Tracy J. Robinson

Implementation of the ACR Dose Index Registry at a Large Academic Institution: Early Experience

A rising conciousness within both the medical community and in the public has been created by the current levels of radiation exposure from increased use of computed tomography. The concern has prompted the need for more data collection and analysis of hospital and imaging center exam doses. This has spurred the American College of Radiology (ACR) to develop the Dose Index Registry (DIR), which will allow participating insitutions to compare the radiation dose from their CT exams to aggregate national CT dose data based on exam type and body part. We outline the steps involved in the process of enrolling in the DIR, the technical requirements, the challenges we encountered, and our solutions to those challenges. A sample of the quaterly report released by the ACR is presented and discussed. Enrolling in the ACR dose registry is a team effort with participation from IT, a site physicist, and a site radiologist. Participation in this registry is a great starting point to initiate a QA process for monitoring CT dose if none has been established at an institution. The ACR has developed an excellent platform for gathering, analyzing, and reporting CT dose data. Even so, each insititutions will have its own unique issues in joining the project.

Comprehensive Imaging Review of Abnormalities of the Umbilical Cord

A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making.

Imaging evaluation of maternal complications associated with repeat cesarean deliveries.

The rate of cesarean deliveries continues to rise, while the rate of vaginal delivery after cesarean birth continues to decline. Many women now tend to undergo multiple cesarean deliveries, and therefore the associated chronic maternal morbidities are of growing concern. Accurate diagnosis of these conditions is crucial in maternal and fetal well-being. Many of these complications are diagnosed by imaging, and radiologists should be aware of the type and imaging appearances of these conditions.

Comprehensive Imaging Review of Abnormalities of the Placenta.

Abstract The placenta has a fundamental role in fetal health and functions as an important bridge to normal fetal development throughout pregnancy. A complete fetal ultrasound (US) survey should include full assessment of the placenta for any possible abnormalities. Placental diseases range from abnormal morphology, size, location, extent, and degree of placentation, to abruption and the presence of rare placental neoplasms of benign or malignant nature. Some of these conditions are associated with other diseases including aneuploidies, and their discovery should alert the radiologist to perform a very thorough fetal US examination. At times, a fetal karyotype may be needed to provide additional information. Timely detection of placental abnormalities can alert the clinician regarding the need to make important management decisions to reduce fetal and maternal morbidity and mortality. Familiarity with the normal and abnormal imaging appearance of the placenta is therefore necessary for the radiologist. Ultrasound with Doppler is the initial imaging modality of choice for placental assessment. Magnetic resonance imaging serves as a problem-solving examination in instances where the US findings are equivocal or where additional information is needed. Computed tomography has a limited role in the evaluation of placental disease because of its relatively limited tissue characterization and in particular because of the resultant direct radiation exposure of the fetus. However, in specific instances, particularly after trauma, computed tomography can provide invaluable information for patient management.

Computed Tomography Angiography for Preoperative Thoracoabdominal Flap Planning

Mastectomy rates have increased, coinciding with more advanced reconstruction options. Deep inferior epigastric perforator (DIEP) flaps decrease abdominal donor site morbidity, but require considerable technical expertise. Preoperative computed tomography angiography (CTA) can accurately demonstrate DIEA anatomy and perforator courses, facilitating preoperative planning and flap design, allowing for more targeted intraoperative microdissection. Patients who undergo CTA before DIEP flap have better clinical outcomes with shorter operative times and hospital length of stay, which can decrease overall associated health care costs. Future directions include selected imaging of the thoracic anatomy and recipient vasculature, allowing for additional preoperative planning and customization.

Academic Portfolio in the Digital Era: Organizing and Maintaining a Portfolio Using Reference Managers

The academic portfolio has become an integral part of the promotions process. Creating and maintaining an academic portfolio in paper-based or web-based formats can be a cumbersome and time-consuming task. In this article, we describe an alternative way to efficiently organize an academic portfolio using a reference manager software, and discuss some of the afforded advantages. The reference manager software Papers (Mekentosj, Amsterdam, The Netherlands) was used to create an academic portfolio. The article outlines the key steps in creating and maintaining a digital academic portfolio. Using reference manager software (Papers), we created an academic portfolio that allows the user to digitally organize clinical, teaching, and research accomplishments in an indexed library enabling efficient updating, rapid retrieval, and easy sharing. To our knowledge, this is the first digital portfolio of its kind.

Sharing a Collection of Radiology Educational Websites as Bookmarks Among Radiologists

a m r t a q c DESCRIPTION OF THE PROBLEM With the explosion of online medical education material, in particular radiology education websites, the majority of medical students and trainees now prefer Googling radiology educational topics for their basic education and quick consults over conventional textbooks [1-5]. Web-based learning is attractive for a variety of reasons: It is widely available, inexpensive, and easily accessible from desktop computers, laptops, and portable devices such as smart phones and tablet computers. This dramatic shift in the learning paradigm is a challenge because the quality of information available at these websites is immensely variable. In a recent survey [2], it was found that 42% of radiologists use the Internet at least once a day and that 97% of radiologists use the Internet for education. Also striking was that 84% of survey respondents reported increasing their use of the Internet for gathering radiology information significantly in the past 3 years. Online resources include teaching files, case collections, web-based lectures, training modules, openaccess electronic journals, traditional journals with online content, and podcasts. With the overwhelming amount of educational content available on the Internet, it is difficult for trainees and practitioners to ascertain which websites have current and trustworthy information. Valuable time may be wasted before this information is reliably obtained [3,6]. Although recent

Challenges to Protocol Optimization Due to Unexpected Variation of CT Contrast Dose Amount and Flow

High-quality computed tomography (CT) exams are critical to maximizing radiologist’s interpretive ability. Exam quality in part depends on proper contrast administration. We examined injector data from consecutive abdominal and pelvic CT exams to analyze variation in contrast administration. Discrepancies between intended IV contrast dose and flow rate with the actual administered contrast dose and measured flow rate were common. In particular, delivered contrast dose discrepancies of at least 10% occurred in 13% of exams while discrepancies in flow rate of at least 10% occurred in 42% of exams. Injector logs are useful for assessing and tracking this type of variability which may confound contrast administration optimization and standardization efforts.

Subperitoneal extension of disease processes between the chest, abdomen, and the pelvis

The subserous space is a large, anatomically continuous potential space that interconnects the chest, abdomen, and pelvis. The subserous space is formed from areolar and adipose tissue, and contains branches of the vascular, lymphatic, and nervous systems. As such, it provides one large continuous space in which many disease processes can spread between the chest, abdomen, and the pelvis.