Carolynn M. DeBenedectis

Utilization of Imaging in Pregnant Patients: 10-year Review of 5270 Examinations in 3285 Patients—1997–2006

PURPOSEnTo document the utilization of radiologic imaging in pregnant patients at one academic institution during a 10-year period (1997-2006).nnnMATERIALS AND METHODSnThe study was approved by the hospital institutional review board and was compliant with HIPAA. Informed consent was waived. At the authors institution, pregnant patients exposed to radiation during imaging are recorded in a database compiled by the medical physics department. The authors retrospectively reviewed this database to document the number of patients, number of each type of imaging examination, date of the examination, and the estimated radiation dose to the fetus from 1997 to 2006. The authors searched the institutions medical records to obtain the total number of deliveries by year as a control for the total pregnant patient population.nnnRESULTSnDuring the 10-year period, 5270 examinations were performed in 3285 pregnant patients (mean age, 28 years). The number of patients and examinations increased from 237 patients undergoing 331 studies in 1997 to 449 patients undergoing 732 examinations in 2006, an increase of 89% in patients and 121% in examinations. The total number of pregnant patients measured by deliveries increased 7%--from 8661 in 1997 to 9264 in 2006. Utilization rates (examinations per 1000 deliveries) of all radiologic examinations increased 107% from 1997 to 2006. The number of conventional radiographic examinations increased by an average of 7% per year, nuclear medicine examinations by 12% per year, and computed tomographic (CT) examinations by 25% per year. The average estimated fetal radiation exposure per examination was 0.43 mGy (range, 0.01-22.5 mGy) for conventional radiography, 4.3 mGy (range, 0.01-43.9 mGy) for CT, and 0.40 mGy (range, 0.01-7.7 mGy) for nuclear medicine examinations.nnnCONCLUSIONnFor the comparison of 1997 to 2006, the radiologic utilization rate in pregnant patients increased by 107% from 1997 to 2006. The greatest increase was in CT.

MR Imaging Evaluation of Abdominal Pain during Pregnancy: Appendicitis and Other Nonobstetric Causes

Clinical diagnosis of the cause of abdominal pain in a pregnant patient is particularly difficult because of multiple confounding factors related to normal pregnancy. Magnetic resonance (MR) imaging is useful in evaluation of abdominal pain during pregnancy, as it offers the benefit of cross-sectional imaging without ionizing radiation or evidence of harmful effects to the fetus. MR imaging is often performed specifically for diagnosis of possible appendicitis, which is the most common illness necessitating emergency surgery in pregnant patients. However, it is important to look for pathologic processes outside the appendix that may be an alternative source of abdominal pain. Numerous entities other than appendicitis can cause abdominal pain during pregnancy, including processes of gastrointestinal, hepatobiliary, genitourinary, vascular, and gynecologic origin. MR imaging is useful in diagnosing the cause of abdominal pain in a pregnant patient because of its ability to safely demonstrate a wide range of pathologic conditions in the abdomen and pelvis beyond appendicitis.

Conventional Medical Education and the History of Simulation in Radiology

Simulation is a promising method for improving clinician performance, enhancing team training, increasing patient safety, and preventing errors. Training scenarios to enrich medical student and resident education, and apply toward competency assessment, recertification, and credentialing are important applications of simulation in radiology. This review will describe simulation training for procedural skills, interpretive and noninterpretive skills, team-based training and crisis management, professionalism and communication skills, as well as hybrid and in situ applications of simulation training. A brief overview of current simulation equipment and software and the barriers and strategies for implementation are described. Finally, methods of measuring competency and assessment are described, so that the interested reader can successfully implement simulation training into their practice.

Utility of Iodinated Contrast Medium in Hydrodissection Fluid when Performing Renal Tumor Ablation

In 21 patients undergoing percutaneous renal tumor ablation, hydrodissection with use of a mixture of 5% dextrose in water and iodinated contrast medium was performed to prevent thermal injury to adjacent structures. This technique allows for the movement of adjacent organs as well as improved differentiation among the hydrodissection fluid, renal tumor, and adjacent tissues.

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.

Coming Out of the Dark: A Curriculum for Teaching and Evaluating Radiology Residents’ Communication Skills Through Simulation

INTRODUCTION The purpose of this pilot is to develop and implement a curriculum to teach radiology residents communication skills through simulation. Communication skills are a core competency for which radiology residents must be evaluated. As the practice of radiology evolves into a more patient-centered model, the importance of effective communication skills will continue to increase.There is evidence that effective communication skills can be acquired through appropriate training [1]. However, very few residency programs provide formal training and evaluation programs for teaching effective communication skills. The task of training radiology residents in effective communication skills is challenging, as this cannot be achieved by merely adding additional didactic lectures to our standard curriculum. Simulation has been shown to be an effective, and long-lasting, method for teaching physicians communication skills [1]. To our knowledge, there is no program that has been created to both teach and assess radiology residents’ communication skills [2].

