Forty-One Million RADPEER Reviews Later: What We Have Learned and Are Still Learning.

ACR RADPEER® is the leading method of radiologic peer review in the United States. The program has evolved since its inception in 2002 and was most recently updated in 2016. In 2018, a survey was sent to RADPEER participants to gauge the current state of the program and explore opportunities for continued improvement. A total of 26 questions were included, and more than 300 practices responded. In this report, the ACR RADPEER Committee authors summarize the survey results and discuss opportunities for future iterations of the RADPEER program.

The utility of scrotal ultrasonography in the emergent setting: beyond epididymitis versus torsion.

Scrotal pain is a common acute presentation for medical care. Testicular torsion and epididymo-orchitis are two diagnoses for which early detection is critical and their sonographic imaging features have been thoroughly described in the radiologic literature. Other important conditions for which radiologists must be aware have received less attention. This article will highlight key traumatic and non-traumatic causes of acute scrotal pain other than testicular torsion and epididymo-orchitis that may present in the emergency department setting.

From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography.

Gastrointestinal (GI) tract perforation is a life-threatening condition that can occur at any site along the alimentary tract. Early perforation detection and intervention significantly improves patient outcome. With a high sensitivity for pneumoperitoneum, computed tomography (CT) is widely accepted as the diagnostic modality of choice when a perforated hollow viscus is suspected. While confirming the presence of a perforation is critical, clinical management and surgical technique also depend on localizing the perforation site. CT is accurate in detecting the site of perforation, with segmental bowel wall thickening, focal bowel wall defect, or bubbles of extraluminal gas concentrated in close proximity to the bowel wall shown to be the most specific findings. In this article, we will present the causes for perforation at each site throughout the GI tract and review the patterns that can lead to prospective diagnosis and perforation site localization utilizing CT images of surgically proven cases.

Characterizing solid renal neoplasms with MRI in adults.

Until recently, most solid renal neoplasms without macroscopic fat were presumed to represent renal cell carcinoma and were indiscriminately treated with nephrectomy. Expanding surgical options and ablative technologies, a growing acceptance of renal mass biopsy, the advent of targeted molecular agents, and advances in our understanding of tumor biology have challenged the wisdom of this approach and are ushering in a potential new era in which therapy is linked to histologic subtype and cytogenetics. This approach mandates evolution of our diagnostic algorithm beyond the distinction between solid and cystic and enhancing and nonenhancing. Computed tomography (CT) has traditionally been the imaging technique of choice for evaluating potential solid renal tumors, in large part due to its widespread availability, high spatial resolution, calcium discrimination, and multiphase, enhanced imaging capabilities. For the most part, however, CT is limited to characterization based upon the attenuation and enhancement characteristics of a lesion and necessitates exposure of patients to ionizing radiation. For these latter reasons, multiparametric magnetic resonance imaging (MRI) is being increasingly used to characterize solid renal masses. The purpose of this manuscript is to review our imaging approach to solid renal masses in adults utilizing MRI with an emphasis on a multiparametric approach augmented by clinical data.

Reducing radiation dose in CT enterography.

Computed tomographic (CT) enterography is a diagnostic examination that is increasingly being used to evaluate disorders of the small bowel. An undesirable consequence of CT, however, is patient exposure to ionizing radiation. This is of particular concern with CT enterography because patients tend to be young and require numerous follow-up examinations. There are multiple strategies to reduce radiation dose at CT enterography, including adjusting acquisition parameters, reducing scan length, and reducing tube voltage or tube current. The drawback to dose reduction strategies is degradation of image quality due to increased image noise. However, image noise can be reduced with commercial iterative reconstruction and denoising techniques. With a combination of low-dose techniques and noise-control strategies, one can markedly reduce radiation dose at CT enterography while maintaining diagnostic accuracy.