Pub Date : 2025-08-21DOI: 10.1067/j.cpradiol.2025.08.013
Samantha Snyder DO, Paras Patel DO, Elizabeth Ives MD, Robyn Roth MD, Catherine E. Loveland-Jones MDMS, Pauline Germaine DO
Inflammatory breast cancer (IBC) is an uncommon, locally aggressive breast cancer with rapid onset of symptoms and an unfavorable prognosis. Diagnosis remains challenging and is frequently delayed; imaging plays an important role in disease detection and characterization. Contrast Enhanced Mammography (CEM) combines conventional mammography with a dual energy technique utilizing iodinated contrast, producing a set of recombined images that demonstrate contrast enhancement similar to magnetic resonance imaging (MRI) at a fraction of the cost and time. Current applications of CEM include the evaluation of abnormal findings on screening mammography, monitoring response to neoadjuvant chemotherapy, and assessment for tumor recurrence. CEM is mostly utilized in patients who are unable to undergo MRI. To our knowledge, CEM applications in IBC are scarce in the published literature. The following cases provide additional information on CEM use in the setting of IBC, from staging to guiding subsequent procedures to treatment response evaluation, emphasizing imaging findings and lessons learned. These cases also highlight the feasibility of CEM use in the setting of IBC, with potential incorporation into the future protocols for those patients unable to undergo MRI.
{"title":"Inflammatory breast cancer: Can contrast enhanced mammography help? Case series and literature review","authors":"Samantha Snyder DO, Paras Patel DO, Elizabeth Ives MD, Robyn Roth MD, Catherine E. Loveland-Jones MDMS, Pauline Germaine DO","doi":"10.1067/j.cpradiol.2025.08.013","DOIUrl":"10.1067/j.cpradiol.2025.08.013","url":null,"abstract":"<div><div>Inflammatory breast cancer (IBC) is an uncommon, locally aggressive breast cancer with rapid onset of symptoms and an unfavorable prognosis. Diagnosis remains challenging and is frequently delayed; imaging plays an important role in disease detection and characterization. Contrast Enhanced Mammography (CEM) combines conventional mammography with a dual energy technique utilizing iodinated contrast, producing a set of recombined images that demonstrate contrast enhancement similar to magnetic resonance imaging (MRI) at a fraction of the cost and time. Current applications of CEM include the evaluation of abnormal findings on screening mammography, monitoring response to neoadjuvant chemotherapy, and assessment for tumor recurrence. CEM is mostly utilized in patients who are unable to undergo MRI. To our knowledge, CEM applications in IBC are scarce in the published literature. The following cases provide additional information on CEM use in the setting of IBC, from staging to guiding subsequent procedures to treatment response evaluation, emphasizing imaging findings and lessons learned. These cases also highlight the feasibility of CEM use in the setting of IBC, with potential incorporation into the future protocols for those patients unable to undergo MRI.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 2","pages":"Pages 333-338"},"PeriodicalIF":1.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gamification is the application of gaming elements in a nongame context. The use of gamification in education increases motivation, participation and both short- and long-term knowledge retention. Millennial and Generation Z learners are the largest percentage of radiology residents and medical students, respectively, and gamification is an educational tool they are likely familiar with and may enjoy. To date, performance of a gamified learning platform for radiology residents has not been compared to validated resources such as RadExam.
Materials and Methods
This is an IRB-approved prospective study evaluating the performance of R1-R4 radiology residents participating in a month-long voluntary novel app-based game at a tertiary care academic program. Questions were created by radiology attendings from several radiology subspecialties and reviewed by a radiologist experienced in radiology education. Informed consent was acquired from all participants, and questions were delivered by Kaizen’s secure online app. Performance was recorded for each group. Scores overall and within each discipline were compared institutional RadExam performance using a one-way Anova test. Likert survey was administered at the conclusion of the study to assess participant engagement, motivation, clinical knowledge, board preparation, satisfaction and likelihood to play again.
Results
There were 25 radiology residents (65.7 %, 25/38) who completed at least one question. First year residents made up the largest percentage of class participation with 89 % (8/9) answering at least one question. Third-year residents answered the highest percentage of questions correctly, while the first-year class answered the lowest percentage correctly. One-way Anova analysis showed no significant difference between mean Kaizen and RadExam scores (p = 0.3641). There was also no significant difference between the RadExam and Kaizen scores separated by question category. Most enjoyed the game and 75 % of survey participants would participate in a Kaizen game again. Team collaboration and question feedback significantly increased motivation for most. Most participants felt the game enhanced their radiology knowledge and was beneficial for daily work and board preparation.
