Academic Radiology

Enterprise-Wide and Multisite Imaging and Archiving in Academic Radiology Departments: Articles Based on the 2011 AUR-Carestream Innovations in Academic Radiology Course

Pablo R. Ros — 2011-11-28

In this issue, Academic Radiology is presenting a number of articles reviewing different aspects of medical informatics . These articles collect the information provided in the Association of University Radiologists (AUR)-Carestream Innovations in Academic Radiology course given during the 2011 AUR meeting held in Boston, MA.

Comparison of Digital with Film Radiographs for the Classification of Pneumoconiotic Pleural Abnormalities

2011-11-21

Rationale and Objectives: Analog film radiographs are typically used to classify pneumoconiosis to allow comparison with standard film radiographs. The aim of this study was to determine if digital radiography is comparable to film for the purpose of classifying pneumoconiotic pleural abnormalities.Materials and Methods: Subjects were 200 asbestos-exposed patients, from whom digital and film chest radiographs were obtained along with chest high-resolution computed tomographic scans. Using a crossover design, radiographs were independently read on two occasions by seven readers, using conventional International Labour Organization standards for film and digitized standards for digital. High-resolution computed tomographic scans were read independently by three readers. Areas under the receiver-operating characteristic curves were calculated using high-resolution computed tomographic ratings as the gold standard for disease status. Mixed linear models were fit to estimate the effects of order of presentation, occasion, and modality, treating the seven readers as a random effect. Comparing digital and film radiography for each reader and occasion, crude agreement and agreement beyond chance (κ) were also calculated.Results: The linear models showed no statistically significant sequence effect for order of presentation (P = .73) or occasion (P = .28). Most important, the difference between modalities was not statistically significant (digital vs film, P = .54). The mean area under the curve for film was 0.736 and increased slightly to 0.741 for digital. Mean crude agreement for the presence of pleural abnormalities consistent with pneumoconiosis across all readers and occasions was 78.3%, while the mean κ value was 0.49.Conclusions: These results indicate that digital radiography is not statistically different from analog film for the purpose of classifying pneumoconiotic pleural abnormalities, when appropriate standards are used.

Hyperpolarized 3He Magnetic Resonance Functional Imaging Semiautomated Segmentation

2011-11-21

Rationale and Objectives: To improve intra- and interobserver variability and enable the use of functional magnetic resonance imaging (MRI) for multicenter, multiobserver studies, we generated a semiautomated segmentation method for hyperpolarized helium-3 (3He) MRI. Therefore the objective of this study was to compare the reproducibility and spatial agreement of manual and semiautomated segmentation of 3He MRI ventilation defect volume (VDV) and ventilation volume (VV) in subjects with asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF).Materials and Methods: The multistep semiautomated segmentation method we developed employed hierarchical K-means clustering to classify 3He MRI pixel intensity values into five user-determined clusters ranging from signal void to hyperintense. A seeded region-growing algorithm was also used to segment the 1H MRI thoracic cavity for coregistration to the 3He cluster-map, generating VDV and VV.Results: We compared manual segmentation performed by an expert observer and semiautomated measurements of 3He MRI VDV and observed strong significant correlations between the volumes generated using each method (asthma, n = 5, r = 0.89, P < .0001; COPD, n = 5, r = 0.84, P < .0001; CF, n = 5, r = 0.89, P < .0001). Semiautomated VDV had high interobserver reproducibility (coefficient of variation [CV] = 7%, intraclass correlation coefficient [ICC] = 0.96); intraobserver reproducibility was significantly higher for semiautomated (CV = 5%, ICC = 1.00) compared to manual VDV (CV = 12%, ICC = 0.98). Spatial agreement for VV determined using the Dice coefficient (D) was also high for all disease states (asthma, D = 0.95; COPD, D = 0.88; CF, D = 0.90).Conclusions: Semiautomated segmentation 3He MRI provides excellent inter- and intraobserver precision with high spatial and quantitative agreement with manual measurements enabling its use in longitudinal studies.

