Social networks in radiology: Toward a new paradigm in medical education?

The universally accepted system for the transmission of scientific knowledge in the field of medicine has long been grounded in scientific publications. Social networks can be a useful alternative or complementary method of transmitting this knowledge. Social networks (e.g., Twitter, Instagram, Facebook, LinkedIn, YouTube, and TikTok) generate educational contents that enable quality training, despite their informality. Each of these networks has strengths and weaknesses that users should know about. These platforms are free and allow for real-time discussion. They make it easy to incorporate content and to contact experts or access sources of knowledge directly. Aware of their influence, publishers have incorporated metrics to measure the impact of their articles in social networks (Altmetrics). These networks should be incorporated into departmental training programs immediately. Nevertheless, navigating through social networks is complex, and the hashtag-based system of searching is inefficient, limiting their use in education. Despite the informality of the knowledge generated on social networks, the importance of these networks as a source of knowledge is growing. Radiology departments must design a strategy for using social networks for education rather than for propaganda, creating well-organized focal groups that search for contents through systematic, filtered review of information, digital repositories, and review sessions and for sharing this knowledge both inside and outside the department. Departments must also implement a strategy for communicating through these networks.

Percutaneous ablation of renal tumors: Long-term outcomes.

OBJECTIVE: To evaluate the long-term outcomes of renal tumor ablation, analyzing efficacy, long-term survival, and factors associated with complications and therapeutic success. MATERIAL AND METHODS: We retrospectively reviewed 305 ablations (generally done with expandable electrodes) of 273 renal tumors between May 2005 and April 2019. We analyzed survival, primary and secondary efficacy, and complications according to various patient factors and tumor characteristics. RESULTS: Mean blood creatinine was 1.14 mg/dL before treatment and 1.30 mg/dL after treatment (p < 0.0001). Complications were observed in 13.25% of the ablations, including major complications in in 4.97%. Complications were associated with age (p = 0.013) and tumor diameter (p < 0.0001). Primary efficacy was 96.28%. Incomplete ablation was more common in lesions measuring > 4 cm in diameter (p = 0.002). Secondary efficacy was 95.28%. The only factor associated with the risk of recurrence was the size of the tumor (p = 0.02). Overall survival was 95.26% at 1 year, 77.01% at 5 years, and 51.78% at 10 years, with no differences between patients with malignant and benign lesions. Mortality was higher in patients with creatinine >1 (p = 0.05) or ASA > 2 (p = 0.0001). CONCLUSIONS: Percutaneous ablation is extremely efficacious for renal tumors; it improves the prognosis of renal carcinoma to the point where it does not differ from that of benign lesions. Complications are rare. Like survival, complications are associated with age and overall health status.

Teleradiology: good practice guide.

Teleradiology is the electronic transmission of radiological images from one location to another with the main purpose of interpreting or consulting a diagnosis and must be subject to codes of conduct agreed upon by professional societies. The content of fourteen teleradiology best practice guidelines is analyzed. Their guiding principles are: the best interest and benefit of the patient, quality and safety standards homologous to the local radiology service, and use as a complement and support of the same. As legal obligations: guaranteeing rights by applying the principle of the patient's country of origin, establishing requirements in international teleradiology and civil liability insurance. Regarding the radiological process: integration with the local service process, guaranteeing the quality of images and reports, access to previous studies and reports and complying with the principles of radioprotection. Regarding professional requirements: compliance with the required registrations, licenses and qualifications, training and qualification of the radiologist and technician, prevention of fraudulent practices, respect for labor standards and remuneration of the radiologist. Subcontracting must be justified, managing the risk of commoditization. Compliance with the system's technical standards.

The new format for the documents to evaluate specialized healthcare training: an inadvertent revolution. / El nuevo formato de los documentos de evaluación de la formación sanitaria especializada: una revolución inadvertida.

The recent publication of the resolution through which the basic directives about the contents of the documents to accredit the assessments of specialists in training maintains the model but incorporates new elements that enable important changes in the assessment. The resolution has errors and is confusing because the rules are hidden in the instructions for filling out the forms and in footnotes. Nevertheless, the resolution is more than a simple change in the forms: it is a step toward a more current assessment based on the evaluation of residents' competence. The most significant changes are a stronger role for collaborating teachers, an increase in the number of possible reasons for negative assessments, and the establishment of the rotation as the basic unit of analysis.

Interventional radiology neck procedures. / Intervencionismo en el cuello.

Ultrasonography has become extremely useful in the evaluation of masses in the head and neck. It enables us to determine the anatomic location of the masses as well as the characteristics of the tissues that compose them, thus making it possible to orient the differential diagnosis toward inflammatory, neoplastic, congenital, traumatic, or vascular lesions, although it is necessary to use computed tomography or magnetic resonance imaging to determine the complete extension of certain lesions. The growing range of interventional procedures, mostly guided by ultrasonography, now includes biopsies, drainages, infiltrations, sclerosing treatments, and tumor ablation.

[Evaluating resident training in radiology]. / Evaluación de la formación MIR en radiología.

