Journal Sciences News
Transactions of Nonferrous Metals Society of China
May–June 2018
Table of Contents
Publication date: May–June 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3

May–June 2018
Convolutional Neural Networks: The Possibilities are Almost Endless
Publication date: May–June 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Rebecca J. Mieloszyk, Puneet Bhargava
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
Beginner’s Guide to Medicare Access and CHIP Reauthorization Act’s Quality Payment Program
Publication date: May–June 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Naiim S. Ali, Anthony Dinizio
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 Objectives Anecdotal 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 Methods Publicly 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. Results Since 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. Conclusions Although 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 Purpose To 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. Methods An 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. Results Seventy-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. Conclusions A 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 Purpose To 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. Methods A 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. Results By 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. Conclusions The 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 Background Our 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. Methods A 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 units Results Since 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%). Conclusions The 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 Purpose The 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 Methods A 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. Results Citations 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). Conclusions Our study helps to characterize the field and identify the characteristics of most-cited articles.
May–June 2018
Invasive Sinonasal Lesions: From the Nasal Fossa and Paranasal Sinuses to the Endocranium
Publication date: May–June 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Pablo Naval Baudin, Albert Pons Escoda, M
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 18 April 2018
Abdominal Lymphangiomatosis With Intestinal Lymphangiectasia Diagnosed by Magnetic Resonance Lymphangiography: A Case Report
Publication date: May–June 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 3 Author(s): Jineesh Valakada, Kumble S. Madhusudhan, Gyan Ranjan, Pramod Kumar Garg, Raju Sharma, Arun Kumar Gupta
Available online 17 April 2018
“Inferior vena cava filter strut penetration into the vertebral column: A case of 10 year clinical follow up.”
Publication date: Available online 18 April 2018
Source:Current Problems in Diagnostic Radiology Author(s): David A. Petrov, Aakash Chauhan, Sean Fitzpatrick, Daniel T. Altman, Casagranda Bethany
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 Purpose To describe the radiology-related Twitter network through the analysis of the most commonly used radiology-associated hashtags. Materials and Methods 959,366 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 Signals Results The 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. Conclusion Radiology-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 Objectives To assess and raise medical student interest in Interventional Radiology (IR); and to evaluate student response across gender, level of training, and surgical vs non-surgical specialty interest. Materials and Methods All 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 pre- and post- attending the event to assess their awareness of IR as a specialty, understanding of the current training pathways, and level of interest. Results A total of 46 participants (M:F 60:40%, MS1–53%, MS2–36%, 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<.001). Students with an interest in a non-surgical specialty showed an increased interest in IR (4.20 vs 3.68, p<.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<.001). Students rated lectures (57%) and endovascular simulators (41%) as the most useful experiences. Conclusions This 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 This resident-driven quality improvement project was undertaken to assess the effectiveness of structured reporting to reduce revision rates for afterhours reports dictated by residents. The first part of the study assessed baseline revision rates for head and neck CT angiography (CTA) exams 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 exams. The template was made available to residents through the speech recognition software for all head and neck CTA exams for a duration of two months. Report revision rates were then compared with and without use of the structured template. The structured template was found to reduce revision rates by approximately 50% with 10/41 unstructured reports revised and 2/17 structured reports revised. Based on our experience, we believe that structured reporting can help reduce reporting errors, particularly in term of typographical errors, train residents to evaluate complex exams in a systematic fashion, and assist them in recalling critical findings on these exams.
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 28 March 2018
Mid-Cavity Variant Takotsubo Cardiomyopathy – MRI Findings
Publication date: Available online 6 April 2018
Source:Current Problems in Diagnostic Radiology Author(s): Crishan Haran, Rhiannon McBean, Alexander Incani, Rohan Tollenaere, Katrina Newbigin
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 Purpose To 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 Methods Sixty-six patients with locally advanced breast cancer who underwent breast MRI monitoring of NACR were retrospectively analyzed. We compared baseline transfer constant (K trans), reflux rate contrast (k ep), and extracellular extravascular volume fraction (v e) 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. Results Higher v e values at baseline were associated with greater decreases in tumor size (P = 0.008). Changes in K trans 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 v e and K trans, with greater changes associated with longer survival. Conclusion Changes in PK and dynamic contrast-enhanced magnetic resonance imaging kinetic parameters may have a role in predicting NACR in breast tumors. Although changes in K trans 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 Background Bibliometric 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. Methods Relevant 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. Results The 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. Conclusion The 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.
Available online 20 March 2018
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 Purpose Interventional 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. Methods A 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. Results Interventional 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. Conclusion Although 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.
