Journal of Magnetic Resonance ImagingEarly View Commentary Chatbots for Literature Review and Research—Insights from a Panel Discussion at the Annual Meeting of the International Society of Magnetic Resonance in Medicine (ISMRM) 2023 Grace McIlvain PhD, Corresponding Author Grace McIlvain PhD [email protected] orcid.org/0000-0001-6594-8757 Department of Biomedical Engineering, Columbia University, New York City, New York, USA Address reprint requests to: G.M., 1210 Amsterdam Ave, New York, NY 10027, USA. E-mail: [email protected]Search for more papers by this authorThekla H. Oechtering MD, Thekla H. Oechtering MD Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Radiology and Nuclear Medicine, University of Luebeck, Lübeck, GermanySearch for more papers by this authorUmmul Afia Shammi PhD, Ummul Afia Shammi PhD Chemical and Biomedical Engineering, University of Missouri, Columbia, Missouri, USASearch for more papers by this authorRajesh Bhayana MD, Rajesh Bhayana MD Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorJana Hutter PhD, Jana Hutter PhD Centre for the Developing Brain, King's College London, UKSearch for more papers by this authorLinda Moy MD, Linda Moy MD Department of Radiology, New York University School of Medicine, New York City, New York, USASearch for more papers by this authorMark Schweitzer MD, Mark Schweitzer MD Wayne State University School of Medicine, Detroit, Michigan, USASearch for more papers by this author Grace McIlvain PhD, Corresponding Author Grace McIlvain PhD [email protected] orcid.org/0000-0001-6594-8757 Department of Biomedical Engineering, Columbia University, New York City, New York, USA Address reprint requests to: G.M., 1210 Amsterdam Ave, New York, NY 10027, USA. E-mail: [email protected]Search for more papers by this authorThekla H. Oechtering MD, Thekla H. Oechtering MD Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Radiology and Nuclear Medicine, University of Luebeck, Lübeck, GermanySearch for more papers by this authorUmmul Afia Shammi PhD, Ummul Afia Shammi PhD Chemical and Biomedical Engineering, University of Missouri, Columbia, Missouri, USASearch for more papers by this authorRajesh Bhayana MD, Rajesh Bhayana MD Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this authorJana Hutter PhD, Jana Hutter PhD Centre for the Developing Brain, King's College London, UKSearch for more papers by this authorLinda Moy MD, Linda Moy MD Department of Radiology, New York University School of Medicine, New York City, New York, USASearch for more papers by this authorMark Schweitzer MD, Mark Schweitzer MD Wayne State University School of Medicine, Detroit, Michigan, USASearch for more papers by this author First published: 05 October 2023 https://doi.org/10.1002/jmri.29036 The first two authors shared first authorship. Level of Evidence: 5 Technical Efficacy: Stage 2 The Annual Meeting of the International Society of Magnetic Resonance in Medicine (ISMRM) includes member-initiated non-scientific sessions. The 2023 meeting featured a panel discussion titled "Chatbots for Literature Review and Research," with panelists Rajesh Bhayana, MD, Jana Hutter, PhD, Linda Moy, MD (Editor-in-Chief of Radiology), and Mark Schweitzer, MD (Editor-in-Chief of JMRI). The session was organized by Grace McIlvain, Thekla H. Oechtering, and Ummul Afia Shammi. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Bhayana R, Krishna S, Bleakney RR. Performance of ChatGPT on a radiology board-style examination: Insights into current strengths and limitations. Radiology 2023; 307:230582. https://doi.org/10.1148/radiol.230582. 2Bhayana R, Bleakney RR, Krishna S. GPT-4 in radiology: Improvements in advanced reasoning. Radiology 2023; 307:230987. https://doi.org/10.1148/radiol.230987. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

