du Plessis J, Kalu A, McKee H
… +4 more, Mohammed A, Maroun R, Berger FH, Maroun G
Can Assoc Radiol J
· 2026 Feb · PMID 40420569
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Computed tomography angiography (CTA) plays an important role in assessing patients with suspected lower extremity traumatic vascular injury. However, CTA overutilization has been reported in some centres, and improper u...Computed tomography angiography (CTA) plays an important role in assessing patients with suspected lower extremity traumatic vascular injury. However, CTA overutilization has been reported in some centres, and improper use has been linked to increased healthcare costs and prolonged Emergency Department wait times. This study evaluated CTA utilization in a Canadian Level I trauma centre, determined the rate of positive CTA studies requiring intervention, and identified factors that may reduce unnecessary examinations. This retrospective study included trauma patients who underwent lower extremity CTA between January 2020 and September 2024. Data regarding patient demographics, mechanism of injury, physical exam and computed tomography findings, ankle-brachial index value, and interventions were collected and evaluated. Statistical analysis included descriptive statistics and chi-square or Fisher's exact tests for categorical associations. Six hundred twelve patients (82% male, median age 32 years) were included. Forty-six percent had a normal physical exam, and CTA was positive in 27% of cases. Eight percent of patients required an intervention, all of whom had at least one hard sign of vascular injury. A statistically significant association was identified between hard signs of a vascular injury and positive CTA findings ( < .001) and major vascular injuries ( < .01). No patients with a normal physical exam and a positive CTA required intervention. Nearly half of the CTA studies were performed on patients with a normal physical exam, none requiring intervention. Our findings suggest that implementing institution-specific appropriate criteria may reduce unnecessary CTA studies.
Muhn O, Kurowecki D, Patlas MN
… +1 more, Alabousi A
Can Assoc Radiol J
· 2026 Feb · PMID 40420568
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Prostate cancer (PCa) remains a leading cause of cancer-related morbidity and mortality among men worldwide. Multiparametric MRI (mpMRI) is currently the gold standard for PCa detection, diagnosis, and active surveillanc...Prostate cancer (PCa) remains a leading cause of cancer-related morbidity and mortality among men worldwide. Multiparametric MRI (mpMRI) is currently the gold standard for PCa detection, diagnosis, and active surveillance. However, its reliance on dynamic contrast-enhanced (DCE) imaging introduces safety concerns, higher costs, and longer scan times. Biparametric MRI (bpMRI), which omits DCE, has emerged as a streamlined alternative that retains T2-weighted and diffusion-weighted imaging. This review critically examines the technical considerations, diagnostic performance, clinical applications, and limitations of bpMRI compared to mpMRI. We evaluate bpMRI's sensitivity, specificity, and negative predictive value in detecting clinically significant prostate cancer (csPCa), highlighting its advantages in terms of patient safety, accessibility, and cost-effectiveness. Despite promising findings, the widespread clinical adoption of bpMRI is hindered by variability in imaging protocols, limited large-scale validation, and concerns over missed subtle lesions. Future directions include standardizing bpMRI protocols, integrating artificial intelligence and biomarkers, and conducting multi-centre trials to establish its role in PCa management. bpMRI holds significant potential as a reliable and efficient imaging tool that could complement or replace mpMRI in select clinical contexts.
Warren BE, Supersad A, Mafeld S
… +2 more, Jaberi A, Oreopoulos G
Can Assoc Radiol J
· 2026 Feb · PMID 40420565
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A survey to determine the availability of after-hours IR on-call services at Ontario hospitals that have a radiology department. A secondary outcome is to determine potential barriers to the provision of IR after-hours o...A survey to determine the availability of after-hours IR on-call services at Ontario hospitals that have a radiology department. A secondary outcome is to determine potential barriers to the provision of IR after-hours on call services within the province. A survey was created and distributed to the radiology department heads across Ontario during a 6-week period in 2024. The survey was sent to the department heads at 73 hospitals across the province of Ontario. Survey completion rate was 41% (30/73). Two thirds of the respondents had formal IR divisions (20/30, 66.7%). A total of 14 hospitals with IR departments offered on call services (70%, 14/20) and 2 of the hospitals without IR departments (2/10, 20%) offered on call services for non-vascular IR procedures (eg, abscess drainage). 92.9% of the groups offering IR call services stated year-over-year demand was increasing. The most common barrier to after-hours services were staffing resources. After-hours IR services have limited availability in the province of Ontario, and not all hospitals with IR departments currently provide after-hours access to IR procedures. The main barrier to provision of after-hours services is the lack of health human resources, in particular IR physicians.
