Establishing a Women-in-Radiology Group: A Toolkit From the American Association for Women in Radiology.

Despite increasing representation in medical schools and surgical specialties, recruitment of women into radiology has failed to exhibit commensurate growth. Furthermore, women are less likely than men to advance to leadership roles in radiology. A women-in-radiology (WIR) group provides a robust support system that has been shown to produce numerous benefits to the group's individual participants as well as the group's institution or practice. These benefits include development of mentor-ship relationships, guidance of career trajectories, improved camaraderie, increased participation in scholarly projects, and increased awareness of gender-specific issues. This article describes a recommended pathway to establishing a WIR group, with the goal of fostering sponsorship and promoting leadership, recruitment, and advancement of women in radiology. We consider barriers to implementation and review resources to facilitate success, including a range of resources provided by the American Association for Women in Radiology. By implementing the provided framework, radiologists at any career stage can start a WIR group, to promote the advancement of their female colleagues.

Radiographic imaging, densitometry and disease severity in Autosomal dominant osteopetrosis type 2.

OBJECTIVE: To characterize relationships between quantitative computed tomography bone mineral density measurements and other qualitative and quantitative imaging measures, as well as clinical metrics, in patients with autosomal dominant osteopetrosis type 2 (ADO2). MATERIALS AND METHODS: Clinical and radiologic parameters of 9 adults and 3 children with autosomal dominant osteopetrosis type 2 were assessed including lumbar spine quantitative computed tomography (QCT), radiographic skeletal survey (skull base thickening; Erlenmeyer flask deformity; endobone pattern; and spine density pattern (endplate sclerosis, "anvil" appearance, or diffuse sclerosis)), dual-energy x-ray absorptiometry (DXA), tibial peripheral quantitative computed tomography (pQCT) volumetric bone mineral density (vBMD), bone turnover markers, and bone marrow failure or visual impairment. RESULTS: The skeletal parameter most divergent from normal was lumbar spine QCT Z-score (+ 3.6 to + 38.7). Lumbar QCT Z-score correlated positively with pQCT tibial diaphysis vBMD (Pearson correlation r = 0.73, p = 0.02) and pQCT tibial metaphysis vBMD (r = 0.87, p < 0.01). A trend towards positive lumbar QCT Z-score correlation with serum P1NP/CTX ratio (r = 0.54, p = 0.10) and lumbar DXA Z-score (r = 0.55, p = 0.10) were observed. Bone marrow failure and vision impairment occurred in those with most severe quantitative and qualitative measures, while those with less severe radiographic features had the lowest QCT Z-scores. CONCLUSION: Lumbar spine QCT provided the most extreme skeletal assessment in ADO2, which correlated positively with other radiologic and clinical markers of disease severity. Given the quantification of trabecular bone and greater variation from normal with wider range of values, lumbar QCT Z-scores may be useful to determine or detect impact of future treatments.

Optimizing Electronic Release of Imaging Results through an Online Patient Portal.

Purpose To determine an optimal embargo period preceding release of radiologic test results to an online patient portal. Materials and Methods This prospective discrete choice conjoint survey with modified orthogonal design was administered to patients by trained interviewers at four outpatient sites and two institutions from December 2016 to February 2018. Three preferences for receiving imaging results associated with a possible or known cancer diagnosis were evaluated: delay in receipt of results (1, 3, or 14 days), method of receipt (online portal, physician's office, or phone), and condition of receipt (before, at the same time as, or after health care provider). Preferences (hereafter, referred to as utilities) were derived from parameter estimates (ß) of multinomial regression stratified according to study participant and choice set. Results Among 464 screened participants, the response and completion rates were 90.5% (420 of 464) and 99.5% (418 of 420), respectively. Participants preferred faster receipt of results (P < .001) from their physician (P < .001) over the telephone (P < .001). Each day of delay decreased preference by 13 percentage points. Participants preferred immediate receipt of results through an online portal (utility, -.57) if made to wait more than 6 days to get results in the office and more than 11 days to get results by telephone. Compared with receiving results in their physician's office on day 7 (utility, -.60), participants preferred immediate release through the online portal without physician involvement if followed by a telephone call within 6 days (utility, -0.49) or an office visit within 2 days (utility, -.53). Older participants preferred physician-directed communication (P < .001). Conclusion The optimal embargo period preceding release of results through an online portal depends on the timing of traditional telephone- and office-based styles of communication. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Arenson et al in this issue.

Evaluation of Gadolinium Deposition in the Brain After MR Arthrography.

