Publications

Multiple barriers have been identified to developing a learning health care systems (LHSs) including organizational culture, data systems and interoperability, funding and workforce limitations, and regulatory challenges. Artificial intelligence (AI) is being explored both inside and outside of health care, with varying degrees of scientific rigor in the testing of AI applications. LHSs and AI face similar implementation challenges, which presents an opportunity for synergy. By reviewing AI use cases from the lens of how it can be used to reduce previously identified barriers to progressing toward an LHS, opportunities for facilitating this journey can be identified. AI tools can impact both clinical and nonclinical business processes. The process of testing and implementing AI tools based on high-quality evidence or signal should prespecify thresholds and expectations of incremental effectiveness (marginal risk-benefit) improvement compared with current standards of care, as is standard in health services research, quality improvement, process improvement, and best practices of comparative health care research. Business process examples to improve workflow using AI tools may adhere to less rigorous evidentiary standards compared with tools guiding patient-centered clinical decision scenarios, such as with AI-based diagnostic applications. This review indicates that AI tools provide tremendous opportunities for radiology to improve health care systems, workflow processes, and patients' health outcomes.

PURPOSE: To evaluate the impact of capsular tension ring (CTR) implantation on refractive outcomes, intraocular lens (IOL) stability, and postoperative complications in high myopic patients undergoing cataract surgery.

DESIGN: Systematic review and meta-analysis.

METHODS: A systematic search of PubMed, EMBASE, Cochrane Library, and Google Scholar through March 2025 identified studies comparing cataract surgery with and without CTR implantation in high myopic eyes. The primary outcome was prediction refractive error (PE). Secondary outcomes included absolute refractive error (AE), postoperative corrected distance visual acuity (CDVA), IOL decentration, anterior chamber depth (ACD), posterior capsular opacification (PCO), and Nd:YAG capsulotomy rates. Random-effects meta-analysis, sensitivity analysis, and meta-regression were performed.

RESULTS: Nine studies (4 randomized controlled trials and 5 cohort studies; 846 eyes) were included. CTR implantation did not significantly affect PE (mean difference [MD], 0.00; 95% confidence interval [CI], -0.07 to 0.08; P = .93) or postoperative CDVA (MD, 0.00; 95% CI, -0.06 to 0.06; P = 1.00). However, CTR significantly reduced AE (MD, -0.12; 95% CI, -0.20 to -0.05; P = .001) and IOL decentration (MD, -0.04; 95% CI, -0.07 to -0.01; P = .004).No covariates significantly influenced PE in meta-regression.

CONCLUSIONS: CTR implantation appears to modestly improve refractive predictability and IOL stability in high myopic eyes without compromising postoperative visual acuity. However, given the limited evidence base and small effect sizes, these findings should be interpreted with caution. CTR implantation may be considered in selected myopic cases with suspected zonular weakness or large capsular bags where additional capsular stability is desired.

Background/Objectives: This study aimed to assess the effectiveness of a combination therapy comprising eyelid hygiene, intense pulsed light (IPL), and meibomian gland expression in patients with meibomian gland dysfunction (MGD). Methods: This retrospective study included MGD patients who completed at least three sessions of combination therapy administered at 4-week intervals, with a minimum follow-up period of 6 months. Ocular surface parameters were evaluated at baseline and at 1, 3, and 6 months after treatment initiation. Based on the clinical response following the initial three sessions, patients were categorized into either the standard treatment group (3 sessions) or the extended treatment group, who received three additional sessions of the same combination therapy. Results: A total of 107 patients (77 females; 30 males) were enrolled. 74 patients received standard treatment, and 33 received extended treatment. In the standard group, significant improvements compared with baseline were observed in the Ocular Surface Disease Index score, non-invasive tear break-up time, corneal staining, lid margin plugging, telangiectasia, and the meibomian gland expressibility score. Conversely, in the extended group, only the meibomian gland expressibility score showed significant improvements at the 3-month follow-up. Conclusions: The standard combination therapy resulted in significant and durable improvements in approximately 70% of MGD patients, with effects persisting for at least 3 months post-treatment. These findings support the clinical utility of this multimodal approach and highlight the need for biomarkers to predict treatment response.