BACKGROUND:Deep learning (DL) often requires an image quality metric; however, widely used metrics are not designed for medical images. PURPOSE:To develop an image quality metric that is specific to MRI using radiologists image rankings and DL models. STUDY TYPE:Retrospective. POPULATION:A total of 19,344 rankings on 2916 unique image pairs from the NYU fastMRI Initiative neuro database was used for the neural network-based image quality metrics training with an 80%/20% training/validation split and fivefold cross-validation. FIELD STRENGTH/SEQUENCE:1.5 T and 3 T T1, T1 postcontrast, T2, and FLuid Attenuated Inversion Recovery (FLAIR). ASSESSMENT:Synthetically corrupted image pairs were ranked by radiologists (N = 7), with a subset also scoring images using a Likert scale (N = 2). DL models were trained to match rankings using two architectures (EfficientNet and IQ-Net) with and without reference image subtraction and compared to ranking based on mean squared error (MSE) and structural similarity (SSIM). Image quality assessing DL models were evaluated as alternatives to MSE and SSIM as optimization targets for DL denoising and reconstruction. STATISTICAL TESTS:Radiologists' agreement was assessed by a percentage metric and quadratic weighted Cohen's kappa. Ranking accuracies were compared using repeated measurements analysis of variance. Reconstruction models trained with IQ-Net score, MSE and SSIM were compared by paired t test. P < 0.05 was considered significant. RESULTS:Compared to direct Likert scoring, ranking produced a higher level of agreement between radiologists (70.4% vs. 25%). Image ranking was subjective with a high level of intraobserver agreement ( 94.9 % ± 2.4 % ) and lower interobserver agreement ( 61.47 % ± 5.51 % ). IQ-Net and EfficientNet accurately predicted rankings with a reference image ( 75.2 % ± 1.3 % and 79.2 % ± 1.7 % ). However, EfficientNet resulted in images with artifacts and high MSE when used in denoising tasks while IQ-Net optimized networks performed well for both denoising and reconstruction tasks. DATA CONCLUSION:Image quality networks can be trained from image ranking and used to optimize DL tasks. LEVEL OF EVIDENCE:3 TECHNICAL EFFICACY: Stage 1.

4D flow MRI can aid in diagnosing pathologies associated with hemodynamic changes in the portal vein, such as portal hypertension. Normal reference ranges for portal venous flow are lacking but essential for future clinical implementation. We report reference values based on radial 4D flow MRI measurements of mean flow, velocity, and effective diameter in the portal venous vasculature in 44 healthy subjects (59% female, 18-74 years). Faint helical and linear flow are physiological flow patterns observed in the portal vein. This study provides normative values for emerging clinical applications of 4D flow MRI currently under development. Keywords: Liver, Velocity&Flow, Vessels

Zielsetzung Nach Pfortaderembolisation würde eine Vorhersage der Hypertrophe der nicht-embolisierten Restleber eine frühere Operation von malignen Lebererkrankungen ermöglichen und somit das Risiko der Tumorprogression verringern. Der portale Blutfluss nach PAE könnte ein wichtiger Prädiktor für die Hypertrophie sein. Unser Ziel war es, Veränderungen des portalen Blutflusses vor und nach PAE mit 4D Fluss MRT zu untersuchen und zu testen, ob 4D Fluss MRT die Hypertrophie der nicht embolisierten Lebersegmente vorhersagen kann.

