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It is unclear whether implicit memory (priming) is affected by aging. Some studies have reported no difference between young and older adults, while others have uncovered reliable reductions. An important factor that may explain these discrepancies is the manner of encoding. Processing requirements (perceptual/conceptual) have varied considerably between studies, yet processing abilities are not equally affected by aging. This study examined whether processing during encoding moderates age effects on priming. Young and older participants studied object-word pairs and made natural/manufactured (conceptual) and left/right rotation (perceptual) judgements in relation to the word or object. Objects served as targets on a subsequent continuous identification with recognition task to assess priming and recognition. Priming and recognition were greater in young than older adults for attended items, with a larger effect size in the conceptual than the perceptual condition. Findings suggest that age differences in priming may be a function of processing at encoding., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author. Published by Elsevier Inc. All rights reserved.)

Previous research has demonstrated that rhythmic presentation of stimuli during encoding boosts subsequent recognition and is associated with distinct neural activity compared with when stimuli are presented in an arrhythmic manner. However, it is unclear whether the effect is driven by automatic entrainment to rhythm or non-rhythmic temporal prediction. This registered report presents an Electroencephalographic (EEG) study aimed at establishing the cognitive and neural mechanisms of the effect of temporal prediction on recognition. In a blocked design, stimulus onset during encoding was systematically manipulated in four conditions prior to recognition testing: rhythmic fixed (RF), rhythmic variable (RV), arrhythmic fixed (AF), and arrhythmic variable (AV). By orthogonally varying rhythm and temporal position we were able to assess their independent contributions to recognition enhancement. Our behavioural results did not replicate previous findings that show a difference in recognition memory based on temporal predictability at encoding. However, event-related potential (ERP) component analysis did show an early (N1) interaction effect of temporal position and rhythm, and later (N2 and Dm) effects driven by temporal position only. Taken together, we observed effects of temporal prediction at encoding, but these differences did not translate to later effects of memory, suggesting that effects of temporal prediction on recognition are less robust than previously thought., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Explicit (declarative) memory declines with age, but age effects on implicit (nondeclarative) memory are debated. Some studies have reported null changes in implicit memory (e.g., priming in word-fragment completion, perceptual identification, category exemplar generation) with age, while others have uncovered declines. One factor that may account for these discrepancies is processing. Evidence suggests that conceptual and perceptual processes are not equally affected by ageing, yet processing requirements have varied greatly between studies. Processing may moderate age effects on priming, but no study has systematically examined this issue. This registered report presents an experiment to manipulate processing (conceptual / perceptual) during incidental encoding of words, prior to measures of perceptual (perceptual identification) and conceptual (category verification) priming. The perceptual and conceptual priming tasks were matched on all characteristics except processing, making them highly comparable. The four orthogonal conditions (perceptual encoding, perceptual test [PP]; conceptual encoding, perceptual test [CP]; perceptual encoding, conceptual test [PC]; conceptual encoding, conceptual test [CC]) were designed to clarify situations in which age effects on implicit memory emerge, which holds important practical and theoretical implications. Significant effects of Age, Test, and an Age × Processing interaction emerged. Priming was greater in young than older adults and on the perceptual than the conceptual test, but in contrast to the predictions, the age difference was only significant when prior encoding was perceptual (i.e., in the PP and CP conditions).

Recent evidence suggests that temporal expectation is beneficial to memory formation. Rhythmic presentation of stimuli during encoding enhances subsequent recognition and is associated with distinct neural activity compared with when stimuli are presented in an arrhythmic manner. However, no prior study has examined how temporal expectation interacts with another important form of facilitation-spatial attention-to affect memory. This study systematically manipulated temporal expectation and spatial attention during encoding to examine their combined effect on behavioral recognition and associated ERPs. Participants performed eight experimental blocks consisting of an encoding phase and recognition test, with EEG recorded throughout. During encoding, pairs of objects and checkerboards were presented and participants were cued to attend to the left or right stream and detect targets as quickly as possible. In four blocks, stimulus presentation followed a rhythmic (constant, predictable) temporal structure, and in the other four blocks, stimulus onset was arrhythmic (random, unpredictable). An interaction between temporal expectation and spatial attention emerged, with greater recognition in the rhythmic than the arrhythmic condition for spatially attended items. Analysis of memory-specific ERP components uncovered effects of spatial attention. There were late positive component and FN400 old/new effects in the attended condition for both rhythmic and arrhythmic items, whereas in the unattended condition, there was an FN400 old/new effect and no late positive component effect. The study provides new evidence that memory improvement as a function of temporal expectation is dependent upon spatial attention., (© 2022 Massachusetts Institute of Technology.)

