Harprit S. Bedi

The iPad in radiology resident education.

BACKGROUND The widespread adoption of mobile devices such as smart phones, laptops, and tablets may have an impact on medical education. A recent survey of health care professionals showed that 79% use iPads for work [1]. Several medical schools and residency programs have already incorporated iPads into their curricula [2]. Given the image-based learning in radiology, tablet devices have the potential to enhance the way radiology is studied and taught [3]. However, few studies have examined the influence of tablet technology on radiology residency education. We aimed to assess the impact of iPad ownership on radiology resident education in terms of study habits and use of

“I Just Bought My Residents iPads… Now What?” The Integration of Mobile Devices Into Radiology Resident Education

OBJECTIVE This article describes how mobile technologies can improve the way we teach radiology and offers ideas to bridge the clinical gap with technology. CONCLUSION Radiology programs across the country are purchasing iPads and other mobile devices for their residents. Many programs, however, do not have a concrete vision for how a mobile device can enhance the learning environment.

Reliability of the modified Tufts Lumbar Degenerative Disc Classification between neurosurgeons and neuroradiologists.

Cross-specialty inter-rater reliability has not been explicitly reported for imaging characteristics that are thought to be important in lumbar intervertebral disc degeneration. Sufficient cross-specialty reliability is an essential consideration if radiographic stratification of symptomatic patients to specific treatment modalities is to ever be realized. Therefore the purpose of this study was to directly compare the assessment of such characteristics between neurosurgeons and neuroradiologists. Sixty consecutive patients with a diagnosis of lumbago and appropriate imaging were selected for inclusion. Lumbar MRI were evaluated using the Tufts Degenerative Disc Classification by two neurosurgeons and two neuroradiologists. Inter-rater reliability was assessed using Cohens κ values both within and between specialties. A sensitivity analysis was performed for a modified grading system, which excluded high intensity zones (HIZ), due to poor cross-specialty inter-rater reliability of HIZ between specialties. The reliability of HIZ between neurosurgeons and neuroradiologists was fair in two of the four cross-specialty comparisons in this study (neurosurgeon 1 versus both radiologists κ=0.364 and κ=0.290). Removing HIZ from the classification improved inter-rater reliability for all comparisons within and between specialties (0.465⩽κ⩽0.576). In addition, intra-rater reliability remained in the moderate to substantial range (0.523⩽κ⩽0.649). Given our findings and corroboration with previous studies, identification of HIZ seems to have a markedly variable reliability. Thus we recommend modification of the original Tufts Degenerative Disc Classification by removing HIZ in order to make the overall grade provided by this classification more reproducible when scored by practitioners of different training backgrounds.

The Two-Minute Teacher

Radiology educators frequently find themselves working next to medical students at a view station or in a procedure room. Often the clinical workload is substantial, and relatively little time is available for direct student teaching. In such a context, much of the student’s learning is largely observational, listening as radiologists dictate cases and interact with residents, fellows, and referring physicians. Yet it is important that students benefit from the attention of radiology educators. If not, they may leave the radiology department having learned little and even feeling that they have been largely ignored. How can radiology educators ensure meaningful educational interactions during the clinical workday without setting aside large chunks of time specifically for teaching? One way is to arrive every day with a set of strategies and techniq ues that make meaningful educational interactions possible in even very short periods. We have developed such a set of approaches, each of which generally requires only a few minutes. At the beginning of the day, between cases, as interruptions in workflow occur, and at the end of the day, the 2-minute educator can draw as appropriate from this set of options to promote learner-educator interaction and foster enhanced learning. This may happen only once or multiple times per day, but each time it does so, it helps to make the most of what otherwise might be a missed educational opportunity. Having such a standard set of approaches can lower the ‘‘energyof activation’’ofteaching.If aneducatorhasnostanding set of strategies and techniques to drawon, other demands on time and attention can make it difficult to devise new teaching opportunities on the spot. With this approach, however, the educator has a preexisting menu from which to choose, based on the particular circumstances at hand. Moreover, each approach can be adapted and customized as appropriate to meet the needs of individual learners. These are starting points for an educational encounter, not rigid formulas. Finally, this approach can be employed not just by faculty members but by residents, fellows, technologists, and other radiology educators. Here are seven such strategies.

