Michele Retrouvey

Radiology's Emerging Role in 3-D Printing Applications in Health Care.

From its inception as a tool for prototype development in the early 1980s, three-dimensional (3-D) printing has made inroads into almost every sector of industry, including health care. Medical applications range from extra- and intracorporeal orthopedic devices to complex, temporal reconstructions of patient-specific anatomy that allow operative planning and education. In the contemporary climate of personalized medicine, the utility of tangible 3-D models extrapolated directly from patient imaging data seems boundless. The purpose of this review is to briefly outline the development of 3-D printing, discuss its applications across the many medical and surgical specialties, and attempt to address obstacles and opportunities facing radiology as this technology continues to be integrated into patient care.

Gianotti–Crosti Syndrome After Childhood Vaccination

Abstract:  A 19‐month‐old boy was evaluated for a skin eruption after recent vaccinations. Clinical and histopathologic findings supported a diagnosis of Gianotti–Crosti syndrome (GCS). This case report examines the link between GCS and vaccinations, particularly the diphtheria, tetanus, and pertussis vaccine and the varicella virus live vaccine.

Frequency and clinical relevance of PET/CT incidentalomas

Rationale and objectivesTo assess the frequency of clinically significant incidental CT findings on PET/CT.Materials and methodsReports of 345 cases of baseline standard skull base to thighs PET/CT exams done over the course of a 6 month period at an outpatient facility affiliated with a large tertiary care level 1 trauma medical center were retrospectively reviewed. Incidental CT findings were assigned a level of clinical significance on a scale of 1–5, from doubtful significance to very significant. CT findings already known from prior CT reports were not included. CT findings corresponding to PET findings were also excluded. A score of 3 or greater was considered significant and reportable.ResultsOut of 345 cases, 171 (50%) had a least one CT finding rated at or above a score of 3 on our scale of significance, while 96 (28%) were found to have at least one CT finding with score at or above 4, and 25 cases (7%) showed at least one CT finding rated 5.ConclusionA substantial percentage of baseline PET/CT studies contain previously undiagnosed, significant incidental findings on the CT images.

Structured Reporting in Radiology

Radiology reports are vital for patient care as referring physicians depend upon them for deciding appropriate patient management. Traditional narrative reports are associated with excessive variability in the language, length, and style, which can minimize report clarity and make it difficult for referring clinicians to identify key information needed for patient care. Structured reporting has been advocated as a potential solution for improving the quality of radiology reports. The Association of University Radiologists-Radiology Research Alliance Structured Reporting Task Force convened to explore the current and future role of structured reporting in radiology and summarized its finding in this article. We review the advantages and disadvantages of structured radiology reports and discuss the current prevailing sentiments among radiologists regarding structured reports. We also discuss the obstacles to the use of structured reports and highlight ways to overcome some of those challenges. We also discuss the future directions in radiology reporting in the era of personalized medicine.

US Preventive Services Task Force CT Lung Cancer Screening Recommendations: Community Awareness and Perceptions

A BRIEF DESCRIPTION OF THE PROBLEM OR CHALLENGE Although lung cancer is the third most common type of cancer diagnosed, it remains the leading cause of death from cancer in the United States for both men and women [1]. The average 5-year survival rate is low, hovering under 20%. However, the survival rate is considerably higher (approximately 50%) when lung cancer is diagnosed early, while the tumor remains localized. Yet currently, the large majority of lung cancer patients are diagnosed with more extensive disease [2]. Given the well-known risk factors for lung cancer and its better prognosis when caught early, targeting high-risk individuals for screening is important. Research has shown a significant decrease in morbidity and mortality secondary to CT lung cancer screening [3]. Hence, the US Preventive Services Task Force favors recommending low-dose CT lung cancer screening of high-risk adults [4]. The ACR supports this recommendation for screening of adults aged 55 to 80 years who have a 30 pack-year smoking history and either currently smoke orhave quit smoking within the past 15 years. The prevalence of individuals that would benefit from this new screening test in urban, low-socioeconomic environments was thought to be high. An awareness campaign was devised by radiology residents to inform the local population about this new screening tool, to gauge community members’ reactions to the

Radiologic Knowledge and Ordering Habits of Clinical Residents: ACR Appropriateness Criteria Awareness and Perceptions.

