Approach to Acute Traumatic and Nontraumatic Diaphragmatic Abnormalities.

Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic and traumatic entities. Nontraumatic abnormalities range from congenital hernia to spontaneous rupture, endometriosis-related disease, infection, paralysis, eventration, and thoracoabdominal fistula. Traumatic abnormalities comprise both blunt and penetrating injuries. Given the role of the diaphragm as the primary inspiratory muscle and the boundary dividing the thoracic and abdominal cavities, compromise to its integrity can yield devastating consequences. Yet, diagnosis can prove challenging, as symptoms may be vague and findings subtle. Imaging plays an essential role in investigation. Radiography is commonly used in emergency evaluation of a patient with a suspected thoracoabdominal process and may reveal evidence of diaphragmatic compromise, such as abdominal contents herniated into the thoracic cavity. CT is often superior, in particular when evaluating a trauma patient, as it allows rapid and more detailed evaluation and localization of pathologic conditions. Additional modalities including US, MRI, and scintigraphy may be required, depending on the clinical context. Developing a strong understanding of the acute pathologic conditions affecting the diaphragm and their characteristic imaging findings aids in efficient and accurate diagnosis. Additionally, understanding the appearance of diaphragmatic anatomy at imaging helps in differentiating acute pathologic conditions from normal variations. Ultimately, this knowledge guides management, which depends on the underlying cause, location, and severity of the abnormality, as well as patient factors. ©RSNA, 2024 Supplemental material is available for this article.

Hepatic Hilar Nerve Block for Adjunctive Analgesia during Percutaneous Thermal Ablation of Hepatic Tumors: A Retrospective Analysis.

PURPOSE: To determine whether hepatic hilar nerve block techniques reduce analgesic and sedation requirements during percutaneous image-guided thermal ablation of hepatic tumors. MATERIALS AND METHODS: A single-center retrospective cohort analysis was performed of 177 patients (median age, 67 years; range, 33-86 years) who underwent percutaneous image-guided thermal ablation of liver tumors. All patients were treated utilizing local anesthetic and moderate sedation between November 2018 and November 2021 at a tertiary level hospital, with or without the administration of a hepatic hilar nerve block. Univariable and multivariable linear regression analyses were performed to determine the relationship between the administration of the hilar nerve block and fentanyl and midazolam dosages. RESULTS: A total of 114 (64%) patients received a hilar nerve block in addition to procedural sedation, and 63 (36%) patients received procedural sedation alone. There were no significant differences in the baseline demographic and tumor characteristics between the cohorts. The procedure duration was longer in the hilar block cohort than in the unblocked cohort (median, 95 vs 82 minutes; P = .0012). The technical success rate (98% in both the cohorts, P = .93) and adverse event rate (11% vs 3%, P = .14) were not significantly different between the cohorts. After adjusting for patient and tumor characteristics, ablation modality, and procedure and ablation durations, hilar nerve blocks were associated with lower fentanyl (-18.4%, P = .0045) and midazolam (-22.7%, P = .0007) dosages. CONCLUSIONS: Hepatic hilar nerve blocks significantly decrease the fentanyl and midazolam requirements during thermal ablation of hepatic tumors, without a significant change in the technical success or adverse event rates.

Undergraduate Radiology Education During the COVID-19 Pandemic: A Review of Teaching and Learning Strategies [Formula: see text].

The Coronavirus disease 2019 (COVID-19) pandemic has altered how medical education is delivered, worldwide. Didactic sessions have transitioned to electronic/online platforms and clinical teaching opportunities are limited. These changes will affect how radiology is taught to medical students at both the pre-clerkship (ie, year 1 and 2) and clinical (ie, year 3 and 4) levels. In the pre-clerkship learning environment, medical students are typically exposed to radiology through didactic lectures, integrated anatomy laboratories, case-based learning, and ultrasound clinical skills sessions. In the clinical learning environment, medical students primarily shadow radiologists and radiology residents and attend radiology resident teaching sessions. These formats of radiology education, which have been the tenets of the specialty, pose significant challenges during the pandemic. This article reviews how undergraduate radiology education is affected by COVID-19 and explores solutions for teaching and learning based on e-learning and blended learning theory.

