暂无摘要。

BACKGROUND. The 2022 Society of Radiologists in Ultrasound (SRU) consensus conference recommendations for small gallbladder polyps support management that is less aggressive than earlier approaches and may help standardize evaluation of polyps by radiologists. OBJECTIVE. The purpose of the present study was to assess the interreader agreement of radiologists in applying SRU recommendations for management of incidental gallbladder polyps on ultrasound. METHODS. This retrospective study included 105 patients (75 women and 30 men; median age, 51 years) with a gallbladder polyp on ultrasound (without features highly suspicious for invasive or malignant tumor) who underwent cholecystectomy between January 1, 2003, and January 1, 2021. Ten abdominal radiologists independently reviewed ultrasound examinations and, using the SRU recommendations, assessed one polyp per patient to assign risk category (extremely low risk, low risk, or indeterminate risk) and make a possible recommendation for surgical consultation. Five radiologists were considered less experienced (< 5 years of experience), and five were considered more experienced (≥ 5 years of experience). Interreader agreement was evaluated. Polyps were classified pathologically as nonneoplastic or neoplastic. RESULTS. For risk category assignments, interreader agreement was substantial among all readers (k = 0.710), less-experienced readers (k = 0.705), and more-experienced readers (k = 0.692). For surgical consultation recommendations, inter-reader agreement was substantial among all readers (k = 0.795) and more-experienced readers (k = 0.740) and was almost perfect among less-experienced readers (k = 0.811). Of 10 readers, a median of 5.0 (IQR, 2.0-8.0), 4.0 (IQR, 2.0-7.0), and 0.0 (IQR, 0.0-0.0) readers classified polyps as extremely low risk, low risk, and indeterminate risk, respectively. Across readers, the percentage of polyps classified as extremely low risk ranged from 32% to 72%; as low risk, from 24% to 65%; and as indeterminate risk, from 0% to 8%. Of 10 readers, a median of zero change to 0 (IQR, 0.0-1.0) readers recommended surgical consultation; the percentage of polyps receiving a recommendation for surgical consultation ranged from 4% to 22%. Of a total of 105 polyps, 102 were nonneo-plastic and three were neoplastic (all benign). Based on readers\' most common assessments for nonneoplastic polyps, the risk category was extremely low risk for 53 polyps, low risk for 48 polyps, and indeterminate risk for one polyp; surgical consultation was recommended for 16 polyps. CONCLUSION. Ten abdominal radiologists showed substantial agreement for polyp risk categorizations and surgical consultation recommendations, although areas of reader variability were identified. CLINICAL IMPACT. The findings support the overall reproducibility of the SRU recommendations, while indicating opportunity for improvement.

Purpose: To evaluate the accuracy of GPT-3.5, GPT-4, and a fine-tuned GPT-3.5 model in applying Fleischner Society recommendations to lung nodules. Methods: We generated 10 lung nodule descriptions for each of the 12 nodule categories from the Fleischner Society guidelines, incorporating them into a single fictitious report (n = 120). GPT-3.5 and GPT-4 were prompted to make follow-up recommendations based on the reports. We then incorporated the full guidelines into the prompts and re-submitted them. Finally, we re-submitted the prompts to a fine-tuned GPT-3.5 model. Results were analyzed using binary accuracy analysis in R. Results: GPT-3.5 accuracy in applying Fleischner Society guidelines was 0.058 (95% CI: 0.02, 0.12). GPT-4 accuracy was improved at 0.15 (95% CI: 0.09, 0.23; P = .02 for accuracy comparison). In recommending PET-CT and/or biopsy, both GPT-3.5 and GPT-4 had an F-score of 0.00. After explicitly including the Fleischner Society guidelines in the prompt, GPT-3.5 and GPT-4 significantly improved their accuracy to 0.42 (95% CI: 0.33, 0.51; P < .001) and to 0.66 (95% CI: 0.57, 0.74; P < .001), respectively. GPT-4 remained significantly better than GPT-3.5 (P < .001). The fine-tuned GPT-3.5 model accuracy was 0.46 (95% CI: 0.37, 0.55), not different from the GPT-3.5 model with guidelines included (P = .53). Conclusion: GPT-3.5 and GPT-4 performed poorly in applying widely known guidelines and never correctly recommended biopsy. Flawed knowledge and reasoning both contributed to their poor performance. While GPT-4 was more accurate than GPT-3.5, its inaccuracy rate was unacceptable for clinical practice. These results underscore the limitations of large language models for knowledge and reasoning-based tasks.

