July–August 2018 The 9 Habits of Highly Effective Radiologists Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Timothy Alves, Monica Kalume-Brigido, Corrie Yablon, Puneet Bhargava, David Fessell Stephen R. Covey’s landmark work in the field of effectiveness and professional development delineated first 7, then ultimately eight, habits of highly effective people with applicability to all professions.1 This article describes the eight habits in specific relation to the radiologist, and proposes a ninth habit to help one bring a positive and centered approach during the journey to effectiveness and beyond.
July–August 2018 Radiologists Are Actually Well Positioned to Innovate in Patient Experience Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Ravi V. Gottumukkala, Thang Q. Le, Richard Duszak, Anand M. Prabhakar Patient experience is becoming increasingly prioritized, most notably as a component of recently passed health care legislation that aims to link physician reimbursement to quality of care and cost-effectiveness. For several reasons, radiologists are better positioned to seize opportunities to enhance patient experience than is readily apparent. We propose that discrete components along the imaging value chain can be evaluated specifically for their effect on patient experience and improved to this end. We also emphasize that the field of radiology has traditionally been the earliest adopter and a serial innovator in health information technology, and we suggest possible ways to leverage the newest technological tools to improve patient experience. Finally, we discuss how carefully vetted opportunities for direct patient interaction might expand the reach of diagnostic radiologists as members of integrated health systems. We believe that emerging patient experience metrics present unconventional opportunities for radiologists to make imaging even more meaningful for the many patients who entrust us with their care.Six Summary PointsPatient experience metrics addressed in recent health care legislation, when implemented, may apply to at least a subset of diagnostic radiologists.Given the scope of imaging services, diagnostic radiologists are better positioned to seize opportunities to innovate in patient experience than is readily apparent.Identifying which components of the imaging value chain represent the most potent modifiers of patient experience could facilitate targeted improvement efforts.The field of radiology has traditionally been an innovator in health IT and should continue capitalizing on its collective technical vision, particularly since incorporation of health IT tools into patient care is becoming increasingly prioritized in health care legislation.In addition to facilitating image interpretation, artificial intelligence tools could be leveraged to noninterpretive ends such as workflow optimization and improved patient access to care.Carefully vetted opportunities for direct patient engagement would likely expand the reach of diagnostic radiologists as members of integrated health systems.
July–August 2018 Missed Case Feedback and Quality Assurance Conferences in Radiology Resident Education: A Survey of United States Radiology Program Directors Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Anne E. Gill, Philip K. Wong, Mark E. Mullins, Amanda S. Corey, Brent P. Little Rationale and ObjectivesDiagnostic Radiology (DR) residents typically generate preliminary reports for imaging examinations, but few publications discuss feedback regarding missed or misinterpreted findings. Our goal was to determine the practices of United States DR residencies with respect to missed case feedback, including the role of Quality Assurance (QA) conferences.Materials and MethodsA 23-item survey containing multiple-choice questions and several free text fields was created and hosted on SurveyMonkeyR. An invitation to complete the survey was sent via email to all DR Program Directors (PDs) or representatives. Responses were tabulated and analyzed using SurveyMonkeyR analytic tools and Microsoft Excel.Results188 PDs or representatives were emailed, resulting in 45 survey responses. Common types of missed case feedback included resident QA case conferences (81%), resident self review of cases (72%), discussion during readout at the end of shift (70%), and faculty-resident meetings (67%). A minority of programs reported using automated methods of resident feedback, such as PACS integration or automated emails. Most resident QA conferences were held monthly (64%). Typical formats of conferences included informal discussion (43%), formal presentation (30%), or case conferences (30%). The majority (78%) of respondents rated resident missed case feedback mechanisms at their institution as at least “good”.ConclusionDR residencies use a variety of mechanisms to provide feedback to residents regarding missed or misinterpreted cases, including QA conferences. Although several possibilities for improvement in feedback mechanisms were highlighted by survey responses, most respondents had a favorable view of their program’s feedback processes.
July–August 2018 Implementing a Systematic Approach to Improve Governance and Deployment of Imaging Codes in Radiology Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Carolina V. Guimaraes, Laura A. Smith, Jo A. Garza, Maria E. Blado, Crystal S. Lokey, Lane F. Donnelly Unlike medical procedure (Current Procedural Terminology [CPT]) and diagnostic (International Classification of Diseases [ICD]) codes, imaging (IMG) codes are defined at the local, institutional level. IMG codes are used within an organization to define IMG procedures and how they are routed between information systems. Our purpose is to describe the implementation of a reorganization (referred to as the IMG code cleanup) and governance structure deployed at a large children’s hospital and the initial effects of that implementation. The number of IMG codes precleanup was 1388 and postcleanup was 826. This is a reduction by 40%. The mean number of addendums to radiology reports for billing reasons per month was 31.7 before and 18.6 after the IMG code cleanup. This represents a 41% decrease. We believe that the reorganization, standardization of the approach to naming and coding, reduction in the number of IMG codes, as well as governance structure put in place to maintain that organization has had both direct and indirect effects on the department’s ability to both provide reliable IMG services and position the department to improve.
