Westhtimmons1479
CONCLUSION Provided UKR is used appropriately, the lifetime revision risk is markedly lower than expected. UKR should be considered to be a definitive knee replacement rather than a Pre-TKR even in the young. These lifetime estimates, alongside established benefits for UKR in speed of recovery, morbidity, mortality and function, can be discussed with appropriate patients when considering whether to implant a UKR or TKR. LEVEL OF EVIDENCE III.CLINICAL/METHODICAL ISSUE Radiological emergencies or incidental findings that require rapid treatment are part of the daily routine of radiological units in clinics-but also in outpatient radiology. What is special about the care of these patients in the outpatient radiological area? STANDARD RADIOLOGICAL METHODS An acute or incidental diagnosis of an emergency situation generally occurs with CT or MRI. Outpatient radiology serves as a gatekeeper by preselecting critical cases and then, in close cooperation with all those involved, providing optimal therapy. METHODOLOGICAL INNOVATIONS Use of CT and MRI to assess the emergency situation allows optimal therapy for the patient to be initiated. In outpatient radiology, close cooperation in the team with the patient and the referring physicians means achieving an optimal result, which can be a great opportunity. ACHIEVEMENTS Close personal collaboration in the team with the referring physician and the patient is a decisive strength of outpatient radiology and can guarantee optimum care for the patient, especially in the case of acute emergencies or incidental findings which turn out to be clinical-radiological emergencies. The largest challenge in outpatient radiology is to select the critical cases of the many noncritical cases in the face of growing time and cost pressure in a time-economic manner. PRACTICAL RECOMMENDATIONS Outpatient radiology should be aware of the chance for close cooperation and communication with referring physician and patient, especially in emergency situations-for the well-being of the patient, but also to increase the acceptance and significance of the field of radiology.CLINICAL/METHODICAL ISSUE Neurological symptoms account for approximately 30% of emergency room (ER) visits. Clinical outcome often relies on a timely diagnosis and treatment initiation. Clinical imaging requirements are fast availability and high diagnostic value. STANDARD RADIOLOGICAL METHODS Availability and quality of magnetic resonance imaging (MRI) in emergency rooms outside of core hours are limited compared to computed tomography (CT). Common reasons are infrastructural accessibility (hospitals using outpatient radiology centers), a lack of experienced and qualified staff and high patient compliance requirements. However, in a neurological emergency setting, MRI may show relevant advantages over CT in certain areas, such as diagnosis of stroke. METHODOLOGICAL INNOVATIONS Advances in MRI technology have led to shorter exam times and robust motion reduction strategies. Common fast sequences and time reduction techniques for imaging of neurological emergencies are presented in this article. ACHIEVEMENTS Recommendations for specific sequences or techniques depend on the institute's MRI hardware and software components. If available, parallel imaging is highly recommended for imaging of neurological emergencies. PRACTICAL RECOMMENDATIONS Imaging of neurological emergencies requires fast, significant and motion insensitive standard acquisitions. Additional sequences should be acquired dependent on clinical and standard protocol imaging findings. An MRI emergency protocol is introduced for the most common neurologic emergencies including recommendations for fast MRI sequences and techniques for imaging time reduction.BACKGROUND Positron-emission tomography/computed tomography (PET/CT) and positron-emission tomography/magnetic resonance imaging (PET/MRI) are hybrid medical imaging techniques that are becoming increasingly important in the diagnostic workup of cancer. Correct definition and interpretation of results are key challenges for both radiologists/specialists in nuclear medicine as well as for the treating clinician. Strong interdisciplinary communication is prerequisite to solve the upcoming complexity of retrieved information generated by hybrid imaging. OBJECTIVES Different indications for hybrid medical imaging and review of current theranostic principles from the perspective of clinicians/clinical oncologists. MATERIALS AND METHODS The GBA guidelines and recommendations retrieved from the corresponding German S3 guidelines for the use of PET imaging are summarized, followed by a review of innovative clinical trials that promote PET-based therapeutic strategies and radioligand therapies. RESULTS Next generation PET/CT and PET/MRI imaging are being increasingly used for diagnostic purposes and follow-up staging in malignant tumors. Radioligand therapy may have the potential to be a further cornerstone in personalized antitumor therapy. CONCLUSIONS Careful implementation of hybrid medical imaging can clearly improve the quality of the diagnosis in cancer patients and even increase the quality of care for cancer patients. Close interdisciplinary collaboration is essential to optimize therapeutic strategies for each patient.CLINICAL/METHODICAL ISSUE Conventional imaging tests like computed tomography (CT) cannot visualize somatostatin receptor (SSTR) expression on the tumor cell surface. STANDARD RADIOLOGICAL METHODS For imaging of SSTR-expressing tumors conventional morphological imaging tests such as CT or magnetic resonance imaging (MRI) are employed. METHODICAL INNOVATIONS Molecular imaging of SSTR expression on the tumor cell surface, in particular by using (whole body) single