Bilirubin Correlation May Preclude MRCP in Acute Cholecystitis Patients With Normal Common Bile Duct Diameter.

OBJECTIVE. In patients with acute cholecystitis (AC), accurate identification of a common bile duct (CBD) stone before cholecystectomy is of concern for surgeons, gastroenterologists, and radiologists. This study evaluates the utility of preoperative MRCP taking into consideration both sonographic findings and biochemical predictors for choledocholithiasis. MATERIALS AND METHODS. Fifty-seven patients (58% women; mean age, 54 years old) with signs of AC on right upper quadrant (RUQ) ultrasound (US) who underwent subsequent MRCP from 2007 to 2017 were identified using a text-based search and retrospectively analyzed, using ERCP as the reference standard. RESULTS. For patients with AC who had a normal CBD diameter on initial RUQ US, we found a significant difference in the total and direct bilirubin levels of patients who had positive (1.94 vs 4.02 mg/dL, respectively; p = 0.013) and negative (0.71 vs 2.13 mg/dL, respectively; p = 0.02) findings for CBD stone on MRCP. ROC curve analysis showed an increased total bilirubin threshold of > 2.3 mg/dL (standard threshold, 1.2 mg/dL), which yielded a negative predictive value (NPV) of 95%. An increased direct bilirubin threshold of > 0.9 mg/dL (standard threshold, 0.2 mg/dL) yielded an NPV of 100%. CONCLUSION. In patients with AC who have a normal CBD diameter on RUQ US, normal or even mildly elevated bilirubin levels below a calculated threshold may obviate preoperative MRCP. Radiologists should be active participants in clinical decision-making; discussion between referring physicians and radiologists regarding biochemical markers and sonographic findings will lead to more appropriate use of preoperative imaging.

Running a Radiology Residency Program: Strategies for Success.

Running a successful radiology residency program requires departments to navigate the evolving educational landscape at the departmental, institutional, and national levels. To attract the best applicants, departments must invest time and money to support the leadership of the program and its faculty to provide innovative educational opportunities in a positive learning environment while simultaneously complying with all of the requirements of the Accreditation Council for Graduate Medical Education. The key administrative requirements of a successful radiology residency program are described and can be grouped into (a) essential administrative components, (b) the clinical learning environment review and self-study process, and (c) resident recruitment. Ten specific strategies for running a successful residency program are also presented. The goal is for this article to serve as a guide for not only existing diagnostic and interventional radiology residency programs but also newly formed programs that are in the process of seeking accreditation. ©RSNA, 2018.

Developing a Late-Career Roadmap to Continued Career Engagement.

Professional development needs span the entirety of a radiologist's career. Great strides have been made in the creation of an infrastructure for early career development. Work is ongoing to develop such resources for mid-career radiologists, given the recent recognition of the needs of this group. Unfortunately, even less attention has been paid to late-career radiologist development needs as a bridge to retirement. As part of the Career Conversations series, this article will highlight the needs and currently available resources for this group.

APDR Healthcare Disparities Curriculum Pilot: Helping Trainees Meet More Than a Milestone.

RATIONALE AND OBJECTIVES: In order to help program directors satisfy the Accreditation Council for Graduate Medical Education common program requirement for health care disparities (HCD) education, a comprehensive web-based curriculum on HCDs in Radiology was developed. The curriculum was designed to educate trainees about existing HCDs, stimulate discussion, and spur research about HCDs in radiology. The curriculum was piloted to assess its educational value and feasibility. MATERIAL AND METHODS: A comprehensive curriculum comprised of four modules (1) Introduction to HCDs in Radiology, (2) Types of HCDs in Radiology, (3) Actions to Address HCDs in Radiology, and (4) Cultural Competency was created and housed on the Associate of Program Directors in Radiology website. Various educational media including recorded lectures or PowerPoint presentations, small group discussions, and journal clubs were employed. A pilot program was initiated to evaluate the benefits of this curriculum for resident education and consisted of a pre- and post-curriculum test for trainees, an experience survey for trainees, and a pre- and post-administration survey for facilitators. RESULTS: Forty-seven radiology residency programs participated in the pilot of the HCD curriculum. Of those facilitating the curriculum, 83% indicated lack of standardized curriculum as a perceived barrier to implementing a HCD curriculum at their program on the pre-survey. Trainee knowledge scores increased from 65% (pre) to 67% (post) (p = 0.05). Following curriculum participation, residents indicated an increase in adequate understanding of HCDs in Radiology (81% post vs. 45% pre). Most program directors (75%) found the curriculum easy to implement. CONCLUSION: This pilot study demonstrated that the APDR Health Care Disparities curriculum increased trainee awareness of HCDs. The curriculum also provided a forum for important discussions about HCDs.

