A simple pre-operative imaging method to assess donor and recipient anatomy in hemi-hamate arthroplasty for proximal interphalangeal joint reconstruction.

PURPOSE: Post-traumatic arthritis is common in long-term follow-up of patients undergoing hemi-hamate arthroplasty (HHA). We hypothesize that anatomic mismatch could play a role in the development of arthritis. The purpose of this study is to establish a novel, computed tomography (CT)-based imaging technique for pre-operative assessment in HHA. With this technique, our group aims to identify digits with a high likelihood for anatomical mismatch between the donor graft and recipient interphalangeal joint. Using this technique to eliminate cases with high-likelihood of incongruent anatomy, we hypothesize the rates of arthritis could be reduced. METHODS: We conducted a retrospective review of upper extremity CT scans from 2007 to 2014 at our institution. Those studies meeting our inclusion criteria were exported to a clinical radiology software suite. Subsequently, angular and linear measurements of the hamate and potential recipient proximal interphalangeal joints were collected. Angular and linear comparisons were then made between the donor hamate graft and the individual recipient sites. Using pre-established cutoff values, matches were deemed to be inconsistent or consistent. RESULTS: The study included 31 CT scans. The rate of anatomical consistency was low; the small finger was most often consistent (38.7 %) and the index finger was least often consistent (12.9 %). Linear inconsistency was common in all joints besides the small finger; angular inconsistency was most prevalent in the index and long fingers. CONCLUSIONS: This novel use of CT scans as a tool for pre-operative HHA planning is a crucial first step in trying to reduce the observed rates of arthritis after HHA.

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.

Innovation Born in Isolation: Rapid Transformation of an In-Person Medical Student Radiology Elective to a Remote Learning Experience During the COVID-19 Pandemic.

RATIONALE AND OBJECTIVES: With social distancing measures in place both nationally and globally, the current COVID-19 pandemic has forced the cancellation of in-person classes at universities and medical schools across the country. This has presented unique challenges for educators in all fields as they have embarked, many for the first time, on the journey into remote education in order to provide distance learning opportunities for students. MATERIALS AND METHODS: In this article we will review our approach to rapidly converting an in-person diagnostic radiology elective to an entirely remote learning experience for medical students at our institution, including modification of course structure, software tools and materials utilized, and strategies for learner engagement and collaboration. RESULTS: Development of an online elective led to a 10-fold increase in student enrollment compared to the traditional course offering, providing a unique opportunity to reach a broad number of students, many of whom were in the early clinical stages of their medical school career. Lastly, we will review faculty feedback after participating in the remote course as well as lessons learned from the transition to distance learning and its implications for future work CONCLUSION: The current state of technology makes radiology particularly well-suited for distance learning, and with the proper tools and approaches, effective remote radiology instruction can be achieved.

Radiology corner. Answer to last month's radiology case and image: gun shot wound to the chest of a military working dog.

This Military Working Dog (MWD) was shot in the chest during combat operations in Iraq. Military Working Dogs are critical to the safety and well-being of deployed troops in combat operations and, as such, they are triaged and treated in our combat hospitals just like any other soldier; their speciation is not a factor in their triage status. This case familiarizes military physicians with the basic canine anatomy, positioning, and radiological technique they should be aware of before deploying. We also strive to raise awareness of the vital roles that these MWDs play for our forces, counterany concerns that may arise over the issue of treating these dogs in human facilities, and leave the reader feeling better prepared to handle the situation should they ever find themselves poised to save one of our four-legged warriors.

How Does the Current Generation of Medical Students View the Radiology Match?: An Analysis of the AuntMinnie and Student Doctor Network Online Forums.

RATIONALE AND OBJECTIVES: The AuntMinnie (AM) and the Student Doctor Network (SDN) online forums are popular resources for medical students applying for residency. The purpose of this study was to describe medical student radiology-related posts on AM and SDN to better understand the medical student perspective on the application and Match process. MATERIALS AND METHODS: We reviewed all posts made on the AM and SDN online forums over 5 consecutive academic years from July 2012 to July 2017. Each thread was organized into one of six major categories. We quantified forum utilization over the past 5 years by the total number of and the most frequently posted and viewed thread topics. RESULTS: We reviewed 2683 total threads with 5,723,909 views. Total number of threads posted and viewed fell by 46% and 63%, respectively, from 2013-2014 to 2014-2015, after which they returned near baseline by 2016-2017, along with an increase in interventional radiology-related posts between 2012-2013 (13%) and 2016-2017 (32%) (P < .001). The most common application-related topics were preapplication and program ranking advice (20% of all threads and views). Many posts were related to postinterview communication with residency programs (2% of all threads and views). CONCLUSIONS: After a drop in 2013-2014, utilization of AM and SDN increased in 2016-2017, along with increased interest in interventional radiology. Addressing the student concerns identified in our study, especially in preparing residency applications, ranking programs, and navigating difficult situations, such as postinterview program communication, may improve the radiology application process for future medical students and their advisors.

Building a Vertical Advisory system: how to succeed as an educator and mentor without going insane.

