多模态影像组学检查在食管癌放化疗疗效评估的临床价值与研究进展

随着影像学研究的广泛开展,已有研究发现临床影像学检查可以提供评估食管癌放化疗疗效的相关依据。现就多种影像学检查及影像组学检查在食管癌放化疗预后预测方面的临床价值进行复习与讨论。     

SEOM/SERAM consensus statement on radiological diagnosis,response assessment and follow-up in colorectal cancer

Colorectal cancer (CRC) is one of the world’s most common cancers, and has one of the highest mortality rates. The last few decades have seen great progress in preventing, diagnosing and treating this disease, providing undeniable impact on patients’ prognosis and quality of life. At all these stages of CRC management, imaging techniques play an essential role. This article reviews some important issues concerning the use of various radiological techniques in the screening, diagnosis, staging, assessment of treatment response, and follow-up of patients with CRC. It also includes a number of practical recommendations on indications for use, technical requirements, minimum information required in the radiology report, evaluation criteria for the response to various drugs, and the recommended frequency at which different examinations should be performed. This consensus statement is the result of cooperation between the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Radiology (SERAM).     

Does breast biopsy marker cost and availability influence utilisation in radiology practice?

Introduction

Breast Screen Australia and Breast Screen Aotearoa guidelines recommend breast biopsy marker (BBM) use in indicated patients. This study aims to evaluate whether BBM cost and availability impacts BBM utilisation.

Methods

An online survey was disseminated to radiologists who identified ‘breast imaging’ as their area of practice in the Royal Australian and New Zealand College of Radiologists (RANZCR) customer relationship management system. Survey questions addressed participant demographics and factors relating to BBM use.

Results

Most (92%, 245/266) participants report that BBMs are routinely available at their place of practice. Those employed in private practice were more likely to report that BBMs are not routinely available. 22% (58/266) of radiologists report that BBM cost influences choice of biopsy type (core biopsy vs fine needle aspirate), this finding was more frequent in those employed in private practice. 47% of respondents report that the cost of BBMs is passed on to the patient, with all these respondents employed in a private or mixed private/public setting. Half the respondents (133/266) reported that their decision to use BBMs would be influenced by the availability of insurance coverage to cover BBM costs.

Conclusions

Results suggest that BBM cost and availability influences both choice of biopsy type (core biopsy vs FNA) and choice to use a BBM. Radiologists working in private practice or mixed private/public practice report that BBMs are less likely to be available for use, and that BBM cost is more likely passed to the patient; possibly disadvantaging patients who present to private radiology providers with imaging findings or conditions that would indicate BBM insertion under current national guidelines.     

Diagnostic errors in patients dying in hospital: Radiology’s contribution

We propose a comprehensive taxonomy of diagnostic errors in radiology that incorporates requests, image acquisition, radiological reports and evidence of communication to the treating team, and is retrospectively applicable to a given set of radiological episodes using pre‐existing standard hospital databases. The taxonomy applies four binary tests to each diagnostic error using widely available hospital records, such as radiological requests, images in Picture Archiving and Communication System, radiological reports and hospital patient records. The taxonomy classifies errors into seven mutually exclusive patterns: no relevant imaging, consistent error (technical non‐demonstration), consistent error (human error), ignored correct dissenting radiology result, de novo radiology error (technical non‐demonstration), de novo radiology error (human error), and ignored correct confirmatory radiology result. The taxonomy was validated against a set of 250 diagnostic errors identified from an audit of clinical and radiological diagnoses with autopsy as the reference standard. All errors were successfully classified by the taxonomy, and the point of initiation of the error assigned. Of a total of 250 diagnostic errors, 138 (55%) had no relevant imaging performed. Ninety percent of all errors (226) were due to human error only, whether at the stage of clinical suspicion, the radiologist’s diagnosis, or afterwards. Of the 112 imaged errors, only 12 (11%) were initiated at diagnostic imaging. The taxonomy of diagnostic error we present is comprehensive, allows retrospective audit of error with commonly available data, and provides clinically useful identification of the point of error initiation.     