Objectives To evaluate work expectations of radiologists at different career levels, their fulfillment, prevalence of exhaustion, and exhaustion-associated factors. Methods A standardized digital questionnaire was distributed internationally to radiologists of all career levels in the hospital and in ambulatory care via radiological societies and sent manually to 4500 radiologists of the largest German hospitals between December 2020 and April 2021. Statistics were based on age- and gender-adjusted regression analyses of respondents working in Germany (510 out of 594 total respondents). Results The most frequent expectations were “joy at work” (97%) and a “good working atmosphere” (97%), which were considered fulfilled by at least 78%. The expectation of a “structured residency within the regular time interval” (79%) was more frequently judged fulfilled by senior physicians (83%, odds ratio (OR) 4.31 [95% confidence interval (95% CI) 1.95–9.52]), chief physicians (85%, 6.81 [95% CI 1.91–24.29]), and radiologists outside the hospital (88%, 7.59 [95% CI 2.40–24.03]) than by residents (68%). Exhaustion was most common among residents (physical exhaustion: 38%; emotional exhaustion: 36%), in-hospital specialists (29%; 38%), and senior physicians (30%; 29%). In contrast to paid extra hours, unpaid extra hours were associated with physical exhaustion (5–10 extra hours: OR 2.54 [95% CI 1.54–4.19]). Fewer opportunities to shape the work environment were related to a higher probability of physical (2.03 [95% CI 1.32–3.13]) and emotional (2.15 [95% CI 1.39–3.33]) exhaustion. Conclusions While most radiologists enjoy their work, residents wish for more training structure. Ensuring payment of extra hours and employee empowerment may help preventing burnout in high-risk groups. Key Points • Most important work expectations of radiologists who work in Germany are “joy at work,” a “good working atmosphere,” “support for further qualification,” and a “structured residency within the regular time interval,” with the latter containing potential for improvement according to residents. • Physical and emotional exhaustion are common at all career levels except for chief physicians and for radiologists who work outside the hospital in ambulatory care. • Exhaustion as a major burnout criterion is associated with unpaid extra hours and reduced opportunities to shape the work environment.

Background Different software programs are available for the evaluation of 4D Flow cardiovascular magnetic resonance (CMR). A good agreement of the results between programs is a prerequisite for the acceptance of the method. Therefore, the goal was to compare quantitative results from a cross-over comparison in individuals examined on two scanners of different vendors analyzed with four postprocessing software packages. Methods Eight healthy subjects (27 ± 3 years, 3 women) were each examined on two 3T CMR systems (Ingenia, Philips Healthcare; MAGNETOM Skyra, Siemens Healthineers) with a standardized 4D Flow CMR sequence. Six manually placed aortic contours were evaluated with Caas (Pie Medical Imaging, SW-A), cvi42 (Circle Cardiovascular Imaging, SW-B), GTFlow (GyroTools, SW-C), and MevisFlow (Fraunhofer Institute MEVIS, SW-D) to analyze seven clinically used parameters including stroke volume, peak flow, peak velocity, and area as well as typically scientifically used wall shear stress values. Statistical analysis of inter- and intrareader variability, inter-software and inter-scanner comparison included calculation of absolute and relative error (E R ), intraclass correlation coefficient (ICC), Bland–Altman analysis, and equivalence testing based on the assumption that inter-software differences needed to be within 80% of the range of intrareader differences. Results SW-A and SW-C were the only software programs showing agreement for stroke volume (ICC = 0.96; E R = 3 ± 8%), peak flow (ICC: 0.97; E R = −1 ± 7%), and area (ICC = 0.81; E R = 2 ± 22%). Results from SW-A/D and SW-C/D were equivalent only for area and peak flow. Other software pairs did not yield equivalent results for routinely used clinical parameters. Especially peak maximum velocity yielded poor agreement (ICC ≤ 0.4) between all software packages except SW-A/D that showed good agreement (ICC = 0.80). Inter- and intrareader consistency for clinically used parameters was best for SW-A and SW-D (ICC = 0.56–97) and worst for SW-B (ICC = -0.01–0.71). Of note, inter-scanner differences per individual tended to be smaller than inter-software differences. Conclusions Of all tested software programs, only SW-A and SW-C can be used equivalently for determination of stroke volume, peak flow, and vessel area. Irrespective of the applied software and scanner, high intra- and interreader variability for all parameters have to be taken into account before introducing 4D Flow CMR in clinical routine. Especially in multicenter clinical trials a single image evaluation software should be applied.

Hemodynamic assessment is an integral part of the diagnosis and management of cardiovascular disease. Four-dimensional cardiovascular magnetic resonance flow imaging (4D Flow CMR) allows comprehensive and accurate assessment of flow in a single acquisition. This consensus paper is an update from the 2015 '4D Flow CMR Consensus Statement'. We elaborate on 4D Flow CMR sequence options and imaging considerations. The document aims to assist centers starting out with 4D Flow CMR of the heart and great vessels with advice on acquisition parameters, post-processing workflows and integration into clinical practice. Furthermore, we define minimum quality assurance and validation standards for clinical centers. We also address the challenges faced in quality assurance and validation in the research setting. We also include a checklist for recommended publication standards, specifically for 4D Flow CMR. Finally, we discuss the current limitations and the future of 4D Flow CMR. This updated consensus paper will further facilitate widespread adoption of 4D Flow CMR in the clinical workflow across the globe and aid consistently high-quality publication standards.

