A 5-Year Update on the IR Residency Match: 2022 National Survey Results of Program Directors and Matched Applicants Compared with 2017.

PURPOSE: To characterize the experiences of matched applicants (MAs) and program directors (PDs) in the 2022 interventional radiology (IR) residency Match and compare with 2017 data. METHODS: Surveys were distributed to IR PDs and MAs from the 2022 Match. Findings were compared with those of 2017 using the 2-sample t test and Fisher exact test. RESULTS: In total, 68 MAs (40%) and 47 PDs (52%) responded. Collected demographic traits were similar, including ongoing male predominance (77% of MAs, 83% of PDs). Moreover, 86% of MAs and 87% of PDs were "satisfied" with Match outcomes. Compared with those in 2017, MAs applied to more IR programs (P < .001). MAs reported more research (P = .003) and abstracts/publications (P < .001) and ranked these as more important than PDs did (P < .001 for both). Approximately 82% of PDs gave special attention to candidates who completed a visiting rotation at their institution; 60% of MAs and 95% of PDs believed virtual interviews resulted in overinterviewing (P < .001); both agreed they provided convenience and accessibility. Furthermore, 63% of MAs believed a Step 1 pass/fail system will be less equitable for applicants. Additional data on demographics, medical school experiences, applications, interviews, intern year, and rank process were reported. CONCLUSIONS: Satisfaction with Match results remained high from 2017 to 2022, although efforts are needed to improve applicants' ability to navigate the application process, address overapplying, and evaluate concerns regarding the Step 1 pass/fail system. These survey findings will help inform applicants and PDs for future match cycles.

The 2017 Integrated IR Residency Match: Results of a National Survey of Applicants and Program Directors.

PURPOSE: To characterize and compare the experiences of matched applicants and program directors (PDs) participating in the first large-scale integrated interventional radiology (IR) residency match. MATERIALS AND METHODS: Survey questionnaires were distributed nationally to integrated IR applicants who matched in the 2017 Match cycle and PDs. Both groups were questioned regarding their experiences with the application, interview, rank, and match processes as well as applicant-specific and PD-specific information. Summary and descriptive statistics were applied to responses, and comparison of Likert scale responses was performed by two-sample t test. RESULTS: Sixty-one matched applicants (51.3%) and 34 PDs (55.7%) responded to the survey. Regarding the match process, applicants believed United States Medical Licensing Examination (USMLE) Step 1 score (P = .002) and connection to a program's geographic location (P = .006) were significantly more important than PDs did, whereas PDs ranked grades (P = .049), class rank (P = .011), academic awards (P = .003), additional degrees (P < .001), and USMLE Step 2 Clinical Skills score (P < .001) as significantly more important factors than applicants did. Additional information regarding demographic data, medical school experiences in IR, application strategies, interview experiences, rank lists, the intern year, and match results are reported. CONCLUSIONS: The completion of the first large-scale integrated IR match represents a paradigm shift in the way in which IR practitioners are recruited and trained. This study provides valuable benchmark data and analysis that can be used to improve efforts to match the best-fitting applicants into the integrated IR residency and improve future match cycles for applicants and PDs alike.

The Roles of Organized Radiology in Career Development for Trainees and Junior Attending Radiologists: A Road Map.

OBJECTIVE: The full spectrum of organized radiology consists of numerous organizations with varied missions targeting their respective members. CONCLUSION: This article highlights many of these organizations, discusses the benefits they can provide to radiology trainees and junior faculty, and provides a road map for progressive participation among trainees to junior faculty as they advance through training.

Combating the Health Risks of Sedentary Behavior in the Contemporary Radiology Reading Room.

