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RATIONALE: Mediastinal lymph node (MLN) enlargement on chest computed tomography (CT) is prevalent in patients with interstitial lung disease (ILD) and may reflect immunologic activation and subsequent cytokine-mediated immune cell trafficking. OBJECTIVES: We aimed to determine whether MLN enlargement on chest CT predicts clinical outcomes and circulating cytokine levels in ILD. METHODS: MLN measurements were obtained from chest CT scans of patients with ILD at baseline evaluation over a 10-year period. Patients with sarcoidosis and drug toxicity-related ILD were excluded. MLN diameter and location were assessed. Plasma cytokine levels were analyzed in a subset of patients. The primary outcome was transplant-free survival (TFS). Secondary outcomes included all-cause and respiratory hospitalizations, lung function, and plasma cytokine concentrations. Cox regression was used to assess mortality risk. Outcomes were assessed in three independent ILD cohorts. MEASUREMENTS AND MAIN RESULTS: Chest CT scans were assessed in 1,094 patients (mean age, 64 yr; 52% male). MLN enlargement (≥10 mm) was present in 66% (n = 726) and strongly predicted TFS (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.12-2.10; P = 0.008) and risk of all-cause and respiratory hospitalizations (internal rate of return [IRR], 1.52; 95% CI, 1.17-1.98; P = 0.002; and IRR, 1.71; 95% CI, 1.15-2.53; P = 0.008, respectively) when compared with subjects with MLN <10 mm. Patients with MLN enlargement had lower lung function and decreased plasma concentrations of soluble CD40L (376 pg/ml vs. 505 pg/ml, P = 0.001) compared with those without MLN enlargement. Plasma IL-10 concentration >45 pg/ml predicted mortality (HR, 4.21; 95% CI, 1.21-14.68; P = 0.024). Independent analysis of external datasets confirmed these findings. CONCLUSIONS: MLN enlargement predicts TFS and hospitalization risk in ILD and is associated with decreased levels of a key circulating cytokine, soluble CD40L. Incorporating MLN and cytokine findings into current prediction models might improve ILD prognostication.
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Doenças Pulmonares Intersticiais/mortalidade , Linfonodos/diagnóstico por imagem , Mediastino/diagnóstico por imagem , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The modern-day radiologist must be adept at image interpretation, and the one who most successfully leverages new technologies may provide the highest value to patients, clinicians, and trainees. Applications of virtual reality (VR) and augmented reality (AR) have the potential to revolutionize how imaging information is applied in clinical practice and how radiologists practice. This review provides an overview of VR and AR, highlights current applications, future developments, and limitations hindering adoption.
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Realidade Aumentada , Radiologia , Realidade Virtual , HumanosRESUMO
OBJECTIVES: To evaluate differences in the tumor response classifications that result from clinical measurements and to compare these response classifications with overall survival for patients with malignant pleural mesothelioma (MPM). METHODS: One hundred thirty-one computed tomography (CT) scans were collected from 41 MPM patients enrolled in a clinical trial. Primary measurements had been acquired by clinical radiologists at a single center during routine clinical workflow, and the variability of these measurements was investigated. Retrospective measurements were acquired by a single radiologist in compliance with the study protocol based on the modified response evaluation criteria in solid tumors (RECIST). Differences in response classification categories by the two measurement approaches were evaluated and compared with patient survival. RESULTS: Eleven (27%) of the 41 MPM patients had primary measurements at baseline or at follow-up that deviated from the guidelines of the clinical trial protocol. Among the 41 baseline scans, no statistical difference was observed in summed tumor measurements between primary and retrospective measurements. Response classification based on primary and retrospective measurements was different in 23 (26%) of the 90 follow-up scans, and best response was the different in seven (17%) of the 41 patients. Using Harrell's C statistic as a measure of correlation, response based on retrospective measurements correlated better with survival (C = 0.62) than did response based on primary measurements (C = 0.57). CONCLUSIONS: Strict compliance with the measurement protocol yields tumor response classifications that may differ from those obtained in clinical practice. Response based on retrospective measurements correlated better with survival than did response based on primary measurements. KEY POINTS: ⢠Response classifications could be different between clinical primary and retrospective measurements for malignant pleural mesothelioma. ⢠Response classifications obtained by strict compliance with the trial-specific protocol correlated better with survival than the classifications based on primary measurements. ⢠Quality assurance and radiologist training measures should be used to ensure the integrity of image-based tumor measurements in mesothelioma clinical trials.
