Journal Sciences News
Transactions of Nonferrous Metals Society of China
Available online 11 January 2018
Ring Ring Ring! Characterising Telephone Interruptions During Radiology Reporting and How to Reduce These
Publication date: Available online 11 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Christopher Watura, Dominic Blunt, Dimitri Amiras Background Telephone calls remain one of the most frequent interruptions in radiology reporting rooms, despite modern electronic order communication systems. A call received by a radiology trainee during the hour before completing a report may increase the chance of a discrepancy by 12%. Aim To characterise telephone calls to radiology reporting rooms and identify ways to reduce these interruptions. Methods and Materials An observational study over five working days (10 programmed activity reporting sessions equivalent) was conducted across two large acute teaching hospital reporting rooms. Radiologists were requested to record all calls between 9a.m–5p.m on a pre-prepared Excel proforma and indicate their initial rating of call appropriateness. Results 288 calls recorded, 92% (266/288) interrupted reporting. Reasons for calls were 48% (139/288) ask for a request to be vetted, 17% (50/288) ask for a study to be reported, 17% (45/288) ‘other
Available online 11 January 2018
Radiographic Cobb Angle: A Feature of Congenital Lumbar Spine Stenosis
Publication date: Available online 11 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Falgun H. Chokshi, Nadja Kadom, Nishant Dwivedi, Suprateek Kundu, Ahmed Y. Moussa, Chadi Tannoury, Tony Tannoury Purpose A low cost, reproducible radiographic method of diagnosing congenital lumbar spinal stenosis (CLSS) is lacking. We hypothesized that the Cobb angle for lumbar lordosis would be smaller in patients with CLSS, based on observations in our spine clinic patient population. Here, we compared lumbar lordosis Cobb angles with the radiographic ratio method in patients with normal spine imaging, degenerative spinal stenosis, and with CLSS. Materials & Methods Orthopedic surgeons categorized patients with low back pain as “Normal”, “Degenerative spinal stenosis”, and “CLSS” based on clinical presentation and findings on lumbar magnetic resonance imaging (MRI). We included 30 patients from each cohort who had undergone lateral lumbar spine radiographs and lumbar MRI. For each lateral radiograph, two measurement methods were used: 1) 4-line lumbosacral Cobb angle between L2-S1 and 2) the ratio of the anteroposterior (AP) vertebral body (VB) diameter and spinal canal AP diameter at the L3 level. We performed logistic regression analyses of CLSS prediction by Cobb angle vs. the ratio method in all three cohorts. Covariates included age, gender, and body mass index (BMI). Results The radiographic Cobb angles were smaller in CLSS patients when compared to the Degenerative Disease and Normal cohorts: A smaller radiographic Cobb angle showed higher odds ratio (OR) of predicting CLSS diagnosis compared to the radiographic ratio when compared with Degenerative Disease (OR 0.28, 95% CI 0.11–0.78, p=0.01) and when compared with the Normal cohort (OR 0.46, 95% CI 0.24–0.92, p=0.03). Radiographic ratio measurements showed no difference between the three cohorts (p=0.12). CLSS was associated with male gender (p=0.04), younger age (p=0.01), and higher BMI (p=0.01). Conclusion The radiographic Cobb angle method for lumbar lordosis may be useful for raising the possibility of CLSS as the diagnosis.
Available online 10 January 2018
CT Imaging of Non-Neoplastic and Neoplastic Benign Gastric Disease
Publication date: Available online 11 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Maria Zulfiqar, Anup Shetty, Vilaas Shetty, Christine Menias
Available online 10 January 2018
Online Interactive Case-based Instruction in Prostate MRI Interpretation using PI-RADS Version 2: Impact for Novice Readers
Publication date: Available online 10 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Andrew B. Rosenkrantz, Jovan Begovic, Antonio Pires, Eugene Won, Samir S. Taneja, James S. Babb Purpose To assess the impact on reader performance of an interactive case-based online tutorial for prostate MRI interpretation using PI-RADS. Methods An educational website was developed incorporating scrollable multi-parametric prostate MRI examinations with annotated solutions based on PI-RADS version 2. Three second-year radiology residents evaluated a separate set of 60 prostate MRI examinations both before and after review of the online case material, identifying and scoring dominant lesions. These 60 examinations included 30 benign cases and 30 cases with a dominant lesion demonstrating Gleason score
Available online 9 January 2018
Male Breast MRI: When is it Helpful? Our Experience over the Last Decade
Publication date: Available online 10 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Kyungmin Shin, Sarah Martaindale, Gary J. Whitman Currently, there are no clear indications or guidelines for performing breast MRI in male patients diagnosed with primary breast cancer. The literature is also very limited on the utilization of breast MRI in male patients. Although it is not common or recommended as a routine clinical practice to perform breast MRI in male patients even in the setting of a diagnosis of breast cancer, there are few instances where MRI may help clinicians and surgeons. With a comprehensive review of cases that was performed at our institution over the last 10 years, the readers may achieve better understanding of when it may be helpful to perform breast MRI in male patients.
Available online 6 January 2018
In the Setting of Negative Mammogram, is Additional Breast Ultrasound Necessary for Evaluation of Breast Pain?