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.

Development of a Standardized Kalamazoo Communication Skills Assessment Tool for Radiologists: Validation, Multisource Reliability, and Lessons Learned

OBJECTIVEnThe purpose of this study was to develop and test a standardized communication skills assessment instrument for radiology.nnnMATERIALS AND METHODSnThe Delphi method was used to validate the Kalamazoo Communication Skills Assessment instrument for radiology by revising and achieving consensus on the 43 items of the preexisting instrument among an interdisciplinary team of experts consisting of five radiologists and four nonradiologists (two men, seven women). Reviewers assessed the applicability of the instrument to evaluation of conversations between radiology trainees and trained actors portraying concerned parents in enactments about bad news, radiation risks, and diagnostic errors that were video recorded during a communication workshop. Interrater reliability was assessed by use of the revised instrument to rate a series of enactments between trainees and actors video recorded in a hospital-based simulator center. Eight raters evaluated each of seven different video-recorded interactions between physicians and parent-actors.nnnRESULTSnThe final instrument contained 43 items. After three review rounds, 42 of 43 (98%) items had an average rating of relevant or very relevant for bad news conversations. All items were rated as relevant or very relevant for conversations about error disclosure and radiation risk. Reliability and rater agreement measures were moderate. The intraclass correlation coefficient range was 0.07-0.58; mean, 0.30; SD, 0.13; and median, 0.30. The range of weighted kappa values was 0.03-0.47; mean, 0.23; SD, 0.12; and median, 0.22. Ratings varied significantly among conversations (χ26 = 1186; p < 0.0001) and varied significantly by viewing order, rater type, and rater sex.nnnCONCLUSIONnThe adapted communication skills assessment instrument is highly relevant for radiology, having moderate interrater reliability. These findings have important implications for assessing the relational competencies of radiology trainees.

The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

RATIONALE AND OBJECTIVESnEvaluation of nodal involvement in early-stage breast cancers (T1 or T2) changed following the Z11 trial; however, not all patients meet the Z11 inclusion criteria. Hence, the relevance of ultrasound imaging of the axilla and fine-needle aspiration biopsy (FNA) in early-stage breast cancers was investigated.nnnMATERIALS AND METHODSnIn this single-center, retrospective study, 758 subjects had pathology-verified breast cancer diagnosis over a 3-year period, of which 128 subjects with T1 or T2 breast tumors had abnormal axillary lymph nodes on ultrasound, had FNA, and proceeded to axillary surgery. Ultrasound images were reviewed and analyzed using multivariable logistic regression to identify the features predictive of positive FNA. Accuracy of FNA was quantified as the area under the receiver operating characteristic curve with axillary surgery as reference standard.nnnRESULTSnOf 128 subjects, 61 were positive on FNA and 65 were positive on axillary surgery. Sensitivity, specificity, positive predictive value, and negative predictive value of FNA were 52 of 65 (80%), 54 of 63 (85.7%), 52 of 61(85.2%), and 54 of 67 (80.5%), respectively. After adjusting for neoadjuvant chemotherapy between FNA and surgery, a positive FNA was associated with higher likelihood for positive axillary surgery (odds ratio: 22.7; 95% confidence interval [CI]: 7.2-71.3, Pu2009<u2009.0001), and the accuracy of FNA was 0.801 (95% CI: 0.727-0.876). Among ultrasound imaging features, cortical thickness and abnormal hilum were predictive (Pu2009<u2009.017) of positive FNA with accuracy of 0.817 (95% CI: 0.741-0.893).nnnCONCLUSIONSnUltrasound imaging and FNA can play an important role in the management of early breast cancers even in the post-Z11 era. Higher weightage can be accorded to cortical thickness and hilum during ultrasound evaluation.

Incidental genitourinary findings on obstetrics/gynecology ultrasound.

Abstract Ultrasound is the standard-of-care imaging modality for initial imaging in obstetrics and gynecology. Given the close proximity of the genitourinary system to the uterus and adnexa, it is not surprising that these studies can result in the discovery of incidental genitourinary findings such as ureterocele, ectopic ureter, bladder mass, ureteral stones, cystitis, bladder diverticulum, and pelvic kidney. Recognition of the etiology of these findings is important for appropriate diagnosis and, at times, patient care. Many of these findings are truly incidental and clinically unimportant but other times can be related to the patient’s chief complaint.