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Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Estadiamento de Neoplasias/métodos , Neoplasias Pleurais/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Vorinostat/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Feminino , Humanos , Illinois/epidemiologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/tratamento farmacológico , Mesotelioma/mortalidade , Mesotelioma Maligno , Pessoa de Meia-Idade , Neoplasias Pleurais/tratamento farmacológico , Neoplasias Pleurais/mortalidade , Critérios de Avaliação de Resposta em Tumores Sólidos , Estudos Retrospectivos , Taxa de Sobrevida/tendênciasRESUMO
OBJECTIVES: The aim of this pilot study was to investigate the utility of haemodynamic parameters derived from dynamic contrast-enhanced computed tomography (DCE-CT) scans in the assessment of tumour response to treatment in malignant pleural mesothelioma (MPM) patients. METHODS: The patient cohort included nine patients undergoing chemotherapy and five patients on observation. Each patient underwent two DCE-CT scans separated by approximately 2 months. The DCE-CT parameters of tissue blood flow (BF) and tissue blood volume (BV) were obtained within the dynamically imaged tumour. Mean relative changes in tumour DCE-CT parameters between scans were compared between the on-treatment and on-observation cohorts. DCE-CT parameter changes were correlated with relative change in tumour bulk evaluated according to the modified RECIST protocol. RESULTS: Differing trends in relative change in BF and BV between scans were found between the two patient groups (p = 0.19 and p = 0.06 for BF and BV, respectively). No significant rank correlations were found when comparing relative changes in DCE-CT parameters with relative change in tumour bulk. CONCLUSIONS: Differing trends in the relative change of BF and BV between patients on treatment and on observation indicate the potential of DCE-CT for the assessment of pharmacodynamic endpoints with respect to treatment in MPM. A future study with a larger patient cohort and unified treatment regimens should be undertaken to confirm the results of this pilot study. KEY POINTS: ⢠CT-derived haemodynamic parameters show differing trends between malignant pleural mesothelioma patients on treatment and patients off treatment ⢠Changes in haemodynamic parameters do not correlate with changes in tumour bulk as measured according to the modified RECIST protocol ⢠Differing trends across the two patient groups indicate the potential sensitivity of DCE-CT to assess pharmacodynamic endpoints in the treatment of MPM.
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Antineoplásicos/uso terapêutico , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Mesotelioma/diagnóstico por imagem , Mesotelioma/tratamento farmacológico , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/farmacologia , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Neoplasias Pulmonares/irrigação sanguínea , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/irrigação sanguínea , Mesotelioma/patologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Neovascularização Patológica/diagnóstico por imagem , Projetos Piloto , Neoplasias Pleurais/irrigação sanguínea , Neoplasias Pleurais/patologia , Critérios de Avaliação de Resposta em Tumores Sólidos , Tomografia Computadorizada Espiral/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: The number of 4th-year medical student applications to the field of diagnostic radiology has decreased from 2009 to 2015. The purpose of this study was to learn how radiology departments are recruiting medical students. MATERIALS AND METHODS: An anonymous online survey hyperlink was distributed to the members of the Society of Chairs of Academic Radiology Departments regarding both innovative and proven recruitment strategies. The results were synthesized with a recently published survey of medical students about factors influencing them to go into radiology. RESULTS: Forty of 126 radiology departments completed the survey. Most felt that radiology exposure and curricula require alteration given recent downward trends in medical student applications. A majority (79%) had changed their outreach to medical students in response to these trends. The responding department chairs felt that interactive learning while on rotation was the most important strategy for recruitment. The presence of a diversity program, dedicated medical school educator, or rotating daily assignment for students did not affect the likelihood of filling residency spots in the main match. CONCLUSION: Many radiology departments are changing their outreach to medical students to improve recruitment. Effective strategies to focus on include early active outreach by involving students in the radiology department, thereby framing radiologists as clinicians.
