Kellow ZS, Alikhassi A, Bane A
… +14 more, Bissell MB, Cordeiro E, Dhamanaskar K, Jessup J, Kirwan RC, Ko G, Kos Z, Kulkarni A, Lambert CC, Martin T, McKevitt E, Solorzano S, Zahra S, Ward C
Can Assoc Radiol J
· 2025 Nov · PMID 40167651
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There are few recommendations in Canada to assist clinicians in selecting appropriate biopsy techniques (fine-needle aspiration, core-needle biopsy, vacuum-assisted biopsy, vacuum-assisted excision) and imaging technolog...There are few recommendations in Canada to assist clinicians in selecting appropriate biopsy techniques (fine-needle aspiration, core-needle biopsy, vacuum-assisted biopsy, vacuum-assisted excision) and imaging technologies (mammography, ultrasound, magnetic resonance imaging, contrast-enhanced mammography) for biopsy guidance. Limited existing recommendations from other countries do not consider the unique aspects of the Canadian healthcare system. To address this gap, 17 experts participated in a modified Delphi panel to reach consensus on biopsy-related topics and provide recommendations. The panel was comprised of 12 radiologists, 2 pathologists, and 3 surgeons from 6 provinces across Canada. Panelists engaged in two rounds of anonymized voting, with an in-person discussion held between the rounds. The modified Delphi panel adhered to best practices, including establishing consensus definitions prior to voting, utilizing anonymized voting, and abstaining from communication among panelists before the in-person meeting. A rigorous statistical approach was utilized to analyze the points of agreement and disagreement. Consensus findings covered a wide range of topics, including recommendations for initial biopsy technique based on lesion type and imaging modality, patient management or rebiopsy considerations after the initial biopsy, procedural recommendations (i.e., gauge size, number of samples), patient considerations (i.e., drug allergies, pregnancy). Overall, 347 individual items were included in the final analysis, 286 (82%) of which achieved consensus. These consensus recommendations intend to offer general recommendations to help standardize and improve practices across Canada and were endorsed by the Canadian Society of Breast Imaging. However, they should be evaluated in the context of each individual case and emerging evidence.
Gupta N, Hiremath SB, Gauthier I
… +2 more, Wilson N, Miller E
Can Assoc Radiol J
· 2025 Nov · PMID 40165030
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Ultrasound (US) is an invaluable tool for evaluating the neonatal spine, offering a non-invasive, cost-effective, and radiation-free imaging alternative. This article reviews the indications, techniques, and sonographic...Ultrasound (US) is an invaluable tool for evaluating the neonatal spine, offering a non-invasive, cost-effective, and radiation-free imaging alternative. This article reviews the indications, techniques, and sonographic features of congenital and acquired spinal pathologies in neonates. Common indications include the evaluation of atypical sacral dimples, spinal anomalies such as tethered cord and syringomyelia, congenital tumours like sacrococcygeal teratomas, and post-traumatic conditions such as spinal hematomas. Detailed sonographic spine anatomy, variants, and ultrasound guidance for interventions like lumbar puncture are also discussed. By enabling early diagnosis, US is crucial in guiding clinical management, especially in pediatric populations with spinal disorders.
DesRoche C, Soulez G, Boucher L
… +2 more, Fohlen A, Menard A
Can Assoc Radiol J
· 2025 Nov · PMID 40131782
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Environmental degradation and climate change pose an increasingly serious threat to global health, necessitating urgent action to implement environmentally sustainable healthcare practices. Interventional radiology (IR)...Environmental degradation and climate change pose an increasingly serious threat to global health, necessitating urgent action to implement environmentally sustainable healthcare practices. Interventional radiology (IR) is a resource-intensive specialty that has not historically emphasized environmental sustainability. This review aims to examine the environmental impact of IR and highlight opportunities for transitioning to more sustainable practices within the IR suite. The environmental impact of IR is assessed in 3 critical domains: (1) energy consumption, (2) waste production, and (3) water pollution. For each domain, actionable strategies are proposed to mitigate environmental harm. Key actions include powering down equipment when not in use, utilizing energysaving modes, minimizing the reliance on single-use items where possible, collaborating with industry to reduce excessive packaging, and implementing recycling programs for waste and iodinated contrast media, along with incorporating environmental sustainability as a quality metric in the departments quality improvement program. Barriers to adopting environmentally sustainable changes include a lack of awareness, financial considerations, and the absence of government, institutional, and industry regulations. Leadership from professional societies and collaboration with industry partners will be essential for driving systemic change. However, individual departments can take action to foster a culture of environmental responsibility and implement sustainable practices.
