Angelisa M. Paladin

Semicircular canal dehiscence in the pediatric population

OBJECTIVES (1) Identify the existence of semicircular canal bony dehiscence in the pediatric population; (2) determine the frequency of this finding in children over 3 years of age who have had temporal bone computed tomography (CT) imaging; (3) correlate the clinical history and audiological data to CT findings in this population. DESIGN AND SETTING Retrospective review of temporal bone CT scans performed at a tertiary care childrens hospital and retrospective chart review. PATIENTS Children over 3 years of age who underwent a temporal bone CT scan between January 2006 and December 2006. RESULTS Review of 131 temporal bone CT scans using multiplanar imaging techniques revealed evidence of semicircular canal bony dehiscence in 18 children older than 3 years of age. Dehiscence of the superior semicircular canal was identified in 14 patients while dehiscence of the posterior semicircular canal was identified in 5 patients. One patient had both the superior and posterior semicircular canal dehiscences. Retrospective chart review comparing children with and without semicircular canal dehiscence showed no significant difference in clinical history or audiological data. CONCLUSIONS Semicircular canal dehiscence exists in the pediatric population. In this series, 18 of 131 temporal bone CT scans were positive for bony dehiscence of the superior or posterior semicircular canals. Further study is required to determine the clinical significance of this radiographic finding.

Cost analysis and feasibility of high-fidelity simulation based radiology contrast reaction curriculum.

RATIONALE AND OBJECTIVES Radiology residents have variable training in managing acute nonrenal adverse reactions to iodinated contrast media because of their rarity. Preliminary results show positive feedback and knowledge gain with high-fidelity simulation-based training. Financial costs and the time required to implement a high-fidelity simulation curriculum are higher than for a lecture series. The objective of this study was to provide a financial and time cost-benefit analysis for high-fidelity simulation training of acute adverse reactions to iodinated contrast media. MATERIALS AND METHODS Forty-four radiology residents were divided into lecture and simulation groups. Five simulation scenarios were created, with core education content mirrored in the lecture. Lengths of faculty time commitment and resident training were recorded. Financial costs, including manikin and simulation facility rates, were recorded and divided by the number of residents to obtain per resident simulation and lecture costs. A written evaluation of the experience, with Likert-type items and unstructured response items, was conducted. RESULTS Cost per resident for simulation training setup was

Allergic reactions to iodinated contrast media: premedication considerations for patients at risk.

259.76, and

24/7/365 in-house radiologist coverage: effect on resident education.

203.46 for subsequent years, compared to <

A 14-year-old girl with recumbent proteinuria

5 for lecture. Faculty time was 7 academic days for simulation versus 2 days for lecture format. Resident simulation commitment was 3 hours 30 minutes. Time to train technologists to run the simulation was 3 hours. All residents provided positive feedback regarding the simulation curriculum, with mean feedback scores statistically higher than lecture group (P < .05). CONCLUSIONS This study illustrates that financial costs of implementation are low compared to the potential cost of morbidity associated with the life-threatening event of an acute adverse reaction to iodinated contrast media.

What Program Directors Think III: Results of the 2014/2015 Annual Surveys of the Association of Program Directors in Radiology (APDR).

The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. Finally, we will discuss the actions of the medications used to help reduce or prevent allergy-type reactions to iodinated contrast media, the protocols used to help reduce or prevent contrast reactions in high-risk patients, and the potential side effects of these medications. We will also discuss the high-risk patient who has received premedication due to a prior index reaction and discuss the risk of having a subsequent reaction, termed “breakthrough reaction.” Identifying patient at high risk for an “allergy-type” reaction to contrast media is an essential task of the radiologist. Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction.