Virtual Dissection with Clinical Radiology Cases Provides Educational Value to First Year Medical Students.

RATIONALE AND AIM: In virtual dissection, three-dimensional computed tomography scans are viewed on a near-life size virtual dissection table and through touchscreen technology, students work together to manipulate the data to perform their dissection. The purpose of this study was to develop a Virtual Dissection Curriculum for first year medical students and to assess its educational value as well as students' preferred pedagogy for learning with this new technology. METHODS: One hundred and five first-year medical students participated in a case-based virtual dissection curriculum and were invited to complete a theory-based post experience survey. Eight unique clinical cases were selected based on the first-year curricular objectives and divided into four 30-minute sessions. In groups of 6-8, students reviewed the cases with a radiologist. First, students' reactions to virtual dissection were measured by three constructs using a 5-point Likert scale: quality of curriculum design (11 questions), impact on learning (7 questions), and comfort with technology (3 questions). Second, students ranked the usefulness of six pedagogical approaches for this technology. Responses were tabulated and rank order item lists were generated statistically using the Schulze method where appropriate. RESULTS: The survey response rate was 83% (87/105). Overall, students' reactions to virtual dissection were positive across all three measured constructs. Most students indicated that the cases were of an appropriate level of difficulty (90%) and that virtual dissection improved their understanding of disease and pathology (89%), the clinical relevance of anatomy (77%), and visuospatial relationships (64%). Almost all students (94%) reported that the curriculum improved understanding of the role of the radiologist in patient care. Students felt that the "very useful" pedagogical approaches were small group demonstration (68%) and problem-based learning (51%). CONCLUSION: First-year medical students perceive the use of virtual dissection as a valuable tool for learning anatomy and radiology. This technology enables the integration of clinical cases and radiology content into preclinical learning.

Integrated virtual and cadaveric dissection laboratories enhance first year medical students' anatomy experience: a pilot study.

BACKGROUND: Radiology integration into medical anatomy courses is well established, but there is a paucity of literature on integrating virtual dissection into cadaveric dissection laboratories. Virtual dissection is the digital dissection of medical images on touchscreen anatomy visualization tables. The purpose of this pilot study was to investigate the feasibility of integrating virtual dissection into a first-year medical cadaver-based anatomy course and to assess students' overall attitude towards this new technology. METHODS: All students in first-year medicine at a single medical school participated in this study (n = 292). Six virtual dissection laboratories, which focused on normal anatomy, were developed and integrated into a cadaver-based anatomy course. The virtual dissection table (VDT) was also integrated into the final anatomy spot exam. Following the course, students completed a short evidence-informed survey which was developed using a theoretical framework for curriculum evaluation. Numerical data were tabulated, and qualitative content analysis was performed on students' unstructured comments. RESULTS: The survey response rate was 69.2% (n = 202/292). Most (78.7%) students reported that virtual dissection enhanced their understanding of the cadaveric anatomy and the clinical applications of anatomy. Most (73.8%) students also felt that the VDT was an effective use of the laboratory time. Thirteen narrative comments were collected, most of which (61.5%) identified strengths of the curriculum. CONCLUSIONS: In this pilot study, students perceived that their learning was enhanced when virtual dissection was combined with a cadaver-based anatomy laboratory. This study demonstrates that there is potential for virtual dissection to augment cadaveric dissection in medical education.

The Challenge With Clinical Radiology Electives: Student and Faculty Perspectives Identify Areas for Improvement.

