Marc H. Willis

Laparoscopic sleeve gastrectomy: a guide to postoperative anatomy and complications

Abstract:The purpose of this pictorial essay is to review the surgical technique, postoperative anatomy, and potential complications of the laparoscopic sleeve gastrectomy. As the laparoscopic sleeve gastrectomy becomes an increasingly popular bariatric surgery, it is important for radiologists to familiarize themselves with the procedure and possible complications.

Measurement of ulnar variance from the lateral radiograph: A comparison of techniques

PURPOSE To determine the reliability of measuring ulnar variance on lateral wrist radiographs and to compare this technique with previously described methods. METHODS Ulnar variance was measured in 100 normal wrist radiographs using the methods of perpendiculars, central reference point, and the lateral radiograph by 3 surgeons on 2 occasions. Intraobserver repeatability and agreement between raters and methods were assessed and compared. RESULTS Intra- and interobserver reliability and agreement were both excellent using all 3 methods within a ± 1.0-mm cutoff. However, there was substantial pairwise disagreement in measures of ulnar variance between all 3 methods. CONCLUSIONS This study demonstrates that, for measurement of ulnar variance, the methods of perpendiculars, central reference point, and lateral radiographic measurement each have clinically acceptable intraobserver repeatability and interobserver agreement. Despite their independent reliability, each method of radiographic determination of ulnar variance had considerable disagreement with the other methods, indicative of inherent inaccuracies in the techniques. The lateral radiograph uniquely allows for visualization of the amount of ulnar head protruding proximal or distal to the concave lunate facet and allows for a rapid estimation of pronosupination, which is known to affect ulnar variance. CLINICAL RELEVANCE Determination of ulnar variance can be an important component of surgical decision making in various pathological conditions of the hand and wrist. Traditionally, it has been measured through methods using the posteroanterior wrist radiograph, but there are potential shortcomings with these methods, and use of the lateral radiograph may provide a more clinically relevant picture of ulnar variance. This study shows that measurement from the lateral radiograph provides similar reliability to previously accepted techniques.

Clinically Oriented Three-Year Medical Physics Curriculum: A New Design for the Future

OBJECTIVE Medical physics instruction for diagnostic radiology residency at our institution has been redesigned with an interactive and image-based approach that encourages clinical application. The new medical physics curriculum spans the first 3 years of radiology residency and is integrated with the core didactic curriculum. CONCLUSION Salient features include clinical medical physics conferences, fundamentals of medical physics lectures, practicums, online modules, journal club, and a final review before the American Board of Radiology core examination.

Clinical Decision Support at the Point-of-Order Entry: An Education Simulation Pilot with Medical Students

RATIONALE AND OBJECTIVES We have been called to reform radiology undergraduate medical education (UME) curricula. Clinically available clinical decision support provides an opportunity to improve education regarding appropriate imaging utilization, patient safety, and cost-effective care. MATERIAL AND METHODS We created an education simulation portal utilizing integrated clinical decision support. The portal was then piloted with 34 volunteer medical students at our institution in a blended learning environment. A program assessment was performed utilizing the results from a qualitative survey, pre-test, and post-test. RESULTS The large majority of medical students felt this supplemental education resource should be included in our UME curriculum (85.29%). All students perceived value in the education simulation portal. The students performed significantly better on the post-test in multiple categories (overall P <.0001), including Choosing Wisely topics (P = .0207). CONCLUSIONS Based on our program assessment from this pilot program, we believe this innovative educational resource has significant potential to fill curricular gaps in radiology UME curricula. This platform is scalable and can be further customized to fill needs across the continuum of medical education.