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Centros Médicos Acadêmicos , Docentes de Medicina/estatística & dados numéricos , Seleção de Pessoal/métodos , Serviço Hospitalar de Radiologia , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Candidatura a Emprego , Liderança , Critérios de Admissão Escolar/estatística & dados numéricos , Estados Unidos , Recursos HumanosRESUMO
To improve awareness and understanding of cybersecurity threats to radiology practice and better equip healthcare practices to manage cybersecurity risks associated with medical imaging, this article reviews topics related to cybersecurity in healthcare, with emphasis on common vulnerabilities in radiology operations. This review is intended to assist radiologists and radiology administrators who are not information technology specialists to attain an updated overview of relevant cybersecurity concepts and concerns relevant to safe and effective practice of radiology and provides a succinct reference for individuals interested in learning about imaging-related vulnerabilities in healthcare settings. As cybersecurity incidents have become increasingly common in healthcare, we first review common cybersecurity threats in healthcare and provide updates on incidence of healthcare data breaches, with emphasis on the impact to radiology. Next, we discuss practical considerations on how to respond to a healthcare data breach, including notification and disclosure requirements, and elaborate on a variety of technical, organizational, and individual actions that can be adopted to minimize cybersecurity risks applicable to radiology professionals and administrators. While emphasis is placed on specific vulnerabilities within radiology workflow, many of the preventive or mitigating strategies are also relevant to cybersecurity within the larger digital healthcare arena. We anticipate that readers, upon completing this review article, will gain a better appreciation of cybersecurity issues relevant to radiology practice and be better equipped to mitigate cybersecurity risks associated with medical imaging.
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Visual illusions are distortions, alterations, or alternatives in the appearance of reality that result primarily from the sensory and perceptual processing mechanisms of the human visual system. These illusions are common phenomena in radiology, and it is important to understand them because they can create the illusion of disease, leading to incorrect image interpretation. Visual illusions in radiology can be organized according to the point in the visual system at which they emerge. Illusions of sensation, including Mach bands and background effect, are "lower-order" visual phenomena that occur as the eye and brain translate light into neural activity. Illusions of perception, such as ambiguous figures and distortion, occur in "higher-order" brain structures that are responsible for coalescing sensory input into a mental image interpreted by the mind. Illusions of image formation (eg, parallax), as the name implies, result from the way images are generated. Some visual illusions occur with all modalities, whereas others tend to be modality specific. The authors discuss a variety of visual illusions, describing their underlying psychologic and neuroscientific basis and demonstrating their relevance to radiology. A thorough understanding of visual illusions in radiology enhances diagnostic accuracy by minimizing the risk of mistaking illusions for disease.
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Artefatos , Ilusões/fisiologia , Modelos Biológicos , Radiografia/métodos , Percepção Visual/fisiologia , Humanos , Variações Dependentes do ObservadorRESUMO
The Clinical Excellence Scholars Track was developed in 2012 as a shared initiative between the Bucksbaum Institute for Clinical Excellence, the University of Chicago (UChicago) Careers in Healthcare office, and the UChicago Medicine Office of Community and External Affairs. The goal of the Clinical Excellence Scholars Track is to foster an understanding of the physician career and the doctor-patient relationship for a select group of undergraduate students. The Clinical Excellence Scholars Track achieves this goal through carefully tailored curricular requirements and direct mentoring experiences between Bucksbaum Institute Faculty Scholars and the student scholars. After participating in the Clinical Excellence Scholars Track program, student scholars report that their career understanding and preparation have benefitted as a result and that they meet with success in the medical school application process as well.
