Pancreatic Trauma: Imaging Review and Management Update.

Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. A high index of suspicion, as well as knowledge of the anatomy, mechanism of injury, injury grade, and role of available imaging modalities, is required for prompt accurate diagnosis. CT is the initial imaging modality of choice, although the severity of injury can be underestimated and assessment of the pancreatic duct is limited with this modality. The time from injury to definitive diagnosis and the treatment of potential pancreatic duct injury are the primary factors that determine outcome following pancreatic trauma. Disruption of the main pancreatic duct (MPD) is associated with higher rates of complications, such as abscess, fistula, and pseudoaneurysm, and is the primary cause of pancreatic injury-related mortality. Although CT findings can suggest pancreatic duct disruption according to the depth of parenchymal injury, MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography facilitate direct assessment of the MPD. Management of traumatic pancreatic injury depends on multiple factors, including mechanism of injury, injury grade, presence (or absence) of vascular injury, hemodynamic status of the patient, and associated organ damage. ©RSNA, 2020 See discussion on this article by Patlas.

Journal Club: Prevalence of flawed multiple-choice questions in continuing medical education activities of major radiology journals.

OBJECTIVE: The purpose of this study was to assess whether the continuing medical education (CME) multiple-choice questions (MCQs) in three major radiology journals adhere to standard question-writing principles. MATERIALS AND METHODS: All CME MCQs (total of 181) in the January 2013 editions of the AJR, RadioGraphics, and Radiology composed the test sample. Each question was evaluated by three reviewers for compliance with seven MCQ-writing guidelines that have been documented in the medical education literature as associated with frequent flaws in medical CME. RESULTS: Seventy-eight of the 181 (43%) questions contained one to four flaws. CONCLUSION: A large fraction of radiology CME questions violate standard question-writing principles.

Imaging of common solid organ and bowel torsion in the emergency department.

OBJECTIVE: This article will discuss the most common forms of torsion encountered in the emergency department. CONCLUSION: Torsion refers to the twisting of an object about its axis and represents the pathophysiologic mechanism underlying an important group of disorders affecting both the bowel and the solid organs of the abdomen and pelvis. Although these disorders typically present with the acute onset of pain, clinical findings are often nonspecific, with imaging playing a key role in diagnosis. Missed or delayed diagnosis may result in complications, such as ischemia; end-organ loss; and, in some cases, death. Therefore, it is critical to have a thorough understanding of the pathophysiology and imaging findings of these entities to avoid the morbidity and mortality associated with a missed or delayed diagnosis.

Review of Learning Tools for Effective Radiology Education During the COVID-19 Era.

Coronavirus disease 2019 (COVID-19) has significantly disrupted medical education around the world and created the risk of students missing vital education and experience previously held within actively engaging in-person activities by switching to online leaning and teaching activities. To retain educational yield, active learning strategies, such as microlearning and visual learning tools are increasingly utilized in the new digital format. This article will introduce the challenges of a digital learning environment, review the efficacy of applying microlearning and visual learning strategies, and demonstrate tools that can reinforce radiology education in this constantly evolving digital era such as innovative tablet apps and tools. This will be key in preserving and augmenting essential medical teaching in the currently trying socially and physically distant times of COVID-19 as well as in similar future scenarios.

Update of the AMSER National Medical Student Curriculum.

Since the first steps of creating the Alliance of Medical Student Educators in Radiology (AMSER) curriculum 20 years ago, dramatic advances in medical imaging, patient care, and medical education have occurred necessitating an update of this valuable resource. The 2020 update of the AMSER curriculum aims to address as many of these changes while providing a succinct resource that will hopefully remain useful for years to come. The updated AMSER curriculum document is freely available for download via the AMSER website at https://www.aur.org/en/affinity-groups/amser/curriculum.

Anterior urethral strictures and retrograde urethrography: An update for radiologists.