Can Assoc Radiol J
· 2025 Nov · PMID 40129035
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Report structures in radiology can be free-text or structured formats. There are currently no guidelines regarding optimal reporting structure for neuroradiological studies. Clear and efficient reports are essential to f...Report structures in radiology can be free-text or structured formats. There are currently no guidelines regarding optimal reporting structure for neuroradiological studies. Clear and efficient reports are essential to facilitating communication between healthcare providers. This project characterizes and compares preferred radiological reporting structures in neuroradiology among physicians. A REDCap survey including questions on practice environments, satisfaction with current reports, and preferences in report structures for 7 studies: MRI Lumbar Spine, MRI Sella, MRI Dementia, MRI Glioma, MRI Brain Metastases, CTA Head and Neck, and CT Unenhanced Brain was drafted and reviewed by radiologists. This anonymous survey collected responses from radiologists and physicians who read neuroradiology reports across the Greater Toronto Area. The survey received 89 responses. Structured reports were preferred over free-text reports across all specialties for each study. Notably, a large proportion (37/44, 84.1%) preferred having structured reports for CTA head and neck. Preferences for MRI Brain Glioma were relatively mixed, with some respondents favouring free-text reports (8/24, 33.3%) and others preferring structured reports (13/24, 54.2%). Respondents preferring structured reports cited "ease in finding information" as the most common reason, while those favouring free-text reports chose "fewer unnecessary sections" most often. This study identifies opportunities to improve the organization and standardization of information in radiology reports. The consistent preference for structured reports highlights the need for guidelines to optimize radiological reporting and enhance communication between specialties.
Kashif Al-Ghita M, Dawit H, Kazi S
… +10 more, Adamo RG, Islam N, Karpinski S, Salameh JP, Lam E, Osman H, Ansari D, Korevaar DA, Bossuyt PM, McInnes MDF
Can Assoc Radiol J
· 2025 Nov · PMID 40091202
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Adherence of diagnostic accuracy imaging research to the STARD 2015 reporting guideline was assessed at baseline in 2016; on average, only 55% of 30 items were reported. Several knowledge translation strategies have sinc...Adherence of diagnostic accuracy imaging research to the STARD 2015 reporting guideline was assessed at baseline in 2016; on average, only 55% of 30 items were reported. Several knowledge translation strategies have since been implemented by the STARD group. The purpose of this study was to evaluate the adherence of diagnostic accuracy studies recently published in imaging journals to STARD 2015, to assess for changes in the level of adherence relative to the baseline study. We performed an electronic search on MEDLINE for diagnostic accuracy studies, published between May and June of 2024, from a select group of imaging journals. The timespan was modulated to achieve a sample size of 100 to 150 included studies. Overall and item-specific adherence to STARD 2015 was evaluated, in addition to associations with journal of publication, imaging modality, study design, country of corresponding author, imaging subspecialty area, journal impact factor, and journal STARD adoption. Statistical comparison to the baseline study from 2016 was also performed. Poisson Regression and two-tailed student's tests were used to compare STARD adherence relative to variables included in subgroup analysis. In the 126 included studies, average adherence to STARD 2015 was 61% (18.3/30 items; SD = 3.1), improved compared to the baseline study (55%; 16.6/30 items; SD = 2.2; < .0001). Studies published in higher impact factor journals reported more items than those in lower impact factor journals (20.6 vs 18.4 items, -value <.0001). There was no significant association between reporting completeness and journal of publication ( = .7), imaging modality ( = .21), country of corresponding author ( = .46), imaging subspecialty ( = .31), and journal STARD adoption status ( = .55). Recently published diagnostic accuracy studies reported more STARD 2015 items than studies published in 2016, but completeness of reporting is still not optimal.
