David M. Naeger

Cytomegalovirus-specific T cells persist at very high levels during long-term antiretroviral treatment of HIV disease.

Background In healthy, HIV seronegative, CMV seropositive adults, a large proportion of T cells are CMV-specific. High-level CMV-specific T cell responses are associated with accelerated immunologic aging (“immunosenesence”) in the elderly population. The impact of untreated and treated HIV infection on the frequency of these cells remains undefined. Methodology/Principal Findings We measured the proportion of CD4+ and CD8+ T cells responding to CMV pp65 and IE proteins was measured using flow cytometry in 685 unique HIV seronegative and seropositive individuals. The proportion of CMV-specific CD8+ T cells was consistently higher in the HIV-seropositive subjects compared to the HIV-seronegative subjects. This HIV effect was observed even in patients who lacked measurable immunodeficiency. Among the HIV-seropositive subjects, CMV-specific CD8+ T cell responses were proportionately lower during recent infection, higher during chronic untreated infection and higher still during long-term antiretroviral treated infection. The CD8+ T cell response to just two CMV proteins (pp65 and IE) was approximately 6% during long-term therapy, which was over twice that seen in HIV-seronegative persons. CMV-specific CD4+ T cell responses followed the same trends, but the magnitude of the effect was smaller. Conclusions/Significance Long-term successfully treated HIV infected patients have remarkably high levels of CMV-specific effector cells. These levels are similar to that observed in the elderly, but occur at much younger ages. Future studies should focus on defining the potential role of the CMV-specific inflammatory response in non-AIDS morbidity and mortality, including immunosenescence.

Medical Student Radiology Education: Summary and Recommendations From a National Survey of Medical School and Radiology Department Leadership

The ACR Task Force on Medical Student Education in Radiology, in partnership with the Alliance of Medical Student Educators in Radiology, investigated the current status of how and to what extent medical imaging was being taught in medical schools. The task force executed a 3-part survey of medical school deans, radiology department chairs, and intern physicians. The results provided an updated understanding of the status of radiology education in medical schools in the United States. This summary includes recommendations about how individual radiology departments and ACR members can assist in advancing the specialty of diagnostic radiology through medical student education.

Strategies for incorporating radiology into early medical school curricula

Clinically oriented material is being incorporated increasingly early into medical school curricula. Traditional models of incorporating radiology early on, mainly as an adjunct to pathology or anatomy instruction, are not focused on learning important aspects of clinical radiology. Medical students can be better served by an integrated curriculum that focuses on appropriate ordering of radiology studies, an intuitive understanding of imaging modalities, and understanding the patient experience.

Embedding 3D Radiology Models in Portable Document Format

OBJECTIVE The purpose of this article is to discuss how to convert cross-sectional images into a 3D model and embed them in a Portable Document Format (PDF) file. Four programs are used: OsiriX, MeshLab, Microsoft PowerPoint, and Adobe Acrobat. Step-by-step instructions are provided. CONCLUSION Embedding 3D radiology models into PDF files is a powerful tool that may be used for clinical, educational, and research purposes.

Clinician-Educator Pathway for Radiology Residents

Faculty clinician-educator tracks have become increasingly common at US academic medical centers. Although many radiology faculty members belong to such tracks, there is little training in radiology residencies to prepare residents to take on these roles. The authors present a summary of a novel radiology residency clinician-educator pathway developed and piloted at their institution. The key components of the pathway include protected time to work on a substantive education project and a small number of high-quality didactic lectures. Publication or presentation in some form is expected. The pathway includes regular mentorship from highly regarded clinician-educators, as well as didactic training in education techniques and skills. A formal application process was established, as were methods of evaluation during and after the experience.

Hepatotoxicity after transarterial chemoembolization and transjugular intrahepatic portosystemic shunt: Do two rights make a wrong?

PURPOSE To compare the rates of hepatotoxicity after transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS) who were stratified into comparable risk groups. MATERIALS AND METHODS A retrospective review of patients with HCC who were treated with transarterial chemoembolization between January 2005 and December 2009 was performed. Of 158 patients with comparable model for end-stage liver disease (MELD) scores, 10 had a patent TIPS. Hepatobiliary severe adverse events (SAEs) occurring after transarterial chemoembolization were documented. In addition, 1-year survival and liver transplantation rate after transarterial chemoembolization were calculated in each group. RESULTS The incidence of hepatobiliary SAEs after transarterial chemoembolization was nearly two times higher in patients with a TIPS (70%) than in patients without a TIPS (36%; P=.046). The liver transplantation rate 1 year after transarterial chemoembolization was 2.5 times higher in patients with a TIPS (80%) than in patients without a TIPS (32%; P=.004). There was no significant difference in 1-year survival between the two groups after transarterial chemoembolization. CONCLUSIONS Patients with HCC and a patent TIPS are more likely to develop significant hepatotoxicity after transarterial chemoembolization than comparable patients without a TIPS in place.

Correctly Using Sensitivity, Specificity, and Predictive Values in Clinical Practice: How to Avoid Three Common Pitfalls

OBJECTIVE Radiology is the specialty of imaging-based diagnostic tests. Understanding the science behind evaluating diagnostic test performance is essential for radiologists because we provide care to patients and interact with our colleagues. CONCLUSION Here, we review the key terminology used and common pitfalls encountered in the literature and in day-to-day discussions of diagnostic test performance.

CT and MRI of Early Intrauterine Pregnancy

OBJECTIVE The objective of this article is to describe the CT and MRI findings of early intrauterine pregnancy. CONCLUSION Early pregnancy should be considered when CT or MRI shows a fluid-filled cystlike structure in the uterus of a woman of reproductive age especially if there is a coexistent ovarian corpus luteum cyst.

Learning Objectives in Radiology Education. Why You Need Them and How to Write Them.

Learning objectives are a critical step in the creation and implementation of a radiology curriculum. Their use is mandated by the Liaison Committee on Medical Education, the Accreditation Council on Graduate Medical Education, and the Accreditation Council on Continuing Medical Education, but more importantly they can have a significant beneficial impact on quality of radiology education programs. Learning objectives guide student learning, help clarify our teaching goals, and simplify learner testing and evaluation. This article will review the components of a proper learning objective and provide a simple, straightforward approach to writing them effectively.

Pairwise comparison versus Likert scale for biomedical image assessment.

OBJECTIVE Biomedical imaging research relies heavily on the subjective and semi-quantitative reader analysis of images. Current methods are limited by interreader variability and fixed upper and lower limits. The purpose of this study was to compare the performance of two assessment methods, pairwise comparison and Likert scale, for improved analysis of biomedical images. MATERIALS AND METHODS A set of 10 images with varying degrees of image sharpness was created by digitally blurring a normal clinical chest radiograph. Readers assessed the degree of image sharpness using two different methods: pairwise comparison and a 10-point Likert scale. Reader agreement with actual chest radiograph sharpness was calculated for each method by use of the Lin concordance correlation coefficient (CCC). RESULTS Reader accuracy was highest for pairwise comparison (CCC, 1.0) and ranked Likert (CCC, 0.99) scores and lowest for nonranked Likert scores (CCC, 0.83). Accuracy improved slightly when readers repeated their assessments (CCC, 0.87) or had reference images available (CCC, 0.91). CONCLUSION Pairwise comparison and ranked Likert scores yield more accurate reader assessments than nonranked Likert scores.