Kay H. Vydareny

Diagnostic radiology milestones.

Kay H. Vydareny, MD, is Associate Executive Director for Diagnostic Radiology at the American Board of Radiology; E. Stephen Amis Jr, MD, is Professor and University Chair in the Department of Radiology, Albert Einstein College of Medicine/Montefiore; Gary J. Becker, MD, is Executive Director of the American Board of Radiology; James P. Borgstede, MD, is a Vice Chairman and Professor at the University of Colorado Hospital; Dorothy I. Bulas, MD, is in the Division of Diagnostic Imaging and Radiology, Children’s National Medical Center, and Professor of Radiology and Pediatrics at the George Washington University Medical Center; Jannette Collins, MD, is Ben Felson Professor and Chair of Radiology in the Department of Radiology, University of Cincinnati Medical Center; Lawrence P. Davis, MD, is Vice Chair and Program Director in the Department of Radiology, Long Island Jewish Medical Center; Jennifer E. Gould, MD, is Program Director and Assistant Professor of Radiology at the Mallinckrodt Institute of Radiology, Washington University; Jason Itri, MD, PhD, is Assistant Professor and Director of Quality and Safety in the Department of Radiology, University of Pittsburgh; Jeanne M. LaBerge, MD, is Professor of Radiology and Director of the VIR Fellowship Program at the University of California, San Francisco, School of Medicine; Lynne Meyer, PhD, MPH, is Executive Director for the Resident Committee of Diagnostic Radiology at the Accreditation Council for Graduate Medical Education; Duane G. Mezwa, MD, is Chair of Diagnostic Radiology and Molecular Imaging at the Oakland University-William Beaumont School of Medicine; Richard L. Morin, PhD, is Brooks-Hollern Professor in the Department of Radiology at the Mayo School of Graduate Medical Education; Steven P. Nestler, PhD, is Senior Consultant in the Education Department at the Accreditation Council for Graduate Medical Education; and Robert Zimmerman, MD, is Vice Chair for Education and Professor of Radiology at Weill Cornell Medical College.

Trial telemedicine system for supporting medical students on elective in the developing world.

RATIONALE AND OBJECTIVES The authors sought to create a simple, versatile, and effective store-and-forward telemedicine system to facilitate consultation between medical students pursuing elective study at remote locations in the developing world and specialists at the central institution. MATERIALS AND METHODS A trial telemedicine system was established between Gizo Hospital (Gizo, Solomon Islands) and Emory University Hospital (Atlanta, Ga). At Gizo Hospital, the system consisted of a commercially available digital camera and a locally available personal computer with a modem providing low-bandwidth (dial-up) Internet access. A visiting British medical student at Gizo Hospital used this equipment to relay digital photographs of patients, as well as the results of relevant tests, such as electrocardiograms, radiographs, and ultrasound images, to Emory University Hospital via the Internet for review by a specialist. RESULTS The medical student, who had received minimal training (approximately 1 hour) in the use of this telemedicine system, used it successfully to perform eight referrals during the elective course period. Following the students return home, his local preceptors at Gizo Hospital and a physician at Helena Goldie Hospital on New Georgia Island used the same system for more than 60 additional referrals. CONCLUSION The telemedicine system is a low-cost, robust, and sustainable means of providing expert support to medical students and other health care providers in remote locations.

Impact and costs of targeted recruitment of minorities to the National Lung Screening Trial

Background To promote results in the National Lung Screening Trial (NLST) that are generalizable across the entire US population, a subset of NLST sites developed dedicated strategies for minority recruitment. Purpose To report the effects of targeted strategies on the accrual of underrepresented groups, to describe participant characteristics, and to estimate the costs of targeted enrollment. Methods The 2002–2004 Tobacco Use Supplement was used to estimate eligible proportions of racial and ethnic categories. Strategic planning included meetings/conferences with key stakeholders and minority organizations. Potential institutions were selected based upon regional racial/ethnic diversity and proven success in recruitment of underrepresented groups. Seven institutions submitted targeted recruitment strategies with budgets. Accrual by racial/ethnic category was tracked for each institution. Cost estimates were based on itemized receipts for minority strategies relative to minority accrual. Results Of 18,842 participants enrolled, 1576 (8.4%) were minority participants. The seven institutions with targeted recruitment strategies accounted for 1223 (77.6%) of all minority participants enrolled. While there was a significant increase in the rate of minority accrual pre-implementation to post-implementation for the institutions with targeted recruitment (9.3% vs. 15.2%, p < 0.0001), there was no significant difference for the institutions without (3.5% vs. 3.8%, p = 0.46). Minority enrollees at the seven institutions tended to have less than a high school education, be economically disadvantaged, and were more often uninsured. These socio-demographic differences persisted at the seven institutions even after adjusting for race and ethnicity. The success of different strategies varied by institution, and no one strategy was successful across all institutions. Costs for implementation were also highly variable, ranging from

Journal publications in radiologic education: a review of the literature, 1987-1997.

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Comparison of the effect of low- and iso-osmolar contrast agents on heart rate during chest CT angiography: Results of a prospective randomized multicenter study

749 per minority enrollee. Limitations Data on minority recruitment processes were not consistently kept at the individual institutions. In addition, participant responses via newspaper advertisements and the efforts of minority staff hired by the institutions could not be coded on Case Report Forms. Conclusions Strategic efforts were associated with significant increases in minority enrollment. The greatest successes require that a priori goals be established based on eligible racial/ethnic proportions; the historical performance of sites in minority accrual should factor into the selection of sites; recruitment planning must begin well in advance of trial launch; and there must be endorsement by prominent representatives of the racial groups of interest.

