Objective To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as “Xinjiang Region”) in diagnosing fundus diseases. MethodsThe three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. ResultsAll the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination (P＜0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance (P＜0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance (P＜0.05). There was no significant correlation (P＞0.05) between the improvement of diagnostic level of participating physicians and educational background (Rho=0.07), professional title (Rho=0.13), age (r=0.20), and working time of ophthalmofundus disease specialty (r=0.26).ConclusionsRelying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.
ObjectiveTo summarize the advantages of double-layer detector spectral CT (DLCT) as compared with conventional CT in disease diagnosis and its research status in the diagnosis of gastric cancer. MethodThe literature relevant research was summarized, including the clinical application of DLCT and its clinical research in the diagnosis of gastric cancer. ResultsThe image quality of DLCT was better than that of conventional CT examination. Its virtual non-contrast could display gastric cancer lesions and evaluate lymph node metastasis. The number of CT scans of patient was reduced by DLCT, correspondingly the radiation dose received by patients was reduced, and the examination time of patient was shortened. The iodine uptake in the tissues could visually be observed by the iodine concentration map in the DLCT and be quantitatively analyzed, which could provide a new option for noninvasive evaluation of angiogenesis in the gastric cancer. The DLCT scanning provided a material decomposition image, the different iodine absorption of normal gastric mucosa and gastric cancer could be reflected by the material decomposition image. The enhancement degree and blood supply of lesions could be effectively reflected by quantitative measurement of iodine concentration and thus the benign and malignant changes of the gastric diseases were effectively identified. The DLCT could distinguish the structure of the gastric wall, which could show the depth of invasion of malignant gastric lesions to the gastric wall and whether the adjacent tissues and organs were involved or not. Through the homology analysis of abnormal lymph nodes and suspicious metastases in the abdominal cavity through the related parameters of the DLCT could more accurately determine the clinical TNM stage of the gastric cancer before surgery. ConclusionsIn recent years, DLCT has shown a better morphological diagnostic efficiency than conventional CT in clinical application. Its virtual non-contrast, iodine concentration, effective atomic number, and other parameters characteristics make it show obvious advantages in gastric cancer, such as evaluation of angiogenesis of gastric cancer, differentiation of benign and malignant gastric diseases, clinical staging of gastric cancer, and other applications. In future, with more usable parameters research and continuous accumulation of clinical application about DLCT in clinic, which can better serve clinical work.
Objective To review the advances in diagnosis and treatment of acute scaphoid fractures. Methods The characteristic, classification, diagnosis, and treatment of acute scaphoid fractures were reviewed and summarized. Results As one of the common fracture in hand, scaphoid fractures are generally classified as either undisplaced and stable or displaced and unstable. CT and MRI has best diagnostic specificity and sensitivity respectively. Most undisplaced and stable fractures can be treated successfully by plaster immobilization, whereas the displaced and unstable fractures have great prognosis after open reduction and internal fixation. Conclusion Acute scaphoid fractures should be diagnosed and treated at an early stage, and choose the appropriate treatment according to the location and stability of the fracture.
Objective To evaluate the sonographic characteristics of peripheral focal inflammation of lung, and to improve the diagnosis and differential diagnosis potency of sonography for pulmonary peripheral lesions. Methods The sonogram of 44 patients with peripheral focal inflammation of lung were retrospectively analyzed and compared with the sonogram of other lesions. Independent variables included lesion’s margin, echotype, the secondary change of visceral pleura, the angulation of lesion’s inner surface and air bronchogram. Lesion’s nature was as dependent variable. The data was analyzed by Logistic regression analysis. Pathological results were confirmed by biopsy. Results The angulation of lesion’s inner surface and air bronchogramwere significant factors affecting the diagnosis of peripheral focal inflammation of lung( P lt;0. 01) . Compared to the pathological yield by biopsy, angulation of lesion’s inner surface being acute angle for diagnosis of peripheral focal inflammation of lung had an accuracy rate of 82. 6% , a sensitivity of 72. 7% , a specificity of 84. 7% , a positive predictive value of 51. 0% , and a negative predictive value of 93. 4%. Conclusions The acute angle of lesion’s inner surface and air bronchogram are sonographic characteristics of peripheral focal inflammation of lung. Bedside lung ultrasound is useful to the diagnosis of peripheral focal inflammation of lung.