Radiology Resident Remediation: Five Important Questions to Ask

OBJECTIVE Residents needing remediation are difficult to recognize, assess, and address. The purposes of this article are to review common signs that a resident needs remediation and the causes of the deficiencies and to detail a checklist for preparing to approach the resident. CONCLUSION Radiology residents who need remediation generally have either academic or professionalism deficits, and their remediation programs should be tailored to the deficit. Having a clear definition of the problem while eliciting the residents thoughts on the nature of and solution to the problem are instrumental in the solution.

Primary and Metastatic Vascular Neoplasms: Imaging Findings

OBJECTIVE The purpose of this article is to review the imaging findings of vascular tumors. CONCLUSION Tumors of the vasculature are a pervasive disease entity consisting of both primary and metastatic lesions. Cross-sectional imaging plays a pivotal role in the diagnosis and delineation of the extent of this entity. Recognition of the characteristic imaging presentation of each tumor at CT and MRI can facilitate prompt diagnosis and accurate staging.

Extracranial Intraluminal Extension of Atypical Meningioma within the Internal Jugular Vein

Meningiomas represent the most common benign intracranial neoplasms, and may spread by direct extension into nearby venous sinuses, but gross spread to the extracranial venous system is uncommon. We report the case of a patient with extracranial intraluminal spread of meningioma within the internal jugular vein to level III of the neck. Review of the preoperative assessment and management is also presented.

Prevalence and Reporting Rates of Incidental Dental Disease on Head CT Examinations

RATIONALE AND OBJECTIVES Routine head computed tomography (CT) examinations often inadvertently include dental pathology which is often overlooked. The purpose of this study is to examine the prevalence of dental disease incidentally present and detected on head CT examinations, and to determine the effect of the institution of a dental disease field or macro in a standardized head CT dictation template on the rate of reporting dental disease. MATERIALS AND METHODS Head CT examinations were retrospectively and randomly selected from all examinations performed 6 months before, and 6 months after the institution of a dental disease field in a standardized head CT template. Dental findings were recorded from the initial finalized report. Examination images were subsequently reviewed for the presence of dental disease by two neuroradiologists who were blinded to the original reports and to each others findings. RESULTS One hundred examinations were reviewed in the analysis. At our institution, 33% of the randomly selected head CT examinations included the level of the teeth (100/307). Dental disease was determined to be present in 40%-41% of these cases. Only 11% of the initial reports mentioned dental disease (P < .01). Addition of a dental disease field in the dictation template resulted in no significant difference in reporting dental disease (14% vs 8%, P = .371). CONCLUSIONS Incidental dental disease is common and frequently underreported. Inclusion of a dental disease field in a standardized template does not significantly improve the rate of reporting dental disease.

Primary fibrosarcoma of the trachea presenting with acute airway loss

Primary sarcomas of the trachea are rare occurrences that present with nonspecific symptoms, making timely diagnosis difficult. We report a case of primary fibrosarcoma of the trachea that presented with acute airway loss secondary to tracheal discontinuity due to tumor destruction. This unusual clinical presentation highlights the difficulties posed in the diagnosis and management of tracheal sarcomas. A discussion of the relevant literature is presented.

The Radiologist as an Anatomy Student.

Richard B. Gunderman and Harprit Bedi 2015 Anatomy is a foundational discipline for the study of medicine, but it lies at the very core of radiology. Essentially, every image a radiologist inspects depicts anatomy, and one of the very first determinations to be made is whether the anatomy in question is normal or abnormal: is the bone fractured, the bile duct dilated, or the subarachnoid space filled with blood? Along with surgery, radiology is one of the most anatomy-intensive fields in medicine. Without a thorough understanding of the structure of the human organism, it is impossible to do anything.