BackgroundElectronic applications are increasingly being used in hospitals for numerous purposes.ObjectiveOur aim was to assess differences in the characteristics of patients who choose paper versus electronic questionnaires and to evaluate the data quality of both approaches.MethodsBetween October 2012 and June 2013, 136 patients participated in a study on diagnosis-induced stress and anxiety. Patients were asked to fill out questionnaires at six different moments during the diagnostic phase. They were given the opportunity to fill out the questionnaires on paper or electronically (a combination of tablet and Web-based questionnaires). Demographic characteristics and completeness of returned data were compared between groups.ResultsNearly two-thirds of patients (88/136, 64.7%) chose to fill out the questionnaires on paper, and just over a third (48/136, 35.3%) preferred the electronic option. Patients choosing electronic questionnaires were significantly younger (mean 47.3 years vs mean 53.5 in the paper group, P=.01) and higher educated (P=.004). There was significantly more missing information (ie, at least one question not answered) in the paper group during the diagnostic day compared to the electronic group (using a tablet) (28/88 vs 1/48, P<.001). However, in the week after the diagnostic day, missing information was significantly higher in the electronic group (Web-based questionnaires) compared to the paper group (41/48 vs 38/88, P<.001).ConclusionsYounger patients and patients with a higher level of education have a preference towards filling out questionnaires electronically. In the hospital, a tablet is an excellent medium for patients to fill out questionnaires with very little missing information. However, for filling out questionnaires at home, paper questionnaires resulted in a better response than Web-based questionnaires.

PURPOSE To compare the diagnostic value of conventional, bilateral diffusion-weighted imaging (DWI) and high-resolution targeted DWI of known breast lesions. MATERIALS AND METHODS Twenty-one consecutive patients with known breast cancer or suspicious breast lesions were scanned with the conventional bilateral DWI technique, a high-resolution, reduced field of view (rFOV) DWI technique and dynamic contrast enhanced MRI (3.0 T). We compared bilateral DWI and rFOV DWI quantitatively by measuring the lesions’ ADC values. For qualitative comparison, three dedicated breast radiologists scored image quality and performed lesion interpretation. RESULTS In a phantom, ADC values were in good agreement with the reference values. Twenty-one patients (30 lesions: 14 invasive carcinomas, 10 benign lesions (of which 5 cysts), 3 high risk and 3 in situ carcinomas) were included. Cysts and high-risk lesions were excluded from the quantitative analysis. Quantitatively, both bilateral and rFOV DWI measured lower ADC values in invasive tumors than other lesions. In vivo, rFOV DWI gave lower ADC values than bilateral DWI (1.11× 10−3 mm2/s vs. 1.24 × 10−3 mm2/s, P=0.002). ROIs were comparable in size between the two techniques (2.90 vs. 2.13 cm2, P=0.721). Qualitatively, all three radiologists scored sharpness of rFOV DWI images as significantly higher than bilateral DWI (P ≤ 0.002). ROC curve analysis showed a higher AUC in BI-RADS classification for rFOV DWI compared to bilateral DWI (0.71 to 0.93 vs. 0.61 to 0.76, respectively). CONCLUSION Tumor morphology can be assessed in more detail with high-resolution DWI (rFOV) than with standard bilateral DWI by providing significantly sharper images.

Purpose Radioembolization based on personalized treatment planning requires established doseresponse and dose-toxicity relationships. The aim of this study was to investigate dose-response and dose-toxicity relationships in patients with colorectal liver metastases (CRLM) treated with glass yttrium-90 ( 90 Y)-microspheres. Methods All CRLM patients treated with glass 90 Y-microspheres in our institution were retrospectively analyzed. The tumor-absorbed dose was calculated for each measurable metastasis (i.e., 18 F-FDG-positive and >5 mL tumor volume) on post-treatment 90 Y-PET. Metabolic tumor response was determined on 18 F-FDG-PET/CT by measuring the total lesion glycolysis at baseline and at three months post-treatment. The relationship between tumor-absorbed dose and metabolic response was determined on a per lesion and per patient basis using a linear mixed-effects regression model. Clinical and laboratory toxicity were correlated with healthy liver-absorbed dose. Results Thirty-one patients were included. The median tumor-absorbed dose of 85 measurable metastases was 133 Gy (range 20-1001 Gy). Per response category this was 196 Gy for complete response (CR), 177 Gy for partial response (PR), 72 Gy for stable disease, and 95 Gy for progressive disease (PD). A significant dose-response relationship was found on a tumor level with a significantly higher tumor-absorbed dose in metastases with CR (+94%) and PR (+74%) compared to metastases with PD, p<0.001. A similar relationship was found on a patient level, with PR having a higher tumor-absorbed dose compared to PD (+58%, p=0.044). A tumor-absorbed dose of >139 Gy predicted three-month metabolic response with the greatest accuracy (89% specificity, 77% sensitivity), while a tumor-absorbed dose of >189 Gy predicted response with 97% specificity and 45% sensitivity. The median healthy liver-absorbed dose was 63 Gy (range: 24-113 Gy).Toxicity was mostly limited to grade 1-2, with one case of radioembolization-induced liver disease who received the highest healthy liver-absorbed dose. A positive trend was seen for most laboratory parameters in our dose-toxicity analysis. Conclusion A significant relation was observed between dose and response in CRLM patients treated with glass 90 Y-radioembolization.

Available scientific evidence suggests that RSL is a safe and accurate technique for localization of non-palpable breast lesions.