Conclusion
The Kaizen game was well-received among radiology residents with positive feedback on content, perceived educational benefits and motivation. Team competition appeared to play a role in maintaining engagement and motivation. Resident performance on the RadExam and Kaizen game by both overall and topic-based assessments showed similar results. More research is needed to assess the reliability and validity of gamified learning for radiology residents.
{"title":"Experience of diagnostic radiology residents with Kaizen, a novel online app-based gamified education tool, and performance compared to RadExam","authors":"Alisa Mobley , Tamara Zaza , Jeremey Walker MD , Madhuri Molleti , Karthik Sadanand , Rohan Badve , Jordan Tzabari , Gracie Trulove , Mei Li Ph.D , Yufeng Li Ph.D , Rachel Bass MD , Angela Choe MD , Padma Manapragada MD , Desmin Milner MD , Aparna Singhal MD , Elainea Smith MD , Janelle West MD , Ceren Yalniz MD , Stefanie Zalasin MD , Kathryn Zamora MD , Stefanie Woodard DO","doi":"10.1067/j.cpradiol.2025.08.005","DOIUrl":"10.1067/j.cpradiol.2025.08.005","url":null,"abstract":"<div><h3>Rationale and Objectives</h3><div>Gamification is the application of gaming elements in a nongame context. The use of gamification in education increases motivation, participation and both short- and long-term knowledge retention. Millennial and Generation Z learners are the largest percentage of radiology residents and medical students, respectively, and gamification is an educational tool they are likely familiar with and may enjoy. To date, performance of a gamified learning platform for radiology residents has not been compared to validated resources such as RadExam.</div></div><div><h3>Materials and Methods</h3><div>This is an IRB-approved prospective study evaluating the performance of R1-R4 radiology residents participating in a month-long voluntary novel app-based game at a tertiary care academic program. Questions were created by radiology attendings from several radiology subspecialties and reviewed by a radiologist experienced in radiology education. Informed consent was acquired from all participants, and questions were delivered by Kaizen’s secure online app. Performance was recorded for each group. Scores overall and within each discipline were compared institutional RadExam performance using a one-way Anova test. Likert survey was administered at the conclusion of the study to assess participant engagement, motivation, clinical knowledge, board preparation, satisfaction and likelihood to play again.</div></div><div><h3>Results</h3><div>There were 25 radiology residents (65.7 %, 25/38) who completed at least one question. First year residents made up the largest percentage of class participation with 89 % (8/9) answering at least one question. Third-year residents answered the highest percentage of questions correctly, while the first-year class answered the lowest percentage correctly. One-way Anova analysis showed no significant difference between mean Kaizen and RadExam scores (<em>p</em> = 0.3641). There was also no significant difference between the RadExam and Kaizen scores separated by question category. Most enjoyed the game and 75 % of survey participants would participate in a Kaizen game again. Team collaboration and question feedback significantly increased motivation for most. Most participants felt the game enhanced their radiology knowledge and was beneficial for daily work and board preparation.</div></div><div><h3>Conclusion</h3><div>The Kaizen game was well-received among radiology residents with positive feedback on content, perceived educational benefits and motivation. Team competition appeared to play a role in maintaining engagement and motivation. Resident performance on the RadExam and Kaizen game by both overall and topic-based assessments showed similar results. More research is needed to assess the reliability and validity of gamified learning for radiology residents.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 54-61"},"PeriodicalIF":1.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-15DOI: 10.1067/j.cpradiol.2025.08.009
Aaron Chafitz MD , Rohan Makhiani MD , Erin Niederkohr BS , Ian Tarnovsky BS , Noah Takacs BS , Xualing Pan PhD , Mina S. Makary MD
Rationale and Objectives
This study aimed to evaluate the socioeconomic and demographic factors that predict overall survival (OS) and progression-free survival (PFS) of patients undergoing transarterial chemoembolization (TACE) for primary and metastatic hepatic disease.
Materials and Methods
Retrospective review from 2016 to 2022 identified 322 patients with hepatocellular carcinoma (HCC) (n = 234) and metastatic liver lesions (n = 98), treated with TACE. Patients were stratified by demographic factors, including mean income, insurance status, race, and social vulnerability index (SVI), a Center for Disease control (CDC) composite measure from geographic census data. Primary outcomes measures included OS and PFS. Correlation, multivariate regression, and Kaplan Meier analyses were performed.
