The Virtual Reality Radiology Workstation: Current Technology and Future Applications.

Virtual reality (VR) and augmented reality (AR) technology hold potential across many disciplines in medicine to expand the delivery of education and healthcare. VR-AR applications in radiology, in particular, have gained prominence and have demonstrated advantages in many areas within the field. Recently, VR software has emerged to redesign the physical radiology workstation (ie, reading room) to expand the possibilities of diagnostic interpretation. Given the novelty of this technology, there is limited research investigating the potential applications of a simulated radiology workstation. In this review article, we explore VR-simulated reading room technology in its current form and illustrate the practical applications this technology will bring to future radiologists and learners. We also discuss the limitations and barriers to adopting this technology that must be overcome to truly understand its potential benefits. VR reading room technology offers great potential in radiology, but further research is needed to appreciate its benefits and identify areas for improvement. The findings and insights presented in this review contribute to the ongoing discourse on future technological advancements in radiology and healthcare, offering valuable recommendations for further research and practical implementation.

Canadian Association of Radiologists Gastrointestinal Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Gastrointestinal Expert Panel consists of radiologists, a gastroenterologist, a general surgeon, a family physician, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 20 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 58 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 85 recommendation statements specific to the adult population across the 20 scenarios. This guideline presents the methods of development and the referral recommendations for dysphagia/dyspepsia, acute nonlocalized abdominal pain, chronic abdominal pain, inflammatory bowel disease, acute gastrointestinal bleeding, chronic gastrointestinal bleeding/anemia, abnormal liver biopsy, pancreatitis, anorectal diseases, diarrhea, fecal incontinence, and foreign body ingestion.

Do Dictation Privileges Add Value to Radiology Electives If Medical Students Have Access to Online Modules?

RATIONALE AND OBJECTIVES: Traditional in-person medical student radiology electives are predominantly observerships. However, during the COVID-19 restrictions, many schools across Canada and the United States moved their radiology electives to an online format with great success. To the best of our knowledge, an evaluation of student experiences at a site where the 2-week on-site elective has both dictation privileges and an online component has not been completed. MATERIALS AND METHODS: We analyzed the pre- and post-test data from the online component of a radiology elective, retrieved the total number of dictation reports, and reviewed qualitative student feedback to gauge student engagement and learning. We used a generalized linear mixed model (GLMM) to compare the difference between the student scores on pre- and postmodule section quizzes, accounting for individual and section-specific variation in performance. A second GLMM was fit to assess improvement in the cumulative test taken before and after the entire elective. Both models accounted for the potential benefit of dictation. RESULTS: Student score improved significantly on the postsection tests (ßpost = 15.9% ± 0.86% SE, P < 0.001) and on the final postelective test (ßpost = 28.1% ± 1.8% SE, P < 0.001). The effect of total number of dictated studies on final test performance was not significant (ßpost = 0.07% ± 0.07% SE, P = 0.317). CONCLUSION: This retrospective study suggests that resources should be directed to the development of mixed online/in-person electives for ideal student engagement at the senior medical student level. Further work must be completed to understand the potential benefits of, and barriers to, student dictation at the medical student level.

Effect of the COVID-19 pandemic on emergency department utilization of computed tomography scans of appendicitis and diverticulitis.

PURPOSE: Investigating the effect of the COVID-19 lockdown on adult patient visits, computed tomography (CT) abdominal scans, and presentations of appendicitis and diverticulitis, to emergency departments (ED) in St. John's NL. METHODS: A retrospective quantitative analysis was applied, using ED visits and Canadian Triage and Acuity Scale (CTAS) scores. mPower (Nuance Communications, UK) identified CT abdominal scan reports, which were categorized into (1) normal/other, (2) appendicitis, or (3) diverticulitis. Time intervals included pre-lockdown (January-February), lockdown (March-June), and post-lockdown (July-August). Data from 2018 to 2019 (January-August) were used to generate expected patient volumes for 2020, and pre- and post-lockdown were included to control for other variables outside the lockdown. RESULTS: Chi-squared goodness of fit tested for deviations from predicted means for 2018-2019. Compared to expectations, daily ED visits from January to August 2020 showed a significant (p < 0.001) decrease in patient volumes independent of gender, age, and CTAS scores. During and post-lockdown, CT abdominal scans did not drop in proportion to patient volume. Appendicitis presentations remained indifferent to lockdown, while diverticulitis presentations appeared to wane, with no difference in combined complicated cases in comparison to what was expected. CONCLUSION: During lockdown, significantly fewer patients presented to the ED. The proportion of ordered CT abdominal scans increased significantly per person seen, without change in CTAS scores. Considering combined pathology cases increased during the lockdown, ED physicians were warranted in increasing abdominal imaging as patients did not avoid the ED. This may have resulted from a change in clinical practice where the uncertainty of COVID-19 increased CT scan usage.

