Lindgren A, Singfer U, Sousa JA
… +8 more, Goodluck Tyndall R, Nasralla M, Chung E, Andrade Barazarte H, Volders D, Schaafsma J, Krings T, Hendriks EJ
Can Assoc Radiol J
· 2026 May · PMID 42170818
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Subarachnoid hemorrhage (SAH) is frequently caused by a ruptured saccular cerebral aneurysm, making early and accurate diagnosis critical for patient outcomes. CT angiography (CTA) is the standard first-line imaging moda...Subarachnoid hemorrhage (SAH) is frequently caused by a ruptured saccular cerebral aneurysm, making early and accurate diagnosis critical for patient outcomes. CT angiography (CTA) is the standard first-line imaging modality for suspected nontraumatic SAH; however, up to 15% of patients present with negative initial CTA findings, necessitating further imaging work-up. A key distinction in SAH is between an aneurysmal and a non-aneurysmal bleeding pattern. Perimesencephalic hemorrhage, a distinct SAH subtype, exhibits a contained bleeding pattern rarely associated with an underlying aneurysm, and therefore requires a different imaging approach than aneurysmal SAH. Given the alarmingly high mortality of untreated ruptured cerebral aneurysms, a comprehensive imaging strategy enabling prompt identification of intracranial aneurysms is essential to prevent rebleeding. This narrative expert review discusses the available evidence for the optimal imaging strategy in patients presenting with aneurysmal-pattern SAH and initially negative findings. It addresses potential pitfalls in neurovascular imaging, offers guidance on identifying rare causes of SAH through advanced imaging techniques, and examines the yield of repeat neuroimaging in the context of evolving imaging technologies. Finally, we address the diagnostic challenges posed by rarer aneurysm subtypes, including spinal artery aneurysms, dissecting aneurysms, blood blister-like aneurysms, and perforating artery aneurysms. Together, these insights inform the development of a comprehensive, patient-centered imaging algorithm for improved care in cases of aneurysmal SAH without a detectable aneurysm on initial imaging.
Can Assoc Radiol J
· 2026 May · PMID 42159165
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PURPOSE: To evaluate the growth, structure, and evidentiary maturity of research related to environmental sustainability in radiology using bibliometric analysis and science mapping. METHODS: A comprehensive bibliometric...PURPOSE: To evaluate the growth, structure, and evidentiary maturity of research related to environmental sustainability in radiology using bibliometric analysis and science mapping. METHODS: A comprehensive bibliometric analysis was conducted to identify publications related to environmental sustainability in radiology. Performance metrics included temporal trends, publication types, journals, countries, and citation analysis. Science mapping techniques included co-authorship networks and thematic classification. Publications were categorized into non-mutually exclusive domains of mitigation, adaptation, and resilience. RESULTS: A total of 535 publications were included, with a marked increase in annual output after 2019; 54% of all publications were published in 2024 to 2025 alone. Publications had a median of 7 citations (IQR 2-24), with 2720 unique authors and a median of 6 authors per publication (IQR 3-10). Overall, 166 publications (31%) involved international collaboration. The field demonstrated substantial heterogeneity in evidentiary maturity: mitigation accounted for the largest proportion of publications (60%) but a minority were original research (39%), whereas adaptation (41%) was primarily composed of original research (83%) with higher citation impact. Resilience was minimally represented (2%). Publications were distributed across 252 journals, with a core group of journals and collaborative author networks indicating emerging structural consolidation. CONCLUSION: Environmental sustainability in radiology is a rapidly expanding and increasingly collaborative field. While adaptation research is embedded within broader environmental health literature, mitigation is transitioning toward data-driven implementation, and resilience remains a critical gap. These findings highlight the need to advance implementation-focused research, develop standardized metrics, and prioritize system resilience to support sustainable radiology practice.
