Anthony Paul Trace

Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges

Since their earliest description, keloids and hypertrophic scars have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, emotionally distressing, and psychologically damaging, culminating in a significant burden for patients. Our current understanding of keloid pathophysiology has grown and continues to advance while molecular biology, genetics, and technology provide ever-deepening insight into the nature of wound healing and the pathologic perturbations thereof. Greater understanding will lead to the development and application of refined therapeutic modalities. This article provides an overview of our current understanding of keloids, highlighting clinical characteristics and diagnostic criteria while providing a comprehensive summary of the many therapeutic modalities available. The proposed mechanism, application, adverse events, and reported efficacy of each modality is evaluated, and current recommendations are summarized.

Radiology's Emerging Role in 3-D Printing Applications in Health Care.

From its inception as a tool for prototype development in the early 1980s, three-dimensional (3-D) printing has made inroads into almost every sector of industry, including health care. Medical applications range from extra- and intracorporeal orthopedic devices to complex, temporal reconstructions of patient-specific anatomy that allow operative planning and education. In the contemporary climate of personalized medicine, the utility of tangible 3-D models extrapolated directly from patient imaging data seems boundless. The purpose of this review is to briefly outline the development of 3-D printing, discuss its applications across the many medical and surgical specialties, and attempt to address obstacles and opportunities facing radiology as this technology continues to be integrated into patient care.

Clinical Applications of 3D Printing: Primer for Radiologists

Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.

Logistics of Three-dimensional Printing: Primer for Radiologists

The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.

Radiologic Knowledge and Ordering Habits of Clinical Residents: ACR Appropriateness Criteria Awareness and Perceptions.

anefforttoinformorderingphysicians on various imaging studies and their indications according to the ACR Appropriateness Criteria, we developed a short presentation that highlights some of the most commonly used studies. We also used a questionnairetodetermine the importance of imaging studies in these residents’ practice of medicine, their levels of comfort with ordering these studies, their perceptions of the amount of education they receive in radiology during their training, and their perceived need for more education to help them adequately select radiologic studies for their patients. WHAT WAS DONE A radiology resident at a large, urban, medical school-affiliated hospital devised a 45-min educational session preceded and followed by a short questionnaire (see Additional Resources) to assess participants’ knowledge of imaging tests and their indications to test the effectiveness of the intervention. The course was presented to 83 residents in the departments of internal medicine, family medicine, psychiatry, and emergency medicine. Figure 1 shows residents’ postgraduate years. The pretest consisted of three sections. The first part addressed the participants’ awareness of the ACR Appropriateness Criteria and their usefulness in clinical practice. The second part of the pretest assessed clinicians’ knowledge of basic radiology, including correct indications and contraindications of select imaging studies and contrast agent selection. The final portion of the pretest addressed participants’ opinions about the importance of radiology in their clinical practice, their comfort levels when ordering imaging studies, their perceptions of the amount of education they receive during their training, and their thoughts on integrating more radiology education. The posttest was administered afterthesessionandaskedparticipantsif they were now more likely to consult

A Resident- and Fellow-Driven Review Course to Prepare Trainees for the ABR Core Examination

DESCRIPTION OF THE PROBLEM With the changing of the board examinations from an oral format to a multiple-choice format, residents have adapted the way they study in response to the imperatives of the new examination. Residents must now understand how to read and interpret the subtleties of the question stems and answers, requiring test-taking skills not emphasized in an oral examination. Furthermore, residents have stated that they learn better from cases than from didactic lectures [1]. Therefore, although they remain popular [2], traditional didactic board reviews seem to no longer fit with the needs of today’s residents. The Virginia Chapter, ACR Resident and Fellow Section (VA ACR RFS), with the financial support of the Virginia state chapter, sought to change the style and content of the review course by implementing an interactive review course that is better suited to both today’s examination and modern learners, who must master the art of answering multiple-choice questions. The goal was to actively engage learners by immersing them in the examination format: fast-paced, casebased questions with multiple-choice answers that would allow residents to

Bilateral hyperdense middle cerebral arteries: Stroke sign or not?

Hyperdense middle cerebral artery (MCA) is a classic sign of acute thromboembolic disease. Simultaneous bilateral occurrence is uncommon and traditionally attributed to physiological hemoconcentration or attributable to imaging artifact. We present the case of a 71-year-old man whose admission noncontrast computed tomography (CT) demonstrated bilateral hyperdense middle cerebral arteries without other radiographic evidence of acute stroke. CT angiography confirmed bilateral MCA, M1 segment vascular occlusion and follow-up noncontrast CT demonstrated MCA territory infarctions.

Bone scintigraphy findings in calciphylaxis

Calciphylaxis is a poorly understood condition involving vascular calcification and thrombosis that leads to skin necrosis. Unfortunately, a noninvasive definitive test for calciphylaxis does not currently exist, and diagnosis relies on clinical symptoms and risk factors. Imaging can help guide diagnosis of this rare disorder. We present a pathology-proven case of calciphylaxis and the corresponding imaging findings seen on bone scintigraphy.

JOURNAL CLUB: Redefining the Radiology Curriculum in Medical School: Vertical Integration and Global Accessibility

OBJECTIVE Radiology interconnects medical disciplines given that a working understanding of imaging is essential to clinicians of every specialty. Using online education, we created a globally accessible, web-based undergraduate medical radiology curriculum modeled after the National Medical Student Curriculum in Radiology program of the Alliance of Medical Student Educators in Radiology. SUBJECTS AND METHODS Seventy-four radiology faculty-mentored video modules were produced, 50 of which were integrated into the 1st-year anatomy course. We administered tests to medical students before and after students saw the videos to assess the effectiveness of the modules. We surveyed students on their interests in pursuing radiology as a career before and after participating in this curriculum. RESULTS On the preexamination questions, the mean score was 58.0%, which increased to 83.6% on the pair-matched imaging-related questions on the actual examination. Before participating in the new curriculum, 88% of students did not express an interest in radiology, and 9% were undecided about radiology as a future career. There was an increase in students who reported that they would definitely or most likely pursue a career in radiology (7%) after they had viewed the lectures. CONCLUSION Radiology education is now available to a greater number of multidisciplinary learners worldwide. This project produced a comprehensive, globally accessible radiology curriculum in a self-paced, flexible learning format for new generations of physicians.

Seeding of a high-grade papillary urothelial carcinoma of the bladder along a nephroureterostomy tract

Percutaneous nephrostomy placement is a common treatment for obstructive uropathy of various causes. Although rare in the literature, tumor seeding along the nephrostomy tract is a potential risk of percutaneous nephrostomy in the treatment of obstructive symptoms secondary to urothelial carcinoma. In this case report, we present one such unusual outcome where urinary bladder urothelial cancer cells metastasized to the paravertebral soft tissues through apparent seeding along a nephroureterostomy tract.