Perspectives From the RadDiscord Annual Survey: Overview of the Top Study Tools and Evaluation of Study Time and Various Resources.

RATIONALE AND OBJECTIVES: Each year, senior radiology residents take the American Board of Radiology Qualifying (Core) exam to evaluate competency. Approximately 10% of first-time examinees will fail this exam (1). Understanding factors that contribute to success will help residency program directors and trainees prepare for future exams. RadDiscord (www.raddiscord.org), an international radiology educational community, is in the unique position to evaluate different study materials and resources. The goal of this paper is to report the results from the RadDiscord survey and analyze the factors that correlate with higher exam performance and passing. MATERIALS AND METHODS: Following the February 2021, June 2021, and June 2022 exams, RadDiscord members were provided an anonymous survey, collecting information on study resources and exam scores. The collected data were analyzed using various statistical methods. Both descriptive and inferential analyses were performed. RESULTS: A total of 318 residents responded (95% passed). Significant variability in Qualifying (Core) exam performance and perceived quality of internal didactics existed between program types. Residents who did less than 2000 practice questions performed lower on the exam. The Diagnostic Radiology In-Training (DXIT) exam was the most predictive for passing and performance. Qualifying (Core) exam performance negatively correlated with study time, though certain residents did receive some benefit from study time. CONCLUSION: Many factors correlate with passing and Qualifying (Core) exam performance. Residency programs with fewer resources should consider alternative ways to support residents beyond offering study time. Residents who complete at least 2000 practice questions are more likely to pass and DXIT results can be a useful gauge to identify exam readiness.

CT imaging of intrauterine devices (IUD): expected findings, unexpected findings, and complications.

Intrauterine devices (IUDs) are a commonly used form of long-acting reversible contraception, which either contain copper or levonorgestrel to prevent pregnancy. Although symptomatic patients with indwelling IUDs may first undergo ultrasound to assess for device malposition and complications, IUDs are commonly encountered on CT in patients undergoing evaluation for unrelated indications. Frequently, IUD malposition and complications may be asymptomatic or clinically unsuspected. For these reasons, it is important for the radiologist to carefully scrutinize the IUD on any study in which it is encountered. To do so, the radiologist must recognize that normally positioned IUDs are located centrally within the uterine cavity. IUDs are extremely effective in preventing pregnancy, though inadvertent pregnancy risk is higher with malpositioned IUDs. Presence of fibroids or Mullerian abnormalities may preclude proper IUD placement. Radiologists play an important role in identifying complications when they arise and special considerations when planning for an IUD placement. There is a wide range of IUD malposition, affecting IUDs differently depending on the type of IUD and its mechanism of action. IUD malposition is the most common complication, but embedment and/or partial perforation can and can lead to difficulty when removed. Retained IUD fragments can result in continued contraceptive effect. Perforated IUDs do not typically cause intraperitoneal imaging findings.

RadDiscord's Big Bang: Perspectives and Impact of Creation of a Successful Radiology Education Community.

The COVID-19 pandemic brought unprecedented challenges in radiology education. RadDiscord, a digital, open-access radiology educational platform now with over 4100 members internationally, emerged as a COVID-era innovation that has transformed radiology education, broken down institutional silos, and equalized access to high-quality education. This special report will discuss the origin of RadDiscord, overcoming early barriers, building an organization and community, innovation and impact, and the future of radiological education. This may offer helpful perspectives to trainees and educators who are interested in innovating in the realm of radiology education.

Taking a second look and zooming out: does this help with abnormality detection in chest radiography?

Purpose: Diagnostic errors are common in radiology. The gestalt impression of an image refers to the rapid holistic understanding one formulates about an image and may facilitate improved diagnostic accuracy. The ability to generate a gestalt impression is typically acquired over time and is generally not explicitly taught. Our study aims to assess whether perceptual training using second look and minification technique (SLMT) can help image interpreters formulate a holistic understanding of an image and become more accurate at evaluating medical images. Approach: Fourteen healthcare trainees voluntarily participated in a perceptual training module, comparing the differences in detection of nodules and other actionable finding (OAF) on chest radiographs before and after perceptual training intervention. The experimental group received SLMT training, and the control group did not. Results: Survey results were positive for all items, with the p-values <0.01. There was improvement in the performance in detection of nodules and OAF in both groups. However, this change was statistically significant only for OAFs in the control group (p-value <0.05) but not the experimental group. Conclusions: SLMT training was viewed by participants as an extremely helpful educational tool. Survey results indicated that participants felt the SLMT was a beneficial educational intervention. The experimental group's detection of nodules and OAF improved after SLMT, though not statistically significantly so, which may be related to the small sample size or lack of training effect. Perceptual training using SLMT may help as a useful educational technique, help radiologists identify abnormalities, and improve workflow.

Pineal Gland Metastasis From Gastric Carcinoid-A Rare Manifestation.

ABSTRACT: Pineal region metastases are very rare, occurring in 0.4% to 3.8% of patients with solid tumors and most frequently arise from a lung cancer primary tumor. We present a case of a 67-year-old man with a gastric well-differentiated neuroendocrine tumor (NET) metastatic to the pineal gland identified on 68Ga-DOTATATE PET/CT imaging followed by MRI confirmation. To our knowledge, this is the third NET case to be reported in the literature with such presentation and first case to be described on 68Ga-DOTATATE PET/CT. A case of metastatic bronchial NET as well as a case of metastatic esophageal NET to the pineal gland were reported previously.

Reporting immunization coverage inequalities in Pakistan.

