Glenn C. Gaviola

Integrative clinical genomics of advanced prostate cancer

Toward development of a precision medicine framework for metastatic, castration-resistant prostate cancer (mCRPC), we established a multi-institutional clinical sequencing infrastructure to conduct prospective whole-exome and transcriptome sequencing of bone or soft tissue tumor biopsies from a cohort of 150 mCRPC affected individuals. Aberrations of AR, ETS genes, TP53, and PTEN were frequent (40%-60% of cases), with TP53 and AR alterations enriched in mCRPC compared to primary prostate cancer. We identified new genomic alterations in PIK3CA/B, R-spondin, BRAF/RAF1, APC, β-catenin, and ZBTB16/PLZF. Moreover, aberrations of BRCA2, BRCA1, and ATM were observed at substantially higher frequencies (19.3% overall) compared to those in primary prostate cancers. 89% of affected individuals harbored a clinically actionable aberration, including 62.7% with aberrations in AR, 65% in other cancer-related genes, and 8% with actionable pathogenic germline alterations. This cohort study provides clinically actionable information that could impact treatment decisions for these affected individuals.

Erratum: Integrative Clinical Genomics of Advanced Prostate Cancer

Dan Robinson, Eliezer M. Van Allen, Yi-Mi Wu, Nikolaus Schultz, Robert J. Lonigro, Juan-Miguel Mosquera, Bruce Montgomery, Mary-Ellen Taplin, Colin C. Pritchard, Gerhardt Attard, Himisha Beltran, Wassim Abida, Robert K. Bradley, Jake Vinson, Xuhong Cao, Pankaj Vats, Lakshmi P. Kunju, Maha Hussain, Felix Y. Feng, Scott A. Tomlins, Kathleen A. Cooney, David C. Smith, Christine Brennan, Javed Siddiqui, Rohit Mehra, Yu Chen, Dana E. Rathkopf, Michael J. Morris, Stephen B. Solomon, Jeremy C. Durack, Victor E. Reuter, Anuradha Gopalan, Jianjiong Gao, Massimo Loda, Rosina T. Lis, Michaela Bowden, Stephen P. Balk, Glenn Gaviola, Carrie Sougnez, Manaswi Gupta, Evan Y. Yu, Elahe A. Mostaghel, Heather H. Cheng, Hyojeong Mulcahy, Lawrence D. True, Stephen R. Plymate, Heidi Dvinge, Roberta Ferraldeschi, Penny Flohr, Susana Miranda, Zafeiris Zafeiriou, Nina Tunariu, Joaquin Mateo, Raquel Perez-Lopez, Francesca Demichelis, Brian D. Robinson, Andrea Sboner, Marc Schiffman, David M. Nanus, Scott T. Tagawa, Alexandros Sigaras, Kenneth W. Eng, Olivier Elemento, Andrea Sboner, Elisabeth I. Heath, Howard I. Scher, Kenneth J. Pienta, Philip Kantoff, Johann S. de Bono, Mark A. Rubin, Peter S. Nelson, Levi A. Garraway, Charles L. Sawyers,* and Arul M. Chinnaiyan* *Correspondence: sawyersc@mskcc.org (C.L.S.), arul@umich.edu (A.M.C.) http://dx.doi.org/10.1016/j.cell.2015.06.053

Traumatic shoulder injuries: a force mechanism analysis-glenohumeral dislocation and instability.

OBJECTIVE Acute traumatic glenohumeral dislocation is one of the most commonly encountered shoulder injuries and can produce a complex combination of associated bony and soft-tissue injuries, the full extent of which is often initially underappreciated. The objectives of this article are to illustrate the relevant anatomy of the shoulder and provide a more intuitive understanding of the complex biomechanics of traumatic glenohumeral instability through the use of 3D modeling and animation to improve the radiologists awareness of some of the most common injury patterns, and potentially improve the detection of associated injuries. Emphasis is placed on the most critical injuries to determine the ultimate treatment modality, and imaging recommendations are provided. CONCLUSION Understanding the force mechanisms responsible for traumatic glenohumeral dislocation can potentially improve detection of associated secondary injuries, which can guide more effective injury classification and ultimately direct more appropriate and timely intervention.

Are Facet Joint Bone Marrow Lesions and Other Facet Joint Features Associated With Low Back Pain? A Pilot Study

To determine the frequency of facet joint (FJ) bone marrow lesions, high FJ periarticular signal intensity, and FJ effusions in a convenience sample of patients with axial low back pain (LBP).

Traumatic Shoulder Injuries: A Force Mechanism Analysis of Complex Injuries to the Shoulder Girdle and Proximal Humerus

OBJECTIVE Acute shoulder trauma can result in complex injuries to the bone and soft-tissue structures of the shoulder girdle with the associated risk of development of shoulder girdle instability. Destabilizing injuries to the shoulder girdle and fractures of the proximal humerus can occur in predictable patterns based on the injury mechanism. The objectives of this article are to illustrate the relevant anatomy of the shoulder, use 3D modeling and animation to aid in a mechanistic understanding of some of the most common injury patterns, discuss the most relevant radiologic findings that determine the ultimate treatment approach, and discuss an approach to imaging diagnosis with attention to the common treatment strategies. CONCLUSION Understanding the force mechanisms responsible for the most common patterns of traumatic shoulder girdle injuries and proximal humeral fractures can improve detection of associated clinically significant secondary injuries, increase the effectiveness of injury classification, and ultimately direct appropriate and timely intervention.