July–August 2018 Radiology Trainee vs Faculty Radiologist Fluoroscopy Time for Imaging-Guided Procedures: A Retrospective Study of 17,966 Reports Over a 5.5-Year Period Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Ariadne K. DeSimone, Andrew Post, Richard Duszak, Phuong-Anh T. Duong To evaluate differences in fluoroscopy time (FT) for common vascular access and gastrointestinal procedures performed by radiology trainees vs faculty radiologists. Report information was extracted for all 17,966 index fluoroscopy services performed by trainees or faculty, or both from 2 university hospitals over 66 months. Various vascular access procedures (eg, peripherally inserted central catheters [PICCs] and ports) and gastrointestinal fluoroscopy procedures (eg, upper gastrointestinal and contrast enema studies) were specifically targeted. Statistical analysis was performed. FT was recorded in 17,549 of 17,966 reports (98%) The 1393 procedures performed by nonphysician providers or transitional year interns were excluded. Residents, fellows, and faculty were primary operators in 5066, 6489, and 4601 procedures, respectively. Average FT (in seconds) for resident and fellow services, respectively, was less than that of faculty only for PICCs (75 and 101 vs 148, P < 0.01). For all other procedures, average FT of trainee services was greater than that for faculty. This was statistically significant (P < 0.05) for fellows vs faculty port placement (121 vs 87), resident vs faculty small bowel series (130 vs 96), and both resident and fellow vs faculty esophagram procedures (143 and 183 vs 126 ). FT for residents was significantly less than that for fellows only for PICCs (75 vs 101, P < 0.01). For most, but not all, fluoroscopy procedures commonly performed by radiology trainees, FT is greater than that for procedures performed by faculty radiologists. Better awareness and understanding of such differences may aid training programs in developing benchmarks, protocols, and focused teaching in the safe use of fluoroscopy for patients and operators.
July–August 2018 Computed Tomography Coronary Angiography for Evaluation of Children With Kawasaki Disease Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Manphool Singhal, Surjit Singh, Pankaj Gupta, Avinash Sharma, Niranjan Khandelwal, Jane C. Burns ObjectiveWe sought to assess the feasibility of computed tomography coronary angiography (CTCA) on a 128-slice, dual source scanner in children with acute and convalescent phase Kawasaki disease (KD).Materials and MethodsA prospective study of 49 children with KD (12 at presentation and 37 in the convalescent phase) was conducted between November 2013 and April 2015. CTCA was performed with either prospective (n = 37) or retrospective (n = 12) electrocardiographic gating. A radiologist blinded to clinical profile and echocardiogram evaluated each scan.ResultsMedian age (36 boys and 13 girls) was 7 years. Median dose-length product value and median effective CT radiation dose was 32mGycm (interquartile range [IQR]: 21-74) and 0.54 miliSieverts (mSv) (IQR: 0.77-3.2) for all scans, and 27mGycm (IQR: 18.5-33.75) and 0.48mSv (IQR: 0.18-1.17) for prospectively triggered scans (n = 37). Fourteen subjects (30 coronary segments) showed abnormalities by CTCA including aneurysms (n = 27) and stenoses (n = 3). In the acute phase (n = 12), aneurysms were detected in 5 children (18 segments).ConclusionCTCA allows comprehensive evaluation of coronary arteries in children with KD.
July–August 2018 Current Techniques and Clinical Applications of Computed Tomography Urography Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Vijay Krishnan, Ashish Chawla, Kedar G. Sharbidre, Wilfred C.G. Peh From conventional radiograph to magnetic resonance urography, imaging of urinary system has evolved with variety of investigations over the past several decades with each of them having advantages and limitations of their own. In the current era, computed tomography (CT) has emerged as a preferred investigations for evaluation of the urinary tract. There are various techniques involved in performing CT urography (CTU) with triple bolus technique (TB-CTU) currently drawing a special attention because of its low radiation exposure. This article aims to discuss the current techniques, indications, and clinical applications of CTU with illustrations.
July–August 2018 Diffusion Tensor Imaging of the Spinal Cord: Clinical Value, Investigational Applications, and Technical Limitations Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Aaron M. Rutman, Daniel J. Peterson, Wendy A. Cohen, Mahmud Mossa-Basha Although diffusion-weighted imaging (DWI) has become a mainstay in modern brain imaging, it remains less utilized in the evaluation of the spinal cord. Many studies have shown promise in using DWI and diffusion-tensor imaging (DTI) for evaluation of the spinal cord; however, application has been stalled by technical obstacles and artifacts, and questions remain regarding its clinical utility on an individual examination level. This review discusses the background, concepts, and technical aspects of DWI and DTI, specifically for imaging of the spinal cord. The clinical and investigational applications of spinal cord DTI, as well as the practical difficulties and limitations of DWI and DTI for the evaluation of the spinal cord are examined.
July–August 2018 Pediatric Skeletal Scintigraphy: What a General Radiologist Needs to Know Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Fathima Fijula Palot Manzil, Jon Baldwin, Asim Kumar Bag Pediatric skeletal scintigraphy is a noninvasive imaging modality which aids in functional as well as anatomic evaluation of bone. Bone scintigraphy plays a major role in diagnosis and evaluation of various benign, primary malignant and metastatic pediatric bone pathologies. The advantage of bone scan is that it becomes positive well before the bone pathology is evident on radiographs and specifically the entire skeleton can be imaged in a single examination. Pediatric bone scintigraphy evaluation can be challenging to the general radiologist not routinely exposed to the study, as the growing skeleton is quite different from a mature skeleton especially at or near the growth plates. Though nonspecific, bone scintigraphy is a very sensitive modality. Correlation with a good history and other imaging modalities like radiographs, computed tomography and magnetic resonance imaging helps in diagnosis.
Available online 12 June 2018 Granulomatous-Lymphocytic Interstitial Lung Disease in a Patient With Common Variable Immunodeficiency Publication date: July–August 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 4 Author(s): Jehan L. Shah, Sagar B. Amin, Nupur Verma, Tan-Lucien Mohammed Common variable immunodeficiency is the most common primary immunodeficiency and consists of impaired immunoglobulin production causing recurrent sinopulmonary infections. The most common cause of mortality for this disorder, however, is from the development of malignancy and autoimmune disorders. One common entity that develops is a systemic granulomatous and lymphoproliferative disorder that can cause an interstitial lung disease more formally referred to as granulomatous-lymphocytic interstitial lung disease (GL-ILD). We discuss a case of a 25-year-old woman with common variable immunodeficiency and GL-ILD and review the literature to summarize the most common radiological findings to raise the suspicion for GL-ILD on high-resolution computed tomography and delineate this from infection and other mimickers. We will also review key histopathological characteristics for diagnosis and the clinical approach and treatment options for this rare disease.