Diagnostic Performance of Dual-time 18F-FDG PET in the Diagnosis of Pulmonary Nodules: A Meta-analysis

Richard L. Barger, Kiran R. Nandalur — 2011-11-21

Rationale and Objective: Perform a comprehensive meta-analysis evaluating the diagnostic performance of dual time point deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) in the diagnosis of pulmonary nodules.Materials and Methods: MEDLINE, EMBASE, and PUBMED were queried between January 2000 and January 2011. Studies were included if they: 1) used dual time point FDG-PET as a diagnostic test for pulmonary nodules, 2) used pathology or clinical follow-up as the reference standard, and 3) reported absolute number of true-positive (TP), true-negative (TN), false-positive (FP), and false-negative (FN) results or stated sufficient data to derive these values. Summary sensitivity (SN), summary specificity (SP), positive and negative likelihood ratios (LR+) and (LR−), and diagnostic odds ratio were calculated. Heterogeneity of the results was assessed using Forest plots and the value of inconsistency index (I2).Results: Inclusion criteria were fulfilled by 10 articles with a total of 816 patients and 890 pulmonary nodules. The summary sensitivity was 85% (82%–89% at 95% confidence interval [CI]) and summary specificity was 77% (CI: 72%–81%), with a LR+ of 2.7 (CI: 1.4–5.2) and a LR− of 0.26 (CI: 0.14–0.49). Diagnostic odds ratio was 11 (CI: 3.8–32.2). Significant heterogeneity was found in the sensitivity (I2 = 77%) and specificity (90.3%).Conclusion: Dual time point FDG-PET demonstrates similar sensitivity and specificity to single time point FDG-PET in the diagnosis of pulmonary nodules. The additive value of the dual time point FDG-PET is questionable, primarily because of the significant overlap of benign and malignant nodule FDG-PET characteristics and lack of consensus criteria for quantitative thresholds to define nodules as malignant.

Comparison between Acetazolamide Challenge and 10% Carbon Dioxide Challenge Perfusion CT in Rat C6 Glioma

2012-02-01

Rationale and Objectives: The aim of this study was to investigate the effect of perfusion computed tomography (PCT) with acetazolamide (ACZ) challenge and compare it to 10% carbon dioxide (CO2) challenge in rat C6 glioma.Materials and Methods: PCT was performed on 32 rats, including 20 with orthotopically implanted C6 gliomas and 12 serving as controls. Ten rats with gliomas and six normal rats underwent PCT with ACZ challenge. The other 10 rats with gliomas and six normal rats underwent PCT with 10% CO2 challenge. The raw data were processed using Philips computed tomographic brain perfusion software. Perfusion parameters before and after the challenge were recorded. Percentage changes due to ACZ administration and 10% CO2 challenge were calculated. Pearson’s correlation coefficients were used to investigate relationships between percentage changes in perfusion parameters and vascular endothelial growth factor and microvessel density.Results: In C6 gliomas, percentage change in cerebral blood flow was significantly different between ACZ (72.73%) and 10% CO2 (28.47%) challenge (P < .01). Percentage change in cerebral blood volume was 37.85% with ACZ and 24.69% with 10% CO2 challenge (P = .02). In controls, percentage change in cerebral blood flow was significantly different between ACZ (117.42%) and 10% CO2 (65.86%) challenge (P < .01). For percentage change in cerebral blood volume, there was no significant difference between ACZ (107.51%) and 10% CO2 (92.95%) challenge. Significant correlations were observed among percentage changes in vascular endothelial growth factor, microvessel density, and cerebral blood volume (P < .01). Percentage change in cerebral blood flow correlated well with vascular endothelial growth factor.Conclusions: The results of this study indicate that PCT with ACZ challenge is a more reliable technique compared to 10% CO2 challenge for the quantitative evaluation of microcirculation in gliomas.

