Academic Neuroradiology: 2023 Update on Turn-Around Time, Financial Recruitment and Retention Strategies.

The ASNR Neuroradiology Division Chief Working Group's 2023 survey, with responses from 62 division chiefs, provides insights into turn-around times, faculty recruitment, moonlighting opportunities, and academic funds.In emergency cases, 61% aim for a turn-around time of less than 45-60 minutes, with two-thirds meeting this expectation more than 75% of the time. For inpatient CT and MRI scans, 54% achieve a turn-around time of 4-8 hours, with three quarters meeting this expectation at least 50% of the time. Outpatient scans have an expected turn-around time of 24-48 hours, which is met in 50% of cases.Faculty recruitment strategies included 35% offering sign-on bonuses, with a median of $30,000. Additionally, 23% provided bonuses to fellows during fellowship to retain them in the practice upon completion of their fellowship. Internal moonlighting opportunities for faculty were offered by 70% of divisions, with a median pay of $250 per hour.The median annual academic fund for a full-time neuroradiology faculty member was $6,000, typically excluding license fees but including ACR and ABR membership, leaving $4,000 for professional expenses.This survey calls for further dialogue on adapting and innovating academic institutions to meet evolving needs in neuroradiology.

Training the New Radiologists: Approaches for Education.

The field of Radiology is continually changing, requiring corresponding evolution in both medical student and resident training to adequately prepare the next generation of radiologists. With advancements in adult education theory and a deeper understanding of perception in imaging interpretation, expert educators are reshaping the training landscape by introducing innovative teaching methods to align with increased workload demands and emerging technologies. These include the use of peer and interdisciplinary teaching, gamification, case repositories, flipped-classroom models, social media, and drawing and comics. This publication aims to investigate these novel approaches and offer persuasive evidence supporting their incorporation into the updated Radiology curriculum.

Cerebral Amyloid Angiopathy.

Cerebral amyloid angiopathy (CAA) is associated with deposition of amyloid proteins within the intracranial vessels. It is most frequently sporadic and risk increases with advancing age. Amyloid deposition is associated with increased risk of peripheral microhemorrhage, lobar hemorrhage, and/or repetitive subarachnoid hemorrhage. The presence of a peripherally located lobar hemorrhage on computed tomography in an elderly patient should raise concern for underlying CAA, as should multiple foci of peripheral susceptibility artifact or superficial siderosis on susceptibility-weighted imaging, the most sensitive modality for these findings. Newer PET radiotracers are also useful in detecting amyloid deposition.

Allelic variation in class I HLA determines CD8+ T cell repertoire shape and cross-reactive memory responses to SARS-CoV-2.

Effective presentation of antigens by human leukocyte antigen (HLA) class I molecules to CD8+ T cells is required for viral elimination and generation of long-term immunological memory. In this study, we applied a single-cell, multiomic technology to generate a unified ex vivo characterization of the CD8+ T cell response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across four major HLA class I alleles. We found that HLA genotype conditions key features of epitope specificity, TCRα/ß sequence diversity, and the utilization of pre-existing SARS-CoV-2-reactive memory T cell pools. Single-cell transcriptomics revealed functionally diverse T cell phenotypes of SARS-CoV-2-reactive T cells, associated with both disease stage and epitope specificity. Our results show that HLA variations notably influence the CD8+ T cell repertoire shape and utilization of immune recall upon SARS-CoV-2 infection.

Mechanisms of targeted therapy resistance in a pediatric glioma driven by ETV6-NTRK3 fusion.

Chromosomal rearrangements of the NTRK genes generate kinase fusions that are targetable oncogenic drivers in diverse adult and pediatric malignancies. Despite robust clinical response to targeted NTRK inhibition, the emergence of therapeutic resistance poses a formidable clinical challenge. Here we report the characterization of an ETV6-NTRK3 fusion-driven pediatric glioma that progressed through NTRK-targeted treatments with entrectinib and selitrectinib. Genetic analysis of multifocal recurrent/resistant lesions identified a previously uncharacterized NTRK3 p.G623A and a known p.G623E resistance mutation, in addition to other alterations of potential pathogenic impact. Functional studies using heterologous reconstitution model systems and patient-derived tumor cell lines establish that NTRK3G623A and NTRK3G623E mutated kinases exhibit reduced sensitivity to entrectinib and selitrectinib, as well as other NTRK inhibitors tested herein. In summary, this genetic analysis of multifocal recurrent/resistant glioma driven by ETV6-NTRK3 fusion captured a cross section of resistance-associated alterations that, based on in vitro analysis, likely contributed to resistance to targeted therapy and disease progression.

An oropharyngeal device for airway management of conscious and semiconscious patients: A randomized clinical trial.

