Review of Junior Resident Plain Film Reporting and Audit in Singapore.

BACKGROUND: Graduate medical education in Singapore recently underwent significant restructuring, leading to the accreditation of residency programs by the Accreditation Council for Graduate Medical Education-International (ACGME-I). In radiology, this involved a change in teaching and quality assurance of plain film (PF) reporting. PF reported by junior residents (postgraduate year 1-3) are subject to a 50% random audit. To date, national data on junior resident performance in PF reporting have not been published. OBJECTIVE: We reviewed performance in PF reporting under the current teaching and audit framework. METHODS: Retrospective review of junior resident reported PF audit data from all 3 radiology residency programs in Singapore. The number of residents audited, number of PF reported and audited, and major discrepancy rates were analyzed. RESULTS: On average, 86 440 PF were audited annually nationwide from an estimated 184 288 junior resident-reported PF. Each program trained between 4 to 24 junior residents annually (mean 15), averaging about 44 each year nationwide. A mean of 28 813 PF were audited annually in each program (range 4355-50 880). An estimated mean of 4148 PF (range 1452-9752) were reported per junior resident per year, about 346 PF per month. The major discrepancy rate ranged from 0.04% to 1.13% (mean 0.34%). One resident required remediation in the study period. CONCLUSIONS: Structured residency training in Singapore has produced a high level of junior resident competency in PF interpretation.

A practical and adaptive approach to lung cancer screening: a review of international evidence and position on CT lung cancer screening in the Singaporean population by the College of Radiologists Singapore.

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.

Imaging findings and clinical features of abdominal vascular compression syndromes.

OBJECTIVE: This article describes the typical imaging findings and clinical features that are associated with four abdominal vascular compression syndromes. We explain the underlying pathophysiology that results in these clinical syndromes so that the patient subset who will benefit from treatment can be identified. CONCLUSION: The abdominal vascular compression syndromes discussed here are uncommon and are potentially easily missed on a cursory review of radiologic examinations, particularly in a nonspecific and vague clinical setting. Hence, knowledge of the typical imaging findings and associated clinical symptoms is essential so that the they can be carefully sought and excluded. However, because these findings may also exist in healthy individuals as anatomic variants, it is important to correlate radiologic findings with clinical symptoms to identify the subset of patients who will benefit from treatment.

CT features of primary epiploic appendagitis.

OBJECTIVE: The aim of this study is to describe the computed tomography (CT) findings of primary epiploic appendagitis (PEA). METHODS: We reviewed the clinical records and CT images of 14 consecutive patients in Singapore who presented with acute abdominal pain from July 2000 to April 2004 and had radiological signs of PEA. RESULTS: Hyperattenuated ring with adjacent fat stranding was present in all the patients. The central high attenuation dot was seen in 42.9% (6/14) of the patients. We observed a lobulated fatty mass in 21.4% (3/14) of our patients. All patients recovered during clinical follow-up. CONCLUSIONS: We believe the lobulated appearance of PEA is due to two or more, contiguous infarcted epiploic appendages lying in close proximity. This appearance further aids in the diagnosis of PEA and helps differentiates the condition from omental infarction. Recognizing the CT signs of PEA should allow a confident diagnosis and avoid unnecessary surgery.

MR renography using a dynamic gradient-echo sequence and low-dose gadopentetate dimeglumine as an alternative to radionuclide renography.

OBJECTIVE: Our aim was to evaluate the feasibility of acquiring an MR signal intensity-time renographic curve and dynamic serial images in a way similar to that of acquiring radionuclide renograms, with a dynamic gradient-echo sequence and a low-dose gadopentetate dimeglumine technique, using a commonly available 1.5-T MR scanner. SUBJECTS AND METHODS. Patients who underwent both radionuclide and MR renographic studies within a 3-month period were included in the analysis. This yielded 21 studies from 19 patients. Nineteen of the 21 studies were available for analysis. Two studies were excluded because of technical errors during MR renographic acquisition. Serial MR renograms were obtained using a dynamic two-dimensional spoiled gradient-echo fast low-angle shot T1-weighted sequence. Low-dose IV furosemide and gadopentetate dimeglumine (0.025 mmol/kg of body weight) were administered. Intensity-time curves were obtained from the manually selected regions of interest over the renal parenchyma and whole kidney for calculation of split renal function and assessment of urinary excretion, respectively. Results were compared with those obtained with radionuclide renography. RESULTS: Good correlation (Pearson's correlation coefficient, r = 0.97, p < 0.001) was observed when the volume-corrected split renal function acquired with MR renography was compared with that obtained with radionuclide renography. There was also good agreement in the excretory curve patterns (weighted kappa(observer 1) = 0.77 and kappa(observer 2) = 0.81) between the two techniques. CONCLUSION: Dynamic MR gradient-echo imaging with a low-dose gadopentetate dimeglumine technique can produce an intensity-time curve and serial dynamic images of the urinary system, in a way similar to that of radionuclide renography. This technique allows assessment of split renal function and urinary excretory status and is a feasible alternative to radionuclide renography.