Dose Reduction in Digital Breast Tomosynthesis (DBT) Screening using Synthetically Reconstructed Projection Images: An Observer Performance Study

2011-11-21

Rationale and Objectives: The aim of this study was to retrospectively compare the interpretive performance of synthetically reconstructed two-dimensional images in combination with digital breast tomosynthesis (DBT) versus full-field digital mammography (FFDM) plus DBT.Materials and Methods: Ten radiologists trained in reading tomosynthesis examinations interpreted retrospectively, under two modes, 114 mammograms. One mode included the directly acquired full-field digital mammograms combined with DBT, and the other included synthetically reconstructed projection images combined with DBT. The reconstructed images do not require additional radiation exposure. The two modes were compared with respect to sensitivity, namely, recommendation to recall a breast with either a pathology-proven cancer (n = 48) or a high-risk lesion (n = 6), and specificity, namely, no recommendation to recall a breast not depicting an abnormality (n = 144) or depicting only benign abnormalities (n = 30).Results: The average sensitivity for FFDM with DBT was 0.826, compared to 0.772 for synthetic FFDM with DBT (difference, 0.054; P = .017 and P = .053 for fixed and random reader effects, respectively). The proportions of breasts with no or benign abnormalities recommended to be recalled were virtually the same: 0.298 and 0.297 for the two modalities, respectively (95% confidence intervals for the difference, −0.028 to 0.036 and −0.070 to 0.066 for fixed and random reader effects, respectively). Sixteen additional clusters of microcalcifications (“positive” breasts) were missed by all readers combined when interpreting the mode with synthesized images versus FFDM.Conclusions: Lower sensitivity with comparable specificity was observed with the tested version of synthetically generated images compared to FFDM, both combined with DBT. Improved synthesized images with experimentally verified acceptable diagnostic quality will be needed to eliminate double exposure during DBT-based screening.

Caudal Image Contrast Inversion in MPRAGE at 7 Tesla: Problem and Solution

2011-11-21

Rationale and Objectives: The magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) sequence regularly shows caudal image contrast inversion at 7 T and therefore reduced clinical applicability. The investigators report the technical source of this problem and present a practical solution.Materials and Methods: A total of 71 subjects were scanned using a 7-T whole-body magnetic resonance imaging system using a 32-channel transmit/receive head coil. In 39 subjects, 45 high-resolution T1 contrast image data sets were acquired with the standard MPRAGE sequence. A modified sequence with an adiabatic wideband uniform rate smooth truncation pulse for magnetization preparation was used for 45 further scans in 39 subjects. In total, seven subjects underwent scans with both sequences. The homogeneity of T1 contrast and the occurrence of caudal image contrast inversion were evaluated in consensus reading by two neuroradiologists.Results: Caudal image contrast inversion was depicted in 19 acquisitions (42.2%) using the standard MPRAGE sequence. Using the adiabatic wideband uniform rate smooth truncation pulse for magnetization preparation, caudal image contrast inversion was depicted in only three acquisitions (6.7%). A χ2 test showed a significant difference between the two preparation pulses (P < .001).Conclusions: Magnetization preparation with an adiabatic wideband uniform rate smooth truncation pulse in the MPRAGE sequence at 7 T can significantly reduce the occurrence of caudal image contrast inversion and improves signal homogeneity.

Trabecular Bone Mineral Density Measurement Using Thoracic and Lumbar Quantitative Computed Tomography

2011-11-24

Purpose: To evaluate the agreement of bone mineral density (BMD) between lumbar (L) and individual thoracic (T) vertebrae and identify a standard thoracic spine level for BMD assessment in cardiac computed tomography (CT) images.Materials and Methods: Three hundred subjects who underwent simultaneous chest and abdomen CT scans for clinical indications were included. A calibration phantom that extended from the first thoracic spine (T1) to the fifth lumbar (L5) was employed. Vertebral BMD were measured by QCT 5000 and NVivo systems. The association between three consecutive lumbar (L1–L3) and thoracic BMD (3T, initiation site equivalent to left main coronary caudally) was evaluated.Results: There was a gradual decrease in BMD values from T1 to L3, subsequently increasing in L4 and L5 in both genders. When stratified by gender, 3T BMD was significantly higher versus L1-3 BMD (156.9 versus 141.9vmg/cm3, P < .001) for women as well as for men (164.8 versus 151.0 mg/cm3, P < .001). There is good correlation between 3T and L1-3 BMD, the Pearson’s correlation coefficients are 0.91 and 0.93 for women and men, respectively. We further analyzed the associations between L1-3 and any individual spine of T1–L5 and similar relationships were observed (r value, 0.62–0.98). The intraobserver, interobserver, and interscan variation measurement of thoracic quantitative CT was 2.5 (1.0, 95% CI 0.099–1.004); 2.6 (1.0, 95CI% 0.992–1.007), and 2.8% (1.0,95% 0.0994–1.008), respectively.Conclusion: The 3T BMD was highly correlated with L1-3 BMD. Thoracic BMD can be measured during cardiac and lung CT imaging without need for additional participant burden or radiation dose. This highly reproducible methodology is actively being applied to large cohort studies to evaluate the prevalence of osteoporosis and track BMD over time.

