRIs performed by radiology services in Galway University Hospital between 1st September 2019 and 1st March 2020 were reviewed. Exclusion criteria were applied. Requests and reports were analysed for the presence of the following parameters: PSA-results, examination findings, biopsy information, PI-RADS score, prostate volume, and PSAD. Results A total of 586 mpMRIs were performed, and of these, 546 were included. PSA value was provided in 497 (91%) of requests, exam findings in 355 (65%), and biopsy information in 452 (82%). PIRADS score was included in 224 (41%) of reports, prostate volume in 178 (32.6%), and PSAD in 106 (19%). Conclusions Great variation in the quality of information contained in both requests and reports for prostate mpMRIs exists within our service. We aim to improve this by collaborating with our radiology colleagues to develop a proforma for requesting and reporting of mpMRIs for our radiology systems to ensure important clinical and radiological information is provided in future.

The Bosniak classification is a CT classification which stratifies renal cysts based on imaging appearances and therefore associated risk of malignancy. Bosniak IIf cysts are renal which have complex features and therefore require surveillance. The aim of this study is to assess the economic and workload burden of diagnosing and following up Bosniak IIf cysts on the urology service in a tertiary hospital in the West of Ireland. All patients with a diagnosis of Bosniak IIf renal cysts attending our urology service between 1st of January 2012 and 31st December 2020 were analysed. The following data were collected: number and modality of follow up scans, number of MDT discussions, number and type of outpatient appointments, surgical intervention, and length of follow up. Financial data were provided by the hospital finance department. One hundred and sixty-two patients were included. Total cost of follow up was €164,056, costing €1,012.7 per patient. Cost of outpatient visits was €77,850. Follow-up length ranged from 1 to 109 months, median follow up time 17.5 months. Overall cost of imaging was €74,518. There were a total of 80 MDT discussions at an overall cost of €11,688. This study demonstrates that surveillance of patients with Bosniak IIf renal cysts represents a significant burden upon both radiology and urology services. Surveillance for these patients could be streamlined in the future through a number of initiatives such as virtual OPDs and dedicated MDTs.

RATIONALE AND OBJECTIVES:Junior doctors find chest radiograph (CXR) interpretation challenging, and commonly make diagnostic errors. The aim of this study was to evaluate the effectiveness of SAFMEDS in teaching undergraduate medical students to identify important chest abnormalities in radiology imaging.MATERIALS AND METHODS:A pragmatic randomized controlled trial design was utilized. Third-year medical students were randomly assigned to an intervention group (n = 20), who received the SAFMEDS intervention, or a control group (n = 20), who did not receive the intervention. Three participants (one intervention, two control) withdrew from participation. Percentage accuracy in CXR interpretation was assessed at three timepoints (baseline, post-test, and retention). A series of one-way between-subjects' analyses of covariance, with percentage accuracy at the pre-test timepoint entered as the covariate, were conducted.RESULTS:Large effect sizes of the SAFMEDS intervention were observed at post-test and retention (η2 = 0.67, η2 = 0.58 respectively), with the intervention group demonstrating significantly higher percentage accuracy in CXR interpretation as compared to the control group at both timepoints. Intervention group performance decreased by 5.26% (SD = 9.80) from post-test to retention. Twelve intervention group participants (63.2%) met the fluency criteria. Despite large effect sizes, there were no significant differences in post-test or retention performance between fluent and non-fluent participants (η2 = 0.17 and η2 = 0.2 respectively).CONCLUSION:SAFMEDS offers an effective adjunct to usual teaching. Future research could focus on examining the effect of fluency with a larger sample, in addition the expansion of the SAFMEDS approach, and its' application to other health profession populations.

