Optimal Abdominal CT Image Quality in Non-Lean Patients: Customization of CM Injection Protocols and Low-Energy Acquisitions.

We compared the image quality of abdominopelvic single-energy CT with 100 kVp (SECT-100 kVp) and dual-energy CT with 65 keV (DECT-65 keV) obtained with customized injection protocols to standard abdominopelvic CT scans (SECT-120 kVp) with fixed volumes of contrast media (CM). We retrospectively included 91 patients (mean age, 60.7 ± 15.8 years) with SECT-100 kVp and 83 (mean age, 60.3 ± 11.7 years) patients with DECT-65 keV in portovenous phase. Total body weight-based customized injection protocols were generated by a software using the following formula: patient weight (kg) × 0.40/contrast concentration (mgI/mL) × 1000. Patients had a prior abdominopelvic SECT-120 kVp with fixed injection. Iopamidol-370 was administered for all examinations. Quantitative and qualitative image quality comparisons were made between customized and fixed injection protocols. Compared to SECT-120 kVp, customized injection yielded a significant reduction in CM volume (mean difference = 9-12 mL; p ≤ 0.001) and injection rate (mean differences = 0.2-0.4 mL/s; p ≤ 0.001) in all weight categories. Improvements in attenuation, noise, signal-to-noise and contrast-to-noise ratios were observed for both SECT-100 kVp and DECT-65 keV compared to SECT-120 kVp in all weight categories (e.g., pancreas DECT-65 keV, 1.2-attenuation-fold increase vs. SECT-120 kVp; p < 0.001). Qualitative scores were ≥4 in 172 cases (98.8.4%) with customized injections and in all cases with fixed injections (100%). These findings suggest that customized CM injection protocols may substantially reduce iodine dose while yielding higher image quality in SECT-100 kVp and DECT-65 keV abdominopelvic scans compared to SECT-120 kVp using fixed CM volumes.

Bleeding disorders and postpartum hemorrhage by mode of delivery: a retrospective cohort study.

Background: Pregnant persons with bleeding disorders and their potentially affected newborns are at a higher risk of peripartum bleeding complications. The safest mode of delivery for persons with bleeding disorders remains debated, leading to uncertainties in decision-making between the patient and her multidisciplinary team. Objectives: This study aimed to describe maternal outcomes for pregnant persons with bleeding disorders by mode of delivery and to examine whether postpartum hemorrhage (PPH) and neonatal hemorrhagic manifestations are associated with the mode of delivery. Methods: We collected retrospective data on pregnant persons with bleeding disorders who delivered at a single center from 2010 to 2021. Descriptive statistics, Fisher exact test, and odds ratios were used for analysis. Results: A total of 82 pregnancies in 56 subjects were included. Hemophilia A and von Willebrand disease represented the largest cohort, at 30% (17/56) each. Overall rates of primary and secondary PPH were 7.3% (6/82) and 17.4% (12/69), respectively. We did not find a statistically significant difference between mode of delivery and PPH. Upon comparing vaginal and cesarian deliveries, we found an odds ratio of 0.7 (95% CI, 0.1-3.4) for primary PPH and 2.6 (95% CI, 0.4-16.4) for secondary PPH. One male newborn with severe hemophilia A was treated for a suspected intracranial hemorrhage. Conclusion: In our cohort, high rates of PPH remained an important complication for pregnant persons with bleeding disorders. There was no significant difference in PPH based on modes of delivery. The small sample size likely limited the power of our study, and consequently, future larger studies are needed.

When Illness and Loss Hit Close to Home-Do Health Care Providers Learn How to Cope?

INTRODUCTION: Up to 85% of newly qualified physicians report loss or illness in themselves or a loved one. These experiences can intensify feelings of grief in the professional setting, but the range of formal training that addresses personal illness or loss is unknown. This study aimed to explore interventions that teach health care providers and trainees about personal illness experience. METHODS: A scoping review was conducted by searching three bibliographic databases using the terms "illness," "personal," "education," and synonyms. Article screening was performed in duplicate to identify studies that described an intervention that included teaching or learning on personal experiences with illness or loss for health care providers and trainees. RESULTS: The search yielded 4168 studies, of which 13 were included. Education most often targeted medical students (54%), resident or attending physicians (31%), and nurses (31%). Other participants included social workers and psychologists. Personal illness was most frequently taught for reflection in the context of palliative care curricula (54%). Only two studies' primary purpose was to teach about coping with grief related to personal experiences. No studies within the scope of our defined methodology described training on how to support colleagues or trainees facing personal illness or loss. Reported outcomes included improved coping skills, decreased stress, and better ability to support bereaving patients. DISCUSSION: Specific training on personal illness experience is limited, with gaps in continuity of learning, particularly for continuing medical education. Future curricula can equip providers with coping strategies while enabling improved resilience and patient care.