Design Considerations for using PET as a Response Measure in Single Site and Multicenter Clinical Trials

Robert K. Doot, Brenda F. Kurland, Paul E. Kinahan, David A. Mankoff — 2011-11-21

Rationale and Objectives: Positron emission tomography (PET) is used to evaluate response to therapy with increasing interest in having PET provide endpoints for clinical trials. Here we demonstrate impacts of PET measurement error and choice of quantification method on clinical trial design.Materials and Methods: Sample size was calculated for two-arm randomized trials with percent change in 18F-fluorodeoxyglucose (FDG) PET uptake as an efficacy endpoint. Two methods of uptake quantification were considered: standardized uptake values (SUVs) and kinetic measures from dynamic imaging. Calculations assumed a 20 percentage point difference in treatment groups’ average percent change, and yielded 80% power at α = 0.05. The range of precision (10%–40%) in PET uptake measures was based on review of the literature. The range of SUV sensitivities (50%–100%) relative to kinetic analyses was based on a study of 75 locally advanced breast cancer patients.Results: Sample sizes increased from 8 to 126 as PET precision worsened from 10% to 40% at full measurement sensitivity to true change. In a subgroup with low initial FDG uptake, a sample size of 126 was required under 20% standard deviation using clinical SUVs. More sophisticated imaging quantification could reduce this sample size to 32.Conclusions: The dependence of sample size on measurement precision and the sensitivity of imaging measures to true change should be considered in single site and multicenter PET trials to avoid underpowered studies with inconclusive results. Sophisticated PET imaging methods that are more sensitive to changes in uptake may be advantageous in early studies with limited patient numbers.

Out of Hours Multidetector Computed Tomography Pulmonary Angiography: Are Specialist Resident Reports Reliable?

George C. Jakanani, Rajesh Botchu, Sumit Gupta, James Entwisle, Amrita Bajaj — 2012-02-01

Rationale and Objectives: The purposes of this study were to assess the accuracy of trainee radiologists’ reports for computed tomographic pulmonary angiographic (CTPA) imaging and to determine agreement or discrepancy with final verified consultant reports.Materials and Methods: A total of 100 consecutive out-of-hours CTPA examinations were prospectively analyzed. Fifty-one male and 49 female subjects were included in the study. The mean age of patients scanned was 63.7 years (range, 17–98 years).Results: Eighteen of the 100 subjects (18%) had findings positive for pulmonary embolism. The interobserver agreement for pulmonary embolism between on-call radiology residents and consultant radiologists was almost perfect (κ = 0.932; 95% confidence interval, 0.84–1.0; P < .0001). There was one false-negative CTPA report. Eighty-two CTPA scans (82%) were reported as negative for pulmonary embolism by consultant radiologists. In this group, there was a single false-positive interpretation by the on-call specialist resident. The interobserver agreement for all findings between resident and consultant reports was almost perfect (weighted κ = 0.87; 95% confidence interval, 0.79–0.96; P < .0001). The overall discrepancy rate, including both false-positive and false-negative findings, between the on-call radiology resident and consultant radiologist was 8% (eight of 100).Conclusions: CTPA reports by radiology residents can be relied and acted upon without any major discrepancies. There is a relatively much higher proportion of patients with alternative diagnoses, mainly infective consolidation and heart failure presenting with similar symptoms and signs as pulmonary emboli. It is imperative for trainees to be systematic and review all images if observational omissions are to be reduced.