Publication date: Available online 9 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Eralda Mema, Emma Cho, Yun-Kyoung Ryu, Priya Jadeja, Ralph Wynn, Brett Taback, Richard Ha Purpose To evaluate whether in the setting of negative diagnostic mammogram for breast pain additional ultrasound is necessary. Methods Retrospective IRB approved review of our database identified 8085 women who underwent ultrasound evaluation for breast pain from 1/1/2013 to 12/31/2013. Of 8085 women, 559 women had mammogram evaluation preceding the ultrasound and these women comprise the basis of this study. The patient
Available online 6 January 2018
Customized Residency Leadership Tracks: A Review of What Works, What We’re Doing and Ideas for the Future
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): S.A. Matalon, S.A. Howard, G. Gaviola, O. Johnson, C.H. Phillips, S.E. Smith, W.W. Mayo-Smith
Available online 6 January 2018
Diffusion Tensor Imaging of the Ankle as a Possible Predictor of Chemotherapy Induced Peripheral Neuropathy: Pilot Study
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Lana Hirai Gimber, Linda Garland, Elizabeth A. Krupinski, Tyson S. Chadaz, Michael Schwenk, Bijan Najafi, Mihra S. Taljanovic Purpose Chemotherapy induced peripheral neuropathy (CIPN) is seen in up to 75% of treated cancer patients and can drastically limit their medical management and affect quality of life. Clinical and electrodiagnostic testing for CIPN have many pitfalls. Magnetic resonance neurography (MRN) is being increasingly utilized in the evaluation of peripheral nerves. Diffusion tensor imaging (DTI) shows promise in the workup of peripheral nerves. In this prospective pilot study, we investigated a possible relationship between DTI and peripheral neuropathy of the ankle and foot in cancer patients treated with chemotherapy. Methods Nine cancer patients with and without CIPN were clinically evaluated using vibratory perception threshold (VPT) testing. VPT score of >25Volts defined presence of CIPN. The posterior tibial nerve and branches in both feet were imaged using MRN and DTI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured at the posterior tibial, medial plantar, and lateral plantar nerves. Measurements for the CIPN group were compared to without CIPN by VPT cut-off. Correlations and possible relationships between DTI parameters and CIPN were analyzed. Results A total of 16 feet of nine enrolled patients were imaged (9 feet with CIPN, 7 feet without CIPN). Average age was 60.6±13.4 years (range=33–74). Posterior tibial nerve ADC values were significantly lower than the medial plantar nerve ADC values in all feet (F=3.50, p=0.04). We found a correlation with FA and ADC values at specific nerve locations with CIPN, with the left medial plantar nerve FA value and left lateral plantar nerve ADC value demonstrating the strongest positive correlations (0.73 and 0.62, respectively). Conclusions The use of DTI for assessing CIPN is challenging but promising. This pilot study provides preliminary data showing correlations between FA and ADC measurements with CIPN and potential utility of DTI as a predictive marker of onset and severity of CIPN in the ankle and foot which could aid in preventive strategies. Larger, prospective DTI studies are needed to draw definitive conclusions. Clinical Relevance MRN with DTI shows promising results as a potential predictive marker of CIPN in the ankle and foot.
Available online 6 January 2018
Common resident errors when interpreting CT of the abdomen and pelvis: A review of types, pitfalls, and strategies for improvement
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Benjamin Wildman-Tobriner, Brian C. Allen, Charles M. Maxfield Objective The purpose of this study was to identify common errors that radiology residents make when interpreting abdominopelvic (AP) CT while on call, to review the typical imaging findings of these cases, and to discuss strategies for improvement. Materials and Methods AP (or chest, abdomen, pelvis) CTs from 518 weekend senior call shifts (R3 or R4) were retrospectively reviewed. Discrepancies between preliminary and final reports were identified and then rated by whether the miss could impact short-term management. The imaging findings from the cases were reviewed. Results 4695 CTs were reviewed, revealing a total of 145 discrepancies that could affect short-term clinical management (miss rate 3.1%). The most common misses were related to blood clots (13.8%), colitis (8.3%), misplaced lines/tubes (6.9%), or pyelonephritis (5.5%). Common pitfalls and strategies from improved detection are discussed using image examples. Conclusions Through increased attention to the vasculature, colon, devices, and kidneys, trainees may improve their discrepancy rates and improve on-call reporting.
Available online 6 January 2018
Benefits of Integrated RIS / PACS / Reporting Due To Automatic Population of Templated Reports
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Mark D. Kovacs, Maximilian Y. Cho, Philip Burchett, Michael Trambert With integration of the RIS, PACS, and reporting systems, patient identifiers and exam information can automatically map into exam reports. There are many potential benefits of report automation to radiologists including improvements in efficiency, accuracy, and fatigue. In this paper we describe a two part study, with the first part being an anonymous survey of radiologists concerning report automation. 13 staff radiologists and 9 radiology residents at a single institution completed an anonymous survey. Respondents were asked if automatic population of exam description, comparison exam data, indications, CT dose, technique, and copy to physician data saved time, decreased fatigue, and increased accuracy. Respondents were asked if a “copy findings” function saved time. The second objective part of the study was a mock exam experiment to assess time savings of report automation and to assess error rates. 9 radiologists were asked to dictate fields for 8 mock exams. Subjects were timed and reporting errors monitored. Estimated daily time savings and error rates were calculated assuming a mix of 80 studies. 95% surveyed responded that report automation saved time; 91% that report automation improved accuracy of dictations; 82% that report automation decreased fatigue. 83% of copy finding function users reported time savings. Average time to dictate these pre-populated fields was 51 seconds per study. Average error rate per report was 0.86, with an average of 0.26 errors remaining uncorrected upon report completion. Estimated average time per day saved per radiologist from report automation was 68 minutes. Estimated average corrected errors was 48 per day. Estimated average uncorrected/missed errors was 21 per day. These estimated benefits from report automation result from tight integration of RIS, PACS, and reporting systems.
Available online 6 January 2018
Evaluating Resident On-Call Performance: Does Volume Affect Discrepancy Rate?
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Benjamin Wildman-Tobriner, Brendan Cline, Christopher Swenson, Brian C. Allen, Charles M. Maxfield
Available online 6 January 2018
Why is this Auntminnie a Diagnostic Conundrum? - A Knowledge-Based Approach to Balo’s Concentric Sclerosis from Reports of Three Cases and Pooled Data from Sixty-Eight other Patients in The Literature
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Mohit Agarwal, John L. Ulmer, Andrew P. Klein, Leighton P. Mark We came across three cases of Balo
Available online 6 January 2018
Patient Knowledge Regarding Colorectal Cancer Risk, Opinion of Screening, and Preferences for a Screening Test
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Courtney C. Moreno, Thomas Jarrett, Brianna L. Vey, Pardeep K. Mittal, Elizabeth A. Krupinski, David L. Roberts A survey assessing knowledge about colorectal cancer incidence and prognosis as well as willingness to undergo screening with various tests (e.g., optical colonoscopy, stool-based tests, CT colonography) was administered to consecutive patients of a general academic-based internal medicine clinic. Survey response rate was 86.3%. A majority of respondents (55%) reported being aware of general information about colorectal cancer, and 99% indicated a belief that colorectal cancer screening was a good idea. A majority of respondents (73%) were willing to undergo optical colonoscopy, and some were willing to undergo stool-based tests (48%) or CT colonography (40%). A majority reported being more willing to undergo a colorectal cancer screening test if the test did not involve radiation (86%), did not involve insertion of a tube or device into the rectum (78%), did not involve a pre-procedural bowel cleansing regimen (73%), or did not involve sedation (60%). In conclusion, improved patient education about the negligible radiation risk associated with CT colonography and/or development of a non-invasive imaging test that did not involve a pre-procedural bowel cleansing regimen may increase rates of colorectal cancer screening.