HomeRadiologyVol. 308, No. 3 PreviousNext Reviews and CommentaryEditorialFour-dimensional Flow MRI Helps Predict Future Liver Remnant Hypertrophy after Transhepatic Portal Vein EmbolizationAlejandro Roldán-Alzate , Thekla H. OechteringAlejandro Roldán-Alzate , Thekla H. OechteringAuthor AffiliationsFrom the Departments of Mechanical Engineering (A.R.A.) and Radiology (T.H.O.), University of Wisconsin–Madison, 1111 Highland Ave, Madison, WI, 53705.Address correspondence to A.R.A. (email: [email protected]).Alejandro Roldán-Alzate Thekla H. OechteringPublished Online:Sep 26 2023https://doi.org/10.1148/radiol.232190See related articleMoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In References1. Heil J, Schiesser M, Schadde E. Current trends in regenerative liver surgery: novel clinical strategies and experimental approaches. Front Surg 2022;9:903825. Crossref, Medline, Google Scholar2. Kito Y, Nagino M, Nimura Y. Doppler sonography of hepatic arterial blood flow velocity after percutaneous transhepatic portal vein embolization. AJR Am J Roentgenol 2001;176(4):909–912. Crossref, Medline, Google Scholar3. Oechtering TH, Roberts GS, Panagiotopoulos N, Wieben O, Reeder SB, Roldán-Alzate A. Clinical applications of 4D Flow MRI in the portal venous system. Magn Reson Med Sci 2022;21(2):340–353. Crossref, Medline, Google Scholar4. Bissell MM, Raimondi F, Ait Ali L, et al. 4D flow cardiovascular magnetic resonance consensus statement: 2023 update. J Cardiovasc Magn Reson 2023;25(1):40. Crossref, Medline, Google Scholar5. Shah V, Haddad FG, Garcia-Cardena G, et al. Liver sinusoidal endothelial cells are responsible for nitric oxide modulation of resistance in the hepatic sinusoids. J Clin Invest 1997;100(11):2923–2930. Crossref, Medline, Google Scholar6. Hyodo R, Takehara Y, Mizuno T, et al. Four-dimensional flow MRI assessment of portal hemodynamics and hepatic regeneration after portal vein embolization. Radiology 2023;308(3):e230709. Google Scholar7. Roldán-Alzate A, Frydrychowicz A, Niespodzany E, et al. In vivo validation of 4D flow MRI for assessing the hemodynamics of portal hypertension. J Magn Reson Imaging 2013;37(5):1100–1108. Crossref, Medline, Google Scholar8. Stankovic Z, Csatari Z, Deibert P, et al. Normal and altered three-dimensional portal venous hemodynamics in patients with liver cirrhosis. Radiology 2012;262(3):862–873. Link, Google Scholar9. Rutkowski DR, Reeder SB, Fernandez LA, Roldán-Alzate A. Surgical planning for living donor liver transplant using 4D flow MRI, computational fluid dynamics and in vitro experiments. Comput Methods Biomech Biomed Eng Imaging Vis 2018;6(5):545–555. Crossref, Medline, Google Scholar10. Oechtering TH, Nowak A, Sieren MM, et al. Repeatability and reproducibility of various 4D Flow MRI postprocessing software programs in a multi-software and multi-vendor cross-over comparison study. J Cardiovasc Magn Reson 2023;25(1):22. Crossref, Medline, Google ScholarArticle HistoryReceived: Aug 19 2023Revision requested: Aug 29 2023Revision received: Aug 31 2023Accepted: Sept 1 2023Published online: Sept 26 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleFour-dimensional Flow MRI Assessment of Portal Hemodynamics and Hepatic Regeneration after Portal Vein EmbolizationSep 26 2023RadiologyRecommended Articles Four-dimensional Flow MRI Assessment of Portal Hemodynamics and Hepatic Regeneration after Portal Vein EmbolizationRadiology2023Volume: 308Issue: 3Promoting Surgical Resection through Future Liver Remnant HypertrophyRadioGraphics2022Volume: 42Issue: 7pp. 2166-2183BestFLR Trial: Liver Regeneration at CT before Major Hepatectomies for Liver Cancer—A Randomized Controlled Trial Comparing Portal Vein Embolization with N-Butyl-Cyanoacrylate Plus Iodized Oil versus Polyvinyl Alcohol Particles Plus CoilsRadiology2021Volume: 299Issue: 3pp. 715-724Portal Venous Interventions: State of the ArtRadiology2016Volume: 278Issue: 2pp. 333-353Role of CT in Two-Stage Liver SurgeryRadioGraphics2022Volume: 42Issue: 1pp. 106-124See More RSNA Education Exhibits Role of Computed Tomography in Two Staged Liver SurgeryDigital Posters2020Imaging Review and Management Update on Portal Vein ThrombosisDigital Posters2022Current Multimodality Imaging Assessment of the Portal Venous System: A Pictorial EssayDigital Posters2020 RSNA Case Collection Arterioportal fistulaRSNA Case Collection2021 Portal Vein AneurysmRSNA Case Collection2022Portal vein varixRSNA Case Collection2021 Vol. 308, No. 3 Metrics Altmetric Score PDF download