Available online 1 June 2018 Strategies for patient-centered communication in the digital age Publication date: Available online 1 June 2018 Source:Current Problems in Diagnostic Radiology Author(s): Arvind Vijayasarathi, Renuka Kharkar, Noriko Salamon Recently, the major professional societies in Radiology have embarked upon a campaign to increase the patient-centeredness of radiology. At the foundation of this initiative is direct communication between radiologist and patient, an area which has long been a deficiency for the field. Historically, there have been a number of barriers to effective radiologist-patient communication including logistical challenges, a negative impact on efficiency, and uncertainty of the role of the radiologist in discussing results with patients. The ubiquity of the internet and the wealth of applications that allow the safe transmission of robust information provides a number of opportunities for the radiologist. The purpose of this article is to review key web-based platforms that can improve communication, highlight unique initiatives being employed by thought leaders, and emphasize why radiologist-patient communication is paramount to the patient centered imaging experience.
Available online 1 June 2018 Diagnostic Features of Emphysematous Osteomyelitis Publication date: Available online 1 June 2018 Source:Current Problems in Diagnostic Radiology Author(s): Juan E. Small, Pauley Chea, Nehal Shah, Kirstin M. Small ObjectiveEmphysematous osteomyelitis (EO) is a rare, aggressive and potentially fatal variant of osteomyelitis related to gas forming organisms. Imaging plays a vital role in diagnosis. The purpose of this study was to describe a novel and distinct imaging sign of EO, by analysis of the imaging characteristics of 3 newly identified cases of EO as well as all reported cases in the literature.Study DesignLiterature review and retrospective study in two tertiary care medical centers.MethodsDuring the course of clinical care over the last year, we have observed two cases of EO. An IRB approved one year systematic retrospective review of our institutional radiology information system identified one additional case of EO. We conducted a MEDLINE literature search to identify all published EO case reports using key phrases. The imaging in all published cases was reviewed. To address the specificity of imaging characteristics, we identified cases demonstrating variants of intraosseous gas that were not caused by emphysematous osteomyelitis.ResultsWe identified 3 cases of emphysematous osteomyelitis (EO) at our institutions. We found 31 individual case reports of EO via MEDLINE search. Of the published cases, 25 of the 31 cases contained images of sufficient extent and quality for image analysis. Including our 3 cases, a total of 34 cases were identified. Of the 34 cases, 28 had images of sufficient quality and extent to determine the presence or absence of the “pumice stone” pattern. The “pumice stone” sign13 was identified in 27 out of 28 cases (96%). The most commonly affected sites of infection include the pelvic bones (38%; 13 out of 34), vertebral bodies (32%; 11 out of 34), and femurs (24%; 8 out of 34). Adjacent soft tissue inflammation and emphysema was evident in 23 out of 29 cases (79%). Cortical destruction, a key diagnostic feature of traditional osteomyelitis, was absent in 79% of cases of emphysematous osteomyelitis.ConclusionWe describe as the “pumice stone sign” as a radiological sign to identify emphysematous osteomyelitis. We found it present in 96% of all currently known cases of emphysematous osteomyelitis. EO commonly involves the pelvic bones (38%) vertebral bodies (32%), and femur (24%). Key features also include adjacent soft tissue emphysema, (79%) and absence of cortical destruction (79%).
Available online 24 May 2018 Health Care Disparities in Radiology: A Primer for Resident Education Publication date: Available online 31 May 2018 Source:Current Problems in Diagnostic Radiology Author(s): Lisa Americo, Amit Ramjit, Michelle Wu, Leif Jensen, Drew Caplin, Joseph Mazzie, Glenn C. Gaviola, James Milburn, Christopher P. Ho, Maitray D. Patel, Carolynn M. DeBenedectis, Darel E. Heitkamp, David Sarkany As the population of the United States grows increasingly diverse, health care disparities become vital to understand and mitigate. The ethical and financial implications of how groups of Americans gain access to health care have evolved into some of today's most challenging socioeconomic problems. Educators in radiology are just beginning to tackle the concepts of health care disparities, unconscious bias and cultural competency.In July 2017, the Accreditation Council for Graduate Medical Education required that all trainees and teaching faculty of accredited training programs receive training and experience in new areas of quality improvement to include an understanding of health care disparities as part of the core competencies. To our knowledge, there is no centralized curriculum regarding health care disparities for radiology residents and fellows. Many programs, in fact, have yet to introduce the concept to their trainees, who may have difficulty recognizing that this is even a problem affecting radiology. This manuscript serves as a primer for radiology trainees on health care disparities, with the goal of defining major concepts and providing examples of how variable access to radiological care can have substantial impact on patient outcomes.
Available online 24 May 2018 Impact of early radiology research experiences on medical student perceptions of radiology and research: a pilot study Publication date: Available online 24 May 2018 Source:Current Problems in Diagnostic Radiology Author(s): Preya Shah, Mike Sheng, David A. Mankoff, Scott O. Trerotola, Maya Galperin-Aizenberg, Sharyn I. Katz, Eduardo J.M. Barbosa, Arun C. Nachiappan Rationale and ObjectivesTo promote opportunities for medical students to gain early exposure to radiology and research, our institution has initiated programs which fund summer radiology research projects for rising second-year medical students. This study assesses the impact of these faculty-mentored summer research experiences on medical student perceptions of radiology and research, in terms of both knowledge and interest.Materials and MethodsA voluntary, anonymous survey was administered to students both before and after the summer research period. Both the pre-survey and post-survey included 7-point Likert-scale questions (1=strongly disagree; 7=strongly agree) to evaluate students’ perceptions about research and students’ perceptions about radiology as a specialty. Faculty mentors were sent an analogous post-summer survey that included an evaluation of their student's research skills.ResultsThe surveys were completed by 9/11 students and 10/11 mentors. Students’ perceived knowledge of radiology as a specialty improved (p=0.02) between the pre-survey and post-survey. Similarly, there was an increase in students’ perceived knowledge of research skills (p=0.02) between the pre-survey and post-survey, with student ratings of research skills consistent with those of mentors. High student interest in both radiology and research was maintained over the course of the program.ConclusionOur pilot study suggests that summer research experiences can improve knowledge of radiology and research among medical students. Continued evaluation of this annual program will allow us to enhance the benefit to medical students and bolster interest in academic radiology.
