Canadian Association of Radiologists Journal

This study aimed to assess the experiences and challenges faced by Canadian radiologists participating in Multidisciplinary Team rounds (MDT), with a focus on demographics, meeting characteristics, preparation processes, and perceptions of workload and compensation.

The Canadian Association of Radiologists constituted a working group which developed a 35-question survey that was distributed to 1958 radiologists and radiology trainees across Canada. The survey garnered 129 complete responses, for a response rate of 6.6%.

Respondents predominantly practiced in academic settings (65.9%) and had subspecialty training (96.1%). The majority reported that MDT rounds lasted 30 to 60 minutes and discussed 6 to 10 cases. Most radiologists (62.8%) were the sole presenters of imaging. Preparation time was often limited, with only 6.2% having dedicated time for preparation. 59.8% of respondents reported receiving additions to caseloads within the 24-hour period prior to the meetings. While 93.8% valued the opportunity for interaction with colleagues, 93.8% felt inadequately compensated for their efforts by their practices, while 92.3% felt inadequately compensated by their province.

While most radiologists indicated adequate time for discussion and meaningful clinical engagement during rounds, many highlighted repeated challenges such as last-minute case additions, lack of protected preparation time, and technological barriers. Systemic barriers also play a role and include lack of provincial remuneration and workforce issues which in turn impact individual workload pressures.

This study examines factors contributing to burnout among radiology residents through a Canadian lens and assesses strategies employed at our institution to mitigate its impact.

This was a single-institution cross-sectional study. Four anonymous online surveys were administered through Qualtrics to PGY 2-5 radiology residents from 2021 to 2025. These surveys identified residents with burnout and distress and assessed contributing factors, suggestions for reducing burnout, and residents’ responses to implemented interventions. Interventions were employed at 2 hospitals within our institution.

The surveys had response rates of 30% (2021), 57.7% (2023), 60% (2024), and 62% (2025). 50% of pre-intervention respondents were identified as burned out. The rate reduced to 18.8% post-intervention, with results not being statistically significant (P = .167). Top factors driving burnout included time (eg, increased work hours, time constraints), extra duties (clinical and administrative), and perceived lack of radiology knowledge when dealing with complex cases. Interventions included additional daily 1-hour teaching sessions, wellness lunch rounds, debriefing sessions, transitioning from paper-based protocolling to a hybrid-electronic paper-based system, call schedule modifications, improved ergonomics, and social functions, including incorporating indoor and outdoor activities. Interventions targeting work hours were subjectively the most well-received in combating burnout.

This study underscores the prevalence of burnout among radiology residents. Our institution has implemented a multi-faceted approach to address burnout within our radiology residency program.

Domain shift has been shown to have a major detrimental effect on AI model performance however prior studies on domain shift for MRI prostate cancer segmentation have been limited to small, or heterogenous cohorts. Our objective was to assess whether prostate cancer segmentation models trained on local MRI data continue to outperform those trained on external data with cohorts exceeding 1000.

We simulated a multi-institutional consortium using the public PICAI dataset (PICAI-TRAIN: 1241 exams, PICAI-TEST: 259) and a local dataset (LOCAL-TRAIN: 1400 exams, LOCAL-TEST: 308). IRB approval was obtained and consent waived. We compared nnUNet-v2 models trained on the combined data (CENTRAL-TRAIN) and separately on PICAI-TRAIN and LOCAL-TRAIN. Accuracy was evaluated using the open source PICAI Score on LOCAL-TEST. Significance was tested using bootstrapping.

Just 22% (309/1400) of LOCAL-TRAIN exams would be sufficient to match the performance of a model trained on PICAI-TRAIN. The CENTRAL-TRAIN performance was similar to LOCAL-TRAIN performance, with PICAI Scores [95% CI] of 65 [58-71] and 66 [60-72], respectively. Both of these models exceeded the model trained on PICAI-TRAIN alone which had a score of 58 [51-64] (P < .002). Reducing training set size did not alter these relative trends.

Domain shift limits MRI prostate cancer segmentation performance even when training with over 1000 exams from 3 external institutions. Use of local data is paramount at these scales.

Osteoporosis is an under-screened musculoskeletal disorder that results in diminished quality of life and significant burden to the healthcare system. We aimed to evaluate the ability of Rho, an artificial intelligence (AI) tool, to prospectively identify patients at-risk for low bone mineral density (BMD) from standard x-rays, its adoption rate by radiologists, and acceptance by primary care providers (PCPs).