Creating and using a Vertical Advisory system allows students and residents to obtain rapid and effective responses to questions or requests for advice. It also encourages this group to become active advisors, teachers, and mentors to those behind them, in the hopes of nurturing strong future academic role models and mentors.

Learning and retaining normal radiographic chest anatomy: does preclinical exposure improve student performance?

RATIONALE AND OBJECTIVES: Although most would concur that preclinical exposure to radiology is a desirable goal, specific learning objectives have been more difficult to delineate. It is also important to assess what is learned and to determine how well it is retained or "retrievable." This study was developed in an attempt to document the extent to which specific measures of preclinically acquired knowledge may be retained and retrieved for later clinical application. MATERIAL AND METHODS: The Anatomic Structure Identification Quiz (ASIQ, or Quiz), previously described in Feigin et al (Academic Radiology 2005) was administered to 236 medical students at the conclusion of the required second-year course, as a 10-item written Quiz based on a projected frontal and lateral chest image. The 10-item Quiz was also administered to 555 senior medical students (194 of which had been included in previous work) on the first day of the Uniformed Services University of the Health Sciences basic radiology elective. Finally, the identical Quiz was completed by 74 of these 555 senior medical students at the conclusion of the academic portion of the elective, approximately 3 weeks after the administration of the first quiz. RESULTS: The second-year students scored a mean of 7.15 points of a possible 10 points with a standard deviation (SD) of 1.42. The senior students completing the quiz at the beginning of the elective scored an average of 4.42 (SD 1.34) compared to a score of 8.65 (SD 1.24) 3 weeks later. CONCLUSION: Long-term recall of specific radiologic structures learned in the second year of medical school was poor despite evidence documenting good initial (short-term) retention of tested information. However, after a brief review, consisting of the Quiz itself, followed by 3 weeks of general radiology emphasizing abnormal chest imaging, the senior students demonstrated a near doubling of their ability to correctly identify these structures, as well as an improvement compared with scores obtained during the second year. Thus the value of a preclinical course in radiology may be not only to teach principles of radiology and to stimulate interest in the discipline, but also, by repetition and reinforcement, to facilitate and possibly improve later recall and retention of important radiographic material.

Clinical utility of a stability-based ankle fracture classification system.

OBJECTIVE: Neither of the ankle fracture classification systems (Lauge-Hansen or Weber) in widespread use today is prognostic. To test the hypothesis that ankle fracture prognosis is dependent on initial biomechanical stability, an alternative classification system created using stability-based treatment criteria was developed on the basis of a structured analysis of the ankle fracture literature. DATA SOURCES: All English-language papers reporting on ankle fractures (searched using the terms "ankle + fracture") published between 1966 and 2005 with available online abstracts via PubMed were screened. STUDY SELECTION: Abstracts were manually screened for inclusion using the following criteria: (1) there were at least 2 groups of patients categorized on the basis of either fracture configuration or treatment and (2) data was reported in sufficient detail to permit interstudy comparisons. DATA EXTRACTION: Each included paper was abstracted into a computerized database for consistent data capture. Data elements included the following: fracture classification, stability definitions, surgical indications, patient follow-up parameters, and outcome measures. Ankle fractures were also stratified into stable and unstable groups using predefined stability criteria, and the outcome measures were re-analyzed. DATA SYNTHESIS: Wilcoxon matched-pairs signed-rank test was used for statistical comparisons, assigning statistical significance to 2-tailed tests with P < 0.05. CONCLUSIONS: The results support the hypothesis that a stability-based ankle fracture classification system can be prognostic. For unstable ankle fractures, the radiographic outcomes were better after surgery, when the decision for surgery was made on the basis of stability (P = 0.0173). Overall, non-operative treatment results were also better with stability-based treatment (P = 0.0299).

Assessing Medical Student Knowledge of Imaging Modality Selection Before and After a General Radiology Elective: A Comparison of MS-IIs, MS-IIIs, and MS-IVs.

RATIONALE AND OBJECTIVES: Correct selection of imaging tests is essential f or clinicians but until recently has been largely neglected in medical education. How and when students acquire such non-interpretive skills are unknown. This study will assess student knowledge of imaging test selection before and after a general radiology elective. MATERIALS AND METHODS: Between 2008 and 2015, an unannounced 13-item test was administered to second, third, and fourth-year students on the first and last days of the Johns Hopkins School of Medicine radiology elective. Scores (0­13) were based on the American College of Radiology Appropriateness Criteria. Pre- and posttest means were compared using paired samples t tests. Whether performance on the pretest and posttest differed by class year was assessed using analysis of variance and Kruskal-Wallis, respectively, and whether year was associated with posttest score after controlling for pretest score was assessed using analysis of covariance. RESULTS: Posttest means were significantly higher than pretest means for students in all years (P values <.0001). Pretest scores differed by year (F(2, 360) = 66.85, P <.0001): fourth-year students scored highest (mean = 9.96 of 13) and second-year students scored lowest (mean = 7.01 of 13). Posttest scores did not differ (χ2(2, 270) = 0.348, P = .841). Year in school had no independent effect on posttest score (F(2, 239) = 0.45, P = .637). CONCLUSION: Knowledge of modality selection increases with clinical training, but room for improvement remains. A general radiology elective increases this knowledge. Second-year students improve most, suggesting that taking radiology early is efficient, but further research to evaluate retention of this knowledge is needed. Medical student education in radiology must increasingly recognize and address non-interpretive skills and intelligent imaging utilization.

