The Influence of Extracurricular Activities on Radiology Resident Selection Decisions.

PURPOSE: Extracurricular activities (EAs) listed on radiology residency applications can signal traits and characteristics desired in holistic reviews. The authors conducted an objective analysis to determine the influence of EAs on resident selection decisions. METHODS: A discrete-choice experiment was designed to model radiology resident selection and determine the relative weights of EAs among academic and demographic application factors. Faculty members involved in resident selection at 30 US radiology programs chose between hypothetical pairs of applicant profiles between October 2021 and February 2022. Each applicant profile included one of 22 EAs chosen for study. A conditional logistic regression model assessed the relative weights of the attributes and odds ratios (ORs) were calculated. RESULTS: Two hundred forty-four participants completed the exercise. Community-service EAs were ranked most highly by participants. LGBTQ Pride Alliance (OR, 1.56; 95% confidence interval [CI], 1.14-2.15; P = .006) and Young Republicans (OR, 0.60; 95% CI, 0.43-0.82; P = .001) significantly influenced decisions. The highest ranked EAs were significantly preferred over the lowest ranked EAs (OR, 1.916; 95% CI, 1.671-2.197; P < .001). Participants preferred EAs that reflected active over passive engagement (OR, 1.154; 95% CI, 1.022-1.304; P = .021) and progressive over conservative ideology (OR, 1.280; 95% CI, 1.133-1.447; P < .001). Participants who ranked progressive EAs more highly preferred applicants with progressive EAs (P < .05 for all). CONCLUSIONS: The influence of EAs on resident selection decisions is significant and likely to gain importance in resident selection as medical student performance metrics are further eliminated. Applicants and selection committees should consider this influence and the bias that EAs can bring to resident selection decisions.

Patient Pathway to Diagnosis of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): Findings from a Multinational Survey of 204 Patients.

INTRODUCTION: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare demyelinating disorder of the central nervous system. Despite increased recognition of MOGAD as a distinct disease and the availability of sensitive methods of MOG antibody testing, diagnostic challenges remain. We conducted a survey to explore the patient experience from the start of symptoms to final MOGAD diagnosis. METHODS: A 23-question online survey (including multiple-choice and free-text responses) covering symptom history, healthcare interactions and impact of diagnosis was emailed to people living with MOGAD by The MOG Project patient advocacy group. People living with MOGAD could share the survey with their caregivers. Anonymised responses were analysed. RESULTS: In total, 204 people living with MOGAD or their caregivers from 21 countries completed the survey; most respondents were from North America. Age of symptom onset ranged from 1 to 66 (median 28) years. Symptoms that prompted patients to seek medical care included blurred vision/loss of vision (58.2%), eye pain (35.8%) and difficulty walking (25.4%). Patients most frequently presented to emergency care physicians (38.7%) and primary care doctors (26.0%), with the MOGAD diagnosis most often made by general neurologists (40.4%) or neuro-immunologists (30.0%). Patients saw a median of four doctors before diagnosis, with 26.5% of patients seeing at least six doctors. Although 60.6% of patients received a MOGAD diagnosis within 6 months of experiencing initial health problems, 17.7% experienced a ≥ 5-year delay. More than half of patients (55.4%) received an alternative primary diagnosis before final MOGAD diagnosis. Most respondents (60.6%) reported receiving insufficient information/resources at the time of MOGAD diagnosis. Diagnostic delay was associated with long-term negative consequences for physical health. CONCLUSION: This survey provides unique insights from people living with MOGAD and their caregivers that could help address the challenges faced in the pathway to final MOGAD diagnosis.

