Academic Radiology

Communicating Results Directly to Patients: Don't Ignore the Price Tag of This Added “Value”

Saurabh Jha — 2012-06-01

A cynic is the man who knows the price of everything but the value of nothing. —Oscar Wilde It is unclear to whom Wilde was alluding. It may have been economists, but certainly not present-day radiologists, who are constantly in search for the seemingly elusive value of their professional existence. Attend any societal meeting, any academic discussion, speak to any radiology resident, and the word value is thrown around effortlessly and frequently, with threat and extinction coming in distant second and third.

Direct Reporting of Results to Patients: The Future of Radiology?

Melanie Kuhlman, Monique Meyer, Elizabeth A. Krupinski — 2012-06-01

Rationale and Objectives: Radiologists have traditionally left relaying exam results to patients in the hands of clinicians. Recent editorials have reexamined radiologists' traditional position and questioned whether radiologists should continue to remain within the confines of the reading room or increase their contact with patients. The present study addressed this issue by surveying patients directly regarding their preferences.Materials and Methods: A survey was given to all patients aged ≥ 21 years undergoing outpatient magnetic resonance imaging or computed tomographic examinations at an academic medical center and at an associated outpatient center. Responses were anonymous. Surveys were provided over a 4-week period in February and March 2011; 237 were returned.Results: The majority of patients (73%–77%) continue to prefer the practice model already established, regardless of whether the results are normal or abnormal. However, the same percentage of patients preferred to hear the results of their exams from the experts interpreting the exams. The discrepancy in these results is likely reflected in the fact that there is persistent confusion as to the role of radiologists. Although most patients correctly defined a radiologist as a physician, 40% believed that a radiologist is a technician or a nurse. A large percentage of patients (64%) responded positively to wanting to meet the radiologists interpreting their exams.Conclusions: As radiologists, we need to reevaluate the established model of communication for reporting radiology results and consider the positive impact on patient care, and on the vitality of the radiology profession, of directly communicating with patients.

Quality of Communication: Different Patterns of Reporting the Location of the Tip of a Nasogastric Tube

Mervyn D. Cohen, Marsha Ellett — 2012-04-05

Purpose: This investigation is part of a prospective National Institutes of Health–funded study evaluating three different methods for estimating the optimal length for placement of a new nasogastric (NG) tube. Abdomen radiographs were required to determine the location of the tube tip. Our objective was to analyze different methods by which the tube location was described in the radiology report of the abdominal radiographs, and the influence of the presence or absence of a relevant clinical history.Methods: We reviewed the imaging reports obtained following placement of a new nasogastric tube in patients enrolled in the study.Results: There were 188 studies. The x-ray report contained separate description and impression sections in 154. In 24 they were combined. When the history on the requisition indicated “tube placement” as the reason for the study, the location of the tube tip was given in the impression on 134/141 (95%). When the requisition failed to mention “tube placement” as the study indication, the impression only mentioned the tube tip location 4/13 (31%). The report provided a specific location for the tube tip in 115 of the 188 cases; in 73 of the 188 cases, the report stated that the tube tip “overlies/is in the region of” the stomach. On 29 occasions the report stated that the tube, not the tube tip, was in the stomach.Conclusions: There is variation in the manner of reporting the location of NG tube tips. When the requisition fails to indicate “tube placement” as the study indication, the report impression often fails to mention the tube location.

