Canadian Radiology Medical Student Interest Groups: What They Are and How We Can Help Them Improve.

BACKGROUND: Radiology interest groups (RIGs) can serve as a means of increasing exposure of the radiology specialty early in the medical curriculum while also increasing educational opportunities. However, the organizational structure and various functions of individual RIGs in Canada are not well-documented. We performed a survey of all active RIGs in Canada for the purpose of better understanding their structure, function, and opportunities for improvement. METHODS: A 21-question survey was sent to current or recent former medical student leaders of all active RIGs in Canada during the 2016-2017 academic year. RESULTS: Radiology interest groups were identified in 88% (15/17) of Canadian medical schools. We received a 100% (15/15) response rate. Events held by RIGs consist mostly of lunch and learns (67%, 10/15), career panels (53%, 8/15), networking events (40%, 6/15), and curriculum-related events (40%, 6/15). General mentorship (93%, 13/14), shadowing opportunities (86%, 12/14), and research mentorship (63%, 8/14) were most often cited in their top 3 choices for opportunities for improvement. Sixty-six percent indicated that if a radiology society were to host a page for their interest group, they would be interested in posting content and/or links. CONCLUSIONS: Canadian RIGs offer increased early awareness and education about radiology in the medical curriculum. Radiology departments can facilitate improvement in Canadian RIGs through targeted institutional mentorship, research opportunities, and shadowing programs for their members.

Cecal carcinoma: initially diagnosed as Crohn's disease on small bowel follow-through.

Lesions in the terminal ileum are often difficult to visualize on routine small bowel follow-through (SBFT) and may require further investigation to rule out associated abnormalities in the ileocecal valve or cecum. This may be done by peroral pneumocolon at the same sitting as the SBFT, but may require bowel preparation. Two cases of cecal carcinoma that were initially diagnosed as Crohn's disease on SBFT without further investigation of the cecum are reported.

Inter-rater reliability between musculoskeletal radiologists and orthopedic surgeons on computed tomography imaging features of spinal metastases.

INTRODUCTION: The primary objective of this pilot study was to examine the inter-rater reliability in scoring the computed tomography (ct) imaging features of spinal metastases in patients referred for radiotherapy (rt) for bone pain. METHODS: In a retrospective review, 3 musculoskeletal radiologists and 2 orthopedic spinal surgeons independently evaluated ct imaging features for 41 patients with spinal metastases treated with rt in an outpatient radiation clinic from January 2007 to October 2008. The evaluation used spinal assessment criteria that had been developed in-house, with reference to osseous and soft tissue tumour extent,presence of a pathologic fracture,severity of vertebral height loss, andpresence of kyphosis.The Cohen kappa coefficient between the two specialties was calculated. RESULTS: Mean patient age was 69.2 years (30 men, 11 women). The mean total daily oral morphine equivalent was 73.4 mg. Treatment dose-fractionation schedules included 8 Gy/1 (n = 28), 20 Gy/5 (n = 12), and 20 Gy/8 (n = 1). Areas of moderate agreement in identifying the ct imaging appearance of spinal metastasis included extent of vertebral body involvement (κ = 0.48) and soft-tissue component (κ = 0.59). Areas of fair agreement included extent of pedicle involvement (κ = 0.28), extent of lamina involvement (κ = 0.35), and presence of pathologic fracture (κ = 0.20). Areas of poor agreement included nerve-root compression (κ = 0.14) and vertebral body height loss (κ = 0.19). CONCLUSIONS: The range of agreement between musculoskeletal radiologists and orthopedic surgeons for most spinal assessment criteria is moderate to poor. A consensus for managing challenging vertebral injuries secondary to spinal metastases needs to be established so as to best triage patients to the most appropriate therapeutic modality.

A comparison of outcome of osteoarticular allograft reconstruction and shoulder arthrodesis following resection of primary tumours of the proximal humerus.