Results
Of the studied population, 67 % were male, 85 % were White, and 62 % had Medicare coverage, with a mean age of 64 years. Mean OS was 25.6 months, and PFS was 19.9 months. The liver-specific disease progression rate and overall mortality rate were 71.7 % and 56.9 %, respectively. Lower SVI group, indicating less social vulnerability, was positively correlated with OS (p = 0.033), and a similar trend was observed for PFS (p = 0.0676) in the overall population. Co-variate analysis demonstrated statistically significant relationship between SVI and OS (HR=3.880, p = 0.01), controlling for underlying disease (HCC vs. metastatic disease) and baseline health characteristics.
Conclusions
Findings highlight underexplored relationships between social factors and treatment outcomes, revealing SVI as a predictive factor of OS following TACE. Further work is warranted to better understand disparities associated with procedural interventions to target mitigation strategies.
{"title":"Socioeconomic and demographic predictors of transarterial chemoembolization outcomes for hepatic malignancies","authors":"Aaron Chafitz MD , Rohan Makhiani MD , Erin Niederkohr BS , Ian Tarnovsky BS , Noah Takacs BS , Xualing Pan PhD , Mina S. Makary MD","doi":"10.1067/j.cpradiol.2025.08.009","DOIUrl":"10.1067/j.cpradiol.2025.08.009","url":null,"abstract":"<div><h3>Rationale and Objectives</h3><div>This study aimed to evaluate the socioeconomic and demographic factors that predict overall survival (OS) and progression-free survival (PFS) of patients undergoing transarterial chemoembolization (TACE) for primary and metastatic hepatic disease.</div></div><div><h3>Materials and Methods</h3><div>Retrospective review from 2016 to 2022 identified 322 patients with hepatocellular carcinoma (HCC) (<em>n</em> = 234) and metastatic liver lesions (<em>n</em> = 98), treated with TACE. Patients were stratified by demographic factors, including mean income, insurance status, race, and social vulnerability index (SVI), a Center for Disease control (CDC) composite measure from geographic census data. Primary outcomes measures included OS and PFS. Correlation, multivariate regression<u>,</u> and Kaplan Meier analyses were performed.</div></div><div><h3>Results</h3><div>Of the studied population, 67 % were male, 85 % were White, and 62 % had Medicare coverage, with a mean age of 64 years. Mean OS was 25.6 months<u>,</u> and PFS was 19.9 months. The liver-specific disease progression rate and overall mortality rate were 71.7 % and 56.9 %, respectively. Lower SVI group, indicating less social vulnerability, was positively correlated with OS (<em>p</em> = 0.033)<u>,</u> and a similar trend was observed for PFS (<em>p</em> = 0.0676) in the overall population. Co-variate analysis demonstrated statistically significant relationship between SVI and OS (HR=3.880, <em>p</em> = 0.01), controlling for underlying disease (HCC vs. metastatic disease) and baseline health characteristics.</div></div><div><h3>Conclusions</h3><div>Findings highlight underexplored relationships between social factors and treatment outcomes, revealing SVI as a predictive factor of OS following TACE. Further work is warranted to better understand disparities associated with procedural interventions to target mitigation strategies.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 2","pages":"Pages 242-246"},"PeriodicalIF":1.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Imaging and pathological evaluation are indispensable for the evaluation of breast pathologies. It is imperative to achieve clinical, radiological, and pathological concordance before initiation of any treatment regimen. Although image-guided biopsies are usually obtained from the most suspicious area of the lesion, we often encounter discordant lesions. This rad-path discordance needs to be addressed in multidisciplinary team meetings to review the clinical, imaging, and pathology findings together to ascertain the next step of evaluation. In this article, we aim to highlight a variety of such results which needed reassessment and provided us with a learning opportunity to deepen our understanding of various breast diseases.
{"title":"RAD-PATH correlation in breast - Lessons learned through unusual cases and MDT discussions","authors":"Ekta Dhamija , Supraja Laguduva Mohan , Smriti Hari , Sandeep Mathur","doi":"10.1067/j.cpradiol.2025.08.012","DOIUrl":"10.1067/j.cpradiol.2025.08.012","url":null,"abstract":"<div><div>Imaging and pathological evaluation are indispensable for the evaluation of breast pathologies. It is imperative to achieve clinical, radiological, and pathological concordance before initiation of any treatment regimen. Although image-guided biopsies are usually obtained from the most suspicious area of the lesion, we often encounter discordant lesions. This rad-path discordance needs to be addressed in multidisciplinary team meetings to review the clinical, imaging, and pathology findings together to ascertain the next step of evaluation. In this article, we aim to highlight a variety of such results which needed reassessment and provided us with a learning opportunity to deepen our understanding of various breast diseases.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 2","pages":"Pages 321-332"},"PeriodicalIF":1.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-13DOI: 10.1067/j.cpradiol.2025.08.007
Issra Osman , Shweta Ravi M.D. , Zachary Baker M.D. , Inas Mohamed M.D., M.S. , Pauravi Vasavada M.D.