Assessing Renal Parenchymal Volume on Unenhanced CT as a Marker for Predicting Renal Function in Patients with Chronic Kidney Disease

2012-06-01

Objectives: To estimate renal volume in chronic kidney disease (CKD) patients using a semiautomated software and compare them with split renal function estimates from radionuclide renogram (RR). We proposed that renal volume from unenhanced computed tomography (CT) scans may serve as surrogate marker for assessing renal function in CKD patients.Materials and Methods: Unenhanced multidetector CT scans of 26 patients with CKD (estimated glomerular filtration rate [eGFR] <60 mL/kg/body surface area [BSA]) and 10 controls (eGFR >60 mL/kg/BSA) were analyzed to calculate renal volumes using a semiautomated software (AMIRAV5.2.0). Volumes obtained were then correlated with corresponding eGFR and split renal function estimates from RR. Volumes were also compared with those obtained on enhanced scans in 10 cases (five disease group, five controls). Bland-Altman analysis was used to assess agreement between methods.Results: A moderately positive correlation was found between renal volume obtained on unenhanced CT and eGFR (r = 0.65, P < .0001), whereas a significantly high correlation with split function estimates from RR (r = 0.95, P < .001) was found. Bland-Altman analysis revealed a good agreement between renal volume from CT and renal function from RR (34/36 observations were within 95% CI and there were two outliers). Correlation between volumes obtained from unenhanced and enhanced CT scans was also significant (r = 0.96).Conclusion: In patients with CKD, renal volume derived from unenhanced CT can possibly serve as a surrogate marker for assessing and monitoring renal function reserves to plan further management.

Breast-specific Gamma Imaging in the Detection of Atypical Ductal Hyperplasia and Lobular Neoplasia

2012-06-01

Rationale and Objectives: Atypical lesions such as atypical ductal hyperplasia (ADH) and lobular neoplasia are nonmalignant lesions that are associated with significant increased risk of developing breast cancer. Atypical lesions have been reported to present with focal increased radiotracer uptake on breast-specific gamma imaging (BSGI) examination, a novel physiologic tool for the detection of breast cancer. To date the sensitivity of BSGI in the detection of atypical lesions has not been reported. The purpose of this study is to determine the sensitivity of BSGI in detecting ADH and lobular neoplasia.Materials and Methods: A total of 1316 patients who received a BSGI exam between January 2006 and July 2009 were retrospectively reviewed. All patients who underwent minimally invasive biopsy and subsequent surgical excision where the highest pathology was solely ADH or lobular neoplasia (reported as ALH, lobular carcinoma in situ or lobular neoplasia), according to the pathology database were included (n = 15). The sensitivity was determined as the percentage of positive BSGI exams out of all patients diagnosed with ADH or lobular neoplasia who received a BSGI.Results: Patient ages ranged from 39 to 67 (mean, 52). Eight of 15 patients had ADH, 6/15 lobular neoplasia, and 1/15 ADH and lobular neoplasia in one lesion. Fifteen of the 15 (100%) patients with surgically confirmed ADH or lobular neoplasia had a positive BSGI, with focally increased radiotracer uptake at the site of the verified high-risk lesion.Conclusion: BSGI has a high sensitivity for the detection of atypical, high-risk breast lesions. A diagnosis of an atypical lesion is concordant with focal increased radiotracer uptake with BSGI and can identify women at increased risk for breast cancer.

Suspicious Breast Lesions Detected at 3.0 T Magnetic Resonance Imaging: Clinical and Histological Outcomes

Karen S. Johnson, Jay A. Baker, Sheila S. Lee, Mary S. Soo — 2012-03-30

Rationale and Objectives: To evaluate the imaging features and histological and clinical outcomes of a series of suspicious, mammographically occult breast lesions detected at 3.0 T magnetic resonance imaging (MRI).Materials and Methods: Approval was obtained from the institutional review board. A Health Insurance Portability and Accountability Act–compliant retrospective review was performed of 121 suspicious, mammographically occult lesions detected on 3.0 T contrast-enhanced breast MRI. All 121 lesions underwent histological sampling. Radiology and clinic reports were reviewed for patient demographics, MRI indication and findings, biopsy and localization details, histological results, and follow-up information. Positive predictive value (PPV) of biopsy recommendations were calculated and compared for screening versus diagnostic cases. Likelihood of malignancy was also compared with lesion size. Statistical analyses were performed using chi-square, Fisher's exact, and two-tail z-tests.Results: Overall 43 malignancies were diagnosed from 121 suspicious, mammographically occult 3.0 T MRI-detected lesions. Seventy-eight (64%) of the 121 were benign. The overall PPV of 3.0 T MRI-detected lesions was 36% (43/121). The PPV for biopsy in the screening setting (22% [10/45]) was statistically significantly less (P = .018) compared to the PPV of a biopsy recommendation in the diagnostic setting (43% [33/76]). There was no correlation between lesion size and the likelihood of detecting malignancy.Conclusion: Our PPV of suspicious, mammographically occult, breast lesions detected at 3.0 T breast MRI is similar to the PPV reported previously for suspicious breast lesions detected at 1.5 T. This study supports the use of 3.0 T breast MRI for both screening and diagnostic breast imaging.