BACKGROUND: Immunization coverage in Pakistan is unequally distributed. Understanding the current status of reporting of immunization coverage inequalities in Pakistan can help to identify gaps and opportunities for strengthened monitoring and reporting. AIMS: To assess the published literature on immunization coverage inequality measurement and reporting in Pakistan. METHODS: We performed a literature search in PubMed in April 2019 to obtain articles reporting inequalities in immunization coverage in Pakistan. A data extraction rubric was applied to collate information about data sources, immunization indicators and dimensions of inequality. RESULTS: We included 42 studies in our analysis. Most studies reported data from household surveys or research studies. Dimensions of inequality reflected geography (primarily provinces/territories), economic status, place of residence, education level, sex and occupation. District-level comparisons were featured in 5 studies that were subnational in scope. CONCLUSIONS: Expanded monitoring at district level is warranted as a major way forward in characterizing immunization inequalities in Pakistan.

Multiple enlarging hepatic and retroperitoneal myelolipomas in the setting of Cushing disease.

Myelolipomas are benign tumours typically occurring in the adrenal glands, made up of fat and trilineage haematopoeitic cells resembling bone marrow. Their aetiology is not well understood; however, they have a clear association with elevated serum adrenocorticotropic hormone (ACTH). Extra-adrenal myelolipomas are rare, and to our knowledge there are no previously reported cases of multiple enlarging hepatic and retroperitoneal myelolipomas in the setting of Cushing disease. We present the case of a patient with an ACTH-producing pituitary adenoma who developed multiple enlarging fat containing lesions in the liver and retroperitoneum, which were histologically proven multifocal myelolipomas.

Promoting equity in maternal, newborn and child health - how does gender factor in? Perceptions of public servants in the Ethiopian health sector.

Background: Advancing gender equality and health equity are concurrent priorities of the Ethiopian health sector. While gender is regarded as an important determinant of health, there is a paucity of literature that considers the interface between how these two priorities are pursued.Objective: This article explores how government stakeholders understand gender issues (gender barriers and roles) in the promotion of maternal, newborn and child health equity in Ethiopia.Methods: Adopting an exploratory qualitative case study design, we conducted semi-structured interviews with 17 purposively-selected stakeholders working in leadership positions with the Federal Ministry of Health and Federal Ministry of Women and Children Affairs as part of a larger study regarding the promotion of health equity in maternal, newborn and child health. A post hoc content and thematic sub-analysis was done to explore how participants raised gender issues in conversations about health equity.Results: Efforts to address gender inequalities were synonymous with the promotion of a women's health agenda, which was largely oriented towards promoting health service use. Men were predominant decision makers with regards to women's health and health care seeking in both public and private spheres. Participants reported persisting gender-related barriers to health stemming from traditional gender roles, and noted the increased inclusion of women in the health workforce since the introduction of the Health Extension Program.Conclusions: The framing of gender as a women's health issue, advanced through patriarchal structures, does little to elevate the status of women, or promote power differentials that contribute to health inequity. Encouraging leadership roles for women as health decision makers and redressing certain gender-based norms, attitudes, practices and discrimination are possible ways forward in re-orienting gender equality efforts to align with the promotion of health equity.

Prostatic intraepithelial neoplasia-like ductal prostatic adenocarcinoma: A case suitable for active surveillance?

In contrast to typical prostatic ductal adenocarcinoma, prostatic intraepithelial neoplasia (PIN)-like ductal adenocarcinoma is a rare variant of prostate cancer with low-grade clinical behavior. We report a case of a 66-year-old African-American male with an elevated serum prostate-specific antigen who underwent multiparametric prostate magnetic resonance imaging (MRI) and MRI/ultrasound fusion-guided biopsies. Pathology demonstrated low-volume Gleason score 3 + 3 = 6 (Grade Group 1), acinar adenocarcinoma involving one core and PIN-like ductal adenocarcinoma on a separate core. Herein, we discuss the potential role of active surveillance for patients with this rare variant of prostate cancer found in the era of advanced imaging with multiparametric MRI for prostate cancer.

Pediatric nephrectomy: incidence, indications and use of minimally invasive techniques.

PURPOSE: There is a paucity of knowledge regarding nephrectomy in contemporary United States pediatric populations. Usage patterns, indications and demographics of children undergoing nephrectomy are unknown. Given the significant increases in the use of minimally invasive nephrectomy in adults, we hypothesized similar trends may be seen in the pediatric population. MATERIALS AND METHODS: An estimated total of 27,615 children undergoing nephrectomy between 1998 and 2010 was extracted from the Nationwide Inpatient Sample. Trends in use were analyzed with the estimated annual percent change methodology using linear regression and proportions by chi-square. Determinants of minimally invasive nephrectomy were evaluated using generalized linear models adjusted for clustering with generalized estimating equations. RESULTS: The annual incidence of pediatric nephrectomy was 2.90 per 100,000 patient-years and remained stable. Nephrectomy was most common in children 0 to 1 year old (36%) and least common in children 6 to 9 years old (14%). However, nephrectomy for malignancy was most common in children 3 to 4 years old. Minimally invasive nephrectomy usage increased from 1.1% to 11.6% during the study period (estimated annual percent change 72.82%, p = 0.007). On multivariable analysis patients with malignancy (OR 0.07, p <0.001) had a lower rate of minimally invasive nephrectomy. Increased use was associated with increasing age (OR 1.07, p <0.001), treatment at a teaching institution (OR 1.95, p = 0.008) and increasing hospital volume (OR 1.01, p = 0.001). CONCLUSIONS: While the annual incidence of nephrectomy is stable, the use of minimally invasive nephrectomy is expanding in the pediatric population. Benign pathology and increasing age as well as nephrectomy at high volume teaching institutions are independently associated with minimally invasive nephrectomy use.