Diagnostic Imaging brings you daily coverage of SIIM 2021 virtual annual meeting.

SIIM 2021 Virtual Annual Meeting: May 24 - 27, 2021

Whitney J. Palmer has been with Diagnostic Imaging since 2011, serving as the Senior Editor since November 2019. She has 20 years experience in healthcare and academic medicine reporting.

When it comes to predicting major cardiac events, the Coronary Artery Disease Reporting and Data System (CAD-RADS) does a better job with patients who have chest pain than coronary artery calcium (CAC) scoring.

investigators from South Korea showed that the CAD-RADS system, introduced in 2016, performs well in accurately predicting these events when acute pain is present. The system has already been shown to outperform CAC scoring for more stable chest pain.

Their work shows relying on CAD-RADS can provide benefit to patients who could be facing major adverse cardiovascular events (MACE).

“The Coronary Artery Disease Reporting and Data System category had an incremental prognostic value compared with clinical risk factors and coronary artery calcium score to predict future major adverse cardiovascular events in patients with acute chest pain presenting to the emergency department,” said the team led by Ji Won Lee, M.D., Ph.D., from the Pusan National University radiology department. “Our results showed that a higher CACS, higher CAD-RADS categories, and presence of high-risk plaque are associated with future MACE risk after adjusting for clinical risk factors.”

For their study, Lee’s team assessed CCTA exams from 1,492 patients who presented to four emergency department between January 2010 and December 2017. During that time, they determined that CAD-RADS augmented risk stratification more than clinical risk factors did with or without CAC scoring. Their findings also showed that CAD-RADS and existing high-risk plaque were independent MACE predictors.

Specifically, during 31.5 months of follow-up, 103 patients (7 percent) experienced MACEs. The team’s analysis revealed that having moderate-to-severe CACS was associated with MACE after adjusting for clinical risk factors, as were CAD-RADS categories 3, 4, or 5. Ultimately, the C statistics showed that CAD-RADS risk stratification improvement was 0.85 over clinical factors alone (0.63) or in combination with CAC scoring (0.76).

, Rozemarijn Vliegenthart, M.D., Ph.D., a radiologist at the University Medical Center Gröningen in The Netherlands, said this study is the first to her knowledge that takes an in-depth look at prognostic value that CAD-RADS brings to evaluating patients with acute chest pain.

She noted that these findings underscore ongoing efforts that show the system can help radiologists better communicate CT findings to referring providers. In addition, she pointed out that the system could help with quality-of-care standardization, ultimately improving patient outcomes.

“This valuable study…gives a first glimpse, but a defining and consequential one, of the value that a standardized CCTA reporting system, including its additional CAD features, can have in patients with acute chest pain,” she said. “CAD-RADS helps to standardize quality of care and, moreover, may improve the outcome in patients with acute chest pain across emergency departments. Although it may still be, as to be expected in such a study, a preliminary expectation, in my opinion, it is a big step in the right direction.”

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

Articles

System does a better job of indicating which patients with acute chest pain could experience adverse outcomes. 

CAD-RADS Outperforms CAC Scoring in Predicting Major Cardiovascular Events

Dr. Arlene Richardson is a radiologist at RP Chicago. Radiology Partners 

is the largest physician-led and physician-owned radiology practice in the United States.

It all started several years ago when Radiology Partners (RP) was offering opportunities to support 

, a nonprofit (501c3) organization with the mission of increasing and improving radiology and medical imaging for medically underserved regions by delivering radiology education and training to healthcare workers in these areas.

I have always had a heart for service, so I got involved as a volunteer. In 2017, I had the opportunity to travel with RAD-AID to Tanzania through my local practice, RP Chicago. The hospital in the Tanzanian community we served had recently launched the country’s second MRI program, so their MRI training was limited. For two months, I worked with radiologists to provide education and training, offer protocol optimization and workflow solutions, assist with musculoskeletal imaging, and help with community outreach.

Radiology and AI for the Developing World

Seeing the community’s needs firsthand was so helpful to understand exactly what RAD-AID does: RAD-AID is working to optimize the role of radiology in global public health initiatives and to build sustainable healthcare solutions for long-term viability of radiology services in communities that need it.

After my trip to Tanzania, I knew my work with RAD-AID wasn’t over. I began serving remotely, continuing to offer virtual assistance in training, education and support, and eventually worked my way up to my current role as director of the RAD-AID Tanzania program.

During the COVID-19 pandemic, RAD-AID was able to pivot, shifting its program to offer interested volunteers virtual opportunities to support their programs, such as assisting with distance learning and offering mentorship.

