Hydrogen Bond Surrogate-Constrained Dynamic Antiparallel ß-Sheets.

Antiparallel ß-sheets are important secondary structures within proteins that equilibrate with random-coil states; however, little is known about the exact dynamics of this process. Here, the first dynamic ß-sheet models that mimic this equilibrium have been designed by using an H-bond surrogate that introduces constraint and torque into a tertiary amide bond. 2D NMR data sufficiently reveal the structure, kinetics, and thermodynamics of the folding process, thereby leading the way to similar analysis in isolated biologically relevant ß-sheets.

Radiology Perspective of Coronavirus Disease 2019 (COVID-19): Lessons From Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome.

OBJECTIVE. Since the outbreak of the novel coronavirus pulmonary illness coronavirus disease 2019 (COVID-19) in China, more than 79,000 people have contracted the virus worldwide. The virus is rapidly spreading with human-to-human transmission despite imposed precautions. Because similar pulmonary syndromes have been reported from other strains of the coronavirus family, our aim is to review the lessons from imaging studies obtained during severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks. CONCLUSION. The review of experiences with the MERS and SARS outbreaks will help us better understand the role of the radiologist in combating the outbreak of COVID-19. The known imaging manifestations of the novel coronavirus and the possible unknowns will also be discussed.

Imaging review of ocular and optic nerve trauma.

Traumatic ocular injuries account for a substantial number of emergency department visits annually and represent a significant source of patient disability. A thorough understanding of ocular/optic nerve anatomy and traumatic pathology is fundamental in the accurate and efficient interpretation of emergency neuroradiology. This article will review relevant anatomy, imaging protocols, clinical symptomatology, and key imaging findings associated with the broad spectrum of traumatic ocular and optic nerve pathology.

Gender disparity in academic emergency radiology.

OBJECTIVE: This study is intended to better understand how academic productivity and career advancement differs between men and women emergency radiologists in academic practices. MATERIALS AND METHODS: Parameters of academic achievement were measured, including number of citations, number of publications, and h-index, while also collecting information on academic and leadership ranking among emergency radiologists in North America. RESULTS: In emergency radiology, there are significantly fewer women than men (22.2% vs 77.8%). Of these women, the greatest proportion of women held the lower academic rank of assistant professor (95.4%). Female assistant professors had a higher h-index than men at the same rank (4 vs 2), but it was not statistically significantly higher. There was no significant difference between gender and academic (p = 0.089) or leadership (p = 0.586) rankings. CONCLUSION: This study provides further evidence that gender disparity persists in emergency radiology, with women achieving less upward academic career mobility than men, despite better academic productivity in the earlier stages of their careers. The academic productivity of emergency radiologists at the rank of assistant professor is significantly higher for women than men.

Surveying Academic Radiology Department Chairs Regarding New and Effective Strategies for Medical Student Recruitment.

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.

ED breast cases and other breast emergencies.

Patients with pathologic processes of the breast commonly present in the Emergency Department (ED). Familiarity with the imaging and management of the most common entities is essential for the radiologist. Additionally, it is important to understand the limitations of ED imaging and management in the acute setting and to recognize when referrals to a specialty breast center are necessary. The goal of this article is to review the clinical presentations, pathophysiology, imaging, and management of emergency breast cases and common breast pathology seen in the ED.

Highlights from the scientific and educational abstracts presented at the ASER 2013 Annual Scientific Meeting and Postgraduate Course.

The American Society of Emergency Radiology (ASER) 2013 Annual Scientific Meeting and Postgraduate Course offered dedicated learning sessions, oral presentations, and digital exhibits on a broad spectrum of topics in emergency radiology, including traumatic and nontraumatic emergencies, quality, communication, education, and technology. This article highlights the scientific and educational abstracts presented at the meeting.

Highlights from the scientific and educational abstracts presented at the ASER 2012 Annual Scientific Meeting and Postgraduate Course.

The American Society of Emergency Radiology 2012 Annual Scientific Meeting and Post-Graduate Course encompassed a wide range of topics: traumatic and non-traumatic emergencies, radiation dose management, technical innovations and advancements, emergency preparedness, mass casualties, and teleradiology. This article highlights the scientific and educational abstracts presented at the meeting.

Work-Life Experience of Academic Radiologists: Food for Thought.