Awad El-Karim L, Kielar A, Krishna S
… +3 more, Elias ZF, Panet H, Brown M
Can Assoc Radiol J
· 2025 Nov · PMID 40420555
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Environmental sustainability in radiology has a growing role in health care as climate changes intensify. Quality Initiative/Improvement (QI) projects lead to improved patient care and safety as well as efficient use of...Environmental sustainability in radiology has a growing role in health care as climate changes intensify. Quality Initiative/Improvement (QI) projects lead to improved patient care and safety as well as efficient use of limited health care resources. When designing a QI project, including an environmental lens increases awareness of sustainability in medicine. This document will focus specifically on sustainability in QI (SusQI) in the field of radiology, though similar principles may be applied in other medical fields. The sustainable QI model updates the value equation denominator from cost to the triple bottom line of environmental, social, and economic measures. Using this SusQI model can lead to a win (patient)-win (health care system)-win (environment). This article will also discuss the importance of the environment for human health and the link between quality initiatives and environmental sustainability in demonstrating the value of Radiology and improving the quality of patient care. It will provide some examples of sustainability applied to many quality initiatives in Radiology: For example, reduction in oral contrast use for many previously used indications, streamlined MRI protocols, as well as using ultrasound over CT or MRI for indications that are equally appropriate.
Gorelik N, Green CR, Hamel C
… +9 more, LeBlanc AM, Ravi B, Frost DR, Ouellette H, Chen KJ, Liang LY, Gelber N, Mirza R, Rakhra KS
Can Assoc Radiol J
· 2026 Feb · PMID 40420549
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To develop Choosing Wisely Canada (CWC) recommendations for musculoskeletal (MSK) imaging indications, informed by the 2024 Canadian Association of Radiologists (CAR) Musculoskeletal System Diagnostic Imaging Referral Gu...To develop Choosing Wisely Canada (CWC) recommendations for musculoskeletal (MSK) imaging indications, informed by the 2024 Canadian Association of Radiologists (CAR) Musculoskeletal System Diagnostic Imaging Referral Guideline. A Steering Committee comprising multidisciplinary MSK experts was convened to guide recommendation development. Using a two-round Delphi method, committee members selected the top 3 scenarios from the CAR MSK referral guidelines deemed most impactful for addressing overuse. Recommendations based on these scenarios were then drafted using the CWC format. The 3 recommendations developed are: (1) Don't order MRI without first considering ultrasound for the assessment of rotator cuff pathology and bursitis; (2) Don't order MRI of the hip or knee when x-ray demonstrates greater than mild osteoarthritis, unless recommended by a musculoskeletal specialist; and (3) Don't order MRI of the hip just based on x-ray features of femoroacetabular impingement unless there are clinical signs and symptoms of joint impingement. This project represents a knowledge translation initiative to disseminate updated MSK imaging guideline recommendations. It strengthens the collaboration between CAR and CWC and establishes a reproducible structured consensus approach that can be applied to developing additional CWC imaging recommendations across the remaining 12 CAR referral guidelines in other subspecialties. This work supports value-based radiology, promoting optimized resource use.
Mirshahvalad SA, Beheshti M, Metser U
… +4 more, Jiang DM, Wong R, Alrekhais I, Veit-Haibach P
Can Assoc Radiol J
· 2026 Feb · PMID 40405808
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Theranostic represents a transformative approach in precision medicine, integrating diagnostic imaging with targeted radiopharmaceutical therapy to enhance individualized disease management. Rooted in nuclear medicine, t...Theranostic represents a transformative approach in precision medicine, integrating diagnostic imaging with targeted radiopharmaceutical therapy to enhance individualized disease management. Rooted in nuclear medicine, this approach uses molecular targeting agents labelled with diagnostic radioisotopes for imaging and therapeutic radioisotopes for treatment, ensuring a seamless transition from diagnosis to therapy. The field has evolved significantly in the last decade, with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy transforming prostate cancer patient management and somatostatin receptor (SSTR)-targeted agents revolutionizing neuroendocrine tumour (NET) treatment. Considering its interdisciplinary nature, collaboration between nuclear medicine specialists, oncologists, radiologists, and other healthcare professionals is critical to refining clinical applications and improving patient outcomes. As prominent members of the theranostic team, radiologists play a pivotal role, from patient selection and imaging-based eligibility assessment to response evaluation and long-term monitoring. In this regard, advanced imaging modalities facilitate the precise evaluation of disease characteristics, guiding treatment decisions. Hence, as theranostics becomes increasingly integrated into patient management, radiologists face the need to be well-versed in both the technical aspects and clinical implications. In this review, we aimed to provide a primer for radiologists to gain a general insight into the theranostic field and its basic principles.