Accuracy of a Remote Eye Tracker for Radiologic Observer Studies: Effects of Calibration and Recording Environment

2012-02-01

Rationale and Objectives: To determine the accuracy and reproducibility of a remote eye-tracking system for studies of observer gaze while displaying volumetric chest computed tomography (CT) images.Materials and Methods: Four participants performed calibrations using three different gray-scale backgrounds (black, gray, and white). Each participant then observed a three-dimensional 10-point test pattern embedded in five Digital Imaging and Communications in Medicine (DICOM) datasets (test backgrounds): a full 190-section chest CT scan, 190 copies of a single chest CT section, and three 190-section datasets of homogeneous intensity (black, gray, and white).Results: Significant variances between participants, calibration backgrounds, and test backgrounds were observed. The least mean systematic error (deviation of recorded gaze position from target) was obtained when the calibration background and test background were black (27 pixels). Systematic error increased when displaying a test background that deviated from the calibration background intensity. Hence, the largest mean systematic error occurred when calibrating to a black background and displaying a white background (67 pixels). For complex chest CT volumes the white calibration background performed best (38 pixels). An angular analysis of the systematic error was performed and demonstrated that the systemic error primarily affects the vertical position of the estimated gaze position.Conclusion: Our findings indicate a potential source of systematic error during gaze recording in a dynamic environment and highlight the importance of configuring the calibration procedure according to the brightness of the display. We recommend that investigators develop routines for postcalibration accuracy measurement and report the effective accuracy for the display environment in which the data are collected.

Usefulness of Perfusion CT to Assess Response to Neoadjuvant Combined Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

2011-12-02

Rationale and Objectives: To prospectively evaluate perfusion computed tomography (CT) for assessment of changes in tumor vascularity after chemoradiation therapy (CRT) in locally advanced rectal cancer and to analyze the correlation between baseline perfusion parameters and tumor response.Materials and Methods: Twenty patients with rectal cancer underwent baseline perfusion CT before CRT, and in 11 an examination after CRT was also performed. For each tumor, blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability-surface area product (PS) were quantified. The Mann-Whitney U test compared baseline perfusion parameters of responders and nonresponders and pre- and post-CRT measurements were compared by the Wilcoxon signed-rank test (P < .05 statistically significant for both tests).Results: Baseline BF was significantly lower (P = .013) and MTT was significantly higher (P = .006) in responders. Both were able to discriminate responders from nonresponders with a sensitivity of 80% and 100% and a specificity of 73.3% and 86.7%, respectively, for BF and MTT. Baseline BV and PS were not significantly different in responders and nonresponders. Perfusion parameters changed significantly in post-CRT scans compared to baseline: BF (P = .003), BV (P = .003), and PS (P = .008) decreased, whereas MTT increased (P = .006).Conclusion: Baseline BF and MTT can discriminate patients with a favorable response from those that fail to respond to CRT, potentially selecting high-risk patients with resistant tumors that may benefit from an aggressive preoperative treatment approach.

Enterprise Imaging: Planning and Business Justification

David Avrin, Stephanie W. Hou — 2012-02-01

To evaluate financial performance, academic radiology departments most often measure examination volume and general technical and professional expenses. Although these metrics are not standardized, their frequency of use reflects that productivity and financial health are high priorities for academic radiology departments across the United States. In this article, we discuss both of these topics, in the context of projects to expand services, particularly those with an information technology (IT) component. First, we discuss several informatics innovations that increase productivity or expand service. Second, we explain core financial analysis concepts applicable to radiology departments. Third, we discuss the unique challenge of evaluating a potential IT project for an academic radiology department, when intangible benefits are difficult to quantify. Financial models are only one of several components used for guidance in strategic decisions, but are crucial to building a business case that justifies the initial or capital investment as well as startup and ongoing operational expenses.