Medical students often lack meaningful exposure and educational opportunities in radiology, especially those facilitated by practicing radiologists. This limits the cultivation of early radiology interest into a future career, since preclinical radiology education often focuses on anatomic correlation. To increase medical students’knowledge, participation, and interest in the field, we created a preclinical elective that emphasizes the clinical application and practice of diagnostic radiology.
The preclinical elective in diagnostic radiology has been held at University Hospitals Cleveland Medical Center since Fall 2021. Medical students attended ten-day sessions that included visiting reading rooms, attending resident- or faculty-led lectures, and simulating image-guided procedures. Upon completion of the elective, informal student feedback was collected and used to adjust curriculum content for future cohorts. A post-course electronic survey was also distributed to the 2024 cohort to provide objective feedback about the provided curriculum.
Our institution's experience indicates that preclinical electives serve as effective educational instruments for enhancing early clinical radiology exposure for medical students. Our educational model highlights the clinical aspects of diagnostic radiology practice while also creating mentorship opportunities, bolstering student understanding of the role of a radiologist, and increasing student motivation to pursue a career in radiology. In this manuscript, we describe our step-by-step approach to building the structured learning curriculum of the radiology preclinical elective and its evolution throughout its four years of implementation.
{"title":"Cultivating the next generation of radiologists: A single institution's experience with radiology preclinical electives for medical students","authors":"Issra Osman , Shweta Ravi M.D. , Zachary Baker M.D. , Inas Mohamed M.D., M.S. , Pauravi Vasavada M.D.","doi":"10.1067/j.cpradiol.2025.08.007","DOIUrl":"10.1067/j.cpradiol.2025.08.007","url":null,"abstract":"<div><div>Medical students often lack meaningful exposure and educational opportunities in radiology, especially those facilitated by practicing radiologists. This limits the cultivation of early radiology interest into a future career, since preclinical radiology education often focuses on anatomic correlation. To increase medical students’knowledge, participation, and interest in the field, we created a preclinical elective that emphasizes the clinical application and practice of diagnostic radiology.</div><div>The preclinical elective in diagnostic radiology has been held at University Hospitals Cleveland Medical Center since Fall 2021. Medical students attended ten-day sessions that included visiting reading rooms, attending resident- or faculty-led lectures, and simulating image-guided procedures. Upon completion of the elective, informal student feedback was collected and used to adjust curriculum content for future cohorts. A post-course electronic survey was also distributed to the 2024 cohort to provide objective feedback about the provided curriculum.</div><div>Our institution's experience indicates that preclinical electives serve as effective educational instruments for enhancing early clinical radiology exposure for medical students. Our educational model highlights the clinical aspects of diagnostic radiology practice while also creating mentorship opportunities, bolstering student understanding of the role of a radiologist, and increasing student motivation to pursue a career in radiology. In this manuscript, we describe our step-by-step approach to building the structured learning curriculum of the radiology preclinical elective and its evolution throughout its four years of implementation.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 14-17"},"PeriodicalIF":1.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1067/j.cpradiol.2025.08.008
Stanek Agatha, Durfee Sara M, Matalon Shanna A
Rationale and Objectives
After >14 years, the American Board of Radiology (ABR) certifying diagnostic radiology examination is reverting to an oral format. Radiology faculty are responsible for helping trainees prepare for the examination, although many have not taken an oral examination or know how best to prepare. This study assessed faculty’s perceived knowledge and confidence in facilitating oral exam teaching sessions before and after a faculty development workshop.
Materials and Methods
All radiology clinical faculty from a single large academic center were invited to participate in a faculty development workshop and complete pre-and post-workshop surveys. Descriptive statistics and Fisher’s exact test were performed.
Results
36/120 faculty (30% response) completed the pre-workshop survey, 43/120 (36%) participated in the workshop and 17/43 (40% response) completed the post-workshop survey. 22/36 (61%) had previously taken an oral board examination. Most faculty were slightly or not at all familiar with the changes to the certifying examination (31, 86%) which improved after the workshop (p<0.001). All respondents (100%) were moderately or completely satisfied with the workshop overall. Faculty that had previously taken oral boards started with greater confidence in various skills related to oral boards teaching (p=0.008-0.04), but there were significant confidence improvements for all faculty in nearly all skills after the workshop (p=0.002 to 0.01).
Conclusion
An oral boards faculty development workshop was well received and demonstrated improved faculty’s perceived knowledge and confidence pertaining to preparing trainees for the ABR oral certifying examination, particularly those who had not previously taken oral boards.