This study aimed to review the neurobiological and neuropsychological correlates of paranoid (persecutory delusions) and misidentification (misidentification delusions and/or hallucinations) subtypes of psychosis in dementia, to establish if they represent distinct subphenotypes. Nine studies were eligible, all included patients with Alzheimer's disease. Greater global cognitive deficits and an accelerated global cognitive decline were observed in the misidentification subtype. Neuroimaging studies showed more marked volume loss in multiple regions in patients with the misidentification subtype, including those involved in object recognition and the processing of information on spatial and temporal context. A single study found greater impairment in visual sustained attention and object recognition in the misidentification subtype. The small number of studies and methodological heterogeneity limit interpretation of the findings. Nevertheless, these findings would tentatively suggest that there may be additional or accelerated pathological change in functional networks involved in visuoperceptual processing in the misidentification subtype. This should be further explored in prospective studies and the investigation extended to other forms of dementia, to gain a transdiagnostic perspective., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

This study examined the effect of matching musical emotion and the mood of the listener on working memory and free recall in normal aging. Memory measures were taken at baseline in healthy young and older participants, and, following a happy or sad mood induction, again after exposure to both mood-matching and -mismatching music in a counterbalanced repeated measures design. Compared to baseline, [i] recall was greater following mood-matching than mood-mismatching music in both groups, and was reduced following mood-mismatching music in older adults, [ii] working memory was greater in the mood-matching condition, but did not differ from baseline in the mismatching condition. The results have significant implications for the increasingly popular forms of intervention involving music used with older populations experiencing cognitive decline., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

Explicit memory declines with age, but age effects on implicit memory are debated. This issue is important because if implicit memory is age invariant, it may support effective interventions in individuals experiencing memory decline. In this study, we overcame several methodological issues in past research to clarify age effects on implicit memory (priming) and their relationship to explicit memory (recognition, source memory). We (a) recruited a large life-span sample of participants ( N = 1,072) during a residency at the Science Museum in London, (b) employed an implicit task that was unaffected by explicit contamination, and (c) systematically manipulated attention and depth of processing to assess their contribution to age effects. Participants witnessed a succession of overlapping colored objects, attending to one color stream and ignoring the other, and identified masked objects at test before judging whether they were previously attended, unattended, or new. Age significantly predicted decline in both explicit and implicit memory for attended items.

Presenting events in a rhythm has been shown to enhance perception and facilitate responses for stimuli that appear in synchrony with the rhythm, but little is known about how rhythm during encoding influences later recognition. In this study, participants were presented with images of everyday objects in an encoding phase before a recognition task in which they judged whether or not objects were previously presented. Blockwise, object presentation during encoding followed either a rhythmic (constant, predictable) or arrhythmic (random, unpredictable) temporal structure, of which participants were unaware. Recognition was greater for items presented in a rhythmic relative to an arrhythmic manner. During encoding, there was a differential neural activity based on memory effect with larger positivity for rhythmic over arrhythmic stimuli. At recognition, memory-specific ERP components were differentially affected by temporal structure: The FN400 old/new effect was unaffected by rhythmic structure, whereas the late positive component old/new effect was observed only for rhythmically encoded items. Taken together, this study provides new evidence that memory-specific processing at recognition is affected by temporal structure at encoding.

Objective: To review evidence evaluating the use of multicomponent frailty assessment tools in assessing frailty in older adults with psychiatric disorders., Methods: A systematic literature review was conducted to identify all multicomponent frailty assessment tools (ie, a tool that assesses two or more indicators of frailty). The items of each frailty assessment tool were compared with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria for psychiatric disorders to assess construct overlap. Studies conducted in community, inpatient, and outpatient clinical settings were considered for inclusion., Participants: Adults aged 60 years or older., Results: A total of 5639 records were identified following the removal of duplicates, from which 95 studies were included for review. Of the 48 multicomponent frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with a psychiatric disorder. Overall, 20 of 48 frailty assessment tools contained a psychological assessment domain, with 17 of 48 tools citing the presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM-5 diagnostic criteria included weight loss (29 of 48) and fatigue (21 of 48)., Conclusions: Significant construct overlap exists between the indicators of frailty as conceptualized in existing frailty assessment tools and DSM-5 diagnostic criteria for common psychiatric disorders including major depressive episode and generalized anxiety disorder that has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population. J Am Geriatr Soc 67:1085-1095, 2019., (© 2018 The American Geriatrics Society.)