Patients ≥50 years were recruited when undergoing an x-ray of a Rho-eligible body part for any clinical indication. Questionnaires were completed at baseline and 6-month follow-up, and PCPs of “Rho-Positive” patients (those likely to have low BMD) were asked for feedback. Positive predictive value (PPV) was calculated in patients who returned within 6 months for a DXA.

Of 1145 patients consented, 987 had x-rays screened by Rho, and 655 were flagged as Rho-Positive. Radiologists included this finding in 524 (80%) of reports. Of all Rho-Positive patients, 125 had a DXA within 6 months; Rho had a 74% PPV for DXA T-Score <−1. From 51 PCP responses, 78% found Rho beneficial. Of 389 patients with follow-up questionnaire data, a greater proportion of patients with Rho results reported vs not reported by a radiologist had discussed bone health with their PCP since study start (37% vs 21%, P < .001), or were newly diagnosed with osteoporosis (12% vs 5%; P = .02).

By identifying patients at-risk of low BMD, with acceptability of reporting by radiologists and generally positive feedback from PCPs, Rho has the potential to improve low screening rates for osteoporosis by leveraging existing x-ray data.

This study aimed to determine the positive predictive value (PPV) of magnetic resonance imaging–transrectal ultrasound (MRI-TRUS) machine fusion prostate biopsies, and to identify factors associated with a positive biopsy.

With ethics approval, we retrospectively evaluated all MRI-TRUS machine fusion prostate biopsies at our institution from September 2022 to April 2025. True positive clinically significant prostate cancers (csPCa) were defined as Gleason ≥7. PPVs were calculated overall and for PI-RADS 3, 4 and 5 categories. A generalized linear mixed model (GLMM) was created evaluating the following factors as fixed effects: PI-RADS category; prostate-specific antigen (PSA) density (<0.10, 0.10-0.15, ≥0.15 ng/mL²); lesion size (<7, 7-15, ≥15 mm); lesion location (peripheral vs transition zone); ultrasound correlate (present/absent); prostate size (<60 vs ≥60 mL); interval from MRI to biopsy (<6 months or not); and biopsy operator (2 radiologists). Referring urologist (n = 19) and reporting radiologist (n = 8) were included as random effects.

372 patients (mean age, 67 ± 7 years) with 529 lesions underwent biopsy. The overall PPV was 314/529 (59.4%). For PI-RADS 3 to 5, PPVs were 32/72 (44.4%), 123/243 (50.6%), and 159/214 (74.3%), respectively. In GLMM analysis, PI-RADS 5 versus 3 (OR 3.6, 95% CI, 1.7-7.4), PSA density ≥0.15 ng/mL² (OR 2.2, 95% CI, 1.2-3.8), and presence of an ultrasound correlate (OR 2.7, 95% CI, 1.7-4.2) were associated with true positive biopsies. Small lesion size <7 mm was associated with a false positive biopsy (OR 0.4, 95% CI, 0.2-0.8).

The yield of fusion prostate biopsies at our institution is high. PI-RADS 5, PSA density ≥0.15 ng/mL², and an ultrasound correlate at biopsy were associated with csPCa, whereas sub-7 mm lesions were negatively associated with csPCa.

To assess the operational and environmental benefits of using an abbreviated protocol for hepatocellular carcinoma (HCC) surveillance.

This IRB-approved retrospective single-center quality improvement study evaluated time, energy use, and appointment access. Inclusion criteria were HCC surveillance MRIs with either a full or abbreviated imaging protocol. Exclusion criteria were other abdominopelvic MR protocols or incomplete studies. DICOM time data were extracted via Quantivly and validated with 10 prospective time studies. Exam times from PACS images were cross-referenced with DICOM data to identify and resolve extraction outliers. Power logs from 10 exams per protocol were used to quantify energy and greenhouse gas emissions. Schedule logs assessed appointment volume changes. Mean times (±SD) and energy (±SD) were reported, and Welch’s t-test determined statistical significance (P < .05).

Exam times for 487 MRIs (318 abbreviated, 169 full protocol) were analyzed, with 67 excluded. The mean duration of exam time for the abbreviated protocol was 12.0 minutes (SD: 4.3), compared with 29.7 minutes (SD: 8.8) for the full protocol (mean difference, 17.7 minutes; P < .0001). The mean energy for the abbreviated protocol was 4.7 kWh (SD: 0.6), compared with 11.7 kWh (SD: 1.3) for the full protocol (mean difference, 7.0 kWh; P < .0001). Across 318 abbreviated exams, estimated savings totaled 2226 kWh and 1494.6 kg CO2eq. Despite time savings, MRI appointment volume and scanner access remained unchanged.