Léon Bouchacourt (1865–1949) : comment un obstétricien mit en évidence la radiosensibilité individuelle

Léon Bouchacourt (1865–1949) was a misknown pioneer of radiology and radiotherapy from Lyon, France. While he was resident in obstetrics in Hôpitaux de Paris from 1892 to 1898, he met Charcot, the future polar explorer, and wrote the first thesis dissertation about X-rays. He invented a new radiology technique for cavitary organs such as vagina, rectum and mouth, the endodiascopy, which permitted him to perform the first pelvimetry and dental radiographies in France. While he undertook the first trials of contact-radiotherapy, he was confronted with radiation-induced reactions. In 1911, he wrote the first paper about individual radiosensitivity. During the First World War, he commanded one of the radiology vehicles, he met Irène Curie and developed his « radiological helmet », which will hold his name and became essential for interventional radiology. After the war, with Béclère and ten others, Léon Bouchacourt funded the French Radiology Society. He ended his career by thinking about public health and the different aspects of the duties of radiologists.     

Diagnostic value of radiological breast imaging in a non-screening population

The aim of this study was to assess the diagnostic performance of breast imaging in the diagnosis of breast cancer in a non-screening population. In a consecutive set of patients referred for mammography in one year, the results of palpation and radiological breast imaging were scored on a 5-point grading scale and linked to pathology as gold standard after a follow up period of one year. The diagnostic performance was studied by logistic regression analysis and ROC-curves. There were 1,944 breast examinations in 1,890 patients and 3,816 breasts. Pathology results reported 118 malignancies in 115 women. With a cut-off point between benign and uncertain benign a sensitivity of 89% and a specificity of 98% was found for radiological imaging. ROC-curves showed a significant increase in diagnostic performance when radiology was added to results of palpation and age (p = 0.007). Radiological imaging tests have a large diagnostic value in the detection of breast cancer in addition to palpation and age. A sensitivity close to 100% could be reached.     

Cancer occurrence after cosmetic breast implantation in Denmark

Most studies on cancer incidence after breast implantation have focused on breast cancer, while the risk of cancers at other sites has been less well investigated. We examined cancer incidence among 1,653 women who underwent cosmetic breast implant surgery at private clinics of plastic surgery in Denmark and 1,736 women attending the same clinics for other reasons during the period 1973-1995. Furthermore, we updated previously reported results among 1,114 women who received implants for cosmetic indications at public hospitals. All women were followed for cancer through the Danish Cancer Registry. In comparison with the general female population, the overall standardized incidence ratio (SIR) for cancer among women who received implants in private clinics was 1.65 [95% confidence interval (CI) = 1.17-2.27]. This elevated SIR reflected increased incidence ratios for almost all major cancer sites; however, only for non-melanoma skin cancer was there an excess of more than 2 cases. No significant excess of cancer was observed among women who received implants in public hospitals (SIR = 1.10, 95% CI = 0.76-1.52) or among women attending the private clinics for other problems (SIR = 1.10, 95% CI = 0.78-1.52). The SIRs for breast cancer after breast implantation were 1.1 (95% CI = 0.5-2.2) among private clinic patients and 0.9 (95% CI = 0.4-1.7) among public hospital patients. The overall findings of these 2 implant cohorts and results from other investigations suggest that cancer risk is probably not increased among women receiving cosmetic breast implants. The inconsistent results for private clinics and public hospitals are likely related to selection bias and confounding among the private clinic patients, but our data did not permit exploration of these possibilities. Further research into the determinants of these inconsistencies is warranted.     

Interpreting urgent brain CT scans: Does review by a radiology trainee make a difference in accuracy?

An urgent brain CT scan is now commonly performed on patients presenting to hospital emergency departments for a wide variety of indications. At most institutions in Australia, such scans are reviewed immediately by an on‐call radiologist, who is usually an accredited registrar. The value of the trainee radiologist in such a setting is unclear. In the present study, the rate of abnormal findings in a random sample of 100 brain CT scans performed on hospital patients is reviewed and the accuracy of detection of potentially urgent lesions is compared between three junior clinicians, an accredited radiology registrar and a junior radiographer, using the final radiological report as the standard of reference. At least one potentially urgent abnormality in 25% of the patients scanned was found. The RANZCR trainee recorded a significantly higher sensitivity compared to the other readers. It is concluded that an urgent brain CT is of greater value as a screening test if a contemporaneous radiological review is made available, and the implications this may have on current imaging practices are briefly considered.     

