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BACKGROUND: The 2018 ovarian-adnexal reporting and data system (O-RADS) guidelines are aimed at providing a system for consistent reports and risk stratification for ovarian lesions found on ultrasound. It provides key characteristics and findings for lesions, a lexicon of descriptors to communicate findings, and risk characterization and associated follow-up recommendation guidelines. However, the O-RADS guidelines have not been validated in North American institutions or amongst less experienced readers. AIM: To evaluate the diagnostic accuracy and inter-reader reliability of ultrasound O-RADS risk stratification amongst less experienced readers in a North American institution with and without pre-test training. METHODS: A single-center retrospective study was performed using 100 ovarian/adnexal lesions of varying O-RADS scores. Of these cases, 50 were allotted to a training cohort and 50 to a testing cohort via a non-randomized group selection process in order to approximately equal distribution of O-RADS categories both within and between groups. Reference standard O-RADS scores were established through consensus of three fellowship-trained body imaging radiologists. Three PGY-4 residents were independently evaluated for diagnostic accuracy and inter-reader reliability with and without pre-test O-RADS training. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the curve (AUC) were used to measure accuracy. Fleiss kappa and weighted quadratic (pairwise) kappa values were used to measure inter-reader reliability. Statistical significance was P < 0.05. RESULTS: Mean patient age was 40 ± 16 years with lesions ranging from 1.2 to 22.5 cm. Readers demonstrated excellent specificities (85%-100% pre-training and 91%-100% post-training) and NPVs (89%-100% pre-training and 91-100% post-training) across the O-RADS categories. Sensitivities were variable (55%-100% pre-training and 64%-100% post-training) with malignant O-RADS 4 and 5 Lesions pre-training and post-training AUC values of 0.87-0.95 and 0.94-098, respectively (P < 0.001). Nineteen of 22 (86%) misclassified cases in pre-training were related to mischaracterization of dermoid features or wall/septation morphology. Fifteen of 17 (88%) of post-training misclassified cases were related to one of these two errors. Fleiss kappa inter-reader reliability was 'good' and pairwise inter-reader reliability was 'very good' with pre-training and post-training assessment (k = 0.76 and 0.77; and k = 0.77-0.87 and 0.85-0.89, respectively). CONCLUSION: Less experienced readers in North America achieved excellent specificities and AUC values with very good pairwise inter-reader reliability. They may be subject to misclassification of potentially malignant lesions, and specific training around dermoid features and smooth vs irregular inner wall/septation morphology may improve sensitivity.

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AIMS: Early diagnosis of developmental dysplasia of the hip (DDH) using ultrasound (US) is safe, effective and inexpensive, but requires high-quality scans. The effect of scan quality on diagnostic accuracy is not well understood, especially as artificial intelligence (AI) begins to automate such diagnosis. In this paper, we developed a 10-point scoring system for reporting DDH US scan quality, evaluated its inter-rater agreement and examined its effect on automated assessment by an AI system-MEDO-Hip. METHODS: Scoring was based on iliac wing straightness and angulation; visibility of labrum, os ischium and femoral head; motion; and other artifacts. Four readers from novice to expert separately scored the quality of 107 scans with this 10-point scale and with holistic grading on a scale of 1-5. MEDO-Hip interpreted the same scans, providing a diagnostic category or identifying the scan as uninterpretable. RESULTS: Inter-rater agreement for the 10-point scale was significantly higher than holistic scoring ICC 0.68 vs 0.93, p < 0.05. Inter-rater agreement on the categorisation of individual features, by Cohen's kappa, was highest for os ischium (0.67 ± 0.06), femoral head (0.65 ± 0.07) and iliac wing (0.49 ± 0.12) indices, and lower for the presence of labrum (0.21 ± 0.19). MEDO-Hip interpreted all images of a quality > 7 and flagged 13/107 as uninterpretable. These were low-quality images (3 ± 1.2 vs. 7 ± 1.8 in others, p < 0.05), with poor visualization of the os ischium and noticeable motion. AI accuracy in cases with quality scores < = 7 was 57% vs. 89% on other cases, p < 0.01. CONCLUSION: This study validates that our scoring system reliably characterises scan quality, and identifies cases likely to be misinterpreted by AI. This could lead to more accurate use of AI in DDH diagnosis by flagging low-quality scans likely to provide poor diagnosis up front.