Can Assoc Radiol J
· 2026 May · PMID 42095256
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OBJECTIVE: The primary outcome of this study was to determine the cancer detection rate (CDR) of surveillance mammography in the autologous reconstructed breast post mastectomy. MATERIALS AND METHODS: In this research et...OBJECTIVE: The primary outcome of this study was to determine the cancer detection rate (CDR) of surveillance mammography in the autologous reconstructed breast post mastectomy. MATERIALS AND METHODS: In this research ethics board approved retrospective study, chart review was performed at a single academic centre to identify women who had undergone mastectomy with AR who underwent annual mammography surveillance of both ipsilateral (reconstructed) and contralateral breasts with a minimum 1 year of clinical and imaging follow-up between 2012 and 2020. Clinical information, imaging, method of detection, pathology and immunohistochemical findings, location of ipsilateral malignancy, and the interval between mastectomy and loco-regional recurrence (LRR) were calculated. The CDR of surveillance mammography, interval cancers, abnormal recall rate (ACR), and PPV1, PPV2, and PPV3 were determined. RESULTS: We included 2127 screening examinations in 371 patients median age was 58 years (25-86 years). The average number of screens per patient was 5.73 (range: 1-17). No screen-detected cancers (CDR 0/1000) were identified in the ipsilateral breast for an abnormal recall rate of 0.42% (9/2127) and 3 benign biopsies. Three interval cancers were detected clinically in the ipsilateral breast. CONCLUSION: No benefit was found for surveillance mammography and detection of non-palpable cancers in autologous reconstructed breasts post mastectomy in this study. Further multicentric studies with larger number of patients may be needed for confirmation of lack of benefit.
INTRODUCTION: Nondiagnostic results after thyroid fine-needle aspiration (FNA) are common and may delay diagnosis. PURPOSE: To identify demographic and sonographic predictors of nondiagnostic cytology at repeat thyroid F...INTRODUCTION: Nondiagnostic results after thyroid fine-needle aspiration (FNA) are common and may delay diagnosis. PURPOSE: To identify demographic and sonographic predictors of nondiagnostic cytology at repeat thyroid FNA and to report malignancy rates in this group. MATERIALS AND METHODS: Single-center retrospective cohort including consecutive adult patients who underwent repeat ultrasound-guided FNA of thyroid nodules with prior nondiagnostic cytology (Bethesda I) between 2015 and 2023. Nodule-level ultrasound features were extracted from structured reports. The primary outcome was nondiagnostic cytology at repeat FNA. Multivariable logistic regression with generalized estimating equations was used to account for clustering of nodules. RESULTS: A total of 208 patients with 242 thyroid nodules were included. On repeat FNA, 77 of 242 nodules (31.8%) remained nondiagnostic. In multivariable analysis, older age (odds ratio [OR] per year, 1.03) and nodule composition were independently associated with a nondiagnostic result at repeat FNA. Solid nodules had lower odds of a nondiagnostic result than cystic or mixed cystic-solid nodules (OR, 0.30). Patient sex, maximum diameter, echogenicity, echogenic foci, calcifications, shape, and margins showed no significant association. Cytology suspicious for or diagnostic of malignancy (Bethesda V-VI) was found in 4 nodules (1.6%); however, this estimate may be affected by verification bias. CONCLUSION: Approximately one-third of nodules remained nondiagnostic at repeat FNA. Older age and cystic or mixed nodule composition were independently associated with a higher risk of repeat nondiagnostic cytology. Alternative diagnostic strategies (eg, rapid on-site evaluation, core-needle biopsy, or surveillance) can be considered early in the diagnostic workup of these nodules.
PURPOSE: To evaluate the clinical effectiveness, safety, and catheter durability of venting percutaneous transesophageal gastrostomy (PTEG) in patients with malignant bowel obstruction (MBO) who were not candidates for p...PURPOSE: To evaluate the clinical effectiveness, safety, and catheter durability of venting percutaneous transesophageal gastrostomy (PTEG) in patients with malignant bowel obstruction (MBO) who were not candidates for percutaneous gastrostomy (PG). MATERIALS AND METHODS: This retrospective single-center study included 47 patients with MBO who underwent PTEG between 2018 and 2025. Outcomes included technical success, >72 hours clinical outcomes, paired pre-post analysis of nausea and vomiting severity, changes in antiemetic and opioid use, >72 hours catheter performance, and survival. Time-to-event analyses were performed using Kaplan-Meier estimates for overall survival and catheter event-free survival. Procedure-related adverse events were classified using the CIRSE system. RESULTS: Technical success was achieved in all patients and clinical success within 72 hours occurred in 90.9%. Nausea and vomiting prevalence decreased from 87.2% to 8.5% and 4.3%, respectively ( < .001), with parallel reductions in antiemetic (87.2%-8.5%) and opioid use (53.2%-12.8%; < .001). Catheter dysfunction occurred in 22.7% of patients. Median overall survival was 52.0 days (95% CI: 38.0-245.0), and median catheter event-free survival was 212 days (95% CI: 65-not reached). Mean overall survival was 136.2 days (95% CI: 75.5-196.8), while mean catheter event-free survival was 229.9 days (95% CI: 131.3-328.6). No major adverse events (CIRSE grade ≥3) were observed. CONCLUSION: Venting PTEG demonstrated favorable short- and long-term clinical outcomes in patients with MBO who were unsuitable for PG.
Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy arising from the adrenal cortex. This tumor shows suggestive imaging features on computed tomography (CT), which include a large size, internal heterogen...Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy arising from the adrenal cortex. This tumor shows suggestive imaging features on computed tomography (CT), which include a large size, internal heterogeneity and various degrees of internal necrosis. Accurate characterization of ACC with imaging is essential to ensure prompt and appropriate management and avoid useless biopsy or delayed surgery. Magnetic resonance imaging (MRI) provides additional information with respect to the internal content of ACC by comparison with CT. Recent studies evaluating the capabilities of radiomics have shown encouraging results in the characterization of ACC and differentiation from other adrenal masses. Surgical resection remains the primary treatment for localized ACC. Complete surgical resection (, R0 resection) offers the best chance for long-term survival for patients with ACC. Preoperative planning with imaging should be performed to identify local extent of ACC into the liver, the ipsilateral kidney, and the inferior vena cava as well as to exclude distant metastases. A precise preoperative assessment is critical to anticipate the radicality of surgery and best manage potential surgical complications. This review article aims to provide a thorough overview of the current role of CT and MRI in the diagnosis and preoperative planning of ACC.
Osman H, Lam E, van der Pol CB
… +11 more, Mahdi HT, Awad R, Islam N, Alabousi M, Salameh JP, Bashir MR, Costa AF, Naringrekar H, Presseau J, Tang A, McInnes MDF
BACKGROUND: Hepatocellular carcinoma (HCC) has an uneven global distribution and a higher incidence in males. The Liver Imaging Reporting and Data System (LI-RADS) is a standardized imaging framework for HCC diagnosis. I...BACKGROUND: Hepatocellular carcinoma (HCC) has an uneven global distribution and a higher incidence in males. The Liver Imaging Reporting and Data System (LI-RADS) is a standardized imaging framework for HCC diagnosis. It is unclear whether the evidence used to inform LI-RADS reflects the global burden of HCC. PURPOSE: To determine whether the geographic and sex distribution of studies assessing LI-RADS and those included in the LI-RADS individual participant data (IPD) database reflect the global burden of HCC. MATERIALS AND METHODS: We conducted a cross-sectional meta-research study comparing the country- and sex-specific HCC prevalence from GLOBOCAN 2022 with the distribution of studies eligible for and included in the LI-RADS IPD database. Studies were identified through a systematic search of 4 databases. STUDY PROTOCOL: . RESULTS: We identified 470 eligible studies including 98 014 patients; of these, 76 studies comprising 11 924 patients were included in the IPD database. Asian and African countries, excluding Republic of Korea, were underrepresented in both the eligible and the IPD dataset. North America was overrepresented. Female patients were under-represented in LI-RADS eligible studies ( = -21.95, < .0001) and in studies included in the IPD ( = -9.02, < .0001) compared to the global prevalence of HCC in females. CONCLUSION: LI-RADS research is disproportionately reported from some countries relative to HCC burden. Asia, Africa, and female patients remain underrepresented. This may affect the generalizability and diagnostic equity of the LI-RADS system and underscore the need for improved global inclusivity in LI-RADS research.
These practice guidelines, developed by the Canadian Association for Interventional Radiology (CAIR) and the Canadian Association of Radiologists (CAR) with input from hematology experts, provide evidence informed, pract...These practice guidelines, developed by the Canadian Association for Interventional Radiology (CAIR) and the Canadian Association of Radiologists (CAR) with input from hematology experts, provide evidence informed, practical recommendations for managing bleeding risk during image guided procedures. Building on the 2019 Society of Interventional Radiology guideline, they streamline decision making around anticoagulation, antiplatelet therapy, laboratory testing, and transfusion thresholds for use across Canadian radiology departments. A systematic review of post 2019 evidence and expert consensus-informed updates to procedural risk stratification and clarified INR and platelet thresholds. The guidance emphasizes that most radiologic procedures carry very low bleeding risk and generally do not require routine laboratory screening or interruption of anticoagulant or antiplatelet medications, while high risk procedures warrant targeted testing and standardized transfusion thresholds, including those tailored for chronic liver disease. Special sections address lumbar puncture, arterial access, and urgent or emergent procedures. Overall, the guideline highlights individualized clinical judgment, avoidance of unnecessary delays or consultations, and careful consideration of transfusion risks, with the goal of promoting streamlined, safe, and consistent care across Canadian imaging practices.