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Educação de Graduação em Medicina , Educação Médica , Humanos , Relações Médico-Paciente , Estudantes , Mentores , Faculdades de MedicinaRESUMO
Radiology education of medical students is increasingly important given the intersection of radiology with virtually all medical specialties and integral role of imaging in modern patient care. Yet radiology education requirements in US medical schools are variable with only a minority of schools requiring a clerkship in radiology. When required, the radiology curriculum is often limited to anatomy courses in the preclinical years or partially incorporated into required core clerkships and often taught by nonradiologists. Given the growing mandate for value-based care and emphasis on patient outcomes, medical students require better imaging education, both interpretive and non-interpretative skills. They should be taught how to apply appropriateness criteria for exam ordering and the relative costs of different imaging modalities given the economic implications of imaging overutilization. Medical students should also be educated regarding imaging safety considerations. In addition, they must learn the radiologist's role as consultant to assure appropriate ordering of imaging studies, oversight for performance of diagnostic exams and image-guided procedures, interpretation of studies, and communication of results. Increasing radiologist teaching and engagement with medical students also has the potential to improve diversity and inclusivity in radiology by increasing interest in the specialty as physicians who identify as underrepresented minorities (URMs) are more likely to practice in underserved areas and with underserved populations thus addressing healthcare disparities and improving access to healthcare for those patient populations. Medical schools should support preclinical and clinical curricula that is designed and taught by radiologists.
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Educação de Graduação em Medicina , Educação Médica , Radiologia , Estudantes de Medicina , Humanos , Radiologia/educação , Currículo , Radiografia , Escolaridade , Educação de Graduação em Medicina/métodos , Faculdades de MedicinaRESUMO
RATIONALE AND OBJECTIVES: Many medical schools offer minimal exposure to radiology, leading to a decreased understanding of the field and negative perceptions among medical students. The purpose of this study was to examine the effects of a radiology intensive series piloted by a novel virtual radiology interest group. Specifically, we were interested in how radiologists and medical educators can expand students' general awareness, drive greater interest in the field, and achieve more uniform national messaging across all trainees. MATERIALS AND METHODS: We launched a national/international interest group called Radiology Student Interest Group (RadSIG) and piloted the RadSIG Intensive, a series of five events aimed at increasing awareness and dispelling misconceptions among preclinical medical students. Validated pre-intensive and post-intensive surveys were used to ascertain the students' baseline and changed perspectives, respectively. A separate faculty survey was also distributed to understand how they perceived our events. Statistical analysis was carried out on the collected data to identify trends and assess the utility of our programming. RESULTS: 205 students completed the pre-intensive survey, and 61 students completed the post-intensive survey. Of the pre-intensive survey respondents, 51.7% (106/205) indicated that they had a limited understanding of what a career in radiology entails. Of those who completed the entire RadSIG Intensive, average 5-point Likert scale scores for understanding of a radiology career rose from 3.30 to 4.38 respectively pre- to post-completion. A Wilcoxon signed-rank test revealed that this difference was statistically significant (Z=-5.95, p<0.001), and that the RadSIG Intensive significantly improved perceptions of radiologists across every single question measured, except for perception of long hours worked (Z=-0.20, p=0.841). The results also showed increased student comfort in reaching out to radiology attendings (Z=-4.30, p<0.001) and residents (Z=-5.12, p<0.001). Faculty survey results indicated positive perceptions of the series. CONCLUSION: Our results show that the RadSIG Intensive was effective in increasing students' understanding of radiology as a field and a potential career. Online outreach can also lower the resistance and improve student comfort in reaching out for mentorship, which may provide a new pathway to reach underserved students with a unifying message. By furthering a platform based on voluntary and supplemental resources, we see a far greater potential of impacting the perception and known role of the imager in patient care among our next generation of physicians.