Available online 19 March 2018
Factors Influencing Choice of Radiology and Relationship to Resident Job Satisfaction
Publication date: Available online 20 March 2018
Source:Current Problems in Diagnostic Radiology Author(s): Shanna A. Matalon, Jeffrey P. Guenette, Stacy E. Smith, Jennifer W. Uyeda, Alicia S. Chua, Glenn C. Gaviola, Sara M. Durfee Purpose Identify when current radiology residents initially became interested in radiology, which factors influenced their decision to pursue a career in radiology, and which factors correlate with job satisfaction. Methods An online survey was distributed to United States radiology residents between December 7, 2016 and March 31, 2017. Respondents identified the most appealing aspects of radiology during medical school, identified experiences most influential in choosing radiology, and scored job satisfaction on visual analog scales. Relative importance was compared with descriptive statistics. Satisfaction scores were compared across factors with analysis of variance and post-hoc Tukey tests. Results 488 radiology residents responded (age 30.8 ± 3.2 years; 358 male, 129 female, 1 unknown; 144 PGY2, 123 PGY3, 103 PGY4, 118 PGY5). The most influential aspects in choosing radiology were the intellectual (n=187, 38%), imaging (n=100, 20%), and procedural (n=96, 20%) components and potential lifestyle (n=69, 14%). Radiology clerkship reading room shadowing (n=143, 29%), radiologist mentor (n=98, 20%), non-radiology clerkship imaging exposure (n=77, 16%), and radiology clerkship interventions exposure (n=75, 15%) were most influential. Choosing radiology because of potential lifestyle correlated with less job satisfaction than choosing radiology for intellectual (p=0.0004) and imaging (p=0.0003) components. Conclusion Recruitment of medical students into radiology may be most effective when radiology clerkships emphasize the intellectual and imaging components of radiology through reading room shadowing and exposure to interventions. Choosing radiology for lifestyle correlates with less job satisfaction, at least during residency.
Available online 19 March 2018
A Comparison of Neuroradiology and Pediatric Radiology Job Boards
Publication date: Available online 19 March 2018
Source:Current Problems in Diagnostic Radiology Author(s): Cory M Pfeifer
Available online 19 March 2018
Variability in the Use of Simulation for Procedural Training in Radiology Residency: Opportunities for Improvement
Publication date: Available online 19 March 2018
Source:Current Problems in Diagnostic Radiology Author(s): Shanna A. Matalon, Sona A. Chikarmane, Eren D. Yeh, Stacy E. Smith, William W. Mayo-Smith, Catherine S. Giess Objective Increased attention to quality and safety has led to a re-evaluation of the classic apprenticeship model for procedural training. Many have proposed simulation as a supplementary teaching tool. The purpose of this study was to assess radiology resident exposure to procedural training and procedural simulation. Materials and Methods An IRB-exempt online survey was distributed to current radiology residents in the United States by e-mail. Survey results were summarized using frequency and percentages. Chi-square tests were used for statistical analysis where appropriate. Results A total of 353 current residents completed the survey. 37% (n = 129/353) of respondents had never used procedure simulation. Of the residents who had used simulation, most did not do so until after having already performed procedures on patients (59%, n = 132/223). The presence of a dedicated simulation center was reported by over half of residents (56%, n = 196/353) and was associated with prior simulation experience (P = 0.007). Residents who had not had procedural simulation were somewhat likely or highly likely (3 and 4 on a 4-point Likert-scale) to participate if it were available (81%, n = 104/129). Simulation training was associated with higher comfort levels in performing procedures (P < 0.001). Conclusions Although procedural simulation training is associated with higher comfort levels when performing procedures, there is variable use in radiology resident training and its use is not currently optimized. Given the increased emphasis on patient safety, these results suggest the need to increase procedural simulation use during residency, including an earlier introduction to simulation before patient exposure.
March–April 2018
The 9 Habits of Highly Effective Radiologists
Publication date: Available online 19 March 2018
Source:Current Problems in Diagnostic Radiology 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.
