School-based Preventive Regimens and Oral Health Knowledge and Practices of Sixth Graders

The purpose of this study was to examine the oral health knowledge and reported practices of sixth grade students in Wichita, Kansas. A quasi-experimental design was used to test differences between two groups: (1) children who had completed a four-year regimen referred to as the National Preventive Dentistry Demonstration Program (NPDDP), and (2) a control group of children who had not been exposed to any aspect of the NPDDP. Based on incidental learning theory, the research question was whether or not students' knowledge and practices were consistent with the preventive regimes provided at school. The study reported here was not directly connected with the NPDDP. A school nurse-administered questionnaire was obtained from 284 students 16 months after the NPDDP had terminated. Students in all groups reported similar dental health practices; no practical differences were found among groups with regard to knowledge about appropriate fluoride uses and benefits. Students who received sealants were somewhat more knowledgeable about the use and purpose of sealants. Although students in five of the six NPDDP groups had received preventive regimens, these data suggest that they lacked awareness and understanding of the procedures and their value in preventing oral diseases. Generally, students were unable to discriminate among methods appropriate for preventing dental caries and periodontal diseases. Education regarding the purpose and value of preventive regimens should be consistent with, and an integral part of, the delivery of such services.     

Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee

The ACR Incidental Findings Committee presents recommendations for managing incidentally detected mediastinal and cardiovascular findings found on CT. The Chest Subcommittee was composed of thoracic radiologists who developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address the most commonly encountered mediastinal and cardiovascular incidental findings and are not intended to be a comprehensive review of all incidental findings associated with these compartments. Our goal is to improve the quality of care by providing guidance on how to manage incidentally detected thoracic findings.     

Impact of incidentally found hepatocellular carcinoma on the outcome of living donor liver transplantation

Hepatocellular carcinoma (HCC) nodules newly found in the explant liver have been observed, but the impact on patient prognosis is not known. Sixty HCC patients who underwent living donor liver transplantation were the subjects of the study. Radiologic findings prior to transplantation and pathologic findings of the explant liver were compared. Histologic characteristics of preoperatively overlooked tumors were examined. The influence of the discrepancy between these findings on tumor recurrence was evaluated. A total of 227 HCC nodules were found in the explant livers. Of these, 91 nodules (40%) were newly found by pathologic examination. They were smaller and more likely to be well differentiated than the others. The number and size of the tumors were underestimated in 50% (30/60) and 32% (19/60), respectively. There was no significant difference in the recurrence-free survival rate between patients who met the Milan criteria both in the pre- and post-transplant evaluation (n = 29) and those who met the Milan criteria preoperatively, but exceeded the criteria in the explant (n = 19). Nodules newly found in the explant liver had little impact on recurrence-free survival. A decision for liver transplantation according to the Milan criteria based on preoperative evaluation is valuable for securing an excellent outcome.     

Strategies for Avoiding Recommendations for Additional Imaging Through a Comprehensive Comparison With Prior Studies

PurposeTo determine the frequency and characteristics of recommendations for additional imaging and/or intervention (RAIs) in abdominal CT and MRI interpretations that might be avoided through comprehensive comparison with all available prior examinations.MethodsA total of 1,006 RAIs in abdominopelvic CT and MRI reports were retrospectively evaluated. Reports and images from each patient’s prior imaging examinations, including those of all relevant body parts and modalities, were reviewed to determine if the RAI could have been avoided based on prior imaging. Frequency and characteristics of such “avoidable” RAIs were evaluated.ResultsA total of 41 of 1,006 (4.1%) RAIs were avoidable. The key prior examination that established the RAI as avoidable was a different modality in 53.7% (22 of 41) and on a different body area in 41.5% (17 of 41) of cases, including chest imaging in 31.7% (13 of 41). A total of 83.3% (5 of 6) adrenal RAIs, and 80.0% (4 of 5) liver RAIs were avoidable based on prior chest imaging. The key finding was present on the prior images but was not described in the report in 46.3% (19 of 41) of cases. A greater number of prior examinations were available in cases of avoidable RAIs (mean, 12.2 ± 16.7) than in those of nonavoidable RAIs (mean, 5.7 ± 9.5) (P < .001).ConclusionsA small fraction of RAIs can be avoided by performing a thorough evaluation of all prior imaging examinations, including different modalities and body parts. Nearly half of the key prior examinations did not report the finding, highlighting the importance of directly reviewing relevant images, particularly chest imaging for evaluation of indeterminate upper-abdominal findings. Configuration of PACS for optimized selection and display of relevant examination reports and images may facilitate such comparisons.