Prevalence and Impact of Workplace Sexual Harassment Experienced by Medical Sonographers.

OBJECTIVE: To assess the prevalence and impact of sexual harassment among a nationwide sample of medical sonographers. METHODS: A survey was distributed anonymously to a convenience sample of medical sonographers via email contacts and sonographer-specific social media pages. Data were analyzed to determine respondent demographics, the prevalence of sexual harassment in the last 2 years, the type and severity of harassment experienced, demographics of perpetrators, personal and institutional responses to such experiences, and the impact of sexual harassment on sonographer physical and mental health and job satisfaction. RESULTS: Of the 220 sonographers (83% female) most (45%) were between 18 and 34 years and identified as white (81%). A total of 192 (87%) reported experiencing at least 1 incident of harassment within the last 2 years. Female respondents experienced higher harassment rates (76%) compared to males (50%, P = .02). The most common forms of harassment were verbal, including suggestive or sexist jokes (69%) and offensive sexist remarks (61%). Perpetrators were predominantly male (78%) and most commonly patients (89%) or their friends/family members (46%). The majority of respondents either ignored the harassing behavior (70%) or treated it like a joke (50%), with only a minority (12%) officially reporting incidents. Of those who reported, 44% were unsatisfied with their institution's response. Among respondents, 34% reported negative impacts of workplace sexual harassment, such as anxiety, depression, sleep loss, or adverse workplace consequences. DISCUSSION: Workplace sexual harassment is a common occurrence for sonographers and often leads to negative health and career outcomes. Further institutional policies to prevent harassment and mitigate its effects are needed.

Can 3-Phase Computed Tomography Urography Be Used to Characterize Adrenal Nodules? Results in 145 Patients.

OBJECTIVE: The aim of the study is to determine whether computed tomography (CT) urography (CTU) can characterize incidental adrenal nodules. METHODS: This retrospective cohort study was performed at an academic medical center. Patients were identified by free text search of CTU reports that contained the terms "adrenal mass" "adrenal nodule" and "adrenal lesion." Computed tomography urography technique consisted of unenhanced images and postcontrast images obtained at 100 seconds and 15 minutes. The final cohort included 145 patients with 151 adrenal nodules. Nodules were considered lipid-rich adenomas or myelolipomas based on unenhanced imaging characteristics. Absolute and relative washout values were calculated for the remaining nodules, using a cutoff of 60% and 40%, respectively, to diagnose adenomas. Reference standard for lipid-poor adenomas and malignant nodules was histopathology or imaging/clinical follow-up. Mann-Whitney U test was used for comparison of continuous variables, and Fisher exact test was used for categorical variables. RESULTS: One hundred nodules were lipid-rich adenomas and 3 were myelolipomas. Forty-eight nodules were indeterminate at unenhanced CT, corresponding to 39 lipid-poor adenomas and 9 malignant nodules based on reference standards. Both absolute and relative washout correctly characterized 71% of nodules (34/48), with a sensitivity of 67% and specificity of 89%. Overall, 91% of all adrenal nodules (137/151) were correctly characterized by CTU alone. Lipid-poor adenomas were smaller than malignant nodules ( P < 0.01) and were lower in attenuation on unenhanced and delayed images ( P < 0.01). CONCLUSIONS: Adrenal nodules detected at 3-phase CTU can be accurately characterized, potentially eliminating the need for subsequent adrenal protocol CT or magnetic resonance imaging.

Senior Resident Grand Rounds: Results From a Survey of 15 Years of Radiology Residency Graduates.

