Added Value of Contrast-enhanced US for Evaluation of Female Pelvic Disease.

Since the first application of contrast-enhanced US (CEUS) in the late 1960s, the use of US contrast agents has grown tremendously, and this examination has proved to be a valuable adjunct to diagnostic US for detection and characterization of disease. Also, CEUS has emerged as an excellent option for evaluation of indeterminate lesions that require additional imaging, given its excellent safety profile, including that in patients with end-stage renal disease or allergies to contrast material who are unable to undergo contrast-enhanced CT or MRI. US traditionally has been considered the imaging modality of choice for evaluation of the female pelvis, followed by MRI and rarely fluoroscopy, CT, PET, or angiography. CEUS has the potential to add significant value in imaging gynecologic disease, and indications for its use in the female pelvis are expected to continue evolving. It can aid in evaluation of nonvascular structures, such as assessment of tubal patency, uterine cavity morphology, and pelvic fistulas. CEUS can help characterize poorly vascularized gynecologic tumors or tissues with slow flow by using qualitative and quantitative parameters and aid in image-guided interventions or biopsies by facilitating visualization of lesions that are difficult to see with other imaging modalities. The authors provide an overview of current applications of US contrast agents in the female pelvis and discuss associated factors such as technique, interpretation, and image optimization. They also discuss the limitations of CEUS and describe its utility in the evaluation of female pelvic disease by using an organ system case-based approach. © RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Visa Opportunities for International Medical Graduates Applying for U.S. Academic Radiology Department Faculty Positions: A National Survey.

BACKGROUND. International medical graduates (IMGs) are a source of physicians who could help alleviate radiologist workforce shortages in the United States. However, IMGs may face barriers in obtaining appropriate visas (e.g., H-1B or O-1 visas) to allow faculty employment. OBJECTIVE. The purpose of this study was to assess the policies and experiences of U.S. academic radiology departments in offering visas to IMGs applying for faculty positions. METHODS. A web-based survey on policies and experiences in offering visas to IMG faculty candidates was distributed to chairs of U.S. radiology departments with a diagnostic radiology training program recognized by the National Resident Matching Program. Individual survey questions were optional. The initial survey and subsequent reminders were sent from October 7, 2022, through November 7, 2022. RESULTS. The survey response rate was 81% (143/177). A total of 24% (28/115), 38% (44/115), 17% (20/115), and 20% (23/115) of departments offered H-1B visas to IMG faculty frequently, sometimes, rarely, and never, respectively; 3% (3/113), 27% (31/113), 22% (25/113), and 48% (54/113) of departments offered O-1 visas frequently, sometimes, rarely, and never, respectively. However, 41% (46/113) and 5% (6/113) of departments had default policies of offering H-1B and O-1 visas for IMG faculty candidates, respectively. The most common reasons given for why departments did not offer visas included, for both H-1B and O-1 visas, the time-consuming process, lack of reliability of candidates' starting time, and the expense of the visa application; for O-1 visas, the reasons given also included lack of expertise. A total of 15% (16/108) of departments set their own visa policies, 75% (81/108) followed institutional policies, and 10% (11/108) followed policies set by other entities (e.g., state government). CONCLUSION. Although to at least some extent most U.S. academic radiology departments offer H-1B and O-1 visas for IMGs seeking faculty positions, use of such visas typically is not the departments' default policy. A variety of barriers contributed to visas not being offered. The departments' visa policies were primarily determined at the institutional level. CLINICAL IMPACT. The identified barriers faced by U.S. academic radiology departments in offering visas to IMG faculty candidates impact the role of IMGs in helping to address radiologist workforce shortages.

International Medical Graduates in Radiology Residencies: Demographics, Performance, and Visa Issues.