Geevarghese R, Lis E, Cohen M
… +4 more, Lin A, Tabar V, Solomon SB, Cornelis FH
Can Assoc Radiol J
· 2025 Nov · PMID 40380871
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Interventional neuro-oncology is an evolving subspecialty that leverages minimally invasive endovascular and percutaneous techniques to improve outcomes for patients with spine, brain, and head-neck tumours. While conven...Interventional neuro-oncology is an evolving subspecialty that leverages minimally invasive endovascular and percutaneous techniques to improve outcomes for patients with spine, brain, and head-neck tumours. While conventional interventions have historically focused on vascular pathologies such as stroke and aneurysms, interventional techniques in oncology are gaining prominence. This review explores the role of image-guided interventions in preoperative tumour embolization, middle meningeal artery embolization in thrombocytopenic cancer patients, management of head and neck hemorrhage, intra-arterial drug delivery, and spinal interventions. Through a synthesis of current evidence, we highlighted the growing importance of interventional techniques in neuro-oncology and discuss future advancements in image guidance, robotics, and targeted drug delivery.
Can Assoc Radiol J
· 2025 Nov · PMID 40380791
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Bariatric surgery is an effective approach to management of morbid obesity. Given its increasing popularity worldwide, post-operative imaging of patients following bariatric surgery is frequently encountered in clinical...Bariatric surgery is an effective approach to management of morbid obesity. Given its increasing popularity worldwide, post-operative imaging of patients following bariatric surgery is frequently encountered in clinical practice. In this article we review the physiological principles, normal post-operative anatomy, and imaging appearance of common bariatric procedures (Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and laparoscopic adjustable gastric banding) as well as less common bariatric procedures (including intragastric balloon and biliopancreatic diversion with duodenal switch). Technical considerations and imaging pearls for identifying perioperative and late complications following bariatric procedures will be illustrated through fluoroscopic upper GI studies and computed tomography case examples. Familiarity with expected anatomy and imaging appearances following bariatric procedures allows the radiologist to play a key role in early identification and management of postoperative complications.
Barat M, Eltaher M, Moawad AW
… +14 more, Soyer P, Fuentes D, Golse M, Jouinot A, Ahmed AA, Shehata MA, Assié G, Elmohr MM, Haissaguerre M, Habra MA, Hoeffel C, Elsayes KM, Bertherat J, Dohan A
Can Assoc Radiol J
· 2025 Nov · PMID 40319410
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Adrenocortical carcinoma (ACC) is a rare condition with a poor and hardly predictable prognosis. This study aims to build and evaluate a preoperative computed tomography (CT)-based score (CT score) using features previou...Adrenocortical carcinoma (ACC) is a rare condition with a poor and hardly predictable prognosis. This study aims to build and evaluate a preoperative computed tomography (CT)-based score (CT score) using features previously reported as biomarkers in ACC to predict overall survival (OS) in patients with ACC. A CT score based on preoperative CT examinations combining shape elongation, maximum tumour diameter, and the European Network for the Study of Adrenal Tumors (ENSAT) stage was built using a logistic regression model to predict OS duration in a development cohort of 89 patients with ACC. An optimal cut-off of the CT score was defined and the Kaplan-Meier method was used to assess OS. The CT score was then tested in an external validation cohort of 54 patients wit ACC. The C-index of the CT score for predicting OS was compared to that of ENSAT stage alone. The CT score helped discriminate between patients with poor prognosis and patients with good prognosis in both the validation cohort (54 patients; mean OS, 69.4 months; 95% confidence interval [CI]: 57.4-81.4 months vs mean OS, 75.6 months; 95% CI: 62.9-88.4 months, respectively; = .022). In the validation cohort the C-index of the CT score was significantly better than that of the ENSAT stage alone (0.62 vs 0.35; = .002). A CT score combining morphological criteria, radiomics, and ENSAT stage on preoperative CT examinations allows a better prognostic stratification of patients with ACC compared to ENSAT stage alone.
