Decoding Program Signals: A Radiology Residency Program's Experience With the ERAS Supplemental Application.

The ERAS supplemental application has had a profound impact on the interview selection process. At our institution, we found the information in the supplemental application, particularly program signals, especially useful when inviting applicants for interviews. Applicant data was reviewed from this application cycle and the previous cycle and was subcategorized according to various demographic variables. Our analysis revealed that we were able to invite more geographically diverse candidates compared to last year. Program signaling was also beneficial for applicants in demonstrating interest in our program. 47% of interview offers were sent to those who had signaled, despite only 5% of total applications containing a program signal to our institution. Overall, we viewed the supplemental application favorably and reaffirmed its value in the interview selection process.

Scheduling Musculoskeletal MRI for Patients With Metallic Hardware: Initial Observations on Decreasing Nondiagnostic and Repeat Examinations at a Multisite Academic Medical Center.

OBJECTIVE: As healthcare delivery systems expand to include multiple imaging centers, the process of scheduling patients at the site which best meets their needs continues to become more complex. This quality improvement study aims to create a protocol for patients with metallic hardware at sites with metallic artifact reduction sequences (MARS), increasing the proportion of exams that are diagnostic and reducing the need for repeat imaging. MATERIALS AND METHODS: The study population included 322 patients with metallic hardware receiving an MRI at a large multisite healthcare system, divided into a pre-intervention and postintervention cohort. A retrospective PACS query was performed using several keywords in musculoskeletal MRI reports indicating the presence of metallic hardware. This cohort was studied to better understand the existing system failures. An intervention was then implemented by meeting with the departmental RIS and scheduling teams to discuss workflow when scheduling exams for patients with metallic hardware System changes were implemented and results were again studied retrospectively. RESULTS: Before protocol implementation, 134/244 (55%) of exams were performed at sites with metallic artifact reduction sequences which improved to 54 of 78 (69%) in the postintervention cohort (P = 0.02). Additionally, the number of exams performed on 3T MRI machines pre-intervention was 14 of 244 (5.7%) compared to 1 of 78 (1.2%) postintervention (P = 0.13). The rate of nondiagnostic exams in the preintervention cohort was significantly higher at 41 of 244 (16.8%) when compared to the postintervention cohort at 4 of 78 (5.1% P = 0.01). CONCLUSIONS: The implementation of this quality improvement protocol reduced the rate of nondiagnostic MSK MRI exams and reduced the inappropriate use of 3T scanners, ultimately saving time and cost for both patients and the health care system.

Enhancing the value of radiology reports: a primer for residents.

PURPOSE: The radiology report is the primary work product of the diagnostic radiologist. Its quality is a direct reflection of his or her knowledge, experience, and confidence. Certain factors hindering one's ability to deliver a diagnostically accurate and concise report are sometimes unavoidable (e.g., study limitations and insufficient history); however, radiologists who routinely produce deficient reports not only erode their credibility and reputation amongst colleagues, they magnify their risk of litigation. METHODS: This article is directed toward radiology residents to help facilitate the adoption of effective reporting habits. RESULTS AND CONCLUSION: Up to 92% of referring physicians and 95% of radiologists agree that learning to report should be an "obligatory and well-structured" component of radiology residency education as discussed by Bosmans JM, Weyler JJ, De Schepper AM, and Parizel PM. Unfortunately, this remains the exception rather than the rule. This article is written with the following objectives: (1) to identify strategies that improve the value of radiology reporting, (2) to define the features of a high-quality radiology report, (3) to instill trust and respect from referring clinicians through clear, accurate, and effective communication, and (4) to understand and avoid potential medicolegal ramifications of deficient radiology reports.

Omission of Planning CT Reduces Patient Radiation Exposure during CT-Guided Bone Marrow Biopsy and Aspiration.

The purpose of this study is to evaluate the impact of eliminating a preprocedural planning computed tomography during CT-guided bone marrow biopsy on the technical aspects of the procedure, including patient dose, sample quality, procedure time, and CT fluoroscopy usage. Retrospective analysis of 109 patients between 1 June 2018 and 1 January 2021 was performed. Patients were grouped based on whether they received a planning CT scan. Relative radiation exposure was measured using dose-length product (DLP). Secondary metrics included number of CT fluoroscopic acquisitions until target localization, total number of CT fluoroscopic acquisitions, biopsy diagnostic yield, and procedure time. A total of 43 bone marrow biopsies with planning CT scans (Group 1) and 66 bone marrow biopsies without planning CT scans (Group 2) were performed. The average total DLP for Group 1 and Group 2 was 268.73 mGy*cm and 50.92 mGy*cm, respectively. The mean radiation dose reduction between the groups was 81% (p < 0.0001). Significantly more CT fluoroscopy acquisitions were needed for needle localization in Group 2 than Group 1 (p < 0.0001). Total number of CT fluoroscopy acquisitions was four for Group 1 and eight for Group 2 (p = 0.0002). There was no significant difference between the groups in procedure time or diagnostic yield. Patients without a planning CT scan received more fluoroscopic CT acquisitions but overall were exposed to significantly less radiation without an increase in procedure time.

Imaging features of hypercalcemia: A primer for emergency radiologists.

Hypercalcemia is a marker for a wide variety of underlying etiologies, and its presentation in the emergency setting may be asymptomatic, incidental, or a primary complaint with associated symptoms and physical exam findings. While the workup is initially driven through serum laboratory testing, imaging plays an important role in diagnosis and post-treatment follow up. This review covers multiple common and uncommon etiologies of hypercalcemia, details their underlying mechanisms, and identifies the most important associated imaging findings. It is important for radiologists to be familiar with these etiologies and imaging findings, particularly in the emergency setting since hypercalcemia may represent the only significant laboratory abnormality associated with the presenting condition. Furthermore, the radiologist's interpretation of a study may be directly influenced by knowing about a patient's hypercalcemia.

Synchronous osseous metastasis, degenerative changes, and incidental multifocal Paget's disease in a case of newly diagnosed prostatic carcinoma.

Tc-99m methylene diphosphonate bone scintigraphy (bone scan) is a highly sensitive technique for the evaluation of osseous pathology. However, the nonspecificity of the method can present diagnostic challenges in differentiating benign from malignant processes. Often, Paget's disease and osseous metastasis can coexist in elderly patients. Therefore, it is important to accurately distinguish the two pathologies, as each has a different prognosis and impacts clinical management. Obtaining the appropriate clinical diagnosis often involves a combination of laboratory, radiographic, and clinical data. We present a case of newly diagnosed prostatic carcinoma presenting with synchronous osseous metastasis, degenerative changes, and incidental multifocal Paget's disease.

Gastric Lipoma: A Review of the Literature.

Gastric lipoma is a rare benign tumor of the stomach. The imaging characteristics are diagnostic because the lesion has fat attenuation on computed tomography and demonstrates characteristics of fat on magnetic resonance images. On ultrasound, the lesion can be identified as a lesion hypoechoic to the gastric mucosa that is soft, but the mass cannot be displaced with compression. Identifying these imaging characteristics can prevent biopsy or surgery in asymptomatic patients. Although this lesion is benign, it can cause gastric obstruction.