Renal Cell Carcinoma with Cardiac Metastases: A Case Report and Review of the Literature.

Cardiac metastases from renal cell carcinoma (RCC) are very rare. We describe the case of a woman with RCC with cardiac metastases involving the entire right atrium, penetrating through the myocardium, with extension into the tricuspid valve and right ventricle. This report highlights the unique challenge of the diagnosis and treatment of cardiac metastases in RCC.

Use of dual-energy computed tomography for the evaluation of calcinosis in patients with systemic sclerosis.

We examined the usefulness of dual-energy computed tomography (DECT) in the evaluation of symptomatic systemic sclerosis (SSc)-related calcinosis of the hands. We performed DECT scan of the hands in 16 patients with symptomatic SSc-calcinosis to better characterize the calcinosis, their locations within the soft tissues, and exclude monosodium urate (MSU) crystal deposition. We also compared their computed tomography (CT) images to plain radiographs of one hand. Pertinent clinical information from this cohort was collected. Sixteen SSc patients underwent DECT and plain X-ray imaging of the hands. Five of the 16 SSc patients in our cohort had overlap disease, either rheumatoid arthritis (RA) and/or myopathy. Calcinosis symptoms included painful deposits (88 %), soft tissue swelling (66 %), and recurrent infections (44 %) from these deposits. On DECT, calcinosis deposits had the same color and density as the bone and no MSU was found. However, their CT images showed better details of the calcinosis locations in the soft tissues as well as the bone destruction, especially if there was overlying bulky deposits or flexion contractures. These deposits were most commonly found in the subcutaneous fat pads of the fingertips, along tendon and muscle groups, or within the carpal tunnel. DECT did not confirm MSU in our cohort with calcinosis. However, CT imaging was superior to plain radiographs in locating these deposits within the soft tissues and may be a useful tool to study SSc-calcinosis affecting the hands, particularly in the setting of progressive hand deformities.

Comparative analysis of the risk of radiation exposure and cost of reduced imaging intensity for surveillance of early-stage nonseminomatous germ cell tumors.

OBJECTIVE: To evaluate the surveillance recommendations for early-stage testis cancer and the risk of secondary malignancies due to increased radiation exposure. MATERIALS AND METHODS: Using National Comprehensive Cancer Network (NCCN) guidelines 2012 and 2014 for early-stage testicular cancer, the numbers of abdominal and pelvic computed tomography scans (CTAPs) and chest radiographies were calculated, and lifetime attributable risk for secondary malignancy was estimated using Biologic Effects of Ionizing Radiation VII organ-specific model for solid organ malignancy based on the initial age of exposure. Cost was based on the Centers for Medicare and Medicaid Services' cost estimates of CTAP and magnetic resonance imaging (MRI). RESULTS: The 2012 NCCN protocol uses a maximum of 17 CTAPs over 6 years, whereas 2014 guidelines suggest a maximum of 13 CTAPs. The radiation dosage in 2014 guidelines is decreased by 25% compared to the 2012 NCCN guidelines. The minimum number of CTAPs under the 2014 NCCN protocol reduced radiation dose by 38% compared to the maximum number, this compared to about 50% decrease from the 2012 NCCN guidelines. The median cost for a single CTAP with contrast is $369.30; median cost for a single MRI with contrast is $772.18. As compared to the 2012 protocol, the 2014 guidelines reduced CTAP cost by approximately 24%-54% for minimum and maximum CTAPs allowed. CONCLUSION: There is low, however nonzero, risk of secondary malignancy for surveillance in stage I testicular cancer. There is also a significant cost difference between protocols as well as between CT and MRI modalities.

ACR appropriateness criteria routine chest radiographs in intensive care unit patients.

Daily routine chest radiographs in the intensive care unit (ICU) have been a tradition for many years. Anecdotal reports of misplacement of life support items, acute lung processes, and extra pulmonary air collections in a small number of patients served as a justification for routine chest radiographs in the ICU. Having analyzed this practice, the ACR Appropriateness Criteria Expert Panel on Thoracic Imaging has made the following recommendations: • When monitoring a stable patient or a patient on mechanical ventilation in the ICU, a portable chest radiograph is appropriate for clinical indications only. • It is appropriate to obtain a chest radiograph after placement of an endotracheal tube, central venous line, Swan-Ganz catheter, nasogastric tube, feeding tube, or chest tube. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The strongest data contributing to these recommendations were derived from a meta-analysis of 8 trials comprising 7,078 ICU patients by Oba and Zaza [1].

Medical students' preferences in radiology education a comparison between the Socratic and didactic methods utilizing powerpoint features in radiology education.

RATIONALE AND OBJECTIVES: The Socratic method has long been a traditional teaching method in medicine and law. It is currently accepted as the standard of teaching in clinical wards, while the didactic teaching method is widely used during the first 2 years of medical school. There are arguments in support of both styles of teaching. MATERIALS AND METHODS: After attending a radiology conference demonstrating different teaching methods, third-year and fourth-year medical students were invited to participate in an online anonymous survey. RESULTS: Of the 74 students who responded, 72% preferred to learn radiology in an active context. They preferred being given adequate time to find abnormalities on images, with feedback afterward from instructors, and they thought the best approach was a volunteer-based system of answering questions using the Socratic method in the small group. They desired to be asked questions in a way that was constructive and not belittling, to realize their knowledge deficits and to have daily pressure to come prepared. The respondents thought that pimping was an effective teaching tool, supporting previous studies. CONCLUSIONS: When teaching radiology, instructors should use the Socratic method to a greater extent. Combining Socratic teaching with gentle questioning by an instructor through the use of PowerPoint is a preferred method among medical students. This information is useful to improve medical education in the future, especially in radiology education.