OBJECTIVE: We detail the association of sedentary behavior with a variety of health problems and provide the radiologist with a number of simple activities and techniques that can improve overall health while still meeting the productivity demands of a high-volume practice. Although these techniques are well known and recognized in the fitness and nutrition literature, they are not widely used in the radiology reading room. The computer- and workstation-based work routinely performed by diagnostic radiologists typically occurs in the seated position, leading to more than 8 hours per day of sitting. Studies have found that even for those who exercise regularly, spending increased time sitting can negate the healthful effects of exercise. Time spent in a seated or sedentary position leads to slowing of one's metabolism, with negative resultant effects. CONCLUSION: The concept of nonexercise activity thermogenesis (NEAT) will be described, with examples given of how to burn more calories while at work and, therefore, improve the health of the diagnostic radiologist. NEAT refers to the energy expended during activities of daily living, excluding sportlike or intentional exercise. The concept of NEAT must be understood by radiologists, because it allows the development of multiple strategies to combat the ill effects of sitting while working. Adding intermittent movement and stretching exercises throughout the day can stimulate metabolism. An understanding of the association of sedentary work behavior with a number of health risks is crucial for radiologists so that they can implement basic changes into their work routine, allowing them to increase activity to address and avoid these potential health hazards.

Ethical Issues in Radiology Journalism, Peer Review, and Research.

OBJECTIVE: Although some research and publication practices are clearly unethical, including fraud and plagiarism, other areas of research and publication, such as informed consent and conflicts of interest, fall into grayer areas. CONCLUSION: The purposes of this article are, therefore, to review a variety of relevant ethical issues in radiology-related journalism, peer review, and research; to review the radiology literature to date that has addressed these issues; and to present position statements and potential solutions to these problems.

Nonamyloid tumoral light-chain-deposition disease (aggregoma) of the paraspinal region.

Aggregomas are rare localized masses of monoclonal nonamyloid immunoglobulin light-chain deposits. To date, there have been only a few reports of isolated aggregomas, with the majority detailing renal, lymph node and brain deposition. We present a rare case of paraspinal aggregoma in a 67-year-old female who presented with a complaint of cough and chest pain. Imaging demonstrated a left-sided paravertebral mass extending from T7-T10. Pathological analysis showed lamellar deposition of extracellular eosinophilic material with an associated lymphoplasmacytic nonamyloid infiltrate. To our knowledge, this is the first report of a paraspinal aggregoma. While exceedingly rare, this tumor can be included in the radiologic differential diagnosis of paravertebral soft tissue tumors in adults. The observation of our case adds to the limited understanding of the etiology, pathogenesis, natural history, and treatment of nonamyloid light-chain depositions.

Adapting to the Era of Virtual Recruitment: Radiology Departmental Website Response to COVID-19 and Portrayal of the Resident Experience.

RATIONALE AND OBJECTIVES: The COVID-19 pandemic has transformed radiology recruitment into a virtual affair and placed an even stronger emphasis on the importance of departmental websites. In this study, we evaluate residency websites in detailing the response to COVID-19 as well as initiatives which help describe the resident experience. MATERIALS AND METHODS: Program websites for diagnostic radiology residencies listed in the 2022 Electronic Residency Application Service (ERAS) program list were evaluated for 31 criteria related to departmental response to COVID-19, online outreach, and resident wellness. RESULTS: Of 184 programs, 182 had functioning websites for review. One program was excluded from analysis as the website was almost entirely video-based. In response to COVID-19, ≤1% described resident redeployment, vaccination information, departmental response to ABR Core Exam changes, or regular administration updates. Six (3.3%) described revised read-out protocols, four (2.2%) mentioned supplementary non-clinical education, and 14 (7.7%) indicated changes to educational conferences. The majority of websites (122, 67.4%) offered an informational or tour video, while 44 (24.3%) described expectations for virtual interviewing, and 20 (11.0%) had virtual "open-houses." Departmental social media, primarily Twitter, was linked for 60 (33.1%) programs. A total of 134 (74.0%) websites described community highlights. More than a quarter mentioned meal stipends (72, 39.8%), paid sick time (54, 29.8%) and healthcare resources (57, 31.5%). Although social activities were described by 44 (24.3%) programs, some specifically indicating changes to COVID-19, formal resident mentoring (25, 13.8%) and wellness committees (28, 15.5%) were less common. These criteria were found more commonly at the largest third of residency programs (chi square, p < 0.00625). CONCLUSION: Programs rarely described work flow changes to COVID-19, and websites could improve in virtual outreach. Compared with prior literature, departmental websites have improved in describing wellness initiatives and related measures.

