Charbel Saade

Background Radiographers play a crucial role in ensuring the safe and effective delivery of iodinated contrast media in pediatric CT imaging. However, practice variability across institutions, such as differences in contrast medium dosing protocols, injection techniques, and timing of image acquisition, raises concerns about consistency, patient safety, and diagnostic quality. Objective To examine the range of real-world practices in pediatric iodinated contrast medium administration, focusing on protocol adherence and variations in technique. Materials and methods An international cross-sectional survey was conducted among 103 CT radiographers. The online questionnaire assessed demographic data, clinical practices, protocol modification behaviors, and institutional procedures. Data were collected over 9 weeks and analyzed using descriptive and comparative statistics to identify trends and practice variability. Results The findings revealed considerable variability in iodinated contrast medium administration practices, including differences in injection rates, contrast volumes, catheter gauge selection, and use of saline flush techniques. Although 93.2% of participants reported confidence in modifying contrast protocols, knowledge assessments showed that 75.7% of radiographers scored in the “Poor” category, with no participants achieving an “Excellent” score. Additionally, many respondents reported relying on experience-based practices rather than standardized institutional guidelines, contributing to inconsistent contrast delivery approaches. No significant associations were found between demographic factors and reported practices, suggesting variability exists across all levels of education and experience. Conclusion The study highlights inconsistencies in pediatric iodinated contrast medium delivery practices among CT radiographers, emphasizing the need for standardized protocols and structured training programs. Addressing these inconsistencies is crucial for improving diagnostic quality, patient safety, and promoting consistency in best practices across clinical settings. Graphical abstract

Objective To evaluate the performance of two versions of ChatGPT, GPT4 and GPT3.5, on the Final FRCR (Part A) also referred to as FRCR Part 2A radiology exam. The primary objective is to assess whether these large language models (LLMs) can effectively answer radiology test questions while providing accurate explanations for the answers. Methods The evaluation involves a total of 281 multiple choice questions, combining the 41 FRCR sample questions found on The Royal Collage of Radiologists website and 240 questions from a supplementary test bank. Both GPT4 and GPT3.5 were given the 281 questions with the answer choices, and their responses were assessed for correctness and accuracy of the explanations provided. The 41 FRCR sample questions difficulty was ranked into “low order” and “high order” questions. A significance level of pResults GPT4 demonstrated significant improvement over GPT3.5 in answering the 281 questions, achieving 76.5% correct answers compared to 52.7%, respectively (pConclusion The findings of this study demonstrate a significant improvement in the performance of GPT4 compared to GPT3.5 on FRCR style examination. However, the accuracy of the provided explanations might limit the models’ reliability as learning tools. Advances in Knowledge The study indirectly explores the potential of LLMs to contribute to the diagnostic accuracy and efficiency of medical imaging while raising questions about the current LLMs limitations in providing reliable explanations for radiology related questions hindering its uses for learning and in clinical practice. Highlights ChatGPT4 passed an FRCR part 2A style exam while ChatGPT3.5 did not. ChatGPT4 showed significantly higher correctness of answers and accuracy of explanations. No significant difference in performance was observed between “high order” and “lower order” questions. Explanation accuracy was lower than correct answers rate limiting the Models’ reliability as learning tools.

Purpose: To compare the quantitative and qualitative image quality of hybrid (HBIR) and model based (MBIR) iterative reconstruction during coronary Computed Tomography Angiography (CTA). Materials and Methods: Institutional review board approved this retrospective study. Patients (n=200) underwent a single coronary CTA with two iterative reconstruction techniques. Group A employed HBIR and group B employed MBIR. Quantitative and qualitative image quality was compared for each group. The mean attenuation values and signal-to-noise ratio (SNR) of each group were compared. Visual grading characteristics (VGC) and Cohen’s Kappa methodology were measured employing an image quality scoring system for coronary CTA. Receiver operating (JAFROC) and stenosis severity were compared with conventional coronary angiography. A p-value Results: Mean attenuation values (HU) in the HBIR group were significantly greater in the cusp (564.18±118.71) and left coronary (517.59±118.63) whilst in the MBIR group, the right coronary (531.67±138.93), left anterior descending (529.82±120.6) and left circumflex (538.32±132.94) arteries were significantly higher (pp<0.0001), with MBIR being superior to HBIR in the total and individual segments of the coronary arteries. VGC image quality assessment demonstrated that readers preferred HBIR over MBIR (pConclusion: When comparing quantitative and qualitative image quality, MBIR was superior in the former, whilst HBIR was superior in the later. Coronary artery stenosis assessment demonstrated less variability in diagnosis when using HBIR compared to MBIR. This highlights the need for careful attention when employing iterative reconstruction in order not to impact clinical outcomes.

This article aims to summarize the available data on the severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2) imaging patterns as well as reducing radiation dose exposure in chest computed tomography (CT) protocols. First, the general aspects of radiation dose in CT and radiation risk are discussed, followed by the effect of changing parameters on image quality. This article attempts to highlight some of the common chest CT signs that radiologists and emergency physicians are likely to encounter. With the increasing trend of using chest CT scans as an imaging tool to diagnose and monitor SAR-CoV-2, we emphasize that pattern recognition is the key, and this pictorial essay should serve as a guide to help establish correct diagnosis coupled with correct scanner parameters to reduce radiation dose without affecting imaging quality in this tragic pandemic the world is facing.