Results of the 2020 Survey of the American Alliance of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVES: An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). The purpose of this study is to summarize the 2020 A3CR2 chief resident survey. MATERIALS AND METHODS: An online survey was distributed to chief residents from 194 Accreditation Council on Graduate Medical Education-accredited radiology residencies. Questions were designed to gather information about residency program practices, benefits, fellowship or advanced interventional radiology (IR) training choices, and the integration of IR training. Subsets of questions focused on the perception of corporatization, non-physician providers (NPPs), and artificial intelligence (AI) in radiology and their relationship to the radiology job market. RESULTS: 174 individual responses from 94 programs were provided, yielding a 48 % program response rate. Extended emergency department coverage has steadily decreased over the last 5 years (2016-2020), however only 52 % of programs have independent overnight call (without attending coverage). Regarding the impact of new integrated IR residencies on training, 42 % indicated there was no appreciable impact on their DR or IR training, while 20 % indicated DR training for IR residents suffered and 19 % indicated IR training for DR residents suffered. Corporatization in radiology was perceived as the biggest potential threat to the future job market. CONCLUSIONS: Integration of IR residency did not detrimentally affect DR or IR training in most programs. Radiology resident perception of corporatization, NPPs, and AI may help residency programs shape educational content.

Results of the 2021-2022 Survey of the American Alliance of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVES: An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). Special topics surveyed for the 2021-2022 academic year were procedural competency and virtual radiology education in the COVID-19 pandemic. The purpose of this study is to summarize the 2021-2022 A3CR2 chief resident survey. MATERIALS AND METHODS: An online survey was distributed to chief residents from 197 Accreditation Council on Graduate Medical Education-accredited radiology residency programs. Chief residents responded to questions regarding their individual procedural readiness and attitudes on virtual radiology education. A single chief resident from each residency answered programmatic questions including the use of virtual education, faculty coverage, and fellowship choices among their graduating classes. RESULTS: We received 110 individual responses from 61 programs, yielding a 31% program response rate. Although the majority (80%) of programs maintained purely in-person attending readout throughout the COVID 19 pandemic, only 13% of programs reported purely in-person didactics and 26% converted to all virtual didactics. The majority (53%-74%) of chief residents perceived virtual learning (in read-out, case conference, and didactic formats) to be less effective than in-person learning. One third of chief residents reported decreased procedural exposure during the pandemic, and 7%-9% of chief residents felt uncomfortable with basic procedures (basic fluoroscopy examinations, basic aspiration/drainage procedures, and superficial biopsy procedures). The number of programs with 24/7 attending coverage increased from 35% in 2019 to 49% in 2022. Body, neuroradiology, and interventional radiology were the most popular advanced training options among graduating radiology residents. CONCLUSION: The COVID-19 pandemic had a profound impact on radiology training, particularly in terms of virtual learning. These survey results suggest that although digital learning offers increased flexibility, most residents still prefer in-person readout and didactics. Despite this, virtual learning will likely remain a viable option as programs continue to evolve following the pandemic.

Fatigue is a common symptom in myelin oligodendrocyte glycoprotein antibody disease.

Background: Unlike multiple sclerosis and neuromyelitis optica, the burden of fatigue in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is unclear. Objective: To compare fatigue levels between people with MOGAD and household controls (HC) and explore factors associated with fatigue severity. Methods: In a cross-sectional survey, data were collected from people with MOGAD and HC by utilizing an online questionnaire. Data elements included demographics, sleep quality measures, comorbidities, MOGAD characteristics, and fatigue severity measured by the Modified Fatigue Impact Scale (MFIS). We compared fatigue severity between MOGAD participants and HC and assessed the associations between demographic and disease characteristics and fatigue severity. Results: There were 180/283 MOGAD and 61/126 HC respondents. Compared to HC, people with MOGAD reported more severe fatigue, as measured by the MFIS total score (49.3 vs. 36.5; p < 0.001), and a larger proportion of MOGAD participants (75.6% vs. 44.3%; p < 0.001) were classified as fatigued. Among MOGAD participants, higher age (p = 0.04), history of bilateral optic neuritis (p = 0.02), and current use of acute treatment (p = 0.04) were independently associated with higher fatigue. Conclusions: Fatigue is common in people with MOGAD, and a history of bilateral optic neuritis, comorbid conditions, and ongoing disease activity appear to contribute to fatigue severity.

Outcomes after successful fallopian tube recanalization: A single institution experience: Observational Retrospective study.