Erratum

2012-06-01

Wu LM, Xu JR, Liu MJ, Zhang XF, Hua J, Zheng J, Hu JN. Value of magnetic resonance imaging for nodal staging in patients with head and neck squamous cell carcinoma: a meta-analysis. Acad Radiol. 2012;19(3):331-40.

Automated vs. Manual Pattern Recognition of 3D 1H MRSI Data of Patients with Prostate Cancer

2012-06-01

Rationale and Objectives: The aim of this study was to assess (1) automated analysis methods versus manual evaluation by human experts of three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) data from patients with prostate cancer and (2) the contribution of spatial information to decision making.Materials and Methods: Three-dimensional proton MRSI was applied at 1.5 T. MRSI data from 10 patients with histologically proven prostate adenocarcinoma, scheduled either for prostatectomy or intensity-modulated radiation therapy, were evaluated. First, two readers manually labeled spectra using spatial information to identify the localization of spectra and neighborhood information, establishing the reference set of this study. Then, spectra were labeled again manually in a blinded and randomized manner and evaluated automatically using software that applied spectral line fitting as well as pattern recognition routines. Statistical analysis of the results of the different approaches was performed.Results: Altogether, 1018 spectra were evaluable by all methods. Numbers of evaluable spectra differed significantly depending on patient and evaluation method. Compared to automated analysis, the readers made rather binary decisions, using information from neighboring spectra in ambiguous cases, when evaluating MRSI data as a whole. Differences between anatomically blinded and unblinded evaluation were larger than differences between evaluations using blinded data and automated techniques.Conclusions: An automated approach, which evaluates each spectrum individually, can be as good as an anatomy-blinded human reader. Spatial information is routinely used by human experts to support their final decisions. Automated procedures that consider anatomic information for spectral evaluation will enhance the diagnostic impact of MRSI of the human prostate.

Node/Aorta and Node/Liver SUV Ratios from 18F-FDG PET/CT May Improve the Detection of Occult Mediastinal Lymph Node Metastases in Patients with Non-Small Cell Lung Carcinoma

2012-03-30

Rationale and Objectives: Research suggests that the semiquantitative determination of nodal 18F–fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/computed tomography (CT) may be useful for the assessment of mediastinal metastases in patients with non-small-cell lung carcinoma (NSCLC). The aim of this study was to evaluate the diagnostic ability of using different standardized uptake value (SUV) parameters in the detection of ipsilateral mediastinal (N2) disease.Materials and Methods: A total of 102 patients newly diagnosed with non-small-cell lung carcinoma who underwent 18F-FDG PET/CT before surgery and had not received prior therapy were retrospectively included. All patients underwent surgical resection of the primary tumor and mediastinal lymph node dissection. On a station-based analysis, different SUV parameters (eg, mediastinal lymph node SUV, node/aorta SUV ratio, and node/liver SUV ratio) were evaluated using the histopathologic results as the reference standard. The optimal cutoff value for each SUV parameter was determined with receiver-operating characteristic curve analysis.Results: The areas under the receiver-operating characteristic curves were 0.674, 0.693, and 0.715 for node SUV, node/aorta SUV ratio, and node/liver SUV ratio, respectively (P < .05). With cutoff values of 3.15, 1.37, and 1.02 for node SUV, node/aorta SUV ratio, and node/liver SUV ratio, respectively, the sensitivity of 18F-FDG PET/CT for N2 staging was 57.1%, 85.7%, and 71.4%, and specificity was 74.2%, 50.5%, and 61.9%.Conclusions: Compared to node SUV alone, the use of node/aorta and node/liver SUV ratios resulted in improved detection of N2 metastases. The two SUV parameters may potentially improve the diagnostic accuracy of 18F-FDG PET/CT for the diagnosis of N2 disease in patients with non-small-cell lung carcinoma.