Can Assoc Radiol J
· 2025 Nov · PMID 40071738
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Climate change, biodiversity loss, and pollution are disrupting earth's biophysical systems, with adverse effects on local and global human health. Planetary health describes the inextricable link between human health an...Climate change, biodiversity loss, and pollution are disrupting earth's biophysical systems, with adverse effects on local and global human health. Planetary health describes the inextricable link between human health and the health of earth's biophysical systems. There is urgent need for a stronger focus on planetary health among healthcare systems and radiology departments. Medical imaging is a substantial contributor to climate change, responsible for 0.8% to 1% of global greenhouse gas emissions. As demands for medical imaging continue to grow, so will the need for radiologists to provide leadership in environmentally sustainable medical imaging. Mitigation strategies targeting overall reductions in environmental impact are pivotal including reducing the energy consumption of medical imaging equipment and establishing a circular supply chain to reduce unnecessary waste. In addition, radiology departments will need to focus on adaptative measures which build resiliency to the impacts of climate change, some of which will be unavoidable. This review aims to define planetary healthcare in the context of radiology and provide a framework within which to consider specific actions to reduce the environmental footprint of medically necessary medical imaging.
Can Assoc Radiol J
· 2025 Nov · PMID 40071690
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This study investigates the impact of deep learning-based contrast boosting (DL-CB) on image quality and measurement reliability in low-contrast media (low-CM) CT for pre-transcatheter aortic valve replacement (TAVR) ass...This study investigates the impact of deep learning-based contrast boosting (DL-CB) on image quality and measurement reliability in low-contrast media (low-CM) CT for pre-transcatheter aortic valve replacement (TAVR) assessment. This retrospective study included TAVR candidates with renal dysfunction who underwent low-CM (30-mL: 15-mL bolus of contrast followed by 50-mL of 30% iomeprol solution) pre-TAVR CT between April and December 2023, along with matched standard-CM controls (n = 68). Low-CM images were reconstructed as conventional, 50-keV, and DL-CB images. Qualitative and quantitative image quality were compared among image sets. The aortic annulus was measured by 2 independent readers on low-CM CT images, and interobserver reliability was assessed. DL-CB significantly improved contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) compared to conventional and 50-keV images (CNR: 12.5-13.4, 18-19.8, and 21.9-24; SNR: 10.8-15.5, 10.7-15.5, and 16.8-26.7 on conventional, 50-keV, and DL-CB images, respectively; < .001). DL-CB achieved comparable CNR (21.9-24 vs 27-27.7, = .39-.61) and comparable to slightly higher SNR (16.8-26.7 vs 15.7-20.2, = .003-.80) to standard-CM images. For aortic annular measurement, DL-CB demonstrated high interobserver reliability, with an intraclass correlation coefficient (ICC) of .96 and small mean differences (area: 0.01 cm², limits of agreement [LoA]: -0.52 to 0.55 cm²; perimeter: 0.02 mm, LoA: -4.49 to 4.53 mm). DL-CB improves image quality and provides high measurement reliability in low-CM CT for pre-TAVR assessment in patients with renal dysfunction, without requiring dual-energy CT.
Castillo F, Taboun O, Farag Alla J
… +2 more, Yankova K, Hanneman K
Can Assoc Radiol J
· 2025 Nov · PMID 40019143
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Climate change is the most important challenge of this century. Global surface temperature is continuously rising to new record highs, adversely affecting the health of the planet and humans. The purpose of this article...Climate change is the most important challenge of this century. Global surface temperature is continuously rising to new record highs, adversely affecting the health of the planet and humans. The purpose of this article is to review the impact of climate related environmental exposures on human health, healthcare delivery, and medical imaging and explore the potential to leverage medical imaging as a non-invasive tool to advance our understanding of climate related health effects. Radiology departments and healthcare systems must focus on building resilience to the effects of climate change while ensuring that the delivery of care is environmentally sustainable. Further research is needed to refine our understanding of the effects of climate change on human health and to forecast the expected changes in the demand for healthcare and radiology services.