Abbreviated HCC surveillance MRIs cut scan time, energy use, and carbon emissions by 60%, but scheduling complexities precluded increased MRI appointments.

To correlate parathyroid scintigraphy results with patient biochemistry, surgery, and pathology to inform appropriateness criteria and assess biochemical metrics in the imaging workup of hyperparathyroidism.

This retrospective study included 421 patients who underwent parathyroid scintigraphy. Patients were grouped based on primary versus secondary hyperparathyroidism, and clinical profiles were reviewed for scan result, blood work, surgical results, and pathology. Performance metrics of scintigraphy were analyzed. Demographics, bloodwork, and location were compared between positive and negative scans. Predictors of positive scans were identified by multivariate logistic regression analysis. The performance of biochemistry to predict scan results was evaluated by ROC analyses.

Positive tests—occurring in 52% of patients—were associated with higher parathyroid hormone (PTH) and corrected calcium. However, PTH was only predictive of a positive test in patients with secondary hyperparathyroidism. On multivariate analysis, male sex, corrected calcium, and younger age were predictors of a positive scan. Corrected calcium was the most predictive with an OR of 1.28 for every 0.1 mmol/L increase. Based on ROC analysis, corrected calcium had an AUC of 0.628 and a cutoff of 2.65 mmol/L maximized sensitivity (88%) and specificity (35%) for a positive test.

In this large retrospective cohort, several biochemical metrics, including corrected calcium levels, were predictive of a positive scintigraphy study. Furthermore, biochemistry, including PTH levels, significantly differed between primary and secondary hyperparathyroidism suggesting that tailored biochemical metrics are required. This work sets a foundation for the development of a robust biochemical scoring system to optimize patient selection for parathyroid imaging.

Evaluate global interest in middle meningeal artery (MMA) embolization, for subdural hematoma, by analyzing search behavior and academic output using Google Trends and PubMed data.

Retrospective analysis conducted using Google Trends data from January 2004 to March 2025 and PubMed publication records from 1965 to 2025. The Google dataset included normalized monthly search volume indices (SVI: 0-100), geographic distribution, and related queries. Academic interest was assessed by annual publication counts. Statistical methods included Mann-Kendall trend tests, Augmented Dickey-Fuller (ADF) unit root tests, Portmanteau white noise tests, and Spearman correlations to evaluate significance and associations. Forecasts were generated using polynomial regression models.

Search interest remained negligible from 2004 to 2011, increasing modestly through 2019 before accelerating significantly. PubMed publications followed a similar pattern, with sharp growth beginning in 2015. Both datasets exhibited significant upward trends (Mann-Kendall: Tau = 0.80 for PubMed; 0.75 for Google, P < .000001). Trends were confirmed as deterministic (ADF P < .001) and non-random (Portmanteau P < .001). A strong correlation was observed between academic and public interest (Spearman r = .86, R² = .74, P < .001). Polynomial forecasting (R² = .93) projects continued publication growth, estimating 267 ± 24 publications by 2027. Search interest is expected to stabilize at high levels (SVI 70-90).

Interest in MMA embolization is rapidly accelerating across both public and academic domains. These trends suggest a paradigm shift that may soon influence treatment guidelines, care delivery models, and the global adoption of this technique.

Physicians in Canada are disproportionately concentrated in urban centers, with rural regions facing significant gaps in specialist care. The geo-spatial characteristics of Interventional Radiology (IR) in Canada have not been systematically studied. This study examines the distribution of Canadian Association of Interventional Radiology (CAIR) members and the sociodemographic characteristics of the populations they serve.

A list of active members of the Canadian Association of IR (CAIR) was obtained in May 2025. Data from the Canadian Census was used to gather census division (CD)-level information on population size and demographics including data on ethnicity, income, education, employment, and income. CDs were grouped and compared between those with access to IR care and those without, compared between top and bottom quartiles for each population characteristic, and mapped.

Of 293 CDs in Canada, only 48 (19.6%) had at least one CAIR IR, leaving 31.6% of the national population without local access. CAIR IRs were strongly clustered in high-population CDs, with Toronto, Vancouver, and Montreal alone accounting for 56.5% of IRs. CDs with CAIR IRs had significantly higher mean populations (527 322 vs 47 675; P < .001), median incomes ($82 760 vs $75 821; P = .002), and educational attainment (31% vs 16%; P < .001). Conversely, CDs with higher proportions of the population being Indigenous were less likely to have CAIR IRs (5% vs 14%; P < .001).

CAIR member IRs are disproportionately concentrated in large urban centers, leaving substantial geographic disparities. Addressing this maldistribution will require coordinated strategies, including outreach models, telehealth integration, and national workforce planning.