The case-based radiology teaching conference for residents: beneficial effect of previewing cases and using answer sheets.

RATIONALE AND OBJECTIVES: Radiology residents often experience the case-based teaching conference as an inquisition, during which the moderator painfully extracts observations, conclusions, and facts from a discussant while other attendees passively observe. This experience is frequently disliked by all participants. The author hypothesized that such conferences could be improved by previewing cases and using answer sheets. MATERIALS AND METHODS: A bimonthly, 1-hour, case-based skeletal radiology teaching conference was modified so that residents previewed 20 single-image cases for 45 seconds each while completing answer sheets. Directed by a moderator, residents then took turns discussing their responses. Attendees completed evaluation forms. RESULTS: Five conferences were evaluated, and a total of 81 evaluation forms were received. The average response rate per conference was 90%. The evaluations indicated that the content was appropriate (96% [78 of 81 evaluations]), the format helped learning (98% [79 of 81]), the new format was preferred to the traditional format (98% [78 of 80]), and more such conferences were desired (99% [80 of 81]). Evaluations also suggested that the requirement to commit to a diagnosis was beneficial, greater participation and engagement were obtained from all attendees, and more cases were discussed. CONCLUSION: Modifying case-based radiology teaching conferences by having participants preview cases and use answer sheets has positive educational benefits and is well received.

Radiologists as clinical tutors in a problem-based medical school curriculum.

RATIONALE AND OBJECTIVES: The authors sought to evaluate the experience of radiologists teaching in a problem-based pre-clinical medical school curriculum. MATERIALS AND METHODS: The undergraduate medical school curriculum at Wake Forest University includes 2 problem-based preclinical years that integrate basic and clinical sciences. Sixteen radiology fellows served as general clinical tutors for 5-9 weeks, each guiding the work of six 2nd-year students, often in tandem with a basic science tutor. On completion of the tutoring. the radiologists and the students were surveyed by means of a questionnaire. A follow-up group interview was conducted with the radiologists. RESULTS: The response rate to the questionnaire was 81% for the radiologists and 47% for the students. On average, radiologists spent 6.1 hours weekly on preparation and tutoring and 3.5 hours in total on administration and grading. All radiologists thought tutoring was rewarding, but seven of the 13 respondents (54%) disliked assigning grades. Radiologists spent less time teaching radiology residents and performing research, but few thought their clinical work was adversely affected. Nearly half of the radiologist-tutors thought that the preliminary orientation and training provided to them by the medical school was not adequate, and nearly all of them thought that they could have been better prepared. All of the medical students improved their perceptions of radiologists after having had a radiologist as a tutor, and most thought that the radiologist-tutors performed as well as or better than tutors from other disciplines. CONCLUSION: Radiologists can be successful as general tutors in a problem-based medical school curriculum. benefiting both radiologists and students. Better orientation and training by the medical school would improve the program.

Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis.

PURPOSE: To evaluate the diagnostic yield of computed tomography (CT)-guided percutaneous needle aspiration procedures in the setting of suspected spontaneous infectious diskitis and to assess the usefulness of concurrent cytologic examination as a supplement to microbiologic evaluation. MATERIALS AND METHODS: A retrospective study was performed to evaluate 105 consecutive CT-guided percutaneous disk space aspiration procedures in 92 patients suspected of having spontaneous (non-postoperative) infectious diskitis. Our criterion standard for the presence of active infection was the identification of a pathogen either from the CT-guided aspiration specimen or from a surgical specimen. All cases had microbiologic analysis, 78 cases had cytopathologic analysis, and 31 cases had open surgery. RESULTS: Microbiologic analysis of the CT-guided percutaneous aspiration specimens was positive in 39 of 43 cases proved to have active infections, with four false-negative and no false-positive cases (sensitivity, 91%; specificity, 100%). The false-negative cases were all active fungal infections identified from surgical specimens. Adding cytopathologic analysis to microbiologic analysis improved sensitivity but reduced specificity. The most common pathogens were species of Staphylococcus, Streptococcus, Candida, and Mycobacterium. All 30 active bacterial infections were identified with the CT-guided procedures, but only five of nine fungal infections were identified. CONCLUSION: CT-guided percutaneous needle aspiration is an accurate method for identifying active bacterial disk space infections but is less reliable for identifying fungal infections.

Osteochondritis dissecans of the tibial plafond: imaging characteristics and a review of the literature.

UNLABELLED: OBJECTIVE; Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). CONCLUSION: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body.

Osteochondritis dissecans of the tarsal navicular bone: imaging findings in four patients.

We report the imaging characteristics of osteochondritis dissecans of the tarsal navicular bone in four cases and review the current literature. Its radiological findings are similar to osteochondritis dissecans found in other sites: focal lucency that disrupts the sharp cortical line, the presence of sclerosis, and cortical depression.

