Neitzschman Hr

Key Component of Resident Selection

Each year, clinical radiology departments around the country are called on to select the best candidates from a pool of applicants for residency, all of whom are medical school graduates with good to outstanding test scores and glowing recommendations. However, a review of the literature clearly reveals that although a great deal has been written about selection processes, no single procedure or combination of procedures has proved effective for predicting which candidates will become competent physicians. Last year we decided to reevaluate the interview process used at Tulane University Medical Center, for two reasons. First, our experience during the previous 2 years suggested that the interview process was very subjective. Each interviewer had his or her own agenda regarding the types of questions asked, the information elicited, and the framework for scoring candidates. Great variability among interviewers in the scoring of candidates had led us to question the reliability and validity of the interview process as a predictive instrument for selecting residents. Second, the minimum competency standards developed by the Accreditation Council for Graduate Medical Education (ACGME) jointly with the American Board of Medical Specialties (1) had redefined what it means to be a physician in the 21st century and had established new benchmarks against which physicians will be measured. Having completed our reevaluation of the selection process, we developed a new interview format and scoring system using the ACGME competency standards as a guide. The ACGME standards define the personal attributes and skills that are necessary for the successful practice of medicine. By redesigning our interview process so as to assess the candidate’s competency in these areas, we believe that we have created a better tool for selecting residents who are more likely to meet the new standards.

Innominate Artery Compression of the Trachea: An Unusual Cause of Apnea in a 12-Year-Old Boy

Innominate artery compression of the trachea is a common cause of airway obstruction in infants and young children. The clinical significance of this lesion, even when compression is documented endoscopically or radiographically, is controversial. Obstructive respiratory symptoms occur in only a fraction of such cases, and symptomatic patients are most commonly detected in the first year of life. We present a case of a 12-year-old boy with a chief complaint of progressive stridor and apnea who was diagnosed with symptomatic innominate artery compression of the trachea. We reviewed the literature regarding the pathology, diagnosis, and treatment of this condition.

Avulsions around the knee portend instability

Bony avulsions about the knee are common injuries seen in the emergency room. Unawareness of characteristic radiographic patterns of injury that herald potential instability and require further workup can result in significant morbidity. We present a radiographic pictoral discussion on bony avulsions and associated soft tissue complex injuries on MRI. Emphasis is on injuries leading to instability, and often surgical management. MRI is a useful imaging tool for screening and surgical planning in this setting of patients.

Splenic papillary angioendothelioma in a 6-year-old girl.

Papillary angioendothelioma is a rare, low-grade neoplasm of lymphatic channels that usually presents intradermally. We report the case of a 6-year-old girl with isolated splenomegaly and symptoms of early satiety and weight loss, whom was found to have a splenic papillary angioendothelioma. Preoperative abdominal computed tomography scan showed an irregular, heterogeneous mass; a tagged red cell scan ruled out a hemangioma, whereas a positron emission tomography scan showed mildly increased uptake. Subsequent surgery and pathologic assessment revealed a papillary angioendothelioma (Dabska tumor) within lymphatic spaces. The child has no evidence of recurrence or metastases 1 year postoperatively.