Injury incidence and patterns associated with electric scooter accidents in a major metropolitan city.

PURPOSE: Despite increased use of e-scooters globally, actionable data around injury incidence and patterns associated with e-scooter accidents are limited. This study aimed to determine the prevalence of imaging exams, injury incidence, and patterns related to e-scooter injuries, with the hope of guiding an appropriate policy response. METHODS: This was a retrospective observational study of imaging exams ordered for injuries related to e-scooters seen in an Emergency Department (ED) setting within our health system from September 2018 through December 2019. Our institutional Radiology Information System (RIS) was searched for the presence of the word "scooter." Manual query of search results was conducted in the electronic medical record (EMR) and only studies confirmed to be related to e-scooters were included. RESULTS: A total of 477 radiologic studies performed on 192 unique patients were confirmed to be performed for injuries related to e-scooters. The median patient age was 28 years and 58.3% were male. One hundred forty patients (72.9%) had injuries identified on imaging, with an overall exam positivity rate of 44.4%. The most common injuries were soft tissue and musculoskeletal in nature. Over half (51.9%) of the entries with the keyword "scooter" were excluded because of lack of EMR specificity regarding scooter type. CONCLUSION: While this study showed that injuries following e-scooter accidents are common and frequently involve the face and extremities, it is limited by lack of documentation in the EMR. Further research with a standardized documentation protocol will be needed to better understand injuries patterns following e-scooter accidents.

Evaluation of Gadolinium Deposition in the Brain After MR Arthrography.

OBJECTIVE: Although significant investigation has been done into the deposition of gadolinium in the brains of patients receiving IV gadolinium, there is little research concerning nonintravenous uses of gadolinium, specifically in conjunction with musculoskeletal MR arthrography. Although small in volume, intraarticular administration is an off-label use of gadolinium, necessitating careful scrutiny for patient safety. Thus, we investigated the relationship between intraarticular gadolinium administration during MR arthrography and the presence of intracranial gadolinium deposition on subsequent brain MRI. MATERIALS AND METHODS: An institutional review board-approved retrospective study was performed of patients with no history of gadolinium exposure who underwent MR arthrography from 2006 to 2016 followed by an unenhanced brain MRI examination. ROIs were manually placed within bilateral dentate nuclei (DN), bilateral globus pallidi (GP), bilateral thalami, bilateral middle cerebral peduncles (MCP), and the central pons (CP) on T1-weighted sequences. The left and right ROIs were averaged, and ratios of signal intensity were calculated for DN/MCP, DN/CP, GP/MCP, GP/CP, thalamus/MCP, and thalamus/CP. Similar ROIs were placed and ratios calculated for age-matched control subjects who had a history of brain MRI but no prior gadolinium exposure. We used t testing to compare signal intensity ratios between patients and control subjects. RESULTS: A total of 31 patients met the inclusion criteria. We found no significant difference in signal intensity between patients and control subjects for DN/MCP (p = 0.40), DN/CP (p = 0.76), GP/MCP (p = 0.51), GP/CP (p = 0.86), thalamus/MCP (p = 0.93), and thalamus/CP (p = 0.30). CONCLUSION: No association was found between intraarticular gadolinium administration for MR arthrography and detectable gadolinium deposition within the brain.

Electronic and Social Media-based Radiology Learning Initiative: Development, Implementation, Viewership Trends, and Assessment at 1 Year.

RATIONALE AND OBJECTIVES: We report the development of a new "Case of the Day" (COTD) educational initiative using email, social media (SoMe), and a website to disseminate content, as well as its trends in viewership and assessment of utility for the first year of implementation. MATERIALS/METHODS: Using an image-rich format, a new unknown case was disseminated to radiology trainees and attendings at our institution by email twice per week, including history, salient images, and follow-up questions. Simultaneously, content was externally disseminated on Twitter and a publicly viewable departmental website. On subsequent days, the answer was posted via email, Twitter, and website in the form of a brief YouTube video lecture. Viewership data were collected over the first 12 months (July 1, 2016 to June 30, 2017), and an anonymous survey of participants was performed. RESULTS: Sixty-five COTDs had complete viewership data and were included in our analysis, yielding 4911 "case" email views (mean = 76), 3798 "answer" email views (mean = 58), 68,034 "case" Twitter impressions (mean = 1047), 75,724 "answer" Twitter impressions (mean = 1164), 5465 "case" Twitter engagements (mean = 84), and 5307 "answer" Twitter engagements (mean = 82). COTD YouTube video lectures garnered 3657 views (mean = 61) amounting to 10,358 minutes of total viewing time. Viewers were very satisfied with COTD quality, with 97% (n = 63) reporting the quality as "good" or "excellent." CONCLUSIONS: Email and SoMe can serve as effective tools for disseminating radiology educational content. SoMe offers substantial external visibility and branding potential for programs.