Purpose: This study addresses the challenges in obtaining abdominal 4D flow MRI of obese patients. We aimed to evaluate spectral saturation and inner volume excitation as methods to mitigating artifacts originating from adipose signals, with the goal of enhancing image quality and improving quantification.Methods: Radial 4D flow MRI acquisitions with fat mitigation (inner volume excitation [IVE] and intermittent fat saturation [FS]) were compared to a standard slab selective excitation (SSE) in a test-retest study of 15 obese participants. IVE selectively excited a cylindrical region of interest, avoiding contamination from peripheral adipose tissue, while FS globally suppressed fat based on spectral selection. Acquisitions were evaluated qualitatively based on expert ratings and quantitatively based on conservation of mass, test-retest repeatability, and a divergence free quality metric. Errors were evaluated statistically using the absolute and relative errors, regression, and Bland-Altman analysis.Results: IVE demonstrated superior performance quantitatively in the conservation of mass analysis in the portal vein, with higher correlation and lower bias in regression analysis. IVE also produced flow fields with the lowest divergence error and was rated best in overall image quality, delineating small vessels, and producing the least streaking artifacts. Evaluation results did not differ significantly between FS and SSE. Test-retest reproducibility was similarly high for all sequences, with data suggesting biological variations dominate the technical variability.Conclusion: IVE improved hemodynamic assessment of radial 4D flow MRI in the abdomen of obese participants while FS did not lead to significant improvements in image quality or flow metrics.

Zielsetzung Mit zunehmender Inzidenz der nichtalkoholischen Steatohepatitis (NASH) wird eine nichtinvasive Diagnose relevanter. Bisherige Studien bei NASH-Patienten konnten keinen prädiktiven Wert für den MRT-Biomarker Proton Density Fat Fraction (PDFF) feststellen. Klinisch relevant wäre der prädiktive Wert jedoch bei Individuen mit erhöhtem Risiko, jedoch keiner NASH-Diagnose. Ziel dieser Arbeit ist es, den prädiktiven Wert von PDFF für NASH bei Personen mit Adipositas ohne Verdacht auf eine Lebererkrankung zu bestimmen.