RATIONALE AND OBJECTIVES: Work-life experience of physicians is a driver of work engagement vs. burnout. We aimed to determine individual and institutional factors affecting work-life experience of the clinical faculty at a large tertiary care academic medical center. MATERIALS AND METHODS: The Department of Radiology clinical faculty (n = 62) were surveyed electronically in October 2022. Twenty-three questions, consisting of multiple choice, Yes/No, and Likert scale ratings were administered to obtain demographic information and data for life outside of work, life at work, and work-life integration for the prior 12 months. Work engagements in terms of clinical, research, administrative, and education; work practices including engagement in extra work and remote work; life responsibilities; and utilization of work-life balance strategies were analyzed for percentages and differences in seniority levels and genders. Ratings of faculty work engagement and life integration strategies were assessed utilizing a 1-5 Likert scale. Descriptive statistics were utilized to report mean, standard deviation, median, Q1 and Q3 for continuous measurements, while count and percentage for categories measurements. Comparisons between seniority and gender categories were conducted using independent t-test or Wilcoxon rank sum test depending on data normality assessed through histogram analysis. Chi-square test was used to make comparisons for categorical data. When encountered with small cell (category with <5 count), Fisher's exact test was used for 2 × 2 table analysis and Freeman-Halton test was used for comparisons with more than two categories. SAS 9.4 was used for the data analysis. RESULTS: Twenty-eight faculty (M:F = 17:11) responded to the survey (survey response rate 45%). The vast majority of faculty reported working extra hours, with 40% working at least 10 hours extra per week. Total of 42.9% reported performing clinical work in the extra hours worked. Total 70.4% of faculty had caregiver responsibilities and 64.3% reported other individual stresses (e.g., financial, family/social, health-related), which required consistent demand of time and effort. A total of 35.7% of faculty reported not being able to balance competing life and work demands. A total of 21.4% respondents reported not utilizing any individual healthy lifestyle choices on a consistent basis over the prior 12 months. Protected time off work and remote work were perceived as effective strategies to provide adequate work-life balance; however, remote work engagement was relatively minor and 35.7% bought back vacation. Total 53.6% respondents reported a level 4 (out of 5) rating for work being meaningful and being positively engaged in their work. CONCLUSION: Institutions should invest in providing the infrastructure for physician work-life balance and in facilitating healthy lifestyle choices for physicians.

Highlights from the scientific and educational abstracts presented at the ASER 2011 Annual Scientific Meeting and Postgraduate Course.

The American Society of Emergency Radiology (ASER) 2011 Annual Scientific Meeting and Post-Graduate Course encompassed a wide range of topics: traumatic and nontraumatic emergencies, radiation dose management, technical innovations and advancements, emergency preparedness, mass casualties, military radiology and teleradiology. This article highlights the scientific and educational abstracts presented at the meeting.

Educational, psychosocial, and clinical impact of SARS-CoV-2 (COVID-19) pandemic on medical students in the United States.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic altered education, exams, and residency applications for United States medical students. AIM: To determine the specific impact of the pandemic on US medical students and its correlation to their anxiety levels. METHODS: An 81-question survey was distributed via email, Facebook and social media groups using REDCapTM. To investigate risk factors associated with elevated anxiety level, we dichotomized the 1-10 anxiety score into low (≤ 5) and high (≥ 6). This cut point represents the 25th percentile. There were 90 (29%) shown as low anxiety and 219 (71%) as high anxiety. For descriptive analyses, we used contingency tables by anxiety categories for categorical measurements with chi square test, or mean ± STD for continuous measurements followed by t-test or Wilcoxson rank sum test depending on data normality. Least Absolute Shrinkage and Selection Operator was used to select important predictors for the final multivariate model. Hierarchical Poisson regression model was used to fit the final multivariate model by considering the nested data structure of students clustered within State. RESULTS: 397 medical students from 29 states were analyzed. Approximately half of respondents reported feeling depressed since the pandemic onset. 62% of participants rated 7 or higher out of 10 when asked about anxiety levels. Stressors correlated with higher anxiety scores included "concern about being unable to complete exams or rotations if contracting COVID-19" (RR 1.34; 95%CI: 1.05-1.72, P = 0.02) and the use of mental health services such as a "psychiatrist" (RR 1.18; 95%CI: 1.01-1.3, P = 0.04). However, those students living in cities that limited restaurant operations to exclusively takeout or delivery as the only measure of implementing social distancing (RR 0.64; 95%CI: 0.49-0.82, P < 0.01) and those who selected "does not apply" for financial assistance available if needed (RR 0.83; 95%CI: 0.66-0.98, P = 0.03) were less likely to have a high anxiety. CONCLUSION: COVID-19 significantly impacted medical students in numerous ways. Medical student education and clinical readiness were reduced, and anxiety levels increased. It is vital that medical students receive support as they become physicians. Further research should be conducted on training medical students in telemedicine to better prepare students in the future for pandemic planning and virtual healthcare.

