Anatomical knowledge retention in Obstetrics and Gynaecology residents and impact of an e-learning tool.

PURPOSE: Anatomical knowledge of medical students and residents is insufficient and further anatomical sciences throughout medical curriculum may be necessary. The first aim of this study was to assess pelvic and perineal anatomical knowledge retention of Obstetrics and Gynaecology (Ob/Gyn) residents. The second was to assess the impact of an e-learning tool on anatomical knowledge. METHODS: A survey was sent by mail to medical students and Ob/Gyn residents. After completion, Ob/Gyn residents were randomised to "e-learning" group or to "Control" group. "E-learning" group had an unlimited access to a tool about female pelvic and perineum anatomy, implemented by iMAIOS society in their online platform. A second assessment of residents' anatomical knowledge was done 2 months after randomisation. RESULTS: Ob/Gyn residents (N = 23) had a significant lower global score than third-year medical students (N = 103) (22.1% (± 10.2) vs 43.8% (± 12.1), p < 0.0001). Two months after randomisation, residents of "control" group demonstrated no significant difference between the two questionnaires (3.6%, p = 0.31), whilst the "e-learning" group demonstrated a significant increase overall (10.6%, p = 0.09). There was no significant difference on the post-intervention questionnaire between control and "e-learning" group (25.4% vs 33% respectively, p = 0.34). CONCLUSION: Knowledge of pelvic and perineal anatomy is poor. This e-learning tool aimed at improving anatomical knowledge retention but is not sufficient. A combination of traditional approaches and innovative solutions should be proposed throughout medical school and residency to maintain anatomical knowledge.

Intracoronary administration of darbepoetin-alpha at onset of reperfusion in acute myocardial infarction: results of the randomized Intra-Co-EpoMI trial.

BACKGROUND: Several trials investigating erythropoietin as a novel cytoprotective agent in myocardial infarction (MI) failed to translate promising preclinical results into the clinical setting. These trials could have missed crucial events occurring in the first few minutes of reperfusion. Our study differs by earlier intracoronary administration of a longer-acting erythropoietin analogue at the onset of reperfusion. AIM: To evaluate the ability of intracoronary administration of darbepoetin-alpha (DA) at the very onset of the reperfusion, to decrease infarct size (IS). METHODS: We randomly assigned 56 patients with acute ST-segment elevation MI to receive an intracoronary bolus of DA 150 µg (DA group) or normal saline (control group) at the onset of reflow obtained by primary percutaneous coronary intervention (PCI). IS and area at risk (AAR) were evaluated by biomarkers, cardiac magnetic resonance (CMR) and validated angiographical scores. RESULTS: There was no difference between groups regarding duration of ischemia, Thrombolysis in Myocardial Infarction flow grade at admission and after PCI, AAR size and extent of the collateral circulation, which are the main determinants of IS. The release of creatine kinase was not significantly different between the two groups even when adjusted to AAR size. Between 3-7 days and at 3 months, the area of hyperenhancement on CMR expressed as a percentage of the left ventricular myocardium was not significantly reduced in the DA group even when adjusted to AAR size. CONCLUSION: Early intracoronary administration of a longer-acting erythropoietin analogue in patients with acute MI at the time of reperfusion does not significantly reduce IS.

Transarterial ethylene vinyl alcohol copolymer visualization and penetration after embolization of life-threatening hemoptysis: technical and clinical outcomes.

OBJECTIVES: This study was designed to evaluate the feasibility of using ethylene vinyl alcohol copolymer (EVAC) for bronchial artery embolization (BAE) in patients with life-threatening hemoptysis and to compare the visualization and transarterial penetration of EVAC under fluoroscopy and computed tomography (CT). METHODS: Fifteen patients (mean age, 62.9 (range, 24-82) years) who were referred for life-threatening hemoptysis (27 month period) underwent BAE using EVAC. All patients had thoracic CT examination before and after BAE. Technical and clinical results were evaluated. Visibility and extent of cast penetration (graded 1-4) on fluoroscopy and postprocedure CT were assessed and compared. RESULTS: BAE was feasible in all but one artery (due to spasm; n=27; 96.4%). No procedure-related complications or deaths were detected. Two patients had recurrent bleeding in the following day (13.3%). Immediate clinical success was achieved in 14 cases (93.3%) after reembolization of pulmonary artery pseudoaneurysm in one patient (mean follow-up, 43.5 (range, 14-148) days). Visibility of the cast was possible in 73.3% of patients (n=11) under fluoroscopy (mean cast penetration 1.66) and in all patients under CT (mean cast penetration 2.06). The postinjection fluoroscopic visibility in 6 of 15 (40%) patients was inferior to CT (P<0.02). CONCLUSIONS: BAE with EVAC seems to be feasible and safe with immediate control of hemoptysis in most patients. The postinjection fluoroscopic visibility of EVAC under fluoroscopy was inferior to CT.

Comparative values of gated blood-pool SPECT and CMR for ejection fraction and volume estimation.

OBJECTIVE: Gated blood-pool single-photon emission computed tomography (GBPS) was compared with cardiac magnetic resonance (CMR) for the measurement of left ventricular (LV) and right ventricular (RV) ejection fractions (EF) and volumes [end-diastolic volume (EDV) or end-systolic volume (ESV)] in a mixed population. METHODS: Thirty patients (70% men; mean age: 61±14 years) referred for various symptoms or heart diseases, predominantly ischemic, were included. GBPS data were analyzed using segmentation software described earlier based on the watershed algorithm. CMR images were acquired for both ventricles at the same time using a steady-state-free precession sequence and short-axis views. No compensation for papillary muscles was used. LVEF and RVEF and volumes were assessed with GBPS and CMR and were compared. RESULTS: LVEF and volumes were correlated (P<0.001). The difference in LVEF between GBPS and CMR was not significant (P=0.063). The limits of agreement were close for LVEF (-11 to 15%) and wider for LV volumes (-82 to 11 ml for EDV and -52 to 15 ml for ESV), with higher volume values obtained with CMR (mean differences of 36±24 ml for EDV and 19±17 ml for ESV). The RVEF and volumes assessed by GBPS and CMR were correlated (P<0.001). The difference in RVESV between GBPS or CMR was not significant (P=0.136). The limits of agreement were relatively close for all RV parameters (-15 to 8% for EF; -44 to 22 ml for EDV, and -25 to 21 ml for ESV). In 24 patients without valvulopathy or shunt, the difference between LV stroke volume and RV stroke volume was lower with GBPS than with CMR (9±14 ml and 18±13 ml, respectively, with P=0.027). CONCLUSION: GBPS is a simple and widely available technique that can assess both LVEF and RVEF, and volumes with slight differences compared with CMR.

Creating an interactive Web-based e-learning course: a practical introduction for radiologists.

With the development of e-learning and its ability to provide rich animated content rapidly to a wide audience, new methods for teaching medical imaging have evolved. E-learning tools allow building of learner-focused structured courses. Standards such as shareable content object reference model (SCORM) or Aviation Industry Computer-based Training Committee (AICC) guidelines and recommendations provide the framework required to combine text, images, videos, animations, and quizzes for learning assessment, even if each of these elements is created with different software. The main features to consider when choosing a learning management system are content management, assessment and reporting tools, customization options, course delivery, administration, and security. The tools for building a Web-based course with pages containing text, images, videos, and Flash animations are now accessible to any radiologist. Open-source learning management systems and content authoring software are available at no cost. The authors developed e-MRI.com, a free Web-based e-learning course with interactive animations and simulations, self-tests, and clinical cases to demonstrate the potential of the latest advances in e-learning and pedagogy applied to magnetic resonance imaging physics.