Available online 6 January 2018
Thyroid Fine Needle Aspiration: Successful Prospective Implementation of Strategies to Eliminate Unnecessary Biopsy in the Veteran Population
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Sean D. Raj, Rohit Ram, David J. Sabbag, Mark A. Sultenfuss, Rebecca Matejowsky Objective Thyroid nodules are prevalent in over half the general population. Several multi-disciplinary societies have management recommendations. However, the majority of data to support these guidelines are derived from studies of predominantly younger and female populations. This study
January–February 2018
Bronchiectasis Revisited: Imaging Based Pattern Approach to Diagnosis
Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Anuradha Singh, Ashu Seith Bhalla, Manisha Jana Bronchiectasis is one of the causes of non-resolving, persistent or recurrent pulmonary infection which, if uncorrected may have deleterious consequences on the lung parenchyma and pulmonary circulation. Chest radiograph is done at the initial suspicion which is supplemented by HRCT to confirm the diagnosis. Imaging diagnosis supplemented by the recognition of the pattern of involvement is essential to outline the differential diagnosis, map the complications and, hence, guiding the further management. Identification of the causative aetiology may not only prevent its further progression but obviate recurrent insults to the lung parenchyma as well. This article focuses on an algorithmic approach to bronchiectasis based on the distribution on imaging.
January–February 2018
Reviewer Awards and Acknowledgments
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Puneet Bhargava
January–February 2018
Real-Time Electronic Dashboard Technology and Its Use to Improve Pediatric Radiology Workflow
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Randheer Shailam, Ariel Botwin, Markus Stout, Michael S. Gee The purpose of our study was to create a real-time electronic dashboard in the pediatric radiology reading room providing a visual display of updated information regarding scheduled and in-progress radiology examinations that could help radiologists to improve clinical workflow and efficiency. To accomplish this, a script was set up to automatically send real-time HL7 messages from the radiology information system (Epic Systems, Verona, WI) to an Iguana Interface engine, with relevant data regarding examinations stored in an SQL Server database for visual display on the dashboard. Implementation of an electronic dashboard in the reading room of a pediatric radiology academic practice has led to several improvements in clinical workflow, including decreasing the time interval for radiologist protocol entry for computed tomography or magnetic resonance imaging examinations as well as fewer telephone calls related to unprotocoled examinations. Other advantages include enhanced ability of radiologists to anticipate and attend to examinations requiring radiologist monitoring or scanning, as well as to work with technologists and operations managers to optimize scheduling in radiology resources. We foresee increased utilization of electronic dashboard technology in the future as a method to improve radiology workflow and quality of patient care.
January–February 2018
Use of Computed Tomography to Determine Perforation in Patients With Acute Appendicitis
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Cameron E. Gaskill, Vlad V. Simianu, Jonathan Carnell, Daniel S. Hippe, Puneet Bhargava, David R. Flum, Giana H. Davidson Purpose Urgent appendectomy has long been the standard of care for acute appendicitis. Six randomized trials have demonstrated that antibiotics can safely treat appendicitis, but approximately 1 in 4 of these patients eventually requires appendectomy. Overall treatment success may be limited by complex disease including perforation. Patients
January–February 2018
Diagnostic Performance of SRU and ATA Thyroid Nodule Classification Algorithms as Tested With a 1 Million Virtual Thyroid Nodule Model
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Mitchell Boehnke, Nayana Patel, Kristin McKinney, Toshimasa Clark Purpose The Society of Radiologists in Ultrasound (SRU 2005) and American Thyroid Association (ATA 2009 and ATA 2015) have published algorithms regarding thyroid nodule management. Kwak et al. and other groups have described models that estimate thyroid nodules’ malignancy risk. The aim of our study is to use Kwak’s model to evaluate the tradeoffs of both sensitivity and specificity of SRU 2005, ATA 2009 and ATA 2015 management algorithms. Materials and Methods 1,000,000 thyroid nodules were modeled in MATLAB. Ultrasound characteristics were modeled after published data. Malignancy risk was estimated per Kwak’s model and assigned as a binary variable. All nodules were then assessed using the published management algorithms. With the malignancy variable as condition positivity and algorithms’ recommendation for FNA as test positivity, diagnostic performance was calculated. Results Modeled nodule characteristics mimic those of Kwak et al. 12.8% nodules were assigned as malignant (malignancy risk range of 2.0-98%). FNA was recommended for 41% of nodules by SRU 2005, 66% by ATA 2009, and 82% by ATA 2015. Sensitivity and specificity is significantly different (< 0.0001): 49% and 60% for SRU; 81% and 36% for ATA 2009; and 95% and 20% for ATA 2015. Conclusion SRU 2005, ATA 2009 and ATA 2015 algorithms are used routinely in clinical practice to determine whether thyroid nodule biopsy is indicated. We demonstrate significant differences in these algorithms’ diagnostic performance, which result in a compromise between sensitivity and specificity.
January–February 2018
Spirometry-Assisted High Resolution Chest Computed Tomography in Children: Is it Worth the Effort?