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Mentoring has a vital role throughout the medical profession. Over the past few years, mentoring has become an area of focus as being an important aspect of radiologists' career starting from the early trainee level. A variety of mentorship strategies have come to the forefront, allowing many avenues for those seeking to engage in mentorship as either a mentee or mentor. Mosaic mentoring is a new approach that emphasizes utilizing a collection of mentorship approaches to maximize outcomes based on individual and/or domain-specific needs. The purpose of our paper is to provide a brief overview of a variety of mentorship models while introducing the concept of mosaic mentoring and exploring how it can benefit radiologists throughout their career.

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PURPOSE: The COVID-19 pandemic indefinitely cancelled visiting medical student radiology electives across Canada. In response, the Canadian Association of Radiologists Resident & Fellow Section (CAR RFS) and Medical Student Network (MSN) developed and evaluated an online series for medical students to learn about Canadian radiology residency programs. METHODS: Medical students from any year of training were recruited through the MSN, local radiology interest groups, and social media to attend a 2-week online series of interactive sessions via Zoom with program representatives from Canadian radiology residency programs. A survey evaluating the online series, in particular its impact on residency and career planning, was administered to program representatives and students. RESULTS: Fifteen of Canada's 16 radiology residency programs participated in the online series. A total of 212 students attended at least one session and nearly half were participating in the Canadian Resident Matching Service (CaRMS) this year. The postsurvey revealed that 77% of students agreed that the online series helped prepare them for CaRMS and ranking programs. The online series also benefited pre-CaRMS students as significantly more students were considering radiology as a specialty on the postsurvey compared to the presurvey. Students and program representatives agreed that this series should be held in future years, regardless of whether health and travel restrictions are lifted. CONCLUSION: The CAR RFS and MSN hosted an online series for medical students to learn about radiology residency programs outside their home institution. Feedback was highly positive with important implications for the future CaRMS iterations for any specialty.

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PURPOSE: Since it is fast, inexpensive and increasingly portable, ultrasound can be used for early detection of Developmental Dysplasia of the Hip (DDH) in infants at point-of-care. However, accurate interpretation\is highly dependent on scan quality. Poor-quality images lead to misdiagnosis, but inexperienced users may not even recognize the deficiencies in the images. Currently, users assess scan quality subjectively, based on image landmarks which are prone to human errors. Instead, we propose using Artificial Intelligence (AI) to automatically assess scan quality. METHODS: We trained separate Convolutional Neural Network (CNN) models to detect presence of each of four commonly used ultrasound landmarks in each hip image: straight horizontal iliac wing, labrum, os ischium and midportion of the femoral head. We used 100 3D ultrasound (3DUS) images for training and validated the technique on a set of 107 3DUS images also scored for landmarks by three non-expert readers and one expert radiologist. RESULTS: We got AI ≥ 85% accuracy for all four landmarks (ilium = 0.89, labrum = 0.94, os ischium = 0.85, femoral head = 0.98) as a binary classifier between adequate and inadequate scan quality. Our technique also showed excellent agreement with manual assessment in terms of Intraclass Correlation Coefficient (ICC) and Cohen's kappa coefficient (K) for ilium (ICC = 0.81, K = 0.56), os ischium (ICC = 0.89, K = 0.63) and femoral head (ICC = 0.83, K = 0.66), and moderate to good agreement for labrum (ICC = 0.65, K = 0.33). CONCLUSION: This new technique could ensure high scan quality and facilitate more widespread use of ultrasound in population screening of DDH.