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Radiologia , Estudantes de Medicina , Humanos , Opinião Pública , Radiologia/educação , Radiografia , RadiologistasRESUMO
OBJECTIVES: To assess the perceived state of diversity in Radiology Residency Programs in the United States and to evaluate the level of acceptance for diversity, equity, and inclusion (DEI) initiatives. METHODS: An electronic survey was conducted of the Radiology Residency Programs in the United States in December 2021 and January 2022. Respondents were recruited by email sent to the members of the Association of University Radiologists who were Radiology Residency Program Directors. Quantitative and Qualitative analyses were performed. RESULTS: Of the 198 emails sent out to the Radiology Program Directors, 53 completed surveys were returned (response rate of 27%). Although some progress has been made in increasing the number of women and Asians in Academic Radiology, there is persisting imbalance of the numbers of African American and Latinx radiologists which comprise far less than 25% of the physician workforce. Nearly half of the respondents reported having a Vice Chair of DEI. Three themes emerged from the qualitative analysis. Most respondents agreed that diversity should be considered when recruiting faculty and residents. Many noted a strong commitment to DEI but they felt there was room for improvement in formalizing efforts to aid in recruitment of underrepresented minorities. Diversity education was more likely mandatory for residents and optional for faculty. CONCLUSION: Academic Radiology programs are recognizing the value of internal DEI leadership roles. Radiologists are implementing DEI initiatives and making intentional changes in the recruitment of diverse radiologists. More concerted efforts are needed to increase the low numbers of African American and Latinx radiologists. Effective evaluation metrics for various DEI programs are needed to assess how successful these endeavors are in creating lasting changes.
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Internato e Residência , Radiologia , Humanos , Feminino , Estados Unidos , Radiologia/educação , Radiografia , Inquéritos e Questionários , PercepçãoRESUMO
Integrating diversity into healthcare systems has its challenges and advantages. Academic medicine strives to expand the diversity of the healthcare workforce. The Association of University Radiologists (AUR) put together a task force to review the concept of Diversity, Equity and Inclusion (DEI) as it pertains to Radiology and to propose strategies for better integrating DEI in Radiology. We present several measures aimed at the trainee, leadership, management and professional society levels to empower DEI in Radiology.
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Diversidade, Equidade, Inclusão , Radiologia , Humanos , Radiografia , Radiologistas , Comitês ConsultivosRESUMO
Malignant pleural mesothelioma (MPM) is the most common form of malignant mesothelioma, with exposure to asbestos being the primary cause of the disease. To assess response to treatment, tumor measurements are acquired and evaluated based on a patient's longitudinal computed tomography (CT) scans. Tumor volume, however, is the more accurate metric for assessing tumor burden and response. Automated segmentation methods using deep learning can be employed to acquire volume, which otherwise is a tedious task performed manually. The deep learning-based tumor volume and contours can then be compared with a standard reference to assess the robustness of the automated segmentations. The purpose of this study was to evaluate the impact of probability map threshold on MPM tumor delineations generated using a convolutional neural network (CNN). Eighty-eight CT scans from 21 MPM patients were segmented by a VGG16/U-Net CNN. A radiologist modified the contours generated at a 0.5 probability threshold. Percent difference of tumor volume and overlap using the Dice Similarity Coefficient (DSC) were compared between the standard reference provided by the radiologist and CNN outputs for thresholds ranging from 0.001 to 0.9. CNN annotations consistently yielded smaller tumor volumes than radiologist contours. Reducing the probability threshold from 0.5 to 0.1 decreased the absolute percent volume difference, on average, from 43.96% to 24.18%. Median and mean DSC ranged from 0.58 to 0.60, with a peak at a threshold of 0.5; no distinct threshold was found for percent volume difference. The CNN exhibited deficiencies with specific disease presentations, such as severe pleural effusion or disease in the pleural fissure. No single output threshold in the CNN probability maps was optimal for both tumor volume and DSC. This study emphasized the importance of considering both figures of merit when evaluating deep learning-based tumor segmentations across probability thresholds. This work underscores the need to simultaneously assess tumor volume and spatial overlap when evaluating CNN performance. While automated segmentations may yield comparable tumor volumes to that of the reference standard, the spatial region delineated by the CNN at a specific threshold is equally important.
