A Women in Radiology Group Fosters Career Development for Faculty and Trainees.

OBJECTIVE: The objective of our study was to evaluate the outcomes of a women in radiology (WIR) group during the first 6 years of its existence, including members' satisfaction, activities, and differences based on seniority. MATERIALS AND METHODS: An anonymous questionnaire was distributed to group members. Survey questions were related to the usefulness of sessions, mentoring, professional opportunities, and camaraderie. Comparisons were made on the basis of training status and seniority. Continuous variables were compared using means, t tests, and correlations, and categoric variables were compared using counts, percentages, and chi-square tests or Mantel-Haenszel tests. RESULTS: Surveys were sent to 61 women, including trainees and faculty; the response rate was 49% (38% of trainees and 53% of faculty). Overall satisfaction score for WIR sessions was high (mean summary score, 1.42 ± 0.37 [SD], with 1 meaning very satisfied and 4 meaning very unsatisfied). Trainees and junior faculty were more likely than senior faculty to report expanded internal networking opportunities (94% vs 69%; p = 0.07), to have gained a mentor (67% vs 8%; p = 0.001), and to have increased research involvement (33% vs 0%; p = 0.02). Both groups were equally likely to have become mentors. Almost all respondents (93%) reported increased camaraderie among women in the department. CONCLUSION: A WIR group can provide career development tools for its members. In this study, trainees and junior faculty reported increased networking and research involvement and gaining a mentor but were equally likely as senior faculty to have become mentors. Most members reported increased camaraderie among women in the department. A WIR group may help to accelerate professional development among trainees and junior faculty, thereby contributing to a more diverse and enabled workforce.

Breast imaging after dark: patient outcomes following evaluation for breast abscess in the emergency department after hours.

In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted.

Abdominopelvic hemorrhage: correlation of CT positivity with the subsequent decision to perform blood transfusion.

The purpose of this study is to determine the role of computed tomography (CT) on the decision to administer blood transfusions in patients with abdominopelvic hemorrhage (trauma, surgery, invasive procedure, and spontaneous) and to determine the clinical parameters most likely to influence the decision to administer blood transfusions in patients with spontaneous abdominopelvic hemorrhage. In this IRB approved and HIPPA compliant study, retrospective analysis was performed on 298 patients undergoing abdominal and pelvic CT for suspected abdominopelvic hemorrhage and the CT reports and electronic medical records were reviewed. Odds ratios and 95% CI were calculated to compare the odds of abdominopelvic hemorrhage and transfusion for categorical and continuous predictors. The presence of abdominopelvic hemorrhage by CT was significantly associated with blood transfusions for trauma patients (p-value <0.0001) only. 106 patients with suspected spontaneous abdominopelvic hemorrhage had the lowest CT positivity rate (n = 23, 21.7%) but the highest blood transfusion rate (n = 62, 58.5%) compared to the patients with abdominopelvic hemorrhage from known preceding causes. In patients with spontaneous abdominopelvic hemorrhage, low hemoglobin and hematocrit levels immediately prior to obtaining the CT study were more predictive for receiving a blood transfusion (p-value <0.0001) than the presence of hemorrhage by CT. CT positivity is strongly correlated with the decision to administer blood transfusions for patients with abdominopelvic hemorrhage from trauma, indicating that CT studies play a significant role in determining the clinical management of trauma patients. For patients with spontaneous abdominopelvic hemorrhage, the decision to transfuse depends not on the CT study but on the patient's hemoglobin and hematocrit levels. CT studies should therefore not be performed for the sole purpose of determining the need for blood transfusion in patients with spontaneous abdominopelvic hemorrhage.

Assessment of 1 mSv urinary tract stone CT with model-based iterative reconstruction.