Clinical examination is highly sensitive for detecting clinically significant spinal injuries after gunshot wounds.

BACKGROUND: The optimal method for spinal evaluation after penetrating trauma is currently unknown. The goal of this study was to determine the sensitivity and specificity of a standardized clinical examination for the detection of spinal injuries after penetrating trauma. METHODS: After Institutional Review Board approval, all evaluable penetrating trauma patients aged 15 years or more admitted to the Los Angeles County + University of Southern California Medical Center were prospectively evaluated for spinal pain, tenderness to palpation, deformity, and neurologic deficit. RESULTS: During the 6-month study period, 282 patients were admitted after sustaining a penetrating injury; 143 (50.7%) as a result of gunshot wound (GSW) and 139 (49.3%) as a result of stab wound (SW). None of the patients sustaining a SW had a spinal injury. Of the 112 evaluable GSW patients, 9 sustained an injury: 6 with a true-positive and 3 with a false-negative clinical examination. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 89.6%, 46.2% and 95.2%, respectively. For clinically significant injuries requiring surgical intervention, cervical or thoracolumbar spine orthosis, or cord transections, however, the sensitivity of clinical examination was 100.0%, specificity 87.5%, positive predictive value 30.8%, and negative predictive value 87.5%. CONCLUSION: Clinically significant spinal injury, although rare after SWs, is not uncommon after GSWs. A structured clinical examination of the spine in evaluable patients who have sustained a GSW is highly reliable for identifying those with clinically significant injuries.

Clinical examination is insufficient to rule out thoracolumbar spine injuries.

PURPOSE: The role of clinical examination in the diagnosis of thoracolumbar (TL) spine injuries is highly controversial. The aim of this study was to assess the sensitivity and specificity of a standardized clinical examination for diagnosing TL spine injuries after blunt trauma. METHODS: This was a prospective observational study conducted at a level I trauma center from March 2008 to September 2008. After Institutional Review Board approval, all evaluable blunt trauma patients older than 15 years were evaluated by a senior resident or attending surgeon for TL spine deformity, tenderness to palpation, and neurologic deficits. Patients were followed through their hospital course to capture all TL spine injury diagnoses, all imaging performed, and any immobilization or stabilization procedures. RESULTS: Of the 884 patients enrolled, 81 (9%) had a TL spine injury. More than half (55.6%) had two or more fractures with 30.9% having three or more. Isolated L-spine fractures occurred in 56.8%, T-spine fractures occurred in 34.6% only, and combination injuries sustained in 8.6%. The most commonly identified fractures were of the transverse process (67.9%) followed by the vertebral body (30.9%) and spinous process (12.3%). Among the 666 patients who were evaluable, 56 (8%) had a TL spine fracture. Of these, 29 (52%) had a negative clinical examination, of which 2 (7%) had clinically significant compression fractures. For evaluable patients who had localized pain or tenderness elicited on examination, although the finding triggered imaging appropriately, the site of pain correlated to the site of actual injury in only 61.5% of cases. The sensitivity and specificity of clinical examination for TL spine fractures were 48.2% and 84.9%, respectively, for all fractures and 78.6% and 83.4% for those that were clinically significant. CONCLUSION: Clinical examination as a stand-alone screening tool for evaluation of the TL spine is inadequate. In this series, all the clinically significant missed fractures were diagnosed on computed tomography (CT) obtained for evaluation of the visceral torso. A combination of both clinical examination and CT screening based on mechanism will likely be required to ensure adequate sensitivity with an acceptable specificity for the diagnosis of clinically significant injuries of the TL spine. Further research is warranted, targeting the at-risk patient with a negative clinical examination, to determine what injury mechanisms warrant evaluation with a screening CT.

The increasing burden of radiation exposure in the management of trauma patients.