PURPOSE: To determine outcomes after successful fallopian tube recanalization (FTR) in women who suffer infertility with documented tubal occlusion on hysterosalpingogram. METHODS: A retrospective review of consecutive successful FTR procedures from January 2010 to December 2016 was performed. 53 women who had hysterosalpingogram confirmed unilateral or bilateral tubal occlusion from a single tertiary academic medical center and successful FTR were eligible for inclusion. 35 (66.0%) patients had follow up at 12 months after FTR, with 13 conceiving within 1 year of the procedure. Data was collected from the medical record. Complication, conception, and take-home-baby (THB) rates were recorded. The average age of patients was 32.3 years (range 26-42 years). All patients received peri- and post-procedure antibiotics. The study was conducted with institutional IRB approval. RESULTS: Average follow-up after FTR was 1335 days. All patients tolerated the procedure well with no immediate complications. One patient had a urinary tract infection a week after FTR. 13 (37.1%) became pregnant after FTR. Of these women, 2 had ectopic pregnancies and 2 patients had spontaneous abortions. The THB rate after FTR for all patients was 25.7%. The THB rate in women who became pregnant after FTR was 69.2%. Of those women who did not become pregnant after FTR, 19 (84.6%) went to assisted reproductive techniques, and of those, 8 (42.1%) became pregnant. CONCLUSION: Infertility affects 8.4% of U.S. women, with tubal disease a major causative factor. In our study, successful FTR led to pregnancy in over a third of the patients with the majority giving birth to healthy babies. Given the success of obtaining pregnancy in combination with a low complication rate, FTR is a viable option in women who suffer from tubal infertility.

A Snapshot of Radiology Training During the Early COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic transformed the personal and professional lives of radiology trainees. The purpose of this study was to broadly summarize the impact of COVID-19 on radiology trainees and their training programs via data collected during the early pandemic. MATERIALS AND METHODS: An online survey was distributed to radiology chief residents in residencies throughout North America with responses collected between March 20th, 2020 and May 15th, 2020, which coincided with the development of initial COVID-19 peaks in North America. A subset of COVID-19 pandemic questions included resident wellness, imaging opinions, residency infrastructure change, and opinions regarding the Core Exam delay. RESULTS: One hundred forty chief residents from 86 institutions responded to COVID-19-related questions. Nearly all responding programs (99%; 85/86) reported institutional positive cases of COVID-19. Most residents (94%; 132/140) thought laboratory testing provided more value than imaging. Fifty-seven percent of respondents (80/140) would use COVID-19-related terminology when encountering chest CT findings supportive of viral pneumonia in symptomatic patients. There was little reported change in the number of residents on call (no change reported in >80% of programs). Fifty-nine percent of residents (83/140) reported increased stress related to the COVID-19 pandemic. The majority of programs (93%) had fewer residents on service (80/86 responding programs). CONCLUSIONS: COVID-19 dramatically affected radiology residencies during the early pandemic period. As we enter future phases of the COVID-19 pandemic, careful thought should also be given to rebuilding the radiology resident experience.

Results of the 2019 Survey of the American Alliance of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVES: An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). The purpose of this study is to summarize the 2019 A3CR2 chief resident survey. MATERIALS AND METHODS: An online survey was distributed to chief residents from 194 Accreditation Council on Graduate Medical Education-accredited radiology residencies. Questions were designed to gather information about residency program details, call and weekend coverage, interventional radiology training, fellowship, social media use, healthcare reform, artificial intelligence, and job market status. RESULTS: One hundred and forty-two unique responses from 99 programs were provided, yielding a 51% program response rate. There was a mean of 7.3 women per residency with a mean program size of 28 residents (26% women). Only 3 of the 99 (3%) programs had a proportion of women that was 50% or higher. The proportion of women in radiology residencies is unchanged since 2014 (p= 0.93) and is significantly lower than 2019 graduating women medical students (49.3%; p < 0.001). Thirty-five percent of programs had 24/7 attending coverage and 40% of programs had extended hours attending shifts. Of programs without 24/7 attending coverage, the proportion of programs without face-to-face readout has increased from 34% in 2014 to 55% in 2019 (p = 0.015). The majority (67%) of respondents had no concerns about the radiology job market; compared to 2014, where only 4% had no concerns (p < 0.001). CONCLUSION: Women remain underrepresented in radiology, face-to-face readout is decreasing, and there has been a shift towards a positive job market outlook.