Social Media Utilization at an Academic Radiology Practice.

RATIONALE AND OBJECTIVES: We report social media (SoMe) utilization trends at an academic radiology department, highlighting differences between trainees and faculty and between Baby Boomers versus Generation X and Millennials. MATERIALS AND METHODS: An anonymous online survey regarding SoMe utilization and SoMe-based educational curriculum was distributed to all radiologists (trainees and faculty) in our department. Regular chi-square, ordered (Mantel-Haenszel) chi-square, and Fischer exact tests were performed. RESULTS: The survey instrument was sent to 172 radiologists with a 65% completion rate (N = 112). Eighty-three percent (n = 92) of the respondents use SoMe, with Facebook (67%, n = 75), YouTube (57%, n = 64), Instagram (26%, n = 29), and Twitter (21%, n = 23) as the most commonly used platforms. Eighty-one percent (n = 91) use SoMe for 30 minutes or less per day. Thirty-five percent (n = 39) reported previously using SoMe for educational purposes, although 66% (n = 73) would be willing to join SoMe for educational activities. The faculty are more likely than trainees to avoid using SoMe (30% vs 9%, P < 0.03). Trainees are more likely than faculty to find an electronic case-based curriculum valuable (95% vs 83%, P < 0.05) and are willing to spend more time on cases (P < 0.01). Baby Boomers are less interested in joining SoMe for educational activities than Generation X and Millennials (24% vs 73%, P = 0.0001). CONCLUSIONS: Generation gaps between trainees and faculty, as well as between Generation X and Millennials versus Baby Boomers, exist with regard to the use of SoMe, which may be underutilized in radiology education.

Characterization of adrenal masses with diffusion-weighted imaging.

OBJECTIVE: The purpose of this article is to assess the role of diffusion-weighted MRI in characterizing adrenal masses. MATERIALS AND METHODS: A retrospective review of the MRI database from August 2007 to July 2009 was performed. The MRI examinations of 48 patients, with 49 lesions, were reviewed independently and blindly by two experienced abdominal radiologists who measured the signal intensities on in-phase and opposed-phase T1-weighted imaging and apparent diffusion coefficient (ADC). ADC measurements and quantitative parameters of chemical shift imaging (signal intensity index and adrenal-to-spleen ratio) were assessed separately and in combination. Lesions with indeterminate signal intensity index (< 16.5%) were considered benign if ADC was greater than or equal to 1.0 × 10(-3) mm(2)/s and malignant if ADC was less than 1.0 × 10(-3) mm(2)/s. Stepwise logistic regression analysis and receiver operating characteristic curves analysis were performed. RESULTS: There were 12 malignant and 37 benign lesions. On multivariate analysis, the only significant predictors of lesion status were signal intensity index from reviewer 2 (p = 0.05) and lesion size (p = 0.04); ADC values were not found to be useful. On receiver operating characteristic curve analysis, there was no significant difference in area under the curve for ADC, signal intensity index, adrenal-to-spleen ratio, or the combined signal intensity index and ADC assessment. For lesions that were indeterminate according to signal intensity index, ADC values greater than 1.50 × 10(-3) mm(2)/s were found only in benign lesions, and nine of 11 lesions with ADC less than 1.0 × 10(-3) mm(2)/s were malignant. CONCLUSION: In general, ADC values are not useful in differentiating adrenal lesions. However, when ADC values are applied to lesions that are indeterminate on signal intensity index, they may help in differentiating a subset of benign and malignant lesions.

Routine isotropic computed tomography scanning of chest: value of coronal and sagittal reformations.