The Role of Ultrasonography in Early Detection and Monitoring of Shoulder Erosions, and Disease Activity in Rheumatoid Arthritis Patients; Comparison with MRI Examination

Mohammed F. Amin, Faten M. Ismail, Rawhya R. El Shereef — 2012-03-29

Objectives: To determine the accuracy of ultrasound in early detection of bone erosions and monitoring disease activity in rheumatoid arthritis (RA) patients using magnetic resonance imaging (MRI) as a gold standard technique.Material and Methods: This prospective study was carried out on 50 patients with known RA and 15 healthy controls. Conventional radiography was standardized and performed in two planes. Ultrasound (US) and MRI was performed to evaluate the presence of synovitis, tenosynovitis, and bursitis as well as erosions on ultrasound and MRI. The results in the study group were compared with those obtained in a control group.Result: In the study group, the most frequent US finding of shoulder joint was Tenosynovitis of the long head of the biceps tendon. Tenosynovitis was observed in the long head of biceps tendon in 20 joints (40%). Erosions of the humeroscapular joint were detected by conventional radiography in 15 (30%), by US in 41 (82%), and by MRI in 46 (92%) of the shoulders examined, no statistically significant difference is noted between US and MRI in overall detection of erosion (P = .333).Conclusion: US is a helpful imaging method and in comparison with MRI in assessing the shoulder joint and, preferably with MRI, are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results.

Benefits of 3D Rotational DSA Compared with 2D DSA in the Evaluation of Intracranial Aneurysm

Siong Chuong Wong, Ouzreiah Nawawi, Norlisah Ramli, Khairul Azmi Abd Kadir — 2012-06-01

Rationale and Objectives: The aim of this study was to compare conventional two-dimensional (2D) digital subtraction angiography (DSA) with three-dimensional (3D) rotational DSA in the investigation of intracranial aneurysm in terms of detection, size measurement, neck diameter, neck delineation, and relationship with surrounding vessels. A further aim was to compare radiation dose, contrast volume, and procedural time between the two protocols.Materials and Methods: Thirty-five patients who presented with subarachnoid bleeds on computed tomography and were suspected of having intracranial aneurysms underwent conventional 2D DSA followed by 3D DSA. The 3D digital subtraction angiographic images were displayed as surface shaded display images. Aneurysm detection, sac size, neck diameter, neck delineation, and relationship of aneurysm to the surrounding vessels analyzed from the two protocols were compared. Radiation dose, contrast volume, and procedural time for both examinations were also compared.Results: Three-dimensional DSA detected 44 aneurysms in 31 patients, with negative findings seen in four patients. A false-negative detection rate of 6.8% (three of 44) for 2D DSA was noted. There was no significant difference in aneurysm size between 3D and 2D DSA. The sizes of aneurysm necks were found to be significantly larger in 3D DSA than on 2D DSA. The aneurysm neck and relationship to surrounding vessels were significantly better demonstrated on 3D DSA than on 2D DSA. Radiation dose (entrance surface dose), contrast use, and procedural time with 3D DSA were significantly less than with 2D DSA.Conclusions: Three-dimensional DSA improves the detection and delineation of intracranial aneurysms, with lower radiation dose, less contrast use, and shorter procedural time compared to 2D DSA. The size of the aneurysm neck on 3D DSA tended to be larger than on 2D DSA.