Renal toxicity of contrast agents in oncologic patients

Cancer patients frequently undergo imaging examinations to diagnosis but also to evaluate their responses to treatment. These patients are also at high risk of kidney impairment before considering the possible nephrotoxicity of their chemotherapy. In this context, it is overriding to know contrast agents induced risks and what are the good practices to avoid them. Renal function evaluation takes a major part in there. The X-ray radiology using iodinated contrast agent (ICA) exposes patients to acute renal failure. This induced nephropathy is prevented by adequate hydration prior to injection when the glomerular filtration rate (GFR) of the patient is less than 60 ml/min/1.73 m². For hardly nephrotoxic, gadolinium-based contrast agents (GBCA) injected in magnetic resonance imaging, were considered for a long as a safe alternative to ICA. Yet they may induce nephrogenic systemic fibrosis (NSF). The recommendations of European and U.S. drugs safety agencies have recently converged defining groups at risk of NSF based on the level of patients GFR and the type of GBCA used. How to assess the risk-benefit balance of the cancer patient for whom you should choose an informative, effective and safe imaging examination?     

Are radiologists meeting the needs of Australian medical oncologists? Results of a national survey

Although radiological evaluation plays an integral role in the management of oncology patients, little is known about which elements of such evaluation are most important or about how satisfied clinicians are with the quality of radiology services in cancer patients. We have developed a 36‐item anonymous survey evaluating availability of and satisfaction with radiology services to medical oncologists. The survey was distributed to members of the Medical Oncology Group of Australia resident in Australia. We received 124 responses (51%). Most respondents (76.9%) were satisfied with their radiology services. Satisfaction correlated closely with the availability of standardized reporting and promptness of reporting (P < 0.001). Oncologists in private practise were more likely to receive prompt reports (P < 0.0001). Oncologists in public practice were more concerned about availability of CT scanning (P = 0.02). Services that were reported as less frequently available, despite being ranked as very important, included measurements of key lesions and comparison to previous studies. Standardized reporting was considered helpful by 91% of respondents. Only 32.5% of respondents reported receiving such a summary in more than 50% of cases and 21% never received such a summary. Our findings highlight the need for closer collaboration between oncologists and radiologists in order to address specific needs and develop optimal patterns of practise. Consideration should be given to standardization of reporting of radiology studies in oncology.     

Cancer treatment cost in the United States

BACKGROUND:

There has not been a comprehensive analysis of how aggregate cancer costs have changed over time. The authors present 1) updated estimates of the prevalence and total cost of cancer for select payers and how these have changed over the past 2 decades; and 2) for each payer, the distribution of payments by type of service over time to assess whether there have been shifts in cancer treatment settings.

METHODS:

Pooled data from the 2001 through 2005 Medical Expenditure Panel Survey and the 1987 National Medical Care Expenditure Survey were used for the analysis. The authors used an econometric approach to estimate cancer‐attributable medical expenditures by payer and type of service.

RESULTS:

In 1987, the total medical cost of cancer (in 2007 US dollars) was $24.7 billion. Private payers financed the largest share of the total (42%), followed by Medicare (33%), out of pocket (17%), other public (7%), and Medicaid (1%). Between 1987 and the 2001 to 2005 period, the total medical cost of cancer increased to $48.1 billion. In 2001 to 2005, the shares of cancer costs were: private insurance (50%), Medicare (34%), out of pocket (8%), other public (5%), and Medicaid (3%). The share of total cancer costs that resulted from inpatient admissions fell from 64.4% in 1987 to 27.5% in 2001 to 2005.

CONCLUSIONS:

The authors identified 3 trends in the total costs of cancer: 1) the medical costs of cancer have nearly doubled; 2) cancer costs have shifted away from the inpatient setting; and 3) the share of these costs paid for by private insurance and Medicaid have increased. Cancer 2010. Published 2010 by American Cancer Society.     

Capital budgeting techniques

The cost of new medical imaging equipment for a radiology practice is a major capital purchase. Due to rapid advances in technology and imaging techniques, the management decision to purchase new capital equipment can present itself every few years. The present report explains various financial management techniques that are generally used by corporations worldwide to determine their cost of capital. The cost of capital is the return on a capital investment project required by the providers of the capital. The published financial accounts of Sonic Healthcare Limited, Australia's largest pathology company, are reproduced as a numerical example of how the financial accounts of a business may be used to determine its cost of capital. The cost of capital forms an integral part of management's financial decision-making process.     