CTPA ordering trends in local emergency departments: are they increasing and did they increase as a result of COVID-19?

PURPOSE: Ordering trends for computed tomographic pulmonary angiogram (CTPA) studies by local emergency departments were assessed, along with the impact of the COVID-19 pandemic on these ordering trends and CTPA positivity rates. METHODS: A retrospective quantitative analysis was performed on all CTPA studies ordered between February 2018 - January 2022 by three local tertiary care emergency rooms to investigate for pulmonary embolism. Data collected from the first two years of the COVID-19 pandemic was compared to the two years prior to the pandemic to assess for significant changes in ordering trends and positivity rates. RESULTS: The overall number of CTPA studies ordered increased from 534 studies in 2018-2019 to 657 in 2021-2022 and the rate of positive diagnosis of acute pulmonary embolism varied between 15.8% to 19.5% over the four years studied. There was no statistically significant difference in the number of CTPA studies ordered when comparing the first two years of the COVID-19 pandemic to the two years immediately prior; however, the positivity rate was significantly higher during the first two years of the pandemic. CONCLUSION: Over the studied period from 2018-2022, the overall number of CTPA studies ordered by local emergency departments has increased, in line with literature reports from other locations. There was also a correlation between the onset of the COVID-19 pandemic and CTPA positivity rates, possibly secondary to the prothrombotic nature of this infection or the increase in sedentary lifestyles during lockdown periods.

Interobserver and intraobserver variability of RECIST assessment in ovarian cancer.

OBJECTIVES: Measurement of Response Evaluation Criteria In Solid Tumors (RECIST) relies on reproducible unidimensional tumor measurements. This study assessed intraobserver and interobserver variability of target lesion selection and measurement, according to RECIST version 1.1 in patients with ovarian cancer. METHODS: Eight international radiologists independently viewed 47 images demonstrating malignant lesions in patients with ovarian cancer and selected and measured lesions according to RECIST V.1.1 criteria. Thirteen images were viewed twice. Interobserver variability of selection and measurement were calculated for all images. Intraobserver variability of selection and measurement were calculated for images viewed twice. Lesions were classified according to their anatomical site as pulmonary, hepatic, pelvic mass, peritoneal, lymph nodal, or other. Lesion selection variability was assessed by calculating the reproducibility rate. Lesion measurement variability was assessed with the intra-class correlation coefficient. RESULTS: From 47 images, 82 distinct lesions were identified. For lesion selection, the interobserver and intraobserver reproducibility rates were high, at 0.91 and 0.93, respectively. Interobserver selection reproducibility was highest (reproducibility rate 1) for pelvic mass and other lesions. Intraobserver selection reproducibility was highest (reproducibility rate 1) for pelvic mass, hepatic, nodal, and other lesions. Selection reproducibility was lowest for peritoneal lesions (interobserver reproducibility rate 0.76 and intraobserver reproducibility rate 0.69). For lesion measurement, the overall interobserver and intraobserver intraclass correlation coefficients showed very good concordance of 0.84 and 0.94, respectively. Interobserver intraclass correlation coefficient showed very good concordance for hepatic, pulmonary, peritoneal, and other lesions, and ranged from 0.84 to 0.97, but only moderate concordance for lymph node lesions (0.58). Intraobserver intraclass correlation coefficient showed very good concordance for all lesions, ranging from 0.82 to 0.99. In total, 85% of total measurement variability resulted from interobserver measurement difference. CONCLUSIONS: Our study showed that while selection and measurement concordance were high, there was significant interobserver and intraobserver variability. Most resulted from interobserver variability. Compared with other lesions, peritoneal lesions had the lowest selection reproducibility, and lymph node lesions had the lowest measurement concordance. These factors need consideration to improve response assessment, especially as progression free survival remains the most common endpoint in phase III trials.