Clinical Significance of Combined Assessment of the Maximum Standardized Uptake Value of F-18 FDG PET with Nodal Size in the Diagnosis of Cervical Lymph Node Metastasis of Oral Squamous Cell Carcinoma

2012-04-09

Rationale and Objectives: This study aimed to elucidate the diagnostic accuracy of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for nodal involvement in oral squamous cell carcinoma (OSCC), and to reveal clinically useful factors to distinguish between true-positive (TP) and false-positive (FP) nodes.Materials and Methods: Thirty-eight patients with primary OSCC who underwent neck dissection were assessed. The diagnostic accuracy of F-18 FDG PET/CT was evaluated, and then compared with that of CT/ultrasonography (US). Furthermore, the association of the maximum standardized uptake value (SUVmax) and nodal size with the histopathologic findings was examined.Results: Sensitivity and specificity using F-18 FDG PET/CT were 77.1% and 97.3%, and those using CT/US were 72.9% and 98.9%, respectively. The SUVmax of TP nodes was significantly higher than that of FP nodes. Nodes with SUVmax >4.5 were pathologically confirmed as metastasis. Nodes with SUVmax ≤4.5 were further discriminated between TP and FP nodes by using the long axis diameters or the ratios of long to short axis diameter as clinical parameters. Positive correlation between the SUVmax and the short-axis diameter was found in TP nodes. The AUC obtained from the ROC curves of the SUVmax alone (AUC, 0.804) was improved by combination with the long-axis diameter (AUC, 0.867) or the short-axis diameter (AUC, 0.846), although no significant difference was found.Conclusions: These results indicated that F-18 FDG PET/CT was potentially useful in diagnosing preoperative nodal state. Furthermore, combined assessment of SUVmax with nodal size could be significant in the identification of metastatic lymph nodes in OSCC patients.

A New Formula for Rapid Assessment of Pericardial Effusion Volume by Computed Tomography

2012-02-24

Rationale and Objectives: The aim of this study was to evaluate a new formula for the rapid assessment of pericardial effusion (PE) volume by computed tomography.Materials and Methods: Twenty computed tomographic scans positive for PE were reviewed by two observers. Diameters of PE were measured at four locations. Additionally, PE volume was assessed by volumetry. The correlation between PE diameters and volume was evaluated, and a linear equation was derived for each diameter location. To test validity and reliability of the measurements, intraclass correlation and Bland-Altman analysis were performed.Results: Good validity was expressed by strong correlations between diameter measurements at all four locations and PE volume (all R values >0.80 and P values 0.75) and Bland-Altman analysis revealed good interobserver and intraobserver reliability of diameter measurements. The best values were observed for apical diameter measurements. The following linear equation was derived for apical diameter measurements: PE volume = 296 (mL/cm) × apical diameter (cm) − 32 mL.Conclusions: PE volume can rapidly be assessed by apical PE diameter measurement using the simplified formula PE volume = 0.3 (L/cm) × apical diameter (cm).

Automatic Left Ventricle Segmentation in Cardiac MRI Using Topological Stable-State Thresholding and Region Restricted Dynamic Programming

