Peer Review in Radiology: A Resident and Fellow Perspective.

PURPOSE: The purpose of this study was to explore Canadian radiology residents' and fellows' understanding, attitudes, opinions, and preferences toward peer review. METHODS: An Internet-based anonymous questionnaire designed to understand one's familiarity, attitudes, opinions, and preferences toward peer review was distributed to radiology residents and fellows across Canada. Data were analyzed using descriptive statistics, and answers were stratified by level of training. RESULTS: A total of 136 trainees responded to the survey with 92 completed survey responses available for descriptive statistics. Approximately half of respondents are familiar with peer review (49%), and 39% of trainees are involved in peer review. Most respondents (92%) expressed an interest in learning more about peer review; believe that it should be incorporated into the residency training curriculum (86%), be mandatory (72%), and that current participation will increase odds of future participation (91%). Most trainees (80%) are comfortable advising one another about errors, but less comfortable advising staff (21%). CONCLUSIONS: Residents and fellows welcome the opportunity to learn more about peer review and believe it should be incorporated into the residency training curriculum. Understanding the attitudes and perceptions held by trainees regarding peer review is important, as a means to optimize education and maximize current and future participation in peer review.

Breast MRI as an adjunct to mammography for breast cancer screening in high-risk patients: retrospective review.

OBJECTIVE: In July 2011, the provincial government of Ontario, Canada, approved funding for the addition of annual breast MRI to mammography screening for all women 30-69 years old considered to be at high risk for breast cancer. The purpose of this study was to evaluate the diagnostic performance of screening breast MRI as compared with mammography in a population-based high-risk screening program. MATERIALS AND METHODS: A retrospective review identified 650 eligible high-risk women who underwent screening breast MRI and mammography between July 2011 and January 2013 at one institution. Results of 806 screening rounds (comprising both MRI and mammography) were reviewed. RESULTS: Malignancy was diagnosed in 13 patients (invasive cancer in nine, ductal carcinoma in situ in three [one with microinvasion], and chest wall metastasis in one). Of the 13 cancers, 12 (92.3%) were detected by MRI and four (30.8%) by mammography. In nine of these patients, the cancer was diagnosed by MRI only, resulting in an incremental cancer detection rate of 10 cancers per 1000 women screened. MRI screening had significantly higher sensitivity than mammography (92.3% vs 30.8%) but lower specificity (85.9% vs 96.8%). MRI also resulted in a higher callback rate for a 6-month follow-up study (BI-RADS category 3 assessment) than mammography (119 [14.8%] vs 13 [1.6%]) and more image-guided biopsies than mammography (95 [11.8%] vs 19 [2.4%]). CONCLUSION: MRI is a useful adjunct to mammography for screening in high-risk women, resulting in a significantly higher rate of cancer detection. However, this was found to be at the cost of more imaging and biopsies for lesions that ultimately proved to be benign.

Comparison of 3% sorbitol vs psyllium fibre as oral contrast agents in MR enterography.

OBJECTIVE: To compare the degree of small bowel distension achieved by 3% sorbitol, a high osmolarity solution, and a psyllium-based bulk fibre as oral contrast agents (OCAs) in MR enterography (MRE). METHODS: This retrospective study was approved by our institutional review board. A total of 45 consecutive normal MRE examinations (sorbitol, n = 20; psyllium, n = 25) were reviewed. The patients received either 1.5 l of 3% sorbitol or 2 l of 1.6 g kg(-1) psyllium prior to imaging. Quantitative small bowel distension measurements were taken in five segments: proximal jejunum, distal jejunum, proximal ileum, distal ileum and terminal ileum by two independent radiologists. Distension in these five segments was also qualitatively graded from 0 (very poor) to 4 (excellent) by two additional independent radiologists. Statistical analysis comparing the groups and assessing agreement included intraclass coefficients, Student's t-test and Mann-Whitney U-test. RESULTS: Small bowel distension was not significantly different in any of the five small bowel segments between the use of sorbitol and psyllium as OCAs in both the qualitative (p = 0.338-0.908) and quantitative assessments (p = 0.083-0.856). The mean bowel distension achieved was 20.1 ± 2.2 mm for sorbitol and 19.8 ± 2.5 mm for psyllium (p = 0.722). Visualization of the ileum was good or excellent in 65% of the examinations in both groups. CONCLUSION: Sorbitol and psyllium are not significantly different at distending the small bowel and both may be used as OCAs for MRE studies. ADVANCES IN KNOWLEDGE: This is the first study to directly compare the degree of distension in MRE between these two common, readily available and inexpensive OCAs.

Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature.

The spleen is the most commonly injured visceral organ in blunt abdominal trauma in both adults and children. Nonoperative management is the current standard of practice for patients who are hemodynamically stable. However, simple observation alone has been reported to have a failure rate as high as 34%; the rate is even higher among patients with high-grade splenic injuries (American Association for the Surgery of Trauma [AAST] grade III-V). Over the past decade, angiography with transcatheter splenic artery embolization, an alternative nonoperative treatment for splenic injuries, has increased splenic salvage rates to as high as 97%. With the help of splenic artery embolization, success rates of more than 80% have also been described for high-grade splenic injuries. We discuss the role of computed tomography and transcatheter splenic artery embolization in the diagnosis and treatment of blunt splenic trauma. We review technical considerations, indications, efficacy and complication rates. We also propose an algorithm to guide the use of angiography and splenic embolization in patients with traumatic splenic injury.

Performance of carotid stenting, vertebroplasty, and EVAR: how many are we doing and why are we not doing more? A survey by the Canadian Interventional Radiology Association.

OBJECTIVE: To determine the percentage of interventional radiologists who currently perform 3 interventional procedures: carotid stenting, vertebroplasty, and endovascular aneurysm repair (EVAR) in Canada, and impediments to their future performance by other interventional radiologists. METHODS: An anonymous online survey was emailed to all members of the Canadian Interventional Radiology Association (CIRA). The survey was open for a period of 2 months. RESULTS: A total of 75 survey responses were received (of an estimated 247). Carotid stenting, vertebroplasty, and EVAR were performed at 40%, 59%, and 46% of respondents' centres respectively. Wait times, from referral to consultation, and from consultation to procedure, were both typically between 2 to 4 weeks, longer for EVAR. Of respondents currently not performing these procedures, 26%, 28%, and 16% anticipated beginning to perform carotid stenting, vertebroplasty, and EVAR, respectively, in the proceeding year from time of survey. Of respondents who wished to perform the procedure, the greatest impediments were a lack of training, lack of a referral base, and lack of support from their radiology department and (or) colleagues. CONCLUSIONS: Although carotid stenting, vertebroplasty, and EVAR were being performed at about one-half of respondent's centres, and there will likely be greater adoption of the procedures in the near future, there remain substantial impediments. The greatest impediments to additional radiologists performing these procedures were a lack of training, lack of referral base, and lack of support from their radiology department and (or) colleagues. The former impediment suggested an unmet need for additional training courses.

Uterine fibroid embolization: CME update for family physicians.

OBJECTIVE: To review evidence supporting the use of uterine fibroid embolization (UFE) as an alternative to hysterectomy and myomectomy for managing uterine fibroids. QUALITY OF EVIDENCE: MEDLINE was searched using the MeSH terms embolization, therapeutic; leiomyoma; treatment outcome; pregnancy; and clinical trials. Most published studies on use of UFE for management of uterine fibroids provide level II evidence. MAIN MESSAGE: For 71% to 92% of patients, UFE is effective at alleviating fibroid-related symptoms. After UFE, fibroids are reduced in size by 42% to 83%. Patients' satisfaction with the procedure is high (>90%), and UFE is safe and has a low rate of major complications (1.25%). When compared with hysterectomy, UFE is associated with fewer major complications, shorter hospital stays, and faster recovery. Although successful pregnancy following UFE is possible, there is insufficient evidence to advocate use of UFE over myomectomy for management of uterine fibroids in women wishing to preserve fertility. CONCLUSION: For treatment of symptomatic uterine fibroids, UFE is a safe and effective nonsurgical alternative to hysterectomy and myomectomy.