Available online 24 May 2018 Radiation Dose Associated With Over Scanning in Neck CT Publication date: Available online 24 May 2018 Source:Current Problems in Diagnostic Radiology Author(s): Mohamed Khaldoun Badawy, Hannah Lane, Michael Galea The increasing utilisation of computed tomography scans exposes patients to significant amounts of radiation. One of the factors that can result in unnecessary radiation dose is scanning beyond the clinically indicated anatomical region. This study aims to assess the optimisation in overscan frequency, scan length and radiation dose following targeted educational talks aimed to address a routinely over scanned protocol; the CT Neck. A targeted radiation awareness talk regarding scan adherence as a method of radiation dose optimisation was delivered to all medical imaging technologists employed at a large teaching hospital. An audit of the radiation dose associated with CT Neck protocols was conducted in the month before, a month after and one year after the awareness talk. Results show that following the radiation awareness talks there was a 15% reduction in overscan frequency, an average over scan length reduction of 33% and a 20% reduction in overall radiation dose. The targeted nature of the talk, explicitly addressing scan range in the neck region, significantly reduced radiation dose to the patients. The results of this study are effective in illustrating the potential clinical radiation dose saving from strict adherence to scan range.
Available online 23 May 2018 Trends in Interventional Radiology Publications Through the Eye of the Journal of Vascular and Interventional Radiology: A 27-Year History Publication date: Available online 23 May 2018 Source:Current Problems in Diagnostic Radiology Author(s): Jacob Bundy, Anthony N. Hage, Jeffrey Forris Beecham Chick, Joseph J. Gemmete, Rajiv N. Srinivasa, Eunjee Lee, Evan Johnson, Jawad Hussain, Michael Cline, Nishant Patel, Ravi N. Srinivasa PurposeTo report the quantity, manuscript types, geographic distribution of publications, and published content trends in a major interventional radiology journal over 27 years.Materials and MethodsAvailable publication data from the JVIR was collected via Scopus from November 1990 to November 2017. Quantity, manuscript type, geographic distribution, number of citations, and publication content were analyzed.Results6,925 papers were published in JVIR during the study period. The number of publications increased by 234% from an average of 103 publications/year in the first 5 years to 344 publications/year in the last 5 years. Manuscript types included 4,891 original articles (70.6%), 987 letters (14.3%), 360 review articles (5.2%), 324 notes (4.7%), 167 conference papers (2.4%), 102 editorials (1.5%), 61 errata (0.9%), 23 articles in press (0.3%), and 10 short surveys (0.1%). The majority of publications originated in the United States with 3,945 articles (57.0%), followed by Canada with 366 articles (5.3%), and Japan and South Korea with 360 (5.2%) and 340 articles (4.9%), respectively. As for article content, arterial disease and interventions were discussed in 2,256 publications (32.6%), followed by venous (1,237; 17.9%), miscellaneous (1,072; 15.5%), oncology (1,006; 14.5%), genitourinary (758; 10.9%), portal (337; 4.9%), neurovascular (253; 3.7%), gastrointestinal (232; 3.4%), biliary (210; 3.0%), pediatric (130; 1.9%), clinical trials (119; 1.7%), and guideline development (119; 1.7%).ConclusionThere has been a marked increase in the number of publications in JVIR over 27 years. JVIR has shown continued growth since its inception and has strengthened its international reputation with more global research than ever before.
Available online 22 May 2018 Making Sense of MACRA: A Guide for Diagnostic Radiologists Publication date: Available online 23 May 2018 Source:Current Problems in Diagnostic Radiology Author(s): David Sadowsky, Tianyang Li, Usama Hasan, Christopher Harnain, Anthony Gilet, Perry Gerard The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, 2015, fundamentally altering the way clinicians are reimbursed for the treatment of Medicare patients starting in 2017. Under this new pay-for-performance model, reimbursement will be tied to multiple metrics related to quality and cost of care. A scaled scoring system will require providers to compete for positive reimbursement adjustments, while also penalizing poor performers with negative adjustments. A firm understanding of this new system will be essential for all physicians looking to maximize their reimbursement, particularly diagnostic radiologists and members of other highly focused fields where special considerations lead to alterations in the scoring system.
May–June 2018 The Joint Commission Ever-Readiness: Understanding Tracer Methodology Publication date: May–June 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Bettina Siewert The Joint Commission (TJC) evaluates the consistent provision of appropriate and safe access to health care, treatment, and services. Currently, TJC uses the tracer methodology to assess standards compliance and follows a number of patients through an organization’s entire health care delivery process. The tracer methodology uses 3 different types of tracers as follows: individual or patient tracers, program-specific, and system tracers, to identify performance issues in one or more steps of the care process or at interfaces between them. This review article describes the different types of tracers used by TJC and provides examples of each tracer in radiology; it outlines how to achieve TJC ever-readiness with the use of mock tracers and provides practical suggestions on how to ensure staff engagement.