BACKGROUND:  Due to the greater use of high-resolution cross-sectional imaging, the number of incidental pulmonary nodules detected each year is increasing. Although the vast majority of incidental pulmonary nodules are benign, many early lung carcinomas could be diagnosed with consistent follow-up. However, for a variety of reasons, the existing recommendations are often not implemented correctly. Therefore, potential for improvement with respect to competence, communication, structure, and process is described.
METHODS:  This article presents the recommendations for incidental pulmonary nodules from the current S3 guideline for lung cancer (July 2023). The internationally established recommendations (BTS guidelines and Fleischner criteria) are compared and further studies on optimized management were included after a systematic literature search in PubMed.
CONCLUSIONS:  In particular, AI-based software solutions are promising, as they can be used in a support capacity on several levels at once and can lead to simpler and more automated management. However, to be applicable in routine clinical practice, software must fit well into the radiology workflow and be integrated. In addition, \"Lung Nodule Management\" programs or clinics that follow a high-quality procedure for patients with incidental lung nodules or nodules detected by screening have been established in the USA. Similar structures might also be implemented in Germany in a future screening program in which patients with incidental pulmonary nodules could be included.
CONCLUSIONS:   · Incidental pulmonary nodules are common but are often not adequately managed. · The updated S3 guideline for lung cancer now includes recommendations for incidental pulmonary nodules. · Competence, communication, structure, and process levels offer significant potential for improvement.
UNASSIGNED: · Glandorf J, Vogel-Claussen J, . Incidental pulmonary nodules - current guidelines and management. Fortschr Röntgenstr 2024; 196: 582 - 590.
UNASSIGNED:  Aufgrund der immer häufiger durchgeführten hochaufgelösten Schnittbildgebung steigt die Anzahl der jährlich detektierten inzidentellen Lungenrundherde. Obwohl die allermeisten inzidentellen Lungenrundherde gutartig sind, ließen sich durch eine konsequente Nachverfolgung viele frühe Lungenkarzinome diagnostizieren. Aus vielfältigen Gründen werden die existierenden Handlungsempfehlungen jedoch häufig nicht korrekt umgesetzt. Daher werden Verbesserungspotenziale auf den Ebenen der Kompetenz, Kommunikation, Struktur und des Prozesses beschrieben.
METHODS:  In diesem Artikel werden die Handlungsempfehlungen für inzidentelle Lungenrundherde aus der aktuellen S3-Leitlinie des Lungenkarzinoms (Juli 2023) vorgestellt. Die international etablierten Handlungsempfehlungen (BTS-Guidelines und Fleischner-Kriterien) werden verglichen und weitere Studien zum optimierten Management wurden nach systematischer Literaturrecherche auf PubMed eingeschlossen.
UNASSIGNED:  Insbesondere KI-basierte Softwarelösungen sind vielversprechend, da sie gleich auf mehreren Ebenen unterstützend eingesetzt werden und zu einem einfacheren und automatisierten Management führen können. Um allerdings auch in der klinischen Routine anwendbar zu sein, muss sich Software gut in den radiologischen Arbeitsablauf einfügen und miteinander integriert werden. Darüber hinaus haben sich in den USA sogenannte „Lung Nodule Management“-Programme bzw. -Kliniken etabliert, die einen standardisierten Ablauf auf hohem Qualitätsniveau für Patienten mit inzidentell oder in der Früherkennung detektierten Lungenrundherden bieten. Gegebenenfalls könnten auch in Deutschland in einem zukünftigen Früherkennungsprogramm Strukturen geschaffen werden, in die auch Patienten mit inzidentellen Lungenrundherden eingebunden werden könnten.
UNASSIGNED:   · Inzidentelle Lungenrundherde sind häufig, aber werden oft nicht leitliniengerecht aufgearbeitet. · Die aktualisierte S3-Leitlinie des Lungenkarzinoms umfasst nun auch Handlungsempfehlungen für inzidentelle Lungenrundherde. · Kompetenz-, Kommunikations-, Struktur- und Prozessebene bieten zahlreiche Verbesserungspotenziale für das Rundherdmanagement der IPNs.
UNASSIGNED: · Glandorf J, Vogel-Claussen J, . Incidental pulmonary nodules – current guidelines and management. Fortschr Röntgenstr 2024; 196: 582 – 590.

Incidental adrenal masses are common and require a multidisciplinary approach to evaluation and management that includes family physicians, urologists, endocrinologists, and radiologists. The purpose of this guideline is to provide an updated approach to the diagnosis, management, and follow-up of adrenal incidentalomas, with a special focus on the areas of discrepancy/controversy existing among the published guidelines from other associations.
This guideline was developed by the Canadian Urological Association (CUA) through a working group comprised of urologists, endocrinologists, and radiologists and subsequently endorsed by the American Urological Association (AUA). A systematic review utilizing the GRADE approach served as the basis for evidence-based recommendations with consensus statements provided in the absence of evidence. For each guideline statement, the strength of recommendation was reported as weak or strong, and the quality of evidence was evaluated as low, medium, or high.
The CUA working group provided evidence- and consensus-based recommendations based on an updated systematic review and subject matter expertise. Important updates on evidence-based radiological evaluation and hormonal testing are included in the recommendations. This guideline clarifies which patients may benefit from surgery and highlights where short term surveillance is appropriate.
Incidentally detected adrenal masses require a comprehensive assessment of hormonal function and oncologic risk. This guideline provides a contemporary approach to the appropriate clinical, radiographic, and endocrine assessments required for the evaluation, management, and follow-up of patients with such lesions.