An Asynchronous Online Collaboration Between Radiologists and Patients: Harnessing the Power of Informatics to Design the Ideal Patient Portal

INTRODUCTION Patient portals (also known as patient health records) are now offered both by large health systems and by small private practices [1]. They enable patients to schedule appointments, email providers, access test results, and even download their entire medical histories. However, few offer direct access to medical images or direct communication with radiologists. If you had to design the ideal patient portal that also included access to diagnostic imaging, how would you determine what features it would need to support? Would you (1) consult PACS engineers to identify relevant technical specifications and challenges, (2) convene an expert panel to discuss features that would maximize the dissemination of information and minimize interruptions to radiologists, or (3) connect radiologists, patients, and referring physicians from around the country and ask what would be most useful to them? The role of the radiologist in patient care has evolved over the past decade [2]. One of the tenets of the Imaging 3.0 framework, championed by the ACR, is the involvement of a radiologist in every step of a patient’s imaging-related care: before, during,

Optimizing Performance by Preventing Disruptive Behavior in Radiology

Disruptive behaviors impede delivery of high-value health care by negatively impacting patient outcomes and increasing costs. Health care is brimming with potential triggers of disruptive behavior. Given omnipresent environmental and cultural factors such as constrained resources, stressful environments, commercialization, fatigue, unrealistic expectation of perfectionism, and burdensome documentation, a burnout epidemic is raging, and medical providers are understandably at tremendous risk to succumb and manifest these unprofessional behaviors. Each medical specialty has its own unique challenges. Radiology is not exempt; these issues do not respect specialty or professional boundaries. Unfortunately, preventive measures are too frequently overlooked, provider support programs rarely exist, and often organizations either tolerate or ineffectively manage the downstream disruptive behaviors. This review summarizes the background, key definitions, contributing factors, impact, prevention, and management of disruptive behavior. Every member of the health care team can gain from an improved understanding and awareness of the contributing factors and preventive measures. Application of these principles can foster a just culture of understanding, trust, support, respect, and teamwork balanced with accountability. The authors discuss these general topics along with specific issues for radiologists in the current medical environment. Patients, providers, health care organizations, and society all stand to benefit from better prevention of these behaviors. There is a strong moral, ethical, and business case to address this issue head-on. ©RSNA, 2018.

How Do We Teach High-Value Radiology?

Purpose of ReviewThe healthcare environment is under tremendous flux and the rate of change is continuously increasing. Calls have been made and efforts are underway to transform medical education. In this article, trends, key drivers, and resources for both global medical education and some specific to radiology are discussed.Recent FindingsGreat strides have been made to begin shifting focus towards high-value healthcare delivery through both non-traditional methods and innovation. We are not alone in this journey; resources are readily offered by instrumental key drivers of medical education with collaboration and sharing as valuable tools at our disposal.SummaryDespite initial progress, barriers persist to achieving meaningful and sustainable changes in medical education. We must commit our resources and empower our current and future medical providers to lead the way in providing high-value healthcare for our patients. An awareness of trends and driving forces in healthcare and medical education is necessary for radiologists to be relevant and vital contributors to the healthcare team.

Carpe Diem: Population Health

The current focus on quality in medicine began with the release of To Err Is Human: Building a Safer Health System by the US Institute of Medicine in 1999 [1]. Contemporaneously, since the Deficit Reduction Act of 2005, multiple governmental programs and legislation have been implemented with the aim of bending the curve of rising cost, driving value into the system, and increasing accessibility to health care [2]. During this era, many threats to radiology have been well chronicled [3,4]. Our professional future depends on our ability to unite and build a culture willing to seek and embrace new roles in a patient-centered environment. Population health is a strategic opportunity for radiology, and a key contribution to the development of this philosophy was Why Are Some People Healthy and Others Not? The Determinants of Health of Populations by Evans et al [5]. The concept has been gaining momentum over the past decade, with a focus on health outcomes as the guiding principle. The ultimate goal is improving the health of an entire population [6]. We can ensure strategic alignment with the population health movement by customizing our product, more clearly defining our role in health care, and improving customer awareness. The health care landscape is changing; in a value-based system of care, payments will likely be disbursed through a shared savings model, with possible capitation [2]. Wemust be well prepared if radiology changes from a profit center to a cost center within the evolving health care enterprise. Population health is an opportunity to customize our product. We should not passively wait for legislative or payer mandates to modify our behavior. To establish ourselves as leaders shaping America’s health care system [7], we must be proactive. We can start by identifying innovative changes that can be readily