"What Program Directors Think" V: Results of the 2019 Spring Survey of the Association of Program Directors in Radiology (APDR).

RATIONALE AND OBJECTIVES: The Association of Program Directors in Radiology (APDR) surveys its membership annually on hot topics and new developments in radiology residency training. Here we report the results of that annual survey. MATERIALS AND METHODS: A web-based survey was posed to the APDR membership in the Fall of 2018. Members were asked 43 questions on program staffing, resident education resources/funding, impact of the integrated-Interventional Radiology residency program on Diagnostic Radiology program resources, resident interest in imaging informatics, Accreditation Council for Graduate Medical Education requirements on resident practice habits data reporting, institutional reliance on residents for clinical coverage, teaching format in the post-oral board era, resident conference attendance, confidentiality of the Match rank list, Early Specialization in Interventional Radiology pathway recruitment and selection, Diagnostic Radiology and Interventional Radiology program relationships, independent resident call, pediatric radiology training, diversity and unconscious bias training, and social media in radiology education. RESULTS: Responses were collected electronically, results were tallied using Qualtrics software, and qualitative responses were tabulated or summarized as comments. There were 86 respondents with a response rate of 31.3%. CONCLUSION: Survey result highlights include perceived resident interest in imaging informatics with the vast majority of residency programs offering an informatics curriculum; the provision of resident practice habits data by nearly all residency programs despite lack of clarity surrounding this Accreditation Council for Graduate Medical Education requirement; continued use of case-taking in the post-oral boards era; frequent disclosure of the Match rank list to departmental and hospital administration; low penetration of unconscious bias training in academic radiology; and finally, the successful integration of interventional and diagnostic radiology training programs.

Results of the 2015 Survey of the American Alliance of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVES: The American Alliance of Academic Chief Residents in Radiology conducts an annual survey of chief residents in Diagnostic Radiology programs in North America. The survey serves as a resource for observing trends and disseminating ideas among radiology training programs. MATERIALS AND METHODS: An online survey was distributed to chief residents at 181 residency programs, with questions on a broad range of topics including resident benefits, program and call structure, American Board of Radiology Core exam preparation, fellowships, and the job market. RESULTS: A total of 193 individual responses were received from 120 programs, for a response rate of 66%. The responses were compared to data from prior years' surveys, principally from 2012 to 2014. CONCLUSIONS: Programs are shifting resident benefits spending toward Core exam preparation resources and away from lead aprons. In addition, 24-hour attending coverage continues to spread among programs, and the fraction of programs providing face-to-face postcall readouts continues to decline. Finally, although resident perception of the job market is now improving, residents feel that the job market continues to discourage medical students from entering radiology, a fact borne out by the 2015 match results. How the upcoming change to a direct interventional radiology residency will affect medical student interest is as yet uncertain.

Results of the 2014 survey of the American Alliance of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVES: The American Alliance of Academic Chief Residents in Radiology (A³CR²) conducts an annual survey of chief residents in accredited radiology programs in North America. The survey serves as a tool for observing trends and disseminating ideas among radiology programs. MATERIALS AND METHODS: An online survey conducted through the SurveyMonkey Web site was distributed to chief residents from 187 Accreditation Council on Graduate Medical Education (ACGME)-accredited radiology training programs. A variety of multiple-choice and free-response questions were designed to gather information about residency program details, benefits, chief resident responsibilities, call, preparations for the recent American Board of Radiology Core Examination, implementation of selectives (mini-fellowships), fellowships, health care economics and the job market, and ACGME milestones. RESULTS: Among those surveyed, 212 unique responses from 136 programs were provided, yielding a 73% response rate. Data were compared to historical data from prior surveys dating back through 2002. CONCLUSIONS: Programs are increasingly providing 24-hour sonographer coverage, full day routine services on weekends, and 24-hour attending radiologist coverage. The new American Board of Radiology examination format and schedule has driven many changes, including when chief residents serve, board preparation and review, and how the final year of residency training is structured. Despite facing many changes, there is slightly more optimism among chief residents regarding their future job prospects.