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PURPOSE: The novel coronavirus disease (COVID-19) pandemic has swept the globe, with a domino effect on medical education and training. In this study, we surveyed Canadian radiology residents to understand the impact of the pandemic on their residency training, strategies utilized by the residency programs in mitigating those impacts, and factors important to residents in the selection of educational resources on COVID-19. METHODS: A 10-item questionnaire was distributed to 460 resident members of the Canadian Association of Radiologists. The survey was open for 2 weeks, with a reminder sent at half-way mark. RESULTS: We received 96 responses (response rate: 20.9%). The 4 highest affected domains of training were daytime case volumes (92.4%), daytime schedules (87.4%), internal and external assessments (86.5%), and vacation/travel (83.3%). Virtual teaching rounds (91.7%), change in schedules to allow staying home (78.1%), and virtual/phone readouts (72.9%) were the most utilized strategies by the Canadian radiology residency programs. Overall stress of exposure to the disease was moderate to low (86.5%). A minority of the residents were redeployed (6.2%), although most (68.8%) were on standby for redeployment. Residents preferred published society guidelines (92.3%), review papers (79.3%), video lectures (79.3%), and web tools (76.9%) for learning about COVID-19 imaging manifestations. CONCLUSION: The COVID-19 pandemic has had a significant impact on various domains of the Canadian radiology residency programs, which has been mitigated by several strategies employed by the training programs.

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PURPOSE: Developmental dysplasia of the hip (DDH) diagnosis by two-dimensional ultrasound (2DUS) can have poor inter-rater reliability. 3D ultrasound (3DUS) may be more reliably performed, particularly by novice users. We compared intra- and inter-rater reliability between expert and novice operators performing 2DUS and 3DUS for DDH. MATERIALS AND METHODS: Infants with suspected DDH were assessed with 2DUS and 3DUS. Novice operators had 1.5 h of training and Experts had 5-15 years' experience. Images included two 2DUS static and two 3DUS sweep images per operator. Image quality was assessed by 5-point system (yes/no: full femoral head; full acetabular roof; horizontal iliac wing; os ischium; absent motion/artifact). 2DUS indices (alpha angle, coverage) were measured centrally by a blinded reader with 2 years DDH US experience. 3DUS was post-processed by semi-automated custom software generating acetabular surface models, indices and estimated probability of DDH. Gold-standard diagnosis of each hip as normal, borderline or dysplastic was based on radiologist review of expert 2DUS. RESULTS: Thirty infants, mean age 10.8 weeks were enrolled. Quality scores were 2.7±1.2 Novice versus 4.9±0.3 Expert for 2DUS (p = 0.04), and 4.2±1.0 Novice versus 4.9±0.3 Expert for 3DUS (p = 0.99). Inter-rater reliability was poor for 2DUS (ICC=0.10 for alpha angle, 0.04 for acetabular coverage) and moderate to high for 3DUS (ICC=0.73-0.83 for alpha angle, 0.55 for acetabular coverage). Intra-rater reliability and diagnostic accuracy was higher for 3DUS than 2DUS. CONCLUSION: Novice operators can perform 3DUS for DDH with reliability and accuracy approaching expert sonographers. Novices perform 2DUS with poor reliability and accuracy. KEY POINTS: • Novice/expert inter-rater reliability improved from poor with 2DUS to moderate/high with 3DUS. • Novice operators using 3DUS correctly classified 57/58 (98%) of infant hips. • DDH can be reliably assessed by novice operators using 3DUS.

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OBJECTIVE: The primary objective of this study was to estimate the effective dose delivered to the sacroiliac joint (SIJ) from low-dose (LD) CT compared with that from radiography. Secondary objectives included evaluation of diagnostic quality of LD CT of the SIJ and development of a clinical protocol for LD CT of the SIJ. MATERIALS AND METHODS: Data from 36 patients (19 women, 17 men) undergoing LD CT for suspected renal colic were analyzed. Two effective dose estimates were calculated: one for the SIJ and another for an extended region from the iliac crest to 1 cm below the SIJ. Thirty-six anteroposterior pelvic and 36 SIJ view radiographs were age-, sex-, and body width-matched to CT scans. Effective dose from radiography was estimated using the method described in International Commission on Radiologic Protection Publication 60. RESULTS: Maximum effective dose to the SIJ from LD CT was less than 1 mSv in all cases, with a mean ± SD of 0.42 ± 0.18 mSv (range, 0.14-0.83 mSv), whereas mean dose to the extended region was 0.57 ± 0.24 mSv (range, 0.19-1.11 mSv). Mean dose from SIJ radiographs was 0.15 ± 0.10 mSv (range, 0.07-1.38 mSv), and mean dose from a single pelvic radiograph was 0.09 ± 0.06 mSv (range, 0.04-0.37 mSv). All CT studies were of diagnostic quality for assessment of the SIJ. CONCLUSION: LD CT of the SIJ can be consistently performed with an effective radiation dose of less than 1 mSv. Because reliability and sensitivity of radiography for sacroiliitis is poor, we recommend that LD CT replace radiography for dedicated evaluation of the SIJ.