Computed tomography (CT) is a routinely employed diagnostic tool for the detection and diagnosis of disease processes. Despite the primary focus of radiation dose reduction and improvements in CT scanners, radiation dose exposure remains an ever-increasing concern. Scanning protocol optimisation relative to body weight and scanner manufacturer still lags behind the diagnostic reference levels (DRLs) that are set on an international scale. The aim of this systematic review is to evaluate the current status of adult DRLs in head, chest and abdominopelvic CT over time on a global scale. A search was carried out in early 2019 using the Medline, PubMed, EMBASE, SCOPUS and manual databases. The reference lists of published articles were also assessed to identify further articles. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology was employed to evaluate articles for relevance. Articles were included if they assessed the DRL in head, chest and abdominopelvic scans. The search resulted in 6079 articles, of which 67 were included after a thorough screening process. The literature demonstrates a wide dose variation in reported head, chest and abdominopelvic dose length product (DLP) DRL, ranging from 700–1359, 330–707 and 550–1486 mGy·cm, respectively. Where reported, the volumed CT dose index (CTDI _vol ) DRL in the head, chest and abdominopelvic studies ranged from 30.4–85.5, 9–15 and 12.3–31 mGy·cm, respectively. The global means were shown to be slightly lower and significantly lower than the reported values of DLP and CTDI _vol values for the American College of Radiology and European Commission, respectively. This review emphasises the need for an international standardisation for head and body DRL establishment methods, to provide a more comparable global measurement of dose variations across CT sites as well as regular monitoring of delivered radiation dose to patients.

Computed tomography (CT) is a key imaging technique in diagnostic radiology, providing highly sensitive and specific information. While its use has increased dramatically in recent years, the quantity and associated risks of radiation from CT scans present major challenges, particularly in paediatrics. The fundamental principles of radiation protection require that radiation quantities be as low as reasonably achievable and CT use must be justified, particularly for paediatric patients. CT radiation knowledge is a key factor in optimising and minimising radiation risk. The objective of this study was to analyse knowledge level, expertise, and competency regarding CT radiation dose and its hazards in paediatrics among radiologists in Saudi Arabian hospitals. A self-reported, multiple-choice questionnaire assessed the attitudes and opinions of radiologists involved in imaging studies using ionising radiation. Among the total respondents, 65% ± 13.5% had a good comprehension of the dangers of carcinogenicity to the patient resulting from CT scans, with 80% presuming that cancer risks were elevated. However, only 48.5%, 56.5%, and 65% of the respondents were aware of specific radiation risks in head, chest, and abdominal paediatric examinations, respectively. Regular, frequent, and specific training courses are suggested to improve the fundamental knowledge of CT radiation among radiologists and other physicians.

Purpose The aim of our study is to investigate the impact of iodine quantification on image reconstruction when employing a vascular-specific contrast media phantom with varying iodine concentrations. Materials and methods A 30-cm phantom simulating arterial and venous blood vessel diameters was manufactured. Small (9 mm) and medium (12 mm) cylinders contained iodine concentrations from 10 to 100% while large (21 mm) cylinders were in quartiles from 25 to 100% diluted in blood equivalent medium. Each phantom was filled with either iohexol 350 mgI/mL (Group A) or iodixanol 320 mgI/mL (Group B) and then scanned separately. For each group, tube potential (80–140 kVp) and current (50–400 mAs) were changed and all image series were reconstructed with filtered back projection (FBP), hybrid-based iterative reconstruction (HBIR) and model-based iterative reconstruction (MBIR). Mean opacification was measured in all groups. All data were compared employing an independent t test and Pearson’s correlation. Visual grading characteristic (VGC) and Cohens’ kappa analyses were performed. Results At 80 kVp, mean opacification using HBIR was significantly higher in Group B (2165 ± 1108 HU) than in Group A (2040 ± 1036 HU) (p < 0.009). At 140 kVp, MBIR and HBIR were greater in Group A (1704 ± 1033 HU and 1685 ± 1023 HU) versus Group B (1567 ± 1036 HU and 1567 ± 1034 HU) (p < 0.022). CNR using FBP, HBIR and MBIR was higher in Group B (46 ± 42 HU, 70 ± 163 HU and 83 ± 74 HU, respectively) than in Group A (43 ± 39 HU, 174 ± 130 HU and 80 ± 65 HU, respectively) (p < 0.0001–0.035). Qualitative image analysis demonstrated no difference in Cohen’s kappa analysis. VGC was higher in Group A at all image reconstruction groups. Conclusion Iohexol outperforms iodixanol in observer performance when assessing image reconstruction techniques and iodine concentrations in a vascular-specific contrast media phantom.

Ushering in the next generation of autonomous surgical robots? current trends and future possibilities with data driven physics simulation and domain randomization