Taylor JL, Adams SJ, Dennie C
… +3 more, Lim R, McInnis M, Manos D
Can Assoc Radiol J
· 2025 Nov · PMID 40016863
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Lung cancer is the second-most diagnosed cancer and the leading cause of cancer-related death in Canada. The updated CAR/CSTR Practice Guideline on CT Screening for Lung Cancer reflects advancements in evidence since the...Lung cancer is the second-most diagnosed cancer and the leading cause of cancer-related death in Canada. The updated CAR/CSTR Practice Guideline on CT Screening for Lung Cancer reflects advancements in evidence since the 2016 guideline, including findings from the NELSON trial and preliminary data from multiple provincial lung cancer screening programs, and aims to support Canadian diagnostic imaging departments in implementing organized lung cancer screening programs. The guideline emphasizes screening with the use of low-dose CT (LDCT) to reduce lung cancer mortality in appropriately selected individuals with increased risk of lung cancer, using eligibility criteria based on risk prediction models such as the PLCO. It outlines training requirements for radiologists, standardized CT and reporting protocols, quality assurance measures, and the integration of AI tools for nodule risk stratification. The document also highlights emerging areas for investigation, including the potential for biennial screening and equitable access to programs across Canada.
Amin P, Malik A, Mcinnes MDF
… +2 more, Brown MJ, Szava-Kovats A
Can Assoc Radiol J
· 2025 Nov · PMID 40016862
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The rising global burden of cancer drives increased demands for medical imaging, which is essential throughout cancer care. However, delivering medical imaging presents significant environmental challenges including high...The rising global burden of cancer drives increased demands for medical imaging, which is essential throughout cancer care. However, delivering medical imaging presents significant environmental challenges including high energy use, reliance on single-use supplies, and the production of environmental pollutants. Environmental factors, such as ultraviolet radiation, wildfire smoke, and carcinogenic pollutants contribute to rising cancer rates, while extreme weather events driven by climate change disrupt cancer care delivery-highlighting the close connection between patient and planetary health. This review explores opportunities to improve the environmental sustainability of oncologic imaging, emphasizing the importance of patient-relevant outcomes-such as quality of life and overall survival-as a guiding principle in cancer care. Key strategies include optimizing imaging schedules to reduce low-value imaging, selecting modalities with lower environmental impact where clinically appropriate, minimizing waste streams, and adopting energy-efficient practices. Artificial intelligence offers the potential to personalize imaging schedules and improve efficiency, though its benefits must be weighed against energy use. Mobile imaging programs and integrated scheduling reduce patient travel-related emissions while promoting health equity, particularly in underserved communities. Future research should focus on optimizing imaging intervals to address patient-relevant outcomes better, expanding the use of abbreviated imaging protocols, and the judicious deployment of artificial intelligence, ensuring its benefits justify energy use.
Can Assoc Radiol J
· 2025 Nov · PMID 40016861
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Large language models (LLMs) have the potential to support clinical decision-making but often lack training on the latest clinical guidelines. Retrieval-augmented generation (RAG) may enhance guideline adherence by dynam...Large language models (LLMs) have the potential to support clinical decision-making but often lack training on the latest clinical guidelines. Retrieval-augmented generation (RAG) may enhance guideline adherence by dynamically integrating external information. This study evaluates the performance of two LLMs, GPT-4o and o1-mini, with and without RAG, in adhering to Canadian radiology guidelines for incidental hepatobiliary findings. A customized RAG architecture was developed to integrate guideline-based recommendations into LLM prompts. Clinical cases were curated and used to prompt models with and without RAG. Primary analyses assessed the rate of guideline adherence with comparisons made between LLMs with and without RAG. Secondary analyses evaluated reading ease, grade level, and response times for generated outputs. A total of 319 clinical cases were evaluated. Adherence rates were 81.7% for GPT-4o without RAG, 97.2% for GPT-4o with RAG, 79.3% for o1-mini without RAG, and 95.1% for o1-mini with RAG. Model performance differed significantly across groups, with RAG-enabled configurations outperforming their non-RAG counterparts ( < .05). RAG-enabled models demonstrated improved reading ease and lower grade level scores; however, all model outputs remained at advanced comprehension levels. Response times for RAG-enabled models increased slightly due to additional retrieval processing but remained clinically acceptable. RAG-enabled LLMs significantly improved adherence to Canadian radiology guidelines for incidental hepatobiliary findings without compromising readability or response times. This approach holds promise for advancing evidence-based care and warrants further validation across broader clinical settings.