May–June 2018 “Partially Matched” US Senior Diagnostic Radiology Applicants: Scope of the Problem and Implications for Applicants, Residency Training Programs, and the Academic Diagnostic Radiology Community Publication date: May–June 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Keith D. Herr, Sravanthi Reddy, Elizabeth A. Krupinski, Mark E. Mullins, Christopher Straus Rationale and ObjectivesAnecdotal reports have recently surfaced of an increase in the number of US senior diagnostic radiology (DR)–bound residency applicants who did not secure a preliminary year position through the Main Resident Match (the Match) of the National Resident Matching Program (NRMP), so-called “partial matches.” This study sought to determine the scope of this phenomenon and address potential causes and solutions.Materials and MethodsPublicly available and proprietary data from the National Resident Matching Program were analyzed from 2005-2016 to determine the number of partially matched US senior applicants, selectivity of DR residency training, availability of preliminary year positions, number of unique preliminary year applicants, distribution of preliminary year matches by successfully matched applicants in relevant specialties (DR, anesthesiology, dermatology, neurology, physical medicine and rehabilitation, and radiation oncology), and percentage of categorical training programs participating in the Match.ResultsSince 2012, there has been a trend toward an increase in the number of partially matched US senior DR applicants, with a transitory recovery in the 2015 Match. Although possible explanations for this increase are proposed, a definitive etiology remains elusive. Strategies to offset this phenomenon include advising perceived at-risk applicants to apply more broadly to preliminary year positions, creating more categorical training positions, abolishing the preliminary year requirement, and drawing high-caliber medical students to the field.ConclusionsAlthough a definitive explanation for a recent increase in partial matches remains elusive, strategies exist for DR applicants, residency programs, and the DR academic community to minimize this risk.
May–June 2018 The Current Status of the Interventional Radiology Fellowship Match: Results of a Resident Survey Publication date: May–June 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Jason C. Hoffmann, Neyra Azimov, Jeffrey Forris Beecham Chick, Siavash Behbahani, Gregory Hall, Micah M. Watts, Paul J. Rochon PurposeTo survey residents who participated in the 2015 interventional radiology fellowship match regarding the overall process, including the number of interviews received, programs ranked, money spent, and perceived effect on board preparation.MethodsAn IRB-approved, anonymous web-based survey was distributed via email link to 151 individuals in 41 states who had interview at 1 of 2 IR fellowship programs in the United States. Most of the survey’s 12 questions were based on a five-point Likert scale, while others were free-text response.ResultsSeventy-five out of 151 residents completed the survey (response rate 49.7%). When asked if the current timing of the core board examination worked well with the IR interview schedule, 62 (96.6%) either strong disagreed or disagreed. Sixty respondents (87%) reported that preparing for and traveling to IR interviews had a very negative or somewhat negative effect on boards preparation. When asked what change they would make to the timing of IR interviews or the core examination, 55 (79.7%) thought that IR fellowship interviews should occur earlier in the year. The median number of IR programs applied to, interviews offered, interviews completed, and programs ranked were 28, 13, 10, and 10, respectively. When asked how much money was spent on the application and interview process, 39% spent between $5000 and $9999, and 17% spent more than $10000.ConclusionsA substantial percentage of radiology residents who participated in the 2015 IR fellowship match have concerns about the proximity of board preparation to the match process. Consideration for restructuring the timing of this process is recommended.
May–June 2018 Usage of an Electronic Database and Checklist System for Improvement in Magnetic Resonance Imaging Acquisition Publication date: May–June 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Juan E. Small, Laura Semine, Jaclyn Therrien, Patricia Doyle, Lorraine Kelly, Robert Marquis, Curtis W. Bakal PurposeTo determine whether implementation of an easily accessible electronic database promotes significant reporting of magnetic resonance imaging (MRI) acquisition errors. Additionally, we wanted to see if analysis of the error reports could be used to create a comprehensive checklist to avoid the most common errors.MethodsA new, simple, and efficient electronic database reporting system was written in-house and implemented at our institution. Over the course of 4 months, the use of this database enabled collection and analysis of sufficient data for trend analysis. A simple 4-point checklist for MRI technologist use was developed based on the most commonly reported errors. Reported MRI acquisition error rates were collected and analyzed thereafter.ResultsBy the first full month of implementation, MRI scan error reporting increased from a previous negligible baseline rate to 3.03%. The comprehensive checklist was based on the 4 most common issues reported. Verification of checklist use showed that adherence to this requirement averaged greater than 94%. Immediately following roll out of the checklist, the percentage of errors reported fell to 1.7% with a continued decline in error reports thereafter. An approximately 60% reduction in errors in the last month of the study was evident as compared to the first month of data collection.ConclusionsThe use of an efficient error reporting system and implementation of a checklist based on the most common MRI acquisition errors results in a substantial decrease in the baseline MRI acquisition error rates.
May–June 2018 Reducing STAT Portable Chest Radiograph Turnaround Times: A Pilot Study Publication date: May–June 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Pratik Rachh, Alexa O. Levey, Andrew Lemmon, Aurora Marinescu, William F. Auffermann, Daniel Haycook, Eugene A. Berkowitz BackgroundOur health system orders a high number of STAT priority portable chest radiographs (62%) compared to Routine (35%) and Today (3%). Retrospective chart review of 1000 chest radiographs ordered with the STAT priority revealed that 38% of studies did not indicate clinical urgency. Given the high number or STAT priority portable chest radiographs ordered, prioritizing acquisition and interpretation of true STATs has become challenging for technologists and radiologists, leading to process inefficiencies, long turnaround times (TATs), communication failures, and patient-safety errors.MethodsA multidisciplinary team analyzed the current pathway for exam order to finalized report, identified failure modes of imaging order to completion process, and developed guidelines for what constitutes a true STAT examination. A new “urgent” order category meeting the definition of true STAT was designed, tested, and implemented over a 9-month period in participating intensive care unitsResultsSince study implementation, 108 “urgent” examinations were ordered. Median TAT for a STAT examination from order entry to image acquisition dropped from 70 minutes preimplementation to 16 minutes for “urgent” examinations. Median TAT for exam completion to radiologist image interpretation dropped from 520 minutes preimplementation to 14 minutes for “urgent” examinations. Since implementation, “urgent” examinations were found to be more concordant (70%) with the status of a critically ill patient than STAT examinations (62%).ConclusionsThe complexity of large multispecialty medical centers and lack of direct interaction of the radiologist with clinicians has led to underappreciation of the needs of ordering providers by radiology, and elucidated system limitations of radiology by ordering providers. By involving a team of frontline clinicians, our team standardized the process of identifying, ordering, procuring, interpreting, and communicating results of true STAT examinations. The process created by our team now serves as a template for implementation in other locations and service lines of our hospital.