Background: Predictor analyses of late-life depression can be used to identify variables associated with outcomes of treatments, and hence ways of tailoring specific treatments to patients. The aim of this review was to systematically identify, review and meta-analyse predictors of outcomes of any type of treatment for late-life depression., Methods: Pubmed, Embase, CINAHL, Web of Science and PsycINFO were searched for studies published up to December 2016. Primary and secondary studies reported treatment predictors from randomised controlled trials of any treatment for patients with major depressive disorder aged over 60 were included. Treatment outcomes included response, remission and change in depression score., Results: Sixty-seven studies met the inclusion criteria. Of 65 identified statistically significant predictors, only 7 were reported in at least 3 studies. Of these, 5 were included in meta-analyses, and only 3 were statistically significant. Most studies were rated as being of moderate to strong quality and satisfied key quality criteria for predictor analyses., Limitations: The searches were limited to randomised controlled trials and most of the included studies were secondary analyses., Conclusions: Baseline depression severity, co-morbid anxiety, executive dysfunction, current episode duration, early improvement, physical illnesses and age were reported as statistically significant predictors of treatment outcomes. Only the first three were significant in meta-analyses. Subgroup analyses showed differences in predictor effect between biological and psychosocial treatment. However, high heterogeneity and small study numbers suggest a cautious interpretation of results. These predictors were associated with various mechanisms including brain pathophysiology, perceived social support and proposed distinct types of depressive disorder. Further investigation of the clinical utility of these predictors is suggested., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Older adults often show greater implicit/unconscious memory than young adults for incidental information that was task-irrelevant during its acquisition. Shallow/perceptual encoding by older adults may boost performance on implicit tasks that reinstate this type of processing, whereas deeper/conceptual encoding by young adults may support greater explicit/conscious memory. To test this, young and older participants were exposed to incidental words in a text color identification task before the trial-by-trial capture of priming and recognition. In Experiments 1-3 priming and recognition were significantly greater in young than older adults, providing evidence against age differences in encoding style. In Experiments 2-3 older adults were more liberal than young adults in making positive recognition judgments to incidental relative to intentional items, even though source memory was poor in both groups. Findings pinpoint age differences in the utilization of previously incidental versus intentional information on different types of task., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Reinstatement of encoding context facilitates memory for targets in young and older individuals (e.g., a word studied on a particular background scene is more likely to be remembered later if it is presented on the same rather than a different scene or no scene), yet older adults are typically inferior at recalling and recognizing target-context pairings. This study examined the mechanisms of the context effect in normal aging. Age differences in word recognition by context condition (original, switched, none, new), and the ability to explicitly remember target-context pairings were investigated using word-scene pairs (Experiment 1) and word-word pairs (Experiment 2). Both age groups benefited from context reinstatement in item recognition, although older adults were significantly worse than young adults at identifying original pairings and at discriminating between original and switched pairings. In Experiment 3, participants were given a three-alternative forced-choice recognition task that allowed older individuals to draw upon intact familiarity processes in selecting original pairings. Performance was age equivalent. Findings suggest that heightened familiarity associated with context reinstatement is useful for boosting recognition memory in aging.

To systematically review the characteristics, validity and outcome measures of tasks that have been described in the literature as assessing pattern separation and pattern completion in humans. Electronic databases were searched for articles. Parameters for task validity were obtained from two reviews that described optimal task design factors to evaluate pattern separation and pattern completion processes. These were that pattern separation should be tested during an encoding task using abstract, never-before-seen visual stimuli, and pattern completion during a retrieval task using partial cues; parametric alteration of the degree of interference of stimuli or degradation of cues should be used to generate a corresponding gradient in behavioral output; studies should explicitly identify the specific memory domain under investigation (sensory/perceptual, temporal, spatial, affect, response, or language) and account for the contribution of other potential attributes involved in performance of the task. A systematic, qualitative assessment of validity in relation to these parameters was performed, along with a review of general validity and task outcome measures. Sixty-two studies were included. The majority of studies investigated pattern separation and most tasks were performed on young, healthy adults. Pattern separation and pattern completion were most frequently tested during a retrieval task using familiar or recognizable visual stimuli and cues. Not all studies parametrically altered the degree of stimulus interference or cue degradation, or controlled for potential confounding factors. This review found evidence that some of the parameters for task validity have been followed in some human studies of pattern separation and pattern completion, but no study was judged to have adequately met all the parameters for task validity. The contribution of these parameters and other task design factors towards an optimal behavioral paradigm is discussed and recommendations for future research are made. © 2015 Wiley Periodicals, Inc., (© 2015 Wiley Periodicals, Inc.)