ASPECTS estimation using dual-energy CTA-derived virtual non-contrast in large vessel occlusion acute ischemic stroke: a dose reduction opportunity for patients undergoing repeat CT?

PURPOSE: Recent studies have shown the feasibility of dual-energy CT (DECT) virtual non-contrast (VNC) for determining infarct extent. In this study, patients presenting with large-vessel occlusion (LVO) acute ischemic stroke (AIS), we assess whether ASPECTS on DECTA-VNC differs from non-contrast CT (NCCT). METHODS: After IRB approval, LVO-AIS patients undergoing NCCT and DECTA between October 2016 and September 2018 were retrospectively reviewed. DECTA-VNC images were derived using Syngo.via (Siemens, Erlangen, Germany). ASPECTS was scored by two blinded neuroradiologists. Square-weighted kappa statistic, diagnostic performance, Wilcoxon signed-rank tests between groups, and CT doses were calculated. RESULTS: Fifty-one patients met inclusion criteria, with median age of 76 (IQR 67-82); 26/51 (51%) were female. Median time between last-known-well and CT was 120 min (IQR 60-252). DECTA-VNC ASPECTS score differed by ≤ 1 from consensus NCCT in 49/51 (96%) patients for reader 1 and in 46/51 (90%) for reader 2. ASPECTS on DECTA-SI and consensus NCCT differed by ≤ 1 in 45/51 (88%) for both readers. On a per ASPECTS-region basis, DECTA-VNC had 87% sensitivity, 95% specificity, 0.82% PPV, and 0.96% NPV. ASPECTS inter-rater agreement was highest for DECTA-VNC (κ = 0.71), DECTA-SI (κ = 0.48), and NCCT (κ = 0.40). NCCT median CTDIvol was 63.7 mGy (IQR 60.7-67.2); DLP was 1060.0 mGy·cm (IQR 981.0-1151.5). DECTA-VNC dose was lower: median CTDIvol was 20.9 mGy (IQR 19.8-22.2); DLP was 804.1 (IQR 691.6-869.4), p < 0.0001. CONCLUSION: DECTA-derived VNC yielded similar ASPECTS scores as NCCT and is therefore non-inferior in early ischemia-related low attenuation edema/infarct detection in acute LVO-AIS patients. Further evaluation of the role of DECTA-VNC in AIS imaging is warranted.

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow.

PURPOSE: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. METHODS: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. RESULTS: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. CONCLUSIONS: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

Canadian and American Emergency Radiology Fellowship Websites: An Evaluation of Content.

PURPOSE: The internet is commonly employed by Radiology trainees to investigate and learn about potential fellowship programs. As a new and emerging subspecialty, Emergency Radiology requires strong internet presence and training program website content. This is vital to ensure good exposure of the fellowship programs to inform medical students, radiology trainees, and program directors, highlight unique aspects of a fellowship and raise awareness of the discipline at large. METHODS: To assess the standard and depth of information available online, Canadian and American Radiology fellowship websites were evaluated for content. Thirty-six criteria related to application process and recruitment, departmental structure, incentives, education, and research and clinical training were evaluated for presence or absence. RESULTS: Sixteen Emergency Radiology fellowship program websites were assessed from the United States and Canada for 36 criteria across 5 individual areas; application process and recruitment, departmental structure, incentives, education and research, and clinical training. Overall there was an absence of information found across all 5 areas. In particular areas for improvement were identified in education and research, and incentives both with median values of 12.5% of criteria present. CONCLUSION: Most Emergency Radiology fellowship program websites demonstrate several information deficiencies. This relative lack of comprehensive information represents an actionable opportunity for individual programs and the field to better educate trainees, program directors and the public about the unique training of Emergency Radiologists.

