Evaluation of Thyroid Ultrasound Report Quality and Assessing Effect of Adherence to Risk Stratification Criteria on Referral for Thyroid Nodule Biopsy.

PURPOSE: This study aims to evaluate the quality of diagnostic thyroid ultrasound reports and determine the impact of consistent adherence to 2015 American Thyroid Association (ATA) and 2017 American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) on reducing unnecessary referrals for thyroid nodule biopsy. MATERIALS AND METHODS: Reports from 291 referrals for thyroid nodule biopsy were included for retrospective report evaluation (males: 42; mean age: 56) according to 2015 ATA and ACR TI-RADS lexicon. Cytology results were collected for each patient. Two radiologists blinded to cytology results independently, retrospectively reviewed imaging of the referrals, and rescored them according to 2015 ATA and 2017 ACR TI-RADS risk stratification systems. Statistical analysis was completed using chi-square analysis and calculation of κ statistic for interobserver variability. RESULTS: No report completely addressed all features associated with malignancy. Over half of the reports did not include descriptors on echogenicity, shape, margin, or echogenic foci. In all, 9.3% of biopsies showed malignant histology. Rescoring of referrals demonstrated decrease in biopsy referrals by 55% as per 2017 ACR TI-RADS and 14% as per 2015 ATA (P < .0001). There was no impact on detection of malignancy with adherence to ATA or ACR criteria and less interobserver variability with application of 2017 ACR TI-RADS compared to 2015 ATA. CONCLUSION: Thyroid ultrasound report quality was found variable with respect to nodule description. Reports recommended biopsy based on nodule size with no detailed description of other imaging features. Adherence to risk stratification system would have resulted in significant reduction in the number of unnecessary biopsy referrals.

131I-MIBG Therapy in a Metastatic Small Bowel Neuroendocrine Tumor Patient Undergoing Hemodialysis.

Systemic radioisotope therapy with I-metaiodobenzylguanidine (I-MIBG) is an effective form of targeted therapy for neuroendocrine tumors. One of the absolute contraindications to administering I-MIBG therapy listed in the 2008 European Association of Nuclear Medicine guidelines is renal insufficiency requiring dialysis, although this contraindication is not evidence based. We describe a 68-year-old woman with a metastatic small bowel neuroendocrine tumor who developed renal insufficiency requiring hemodialysis. Imaging and dosimetry with I-MIBG were performed and showed that the radiation doses to the whole body and lungs were within safe limits. She was treated with 1820 MBq of I-MIBG with no short-term adverse reactions.

Resilience, stress, and coping among Canadian medical students.

BACKGROUND: Numerous studies have established that medical school is a stressful place but coping styles and resilience have not been adequately addressed as protective factors. METHOD: Using a cross-sectional design, 155 students were surveyed using the Connor-Davidson Resilience Scale, Perceived Stress Scale, and the Canadian Community Health Survey Coping Scale. Mean scores were compared by gender and between our sample and normative scores using t-tests. Multivariate linear regression was performed to examine whether stress levels were related to coping and resilience. RESULTS: Medical students had higher perceived stress, negative coping, and lower resilience than age and gender-matched peers in the general population. Male medical students had higher positive coping scores than general population peers and higher resilience, and lower perceived stress than female medical students. Coping scores did not vary by gender in our sample. The multivariate model showed that resilience and negative, but not positive coping, predicted stress. CONCLUSIONS: Medical students are neither more resilient nor better equipped with coping skills than peers in the population. Greater emphasis on self-care among medical trainees is recommended. Emphasizing the importance of self-care during medical training, whether by formal incorporation into the curriculum or informal mentorship, deserves further study.