Appendicitis and beyond: a pictorial review of various appendiceal abnormalities.

Acute appendicitis is the most common disease of the appendix. However, the differential diagnosis for an abnormal appendix includes other conditions that often present with symptoms and imaging features that overlap with acute appendicitis. In this pictorial essay, we review the normal anatomy of the appendix and outline the pathogenesis, clinical manifestations, and imaging findings that are characteristic of acute appendicitis and other less common appendiceal abnormalities. Inflammatory/non-neoplastic processes including appendiceal diverticulitis, stump appendicitis, foreign body appendicitis, Crohn's appendicitis, and appendiceal hernias are discussed. Neoplastic considerations include appendiceal neuroendocrine tumors, mucinous and non-mucinous (colonic type) epithelial neoplasms, and lymphoma. It is important for the radiologist to be able to differentiate these alternative diagnoses for the purpose of directing appropriate patient management.

Radiology Interest Groups: A Recipe for Success.

OBJECTIVES: Radiology Interest Groups (RIGs) are valuable for medical students and the radiology profession. The purpose of this study is to identify key components of a successful RIG and to discuss how to optimize available resources to increase student engagement in radiology. METHODS: Anonymous feedback forms (n = 478) completed by preclinical medical students attending 20 RIG events between September 2016 and May 2019 were analyzed. A five-point Likert-type scale was used to determine event effectiveness, and important themes reflecting student perspectives were identified using thematic analysis of freeform comments. RESULTS: Based on Likert feedback, 75% to 78% of students had a positive experience of RIG events and believed sessions were relevant to their studies. 31% to 42% of students believed these events increased their interest or insight into radiology and influenced their career choice. Four representative themes were identified by qualitative analysis of written feedback: engagement, professional development, mentorship, and suggestions for improvement. These themes provided insight into student perspectives of our RIG, and, along with experience from the RIG organizers, the authors present elements perceived to have contributed to these positive results. CONCLUSION: Thematic analysis of feedback reveals that students consider interactive events, contribution to professional development, and the opportunity for mentorship valuable elements of a RIG. From the perspective of the organizing committee, we embody these aspects through careful planning, innovative events, and consistent debriefing. In this way, our RIG promotes the future of the radiology profession and serves as a practical model for other similar organizations.

Effectiveness of a 12-Month Emergency Radiology Curriculum for Improving Self-Confidence and Competence of Postgraduate Year 1 Radiology Residents-A Canadian Study.

PURPOSE: Limited radiology curriculum during postgraduate year 1 of radiology residency combined with increasing workloads during emergency radiology call have contributed to heightened anxiety and responsibilities for junior residents. This study aimed to evaluate the effectiveness of a 12-month emergency radiology curriculum on self-rated confidence and general competence of Canadian postgraduate year 1 radiology residents. METHODS: A cohort of Canadian postgraduate year 1 Diagnostic Radiology residents voluntarily enrolled in a 12-month self-directed online emergency radiology curriculum (9 modules). Participants completed pretest and posttest surveys and examinations to gauge their self-rated competence on module material and knowledge acquisition, respectively. Average pretest and posttest scores were compared using Student 2-tailed unpaired t test, and Likert data from self-reported confidence were compared using a Mann Whitney U test. Statistical significance was defined as P < .05. RESULTS: Sixty-six trainees completed at least 1 module, and 15 trainees completed all 9 modules. Both self-rated confidence and posttest scores were statistically higher after module completion (P < .001) for all 9 learning modules. The greatest improvement in test scores was seen in the female genitourinary module (28.12 ± 3.018; difference between pretest and posttest means ± SEM). CONCLUSIONS: Our study demonstrates learning benefits for junior radiology trainees who participated in a self-directed online emergency radiology curriculum during postgraduate year 1. In the face of ever-increasing demands for imaging in on-call settings across Canada, inclusion of a self-directed online curriculum may become more important for upcoming competency-based medical education as it encourages a learner-driven and non-time-based method of education.

