Can Assoc Radiol J
· 2025 Aug · PMID 39973060
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The applications of artificial intelligence (AI) in radiology are rapidly advancing with AI algorithms being used in a wide range of disease pathologies and clinical settings. Acute thoracic pathologies including rib fra...The applications of artificial intelligence (AI) in radiology are rapidly advancing with AI algorithms being used in a wide range of disease pathologies and clinical settings. Acute thoracic pathologies including rib fractures, pneumothoraces, and acute PE are associated with significant morbidity and mortality and their identification is crucial for prompt treatment. AI models which increase diagnostic accuracy, improve radiologist efficiency and reduce time to diagnosis of acute abnormalities in the thorax have the potential to significantly improve patient outcomes. The purpose of this review is to summarize the current applications of AI in acute thoracic imaging, highlighting their strengths, limitations, and future research opportunities.
Hamel C, Avard B, Dea N
… +8 more, Margau R, Mattar A, Michaud A, Schmidt M, Volders D, Witiw C, Worrall J, Murphy A
Can Assoc Radiol J
· 2025 Aug · PMID 39882774
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The Canadian Association of Radiologists (CAR) Central Nervous System Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurosurgery, and neurology, a patient advisor, and an ep...The Canadian Association of Radiologists (CAR) Central Nervous System Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurosurgery, and neurology, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 24 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 55 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 51 recommendation statements across the 24 scenarios. This guideline presents the methods of development and the referral recommendations for congenital disorders of the brain, cerebrovascular disease, multiple sclerosis and demyelinating disease, headache, concussion, pituitary and juxtasellar lesions, cranial neuropathy, brain stem symptoms, altered intracranial pressure (hypertension, hypotension, hydrocephalus suspected shunt malfunction, normal pressure hydrocephalus), vestibular and cochlear symptoms (hearing loss, vertigo), mental status change (acute, dementia/memory loss), visual loss, epilepsy and seizure, CNS infection, intracranial space-occupying lesions, suspected cerebral venous sinus thrombosis, vasculitis, movement disorders/Parkinsonism, metabolic and toxic encephalopathies, and aneurysm screening.
Hamel C, Avard B, Lim H
… +7 more, Mathieson A, Michaud A, Nelson K, Odedra D, Pantarotto J, Wilkinson A, Samji K
Can Assoc Radiol J
· 2025 Aug · PMID 39843994
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The Canadian Association of Radiologists (CAR) Cancer Expert Panel is made up of physicians from the disciplines of radiology, medical oncology, surgical oncology, radiation oncology, family medicine/general practitioner...The Canadian Association of Radiologists (CAR) Cancer Expert Panel is made up of physicians from the disciplines of radiology, medical oncology, surgical oncology, radiation oncology, family medicine/general practitioner oncology, a patient advisor, and an epidemiologist/guideline methodologist. The Expert Panel developed a list of 29 clinical/diagnostic scenarios, of which 16 pointed to other CAR guidelines. A rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of the remaining 13 scenarios. Recommendations from 21 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop the recommendation for these scenarios. During recommendation formulation, one additional scenario was mapped to an existing CAR guideline scenario, leaving 12 scenarios with new recommendations. The guideline focuses on cancer diagnosis and does not cover cancer staging, follow-up, and surveillance. This guideline presents the methods of development and the referral recommendations for suspected pancreatic cancer, suspected liver cancer, incidental liver mass, incidental colon mass or suspected colon cancer, suspected anal cancer, suspected penile cancer, suspected cervical cancer, suspected endometrial/uterine cancer, suspected vulvar cancer, suspected vaginal cancer, suspected haematologic malignancies, and suspected skin cancer. The guideline also points to other CAR guidelines for suspected neck, thyroid, brain, lung, intracardiac/pericardial, esophageal/gastric, renal, adrenal, bladder, testicular, prostate and ovarian cancers, suspected soft tissue mass or tumour, suspected bone tumour, suspected bone tumour --myeloma, suspected spine tumours, and incidental lung cancer.