Resident Wellness in Radiology as Portrayed by Departmental Websites.

RATIONALE AND OBJECTIVES: Departmental websites are often the first exposure applicants have in researching programs. Websites provide information about resident education as well as infrastructure for resident wellness. For this study, we reviewed residency websites to evaluate resident wellness initiatives and extent of details available online. MATERIALS AND METHODS: Program websites for diagnostic radiology residencies listed in the 2020 ERAS program list were evaluated for 26 criteria pertaining to resident wellness. Criteria which are not radiology resident specific were also evaluated on their graduate medical education (GME) websites if unavailable on the departmental website. RESULTS: Of 189 programs, 185 (97.9%) had functioning websites for review. Book funds were mentioned by 57% (mean $3,762), and 43.5% discussed housing stipends during AIRP (mean $2,204); neither significantly correlated with program size. Retirement plan matching was present for 47.8% of programs. Almost all programs utilized night float call schedules, with relatively similar distribution of residents starting on-call duties as fall PGY2s, spring PGY2s, and starting PGY3s. Moonlighting was mentioned by 22.8% of departments. Paid wellness days were discussed in 10.8% (mean 3.1 days/year), and 37.7% described paid parental leave (mean 27.8 days/year). Less than 10% described resident mentoring, wellness committees, or non-clinical curricula. Resident retreats were mentioned by 21.6% of programs, and 11.4% described regular social activities; both were found more frequently at larger programs (chi-square analysis, p <0.00625). CONCLUSION: This study evaluated radiology residency program and GME websites for information pertaining to resident wellness. While financial and clinical information was typically present for >50% of programs, information regarding social initiatives was generally lacking and may be one area to bolster resident wellness and describe on websites.

Development and Pilot Evaluation of a Decision Aid for Small Kidney Masses.

OBJECTIVE: To develop and pilot test a patient decision aid (DA) describing small kidney masses and risks and benefits of treatment for the masses. METHODS: An expert committee iteratively designed a small kidney mass DA, incorporating evidence-based risk communication and informational needs for treatment options and shared decision-making. After literature review and drafting content with the feedback of urologists, radiologists, and an internist, a rapid qualitative assessment was conducted using two patient focus groups to inform user-centered design. In a pilot study, 30 patients were randomized at the initial urologic consultation to receive the DA or existing institutional patient educational material (PEM). Preconsultation questionnaires captured patient knowledge and shared decision-making preferences. After review of the DA and subsequent clinician consultation, patients completed questionnaires on discussion content and satisfaction. Proportions between arms were compared using Fisher exact tests, and decision measures were compared using Mann-Whitney tests. RESULTS: Patient informational needs included risk of tumor growth during active surveillance and ablation, significance of comorbidities, and posttreatment recovery. For the DA, 84% of patients viewed all content, and mean viewing time was 20 min. Significant improvements in knowledge about small mass risks and treatments were observed (mean total scores: 52.6% DA versus 22.3% PEM, P < .001). DA use also increased the proportion of patients discussing ablation (66.7% DA versus 18.2% PEM, P = .02). Decision satisfaction measures were similar in both arms. DISCUSSION: Patients receiving a small kidney mass DA are likely to gain knowledge and preparedness to discuss all treatment options over standard educational materials.

National Survey to Assess Gender, Racial, and Ethnic Differences Among Radiology Residency Applicants Regarding Factors Impacting Program Selection.