Canadian Radiology Medical Student Interest Groups: What They Are and How We Can Help Them Improve.

BACKGROUND: Radiology interest groups (RIGs) can serve as a means of increasing exposure of the radiology specialty early in the medical curriculum while also increasing educational opportunities. However, the organizational structure and various functions of individual RIGs in Canada are not well-documented. We performed a survey of all active RIGs in Canada for the purpose of better understanding their structure, function, and opportunities for improvement. METHODS: A 21-question survey was sent to current or recent former medical student leaders of all active RIGs in Canada during the 2016-2017 academic year. RESULTS: Radiology interest groups were identified in 88% (15/17) of Canadian medical schools. We received a 100% (15/15) response rate. Events held by RIGs consist mostly of lunch and learns (67%, 10/15), career panels (53%, 8/15), networking events (40%, 6/15), and curriculum-related events (40%, 6/15). General mentorship (93%, 13/14), shadowing opportunities (86%, 12/14), and research mentorship (63%, 8/14) were most often cited in their top 3 choices for opportunities for improvement. Sixty-six percent indicated that if a radiology society were to host a page for their interest group, they would be interested in posting content and/or links. CONCLUSIONS: Canadian RIGs offer increased early awareness and education about radiology in the medical curriculum. Radiology departments can facilitate improvement in Canadian RIGs through targeted institutional mentorship, research opportunities, and shadowing programs for their members.

Retrospective Analysis of Emergency Computed Tomography Imaging Utilization at an Academic Centre: An Analysis of Clinical Indications and Outcomes.

PURPOSE: To explore resource utilization through evaluation of computed tomography (CT) imaging trends in the emergency department by examining common indications/outcomes for imaging in this setting. METHODS: A retrospective analysis of clinical indications/outcomes for all CT imaging in 3 emergency departments over a 1-year period was conducted. Scans were divided by body part and the most common indications for each type of scan were determined. Clinical outcomes from each study were extracted from final interpretations by the reporting radiologist. RESULTS: A total of 4556 CT scans were performed in the emergency department over a 1-year period. A total of 3.6% of all-comers to our emergency departments underwent CT scan as part of their investigation. There were 2107 head CTs (46%), 1296 (28%) abdominal CTs, 468 (10%) CTs of the chest, 408 (9%) CTs of the neck/spine, and 101 (2%) extremity CTs performed. The most common clinical indication for performing a CT head was focal neurological defect comprising 1534 (73%) of all CT heads. Twenty-four percent of abdominal CTs were for investigation of right lower quadrant pain, followed by flank pain (19%). Chest pain and shortness of breath were the most common indications for CTs of the chest (315 [75%]) with 10% of these examinations for this indication positive for pulmonary embolism. Trauma was the most common indication for neck CTs (296 [73%]) and extremities (70 [69%]). Nil acute was the most common final interpretation in all categories (79% CT heads, 75% neck CTs, 38% abdominal CTs, 43% chest CTs). CONCLUSIONS: Nil acute was the most common diagnosis; however, serious clinical outcomes were identified 40% of the time. Cross-sectional imaging remains an integral tool for triage and diagnosis in this environment as the cost of missing a diagnosis in this setting has a great impact on patient care.

MRCP imaging of duplicate gallbladder: a case report and review of the literature.

PURPOSE: Duplicate gallbladder is a rare congenital abnormality of the hepatobiliary system that has an incidence of roughly 1 in 4000. Many surgical studies have demonstrated that congenital anomalies of the gallbladder and anatomical variations of its position are associated with an increased risk of complications after laparoscopic cholecystectomy. METHODS: Using ultrasound, MRCP and 3D reconstructions, we report a case of a 29-year-old female who was incidentally revealed to have a duplicated gallbladder. A review of the literature surrounding this variant, its anatomical classifications and relevance to surgical practice is included. CONCLUSION: The double gallbladder is a rare congenital condition that is often not considered in the differential diagnosis for a patient with gallbladder disease or intraoperatively. At present, it is only detected via pre-operative imaging in 50% of cases, but an understanding of the limitations of ultrasound combined with more frequent and thorough use of MRCP before surgical intervention could prevent serious complications of laparoscopy in these patients.