Can Assoc Radiol J
· 2025 Nov · PMID 40317168
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Breast arterial calcifications (BAC) are not routinely reported on mammography but are linked to coronary artery calcification (CAC) and cardiovascular disease (CVD) events. We sought to assess primary care provider (PCP...Breast arterial calcifications (BAC) are not routinely reported on mammography but are linked to coronary artery calcification (CAC) and cardiovascular disease (CVD) events. We sought to assess primary care provider (PCP) follow-up after BAC and CAC notification and the association between BAC on mammography and CAC on CT. Participants without known CVD undergoing mammography at a single centre were prospectively recruited over 18 months. BAC were qualitatively scored (none/mild/moderate/severe) by 2 breast radiologists. All participants had research cardiac CT for CAC within 6 months, scored using the Agatston method. Questionnaires collected baseline demographics, risk factors, and follow-up data. 286 participants were included (median age 62 ± 10). Prevalence of BAC was 13% (38/286), 248 had none, 18 mild, 16 moderate, and 4 severe. For CAC: 180 had none, 70 had mild (CAC 1-99), 28 had moderate (CAC 100-399), and 8 had severe (CAC >400). For detecting CAC, BAC presence had 92% specificity (166/180), 23% sensitivity (24/106), and 67% negative predictive value (166/248). Most participants with BAC and CAC (71%, 17/24) were not on lipid-lowering therapy and 63% (15/24) did not believe they had elevated CVD risk. At follow-up (median 202 days), 46% (11/24) with BAC and CAC implemented lifestyle modifications, 92% (22/24) scheduled PCP follow-up, and 56% (10/18) underwent further CV risk assessment following their appointment. One participant with BAC and CAC had a stroke during follow-up. In a prospective cohort without known CVD undergoing mammography, notification of BAC and CAC status prompted high follow-up rates with PCPs and lifestyle modifications.
Murad V, Metser U, Kohan A
… +3 more, Murad S, Veit-Haibach P, Ortega C
Can Assoc Radiol J
· 2025 Nov · PMID 40308072
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To evaluate frequency and distribution of immune-related adverse events detected by F-FDG PET/CT in patients with metastatic melanoma undergoing immunotherapy. Retrospective observational cohort study evaluating 147 pat...To evaluate frequency and distribution of immune-related adverse events detected by F-FDG PET/CT in patients with metastatic melanoma undergoing immunotherapy. Retrospective observational cohort study evaluating 147 patients with metastatic melanoma treated with immunotherapy and referred for therapy response assessment with F-FDG PET/CT at our institution from January 2010 to August 2022. In total, 201 PET/CT scans performed at various time points were analyzed. IRAEs detected on PET/CT were compared against clinical reference standards, including physical examinations, laboratory tests, and biopsies. Diagnostic performance metrics (sensitivity, specificity, positive predictive value, negative predictive value), and diagnostic yields were calculated. There were 36/147 patients (24.5%) with IRAEs recorded according to standard of reference, with 39 IRAEs in the entire cohort. At time point level, PET/CT identified 36/36 (100%) patients with IRAEs confirmed by the reference standard, while clinical suspicion identified 26/36 (72%) cases. At IRAE level, PET/CT identified 36/39 (92%) of IRAEs confirmed by the reference standard. Thirteen out of 39 (33.3%) cases identified on PET/CT were not suspected clinically but confirmed by the reference standard. The most frequent IRAEs, both suspected clinically and on PET/CT, corresponded to thyroiditis and colitis. Among the PET/CT positive cases, the majority corresponded to grade 2 severity. F-FDG PET/CT is highly effective in detecting IRAEs in patients with metastatic melanoma on immunotherapy, uncovering clinically unsuspected events in up to 33% of cases. These results highlight its important role in early detection, guiding timely interventions, and improving overall outcomes of immunotherapy-related toxicities.