Integration of Art Into Radiological Societies & Educational Conferences: Early Experiences of the 2021 ACR Art Task Force.

Interest in incorporating art into radiology has been growing in recent years. Radiological societies have begun to acknowledge the benefits art can bring to our field. Given this growing interest, a task force was created in 2021 to carry out integration of the arts into the annual American College of Radiology (ACR) meeting. Experiences of this task force are described, including consideration of benefits of integrating art in radiology practice and education as well as strategies, outcomes, and future directions for melding arts with radiology.

It's a Two-Way Street: Giving and Receiving Feedback to the Unaware.

Giving and receiving constructive feedback is a valuable skill and an evolving process due to improved understanding and changes in culture. This article provides a practical review of key elements of effective feedback skills and strategies for providing constructive feedback, with a focus on how to address recipients who may have impaired insight into the issue at hand. Commonly known tips and tricks include direct, immediate, and specific feedback delivered in a safe setting and in a conversational manner. This article specifically considers how the feedback will be heard or accepted by the intended recipient, in order for the educator to best overcome hurdles in relaying constructive criticism.

Health Care Disparities in Radiology-A Review of the Current Literature.

INTRODUCTION: Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology. METHODS: We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis. DISCUSSION: We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.

Substantial interreader agreement for biopsy with reduction in biopsy rate: A multireader diagnostic performance study of ACR TI-RADS.

PURPOSE: To assess diagnostic performance of ACR TI-RADS in thyroid cancer detection and evaluate interobserver agreement among radiologists with lower interpreting experience. METHODS: Four radiologists retrospectively assessed 295 biopsied thyroid nodules from ultrasound studies performed between 2009 and 2019, blinded to histopathology. Diagnostic performance for cancer detection was determined individually, and interobserver agreement among four readers was evaluated with Fleiss kappa coefficient (ⱪ). RESULTS: 245 (83.1%) benign and 50 (16.9%) malignant nodules were evaluated. Diagnostic performance based on final TR level was consistent and without significant difference among four readers, with excellent sensitivity (≥98.0%) and negative predictive value (NPV) [≥94.4%] for TR levels 3 to 5. Diagnostic performance based on recommendation to biopsy has moderate sensitivity (≥62%) and high NPV (≥84.7%). Retrospective scoring with established ACR TI-RADS criteria would have substantially reduced the number of biopsies performed, with 63.2% of malignancy not biopsied meeting criteria for sonographic surveillance. Interobserver agreement on TI-RADS scoring for final TR level was fair (ⱪ = 0.39, 95% CI 0.32, 0.47), with substantial agreement for recommendation to biopsy (ⱪ = 0.64, 95% CI 0.58, 0.70). CONCLUSIONS: Substantial reduction in biopsy rate (up to 48%) would have been achieved using the ACR TI-RADS criteria, with 63% of malignancy not biopsied meeting criteria for sonographic surveillance. Interobserver agreement was fair for TI-RADS level scoring and substantial for recommendation to biopsy.

ACGME Diagnostic Radiology Milestones 2.0: the Time is Now.

The Accreditation Council for Graduate Medical Education oversees graduate medical education in the United States. Designed to provide broad based training in all aspects of imaging, the diagnostic radiology residency program must provide educational experiences that not only provide technical, professional, and patient centered training, but also meet accreditation standards. With the breadth of material to cover during training, carefully orchestrated educational experiences must be planned. This manuscript offers residency program leaders resources to meet the challenges of the new Accreditation Council for Graduate Medical Education Diagnostic Radiology Milestones 2.0 and highlights potential opportunities for future educational endeavors.