Background: Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability. The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidenced. There is currently no gold standard frailty assessment tool; optimizing the assessment of frailty in older people therefore remains a research priority. The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged ≥60 years old and to systematically and critically evaluate the reliability and validity of these tools., Methods: A systematic literature review was conducted using the standardised COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist to assess the methodological quality of included studies., Results: Five thousand sixty-three studies were identified in total: 73 of which were included for review. 38 multi-component frailty assessment tools were identified: Reliability and validity data were available for 21 % (8/38) of tools. Only 5 % (2/38) of the frailty assessment tools had evidence of reliability and validity that was within statistically significant parameters and of fair-excellent methodological quality (the Frailty Index-Comprehensive Geriatric Assessment [FI-CGA] and the Tilburg Frailty Indicator [TFI])., Conclusions: The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties. However, there is insufficient evidence at present to determine the best tool for use in research and clinical practice. Further in-depth evaluation of the psychometric properties of these tools is required before they can fulfil the criteria for a gold standard assessment tool.

Aim: To evaluate the feasibility of using therapeutic ultrasound as an alternative treatment option for organ-confined prostate cancer., Methods: In this study, a trans-urethral therapeutic ultrasound applicator in combination with 3T magnetic resonance imaging (MRI) guidance was used for real-time multi-planar MRI-based temperature monitoring and temperature feedback control of prostatic tissue thermal ablation in vivo. We evaluated the feasibility and safety of MRI-guided trans-urethral ultrasound to effectively and accurately ablate prostate tissue while minimizing the damage to surrounding tissues in eight canine prostates. MRI was used to plan sonications, monitor temperature changes during therapy, and to evaluate treatment outcome. Real-time temperature and thermal dose maps were calculated using the proton resonance frequency shift technique and were displayed as two-dimensional color-coded overlays on top of the anatomical images. After ultrasound treatment, an evaluation of the integrity of cavernosal nerves was performed during prostatectomy with a nerve stimulator that measured tumescence response quantitatively and indicated intact cavernous nerve functionality. Planned sonication volumes were visually correlated to MRI ablation volumes and corresponding histo-pathological sections after prostatectomy., Results: A total of 16 sonications were performed in 8 canines. MR images acquired before ultrasound treatment were used to localize the prostate and to prescribe sonication targets in all canines. Temperature elevations corresponded within 1 degree of the targeted sonication angle, as well as with the width and length of the active transducer elements. The ultrasound treatment procedures were automatically interrupted when the temperature in the target zone reached 56 °C. In all canines erectile responses were evaluated with a cavernous nerve stimulator post-treatment and showed a tumescence response after stimulation with an electric current. These results indicated intact cavernous nerve functionality. In all specimens, regions of thermal ablation were limited to areas within the prostate capsule and no damage was observed in periprostatic tissues. Additionally, a visual analysis of the ablation zones on contrast-enhanced MR images acquired post ultrasound treatment correlated excellent with the ablation zones on thermal dose maps. All of the ablation zones received a consensus score of 3 (excellent) for the location and size of the correlation between the histologic ablation zone and MRI based ablation zone. During the prostatectomy and histologic examination, no damage was noted in the bladder or rectum., Conclusion: Trans-urethral ultrasound treatment of the prostate with MRI guidance has potential to safely, reliably, and accurately ablate prostatic regions, while minimizing the morbidities associated with conventional whole-gland resection or therapy.