OBJECTIVE: Although significant investigation has been done into the deposition of gadolinium in the brains of patients receiving IV gadolinium, there is little research concerning nonintravenous uses of gadolinium, specifically in conjunction with musculoskeletal MR arthrography. Although small in volume, intraarticular administration is an off-label use of gadolinium, necessitating careful scrutiny for patient safety. Thus, we investigated the relationship between intraarticular gadolinium administration during MR arthrography and the presence of intracranial gadolinium deposition on subsequent brain MRI. MATERIALS AND METHODS: An institutional review board-approved retrospective study was performed of patients with no history of gadolinium exposure who underwent MR arthrography from 2006 to 2016 followed by an unenhanced brain MRI examination. ROIs were manually placed within bilateral dentate nuclei (DN), bilateral globus pallidi (GP), bilateral thalami, bilateral middle cerebral peduncles (MCP), and the central pons (CP) on T1-weighted sequences. The left and right ROIs were averaged, and ratios of signal intensity were calculated for DN/MCP, DN/CP, GP/MCP, GP/CP, thalamus/MCP, and thalamus/CP. Similar ROIs were placed and ratios calculated for age-matched control subjects who had a history of brain MRI but no prior gadolinium exposure. We used t testing to compare signal intensity ratios between patients and control subjects. RESULTS: A total of 31 patients met the inclusion criteria. We found no significant difference in signal intensity between patients and control subjects for DN/MCP (p = 0.40), DN/CP (p = 0.76), GP/MCP (p = 0.51), GP/CP (p = 0.86), thalamus/MCP (p = 0.93), and thalamus/CP (p = 0.30). CONCLUSION: No association was found between intraarticular gadolinium administration for MR arthrography and detectable gadolinium deposition within the brain.

Correlation Between Hip Arthroscopy Outcomes and Preoperative Anesthetic Hip Joint Injections, MR Arthrogram Imaging Findings, and Patient Demographic Characteristics.

OBJECTIVE: The purpose of this study is to determine whether the preoperative response to intraarticular hip anesthetic injection correlates with the outcome of hip arthroscopy. A secondary aim is to determine whether the outcome of arthroscopy correlates with intraarticular pathologic findings or patient demographic characteristics. MATERIALS AND METHODS: Ninety-three patients who underwent MR arthrography (MRA), preoperative injections of anesthetic into the hip joint (with pain scores documented), and subsequent hip arthroscopy (with a modified Harris Hip Score [mHHS] determined at 1 year after arthroscopy) were included in the study. MRA images and surgery reports were retrospectively reviewed to identify information about labral tear type and size and cartilage damage grade. The correlation between the response to hip anesthetic injection (defined as poor [0-30% improvement], moderate [31-60% improvement], or good [61-100% improvement]) and the surgical outcome (poor, fair, or good, as determined on the basis of the mHHS or the need for repeat surgery) was evaluated using the Fisher exact test. Univariate analysis (performed using the Fisher exact test) and multivariate analysis (performed using ANOVA) of correlations with age, sex, body mass index (BMI [weight in kilograms divided by the square of height in meters]), the interval between injection and surgery, labral tear type and size, and cartilage damage grade were also performed. RESULTS: Comparison of the response to preoperative hip anesthetic injection with the outcome of arthroscopy at 1 year indicated no statistically significant association (p = 0.59). The BMI of the patient, however, was statistically significantly associated with surgical outcome (p = 0.03), with a BMI of less than 25 denoting a higher likelihood of a good surgical outcome. No statistically significant correlations were noted in analyses of surgical outcomes and patient age (p = 0.31) and sex (p = 0.83); the interval between injection and surgery (p = 0.28); labral tear type, as determined by MRA (p = 0.34) and arthroscopy (p = 0.47); labral tear size, as determined by MRA (p = 0.34); and cartilage grade, as determined by MRA (p = 0.58) and arthroscopy (p = 0.26). CONCLUSION: No positive or negative correlation was noted between the response to preoperative hip anesthetic injection and the outcome at 1 year after hip arthroscopy. Only BMI was shown to correlate with the surgical outcome.

Radiation exposure as a consequence of spinal immobilization and extrication.

BACKGROUND: Extrication and spinal immobilization in the trauma patient with unknown injuries is a common practice of emergency medical services. High-speed crashes occurring in open-wheel racing seldom result in extrication or spinal immobilization. OBJECTIVES: To evaluate the safety of self-extrication in IndyCar® (Indianapolis, IN) by comparing drivers self extricated with full spinal immobilization and subsequent radiation exposure. METHODS: A retrospective review of prospectively collected de-identified IndyCar® crash and drivers' medical records was performed at treating Level I trauma centers. One hundred thirty-five crash incidents involving drivers evaluated by a medical team were included. Any driver with severe multiple trauma was excluded due to distracting injuries. Drivers underwent standard protocol for postcrash injury. Diagnostic and treatment outcomes including spinal and neurologic injury, need for surgery, and radiation exposure were collected for review. RESULTS: Self-extrication occurred in 121 (90%) crashes, and overall cumulative radiation exposure ranged from 100 to 250 mSv, or 0.82-2.06 mSv per driver. Extrication with full spinal immobilization occurred in 14 (10%) drivers, with overall cumulative radiation exposure ranging from 140 to 350 mSv, or 10-25 mSv per driver. A total of 29 injuries were identified, nine of which (31%) were spinal. In these, six were emergency medical services extricated and three self extricated. None were unstable spinal fractures resulting in surgical care, surgical disease, or neurologic deficit. CONCLUSION: In our IndyCar® racing experience, a protocol-led self-extrication system resulted in neither a mismanagement of an unstable spinal fracture nor neurological deficit, and reduced radiation exposure.