Evaluation of the effect of double reporting on test accuracy in screening and diagnostic imaging studies: A review of the evidence

Diagnostic error in radiology is not uncommon, with rates of clinically significant error reported to be as high as 20%. Radiological errors are often multifactorial, however, perceptual factors are thought to be mainly responsible. One way of reducing perceptual error is that of double reporting, which refers to the interpretation of radiological investigations by two observers, with strategies of arbitration and consensus available to settle discordant reports. Independent double reporting, where observers have no knowledge of each other's reports, is generally considered to be the most effective form. The impact of double reporting on diagnostic efficacy has been primarily explored in screening mammography, where it has consistently been shown to improve sensitivity, cancer detection rate and depending on local policy, have a positive influence on recall rates. Subsequently, the adoption of double reporting is reported as standard practice in many national and regional breast cancer‐screening programmes. To a lesser extent, the impact of double reporting has also been investigated for neuroradiology, thoracic and gastrointestinal imaging, with small‐scale studies in these fields showing promising results. With the widespread implementation of digitisation and the ease of access to images, the efficacy and cost‐effectiveness of double reporting for other common radiological investigations requires attention. The review will evaluate the evidence regarding the effect of double interpretation of diagnostic imaging studies on test accuracy.     

Place de la chirurgie robotique dans les pathologies tumorales thoraciques

Videothoracoscopy (VTC) has found its place in minimally invasive thoracic surgery, with a wide range of indications: mediastinal conditions (myasthenia gravis, thymoma, neurogenic tumours) and lung diseases (lung cancer, lung metastases). VTC has also enabled the development of robot-assisted thoracic surgery (RAV). VTC and RAV enable closed thoracic surgical procedures to be performed, but with different tools. The post-operative objectives are the same: reduction in morbidity and mortality rates, early rehabilitation, improvement in quality of life and improvements in long-term results. The short- and medium-term results of both of these techniques are also the same. RAV has seen considerable developments in France in terms of its indications, surgical volume and its distribution across numerous academic and private centres. Some exereses would be more simplistic, and likely to be more reproducible from a technical point of view via RAV than with VTC. For example: mediastinal exereses and pulmonary segmentectomies, where RAV appears to be a more appropriate route than VTC. The cost of robotics in thoracic surgery is yet to be determined compared with classic minimally invasive surgery, but any difference is not likely to put a stop to its development. Finally, RAV has teaching implications through simulations and also the integration of modern imaging techniques, which will allow better preparation for the surgical procedure and ensure it is as safe as ultimately possible.     

A systematic survey of breast cancer incidence in the département of Rhône,France

A systematic survey of all centres of diagnosis and care of breast cancer patients in the Rhône “département” of France was carried out to evaluate, for the year 1985, the incidence rate of breast cancer in an urban, industrialised part of France not covered by a cancer registry. Two hundred and fifty seven institutions or individuals were involved, covering the public and private sectors in the Rhône département, but also in neighbouring cities and elsewhere in France, which also enabled a search to be carried out for cases diagnosed or treated outside the département. Altogether, over this 1-year period, 801 new cases were identified (791 women and 10 men). This study demonstrated a high incidence of female breast cancer (80.5 new cases per 100 000 woman-years, standardised to the world population) which was particularly marked among women aged 40–60. This incidence is higher than that described by the cancer registry of the neighbouring département of Isère, but is close to the incidence found in Geneva. Results also concur with the relatively high mortality rate from breast cancer observed in the Rhône département.     

介入分子影像学研究现状与进展*

随着介入放射学与分子影像学的发展、延伸和融合,形成了一门新的学科- 介入分子影像学。介入放射学和分子影像学协同发展,不断拓宽应用领域,提升实用性,明显提高了恶性肿瘤的早期诊断、局部治疗和治疗监测水平。一方面,介入放射学拓展了分子影像学的研究和应用领域,使其可以监测深部、微小的病变部位,同时辅助传送非靶向分子探针和药物,从而提高靶向成像与治疗的有效性。另一方面,分子影像学已融入介入放射学,可更加精准地监测与评价介入治疗疗效,进一步提高介入治疗的安全性和有效性。虽然当前的分子影像学研究大多还处于动物实验或临床前阶段,随着介入分子影像学理念和技术的不断完善,必将推动分子影像学的临床实践,提升恶性肿瘤的诊治水平。      

The localisation of cancer in the sigmoid,rectum or rectosigmoid junction using endoscopy or radiology—What is the most accurate method?