The effect of retinal defocus on simple eye-hand and eye-foot reaction time in traumatic brain injury (TBI).

PRIMARY OBJECTIVE: The purpose of the experiment was to assess the effect of retinal defocus on simple eye-hand (E-H) and eye-foot (E-F) reaction time (RT) in traumatic brain injury (TBI). DESIGN AND METHODS: Sixteen subjects with traumatic brain injury (five males and 11 females; aged 22-34 years) participated in the experiment. These were compared with 16 visually-normal, age/gender-match subjects. Retinal defocus was introduced optically (plano, +1, +2, +3, +4, +10D and +2D × 90) in the spectacle plane with binocular viewing. E-H and E-F RT were assessed binocularly using the RT-2S Simple Reaction Time Tester (Advanced Therapy Products, Glen Allen, VA). The test target colour and angular subtense simulated a conventional red/green traffic signal at 120 feet. RESULTS: There was no significant effect (p > 0.05) of retinal defocus on either E-H or E-F RT in each population. There was a significant effect (p < 0.05) of TBI on both E-H and E-F RT as compared with the normative data, with it being longer and more variable in TBI. Each RT condition was longest in those with moderate TBI. CONCLUSIONS: Both RTs were robust to retinal defocus, thus suggesting central nervous system insensitivity for this simple RT task. However, the increased RTs and related variability found in TBI, especially in moderate TBI, have potential safety implications (e.g. driving a car, ambulating).

Results of the 2012 survey of the American Association of Academic Chief Residents in Radiology.

RATIONALE AND OBJECTIVE: Every year, the American Association of Academic Chief Residents in Radiology conducts a survey of the chief residents in accredited radiology training programs in North America. The survey serves as a tool for gathering information, sharing ideas, and voicing opinions. MATERIALS AND METHODS: An online survey was made available to the chief residents from 187 training programs in North America. Questions were presented in multiple-choice and free response formats, designed to address many issues ranging from program structure to on-call policies, changes for the new board examination format and fellowships, and the effects of health care reform on radiology practices. The results of the survey were tabulated and responses to the repeated questions were compared with those from earlier surveys dating to 2003. RESULTS: Among those surveyed, 185 individual responses representing 135 unique programs were completed, yielding a 73% response rate. Thirty-eight percent of programs responded from the northeast and 17% of programs responded from the southeast. Nineteen percent of responses were from central United States, 14% of responses were from western United States, and 12% of responses were from Canada. CONCLUSIONS: There is an increasing number of programs, which cover more hospitals, during the past decade. There are more programs providing ultrasound and magnetic resonance services after hours, with an associated increase in after-hours attending physician coverage. Many changes are being made for the future board examination format. Health care reform is affecting how residents are preparing themselves for their future practices.

Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria.

The field of interventional oncology includes tumor ablation as well as the use of transcatheter therapies such as embolization, chemoembolization, and radioembolization. Terminology and reporting standards for tumor ablation have been developed. The development of standardization of terminology and reporting criteria for transcatheter therapies should provide a similar framework to facilitate the clearest communication among investigators and provide the greatest flexibility in comparing established and emerging technologies. An appropriate vehicle for reporting the various aspects of catheter directed therapy is outlined, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings. Methods for standardizing the reporting of outcomes toxicities, complications, and other important aspects that require attention when reporting clinical results are addressed. It is the intention of the group that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication for reporting the various aspects of transcatheter management of hepatic malignancy that will translate to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes.

Hepatic metastasis from uveal melanoma: angiographic pattern predictive of survival after hepatic arterial chemoembolization.