OBJECTIVE: No oropharyngeal devices exist for use in conscious and semiconscious trauma patients during emergency evacuation, transport, or resuscitation. We aimed to test the hypotheses that the ManMaxAirway (MMA) is better tolerated than the standard Guedel-style device in awake volunteers and that it produces a jaw thrust and improves air flow. METHODS: This was a randomized cross-over study of healthy volunteers with either the MMA or standard device. The primary outcome of tolerability was defined as maintaining the device in place for 60 seconds. Secondary outcomes included respiratory system function and jaw thrust. Resistance to airflow through the device lumen was measured in situ and when placed in subjects in the pulmonary laboratory alone. Jaw thrust was quantified as displacement between the mandibular condyle and condylar fossa apex relative to baseline visualized with magnetic resonance imaging (MRI). RESULTS: We enrolled 19 subjects. Of these, a convenience sample of 5 individuals was selected for MRI; the remaining individuals (n = 14) were randomized for the cross-over study. All 14 subjects were able to maintain the MMA for 60 seconds compared with 2/14 (14%) with the standard device (odds ratio, 145; 95% confidence interval, 6.3-3314). Subjects reported that the experimental device was more comfortable and its placement did not trigger the gag reflex. Airway resistance produced by the MMA in an oscillatory flow model was nearly an order of magnitude lower than that of the standard device (experimental vs standard, 8 Hz-0.092 vs 0.786 cmH20·s/L; 15 Hz-0.193 vs 1.321 cmH20·s/L). Rapid induction of the gag reflex precluded further measurements with the standard device. Forced oscillation pulmonary testing in conscious volunteers with and without the MMA demonstrated that the device decreased respiratory system resistance to airflow and reduced respiratory elastance (31% ± 8% and 44% ± 13.4%, respectively; P < 0.05). MRIs of the subjects (n = 5) with the MMA in place showed a significant jaw thrust compared with baseline (7 ± 1 mm). CONCLUSIONS: The MMA proved well tolerated in conscious subjects, resulting in an opening of the anatomic airway and a decreased resistance to airflow.

Case Report: Yellow Fever Vaccine-Associated Neurotropic Disease and Associated MRI, EEG, and CSF Findings.

Yellow fever vaccine-associated neurotropic disease (YEL-AND) is a rare and serious complication following vaccination with the 17D live attenuated yellow fever vaccine. Cases of YEL-AND have presented as acute inflammatory demyelinating polyneuropathy, acute disseminated encephalomyelitis, and meningoencephalitis. To date, intracranial imaging of the progression and resolution of this disease has been minimally depicted in the literature. We present the case of a 67-year-old woman who developed YEL-AND following vaccination. Her diagnosis was complicated by imaging findings consistent with variant Creutzfeldt Jakob Disease. Her clinical history and the progression of her intracranial imaging is discussed in this case report.

Correlation Between Radiology ACGME Case Logs Values and ABR Core Exam Pass Rate.

RATIONALE AND OBJECTIVES: There is discordance between the American Board of Radiology (ABR) and many radiology trainees with respect to the most appropriate means to prepare for the ABR Core Examination. Whereas the ABR suggests that participation in routine clinical examination interpretation best prepares a trainee for the practical material of the test, residents, and many program directors feel that time away from clinical service for study and review courses are necessary. This study examines the relationship between studies interpreted in the first three years of residency as reported in the Accreditation Council for Graduate Medical Education case logs and performance of first-time test takers on the ABR Core Examination. MATERIALS AND METHODS: Accreditation Council for Graduate Medical Education case log data was anonymized for a single year cohort of residents in all accredited radiology residencies. This was then provided to the ABR and matched with performance on the Core Examination. A random effects logistic regression model was used to evaluate for a relationship between the number of examinations read and the pass/fail status of the Core Exam. RESULTS: Modeling using a linear and a quadratic term yields a significant relationship between case log values and Core Exam performance. There is a positive correlation until an inflection point of approximately 11,000 examinations, at which point a negative correlation develops. CONCLUSION: The data supports that active engagement in clinical duties is associated with better performance on the ABR Core Examination, with the caveat that there appears to be a point at which service outweighs educational value. Beyond this, performance on the examination declines.

Dental caries on CT in the ER population: prevalence and reporting practices.

PURPOSE: Although dental caries can be identified on CT and may be treatable, the literature provides little, if any, guidance on the responsibility of a neuroradiologist in reporting them. Untreated dental caries can impact diet and nutrition and can result in a variety of complications such as an odontogenic abscess, tooth loss, sinusitis, and dental pain, which can impact quality of life. The estimated prevalence of untreated dental caries in adults is 27%. In our experience, the prevalence of untreated dental caries in patients presenting to the Emergency Department (ED) is higher but dental caries are often unmentioned or unrecognized. We aim to determine the frequency of unreported dental caries and propose a paradigm for reporting and management. METHODS: Our research was IRB-approved and HIPPA compliant. We searched the radiology database for adult patients who underwent a CT of the facial bones while in the Emergency Department between January 1, 2015 and June 30, 2015. The examinations were reviewed by a faculty neuroradiologist for the presence of untreated dental caries. Untreated dental caries were documented and characterized by depth. Caries that were partially or completely obscured by dental amalgam artifact were excluded. The radiology reports were reviewed to evaluate reporting frequency. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. RESULTS: A total of 200 patients (113 male, 87 female; age 18-98 years) underwent 200 CT examinations of the facial bones. One hundred fourteen (57%) patients had at least one dental caries. When caries were present, 14.9% of radiology reports included caries in the findings section and 9.6% of the reports mentioned caries in the impression. CONCLUSIONS: The presence of dental caries should be mentioned in the radiology report. The prevalence of untreated dental caries is higher in our cohort than reported in the general population, and dental caries are underreported by neuroradiologists at our institution. A paradigm for reporting and management was created upon collaboration with faculty from the University of Vermont Dental and Oral Health practice. A visit with a dentist should be recommended within 6 months if caries are limited to the enamel, within 3 months if caries involve the dentin, and within 2 weeks if caries extend in to the pulp. Further research is necessary to determine the clinical impact of improved reporting.