{"title":"Radiology oral boards faculty development workshop: A single institution experience","authors":"Stanek Agatha, Durfee Sara M, Matalon Shanna A","doi":"10.1067/j.cpradiol.2025.08.008","DOIUrl":"10.1067/j.cpradiol.2025.08.008","url":null,"abstract":"<div><h3>Rationale and Objectives</h3><div>After >14 years, the American Board of Radiology (ABR) certifying diagnostic radiology examination is reverting to an oral format. Radiology faculty are responsible for helping trainees prepare for the examination, although many have not taken an oral examination or know how best to prepare. This study assessed faculty’s perceived knowledge and confidence in facilitating oral exam teaching sessions before and after a faculty development workshop.</div></div><div><h3>Materials and Methods</h3><div>All radiology clinical faculty from a single large academic center were invited to participate in a faculty development workshop and complete pre-and post-workshop surveys. Descriptive statistics and Fisher’s exact test were performed.</div></div><div><h3>Results</h3><div>36/120 faculty (30% response) completed the pre-workshop survey, 43/120 (36%) participated in the workshop and 17/43 (40% response) completed the post-workshop survey. 22/36 (61%) had previously taken an oral board examination. Most faculty were slightly or not at all familiar with the changes to the certifying examination (31, 86%) which improved after the workshop (p<0.001). All respondents (100%) were moderately or completely satisfied with the workshop overall. Faculty that had previously taken oral boards started with greater confidence in various skills related to oral boards teaching (p=0.008-0.04), but there were significant confidence improvements for all faculty in nearly all skills after the workshop (p=0.002 to 0.01).</div></div><div><h3>Conclusion</h3><div>An oral boards faculty development workshop was well received and demonstrated improved faculty’s perceived knowledge and confidence pertaining to preparing trainees for the ABR oral certifying examination, particularly those who had not previously taken oral boards.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 62-66"},"PeriodicalIF":1.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1067/j.cpradiol.2025.08.006
Liang Meng Loy , Sanchalika Acharyya , Hsien Min Low , Uei Pua , Cher Heng Tan
Objective
To systematically determine the diagnostic performance of diffusion weighted imaging (DWI) in early imaging assessment following Y-90 transarterial radioembolization (TARE) of HCC.
Materials and methods
Searches were conducted in PubMed and Cochrane library electronic databases up to July 2024 to identify original studies that reported the diagnostic performance of DWI/apparent diffusion coefficient (DWI/ADC) for assessing early treatment response following TARE. The summary measures of diagnostic accuracy were estimated using bivariate random effect meta-analysis.
Results
Our search identified 194 titles, of which 5 studies with data from 104 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.90 (95%-confidence interval [CI] 0.75,0.96) and 0.81 (95%-CI 0.58,0.92) with a diagnostic odds ratio (DOR) of 45.4 (95% CI 10.2, 132). The area under the summary receiver-operating characteristic curve was 0.919 (95%-CI 0.708,0.924). Exploratory analysis of predictive values projected DWI/ADC to have a NPV of 46.4% (95%-CI 26.8%,69.4%) and projected PPV of 97.6% (95%-CI 95.1%,99.0%), assuming a 90% treatment response rate. The diagnostic performance for early response assessment was comparable with that of traditional imaging criteria reported in literature.
Conclusion
Restricted diffusion has high diagnostic accuracy in early response assessment after TARE. Our study validates the inclusion of restricted diffusion as an ancillary criterion in the LI-RADS TR 2024 algorithm for radiation-based treatment.