OBJECTIVE: To identify clinical features associated with survival after hepatic arterial chemoembolization (HACE) for uveal melanoma metastasis. METHODS: Retrospective case series including 11 men and 10 women with uveal melanoma metastasis. RESULTS: The hepatic angiographic pattern of metastasis was infiltrative in 12 patients (57%) and nodular in 9 patients (43%). The infiltrative pattern was associated with ciliary body involvement by the primary tumor (Fisher exact test, P = .01) and extrascleral tumor extension (Fisher exact test, P = .01). Mean survival after the first HACE treatment was 7.6 months overall, 3.7 months for the patients with the infiltrative pattern, and 12.7 months for those with the nodular pattern. This difference was highly significant (Kaplan-Meier, P < .001). Chromosome 8p was found to be deleted in 4 patients with the infiltrative pattern and in no patients with the nodular pattern. CONCLUSIONS: The hepatic metastasis pattern can be used to predict response to and survival after HACE. Loss of chromosome 8p may be a biomarker for the infiltrative metastasis pattern. Hepatic arterial chemoembolization may play an important role in the treatment of hepatic metastasis from uveal melanoma in patients with the nodular metastatic pattern. Regular screening for hepatic metastasis in patients with uveal melanoma may be beneficial in identifying those who would benefit from HACE.

Pagetoid reticulosis in a 5-year-old boy.

We present a rare case of pagetoid reticulosis arising in a 5-year-old white boy. He had a history of a large chronic erythematous, scaly patch on his left buttock that had shown intermittent partial response to a topical antifungal medication. A punch biopsy specimen revealed dramatic epidermal hyperplasia, with parakeratosis and prominent exocytosis of single and clustered mononuclear cells (Pautrier's microabscesses) into the epidermis. Some of these exhibited hyperchromatic nuclei with irregular contours. They stained prominently for CD3, CD4, and CD8, with a predominance of CD8(+) cells. T-cell receptor gene rearrangement by polymerase chain reaction was negative for a clonal process on a second biopsy specimen that was nondiagnostic on routine sections. Pagetoid reticulosis is an indolent, unilesional variant of mycosis fungoides, in which the atypical T cells may express a CD4(-)/CD8(+) phenotype. This is in contrast to primary cutaneous epidermotropic CD8(+) cytotoxic T-cell lymphoma, which is often very aggressive with a poor outcome. Pagetoid reticulosis is exceedingly rare in children and adolescents. Two features predict a benign course in this 5-year-old child: the unilesional clinical presentation and the CD8 predominance of the epidermal lymphocytes.

Chemoembolization of hepatocellular carcinoma: patient status at presentation and outcome over 15 years at a single center.

OBJECTIVE: We report the outcome of the care of 209 patients with hepatocellular carcinoma with a focus on relevant scoring systems for predicting overall survival and time to progression and on changes in presentation status and outcome from 1991 to 2006. MATERIALS AND METHODS: Hepatic arterial chemoembolization was performed on 209 patients in 375 sessions. Disease status was evaluated with the Child-Pugh, Okuda, Cancer of the Liver Italian Program, and American Joint Committee on Cancer (AJCC) systems. Changes in status at presentation from 1991 to 2006 and change in overall survival period and time to progression were analyzed. RESULTS: Median and mean overall survival periods for the entire group were 376 and 574 +/- 61 days. Median and mean times to progression were 267 and 409 +/- 54 days. Forty-nine patients underwent liver transplantation a median of 143 days after chemoembolization. The median and mean overall survival times among patients not undergoing transplantations were 466 and 574 +/- 61 days. Okuda score (p < 0.0001) and AJCC stage (p = 0.014) were the best predictors of overall survival and time to progression, respectively. Patients with disease with an Okuda I score and in AJCC stage I or II had median and mean overall survival periods of 667 and 992 +/- 176 days and times to progression of 378 and 589 +/- 110 days. Clinical status at presentation, overall survival period (p = 0.64), and time to progression (p = 0.44) were unchanged from 1991 to 2006. The 30-day mortality was 3.2%. CONCLUSION: Patients treated with hepatic arterial chemoembolization for HCC in Okuda score I and AJCC stage I or II have more durable survival than previously reported in a U.S. population.