OBJECTIVE: We sought to evaluate the usefulness of coronal and sagittal reformations from isotropic chest computed tomography (CT) examinations. METHODS: A total of 30 chest CT examinations were reconstructed into 2 sets of axial source images: 0.9-mm slice width with 0.45-mm reconstruction interval (isotropic) and 4-mm slices with 3-mm reconstruction interval. The isotropic dataset was reformatted into coronal and sagittal stacks with 4-mm slices. Three readers reviewed the image sets with 4-mm slice widths. Coronal and sagittal reformations were compared at the same sitting to axial images for depiction of anatomy and disease in the aorta, pulmonary arteries, hilar regions, mediastinum, lung parenchyma, pleura, diaphragm, thoracic spine, ribs, and trachea. A 5-point scale was used to determine whether nonaxial reformations showed anatomy and disease significantly better, somewhat better, same, somewhat worse or significantly worse than equivalent thickness axial source images. A 3-point scale was used to score if nonaxial image sets showed no, some, or significant additional information compared with the axial plane regarding the main diagnosis. RESULTS: There was better visualization of the hilar regions, diaphragm, spine, and trachea on the coronal reformations compared with source axial images (P < 0.05). Sagittal reformations scored better than axial source images for aorta, pleura, diaphragm, spine, and ribs (P < 0.05). The coronal and sagittal series showed significant additional information in 11% and 9% of patients, respectively. CONCLUSION: Radiologists should consider the use of one or both of coronal and sagittal planes in addition to the axial series in routine interpretation of chest CT.

A solution for transferring 35-mm slide collections into a digital teaching-file database system.

OBJECTIVE: Our objective was to develop a convenient yet comprehensive process for transferring 35-mm radiology slides into a digital teaching-file system capable of delivering online educational content and serving also as a general-purpose digital media repository. CONCLUSION: We believe this approach provides a feasible solution for converting radiologists' educational 35-mm slides into well-organized, high-quality digital media suitable for both online education and speaker-led presentations.

Challenges facing radiology educators.

This article summarizes the current challenges faced by radiology educators. These are discussed under the headings of time available for education, financing education, what and how to teach, student evaluation, support infrastructure, and challenges to leadership.

New opportunities for the use of digital video in on-line radiologic curricula.

RATIONALE AND OBJECTIVES: To explore techniques to conveniently and self-sufficiently create high-quality, web-ready instructional digital video snippets suitable for routine use in on-line radiologic curricula. MATERIALS: A commercially available digital camera with an 8-megapixel image receptor and the capability to record web-ready digital video and audio at a resolution of up to 640 x 480 pixels and a frame rate of up to 30 per second was used to obtain video snippets intended for inclusion in on-line curricula. Hand-held and tripod techniques were compared. Evaluation focused on the types of snippets deemed most likely to be used within on-line educational content, ranging in length from 10 seconds to 2 minutes. Additionally, basic postprocessing functions to experiment with combinations of video-file size, format, transmission efficiency, and image quality were used. RESULTS: The overall video quality was considered by participating radiologists to be good to excellent for its intended purposes. For most situations tested, a matrix size of 320 x 240 pixels provided a good balance of visual quality versus file size and transmission overhead. The 640 x 480 format was occasionally optimal, but was usually larger than necessary and resulted in substantially larger files, especially at a rate of 30 frames per second. A rate of 15 frames per second was considered adequate for most situations, regardless of matrix size, although it did add some barely discernible choppiness to the display. For all but very short snippets, a tripod or some other form of stabilization was necessary to eliminate distracting "camera shake" associated with free-hand acquisition. With a tripod, appropriate ambient lighting, and a favorable acoustical environment, videos of excellent quality when using the highest settings available on the camera (640 x 480, 30 frames/sec) could be self-sufficiently produced. However, such high-quality video with its associated large file size was rarely the optimal fit for the needs of this curricula. CONCLUSION: These results indicate that newer-generation digital cameras are useful for quickly and inexpensively producing high-quality, web-ready digital video suitable for use in on-line education.

2003 AUR Joseph E. And Nancy O. Whitley Award. Developing tomorrow's academic radiologists: a 3-month residency elective in education.

RATIONALE AND OBJECTIVES: The shortage of academic radiologists reveals an urgent need to attract more residents into academic careers. A great deal of attention has been focused on research, but few programmatic initiatives have addressed the development of the next generation of radiology educators. The purpose of this study was to develop and test a new 3-month residency elective in education. MATERIALS AND METHODS: A large academic radiology department developed a 3-month education elective, during which two residents would be relieved of clinical duties and focus full-time on tasks related to their development as educators, including the completion of a major educational project. RESULTS: Two residents, in their 3rd year and 4th year of residency, respectively, proposed to collaborate in developing a Web-delivered tutorial for the department's senior medical student clerkship. At the end of 3 months, their radiology tutorial was introduced. In its 1st month, it received a mean rating of 4.3 on a five-point scale. The residents stated that the elective had enabled them to develop important skills in instructional technology, put into practice their enhanced understanding of learning psychology, and substantially strengthened their overall commitment to academic careers. CONCLUSION: It is vital that residency programs focus on developing the next generation of radiology educators. This ongoing education elective represents one successful model.