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The rich collection of annotated datasets piloted the robustness of deep learning techniques to effectuate the implementation of diverse medical imaging tasks. Over 15% of deaths include children under age five are caused by pneumonia globally. In this study, we describe our deep learning based approach for the identification and localization of pneumonia in Chest X-rays (CXRs) images. Researchers usually employ CXRs for the diagnostic imaging study. Several factors such as positioning of the patient and depth of inspiration can change the appearance of the chest X-ray, complicating interpretation further. Our identification model ( https://github.com/amitkumarj441/identify_pneumonia ) is based on Mask-RCNN, a deep neural network which incorporates global and local features for pixel-wise segmentation. Our approach achieves robustness through critical modifications of the training process and a novel post-processing step which merges bounding boxes from multiple models. The proposed identification model achieves better performances evaluated on chest radiograph dataset which depict potential pneumonia causes.

Resumen La ecografía es un estudio de imágenes diagnósticas con una amplia historia de uso en todas las especialidades de la Medicina; su advenimiento ha ayudado al enfoque diagnóstico e, incluso, al abordaje terapéutico de los pacientes. Desde su origen en el siglo XIX con mediciones de la velocidad del sonido en el agua, hasta el desarrollo de las máquinas de ultrasonografía sustentadas en los avances de la tecnología, la física y la ingeniería, se ha utilizado de manera notable en la Medicina. No hay duda de que, en el campo de la Cirugía General, ha sido útil para el manejo de los pacientes con enfermedad abdominal. La tecnología ecográfica permite identificar las características de un órgano normal y, cuando este patrón se afecta, orienta sobre la causa o determina la enfermedad que puede estar produciendo la alteración. En la presente revisión, se hace un recuento histórico del nacimiento de la ecografía, su aplicación en el campo de la medicina y su utilidad para el cirujano general en diversas circunstancias de la práctica quirúrgica. Abstract Ultrasound is a diagnostic imaging study with a broad history of use in all medical specialties. Its advent has helped the medical approach as well as the therapeutic approach of patients. From its origin in the nineteenth century with the measurements of the speed of sound in the water, until the development of ultrasonic machines, sustained in the advances of technology in physics and engineering, has been used in a remarkable ways in medicine. There is no doubt that in the field of general surgery it has been useful for the management of patients with abdominal pathologies, mainly to identify the characteristics of a normal organ and when this pattern of normality is affected the ultrasound technology allows to identify which disease is in place. This review provides a historical review of how ultrasound was born, and how it began to be applied in the field of medicine and its utility for the general surgeon in various scenarios of surgical practice.

INTRODUCTION AND OBJECTIVES:A previous randomized trial found that obtaining ultrasound (US) as the first diagnostic imaging study for adults with suspected ureteral stones reduces radiation without increasing return ED visits or missed diagnoses. These results are consistent with EAU guidelines that US should be the first imaging modality for nephrolithiasis. We sought to determine the potential reduction in radiation exposure for an US-first approach using population-based diagnostic imaging patterns in the ED.METHODS:We performed a cross-sectional study of adults who presented to 70 emergency departments in South Carolina between 1996 and 2017 using all payer hospital claims data. All ED encounters within a 6 month “episode” following the initial ED visit were identified, along with ultrasound and CT ordered at the visits. Patterns of US and CT during the first two consecutive ER visits were determined at the patient- and hospital-level. Imaging patterns in which only a CT was performed were classified...

Gastrointestinal bleeding (GIB) occurs in up to 40% of patients with continuous-flow (CF) left ventricular assist devices (LVADs). We sought to identify targets to improve hospital resource utilization and decrease readmissions after GIB. We performed a single-center, retrospective analysis of LVAD-associated GIB resulting in hospital admission between July 2011 and April 2014. Follow-up data were collected through March 2015. We analyzed 57 admissions for GIB in 23 patients. One or more diagnostic imaging study was performed in 47% of admissions, with a definite or probable source of GIB identified in 23%. A total of 76 endoscopies were performed (≥ 1 endoscopy in 79% of admissions, ≥ 2 in 42%). Definite or probable bleeding sources were identified in 25% and 12% of endoscopies, respectively. Patients who underwent multiple endoscopies were no more likely to have a bleeding source identified (OR 1.48; 95% CI 0.50–4.32; p = 0.59) and had longer hospital stays (11.1 vs. 7.8 days, p

Diagnostic imaging has mirrored the steady growth of healthcare utilization in the USA. This has created greater opportunity for diagnostic errors, which can be costly in terms of morbidity and mortality as well as dollars and cents. The purposes of this study were to describe all return visits to a tertiary care urban pediatric emergency department (PED) resulting from diagnostic imaging discrepancies and to calculate the costs of these return visits. From July 2014 to February 2015, all children who underwent a diagnostic imaging study during an ED visit were assembled. Analysis was performed on all children who were called back and returned to the ED following a discrepant read. Direct and indirect costs to the patient, family, hospital, and society for these return visits were calculated. During the study period, 8310 diagnostic imaging studies were performed, with 207 (2.5%) discrepant reads. Among the discrepant reads, 37 (0.4% of total, 17.9% of discrepant) patients had a return visit to the ED for further management. Including ED charges, time and travel costs to the family, and costs of radiation exposure, return visits for radiologic discrepancies over this 8-month period cost a total of $84,686.47, averaging $2288.82 per patient. Though the overall diagnostic imaging discrepancy rate among our study population was low, the clinically significant discrepancies requiring return ED visits were potentially high risk, and costly for the patient, family, and healthcare system.