Strengthening the Clinical Learning Environment by Mandate-Implementing the ACGME Common Program Requirements.

RATIONALE: Three years ago, the Accreditation Council for Graduate Medical Education (ACGME) introduced updated Common Program Requirements in recognition of the need to further promote resident and faculty member well-being and patient safety. The ACGME acknowledged residencies would need time to comply with new requirements. This grace period, however, concluded as of July 1, 2019, and programs now risk citations for failure to implement new requirements. METHODS AND RESULTS: The authors, members of the Association of Program Directors in Radiology Common Program Requirements Ad Hoc committee, developed downloadable resources provided in the Appendix delineating the 2019 Common Program Requirements and offering sample resources as compliant solutions. CONCLUSION: The resources offer a national standardized approach to educating trainees in these essential skills and should be especially helpful to programs with access to fewer resources. In addition to achieving compliance, incorporation of these resources into residency training will ensure the next generation of radiologists are equipped to add value while remaining physically and emotionally healthy.

Evaluating Neuroradiology Fellowship Program Websites: A Critical Analysis of all 84 Programs in the United States.

PURPOSE: To investigate the accessibility and content of neuroradiology fellowship program websites (NRFW). METHODS: A list of neuroradiology fellowship programs were obtained from the official Accreditation Council for Graduate Medical Education (ACGME) website. A google search was used to identify each NRFW of individual programs. Each NRFW was evaluated for the availability of content under recruitment and education domains. RESULTS: At the time of the study, there were 84 ACGME accredited neuroradiology fellowship websites available for analysis. In the recruitment domain, evaluators found program description (98.8%), contact address (94.1%), and searchable on google (97.7%) most readily available while, interview day itinerary (3.5%), meal allowance (16.5%), and parking (21.2%) were least readily available. In the education domain, research (91.8%), facility description (89.4%), and faculty listing (82.4%) were most readily available, while postfellowship placement (10.6%), alumni education history (17.7%), and responsibility progression (25.9%) were least readily available. CONCLUSIONS: NRFW vary greatly in the amount of information they display. Programs display their descriptions and contact information most frequently while interview day itinerary was the least likely to be found. There were no statistically significant differences between the amount of recruitment and educational content listed when programs were stratified by rank (top ten vs below top ten), region (west, midwest, northeast, and south), and program size (>3 fellows vs 1-3 fellows). Website content development is relatively low cost and our findings suggest that there is room for improvement in website comprehensiveness.

Addressing the ACGME Mandate for Healthcare Disparities Education in Residency Programs: A Needs Assessment.

PURPOSE: To assess current opinions and efforts from radiology residency program leadership regarding healthcare disparities (HCD) education for residents. METHODS: Radiology residency program directors across the United States were sent a 10-item survey and asked a series of qualitative questions regarding their opinions about HCD and current methods of implementation into their residency curriculum, in addition to demographic information such as program location and setting. RESULTS: 73 out of 334 program directors responded. 49.3% were located in the Northeast, 16.4% in the Southeast, 16.4% in the Midwest, 12.3% in the Southwest, and 5.5% in the Pacific. Community programs made up 16.4% of respondents, while academic programs made up 76.7%. 6.8% identified as "other". 98.6% agreed with the provided definition of HCD. 83.6% agreed or strongly agreed that HCD present an obstacle to providing imaging care. 74.0% agreed or strongly agreed that HCD education is an essential component of residency training. However, 74.0% agreed or strongly agreed that HCD education is difficult to implement due to competing educational requirements. Only 16.4% agreed or strongly agreed that they had sufficient material on HCD to train residents. CONCLUSION: Although many radiology residency programs agree that HCD education is essential in residency training, the majority feel that a curriculum is difficult to implement and that they lack sufficient resources. This study confirms the need to address this gap with a standardized curriculum which has been developed and is discussed.

Analysis of Literature Regarding Health Care Disparities in Radiology: Is Radiology Falling Behind?

