Jatin Kaicker

Reliability of on-call radiology residents' interpretation of 64-slice CT pulmonary angiography for the detection of pulmonary embolism.

Background Computed tomography (CT) angiography for pulmonary embolism (PE) is the present standard for diagnosing PE. In many teaching hospitals, radiology residents are the first to review the case and to make an initial interpretation of the images. Accurate diagnosis of PE is crucial, especially in the emergency care setting. Purpose To evaluate the discrepancies between resident and staff interpretations of 64-slice CT angiogram for PE. Material and Methods Discrepancies between the preliminary reports by the on-call radiology resident were compared to the final report by the staff radiologist in 215 consecutive cases of 64-slice CT angiogram performed for PE, from May 2005 to March 2008. Results Discrepancies were noted in 25 of the 215 studies (11.6%). These residents’ discrepancies consisted of three false-positive, four false-negative, and 18 equivocal cases. There was a decrease in the discrepancy rate from the second year to the fifth year of training by approximately 60%. Conclusion The rate of discrepancy fell steeply between the second and fifth year of the residents training from 18.5% to 6.9%. Our study suggests that it is reasonable to have on-call radiology residents perform the preliminary interpretations of 64-slice CT for PE studies.

Imagine IR symposium: an approach to increasing IR awareness and understanding among medical students.

treatment methods are determined on a case-by-case basis. A 2013 literature review by Saeki et al (1) identified 13 cases, from 11 reports, of bleeding ectopic varices at the sites of previous choledochojejunostomies. In that series, interventional radiologic techniques were employed in eight patients, including dilation and stent implantation of the portal vein (n 1⁄4 5) and embolization of varices (n 1⁄4 3). None of these cases involved percutaneous creation of an extraanatomic shunt as performed in the present case. Decompression of splenic outflow with an extraanatomic shunt was effectively established in the patient described

The challenge of objective confirmation of asthma diagnosis in primary care

Asthma represents one of the most common chronic conditions encountered in primary care and diagnosis should be confirmed objectively with the demonstration of variable airflow obstruction. As many asthmatics have normal lung function at the time of clinical presentation, objective confirmation of airflow limitation may be challenging. Fluctuations in airflow obstruction can be documented with simple office spirometry after bronchodilator challenge, home monitoring of peak expiratory flow and bronchoconstriction induced by spasmogens such as methacholine. We present a case highlighting the challenge of objective confirmation of asthma diagnosis in primary care and provide a critical review of the diagnostic approaches highlighted above. Our aim is to provide a pragmatic interpretation of the available literature with a view to assisting clinicians in selecting the diagnostic test best suited for individualised patient encounters.