Arun Krishnaraj

Pelvic applications of diffusion magnetic resonance images

Diffusion-weighted imaging (DWI) is a powerful imaging technique in neuroimaging; its value in abdominal and pelvic imaging has only recently been appreciated as a result of improvements in magnetic resonance imaging technology. There is growing interest in the use of DWI for evaluating pathology in the pelvis. Its ability to noninvasively characterize tissues and to depict changes at a cellular level allows DWI to be an effective complement to conventional sequences of pelvic imaging, especially in oncologic patients. The addition of DWI may obviate contrast material in those with renal insufficiency or contrast material allergy.

Impact of Generational Differences on the Future of Radiology: Proceedings of the 11th Annual ACR Forum

The 2011 ACR Forum focused on the impact of generational differences on the future of radiology, seeking to inform ACR leadership and members on how best to address the influence of the new integrated workforce on the specialty of radiology and on individual practices.

Do We Need a National Incident Reporting System for Medical Imaging

The essential role of an incident reporting system as a tool to improve safety and reliability has been described in high-risk industries such as aviation and nuclear power, with anesthesia being the first medical specialty to successfully integrate incident reporting into a comprehensive quality improvement strategy. Establishing an incident reporting system for medical imaging that effectively captures system errors and drives improvement in the delivery of imaging services is a key component of developing and evaluating national quality improvement initiatives in radiology. Such a national incident reporting system would be most effective if implemented as one piece of a comprehensive quality improvement strategy designed to enhance knowledge about safety, identify and learn from errors, raise standards and expectations for improvement, and create safer systems through implementation of safe practices. The potential benefits of a national incident reporting system for medical imaging include reduced morbidity and mortality, improved patient and referring physician satisfaction, reduced health care expenses and medical liability costs, and improved radiologist satisfaction. The purposes of this article are to highlight the positive impact of external reporting systems, discuss how similar advancements in quality and safety can be achieved with an incident reporting system for medical imaging in the United States, and describe current efforts within the imaging community toward achieving this goal.

Radiology in 2022: Challenges and Opportunities in the Coming Decade—Proceedings of the 12th Annual ACR Forum

The 2012 ACR Forum focused on the anticipated challenges and opportunities facing radiology in the next 10 years, centered on the themes of health care reform, future payment models, research and innovation, patient-centered radiology, and information management. The recommendations generated from the forum seek to inform ACR leadership on the best strategies to pursue to ensure the continued success of the profession in the coming decade.

Resident and Fellow State Chapters: Providing Impact From the Local Level

The ACR works to support radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists in their efforts to best serve patients. The College establishes quality standards for medical imaging, ensures effective legislative representation on Capitol Hill through its government relations office, and advocates for the future of our profession. However, the ACR would not be an effective organization without the strength of its state radiology societies, which provide forums to tackle local issues. Likewise, the national RFS is bolstered by active state RFS chapters. By increasing resident involvement at the state level, our national RFS will continue to grow its influence within the ACR. Why should we, as trainees, be involved in another organization at the state level? Although the thought of participating in an additional society and balancing the rigors of medical training may seem overwhelming, the significance of participation at the state level cannot be overstated. State chapters provide an arena for colleagues in training from multiple programs to discuss resident issues such as call and rotation distribution. These exchanges often cultivate ideas that can improve the overall training environment in individual states. State chapter radiology society meetings also offer opportunities to network with local radiology leaders from both private and academic settings. Moreover, consistent face-to-face interactions among colleagues at the local level provide greater opportunity for volunteer outreach efforts that demonstrate the often forgotten humanistic side of our profession. The returns of state chapter involvement are worth the additional time commitment. The successes of the Massachusetts and California RFS chapters have been documented previously [1]. Many other successful state RFS chapters are scattered throughout the country. New chapters are continually being established, with Missouri, Alabama, and Vermont initiating their chapters just this year. But how does a group of residents, who likely do not know one another and are often spread throughout an inconvenient geographic locale, organize themselves to establish a successful RFS? The answers are diverse. Chapters have had success with varying organizational approaches, but examining successful state RFS chapters reveals some common elements.

Boston Med: The Untold Stories

Following a fall from a ladder, Patrick Coleman was rushed to the operating room at Massachusetts General Hospital (MGH), trailed not only by a trauma surgery team but also by an ABC News film crew. The details of Mr Coleman’s fall were unclear, but what became apparent as the scene unfolded was that Mr Coleman was dying. He was profoundly hypotensive and losing massive amounts of blood. Despite receiving bag after bag of blood products, Mr Coleman remained in critical condition. Approximately 1 hour and 30 L of volume later, Mr Coleman continued to crash. The trauma surgeon was packing Mr Coleman’s abdomen with multiple sterile towels to stop the internal hemorrhage but to no avail. The trauma team then discovered that the blood loss stemmed from injuries to the vessels of his pelvis. fter the bleeding was halted (which as not shown), Mr Coleman’s conition stabilized, and he was transerred to the intensive care unit ICU). Viewers then encounter a much ifferent Patrick Coleman. Two eeks have passed, and no longer in he ICU, he is sitting up in his hosital bed talking with the trauma urgeon who tended to him that ateful night. Mr Coleman exresses his sincere gratitude for the urgeon’s efforts while the surgeon mphasizes how lucky Mr Coleman s to be alive. Wow! The MGH trauma sureons saved the day, and ABC ews was there to capture the story s it unfolded. This vignette had it ll: drama, suspense, and a happy nding. But is the story accurate? Did the television audience see the valiant efforts of all the doctors involved? Billed as “the drama of real life unfolding inside the nation’s best hospitals,” Boston Med harnessed the journalistic talents of producer Terrence Wrong and distilled 4 months of footage into 8 captivating episodes. The real-life stories that constituted Boston Med focused both on the patients and their families, as well as the often tumultuous and stressful lives of the doctors and nurses who care for them. The series exposed viewers to a variety of medical conditions in an attempt to illustrate the inner workings of a large academic hospital. These stories often featured the most dramatic cases (trauma, transplantation, and children in peril) and the sexy specialties that care for them (trauma surgery, transplant surgery, and emergency medicine). However, Boston Med framed these stories narrowly and inaccurately. The show propagated the myth that one service or one doctor delivers care to a patient. However, anyone who has spent any time in an academic hospital knows that achieving high-quality care requires a team of doctors, nurses, and other staff members working together. The most difficult cases require coordination, communication, and respect. This concept of care coordination is best illustrated by cases similar to that of Mr Coleman. He survived his injury despite the seemingly insurmountable odds stacked against him. In the end, he received a total of 50 L of transfusion products and was cared for not only by trauma surgery but also by anesthesiology, critical care, and vascular interven-