The purpose of this work was to establish normal reference values for 4D flow MRI-derived flow, velocity, and vessel diameters, and to define characteristic flow patterns in the portal venous system of healthy adult subjects. For this retrospective study, we screened all available 4D flow MRI exams of the upper abdomen in healthy adults acquired at our institution between 2012 and 2022 at either 1.5 T or 3.0 T MRI after ≥ 5 h fasting. Flow, velocity, and effective diameter were quantified in the 8 planes in the portal venous system (splenic vein, superior mesenteric vein, main, right, and left portal veins). Vessel delineation was manually adjusted over time. Reference ranges for were defined as the mean ± 2 standard deviations. Three readers noted helical and vortical flow on time-resolved pathline visualizations. Conservation of mass flow analysis was performed for quality assurance. We included 44 healthy subjects (26 female, 18–74 years) in the analysis. We report reference values for mean and peak flow, mean velocity, and vessel diameter in the healthy portal vein using 4D flow MRI. Normal flow patterns in the portal vein included faint helical (66

4D flow MRI of the portal vein has the potential to provide diagnostic value for detecting and staging certain liver diseases. To date, it is unknown whether weight loss influences portal flow in obese patients. We aimed to investigate the effect of weight loss on portal flow rate measured by non-contrast 4D flow MRI in obese patients undergoing weight loss surgery. Preliminary data of this ongoing study detected no statistically significant change in the mean volumetric portal flow rate in subjects during 2-6 months of weight loss. However, portal flow rate normalized to body weight or BMI increased significantly.

Zielsetzung 4D Fluss MRT hat das Potenzial, Blutfluss-assoziierte Leberpathologien nichtinvasiv zu diagnostizieren. Messzeiten von>10min stehen der klinischen Nutzung im Wege. Ziel dieser Studie war die prospektive Validierung einer verkürzten radialen 4D Fluss Sequenz zur Charakterisierung der portalen Hämodynamik.

With the increasing need for minimally invasive procedures based on lower complication rates, higher patient acceptance, and technical developments, there is a growing focus on the sound interventional training of young radiologists. This survey aimed to analyze the current situation in interventional radiology (IR) training in Germany to detect shortcomings and identify areas for improvement.From November 1-30, 2020, an online questionnaire was distributed to representative radiological associations and societies with the request to forward it to radiology residents and radiologists < 40 years. The 44 questions covered six distinct areas from personal working conditions to the characterization of the IR department, training conditions, role of women in IR, and attendance at congresses/external training.A total of 330 participants completed the questionnaire. 77 % of participants expressed a high interest in IR, and 47 % could even imagine subspecializing in interventional radiology. Most institutions provided the necessary learning conditions and infrastructure. The rate of overall satisfaction with IR training conditions was 45 % (vs. a dissatisfaction rate of 39 %). However, females showed a lower satisfaction rate with their training environment than male participants (28 % vs. 51 %; P = 0.06). Positive correlations with work satisfaction were found for the presence and duration of the IR rotation, the number of partly independently/mentored performed interventions, and structured feedback. Moreover, the need for a structured training curriculum was expressed by 67 % of participants.Radiological residents and young radiologists expressed a high interest in interventional radiology, and they rate the infrastructure of German hospitals regarding IR as sufficient. However, they expressed the need for consistent IR rotations and better-structured resident and postgraduate education (curricula & interviews).Interest in interventional radiology among radiological residents and young radiologists in Germany is high, but satisfaction with interventional radiology training leaves room for improvement. The most frequently mentioned aspects that can improve IR training were · organized rotations of at least 6 months. · structured curriculums with face-to-face feedback. · structured guidance by senior interventionists during procedures. CITATION FORMAT: · Sieren M, Katoh M, Mahnken AH et al. Work and Training Conditions of German Residents and Young Radiologists in Interventional Radiology - A Nationwide Survey. Fortschr Röntgenstr 2022; 194: 1346 - 1357.

Zielsetzung Der Aortenklappenersatz (AKE) ist eine der häufigsten herzchirurgischen Operationen. Neben dem mechanischen oder biologischen Klappenersatz wird zunehmend auch die Ozaki-Prozedur durchgeführt. Dabei wird die Aortenklappe aus Patienten-eigenem Perikard rekonstruiert. Vorstudien zeigten Veränderungen der Hämodynamik nach unterschiedlichen AKE-Methoden. Allerdings ist unklar, welchen Anteil die Klappe oder das chirurgische Verfahren an den Veränderungen haben. Ziel dieser Arbeit war es, die Auswirkungen der Aortotomie allein sowie in Kombination mit unterschiedlichen AKE-Verfahren zu untersuchen.