Byrne A, Macdonald DB, Kirkpatrick IDC
… +7 more, Pham M, Green CR, Copaescu AM, McInnes MDF, Ling L, Ellis A, Costa AF
Can Assoc Radiol J
· 2025 Aug · PMID 39797723
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Contrast media, including iodinated contrast media and gadolinium-based contrast agents, are commonly administered pharmaceuticals with excellent safety profiles. However, a minority of the population may experience a hy...Contrast media, including iodinated contrast media and gadolinium-based contrast agents, are commonly administered pharmaceuticals with excellent safety profiles. However, a minority of the population may experience a hypersensitivity reaction following intravenous administration. Hypersensitivity reactions can be immediate or delayed, and range from mild, such as urticaria, to severe, including anaphylaxis. There is emerging evidence that longstanding pretreatment protocols, such as diphenhydramine and corticosteroids, are ineffective and have the potential for side effects and other harms. Moreover, the evidence for efficacy on which this practice is based is weak and outdated. A joint collaborative working group of representatives from the Canadian Association of Radiologists and the Canadian Society of Allergy and Clinical Immunology was assembled to inform medical professionals and hospital policies regarding hypersensitivity reactions to contrast media. The objectives of the working group were to provide an overview of the epidemiology, physiology, risk factors, and types of hypersensitivity reactions; to synthesize the evidence for pretreatment strategies that minimize the risk of a breakthrough reaction for both iodinated contrast media and gadolinium-based contrast agents; to review the allergy investigations used to evaluate patients with a history of severe hypersensitivity reaction; and to provide an overview of existing guidelines. Following appraisal of the evidence, the working group established recommendations based on consensus in this practice guidance.
Can Assoc Radiol J
· 2025 Aug · PMID 39797546
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Radiologists and other diagnostic imaging specialists play a pivotal role in the management of osteoporosis, a highly prevalent condition of reduced bone strength and increased fracture risk. Bone mineral density (BMD) m...Radiologists and other diagnostic imaging specialists play a pivotal role in the management of osteoporosis, a highly prevalent condition of reduced bone strength and increased fracture risk. Bone mineral density (BMD) measurement with dual-energy X-ray absorptiometry (DXA) is a critical component of identifying individuals at high risk for fracture. Strategies to prevent fractures are consolidated in the Osteoporosis Canada clinical practice guideline which was updated in 2023. In this guideline, treatment recommendations are based upon a consideration of fracture history, 10-year major osteoporotic fracture (MOF) risk, and BMD T-score in conjunction with age. The current review aims to familiarize radiologists and other diagnostic imaging specialists with the reporting requirements needed to support implementation of this guideline using the FRAX™ risk calculation tool. Fortunately, for specialists already familiar with the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool, the transition to FRAX-based reporting is readily accommodated in a radiology workflow.
Burrell S, Desaulniers M, Jen H
… +2 more, Maguire C, Stilwell M
Can Assoc Radiol J
· 2025 Aug · PMID 39797534
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This practice guideline serves as an update to the Canadian Association of Radiologists' 2013 Technical Standards for Bone Mineral Densitometry Reporting. It aims to align bone mineral density testing and reporting pract...This practice guideline serves as an update to the Canadian Association of Radiologists' 2013 Technical Standards for Bone Mineral Densitometry Reporting. It aims to align bone mineral density testing and reporting practices in Canada with current clinical best practices, including guidelines from Osteoporosis Canada and the International Society for Clinical Densitometry. Key updates include the endorsement of both FRAX and CAROC tools for evaluating fracture risk, guidance for analyzing male patients and transgender patients, and provision of clinical management guidance of relevance to BMD reporting harmonized with that of Osteoporosis Canada. The document emphasizes the importance of accurate data collection in fracture risk assessment and provides recommendations for reporting fracture risk, T-scores, and clinical management strategies. Additionally, it outlines indications for baseline BMD testing and reassessment timelines, aiming to facilitate appropriate patient management and enhance bone health outcomes. This guideline is intended to complement existing standards and support healthcare professionals in delivering optimal care for patients undergoing BMD testing in Canada.
Bouchard-Fortier G, Glanc P, Ferguson SE
… +6 more, Elman D, Kupets R, Po L, Taleghani S, Lo L, Hack K
Can Assoc Radiol J
· 2025 Aug · PMID 39780309
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To determine the feasibility of implementing Ovarian-Adnexal Reporting & Data System (O-RADS) ultrasound (US) for reporting of adnexal masses at our institution, with a specific goal of increasing the use of O-RADS from...To determine the feasibility of implementing Ovarian-Adnexal Reporting & Data System (O-RADS) ultrasound (US) for reporting of adnexal masses at our institution, with a specific goal of increasing the use of O-RADS from a baseline of <5% to at least 75% over a 16-month period. A prospective interrupted time series quality improvement study was undertaken over a 16-month period. Plan, do, study, act cycles included: (1) Engagement of interested parties, (2) Targeted educational sessions, (3) Development of reporting templates, (4) Weekly audit-feedback. Inter-reader variability assessment was performed on 70% of O-RADS risk-category 2 to 5. The primary outcome was the reporting of an O-RADS risk category. A total of 635 female pelvic US were performed at our centre between July 2022 and April 2023. An O-RADS risk category was provided on the final radiology report by the radiologist for 489/635 (77%) US. From November 2022 to April 2023, the weekly rate of O-RADS risk category reporting reached 88%. The O-RADS score was concordant between readers for 83/103 (81%) of US reports with kappa score of 0.69 corresponding to good agreement. The reporting of O-RADS risk category increased from <5% to 88% over a 16-month period with a high level of agreement among readers in assigning O-RADS risk category. Implementation of a standardizing reporting ultrasound system at a tertiary cancer centre is feasible with rapid learning and uptake curves.
