Six-Year Evaluation of Same-Day Discharge following Conventional Transarterial Chemoembolization of Hepatocellular Carcinoma.

PURPOSE: To evaluate whether same-day discharge increased the incidence of 30-day readmission (30dR) after conventional transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) at a single institution. MATERIALS AND METHODS: In this retrospective study, 253 patients with HCC underwent 521 transarterial chemoembolization procedures between 2013 and 2020. TACE was performed with 50-mg doxorubicin/10-mg mitomycin C/5-10-mL ethiodized oil/particles. Patients not requiring intravenous pain medications were discharged after a 3-hour observation, and 30dR was tracked. The primary objective was to determine the incidence of 30dR in same-day discharge patients versus patients admitted for observation using the chi-square test. Secondary objectives assessed factors associated with overnight admission and factors predictive of 30dR using generalized estimated equation calculations and logistic regression. RESULTS: In the cohort, 24 readmissions occurred within 30 days (4.6%). Same-day discharge was completed after 331 TACE procedures with sixteen 30dRs (4.8%). Patients admitted overnight were readmitted 8 times after 190 TACE procedures (4.2%). This difference was not statistically significant (P = .4). Factors predicting overnight admission included female sex (58/190 [30.5%] vs 58/331 [17.5%], P < .001) and tumor size of ≥3.8 cm (104/190 [55%] vs 85/190 [45%]). Factors predicting 30dR included female sex (10/116 [8.6%] vs 14/405 [0.2%]) and younger age (median [interquartile range], 63 years [55-65 years] vs 65 years [59-71 years]). At regression, factors predictive of 30dR were Child-Pugh Class B/C (odds ratio [OR], 2.1; P = .04) and female sex (OR, 2.9; P = .004). CONCLUSIONS: Same-day discharge after conventional TACE is a safe and effective strategy with 30dR rate of <5%, similar to overnight observation.

Adapting to the Era of Virtual Recruitment: Radiology Departmental Website Response to COVID-19 and Portrayal of the Resident Experience.

RATIONALE AND OBJECTIVES: The COVID-19 pandemic has transformed radiology recruitment into a virtual affair and placed an even stronger emphasis on the importance of departmental websites. In this study, we evaluate residency websites in detailing the response to COVID-19 as well as initiatives which help describe the resident experience. MATERIALS AND METHODS: Program websites for diagnostic radiology residencies listed in the 2022 Electronic Residency Application Service (ERAS) program list were evaluated for 31 criteria related to departmental response to COVID-19, online outreach, and resident wellness. RESULTS: Of 184 programs, 182 had functioning websites for review. One program was excluded from analysis as the website was almost entirely video-based. In response to COVID-19, ≤1% described resident redeployment, vaccination information, departmental response to ABR Core Exam changes, or regular administration updates. Six (3.3%) described revised read-out protocols, four (2.2%) mentioned supplementary non-clinical education, and 14 (7.7%) indicated changes to educational conferences. The majority of websites (122, 67.4%) offered an informational or tour video, while 44 (24.3%) described expectations for virtual interviewing, and 20 (11.0%) had virtual "open-houses." Departmental social media, primarily Twitter, was linked for 60 (33.1%) programs. A total of 134 (74.0%) websites described community highlights. More than a quarter mentioned meal stipends (72, 39.8%), paid sick time (54, 29.8%) and healthcare resources (57, 31.5%). Although social activities were described by 44 (24.3%) programs, some specifically indicating changes to COVID-19, formal resident mentoring (25, 13.8%) and wellness committees (28, 15.5%) were less common. These criteria were found more commonly at the largest third of residency programs (chi square, p < 0.00625). CONCLUSION: Programs rarely described work flow changes to COVID-19, and websites could improve in virtual outreach. Compared with prior literature, departmental websites have improved in describing wellness initiatives and related measures.

Long-term outcomes following 90Y Radioembolization of neuroendocrine liver metastases: evaluation of the radiation-emitting SIR-spheres in non-resectable liver tumor (RESiN) registry.