PURPOSE:During the SARS-CoV-2 pandemic, higher education worldwide had to switch to digital formats. The purpose of this study was to evaluate CoRad-19, a digital teaching tool created by the German Radiological Society for medical students during the COVID-19 pandemic. MATERIALS AND METHODS:A total of 13 German-speaking universities implemented CoRad-19 in their curriculum and partially or completely replaced their classes with the online courses. Previous experience and contact with radiology and the participants' opinions regarding the medium of e-learning were surveyed using a custom questionnaire. The subjective level of knowledge regarding the individual modules was also surveyed before and after participation to measure learning effects. The data of 994 medical students from the participating sites were analyzed and compared intraindividually using the Friedman test. RESULTS:From 4/1/2020-10/1/2020, 451 complete data sets from a total of 994 surveys were included. E-learning was rated "very useful" both before and after course participation (4 [IQR 3-4], p = 0.527, r = 0.16). E-learning as a method was also rated as a "very good" medium both before and after participation (4 [IQR 3-4], p = 0.414, r = 0.17). After participation, participants rated radiology as particularly suitable for digital teaching (before: 3 [IQR 3-4] vs. after 4 [IQR 3-4], p = 0.005, r = 0.6). Significant learning gains were measurable in all course modules (p ≤ 0.009). Post-hoc analysis showed interest in radiology to increase significantly after course participation (p = 0.02). CONCLUSION:In the representative survey, significant learning effects were observed in all course modules. In addition, it should be particularly emphasized that the students' interest in radiology was increased by course participation. Thus, the German Radiological Society provided significant support to German-speaking medical faculties with respect to maintaining excellent education using CoRad-19. KEY POINT:· Co-Rad-19 course participation results in measurable subjective learning effects and increases student interest in radiology.. CITATION FORMAT:· Brendlin AS, Molwitz I, Oechtering TH et al. CoRad-19 - Modular Digital Teaching during the SARS-CoV-2 Pandemic. Fortschr Röntgenstr 2022; 194: 644 - 651.

Evaluation of the hemodynamics in the portal venous system plays an essential role in many hepatic pathologies. Changes in portal flow and vessel morphology are often indicative of disease.Routinely used imaging modalities, such as CT, ultrasound, invasive angiography, and MRI, often focus on either hemodynamics or anatomical imaging. In contrast, 4D flow MRI facilitiates a more comprehensive understanding of pathophysiological mechanisms by simultaneously and noninvasively acquiring time-resolved flow and anatomical information in a 3D imaging volume.Though promising, 4D flow MRI in the portal venous system is especially challenging due to small vessel calibers, slow flow velocities, and breathing motion. In this review article, we will discuss how to account for these challenges when planning and conducting 4D flow MRI acquisitions in the upper abdomen. We will address patient preparation, sequence acquisition, postprocessing, quality control, and analysis of 4D flow data.In the second part of this article, we will review potential clinical applications of 4D flow MRI in the portal venous system. The most promising area for clinical utilization is the diagnosis and grading of liver cirrhosis and its complications. Relevant parameters acquired by 4D flow MRI include the detection of reduced or reversed flow in the portal venous system, characterization of portosystemic collaterals, and impaired response to a meal challenge. In patients with cirrhosis, 4D flow MRI has the potential to address the major unmet need of noninvasive detection of gastroesophageal varices at high risk for bleeding. This could replace many unnecessary, purely diagnostic, and invasive esophagogastroduodenoscopy procedures, thereby improving patient compliance with follow-up. Moreover, 4D flow MRI offers unique insights and added value for surgical planning and follow-up of multiple hepatic interventions, including transjugular intrahepatic portosystemic shunts, liver transplantation, and hepatic disease in children. Lastly, we will discuss the path to clinical implementation and remaining challenges.

