Der Doctor Schnabel Von Rom

Plague doctors were usually inexperienced physicians, hired by towns, who treated patients with bubonic plague.  

A famous doctor whose advice on how to prevent the plague still has some validity was Nostradamus. He adviced the removal of infected corpses, getting fresh air and drinking clean water.  Other famous plague doctors were Giovanni Ventura whom the city of Pavia contracted in 1479 and the Irish physician, Niall O Glacáin (1563-1653) who earned deep respect in Spain, France and Italy for his bravery in treating numerous people with the plague.

In the 17th and 18th centuries, some doctors wore a beak-like masks filled with aromatic items designed to protect them from putrid air, which according to the miasmatic theory of disease was seen as the cause of infections. 

Copper engraving of Doctor Schnabel, circa 1656, by Paulus Fürst.  A plague of a  doctor in 17^th Century Rome with a satirical poem.  The German title translates as Doctor Beak of Rome and depicts a plague doctor in his costume.  The engraving features a satirical Latin/German macaronic poem (‘Vos Creditis, als eine Fabel, / quod scribitur vom Doctor Schnabel’) roughly meaning "a funny tale is disclosed, / by a doctor with a big nose."

Artificial Intelligence (AI) Outperforms Radiologists in Mammography

The aim of screening mammography is to detect breast cancer in women as early as possible before signs of the disease become clinically obvious.  In a study published in Nature McKinney et al found that AI bested radiologists in detecting breast cancer in screening mammograms. 

Mammograms of 25,856 women in the United Kingdom and 3,097 women in the United States were used to train the AI system. AI was then used to identify the presence of breast cancer in mammograms of women who were known to have had either biopsy-proven breast cancer or normal follow-up imaging results at least 365 days later. The study included mammograms; by conventional digital (2D) mammography and tomosynthesis (also known as 3D mammography). 

The authors report that the AI system outperformed diagnoses made by the radiologists who initially interpreted the mammograms, and the decisions of 6 expert radiologists who interpreted 500 randomly selected cases.

The study reports an absolute reduction of 5.7% and 1.2% (USA and UK) in false positives and 9.4% and 2.7% in false negatives. In an independent study of six radiologists, the AI system outperformed all of the human readers: the area under the receiver operating characteristic curve (AUC-ROC) for the AI system was greater than the AUC-ROC for the average radiologist by an absolute margin of 11.5%. The authors also performed a simulation in which the AI system participated in the double-reading process that is common in the UK, and found that the AI system maintained non-inferior performance and reduced the workload of the second reader by 88%. 

The authors suggest that further assessment of the AI system with clinical trials may lead to improvements in the accuracy and efficiency of breast cancer screening by limiting the high rates of false positives and negatives which are known to take place in the interpretation of mammograms.

Adobe on the bay

Adobe on the bay features distinct swaths of white, blue and green, and obscured rainbow moiré patterns. With its jagged, but even edges, it is decidedly removed from any notion of a canvas.  In this digitally manipulated image, my intend was to infer the calmness of our adobe in the little paradise on earth the bay of Porto Rafti, which has a landscape known for its blue sea, blue skies and expansive vistas.

Dear readers please notice the new URL
http://radiologymonthly.blogspot.com/
  

DWI-MRI Predicts Breast Cancer Response to Treatment

Diffusion-weighted MR images (DWI_MRI) acquired 12 weeks after the start of neoadjuvant chemotherapy for breast cancer may provide the best indication of how patients will respond to treatment, according to a study published in Radiology.

The researchers analyzed 242 participants who were randomized to receive 12 weekly doses of paclitaxel with four cycles of anthracycline.   The MRI protocol included, DWI imaging T2-weighted and contrast enhanced sequences.

  

The authors concluded that after 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy

Embolization Helps Severely Obese Patients Lose Weight

A study published in Radiology found that bariatric embolization of the gastric fundus leads to weight loss and a reduced appetite in severely obese patients.

In this prospective study 20 participants whose mean age was 44 years and who had a mean body mass index of 45 +/- 4.1 were enrolled at two institutions from June 2014 to February 2018.  Trans-arterial embolization of the gastric fundus was performed. Primary end points were 30-day adverse events and weight loss at up to 12 months.  Average weight loss of 8.2 percent after one month, 11.5 percent after three months, 12.8 percent at six months and 11.5 percent at one year.

In conclusion severely obese adults tolerate well bariatric embolization.  It induces appetite suppression and weight loss for up to 12 months.

AI can diagnose Myocardial Infarction on non-enhanced MRI

A retrospective study of 212 patients published in Radiology used deep learning (AI) to identify and delineate chronic myocardial infarction without late gadolinium enhancement.

The model extracted motion features from the left ventricle on non-enhanced cardiac cine MRI and its per-segment sensitivity and specificity was 90% and 99 percent, therefore deep learning on non-enhanced cine cardiac MRI data can detect the presence and extent of chronic myocardial infarction. 

This approach has the potential to reduce the use of gadolinium contrast administration in patients with renal impairment, which is common in patients with coronary artery disease.

Self-compression in mammography does not interfere with image quality

A study that was published in JAMA Internal Medicine reports suggests that breast cancer screening might be just as effective and less unpleasant when women can control the compression device themselves.  

The investigators randomly assigned 584 women to either practice self-compression or undergo traditional mammograms in which a medical person positioned the breast in the mammographic unit found that when women compressed their own breasts in the machine, they achieved breast thickness that was within 3 millimeters of what women typically had with the traditional mammogram process. 

The authors concluded that there was no difference between the two groups in the quality of images and women reported less pain when the handled the compression on their own and self-compression may be an effective option for women who want to be involved in their breast examination.