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AIM: To explore the factors associated with exercise-induced acute capillary glucose (CapBG) changes in individuals with type 2 diabetes (T2D). METHODS: Fifteen individuals with T2D were randomly assigned to energy-matched high intensity interval exercise (HI-IE) and moderate intensity continuous exercise (MI-CE) interventions and performed a designated exercise protocol 5 days per week for 12 weeks. The duration of exercise progressed from 30 to 60 minutes. CapBG was measured immediately before and after each exercise session. Timing of food and antihyperglycemic medication intake prior to exercise was recorded. RESULTS: Overall, the mean CapBG was lowered by 1.9 mmol/L (P < 0.001) with the change ranging from -8.9 to +2.7 mmol/L. Preexercise CapBG (44%; P < 0.001), medication (5%; P < 0.001), food intake (4%; P = 0.043), exercise duration (5%; P < 0.001), and exercise intensity (1%; P = 0.007) were all associated with CapBG changes, explaining 59% of the variability. CONCLUSION: The greater reduction in CapBG seen in individuals with higher preexercise CapBG may suggest the importance of exercise in the population with elevated glycemia. Lower blood glucose can be achieved with moderate intensity exercise, but prolonging exercise duration and/or including brief bouts of intense exercise accentuate the reduction, which can further be magnified by performing exercise after meals and antihyperglycemic medication. This trial is registered with ClinicalTrial.gov NCT01144078.

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AIMS: To compare the feasibility of high intensity interval exercise (HI-IE) versus moderate intensity continuous exercise (MI-CE) in patients with type 2 diabetes (T2D), and to investigate the preliminary efficacy of HI-IE and MI-CE for improving glycated hemoglobin A1c (HbA1c) and body composition. METHODS: Individuals with T2D were recruited and randomly assigned to HI-IE and MI-CE. Exercise training was performed 5 days per week for 12 weeks. Recruitment, retention, adherence, feeling states and self-efficacy were analyzed for feasibility. Changes in HbA1c and percent body fat from baseline were investigated at 12 weeks to determine the preliminary efficacy. RESULTS: Of 126 participants showing interest to join the study, 15 individuals were randomized and completed the program. No participants dropped out from the study after enrollment. Adherence rates were high and did not differ between HI-IE and MI-CE (p>0.05; >97.2% of the eligible exercise sessions for both groups). Feeling states and self-efficacy did not differ between the groups. Percent trunk fat decreased in both HI-IE and MI-CE (p=0.007 and 0.085, respectively). Total percent body fat, percent leg fat, and subcutaneous fat width were significantly reduced in both groups (p<0.05), whereas HbA1c did not change from baseline (p>0.05). The degree of improvement was similar between the interventions (p>0.05). CONCLUSION: In individuals with T2D, implementing a 12-week structured HI-IE training can be as feasible as MI-CE training. Both interventions are equally effective in lowering total body fat but have little impact on HbA1c in relatively well controlled participants with T2D.

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Ovotransferrin is a glycoprotein well-known for its iron-binding property. Ovotransferrin was reported to have antioxidative properties, but the presence of antioxidant peptides within the protein has not been reported. The purpose of the study was to characterize the antioxidant peptides within ovotransferrin. Ovotransferrin was sonicated and hydrolyzed by thermolysin, and peptides from the hydrolysate were fractionated by ion-exchange fast protein liquid chromatography and reversed-phase high-performance liquid chromatography. Fourteen peptides derived from ovotransferrin were characterized using LC-MS/MS, and their oxygen radical absorbance capacity (ORAC) values were determined using synthetic peptides. Two tetrapeptides (Trp-Asn-Ile-Pro and Gly-Trp-Asn-Ile) showed the highest antioxidant activity. Interestingly, the addition of amino acid residues to either the N or C terminus of the two peptides decreased the antioxidant activity, suggesting that the motif of Trp-Asn-Ile is responsible for the high antioxidant activity.

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