Purpose, A Work in Progress: AJR Podcast Series on Wellness, Episode 6.

In this episode of the AJR podcast series on Wellness, Sherry Wang, MBBS, discusses finding purpose.

A Radiologist's Wellness Journey: AJR Podcast Series on Wellness, Episode 5.

In this episode of the AJR Podcast Series on Wellness, Sherry Wang, MBBS, interviews Jay Parikh, MD, Chair of the ARRS Wellness Subcommittee, regarding his perspective on wellness and his own wellness journey.

Dopamine Dressing: AJR Podcast Series on Wellness, Episode 4.

In this episode of the AJR Podcast Series on Wellness, Sherry Wang, MBBS, discusses dopamine dressing. What is it? How do you do it? How can it boost your mood for wellness?

Together: AJR Podcast Series on Wellness, Episode 3.

In this episode of the AJR Podcast Series on Wellness, Sherry Wang, MBBS, discusses how loneliness and social connectedness impact well-being and how we can connect with others to build meaningful relationships. These issues are important in view of the continued growth of teleradiology.

In this episode of the AJR Podcast Series on Wellness, Sherry Wang, MBBS, discusses how loneliness and social connectedness impact well-being and how we can connect with others to build meaningful relationships. These issues are important in view of the continued growth of teleradiology.

Scintigraphy of Gastrointestinal Motility: Best Practices in Assessment of Gastric and Bowel Transit in Adults.

Various radiologic examinations and other diagnostic tools exist for evaluating gastrointestinal diseases. When symptoms of gastrointestinal disease persist and no underlying anatomic or structural abnormality is identified, the diagnosis of functional gastrointestinal disorder is frequently applied. Given its physiologic and quantitative nature, scintigraphy often plays a central role in the diagnosis and treatment of patients with suspected functional gastrointestinal disorder. Most frequently, after functional gallbladder disease is excluded, gastric emptying scintigraphy (GES) is considered the next step in evaluating patients with suspected gastric motility disorder who present with upper gastrointestinal symptoms such as dyspepsia or bloating. GES is the standard modality for detecting delayed gastric emptying (gastroparesis) and the less commonly encountered clinical entity, gastric dumping syndrome. Additionally, GES can be used to assess abnormalities of intragastric distribution, suggesting specific disorders such as impaired fundal accommodation or antral dysfunction, as well as to evaluate gastric emptying of liquid. More recently, scintigraphic examinations for evaluating small bowel and large bowel transit have been developed and validated for routine diagnostic use. These can be performed individually or as part of a comprehensive whole-gut transit evaluation. Such scintigraphic examinations are of particular importance because clinical assessment of suspected functional gastrointestinal disorder frequently fails to accurately localize the site of disease, and those patients may have motility disorders involving multiple portions of the gastrointestinal tract. The authors comprehensively review the current practice of gastrointestinal transit scintigraphy, with diseases and best imaging practices illustrated by means of case review. ©RSNA, 2024 See the invited commentary by Maurer and Parkman in this issue.

Alone: AJR Podcast Series on Wellness, Episode 2.

In this episode of the AJR Podcast Series on Wellness, Sherry Wang, MBBS, discusses being alone. The episode addresses how being alone can be conducive to wellness. Being alone is not the same as loneliness.

Feeling Unwell: AJR Podcast Series on Wellness, Episode 1.

In this episode of the AJR Podcast Series on Wellness, Sherry Wang, MBBS, discusses feeling unwell. The episode addresses the state of physician burnout, depression, moral injury, and personal experiences.

Proposed revision of the American Association for Surgery of Trauma Renal Organ Injury Scale: Secondary analysis of the Multi-institutional Genitourinary Trauma Study.

BACKGROUND: This study updates the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for renal trauma using evidence-based criteria for bleeding control intervention. METHODS: This was a secondary analysis of a multicenter retrospective study including patients with high-grade renal trauma from seven level 1 trauma centers from 2013 to 2018. All eligible patients were assigned new renal trauma grades based on revised criteria. The primary outcome used to measure injury severity was intervention for renal bleeding. Secondary outcomes included intervention for urinary extravasation, units of packed red blood cells transfused within 24 hours, and mortality. To test the revised grading system, we performed mixed-effect logistic regression adjusted for multiple baseline demographic and trauma covariates. We determined the area under the curve (AUC) to assess accuracy of predicting bleeding interventions from the revised grading system and compared this to 2018 AAST OIS. RESULTS: Based on the 2018 OIS grading system, we included 549 patients with AAST grades III to V injuries and computed tomography scans (III, 52% [n = 284]; IV, 45% [n = 249]; and V, 3% [n = 16]). Among these patients, 89% experienced blunt injury (n = 491), and 12% (n = 64) underwent intervention for bleeding. After applying the revised grading criteria, 60% (n = 329) of patients were downgraded, and 4% (n = 23) were upgraded; 2.8% (n = 7) downgraded from grade V to IV, and 69.5% (n = 173) downgraded from grade IV to III. The revised renal trauma grading system demonstrated improved predictive ability for bleeding interventions (2018 AUC, 0.805; revised AUC, 0.883; p = 0.001) and number of units of packed red blood cells transfused. When we removed urinary injury from the revised system, there was no difference in its predictive ability for renal hemorrhage intervention. CONCLUSION: A revised renal trauma grading system better delineates the need for hemostatic interventions than the current AAST OIS renal trauma grading system. LEVEL OF EVIDENCE: Diagnostic Test/Criteria; Level III.

