Continuous Certification Within Residency: An Educational Model.

Given that maintaining compliance with Maintenance of Certification is necessary for maintaining licensure to practice as a radiologist and provide quality patient care, it is important for radiology residents to practice fulfilling each part of the program during their training not only to prepare for success after graduation but also to adequately learn best practices from the beginning of their professional careers. This article discusses ways to implement continuous certification (called Continuous Residency Certification) as an educational model within the residency training program.

Experience with duplex sonographic evaluation of meso-rex bypass in extrahepatic portal vein obstruction.

Meso-Rex bypass is a surgical procedure for managing extrahepatic portal vein obstruction in children. Although duplex sonography has been used for assessing the patency of the bypass graft and the changes in the intrahepatic portal venous system after the surgery, there was little sonographic description of functioning and dysfunctioning bypass grafts found in the literature. In this case series, we retrospectively evaluated duplex sonography of functioning and dysfunctioning bypass grafts in 5 pediatric patients who received meso-Rex bypass grafts. Sonography was performed preoperatively and postoperatively within 48 hours, 1 to 2 weeks later, and at follow-up 1 month and up to 3 years later. Changes in the direction and velocity of the flow in the intrahepatic portal veins and bypass grafts and diameters of the grafts and the left portal veins were analyzed. Preoperative sonography revealed varied extension of extrahepatic portal vein occlusion with cavernous transformation and diminished intrahepatic portal venous flow, whereas postoperative studies showed a rapid increase of the intrahepatic portal flow via the meso-Rex bypass graft in all cases. A patent graft with reversed flow in the left portal vein was a predominant feature of a functioning graft. In contrast, absent flow in the graft with diminished flow or an altered flow direction in the left portal vein indicated graft failure. It is believed that duplex sonography provides a valuable tool for monitoring the hemodynamic changes in the portal venous system and detecting graft malfunction.

Multimodality imaging of an appendiceal intussusception.

Appendiceal intussusception is a rare entity. The majority of cases reported in the literature address surgical and colonoscopic approaches to treatment of the condition. The existing radiologic literature largely describes the sonographic and double-contrast enema findings of appendiceal intussusception. We present a case of appendiceal intussusception and describe the air-contrast enema, sonographic and CT findings.

Doppler ultrasonographic findings on hepatic arterial vasospasm early after liver transplantation.

OBJECTIVE: Hepatic arterial vasospasm has not been well recognized clinically as a post-liver transplant vascular complication because of the lack of sufficient data and diagnostic standards. The goal of this study was to provide new evidence and a diagnostic model for the clinical appreciation of hepatic arterial vasospasm and evaluate the role of ultrasonography in the diagnostic process. METHODS: Nine post-orthotopic liver transplant cases were retrospectively reviewed. Multiple clinical measurements were analyzed. Routine Doppler ultrasonography was performed within 24 hours, and additional ultrasonographic examinations were conducted as indicated. Each of the 9 patients was given a single 10 mg dose of nifedipine sublingually and monitored by ultrasonography when vasospasm was suspected on the basis of the Doppler ultrasonographic results. RESULTS: Doppler ultrasonography showed high-resistance hepatic arterial flow with absence of antegrade flow and even reversal of flow during diastole both extrahepatically and intrahepatically in all cases. Ten to 45 minutes after administration of the vasodilator, antegrade diastolic flow was observed along the course of the main hepatic artery and its intrahepatic branches with the resistive indices decreasing on average from 1.0 to 0.76. In addition, the peak systolic velocities increased from 57 cm/s before nifedipine administration to 77 cm/s after administration. CONCLUSIONS: High-resistance hepatic arterial flow (resistive index = 1) early after liver transplantation is indicative of hepatic arterial vasospasm if it responds to vasodilators. Doppler ultrasonography is a useful tool for the diagnosis of this vascular complication.

Diagnostic imaging in the follow-up of nonoperative management of splenic trauma in children.

The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). Contrast-enhanced computed tomography (CT) is approximately 95% sensitive and specific for detection of splenic injury. In children, nonoperative treatment is well-established. The basic tenet of such management is an obligatory period of rest to prevent recurrent bleeding and allow splenic healing. Splenic preservation prevents post-splenectomy sepsis. At our level I trauma center, pediatric patients (N=54) with BAT between 1993 and 1998 were retrospectively studied. Two (3.7%) died of associated injuries; 2 underwent splenectomy before transfer to our hospital. All had been diagnosed with splenic injury by CT. The mean age was 11.3 years. The mechanisms of injury were motor vehicle accidents (66%), bicycle accidents (26%), and falls (8%). All 50 remaining patients were followed by ultrasound (US) after the initial diagnosis by CT. The mean hospital stay was 6 days. One patient developed the rare complication of an arterio venous (AV) fistula within the damaged spleen; 47 (94%) had normal, homogeneous parenchymal echogenicity at healing (including the patient with the AV fistula). The remaining 3 demonstrated a visible echogenic scar. Imaging documentation of healing blunt splenic trauma should ideally minimize cost and relative risk. Our results add further evidence that US is well-suited to the task. No delayed complications with this approach were recorded in this series.