Glenohumeral Joint Instability: A Review of Anatomy, Clinical Presentation, and Imaging.

The glenohumeral joint is intrinsically predisposed to instability because of the bony anatomy but maintained in alignment by many important structures, including the glenoid labrum, glenohumeral ligaments (GHLs), and muscles and tendons. Trauma and overuse can damage these stabilizers, which may then lead to subluxation or dislocation and eventually recurrent instability. This is most common in the anterior direction, which has several recognizable patterns of injury on advanced imaging, including humeral Hill Sachs deformities, bony Bankart lesion of the anteroinferior glenoid, soft tissue Bankart lesions, Bankart variant lesions (Perthes and ALPSA lesions), and HAGL/GAGL lesions. Similar reverse lesions are seen, as well as unique posterior lesions, such as Bennett and Kim's lesions. When symptoms of apprehension and instability in more than one direction are seen, one should consider multidirectional instability, which often presents with a patulous joint capsule. Finally, owing to significant impacts of daily activities and quality of life, surgical correction of labral tears, bony Bankart defects, Hill Sachs defects, and capsular laxity, may be considered.

Radiology in the Study of Bone Physiology.

RATIONALE AND OBJECTIVES: In this article, we review the core principles of bone physiology alongside imaging examples that demonstrate such principles. MATERIALS AND METHODS: The core principles of bone physiology are reviewed and further solidified with a corresponding abnormal pathophysiologic example. The key principles of bone physiology to be reviewed include the following: (1) formation and growth, (2) maintenance and repair, (3) metabolism and regulation, and (4) neoplastic disease. Lastly, a collection of secondary bone diseases is presented to demonstrate the skeletal manifestations of numerous systemic diseases. With this integrative method, we hope to emphasize the value of using radiology to teach physiology within a clinical context. This is especially relevant now, as many US medical schools undergo curricular reform with more emphasis on integrative interdisciplinary learning. Ultimately, we intend to provide a paradigm for incorporating radiology into the pre-clinical medical curriculum through a review of basic science physiology that underlies key radiographic findings of the skeletal system. RESULTS: Radiology is known for its role in helping make diagnoses and clinical decisions. However, radiology is also well suited to enhance medical education by offering the ability to visualize physiology in action. This is especially true in skeletal radiology, where radiographic osseous changes represent a wide range of physiological processes. Therefore, skeletal radiology can be a useful tool for illustrating concepts of physiology that underlie the normal and abnormal radiologic appearances of bone. CONCLUSION: Radiology is an important but underutilized tool for demonstrating concepts in bone physiology.

Comparison of hepatic MDCT, MRI, and DSA to explant pathology for the detection and treatment planning of hepatocellular carcinoma.

BACKGROUND/AIMS: The diagnosis and treatment plan for hepatocellular carcinoma (HCC) can be made from radiologic imaging. However, lesion detection may vary depending on the imaging modality. This study aims to evaluate the sensitivities of hepatic multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) in the detection of HCC and the consequent management impact on potential liver transplant patients. METHODS: One hundred and sixteen HCC lesions were analyzed in 41 patients who received an orthotopic liver transplant (OLT). All of the patients underwent pretransplantation hepatic DSA, MDCT, and/or MRI. The imaging results were independently reviewed retrospectively in a blinded fashion by two interventional and two abdominal radiologists. The liver explant pathology was used as the gold standard for assessing each imaging modality. RESULTS: The sensitivity for overall HCC detection was higher for cross-sectional imaging using MRI (51.5%, 95% confidence interval [CI]=36.2-58.4%) and MDCT (49.8%, 95% CI=43.7-55.9%) than for DSA (41.7%, 95% CI=36.2-47.3%) (P=0.05). The difference in false-positive rate was not statistically significant between MRI (22%), MDCT (29%), and DSA (29%) (P=0.67). The sensitivity was significantly higher for detecting right lobe lesions than left lobe lesions for all modalities (MRI: 56.1% vs. 43.1%, MDCT: 55.0% vs. 42.0%, and DSA: 46.9% vs. 33.9%; all P<0.01). The sensitivities of the three imaging modalities were also higher for lesions ≥2 cm vs. <2 cm (MRI: 73.4% vs. 32.7%, MDCT: 66.9% vs. 33.8%, and DSA: 62.2% vs. 24.1%; all P<0.01). The interobserver correlation was rated as very good to excellent. CONCLUSION: The sensitivity for detecting HCC is higher for MRI and MDCT than for DSA, and so cross-sectional imaging modalities should be used to evaluate OLT candidacy.