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Malignant pleural mesothelioma (MPM) is an aggressive primary malignancy of the pleura that presents unique radiologic challenges with regard to accurate and reproducible assessment of disease extent at staging and follow-up imaging. By optimizing and harmonizing technical approaches to imaging MPM, the best quality imaging can be achieved for individual patient care, clinical trials, and imaging research. This consensus statement represents agreement on harmonized, standard practices for routine multimodality imaging of MPM, including radiography, computed tomography, 18F-2-deoxy-D-glucose positron emission tomography, and magnetic resonance imaging, by an international panel of experts in the field of pleural imaging assembled by the International Mesothelioma Interest Group. In addition, modality-specific technical considerations and future directions are discussed. A bulleted summary of all technical recommendations is provided.
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Neoplasias Pulmonares , Mesotelioma Maligno , Mesotelioma , Neoplasias Pleurais , Humanos , Mesotelioma Maligno/patologia , Opinião Pública , Neoplasias Pleurais/patologia , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Mesotelioma/patologia , Tomografia por Emissão de Pósitrons/métodosRESUMO
BACKGROUND: Radiologic imaging is increasingly utilized as supplemental material in preclinical gross anatomy courses, but few studies have investigated its utility as a fully integrated instructional tool. AIMS: Establish the benefit of a teaching method that simultaneously correlates cadaveric and radiologic structures for learning human anatomy. METHOD: We performed a mixed-methods randomized controlled trial and one-way cross-over study comparing exam grades and subjective student perception in a gross anatomy course. The intervention consisted of daily direct correlation small group sessions in which students simultaneously identified and correlated radiologic and cadaveric structures. The control method utilized identical laboratory and teaching conditions but students did not simultaneously correlate structures. Spatial relationships of structures within each respective media (gross or radiologic) were emphasized in both groups. RESULTS: No significant differences in radiology, gross, or written exam scores were observed between the intervention and control groups. The cross-over group preferred the intervention and control methods equally. The correlation teaching sessions ranked equally with active dissection as the most important instructional components of the course. CONCLUSION: Direct, simultaneous correlation of radiologic and cadaveric structures did not affect exam scores or student preference but helped students understand anatomical concepts in comparison with other course components.
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Anatomia/educação , Cadáver , Radiografia , Estudantes de Medicina/psicologia , Ensino/métodos , Adulto , Estudos Cross-Over , Método Duplo-Cego , Avaliação Educacional , Feminino , Humanos , Masculino , Estados Unidos , Adulto JovemRESUMO
RATIONALE AND OBJECTIVES: Identification of shifts in match metrics, such as applicant volumes, match rates, and interview patterns, stands to inform and empower both applicants and programs participating in the NRMP residency match. Residency programs rarely publish their internal data. Accordingly, we employed publicly available resources to evaluate changes in such metrics for the diagnostic radiology match from 2008 to 2018. MATERIALS AND METHODS: Reports made available to the public by the NRMP, alongside student discussion on the AuntMinnie.com and StudentDoctor.net forums, were used to determine applicant volumes, interview volumes, program rank-order-list metrics, match rates, and interview invite patterns. Linear regression and correlation analyses were employed to identify statistically significant trends. RESULTS: No statistically significant trends were identified across the selected timeframe for applicant volumes or match rates. Statistically significant upward trends were identified for total interview volumes, average interviews attended per applicant, and the fraction of programs inviting students to interview before October 1st, the MSPE release date (p < 0.05). A very strong and significant positive correlation was identified between average interviews attended per applicant and the average number of ranks needed by programs to fill a position (p < 0.01, Râ¯=â¯0.804). CONCLUSION: Applicants pursuing a diagnostic radiology residency are attending more interviews, and programs are increasingly inviting students to interview based on incomplete applications. However, there has been no corresponding uptrend in match rates. Moreover, increased applicant interview attendance is highly associated with programs falling further down their rank lists. Given the expenses usually associated with the match process and forthcoming changes to USMLE scoring, these trends may be unsustainable.