After-hours radiologic interpretation by nonradiology attendings or resident radiologists introduces the risk of discrepancies. Clinical outcomes following radiologic discrepancies among pediatric emergency department (ED) patients are poorly described. In particular, children with special healthcare needs (CSHCN), have more opportunities for discrepancies and potential consequences than non- CSHCN. Our objective was to determine the rates and types of radiologic discrepancies, and to compare CSHCN to non-CSHCN.From July 2014 to February 2015, all children who underwent a diagnostic imaging study at a free-standing children's ED were included. Data collected included radiologic studies - type and location - and clinical details - chief complaint and CSHCN type. Differences between preliminary reads and final pediatric radiology attending reads were defined as discrepancies, and categorized by clinical significance. Descriptive statistics, z-tests, and chi-square were used.Over 8months, 8310 visits (7462 unique patients) had radiologic studies (2620 CSHCN, 5690 non-CSHCN). A total of 198 (2.4%) radiologic discrepancies [56 (28.3%) CSHCN, 142 (71.7%) non-CSHCN] were found. Chief complaints for CSCHN were more often within the cardiac, pulmonary and neurologic systems (p0.001 for each), whereas non-CSHCN presented with more trauma (p0.001). The rates of discrepancies (CSHCN 2.1%, non- CSHCN 2.5%, p=0.3) and severity of clinical consequences (p=0.6) were not significantly different between CSHCN and non-CSHCN.Though the frequency and type of radiologic studies performed between CSHCN and non-CSHCN were different, we found no significant difference in the rate of radiologic discrepancies or the rate of clinically significant radiologic discrepancies.

Because of the increasing concern about its excessive and inappropriate use, guidelines have been developed for the appropriate use of diagnostic imaging [1-3]. Guidelines for diagnostic imaging are also incorporated into more comprehensive clinical practice guidelines [4,5]. Guidelines should be evidence based [6], and in assessing the evidence, accuracy is usually the primary criterion used to evaluate the role of diagnostic imaging [7,8]. Unfortunately, the quality of the evidence is usually given a lower grade [4,5], and the methodology for assessing the evidence in imaging guidelines has been criticized [9]. In fact, the type of evidence needed for imaging guidelines needs to be reassessed. Accuracy is obviously a very important attribute of effective diagnostic imaging. A study designed to test the accuracy of diagnostic imaging must be methodologically rigorous to avoid bias, and the methodology must be clearly described in any report [10]. The ost difficult issue in the design of study of the accuracy of a diagnosic imaging procedure is the selecion of the reference or “gold” stanard against which the accuracy of he diagnostic test is measured. The est reference standard is usually athology. In the ideal world, all he patients in a study should be ssessed by the same reference stanard. However, in practice, this is irtually never possible. In assessing he accuracy of diagnostic imaging, atients in a study who are thought o have the condition being assessed ay undergo biopsy or some other ype of surgical exploration, and the ccuracy of the test for those patients can be assessed against the reference standard of pathology. However, patients who do not have any evidence of the disease on their imaging studies cannot ethically undergo biopsy and are therefore assessed using a different reference standard, usually follow-up. This results in what is called verification bias, and verification bias can result in overestimation of both sensitivity and specificity [10]. If 2 diagnostic imaging examinations are being compared, and the same reference standards are being used for both, verification bias may be less of a problem. There are also statistical methods available that can help correct for verification bias [11]. However, if the true accuracy of a diagnostic imaging study is being investigated, verification bias is a significant and usually unavoidable problem. Defining a reference standard for assessing the accuracy of imaging in the diagnosis of conditions that are not usually or cannot be confirmed pathologically becomes even more difficult. For instance, radiography has been used to diagnose fractures for more than a century [12]. We do know certain situations in which the diagnostic accuracy of an x-ray is limited, for instance, in the diagnosis of fractures of the femoral neck in the elderly [13], but there have been no large-scale studies to determine the overall accuracy of x-rays in the diagnosis of fractures. There are other conditions in which the establishment of a reference standard is extremely difficult or controversial. A very common indication for an x-ray of the chest is the diagnosis of pneumonia. However, we do not know the ac