Introduction

There is a difference in approach between colon and rectal cancer.

Aim

Evaluate the methods of localisation: endoscopy and radiology.

Materials and methods

Patients with cancer in the sigmoid or rectum diagnosed with endoscopy, were included. Patients underwent additional radiological examinations. The resection specimen served as the gold standard. A tumour surrounded by serosa was considered a sigmoid cancer, surrounded by perirectal fat, than it was rectal cancer. If the frontal edge of the tumour showed serosa and the dorsal plane perirectal fat than the tumour was located in the “rectosigmoid”.

Results

A total of 182 cancers were diagnosed. Of the 128 cancers with gold standard, endoscopy had the correct localisation in 112 (87.5%), and radiology in 114 (90.5%) cases. Concordance between both techniques was present in 80%. In 28 cases there was discordance. Radiology located 10 sigmoidal cancers wrongly in the rectum. One rectal cancer was placed in the sigmoid. In 16 cases the endoscopic localisation wrongly was the sigmoid. Sensitivity and specificity for endoscopy in sigmoidal cancer is 100% and 77% respectively, for rectal cancer 77% and 100%. Sensitivity of radiology for cancer in the sigmoid and rectum are 80% and 98% respectively. Specificity for both cancers is 98% and 80% respectively.

Conclusions

The endoscopist and the radiologist should not be too overconfident with localisation of the tumour in cases of high rectal or low sigmoidal cancer.     

The adverse implications of the transition from film to digital mammography for performing surveillance in patients with a history of breast cancer or significant risk factors for the disease

Aim: The transition from screen‐film to digital mammography at Peter MacCallum Cancer Centre was investigated, considering the impact on patient management and resource utilization. Methods: A retrospective comparison of the imaging outcomes of the last year of screen‐film and the first year of digital mammography was performed. The study group of 692 patients, all with a history or a significant risk factor of breast cancer, underwent a surveillance mammogram in both periods, enabling serial comparison of imaging outcomes on the same patient. Results: Overall 92 patients required a total of 125 further investigations after their film mammogram due to a mammographic abnormality while 130 underwent a total of 202 additional investigations after their digital mammogram. This is a significant increase in the number of patients further investigated (Fisher's exact test P = 0.005). However, the positive predictive value of further investigation finding a tumor after digital mammography was not significantly higher than that of film mammography (7.4 vs 6.5%, Fisher's exact test P = 0.57). There was a 44% increase in the cost of additional investigations during the first year of digital mammography compared to the previous year and an associated increase in hospital visits for patients. Conclusion: For patients undergoing annual surveillance mammography at Peter MacCallum Cancer Centre, the transition from film to digital mammography was found to be associated with an increase in both the number of additional investigations performed and in the number of hospital visits. The findings of this study should be considered when conversions from film to digital mammography are planned, specifically in terms of cost allocations and the burden on patient services in radiology and outpatient departments.     

An evidence-based patient information and patient education programme: the SOR SAVOIR PATIENT

The development of good-quality patient information is a major challenge to improve quality of cancer care. The SOR SAVOIR PATIENT program aims to improve patients' understanding of cancer treatment and to facilitate their participation in clinical decisions. This programme develops evidence-based information for cancer patients based on clinical practice guidelines in oncology, the "Standards, Options and Recommendations" (SOR) which are used as primary information sources. "Translation" of SOR guidelines to laymen uses a multidisciplinary approach involving specialists in cancer care, psychologists, linguists and anthropologists. The development actively involves cancer patients using focus group methods, individual interviews and postal surveys. The SOR SAVOIR PATIENT program is conducted by the FNCLCC and the 20 French regional cancer centres, with active participation of specialists (public and private), learned societies and institutions, collaborating in multidisciplinary working groups. The leaflets Understanding scanner and Understanding Magnetic Resonance Imaging available in this edition of Bulletin du Cancer have been developed by a multidisciplinary group (radiologist, oncologist, methodologist, health care practioners, psychologist, linguist) and 30 patients, experienced patients and caregivers. These leaflets stem from a collection of patients documents on radiological examinations (Understanding mammography, Ultrasound, etc.) which have been developed to help patients and caregivers to better understand these examinations.