Publications by authors named "Anna Trofimova"

21 Publications

  • Page 1 of 1

ACR Appropriateness Criteria® Seizures-Child.

J Am Coll Radiol 2021 May;18(5S):S199-S211

Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana.

In children, seizures represent an extremely heterogeneous group of medical conditions ranging from benign cases, such as a simple febrile seizure, to life-threatening situations, such as status epilepticus. Underlying causes of seizures also represent a wide range of pathologies from idiopathic cases, usually genetic, to a variety of acute and chronic intracranial or systemic abnormalities. This document discusses appropriate utilization of neuroimaging tests in a child with seizures. The clinical scenarios in this document take into consideration different circumstances at the time of a child's presentation including the patient's age, precipitating event (if any), and clinical and electroencephalogram findings and include neonatal seizures, simple and complex febrile seizures, post-traumatic seizures, focal seizures, primary generalized seizures in a neurologically normal child, and generalized seizures in neurologically abnormal child. This practical approach aims to guide clinicians in clinical decision-making and to help identify efficient and appropriate imaging workup. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2021.02.020DOI Listing
May 2021

Vascular anomalies of the head and neck: diagnosis and treatment.

Pediatr Radiol 2021 Jun 16;51(7):1162-1184. Epub 2021 Apr 16.

Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.

Vascular malformations and vascular tumors comprise the two specific subsets of vascular anomalies that arise as a result of disorganized angiogenesis and neoplasm, respectively. Malformations are separate entities from vascular tumors (e.g., hemangiomas) and are recognized by the International Society for the Study of Vascular Anomalies (ISSVA) as such. Vascular malformations are classified into four main groups: simple, combined, anomalies of major vessels, and those associated with other vascular anomalies. Vascular tumors are neoplastic growths of blood vessels and are morphologically and molecularly distinct from malformations but can arise in the head and neck and have syndromic association. Head and neck vascular anomalies are not uncommon in the pediatric population and require special care in the workup, diagnostic imaging and clinical care. The purpose of this manuscript is to discuss the diagnosis and management of the most common intracranial and extracranial vascular malformations and tumors in the head and neck in children and adolescents.
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http://dx.doi.org/10.1007/s00247-021-04968-2DOI Listing
June 2021

Essential and non-essential elements in biological samples of inhabitants residing in Nenets Autonomous Okrug of the Russian Arctic.

Environ Int 2021 07 21;152:106510. Epub 2021 Mar 21.

Northern (Arctic) Federal University Named After M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; National Institute of Occupational Health, Gydas vei 8, N-0363 Oslo, Norway; Institute of Ecology, HSE University, Myasnitskaya str. 20, 101000 Moscow, Russia.

Exposure of Arctic residents to environmental pollutants is an emerging public health problem receiving little global attention. The objective of this study was to assess whole blood concentrations of nine selected essential (Co, Cu, Mn, Se, Zn) and non-essential (As, Cd, Hg, Pb) elements among Nenets and non-Nenets adult residents of the Nenets Autonomous Okrug (NAO) living in seven coastal and inland settlements. Urine was collected in two settlements for assessment of iodine status. Altogether 297 whole blood and 68 urine samples were analysed by inductively coupled mass spectrometry and the accuracy of the measurements was assessed by use of human whole blood and urine quality control materials. Several essential and non-essential showed significant variations in whole blood concentrations characterized by gender, population group and locality. Cd levels among non-Nenets non-smokers (0.19 µg/L) indicated a dietary intake at a natural global background level. Hg concentrations in whole blood show that not more than 10% of women in the fertile age had a Hg intake above the EFAS's recommendation. The Pb concentrations were in the range of, or partly exceeding reference values for increased risk of nephrotoxicity, and there is a need for a continued effort to reduce Pb exposure among the population groups in NAO. With high prevalence of obesity among the Nenets and non-Nenets population, a high prevalence of Fe-deficiency among menstruating women (<50 years) (37.2%) and a lower I status than recommended by WHO, these nutritional dependent components deserve further attention.
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http://dx.doi.org/10.1016/j.envint.2021.106510DOI Listing
July 2021

Alterations in Resting-State Functional Brain Connectivity and Correlations with Vestibular/Ocular-Motor Screening Measures in Postconcussion Vestibular Dysfunction.