May–June 2018 The Top 100 Most-Cited Articles in Stroke Imaging: A Bibliometric Analysis Publication date: May–June 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Mohammed F. Mohammed, Olivia Marais, Adnan I. Qureshi, Nizar Bhulani, David Ferguson, Hossain Abu-Alola, Savvas Nicolaou, Faisal Khosa PurposeThe goal of our study was to compile a list of the top 100 most-cited articles in stroke imaging literature across all peer-reviewed scientific journals. These articles were then analyzed to identify current trends in stroke imaging research and determine the characteristics of highly-cited articles.Materials and MethodsA database of the top 100 most-cited articles was created using Scopus and Web of Science. Articles were reviewed for applicability by 2 fellowship-trained radiologists with over 10 years of combined experience in neuroimaging. The following information was collected from each article: Article Title, Scopus Citations, Year of Publication, Journal, Journal Impact Factor, Authors, Number of Institutions, Country of Origin, Study Topic, Study Design, and Sample Size.ResultsCitations for the top 100 most-cited articles ranged from 159-810, and citations per year ranged from 5.7-516.0. Most of articles were published between 1996 and 2000 (n = 43). Articles were published across 18 journals, most commonly in Stroke (n = 40). Magnetic resonance imaging was the focus in 46 articles, computed tomogrphy in 16, and functional magnetic resonance imaging in 10. The most common study topic is prognostic use of an imaging modality (n = 27).ConclusionsOur study helps to characterize the field and identify the characteristics of most-cited articles.
May–June 2018 Tricky Findings in Liver Transplant Imaging: A Review of Pitfalls With Solutions Publication date: May–June 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Bhagya Sannananja, Adeel R. Seyal, Akshay D. Baheti, Sooah Kim, Chandana Lall, Puneet Bhargava Orthotopic liver transplantation is the preferred treatment for end-stage liver disease. Imaging plays an important role in the follow-up of transplant recipients by identifying a variety of complications. Posttransplant liver imaging can be challenging with altered vascular and nonvascular postoperative findings closely mimicking pathologies. A thorough knowledge of these common imaging findings in a posttransplant liver is essential for the radiologist to avoid erroneous diagnoses and unnecessary workup. We focus on such imaging findings and provide tips to avoid misinterpretation.
May–June 2018 Complications After Gynecologic and Obstetric Procedures: A Pictorial Review Publication date: May–June 2018 Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Richard Tsai, Demetrios Raptis, Constantine Raptis, Vincent M. Mellnick Gynecologic and obstetric procedures require careful dissection in to high real-estate regions in the pelvis and abdomen where many structures lie in close proximity: the urinary bladder, ureter, and bowel. Damage to one of these structures can cause significant morbidity. Recognition of the patient who has an acute complication of gynecologic or obstetric surgery on imaging can precipitate quick and effective medical management. Imaging can appropriately diagnose the underlying problem and provide critical information for the clinical team. In this review, we present acute complications of gynecologic and obstetric procedures and their imaging appearances.
Available online 12 April 2018 #Radiology: A 7-year Analysis of Radiology-Associated Hashtags Publication date: Available online 17 April 2018 Source:Current Problems in Diagnostic Radiology Author(s): Jacob J. Bundy, Anthony N. Hage, Jeffrey Forris Beecham Chick, Rajiv N. Srinivasa, Nishant Patel, Evan Johnson, Joseph J. Gemmete, Ravi N. Srinivasa PurposeTo describe the radiology-related Twitter network through the analysis of the most commonly used radiology-associated hashtags.Materials and Methods959,366 tweets containing the hashtags from the nine most commonly used radiology-associated hashtags composed by 66,568 Twitter users from October 13, 2010 to February 22, 2018 were analyzed. Twitter activity metrics, engagement, user characteristics, content analysis, and network analysis were obtained using the healthcare social media analytics platform, Symplur SignalsResultsThe number of tweets containing the most commonly used radiology hashtags increased by 198% during 2011. Regarding tweet content, 246,949 (46.9%) tweets were related to patients, 140,562 (26.7%) tweets were cancer related, 47,704 (9.1%) tweets were related to research, and 26,994 (5.1%) tweets were related to radiation. As for engagement, there were 374,082 retweets (39%), 512,919 mentions (53.5%), and 12,919 replies (1.3%). Healthcare organizations not directly involved with patient care, physicians, and patients authored 283,698 (29.6%), 217,152 (22.6%), and 27,595 (2.9%) tweets, respectively. Network analysis demonstrated healthcare organizations not directly involved with patient care, physicians, media organizations, and individuals working in the healthcare industry in non-clinical roles to be the users most active on the radiology-related hashtags on Twitter.ConclusionRadiology-related hashtag use has grown substantially over the years, with a majority of the discussions involving physicians and healthcare organizations not directly involved with patient care.