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Jeffrey Parke Otjen, Jonathan Ogden Swanson, Assaf Oron, Robert M. DiBlasi, Tim Swortzel, Jade Adriana Marie van Well, Eva Anna Elisabeth Gommers, Margaret Rosenfeld Background Image quality of high resolution chest computed tomographies (HRCTs) depends on adequate breath holds at end inspiration and end expiration. We hypothesized that implementation of spirometry-assisted breath holds in children undergoing HRCTs would improve image quality over that obtained with voluntary breath holds by decreasing motion artifact and atelectasis. Methods This is a retrospective case-control study of HRCTs obtained at a tertiary care children’s hospital before and after implementation of a spirometry-assisted CT protocol, in which children
January–February 2018
Abdominal Imaging Surveillance in Adult Patients After Fontan Procedure: Risk of Chronic Liver Disease and Hepatocellular Carcinoma
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Sadhna B. Nandwana, Babatunde Olaiya, Kelly Cox, Anurag Sahu, Pardeep Mittal Purpose To assess the prevalence of chronic liver disease (CLD) and hepatocellular carcinoma (HCC) in adult patients who had surveillance imaging after Fontan procedure. Methods Institutional review board–approved, Health Insurance Portability and Accountability Act–compliant retrospective study evaluated electronic medical records including radiology reports and clinical notes for adult patients after Fontan procedure between January 1993 and January 2016. Abdominal ultrasound, computed tomography, and magnetic resonance imaging reports were reviewed for changes of CLD and HCC. Existence of concomitant viral hepatitis was also recorded. Results A total of 145 patients (male: 78 and female: 67) had surveillance imaging after Fontan procedure. In all, 78% (113/145) had ongoing imaging surveillance (median follow-up 3.05 years, IQR: 0.75-5.3 years); 19% (21/113) had an initial normal study and remained normal throughout follow-up; 19% (21/113) had an initial normal study with subsequent imaging reporting changes of CLD; and 62% (71/113) had existing changes of CLD on initial study. HCC was identified in 5 patients (median 22 years post-Fontan, IQR: 10-29 years), 4 of which had a normal initial study. Only 1 patient with HCC had concomitant viral hepatitis C infection. Conclusion Radiologists should be aware that CLD is exceedingly common in post-Fontan cardiac physiology, and surveillance imaging is warranted given the risk of HCC.
January–February 2018
Limited Utility of Pulmonary Nodule Risk Calculators for Managing Large Nodules
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Mark M. Hammer, Arun C. Nachiappan, Eduardo J. Mortani Barbosa Rationale and Objectives The optimal management of large pulmonary nodules, at higher risk for lung cancer, has not been determined, and it remains unclear as to which patients should undergo follow-up imaging vs invasive tissue diagnosis via biopsy or surgical resection. Materials and Methods Through search of radiology reports, 86 nodules from our institution were identified using the inclusion criterion of solid nodules measuring greater than 8mm. We evaluated these nodules with a number of risk prediction calculators, including the Brock University model, and compared these against the proven diagnosis. Results Of 86 nodules, 59 (69%) nodules were malignant. The most accurate predictive model, the Brock University calculator, underestimated the risk for this group at 33%. At its optimal threshold, this model had a positive predictive value of 81% and negative predictive value of 53%. Notwithstanding the low negative predictive value, the positive predictive value was no better than patients clinically selected for biopsy (86% of biopsies were malignant). Conclusion Existing nodule risk prediction calculators are of limited usage in guiding the management of large pulmonary nodules. At present, the accuracy of these models in this setting is inferior to expert clinical judgment, and future work is needed to develop management algorithms for higher-risk nodules.
January–February 2018
Magnetic Resonance Imaging Evaluation of Urothelial Cell Carcinoma: Histopathological Correlation, Staging, and Treatment Planning
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Peter A. Harri, Lauren Alexander, Juan C. Camacho, Courtney C. Moreno, Pardeep Mittal
January–February 2018
Magnetic Resonance Imaging of the Digital Nerves of the Hand: Anatomy and Spectrum of Pathology
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Charles H. Mitchell, Laura M. Fayad, Shivani Ahlawat Digital nerves are intrinsic to the sensory and motor function of the hand. These nerves represent the terminal ramifications of the ulnar, median, and radial nerves and are located distal to the carpal tunnel and Guyon canal. With magnetic resonance imaging, traumatic and nontraumatic abnormalities of the digital nerves can be shown with high contrast as well as high spatial resolution. Digital nerve abnormalities are most commonly posttraumatic in nature; however, infection, inflammatory, vascular malformations, and neoplasms can rarely occur. Magnetic resonance imaging is playing an increasing role in the assessment of peripheral nerve injury throughout the body, and in the hand, which can accurately identify the extent and character of digital nerve abnormalities before operative intervention.
January–February 2018
Intimal Problems: A Pictorial Review of Nontraumatic Aortic Disease at Multidetector Computed Tomography
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Abigail V. Berniker, Justin E. Mackey, Oleg M. Teytelboym Nontraumatic aortic diseases include a spectrum of disorders, many of which result in high morbidity and mortality. This article highlights the multidetector computed tomography appearance of common and uncommon nontraumatic aortic entities: dissection, intramural hematoma, penetrating atherosclerotic ulcer, pseudoaneurysm, aneurysm, acute thrombus, chronic occlusion, and vasculitis. Additionally, classical imaging mimics and pitfalls are addressed. Radiologists should feel confident identifying these conditions and providing accurate diagnoses to expedite patient care and prevent devastating, even fatal outcomes.
January–February 2018
Orbital Imaging Manifestations of Neurocutaneous Syndromes Revisited
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): Abanti Das, Sanjay Sharma Neurocutaneous syndromes or phakomatoses represent a heterogeneous group of multisystemic disorders involving structures of ectodermal origin. Characteristic ocular manifestations are described for individual entities that are often the first clues to the underlying diagnosis. However, opaque ocular media or involvement of retrobulbar orbit limits adequate clinical evaluation. This underlines the role of imaging, especially cross-sectional imaging modalities, such as computed tomography and magnetic resonance imaging, which offer a comprehensive evaluation of orbit and its contents. This review aims to summarize the cross-sectional imaging features of orbital manifestations of common neurocutaneous syndromes encountered in clinical practice.
Available online 10 November 2017
Wandering Spleen: An Overview
Publication date: January–February 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 1 Author(s): David C. Reisner, Constantine M. Burgan An ectopic (or “wandering”) spleen results from abnormal ligamentous laxity failing to fixate the spleen in its normal location in the left upper quadrant. Ligamentous laxity can be acquired due to conditions, such as splenomegaly or pregnancy, but is often congenital. Because of this laxity, there is an elongated vascular pedicle, which is prone to torsion and resultant splenic infarction. These patients generally present with abdominal pain and other nonspecific symptoms making the diagnosis very difficult to make clinically. As such, the radiologist plays a crucial role in the diagnosis and care of these patients, as often the diagnosis is only considered after imaging.