Urethral strictures are a relatively common affliction of men with the anterior urethra being most frequently affected. Anterior urethral strictures (AUS) typically present with obstructive voiding symptoms and appropriate management is often based on findings at cystourethroscopy and retrograde urethrography (RUG). In particular, determining the number, length, severity and location of urethral strictures is of pivotal importance. The accurate reporting of findings at RUG is dependent on a thorough knowledge of the urethral anatomy as well as recognizing periurethral structures that may opacify during the procedure. Obtaining a diagnostic, high-quality RUG study requires adherence to proper fluoroscopic technique as well as recognizing when to adjust or modify the technique to address pitfalls that may be encountered during the procedure. AUS may be treated by a variety of procedures including urinary diversion, transurethral procedures such as urethral dilation and internal urethrotomy and open surgical repair techniques termed urethroplasty. Some authors have recommended urethroplasty as first-line treatment given the high rate of stricture recurrence with other treatment options. Buccal mucosal grafts are a mainstay of modern urethroplasty. Familiarity with the commonly performed urethroplasty procedures allows radiologists to accurately assess the post-operative urethra thus guiding the management of these patients.

Development of a Web-based Curriculum to Prepare Diagnostic Radiology Residents during Post-Graduate Year 1 by Promoting Learning via Spaced Repetition and Interim Testing: If You Build It, Will They Come?

RATIONALE AND OBJECTIVES: The purpose of this pilot project was to determine the feasibility of creating a single web-based resource to allow independent study for pre-radiology interns during their first post-graduate year of training, and to measure intern use of and satisfaction with this resource. MATERIALS AND METHODS: A web-based curriculum, based on the principles of spaced learning and interim testing, was created and housed on an institutional learning management system. The curriculum consisted of narrated, interactive learning modules, electronic flashcards, and quizzes. We monitored the use of this curriculum by six pre-radiology interns. Surveys were completed to assess resident satisfaction. RESULTS: 73% of the total learning modules were completed. Of the completed modules, 90% were completed in either the first or the last three months of the study. The total hours spent reviewing the flashcards during the entire study period ranged from <1 to 7 hours. 67% of the quizzes were completed. Survey results showed that the learners perceived the course as a useful resource and reported high satisfaction with the curriculum. CONCLUSION: Creating a web-based curriculum capable of monitoring intern use is feasible. There was variable use of the different components of the curriculum with clear clustering of use at the beginning and end of the study period. The users perceived the course as a useful resource and reported high satisfaction with the curriculum.

Radiology Field Trips-A List of "Must Sees" in the Radiology Department for Medical Students: How We Do It.

RATIONALE AND OBJECTIVE: Traditionally, the radiology elective has been designed to teach medical students the fundamentals of radiologic interpretation, typically through passive means, such as didactic conferences and observational shadowing of radiologists as they interpret images. In doing so, the importance of noninterpretive skills and active learning has been minimized. Additionally, in the traditional model, students typically only gain a superficial appreciation of radiologists' role in patient care and their interactions with clinical services, multidisciplinary teams, and patients. With the emphasis on value-focused, team-based, patient-centered care, it is important to expand the focus of radiology education beyond interpretive skills alone such that these future physicians can most effectively utilize imaging to care for patients. MATERIALS AND METHODS: A list of integrated radiology field trips was created for medical students from two institutions, Allegheny Health Network and the University of Kentucky, representing a consolidation of the instructional strategies utilized at these institutions. This paradigm uses active observation to extend learning beyond the reading room. RESULTS: It targets noninterpretive skills that will be of vital importance in the majority of students' future clinical practice, such as patient safety and appropriate ordering practices. CONCLUSION: This article describes the integration of nine field trip experiences into a 4-week radiology clerkship and its effect on learning outcomes and student satisfaction.

Endometriosis revisited: an imaging review of the usual and unusual manifestations with pathological correlation.

The manifestations of endometriosis commonly present a diagnostic challenge to the gynecologist and radiologist. Familiarity with its varied presentations may allow for a more accurate diagnosis. The goal of this review is to the present the imaging spectrum of endometriosis, less common sites of involvement as well as the potential rare complications. Relevant surgical and histopathological correlation is also provided. In addition to clinical evaluation and sonography, MRI is a highly accurate imaging modality in the diagnosis of endometriosis. It possesses a distinctive advantage over other modalities in that it allows a complete survey of the pelvic compartments. The potentially devastating effects of endometriosis include pelvic pain and even infertility. Since standard treatment is surgical, the radiologist needs to be familiar with the various manifestations in order to aid diagnosis for appropriate management.