Pang E, Shergill A, Chang S
… +9 more, Crivellaro P, Duigenan S, Green CR, Hamel C, Holmes S, Kielar A, Rehman I, Reinhold C, Al-Arnawoot B
Can Assoc Radiol J
· 2025 Aug · PMID 39772972
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The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and interpretation for advanced imaging modalities associate...The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and interpretation for advanced imaging modalities associated with diagnosing endometriosis. Advanced pelvic ultrasound is essential in diagnosing and mapping pelvic endometriosis, but pelvic MRI serves as an excellent imaging tool in instances where access to advanced ultrasound is limited, or an alternative imaging modality is required. Despite the known utility of MRI for endometriosis, there is no consensus on imaging protocol and patient preparation in Canada. To improve patient care and support excellence in imaging, the Working Group has developed recommendations for the use of pelvic MRI to assess for endometriosis with an aim to standardize MRI technique for use in both community and academic practices across Canada. The guidelines provide recommendations regarding imaging technique and patient preparation for pelvic MRI, along with suggestions for structured reporting of pelvic MRI for endometriosis.
Gupta N, Hiremath SB, Gauthier I
… +2 more, Wilson N, Miller E
Can Assoc Radiol J
· 2025 Aug · PMID 39733395
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Neurosonography (NSG) is pivotal for rapid, point-of-care neonatal brain assessment. This review elucidates the comprehensive applications of NSG in pediatric care, emphasizing its role in early diagnosis and management...Neurosonography (NSG) is pivotal for rapid, point-of-care neonatal brain assessment. This review elucidates the comprehensive applications of NSG in pediatric care, emphasizing its role in early diagnosis and management of pathologies affecting the pediatric head-such as scalp lesions, misshapen calvarium, ventricular distortions, and cerebrovascular abnormalities, and its specific role in conditions like hypoxic-ischaemic encephalopathy (HIE) across different neonatal gestational ages. We explore its diagnostic advantage in critical care settings, particularly for infants with stroke risk in sickle cell disease, ECMO-related complications, screening for therapeutic hypothermia, and routine neonatal intensive care unit monitoring. This review discusses the recommendations based on the timing of brain injury (preterm and term) and describes technical considerations that enhance diagnostic accuracy. Ultimately, this article advocates for its incorporation into routine neonatal screening to improve neurodevelopmental outcomes, underscoring its importance in clinical decision-making and long-term management of pediatric brain disorders.
Adamo RG, Lam E, Salameh JP
… +32 more, van der Pol CB, Goins SM, Dawit H, Costa AF, Levis B, Singal AG, Chernyak V, Sirlin CB, Bashir MR, Tang A, Alhasan A, Allen BC, Reiner CS, Clarke C, Ludwig DR, Cerny M, Wang J, Hyun Choi S, Fraum TJ, Song B, Joo I, Yeon Kim S, Kwon H, Jiang H, Kang HJ, Kierans AS, Kim YY, Ronot M, Podgórska J, Rosiak G, Soo Song J, McInnes MDF
Can Assoc Radiol J
· 2025 Aug · PMID 39733353
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Guidelines suggest the Liver Imaging Reporting and Data System (LI-RADS) may not be applicable for some populations at risk for hepatocellular carcinoma (HCC). However, data assessing the association of HCC risk factors...Guidelines suggest the Liver Imaging Reporting and Data System (LI-RADS) may not be applicable for some populations at risk for hepatocellular carcinoma (HCC). However, data assessing the association of HCC risk factors with LI-RADS major features are lacking. To evaluate whether the association between HCC risk factors and each CT/MRI LI-RADS major feature differs among individuals at-risk for HCC. Databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus) were searched from 2014 to 2022. Individual participant data (IPD) were extracted from studies evaluating HCC diagnosis using CT/MRI LI-RADS and reporting HCC risk factors. IPD from studies were pooled and modelled with one-stage meta-regressions. Interactions were assessed between major features and HCC risk factors, including age, sex, cirrhosis, chronic hepatitis B virus (HBV), and study location. A mixed effects model that included the major features, as well as separate models that included interactions between each risk factor and each major feature, were fit. Differences in interactions across levels of each risk factor were calculated using adjusted odds-ratios (ORs), 95% confidence-intervals (CI), and -tests. Risk of bias was assessed using QUADAS-2. (Protocol: https://osf.io/tdv7j/). Across 23 studies (2958 patients and 3553 observations), the associations between LI-RADS major features and HCC were consistent across several HCC risk factors (-value range: .09-.99). A sensitivity analysis among the 4 studies with a low risk of bias did not differ from the primary analysis. The association between CT/MRI LI-RADS major features and HCC risk factors do not significantly differ in individuals at-risk for HCC. These findings suggest that CT/MR LI-RADS should be applied to all patients considered at risk by LI-RADS without modification or exclusions, regardless of the presence or absence of the risk factors evaluated in this study.