Available online 10 November 2017
Perioperative Internal Iliac Artery Balloon Occlusion, In the Setting of Placenta Accreta and Its Variants: The Role of the Interventional Radiologist
Publication date: Available online 10 November 2017
Source:Current Problems in Diagnostic Radiology Author(s): David A. Petrov, Benjamin Karlberg, Kamalpreet Singh, Matthew Hartman, Pardeep K. Mittal Placenta accreta and its variants (increta and percreta) are conditions of abnormal placentation that are encountered with increasing frequency. The spectrum of placenta accreta (including placenta increta and percreta) involves an abnormal attachment of the placental chorionic villi to the uterine myometrium. This abnormal attachment leads to increased adherence of the placenta to the uterus and abnormal placental-uterine separation at the time of delivery. Placental invasion into, or through the myometrium is associated with increased postpartum morbidity and mortality as a result of uterine hemorrhage during and following cesarean section. A multidisciplinary clinical approach to the treatment of patients with placenta accreta is recommended by the American College of Obstetricians and Gynecologists. As potential members of an interdisciplinary team, interventional radiologists can perform prophylactic internal iliac arterial balloon occlusion as an adjunctive therapy for reducing potentially life-threatening postpartum hemorrhage. The procedure involves placement of a balloon catheter into the internal iliac or common iliac arteries bilaterally prior to cesarean section. Following delivery, and prior to placental separation, the catheter balloons are inflated with a pre-determined volume of saline leading to transient occlusion of the internal iliac arteries and reduced uterine blood flow.
Available online 6 November 2017
In Pursuit of Fellowship: Results From a 2016 Survey of US Trainees
Publication date: Available online 10 November 2017
Source:Current Problems in Diagnostic Radiology Author(s): Junjian Huang, Suhag Patel, Richard Scruggs, Dayna Levin Purpose The purpose of this study was to gauge radiology trainee perceptions regarding the fellowship selection process and survey their perceived level of preparedness and desire for a fellowship-oriented lecture. Methods A survey, approved by Association of Program Coordinators in Radiology (APCR) was distributed via e-mail to all APCR members for distribution to their residents. Results A total of 98.6% (n = 261) of residents plan to pursue a fellowship. The most popular fellowships are interventional radiology, body, musculoskeletal, and Neuro. For fellowship information, residents believe that fellowship directors in their field of intent were the most reliable (76%), followed by fellows (65%). Only approximately 50% of residents felt somewhat strongly that they were preparing for their fellowship application correctly. Lastly, 44% of residents (n = 94) replied extremely likely to attend a lecture series given by fellowship directors, and 36% (n = 77) said somewhat likely. Conclusion This survey demonstrates that most trainees plan to pursue fellowship training. Residents ranked certain resources as more important in fellowship selection, such as fellowship directors and fellows. Lastly, there is a high interest in a lecture series that would bring together fellowship directors and residents that are interested in that particular fellowship.
Available online 4 November 2017
Preoperative Computed Tomography-Guided Pulmonary Lesion Marking in Preparation for Fluoroscopic Wedge Resection—Rates of Success, Complications, and Pathology Outcomes
Publication date: Available online 6 November 2017
Source:Current Problems in Diagnostic Radiology Author(s): Babatunde Olaiya, Charles A. Gilliland, Seth D. Force, Felix G. Fernandez, Manu S. Sancheti, William C. Small Purpose In this study, we describe our experience of lesion marking with fiducial markers (FM) and microcoils (MC) facilitating same-day surgical wedge resection, including success rates, pathology outcomes, and complications. We also explored patient/nodular characteristics associated with developing complications. Materials and Methods An IRB-approved single-institutional retrospective study of 136 patients who had 148 pulmonary nodules was conducted. All patients had CT-guided pulmonary nodule labeling with either FM (121) or MC (15) patients with plan for same-day fluoroscopic-guided wedge resection. Results Of 136 (98%) patients, 133 had successful same-day wedge resection as planned; 2 had delayed but successful wedge resection surgery due to complications at the time of marker placement (fiducial embolization and hemorrhage/pneumothorax, respectively). A third patient ultimately needed lobectomy due to deep lesion location. Eighty percent [118/148] of resected nodules were malignant. Further, 68% of the total group of patients [93/136] had mild complications of various types including hemorrhage [44/136, 32%], pneumothorax [35/136, 26%], a combination of both hemorrhage and pneumothorax [10/136, 7%], or migration/embolization [4/136, 3%]. Depth of nodule from skin (P = 0.011) and pleura (P = 0.027) was significantly associated with complications. Conclusion CT-guided marking of small or deep pulmonary lesions using either fiducial markers or microcoils provides an effective means to aid surgeons to accomplish minimally invasive wedge resection. The importance of the success of this technique is supported by the high incidence (80%) of malignant lesion etiology found at postresection pathology. Although complications occurred, the vast majority were mild and did not alter planned same-day resection.
Available online 3 November 2017
Use of Shoulder Imaging in the Outpatient Setting: A Pilot Study
Publication date: Available online 4 November 2017
Source:Current Problems in Diagnostic Radiology Author(s): Elisabeth R. Garwood, Gregory S. Mittl, Michael J. Alaia, James Babb, Soterios Gyftopoulos Purpose Characterize the clinical utility of diagnostic shoulder imaging modalities commonly used in the outpatient workup of shoulder pain. Materials/Methods Retrospective review of adults imaged for outpatient shoulder pain from 1/1/2013 to 9/1/2015. To be categorized as “useful”, a study had to meet one of the following criteria: change the clinical diagnosis or treatment plan, provide a final diagnosis, or guide definitive treatment. A utility score was assigned to each study based on the number of utility criteria met (range 0-4). A score of 1 was considered low utility; a score of greater than or equal to 2 was considered high utility. Statistical analysis included binary logistic regression and generalized estimating equations. Results 210 subjects (65% male); mean age 47 (range 18-84), underwent 302 imaging studies (159 X-ray, 137 MRI, 2 CT, 4 ultrasound) during the study period. 92.1% of all studies met minimum criteria for utility (score >1). Most commonly, diagnostic studies obtained during the outpatient workup of shoulder pain were found to guide definitive treatment (70.5%) or provide a final diagnosis (53%). Most X-rays were categorized as no or low utility (85.5%). 97.8% of the MRI studies were categorized as useful with most being high utility (73%). Overall, MRI was the most useful modality in all clinical scenarios (P = 0.002) and more likely to be high utility (P < 0.001) compared to X-rays. None of the investigated patient or injury characteristics were significant predictors of useful imaging. Conclusion Our study suggests that both radiographs and MRI are useful in the evaluation of adult unilateral shoulder pain in the outpatient setting. MRI appears to be the most useful imaging modality in terms of helping guide diagnosis and treatment selection. This serves as a potential first step towards the development of evidence based imaging algorithms that can be used and tested in future studies.