RAD-AID also began other initiatives. With their focus on healthcare disparities and access to quality care, the organization has increased support to more underserved regions of the United States and recently launched its 

 in collaboration with Hologic and Black Women’s Health Imperative to increase access to breast and cervical cancer screenings for women of color in 10 different U.S. communities. In fact, Jackson Park Hospital in Chicago, where I chair the radiology department, was selected as the Chicago site for this initiative.

This grant will provide previously unavailable 3D mammography equipment and stereotactic biopsy services for us to improve the quality of screening and diagnostic breast imaging for women in our community. It will also help improve cervical cancer screening rates, add patient navigation services, and improve our IT infrastructure.

I’m proud that in early 2020, RP announced 

a global health partnership with RAD-AID International

, committing to collaborate with RAD-AID’s global network of more than 13,000 radiology volunteers to help 85 hospitals in 38 countries they serve.

Our colleagues at vRad have been supporting RAD-AID since 2018, when they started the 

, a program where vRad physicians can donate the funds from the first read of their day to RAD-AID.

Now, all roles in radiology can get involved with the organization, including radiologists, AI experts, IT professionals, nurses and technologists, even virtual lecturers and teachers. Different regions have different needs, and RAD-AID is able to offer opportunities for all radiology professional to support, whether its remote or on-site. There will even be opportunities to travel again with RAD-AID in the future.

My experience has been invaluable with RAD-AID. This organization is very close to my heart, but now, after seeing its dedication to medically underserved regions only continue in the most challenging circumstances, I know that it’s invaluable to many communities in the United States and across the globe.

If you would like more information about RAD-AID, you can 

sign up for the e-newsletter and/or register for the annual conference

. If you are interested in volunteer opportunities, visit the dedicated 

Dr. Arlene Richardson is a radiologist at RP Chicago.

is the largest physician-led and physician-owned radiology practice in the U.S.

How radiology professionals can help medically underserved communities at home and abroad.

RAD-AID and Radiology

Edwin Chu, M.D., is a board-certified, fellowship-trained radiologist. Dr. Chu completed medical school at The University of Texas at San Antonio and his radiology residency at The University of Pittsburgh Medical Center. Dr. Chu also completed his fellowship in Musculoskeletal Imaging at the University of California at San Francisco.

20-year-old Female with Chronic Dorsal Foot Pain


- Usually occult until late adolescence or early adulthood
- Most common presentation: joint contracture or pain
- Usually affects only one limb
- Predilection for long bones of the limbs, hands, and feet


- Manifests as periosteal cortical thickening, thick undulating ridges of bone
- Demonstrates dripping wax appearance or flowing candle wax appearance
- Affected bones on this case: 2nd/3rd metatarsals and phalanges, cuneiforms, calcaneus, talus, and partially visualized distal fibula


- Benign soft-tissue tumor
- Classically located in the subscapular or infrascapular region, deep to the serratus anterior and latissimus dorsi musculature
- Can be bilateral
- Most common in elderly women
- Thought to result from recurrent friction between inferior scapula and posterior chest wall



- Similar attenuation and intensity to adjacent skeletal muscle
- Can demonstrate low level, heterogeneous enhancement on MR
- Can demonstrate mild to moderate FDG uptake on PET imaging


20-year-old female with chronic dorsal foot pain. What most likely represents the imaging finding? ​

Image IQ Quiz: 20-Year-Old Female with Chronic Foot Pain

Transthoracic echocardiography (TTE) plays a role in pinpointing the risk a COVID-19-positive patient has of dying.

European Journal of Clinical Investigation

a team of investigators from Italy determined that left ventricular ejection fraction and tricuspid annular plane systolic excursion are independently associated with whether a hospitalized COVID-19 patient will die.

“Cardiovascular complications can negatively impact on outcomes of patients with COVID-19,” said the team led by Angelo Silverio from the University of Salerno. “Clinical and echocardiographic parameters…might help to identify patients at higher risk for in-hospital mortality.”

Their findings also indicated that patients with acute respiratory distress syndrome (ARDS) had a higher mortality risk than did unaffected patients.

Despite being proven effective for diagnosing critical-care patients who have suspected or confirmed cardiac disease, TTE requires close contact. Consequently, it’s hard to use it with COVID-19 patients – and it is recommended on an essential case-by-case basis – as it could place echocardiographers at increased infection risk.

For this study, the team was interested in identifying if there were any association between certain clinical characteristics and echocardiography factors and inpatient mortality. To find out, they assessed data from 1,401 COVID-19-positive patients who were treated in seven Italian hospitals between March 2020 to April 2020. Of the group, 226 underwent TTE within 48 hours of hospital admission, and 68 patients died while hospitalized.

