BackgroundMeasures of tumour heterogeneity derived from 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans are increasingly reported as potential biomarkers of non-small cell lung cancer (NSCLC) for classification and prognostication. Several segmentation algorithms have been used to delineate tumours, but their effects on the reproducibility and predictive and prognostic capability of derived parameters have not been evaluated. The purpose of our study was to retrospectively compare various segmentation algorithms in terms of inter-observer reproducibility and prognostic capability of texture parameters derived from non-small cell lung cancer (NSCLC) 18F-FDG PET/CT images.Fifty three NSCLC patients (mean age 65.8 years; 31 males) underwent pre-chemoradiotherapy 18F-FDG PET/CT scans. Three readers segmented tumours using freehand (FH), 40% of maximum intensity threshold (40P), and fuzzy locally adaptive Bayesian (FLAB) algorithms. Intraclass correlation coefficient (ICC) was used to measure the inter-observer variability of the texture features derived by the three segmentation algorithms. Univariate cox regression was used on 12 commonly reported texture features to predict overall survival (OS) for each segmentation algorithm. Model quality was compared across segmentation algorithms using Akaike information criterion (AIC).Results40P was the most reproducible algorithm (median ICC 0.9; interquartile range [IQR] 0.85–0.92) compared with FLAB (median ICC 0.83; IQR 0.77–0.86) and FH (median ICC 0.77; IQR 0.7–0.85). On univariate cox regression analysis, 40P found 2 out of 12 variables, i.e. first-order entropy and grey-level co-occurence matrix (GLCM) entropy, to be significantly associated with OS; FH and FLAB found 1, i.e., first-order entropy. For each tested variable, survival models for all three segmentation algorithms were of similar quality, exhibiting comparable AIC values with overlapping 95% CIs.ConclusionsCompared with both FLAB and FH, segmentation with 40P yields superior inter-observer reproducibility of texture features. Survival models generated by all three segmentation algorithms are of at least equivalent utility. Our findings suggest that a segmentation algorithm using a 40% of maximum threshold is acceptable for texture analysis of 18F-FDG PET in NSCLC.

Objective: Dizziness is a sensation of spatial disorientation of rotating or non-rotating in nature, mostly due to Oto-neurological insults. A symptom-specific dizziness handicap inventory may aid in understanding the severity of the condition and its impact on the quality of life. Therefore, the Dizziness Handicap Inventory-English version (DHI-E) was used as the most reliable subjective tool to assess the effect of dizziness in various aspects of life and so was translated into several languages. Hence, the present study aimed at developing and standardizing the self-administering Dizziness Handicap Inventory -Gujarati version (DHI-G). Methods:A cross-sectional survey design was performed. 50 participants, i.e. 18 males and 32 females aged between 15 to 55 years with complaints of vertigo/dizziness were recruited for the study. The questionnaire was re-administered to thirty of the total participants after 10 days of initial administration for examining test-retest reliability.Results: DHI-G achieved an overall alpha score of 0.92 suggesting good internal consistency and the score of 0.84, 0.82 and 0.81 on three subscales i.e. physical, functional and emotional respectively. Intra class correlation (ICC) revealed good test-retest reliability with a score of 0.81. Conclusion:DHI-G can be used as a reliable and valid tool in the clinical and research setting extensively.

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Aims Uncomplicated acute diverticulitis is conventionally treated with antibiotics. Emerging evidence has suggested a non-antimicrobial approach in systemically well patients is a safe alternative strategy. Our aim was to assess adherence to national (NICE) & international (WJES) guidelines for uncomplicated cases. Methodology Data was gathered from PACS imaging & discharge summaries retrospectively (1st October 2020–1st March 2021).The inclusion criteria was: CT confirmed cases of modified Hinchey stage 0 or 1a. The cohort was stratified into systemically well or unwell based on: admission CRP <150, observation score <2 (NICE sepsis stratification), immunocompetance status & Charlson score <3, as evidenced in the literature. Results There were 48 patients included (female 29 vs male 19). The number of systemically well patients was 32 (67%) & unwell 16 (33%). Compliance to guidance 1 (NICE) - ‘systemically well & therefore no antibiotics’, was low with only 2/32 (6%) patients. Of the remaining, 14/30 (47%) were given intravenous antibiotics. Compliance to guidance 2 (NICE) - ‘systemically unwell & therefore oral antibiotics’, was 4/16 (25%) with the remaining majority of 12/16 (75%) treated with intravenous form. The median number of inpatient nights was 1.48 (well: 1.28 vs unwell: 1.88). Conclusions The majority of patients with uncomplicated diverticulitis were systemically well. Compliance with guidelines on antimicrobial strategy was low. The incorporation of a risk stratification tool as demonstrated, allows for identification of patients that be discharged (with ambulatory follow up) after assessment. CT scans should be reviewed by radiologists with a multidisciplinary discussion on the most appropriate antimicrobial strategy.

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