Practice Analysis: A Basis for Content Validity for American Board of Radiology Examinations in Diagnostic Radiology

RATIONALE AND OBJECTIVES This study was designed to analyze articles on radiologic education quantitatively and qualitatively, comparing those published in 1987-1997 with those published in 1966-1986. MATERIALS AND METHODS An initial literature search used four major databases to identify and retrieve articles related to radiologic education. Additional articles were identified through manual cross-checking of references from the original articles. All articles were reviewed by two radiologists as to type of article (editorial, expository, survey, correlational, or experimental, including preexperimental, quasi-experimental, or true experimental), statistics used (inferential or descriptive), educational emphasis (medical student, resident, postgraduate, or other), and topic of article (philosophical or political, technology, program evaluation, program description, examinations, or career decisions). Interrater agreement was estimated by means of the kappa statistic. A chi2 test for independence was used to assess whether the relative distribution of articles was similar for the two periods. RESULTS More articles per year were published in 1987-1997 (n = 12.6, P < .01) compared with 1966-1986 (n = 9.2). Articles pertinent to radiologic resident education predominated (50.7% vs 29.9% in the prior study, P < .01). In both periods, most articles were expository (37.7% vs 49.5%), and the most common topic was program description (34% vs 35%). Editorials decreased from 35.5% to 18.1%. Experimental studies accounted for 12.3%, increased from 8.7%. The fastest-growing topic of study was technology (30.4% vs 17.5%, P < .01). CONCLUSION The increased number of articles addressing radiologic education is encouraging. Although the percentage of experimental studies increased slightly in this period, there is still little empirical research in radiologic education.

The Milestones Really Do Add Value

PURPOSE To prospectively compare the effect of intravenous injection of low-osmolar iopamidol with that of intravenous injection of iso-osmolar iodixanol on heart rate (HR) during nongated chest computed tomographic (CT) angiography. MATERIALS AND METHODS This multicenter study was approved by local institutional review boards, and patients provided written informed consent. Patient enrollment and examination at centers in the United States complied with HIPAA regulations. One hundred and thirty patients (54 male; mean age, 52 years) clinically suspected of having pulmonary embolism were referred for pulmonary CT angiography and were randomly assigned to receive 80 mL of either iopamidol (370 mg of iodine per milliliter, n = 63) or iodixanol (320 mg of iodine per milliliter, n = 67) at a rate of 4 mL/sec. HR (measured in beats per minute) was monitored from 5 minutes before the start of injection to the end of imaging, and precontrast HR and maximum postcontrast HR were recorded. Student t and χ(2) tests were used for continuous and categorical variables, respectively. RESULTS Precontrast HR in patients who received iopamidol (mean, 81 beats per minute ± 18 [standard deviation]) was similar to that in patients who received iodixanol (mean, 77 beats per minute ± 17) (P = .16). Mean postcontrast HR was 87 beats per minute ± 17 and 82 beats per minute ± 18 (P = .16) in the iopamidol and iodixanol groups, respectively. Mean increase from precontrast HR to postcontrast HR was 5 beats per minute ± 9 and 5 beats per minute ± 7 (P = .72) in the iopamidol and iodixanol groups, respectively. Thirty-five (56%) of the 63 patients who received iopamidol and 33 (49%) of the 67 patients who received iodixanol had an HR increase of fewer than 5 beats per minute, 15 (24%) and 18 (27%) patients, respectively, had an increase of 5-9 beats per minute, and four (6%) and three (4%) patients, respectively, had an increase of more than 20 beats per minute. These proportions were not significantly different between the groups (P = .51, χ(2) test). CONCLUSION High-rate intravenous administration of 80 mL of iopamidol and iodixanol during pulmonary CT angiography slightly increased HR; there was no difference in HR between the contrast agent groups.

Educational Milestone Development in the First 7 Specialties to Enter the Next Accreditation System

The ABR performs practice analysis every 3 years, according to its strategic plan, in an effort to strengthen the content validity of its qualifying and certifying examinations as well as its maintenance of certification examinations. A nationwide survey of diagnostic radiologists was conducted in July 2010 for the purpose of determining the critically important and frequently performed activities in 12 clinical categories. The survey instrument was distributed electronically to 17,721 members of the ACR, with a unique identification code for each individual. A 5-point scale was established for both frequency and importance variables. The frequency scale ranged from 1 to 5 as follows: 1 = not applicable, 2 = occasionally, 3 = monthly, 4 = weekly, and 5 = daily. The scale for importance also ranged from 1 to 5: 1 = not applicable, 2 = not important, 3 = somewhat important, 4 = important, and 5 = essential. A total of 2,909 diagnostic radiologists (19.32%) participated. Of these, 2,233 (76.76%) indicated that they spent ≥50% of their time in clinical practice. Because of its brevity of the list of the activities, results for the gastrointestinal category are presented in this article. The list of activities weighted according to importance and frequency is presented in this article and, as illustrated, could become the foundation for developing a more detailed blueprint for the gastrointestinal category certifying examinations in diagnostic radiology. Findings on demographic information are also presented.

Career advancement of men and women in academic radiology: Is the playing field level?

The milestones process required programs to create a clinical competency committee and to develop new, more focused, and innovative evaluation methods.