March–April 2018
Traffic University: How Small Changes in Lifestyle Can Change Your Life
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Puneet Bhargava
March–April 2018
Launchpad for Onboarding New Faculty Into Academic Life
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Toshimasa Clark, Janet Corral, Eric Nyberg, Tami Bang, Premal Trivedi, Peter Sachs, Tatum Mcarthur, Jonathan Flug, Carol Rumack We developed a faculty professional development seminar series in order to facilitate the integration of our numerous new faculty into academics. The changing nature of the healthcare system, increasing clinical and administrative responsibility, and lack of access to senior mentors can hinder junior faculty productivity and possibly increase attrition. Given that no ready-made resources existed to address these issues we established a Professional Development Committee, developed a curriculum that covers relevant topics including promotion, mentorship, conflict management and feedback, and effective presentation of scientific data, and instituted changes iteratively based upon feedback. We used surveys from successive years of this seminar series to assess effectiveness, and our data demonstrate that our Professional Development Seminar Series was valued by its participants and that individual lectures improved from year to year. While it is too early to determine whether our efforts will lead to long-term changes in promotion success or faculty retention, our initial data are promising.
March–April 2018
Radiology Online Patient Education Materials Provided by Major University Hospitals: Do They Conform to NIH and AMA Guidelines?
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Arpan V. Prabhu, Ashley L. Donovan, Tudor Crihalmeanu, David R. Hansberry, Nitin Agarwal, Sushil Beriwal, Hrishikesh Kale, Matthew Heller Aims The internet creates opportunities for Americans to access medical information about imaging tests and modalities to guide them in their medical decision-making. Owing to health literacy variations in the general population, the American Medical Association and National Institutes of Health recommend patient education resources to be written between the third and seventh grade levels. Our purpose is to quantitatively assess the readability levels of online radiology educational materials, written for the public, in 20 major university hospitals. Materials and Methods In September and October 2016, we identified 20 major university hospitals with radiology residency-affiliated hospital systems. On each hospital
March–April 2018
Breaking Bad News: A Survey of Radiology Residents’ Experiences Communicating Results to Patients
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Anand Narayan, Sergio Dromi, Adam Meeks, Erin Gomez, Bonmyong Lee Purpose The practice of radiology often includes routine communication of diagnostic test results directly to patients in breast imaging and interventional radiology. There is increasing interest in expanding direct communication throughout radiology. Though these conversations can substantially affect patient well-being, there is limited evidence indicating that radiology residents are specifically taught methods to effectively convey imaging results to patients. Our purpose is to evaluate resident experience communicating imaging results to patients. Materials and Methods An IRB-approved study with a total of 11 pilot-tested questions was used. Surveyed programs included radiology residents (PGY2-PGY5) at 2 urban residency programs. Online surveys were administered using SurveyMonkey and e-mailed to residents at both programs (starting November 20, 2015, completed March 31, 2016). Demographics were obtained with survey proportions compared using logistic regression (P < 0.05, statistically significant). Results A total of 73 residents responded (93.6% response rate) with similar response rates at each institution (P = 0.689). Most were male (71.2%) with 17.8% planning to go into breast imaging (21.9%, interventional radiology (IR)). Furthermore, 83.6% described no training in communicating radiology results to patients; 91.8% of residents communicated results with patients (87.7% diagnostic imaging tests and 57.5% biopsies). Residents most commonly communicated results in person (75.3%) followed by phone (64.4%), and 79.4% agreed or strongly agreed that additional training relaying results would be helpful. Conclusions A large majority of radiology residents have communicated test results to patients, yet few have received training in how to communicate these results. A large majority of residents expressed interest in obtaining additional communication training. Additional research is required to determine ideal methods to educate residents on communicating test results.
March–April 2018
Emergency Magnetic Resonance Imaging 3-Tiered Prioritization
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Juan E. Small, Stacey Sullivan-Richard, Lisa A. Kingsley Rocker, Jacob J. Kim, Jennifer C. Broder Background/Purpose Traditional methods for prioritization are limited and insufficient for today’s magnetic resonance imaging (MRI) demands. In particular, the discrepancy in urgency of the heterogeneous emergency department (ED) patient population necessitates risk stratification to meet different degrees of urgency. The purpose of this study is to more effectively prioritize the MRI imaging needs of ED patients commensurate with the severity of their presenting illness. Methods A 3-level tiered classification system (tier 1: critical, tier 2: emergent, and tier 3: urgent) of ED patients with unambiguous hierarchically defined numerical classifications was implemented to replace a traditional method of MRI orders. Each tier was accompanied by guiding consensus-driven clinical definitions and common qualifying examples. Lastly, each tier imaging order was tied to a specific target “order to imaging start time” (OTST). After implementation, a month-by-month 1-year retrospective analysis of ED MRI imaging order volume was conducted to assess the percentage distribution of each category. In addition, a month-by-month 1-year retrospective analysis of the OTST for each tier was conducted. The OTST outcome measure was used to monitor the ability of the system to meet tier target times based on severity. Results The system effectively prioritized ED patients into 3 tiers based on acuity. An inverse relationship existed between ED MRI OTST and the tier severity into which the patient was stratified. We found that only 4% of the ED-specific volume is truly critical (tier 1). In addition, tier 3 MRI examinations constituted 75% of the ED volume. Month-by-month quality assurance analysis demonstrated consistent completion of examinations under or close to the target times tied to each tier. The average overall wait time from order time to begin scan time for all ED MRIs decreased from 245 minutes (4.1 hours) at baseline to less than 136 minutes (2.7 hours). Conclusions We implemented and evaluated a 3-tiered system of ED MRI imaging orders based on patient severity. The system was unambiguous due to its numerical hierarchy, and each of the 3 tiers was accompanied by explicit guiding definitions for each category. A quality assurance process following implementation allowed us to monitor the ability of the system to meet target times tied to each tier. Our current ability to accurately predict a target performance time allows us to set accurate expectations for both providers and patients.