Hong Liu, Huaifei Hu, Xiangyang Xu, Enmin Song — 2012-04-02

Rationale and Objectives: Segmentation of the left ventricle (LV) is very important in the assessment of cardiac functional parameters. The aim of this study is to develop a novel and robust algorithm which can improve the accuracy of automatic LV segmentation on short-axis cardiac magnetic resonance images (MRI).Materials and Methods: The database used in this study consists of 45 cases obtained from the Sunnybrook Health Sciences Centre. The 45 cases contain 12 ischemic heart failures, 12 non-ischemic heart failures, 12 LV hypertrophies, and 9 normal cases. Three key techniques are developed in this segmentation algorithm: 1) topological stable-state thresholding method is proposed to refine the endocardial contour, 2) an edge map with non-maxima gradient suppression approach, and 3) a region-restricted technique that is proposed to improve the dynamic programming to derive the epicardial boundary.Results: The validation experiments were performed on a pool of data sets of 45 cases. For both endo- and epicardial contours of our results, percentage of good contours is about 91%, the average perpendicular distance is about 2 mm, and the overlapping dice metric is about 0.91. The regression and determination coefficient for the experts and our proposed method on the ejection fraction is 1.05 and 0.9048, respectively; they are 0.98 and 0.8221 for LV mass.Conclusions: An automatic method using topological stable-state thresholding and region restricted dynamic programming has been proposed to segment left ventricle in short-axis cardiac MRI. Evaluation results indicate that the proposed segmentation method can improve the accuracy and robust of left ventricle segmentation. The proposed segmentation approach shows the better performance and has great potential in improving the accuracy of computer-aided diagnosis systems in cardiovascular diseases.

Three-Dimensional Subharmonic Ultrasound Imaging In Vitro and In Vivo

2012-04-05

Rationale and Objectives: Although contrast-enhanced ultrasound imaging techniques such as harmonic imaging (HI) have evolved to reduce tissue signals using the nonlinear properties of the contrast agent, levels of background suppression have been mixed. Subharmonic imaging (SHI) offers near complete tissue suppression by centering the receive bandwidth at half the transmitting frequency. The aims of this study were to demonstrate the feasibility of three-dimensional (3D) SHI and to compare it to 3D HI.Materials and Methods: Three-dimensional HI and SHI were implemented on a Logiq 9 ultrasound scanner with a 4D10L probe. Four-cycle SHI was implemented to transmit at 5.8 MHz and receive at 2.9 MHz, while two-cycle HI was implemented to transmit at 5 MHz and receive at 10 MHz. The ultrasound contrast agent Definity was imaged within a flow phantom and the lower pole of two canine kidneys in both HI and SHI modes. Contrast-to-tissue ratios and rendered images were compared offline.Results: SHI resulted in significant improvement in contrast-to-tissue ratios relative to HI both in vitro (12.11 ± 0.52 vs 2.67 ± 0.77, P < .001) and in vivo (5.74 ± 1.92 vs 2.40 ± 0.48, P = .04). Rendered 3D subharmonic images provided better tissue suppression and a greater overall view of vessels in a flow phantom and canine renal vasculature.Conclusions: The successful implementation of SHI in 3D allows imaging of vascular networks over a heterogeneous sample volume and should improve future diagnostic accuracy. Additionally, 3D SHI provides improved contrast-to-tissue ratios relative to 3D HI.

Development of a Calibration Phantom Set for MRI Temperature Imaging System Quality Assurance

Xuegang Xin, Jijun Han, Di Wang, Yanqiu Feng, Qianjin Feng, Wufan Chen — 2012-03-30

Rationale and Objectives: Magnetic resonance imaging (MRI) temperature imaging systems need to be routinely calibrated to guarantee accurate temperature results and qualified MRI. No independent physical temperature calibration phantom (TCP) set is currently available. An economical TCP set was developed to routinely ensure the quality of MRI temperature imaging system.Materials and Methods: The novel TCP was constructed using a heating unit, temperature sensor, and MRI phantom liquid. A specialized heating unit was developed using carbon fibers. The TCP set design was an integration of the TCP, temperature measurement unit, display unit, and control unit. The proposed MRI calibration kit, which is a combination of the TCP set and standard MRI phantom, was used in the MRI thermometry calibration and MRI quality calibration.Results: The TCP set provided an efficient, accurate, and homogeneous temperature map as the reference standard temperature for calibration. Accuracy and heating efficiency of the TCP set were 1°C and 1°C/minute, respectively. Calibration of the MRI thermometry and MRI quality were implemented successfully.Conclusion: The proposed TCP set is completely compatible with the MRI system and can be used to calibrate MRI thermometry and MRI quality to ensure the quality performance of the MRI temperature imaging system.