RATIONAL AND OBJECTIVES: Radiology has one of the lowest female representation rates in medicine and recruiting female residents is a challenge for some residency programs. There is limited understanding of gender differences among residency applicants during program selection. The study objective is to investigate which program factors were considered most important by radiology residency applicants and to assess for differences by gender, race and ethnicity. MATERIALS AND METHODS: An anonymous survey was distributed electronically to diagnostic and interventional radiology residency programs in the US and Canada via the Association of Program Coordinators in Radiology (APCR). Residents were asked to evaluate the importance of 30 factors during evaluation of residency programs using a 5-point Likert scale (1 = not important, 5 = extremely important). RESULTS: 370 residents and 1 fellow completed the survey. Of the respondents, 269 were male (72.5%) and 101 were female (27.2%). The most important factors to respondents during program selection were program culture (4.42), geographic location (4.17), fellowship placement (4.14), and imaging and/or procedure volume (3.98). There was a significant difference between male and female respondents in the importance of program culture (p = 0.002), composition of current residents (p = 0.007), percentage of current female residents (p < 0.0001), program size (p = 0.047), call schedule (p = 0.025), percentage of female faculty (p < 0.0001), faculty ethnic and racial diversity (p < 0.0001), resident ethnic and racial diversity (p < 0.0001), which female respondents ranked more highly. CONCLUSION: Applicants consider many factors during residency program selection. Program culture, geographic location, fellowship placement and imaging and/or procedural volume were most important. There were significant differences by gender, race and ethnicity in importance of several factors.

Training by the Numbers: A Survey-Based Analysis of the Number of Positions Available in New Interventional Radiology Training Pathways.

OBJECTIVE: As of June 30, 2020, interventional radiology (IR) fellowships will cease to exist and will be replaced by the integrated IR, independent IR, and early specialization in IR (ESIR) pathways. The objective of this study is to determine the alignment in the number of available positions between the ESIR and independent IR pathways. METHODS: An analysis was performed of 150 residency programs offering at least 1 of the 3 IR training pathways. Information regarding the most up-to-date list for integrated IR, independent IR, ESIR, and IR fellowship programs were obtained from the Society of Interventional Radiology (SIR), the Electronic Residency Application Service (ERAS), and the Accreditation Council for Graduate Medical Education (ACGME) websites. A 4-question survey was distributed to residency program directors and residency program coordinators to confirm the number of positions offered in each of the training pathways at their institution. RESULTS: Ninety-nine of 113 ESIR programs (87.6% response rate) reported a total of 176 approved ESIR positions. One hundred and eleven fellowship programs in the United States currently offer a total of 331 positions. Seventy-seven integrated IR programs and 48 independent IR programs offer 150 and 133 positions, respectively, for a total of 283 advanced IR training positions. DISCUSSION: A substantial discrepancy currently exists with IR training pathways, as the number of available ESIR positions far outnumbers the available independent IR pathway positions. There is a continuing need for communication with residency programs and frequent reevaluation of the various IR training pathways to maintain the most accurate database.

How to Read, Write, and Review the Imaging Literature.

Everyone at all levels in academic radiology is supposed to know how to read an original research article or a review article and to evaluate it critically, to participate in writing such manuscripts, and, as one becomes more senior, to participate in the peer review process, yet there is little formal teaching in our experience as to how to do these inter-related activities throughout radiology training. The purpose of this review article is therefore to provide our perspective - from the junior trainee to the senior radiology attending - as to how one should be reading, reviewing, and writing the imaging literature, and also providing guidance from other thought leaders in this area, and from the literature itself. We hope to inspire radiology trainees and radiologists at all levels, particularly those in academic careers, to more fully participate in peer review and in radiology publication.

Preventing Physician Burnout in Breast Imaging: Scope of the Problem and Keys to Success.