Can Assoc Radiol J
· 2025 Nov · PMID 40008968
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This shadow deployment evaluated an externally-developed AI tool to predict disposition using chest X-rays (CXR) in patients with community-acquired pneumonia (CAP) in the Emergency Department (ED). Retrospective and pro...This shadow deployment evaluated an externally-developed AI tool to predict disposition using chest X-rays (CXR) in patients with community-acquired pneumonia (CAP) in the Emergency Department (ED). Retrospective and prospective external validations were conducted to assess differences between the 2 evaluations and across subgroups to inform deployment decisions. The CNN was retrospectively validated (n = 17 689) from November 1, 2020, to June 30, 2021, and prospectively validated on "suspected-CAP" patients (n = 3062) from Jan 1 to Jan 31, 2023. Calibration and standard metrics, including AUC, accuracy, sensitivity, specificity, PPV, and NPV, were calculated. Subgroup analyses were conducted for age, sex, modality, and CXR projection (PA vs AP). The model's AUC was 67% in both validations. The prospective evaluation showed a non-significant increase in sensitivity (65% vs 59%) and PPV (64% vs 63%), while specificity (68% vs 73%) and NPV (69% vs 70%) slightly decreased. NPV was very high for younger patients in the prospective evaluation (95%); PPV was moderately high for older patients (81%). Sensitivity dropped significantly in females under 31 years (50%), and specificity was reduced in females over 86 years (38%). This study showed moderate, consistent performance in both retrospective and prospective validations. While this consistency is encouraging, further direct comparisons are needed to determine whether both validation approaches are necessary in different clinical settings. Subgroup analysis suggests the tool may be helpful to accelerate discharge in younger patients (high NPV) and possibly for admission in older patients (high PPV).
Rockall AG, Allen B, Brown MJ
… +12 more, El-Diasty T, Fletcher J, Gerson RF, Goergen S, Marrero González AP, Grist TM, Hanneman K, Hess CP, Ho ELM, Salama DH, Schoen J, Sheard S
Can Assoc Radiol J
· 2025 Aug · PMID 40007055
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The urgency for climate action is recognised by international government and healthcare organisations, including the United Nations (UN) and World Health Organisation (WHO). Climate change, biodiversity loss, and polluti...The urgency for climate action is recognised by international government and healthcare organisations, including the United Nations (UN) and World Health Organisation (WHO). Climate change, biodiversity loss, and pollution negatively impact all life on earth. All populations are impacted but not equally; the most vulnerable are at highest risk, an inequity further exacerbated by differences in access to healthcare globally.The delivery of healthcare exacerbates the planetary health crisis through greenhouse gas emissions, largely due to combustion of fossil fuels for medical equipment production and operation, creation of medical and non-medical waste, and contamination of water supplies.As representatives of radiology societies from across the globe who work closely with industry, and both governmental and non-governmental leaders in multiple capacities, we advocate together for urgent, impactful, and measurable changes to the way we deliver care by further engaging our members, policymakers, industry partners, and our patients. Simultaneous challenges including global health disparities, resource allocation, and access to care must inform these efforts.Climate literacy should be increasingly added to radiology training programmes. More research is required to understand and measure the environmental impact of radiological services and inform mitigation, adaptation and monitoring efforts. Deeper collaboration with industry partners is necessary to support innovations in the supply chain, energy utilization, and circular economy. Many solutions have been proposed and are already available, but we must understand and address barriers to implementation of current and future sustainable innovations. Finally, there is a compelling need to partner with patients, to ensure that trust in the excellence of clinical care is maintained during the transition to sustainable radiology.By fostering a culture of global cooperation and rapid sharing of solutions amongst the broader imaging community, we can transform radiological practice to mitigate its environmental impact, adapt and develop resilience to current and future climate and environmental threats, and simultaneously improve access to care.