Based on their evaluation, the team determined that reduced left ventricular ejection fraction, reduced tricuspid annular plane systolic excursion, and ARDS were all independently associated with inpatient mortality. Specifically, left ventricular ejection fraction of 50 percent or less had a hazard ratio of 4.06. Additionally, tricuspid annular plan systolic excursion of 17 mm or less and ARDS had hazard ratios of 5.08 and 7.66, respectively.

The team also found that men were more negative affected that women with 51 of 141 male patients dying while hospitalized.

Further investigations are needed to confirm these preliminary findings, the team concluded.

Echocardiography parameters and ARDS linked to higher mortality risk for hospitalized patients.

Echocardiography Can Determine Mortality Risk in COVID-19 Patients

Registration for RSNA 2021 opened Wednesday.

The conference, which will be held Nov. 28 to Dec. 2021 at McCormick Place in Chicago, will have the theme of “Redefining Radiology.” The more than 300 sessions and events, featuring more than 2,000 presenters, will highlight new ideas and technologies that will re-shape what it means to be a radiologist in the coming years.

“We have an outstanding plenary program highlighting timely, relevant topics in radiology presented by some of the leading experts in the field,” said Mary C. Mahoney, M.D., RSNA president.

In addition to Mahoney’s President’s Address, entitled “Redefining Radiology: The Road Ahead,” other presentations will focus on the patient experience, value-based care, healthcare equity, and diversity in radiation oncology. In addition, the Discovery Theater will return this year, as will the “Fast 5” medical insight and research presentations, Image Interpretation Session, and Case of the Day. Attendees can also expect to see the AI Showcase and Theater.

Currently, 518 exhibitors are confirmed for the 342,600-square foot exhibit space, including 103 exhibitors for the 34,900-square foot AI Showcase.

For interested registrants who will be impacted by institutional, corporate, or national travel restrictions still in place during the ongoing pandemic, RSNA 2021 will have a virtual component. Live conference attendees traveling with children can take advantage of Camp RSNA, the onsite childcare service, at no cost.

 are available, and in-person registration is free to RSNA members through Oct. 1. 

“Redefining Radiology” theme will focus on new ideas and technologies.

RSNA 2021 Registration Opens

You capture that X-ray, CT, or MRI image for a patient who’s facing an orthopedic procedure, but how confident are you that the surgeon is actually going to read your report?

A new survey conducted by radiologists with orthopedic surgeons in Europe shows they do routinely consult your assessments. But, the results also revealed surgeons have suggestions on what would make the reports more useful.

These results contradict the widely held belief that orthopedic surgeons ignore the radiology report, relying rather on their own experience with image interpretation. A team of investigators from Switzerland, Austria, and England published their findings in a July 20 

“Orthopedic surgery is one of the sub-specialties where imaging is ubiquitous. Therefore, it has become common practice of orthopedists to assess radiology images of their patients,” said the team led by Dorothee Harder, from the radiology department at the University Hospital Basel in Switzerland. “It is conceived that the written radiology report is not or only rarely consulted by these experts.”

For their study, a group of six radiologists prepared a 14-question survey, asking orthopedic surgeons if they consult radiology reports, and if so, for what modalities. In addition, the team wanted to know what prompted the review, what stopped surgeons from reading the report, and what they thought would make them more helpful. Overall, 81 surgeons replied.

According to their analysis, they found that the vast majority of surgeons do consult the reports when determining the best course of treatment. Specifically, 86 percent routinely review MRI reports while 67 percent and 43 percent take a look at reports for CT and X-ray, respectively. In some cases, though, surgeons said they would only consult a report if they had personal uncertainty about an image.

The surgeons reported several reasons why they would bypass the report. The following three reasons accounted for 60 percent of responses:

Duration of report availability is too long

In addition, many surgeons said they did not review the report because, as the surgeon, they wanted to examine the images and personally assess them for patient consultation and surgery planning. Several also deemed themselves to be more experienced than the reporting radiologist or they felt the report lacked technical terms or included false descriptions.

Of the surgeons who consulted the reports, 86 percent said they preferred a radiologist include a specific recommendation in their report. But, that doesn’t mean the surgeon was always in agreement. Most indicated they have had instances where they disagreed with the radiologist’s findings, but only half said they would reach out to the radiologist for a discussion. If they did, 64 percent preferred to do so by phone, and 33 percent would do so via email.

