Current problems in diagnostic radiology最新文献

Background: We hypothesized that faculty from a radiology division with weekly case conferences would be interested in adopting a peer learning meeting to grow the practice of peer learning in our department.

Materials and methods: The Abdominal Division volunteered to pilot peer learning once a month in lieu of the weekly case conferences. A peer learning champion from the division took leadership for this project. An abdominal division faculty survey was completed to gauge interest in peer learning.

Results: The survey had an 81 % response rate: Faculty felt comfortable collecting cases in a database (47 %) and preferred receiving case feedback by chat or email; faculty favored a variety of case types for inclusion in peer learning; faculty slightly preferred having a dedicated peer learning conference leader (35 %) and indicated the submission target for the division faculty should be 1 case per month per faculty (88 %). All faculty indicated the importance of a no-blame culture and most favored anonymous case presentations (70 %). Despite the positive attitudes towards peer learning among the division faculty, the technical piece of the implementation represented a major barrier due to lack of integration into the radiologist workflow and inability to commit time to a faculty member's role as peer learning conference leader.

Conclusions: Our faculty members' concerns regarding peer learning integration into the daily and monthly divisional workflow needed to be addressed before attempting to implement peer learning. In the context of high clinical imaging volumes, additional efforts, such as accessing case submission tools and time needed to prepare conferences, outweighed the overall perceived value of peer learning in our setting.

Staffing shortages and increased radiology study volumes have led to higher workloads and increased rates of burnout among pediatric radiologists. These conditions are exacerbated by daily fluctuations in study volumes which can occur due to a plethora of reasons and can often be unpredictable. Current solutions involve increasing staffing numbers and offsetting certain specialized studies to other subspecialties. However, these solutions can be costly and impractical. Therefore, we devised a dynamic, flexible two-hour shift called the Ad Hoc shift in which a designated pediatric radiologist dubbed as the "maestro" assesses the body division workflow in real-time and decides whether to recruit additional radiologists during high study volumes. In this paper, we discuss the protocol of the proposed Ad Hoc shift, along with preliminary results from our institution after a year of implementation. Additionally, we discuss its advantages and address some considerations that may arise during the implementation process.

The American Board of Radiology Core exam requires that trainees demonstrate knowledge of critical concepts across 12 domains spanning a range of imaging modalities and anatomic regions. Mobile apps have become popular components of medical and radiology education since the inception of smartphones. Numerous medical educational apps are accessible via smartphone devices and tablets, regardless of operating system, for medical training and learning purposes. For over two decades, CTisus has served as an informational and educational radiology website containing image-rich materials and resources dedicated to the use of body CT. We conducted a study to evaluate the perceived utility of the CTisus iQuiz app as a study resource for the American Board of Radiology Core exam. The overall rating of the app was above average with 50 % of respondents characterizing the app as "Good" and 29 % evaluating the app as "Excellent." Further, 85 % of survey respondents found the app easy to understand and use, with related pearls deemed helpful by 75 % of participants, the video discussions found to be clear and beneficial by 79 %. Mobile apps are a valuable tool for the current generation of medical trainees, with quizzes shown to be an effective method to evaluate and enhance knowledge. The CTisus iQuiz app may benefit radiology residents studying for the ABR Core exam by providing access to image-rich, multiple choice-based self-assessments with in-depth explanations and feedback in an accessible interface, allowing for asynchronous learning and repeated practice.

In 2014, The Royal College of Physicians and Surgeons of Canada (RCPSC) began a national initiative to rollout Competency-Based Medical Education (CBME) for all postgraduate medical programs. This represents a paradigm shift in the approach to resident training and transformative changes on many levels. In 2017, the department of Diagnostic Radiology at Queen's University became an early adopter of the CBME training model. The department began curricular planning using program specific Entrustable Professional Activities (EPAs), milestones based on the CanMeds roles, and an assessment framework. Associated processes were created to support implementation, with formation of a new competence committee, structure and process for academic advisors, and faculty development. In July 2018, the model was implemented using an electronic portfolio system, Elentra. In July 2022, the RCPSC launched the national implementation of their CBME CBD model, which was implemented for the incoming cohorts in the department of Diagnostic Radiology. Drawing from CBME implementation in the department of Diagnostic Radiology at Queen's University, we highlight the challenges encountered at our institution, methods for addressing these challenges, and corresponding outcomes. From our experience, we aim to provide a roadmap for the reader that will aid in planning for CBME implementation at other institutions.

Incidental findings are unexpected, actionable discoveries made on diagnostic imaging that have significant patient care and medicolegal implications if not well managed. Despite their importance, few systems exist to manage incidental findings. The Radiology Actionable Findings Tracking (RAFT) Program was developed to improve communication of incidental findings to radiologists, providers, and their patients. The RAFT template is incorporated into the electronic medical record and discloses important information such as: Finding, Acuity, Communication Status, and General Recommendation for follow-up. This data is automatically compiled into a spreadsheet monitored by a clinical coordinator who is responsible for notifying the primary care physician or referring provider. The alert is resolved once appropriate communication is made and the recommended follow-up measures are documented. Between January 2021 and June 2023, the program has tracked the communication of 2,243 incidental findings, for an average of 75 incidental findings each month. Of those total findings, 270 findings (12 %) triggered additional protocols for provider and patient notification with subsequent follow-up. The program is effective in improving communication of incidental findings and can serve as a valuable tool for radiologists, providers, and the patients they serve.