J Neuroimaging 2021 03 21;31(2):277-286. Epub 2021 Jan 21.

Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.

Background And Purpose: Vestibular symptoms after concussion are common and associated with protracted recovery. The purpose of this study is to define resting-state functional MRI (rs-fMRI) brain connectivity alterations in patients with postconcussion vestibular dysfunction (PCVD) and correlations between rs-fMRI connectivity and symptoms provoked during Vestibular/Ocular-Motor Screening (VOMS) assessment.

Methods: Prospective IRB approved study.

Study Group: 12 subjects with subacute PCVD (2-10 weeks); control group: 10 age-matched subjects without history of concussion or vestibular impairment. Both groups underwent clinical vestibular assessment. rs-fMRI was acquired on 3.0T Siemens Trio with a 12-channel head coil. rs-fMRI data analysis included independent component analysis-based functional connectivity group differences, graph theory analysis, and ROI-to-ROI connectivity correlation analysis with VOMS clinical derivatives. Group difference maps between resting-state networks were calculated using dual regression method and corrected for multiple comparisons. Correlation analysis between ROI-to-ROI rs-fMRI brain activation and VOMS assessment ratings was performed using Pearson correlation coefficient, with a significance threshold of P ≤ .05.

Results: Compared to controls, PCVD group demonstrated significantly increased rs-fMRI connectivity between the default-mode network and right middle frontal gyrus and right postcentral gyrus; and between a vestibular-sensorimotor network and right prefrontal cortex. Significant positive correlations were found between clinical derivative VOMS scores and components of the vestibular, visual networks, and multisensory processing cortical representations.

Conclusion: Altered rs-fMRI brain connectivity with increased connectivity of visual input, multisensory processing, and spatial memory in PCVD is correlative with clinical derivative VOMS scores, suggesting maladaptive brain plasticity underlying vestibular symptomatology.
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http://dx.doi.org/10.1111/jon.12834DOI Listing
March 2021

Concentrations of Persistent Organic Pollutants in Women's Serum in the European Arctic Russia.

Toxics 2021 Jan 7;9(1). Epub 2021 Jan 7.

Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia.

Persistent organic pollutants (POPs) are heterogeneous carbon-based compounds that can seriously affect human health. The aim of this study was to measure serum concentrations of POPs in women residing in the Euro-Arctic Region of Russia. A total of 204 women from seven rural settlements of the Nenets Autonomous Okrug (NAO) took part in the study. We measured serum concentrations of 11 polychlorinated biphenyls (PCBs) and 17 organochlorine pesticides (OCPs) across the study sites and among Nenets and non-Nenets residents. Measurement of POPs was performed using an Agilent 7890A gas chromatograph equipped with an Agilent 7000 series MS/MS triple quadrupole system. The concentrations of all POPs were low and similar to findings from other Arctic countries. However, significant geographic differences between the settlements were observed with exceptionally high concentrations of PCBs in Varnek located on Vaygach Island. Both ΣDDT ( = 0.011) and ΣPCB ( = 0.038) concentrations were significantly lower in Nenets. Our main findings suggest that the serum concentrations of the legacy POPs in women in the Euro-Arctic Region of Russia are low and similar to those in other Arctic countries. Significant variations between settlements, and between Nenets and non-Nenets residents, were found. Arctic biomonitoring research in Russia should include studies on the associations between nutrition and concentrations of POPs.
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http://dx.doi.org/10.3390/toxics9010006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828080PMC
January 2021

Increasing and disparate use of neuroimaging for adults and children with non-traumatic headaches in the US emergency departments: Opportunities for improvement.