The urachus is a fibrous tube extending from the umbilicus to the anterosuperior bladder dome that usually obliterates at week 12 of gestation, becoming the median umbilical ligament. Urachal pathology occurs when there is incomplete obliteration of this channel during foetal development, resulting in the formation of a urachal cyst, patent urachus, urachal sinus or urachal diverticulum. Patients with persistent urachal remnants may be asymptomatic or present with lower abdominal or urinary tract symptoms and can develop complications. The purpose of this review is to describe imaging features of urachal remnant pathology and potential benign and malignant complications on ultrasound, CT, positron emission tomography CT and MRI.

Objective: Due to an insidious proliferative pattern, invasive lobular breast cancer (ILC) often fails to form a defined radiological or palpable lesion and accurate diagnosis remains challenging. This study aimed to determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes. Methods: Consecutive symptomatic patients diagnosed with ILC in a tertiary centre over a 9-year period were reviewed. The time from diagnosis until surgery, initial type of surgery/index operation (breast-conserving surgery [BCS]/mastectomy) and the rates of reoperation (re-excision/completion mastectomy) were recorded. Patients were grouped into those who received conventional imaging and preoperative MRI (MR+) and those who received conventional imaging alone (MR–). Results: There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR– group (32.5 vs 21.1 days, P < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR– group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; χ2 = 5.63; P = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR– group (50.0%, n = 35 vs 37.8%, n = 56; χ2 = 2.89; P = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; χ2 = 0.076, P = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period. Conclusion: While MRI was associated with minor delays in treatment and did not reduce overall rates of margin re-excision or completion mastectomy, it altered the choice of surgical procedure in almost a quarter of MR+ cases. The benefit of preoperative breast MRI appears to be confined to select (younger, dense breast, borderline conservable) cases in symptomatic ILC.

Deep vein thrombosis (DVT) is a condition classically associated with blood stasis, hypercoagulability or injury to the vasculature. As blood stasis is usually associated with patient immobility, DVT occurrence in young active patients with no underlying haematological conditions is a rarity. An exostosis, also known as osteochondroma, is a cartilage capped lesion. If solitary, they represent low malignant potential and unless symptomatic, they are rarely excised. A 23-year-old, active male, presented to hospital with pain and swelling in the left lower leg. It was a deep, non-radiating pain, exacerbated by exercise. Wells' criteria score for DVT was 2. An ultrasound was performed which identified thrombosis in the superficial femoral, and popliteal veins. Haematological causes of thrombosis were ruled out. X-ray showed a posterior femoral exostosis. It was determined that compression by the exostosis was the cause of the thrombosis. We present a case of a DVT secondary to osteochondroma formation in a young male. Isolated DVT in this setting is uncommon with fewer than five previously reported cases identified in the literature. We also discuss the current literature and management of this rare entity.

Waldron, Ronan M. MBBCH, BAO; Kelly, Michael E.; Moloney, Brian M. MB MCh; Waldron, Michael; Joyce, Myles R.; McCarthy, Peter A.; Kerin, Michael J. Author Information

Background Ultrasound has been used in the diagnosis of soft-tissue lesions for well over a decade. Lipomas are the most common, benign, soft-tissue tumor and comprise adipose tissue. The sensitivity and specificity of diagnosing lipomas on ultrasound vary greatly in the literature. Purpose To perform a systematic review on ultrasonography in soft-tissue lipomas to better ascertain the true diagnostic value of this test. Material and Methods A systematic review of the diagnostic value of ultrasound in lipomas was performed where possible in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of the literature was conducted using several well-known databases Scopus®, PubMed®, Ovid® Medline, and Web of Science®. Results A total of 455 articles were identified in the initial literature search. Six papers were included in the final systematic review, which revealed an overall sensitivity and specificity of 86.87% (95% confidence interval [CI] = 82.14–90.73) and 95.95% (95% CI = 93.75–97.54), respectively. Conclusion Ultrasound is a useful tool in the diagnosis of superficial lipomas with good sensitivity and even better specificity and should continue to be the first line investigation in such cases.

