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Objective: We sought to compare three popular radiographic landmarks for their accuracy and inter-observer reliability in determination of the cavoatrial junction (CAJ) by analysing the anteroposterior scout and electrocardiogram-gated coronary computed tomographic angiography (CTA) images. Methods: CTA image data of 148 patients were assessed. The position of the CAJ defined by CTA was regarded as the gold standard. The median vertical distance between the CAJ and three radiographic landmarks (two vertebral body units [vertebrae plus discs] below the carina, the superior aspect of the right heart border, and the intersection of the bronchus intermedius with the right heart border) were assessed and compared using the Kruskal-Wallis test. For inter-observer reliability between two radiologists, each with at least 4 years of experience, intra-class correlation (ICC) was analysed. Results:The median vertical distances between the CAJ and two vertebral body units below the carina, the superior aspect of the right heart border, and the intersection of the inferior wall of the bronchus intermedius with the right heart border were 5.1 mm (0-24.6), 10.2 mm (1-45.2) and 9.8 mm (0.8-45.8), respectively. The radiographic landmark of two vertebral body units below the carina provided the closest estimation of the CAJ (p < 0.001). It also demonstrated higher ICC (0.931, 95% confidence interval [CI]=0. 905-0.950) than the other two (0.833, 95% CI=0. respectively). Conclusion: Among the three popular radiographic landmarks for the CAJ, we found that a point two vertebral body units below the carina provided the most accurate estimate of CAJ location.

Introduction:Precise preoperative localisation is essential for nonpalpable breast lesions undergoing lumpectomy. Hookwire localisation has been gradually replaced by radioisotope-guided occult lesion localisation (ROLL). We aimed to evaluate the use of magnetic metal markers (Magseed) as a nonradioactive and wireless alternative. Methods: We compared cases of Magseed localisation performed between September 2018 and April 2020 with the same number of ROLL procedures with identical pathology in the same period. Results: In total, 24 Magseed and 24 ROLL procedures were included. There were no significant differences between the case groups in terms of target characteristics, operation time, specimen size, pathological diagnosis, margin clearance, or reoperation rate. Localisation duration was significantly shorter in ROLL procedures (8.7 min) compared with Magseed localisation (12.9 min, p < 0.0001). No complications were reported. Same-day surgery was performed in all ROLL and 17 Magseed lesions. The localisation-operation interval for the other seven Magseed lesions were 4 to 14 days. Significantly lower intraoperative re-excision rates (p = 0.006) were observed in the Magseed group (8.3%) compared with the ROLL group (45.8%). Technical success of the ROLL group was 100%. Twenty-two (91.7%) Magseed localisations achieved technical success with 11/11 (100%) using ultrasound and 11/13 (84.6%) using stereotactic guidance. Magseed displacement was up to 4.8 mm in the localisation-operation interval. Conclusion: Magseed is a safe and effective localisation technique for nonpalpable breast lesions, which allows decoupling of radiological and surgical schedules.

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