Headache 2021 Jan 14;61(1):179-189. Epub 2020 Dec 14.

Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.

Background: Optimization of neuroimaging practices for headache is considered a national priority; however, nationwide patterns and predictors of neuroimaging use for headache in the US emergency departments (EDs) are unknown.

Objective: To analyze temporal neuroimaging utilization trends for adults and children with non-traumatic headache in the US EDs and identify factors predictive of neuroimaging use in this patient population.

Methods: Retrospective cross-sectional study using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database for administrative encounter-level data analysis of a nationwide group of adult and pediatric patients with primary diagnosis of headache (ICD-9CM codes 784.0x, 339.xx, 346.xx) visited the US EDs between January 1, 2006 and December 31, 2014. Temporal trends and independent predictors of neuroimaging use (e.g., patient and hospital characteristics, primary payment sources) were determined.

Results: In 2006-2014, a weighted group of 18,146,302 patients with a primary diagnosis of non-traumatic headache visited US EDs. Advanced neuroimaging utilization increased from 18.6% (n = 350,777) to 34.8% (n = 756,895) in the total group, from 18.8% (n = 314,646) to 36.5% (n = 698,080) in the adult subgroup (+94.1%), and from 16.9% (n = 36,131) to 22.0% (n = 58,815) (+30.2%) in the pediatric subgroup (+87.0%) between 2006 and 2014. The strongest predictors of higher neuroimaging utilization were hospital location in the Northeast (OR 3.17, 95% CI 2.67-3.76) or South (OR 2.42, 95% CI 2.03-2.88) regions. Lower utilization of imaging was associated with weekend ED visits (OR 0.92, 95% CI 0.92-0.93), female gender (OR 0.82, 95% CI 0.81-0.83), and Medicare, Medicaid, or self-pay (vs. private insurance) encounters.

Conclusion: Neuroimaging utilization in patients with headache in US EDs nearly doubled in 2006-2014, and was used in 34.8% of all ED encounters in 2014. Utilization was higher and increased at faster rates for adults than children. In US EDs, imaging for headache is preferentially performed on commercially insured and male patients, at urban hospitals, in certain geographic regions, and on weekdays, raising concerns regarding disparate imaging use.
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http://dx.doi.org/10.1111/head.14020DOI Listing
January 2021

2020 Top Images in : In Training Editors' Choices.

Radiology 2021 Feb 1;298(2):284-286. Epub 2020 Dec 1.

From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road, Suite BG20, Atlanta, GA (A.V.T.); Department of Radiology, New York University School of Medicine, New York, NY (E.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (S.I.L.).

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http://dx.doi.org/10.1148/radiol.2020204366DOI Listing
February 2021

Iodine Status of Women and Infants in Russia: A Systematic Review.

Int J Environ Res Public Health 2020 11 11;17(22). Epub 2020 Nov 11.

Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named After M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia.

This systematic review presents a critical synthesis of the available information on the iodine status among women and infants in Russia. Literature search was performed in accordance with PRISMA guidelines using PubMed, Scopus Web of Science databases as well as eLIBRARY-the Russian national source. Altogether, 277 papers were identified and 19 of them were eligible for the review. The data on median urinary iodine concentration (UIC) in women and infants from 25 Russian regions were presented. A substantial variability in UIC across the country with no clear geographical pattern was observed. Despite substantial heterogeneity in research methodology and data presentation the results suggest that the iodine status among pregnant women and infants in Russia is below the recommended levels. Our findings demonstrate that iodine deficiency is a re-emerging public health problem in Russia. Urgent public health measures on national, regional and individual levels are warranted.
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http://dx.doi.org/10.3390/ijerph17228346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697687PMC
November 2020

Technology-enhanced visual desensitization home exercise program for post-concussive visually induced dizziness: a case series.