November–December 2017
Risk Factors for Late Screening Mammography
Publication date: Available online 3 November 2017
Source:Current Problems in Diagnostic Radiology Author(s): John Davis, Juliana Liang, Matthew B. Petterson, Albert T. Roh, Navya Chundu, Paul Kang, Samantha L. Matz, Mary J. Connell, Daniel G. Gridley Background Breast cancer has the highest incidence of cancers in women in the United States. Previous research has shown that screening mammography contributes to reduced breast cancer mortality. This study aimed to clarify why late screening might occur in an at-risk population. Materials and Methods This study was a prospective cross-sectional study including 758 patients presenting to our radiology department for routine screening mammography who completed a 30-question survey regarding personal characteristics and mammography history. Univariate and multivariate logistic regression were performed to determine whether survey responses correlated with late screening. Results Of the 758 patients, 184 (24%) were noncompliant with screening mammography guidelines. Risk factors for late screening included younger age (P = 0.001), white race/ethnicity (P = 0.03), self-reported lack of financial means or health insurance (P = 0.005), lack of satisfaction with a previous mammogram experience (P = 0.001), inadequate mammography education by a physician (P = 0.001), and lack of awareness/comprehension of screening mammography guidelines (P = 0.002). Conclusion Many factors contribute to late screening mammography. Although some are outside physician control, others can be influenced: patient education regarding screening mammography guidelines, and patient satisfaction with the mammography experience. This study highlights the importance of communication with and education of patients.
November–December 2017
Altmetrics: A Measure of Social Attention toward Scientific Research
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Akshay D. Baheti, Puneet Bhargava The quality and impact of scientific research is traditionally measured by citation-based metrics. However, the internet and social media revolution has led to radical changes in the way scientific information is shared and how it impacts the world. Alternative metrics (altmetrics) is a rapidly evolving measure to quantify social media attention received by a scientific work. It is a complement to the conventional metrics, and has tremendous potential in enabling faster alternative ways of evaluating research impact. We discuss the Altmetric Score and the growing role of altmetrics for measuring research impact.
November–December 2017
The Champion’s Creed: Shared Values of Athletes and Academicians
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Laura M. Fayad Although the pursuit of sports may be dismissed as unimportant by those in the academic fields, sports are pervasive, and in our society, elite athletes are revered. There are lessons to be appreciated from the training journey and ultimate achievements of such athletes, which parallel the development and sustainment of the academic radiologist on many fronts, including educational training, clinical work, the pursuit of research, and for some, the culmination of a career in a leadership role.
November–December 2017
Resident Perspectives of an Interactive Case Review Following Independent Didactic Study as a Method of Teaching a Pediatric Imaging Curriculum
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Aleksandr Rozenberg, Sachin Dheer, Levon N. Nazarian, Suzanne S. Long Purpose The ABR has recently changed the format of the board examination, in which the oral examination was replaced by a computer based multiple-choice test. The purpose of this study was to determine resident’s perceptions of a new conference resembling the new ABR format. Methods Residents were requested to review a series of didactic pediatric imaging presentations prior to attending case conference. During conference, unknown cases reflecting the subject matter from the didactic presentations were presented along with multiple-choice questions. We then surveyed resident perspectives after each case conference. Results Between 14 and 18 residents were surveyed at the end of each subspecialty case review presentation. About 94% of resident respondents felt that the independent didactic study followed by an interactive case review session would better prepare them for the ABR certification exams, compared to didactic lectures alone. Furthermore, 95% of the respondents indicated that they preferred the independent didactic review followed by interactive case review versus didactic lecture alone. Most the respondents (85%) felt that combining independent didactic review with interactive unknown case sessions made the material more interesting and provided greater understanding of the material. There was no statistically significant difference in the distribution of answers across the subspecialty sessions (p > .05). Conclusion Radiology residents favorably reviewed the combination of independent review of didactic material prior to interactive case review. Material presented in this fashion is felt to be more interesting and is thought to result in enhanced understanding of pediatric radiology material.
November–December 2017
The Use of Team-Building Activities to Build a Better Resident
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): James D. Ireland, Linda A. Deloney, Shyann Renfroe, Kedar Jambhekar We implemented team building activities to build a better resident during our orientation process and we have refined the choice of activities each year since. Resident satisfaction with their team building actives provided feedback to improve the following years’ experience. While there is no definite way to demonstrate the effectiveness of our team building initiative, our expectation is it will improve the residency experience and work environment, and ultimately, result in better patient care. We focus on five aspects of team building – personal history sharing, creativity and imagination, common bonds, cooperation, and shared experience. The purpose of this paper is to recommend activities in each of these areas based on our experience.