PURPOSE: To determine medical students' and radiologists' attitude toward radiology electives at a distributed medical school and identify specific areas for improvement. METHODS: During a single academic year, both students and faculty preceptors were surveyed anonymously following a senior radiology elective. The survey was based on an established theoretical framework for studying the educational environment which takes into account domains: (1) goal orientation, (2) organization/regulation, and (3) relationships. Mann-Whitney tests were performed to determine if there was any difference between the overall satisfaction of students and preceptors, responses from the different elective sites and students' ratings of the domains. Statistical significance was set at P < .05. Thematic analysis was performed on the narrative comments to identify specific challenges. RESULTS: The response rate was 82.0% for students (95/116) and 19.5% (31/159) for radiologists. There was no difference in responses based on elective site. Overall, the elective was viewed positively by both groups however students rated their experience as significantly better than their preceptors (P = .0012). Students viewed the relationships domain more positively than both the other two (goal orientation, P = .0001; organization/regulation, P = .0038). Thematic analysis identified that the student challenges were lack of autonomy, structured teaching, and preceptor continuity and the preceptor challenges were ambiguous learning objectives/expectations and insufficient resources. CONCLUSIONS: The radiology elective challenges identified in this study provide educators with specific areas to target when updating radiology electives. A better elective experience may improve students' radiology knowledge and attitude towards the specialty as well as radiologists' interest in teaching.

Development and Evaluation of a Competency-Based Anatomy Rotation for Diagnostic Radiology Residents During Internship Year: A Canadian Experience.

RATIONALE AND AIM: As medical schools reduce the hours of anatomy teaching, residents in anatomy-intensive residency programs like radiology must independently acquire the anatomy knowledge needed to achieve competency. The purpose of this study was to develop and evaluate a 4-week competency-based self-directed anatomy rotation for junior residents. METHODS: Seven post-graduate year 1 (PGY-1) radiology residents completed a 4-week rotation of radiologic anatomy. The objectives were developed from standards, senior residents, and expert opinion, and the competency-based curriculum included self-directed modules. Pre-course and post-course tests were administered and test scores were compared using an unpaired t test. In addition, PGY-1 residents completed a course evaluation and survey regarding their anatomy knowledge and anatomy exposure prior to completing the course. RESULTS: Out of the 25 points available, the average pre-test score was 10.79 ± 2.78 (range 8-16.5), and the average post-test score was 21.64 ± 2.23 (range 18.5-25). This difference was statistically significant (P < .0001). The PGY-1 residents reported receiving < 10% of dedicated radiologic anatomy teaching prior to residency and felt unprepared for the anatomy required in residency. Overall, residents felt more confident in looking at images after completing the self-directed radiologic anatomy course. CONCLUSION: This study demonstrates the feasibility of creating a self-directed course for radiology residents that significant improves their anatomy knowledge. Given the trend in medical undergraduate education away from dedicated anatomy teaching, residency programs should consider addressing anatomy education more formally for junior residents to ensure that trainees receive the foundational knowledge required for residency.

The use of TPA in combination with alcohol in the treatment of the recurrent complex hydrocele.

A hydrocele is an abnormal collection of serous fluid in the space between the parietal and visceral layers of the tunica vaginalis. Hydrocele is the most common cause of painless scrotal swelling which affects about 1% of men. Generally, adult hydroceles are idiopathic in origin; however, inguinal surgery, varicocelectomy, infection, trauma and a patent processus vaginalis are each associated with the subsequent development of a hydrocele. Surgical removal of hydroceles is the gold standard of care. However, multiple cases have reported high success rates (ranging from 85% to 96%) using a combination of aspiration and sclerotherapy. We present a case of a patient with recurring complex hydrocele and effective treatment utilizing a combination of thrombolytic therapy, catheter drainage and subsequent alcohol ablation.

Ethanol ablation of extradigital solid glomus tumors.

Glomus tumors are predominantly benign neoplasms accounting for less than 2% of all soft tissue tumors. While generally solitary, multiple lesions have been reported in approximately 10% of cases. Glomus tumors are typically under 1 cm in dimension accompanied by the classic triad of symptoms: debilitating pain, pinpoint tenderness, and hypersensitivity to cold temperatures. Excisional therapy is the accepted standard of care, however, past reports of non-invasive treatments for multiple glomangiomata variant tumors include laser therapy, irradiation, and sclerotherapy with STS and hypertonic saline. We present a case of a patient with multiple subcutaneous and intramuscular, lower-extremity benign solid glomus tumors treated successfully utilizing ethanol ablation, which has not been previously reported. This minimally invasive treatment allowed for control of symptoms from a benign condition previously requiring multiple invasive surgeries.