Physiother Theory Pract 2020 Sep 21:1-10. Epub 2020 Sep 21.

Shepherd Center, Complex Concussion Clinic , Atlanta, GA, USA.

Post-concussive visually induced dizziness (VID), in which symptoms are provoked by exposure to complex visual motion, is associated with protracted recovery. Although vestibular rehabilitation therapy (VRT) is recommended to treat post-concussive dizziness, there is sparse literature reporting on specific VRT interventions treating VID.  A consecutive series of 26 individuals referred for VRT post-concussion were retrospectively assessed for inclusion in this case series. Each participant underwent a combination of conventional VRT and a technology-enhanced visual desensitization home exercise program (HEP). Self-report and objective measures were recorded from initial and discharge therapy evaluations. Twenty-three individuals (mean age 23.1 ± 12.4) with post-concussive dizziness (mean 109 ± 56 days post-injury) and no evidence for peripheral vestibular dysfunction were included. Treatment duration averaged 6.9 ± 2.5 weeks.  There were significant improvements in post-intervention on subjective and objective measures of dizziness and gait ( < .05). The response to intervention was independent of pre-injury migraine history but pre-injury depression/anxiety increased self-report of post-treatment anxiety. Concurrent treatment with medications did not influence response to treatment.  The combination therapy intervention improved outcome measures consistent with VRT treatment outcomes in both concussion and non-traumatic vestibular conditions. Individuals referred for VRT post-concussion warrant assessment for VID and may benefit from the addition of technology-enhanced visual desensitization.
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http://dx.doi.org/10.1080/09593985.2020.1815259DOI Listing
September 2020

Cumulative contact frequency of a chromatin region is an intrinsic property linked to its function.

PeerJ 2020 10;8:e9566. Epub 2020 Aug 10.

Center of Life Sciences, Skolkovo Institute of Science and Technology, Moscow, Russia.

Regulation of gene transcription is a complex process controlled by many factors, including the conformation of chromatin in the nucleus. Insights into chromatin conformation on both local and global scales can be provided by the Hi-C (high-throughput chromosomes conformation capture) method. One of the drawbacks of Hi-C analysis and interpretation is the presence of systematic biases, such as different accessibility to enzymes, amplification, and mappability of DNA regions, which all result in different visibility of the regions. Iterative correction (IC) is one of the most popular techniques developed for the elimination of these systematic biases. IC is based on the assumption that all chromatin regions have an equal number of observed contacts in Hi-C. In other words, the IC procedure is equalizing the experimental visibility approximated by the cumulative contact frequency (CCF) for all genomic regions. However, the differences in experimental visibility might be explained by biological factors such as chromatin openness, which is characteristic of distinct chromatin states. Here we show that CCF is positively correlated with active transcription. It is associated with compartment organization, since compartment A demonstrates higher CCF and gene expression levels than compartment B. Notably, this observation holds for a wide range of species, including human, mouse, and . Moreover, we track the CCF state for syntenic blocks between human and mouse and conclude that active state assessed by CCF is an intrinsic property of the DNA region, which is independent of local genomic and epigenomic context. Our findings establish a missing link between Hi-C normalization procedures removing CCF from the data and poorly investigated and possibly relevant biological factors contributing to CCF.
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http://dx.doi.org/10.7717/peerj.9566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425636PMC
August 2020

Imaging Utilization in Children With Headaches: Current Status and Opportunities for Improvement.

J Am Coll Radiol 2020 May;17(5):574-583

Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta- Egleston Campus, Atlanta, Georgia. Electronic address:

Background: Despite a variety of evidence-based guidelines documents, imaging is anecdotally commonly used in the setting of children with headaches, but the frequency of such imaging is unknown. We assessed the use of and estimated costs of imaging utilization in children with headaches at a pediatric hospital.