Available online 12 April 2018 Institutional Interventional Radiology Symposium Increases Medical Student Interest and Identifies Target Recruitment Candidates Publication date: Available online 12 April 2018 Source:Current Problems in Diagnostic Radiology Author(s): Mina S. Makary, Anand Rajan, Rose J. Miller, Eric D. Elliott, James W. Spain, Gregory E. Guy ObjectivesTo assess and raise medical student interest in interventional radiology (IR); and to evaluate student response across gender, level of training, and surgical vs nonsurgical specialty interest.Materials and MethodsAll Ohio medical students were invited to an IR Symposium held by a large academic medical center in central Ohio. The program encompassed didactic lectures, hands-on simulation models, and a networking luncheon with faculty, trainees, and industry partners. All attendees completed an anonymous, 5-point Likert scaled survey preattending and postattending the event to assess their awareness of IR as a specialty, understanding of the current training pathways, and level of interest.ResultsA total of 46 participants (M:F 60%:40%, MS1—53%, MS2—36%, and MS3—11%) attended the symposium. The cohort demonstrated increased interest in pursuing a career in IR following the symposium (4.12 vs 3.70, P < 0.001). Students with an interest in a nonsurgical specialty showed an increased interest in IR (4.20 vs 3.68, P < 0.001), whereas surgically oriented students did not demonstrate a significant increase (4.00 vs 3.71, P = 0.375). No statistically significant differences were noted across gender or level of training. The symposium experience significantly increased understanding of the IR training pathways (4.51 vs 2.94, P < 0.001). Students rated lectures (57%) and endovascular simulators (41%) as the most useful experiences.ConclusionsThis study demonstrated the role of symposia in improving medical student awareness of IR and training pathways. Findings were validated across gender and training level, and identified the subset of students with nonsurgical interests as most responsive to such intervention and potential recruitment.
Available online 6 April 2018 Structured Head and Neck CT Angiography Reporting Reduces Resident Revision Rates Publication date: Available online 12 April 2018 Source:Current Problems in Diagnostic Radiology Author(s): Tucker F. Johnson, Waleed Brinjikji, Derrick A. Doolittle, Alex A. Nagelschneider, Brian T. Welch, Amy L. Kotsenas PurposeThis resident-driven quality improvement project was undertaken to assess the effectiveness of structured reporting to reduce revision rates for afterhours reports dictated by residents.MethodsThe first part of the study assessed baseline revision rates for head and neck CT angiography (CTA) examinations dictated by residents during afterhours call. A structured report was subsequently created based on templates on the RSNA informatics reporting website and critical findings that should be assessed for on all CTA examinations. The template was made available to residents through the speech recognition software for all head and neck CTA examinations for a duration of 2 months. Report revision rates were then compared with and without use of the structured template.ResultsThe structured template was found to reduce revision rates by approximately 50% with 10/41 unstructured reports revised and 2/17 structured reports revised.ConclusionsWe believe that structured reporting can help reduce reporting errors, particularly in term of typographical errors, train residents to evaluate complex examinations in a systematic fashion, and assist them in recalling critical findings on these examinations.
Available online 6 April 2018 How to Diagnose Enchondroma, Bone Infarct, and Chondrosarcoma Publication date: Available online 6 April 2018 Source:Current Problems in Diagnostic Radiology Author(s): Michael E. Mulligan Enchondromas are among the most common benign tumors seen in the skeleton. They are encountered frequently in routine clinical practice. The purpose of this review is to help radiologists confidently diagnose enchondroma and distinguish it from other entities, such as bone infarct, bone graft, and low-grade chondrosarcoma.
Available online 20 March 2018 Comparing the Performances of Magnetic Resonance Imaging Size vs Pharmacokinetic Parameters to Predict Response to Neoadjuvant Chemotherapy and Survival in Patients With Breast Cancer Publication date: Available online 28 March 2018 Source:Current Problems in Diagnostic Radiology Author(s): Basak E. Dogan, Qing Yuan, Roland Bassett, Inanc Guvenc, Edward F. Jackson, Massimo Cristofanilli, Gary J. Whitman PurposeTo compare the value of dynamic contrast-enhanced magnetic resonance imaging-pharmacokinetic (PK) parameters vs tumor volume in predicting breast cancer neoadjuvant chemotherapy response (NACR) and patient survival.Subjects and MethodsSixty-six patients with locally advanced breast cancer who underwent breast MRI monitoring of NACR were retrospectively analyzed. We compared baseline transfer constant (Ktrans), reflux rate contrast (kep), and extracellular extravascular volume fraction (ve) with the same parameters obtained at early postchemotherapy MRI, and examined model-independent changes in time-intensity curves (maximum slope, contrast enhancement ratio, and IAUC90). Tumor size changes (tumor volume, single dimension, and Response Evaluation Criteria in Solid Tumors [RECIST]) were also analyzed. The Spearman correlation test was used to assess the association between size and PK parameters, and regression analysis to assess the association with 5-year disease-free survival.ResultsHigher ve values at baseline were associated with greater decreases in tumor size (P = 0.008). Changes in Ktrans and IAUC90 were the strongest predictors of NACR. Changes in IAUC90 (P = 0.04) and RECIST (P = 0.003) were independently associated with pathologic response. The only parameter significantly associated with 5-year survival was change in RECIST (P = 0.001). However, there was a trend toward statistical significance for changes in ve and Ktrans, with greater changes associated with longer survival.ConclusionChanges in PK and dynamic contrast-enhanced magnetic resonance imaging kinetic parameters may have a role in predicting NACR in breast tumors. Although changes in Ktrans and IAUC90 are helpful in predicting NACR, they do not show significant association with survival. Early RECIST size change measured by MRI remains the strongest predictor of overall patient survival.
