Radiology Overview: Defining Radiology and Stakeholders in the Radiology Enterprise

Mollura, Daniel J.; Mayo-Smith, William W.

doi:10.1007/978-1-4614-0604-4_2

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…The striking lack of published DRL data from lowincome countries suggests that there may be a critical mass of key resources that are required to generate such data. In this context, the notion of the ''radiology enterprise'' is useful (32), being a loose organization of imaging modalities, specialized staff, and quality assurance instrumentation dedicated to the delivery of medical imaging services. It could be that below a certain collective resource threshold, a country's ''radiology enterprise'' is incapable of generating appropriate DRL data.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic reference levels in low- and middle-income countries: early “ALARAm” bells?

2016

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Background: In 1996 the International Commission on Radiological Protection (ICRP) introduced diagnostic reference levels (DRLs) as a quality assurance tool for radiation dose optimization. While many countries have published DRLs, available data are largely from high-income countries. There is arguably a greater need for DRLs in low-and middleincome-countries (LMICs), where imaging equipment may be older and trained imaging technicians are scarce. To date, there has been no critical analysis of the published work on DRLs in LMICs. Such work is important to evaluate data deficiencies and stimulate future quality assurance initiatives. Purpose: To review the published work on DRLs in LMICs and to critically analyze the comprehensiveness of available data. Material and Methods: Medline, Scopus, and Web of Science database searches were conducted for English-language articles published between 1996 and 2015 documenting DRLs for diagnostic imaging in LMICs. Retrieved articles were analyzed and classified by geographical region, country of origin, contributing author, year of publication, imaging modality, body part, and patient age. Results: Fifty-three articles reported DRLs for 28 of 135 LMICs (21%), reflecting data from 26/104 (25%) middle-income countries and 2/31 (6%) low-income countries. General radiography (n ¼ 26, 49%) and computerized tomography (n ¼ 17, 32%) data were most commonly reported. Pediatric DRLs (n ¼ 14, 26%) constituted approximately one-quarter of published work. Conclusion: Published DRL data are deficient in the majority of LMICs, with the paucity most striking in low-income countries. DRL initiatives are required in LMICs to enhance dose optimization.

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Section: Discussionmentioning

confidence: 99%

Diagnostic reference levels in low- and middle-income countries: early “ALARAm” bells?

2016

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Characteristics of the Most Recently Awarded Magnetic Resonance Imaging Patents in the United States

Gaddam

Lemberskiy

Rosenkrantz

2018

Current Problems in Diagnostic Radiology

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2018 FIGO Staging System for Uterine Cervical Cancer: Enter Cross-sectional Imaging

2019

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ynecologic cancers are staged according to the International Federation of Gynecology and Obstetrics (FIGO) system (1). Although a parallel TNM system for gynecologic cancers has been described by the American Joint Committee on Cancer, the FIGO system continues to predominate worldwide in clinical practice and for cancer database reporting (2). The first staging system put forth by FIGO around the turn of the 20th century applied to carcinoma of the uterine cervix, at the time the most common cancer among women in the developed world (3). The most recent revision of the FIGO staging system was announced in 2018 (Table 1). Whereas FIGO staging of most gynecologic cancers relies on surgery and pathologic analysis, uterine cervical cancer is unusual among the gynecologic cancers in that it is staged clinically with pelvic examination, often under anesthesia with bladder cystoscopy and colposcopy, in combination with imaging. Preceding versions of the staging system included imaging with chest and skeletal radiography, intravenous pyelography, and barium enema (4-6). These low-technology choices reflected the demographic reality that nearly 85% of invasive cervical cancer is diagnosed in low-resource settings where advanced imaging modalities are unavailable. Staging according to the old systems (ie, FIGO cervical staging systems from 1999, 2009, and 2014) was inaccurate, with 20%-40% of stage IB-IIIB cancers understaged and up to 64% of stage IIIB cancers overstaged (7-9). Older systems did not include assessment of lymph node metastases, an important determinant for prognosis and treatment planning. Moreover, radical trachelectomy, an emerging fertility-preserving technique in which the uterine corpus is anastomosed to the vagina to treat the many women diagnosed during their reproductive years, was not a consideration with these older systems. To compensate for these shortfalls, treatment planning for invasive cervical cancer in much of the developed world has included modern cross-sectional and functional imaging such as CT, MRI, and fluorine 18 fluorodeoxyglucose, or FDG, PET (10,11). Such pretreatment imaging spared many women the particularly toxic combination of surgery, followed by concurrent chemotherapy and radiation therapy. Instead, they are triaged to one or the other curative, and far less morbid, options (12). The revisions introduced in the 2018 FIGO staging system are intended to address the gap between the staging formalism and ongoing clinical practice and to explicitly acknowledge the role that advanced imaging has come to play in the care of women with invasive uterine cervical cancer (13). In this article, we review the 2018 FIGO staging system for cervical cancer and the new additions relevant to radiologists. Imaging modalities for staging in a range of high-to low-resource practice settings are presented. The standards for image acquisition and interpretation are summarized with cases illustrating potential pitfalls. Finally, we describe how the recommended imaging choices can be directly a...

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Radiology Overview: Defining Radiology and Stakeholders in the Radiology Enterprise

Cited by 3 publications

References 6 publications

Diagnostic reference levels in low- and middle-income countries: early “ALARAm” bells?

Diagnostic reference levels in low- and middle-income countries: early “ALARAm” bells?

Characteristics of the Most Recently Awarded Magnetic Resonance Imaging Patents in the United States

2018 FIGO Staging System for Uterine Cervical Cancer: Enter Cross-sectional Imaging

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