OBJECTIVE: The purpose of this study was to evaluate stone detection, assessment of secondary signs of stone disease, and diagnostic confidence utilizing submillisievert CT with model-based iterative reconstruction (MBIR) in a North American population with diverse body habitus. MATERIALS AND METHODS: Fifty-two adults underwent stone CT using a split-dose protocol; weight-based projected volume CT dose index (CTDIvol) and dose-length product (DLP) were divided into two separate acquisitions at 80% and 20% dose levels. Images were reconstructed with MBIR. Five blinded readers counted stones in three size categories and rated "overall diagnostic confidence" and "detectability of secondary signs of stone disease" on a 0-4 scale at both dose levels. Effective dose (ED) in mSv was calculated as DLP multiplied by conversion coefficient, k, equal to 0.017. RESULTS: Mean ED (80%, 3.90±1.44 mSv; vs 20%, 0.97±0.34 mSv [p<0.001]) and number of stones detected (80%, 193.6±25.0; vs 20%, 154.4±15.4 [p=0.03]) were higher in scans at 80% dose level. Intrareader correlation between scans at 80% and 20% dose levels was excellent (0.83-0.97). With 80% scans as reference standard, mean sensitivity and specificity at 20% varied with stone size (<3 mm, 74% and 77%; ≥3 mm, 92% and 82%). The 20% scans scored lower than 80% scans in diagnostic confidence (2.46±0.50; vs 3.21±0.36 [p<0.005]) and detectability of secondary signs (2.41±0.39; vs 3.19±0.29 [p<0.005]). CONCLUSION: Aggressively dose-reduced (~1 mSv) MBIR scans detected most urinary tract stones of 3 mm or larger but underperformed the low-dose reference standard (3-4 mSv) scans in small (<3 mm) stone detection and diagnostic confidence.

MR Imaging of Pelvic Emergencies in Women.

MR imaging is a useful adjunct imaging modality for evaluating women presenting with acute lower abdominal/pelvic pain who have negative or inconclusive sonographic findings. In pregnant women, although obstetric complications are of prime concern, gastrointestinal pathologies also warrant careful attention, and MR imaging is often useful in refining the diagnosis. In nonpregnant women, gynecologic pathologies and gastrointestinal pathologies are of major concern, and may necessitate evaluation with MR imaging. Knowledge of imaging features in the appropriate clinical setting helps in early and accurate diagnosis, enabling timely management for better clinical outcomes.

Emergency radiology elective improves second-year medical students' perceived confidence and knowledge of appropriate imaging utilization.

RATIONALE AND OBJECTIVES: Given recent advances in and wider availability of complex imaging, physicians are expected to understand imaging appropriateness. We introduced second-year medical students to the American College of Radiology Appropriateness Criteria (ACR-AC) in an interactive case-based elective to demonstrate their use in imaging for common emergency department clinical complaints. MATERIALS AND METHODS: Prospective pre- and post-test design assessed second-year medical students' performance on case-based knowledge applications and self-assessed confidence related to ACR-AC guidelines compared to second-year students participating in a different concurrent radiology elective. Students participated in a 3-day elective covering the ACR-AC, comparative effective imaging, and risks associated with imaging radiation exposure, with outcomes of perceived confidence using a 5-point Likert scale and knowledge of ACR-AC using case-based multiple choice questions. Analysis included computing mean scores and assessing effect sizes for changes in knowledge. RESULTS: Before the elective, 24 students scored an average of 3.45 questions correct of 8 (43.1%). On course completion, students scored an average of 5.3 questions correct of the same questions (66.3%) (P < .001; effect size [Cohen's d] = 1.3940. In the comparison group, 12 students scored an average of 3.08 questions (38.5%) correctly pretest and 3.09 questions (38.6%) correctly post-test (P > .85; effect size = 0.008). Students' confidence in ordering appropriate imaging improved nearly 2-fold from a range of 1.9 to 3.2 (on a scale of 1.0 to 5.0) to a range of 3.7 to 4.5. CONCLUSIONS: Following a short radiology elective, second-year medical students improved their knowledge of appropriate image utilization and perceived awareness of the indications, contraindications, and effects of radiation exposure related to medical imaging.