Virtual monochromatic reconstructions of dual energy CT in abdominal trauma: optimization of energy level improves pancreas laceration conspicuity and diagnostic confidence.

PURPOSE: Pancreatic injury is associated with significant morbidity and mortality. Pancreatic lacerations can be challenging to identify as the pancreas is not scanned at peak enhancement in most trauma CT protocols. This study qualitatively and quantitively assessed pancreatic lacerations with virtual monoenergetic dual-energy CT (DE CT) to establish an optimal energy level for visualization of pancreatic lacerations. METHODS: Institutional review board approval was obtained. We retrospectively examined 17 contrast-enhanced CT studies in patients with blunt trauma with MRCP, ERCP, or surgically proven pancreatic lacerations. All studies were performed in our Emergency Department from 2016 to 2019 with a 128 slice dual-source DE CT scanner. Conventional 120 kVp and noise-optimized virtual monoenergetic imaging (VMI) datasets were created. VMI energy levels were constructed from 40 to 100 keV in 10 keV increments and analyzed quantitatively and qualitatively. Pancreatic laceration attenuation, background parenchymal attenuation, and noise were calculated. Qualitative assessment was performed by two independent readers. RESULTS: The optimal CNR for the assessment of pancreatic lacerations was observed at VMI-40 in comparison with standard reconstructions and the remaining VMI energy levels (p = 0.001). Readers reported improved contrast resolution, diagnostic confidence, and laceration conspicuity at VMI at 40 keV (p = 0.016, p = 0.002, and p = 0.0012 respectively). However, diagnostic acceptability and subjective noise were improved on conventional polyenergentic images (p = 0.0006 and p = 0.001 respectively). CONCLUSION: Dual energy CT at VMI-40 maximizes the CNR of pancreatic laceration, improves diagnostic confidence, and increases laceration conspicuity.

An Evaluation of the Content of Canadian and American Nuclear Medicine Fellowship Websites.

BACKGROUND: Radiology trainees frequently use the Internet to research potential fellowship programs across all subspecialties. For a field like nuclear medicine, which has multiple training pathways, program websites can be an essential resource for potential applicants. This study aimed to analyze the online content of Canadian and American Nuclear Medicine fellowship websites. MATERIALS AND METHODS: The content of all active Canadian and American Nuclear Medicine fellowship websites was evaluated using 26 criteria in the following subdivisions: application, recruitment, education, research, clinical work, and incentives. Fellowships without websites were excluded from the study. Scores were summed per program and compared by geographic region and ranking. RESULTS: A total of 42 active Canadian and American Nuclear Medicine fellowship programs were identified, of which 39 fellowships had dedicated fellowship websites available for the analysis. On average, fellowship websites contained 34.4% (9 ± 3.3) of the 26 criteria. Programs did not score differently on the criteria by geographical distribution (P = .08) nor by ranking (P = .18). CONCLUSION: Most Canadian and American Nuclear Medicine fellowship websites are lacking content relevant to prospective fellows. Addressing inadequacies in online content may support programs to inform and recruit residents into fellowship programs.

How well do we represent ourselves: an analysis of musculoskeletal radiology fellowships website content in Canada and the USA.

OBJECTIVE: Radiology residents review information available on fellowship program websites for shortlisting programs and for applying for fellowships. The aim of this study was to evaluate the comprehensiveness of musculoskeletal (MSK) fellowship program websites. METHODS: The content of US and Canadian MSK fellowship program websites was evaluated using 25 distinct criteria in the following domains: application, recruitment, research, clinical, education, clinical work, benefits. Programs without websites were excluded from analysis. RESULTS: In Canada and the USA, there were 100 MSK fellowship programs, 90 of them having dedicated websites. The average score across all programs was 9.5/25 or 38%. The most comprehensive program included 18/25 items or 72%. The least comprehensive program included only 1/25 items or 4%. The median score across all programs was 9/25 or 36%.More programs included information on the application process (65.5/90, 72.8%; SD 24.7%) than in education/research (24/90, 26.7%; SD 17.3%) or incentives (12.5/90, 13.9%; SD 7.8%).Mean scores amongst US schools did not differ based on geographical distribution (p = 0.32), although they did by rank; schools ranked in the bottom tier scored lower than the unranked, middle, and top tier schools (p < 0.05). CONCLUSION: The majority of MSK fellowship program websites are not comprehensive. Areas that needed the most improvement include incentives, education/research, clinical teaching, and recruitment information. Addressing these insufficiencies can help programs in easing the application process for prospective fellows and enhance recruitment.