The Lumbar Neural Foramen and Transforaminal Epidural Steroid Injections: An Anatomic Review With Key Safety Considerations in Planning the Percutaneous Approach

OBJECTIVE The purpose of this article is to review the anatomy of the lumbar neural foramen and to describe techniques of transforaminal epidural steroid injections with emphasis on safety. Rare cases of paraplegia have been reported. CONCLUSION Although no consensus currently exists about which approach is the safest, knowledge of the foraminal anatomy is a key consideration when choosing a needle approach for transforaminal epidural steroid injections.

A Biomechanical Approach to Interpreting Magnetic Resonance Imaging of Knee Injuries

This article discusses common injury mechanisms and the subsequent constellation of magnetic resonance (MR) imaging findings in the knee following trauma in the context of instability, as distinguished by the degree of knee flexion and tibial rotation at the time of initial injury, in addition to the direction and magnitude of the responsible force vectors. Using 3-dimensional imaging, common injury mechanisms are illustrated and correlated with MR imaging findings of the resulting osteochondral, ligamentous, meniscal, and musculotendinous lesions. The most common classification and grading systems for these individual lesions and their subsequent treatment implications are discussed.

Factors Influencing Choice of Radiology and Relationship to Resident Job Satisfaction

PURPOSE Identify when current radiology residents initially became interested in radiology, which factors influenced their decision to pursue a career in radiology, and which factors correlate with job satisfaction. METHODS An online survey was distributed to United States radiology residents between December 7, 2016 and March 31, 2017. Respondents identified the most appealing aspects of radiology during medical school, identified experiences most influential in choosing radiology, and scored job satisfaction on visual analog scales. Relative importance was compared with descriptive statistics. Satisfaction scores were compared across factors with analysis of variance and post-hoc Tukey tests. RESULTS 488 radiology residents responded (age 30.8 ± 3.2 years; 358 male, 129 female, 1 unknown; 144 PGY2, 123 PGY3, 103 PGY4, 118 PGY5). The most influential aspects in choosing radiology were the intellectual (n=187, 38%), imaging (n=100, 20%), and procedural (n=96, 20%) components and potential lifestyle (n=69, 14%). Radiology clerkship reading room shadowing (n=143, 29%), radiologist mentor (n=98, 20%), non-radiology clerkship imaging exposure (n=77, 16%), and radiology clerkship interventions exposure (n=75, 15%) were most influential. Choosing radiology because of potential lifestyle correlated with less job satisfaction than choosing radiology for intellectual (p=0.0004) and imaging (p=0.0003) components. CONCLUSION Recruitment of medical students into radiology may be most effective when radiology clerkships emphasize the intellectual and imaging components of radiology through reading room shadowing and exposure to interventions. Choosing radiology for lifestyle correlates with less job satisfaction, at least during residency.

Quantifying and Characterizing Trainee Participation in a Major Academic Radiology Department

OBJECTIVE Trainees play an important role in the delivery of medical services in academic medical centers, yet the full extent of their contribution in radiology is unknown. The purpose of this study was to quantify trainee involvement in a single large academic radiology department. MATERIALS AND METHODS In this Institutional Review Board-approved retrospective study performed in a tertiary care academic medical center, we identified the proportion of radiology reports with trainee involvement (by means of report co-signature) between July 2015 and June 2016. For each exam, we documented the modality, whether a trainee co-signed the report, and the division/subspecialty of the attending radiologist. We computed the overall proportion of radiology reports that involved a trainee and compared this proportion between imaging modalities, type of patient setting (Emergency Department, inpatient, outpatient), and across subspecialty divisions using Chi-square tests. RESULTS Overall, we analyzed 607,074 radiology reports, of which trainees co-signed 239,187 (39.4%) reports. Trainee involvement varied considerably by division, ranging from 7.1% (ultrasound division) to 99.2% (cardiovascular imaging division) of reports, P <0.001. Among diagnostic imaging modalities, trainee participation was highest in CT (67.0%) and MRI (60.9%) examinations, and lowest in ultrasound (15.3%), P < 0.001. Trainees were more involved in the emergency department (58.0%) and inpatient (43.4%) settings than in the outpatient setting (33.9%), P < 0.001. CONCLUSIONS Less than half of the imaging studies performed in an academic radiology department involved radiology trainees. Similar data and studies at other institutions may be useful to help define, monitor and improve optimal trainee education nationally.

Health Care Disparities in Radiology: A Primer for Resident Education

As the population of the United States grows increasingly diverse, health care disparities become vital to understand and mitigate. The ethical and financial implications of how groups of Americans gain access to health care have evolved into some of todays most challenging socioeconomic problems. Educators in radiology are just beginning to tackle the concepts of health care disparities, unconscious bias, and cultural competency. In July 2017, the Accreditation Council for Graduate Medical Education required that all trainees and teaching faculty of accredited training programs receive training and experience in new areas of quality improvement to include an understanding of health care disparities as part of the core competencies. To our knowledge, there is no centralized curriculum regarding health care disparities for radiology residents and fellows. Many programs, in fact, have yet to introduce the concept to their trainees, who may have difficulty recognizing that this is even a problem affecting radiology. This manuscript serves as a primer for radiology trainees on health care disparities, with the goal of defining major concepts and providing examples of how variable access to radiological care can have substantial impact on patient outcomes.