目的：系统评价弥散加权成像（DWI）在肝细胞癌Y-90经动脉放射栓塞（TARE）术后早期影像学评估中的诊断价值。材料和方法：截至2024年7月，检索PubMed和Cochrane图书馆电子数据库，以确定报道DWI/表观扩散系数（DWI/ADC）用于评估TARE早期治疗反应的诊断性能的原始研究。使用双变量随机效应荟萃分析估计诊断准确性的汇总测量。结果：我们检索了194篇文献，其中5篇文献的数据来自104名患者被纳入meta分析。合并敏感性和特异性分别为0.90（95%可信区间[CI] 0.75,0.96）和0.81(95%可信区间[CI] 0.58,0.92)，诊断优势比（DOR）为45.4 （95% CI 10.2, 132）。综合受试者-工作特征曲线下面积为0.919 （95% ci 0.708,0.924）。探索性分析预测值预测DWI/ADC的NPV为46.4% (95%-CI 26.8%,69.4%)， PPV为97.6% (95%-CI 95.1%,99.0%)，假设治疗有效率为90%。早期反应评估的诊断性能与文献报道的传统影像学标准相当。结论：限制性弥散对TARE术后早期反应评价具有较高的诊断准确性。我们的研究验证了将受限扩散作为辅助标准纳入LI-RADS TR 2024放射治疗算法。
{"title":"Diagnostic performance of diffusion weighted imaging for early response assessment after Y-90 transarterial radioembolization of Hepatocellular Carcinoma (HCC) – A systematic review and meta-analysis","authors":"Liang Meng Loy , Sanchalika Acharyya , Hsien Min Low , Uei Pua , Cher Heng Tan","doi":"10.1067/j.cpradiol.2025.08.006","DOIUrl":"10.1067/j.cpradiol.2025.08.006","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically determine the diagnostic performance of diffusion weighted imaging (DWI) in early imaging assessment following Y-90 transarterial radioembolization (TARE) of HCC.</div></div><div><h3>Materials and methods</h3><div>Searches were conducted in PubMed and Cochrane library electronic databases up to July 2024 to identify original studies that reported the diagnostic performance of DWI/apparent diffusion coefficient (DWI/ADC) for assessing early treatment response following TARE. The summary measures of diagnostic accuracy were estimated using bivariate random effect meta-analysis.</div></div><div><h3>Results</h3><div>Our search identified 194 titles, of which 5 studies with data from 104 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.90 (95%-confidence interval [CI] 0.75,0.96) and 0.81 (95%-CI 0.58,0.92) with a diagnostic odds ratio (DOR) of 45.4 (95% CI 10.2, 132). The area under the summary receiver-operating characteristic curve was 0.919 (95%-CI 0.708,0.924). Exploratory analysis of predictive values projected DWI/ADC to have a NPV of 46.4% (95%-CI 26.8%,69.4%) and projected PPV of 97.6% (95%-CI 95.1%,99.0%), assuming a 90% treatment response rate. The diagnostic performance for early response assessment was comparable with that of traditional imaging criteria reported in literature.</div></div><div><h3>Conclusion</h3><div>Restricted diffusion has high diagnostic accuracy in early response assessment after TARE. Our study validates the inclusion of restricted diffusion as an ancillary criterion in the LI-RADS TR 2024 algorithm for radiation-based treatment.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 2","pages":"Pages 234-241"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1067/j.cpradiol.2025.08.010
Jeffrey Girardot MD , Anthony Higinbotham MD , Kamand Khalaj MD, MPH , Ameya Nayate MD , Inas Mohamed MD , Michael Wien MD , Navid Faraji MD
Objective
The aim of this study was to evaluate the impact of a "no-pull" policy in radiology residency programs, which prevents residents from being pulled from their scheduled rotations to cover other services. The hypothesis was that such a policy reduces the uneven distribution of training across subspecialties, ensuring that residents receive a more comprehensive education.
Methods
Resident schedules from two years prior to the implementation of the no-pull policy were compared with those from two years after the policy was enacted. Any instance where a resident was reassigned from their scheduled rotation to cover a different subspecialty due to staffing needs was recorded as a "pull." The number of pull days was calculated and compared across both periods. A total of 40 residents' schedules were analyzed for both pre- and post-policy periods.
Results
Two- and one-year pre-policy, the number of total pulls was substantial at 369 and 372 pull days, respectively. One- and two-years post-policy, the number of pull days dramatically decreased to 76 and 89 pull days, respectively. This equates to an average of 82.5 total pull days per year, or just 2 pull days per resident annually—a 78% reduction.
Discussion
The implementation of a no-pull policy in radiology residency programs significantly decreased the number of days residents were reassigned to cover under-staffed specialties. This change contributed to a more consistent and well-rounded training experience, ensuring residents gained valuable time in all subspecialty rotations without being diverted to cover others.