PURPOSE: To quantify the gap between radiology and other specialties regarding the amount of literature on healthcare disparities (HCD). METHODS: Four different searches were conducted to evaluate the amount of literature on HCD in radiology as compared to internal medicine and surgery. Initially, the Journal Citation Report was utilized to search for the five highest ranking journals in each field and a second search used impact factor. A combination of search terms "health" AND "disparities" was used. Two additional searches were performed with PubMed using the terms "health" AND "disparities AND "radiology" with the final term changed for each specialty. The second PubMed search added the term "medical education" for each specialty. Articles were limited to years 2017 to 2020. RESULTS: The initial search found 1817 articles discussing "health" and "disparities". 14.6% of these were radiology, 65.7% internal medicine, and 19.7% surgery. The subsequent search controlling for impact factor found 2176 articles. 12.2% were for radiology, 66.1% were for internal medicine, and 21.7% for surgery. The initial PubMed search found 6543 articles. 9.9% were for radiology, 32.4% for internal medicine, and 57.7% were for surgery. The addition of "medical education" decreased the articles to 807. Radiology had 9.9%, internal medicine was 44.2%, and surgery was 45.9 %. CONCLUSION: A gap in HCD literature exists for radiology as compared to surgery and internal medicine. However, radiology has demonstrated a recent significant push towards understanding HCD.  Radiology should continue to capitalize on its momentum and develop HCD curricula and research.

MD and DO: Differing Medical Degrees and the Associated Perceptions.

PURPOSE: To highlight perspectives about differing medical degrees and graduate medical education amongst current allopathic (MD) and osteopathic (DO) radiology residents. MATERIALS AND METHOD: Two hundred sixty-eight radiology residents were interviewed using an approved Association of Program Coordinators in Radiology (APCR) survey designed to evaluate perceptions of allopathic and osteopathic radiology residents regarding type of medical degree and their career development. The surveys were kept anonymous with no identifiable information. Residents in their first through fourth years of training replied with an approximate equal distribution amongst the different years. RESULTS: Based on the 268 respondents, DOs' more so than MDs', reported that their degree type altered their medical careers (P < 0.0001) and that they were advised to not pursue a radiology residency based on degree type (P< 0.0001). In addition, a large majority of both DOs' and MDs' felt that residency selection is favored towards the allopathic degree (P= 0.0451). CONCLUSION: This survey-based study does reveal perceived differences in the residency recruitment process based on degree type. Future discussions to bridge this perceived gap will be important, especially in light of the recent ACGME merger between the 2 educational pathways.

Adding value to imaging services: a survey of patient and referring physician preferences for direct radiologic reporting of results.

PURPOSE: To identify preferences of patients and referring physicians for direct patient communication and notification of radiologic study results. METHODS: An anonymous survey was conducted of patients undergoing outpatient radiologic imaging studies and their referring physicians. The voluntary surveys elicited responses regarding preferences on a 5-point Likert scale (Strongly disagree, disagree, neutral, agree and strongly agree), as well as indicated by responding yes or no to specific questions. RESULTS: 368 patients completed the survey. 81.5% of patient responders preferred all results communicated from the radiologist within the same day. 65.9% of patients preferred same day results if normal vs 65.8% if abnormal. 34.5% preferred to wait and review normal results with the referring physician. 41.5% preferred to wait and review abnormal results with the referring physician. It was found that patients were more likely to strongly agree with waiting to review results with the referring physician if the results were abnormal, as opposed to normal (18.5% vs 11.9%, respectively; P < 0.014). 64% of physicians did not want results reviewed with their patients; 87.6% did not want a report sent to the patient by the radiologist, even after report was sent to their office. 66.4% of patients surveyed indicated that waiting for imaging results gives them anxiety. CONCLUSIONS: 58-82% of patients preferred same day radiologist communication of their results while 55-87.6% of physicians did not prefer same day radiologist communication of results directly with their patients. 66.4% of patients surveyed indicated that waiting for imaging results gives them anxiety.