RATIONALE AND OBJECTIVES: The number of international medical graduates (IMG) in radiology residencies has varied from year to year even as the number of candidates continues to grow. It is unclear from which countries the IMGs are arriving and what visas are being used to accommodate them. MATERIALS AND METHODS: We sent a survey to 195 program directors (PD) in diagnostic radiology (DR) inquiring about the number and nationality of IMG residents in their program, their attitudes about IMG candidates, the performance of their IMG trainees, and the visas that are offered. RESULTS: We received responses from 121 of 195 (62.1%) DR programs (121/149 =81.2% of actionable emails). 80/121 (66.1%) had at least one IMG in their DR residency program and the countries of origin included India (36), Iran (30), Saudi Arabia (24), Egypt (16), Canada (14), Brazil (14), and Pakistan (9), as the most common. While most programs (76/104, 73.1%) offered J1 visas, 23/99 (23.2%) provided H-1B visas to trainees. IMG DR residents overall performed as well as American graduates, with an equal number of PDs saying IMGs performed better and worse than American graduates. PDs' issues with IMGs centered on visas: (1) expense, (2) lack of familiarity, (3) Educational Commission for Foreign Medical Graduates regulations, and (4) time commitment in submitting paperwork. CONCLUSION: Most radiology IMG residents originate from India and Middle Eastern countries. Once enrolled, IMG residents perform similarly to US graduates. However, adding IMG candidates to the training program requires overcoming bureaucratic and monetary hurdles around visas. SUMMARY SENTENCE: Most DR international medical graduate residents are from India or the Middle East. Although their performance is the same as American graduates in general, PDs note the monetary and bureaucratic hassles accompanying their recruitment.

Transcranial Magnetic Stimulation and its Imaging Features in Patients With Depression, Post-traumatic Stress Disorder, and Traumatic Brain Injury.

Transcranial magnetic stimulation (TMS) is a type of noninvasive neurostimulation used increasingly often in clinical medicine. While most studies to date have focused on TMS's ability to treat major depressive disorder, it has shown promise in several other conditions including post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). As different treatment protocols are often used across studies, the ability to predict patient outcomes and evaluate immediate and long-term changes using imaging becomes increasingly important. Several imaging features, such as thickness, connectedness, and baseline activity of a variety of cortical and subcortical areas, have been found to be correlated with a greater response to TMS therapy. Intrastimulation imaging can reveal in real time how TMS applied to superficial areas activates or inhibits activity in deeper brain regions. Functional imaging performed weeks to months after treatment can offer an understanding of how long-term effects on brain activity relate to clinical improvement. Further work should be done to expand our knowledge of imaging features relevant to TMS therapy and how they vary across patients with different neurological and psychiatric conditions.

A Review of Posteromedial Lesions of the Chest Wall: What Should a Chest Radiologist Know?

A heterogeneous group of tumors can affect the posteromedial chest wall. They form diverse groups of benign and malignant (primary or secondary) pathologies that can arise from different chest wall structures, i.e., fat, muscular, vascular, osseous, or neurogenic tissues. Chest radiography is very nonspecific for the characterization of chest wall lesions. The modality of choice for the initial assessment of the chest wall lesions is computed tomography (CT). More advanced cross-sectional modalities such as magnetic resonance imaging (MRI) and positron emission tomography (PET) with fluorodeoxyglucose are usually used for further characterization, staging, treatment response, and assessment of recurrence. A systematic approach based on age, clinical history, and radiologic findings is required for correct diagnosis. It is essential for radiologists to be familiar with the spectrum of lesions that might affect the posteromedial chest wall and their characteristic imaging features. Although the imaging findings of these tumors can be nonspecific, cross-sectional imaging helps to limit the differential diagnosis and determine the further diagnostic investigation (e.g., image-guided biopsy). Specific imaging findings, e.g., location, mineralization, enhancement pattern, and local invasion, occasionally allow a particular diagnosis. This article reviews the posteromedial chest wall anatomy and different pathologies. We provide a combination of location and imaging features of each pathology. We will also explore the role of imaging and its strengths and limitations for diagnosing posteromedial chest wall lesions.

3-T MRI of the Ankle Tendons and Ligaments.

Ankle sprain is the most common injury in athletic populations. Ligament and tendon pathologies of the ankle are common, ranging from traumatic injuries to degeneration leading to chronic pain and acquired foot deformities. MRI is the imaging modality of choice to evaluate tendon and ligament pathology of the ankle, specifically derangements of tendons and ligaments. 3-T MRI offers improved imaging characteristics relative to 1.5-T MRI, allowing for better delineation of anatomic detail and pathology. This article provides a review of the anatomy and common pathologies of the ankle ligaments and tendons using high-resolution 3-T MRI.

The Beginning of the End.

OBJECTIVES: The purpose of this study was to determine the relationship between gender, research productivity, academic rank, and departmental leadership positions of pathology faculty in North America. METHODS: The online information presented for the faculty members in all American- and Canadian-accredited pathology residency programs' official websites and Elsevier's SCOPUS were queried to assess research productivity, academic ranks, and leadership positions. RESULTS: Among 5,228 academic pathologists included in our study, there were 3,122 (59.7%) males and 2,106 (40.3%) females. Male faculty held higher academic ranks (being professor) and leadership positions (chair/program director) (P < .0001). Males were more likely to hold combined MD-PhD degrees (P < .0001) than females. The median h-index for the male faculty was 17 vs 9 for the female faculty (P = .023). CONCLUSIONS: Gender has a significant influence on leadership positions, academic ranks, and research productivity among pathology faculty members in North America.