BACKGROUND: As trauma care evolves, there has been increased reliance on imaging. The purpose of this study was to examine changes in trauma imaging and radiation exposure over time. Our hypothesis was that there has been an increased usage of imaging in the management of trauma patients without measurable improvements in outcomes. METHODS: A continuous series of injured patients admitted to a Level I trauma center during a 2-month period in 2002 was compared with the same period in 2007. All computed tomography (CT)s and plain radiographs performed for each patient were tabulated. Effective radiation dose estimates for each patient were then calculated. The outcome measures were length of stay, mortality, and missed injuries. RESULTS: The 495 patients in 2007 and 497 patients in 2002 demonstrated no significant differences in demographics, clinical data, or outcomes between groups. However, from 2002 to 2007, for blunt trauma, the mean CTs per patient increased significantly (2.1 ± 1.6 vs. 3.2 ± 2.0, p < 0.001), as did plain radiographs (8.8 ± 12.9 vs. 14.9 ± 17.0, p < 0.001). For penetrating trauma, roentgenogram usage increased significantly (4.2 ± 5.3 vs. 9.1 ± 14.4, p = 0.01) with a trend toward increased CTs (0.7 ± 1.1 vs.1.0 ± 1.6, p = 0.11). Total radiation dose estimates demonstrated significantly increased radiation exposure in 2007; blunt (11.5 ± 11.3 mSv vs. 20.7 ± 14.9 mSv, p < 0.05) and penetrating (2.9 ± 4.9 mSv vs. 5.4 ± 7.9 mSv, p < 0.05). CONCLUSION: From 2002 to 2007, there was a significant increase in the use of CT and plain radiographs in the management of trauma patients, leading to significantly higher radiation exposure with no demonstrable improvements in the diagnosis of missed injuries, mortality, or length of stay.

Prospective evaluation of multidetector computed tomography for extremity vascular trauma.

BACKGROUND: Multidetector computed tomographic angiography (MDCTA) is increasingly being used for the assessment of extremity vascular injury. However, to date, there are only retrospective series and a single small prospective study evaluating its efficacy. Therefore, the objective of this study was to prospectively evaluate the ability of MDCTA to detect arterial injury in the injured upper and lower extremities. METHODS: After institutional review board approval, all trauma patients aged 16 years or older admitted to a Level I trauma center who sustained extremity trauma and underwent initial evaluation with a 64-channel MDCTA from March 2009 to June 2010 were prospectively enrolled. The sensitivity and specificity of MDCTA were tested against an aggregate gold standard of operative intervention, conventional angiography, and clinical follow-up. RESULTS: During the 20-month study period, 635 patients with extremity trauma underwent a structured clinical examination. Hard signs of vascular injury was observed in 5.5% of patients with a 97.1% incidence of clinically significant injury requiring operative intervention. Eighty-three percent of patients had no signs of vascular injury with no missed injuries detected during follow-up. Eighty-nine MDCTAs were performed in the remaining 73 patients (11.5%) with soft signs. The mechanism of injury was penetrating in 69.9% (42 gunshot wound, 5 stab wound, and 4 shotgun). There were 24 positive studies, 23 of which were confirmed at operation (5 brachial artery injuries, 2 radial, 1 ulnar, 1 external iliac, 2 common femoral, 5 proximal superficial femoral, 2 distal superficial femoral, 4 popliteal, and 1 posterior tibial artery injury). A left posterior tibial artery occlusion was managed nonoperatively. There were 58 negative studies with clinical follow-up available in 100%, for a mean of 10.6 days ± 11.7 days (median, 6 days; range, 1-41 days). MDCTA was nondiagnostic in seven patients (9.6%), five secondary to artifact from retained missile fragments (3 shotgun and 2 gunshot wound), and two secondary to technical errors in reformatting. In the absence of artifact, MDCTA achieved 100% sensitivity and 100% specificity in detecting all clinically significant arterial injuries. CONCLUSIONS: Physical examination is critical in the decision-making process for the injured extremity and can accurately reduce unnecessary imaging. If imaging is required, MDCTA is a sensitive and a specific noninvasive modality for arterial evaluation and may replace conventional angiography as the diagnostic modality of choice for the evaluation of the acutely injured extremity.

Highlights from the scientific and educational abstracts presented at the ASER 2010 Annual Scientific Meeting and Postgraduate Course.

The American Society of Emergency Radiology 2010 Annual Scientific Meeting and Postgraduate Course encompassed a wide range of topics: traumatic and non-traumatic emergencies, radiation dose management, technical innovations and advancements, emergency preparedness, mass casualties, military radiology, and teleradiology. This article highlights the scientific and educational abstracts presented at the meeting (Emerg Radiol 17:517-551, 2010).