Materials And Methods: Retrospectively reviewing charts of all relevant imaging examinations in 2015, we focused on radiology reports with indications containing the terms "headache" or "migraine" and excluded patients who fulfilled evidence-based criteria in support of obtaining imaging. All radiology results were recorded and categorized as normal, likely causative, possibly causative, or unlikely causative of headache. Societal costs were estimated using allowable Medicare fees, and losses of total facility time were estimated using scheduled examination slots.

Results: In 2015, 4,257 imaging studies were performed for indications of headache or migraine. Of these, 3,098 (73%) met our exclusion criteria, meaning they had appropriate indications, and 1,159 (27%) were presumably imaged outside of guideline recommendations. Overall, 19.8% (230 of 1,159) had diagnoses that were likely or potentially causative of headaches, and 71.2% (825 of 1,159) were normal. The remainder had findings unlikely to cause headaches. The total estimated societal cost of imaging studies for presumed primary headache imaging at our institution in 2015 was $322,422. The loss of imaging time was 845.3 hours.

Conclusion: Given the large number of normal examinations and the inappropriate use of radiography, imaging utilization in children with headaches can likely be improved. In addition to reducing ionizing radiation and the need for sedation, reductions in unnecessary imaging would result in societal cost savings and increase imaging capacity for other patients.
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http://dx.doi.org/10.1016/j.jacr.2020.01.008DOI Listing
May 2020

ACR Appropriateness Criteria® Dementia.

J Am Coll Radiol 2020 May;17(5S):S100-S112

Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

Degenerative disease of the central nervous system is a growing public health concern. The primary role of neuroimaging in the workup of patients with probable or possible Alzheimer disease has typically been to exclude other significant intracranial abnormalities. In general, the imaging findings in structural studies, such as MRI, are nonspecific and have limited potential in differentiating different types of dementia. Advanced imaging methods are not routinely used in community or general practices for the diagnosis or differentiation of forms of dementia. Nonetheless, in patients who have been evaluated by a dementia expert, FDG-PET helps to distinguish Alzheimer disease from frontotemporal dementia. In patients with suspected dementia with Lewy bodies, functional imaging of the dopamine transporter (ioflupane) using SPECT may be helpful. In patients with suspected normal-pressure hydrocephalus, DTPA cisternography and HMPAO SPECT/CT brain may provide assessment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2020.01.040DOI Listing
May 2020

Health Risk Modifiers of Exposure to Persistent Pollutants among Indigenous Peoples of Chukotka.

Int J Environ Res Public Health 2019 12 23;17(1). Epub 2019 Dec 23.

Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada.

The aim of the study was to assess temporal trends in health risks related to most common persistent contaminants, including polychlorinated biphenyls (PCBs), dichloro-diphenyl-trichloroethanes (DDTs), lead (Pb), as well as mercury (Hg) among indigenous peoples living in coastal areas of Chukotka in Arctic Russia. This is examined in relation to exposure pathways and a range of social and behavioral factors capable of modifying the exposure to these contaminants, including place of residence, income, traditional subsistence, alcohol consumption, and awareness of risk prevention. The primary exposure pathway for PCBs is shown to be the intake of traditional foods, which explained as much as 90% of the total health risk calculated employing established risk guidelines. Nearly 50% of past DDT-related health risks also appear to have been contributed by contaminated indoor surfaces involving commonly used DDT-containing insecticides. Individuals who practiced traditional activities are shown to have experienced a 4.4-fold higher risk of exposure to PCBs and a 1.3-fold higher risk for DDTs, Pb, and Hg. Low income, high consumption of marine mammal fat, alcohol consumption, and lack of awareness of health risk prevention are attributed to a further 2- to 6-fold increase in the risk of PCBs exposure. Low socioeconomic status enhances the health risks associated with exposure to the persistent contaminants examined.
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http://dx.doi.org/10.3390/ijerph17010128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982306PMC
December 2019

Added Value From Abbreviated Brain MRI in Children With Headache.

AJR Am J Roentgenol 2019 Mar 12:1-6. Epub 2019 Mar 12.