Radial Artery Pseudoaneurysm with Aberrant Radial Artery Anatomy: An Unusual Presentation of Flexor Tenosynovitis.

Purpose Radial artery pseudoaneurysm is uncommon and mainly associated with radial artery cannulization for cardiac intervention or invasive hemodynamic monitoring. It is rarely seen as a result of intra-arterial recreational drug injection. Methods We present the case of a 35-year-old man with a 12-year history of intravenous drug use and 1-year history of intra-arterial drug use who developed radial artery pseudoaneurysm with a right long finger suppurative flexor tenosynovitis and subsequent acute radial-sided hand ischemia. Computed tomography (CT) angiography with three-dimensional reconstructions was used in diagnosis. We treated him with parenteral antibiotics followed by surgical debridement of his infection and removal of the infected pseudoaneurysm. Results Examination of the three-dimensional CT angiogram showed an unusual anatomical variant that likely predisposed him to isolated long finger flexor tenosynovitis. Conclusion Prompt diagnosis and treatment of pseudoaneurysm in this context is crucial to avoiding sepsis, hemorrhage, and irreversible ischemia. In rare cases, imaging can demonstrate an underlying anatomical variant that may be a predisposing factor.

Strategic improvements for gross anatomy web-based teaching.

Current generations of graduate students have been immersed in technology from their early school years and have high expectations regarding digital resources. To better meet the expectations of Gross Anatomy students at our institution, electronic radiology teaching files for first-year coursework were organized into a web site. The web site was custom designed to provide material that directly correlated to the Gross Anatomy dissection and lectures. Quick links provided sets of images grouped by anatomic location. Additionally, Lab and Study Companions provided specific material for the students to review prior to and after lectures and gross dissections. Student opinions of this education resource were compared to student opinions of the prior year's digital teaching files. The new content was ranked as more user friendly (3.1 points versus 2.3 points) and more useful for learning anatomy (3.3 points versus 2.6 points). Many students reported that using the web portal was critical in helping them to better understand relationships of anatomical structures. These findings suggest that a well-organized web portal can provide a user-friendly, valuable educational resource for medical students who are studying Gross Anatomy.

Developing a radiology-based teaching approach for gross anatomy in the digital era.

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the implementation of a digital anatomy lecture series based largely on annotated, radiographic images and the utility of the Radiological Society of North America-developed Medical Imaging Resource Center (MIRC) for providing an online educational resource. MATERIALS AND METHODS: A series of digital teaching images were collected and organized to correspond to lecture and dissection topics. MIRC was used to provide the images in a Web-based educational format for incorporation into anatomy lectures and as a review resource. A survey assessed the impressions of the medical students regarding this educational format. RESULTS: MIRC teaching files were successfully used in our teaching approach. The lectures were interactive with questions to and from the medical student audience regarding the labeled images used in the presentation. Eighty-five of 120 students completed the survey. The majority of students (87%) indicated that the MIRC teaching files were "somewhat useful" to "very useful" when incorporated into the lecture. The students who used the MIRC files were most likely to access the material from home (82%) on an occasional basis (76%). With regard to areas for improvement, 63% of the students reported that they would have benefited from more teaching files, and only 9% of the students indicated that the online files were not user friendly. CONCLUSIONS: The combination of electronic radiology resources available in lecture format and on the Internet can provide multiple opportunities for medical students to learn and revisit first-year anatomy. MIRC provides a user-friendly format for presenting radiology education files for medical students.

Chest radiographic anatomy retention: the impact of preclinical groundwork on clinical recall in two schools.

RATIONALE AND OBJECTIVES: The aim of this study was to verify earlier work on learning and retaining chest radiographic anatomy introduced during preclinical education and revisited in the clinical years by comparing the initial clinical group to clinical students in a second setting who had no preclinical exposure. MATERIALS AND METHODS: One hundred thirty-seven clinical medical students were pretested and posttested on the same 10 items as were used in the first study. Scores on these 10-item standardized pretests and posttests were compared and assessed for statistical significance. RESULTS: Although the clinical students with preclinical exposure scored significantly higher on the pretest than the students without preclinical exposure (mean, 4.42 vs 4.09), there was a much larger significant difference in posttest improvement (mean, 8.65 vs 6.09). Isolating only the senior students to control for clinical experience (pretest, 4.42 vs 4.38; posttest, 8.65 vs 6.09) did not significantly affect outcomes. CONCLUSIONS: Many medical schools are revising curricula and incorporating new models of learning. It may be important to recognize that older approaches such as memorization and testing are still necessary to start building the enormous "filing cabinet" of facts that must be cross-linked, revisited, and retrievable to contribute to a usable fund of medical knowledge.