Multimodal Neuroimaging Differences in Nicotine Abstinent Smokers Versus Satiated Smokers.

INTRODUCTION: Research on cigarette smokers suggests cognitive and behavioral impairments. However, much remains unclear how the functional neurobiology of smokers is influenced by nicotine state. Therefore, we sought to determine which state, be it acute nicotine abstinence or satiety, would yield the most robust differences compared with nonsmokers when assessing neurobiological markers of nicotine dependence. METHODS: Smokers (N = 15) and sociodemographically matched nonsmokers (N = 15) were scanned twice using a repeated-measures design. Smokers were scanned after a 24-hour nicotine abstinence and immediately after smoking their usual brand cigarette. The neuroimaging battery included a stop-signal task of response inhibition and pseudocontinuous arterial spin labeling to measure cerebral blood flow (CBF). Whole-brain voxel-wise analyses of covariance were carried out on stop success and stop fail Stop-Signal Task contrasts and CBF maps to assess differences among nonsmokers, abstinent smokers, and satiated smokers. Cluster correction was performed using AFNI's 3dClustSim to achieve a significance of p < .05. RESULTS: Smokers exhibited higher brain activation in bilateral inferior frontal gyrus, a brain region known to be involved in inhibitory control, during successful response inhibitions relative to nonsmokers. This effect was significantly higher during nicotine abstinence relative to satiety. Smokers also exhibited lower CBF in the bilateral inferior frontal gyrus than nonsmokers. These hypoperfusions were not different between abstinence and satiety. CONCLUSIONS: These findings converge on alterations in smokers in prefrontal circuits known to be critical for inhibitory control. These effects are present, even when smokers are satiated, but the neural activity required to achieve performance equal to controls is increased when smokers are in acute abstinence. IMPLICATIONS: Our multimodal neuroimaging study gives neurobiological insights into the cognitive demands of maintaining abstinence and suggests targets for assessing the efficacy of therapeutic interventions.

Social Media and Radiology Education: Are We #Ready?

Social media has become integrated into the lives of millions of people, but it has only recently been explored as a potential teaching tool. There is a body of literature to suggest that today's learners desire use of these interactive platforms for learning and that they result in higher degrees of student satisfaction, although it is not yet clear that a greater degree of knowledge transfer or retention is achieved. There are barriers to implementation in a curriculum, but as we learn to overcome these barriers and find new and creative ways to leverage social media we as educators will meet our students needs in the era of "web 2.0" and the digital native generation.

Dopamine-dependent cognitive processes after menopause: the relationship between COMT genotype, estradiol, and working memory.

The present study examined how a gene related to functioning of the dopaminergic system, catechol-O-methyltransferase (COMT), and estradiol were related to brain functioning in healthy postmenopausal women. Participants were 118 healthy, cognitively normal postmenopausal women between the ages of 50-60 years. All women provided a blood sample for COMT and estradiol analyses and underwent a magnetic resonance imaging scan. Working memory performance and related brain activation were measured with BOLD functional magnetic resonance imaging during the N-back task. Results were examined across each COMT genotype and a median split was performed on the circulating estradiol levels to create high and low estradiol groups for each genotype. COMT genotype and estradiol level were hypothesized to be proxy measures for brain dopamine levels with the Met/Met and high estradiol group having the most dopamine and Val/Val and low estradiol group having the least dopamine. The functional magnetic resonance imaging results showed that the N-back task activated the expected bilateral frontal and bilateral parietal working memory network. However, no main effects of COMT genotype or estradiol group were found. There was COMT-estradiol interaction found in a small area of decreased activation in the right precentral gyrus (Brodmann Area 6) that was related to the increasing hypothesized dopamine level. Specifically, women with a Met/Met genotype in the high estradiol group had the least activation in this frontal lobe working memory region. Women with a Val/Val genotype in the low estradiol group had greater activation in this region relative to the other groups. Performance on the N-back task did not show any group differences. These data indicate that after menopause COMT genotype and potentially the menopause-related changes to the dopaminergic system are not related to cognition. Future studies should examine how the relationship between COMT, estradiol, and cognition around the menopause transition as there appear to be differences in this relationship for premenopausal and postmenopausal women.