High-resolution US and MR imaging of peroneal tendon injuries.

Injuries of the peroneal tendon complex are common and should be considered in every patient who presents with chronic lateral ankle pain. These injuries occur as a result of trauma (including ankle sprains), in tendons with preexisting tendonopathy, and with repetitive microtrauma due to instability. The peroneus brevis and peroneus longus tendons are rarely torn simultaneously. Several anatomic variants, including a flat or convex fibular retromalleolar groove, hypertrophy of the peroneal tubercle at the lateral aspect of the calcaneus, an accessory peroneus quartus muscle, a low-lying peroneus brevis muscle belly, and an os peroneum, may predispose to peroneal tendon injuries. High-resolution 1.5-T and 3-T magnetic resonance (MR) imaging with use of dedicated extremity coils and high-resolution ultrasonography (US) with high-frequency linear transducers and dynamic imaging are proved to adequately depict the peroneal tendons for evaluation and can aid the orthopedic surgeon in injury management. An understanding of current treatment approaches for partial- and full-thickness peroneal tendon tears, subluxation and dislocation of these tendons with superior peroneal retinaculum (SPR) injuries, intrasheath subluxations, and peroneal tendonopathy and tenosynovitis can help physicians achieve a favorable outcome. Patients with low functional demands do well with conservative treatment, while those with high functional demands may benefit from surgery if nonsurgical treatment is unsuccessful. Radiologists should recognize the normal anatomy and specific pathologic conditions of the peroneal tendons at US and MR imaging and understand the various treatment options for peroneal tendon and SPR superior peroneal retinaculum injuries. Online supplemental material is available for this article.

Academic radiology: the reasons to stay or leave.

RATIONALE AND OBJECTIVES: To find major reasons why junior academic radiologists leave academia for private practice and to suggest future changes to motivate them to stay. MATERIALS AND METHODS: 2000 surveys were sent to every tenth member of the Radiological Society of North America (RSNA) who completed training within the past decade. Those in academic institutions and those who left within 5 years were asked to respond. RESULTS: 132 radiologists responded. Thirty-two percent of responders were in academic radiology. Of those in academic radiology, 71% plan to stay at the same institution, 7% are planning to move to another academic institution, 17% are considering private practice, and 5% are leaving for private practice. The main reasons to leave were low pay and lack of academic time. Sixty-eight percent of responders already left academia after an average of 3.28 years. Ninety-five percent feel the decision was good, and 65% would not go back. Forty-nine percent experienced more than 100% pay increase, 60% feel they work harder, and 62% feel quality of life is better. CONCLUSION: Significant changes should be made to motivate junior radiologists to stay in academia. Developing leaders in radiology is a must, and should be a top priority. Academic radiologists should not be expected to read private practice volumes and still have time to produce quality research and teaching. Clinical duties should be limited to 32 hours per week. At least 1 day a week should be protected academic time. Efforts should be made to decrease the discrepancy between incomes. Mentoring is important, allowing a smooth transition for junior faculty members to optimize academic progress and lead to promotion.

Evaluation of emergency CT scans of the head: is there a community standard?

OBJECTIVE: This study was designed to assess the accuracy of general radiologists in the interpretation via teleradiology of emergency CT scans of the head. MATERIALS AND METHODS: We studied the interpretations of 716 consecutive emergency CT scans of the head by a group of 15 board-certified general radiologists practicing in the community (as opposed to an academic setting). The scans were sent via teleradiology, and the preliminary interpretations were made. Three of the general radiologists were functioning as nighthawks, and the remaining 12 were acting as on-call radiologists in addition to their normal daytime duties. Each CT examination was interpreted by one of five neuroradiologists the day after the initial interpretation had been performed. The findings of the final interpretation and the preliminary interpretation were categorized as showing agreement, insignificant disagreement, or significant disagreement. The reports in the two categories indicating disagreement were reviewed and reclassified by a consensus of three university-based neuroradiologists. RESULTS: Agreement between the initial interpretation by the general radiologist and the final interpretation by the neuroradiologist was found in 95% of the CT scans. The interpretations were judged to show insignificant disagreement in 3% (23/716) of the scans and to show significant disagreement in 2% (16/716). Of the 16 significant errors, five were false-positive findings and 11 were false-negative findings. Forty-seven CT scans depicted significant or active disease, and in 11 (23%) of these scans, the final report differed significantly from the preliminary interpretation. Three patients had pituitary masses, none of which had been described on the preliminary interpretation. CONCLUSION: The rate of significant discordance between board-certified on-call general radiologists and neuroradiologists in the interpretation of emergency CT scans was 2%, which was comparable to previously published reports of residents' performance. The pituitary gland may be a blind spot, and additional attention should be focused on this area.