November–December 2017
Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Lindsay M. Thornton, Roniel Cabrera, Melissa Kapp, Michael Lazarowicz, Jeffrey D. Vogel, Beau B. Toskich Aim To retrospectively compare the initial response, local recurrence, and complication rates of radiofrequency ablation (RFA) vs microwave ablation (MWA) when combined with neoadjuvant bland transarterial embolization (TAE) or drug-eluting microsphere chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). Methods A total of 35 subjects with Barcelona Clinic Liver Cancer (BCLC) very early and early-stage HCC (range: 1.2-4.1cm) underwent TAE (23) or TACE (12) with RFA (15) or microwave ablation (MWA) (20) from January 2009 to June 2015 as either definitive therapy or a bridge to transplant. TAE and TACE were performed with 40-400
November–December 2017
Effect of Mammography on Marker Clip Migration After Stereotactic-Guided Core Needle Breast Biopsy
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Huong T. Le-Petross, Kenneth R. Hess, John D. Knudtson, Deanna L. Lane, Tanya W. Moseley, William R. Geiser, Gary J. Whitman Objective To determine whether the type of projection used—same as or orthogonal to the projection used during a stereotactic-guided core needle biopsy procedure—to obtain the first view on a 2-view postbiopsy mammogram affects biopsy marker clip migration. Patients and Methods We prospectively recruited women scheduled to undergo stereotactic-guided core needle breast biopsy with marker clip deployment and categorized the women randomly into one of the following 2 groups: first view on the postbiopsy mammogram obtained in the same projection as that used during the biopsy procedure (group 1), or first view on the postbiopsy mammogram obtained orthogonally to the projection used during the biopsy procedure (group 2). Masks of the prebiopsy and postbiopsy mammograms were used to determine whether and how far the biopsy marker clip moved from the biopsy cavity. Results Sixty-two biopsies were performed in 60 patients (mean age = 56 years; range: 30-78 years); 30 women (32 lesions) were randomized to group 1 and 30 women (30 lesions) were randomized to group 2. Marker clip migration occurred in 10 cases in group 1 (20%, <1cm; 30%, 1-3cm; and 60%, >3cm) and 8 cases in group 2 (0%, <1cm; 75%, 1-3cm; and 25%, >3cm). The mean displacement distance was 0.84cm in group 1 and 0.67cm in group 2 (P = 0.83). The mean displacement distance difference was
November–December 2017
Arthrographic Anatomy of the Biceps Tendon Sheath: Potential Implications for Selective Injection
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Nathan Webb, Jonathan Bravman, Alexandria Jensen, Jonathan Flug, Colin Strickland The purpose of this investigation was to better define the anatomical features of the biceps tendon sheath, including the distance the sheath extends below the inferior margin of the subscapularis tendon and below the termination of the bony bicipital groove. A total of 110 magnetic resonance and computed tomography arthrograms performed during 1-year period at our institution were retrospectively reviewed, and the length of the biceps tendon sheath and distances from the inferior margin of the subscapularis tendon and from the termination of the bicipital groove to the inferior margin of the biceps tendon sheath were measured by 3 radiologists. The mean length of the biceps tendon sheath was 47.5mm. The mean distances from the inferior margin of the subscapularis tendon and from the inferior margin of the bicipital groove to the distal extent of the biceps tendon sheath were 24.5mm and 11.9mm, respectively. The relationships among these 3 anatomical measurements and biological confounders of sex and age were investigated while controlling for measurement variability. The anatomical relationships between the biceps tendon sheath and surrounding structures may have implications for needle placement when attempting to inject into the biceps tendon sheath for diagnostic or therapeutic purposes.
November–December 2017
Improving Access to Image-guided Procedures at an Integrated Rural Critical Access Hospital: Ultrasound-guided Thyroid Biopsy Program
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Thang Q. Le, Yadiel S
November–December 2017
What to Expect When They are Expecting: Magnetic Resonance Imaging of the Acute Abdomen and Pelvis in Pregnancy
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Hemang M. Kotecha, Lacey J. McIntosh, Hao S. Lo, Byron Y. Chen, Carolyn S. Dupuis In this article, we discuss the challenges in the diagnosis of acute abdominopelvic pain in pregnant patients, role of imaging, and advantages of MRI over other modalities. Methods consist of pictorial review. We review the differential diagnoses and illustrate the MRI findings in pregnant patients with acute abdominopelvic pain, including gastrointestinal, gynecologic, urologic, and vascular etiologies.
November–December 2017
Spectrum of Pregnancy- and Lactation-related Benign Breast Findings
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Scott Parker, Megan Saettele, Matthew Morgan, Matthew Stein, Nicole Winkler Introduction Extensive physiologic changes occur in the breasts during pregnancy and lactation. Additionally, several specific benign lesions are also common in pregnant and lactating patients. These changes and lesions have characteristic imaging appearances and findings. Objective This article provides an image-rich educational review of typical and atypical benign imaging findings in pregnant and lactating patients. The discussion also includes basic imaging protocol considerations and explores management options. Conclusion An understanding of the typical and atypical imaging appearance of physiological changes and specific benign lesions occurring in pregnancy and lactation is essential for appropriate patient care and management.
November–December 2017
Imaging of Intracranial and Orbital Complications of Sinusitis and Atypical Sinus Infection: What the Radiologist Needs to Know
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Vinodkumar Velayudhan, Zeshan A. Chaudhry, Wendy R.K. Smoker, Roman Shinder, Deborah L. Reede Sinusitis is a common disease. Complications, however, are less common and can be life threatening. Major complications occur from extension of disease into the orbit and intracranial compartment and often require emergent treatment with intravenous (IV) antibiotics or operative intervention. Immunocompromised patients with acute sinusitis are susceptible to atypical infections, such as invasive fungal sinusitis, which is a surgical emergency. Therefore, it is important to accurately and promptly identify potentional complications of acute sinusitis to ensure appropriate treatment and minimize negative outcomes. This article reviews the imaging features of a spectrum of complications associated with acute sinusitis and atypical infections.
Available online 31 October 2017
Unexpected Presentation of Perianal Granular Cell Tumor in a Young Woman
Publication date: November–December 2017
Source:Current Problems in Diagnostic Radiology, Volume 46, Issue 6 Author(s): Laila Rashidi, Darren Pollock, Sarah Bastawrous Granular cell tumors originate from Schwann cells of the soft tissues and are rarely observed in the perianal region. Often, correct diagnosis can be challenging owing to nonspecific clinical symptoms and imaging characteristics, as well as its ability to mimic other malignant lesions histologically. We describe the case of a previously healthy 36-year-old woman who presents with a slow growing, painless lump in her perianal region who underwent surgical excision and was found to have a granular cell tumor on microscopic evaluation. This case highlights the importance for radiologists, pathologists, surgeons, and other health care providers to be aware of this rare neoplasm and consider it in the differential diagnosis when encountering perianal masses.
Available online 31 October 2017
Developing a Multidisciplinary Vascular Anomalies Clinic and Reviewing the Radiologist’s Clinic Role
Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology Author(s): Mark D. Mamlouk, Pristine W. Lee Cutaneous vascular anomalies can be challenging to diagnose and treat given their rare presentation and that they do not always fall under the purview of a specific medical specialty. Patients with cutaneous vascular anomalies are best managed in vascular anomalies clinics, but to our knowledge, no reported publications exist on how to develop such a clinic. In this article, we describe the specifics steps our institution took to create a vascular anomalies clinic and discuss how it benefitted our patients and referring providers. We also highlight the roles of the diagnostic and interventional radiologist within a vascular anomalies clinic.
