Resident clinical duties while preparing for the ABR core examination: position statement of the Association of Program Directors in Radiology.

Historically, diagnostic radiology residents have been allowed time off from clinical duties to study for the ABR oral board examination. This practice has resulted in a disruptive "board frenzy" at many programs. The new ABR examination structure gives programs an opportunity to evaluate this practice. This position statement of the Association of Program Directors in Radiology describes the rationale behind a recommendation of no time off from clinical service before the ABR core examination.

An overview of the ACR Committee on Ethics: from hospital contracts to expert witness testimony.

Professional medical ethics has challenged physicians since time immemorial. Difficult questions about whether physicians appropriately interact with patients, staff members, and their medical colleagues seldom yield ready answers. Like other professional societies, the ACR offers guidance for its members on medical ethics issues. This article discusses how the ACR Committee on Ethics serves educational and investigative and disciplinary roles. The committee has authored and contributed to articles and other resources on such topics as physician-patient communication, informed consent, and ethics training for residents. It also has received complaints that a member's conduct allegedly violated the ACR's Code of Ethics. Many recent complaints have alleged that a member failed to provide nonpartisan and accurate expert medical testimony in a legal proceeding. The committee carefully screens each complaint and has established a process for investigating and deciding whether the testimony has violated the code.

Site-specific cancer incidence and mortality after cerebral angiography with radioactive thorotrast.

Few opportunities exist to evaluate the carcinogenic effects of long-term internal exposure to alpha-particle-emitting radionuclides. Patients injected with Thorotrast (thorium-232) during radiographic procedures, beginning in the 1930s, provide one such valuable opportunity. We evaluated site-specific cancer incidence and mortality among an international cohort of 3,042 patients injected during cerebral angiography with either Thorotrast (n = 1,650) or a nonradioactive agent (n = 1,392) and who survived 2 or more years. Standardized incidence ratios (SIR) for Thorotrast and comparison patients (Denmark and Sweden) were estimated and relative risks (RR), adjusted for population, age and sex, were generated with multivariate statistical modeling. For U.S. patients, comparable procedures were used to estimate standardized mortality ratios (SMR) and RR, representing the first evaluation of long-term, site-specific cancer mortality in this group. Compared with nonexposed patients, significantly increased risks in Thorotrast patients were observed for all incident cancers combined (RR = 3.4, 95% CI 2.9-4.1, n = 480, Denmark and Sweden) and for cancer mortality (RR = 4.0, 95% CI 2.5-6.7, n = 114, U.S.). Approximately 335 incident cancers were above expectation, with large excesses seen for cancers of the liver, bile ducts and gallbladder (55% or 185 excess cancers) and leukemias other than CLL (8% or 26 excess cancers). The RR of all incident cancers increased with time since angiography (P < 0.001) and was threefold at 40 or more years; significant excesses (SIR = 4.0) persisted for 50 years. Increasing cumulative dose of radiation was associated with an increasing risk of all incident cancers taken together and with cancers of the liver, gallbladder, and peritoneum and other digestive sites; similar findings were observed for U.S. cancer mortality. A marginally significant dose response was observed for the incidence of pancreas cancer (P = 0.05) but not for lung cancer. Our study confirms the relationship between Thorotrast and increased cancer incidence at sites of Thorotrast deposition and suggests a possible association with pancreas cancer. After injection with >20 ml Thorotrast, the cumulative excess risk of cancer incidence remained elevated for up to 50 years and approached 97%. Caution is needed in interpreting the excess risks observed for site-specific cancers, however, because of the potential bias associated with the selection of cohort participants, noncomparability with respect to the internal or external comparison groups, and confounding by indication. Nonetheless, the substantial risks associated with liver cancer and leukemia indicate that unique and prolonged exposure to alpha-particle-emitting Thorotrast increased carcinogenic risks.