Culture: what is its effect on stress in the military?

Culture provides the unwritten rules that inform and shape expected behaviors. To date, little research has been conducted into the attitudes or opinions that service personnel hold toward mental health issues. This article examines current literature and research into the recognition of mental health problems in the military and potential organizational barriers to care including stigma and the specific characteristics of a military culture such as the significant reliance on buddy support. We conclude that the barriers to care which operate in both military and civilian populations are not insignificant. Western militaries in fact currently face an uphill struggle to combat the substantial barriers to care that exist.     

Midcareer Transition in Radiology: Threat or Opportunity?

Midcareer job transitions are occurring for many reasons other than individual radiologists’ professional performance quality, affability, and desire for geographic change. New causes seem to be related to the present health care environment. All radiologists should be aware of this disruptive change to the profession and of the resources available to help job seekers find new positions.     

Artificial intelligence in oral and maxillofacial radiology: what is currently possible?

Artificial intelligence, which has been actively applied in a broad range of industries in recent years, is an active area of interest for many researchers. Dentistry is no exception to this trend, and the applications of artificial intelligence are particularly promising in the field of oral and maxillofacial (OMF) radiology. Recent researches on artificial intelligence in OMF radiology have mainly used convolutional neural networks, which can perform image classification, detection, segmentation, registration, generation, and refinement. Artificial intelligence systems in this field have been developed for the purposes of radiographic diagnosis, image analysis, forensic dentistry, and image quality improvement. Tremendous amounts of data are needed to achieve good results, and involvement of OMF radiologist is essential for making accurate and consistent data sets, which is a time-consuming task. In order to widely use artificial intelligence in actual clinical practice in the future, there are lots of problems to be solved, such as building up a huge amount of fine-labeled open data set, understanding of the judgment criteria of artificial intelligence, and DICOM hacking threats using artificial intelligence. If solutions to these problems are presented with the development of artificial intelligence, artificial intelligence will develop further in the future and is expected to play an important role in the development of automatic diagnosis systems, the establishment of treatment plans, and the fabrication of treatment tools. OMF radiologists, as professionals who thoroughly understand the characteristics of radiographic images, will play a very important role in the development of artificial intelligence applications in this field.     

Multiparametric MRI guidance in first-time prostate biopsies: what is the real benefit?

PURPOSE

With the increased recognition of the capabilities of prostate multiparametric (mp) magnetic resonance imaging (MRI), attempts are being made to incorporate MRI into routine prostate biopsies. In this study, we aimed to analyze the diagnostic yield via cognitive fusion, transrectal ultrasound (TRUS)-guided, and in-bore MRI-guided biopsies in biopsy-naive patients with positive findings for prostate cancer screening.

METHODS

Charts of 140 patients, who underwent transrectal prostate biopsy after the adaptation of mp-MRI into our routine clinical practice, were reviewed retrospectively. Patients with previous negative biopsies (n=24) and digital rectal examination findings suspicious for ≥cT3 prostate cancer (n=16) were excluded. T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging were included in mp-MRI. Cognitive fusion biopsies were performed after a review of mp-MRI data, whereas TRUS-guided biopsies were performed blinded to MRI information. In-bore biopsies were conducted by means of real-time targeting under MRI guidance.

RESULTS

Between January 2012 and February 2014, a total of 100 patients fulfilling the inclusion criteria underwent TRUS-guided (n=37), cognitive fusion (n=49), and in-bore (n=14) biopsies. Mean age, serum prostate specific antigen level, and prostate size did not differ significantly among the study groups. In TRUS-guided biopsy group, 51.3% were diagnosed with prostate cancer, while the same ratio was 55.1% and 71.4% in cognitive fusion and in-bore biopsy groups, respectively (P = 0.429). Clinically significant prostate cancer detection rate was 69.1%, 70.3%, and 90% in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively (P = 0.31). According to histopathologic variables in the prostatectomy specimen, significant prostate cancer was detected in 85.7%, 93.3%, and 100% of patients in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively.

CONCLUSION

In the first set of transrectal prostate biopsies, mp-MRI guidance did not increase the diagnostic yield significantly.Transrectal ultrasound-guided prostate biopsy (TRUS-guided) to diagnose prostate cancer is currently estimated to be performed in one million men annually in the USA (1). The original random systematic, six-core transrectal prostate biopsy, initially described by Stamey in 1989 (2), has incorporated more cores over time, with laterally directed 12–14 cores being an accepted practice standard. The major limitation of random systematic sampling is that; clinically insignificant cancers are often identified by chance and affect survival data due to lead and length time bias from overdetection and overtreatment of indolent disease (3). Unlike the diagnostic pathways for other organ cancers, which include direct visual or radiologic guidance, the prostate is being sampled by way of standardized, systematic but essentially random approaches.With the aid of multiparametric MRI of the prostate (mp-MRI), clinically relevant localized prostate cancer foci may be identified, selectively sampled, and treated (4–6). Hence attempts are being made to incorporate mp-MRI into routine prostate biopsies. Techniques of MRI-targeted biopsy include visual estimation TRUS-guided biopsy (cognitive fusion); software co-registered MRI-ultrasound TRUS-guided biopsy; and in-bore MRI-guided biopsy.MRI-guided prostate biopsies are particularly useful in the setting of ongoing clinical suspicion of prostate cancer despite previous negative biopsies. Among men with a previous negative biopsy, 72% to 87% of cancers detected by MRI-guidance are clinically significant (7). Likewise, mp-MRI findings can also be utilized to cognitively tailor the initial transrectal prostate biopsy protocol. Among men with no previous biopsy, MRI increases the frequency of significant cancer detection to 50% in low risk and 71% in high risk patients (7).In this study, we aimed to compare the diagnostic efficiency of cognitive fusion, TRUS-guided and in-bore biopsies, which were conducted as the initial sampling modality, in terms of detecting clinically significant prostate cancer.