March–April 2018
Utility of Single-Phase Computed Tomography in Identifying Parathyroid Adenomas: A Feasibility Study
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Ethan Silver, Nader Sadeghi, Stanley Knoll, M. Reza Taheri Objective We tested the hypothesis that a single-phase neck computed tomography (CT) is not inferior to multiphase neck CT (MPNCT), ultrasound, or nuclear medicine sestamibi scan in identifying parathyroid adenomas (PAs). Methods A total of 29 patients who had an MPNCT for the evaluation of a PA were identified; 11 patients met the inclusion criteria. During the 30-second arterial phase CT (APNCT), a normalized Hounsfield unit of suspected PA was compared to Hounsfield unit of a normal-appearing level I and a level II lymph node. A PA was defined as a lesion with a ratio of greater than 1.4 when compared to the level I and level II lymph node. This cutoff was determined based on the normalized ratios between level II and level I lymph nodes. Results of intraoperative parathyroid hormone assays and surgical pathology were used to validate the accuracy of this technique. Results The sensitivity of this method in APNCT is 90.9% whereas positive predictive value is 100%. The sensitivity or positive predictive value of ultrasound and nuclear medicine are 60% or 100% and 90% or 100%, respectively. Conclusion The sensitivity of APNCT is equivalent to that of MPNCT in identifying PA.
March–April 2018
Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Liang Zhang, Colm J. McMahon, Samir Shah, Jim S. Wu, Ronald L. Eisenberg, Justin W. Kung Purpose To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients. Method and Materials Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting. The frontal chest radiograph and dedicated rib series were sequentially reviewed in consensus by two fellowship-trained musculoskeletal radiologists blinded to the initial report. The consensus interpretation of the dedicated rib series was used as the gold standard. Multiple variable logistic regression analysis assessed clinical and radiological factors associated with rib fractures. Fisher exact test was used to assess differences in medical treatment between the 2 groups. Results Of the 339 patients, 53 (15.6%) had at least 1 rib fracture. Only 20 of the 53 (37.7%) patients’ fractures could be identified on the frontal chest radiograph. The frontal chest radiograph had a sensitivity of 38% and specificity of 100% when using the rib series as the reference standard. No pneumothorax, new mediastinal widening or pulmonary contusion was identified. Multiple variable logistic regression analysis of clinical factors associated with the presence of rib fractures revealed a significant association of trauma history (odds ratio 5.7 [p < 0.05]) and age
March–April 2018
Long-Term Clinical Outcomes Following Radiofrequency and Microwave Ablation of Renal Cell Carcinoma at a Single VA Medical Center
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Salim E. Abboud, Tanay Patel, Stephanie Soriano, Joseph Giesler, Nannette Alvarado, Preet Kang Purpose Microwave ablation (MWA) is a relatively newer treatment modality for treatment of renal cell carcinoma (RCC), and only a few small studies have examined the short- and long-term outcomes for MWA applied to renal tumors. The purpose of this retrospective review is to assess the initial experience including technical short- and long-term success rates of using radiofrequency ablation (RFA) and MWA for RCC at a single Veterans Affairs (VA) medical center. Materials and Methods Tumor characteristics were recorded using the R.E.N.A.L. nephrometry score. Group comparisons were performed by using univariate logistic regression analysis to determine factors affecting primary treatment success, failure, and effectiveness. Kaplan-Meier local tumor progression-free survival following ablation was calculated. Results MWA and RFA groups were not significantly different in primary treatment success (P = 0.82). MWA primary treatment success (90.2%) was not associated with R.E.N.A.L criteria, whereas primary success in the RFA group (88.2%) was predicted by smaller tumor size (P = 0.002). Primary treatment effectiveness rates were not significantly different in MWA (88.2%) and RFA (80.3%) groups (P = 0.29). Although overall primary technique effectiveness was associated with size (P = 0.02), univariate analysis showed a significant association between tumor size and primary effectiveness for RFA (P = 0.002) but not MWA. There was no significant association between R.E.N.A.L score or criteria and primary treatment effectiveness in the RFA or MWA groups. Conclusion RFA and MWA both represent effective treatment modalities for RCC; larger tumor size may be associated with decreased efficacy of thermal ablation techniques.
