Superselectiye Embolization as Palliative Treatment of Recurrent Hemorrhage in Advanced Carcinoma of the Head and Neck

We report a case of recurrent major hemorrhage in a patient with advanced head and neck squamous cell carcinoma. Before and between the bleeding episodes, the functional level of the patient was remarkably high. Therefore, an attempt at bleeding control with superselective embolization with Ethibloc was made. Because of its specific characteristics, this substance is almost ideal for the purpose of palliative embolization. The material used and the technique of application are described in detail. After the procedure, no hemorrhage occurred for more than 4 months. We recommend superselective embolization, preferably with Ethibloc, for minimally invasive control of recurrent bleeding as palliative treatment in selected patients with advanced head and neck carcinoma, since significant benefit in terms of the quality of life may result. </jats:p

Pneumocystis jirovecii induced chronic interstitial lung disease in Waldenstrom's macroglobulinemia

Infections with Pneumocystis jirovecii can result in asymptomatic colonization or induce life threatening clinical symptoms. However, there appears to be a 'gray area' between colonization and severe pneumonia that remains underestimated so far. We describe a case with chronic interstitial lung disease and chronic cough that was attributed to P. jirovecii. The patient's history of chronic cough, although very likely being fostered by the underlying Waldenstrom's macroglobulinemia and interstitial lung disease, was most likely caused by P. jirovecii infection. This gives raise to the hypothesis that P. jirovecii infections do not necessarily induce life threatening pneumonia. Consequently, serial testing is required in eligible patients with positive PCR results in order to discriminate between colonization, 'gray zone' infection, and beginning pneumonia

Impact of AI-based Real Time Image Quality Feedback for Chest Radiographs in the Clinical Routine

AbstractPurposeTo implement a tool for real time image quality feedback for chest radiographs into the clinical routine and to evaluate the effect of the system on the image quality of the acquired radiographs.Materials and MethodsA real time Artificial Intelligence (AI) image quality feedback tool is developed that analyzes chest PA x-rays right after the completion of the examination at the x-ray system and provides visual feedback to the system operator with respect to adherence to desired standards of collimation, patient rotation and inspiration. In order to track image quality changes over time, results were compared to image quality assessment for images, acquired prior to system implementation.ResultsCompared to the image quality prior to the installation of the real time image quality feedback solution, it is shown that a relative increase of images with optimal image quality with respect to collimation, patient rotation and inspiration is achieved by 30% (p&lt;0.01). A relative improvement of 28% (p&lt;0.01) is observed for the increase of images with optimal collimation, followed by a relative increase of 4% (p&lt;0.01) of images with optimal inspiration. Finally, a detailed analysis is presented that shows that the average unnecessarily exposed area is reduced by 34% (p&lt;0.01).DiscussionThis study shows that it is possible to significantly improve image quality using a real time AI-based image quality feedback tool. The developed tool not only provides objective and impartial criticism and helps x-ray operators identify areas for improvement, but also gives positive feedback.Key FindingsA substantial amount of images acquired in the clinical routine does not suffice the international guidelinesContinuous AI-based image quality feedback to the x-ray system operator in the clinical routine leads to a significant image quality improvement over timeUsing the developed tool, the overall fraction of images with optimal patient positioning could be improved by 30%, followed by a 34% decrease of unnecessarily exposed area.</jats:sec

Supplemental screening ultrasound increases cancer detection yield in BRCA1 and BRCA2 mutation carriers

This study aimed at evaluating the efficacy of ultrasound for the early detection of breast cancers in BRCA1/2 mutation carriers. Between 01/1997 and 10/2008 221 BRCA1/2 mutation carriers participated in a breast cancer screening program which included semi-annual ultrasound in combination with annual mammography and magnetic resonance imaging (MRI). Women underwent on average (median) five semi-annual screening rounds with a range of one to 22 appointments, totaling 1,855 rounds of screening. All three imaging modalities were coded according to the American College of Radiology (BI-RADS classification). In total, we detected 27 BRCA-associated breast cancers in 25 patients. The sensitivity was 77 % for ultrasound, 27 % for mammography, and 100 % for MRI. Three tumors were detected directly as a result of only the semi-annual ultrasound screen. Due to the specific tumor morphology and the considerably elevated tumor doubling time, mutation carriers benefit from the addition of semi-annual ultrasound screening as a sensitive and cost-effective method