Talking about race in a scientific context.

There are at least two approaches that assist students in understanding complexity and differing interpretations about human diversity and race. Because differing perspectives emerge from data perceived at different levels, different scales provide a tool for understanding relationships among perspectives and understanding the differential importance of specific factors. Constructivist listening, which assists students in examining their own experiences, feelings and understanding, provides a tool for digesting complex new material and learning emotional literacy. It can be applied to dialogue about race and to classroom situations. These approaches can help students master the conceptual and interpersonal skills needed for successful scientific practice.

CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy.

OBJECTIVE: We assessed the positive predictive value of percutaneous biopsy of sclerotic lesions to determine whether the reported success rate of the percutaneous technique could be generalized to sclerotic lesions or whether our diagnostic yield was too low to justify this added step before open surgical confirmation. MATERIALS AND METHODS: We retrospectively studied all sclerotic bone lesions biopsied by the percutaneous CT-guided technique at the Massachusetts General Hospital between 1988 and 1997. The 43 lesions were categorized by location, maximum diameter, density (graded 1-4, relative to cortex), and pattern of density (geographic, vague, or geographic with sclerotic margins). Pathologic and clinical follow-up were used to determine the positive and negative predictive values. RESULTS: Of the 43 patients biopsied, neither the maximum diameter of the lesion nor its density was predictive of benignancy or malignancy. Fine-needle aspiration (FNA) complemented core biopsy results; for example, in one case, FNA showed findings indicating disease when the core biopsy showed none, and in another case the reverse occurred. No complications were reported in these 43 patients. CONCLUSION: Percutaneous CT-guided biopsy of sclerotic bone lesions is a viable alternative to open surgical biopsy. In this study, the positive predictive value of the combined FNA and bone biopsy results was 82% and the negative predictive value was 100%. No complications were reported.

Evaluation of clinical experience in a radiology residency program with quantitative profiling: rationale, methods, and application.

RATIONALE AND OBJECTIVES: The author developed a technique for residency program evaluation, called "quantitative profiling," that is based on computer retrieval of radiologic reports. The hypothesis was that it would provide insights into the contributions of residents to clinical service, measures of resident experience and productivity for program evaluation, and benchmarks for comparison. MATERIALS AND METHODS: The radiology residency program of a major teaching hospital was studied retrospectively from 1989 to 1997. The number of radiologic reports signed by individual residents and faculty members was retrieved. The clinical experience of the 1993-1997 cohort of residents was described according to subspecialty area and modality. RESULTS: Residents signed 46.5% of all reports, with a mean total of 14,445 reports +/- 1,292 per resident during the entire residency. The distribution of examinations was as follows: thoracic, 42.1%; musculoskeletal, 26.1%; abdominal, 13.4%; sonography, 8.7%; neuroradiology, 4.3%; nuclear, 2.4%; breast, 1.6%; and vascular, 1.4%. The most frequently reported results were for one-view chest radiography. CONCLUSION: Quantitative profiling can help track the range and progress of resident experience, help determine the deployment of residents, and provide empirical data upon which decisions to modify residency programs may be based.

1998 ARRS Executive Council Award. Radiology in the emergency department: technique for quantitative description of use and results. American Roentgen Ray Society.

OBJECTIVE: We sought to develop quantitative methods to describe the use and results of imaging studies in emergency department patients. MATERIALS AND METHODS: A computerized nonrelational database containing records of 3.5 million diagnostic reports generated by our radiology department from 1988 to 1997 was queried using Boolean and natural language search tools. Each record contained data fields for patient demographics, examination description and billing code, names of interpreting radiologists and referring physicians, patient history, report body, and report impression. RESULTS: Emergency department admissions and imaging studies were stable from 1991 to 1997, averaging 60,000 and 52,000 per year, respectively. Bone radiographs comprised 45.1% of examinations; chest radiographs, 44.6%; and abdominal radiographs, 10.4%. The percentages of radiographs interpreted as normal were 75.9% in 1992 and 75.3% in 1996, with cervical spine (88.7%), thoracic spine (86.3%), and knee (86.3%) yielding the highest proportion of studies with normal findings. The number of CT studies of the body increased from 1840 in 1993 to 3101 in 1997. Studies of the abdomen accounted for most of this increase (52.3% in 1993 to 66.0% in 1997). During evaluations for cervical spine injury, a mean of 6.5% of radiographic studies were followed by CT studies, and the findings of 89.0% of those CT studies were interpreted as normal. CONCLUSION: Radiology report databases represent a resource from which broad descriptions of the use and results of imaging studies can be obtained. Such descriptions may be useful in departmental and hospital administration, technology assessment, cost-effectiveness studies, and health policy formulation.