March–April 2018
Radiologic Guide to Surgical Treatment of Kienbock’s Disease
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Erika M. Nealey, Jonelle M. Petscavage-Thomas, Felix S. Chew, Christopher H. Allan, Alice S. Ha Kienbock’s disease, or avascular necrosis of the lunate, is a progressive disease ultimately resulting in end-stage arthrosis of the wrist. Various surgical treatments are available for different Lichtman stages of disease. We review the surgical options and indications, expected radiologic post-operative appearance, as well as detail potential surgical complications, as they relate to Kienbock’s disease.
March–April 2018
Abdominal Applications of a Novel Detector-Based Spectral CT
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Nicholas Fulton, Prabhakar Rajiah Detector-based spectral computed tomography (SDCT) is a recently introduced technology that uses a single x-ray tube and 2 layers of detectors to simultaneously collect low- and high-energy data. In this article, we provide an overview of this novel SDCT technology in abdominal imaging. Several applications of SDCT in abdominal imaging are discussed and illustrated, along with a brief description of current literature on the status of dual-energy computed tomography in these applications. This includes urinary calculus composition, characterization of masses (renal, adrenal, hepatic, and others), tumor perfusion, improving vascular contrast, improving lesion conspicuity, decreasing artifacts, and reducing radiation dose.
March–April 2018
High-Resolution Computed Tomography Imaging in Conductive Hearing Loss: What to Look for?
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Manickam Subramanian, Ashish Chawla, Kabilan Chokkappan, Tze Lim, Jagadish Narayana Shenoy, Wilfred Chin Guan Peh Conductive hearing loss (CHL) is caused by the disruption of the sound conductive chain that, in turn, may be due to diseases of the external and middle ear. High-resolution computed tomography (CT) is the imaging modality of choice to evaluate CHL because of its excellent spatial resolution. Along with clinical and otoscopic findings, CT also helps in the diagnosis and preoperative planning. This pictorial review aims to illustrate the CT features of common conditions causing CHL that may arise from the external and middle ear, as well as highlights some of the key imaging features that are helpful in management.
Available online 23 February 2018
Use of Reduced Field-of-View Acquisition to Improve Prostate Cancer Visualization on Diffusion-Weighted Magnetic Resonance Imaging in the Presence of Hip Implants: Report of 2 Cases
Publication date: March–April 2018
Source:Current Problems in Diagnostic Radiology, Volume 47, Issue 2 Author(s): Andrew B. Rosenkrantz, Samir S. Taneja In patients with metallic hip implants, distortions, and other artifacts relating to the echo-planar imaging acquisition may render prostate diffusion-weighted imaging (DWI) nondiagnostic. Reduced field-of-view (rFOV) acquisition, using parallel transmission and focused excitation, is a novel DWI approach that reduces distortions and improves images quality. This article presents images from both standard and rFOV DWI acquisitions in 2 prostate cancer patients with hip implants, showing the effect of rFOV DWI for improving tumor localization. The findings have implications for the potential application of magnetic resonance imaging for guiding targeted biopsy and planning focal therapy in the growing population of patients with hip implants.
Available online 14 February 2018
Prevalence and Severity of Off-Centering During Diagnostic CT: Observations From 57,621 CT scans of the Chest, Abdomen, and/or Pelvis
Publication date: Available online 23 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Oladunni O. Akin-Akintayo, Lauren F. Alexander, Rebecca Neill, Elizabeth A. Krupinksi, Xiangyang Tang, Pardeep K. Mittal, William C. Small, Courtney C. Moreno Purpose To determine distances between patient centroid and gantry isocenter during CT imaging of the chest, abdomen, and/or pelvis, and to evaluate differences based on patient gender, scan region, patient position, and gantry aperture. Materials and Methods A water phantom and an anthropomorphic phantom were imaged in the centered position in the CT gantry and at several off-centered positions. Additionally, data from 57,621 adult chest, abdomen, and/or pelvic CT acquisitions were evaluated. Data were analyzed with an analysis of variance using the centroid-to-isocenter data as the dependent variable and the other parameters as independent variables. Results The majority of patient acquisitions (83.7% (48271/57621)) were performed with the patient’s centroid positioned below isocenter (mean 1.7 cm below isocenter (SD 1.8 cm); range 12.1 cm below to 7.8 cm above isocenter). Off-centering in the x-axis was less severe (mean 0.01 cm left of isocenter (SD 1.6 cm)). Distance between centroid and isocenter in the y-axis did not differ as a function of sex but did differ based on scan region, patient position, and gantry aperture. Conclusion Off-centering is common during CT imaging and has been previously demonstrated to impact dose and image quality.