Reason for Exam Imaging Reporting and Data System: Consensus Reached on Quality Assessment of Radiology Requisitions.

OBJECTIVE: The aim of this study was to reach consensus on quality assessment of clinical information in imaging requisitions using Reason for exam Imaging Reporting and Data System (RI-RADS). METHODS: A Delphi study was conducted in September 2018 with a panel of 87 radiologists with diverse levels of experience from various settings (community hospitals, private hospitals, university hospitals, and clinics), of which 74.7% completed the survey. The agreement was assessed in the following subjects: (a) presumed effect of standardization, (b) the standardized system for information, (c) the scoring system for evaluation of requisitions, and (d) the implementation of RI-RADS. The consensus threshold was set at 51% responding (strongly) agree. The rate of lawsuits preventable with clinical information was also assessed. RESULTS: Consensus was reached on all objectives of the study with a high level of agreement. Radiologists agreed on the need for standardization of imaging requisitions and attributed it to increased speed and accuracy of interpretations. Three categories of information were determined as key indicators of quality: impression, clinical findings, and clinical question. The scoring system is intended to grade requisitions based on the presence of these categories. Radiologists also agreed that RI-RADS will encourage physicians to improve requisitions. Among radiologists who responded to the survey, 12.6% had experienced at least one lawsuit potentially preventable with sufficient information in requisitions. CONCLUSIONS: Reason for exam Imaging Reporting and Data System can be used as a standard for quality assessment of requisitions. Its use may improve the quality of patient care and reduce lawsuits against radiologists.

Highlights from the scientific and educational abstracts presented at the ASER 2009 Annual Scientific Meeting and Postgraduate Course.

The American Society of Emergency Radiology 2009 Annual Scientific Meeting and Postgraduate Course encompassed a wide range of topics: traumatic and nontraumatic emergencies, radiation dose management, technical innovations and advancements, emergency preparedness, mass casualties, military radiology, and teleradiology. This article highlights the scientific and educational abstracts presented at the meeting (Scientific and Educational Abstracts Presented at the ASER, Emerg Radiol 16:501-516, 2009).

Coronavirus Outbreak: Is Radiology Ready? Mass Casualty Incident Planning.

On March 11, 2020, the World Health Organization declared a coronavirus disease 2019 (COVID-19) pandemic. Health care systems worldwide should be prepared for an unusually high volume of patients in the next few weeks to months. Even the most efficient radiology department will undergo tremendous stress when victims of a mass casualty flood the emergency department and in turn the radiology department. A significant increase is expected in the number of imaging studies ordered for the initial diagnosis and treatment follow-up of cases of COVID-19. Here, we highlight recommendations for developing and implementing a mass casualty incident (MCI) plan for a viral outbreak, such as the current COVID-19 infection. The MCI plan consists of several steps, including preparation, mobilization of resources, imaging chain, adjusting imaging protocols, and education, such as MCI plan simulation and in-service training. Having an MCI plan in place for a viral outbreak will protect patients and staff and ultimately decrease virus transmission. The use of simulations will help identify throughput and logistical issues.

Coronavirus disease 2019 (COVID-19) pandemic: Review of guidelines for resuming non-urgent imaging and procedures in radiology during Phase II.

Since the spread of the coronavirus disease 2019 (COVID-19) was designated as a pandemic by the World Health Organization, health care systems have been forced to adapt rapidly to defer less urgent care during the crisis. The United States (U.S.) has adopted a four-phase approach to decreasing and then resuming non-essential work. Through strong restrictive measures, Phase I slowed the spread of disease, allowing states to safely diagnose, isolate, and treat patients with COVID-19. In support of social distancing measures, non-urgent studies were postponed, and this created a backlog. Now, as states transition to Phase II, restrictions on non-essential activities will ease, and radiology departments must re-establish care while continuing to mitigate the risk of COVID-19 transmission all while accommodating this backlog. In this article, we propose a roadmap that incorporates the current practice guidelines and subject matter consensus statements for the phased reopening of non-urgent and elective radiology services. This roadmap will focus on operationalizing these recommendations for patient care and workforce management. Tiered systems are proposed for the prioritization of elective procedures, with physician-to-physician communication encouraged. Infection control methods, provision of personal protective equipment (PPE), and physical distancing measures are highlighted. Finally, changes in hours of operation, hiring strategies, and remote reading services are discussed for their potential to ease the transition to normal operations.