Purpose. The purpose of this study was to compare the oncologic, reconstructive and functional outcomes of patients who underwent osteoarticular allograft reconstruction with those who underwent arthrodesis for a primary malignant bone tumour of the proximal humerus.Patients. Eleven patients were treated with osteoarticular allograft reconstruction of the proximal humerus. Five of these reconstructions failed, necessitating revision to a secondary arthrodesis. Five patients underwent arthrodesis as a primary reconstruction, for a total of ten patients in the arthrodesis group.Methods. End points included local and systemic disease recurrence, complications and functional outcome (measured using the 1987 and 1993 Musculoskeletal Tumour Society Rating Scales (MSTS) and the Toronto Extremity Salvage Score (TESS)).Results. One patient died of systemic disease 2 years post-operatively and one patient had an axillary node recurrence resected 10 months post-operatively and remains free of disease 53 months later. The other 14 patients were alive with no evidence of disease at the time of the last follow-up. Complications after the osteochondral allografts (n=11) included two infections, four fractures and three subluxations in eight patients. Six of these patients required removal of the allograft; one had a repeat osteochondral allograft and five were converted to an arthrodesis. Complications after arthrodesis in the ten patients (five primary and five secondary arthrodeses) included two non-unions, one infection and one fracture in three patients. Patients who underwent shoulder arthrodesis scored better in all outcome measures and this was statistically significant in the MSTS 1993 (p=0.001, Mann-Whitney U Test).Discussion. In this study, there was a trend towards improved function following arthrodesis compared to osteochondral allograft reconstruction following proximal humerus bone tumour resection.

An evaluation of the effectiveness of a videotape programme on interobserver reliability in outcome assessment for fibromyalgia.

AIMS: A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used observer dependent outcome measures in patients with fibromyalgia (FM). METHODS: During a single day, six third-year medical students independently examined six patients with FM in predetermined order using a Latin Square design, before and after viewing a standardized videotape which demonstrated methods for performing doiorimelry and for delecting skinfold tenderness and reactive hyperaemia. Reliability coefficients were calculated based on the variance components of the Analysis of Variance (ANOVA) table. RESULTS: Prestandardization reliability coefficients were <0.80 for 8 measures. Following standardization all reliability coefficients, but one, approximated or exceeded 0.80. CONCLUSIONS: An important and beneficial effect of the standardization procedure was noted for several outcome variables. Such improvements in observer agreement have important implications for training senior medical students to perform quantitative measurement in the longitudinal management of FM patients in clinical practice. The use of a videotape to achieve this goal has obvious cost and convenience advantages compared with personal onc-on-one or small group training procedures.

Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada.

PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) may be at higher risk for osteoporosis. The primary objective of this case-control study was to determine the prevalence of vertebral fractures among patients with COPD admitted to acute care compared with a gender- and age-matched control group. SUBJECTS AND METHODS: Subjects were identified by chart reviews from an acute care hospital in Hamilton, Ontario, in 1999, including patients who were over 50 years old. In total, 127 patients with ICD-9 codes specifying COPD were randomly selected and compared with 127 gender- and age-matched controls. Chest radiographs were interpreted by two radiologists who defined and graded vertebral fractures using Genant's method. Medications taken, or prescribed at discharge, were recorded from charts. RESULTS: The overall prevalence of at least one vertebral fracture was found to be 34/127 (26.8%) in the COPD patients compared with 30/127 (23.6%) in the controls ( p=0.556). A significantly greater proportion of COPD patients had at least one severe vertebral fracture (OR=3.75, 95% CI 1.24 to 11.3). Review of hospital chest X-ray reports indicated that only 12 of 64 (18.8%) patients with vertebral fractures identified by the study radiologists actually had a vertebral fracture noted in the report. The proportion of COPD patients with vertebral fractures who were discharged on osteoporosis therapy was 5/27 (18.5%). There was a suggestion of lower lung function, as measured by forced vital capacity (FVC%), in patients with severe vertebral fractures ( p=0.067). CONCLUSIONS: These data indicate that: (1) There is an increased proportion of COPD patients with severe vertebral fracture, and (2) Documentation and treatment of osteoporosis in acute care COPD patients is low. Therefore, there is a need to target this high-risk group for osteoporosis screening and potential clinical management.