Available online 13 February 2018
Imaging and Pathologic findings of Hepatic Small Vessel Hemangioma
Publication date: Available online 14 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Balasubramanya Rangaswamy, Marta Minervini, Mitchell Tublin, Biatta Sholosh, Anil K. Dasyam Hepatic small vessel hemangioma represents a distinct yet very rare pathologic entity of the liver. The entity has also been in the past referred to as adult capillary hemangioma of the liver and congenital noninvoluting hemangioma. Imaging findings are not definitive and biopsy or resection is ultimately necessary. Pathologically these represent vasoformative abnormalities with infiltrative margins that can potentially mimic hepatic angiosarcoma. Immunohistochemistry can help differentiate hepatic small vessel hemangioma from angiosarcoma. Given the infiltrative growth pattern and unknown outcomes, resection and or close follow up has been recommended. Recently the term hepatic small vessel neoplasm has been coined in view of the unknown outcomes and some concerning findings on molecular analysis. We report 2 cases of this unusual entity and describe its imaging, gross pathologic, histopathologic, and immunohistochemical features.
Available online 10 February 2018
When the Reading Room Meets the Team Room: Resident Perspectives From Radiology and Internal Medicine on the Effect of Personal Communication After Implementing a Resident-Led Radiology Rounds
Publication date: Available online 13 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Andrew J. Klobuka, John Lee, Raquel Buranosky, Matthew Heller Objective Current radiology and internal medicine (IM) residents have trained to varying degrees depending on program in the post picture archiving and communication systems implementation era and thus have largely missed out on the benefits of in-person, 2-way communication between radiologists and consulting clinicians. The purpose of this study is to broadly explore resident perspectives from these groups on the desire for personal contact between radiologists and referring physicians and the effect of improved contact on clinical practice. Materials and Methods A radiology rounds was implemented in which radiology residents travel to the IM teaching service teams to discuss their inpatients and review ordered imaging biweekly. Surveys were given to both cohorts following 9 months of implementation. Results A total of 23/49 diagnostic radiology (DR) and 72/197 IM residents responded. In all, 83% of DR and 96% of IM residents desired more personal contact between radiologists and clinicians. Of all, 92% of DR residents agree that contact with referring clinicians changes their approach to a study, 96% of IM residents agree that personal contact with a radiologist has changed patient management in a way that they otherwise would not have done having simply read a report, 85% of DR residents report that more clinician contact will improve resource use, and 96% report that it will improve care quality. Furthermore, 99% of IM residents report that increased access to a radiologist would make selecting the most appropriate imaging study easier in various clinical scenarios. A majority of IM residents prefer radiology reports that provide specific next-step recommendations and that include arrows/key-image series. Conclusion We conclude that the newest generation of physicians is already attuned to the value of a radiologist who plays an active, in-person role in the clinical decision-making process.
Available online 7 February 2018
Hepatic Heterogeneity and Attenuation on Contrast-Enhanced CT in Patients With the Hypovolemic Shock Complex: Objective Classification Using a Contemporary Cohort
Publication date: Available online 10 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Benjamin Wildman-Tobriner, Michael S. Enslow, Rendon C. Nelson Objective When objectively measured on computed tomography (CT), does hepatic heterogeneity or overall liver attenuation predict the presence of shock? Methods This retrospective study included 73 patients (mean age 33 years) with the hypoperfusion shock complex (HSC) on CT (cases) and 100 patients (mean age 43 years) with negative trauma CT scans (controls). Liver heterogeneity was calculated by using consistently sized regions of interest (ROIs) to measure the 2 highest and the 2 lowest areas of hepatic density (in Hounsfield units [HU]). The difference between the means of the 2 highest and 2 lowest ROIs was considered the heterogeneity. Attenuation was calculated using the mean of 3 randomly placed ROIs. Both heterogeneity and attenuation were then compared between cases and controls. Results Median hepatic heterogeneity was 16.8 HU (IQR: 10.7-23.4) for the HSC group and 9.0 HU (IQR: 7.0-10.4) for the controls (P < 0.001). The area under the curve was 0.79, and a threshold of 30 HU yielded a specificity of 100%. Median hepatic attenuation was not significantly different between the HSC and the control groups, with an area under the curve of 0.56. Conclusions Increased hepatic heterogeneity may represent an objective marker of the HSC that performs in a similar manner to other established signs. By comparison, overall hepatic hypoattenuation is a poor indicator of the HSC.