Meaningful Use: A Call to Arms

Adeel Siddiqui, Keith Jay Dreyer, Supriya Gupta — 2012-02-01

The benefits of an interactive online world have affected the way we purchase products and plan our vacations. It is only a matter of time before consumers start demanding health care with the same convenience that comes with booking an airline flight or managing a bank account. The health care industry itself requires periodic and mandatory data analysis for outcome analysis, clinical benchmarking, quality improvement, forming guidelines, and making decisions. The federal government and health care community have been working together to come up with more robust and cost-effective health care informatics solutions. Meaningful use (MU) intends to establish a new standard for health care informatics in the United States. The term “meaningful use” implies that health care information and technology systems not just exist, but also serve as an integral part of physician and hospital workflow; leading to cost savings as well as improved outcomes. Under this concept, the federal government is offering maximum incentive payments of up to $44,000 per physician (including radiologists) if they can meet all the requirements as laid down in the MU measures. Unfortunately, penalties will kick in if physicians are not compliant with MU by 2015. This will be done in at least three stages, with Stage 1 already in effect (as of January 3, 2011). This will be the first in a series of articles outlining MU and what is in store for radiology. We will go in depth about who is eligible, and how the payment schedule is set up. We will break down the core and menu set measures to suggest what can be excluded by most radiologists. We will also go through some case studies and examine what lies in store for radiology.

Picture Archiving and Communication System (PACS) Implementation, Integration & Benefits in an Integrated Health System

Bahar Mansoori, Karen K. Erhard, Jeffrey L. Sunshine — 2012-02-01

The availability of the Picture Archiving and Communication System (PACS) has revolutionized the practice of radiology in the past two decades and has shown to eventually increase productivity in radiology and medicine. PACS implementation and integration may bring along numerous unexpected issues, particularly in a large-scale enterprise. To achieve a successful PACS implementation, identifying the critical success and failure factors is essential. This article provides an overview of the process of implementing and integrating PACS in a comprehensive health system comprising an academic core hospital and numerous community hospitals. Important issues are addressed, touching all stages from planning to operation and training. The impact of an enterprise-wide radiology information system and PACS at the academic medical center (four specialty hospitals), in six additional community hospitals, and in all associated outpatient clinics as well as the implications on the productivity and efficiency of the entire enterprise are presented.

INbreast: Toward a Full-field Digital Mammographic Database

2011-11-14

Rationale and Objectives: Computer-aided detection and diagnosis (CAD) systems have been developed in the past two decades to assist radiologists in the detection and diagnosis of lesions seen on breast imaging exams, thus providing a second opinion. Mammographic databases play an important role in the development of algorithms aiming at the detection and diagnosis of mammary lesions. However, available databases often do not take into consideration all the requirements needed for research and study purposes. This article aims to present and detail a new mammographic database.Materials and Methods: Images were acquired at a breast center located in a university hospital (Centro Hospitalar de S. João [CHSJ], Breast Centre, Porto) with the permission of the Portuguese National Committee of Data Protection and Hospital's Ethics Committee. MammoNovation Siemens full-field digital mammography, with a solid-state detector of amorphous selenium was used.Results: The new database—INbreast—has a total of 115 cases (410 images) from which 90 cases are from women with both breasts affected (four images per case) and 25 cases are from mastectomy patients (two images per case). Several types of lesions (masses, calcifications, asymmetries, and distortions) were included. Accurate contours made by specialists are also provided in XML format.Conclusion: The strengths of the actually presented database—INbreast—relies on the fact that it was built with full-field digital mammograms (in opposition to digitized mammograms), it presents a wide variability of cases, and is made publicly available together with precise annotations. We believe that this database can be a reference for future works centered or related to breast cancer imaging.

Bureaucracy and the Future of Residency Education

Richard B. Gunderman, Mark E. Mullins — 2011-11-21

The organizational form known as bureaucracy tends to be perceived in pejorative terms, but bureaucracies play a vital role in contemporary radiology. Individual radiology departments, hospitals, and national radiology organizations exhibit features of bureaucratic organization. When bureaucracy underwent its most rapid period of development in the 19th century, it offered several advantages . For one thing, the impersonality of bureaucratic decision making and procedures reduced the arbitrariness and bias that previously characterized the work of many large organizations such as governments and corporations, making them operate more fairly. Moreover, through specialization of function, bureaucracies were often able to enhance efficiency.