In this paper, we designed, built, characterized and demonstrated a cost-effective diffuse optical tomographic (DOT) system for imaging absorbing and fluorescent targets and fluorescence alteration induced by temperature change in a scattering medium. DOT based imaging in a scattering media (such as biological tissue) is highly desired because of its high sensitivity and non-invasive nature. Unfortunately, conventional methods require expensive devices, such as lasers, optical switches, scientific cameras or photon detectors and advanced electronic controlling systems and data acquisition tools. To lower the cost and provide a simple system that can be used by researchers, teachers, and students who have a limited budget, we investigated and tested a method that uses light-emitting diodes (LEDs), a mobile phone-based camera, and a low-cost microcontroller (an Uno R3 board) to achieve the goal with reasonable accuracy. This method includes a hardware system, a software system for hardware controlling, data acquisition and processing, and an imaging reconstruction algorithm. By combining these subsystems, we demonstrated the feasibility of 3-dimensional imaging of absorbing and fluorescence targets and temperature change-induced fluorescence in a scattering medium using a temperature-sensitive fluorophore.

PURPOSE: To evaluate whether left-sided transjugular intrahepatic portosystemic shunt (L-TIPS) placement offers an advantage over conventional right-sided transjugular intrahepatic portosystemic shunt (R-TIPS) in cirrhotic patients with a history of Grade 1 hepatic encephalopathy (HE), specifically in lowering the incidence and progression of HE.

MATERIALS AND METHODS: This institutional review board (IRB)-approved, single-center retrospective study analyzed 25 consecutive patients who underwent L-TIPS creation between January 2016 and March 2023 who had a history of Grade 1 HE. Using 1:2 matching for 5 variables (pre-transjugular intrahepatic portosystemic shunt HE grades, albumin levels, stent size, Model for End-stage Liver Disease [MELD] score, and age), 50 patients who received R-TIPS were selected for comparison of procedural and clinical outcomes.

RESULTS: Of the 75 patients, there were 25 in the L-TIPS group (age, 58.4 years [SD ± 6.8]; 72% male) and 50 in R-TIPS group (age, 58.8 years [SD ± 8.4]; 66% male; P = .828 for age; P = .600 for sex). Rates of HE stage escalation after transjugular intrahepatic portosystemic shunt placement were not significantly different between groups (48% L-TIPS vs 38% R-TIPS; P = .562). The rate of medically refractory HE was 4% in the L-TIPS group and 0% in the R-TIPS group. There was no significant difference in the number of adverse events between the 2 groups (P = .802).

CONCLUSIONS: L-TIPS demonstrates a similar safety profile and similar rates of HE as R-TIPS in patients with pre-existing Grade 1 HE.

Background: Adrenal incidentalomas are common findings at contrast-enhanced CT, yet their management remains controversial. Objective: The purpose of this study was to determine the prevalence of malignancy among incidental indeterminate adrenal nodules detected on contrast-enhanced CT in patients without known cancer. Methods: We performed a 12-institution retrospective cohort study of adult patients without known cancer who underwent contrast-enhanced CT of the abdomen from January 1, 2010, to April 2, 2016. Consecutive reports from 10,646 cases were reviewed. CT images were reviewed for 2603 cases with reports describing an adrenal nodule measuring 1 cm or larger. Malignancy or benignity was determined using the following reference standards: pathology, diagnostic imaging (attenuation on unenhanced CT < 10 HU or signal-intensity loss at chemical shift MRI), imaging stability for at least 1 year, or clinical follow-up of at least 5 years. Descriptive statistics were performed using the binomial exact method and chi-square test. Results: The final cohort included 1320 patients (813 women, 507 men; mean age, 63.1 ± 15.2 years) with 1506 adrenal nodules. Mean nodule size was 2.1 cm ± 0.7 cm (range, 1.0-10.7 cm; IQR, 1.6-2.5 cm). The prevalence of malignancy among all nodules, nodules measuring 1-2 cm, nodules measuring 2-4 cm, and nodules measuring more than 4 cm was 0.07% (1/1506; 95% CI, 0.0-0.37%), 0.0% (0/773; 95% CI, 0.0-0.39%), 0.14% (1/694; 95% CI, 0.0-0.80%), and 0.0% (0/39; 95% CI, 0.0-7.4%). respectively. The one malignant nodule was an adrenocortical carcinoma diagnosed 9 years after initial detection. A total of 940 nodules underwent unenhanced CT after the index CT; all were benign. Of these, 654 were less than 10 HU, 157 were 10-20 HU, and 129 were more than 20 HU. Conclusion: The prevalence of malignancy among incidental indeterminate adrenal nodules on contrast-enhanced CT in patients without known cancer was exceedingly low. Clinical Impact: Follow-up imaging is not warranted for small (1-2 cm) incidental indeterminate adrenal nodules detected on contrast-enhanced CT in patients without known cancer.