Rationale and Objectives: Deriving maximum benefit from radiology rotations in medical schools is challenging. Lack of education on appropriate imaging render students feeling unprepared. ThiS study compares the ability of undergraduate medical students to identify appropriate radiological investigations, both at the beginning and end of their final year of education, to those of residents in their first year of clinical practice.Materials and Methods: Twelve scenarios were extracted from the American College of Radiology's Appropriateness Criteria (ACR-AC) and a questionnaire was generated. One topic was selected from each of the 10 sections in the diagnostic section and two from the interventional section. The questionnaire was distributed to three groups. Group A was composed of medical students at the beginning of final year. Group B was composed of medical students at the end of final year. Group C was composed of residents at the, end of their first year of clinical practice. Radiology residents were surveyed to assess familiarity with the ACR-AC among trainees in Ireland.Results: The total cohort included 160 participants. Group C (n = 35) performed significantly better than group A (n = 72) and group B = 53). There was no statistical, difference in the mean scores achieved by group A and group B. Sixteen (73%) of 22 radiology trainees were familiar with the ACR-AC.Conclusions: A minimal improvement in the knowledge of medical students in requesting radiological investigations over the course of the final medical year, yet a significant impact of a relatively short period of "on-the-job" learning in the clinical setting; was indicated. Emphasis on education on appropriateness may offer an improvement in the utilization of radiology services and improve patient care.

Background Mixed martial arts is a sport that has recently enjoyed a significant increase in popularity. This rise in popularity has catapulted many of these “cage fighters” into stardom and many regularly use social media to reach out to their fans. An interesting result of this interaction on social media is that athletes are sharing images of their radiological examinations when they sustain an injury. Purpose To review instances where mixed martial arts fighters shared images of their radiological examinations on social media and in what context they were shared. Material and Methods An Internet search was performed using the Google search engine. Search terms included “MMA,” “mixed martial arts,” “injury,” “scan,” “X-ray,” “fracture,” and “break.” Articles which discussed injuries to MMA fighters were examined and those in which the fighter themselves shared a radiological image of their injury on social media were identified. Results During our search, we identified 20 MMA fighters that had shared radiological images of their injuries on social media. There were 15 different types of injury, with a fracture of the mid-shaft of the ulna being the most common. The most popular social media platform was Twitter. The most common imaging modality X-ray (71%). The majority of injuries were sustained during competition (81%) and 35% of these fights resulted in a win for the fighter. Conclusion Professional mixed martial artists are sharing radiological images of their injuries on social media. This may be in an attempt to connect with fans and raise their profile among other fighters.

Laparoscopic cholecystectomy (LC) is now considered the gold standard treatment for symptomatic gallbladder disease. Over the last two decades, a reduction in postoperative morbidity, mortality and hospital stay have seen a complete shift from open surgery to a laparoscopic approach. Intrahepatic subcapsular haematoma (ISH) is a rare and potentially life-threatening complication of LC. A 34-year-old female underwent LC for uncomplicated cholelithiasis. No complications were observed intra-operatively. 2 h postoperatively, the patient developed severe abdominal pain and tachycardia. Ultrasonography demonstrated an echogenic collection adjacent to the gallbladder fossa. Laparoscopy showed an ISH involving the right and left lobes of the liver, and no evidence of any intra-abdominal haemorrhage. Subsequent urgent triphasic CT identified a large ISH and a hypervascular lesion on the right lobe of the liver. This lesion demonstrated delayed enhancement with contrast filling suggestive of a hepatic haemangioma. This case report demonstrates the impact of imaging on postoperative management and the importance of postoperative patient monitoring in patients who have undergone laparoscopic surgery. Imaging explorations have a decisive role in the detection and characterization of haematomas.

Poster: ECR 2014 / C-2086 / Safety and Accuracy of Ultrasound-Guided Percutaneous Renal Biopsy in Native and Trasplanted Kidneys: A Retrospective Review of 454 Cases by: P. Das1, B. Hutchinson1, P. Navin1, R. McLoughlin1, I. R. Davidson2, G. J. O'Sullivan1, P. McCarthy1, D. Lohan1; 1Galway/IE, 2None/IE