photon emission computed tomography (SPECT) and positron emission tomography (PET), are considered the current standard of care. Only the use of CT enables for exact localization of putative sites of disease (hybrid imaging). PERFORMANCE Hybrid SPECT/CT and PET/CT are of utmost importance for staging and monitoring of treatment efficacy. SSTR-PET is superior to SPECT and the PET radiotracer 68Ga-DOTATATE has been approved in multiple countries. In addition, SSTR positivity revealed by SPECT or PET pave the way for a peptide receptor radionuclide therapy (PRRT). Such a theranostic approach enables for systemic or locoregional radiation with β‑emitting radionuclides, which are linked to the identical amino acid peptide used for PET or SPECT imaging. The prospective, randomized Netter‑1 trial has shown significant benefit for patients receiving PRRT. ACHIEVEMENTS A combined use of conventional and functional imaging tests is superior to conventional imaging alone and allows for identification of suitable candidates for a theranostic approach. PRACTICAL RECOMMENDATIONS In case of clinical suspicion or after having obtained histological evidence, hybrid SSTR-SPECT/CT or -PET/CT should be performed, preferably in a dedicated molecular imaging center.BACKGROUND The acute abdomen is a life-threatening condition that demands urgent intervention. The required diagnostics should address the core problem and has to be chosen based upon the diagnostic strength of each diagnostic tool. Modalities with limited discriminating information regarding differential diagnosis have to be avoided. Expectancy and thoughts of the radiologist often differ from the view of the clinician in the emergency department. OBJECTIVE The decision about which diagnostic tools are valuable or unnecessary in the emergency setting is made from a surgeon's point of view. Close communication with radiologists is mandatory. We demonstrate the importance of clinical signs and symptoms and their correlation with helpful radiologic diagnostics. CONCLUSION The emergency radiologic diagnostic workup of acute abdomen has to be targeted and the radiologist must answer the questions in order to clarify whether an operation is indicated and to help define the surgical strategy. In emergency surgery as in acute abdomen extended diagnostics to reach a decision is a dangerous waste of time and must be avoided at all costs. Therefore close communication with the radiologist is crucial.CLINICAL ISSUE Hybrid imaging enables the precise visualization of cellular metabolism by combining anatomical and metabolic information. Advances in artificial intelligence (AI) offer new methods for processing and evaluating this data. METHODOLOGICAL INNOVATIONS This review summarizes current developments and applications of AI methods in hybrid imaging. Applications in image processing as well as methods for disease-related evaluation are presented and discussed. MATERIALS AND METHODS This article is based on a selective literature search with the search engines PubMed and arXiv. ASSESSMENT Currently, there are only a few AI applications using hybrid imaging data and no applications are established in clinical routine yet. Although the first promising approaches are emerging, they still need to be evaluated prospectively. In the future, AI applications will support radiologists and nuclear medicine radiologists in diagnosis and therapy.Unfortunately, some errors slipped into the manuscript, which we correct here.Intraoperative parathyroid hormone (IOPTH) determination is based on the short half-life of parathyroid hormone (PTH) and the rapid analytical technology. The IOPTH provides functional information regarding correction of the overproductive state in hyperparathyroidism (HPT) and is superior to macroscopic evaluation of the parathyroid gland (PG) as well as any (intraoperative frozen section) form of histology (so-called biochemical frozen section). In this article the relevance and evaluation of IOPTH is defined for the most important forms of HPT, for primary HPT, renal secondary and tertiary HPT, multiple endocrine neoplasia type 1 (MEN1) and parathyroid carcinoma and clinical scenarios based on the currently available data. It becomes apparent that the additional benefits of IOPTH depend on diverse prerequisites of the specific type of HPT, the diagnostics as well as individual patient factors and strategic considerations for resection. Overall, the costs for IOPTH are comparably low and seem to be justified with respect to the gain in quality. In the hands of specialized endocrine surgeons IOPTH is an essential tool for intraoperative decision-making and quality assurance.BACKGROUND Artificial intelligence (AI) in neurosurgery is becoming increasingly more important as the technology advances. KIN-002787 This development can be measured by the increase of publications on AI in neurosurgery over the last years. OBJECTIVE This article provides insights into the current possibilities of using AI in neurosurgery. MATERIAL AND METHODS A review of the literature was carried out with a focus on exemplary work on the use of AI in neurosurgery. RESULTS The current neurosurgical publications on the use of AI show the diversity of the topic in this field. The main areas of application are diagnostics, outcome and treatment models. CONCLUSION The various areas of application of AI in the field of neurosurgery with a refined preoperative diagnostics and outcome predictions will significantly influence the future of neurosurgery. Neurosurgeons will continue to make the decisions on the indications for surgery but an optimized statement on diagnosis, treatment options and on the risk of surgery will be made by neurosurgeons with the help of AI in the future.