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Internato e Residência , Radiologia , HumanosRESUMO
Giving and receiving constructive feedback is a valuable skill and an evolving process due to improved understanding and changes in culture. This article provides a practical review of key elements of effective feedback skills and strategies for providing constructive feedback, with a focus on how to address recipients who may have impaired insight into the issue at hand. Commonly known tips and tricks include direct, immediate, and specific feedback delivered in a safe setting and in a conversational manner. This article specifically considers how the feedback will be heard or accepted by the intended recipient, in order for the educator to best overcome hurdles in relaying constructive criticism.
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Comunicação , Feedback Formativo , Retroalimentação , HumanosRESUMO
Adolescent human papillomavirus (HPV) vaccination uptake, as a means of cervical cancer prevention, remains suboptimal with significant racial disparity. A survey study of mothers already engaging in their own cancer screening, at a predominantly black urban site and a predominantly white suburban site, finds that a majority of mothers surveyed support hypothetical mandates for adolescent HPV vaccination three years after the introduction of these vaccines. Enactment of state laws may represent an efficient means to improve HPV vaccination in adolescent daughters of these mothers. Nevertheless, in a sizable minority, maternal perceptions of the HPV vaccine may hinder adherence to these vaccination laws. In these women, tailored interventions directed at these perceptions may be required.
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Mães , Vacinas contra Papillomavirus/imunologia , Vacinação/legislação & jurisprudência , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Núcleo FamiliarRESUMO
Radiologists are facing ever increasing volumes while trying to provide value-based care. There are several drivers of increasing volumes: increasing population size, aging population, increased utilization, gaps in evidence-based care, changes in the provider workforce, defensive medicine, and increasing case complexity. Higher volumes result in increased cognitive and systemic errors and contribute to radiologist fatigue and burnout. We discuss several strategies for mitigating high volumes including abbreviated MRI protocols, 24/7 radiologist coverage, reading room assistants, and other strategies to tackle radiologist burnout.
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Esgotamento Profissional , Radiologistas , Idoso , Humanos , Imageamento por Ressonância Magnética , Recursos HumanosRESUMO
Tumor volume is a topic of interest for the prognostic assessment, treatment response evaluation, and staging of malignant pleural mesothelioma. Many mesothelioma patients present with, or develop, pleural fluid, which may complicate the segmentation of this disease. Deep convolutional neural networks (CNNs) of the two-dimensional U-Net architecture were trained for segmentation of tumor in the left and right hemithoraces, with the networks initialized through layers pretrained on ImageNet. Networks were trained on a dataset of 5230 axial sections from 154 CT scans of 126 mesothelioma patients. A test set of 94 CT sections from 34 patients, who all presented with both tumor and pleural effusion, in addition to a more general test set of 130 CT sections from 43 patients, were used to evaluate segmentation performance of the deep CNNs. The Dice similarity coefficient (DSC), average Hausdorff distance, and bias in predicted tumor area were calculated through comparisons with radiologist-provided tumor segmentations on the test sets. The present method achieved a median DSC of 0.690 on the tumor and effusion test set and achieved significantly higher performance on both test sets when compared with a previous deep learning-based segmentation method for mesothelioma.