The responding surgeons did offer suggestions for what would make a radiology report more useful and actionable:

Include more clinical and technical background knowledge

The respondents also called for increased inter-disciplinary communication, as well as consultations with referring providers for equivocal cases.

“The majority of participating orthopedic surgeons would welcome more inter-disciplinary interaction with radiologists,” the team said. “This concerns the discussion of equivocal cases to come to a mutual, sensible conclusion in the appropriate clinical context, as well as information on incidental findings requiring further work-up.”

This improved communication, they said, could lead to dedicated teaching sessions that improve the use of terminology and technical background knowledge in reports.

Survey shows orthopedic surgeons do read radiology reports, but they have recommendations for improvements.

Orthopedic Radiology Reports: Is Anyone Reading?

Screening efforts have succeeded in improving mammography rates among Black women over the past 30 years, but this same group of women experience at least a two-fold increase in delays for diagnostic evaluation and biopsy, leading to a higher mortality level.

In fact, according to a team of investigators from Emory University, race is the most pronounced factor in delayed diagnoses of screening-detected breast cancers. In an article published July 16 in the 

they demonstrated that diagnostic delays can result in a 1.6-fold increase in mortality from breast cancer.

“We found that Black women were at least twice as likely to experience delays at each stage of the diagnostic process compared with white women,” the team said. “Interestingly, in our study, race was the only patient characteristic associated with delay to biopsy; Black women had a 2.4-fold increase in the odds of delay to biopsy compared with white women.”

These results highlight that there are still significant barriers to primary care, screening, and diagnostic services that can lead to negative outcomes.

For their study, the team enrolled 730 women – 362 white and 368 Black – who underwent breast cancer screening prior to diagnosis at the Emory University Breast Imaging Center between Jan. 1, 2010, to Dec. 31, 2014. They examined time intervals to diagnostic evaluation (less than or more than 30 days), time to biopsy (less than or more than 15 days), and total time delay (less than or more than 45 days).

Overall, they found that Black women and those from lower socioeconomic-status neighborhoods experienced longer delays and worse outcomes. Across all categories, delays were 60 percent greater for Black women than their white counterparts, averaging 10 days longer. In addition, women in lower socioeconomic neighborhoods also had a 1.69-fold increase in total delays – 42 days compared with 28 days for women in wealthier neighborhoods.

The team also discovered that women who had total delays of more than 45 days were more likely to have later-stage tumors, and women who had diagnostic delays were less likely to be diagnosed with ER+ disease, pointing to a need for truncated time intervals.

“Given that ER- tumors (particularly triple-negative breast cancer) are more likely to have an aggressive phenotype and poorer prognosis compared with ER+ tumors,” they explained, “it is imperative to ensure that women at highest risk for aggressive tumor types (namely, Black and young women) are evaluated in a timely manner.”

From the perspective of breast cancer mortality, the team determined that women who experience total delays of more than 45 days had a 1.57-fold increase in the odds of dying from breast cancer than women who did not have delays. And, among those who did have delays, Black women had a 1.6-fold odds increase of dying than did white women.

More work is needed, they said, to fully understand the impact of diagnostic delays on racial disparities in the context of breast cancer. But, their findings make it clear that Black women still face significant barriers than negatively impact their care.

“Our results suggest that race is the most pronounced driver of delays in the diagnosis of screen-detected breast cancer,” they concluded. “As such, necessary steps must be taken to identify the personal and structural barriers that influence timely receipt of care for Black women.”

Race is the most significant contributor to delays with breast cancer diagnosis. 



Black Women Twice as Likely to Experience Breast Cancer Diagnostic Delay

Using MRI to non-invasively capture a clear cell likelihood score (ccLS) can help providers better determine how quickly small kidney masses are growing. With this knowledge that can make better decisions about management strategies.

a team of investigators from the University of Texas Southwestern Medical Center showed that relying on MRI-derived ccLS rather than pre-operative percutaneous renal mass biopsy can effectively grade whether a mass will come back as renal cell carcinoma after evaluation.

ccLS scores are used to assess the likelihood that a small renal mass (equal to or less than 4 cm) is actually cancer with a score of 1 being unlikely and a score of 5 being very likely. The team, led by Ivan Pedrosa, M.D., Ph.D., professor of radiology and vice chair of radiology research, found that, based on their evaluations, higher ccLS scores correlate to more significant growth rates.

“The ccLS of small renal masses is significantly associated with growth. ccLS4-5 small renal masses grow more rapidly than ccLS1-2 and ccLS3 small renal masses,” the team said. “The information provided by ccLS may be beneficial in counseling patients and planning personalized management strategies.”