USMLE Step 3 Scores Have Value in Predicting ABR Core Examination Outcome and Performance: A Multi-institutional Study.

RATIONALE AND OBJECTIVES: We analyzed multi-institutional data to determine if Step 3 performance tiers can identify radiology residents with increased risk of Core examination failure and submean performance. MATERIALS AND METHODS: We collected Step 3 scores (USMLE Step 3 or COMLEX Level 3) and American Board of Radiology (ABR) Core examination outcomes and scores for anonymized residents from 13 different Diagnostic Radiology residency programs taking the ABR Core examination between 2013 and 2019. Step 3 scores were converted to percentiles based on Z-score, with Core outcome and performance analyzed for Step 3 groups based on 50th percentile and based on quintiles. Core outcome was scored as fail when conditionally passed or failed. Core performance was measured by the percent of residents with scores below the mean. Differences between Step 3 groups for Core outcome and Core performance were statistically evaluated. RESULTS: Data were available for 342 residents. The Core examination failure rate for 121 residents with Step 3 scores <50th percentile was 19.8% (fail relative risk = 2.26), significantly higher than the 2.7% failure rate for the 221 other residents. Of 42 residents with Step 3 scores in the lowest quintile, the Core failure rate increased to 31.0% (fail relative risk = 3.52). Core performance improved with higher Step 3 quintiles. CONCLUSION: Step 3 licensing scores have value in predicting radiology resident performance on the ABR Core examination, enabling residency programs to target higher risk residents for early assessment and intervention.

Should Radiologists Comment on Incidental Findings of Vascular Calcifications Found on Abdominal/Pelvic CT in Patients Less Than 50 Years of Age?

RATIONALE AND OBJECTIVES: To evaluate if incidental abdominopelvic calcified atherosclerosis (ACA) in patients under 50 years of age correlates with cardiovascular disease (CVD) risk factors. Most studies evaluating calcific atherosclerosis and associated increased risk of CVD have concentrated on middle age and older populations. MATERIALS AND METHODS: A retrospective review of 519 emergency department patients, aged 25-50 years, receiving computed tomography (CT) was performed and ACA correlated with lipid panels obtained via chart review. Those with calcified atherosclerosis were subdivided by vessel location and calcification burden (mild, moderate, or severe). Patients were followed for six years. Normality, Wilcoxon-Mann-Whitney, Kruskal-Wallis, and chi-square tests were performed. RESULTS: Two hundred and sixty-nine patients with incidental ACA on CT and 250 without ACA were studied. Atherosclerotic calcifications had a statistically significant correlation with elevated triglyceride (128 mg/dL vs 105 mg/dL; p = 0.0003) and decreased high-density lipoprotein (38 mg/dL vs 41 mg/dL; p = 0.0032) as compared to the control. Patients with ACA were at higher risk of stroke, heart attack, and death (p < 0.0001) during a six-year follow-up period. CONCLUSION: Incidental atherosclerotic calcification on abdominopelvic CT in patients under 50 years of age correlated with elevated triglycerides and decreased high-density lipoprotein as well as higher risk of cardiovascular events. Since radiologists may be the first to identify this finding and CVD is the leading cause of US deaths, proper recognition and reporting of calcification is valuable.

The Relationship Between ACR Diagnostic Radiology In-Training Examination Scores and ABR Core Examination Outcome and Performance: A Multi-Institutional Study.

PURPOSE: We analyzed multi-institutional data to understand the relationship of ACR Diagnostic Radiology In-Training Examination (DXIT) scores to ABR Core examination performance. METHODS: We collected DXIT rank scores and ABR Core examination outcomes and scores for anonymized residents from 12 different diagnostic radiology residency programs taking the ABR Core examination between 2013 and 2019. DXIT scores were grouped into quintiles based on rank score for residency year 1 (R1), residency year 2 (R2), and residency year 3 (R3) residents. Core outcome was scored as fail when conditionally passed or failed. Core performance was grouped using SD from the mean and measured by the percent of residents with scores below the mean. Differences between DXIT score quintiles for Core outcome and Core performance were statistically evaluated. RESULTS: DXIT and Core outcome data were available for 446 residents. The Core examination failure rate for the lowest quintile R1, R2, and R3 DXIT scores was 20.3%, 34.2%, and 38.0%, respectively. Core performance improved with higher R3 DXIT quintiles. Only 2 of 229 residents with R3 DXIT score ≥ 50th percentile failed the Core examination, with both failing residents having R2 DXIT scores in the lowest quintile. CONCLUSIONS: DXIT scores are useful evaluation metrics to identify a subgroup of residents at significantly higher risk for Core examination failure and another subgroup of residents at significantly lower risk for Core examination failure, with increasing predictive power with advancing residency year. These scores enable identification of approximately one-half of R3 residents whose risk of Core examination failure is negligible.