3T Magnetic Resonance Imaging of the Wrist Tendons.

Magnetic resonance imaging (MRI) is frequently used in the imaging evaluation of wrist pain. The complex anatomy of the wrist can be demonstrated by MRI. Three tesla (3 T) MRI offers increased signal-to-noise ratio relative to 1.5 T MRI allowing for higher soft tissue contrast and better spatial resolution. The resulting increase in conspicuity of fine anatomic detail may improve the detection and characterization of wrist pathology. In this article, we will review the anatomy, normal variants, and common pathologies of the wrist tendons as evaluated on 3 T MRI.

How Do American Radiology Institutions Deal With Second Opinion Consultations on Outside Studies?

OBJECTIVE. Policies regarding how to handle the review of imaging studies performed at another institution (second opinion consultations) have not been uniform in academic radiology. Departments must decide whether to simply store outside studies in the PACS, report the studies officially, bill third-party payers, repeat such studies, or take a combination of these steps. The purpose of this study was to determine the current state of practice in dealing with second opinion consultations in academic radiology departments. SUBJECTS AND METHODS. A survey was conducted of the members of the Society of Chairs of Academic Radiology Departments (SCARD) and the Association of Administration in Academic Radiology (AAARAD) for their practices with respect to outside studies. RESULTS. Completed surveys were received from 91 of 160 (56.9%) SCARD and 35 of 106 (33.0%) AAARAD members. Of the 91 SCARD respondents, 70 (76.9%) added outside studies to their PACS, and 34 (37.4%) required formal internal reports on all outside studies. By contrast, 74 (81.3%) allowed at least some outside studies into their PACS without requiring an internal report. Many respondents interpreted outside studies only if specifically requested. Most (67/91 [73.6%]) billed insurers but not patients (61/91 [67.0%]) for the second opinion consultations. Fifteen (16.5%) preferred repeating studies rather than including outside studies in the PACS. With minimal exceptions, the AAARAD results paralleled the SCARD results. CONCLUSION. The survey showed that common practices in academic radiology are to add outside studies to the institutional PACS without mandating an internal report and to bill insurers but not patients for second opinion consultations.

The Policy of Co-First Authorship and Co-Senior Authorship in Radiology Journals.

OBJECTIVE: Increasingly, medical journals are recognizing "equally credited authors" (ECA) in the primary and senior authorship of articles. The aim of this study was to assess the policies of co-first authorship, co-senior authorship, and designation of a corresponding author in the radiology literature. METHODS: We identified 29 radiology journals based on impact factor ranking. Journal offices were contacted by phone and e-mail to ascertain their practices on first and senior authorship ECA designations. We surveyed the March, June, and December 2018 issues of each journal (when available) to assess the utilization of the co-designations in articles. RESULTS: Twenty-five of 29 journals responded to our survey (response rate: 86.2%). Of 25 journals, 20 (80%) allowed co-first authorship. Among these, 4 of 25 journals (16%) allowed more than two co-first authors. Among the 25 responses, 14 journals (56%) allowed co-senior authorship. Among the 24 journals who responded to this specific question, 23 (96%) approved designation of a corresponding author, different from the first or senior author. The review of March, June, December 2018 editions found co-first authorship and co-senior authorship ECA rates of 8.6% (range 0.0%-22.7%) and 1.8% (range 0.0%-13.3%), respectively. A corresponding author other than first or senior author was noted in 13.3% (range 0.0%-34.7%). DISCUSSION: There has been widespread acceptance of the concept of ECA in the policies of the top cited imaging journals particularly for first authors (80%). However, the utilization of these designations is uncommon for first authorship (8.6%) and rare (1.8%) for senior authorship based on our 2018 sampling.

Interatrial septum: A pictorial review of congenital and acquired pathologies and their management.

There are many different congenital abnormalities and acquired pathologies involving the interatrial septum. Differentiation of these pathologies significantly affects patient management. We have reviewed the various interatrial septal pathologies and discussed their congenital associates, clinical significance, and management. After reading this article, the reader should be able to better characterize the interatrial septal pathologies using the optimal imaging tools, and have a better understanding of their clinical significance and management.