Current Status of Residency Training of Allergic-like Adverse Events to Contrast Media

2011-12-08

Rationale and Objectives: Acute allergic-like adverse reactions to contrast media are rare but life-threatening events. Residents may complete training without ever managing such an event. Surveys have shown practicing radiologists to incorrectly dose and administer medications for treatment. Thus, contrast education may be deficient or inconsistent. The purpose of this study was to assess the current status of contrast reaction education in US radiology residency programs and the methods used to test residents’ knowledge.Materials and Methods: A 10-question anonymous survey on residency education methods and testing pertaining to allergic-like adverse events to contrast media was distributed through the Association of Program Directors in Radiology to program directors of US diagnostic radiology residency programs. The past 4 years of the American College of Radiology in-service examination were reviewed to assess the number of contrast reaction questions.Results: Fifty-one programs responded to the Association of Program Directors in Radiology survey. Forty-nine percent of programs train with one lecture per year, 29.4% train with two lectures, and 16% train with three or more lectures. Only 44% include role-playing training during the lectures. Eighteen percent of programs are incorporating simulation training. Fewer than 50% of programs formally test residents’ knowledge, and there were no questions on the 2007 to 2010 American College of Radiology in-service examinations.Conclusions: Resident education for contrast reaction management is primarily performed with annual lectures. Only 18% of programs are using simulation training, and <50% are testing residents’ knowledge or skills. These findings suggest that education may need revision to incorporate simulation or other means of psychomotor learning.

The Importance of Experience in Percutaneous Liver Biopsies Guided with Ultrasonography: A Lesion-focused Approach

Kosti Can Caliskan, Emin Cakmakci, Irfan Celebi, Muzaffer Basak — 2011-12-02

Rationale and Objectives: The goal of this study is to emphasize the value of lesion-focused approach in ultrasonography (US)-guided solid liver lesion biopsies performed under our guidance.Materials and Methods: In our retrospective study, after the standard preparation for US-guidance solid liver lesion biopsy was accomplished, we performed standard intercostal approach and the biopsy procedure though one of our patients experienced a major complication (pneumothorax). After this undesirable case, we reviewed our biopsy procedure and performed a lesion-focused approach technique as described in this article. A Tru-cut biopsy gun (18 gauge) was used in this trial. The liver biopsies were divided into two groups according to the biopsy technique and all results were compared with each other.Results: A total of 202 solid liver lesion biopsies were was performed under the guidance of US between October 2007 and July 2010. One major complication occurred in first group. All of the minor complications occurred in the first group. In group 2, there were no complications. For this reason, all patients in group 2 were discharged home after a few hours. Patients with minor complications in the first group were observed an average of 6 hours. Adequate tissue for pathological diagnosis was similar in both groups.Conclusion: The lesion-focused approach technique has the potential to reduce both complication rates and patient incompliance. Percutaneous liver biopsies performed with this technique using real-time US guidance are convincing and clinically beneficial.

X-rays Can Harm You and Others

Otha W. Linton — 2012-02-01

Within only weeks after Wilhelm Conrad Roentgen wrote his papers about discovering x-rays, many physicians were intrigued at the new device that produced internal images and also had the effect of penetrating, exposing, and curing skin cancers and arthritis. Within just a few months after doctors began using x-rays, some of them noticed harm to segments of their anatomy and induced cancers in a total lack of x-ray protection from the use of unshielded x-ray-generating gas tubes.

Thoracic Imaging: Case Review Series, Second Edition

Nicholas Bodmer, Alice Ha — 2012-02-01

Thoracic Imaging: Case Review Series is not only a necessary resource for the senior radiology resident preparing for boards, but a readable and comprehensive text that can make the average junior radiology resident into a case conference juggernaut. I read the original edition during my first year of radiology residency and fooled my thoracic attending into thinking I was a genius. I read the second edition before writing this review.

Thoracic Imaging

Jeffrey P. Otjen — 2012-02-01

No grants or other monetary funds were used for the conduction of this study. This book is another of a multibook series published by Thieme (series title RadCases), each covering a major subspecialty of radiology. It is a compilation of 100 cases aimed at giving radiology residents and trainees a review of primarily commonly encountered and need-to-know diagnoses. Cases are presented as unknowns on a single page, with the diagnosis and discussion on the following page. The overall format is easy to follow and lends itself to short sessions but can certainly be read straight through. The text’s large (but thin) size allows full image resolution for computed tomography (CT) and good resolution for plain radiographs. This alleviates some of the problems with other similar series where subtle findings can be difficult to visualize.