OBJECTIVE: Radiology residents in their final year of training at our institution are required to deliver a grand rounds presentation prior to graduation in order to facilitate resident involvement in the medical tradition of ground rounds. We evaluated this requirement by conducting a survey of recent residency alumni on their experience delivering grand rounds and its perceived value in radiology training. MATERIALS AND METHODS: We developed an anonymous, 10-question survey regarding the alumni experience with the grand rounds presentation requirement, which has been required since 2007. Question formats included yes-or-no and 5 point Likert-type formats, as well as a space to provide comments. RESULTS: Eighty-three alumni were contacted and 39 responded (46.9% response rate). Current practice setting was academic in 41.0%, 46.2% have reused material from their presentation, and 46.2% have given a grand rounds presentation since completing residency. When asked if delivering the presentation was a valuable experience, 2.6% disagreed, 23.1% were neutral, 35.9% agreed, and 38.5% strongly agreed. When asked if they would recommend future senior residents to give a grand rounds presentation, 2.6% strongly disagreed, 30.8% were neutral, 30.8% agreed, and 35.9% strongly agreed. CONCLUSIONS: The majority of survey respondents agree or strongly agree their grand rounds presentation experience was valuable and would recommend future residents to continue this process. Based on survey comments, we conclude this experience is valuable for multiple reasons, including the opportunity to demonstrate mastery of a radiology topic, the ability to repurpose presentation material in the future, and the experience of delivering a formal presentation.

Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma.

PURPOSE: Abdominal ultrasound is a cost-effective method for screening for hepatocellular carcinoma (HCC) in high-risk individuals. Currently, at many institutions the protocol for obtaining HCC screening ultrasounds includes a traditional examination of the right upper quadrant, including the pancreas and right kidney. There is no consensus on the role of imaging of extra-hepatic structures and there are limited data describing the frequency and clinical significance of incidental findings discovered during HCC screening. The purpose of this retrospective study is to assess the prevalence and significance of extra-hepatic incidental findings during HCC screening ultrasounds. METHODS: A single-center retrospective review of all right upper quadrant HCC screening ultrasounds identified 432 HCC screening ultrasounds performed on 294 adults over a 2.5-year period. Findings in all organs evaluated were recorded. Any incidental finding was classified as minor, moderate, or major clinical significance. RESULTS: At least one extra-hepatic finding was documented in 57.4% of examinations. The most common extra-hepatic findings occurred in the gallbladder (40.3%), most commonly gallstones (25.4%). Four moderate clinically significant incidental findings were recorded (0.9%). Only one of these incidental findings required specific imaging follow up (0.2%). No major clinical significance incidental findings were identified. CONCLUSIONS: Potentially clinically significant incidental findings during ultrasound HCC screenings are rare. Incidental findings identified on HCC screening did not result in significant additional follow-up imaging or interventions.

Ultrasound Imaging of Superficial Venous Thrombosis in the Upper and Lower Extremities: Closing the Gap Between Clinical Management Guidelines and Ultrasound Practice Parameters.

Superficial venous thrombosis (SVT) of the upper and lower extremities has long been considered a relatively benign condition. But in recent years, the literature has suggested a benefit to anticoagulation in patients with certain thrombus characteristics (size, location, and distance to deep venous system) resulting in updates to clinical guidelines for the treatment of lower extremity SVT. Despite these now well-established guidelines, there remains a paucity of guidance from national and international societies regarding the imaging of superficial veins when evaluating for venous thrombosis. We recommend potential strategies to close this gap.

Formation of a traumatic air cyst and ensuing hemopneumothorax during CT angiography in a patient with Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) refers to a rare group of genetic disorders that makeup part of the connective tissue disorders consortium. It is characterized by clinical features such as skin hyperextensibility, joint hypermobility, and tissue fragility. A vascular subtype (EDS IV) exists, that predisposes affected patients to vascular injury and is well-known and documented. However, other manifestations of EDS IV are less commonly understood and reported. Though spontaneous pneumothorax has been described in several cases, formation of traumatic air cysts/pneumatoceles with little to no inciting factors has not. This can eventually lead to pulmonary hemorrhage or hemopneumothorax. We present a case of spontaneous formation of a traumatic air cyst with ensuing large-volume hemopneumothorax occurring in a time period of under 3 minutes, between pre- and post-contrast-media administration during CT angiography of the chest.

Body MRI Subspecialty Reinterpretations at a Tertiary Care Center: Discrepancy Rates and Error Types.