Physicians, including radiologists and specifically breast imagers, face many challenges, and stressors during their daily routine, many of which can contribute to burnout. While there is an increasing body of literature evaluating burnout, including its prevalence in and impact on radiologists, there is a relative lack of information specifically addressing this topic as it relates to breast imaging. This article reviews key concepts in burnout, describes the potential impact on physicians at all levels of training and work, highlights unique aspects to the specialty of breast imaging that may contribute to burnout, and suggests tool and/or strategies that may help to combat and prevent burnout among breast imagers.

Prostatic Artery Embolization and Sexual Function: Literature Review and Comparison to Other Urologic Interventions.

Many interventions to treat men with benign prostatic hyperplasia (BPH) associated lower urinary tract symptoms (LUTS) are associated with sexual side effects or complications, such as hematospermia, erectile dysfunction, or ejaculatory dysfunction. As loss of sexual function can significantly impact quality of life, an optimal treatment for BPH associated LUTS would be one without any sexual dysfunction side effects. Prostatic artery embolization is a minimally invasive treatment for men with BPH associated LUTS. The aim of this paper is to review the effects of prostatic artery embolization on sexual function and compare the sexual side effect profile to the other available BPH procedures.

Characteristics of musculoskeletal radiology job postings to guide radiology trainees.

OBJECTIVE: To review current musculoskeletal (MSK) job market postings to define the listed requirements for practice in order to provide insight to guide residents pursuing fellowship training in MSK radiology to best meet the needs of potential future employers. METHODS: Utilizing the ACR (American College of Radiology) Career Center, a review of the ACR job postings began 6/1/2018 focusing on jobs labeled as musculoskeletal (MSK) subspecialty. E-mail notifications from the career center were reviewed, and jobs were tracked prospectively for 1 year. Data was collected regarding the number of positions, the location, the practice type, and required skills both within musculoskeletal radiology and within the remainder of the radiology subspecialties. RESULTS: 456 postings met the inclusion criteria. Approximately 19% were for a dedicated MSK radiologist, 25% sought a combination of MSK and a general skill set, and 56% were specifically for a general radiologist position. Approximately 29% of jobs require some combination of mammography and/or light interventional radiology (IR). DISCUSSION: Our results indicate that majority of job postings for musculoskeletal radiology require a practice that is not specifically limited to MSK, mirroring trends in other radiology subspecialties. Radiology trainees and program directors should be aware of the needs being demanded by the job market to help guide trainees to individualize their training to best meet the needs of their future employment.

Assessing the Status of Mentorship Programs in Interventional Radiology Residency Training: Results of a 2018 Survey.

RATIONALE AND OBJECTIVES: To assess the prevalence and structure of mentorship programs in interventional radiology (IR) residency programs. MATERIALS AND METHODS: A 12-question anonymous survey was distributed via email to all 78 program directors (PDs) of United States IR residency programs. The survey included information about the presence or absence of a formal mentorship program at their institution, how the program functions, potential barriers to implementation, and future plans for mentorship. RESULTS: Twenty-three of 78 integrated IR residency PDs completed the survey (response rate 29.5%). Thirteen of 23 reports that they currently have a formal mentorship program in place and 11 of 13 report no direct departmental support for mentorship. Of those that do not have a mentorship program in place, 5 of 10 report that implementation is underway. These programs report that the absence of a mentorship program is due to a lack of dedicated time and financial support. While 8 of 23 PDs were unaware of the Society of Interventional Radiology Mentor Match program, 6of 23 were registered as mentors through it. Nearly all PDs reported interest in receiving mentoring resources from SIR with the most popular choices being a dedicated mentorship educational course at the SIR annual meeting and regular mentorship articles and practical tips in publications such as IR quarterly. CONCLUSIONS: Despite involvement of many IR PDs in mentorship, numerous residency programs lack a formal mentorship program. Of those with a program, most don't receive direct departmental support and those without a program cite lack of time and financial support as barriers to effective implementation.