1 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.

Objective: The purposes of this article are to describe implementation of an abbreviated brain MRI protocol for use in children with primary headache and to present an experience with the adaptation of the protocol in practice, work flow integration, and effects on sedation use.

Conclusion: The abbreviated brain MRI protocol reduced the need for sedation for 74% of the study sample. Use of this protocol in this particular patient population continues, but further validation is required before its use is expanded to other pediatric populations.
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http://dx.doi.org/10.2214/AJR.18.20439DOI Listing
March 2019

Radiology Reading Room Huddles: Our Initial Experience.

AJR Am J Roentgenol 2019 Feb 19:1-7. Epub 2019 Feb 19.

1 Department of Radiology and Imaging Sciences, Emory University, 1405 Clifton Rd NE, Atlanta, GA 30322.

Objective: The objective of our study was to adapt the safety, methods, equipment, supplies, and associates, termed "S-MESA," communication tool from daily management huddles and implement it in radiology reading rooms to address the complexities of daily communications. We collected data on huddle logistics and perceived value from radiologists at an academic institution.

Materials And Methods: We constructed a 16-item survey composed of multiple-choice questions (single answer and multiple answers), statements requiring Likert scale ratings (from 1 [strongly disagree] to 5 [strongly agree]), and items requiring free text responses. The survey was distributed to 244 radiologists. Answers were collected over a 6-week period.

Results: The response rate was 41% (101/244). The majority of huddles were performed sometimes (59%) or daily or nearly daily (25%), and most lasted 5 minutes or less (83%), which was perceived as "just right" (87.5%). The components discussed more frequently in the huddle were availability (33.5%) and time goals (27%). Task review (19%) and miscellaneous (14%) were not as common. Huddles were valued for facilitating communication and better organizing the workday.

Conclusion: Reading room huddles are feasible and perceived as useful. Moving forward, we are planning to integrate reading room huddles with multitier system huddles and include items that are of specific interest to radiology trainees.
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http://dx.doi.org/10.2214/AJR.18.20423DOI Listing
February 2019

Cost-Effectiveness Analysis: An Overview of Key Concepts, Recommendations, Controversies, and Pitfalls.

Acad Radiol 2019 04 8;26(4):534-541. Epub 2018 Nov 8.

Department of Radiology and Imaging Sciences, Emory University, 1405 Clifton Rd NE, Atlanta, GA 30322; Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Policy and Management, Emory University, Atlanta, Georgia.

The field of radiology has witnessed a burst of technological advances that improve diagnostic quality, reduce harm to patients, support clinical needs, and better serve larger more diverse patient populations. One of the critical challenges with these advances is proving that value outweighs the cost. The use of cutting-edge technology is often expensive, and the reality is that our society cannot afford all the screening and diagnostic tests that are being developed. At the societal level, we need tools to help us decide which health programs should be funded. Therefore, decision makers are increasingly looking toward scientific methods to compare health technologies in order to improve allocation of resources. One of such methods is cost-effectiveness analysis. In this article, we review key features of cost-effectiveness analysis and its specific issues as they relate to radiology.
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http://dx.doi.org/10.1016/j.acra.2018.10.014DOI Listing
April 2019

Radiology Report Readability: An Opportunity to Improve Patient Communication.

J Am Coll Radiol 2018 Aug 10;15(8):1182-1184. Epub 2018 May 10.

Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta (Egleston), Atlanta, Georgia. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2018.03.032DOI Listing
August 2018

Occipital intraosseous dermoid cyst with restricted diffusion on magnetic resonance imaging in a child.

Radiol Case Rep 2018 Feb 23;13(1):248-253. Epub 2017 Dec 23.

Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd NE, Atlanta, GA 30322 USA.