Available online 6 February 2018
The Impact of Gadolinium Deposition on Radiology Practice: An International Survey of Radiologists
Publication date: Available online 7 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Ryan T. Fitzgerald, Vikas Agarwal, Jenny K. Hoang, Frank Gaillard, Andrew Dixon, Emanuel Kanal Rationale and Objectives Brain deposition of gadolinium following the administration of gadolinium-based contrast agents (GBCAs) was initially reported in 2014. Gadolinium deposition is now recognized as a dose-dependent consequence of exposure. The potential clinical implications are not yet understood. The purpose of this study was to determine radiologists’ reporting practices in response to gadolinium deposition. Materials and Methods An electronic survey querying radiologists’ practices regarding gadolinium deposition was distributed by Radiopaedia.org from November-December 2015. Results Our study sample included 94 total respondents (50% academic; 27% private practice; 23% hybrid) from 30 different countries (USA 18%). Fifty-seven (62%) radiologists had observed brain gadolinium deposition on MRI brain studies howerver more than half of these (30 of 57) reported detecting dentate T1 shortening only rarely (<1/month). Among respondents, 58% (52 of 89) do not or would not include the finding in the radiology report; only 12 (13%) report the finding in the impression of their reports. The most common reason for not reporting gadolinium deposition was the risk of provoking unnecessary patient anxiety (29%, 20 of 70). Recent data on gadolinium deposition has led to a reported practice change in 24 of 87 (28%) of respondents. Conclusion Recognition of, and attitudes toward, brain gadolinium deposition were inconsistent in this worldwide sample. Most surveyed radiologists do not routinely report dentate T1shortening as a marker of gadolinium deposition. Fear of provoking patient/clinician anxiety and an incomplete understanding of the implications of gadolinium deposition contribute to inconsistencies in reporting.
Available online 6 February 2018
Pitfalls and Misinterpretations of Cardiac Findings on PET/CT Imaging: A Careful Look at the Heart in Oncology Patients
Publication date: Available online 6 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Sonia L. Betancourt Cuellar, Diana Palacio, Marcelo F. Benveniste, Brett W. Carter, Gregory Gladish Positron emission tomography (PET) computed tomography (CT) with 2-[fluorine-18] fluoro-2-deoxy-d-glucose (FDG) has been established as an effective modality for evaluation of cancer. Interpretations of patterns of physiologic 18F-FDG uptake by the heart is particularly difficult given the wide normal variations of 18F-FDG metabolic activity observed. Atypical patterns of focal or diffuse physiologic cardiac 18F-FDG uptake and post-therapeutic effects after radiation therapy, systemic diseases, or cardiomyopathy may also be confused with malignant disease on 18F-FDG PET/CT. In this article, we review the variations of normal cardiac 18F-FDG uptake observed in oncology patients and the appearances of other patterns of pathologic metabolic activity, related or not related to the malignancy being investigated, that may lead to false-negative and false-positive results.
Available online 2 February 2018
Comprehensive Imaging and Surgical Review of Urinary Diversions: What the Radiologist Needs to Know
Publication date: Available online 6 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Arvind K. Shergill, David C. Wang, Seng Thipphavong, Alexandre R. Zlotta, Nasir Jaffer Urinary diversions are surgical procedures that reconstruct the lower urinary tract following cystectomy. The 2 common surgical approaches are based on the continence status of the urinary tract. Incontinent diversions have continuous urine drainage through a cutaneous stoma, whereas continent diversions offer the patient the ability to self-void either via stoma catheterization or with the patient's own urethra. Given the large number of diversion procedures available, postsurgical anatomy may be complex. Multiple imaging modalities can be used to assess the postprocedural anatomy, potential complications, and for on-going oncologic monitoring. The purpose of this review is to describe the common surgical techniques and associated complications.