Evaluation plays a key role in both the educational process and in its results. The evaluation established in the regulations for the Spanish residency system (MIR) is a two-step process that aims to teach. These steps are: a) continuous evaluation by the tutor and specialists at the training unit and b) an annual review by the evaluating committee. The resident's handbook and evaluation sheets from the rotations are the tools used for this task. Other techniques for evaluation, such as 360-degree feedback, examinations (conventional, case-based, and/or Objective Structured Clinical Examination [OSCE]), checklists, reviewing reports, or public presentation, can also complement or enhance the official evaluation. This article aims to provide information about the evaluation process and to open new possibilities to make evaluation more objective.

[The role of tutors in training residents: future outlook]. / El papel de los tutores en la formación de los residentes. Perspectivas de futuro.

Introduced late in the Spanish system of training residents, the figure of the tutor has been detailed in the new legislation governing the training of medical specialists. The law also details the functions of tutors, some of which have been relegated to the regional governments. The functions of tutors are outlined in six sections: planning training activity, receiving new residents, proposing individual training plans, acting as a reference for residents, promoting residents' participation in educational activities and research, and participating in the evaluation of residents. The recognition of tutors' work has hardly gone beyond the recognition of their managerial functions and of their need for special training. The future publication of new regulations by the regional governments might increase this recognition. On the other hand, the development of the new core curriculum with different training trunks will probably pose new challenges and increase tutors' workload.

[The resident's role in training and teaching in diagnostic imaging departments]. / El papel del residente en su formación y en la actividad docente del servicio de radiodiagnóstico.

New Spanish Law of Medical Specialties has come to correct the limitations of previous regulations regarding the figure and the functions of the Tutor. However, it continues lacking a description of the role of the residents in their training. Resident's Statute and Specialty Program add some information. Regulations establish that the residents are not passive actors in their training. As well as their labor obligations, including exclusivity and observance of the rules of the institutions in which they are working, the residents have the obligation of training themselves and of progressively taking on responsibilities relative to the specialty. This includes non-assistential training also, medical sessions preparation, attendance to committees and use of new technologies and on-line resources. Moreover, following Resident's Statute, the residents are full members of the Radiology department, sharing its goals and those of the institution in which it is included, and helping in its achievement. And they are committed also to achieve the goals of their training program and to have an active attitude in the training process. A resident is as important to the result of the training process as the members of the staff.

[Usefulness of contrast-enhanced ultrasonography in daily clinical practice: a multicenter study in Spain]. / Utilidad de la ecografía con contraste en la práctica clínica diaria. Estudio multicéntrico español CEUS.

OBJECTIVES: We aimed to determine whether the use of ultrasonographic contrast agents improves the diagnostic performance of ultrasonography (US). MATERIAL AND METHODS: We carried out a prospective multicenter study in 42 hospitals. We included 1786 patients with inconclusive US; 84.9% of the inconclusive studies were abdominal US (including studies of the liver, kidneys, spleen, and other sites), 6.2% were studies of the peripheral vessels, 4.3% were breast studies, and 4.6% were other studies. We evaluated the type of contrast-enhanced US (color Doppler or contrast-specific method), type of contrast agent, dose and number of doses, and type of administration (bolus or infusion). We evaluated whether the findings at contrast-enhanced US improved the diagnostic performance of unenhanced US and whether they enabled a conclusive diagnosis to be reached. RESULTS: The contrast agent SonoVue was used in 99.9% of the studies; a single dose of contrast agent was used in 84.8%, and the contrast agent was administered in bolus in 98.5%. Contrast-enhanced US improved the diagnostic performance in 91.6% of cases and enabled the conclusive diagnosis in 69.2%. The best diagnostic performance was obtained in the supraaortic trunks, where a definitive diagnosis was reached in 95.4% of cases, followed by the abdominal area, with a conclusive diagnosis in 72.6% of cases. CONCLUSIONS: The use of contrast-enhanced US significantly improved the diagnostic performance of US and enabled a conclusive diagnosis in most cases.

[Regulations governing the training of diagnostic imaging residents: the residents' statute and the medical specialties law]. / Normativa de la formación del residente de Radiodiagnóstico: estatuto del residente y ley de especialidades.

The current system for training medical specialists in Spain originated in 1963, and diagnostic radiology was one of the first specialties recognized. There are currently three types of regulations that govern the training of specialists: a) professional, The Health Professions Law; b) labor: The Residents' Statute; and c) educational, The New Medical Specialties Law and the Diagnostic Imaging Program This system consists of an exclusive contract with the training organization, a unified system of access, and a training program in accredited units that includes tutoring, evaluation, and progressive assignment of responsibilities. Residents have a right to be trained and evaluated, to participate in the teaching unit, and to their labor rights. In exchange, they must complete the tasks assigned in the program and abide by the institution's rules. Residents must be supervised directly in the first year and thereafter they should be given progressively more responsibility.

[Presacral kidney]. / Riñón presacro.

The ectopic kidney in the presacral position can occur in 1 of 800 subjects. This condition results from metanephrogenic anomalies during the embryological development. When urographic images of the kidney are absent, one should always suspect this condition. In most of the cases, this condition does not cause a disorder and are incidentally detected while performing other studies for other disorders. A normally functioning presacral kidney requires no treatment.