This review examines the current state-of-the-art of ultrasound-guided lumbar facet joint injections (FJI), highlighting its emergence as a novel and increasingly successful approach. The literature underscores its growing popularity owing to practical advantages such as low cost, absence of radiation, real-time needle visualisation and tracking, and a low rate of complications. The procedure serves a dual purpose: as a diagnostic test for facet joint syndrome-related low back pain and as a therapeutic intervention for pain alleviation. Ultrasound guidance is particularly advantageous when coupled with needle guidance systems, ensuring precise needle direction for deep structure penetration with heightened accuracy. In conclusion, ultrasound-guided lumbar FJI is a non-invasive, cost-effective, and radiation- free alternative to intrarticular injections guided by fluoroscopy and computed tomography. This comprehensive review aims to serve as an insightful resource for practitioners, providing valuable insights into the procedural nuances and clinical benefits of this procedure.
A 69-year-old woman was admitted to our Emergency Department with cough and dyspnea.Laboratory investigations showed increased white blood cell count (10,500 per μL), and C-reactive protein levels (124 mg/dL).Chest X-ray (Figure 1A) showed findings consistent with bilateral interstitial pneumonia; COVID-19 was detected in a throat swab sample by RT-PCR.From day one, the patient suffered from a type I respiratory failure requiring supplemental oxygen through a Venturi mask, FiO 2 up to 60%.She was treated with lopinavir/ritonavir and hydroxychloroquine; because of the persistent severe conditions (Figure 1B), tocilizumab was added on day 14.Two days later, after improvement in respiratory exchange, the oxygen therapy was suspended.A slow progressive improvement occurred (Figure 1C), and on days 30 and 31, RT-PCR was negative.On day 32, the patient underwent an unenhanced chest computed tomography (CT), showing diffuse lung architectural distortion, with reticular interstitial pattern, peripheral honeycombing, and bronchial wall thickening.Images of a previous chest CT performed by the patient a year ago are available, showing no significant abnormalities.The dramatic pulmonary changes (Figure 2A and B) make us question the possible long-term consequences of COVID-19 pneumonia.
Breast ultrasound has emerged as a valuable imaging modality in the detection and characterization of breast lesions, particularly in women with dense breast tissue or contraindications for mammography. Within this framework, artificial intelligence (AI) has garnered significant attention for its potential to improve diagnostic accuracy in breast ultrasound and revolutionize the workflow. This review article aims to comprehensively explore the current state of research and development in harnessing AI's capabilities for breast ultrasound. We delve into various AI techniques, including machine learning, deep learning, as well as their applications in automating lesion detection, segmentation, and classification tasks. Furthermore, the review addresses the challenges and hurdles faced in implementing AI systems in breast ultrasound diagnostics, such as data privacy, interpretability, and regulatory approval. Ethical considerations pertaining to the integration of AI into clinical practice are also discussed, emphasizing the importance of maintaining a patient-centered approach. The integration of AI into breast ultrasound holds great promise for improving diagnostic accuracy, enhancing efficiency, and ultimately advancing patient's care. By examining the current state of research and identifying future opportunities, this review aims to contribute to the understanding and utilization of AI in breast ultrasound and encourage further interdisciplinary collaboration to maximize its potential in clinical practice.
We read with great interest the article "Response to COVID-19 in Breast Imaging," published April 1, 2020 (1).COVID-19 has spread worldwide, with more than 1,000,000 confirmed cases in 207 countries as of April 4, 2020 (2).The measures put in place to combat COVID-19 are impressive, with negative consequences and uncertainty in various health sectors (3).In this situation, it is mandatory to reorganize clinical activity in order to continue providing essential services.The authors of the article highlighted some important key points of managing a breast imaging department during the COVID-19 pandemic (1).A rapid and unexpected surge of COVID-19 in the northern part of Italy forced our hospital, in Milan, to respond quickly to this event, without any comparison in the western world (4).Our screening activity (12 000 mammograms per year) was suspended on February 24, 2020, reopened on March 2, 2020, and then suspended again on March 9, 2020, following the evidence of the growing infection.Regarding the important recommendations provided, we would like to emphasize the protection of staff and patients through temperature control and the administration of a screening questionnaire; in addition, both staff and patients are provided with a surgical mask to be worn in the hospital.A breast radiologist and a technologist must always be available for urgent cases: evaluation and sampling of BI-RADS 4 and 5 lesions (5), clinical symptoms, known cancer needing localization, and the extent of disease determination.Moreover, a staff person is always present to answer the phone.A subset that deserves to be better analyzed are BI-RADS 3 patients.As stated by Dr. Plecha and Dr.Leung (1), this category could be rescheduled; in order to do this, we ran a query in the reports from July 2019 to October 2019 for the words "BI-RADS 3" and contacted these patients, who were happy for this initiative.Understanding that we are facing an unprecedented situation, we underline and support the need for a "standard operating procedure" in the setting of rescheduling exams and case management to avoid unequal attitudes or possible lawsuits.
Background The paranasal sinuses are complex anatomical structures, characterised by highly variable shape, morphology and size. With the introduction of multidetector scanners and the development of many post-processing possibilities, computed tomography became the gold standard technique to image the paranasal sinuses. Segmentation allows the extraction of metrical and shape data of these anatomical components that can be applied for diagnostic, education, surgical planning and simulation, and to plan minimally invasive interventions in otorhinolaryngology and neurosurgery. Discussion Our aim was to provide a review of the existing literature on segmentation, its types and application, and the data obtained from this procedure. The literature search was conducted on PubMed (including Medline), ScienceDirect and Google Scholar databases, using the keywords as follows: ‘paranasal sinuses’, ‘frontal sinus’, ‘maxillary sinus’, ‘sphenoid sinus’, ‘ethmoid sinus’, in all possible combinations with the keywords ‘segmentation’ and ‘volumetric analysis’. Inclusion criteria were: articles written in English, on living human subjects, on the adult population and focused on paranasal sinuses analysis. Conclusion This article provides an overview of the types and main application of segmentation procedures on paranasal sinuses, and the results provided by the studies on this topic.