Available online 2 February 2018
Non-contrast MDCT for Ureteral Calculi and Alternative Diagnoses: Yield in Adult Women vs in Adult Men
Publication date: Available online 2 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Parisa Fani, Michael N. Patlas, Sandra Monteiro, Douglas S. Katz Purpose To determine the yield of non-contrast multi-detector computed tomography (MDCT) of the abdomen and pelvis in diagnosing ureteral calculi as well as other alternative acute conditions in male vs in female adult patients presenting to the emergency department with new onset of symptoms. Methods Our institutional review board approved a retrospective review of the official reports of the non-contrast MDCT examinations of the abdomen and pelvis performed on adults (18 years and older) presenting to our emergency department with a suspected ureteral calculus from October 1, 2011 to October 30, 2013. Patients with recently documented ureteral calculi, known urinary tract infection, malignancy, and trauma were excluded from the study. From a total of 1097 non-contrast MDCT examinations of the abdomen and pelvis over the 2-year period, 400 randomly selected examinations were reviewed (approximately one-third of all the examinations). We compared the prevalence of ureteral calculi between the male and female population. P values and confidence intervals were determined using software Stata 14. Other acute intra-abdominal and intra-pelvic findings amenable to prompt medical care were also documented and analyzed separately. Results The mean patient age was 55.2 years, with a range of 19-90 years. This included 170 female (mean age 56.8 years) and 230 male patients (mean age 54.2 years). Ureteral calculi were detected in 170 (42.5%) of the patients [111 males (48%) and 59 females (34.7%)] with a prevalence which was statistically significantly higher in the male patients compared to in the female patients (P < 0.01, confidence level of 95% and CI of 13.2-13.4). An alternative diagnosis was made based on the MDCT findings in 49 patient cases (12.25 %), including 26 females (15.29%) and 23 males (10.00%). There was no statistically significant difference in alternative acute findings in male compared to in female patients (P > 0.05). This was with the exception of acute pyelonephritis, which was statistically significantly higher in the female patients (P < 0.01). Conclusion The likelihood of making the diagnosis of a ureteral calculus on non-contrast MDCT of the abdomen and pelvis was statistically significantly higher in male patients compared with female patients presenting to our emergency department. However, there was no statistically significant difference in the alternative diagnoses, with the exception of pyelonephritis, which was more common in women.
Available online 31 January 2018
Pancreatic Walled-Off Necrosis Eroding into the Inferior Vena Cava
Publication date: Available online 2 February 2018
Source:Current Problems in Diagnostic Radiology Author(s): Anupama Ramachandran, Sanchit Sharma, Shalimar, Raju Sharma, Kumble Seetharama Madhusudhan Walled-off necrosis (WON) is a well-known delayed local complication of acute necrotizing pancreatitis. Occasionally, WON may spontaneously rupture into the gastrointestinal tract or peritoneal cavity. However, erosion of a WON to a systemic vein has not been reported in literature so far. We report an unusual case of a 63-year-old male with acute necrotizing pancreatitis in whom WON was eroding into the inferior vena cava resulting in its thrombosis. Our patient also had a bunch of other well-described complications of pancreatitis including splanchnic venous thrombosis.

Thoracic Imaging of Non-Small Cell Lung Cancer Treated With Anti-programmed Death Receptor-1 Therapy
Publication date: Available online 31 January 2018
Source:Current Problems in Diagnostic Radiology Author(s): Mark Hammer, Stephen Bagley, Charu Aggarwal, Joshua Bauml, Arun C. Nachiappan, Charles B. Simone, Corey Langer, Sharyn I. Katz Purpose Treatment with anti-programmed death receptor-1 (PD-1) therapeutics can lead to unconventional responses and side effect profiles due to their potentiating effects on the immune system. Here we evaluate the radiologic manifestations of anti-PD-1 therapy in the chest in patients with non-small cell lung cancer (NSCLC) receiving anti-PD-1 therapy. Materials and Methods A retrospective review of real-world clinical practice was conducted of all the patients with NSCLC receiving anti-PD-1 therapy at our institution between 2013 and 2016. All patients without adequate clinical or radiologic follow-up data in the electronic medical records were excluded. Imaging examinations for all patients deemed by their thoracic oncologists to have radiologic pseudoprogression or therapy-associated pneumonitis were reviewed by experienced thoracic radiologists. Results A total of 166 patients with NSCLC had available clinical and imaging data for retrospective review. Of these patients, 4 (2%) were considered to have radiologic pseudoprogression, 3 of which manifested as increased tumor size and 1 of which manifested with new lesions. A total of 5 patients (3%) were clinically deemed to have pneumonitis attributable to anti-PD-1 therapy, 4 of which had radiologic manifestations on computed tomography. Conclusion Radiologic pseudoprogression and drug-induced pneumonitis are uncommon but important manifestations of anti-PD-1 therapy on thoracic imaging.
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