Search

Objective: To evaluate the effectiveness of a new strategy for using artificial intelligence (AI) as supporting reader for the detection of breast cancer in mammography-based double reading screening practice. Methods: Large-scale multi-site, multi-vendor data were used to retrospectively evaluate a new paradigm of AI-supported reading. Here, the AI served as the second reader only if it agrees with the recall/no-recall decision of the first human reader. Otherwise, a second human reader made an assessment followed by the standard clinical workflow. The data included 280 594 cases from 180 542 female participants screened for breast cancer at seven screening sites in two countries and using equipment from four hardware vendors. The statistical analysis included non-inferiority and superiority testing of cancer screening performance and evaluation of the reduction in workload, measured as arbitration rate and number of cases requiring second human reading. Results: Artificial intelligence as a supporting reader was found to be superior or noninferior on all screening metrics compared with human double reading while reducing the number of cases requiring second human reading by up to 87% (245 395/280 594). Compared with AI as an independent reader, the number of cases referred to arbitration was reduced from 13% (35 199/280 594) to 2% (5056/280 594). Conclusion: The simulation indicates that the proposed workflow retains screening performance of human double reading while substantially reducing the workload. Further research should study the impact on the second human reader because they would only assess cases in which the AI prediction and first human reader disagree. [ABSTRACT FROM AUTHOR]

Contrast-enhanced spectral mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI-guided biopsy. An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally, this would have necessitated an MRI-guided breast biopsy, but was performed under CESM guidance. A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer. CESM-guided breast biopsy is a new technique that can be successfully used as an alternative to MRI-guided breast biopsy. CESM-guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound. [ABSTRACT FROM AUTHOR]

Background Venlafaxine is a dual serotonin (5-HT) and norepinephrine reuptake inhibitor. The specific dose at which it begins to efficiently engage the norepinephrine transporter (NET) remained to be determined. Paroxetine is generally considered as a selective 5-HT reuptake inhibitor but exhibits some affinity for NET. Atomoxetine is a NET inhibitor but also has some affinity for the 5-HT reuptake transporter (SERT). Methods This study examined the effects of forced titration of venlafaxine from 75 to 300 mg/d, paroxetine from 20 to 50 mg/d, or atomoxetine from 25 to 80 mg/d in 32 patients with major depressive disorder. Inhibition of SERT was estimated using the depletion of whole-blood 5-HT. Inhibition of NET was assessed using the attenuation of the systolic blood pressure produced by i.v. injections of tyramine. Results All 3 medications significantly reduced 5-HT levels at the initiating regimens: venlafaxine and paroxetine by approximately 60% and atomoxetine by 16%. The 3 subsequent regimens of venlafaxine and paroxetine reduced 5-HT levels by over 90%, but the highest dose of atomoxetine only reached a 40% inhibition. Atomoxetine dose dependently inhibited the tyramine pressor response from the lowest dose, venlafaxine from 225 mg/d, and paroxetine left it unaltered throughout. Conclusion These results confirm that venlafaxine and paroxetine are potent SERT inhibitors over their usual therapeutic range but that venlafaxine starts inhibiting NET only at 225 mg/d, whereas paroxetine remains selective for SERT up to 50 mg/d. Atomoxetine dose dependently inhibits NET from a low dose but does not inhibit SERT to a clinically relevant degree. [ABSTRACT FROM AUTHOR]

We estimate the effect of binge drinking on road accidents, accident and emergency (A&E) attendances and arrests using a variety of unique English data and a two-sample instrumental variables estimation procedure. Drinking |$10+$| units of alcohol in a single session increases road accidents by 18.6%, injury-related A&E attendances by 6.6% and arrests by 71%. The marginal increase from eight to |$10+$| alcoholic units implies nearly 6,100 extra road accidents every year, 63,000 additional A&E attendances and 100,000 additional arrests. The externality per mile driven by a binge drinker is about five pence and the punishment that internalises this externality is equivalent to a fine of £22,800 per drunk driving arrest. [ABSTRACT FROM AUTHOR]