Breast arterial calcifications (BAC) are associated with increased cardiovascular risk and have been correlated with other methods of cardiovascular risk stratification. BAC are present in 12% to 43% of patients who unde...Breast arterial calcifications (BAC) are associated with increased cardiovascular risk and have been correlated with other methods of cardiovascular risk stratification. BAC are present in 12% to 43% of patients who undergo screening mammography, with incidence increasing with advancing age. BAC are also positively correlated with multiparity, menopausal status, metabolic syndrome, hyperlipidemia, hypertension, diabetes, and chronic renal disease. There are multiple methods to identify and quantify BAC including visual binary assessment, subjective severity grading, digital measurement and quantification, and artificial intelligence-based models. BAC reporting on mammography is heterogeneous across Canada, Europe, and the United States of America. North American survey studies suggest that referring physicians and patients prefer to be informed of the presence of BAC on mammography. Given the overlap in populations of perimenopausal and postmenopausal women at risk for cardiovascular disease and those undergoing screening mammography, there is an opportunity to use BAC to identify women at increased cardiovascular risk, particularly as current cardiovascular risk assessment models are known to underserve this population.
Radiology is increasingly defined by interdependence: imaging value is created through tightly coupled relationships among radiologists, technologists, nurses, physicists, administrators, and referring clinicians, under...Radiology is increasingly defined by interdependence: imaging value is created through tightly coupled relationships among radiologists, technologists, nurses, physicists, administrators, and referring clinicians, under escalating expectations for access, safety, quality, and timeliness. In this context, leadership is a department-wide capability that must be deliberately designed, taught, and sustained. Drawing on distributive leadership and servant leadership literatures, we propose a radiology-specific synthesis, that decentralizes problem-solving while maintaining accountability, and positions leaders as multipliers who build others' competence, agency, and voice. We review why "heroic" leadership models predictably fail in complex adaptive clinical environments; summarize the empirical foundations of distributive and servant leadership; and translate these concepts into operational practices for radiology departments. This includes decision-rights design, meeting architecture, psychological safety, inclusive leadership, mentorship and sponsorship systems, and leadership development pathways for trainees and early-career faculty. We then examine 2 contemporary leadership stress tests: workforce sustainability (burnout, boreout, moral distress, hybrid work) and digital transformation (AI governance), arguing that both are best understood as organizational design challenges rather than individual resilience deficits or technology procurement exercises. Finally, we outline pragmatic metrics and evaluation approaches that align leadership behaviours with departmental outcomes (quality, access, safety culture, retention, and patient-centred value). A distributive servant leadership model offers a coherent, evidence-informed approach to building radiology departments that are adaptable, humane, and performance-oriented.
Blommers M, Park M, Kimber J
… +6 more, Quiranz MR, Ramdass S, MacDonald B, Gardner K, Ahmad T, Kraus MS
Can Assoc Radiol J
· 2026 Mar · PMID 41914523
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BACKGROUND/OBJECTIVES: Acute head trauma (AHT) is a common reason for pediatric emergency department (ED) visits, although most cases do not result in clinically important traumatic brain injury (ciTBI). Clinical decisio...BACKGROUND/OBJECTIVES: Acute head trauma (AHT) is a common reason for pediatric emergency department (ED) visits, although most cases do not result in clinically important traumatic brain injury (ciTBI). Clinical decision rules such as PECARN can help identify children at risk for ciTBI and guide the need for cranial computed tomography (CT). Despite this, CT appears frequently overused, raising ongoing concerns about radiation exposure, resource utilization, and clinical yield. This study evaluated after-hours CT utilization patterns and diagnostic yield for pediatric head trauma at a tertiary care centre. METHODS: We conducted a retrospective review of after-hours non-contrast cranial CT examinations for pediatric (<16 years) head trauma performed between January 2020 and February 2024. Data extracted included presence of skull fracture and/or intracranial injury (ICI; bleed, contusion, or combination), radiation dose, and follow-up imaging. Patients were grouped by age (<2 and ≥2 years). RESULTS: Among 361 children (median age 6 years; 150 females), 267 examinations (74%) were normal, with no evidence of skull fracture (79.8%) or acute ICI (83.9%). Only 29 cases (8%) underwent follow-up imaging. Children <2 years (n = 97) demonstrated higher rates of positive findings: 34% (33/97) had skull fractures and 24.7% (24/97) had ICI. CONCLUSION: In this cohort of after-hours ED-initiated cranial CT examinations, most studies did not demonstrate acute traumatic findings, particularly in children ≥2 years. Imaging of younger children had a comparatively higher diagnostic yield. These findings describe institutional CT utilization patterns and may inform future quality improvement initiatives and local imaging pathways.