Available online 20 March 2018 Top 100 Cited articles on Radiation Exposure in Medical Imaging: A Bibliometric Analysis Publication date: Available online 20 March 2018 Source:Current Problems in Diagnostic Radiology Author(s): Jason Kinnin, Tarek N. Hanna, Marc Jutras, Babar Hasan, Rick Bhatia, Faisal Khosa BackgroundBibliometric analyses by highest number of citations can help researchers and funding agencies in determining the most influential articles in a field. The main objective of this analysis was to identify the top 100 cited articles addressing radiation exposure from medical imaging and assess their characteristics.MethodsRelevant articles were extracted from the Scopus database after a systematic search by researchers using an iteratively defined Boolean search string. Subsequently, exclusion criteria were applied. A list of top 100 articles was prepared, and articles were ranked according to the citations they had received. No time restriction was applied. Descriptive statistics of the data were compiled.ResultsThe top-cited articles were published from 1970-2013, with the most articles published in 2009 and 2010 (12 articles in each year). The citations ranged from 107-1888 with a median of 272. Manuscripts from our top-cited list originated from 20 different countries, with contributions made by 158 authors and 160 organizations. Eighty-eight percent of studies evaluated patient-related radiation exposure, 7% health care workers, and 5% both or were not specified. Thirty-two percent of studies examined adult populations, 14% pediatric, and 54% included both populations or did not specify. Seventy-two percent of studies were dedicated to Computed Tomography, 8% to radiography/fluoroscopy, 9% to interventional procedures, 4% to nuclear medicine, and 7% to a combination of 2 or more modalities.ConclusionThe top 100 cited articles in medical imaging related to radiation exposure are diverse, originating from many countries with numerous contributing authors. The most common topics covered involve CT and adult patients. The recent peak in the most-highly cited articles (2010) suggests that increased attention has been devoted to this field in recent years. Based on these results, it would appear that research on radiation exposure in medical imaging is poised to continue expanding.
Available online 20 March 2018 Angiomyolipoma of the Kidneys: Current Perspectives and Challenges in Diagnostic Imaging and Image-Guided Therapy Publication date: Available online 20 March 2018 Source:Current Problems in Diagnostic Radiology Author(s): Abdul Razik, Chandan J. Das, Sanjay Sharma Angiomyolipomas (AML) are benign tumors of the kidneys frequently encountered in radiologic practice in large tertiary centers. In comparison to renal cell carcinomas (RCC), AML are seldom treated unless they are large, undergo malignant transformation or develop complications like acute hemorrhage. The common garden triphasic (classic) AML is an easy diagnosis, however, some variants lack macroscopic fat in which case the radiologic differentiation from RCC becomes challenging. Several imaging features, both qualitative and quantitative, have been described in differentiating the 2 entities. Although minimal fat AML is not entirely a radiologic diagnosis, the suspicion raised on imaging necessitates sampling and potentially avoids an unwanted surgery. Recently a new variant, epitheloid AML has been described which often has atypical imaging features and is at a higher risk for malignant transformation. Apart from the diagnosis, the radiologist also needs to convey information regarding nephrometric scores which help in surgical decision-making. Recently, more and more AMLs are managed with selective arterial embolization and percutaneous ablation, both of which are associated with less morbidity when compared to surgery. The purpose of this article is to review the imaging and pathologic features of classic AML as well as the differentiation of minimal fat AML from RCC. In addition, an overview of nephrometric scoring and image-guided interventions is also provided.
Available online 20 March 2018 Endovascular Transjugular Occlusion of Congenital Intrahepatic Portosystemic Venous Shunt Using Simultaneous Fluoroscopy and Transabdominal Ultrasound Guidance: Report of 2 Cases Publication date: Available online 20 March 2018 Source:Current Problems in Diagnostic Radiology Author(s): Ujjwal Gorsi, Naveen Kalra, Pankaj Gupta, Karthik Rayasam, Babu Ram Thapa, Hemant Bhagat, Niranjan Khandelwal Congenital intrahepatic portosystemic venous shunts (CIPVS) are rare anomalies that can be detected before birth or in early infancy or later in life. Symptomatic shunts are treated as they carry high risk of complications like hepatic encephalopathy. Various treatment options include surgery, endovascular embolization, and percutaneous closure devices. We treated 2 infants with CIPVS successfully by endovascular embolization of the shunt using vascular plug through transjugular route. Transabdominal ultrasound guidance in addition to fluoroscopy was used at the time of vascular plug placement. We emphasize that the use of transabdominal ultrasound during endovascular occlusion enhances the safety and technical success rate.
Interventional Radiology-Operated Endoscopy as an Adjunct to Image-Guided Interventions Publication date: Available online 20 March 2018 Source:Current Problems in Diagnostic Radiology Author(s): Rajiv N. Srinivasa, Jeffrey Forris Beecham Chick, Kyle Cooper, Ravi N. Srinivasa PurposeInterventional radiology-operated endoscopy is an underused technique, which may have a significant impact on the ability to treat patients with a variety of conditions. The purpose of this article is to discuss the setup, equipment, and potential clinical uses of interventional radiology-operated endoscopy.MethodsA number of new and innovative interventions may be performed in the biliary, genitourinary, and gastrointestinal systems through percutaneous access that interventional radiologists already create. When used in combination, endoscopy adds an entirely new dimension to the fluoroscopic-guided procedures of which interventional radiologists are accustomed.ResultsInterventional radiologists are in a unique position to implement endoscopy into routine practice given the manual dexterity and hand-eye coordination already required to perform other image-guided interventions.ConclusionAlthough other specialists traditionally have performed endoscopic interventions and local politics often dictate referral patterns, a collaborative relationship among these specialists and interventional radiology will allow for improved patient care. A concerted effort is needed by interventional radiologists to learn the techniques and equipment required to successfully incorporate endoscopy into practice. view: 184