{"title":"Effects of the implementation of a no-pull policy on radiology resident staffing","authors":"Jeffrey Girardot MD , Anthony Higinbotham MD , Kamand Khalaj MD, MPH , Ameya Nayate MD , Inas Mohamed MD , Michael Wien MD , Navid Faraji MD","doi":"10.1067/j.cpradiol.2025.08.010","DOIUrl":"10.1067/j.cpradiol.2025.08.010","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to evaluate the impact of a \"no-pull\" policy in radiology residency programs, which prevents residents from being pulled from their scheduled rotations to cover other services. The hypothesis was that such a policy reduces the uneven distribution of training across subspecialties, ensuring that residents receive a more comprehensive education.</div></div><div><h3>Methods</h3><div>Resident schedules from two years prior to the implementation of the no-pull policy were compared with those from two years after the policy was enacted. Any instance where a resident was reassigned from their scheduled rotation to cover a different subspecialty due to staffing needs was recorded as a \"pull.\" The number of pull days was calculated and compared across both periods. A total of 40 residents' schedules were analyzed for both pre- and post-policy periods.</div></div><div><h3>Results</h3><div>Two- and one-year pre-policy, the number of total pulls was substantial at 369 and 372 pull days, respectively. One- and two-years post-policy, the number of pull days dramatically decreased to 76 and 89 pull days, respectively. This equates to an average of 82.5 total pull days per year, or just 2 pull days per resident annually—a 78% reduction.</div></div><div><h3>Discussion</h3><div>The implementation of a no-pull policy in radiology residency programs significantly decreased the number of days residents were reassigned to cover under-staffed specialties. This change contributed to a more consistent and well-rounded training experience, ensuring residents gained valuable time in all subspecialty rotations without being diverted to cover others.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 42-47"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1067/j.cpradiol.2025.08.004
Mehrshad Bakhshi M.D. , Marie-Xinyi Sun DEC , Charles-Antoine Boucher B.H.Sc. , Tharshanna Nadarajah PhD , Ralph Nelson M.D. , Karl Muchantef M.D. , Josephine Pressacco M.D.
Rationale and Objectives
Radiology plays a critical role in healthcare but is marked by stark global inequities. Low- and middle-income countries have far fewer imaging resources and trained personnel compared to high-income countries. As global health interest grows among trainees, understanding Canadian radiology residents’ perspectives on global health imaging (GHI) is essential. This study aimed to assess their prior experiences, perceived barriers, and recommendations for integrating GHI into residency training.
Materials and Methods
A bilingual, anonymous survey was developed and distributed to residents across all 16 Canadian radiology residency programs from May 2024 to April 2025. The questionnaire included items on demographics, prior global health involvement, interest in GHI, perceived preparedness, institutional opportunities, and barriers to international engagement. Respondents were also asked to identify preferred approaches for integrating GHI into training programs.
Results
Fifty-one trainees responded from 14 different programs. 64.7% reported prior work in developing countries, with 54.9% perceiving an unmet need for medical imaging in those settings. Nearly half (47.1%) expressed plans to engage in GHI. On-site collaboration and education of local staff (47.1%) and residents (49%) were the most preferred methods of contribution. However, 78.4% felt unprepared or unsure to get involved in GHI. 45.1% reported no GHI opportunities in their current program. Major barriers included call coverage (94.1%), lack of funding (90.2%), and limited infrastructure (90.2%). The top proposed solutions were international electives (86.3%), teleradiology (60.8%), and case presentations focused on diseases highly prevalent in developing countries (51%).
Conclusion
Canadian radiology trainees show strong interest in global health imaging but face systemic barriers. Curricular integration of electives, teleradiology, and global health education, along with improved access to funding, could bridge the gap between interest and participation.
{"title":"Resident perspectives on global health imaging in canadian radiology training: A national survey","authors":"Mehrshad Bakhshi M.D. , Marie-Xinyi Sun DEC , Charles-Antoine Boucher B.H.Sc. , Tharshanna Nadarajah PhD , Ralph Nelson M.D. , Karl Muchantef M.D. , Josephine Pressacco M.D.","doi":"10.1067/j.cpradiol.2025.08.004","DOIUrl":"10.1067/j.cpradiol.2025.08.004","url":null,"abstract":"<div><h3>Rationale and Objectives</h3><div>Radiology plays a critical role in healthcare but is marked by stark global inequities. Low- and middle-income countries have far fewer imaging resources and trained personnel compared to high-income countries. As global health interest grows among trainees, understanding Canadian radiology residents’ perspectives on global health imaging (GHI) is essential. This study aimed to assess their prior experiences, perceived barriers, and recommendations for integrating GHI into residency training.</div></div><div><h3>Materials and Methods</h3><div>A bilingual, anonymous survey was developed and distributed to residents across all 16 Canadian radiology residency programs from May 2024 to April 2025. The questionnaire included items on demographics, prior global health involvement, interest in GHI, perceived preparedness, institutional opportunities, and barriers to international engagement. Respondents were also asked to identify preferred approaches for integrating GHI into training programs.</div></div><div><h3>Results</h3><div>Fifty-one trainees responded from 14 different programs. 64.7% reported prior work in developing countries, with 54.9% perceiving an unmet need for medical imaging in those settings. Nearly half (47.1%) expressed plans to engage in GHI. On-site collaboration and education of local staff (47.1%) and residents (49%) were the most preferred methods of contribution. However, 78.4% felt unprepared or unsure to get involved in GHI<strong>.</strong> 45.1% reported no GHI opportunities in their current program. Major barriers included call coverage (94.1%), lack of funding (90.2%), and limited infrastructure (90.2%). The top proposed solutions were international electives (86.3%), teleradiology (60.8%), and case presentations focused on diseases highly prevalent in developing countries (51%).</div></div><div><h3>Conclusion</h3><div>Canadian radiology trainees show strong interest in global health imaging but face systemic barriers. Curricular integration of electives, teleradiology, and global health education, along with improved access to funding, could bridge the gap between interest and participation.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 1","pages":"Pages 37-41"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the perception of clinical faculty and staff on the discontinuation of routine gonadal shielding for diagnostic imaging procedures and assess the impact of targeted educational intervention on awareness and comfort levels.