The use of previously distracting information on memory tests with indirect instructions is usually age-equivalent, while young adults typically show greater explicit memory for such information. This could reflect qualitatively distinct initial processing (encoding) of distracting information by younger and older adults, but could also be caused by greater suppression of such information by younger adults on tasks with indirect instructions. In Experiment 1, young and older adults read stories containing distracting words, which they ignored, before studying a list of words containing previously distracting items for a free recall task. Half the participants were informed of the presence of previously distracting items in the study list prior to recall (direct instruction), and half were not (indirect instruction). Recall of previously distracting words was age-equivalent in the indirect condition, but young adults recalled more distracting words in the direct condition. In Experiment 2, participants performed the continuous identification with recognition task, which captures a measure of perceptual priming and recognition on each trial, and is immune to suppression. Priming and recognition of previously distracting words was greater in younger than older adults, suggesting that the young engage in more successful suppression of previously distracting information on tasks in which its relevance is not overtly signaled.

Purpose: To evaluate two nonenhanced MRA methods: quiescent-interval single-shot (QISS) and Native SPACE (NATIVE = Non-contrast Angiography of the Arteries and Veins; SPACE = Sampling Perfection with Application Optimized Contrast by using different flip angle Evolution), using contrast-enhanced MR angiography (CEMRA) as a reference standard., Materials and Methods: Twenty patients (14 male; mean, 69.3 years old) referred for lower extremity MRA were recruited in a HIPAA-compliant prospective study. QISS and Native SPACE of the lower extremities were performed at 1.5 Tesla with a hybrid dual-injection contrast-enhanced MRA as reference. Image quality and stenosis severity were assessed in segments by two blinded radiologists. Methods were compared with logistic regression for correlated data for diagnostic accuracy., Results: Of 496 arterial segments, 24 were considered nondiagnostic on the Native SPACE images. There were no QISS or CEMRA imaging segments considered to be nondiagnostic. Image quality was significantly higher for QISS than for Native SPACE. QISS stenosis sensitivity (84.9%) was not significantly different from Native SPACE (87.3%). QISS had better specificity (95.6%) than Native SPACE (87.0%), P = 0.0041. In comparison with QISS, Native SPACE proved less robust for imaging of the abdominal and pelvic segments., Conclusion: Native SPACE and QISS were sensitive for hemodynamically significant stenosis in this pilot study. QISS NEMRA demonstrated superior specificity and image quality, and was more robust in the abdominal and pelvic regions., (Copyright © 2013 Wiley Periodicals, Inc.)

It is well-documented that explicit memory (e.g., recognition) declines with age. In contrast, many argue that implicit memory (e.g., priming) is preserved in healthy aging. For example, priming on tasks such as perceptual identification is often not statistically different in groups of young and older adults. Such observations are commonly taken as evidence for distinct explicit and implicit learning/memory systems. In this article we discuss several lines of evidence that challenge this view. We describe how patterns of differential age-related decline may arise from differences in the ways in which the two forms of memory are commonly measured, and review recent research suggesting that under improved measurement methods, implicit memory is not age-invariant. Formal computational models are of considerable utility in revealing the nature of underlying systems. We report the results of applying single and multiple-systems models to data on age effects in implicit and explicit memory. Model comparison clearly favors the single-system view. Implications for the memory systems debate are discussed.