A 4-year-old girl presented repeatedly with a complicated occipital mass, which was erroneously treated as a pyogenic granuloma. Imaging performed before a planned surgical resection detected an underlying intraoccipital dermoid with a sinus tract to the skin surface and extension into the posterior fossa. This case highlights the value of high-resolution computed tomography imaging for depiction of anatomic details and the value of magnetic resonance imaging for differential diagnosis and surgical management. A comprehensive literature review of intraosseous dermoid cyst and detailed discussion of the differential diagnoses are provided.
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http://dx.doi.org/10.1016/j.radcr.2017.10.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826499PMC
February 2018

Imaging of Children With Nontraumatic Headaches.

AJR Am J Roentgenol 2018 Jan 12;210(1):8-17. Epub 2017 Sep 12.

1 Department of Radiology and Imaging Sciences, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322.

Objective: Headache in children is a common symptom and often is worrisome for clinicians and parents because of the breadth of possible underlying significant abnormalities, including meningitis, brain neoplasms, and intracranial hemorrhage. For this reason, many children with headaches undergo neuroimaging. Most neuroimaging studies performed of children with headaches have normal findings but may lead to significant downstream effects, including unnecessary exposure to ionizing radiation or sedation, as well as unnecessary cost to the health care system. In this article, we review the current evidence and discuss the role of neuroimaging in the diagnosis and management of pediatric headaches, with a special focus on tools that may aid in increasing the rate of positive findings, such as classification systems, algorithms, and red flag criteria.

Conclusion: Many tools exist that can help in improving the appropriateness of neuroimaging in pediatric headache. The main issues that remain to be addressed include scientific proof of safety and validity of these tools and clarity regarding the risks, benefits, and cost-effectiveness of CT versus MRI in various clinical settings and scenarios.
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http://dx.doi.org/10.2214/AJR.17.18561DOI Listing
January 2018

Human Behavior Drift Detection in a Smart Home Environment.

Stud Health Technol Inform 2017 ;242:199-203

Department of Electronics, Information and Bioengineering, Politecnico di Milano - via Anzani 42, 22100, Como, Italy.

The proposed system aims at elderly people independent living by providing an early indicator of habits changes which might be relevant for a diagnosis of diseases. It relies on Hidden Markov Model to describe the behavior observing sensors data, while Likelihood Ratio Test gives the variation within different time periods.
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April 2018

Neuroimaging experience in pediatric Horner syndrome.

Pediatr Radiol 2015 Sep 2;45(10):1535-43. Epub 2015 Apr 2.

Department of Radiology, Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave., FGH Building, 3rd Floor, Boston, MA, 02118, USA,

Background: Horner syndrome in children is rare. The frequency and spectrum of malignancy as the cause of Horner syndrome in children remains unclear. Also unclear is whether the imaging work-up should include the entire oculo-sympathetic pathway or should be more targeted. In addition, the value of cross-sectional angiographic imaging in Horner syndrome is uncertain.

Objective: To review imaging pathology in a cohort of children with Horner syndrome at a major academic pediatric medical center.

Materials And Methods: We reviewed a 22-year period of CT and MR imaging studies in children with a clinical diagnosis of Horner syndrome referred for imaging.

Results: We found 38 patients who fulfilled study criteria of Horner syndrome and 6/38 had relevant imaging findings: 2/6 etiologies were neoplastic (congenital neuroblastoma and central astrocytoma), 1/6 had a vascular abnormality (hypoplastic carotid artery), 1/6 had maldevelopment (Chiari I malformation), and 2/6 had inflammatory/traumatic etiology (viral cervical lymphadenopathy, post jugular vein cannulation). There was a similar number of congenital and acquired pathologies. The malignancies were found at any level of the oculosympathetic pathway.

Conclusion: There are treatable causes, including malignancies, in children presenting with Horner syndrome, which justify imaging work-up of the entire oculosympathetic pathway, unless the lesion level can be determined clinically.
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http://dx.doi.org/10.1007/s00247-015-3341-9DOI Listing
September 2015