Running an Online Radiology Teaching Conference: Why It’s a Great Idea and How to Do It Successfully

2012-06-01

Rationale and Objectives: At the authors’ institutions, faculty members and trainees work at multiple sites scattered miles apart, making it difficult to physically attend weekly teaching conferences. As a possible solution, a weekly online musculoskeletal teaching conference was undertaken. This quickly grew to include multiple other sites around North America. The authors share their experiences to assist other radiologists in organizing similar educational conferences.Materials and Methods: The conferences are run using the Citrix GoToMeeting online meeting system. It runs on multiple platforms, including Mac, PC, iPhone, iPad, and Android. Attendees use a wide variety of microphones, sound cards, powered speakers, and webcams. Most users have fast institutional Internet connections, though several attend via slower connections, such as 3G.Results: The conference has run successfully for 2 years, with participants logging in from 24 different sites in 18 states, two Canadian provinces, and three countries. About 48 sessions are held each year, with 10 to 15 sites joining the conferences each week and about 10 to 15 cases seen each week. Most attendees are from university medical centers, though several private practice radiologists attend regularly. Screen-sharing quality is superb, with no discernible difference between local and remote slide quality. Audio quality is usually quite good, particularly for those using computer audio. Audio feedback is an occasional problem, but this issue is now more easily addressed. No single time is equally convenient for participants scattered among four to six time zones. However, some sites find the conferences sufficiently valuable to rearrange their afternoon procedure schedules to reduce conflicts with the conferences. The social aspect of visiting weekly with friends and colleagues from afar is highly valued, as are seeing the wide range of pathology from other institutions and the ability to confer with colleagues on difficult cases. The conferences have also spawned several collaborative educational projects, such as an online journal club, a published book of conference cases, and an online musculoskeletal hardware atlas.Conclusions: The weekly online musculoskeletal conference described in this report has matured over 2 years from a peculiar experiment to a very popular conference. Cases not seen locally provide enrichment, and attendees gain educational opportunities not otherwise available. Other radiology groups should be able to create and maintain similar conferences.

Assessing First Year Radiology Resident Competence Pre-call: Development and Implementation of a Computer-based Exam before and after the 12 Month Training Requirement

Rihan Khan, Elizabeth Krupinski, J. Allen Graham, Les Benodin, Petra Lewis — 2012-02-02

Rationale and Objectives: Whether first-year radiology residents are ready to start call after 6 or 12 months has been a subject of much debate. The purpose of this study was to establish an assessment that would evaluate the call readiness of first-year radiology residents and identify any individual areas of weakness using a comprehensive computerized format. Secondarily, we evaluated for any significant differences in performance before and after the change in precall training requirement from 6 to 12 months.Materials and Methods: A list of >140 potential emergency radiology cases was given to first-year radiology residents at the beginning of the academic year. Over 4 years, three separate versions of a computerized examination were constructed using hyperlinked PowerPoint presentations and given to both first-year and second-year residents. No resident took the same version of the exam twice. Exam score and number of cases failed were assessed. Individual areas of weakness were identified and remediated with the residents. Statistical analysis was used to evaluate exam score and the number of cases failed, considering resident year and the three versions of the exam.Results: Over 4 years, 17 of 19 (89%) first-year radiology residents passed the exam on first attempt. The two who failed were remediated and passed a different version of the exam 6 weeks later. Using the oral board scoring system, first-year radiology residents scored an average of 70.7 with 13 cases failed, compared to 71.1 with eight cases failed for second-year residents who scored statistically significantly higher. No significant difference was found in first-year radiology resident scoring before and after the 12-month training requirement prior to call.Conclusions: An emergency radiology examination was established to aid in the assessment of first-year radiology residents’ competency prior to starting call, which has become a permanent part of the first-year curriculum. Over 4 years, all first-year residents were ultimately judged ready to start call. Of the variables assessed, only resident year showed a significant difference in scoring parameters. In particular, length of training prior to taking call showed no significant difference. Areas of weakness were identified for further study.