Recognition memory is typically weaker in healthy older relative to young adults, while performance on implicit tests (e.g., repetition priming) is often comparable between groups. Such observations are commonly taken as evidence for independent explicit and implicit memory systems. On a picture version of the continuous identification with recognition (CID-R) task, we found a reliable age-related reduction in recognition memory, while the age effect on priming did not reach statistical significance (Experiment 1). This pattern was consistent with the predictions of a formal single-system model. Experiment 2 replicated these observations using separate priming (continuous identification; CID) and recognition phases, while a combined data analysis revealed a significant effect of age on priming. In Experiment 3, we provide evidence that priming in this task is unaffected by explicit processing, and we conclude that the age difference in priming is unlikely to have been driven by differences in explicit processing between groups of young and older adults ("explicit contamination"). The results support the view that explicit and implicit expressions of memory are driven by a single underlying memory system., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Objective: The joint guidelines of the American College of Cardiology and American Heart Association support the use of contrast-enhanced MR angiography (CEMRA) to diagnose the location and degree of stenosis in patients with known or suspected peripheral arterial disease (PAD). The high prevalence of chronic renal impairment in diabetic patients with PAD and the need for high doses of gadolinium-based contrast agents place them at risk for nephrogenic systemic fibrosis. The purpose of our study was to evaluate the accuracy of the rapid technique of quiescent-interval single-shot (QISS) unenhanced MR angiography (MRA) compared with CEMRA for the diagnosis in diabetic patients referred with symptomatic chronic PAD., Subjects and Methods: This prospective two-center study evaluated 25 consecutive diabetic patients with documented or suspected symptomatic PAD. Both centers used identical imaging protocols. Images were independently analyzed by two radiologists. A subgroup analysis was performed of patients who were also assessed with digital subtraction angiography (DSA) as part of the standard-of-care protocol before revascularization., Results: For this study, 775 segments were analyzed. On a per-segment basis, the mean values of the diagnostic accuracy of unenhanced MRA compared with reference CEMRA for two reviewers, reviewers 1 and 2, were as follows: sensitivity, 87.4% and 92.1%; specificity, 96.8% and 96.0%; positive predictive value, 90.8% and 94.0%; and negative predictive value, 95.5% and 94.6%. Substantial agreement was found when overall DSA results were compared with QISS unenhanced MRA (κ = 0.68) and CEMRA (κ = 0.63) in the subgroup of patients who also underwent DSA. There was almost perfect agreement between the two readers for stenosis scores, with Cohen's kappa values being greater than 0.80 for both MRA techniques., Conclusion: The results of our study indicate that QISS unenhanced MRA is an accurate noncontrast alternative to CEMRA for showing clinically significant arterial disease in patients with diabetes with symptomatic PAD.

Splenic cysts are relatively uncommon, and are usually asymptomatic. They are benign, typically treated conservatively and followed up with ultrasound examination, with few reported complications. We report a case of a simple splenic cyst that was followed up on imaging over a seven-year period. During that time, the cyst gradually enlarged from 5 cm to 12 cm in diameter, however the patient remained asymptomatic. After seven years, the patient was admitted with abdominal pain and a pelvic mass. The spleen was located within the pelvis, which was felt to be due to the weight of the cyst which caused the spleen to migrate out of its normal position. This case illustrates an extremely unusual complication, and suggests that while most splenic cysts may be managed conservatively, enlarging cysts may be prone to gravitational effects and prophylactic treatment should be considered.

In today's environment of progressively evolving and expensive imaging modalities, radiologists are asked to justify the use of resources to patients, referring physicians, hospital management, and third party payers. With this aim, the radiologist may use "top-down" or "bottom-up" "evidence-based practice" (EBP) techniques. "Top-down" suggests that the practitioner should wait until a higher authority, external to their practice, generates a solution to practice dilemmas (e.g., National Institute for Health and Clinical Excellence [NICE] guidelines). "Bottom-up" however, is based on the theory that the ordinary practitioner is best served by a decentralized approach to problem solving that is internal to their practice. The technology assessment framework modeled by Mackenzie and Dixon comprehensively assesses the effects of imaging using levels of efficacy including diagnostic performance, diagnostic impact, and therapeutic impact, impact on health and cost effectiveness. In this article, we describe how issues regarding new imaging modalities in ordinary radiology practice can be addressed by using stepwise "bottom-up" EBP techniques combined with the technology assessment framework. We also detail how EBP techniques form an integral part of practice-based learning among radiology residents as part of noninterpretive residency training. The following clinical scenario is used: your hospital's chief hepatobiliary surgeon writes to your department regarding the lack of access to 18-fluoro-2-deoxy-D-glucose positron emission tomography in the preoperative assessment of patients with colorectal cancer liver metastases under consideration for hepatic resection. How would you approach this problem? Here is how we would do it.

Peripancreatic pseudoaneurysm formation is a recognized complication of pancreatitis. When associated with an acute episode of pancreatitis, surgical treatment is often difficult due to the inflammatory process that surrounds the pseudoaneurysm. In the stable patient, transcatheter embolization is the treatment of choice of this complication. However, this is not always technically feasible, as the aneurysm may be supplied by small inaccessible branch vessels. Recently, percutaneous thrombin injection has been described as a possible alternative for pseudoaneurysms. This is generally performed under computed tomography guidance in stable patients with non-ruptured pseudoaneurysms. We describe an acutely ruptured peripancreatic pseudoaneurysm in a critically ill patient, in whom percutaneous thrombin injection under computed tomography guidance resulted in immediate stabilization and cure of the pseudoaneurysm.