Objectives: The interpretation of digital breast tomosynthesis (DBT) screening examinations is a complex task for an already overstretched workforce which has the potential to increase pressure on readers leading to fatigue and patient safety issues. Studies in non‐medical and medical settings have suggested that changes in blink characteristics can reflect fatigue. The purpose of this study is to investigate the use of blink characteristics as an objective marker of fatigue in readers interpreting DBT breast screening examinations. Methods: Twenty‐six DBT readers involved in the UK PROSPECTS trial interpreted a test set of 40 DBT cases while being observed by an eye tracking device from November 2019 to February 2021. Raw data from the eye tracker were collected and automated processing software was used to produce eye blinking characteristics data which were analysed using multiple linear regression statistical models. Results: Of the 26 DBT readers recruited, eye tracking data from 23 participants were analysed due to missing data rendering 3 participants' data uninterpretable. The mean reading time per DBT case was 2.81 min. There was a statistically significant increase in blinking duration of 0.38 ms/case as the reading session progressed (p < 0.0001). This was the result of a significant decrease in the number of ultra‐short blinks lasting ≤50 ms (p = 0.0005) and a significant increase in longer blinks lasting 51–100 ms (p = 0.008). Conclusion: Changes in blinking characteristics could serve as objective measures of reader fatigue and may prove useful in the development of DBT reading protocols. Advances in knowledge: Blink characteristics can be used as an objective measure of fatigue; however there is limited evidence of their use in radiological settings. Our study suggests that changes in blink duration and frequency could be used to monitor fatigue in DBT reading sessions. [ABSTRACT FROM AUTHOR]

Objective: To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft-tissue mammographic abnormalities. Methods: Women recalled for further assessment of soft-tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two-view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymization of cases, there was also a retrospective multireader review. The readers first read bilateral standard two-view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five-point scale. The same readers then read bilateral standard two-view DM together with two-view DBT. Pathology data were obtained. Differences were assessed using receiver operating characteristic analysis. Results: The study population was 342 lesions in 322 patients. The final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two-view DM plus DBT was at least equivalent to the performance of two-view DM and standard mammographic supplementary views--the area under the curve (AUC) was 0.946 and 0.922, respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review--AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. Conclusion: The accuracy of GE DBT in the assessment of screen detected soft-tissue abnormalities is equivalent to the use of standard supplementary mammographic views. Advances in knowledge: The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft-tissue screen-detected abnormalities. [ABSTRACT FROM AUTHOR]

Objective: Ultrasound‐guided intervention is an essential skill for many radiologists and critical for accurate diagnosis and treatment in many radiology subspecialties. Simulation using phantoms have demonstrated statistically significant benefits for trainees within the literature. We propose a novel phantom model which the authors feel is ideal for training clinical radiology trainees in the performance of ultrasound‐guided procedures. Methods: The recipe to prepare a homemade phantom is described. Results of a local survey from trainees preparing and using the phantom are also presented. Results: This realistic training simulation model can be adapted to suit a variety of biopsy devices and procedures including soft tissue biopsy and cyst aspiration. The phantom mimics the sonographic appearances of soft tissue and biopsy targets can be concealed within. The phantom was easily prepared by 22 trainees (Likert score 4.5) and it functioned well (Likert score of 4.7). Conclusion: In summary, our phantom model is ideal for training clinical radiology trainees in the performance of ultrasound‐guided core biopsy. The availability and low cost of the model, combined with the ease of preparation and reproducibility, make this an efficient and effective addition to the training process. Advances in knowledge: A low cost easily handmade phantom recipe is described that could be easily implemented in training schemes. [ABSTRACT FROM AUTHOR]

A correction to the article "Liquid Assets? The Short-Run Liabilities of Binge Drinking" that was published in the previous issue of the periodical, is presented.