Methods
A pre-post survey study was conducted among radiology and non-radiology staff involved in imaging operations at a large academic center. A pre-rollout survey (August 2023) established baseline awareness and attitudes toward gonadal shielding discontinuation, while a post-rollout survey (August 2024) reassessed these measures following policy implementation while also assessing the impact of educational outreach. The surveys included Likert-scale questions on comfort levels, policy awareness, and perceived preparedness, along with open-ended responses for qualitative analysis. Educational interventions included email communications, online FAQs, informational flyers, and live Q&A sessions. Cumulative logit models evaluated changes in responses, and subgroup analyses examined differences based on departmental affiliation and years of experience.
Results
Of 266 pre-rollout and 188 post-rollout responses, awareness of shielding discontinuation guidelines significantly increased post-rollout (26% to 75%, p < 0.0001), with radiology-affiliated staff demonstrating higher awareness than non-radiology staff (91% vs. 45%). Complete comfort with discontinuation improved significantly (28% to 49%, p < 0.0001), with radiology staff experiencing a larger shift (p = 0.045). The need for more information was the main driver of discomfort pre-rollout (49%), dropping to 26% post-rollout. However, concerns regarding pediatric and pregnant patient populations remained consistent despite educational efforts.
Conclusion
Educational and communication initiatives increased awareness and improved comfort levels for hospital staff after gonadal shielding discontinuation. Concerns remain around how to best communicate this change to patients and whether patients will accept the end of decades-long routine shielding practices.
{"title":"Faculty and staff attitudes towards discontinuation of routine gonadal shielding: perceptions before and after policy change in an academic medical center","authors":"Obaidah Bitar MD, Aparna Joshi MD, FACR, Tresa Griffith, Sarah Clos, Ashok Srinivasan MD, FACR, Emily Bellile, Gunjan Malhotra MD","doi":"10.1067/j.cpradiol.2025.08.011","DOIUrl":"10.1067/j.cpradiol.2025.08.011","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the perception of clinical faculty and staff on the discontinuation of routine gonadal shielding for diagnostic imaging procedures and assess the impact of targeted educational intervention on awareness and comfort levels.</div></div><div><h3>Methods</h3><div>A pre-post survey study was conducted among radiology and non-radiology staff involved in imaging operations at a large academic center. A pre-rollout survey (August 2023) established baseline awareness and attitudes toward gonadal shielding discontinuation, while a post-rollout survey (August 2024) reassessed these measures following policy implementation while also assessing the impact of educational outreach. The surveys included Likert-scale questions on comfort levels, policy awareness, and perceived preparedness, along with open-ended responses for qualitative analysis. Educational interventions included email communications, online FAQs, informational flyers, and live Q&A sessions. Cumulative logit models evaluated changes in responses, and subgroup analyses examined differences based on departmental affiliation and years of experience.</div></div><div><h3>Results</h3><div>Of 266 pre-rollout and 188 post-rollout responses, awareness of shielding discontinuation guidelines significantly increased post-rollout (26% to 75%, p < 0.0001), with radiology-affiliated staff demonstrating higher awareness than non-radiology staff (91% vs. 45%). Complete comfort with discontinuation improved significantly (28% to 49%, p < 0.0001), with radiology staff experiencing a larger shift (p = 0.045). The need for more information was the main driver of discomfort pre-rollout (49%), dropping to 26% post-rollout. However, concerns regarding pediatric and pregnant patient populations remained consistent despite educational efforts.</div></div><div><h3>Conclusion</h3><div>Educational and communication initiatives increased awareness and improved comfort levels for hospital staff after gonadal shielding discontinuation. Concerns remain around how to best communicate this change to patients and whether patients will accept the end of decades-long routine shielding practices.</div></div>","PeriodicalId":51617,"journal":{"name":"Current Problems in Diagnostic Radiology","volume":"55 2","pages":"Pages 188-193"},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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