OBJECTIVE. Radiology departments in tertiary care centers are frequently asked to perform secondary interpretations of imaging studies, particularly when a patient is transferred from a community hospital. Discrepancy rates in radiology vary widely, with low rates reported for preliminary resident reports that are overread by attending radiologists (2-6%) and higher rates (up to 56%) for secondary interpretations. Abdominal and pelvic imaging and cross-sectional imaging have the highest discrepancy rates. The purpose of our study was to determine the discrepancy rate and the most common reasons for discrepancies between abdominal and pelvic MRI reports obtained from outside institutions and secondary interpretations of these reports by a fellowship-trained radiologist at a tertiary care center. MATERIALS AND METHODS. We retrospectively identified 395 secondary MRI reports from January 2015 to December 2018 that were labeled as body MRI examinations at a tertiary care center. Thirty-eight cases were excluded for various reasons, including incorrect categorization or lack of outside report. We reviewed the outside reports, compared them with the secondary interpretations, and categorized the cases as discrepancy or no discrepancy. The discrepancies were subdivided into the most likely reason for the error using previously published categories; these categories were also divided into perceptive and cognitive errors. RESULTS. Of the 357 included cases, 246 (68.9%) had at least one discrepancy. The most common reason for error was faulty reasoning (34.3%), which is a cognitive error characterized by misidentifying an abnormality. Satisfaction of search, which is a perceptive error, was the most common reason for second discrepancies (15.0%). CONCLUSION. Secondary interpretations of body MR images at a tertiary care center identify a high rate of discrepancies, with cognitive error types predominating.

A preliminary study on treatment of human breast cancer xenografts with a cocktail of paclitaxel, doxorubicin, and 131I-anti-epithelial cell adhesion molecule (9C4).

Triple-negative breast cancer often has devastating outcomes and treatment options remain limited. Therefore, different treatment combinations are worthy of testing. The efficacy of a cocktail of paclitaxel, doxorubicin, and 131I-anti-epithelial cell adhesion molecule (EpCAM) (9C4) to treat breast cancer was tested. Efficacy was tested with an MDA-MB-231 human breast cancer xenograft model. Anti-EpCAM (9C4) was demonstrated to bind to MDA-MB-231 human adenocarcinoma cells in vitro. Subsequently, mice-bearing MDA-MB-231× enografts were treated with either 131I-anti-EpCAM (9C4), unlabeled anti-EpCAM (9C4), paclitaxel, doxorubicin, or a cocktail of all of the agents. Tumor volume was measured for up to 70-day postinjection. Exponential regression was performed on tumor growth curves for each of the therapy groups. Statistical comparison of the growth constants λ of the regression models for each of the treatment groups with that of the cold antibody and control groups was done using extra sum-of-square F-tests. Biexponential clearance of 131I-anti-EpCAM (9C4) was observed with biological clearance half-times of 1.14 and 17.6 days for the first and second components, respectively. The mean growth rate of the tumors in animals treated with a cocktail of all of the agents was slower than in those treated with unlabeled anti-EpCAM (9C4) (P = 0.022). These preliminary data suggest that a cocktail of 131I-anti-EpCAM (9C4), paclitaxel, and doxorubicin may be suitable for treating breast cancers with high expression of EpCAM.

Small bowel obstruction and the gastrografin challenge.

The "gastrografin challenge" has been used for decades in the evaluation of small bowel obstruction (SBO). This type of study involves enteric administration of a water-soluble contrast followed by serial abdominal radiographs. While its diagnostic role is well established, its therapeutic role remains controversial. Following an algorithm for gastrografin challenge cases can help with interpretation. An understanding of the appearance of diluted contrast in the small bowel, the concentrating effect of contrast in the colon, and knowledge of surgical history and anatomy is paramount for diagnosis. In this article, we review the approach to acute SBO and the use of gastrografin along with reviewing image interpretation of cases of partial and complete SBO. Gastrografin use in adynamic ileus along with other potential future uses is also discussed.