Bovard J, Frysch T, Tong N
… +2 more, Sharma S, Yong-Hing CJ
Can Assoc Radiol J
· 2025 Aug · PMID 39708343
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Breast Imaging-Reporting and Data System (BI-RADS) density scores have been included in screening mammography reports in BC since 2018. Despite these density scores being present in screening mammography reports for nume...Breast Imaging-Reporting and Data System (BI-RADS) density scores have been included in screening mammography reports in BC since 2018. Despite these density scores being present in screening mammography reports for numerous years, there remains insufficient evidence to guide supplemental testing for patients with dense breasts. The primary objective of this study was to evaluate how primary care providers in Canada utilize BI-RADS density scores reported on normal screening mammograms of average risk, asymptomatic patients in their clinical practice. The secondary objective of this study was to determine if there are any patterns related to primary care provider demographics and practice settings in BC that could be linked to differences in screening practices for patients based on BI-RADS density scores. A cross-sectional survey was conducted with family physicians (FPs) and nurse practitioners (NPs) practicing in BC. Descriptive statistics were calculated using percentages and further stratified by participant demographics. values were derived from Fisher's exact test and results were regarded as statistically significant at < .05. Ninety-eight participants (85 FPs, 13 NPs) responded to the survey. The percentage of participants who ordered supplemental testing based on BI-RADS density scores alone was 8% for BI-RADS score D, 37% for BI-RADS scores C or D, and 2% for BI-RADS scores B, C, or D. Forty-eight percent of female participants and 45% of male participants would order supplemental testing based on BI-RADS density scores alone ( = 1). Forty-nine percent of FPs and 39% of NPs would order supplemental testing based on BI-RADS density scores ( = .56). Fifty-three percent of participants who had been in practice for more than 10 years, 50% of those who had been in practice for 6 to 10 years, and 36% of those in practice for 5 years or less would order supplemental testing ( = .34). Fifty-seven percent of those practicing in large urban centres, 43% of those practicing in medium-sized communities, and 32% of those in rural or remote communities would order testing ( = .17). Fifty-seven percent of participants were aware of the increased risk of breast cancer with higher breast density. Variations exist in how primary care providers in BC utilize the BI-RADS density scores reported on normal screening mammography of average risk, asymptomatic patients in their clinical practice. Further research in this area is needed to establish clearer clinical guidelines to educate and inform primary care providers on the need for supplemental testing for patients with dense breasts and to improve resources for breast cancer screening in BC.
Can Assoc Radiol J
· 2025 Aug · PMID 39692687
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To determine the benefit of a FDG PET/CT scan prior to CT-guided lung biopsy on the rate of diagnosis, rate of complication, and the identification of potentially safer biopsy sites. This retrospective observational cro...To determine the benefit of a FDG PET/CT scan prior to CT-guided lung biopsy on the rate of diagnosis, rate of complication, and the identification of potentially safer biopsy sites. This retrospective observational cross-sectional study evaluated consecutive adult patients who underwent CT-guided lung biopsy in 2020 or 2021 at 2 Canadian tertiary care hospitals. These patients were grouped into those that had PET/CT performed within 8 weeks prior to biopsy, within 8 weeks after biopsy, or no PET/CT scan within this time frame. Biopsy complication rates and pathology diagnostic rates were compared. The PET/CT images of those performed after biopsy were reviewed to determine if alternate safer biopsy sites could be identified. Categorical variables were compared using Pearson chi square test ( < .05 significant). 547 patients who had CT-guided lung biopsy were included. Patients with lung masses (≥3 cm) who had a PET/CT scan prior to biopsy had a higher diagnostic rate (90.8%) compared to those that did not (80.2%). The overall post-biopsy pneumothorax rate was 43.3% with 11.3% overall requiring chest tube insertion and 13.9% requiring hospitalization. There was no difference in complication rate for those who had PET/CT prior to biopsy and those that did not. 28.9% to 42.1% of patients who had PET/CT after biopsy had safer sites amenable to biopsy identified retrospectively outside of the lungs. PET/CT prior to CT-guided lung biopsy improves the diagnostic rate in 10.6% of patients with lung masses (≥3 cm) and identifies alternate safer sites to biopsy in 28.9% to 42.1% of patients (any size lesion).