The 2021 ACR/Radiology Business Management Association Workforce Survey: Diversity in Radiology.

The landscape of the radiology workforce is changing, especially in the diversity of the demographics of practicing radiologists across subspecialties, practice types, and leadership positions in both academic and nonacademic settings. The 2021 ACR/Radiology Business Management Association Workforce Survey examines these facets in detail and contributes to our understanding of the current state of diversity in the radiology workforce and potential barriers to change. The results suggest opportunities and future directions for improving diversity, equity, and inclusion.

Grade V renal trauma management: results from the multi-institutional genito-urinary trauma study.

PURPOSE: To investigate management trends for American Association for the Surgery of Trauma (AAST) grade V renal trauma with focus on non-operative management. METHODS: We used prospectively collected data as part of the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). We included patients with grade V renal trauma according to the AAST Injury Scoring Scale 2018 update. All cases submitted by participating centers with radiology images available were independently reviewed to confirm renal trauma grade. Management was classified as expectant, conservative (minimally invasive, endoscopic or percutaneous procedures), or operative (renal-related surgery). RESULTS: Eighty patients were included, 25 of whom had complete imaging and had independent confirmation of AAST grade V renal trauma. Median age was 35 years (Interquartile range (IQR) 25-50) and 23 (92%) had blunt trauma. Ten patients (40%) were managed operatively with nephrectomy. Conservative management was used in nine patients (36%) of which six received angioembolization and three had a stent or drainage tube placed. Expectant management was followed in six (24%) patients. Transfusion requirements were progressively higher with groups requiring more aggressive treatment, and injury characteristics differed significantly across management groups in terms of hematoma size and laceration size. Vascular contrast extravasation was more likely in operatively managed patients though a statistically significant association was not found. CONCLUSION: Successful use of nonoperative management for grade V injuries is used for a substantial subset of patients. Lower transfusion requirement and less severe injury radiologic phenotype appear to be important characteristics delineating this group.

Shattered Kidney After Renal Trauma: Should It Be Classified As an American Association for the Surgery of Trauma Grade V Injury?

OBJECTIVE: To study the prevalence and management of shattered kidney and to evaluate if the new description of "loss of identifiable renal anatomy" in the 2018 American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) would improve the ability to predict bleeding control interventions. METHODS: We used high-grade renal trauma data from 21 Level-1 trauma centers from 2013 to 2018. Initial CT scans were reviewed to identify shattered kidneys, defined as a kidney having ≥3 parenchymal fragments displaced by blood or fluid on cross-sectional imaging. We further categorized patients with shattered kidney in two models based on loss of identifiable renal parenchymal anatomy and presence or absence of vascular contrast extravasation (VCE). Bleeding interventions were compared between the groups. RESULTS: From 861 high-grade renal trauma patients, 41 (4.8%) had shattered kidney injury. 25 (61%) underwent a bleeding control intervention including 18 (43.9%) nephrectomies and 11 (26.8%) angioembolizations. 18 (41%) had shattered kidney with "loss of identifiable parenchymal renal anatomy" per 2018 AAST OIS (model-1). 28 (68.3%) had concurrent VCE (model-2). Model-2 had a statistically significant improvement in area under the curve over model-1 in predicting bleeding interventions (0.75 vs 0.72; P = .01). CONCLUSION: Shattered kidney is associated with high rates of active bleeding, urinary extravasation, and interventions including nephrectomy. The definition of shattered kidney is vague and subjective and our definition might be simpler and more reproducible. Loss of identifiable renal anatomy per the 2018 AAST OIS did not provide better distinction for bleeding control interventions over presence of VCE.

At the intersection of the model minority myth and antiblackness: From Asian American triangulation to recommendations for solidarity.

Asian Americans are situated in a triangulated role in a black-white racial hierarchy designed to legitimize white supremacy (Kim, 1999). However, little is known about the lived experiences of Asian American triangulation and even less so in the context of anti-Asian racism. The present study was initially designed to examine anti-Asian racism at the outset of the COVID-19 pandemic. Yet, in a sociopolitical climate described as a "racial reckoning," our study evolved to capture the process of racial triangulation and the interplay of anti-Asian racism and antiblackness. Based on the online responses of 201 Asian Americans (from over 32 U.S. states), four themes emerged to showcase the ways in which Asian Americans suffered from and recapitulated racial oppression: (a) anti-Asian racism is overlooked in the black-white racial discourse, (b) anti-Asian racism is not taken seriously, (c) anti-Asian racism is also perpetrated by people of color (POC), and (d) anti-Asian racism is deprioritized in the presence of anti-Black racism. Regarding participant recommendations to combat anti-Asian racism, our second research question focused on areas of convergence with dismantling anti-Black racism. Two key themes emerged: (a) foster Asian American pan-ethnic solidarity and (b) build and strengthen cross-racial coalitions (POC solidarity and White allyship). Altogether, our study descriptively captured the process of racial triangulation to showcase the manifestation and recapitulation of anti-Asian racism and antiblackness. While Asian Americans suffered as victims and perpetrators of racial oppression, they also recognized the need to dismantle white supremacy with racial solidarity, coalition-building, and advocacy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Building Effective Teams in the Real World From Traps to Triumph.

Quality patient care and advancements in medical education, investigation, and innovation require effective teamwork. High-functioning teams navigate stressful environments, learning openly from failures and leveraging successes to fuel future initiatives. The authors review foundational concepts for implementing and sustaining successful teams, including emotional intelligence, trust, inclusivity, clear communication, and accountability. Focus is given to real-world examples and actionable, practical solutions.