Objective. To develop a pathway to provide safe, effective, and efficient sedation for pediatric diagnostic imaging studies using non-radiology personnel. Materials and methods. A multidisciplinary team considered manpower and training requirements and national sedation standards before designing a sedation pathway, which included scheduling, pre-sedation history and physical, medication protocols, and monitoring. Oral and IV medication protocols were developed based on patient age and weight. Sedation delays were defined as >15 min (IV) or >30 min (PO) from start of sedation to start of imaging. A sedation failure resulted in an incomplete diagnostic imaging study. Failure rates of 124 sedations before and 388 sedations after the pathway were compared. Results. The sedation failure rate for 7 months prior to pathway initiation was 15% (19/124). In the first 25 months after pathway initiation, failures were significantly reduced to 1.5% (6/388) (P 55 min). Deviation from the recommended medication protocol accounted for most of the 115 delays. Only minor adverse events were seen (12/388, 3.1%). Conclusion. Implementing a pediatric sedation pathway significantly decreases the sedation failure rate. Pediatric residents and nurses can safely, effectively and efficiently sedate pediatric patients for routine diagnostic imaging procedures without the need for a radiology department sedation team in a department with a small-to-moderate volume of pediatric patients.

Cholescintigraphy with (99m)Tc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide.

Ultrasound is the appropriate first diagnostic imaging study in the evaluation of acute scrotal disease. This review highlights the major causes of acute disease of the scrotal sac, testis, epididymis, and spermatic cord, details the typical findings of the pathologic entities, and defines how duplex and color Doppler improve the diagnostic yield.

Pediatric Urology is a surgical subspecialty that is very dependent upon radiographic imaging as the majority of the genitourinary (GU) tract is internally located. Technological advances in various imaging modalities (e.g. ultrasonography, nuclear medicine, CT and MRI) have aided in our ability to visualize and evaluate the functionality of the GU tract, enabling the diagnosis of various disease processes that affect the genitourinary system. Collectively the advances in uro-radiology have improved our understanding of the natural history of many conditions that involve the GU tract. As a result of these newer imaging modalities, some of the more traditional techniques have assumed a limited role in the diagnostic evaluation of the pediatric GU patient (e.g. intravenous urography). The purpose of this article is to review the advances in radiographic imaging, in particular the cross-sectional imaging modalities and discuss their utility (appropriate indications and application) in Pediatric Urology, so that the reader can maximize the diagnostic yield of these studies. For a thorough review of any of the imaging modalities discussed in this article and their utility in the practice of pediatric urology, I would direct the readers to articles in the radiological literature that are specific to that technology. Besides the obvious technological advances in imaging modalities, this review also discusses the attention to radiation safety for the pediatric patient that every physician who orders a diagnostic imaging study in a child should be aware of.

Intracranial haemorrhage can be a devastating disorder that requires rapid diagnosis and management. Neuroimaging studies are not only required for diagnosis but also provide important insights into the type of haemorrhage, the underlying aetiology, and the accompanying pathophysiology. Historically, CT has been the diagnostic imaging study of choice; however, there is a growing body of data that suggest that MRI is at least as sensitive as CT to detect haemorrhage in the hyperacute setting, and superior to CT in the subacute and chronic settings. Blood has characteristic appearances on both imaging modalities at each stage (acute, subacute, and chronic) and it is important that physicians are familiar with the appearance of various types of intracranial haemorrhage on CT and MRI and their clinical implications. In addition, new imaging applications, such as magnetic resonance spectroscopy and diffusion tensor imaging, are promising research techniques that have the potential to enhance our understanding of the tissue injury and recovery that result from intracranial haemorrhage.

Introduction Subarachnoid hemorrhage is one of the most feared acute neurologic events. Accurate diagnosis of subarachnoid hemorrhage is essential, and computed tomography of the brain is the first diagnostic imaging study. However, in rare circumstances, a similar appearance may occur in the absence of blood in the subarachnoid space. The contrast enhancement of subarachnoid space is a rare complication after lumbar percutaneous epidural neuroplasty, with, to the best of our knowledge, no previous report in the literature. Case presentation A 42-year-old Korean male patient, who underwent a spinal operation five years previously at the level of L4 to S1, visited our clinic with persistent and aggravating low back pain. An imaging study revealed the focal and diffuse disc protrusion at the level of L4/5 and L5/S1. The clinician decided to perform a lumbar percutaneous epidural neuroplasty. During the procedure, dural adhesion was suspected at the previously operated level, and the neuroplasty catheter was malpositioned into the intradural space on the first attempt. After the catheter was repositioned, the scheduled epidural neuroplasty was completed. Our patient had no definite abnormal neurological signs. But, after a day, our patient complained of severe headache with sustained high blood pressure without neurological disorientation. Computed tomography of his brain showed a subarachnoid hemorrhage-like appearance with intracranial air. Sequential angiography, subtractional magnetic resonance imaging and examination of the cerebrospinal fluid revealed no abnormalities. Follow-up computed tomography after one day revealed no definite intracranial hemorrhage, and our patient was discharged with improved low back pain without neurological deficit. Conclusion We report a rare case of contrast mimicking a subarachnoid hemorrhage after lumbar percutaneous epidural neuroplasty. The physician should keep in mind a rare case like this, and the supine position with head elevation is necessary to avoid a similar complication after lumbar percutaneous epidural neuroplasty.