Trends in Gender and Racial Profiles of US Academic Radiology Faculty.

OBJECTIVE: To evaluate gender and racial profiles of US academic radiology faculty. MATERIALS AND METHODS: This is a retrospective analysis of the American Association of Medical College database of radiology faculty members from 2006 to 2017 by academic rank, chair position, race or ethnicity, and gender. The data were described with annual proportions and average annual counts and fit to a Poisson regression model. Comparison data were taken from American Association of Medical College on matriculants at US medical schools and from ACGME on radiology residents. RESULTS: Women increased significantly in the ranks of professor by 4.5%, associate professor by 4.8%, and assistant professor by 4.8% (P < .05). Asian and multiple race non-Hispanic radiologists increased in the rank of professor by 5.9% and 3.1%, respectively (P < .05). Among department chairs, only women and Asian faculty increased by 6.4% and 7.5%, respectively (P < .05). The proportion of women chairs increased from 10.0% (19 of 191) in 2006 to 17.4% (39 of 224) in 2017. Black and Hispanic chairs collectively represented less than 10% of the total chairs every year. DISCUSSION: The significant percent annual increase in women faculty in academic ranks and chair positions suggests that the radiology faculty is becoming more diverse. However, the decreasing proportion of women with increasing academic ranks within each year of the study period suggests attrition or lack of promotion of women radiology faculty. The disparity in black and Hispanic faculty members and chairs suggests that emphasis should continue to be placed on tailored recruitment.

A Comparative Evaluation of Cardiothoracic Radiology Fellowship Website Content.

PURPOSE: Prospective radiology fellows often rely on the internet to obtain information with regard to the application process for and the unique qualities of different fellowship programs. The aim of this study was to analyze the content of websites of the United States' and Canadian cardiothoracic radiology fellowships. METHODS: All active Cardiothoracic Radiology fellowship websites as of July 2019 were evaluated and compared using 25 criteria in the following domains: Application, Recruitment, Clinical Training, Education/Research, and Incentives. Program website information availability was compared by geographic region. RESULTS: There were 60 active cardiothoracic radiology fellowships, and 59 of these fellowships had a dedicated fellowship website. Websites, on average, had 9.3 of the 25 criteria (37.2%). The mean number of schools that satisfied the criterion in the "Incentives" domain ([7.75/59] 10.5%±2.8%) was significantly lower than that for the "Application Process" domain ([40.50/59]; 68.7%±40.6%) (P=0.01). There was no significant difference in the information content of programs in different geographic regions (P=0.246). CONCLUSION: Most cardiothoracic radiology fellowship websites were lacking content relevant to prospective fellows. Provision of more relevant and easily accessible online content may support programs to better inform and recruit residents and to promote the specialty of cardiothoracic radiology.

An Evaluation of the Content of Canadian Radiology Fellowship Websites.

PURPOSE: Prospective radiology fellows utilize the internet to apply for radiology fellowship programs. The aim of this study was to analyze the online content of Canadian radiology fellowship websites. METHODS: The content of all active Canadian radiology fellowship websites were evaluated using 30 criteria in the following domains: application, recruitment, education and research, clinical work and benefits. Fellowships without websites were excluded from the study. The prevalence of assessed elements was compared to geography and Canadian medical school ranking. RESULTS: We identified 107 active Canadian radiology fellowship programmes, of which 102 university fellowships (95.3%) had dedicated fellowship websites available for analysis. Of these 102 programs, the median score was 13/30 (43.0%). Websites of fellowship programs affiliated with top ranked medical schools contained more of the assessed criteria than middle and lower ranked schools (17.0 vs 13.0 vs 9.0, p < 0.0001)). Geographical difference was identified across Canada with Atlantic and Central Canada fellowship programs having significantly more criteria than Western programs (15.5 vs 16.0 vs 10.0, p < 0.001). CONCLUSIONS: Most Canadian radiology fellowship websites are devoid of content pertinent to prospective radiology fellows. Addressing deficiencies in online content may assist programs to inform and recruit residents into radiology fellowship programs.