The Relationship Between US Medical Licensing Examination Step Scores and ABR Core Examination Outcome and Performance: A Multi-institutional Study.

PURPOSE: We analyzed multi-institutional data to understand the relationship of US Medical Licensing Examination (USMLE) Step scores to ABR Core examination performance to identify Step score tiers that stratify radiology residents into different Core performance groups. METHODS: We collected USMLE Step scores and ABR Core examination outcomes and scores for anonymized residents from 13 different diagnostic radiology residency programs taking the ABR Core examination between 2013 and 2019. USMLE scores were grouped into noniles using z scores and then aggregated into three tiers based on similar Core examination pass-or-fail outcomes. Core performance was grouped using standard deviation from the mean and then measured by the percent of residents with scores below the mean. Differences between Step tiers for Core outcome and Core performance were statistically evaluated (P < .05 considered significant). RESULTS: Differences in Step 1 terciles Core failure rates (45.9%, 11.9%, and 3.0%, from lowest to highest Step tiers; n = 416) and below-mean Core performance (83.8%, 54.1%, and 21.1%, respectively; n = 402) were significant. Differences in Step 2 groups Core failure rates (30.0%, 10.6%, and 2.0%, from lowest to highest Step tiers; n = 387) and below-mean Core performance (80.0%, 43.7%, and 14.0%, respectively; n = 380) were significant. Step 2 results modified Core outcome and performance predictions for residents in Step 1 terciles of varying statistical significance. CONCLUSIONS: Tiered scoring of USMLE Step results has value in predicting radiology resident performance on the ABR Core examination; effective stratification of radiology resident applicants can be done without reporting numerical Step scores.

COVID-19 Impact on Well-Being and Education in Radiology Residencies: A Survey of the Association of Program Directors in Radiology.

RATIONALE AND OBJECTIVES: The COVID-19 pandemic has forced rapid evolution of the healthcare environment. Efforts to mitigate the spread of the virus through social distancing and shelter-at-home edicts have unintended consequences upon clinical and educational missions and mental well-being of radiology departments. We sought to understand the impact of the COVID-19 pandemic on radiology residencies with respect to the educational mission and perceptions of impact on well-being. MATERIALS AND METHODS: This study was IRB exempt. An anonymous 22 question survey regarding the impact of COVID-19 pandemic on educational and clinical missions of residencies, its perceived impact upon morale of radiologists and trainees and a query of innovative solutions devised in response, was emailed to the Association of Program Directors in Radiology membership. Survey data were collected using SurveyMonkey (San Mateo, California). RESULTS: Respondents felt the COVID-19 pandemic has negatively impacted their residency programs. Regarding the educational mission impact, 70.1% (75/107) report moderate/marked negative impact and 2.8% (3/107) that educational activities have ceased. Regarding the pandemic's impact on resident morale, 44.8% (48/107) perceive moderate/marked negative effect; perceived resident morale in programs with redeployment is significantly worse with 57.1% (12/21) reporting moderate/marked decrease. Respondents overwhelmingly report adequate resident access to mental health resources during the acute phase of the pandemic (88.8%, 95/107). Regarding morale of program directors, 61% (65/106) report either mild or marked decreased morale. Program innovations reported by program directors were catalogued and shared. CONCLUSION: The COVID-19 pandemic has markedly impacted the perceived well-being and educational missions of radiology residency programs across the United States.