Available online 31 October 2017
Gastrointestinal Stromal Tumor of the Jejunum With Active Bleeding Demonstrated on Dual-Energy MDCT Angiography: A Case Report
Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology Author(s): Abdul Razik, Kumble S. Madhusudhan, Abhishek Aggarwal, Rajesh Panwar, Deep N. Srivastava Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and may occasionally present with acute gastrointestinal bleed (GIB). Multidetector computed tomography (MDCT) angiography is extremely useful in demonstrating the tumor as well as the presence of active hemorrhage, thereby guiding subsequent interventional or surgical management. We report a case of a 38-year-old man who presented with acute-onset melena and compensated shock, whose source of bleed remained elusive on endoscopy. MDCT angiography performed on a dual-energy scanner showed a jejunal tumor with active intraluminal contrast extravasation. The tumor was subsequently resected and the patient did well on follow-up. This was one of the few instances when MDCT angiography demonstrated active bleeding in a GIST and the first such case demonstrated on a dual-energy scanner.
Available online 31 October 2017
Trainee Knowledge of Imaging Appropriateness and Safety: Results of a Series of Surveys From a Large Academic Medical Center
Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology Author(s): Thaddeus D. Hollingsworth, Richard Duszak, Arvind Vijayasarathi, Rondi B. Gelbard, Mark E. Mullins Objective In order to provide high quality care to their patients and utilize imaging most judiciously, physician trainees should possess a working knowledge of appropriate use, radiation dose, and safety. Prior work has suggested knowledge gaps in similar areas. We aimed to evaluate the knowledge of imaging appropriateness, radiation dose, and MRI and contrast safety of physician trainees across a variety of specialties. Methods Between May 2016 and January 2017, three online surveys were distributed to all interns, residents, and fellows in ACGME accredited training programs at a large academic institution over two academic years. Results Response rates to three surveys ranged from 17.2% (218 of 1266) for MRI and contrast material safety, 19.1% (242 of 1266) for imaging appropriateness, to19.9% (246 of 1238) for radiation dose. Overall 72% (509 of 706) of survey respondents reported regularly ordering diagnostic imaging examinations, but fewer than half (47.8%; 470 of 984) could correctly estimate radiation dose across four commonly performed imaging studies. Only one third (34%; 167 of 488) of trainees chose appropriate imaging in scenarios involving pregnant patients. Trainee post-graduate year was not significantly correlated with overall radiation safety scores, and no significant difference was found between radiation safety or appropriate imaging scores of those who participated in a medical school radiology elective vs. those who did not. A total of 84% (57 of 68) of radiology trainees and 43% (269 of 630) of non-radiology trainees considered their knowledge adequate but that correlated only weakly correlated to actual knowledge scores (p<0.001). Most trainees (73%, 518 of 706) agreed that more training in these areas would have beneficial effects on patient care. Conclusions Knowledge gaps pertaining to appropriateness and imaging safety exist among many trainees. In order to enhance the value of imaging at the population level, further work is needed to assess the most appropriate method and stage of training to address these knowledge gaps.
Available online 31 October 2017
Development and Assessment of a Multidisciplinary Radiology Contrast Reaction Training Course: Our Experience and Future Directions
Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology Author(s): Alisa Sumkin, Michael J. Magnetta, Ryan Anderson, Deborah Farkas, Margarita Zuley, Philip Orons, Marion Hughes
Available online 31 October 2017
Portable CT Pulmonary Angiogram in an Infant on Veno-Arterial Extracorporeal Membrane Oxygenation in the Pediatric Intensive Care Unit
Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology Author(s): Simon S. Ho, Meral M. Patel, Renee M. Mansour, Atul Vats, Nikhil K. Chanani, Bradley S. Rostad Purpose Computed tomography (CT) has been shown to change management in children on extracorporeal membrane oxygenation (ECMO). Although techniques have been described to transport these critically ill patients to the CT suite in the radiology department, transport out of the intensive care setting is not without risk, and using portable CT is a practical alternative. However, obtaining a CT pulmonary angiogram (CTPA) in a patient on veno-arterial (VA) ECMO presents unique challenges due to bypass of the cardiopulmonary system, which may lead to suboptimal opacification of the pulmonary arteries. Methods We describe a method to obtain a diagnostic CTPA study in an infant on VA ECMO in the intensive care unit using portable CT. Our solution involved temporary withholding ECMO and using the venous cannula to deliver a compact contrast bolus to the right atrium to adequately opacify the pulmonary arteries. Special attention was given to the delivery of the contrast bolus, which was given by hand injection, to ensure it coincided with image acquisition and minimized the time ECMO was withheld. Results We were able to successfully obtain a diagnostic CTPA study in an infant on VA ECMO in the intensive care unit using portable CT. Conclusion: This case demonstrates that in select instances CTPA in infants on VA ECMO can be achieved using a portable CT system.

Towards Consensus: Training in Procedural Skills for Diagnostic Radiology Residents—Current Opinions of Residents and Faculty at a Large Academic Center
Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology Author(s): Adam Prater, Bradley S. Rostad, Emily L. Ebert, Mark E. Mullins, Christopher P. Ho Rationale and Objectives The Diagnostic Radiology Milestones Project provides a framework for measuring resident competence in radiologic procedures, but there are limited data available to assist in developing these guidelines. We performed a survey of current radiology residents and faculty at our institution as a first step toward obtaining data for this purpose. The survey addressed attitudes toward procedural standardization and procedures that trainees should be competent by the end of residency. Materials and Methods Current residents and faculty members were surveyed about whether or not there should be standardization of procedural training, in which procedures residents should achieve competency, and the number of times a procedure needs to be performed to achieve competency. Results Survey data were received from 60 study participants with an overall response rate of 32%. Sixty-five percent of respondents thought that procedural training should be standardized. Standardization of procedural training would include both the list of procedures that trainees should be competent in at the end of residency and the standard minimum number of procedures to achieve competency. Procedures that both residents and faculty agreed are important in which to achieve competency included central line/port procedures; CT-guided abdominal, thoracic, and musculoskeletal procedures; minor fluoroscopic-guided procedures; general fluoroscopy; peripheral line placements; and US-guided abdominal procedures. For most of these categories, most respondents believed that these procedures needed to be performed 6-20 times to achieve competency. Conclusion Both resident and faculty respondents agreed that procedural training should be standardized during residency, and competence in specific procedures should be achieved at the completion of residency. Although this study is limited to a single institution, our data may provide assistance in developing future guidelines for standardizing image-guided procedure training. Future studies could be expanded to create a national consensus regarding the implementation of the Diagnostic Radiology Milestones Project.
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