Ideas and Opportunities for Radiologists--Career and Professional Advising and Medical Education.

This article is about two highly diverse radiologists, who fortuitously came together by working as Career and Professional Advisors in the Student Affairs Department of a U.S. medical school. This job opportunity offered each radiologist, albeit for markedly different reasons, a means to transition from full-time Radiology to the opportune world of medical school education. The focus of this paper will be on Career and Professional Advising, while also highlighting the many opportunities for radiologists in current medical school education.

Malignant phyllodes breast tumor.

Malignant phyllodes tumor is a rare tumor of the breast occurring in females usually between the ages of 35 and 55 years. It is often difficult to distinguish benign from malignant phyllodes tumors from other benign entities such as fibroadenomas. This case presentation demonstrates a woman with malignant phyllodes tumor treated with mastectomy with abdominal skin flap reconstruction.

Adverse events in a freestanding radiology office.

OBJECTIVE: The aim of this study was to evaluate the frequency, types, and severity of adverse events that occur in a freestanding outpatient radiology office setting and discuss the actions taken for patient treatment and subsequent triage. MATERIALS AND METHODS: Adverse event records from a freestanding outpatient radiology office were reviewed from January 2003 through December 2006. Data were grouped into different modalities, including computed tomography, magnetic resonance imaging, positron emission tomography/computed tomography, and interventional radiology. Adverse reactions and events were reviewed, including what, if any, immediate treatment was provided in the office, how the patient responded, whether the patient was discharged home, and whether emergency medical services were called. RESULTS: A total of 106,800 patients were evaluated over 4 years, among whom 59 experienced (0.06%) adverse events. Seventy-six percent of the patients (n = 45) were treated in the office and were discharged home or returned to work. Thirty-one percent of the patients (n = 18) required assistance from emergency medical services. CONCLUSION: The outpatient radiology office setting is a safe arena for patients to undergo imaging studies and selected interventional procedures. Medical personnel in office settings are able to assess and treat those patients experiencing adverse events and can appropriately judge whether further aid is needed for patients in distress via emergency medical services or hospital care.

Cost-effectiveness and patient tolerance of low-attenuation oral contrast material: milk versus VoLumen.

OBJECTIVE: The purpose of our study was to prospectively compare the cost, effectiveness, and patient tolerance of milk and VoLumen, a 0.1% barium suspension, in patients undergoing abdominal and pelvic CT with oral and i.v. contrast media. SUBJECTS AND METHODS: Two hundred fifteen consecutive outpatients were randomly assigned to receive either whole milk (n = 115) or VoLumen (n = 100). Results were independently reviewed by two radiologists who were blinded to the oral contrast agent used. Degree of bowel distention was qualitatively scored on a 4-point scale, and bowel wall visibility was graded qualitatively on a yes-or-no basis. A questionnaire regarding oral contrast tolerability was provided to each patient. Cost comparison of the two agents was performed. RESULTS: No statistically significant differences were seen between whole milk and VoLumen with respect to degree of bowel distention and mural visualization for all segments of bowel studied (p > 0.05 for both reviewers). Significantly more patients ranked milk as pleasant in taste compared with VoLumen (p < 0.0001). More patients preferred milk compared with VoLumen (p < 0.0001). Milk was better tolerated than VoLumen, with fewer abdominal side effects, including abdominal discomfort (p = 0.019), cramping (p = 0.019), nausea (p = 0.016), and diarrhea (p = 0.0002). The cost per patient for VoLumen is $18 compared with $1.48 for milk. CONCLUSION: Whole milk is comparable to VoLumen with respect to bowel distention and bowel wall visualization and has a lower cost, better patient acceptance, and fewer adverse symptoms. Milk is a cost-effective alternative to VoLumen as a low-attenuation oral contrast agent.

Gamma Probe Detection of Ectopic Parathyroid Adenoma.

A 34-year-old man with hypercalcemia had a sestamibi scan that showed increased uptake that appeared to correspond with a 7 mm density in the mediastinum, adjacent to the aortic arch, on chest CT. This lesion was thought to be consistent with an ectopic parathyroid adenoma. Prior to surgical exploration, the patient was injected intravenously with 12.3 millicuries of Tc99m-sestamibi. The lesion identified preoperatively did not show abnormal radionuclide uptake using the intraoperative gamma probe, and was subsequently determined to be a hyperplastic lymph node. However, abnormal activity was localized to the thymus gland, from which an ectopic parathyroid adenoma was successfully excised. The patient recovered without incident. The use of the intraoperative gamma probe was critical in identifying and resecting the ectopic parathyroid adenoma in this patient, and in general, may reduce surgical time and reduce the morbidity and/or complications associated with surgical exploration.