Since January 2020, due to the epidemic of coronavirus disease 2019, all universities in China have postponed their studies or even suspend their studies. In response to the teaching policy of “suspending class, but keeping teaching and learning” , college teachers have rapidly changed into online teaching mode. However, how to ensure the quality and effect of online teaching still needs further exploration. Through analyzing the course characteristics of medical imaging diagnostics and students’ learning situations, this study discusses how to design detailed online teaching projects and improve the teaching quality and how to select online software suitable for the course. A questionnaire survey was conducted to evaluate the effect of online teaching during the spring course in 2020, selecting a total of 297 clinical and other undergraduate students of grade 2017 from West China School of Medicine of Sichuan University. The results showed that the detailed online teaching programs including “video learning” “distance teaching” “periodic examination” “weakness tutorial” were helpful to the learning process agreed by the majority of students. During the epidemic period, online teaching method can help students master the content of medical imaging diagnosis. In the era of Internet, the “online+offline” teaching mode is expected to be popularized in the future.
Objective To analyze the status of applying diagnostic test in imaging scientific study internationally and domestically, and to compare the application of the image diagnostic studies of our country with that of abroad. Method We hand-searched the diagnosis tests published in the "Chinese Journal of Radiology", the most influential in China, and in "Radiology’’, the most influential abroad, from 1998 to 1999 respectively. Then we evaluated each of the diagnosis tests according to the international standards. Results We searched 408 original articles in "Chinese Journal of Radiology" in which the diagnostic test articles were 12%, and 796 original articles in "Radiology" with the diagnostic test articles 23% from 1998 to 1999 respectively. In these diagnosis tests, by comparing the "Chinese journal of radiology" with the "Radiology", it was found that 19% applied blind comparison with Gold Standard, 28% calculated sensitivity, specificity and accuracy, 9% both calculated negative predictive value and positive predictive value and none calculated likelihood ratios in the former versus 64%, 57%, 33% and 26% and 3% respectivdy in the latter. Conclusions Compared with the international level, both the quality and the quantity of the diagnosis tests applied in the specialty of imaging scientific study in China are much lower and far from meeting the clinical requirement. Improving the methods of scientific study and carrying on more diagnosis tests with high qualities are of important significance in improving the diagnostic level of imaging.
ObjectiveTo investigate the recommendations on imaging diagnosis in Chinese clinical practice guidelines (CPGs). MethodsWe electronically searched WanFang Data, VIP, CNKI and CBM databases from inception to December 31, 2014. Two reviewers independently screened literature and extracted data. The method of bibliometrics was used to analyze the data (including basic characteristics, strength of recommendation, quality of evidence, etc.). ResultsA total of 341 CPGs formulating the recommendations on diagnosis were included. 48.7% (166/341) guidelines developed the recommendations on imaging diagnosis (a total of 534). 25.7% (137/534) recommendations were with the symbols of quality of evidence and strength of recommendation, and 18.9% (101/534) with special words such as recommend, suggest. 22.3% (119/534) recommendations reported the strength of recommendation. Of which, 38.7% (46/119) were strong and 16.0% (19/119) were weak. However, 23.9% (11/46) strong recommendations were based on low quality of evidence. And 42.1% (8/19) weak recommendations were based on high quality of evidence. ConclusionAmong Chinese CPGs formulating the recommendations on diagnosis, the number of CPGs with recommendations on imaging is about 50%. And the quantity increases by years. The proportions of recommendations on imaging which report the strength of recommendation and/or quality of evidence are low. Meanwhile, the rating systems are uniform. Then the developers do not report the explanation for the strong recommendations based on low quality of evidence or the weak recommendations based on high quality of evidence in guideline.
Chronic venous diseases are the most common vascular diseases, which are the key field of vascular surgery. This review focused on the development about imaging diagnosis (including ultrasound, CT venogram, magnetic resonance venogram, venography, and intravascular ultrasound), genetic screening, drug therapy (including venous active drugs, antithrombotic drugs, and sulodexide), compression therapy, and surgical treatment (including heat venous ablation, non-heat venous ablation, endovascular treatment of iliac vein, and repair of venous valves) of chronic venous diseases during the past years. This reflects the trend of preciseness, individualization, and microinvasiveness in this field.
Liver cancer is a highly prevalent malignancy of the digestive system in China. Hepatic imaging examinations, including CT and MRI, play a critical role in the screening, diagnosis, and therapeutic evaluation of liver cancer. To standardize terminology, reduce variability in imaging interpretation, and improve diagnostic consistency and accuracy, the Department of Radiology of West China Hospital of Sichuan University has developed a CT/MRI structured reporting specifically designed for high-risk populations of primary liver cancer, which is based on the 2018 version of the Liver Imaging Reporting and Data System published by the American College of Radiology. We introduce the design background, core elements, and practical application experience of the CT/MRI structured reporting developed by West China Hospital of Sichuan University, aiming to promote the standardization and uniformity of hepatic imaging evaluation for high-risk populations of liver cancer.