The next accreditation system in radiology: A report from the APDR residency structure committee

RATIONALE AND OBJECTIVES To compare programs with and without 24-hour/7 days a week/365 days a year (24/7/365) in-house radiologist coverage regarding resident perceptions of their on-call experience, volume of resident dictations on call, and report turnaround time. MATERIALS AND METHODS Residents from six academic radiology departments were invited to participate in an 11-item online survey. Survey items were related to workload, level of autonomy, faculty feedback, comfort level, faculty supervision, and overall educational experience while on call from 8 pm to 8 am. Each site provided data on imaging volume, radiologist coverage, volume of examinations dictated by residents, number of residents on call, and report turnaround time from 8 pm to 8 am. F-ratios and eta-squares were calculated to determine the relationships between dependent and independent variables. A P value < .05 was considered statistically significant. RESULTS A total of 146 (67%) of 217 residents responded. Residents in programs with 24/7/365 in-house radiologist coverage dictated a lower percentage of examinations (46%) compared with other residents (81%) and rated faculty feedback more positively (mean 3.8 vs. 3.3) but rated their level of autonomy (mean 3.6 vs. 4.5) and educational experience (mean 3.6 vs. 4.2) more negatively (all P < .05). Report turnaround time was lower in programs with 24/7/365 coverage than those without (mean 1.7 hours vs. 9.1 hours). The majority of resident comments were negative and related to loss of autonomy with 24/7/365 coverage. CONCLUSION More rapid report turnaround time related to 24/7/365 coverage may come at the expense of resident education.

How to Critically Appraise the Clinical Literature

Abstract We describe a 14-year-old female who presented with persistently elevated nighttime urinary protein excretion without additional clinical symptoms. She had no evidence of intrinsic renal disease on physical examination or laboratory studies. Ultrasound examination of the abdomen revealed a large cyst arising from the spleen. CT scan showed compression of the left renal vein by the splenic cyst. Removal of the cyst resulted in resolution of her proteinuria. Entrapment of the left renal vein (nutcracker syndrome) remains a rare but important cause of elevated protein excretion.

Bony cochlear nerve canal stenosis and speech discrimination in pediatric unilateral hearing loss

RATIONALE AND OBJECTIVES The Association of Program Directors in Radiology regularly surveys its members regarding issues of importance to support radiology residency programs and their directors. MATERIALS AND METHODS This is an observational cross-sectional study using two Web-based surveys posed to the Association of Program Directors in Radiology membership in the fall of 2014 (49 items) and the spring of 2015 (46 items) on the subjects of importance to the members, including the Accreditation Council on Graduate Medical Education Milestones, the Non-Interpretative Skills Curriculum, the American Board of Radiology Core Examination, the effect of the new resident testing and program accreditation paradigms on training outcomes, the 2015 Residency Match, the Interventional Radiology/Diagnostic Radiology (IR/DR) Residency, and Program Director (PD)/Program Coordinator resources. RESULTS Responses were collected electronically, results were tallied using SurveyMonkey software, and qualitative responses were tabulated or summarized as comments. Findings were reported during the 63rd annual meeting of the Association of University Radiologists. The maximal response rate was 33% in the fall of 2014 and 36% in the spring of 2015. CONCLUSIONS PDs believed that the radiology Milestones, now largely implemented, did not affect overall resident evaluation, was not reflective of resident experience, and actually made evaluation of residents more difficult. PDs also felt that although the American Board of Radiology oral examination had been a better test for clinical practice preparedness, their new residents knew at least as much as before. There was little evidence of recall reemergence. The radiology training community saw a drop in residency applicant quality as demonstrated by the United States Medical Licensing Examination scores and clinical rotation grades. Because the new IR/DR Residency positions were to be funded at the expense of the traditional DR positions, the majority of PDs expected a negative effect of the impending IR/DR match on their DR recruitment. PDs were in favor of a unified clinical radiology curriculum similar to the Radiological Society of North America online physics modules.

Errors of epinephrine administration during severe allergic-like contrast reactions: lessons learned from a bi-institutional study using high-fidelity simulation testing

In a move to emphasize the educational outcomes of training programs, the ACGME has created the Next Accreditation System (NAS). The stated goals of NAS include aiding the ACGME in the accreditation of programs based on educational outcome measures, decreasing program burdens associated with the conventional process-based approach to ACGME accreditation, allowing good programs to innovate while enabling struggling programs to steadily improve, and providing public accountability for outcomes. Diagnostic radiology is among the first group of specialties to undergo NAS implementation and began operating under the NAS in July 2013. This article describes the various components of the NAS and explains the new elements, including the clinical learning environment review program, the milestones, the clinical competency committee, and the self-study visits.