The use of cross-sectional imaging in Sweden has increased more than twofold in the last 20 years. Inadvertently discovered adrenal lesions, adrenal incidentalomas, are reported in about one per cent of abdominal investigations. The first Swedish guidelines for the management of adrenal incidentalomas were published in 1996 and have since then been regularly revised. Still, data indicate that less than half of patients receive adequate follow-up. Here we comment on the newly updated guidelines and briefly review the recommended clinical and radiological work-up.

暂无摘要。

Follow established management guidelines from the ACR and improve adherence to follow-up recommendations for incidental liver lesions (ILLs) for all patients undergoing CT abdomen and pelvis with contrast (CTAPw) examinations, with advocacy from a multidisciplinary care team.
A mandatory structured radiology reporting module was developed for use in CTAPw reports for ILL recommendations. Data from the electronic medical record describing patients with radiology-reported ILLs and their clinical risk diagnosis categories were tabulated in a queryable electronic database. A nurse co-ordinator initiated workflow to communicate the need for ILL follow-up MRI to ordering physicians and primary care providers. MRIs were ordered by the ILL team. An interactive process was undertaken with continuous review to improve identification of eligible patients and adherence to recommendations.
During the initial launch phase from December 2020 to March 2021, 1,577 ILLs were detected on 20,667 CTAPw examinations, and for those with the characterize now recommendation, 36 of 114 (31.6%) received follow-up in 30 days. Between January 2021 and June 2022, 117,520 CTAPws were performed and 4,371 ILLs were detected. Using the ILL workflow, in the MRI now cohort, follow-up occurred within 30 days in 202 of 542 (36.2%) patients, and a total of 368 of 542 (67.9%) patients have completed their follow-up to date.
Using a focused effort to close a gap in ILL care, adherence to follow-up recommendations improved over the long term, although there remains a gap in adherence to short-term interventions. A multidisciplinary approach, radiology reporting, and software solutions were leveraged to improve a complex process.

Incidental research findings pose a considerable challenge to hospital-based research biobanks since they are acting as intermediaries between healthcare and research. In a joint action the centralized biobank ibdw (Interdisciplinary Bank of Biomaterials and Data Wuerzburg) together with local authorities drafted a coherent concept to manage incidental research findings in full compliance with relevant ethical and data privacy regulations. The concept was developed and elaborated in close collaboration with the German Biobank Alliance (GBA). Comprehensive documentation of all steps guarantees the traceability of the process. By a mandatory assessment of the findings prior to re-identification of the individual concerned, unnecessary measures can be avoided. The individual\'s \"right not to know\" is respected according to the stipulations of the informed consent. As a general principle any communication with the individual occurs exclusively through the hospital and by competent physicians with appropriate knowledge and communication skills. We propose this scheme as a blueprint for reporting workflows for incidental research findings at hospital-based biobanks.

Incidental radiographic findings are common, and primary care providers (PCPs) are often charged with the conducting or initiating an appropriate evaluation. Clinical guidelines are available for management of common \'incidentalomas\' including lung and adrenal nodules, but guidelines-adherent evaluations are not always performed; for example, in the setting of incidental adrenal masses (IAMs), recent literature suggests that an evidence-based evaluation occurs in <25% of patients for whom it is warranted-a quality and safety concern.
The objective of this study was to examine whether point-of-care access to concise clinical guidelines would promote appropriate evaluations of two common incidentalomas: IAMs and lung nodules.
This study was a survey-based, single-blinded, randomized experiment of decision-making within clinical vignettes. Respondents were PCPs in a variety of clinical practice settings, and half were randomly assigned to surveys that included concise clinical guidelines while the other half served as controls without access to guidelines. Scenarios involved patients with IAMs and lung nodules, and the scenarios included both higher-risk and lower-risk lesions. Our primary analysis examined safe versus inappropriate clinical decisions, while a secondary analysis compared guidelines-concordant versus guidelines-discordant responses.
For both the higher-risk IAM and higher-risk lung nodule scenarios, safe answer choices were selected at a similar rate by respondents regardless of whether they had access to guidelines or not. However, for the lower risk scenarios, inappropriate answer choices were chosen substantially more frequently by respondents without access to guidelines compared to those with the guidelines (lung: 29.3% vs. 4.5%, p = 0.003, adrenal: 31.6% vs. 7.0%, p = 0.01). There was less variation in the secondary analysis.
Survey respondents were significantly more likely to make safe management decisions in lower-risk clinical scenarios when clinical guidelines were available. Point-of-care access to clinical guidelines for incidentalomas is an intervention that may reduce management errors and improve patient safety.