Can Assoc Radiol J
· 2025 Nov · PMID 40299981
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Chronic pelvic pain (CPP) is a debilitating condition affecting up to 26% of women worldwide. Among its many causes, pelvic venous disorders (PeVD) is increasingly recognized as an underdiagnosed contributor, often overl...Chronic pelvic pain (CPP) is a debilitating condition affecting up to 26% of women worldwide. Among its many causes, pelvic venous disorders (PeVD) is increasingly recognized as an underdiagnosed contributor, often overlooked due to its non-specific presentation. PeVD results from venous reflux, or obstruction, leading to venous hypertension, congestion, and chronic pain. Advanced imaging techniques play a pivotal role in diagnosing PeVD, differentiating it from other etiologies of CPP. Ultrasound, particularly Doppler imaging, serves as the firstline modality for assessing venous reflux and dilation. Computed tomography and magnetic resonance venography provide detailed anatomical and haemodynamic evaluations, aiding in the identification of compressive syndromes and collateral pathways. Selective venography remains the gold standard, offering real-time visualization of reflux severity and guiding minimally invasive interventions such as venous embolization. Despite these advances, PeVD remains underrecognized in clinical practice, leading to delays in diagnosis and management. Increased awareness and standardized diagnostic criteria are crucial for improving patient outcomes. A multidisciplinary approach incorporating radiologists, gynecologists, and vascular specialists is essential for the comprehensive evaluation and treatment of PeVD. Emerging therapies, including endovascular techniques, offer promising options for symptom relief, reducing the need for invasive surgical procedures. This review highlights the pathophysiology, imaging modalities, and evolving management strategies for PeVD, emphasizing the importance of early recognition and intervention in patients with CPP.
Can Assoc Radiol J
· 2025 Nov · PMID 40245170
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When discussing leadership, multiple questions arise: what does it mean to be an effective leader?; what are the characteristics of a person that make them so?; and are leaders born, or are they made? Organizations need...When discussing leadership, multiple questions arise: what does it mean to be an effective leader?; what are the characteristics of a person that make them so?; and are leaders born, or are they made? Organizations need effective leaders at all levels, especially in the constant and rapidly changing landscape that is healthcare provision. Those in senior leadership roles should encourage junior team members to engage in leadership activities appropriate to their level of comfort and expertise. Integrity and principle are also essential leadership characteristics, particularly when faced with making decisions that are difficult, or considered to be "unpopular." Organizations that wish to develop and maintain effective leadership programs must ensure that they balance the needs of the organization with those of the leaders. Adequate space must be made to facilitate leadership activities as well as personal, academic, and clinical duties. Ultimately, leadership takes practice and persistence on the part of the leader themselves, but also on the part of the organization in which they work.
Leswick DA, Kulanthaivelu R, Jamil H
… +4 more, Nguyen CL, Munir O, Mirshahvalad SA, Islam O
Can Assoc Radiol J
· 2025 Nov · PMID 40179037
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Medical imaging, including MRI, CT, and nuclear medicine play a critical role in healthcare but also imposes significant environmental burdens due to high energy consumption and waste production. Of the diagnostic modali...Medical imaging, including MRI, CT, and nuclear medicine play a critical role in healthcare but also imposes significant environmental burdens due to high energy consumption and waste production. Of the diagnostic modalities, MRI is the most energy-intensive modality, consuming up to 60 kWh per scan, followed by CT, which ranges from 1.0 to 11.4 kWh per scan. Lifecycle analyses show that operational energy use far exceeds manufacturing emissions, highlighting the need for energy-saving strategies. Implementing standby and power-off modes, optimizing scan protocols, and using AI-driven efficiency improvements can significantly reduce unnecessary energy use. Additionally, sustainable infrastructure, such as variable-flow cooling systems and strategic equipment placement, can further minimize environmental impact. Nuclear medicine, while relatively lower in energy consumption, relies on energy-intensive radioisotope production, often requiring fossil fuel-powered reactors and extensive transport logistics. Contrast agents in MRI and CT pose contamination risks in wastewater, as they are inadequately removed via conventional treatment plants methods. This results in the accumulation of gadolinium and iodinated byproducts in drinking water sources, posing potential human and ecological risks. Nuclear medicine radioisotopes, including Tc-99, also contribute to long-term contamination concerns. Strategies to mitigate these impacts include urine recycling, contrast separation, and advanced wastewater treatment. Sustainable practices in medical imaging require a multi-pronged approach, combining operational efficiency, renewable energy adoption, and stricter waste management protocols. Future efforts may also focus on promoting low-field MRI, AI-driven scan optimization, and alternative contrast agents, ensuring that radiology departments balance diagnostic efficacy with environmental responsibility.