64-Year-Old Man With Clear Cell Likelihood Score (ccLS) 5 Renal Masses: 

Coronal T2-weighted single shot fast spin echo and coronal T1-weighted fat-saturated spoiled gradient echo acquired during corticomedullary phase—ccLS5 lesion outlined red for clarity.

Credit: American Journal of Roentgenology

This is the first study, the team said, that examines the correlation between ccLS and small renal mass growth.

For their retrospective study, the team evaluated ccLS scores derived from MRI scans conducted on 339 patients with an average age of 65 between June 2016 and November 2019. They examined tumor size measurements and tumor progression.

Axial T1-weighted gradient echo opposed-phase and in-phase images.

Overall, the team looked at 386 small renal masses. They determined that ccLS was correlated with growth rate by size – ccLS4-5 of 9 percent annually and ccLS 1-2 by 5 percent annually – as well as by volume – ccLS4-5 by 29 percent annually and ccLS1-2 by 16 percent annually.

Follow-up coronal T2-weighted single shot fast spin echo at 2.79 years. ccLS5 renal mass heterogeneously hyperintense with intense corticomedullary enhancement, presence of microscopic fat (i.e., drop in signal intensity on opposed-phase compared to in-phase), and significant interval growth (50.4%/year volume growth).

“Our study supports the conclusion of the more aggressive faster-growing nature of ccLS4-5 small renal masses. This…favors our recommendation of disease intervention in larger ccLS4-5 masses, in consideration of the patients’ clinical context and preferences,” the team said. “The results support the use of the ccLS as an ‘informational tool’ to assist with clinical decision making.”

In that vein, the team said they created an online calculator that patients and treating providers can use when making management decisions, helping them consider the likelihood of tumor growth in context with the patient’s life expectancy and co-morbidities.

The clear cell likelihood score can help providers determine the growth rate of masses that could be cancerous.

MRI-Derived Score Helps Determine Renal Mass Growth Rate

Adding ultrasound screening to routine annual visits for older patients can potentially catch more emerging chronic conditions or other problems in nearly all cases.

In an article published this week in the 

a team of investigators from Allina Health in Minnesota showed that including ultrasound as a preventive measure in regular wellness checks can be beneficial for older individuals.

Currently, a blood pressure check is the only required physical examination under the Standard Medicare Wellness checkup, but the team, led by Terry K. Rosborough, M.D., an internal medicine specialist with Northwestern Memorial Hospital’s graduate medical education department, showed doctors could perform more assessments with little additional cost for follow-up testing. 

“One or more abnormalities were found in 94 percent of our participants, the great majority of which would have been undetected by a traditional physical exam,” the team said. “Many participants benefited from the information and harm was rare and only economic.”

For their study, the team launched a program where experienced physicians used ultrasound to screen 108 adults between ages 65 and 85 during their annual Medicare Wellness appointments. Based on these exams, providers detected 283 abnormalities and made 172 new diagnoses, resulting in 30 ordered follow-ups.

Of the results, new diagnoses of liver steatosis (19 percent of patients) and kidney cysts (10 percent of patients) were the most common abdominal findings. Among the cardiovascular outcomes, the physicians pinpointed new cases of carotid plaque (44 percent of patients), left ventricular diastolic dysfunction (14 percent of patients), and tricuspid value regurgitation (22 percent of patients) the most.

Alongside the added benefit of these new findings, most patients (76 percent) saw no added cost. The price tag for most visits ranged from $5 to $50, the team said. But, those medical bills could have been higher later down the road had these findings not been identified.

While not every patient qualifies for or needs an added ultrasound screening during their routine annual check-up, Rosborough’s team contended such a program still does provide benefit overall. Additional work is needed on how best to design and use these initiatives, though.

“The assessed benefit of these abnormalities was rarely negative and often mild to moderately positive, with important new chronic conditions identified,” the team said. “We continue to investigate how to implement an ultrasound screening exam for select patients having periodic health visits.”

Including the screening adds little extra cost and can identify emerging problems in almost all patients.

Adding Ultrasound to Routine Check-Ups Catches More Abnormalities in Older Patients

Diagnostic Imaging's Weekly Scan: The Top 5

Slideshows

Take a quick look at Diagnostic Imaging's Top 5 stories of the week.



MRI-Derived Score Helps Determine Renal Mass Growth Rate

Adding Ultrasound to Routine Check-Ups Catches More Abnormalities in Older Patients

Diagnostic Imaging's Weekly Scan: July 19, 2021, to July 23, 2021