According to the Model Specialist Training Regulations (MWBO) of the German Medical Association (Bundesärztekammer) “specialist training is undertaken in a structured form” [1]. In surveys conducted by the Young Radiology Forum of the German Roentgen Society in 2018 and 2020, physicians undergoing specialist training in radiology rated supervision with case discussion, a structured specialist training curriculum, and a fixed rotation schedule as the most helpful tools for successful specialist training [2] However, according to those surveyed, 63 % of all radiology training centers and 48 % of university hospitals did not have a structured training curriculum [2]. Even though a “structured program for specialist training [...] must be provided” (Model Specialist Training Regulations § 5 (6) [1]) when applying for specialist training authorization, physicians undergoing specialist training are apparently not sufficiently aware of these structured programs. Moreover, the scope and depth of existing local curricula vary which is a disadvantage with respect to ensuring a uniformly high training standard. To date, a national interdisciplinary curriculum that is supported by the professional societies has been realized by only a few disciplines in Germany. General medicine has had a national specialist training curriculum since 2015 [3], while cardiology’s national specialist training curriculum was introduced in 2013 [4] and updated in 2020. In particular, the general medicine curriculum has been used to increase not only the quality of specialist training as a result of the improved structure but also the popularity of specialist training in general medicine.

OBJECTIVESThis is a comprehensive analysis of haemodynamics after valve-sparing aortic root replacement (VSARR) with anatomically curved prosthesis (CP) compared to straight prosthesis (SP) and age-matched volunteers (VOL) using 4D flow MRI (time-resolved three-dimensional magnetic resonance phase-contrast imaging).METHODSNine patients with 90° CP, nine patients with SP, and twelve VOL were examined with 4D flow MRI. Analyses included various characteristic anatomical, qualitative and quantitative haemodynamic parameters.RESULTSGrading of secondary flow patterns was lower in CP patients than in SP patients (P = 0.09) and more comparable to VOL, albeit not reaching statistical significance. However, it was easy to differentiate between VSARR patients and healthy volunteers: Patients more often had angular aortic arches (CP: 89%, SP: 100%; VOL: 17%; P ≤ 0.002), increased average curvature (CP: 0.17/cm [0.15, 0.18]; SP: 0.15/cm [0.14, 0.16]; VOL: 0.14/cm [0.13, 0.16]; P ≤ 0.007; values given as median [interquartile range]), and more secondary flow patterns (CP: 3 [2, 4] SP: 3 [2, 3] VOL: 2 [1, 2]; P < 0.01). Maximum circulation (CP: 142.7 cm2/s [116.1, 187.3]; SP: 101.8 cm2/s [77.7, 132.5]; VOL: 42.8cm2/s [39.3, 65.6]; P ≤ 0.002), maximum helicity density (CP: 9.6 m/s2 [9.3, 23.9]; SP: 9.7 m/s2 [8.6, 12.5]; VOL 4.9 m/s2 [4.2, 7.7]; P ≤ 0.007), and wall shear stress gradient (e.g., proximal ascending aorta CP: 0.97 N/m2 [0.54, 1.07]; SP: 1.08 N/m2 [0.74, 1.24]; VOL: 0.41 N/m2 [0.32, 0.60]; P ≤ 0.01) were increased in patients. One CP patient had a round aortic arch with physiological haemodynamic parameters.CONCLUSIONSThe restoration of physiological aortic configuration and haemodynamics was not fully achieved with the curved prostheses in our study cohort. However, there was a tendency towards improved haemodynamic conditions in the patients with curved prostheses overall but without statistical significance. A single patient with a CP and near-physiological configuration of the thoracic aorta underlines the importance of optimizing postoperative geometric conditions for allowing for physiological haemodynamics and cardiovascular energetics after VSARR.

Zielsetzung Für die klinische und wissenschaftliche Akzeptanz der 4D Fluss MRT ist entscheidend, dass Ergebnisse unterschiedlicher Nachbearbeitungsprogramme und MRT Geräte vergleichbar sind. Daher wurden in einem cross-over Vergleich Daten von 2 MRTs verschiedener Hersteller mit 4 Programmen ausgewertet.