Brandon P. Brown

Brain Life and the Argument from Potential: Affirming the Ontological Status of Human Embryos and Fetuses

The moral status of human embryos and fetuses is one of the most vexed questions in bioethics and various responses often stand or fall on the answer to the question of the ontological status of such entities: whether they count as “persons,” “potential persons,” or merely “human biological material.” The “argument from potential” is intended to support the claim that embryos and fetuses, while not yet persons, are more than mere biological material insofar as there is a high degree of probability that they will develop into persons. A stronger foundation for contending that embryos and fetuses bear the same basic right to life as persons is to establish that such entities are not potential, but actual persons due to their intrinsic potentiality to develop themselves into beings who can engage in those activities definitive of personhood. In addition to critiquing the argument from potential, those who deny that embryos and early-term fetuses count as persons charge that those who understand “whole-brain death” to be necessary and sufficient for a human person to go out of existence inconsistently deny a symmetrical criterion of “brain life” to mark the beginning of a person’s existence. We respond to this charge of inconsistency while further arguing that embryos and fetuses possess the ontological and moral status of persons due to their intrinsic potentiality to develop a brain supportive of self-conscious rational thought.

Excellence and Professionalism in Radiology

W557 and profitability, which are separable from those doing the work, count for a lot but are not the “whole story.” For one thing, their supply is limited and their pursuit can result in destructive competition. In health care, the successful pursuit of goods by any single individual or organization often entails the failure of other organizations. For one to win, others must lose. Each is trying to take away the others’ business. When it comes to intrinsic goods, however, the flourishing of one individual or organization does not threaten others. In fact, cultivating excellence of character actually redounds to everyone’s benefit by enhancing the standing of the field. Whereas the number of radiologic examinations and amount of money that can be allocated to radiology are relatively fixed from year to year, the pursuit of excellence is unlimited. For example, every department could foster higher-quality relationships with patients and the benefits in enhanced respect and trust would enrich all of radiology [2]. Someone who pursues excellence to gain extrinsic goods has mistaken the lesser good for the greater [3]. Excellence is not a means to augment profitability, promote a career, or win awards. Quite the reverse: Extrinsic goods such as money, power, and fame are useful primarily to the extent that they enable us to become better professionals and human beings. The goal is not simply to maximize productivity or profitability, which might entail excessive professional and personal sacrifices. Seeking to acquire more things makes no sense if it requires us to become lesser human beings. When it comes to excellence, people are more important than processes, and personal integrity and fulfillment are more important than mere profitability [4]. An individual or organization that is prepared to Excellence and Professionalism in Radiology

Social Media Utilization at an Academic Radiology Practice

RATIONALE AND OBJECTIVESnWe report social media (SoMe) utilization trends at an academic radiology department, highlighting differences between trainees and faculty and between Baby Boomers versus Generation X and Millennials.nnnMATERIALS AND METHODSnAn anonymous online survey regarding SoMe utilization and SoMe-based educational curriculum was distributed to all radiologists (trainees and faculty) in our department. Regular chi-square, ordered (Mantel-Haenszel) chi-square, and Fischer exact tests were performed.nnnRESULTSnThe survey instrument was sent to 172 radiologists with a 65% completion rate (Nu2009=u2009112). Eighty-three percent (nu2009=u200992) of the respondents use SoMe, with Facebook (67%, nu2009=u200975), YouTube (57%, nu2009=u200964), Instagram (26%, nu2009=u200929), and Twitter (21%, nu2009=u200923) as the most commonly used platforms. Eighty-one percent (nu2009=u200991) use SoMe for 30 minutes or less per day. Thirty-five percent (nu2009=u200939) reported previously using SoMe for educational purposes, although 66% (nu2009=u200973) would be willing to join SoMe for educational activities. The faculty are more likely than trainees to avoid using SoMe (30% vs 9%, Pu2009<u20090.03). Trainees are more likely than faculty to find an electronic case-based curriculum valuable (95% vs 83%, Pu2009<u20090.05) and are willing to spend more time on cases (Pu2009<u20090.01). Baby Boomers are less interested in joining SoMe for educational activities than Generation X and Millennials (24% vs 73%, Pu2009=u20090.0001).nnnCONCLUSIONSnGeneration gaps between trainees and faculty, as well as between Generation X and Millennials versus Baby Boomers, exist with regard to the use of SoMe, which may be underutilized in radiology education.

A comprehensive severity score for the morbidly adherent placenta: combining ultrasound and magnetic resonance imaging

BackgroundUltrasound (US) is the first-line imaging modality to assess the morbidly adherent placenta, but sensitivity and specificity are lacking.ObjectiveThis investigation aims to improve diagnostic accuracy with a comprehensive score using clinical history, US, and magnetic resonance imaging (MRI).Materials and methodsWe conducted a retrospective cohort study of pregnant women who received both transvaginal US and MRI with suspicion for morbidly adherent placenta between 2009 and 2016. US was scored with the following metrics: (i) previa, (ii) hypervascularity, (iii) loss of retroplacental clear space and (iv) lacunae. MRI was evaluated for (i) intraparenchymal vessels, (ii) abnormally dilated vessels, (iii) fibrin deposition, (iv) placental bulge and (v) bladder dome irregularity. Bayesian analysis was used to estimate the probability of morbidly adherent placenta for a given score. Diagnostic testing parameters were calculated.ResultsAmong the 41 women with concerning imaging, histologically identified disease was confirmed in 16. The probability of morbidly adherent placenta increased with the score. At the highest US score, the probability of disease was 63.7%. With the highest MRI score, the probability of adherent placentation was 90.5%. Combining the US and MRI findings had a sensitivity of 56% and a specificity of 92%.ConclusionA combined scoring system using MRI and US may accurately identify patients at risk for morbidity associated with morbidly adherent placenta.

A retrospective segmentation analysis of placental volume by magnetic resonance imaging from first trimester to term gestation

BackgroundAbnormalities of the placenta affect 5–7% of pregnancies. Because disturbances in fetal growth are often preceded by dysfunction of the placenta or attenuation of its normal expansion, placental health warrants careful surveillance. There are limited normative data available for placental volume by MRI.ObjectiveTo determine normative ranges of placental volume by MRI throughout gestation.Materials and methodsIn this cross-sectional retrospective analysis, we reviewed MRI examinations of pregnant females obtained between 2002 and 2017 at a single institution. We performed semi-automated segmentation of the placenta in images obtained in patients with no radiologic evidence of maternal or fetal pathology, using the Philips Intellispace Tumor Tracking Tool.ResultsPlacental segmentation was performed in 112 women and had a high degree of interrater reliability (single-measure intraclass correlation coefficient =0.978 with 95% confidence interval [CI] 0.956, 0.989; P<0.001). Normative data on placental volume by MRI increased nonlinearly from 6xa0weeks to 39xa0weeks of gestation, with wider variability of placental volume at higher gestational age (GA). We fit placental volumetric data to a polynomial curve of third order described as placental volume = –0.02*GA3 + 1.6*GA2 – 13.3*GA + 8.3. Placental volume showed positive correlation with estimated fetal weight (P=0.03) and birth weight (P=0.05).ConclusionThis study provides normative placental volume by MRI from early first trimester to term gestation. Deviations in placental volume from normal might prove to be an imaging biomarker of adverse fetal health and neonatal outcome, and further studies are needed to more fully understand this metric. Assessment of placental volume should be considered in all routine fetal MRI examinations.