Radiologist and Sonographer Interpretation Discrepancies for Biliary Sonographic Findings: Our Experience.

PURPOSE: The aim was to determine the discrepancy rate between the preliminary interpretation by sonographers and the final radiology interpretation for biliary sonographic findings. MATERIALS AND METHODS: Institutional review board approval was obtained. Four hundred consecutive right upper quadrant sonographer performed ultrasounds were reviewed retrospectively. Sonographers' worksheets were compared with the final radiology report. For the purposes of this project, only the biliary findings were compared and reviewed. Discrepant findings were reviewed by 5 ultrasound experts, and a majority vote sought to determine truth, sonographer worksheet findings, or radiologist report. The clinical impact of the discrepant findings was also evaluated. RESULTS: Of the 400 scans, there were 338 agreements and 62 discrepancies. The overall discrepancy rate was 15.5%. The most frequently contested discrepancy was the presence or absence of pericholecystic fluid n = 21. Sonographers (S) were deemed correct 8 times and radiologists (R) 13 times, denoted 8/13 (S/R). The overall split was 30/32 (S/R) with radiologists deemed correct 52% of the time and sonographers 48% of the time. Using a 1-sample proportion χ test with Yates' continuity correction, there were no statistically significant discrepancies between the 2 groups. CONCLUSIONS: We observed an interpretation discrepancy rate of 15.5% with radiologists deemed correct slightly more frequently, although this did not meet statistical significance. Clinically impactful discrepant findings (6.5% of all discrepancies) were all correctly called by the radiologists. Both groups bring tremendous value to the ultrasound arena, and continued collaboration should be encouraged. PURPOSE: The aim of this study was to determine the discrepancy rate that exists between the preliminary interpretation by sonographers and the subsequent final radiology interpretation for biliary sonographic findings.

Development of the AMSER standardized examinations in radiology for medical students.

RATIONALE AND OBJECTIVES: The variability in medical imaging evaluation across US medical schools inspired leading radiology student educators to develop the Alliance of Medical Student Educators in Radiology (AMSER) Standardized Exam (SE). This examination tests the understanding of essential material and concepts which are endorsed by the AMSER National Medical Student Curriculum in Radiology. MATERIALS AND METHODS: The AMSER Electronics Committee developed and deployed the AMSER SE using Radiology ExamWeb (REW), a previously-developed databank of imaging questions. The Committee created an examination blueprint that placed emphasis on effective use of medical imaging and less emphasis on image interpretation. Question items correlating to the blueprint were used from the REW databank to draft AMSER SE version 1, which was piloted in early 2012. Item performance was then analyzed, and the exam was revised. After national deployment, a subsequent revision was performed 1 year later. AMSER SE version 2, developed in a similar manner, was released in early 2013 and will go through a similar process of revision. A 20-question Practice Exam was also developed. RESULTS: Since national deployment, more than 1400 students, in over 22 institutions, have taken the AMSER SEs. CONCLUSIONS: The collaborative project of the AMSER Electronics Committee has resulted in the successful national deployment of two examinations using questions that have been validated and based on the AMSER peer-reviewed national curriculum. We hope that this assessment tool will help drive a more uniform approach to curriculum development, promoting more effective and safe use of medical imaging. This step should also help promote the value radiologists bring to the patient care arena.

Classic Cushing's syndrome in a patient with adrenocortical carcinoma.

Adrenocortical carcinoma is an aggressive but rare neoplasm of the adrenal cortex, with an estimated incidence of approximately 2.5 per one million patients. The prognosis for patients with adrenocortical carcinoma is often very poor. Patients often present with symptoms of hormone hypersecretion but may also present with pain or a palpable mass. Imaging plays an important role in preoperative planning when clinical and biochemical findings are compatible with adrenal cortical carcinoma. We report a case of adrenocortical carcinoma in a young woman who presented with classical Cushing syndrome, but who had an atypical hormonal profile.