anefforttoinformorderingphysicians on various imaging studies and their indications according to the ACR Appropriateness Criteria, we developed a short presentation that highlights some of the most commonly used studies. We also used a questionnairetodetermine the importance of imaging studies in these residents’ practice of medicine, their levels of comfort with ordering these studies, their perceptions of the amount of education they receive in radiology during their training, and their perceived need for more education to help them adequately select radiologic studies for their patients. WHAT WAS DONE A radiology resident at a large, urban, medical school-affiliated hospital devised a 45-min educational session preceded and followed by a short questionnaire (see Additional Resources) to assess participants’ knowledge of imaging tests and their indications to test the effectiveness of the intervention. The course was presented to 83 residents in the departments of internal medicine, family medicine, psychiatry, and emergency medicine. Figure 1 shows residents’ postgraduate years. The pretest consisted of three sections. The first part addressed the participants’ awareness of the ACR Appropriateness Criteria and their usefulness in clinical practice. The second part of the pretest assessed clinicians’ knowledge of basic radiology, including correct indications and contraindications of select imaging studies and contrast agent selection. The final portion of the pretest addressed participants’ opinions about the importance of radiology in their clinical practice, their comfort levels when ordering imaging studies, their perceptions of the amount of education they receive during their training, and their thoughts on integrating more radiology education. The posttest was administered afterthesessionandaskedparticipantsif they were now more likely to consult

Tumor track seeding: A new complication of fiducial marker insertion.

In the United States, lung cancer is the leading cause of cancer-related death. Candidates for tumor ablation using CyberKnife® require fiducial placement in or near the target tumor to achieve precision. Placing these reference points may lead to complications including pneumothorax and/or hemorrhage. We report a new complication: the appearance of metastatic foci along the track of the fiducial marker. Since the marker was inserted by traversing the original primary tumor, we hypothesize that malignant cells were seeded along the track. In light of this new complication, current techniques for the insertion of fiducial markers should consider a peripheral approach when possible to avoid tracking of malignant cells.

A Resident- and Fellow-Driven Review Course to Prepare Trainees for the ABR Core Examination

DESCRIPTION OF THE PROBLEM With the changing of the board examinations from an oral format to a multiple-choice format, residents have adapted the way they study in response to the imperatives of the new examination. Residents must now understand how to read and interpret the subtleties of the question stems and answers, requiring test-taking skills not emphasized in an oral examination. Furthermore, residents have stated that they learn better from cases than from didactic lectures [1]. Therefore, although they remain popular [2], traditional didactic board reviews seem to no longer fit with the needs of today’s residents. The Virginia Chapter, ACR Resident and Fellow Section (VA ACR RFS), with the financial support of the Virginia state chapter, sought to change the style and content of the review course by implementing an interactive review course that is better suited to both today’s examination and modern learners, who must master the art of answering multiple-choice questions. The goal was to actively engage learners by immersing them in the examination format: fast-paced, casebased questions with multiple-choice answers that would allow residents to

JOURNAL CLUB: Redefining the Radiology Curriculum in Medical School: Vertical Integration and Global Accessibility

OBJECTIVE Radiology interconnects medical disciplines given that a working understanding of imaging is essential to clinicians of every specialty. Using online education, we created a globally accessible, web-based undergraduate medical radiology curriculum modeled after the National Medical Student Curriculum in Radiology program of the Alliance of Medical Student Educators in Radiology. SUBJECTS AND METHODS Seventy-four radiology faculty-mentored video modules were produced, 50 of which were integrated into the 1st-year anatomy course. We administered tests to medical students before and after students saw the videos to assess the effectiveness of the modules. We surveyed students on their interests in pursuing radiology as a career before and after participating in this curriculum. RESULTS On the preexamination questions, the mean score was 58.0%, which increased to 83.6% on the pair-matched imaging-related questions on the actual examination. Before participating in the new curriculum, 88% of students did not express an interest in radiology, and 9% were undecided about radiology as a future career. There was an increase in students who reported that they would definitely or most likely pursue a career in radiology (7%) after they had viewed the lectures. CONCLUSION Radiology education is now available to a greater number of multidisciplinary learners worldwide. This project produced a comprehensive, globally accessible radiology curriculum in a self-paced, flexible learning format for new generations of physicians.

Simultaneous duodenal stenosis and duodenal web in a newborn

Failure of duodenal recanalization results in a spectrum of proximal bowel obstruction from stenosis to atresia. Associations between congenital duodenal obstruction and other congenital anomalies have been well documented although the coincidence of duodenal stenosis and duodenal web is incredibly rare, posing a unique diagnostic challenge. We report a case of a full-term 4-day-old female child presented with forceful, bilious emesis and poor oral intake with decreased frequency of urination, and stooling whose initial abdominal radiograph showed several loops of gas-filled bowel in the distal stomach and proximal duodenum mimicking the classic “double-bubble” sign. An upper gastrointestinal barium contrast study revealed distention of the duodenal bulb with an abrupt narrowing and subsequent dilation at the second portion of the duodenum raising the suggestion of multiple duodenal obstructions. Ladd’s procedure was performed, and the stenotic and webbed segments were bypassed with a Kimura diamond-shaped duodenoduodenostomy.