Barat M, Greffier J, Si-Mohamed S
… +5 more, Dohan A, Pellat A, Frandon J, Calame P, Soyer P
Can Assoc Radiol J
· 2025 Aug · PMID 39985297
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Publisher ↗
Pancreatic cancer continues to pose daily challenges to clinicians, radiologists, and researchers. These challenges are encountered at each stage of pancreatic cancer management, including early detection, definite chara...Pancreatic cancer continues to pose daily challenges to clinicians, radiologists, and researchers. These challenges are encountered at each stage of pancreatic cancer management, including early detection, definite characterization, accurate assessment of tumour burden, preoperative planning when surgical resection is possible, prediction of tumour aggressiveness, response to treatment, and detection of recurrence. CT imaging of the pancreas has made major advances in recent years through innovations in research and clinical practice. Technical advances in CT imaging, often in combination with imaging biomarkers, hold considerable promise in addressing such challenges. Ongoing research in dual-energy and spectral photon-counting computed tomography, new applications of artificial intelligence and image rendering have led to innovative implementations that allow now a more precise diagnosis of pancreatic cancer and other diseases affecting this organ. This article aims to explore the major research initiatives and technological advances that are shaping the landscape of CT imaging of the pancreas. By highlighting key contributions in diagnostic imaging, artificial intelligence, and image rendering, this article provides a comprehensive overview of how these innovations are enhancing diagnostic precision and improving outcome in patients with pancreatic diseases.
Can Assoc Radiol J
· 2025 Aug · PMID 39982450
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Breast ultrasound is one of several tools proposed for supplemental screening of women with dense breasts but is not widely available in Canada. An IRB-approved, evaluation of ultrasound-guided breast biopsies prompted...Breast ultrasound is one of several tools proposed for supplemental screening of women with dense breasts but is not widely available in Canada. An IRB-approved, evaluation of ultrasound-guided breast biopsies prompted by screening breast ultrasound performed from August 1, 2021, to December 31, 2022, offered to asymptomatic women with category C and D breast tissue density after normal screening mammography (2D) in the provincial organized screening program, or surveillance diagnostic mammography after breast cancer. Risk factors, stage (AJCC 8th ed), incremental cancer detection rate (ICDR), biopsy rates, and positive predictive values for biopsy (PPV3) were evaluated. 5257 women were screened, yielding 247 women (ages 34-82, median age of 56) who underwent biopsies (281 masses), 32 of whom were diagnosed with breast cancer, 27 invasive and 5 DCIS for PPV3 13.0% (32/247), and ICDR 6.1/1000. Ductal cancers found were stage 0 in 5/32 (15.6%), stage 1A in 18/32 (56.3%), and stage 1B in 2/32 (6.3%), 1 ductal/lobular cancer was stage 3B (3.1%), 5 lobular cancers (16.6%) were stage 1A (1), 1B (2), and 2B (2) and 1 adenoid cystic carcinoma was stage 2A (3.1%); 3 cancers were found on incident and 29 on prevalent screens, 27 (84.4%) in category c and 20 (62.5%) in women with no personal or first-degree family history of breast cancer. A high ICDR for screening breast ultrasound of 6.1/1000 was found. In women with dense breasts screened with 2D mammography where access to supplemental screening with MRI and contrast mammography is limited, supplemental screening ultrasound can play a significant role in cancer detection with a high ICDR in women in both category c and d densities that is higher than in jurisdictions offering annual screening mammography, or where MRI is used for surveillance after cancer.