The work relative value unit (wRVU) measures the physician's work involved in performing a service and is commonly used to quantify physician productivity. A critical component factored in wRVUs is the time required to perform a service. In musculoskeletal radiology, this time correlates directly with the number of images produced per radiograph. The purpose of this project was to evaluate whether the actual number of acquired images matches the number of views indicated in musculoskeletal radiographs CPT code descriptions. A query of our internal database returned 76,204 musculoskeletal radiograph reports. 440 random radiographs were reviewed to evaluate variability in the number of images obtained. This sample consisted of ten studies from each of the forty-four musculoskeletal codes. We recorded the number of actual images obtained. 242 studies from the safety net health care system and 198 studies from the university associated hospitals and clinics were evaluated. Seventy-five studies (31 %) were found to have mismatched number of images among the 242 studies from the safety net health care system. Sixty-six studies (33 %) were found to have mismatched number of images among the 198 studies sample from university associated tertiary care system. There was significant difference between the extra images obtained at two different health care systems (p < 0.001). There were more studies with extra images in the safety net system compared to the university hospital. The commonly used wRVU metric has broad variability in the assessment of work productivity for musculoskeletal radiographs given the variance in the number of images obtained.

Breast magnetic resonance imaging (MRI) has the highest sensitivity for breast cancer detection compared to other breast imaging modalities such as mammography and ultrasound. As a functional modality, it captures the increased angiogenic activity of breast cancer through gadolinium-based contrast enhancement. Normal breast tissue also enhances, albeit in distinct patterns termed background parenchymal enhancement (BPE). Asymmetric enhancement, i.e., when one breast enhances more prominently than the other, can pose a diagnostic challenge for interpreting radiologists as distinguishing suspicious nonmass enhancement (NME) versus benign asymmetric BPE can be difficult. Correlating with patient history and imaging findings can help differentiate benign versus suspicious patterns of asymmetric enhancement. We present a collection of cases illustrating clues helpful for assessing asymmetric enhancement encountered on breast MRI.

Background: Distinguishing between benign and malignant pulmonary nodules based on CT imaging features such as the spiculation sign and/or lobulation sign remains challenging and these nodules are often misinterpreted as malignant tumors. this retrospective study aimed to develop a prediction model to estimate the likelihood of benign and malignant lung nodules exhibiting spiculation and/or lobulation signs.

Methods: A total of 500 patients with pulmonary nodules from June 2022 to August 2024 were retrospectively analyzed. Among them, 190 patients with spiculation sign and lobar sign or both on CT scan were included in this study. This investigation collected the clinical information, preoperative chest CT imaging characteristics, and postoperative histopathologic results from patients.Univariate and multivariate logistic regression analyses were employed to identify independent risk factors, from which a prediction model and nomogram were developed. In addition, The model performance was assessed through receiver operating characteristic(ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA).

Results: In our study, 190 patients with pulmonary nodules underwent lung biopsy in 10 patients and surgical resection in 180 patients, of whom 53 were benign nodules and 137 were malignant nodules. When combined with the spiculation sign or (and) the lobulation sign, the vascular cluster sign, bronchial architectural distortion, bubble-like translucent area, nodule density, and CEA were found to be significant independent predictors for determining the benignity and malignancy of pulmonary nodules. The nomogram prediction model demonstrated high predictive accuracy with an area under the ROC curve (AUC) of 0.904. Furthermore, the model's calibration curve demonstrated adequate calibration. DCA confirmed the prediction model's validity.

Conclusion: The model can assist clinicians in making more accurate preoperative diagnoses and in guiding clinical decision-making regarding treatment, potentially reducing unnecessary surgical interventions.

The diagnostic algorithm for histoplasmosis highlights the importance of imaging and emphasizes the role of the radiologist in the diagnostic workup. Here we describe a case series of patients with a novel sign of lung involvement in histoplasmosis which we have coined the Pseudo-Pulmonary Arteriovenous Malformation (PAVM) sign, the usage of which would help in the imaging diagnosis of histoplasmosis aid by distinguishing it from PAVMs. PAVMs carry risk for serious complications such as systemic emboli and may require treatment; whereas, histoplasmomas do not. Differentiation of histoplasmosis from other diagnoses can be made with laboratory studies, but may require bronchoscopy, biopsy, or both. Meanwhile, PAVMs should not be biopsied due to risk of bleeding. For these reasons, distinguishing PAVMs and histoplasmosis radiologically therefore greatly impacts clinical management, and it is important for radiologists to be aware of this appearance of histoplasmosis to avoid misinterpretation as PAVM and effectively inform clinical care.

This paper discusses the use of AutoHotkey (AHK) and programmable peripheral computing devices to enhance the workflow of diagnostic radiologists. Multiple features designed and coded by an emergency teleradiologist to optimize efficiency and complete redundant tasks with ease are presented. The full AutoHotkey script, which currently supports Visage PACS, PowerScribe 360, and Epic EHR, is available in the article appendix. Recommended peripheral devices and schematics for easy integration with the AutoHotkey script are provided. Downloadable peripheral device profiles for the recommended devices are available in the appendix. The combination of task automation, achieved with AutoHotkey, and the thoughtful configuration of programmable peripheral devices, providing easy access to task automations, can lead to improved ergonomics, increased efficiency, productivity, and job satisfaction.