Transitioning to a New Residency Curriculum

Darel E. Heitkamp, Richard B. Gunderman — 2012-02-27

An important transition is under way in US diagnostic radiology residency training. Every program in the country is now composed of groups of upper-level residents following the traditional curriculum and lower-level residents following the new model. This transition has been the topic of lively and constructive conversation, particularly at the annual meetings of the Association of University Radiologists .

Research Imaging in an Academic Medical Center

2012-04-06

Rationale and Objectives: Managing and supervising the complex imaging examinations performed for clinical research in an academic medical center can be a daunting task. Coordinating with both radiology and research staff to ensure that the necessary imaging is performed, analyzed, and delivered in accordance with the research protocol is nontrivial. The purpose of this communication is to report on the establishment of a new Human Imaging Research Office (HIRO) at our institution that provides a dedicated infrastructure to assist with these issues and improve collaborations between radiology and research staff.Materials and Methods: The HIRO was created with three primary responsibilities: 1) coordinate the acquisition of images for clinical research per the study protocol, 2) facilitate reliable and consistent assessment of disease response for clinical research, and 3) manage and distribute clinical research images in a compliant manner.Results: The HIRO currently provides assistance for 191 clinical research studies from 14 sections and departments within our medical center and performs quality assessment of image-based measurements for six clinical research studies. The HIRO has fulfilled 1806 requests for medical images, delivering 81,712 imaging examinations (more than 44.1 million images) and related reports to investigators for research purposes.Conclusions: The ultimate goal of the HIRO is to increase the level of satisfaction and interaction among investigators, research subjects, radiologists, and other imaging professionals. Clinical research studies that use the HIRO benefit from a more efficient and accurate imaging process. The HIRO model could be adopted by other academic medical centers to support their clinical research activities; the details of implementation may differ among institutions, but the need to support imaging in clinical research through a dedicated, centralized initiative should apply to most academic medical centers.

X-rays Can Harm You and Others

Stephen J. Golding — 2012-04-09

Otha Linton is quite right that the benefits of medical imaging are well established and that we must not allow concern over radiation protection to provoke fear and scaremongering in the population. Such action would be poor medicine indeed.

Lifetime Acquaintances

Otha Linton — 2012-06-01

When my son was born, 49 years ago, I remember going home from the hospital after I had been awake all night waiting for his birth. So once I saw the infant and his mother, I got in my car and drove from the central part of Chicago to our home some 30 miles away, in the suburb of Highland Park. When I got home, I was tired but somehow not sleepy. So I sat down at my typewriter and wrote him a letter. It ran about four pages.

Differential Diagnosis in Pediatric Imaging

Stephen Darling — 2012-04-05

Differential Diagnosis in Pediatric Imaging, a collaborative effort between Rick R. van Rijn and Johan G. Blickman as well as an international group of expert authors, is an excellent reference for anyone who interprets pediatric radiologic examinations as part of his or her regular practice. The book provides a well-organized reference for differential diagnoses commonly encountered in pediatric imaging, with differentials supplemented by high-quality imaging examples. This reference is targeted toward practicing pediatric radiologists, although residents and fellows would find this book an invaluable reference to have at the workstation while interpreting pediatric studies.

Diagnostic Ultrasound: Physics and Equipment, Second Edition

Courtney C. Moreno — 2012-06-01

The second edition of Cambridge University Press’s Diagnostic Ultrasound: Physics and Equipment is a superb textbook that impressed me in many ways. Initially, I was concerned that based on its title, the book would read like a text used at the engineering school across town. This worry was misplaced, however, as the book reads like a series of very well written and extremely well illustrated review articles that one might find in a major radiology journal geared toward clinical radiologists.