Hamel C, Avard B, Chow R
… +17 more, Davies D, Dixon A, Eamer G, Garel J, Grimbly C, Jamieson L, Kovesi T, MacLean J, Mehta V, Metcalfe P, Michaud A, Miller E, O'Brien K, Otley A, Pohl D, Stein N, Abdeen N
Can Assoc Radiol J
· 2025 May · PMID 39641420
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The Canadian Association of Radiologists (CAR) Pediatric Expert Panel is made up of pediatric physicians from the disciplines of radiology, emergency medicine, endocrinology, gastroenterology, general surgery, neurology,...The Canadian Association of Radiologists (CAR) Pediatric Expert Panel is made up of pediatric physicians from the disciplines of radiology, emergency medicine, endocrinology, gastroenterology, general surgery, neurology, neurosurgery, respirology, orthopaedic surgery, otolaryngology, urology, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 50 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 32 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 133 recommendation statements across the 50 scenarios. This guideline presents the methods of development and the referral recommendations for head, neck, spine, hip, chest, abdomen, genitourinary, and non-accidental trauma clinical scenarios.
McQuade C, Renton M, Chouhan A
… +2 more, MacDermott R, O'Brien C
Can Assoc Radiol J
· 2025 May · PMID 39641413
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Peritoneal disease can be classified as either benign or malignant in nature. Malignant peritoneal disease can be further considered as either primary or secondary in origin. Primary peritoneal malignancy includes perito...Peritoneal disease can be classified as either benign or malignant in nature. Malignant peritoneal disease can be further considered as either primary or secondary in origin. Primary peritoneal malignancy includes peritoneal mesothelioma, serous carcinoma, and desmoplastic small round cell tumour. Peritoneal carcinomatosis is the most commonly encountered secondary malignant peritoneal disease, typically of ovarian, gastric, colorectal, pancreatic, small bowel neuroendocrine, or breast origin. Others include peritoneal lymphomatosis and sarcomatosis. Benign peritoneal pathology may mimic malignant disease. Differentiating benign from malignant peritoneal pathology can be challenging, but is critical to guide appropriate care and avoid unnecessary intervention. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) offers potentially curative treatment for patients with peritoneal carcinomatosis, pseudomyxoma peritonei, and peritoneal mesothelioma. For such patients, the radiologist provides crucial pre-operative information highlighting sites of disease involvement, particularly for sites which are challenging to assess at laparotomy or laparoscopy, including the hepatic dome, subdiaphragmatic space and mesenteric root. The radiologist is also essential to identify potential contraindications to surgery, as well as interpreting normal post-operative appearances, complications and assessing for disease recurrence.
Freitas V, Ghai S, Au F
… +2 more, Muradali D, Kulkarni S
Can Assoc Radiol J
· 2025 May · PMID 39627928
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The integration of Digital Breast Tomosynthesis (DBT) and Artificial Intelligence (AI) represents a significant advance in breast cancer screening. This combination aims to address several challenges inherent in traditio...The integration of Digital Breast Tomosynthesis (DBT) and Artificial Intelligence (AI) represents a significant advance in breast cancer screening. This combination aims to address several challenges inherent in traditional screening while promising an improvement in healthcare delivery across multiple dimensions. For patients, this technological synergy has the potential to lower the number of unnecessary recalls and associated procedures such as biopsies, thereby reducing patient anxiety and improving overall experience without compromising diagnostic accuracy. For radiologists, the use of combined AI and DBT could significantly decrease workload and reduce fatigue by effectively highlighting breast imaging abnormalities, which is especially beneficial in high-volume clinical settings. Health systems stand to gain from streamlined workflows and the facilitated deployment of DBT, which is particularly valuable in areas with a scarcity of specialized breast radiologists. However, despite these potential benefits, substantial challenges remain. Bridging the gap between the development of complex AI algorithms and implementation into clinical practice requires ongoing research and development. This is essential to optimize the reliability of these systems and ensure they are accessible to healthcare providers and patients, who are the ultimate beneficiaries of this technological advancement. This article reviews the benefits of combined AI-DBT imaging, particularly the ability of AI to enhance the benefits of DBT and reduce its existing limitations.