BACKGROUND: The goal of this study was to evaluate efficacy and safety of 90Y radioembolization for neuroendocrine liver metastases (NELM) in a multicenter registry. METHODS: One hundred-seventy patients with NELM were enrolled in the registry (NCT02685631). Prior treatments included hepatic resection (n = 23, 14%), arterial therapy (n = 62, 36%), octreotide (n = 119, 83%), cytotoxic chemotherapy (n = 58, 41%), biologic therapy (n = 49, 33%) and immunotherapy (n = 10, 6%). Seventy-seven (45%) patients had extrahepatic disease. Seventy-eight (48%), 61 (37%), and 25 (15%) patients were Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or ≥ 2. Tumor grade was known in 81 (48%) patients: 57 (70%) were well-, 12 (15%) moderate-, and 12 (15%) poorly-differentiated. Kaplan-Meier analysis and log rank tests were performed to compare overall and progression-free survival (OS/PFS) by tumor location and grade. Toxicities were reported using Common Terminology Criteria for Adverse Events v.5. Cox Proportional Hazards were calculated for pancreatic primary, performance status, extrahepatic disease at treatment, unilobar treatment, baseline ascites, and > 25% tumor burden. RESULTS: One, 2, and 3-year OS rates were 75, 62 and 46%, respectively. Median OS was 33 months [(95% CI: 25-not reached (NR)]. The longest median OS was in patients with pancreatic (42 months, 95% CI: 33-NR) and hindgut 41 months, 95% CI: 12-NR) primaries. The shortest OS was in foregut primaries (26 months; 95% CI: 23-NR; X2 = 7, p = 0.1). Median OS of well-differentiated tumors was 36 months (95% CI: 10-NR), compared to 44 (95% CI: 7-NR) and 25 (95% CI: 3-NR) months for moderate and poorly differentiated tumors. Median progression-free survival (PFS) was 25 months with 1, 2, and 3-year PFS rates of 70, 54, and 35%, respectively. Thirteen patients (7.6%) developed grade 3 hepatic toxicity, most commonly new ascites (n = 8, 5%) at a median of 5.5 months. Performance status of ≥2 (HR 2.7, p = 0.01) and baseline ascites (HR 2.8, P = 0.049) predicted shorter OS. DISCUSSION: In a population with a high incidence of extrahepatic disease, 90Y was effective and safe in treatment of NELM, with median OS of 41 months for well differentiated tumors. Grade 3 or greater hepatic toxicity was developed in 7.6% of patients. TRIAL REGISTRATION: NCT02685631 .

Resident Wellness in Radiology as Portrayed by Departmental Websites.

RATIONALE AND OBJECTIVES: Departmental websites are often the first exposure applicants have in researching programs. Websites provide information about resident education as well as infrastructure for resident wellness. For this study, we reviewed residency websites to evaluate resident wellness initiatives and extent of details available online. MATERIALS AND METHODS: Program websites for diagnostic radiology residencies listed in the 2020 ERAS program list were evaluated for 26 criteria pertaining to resident wellness. Criteria which are not radiology resident specific were also evaluated on their graduate medical education (GME) websites if unavailable on the departmental website. RESULTS: Of 189 programs, 185 (97.9%) had functioning websites for review. Book funds were mentioned by 57% (mean $3,762), and 43.5% discussed housing stipends during AIRP (mean $2,204); neither significantly correlated with program size. Retirement plan matching was present for 47.8% of programs. Almost all programs utilized night float call schedules, with relatively similar distribution of residents starting on-call duties as fall PGY2s, spring PGY2s, and starting PGY3s. Moonlighting was mentioned by 22.8% of departments. Paid wellness days were discussed in 10.8% (mean 3.1 days/year), and 37.7% described paid parental leave (mean 27.8 days/year). Less than 10% described resident mentoring, wellness committees, or non-clinical curricula. Resident retreats were mentioned by 21.6% of programs, and 11.4% described regular social activities; both were found more frequently at larger programs (chi-square analysis, p <0.00625). CONCLUSION: This study evaluated radiology residency program and GME websites for information pertaining to resident wellness. While financial and clinical information was typically present for >50% of programs, information regarding social initiatives was generally lacking and may be one area to bolster resident wellness and describe on websites.

Upsloping lateral sourcil: a radiographic finding of hip instability.

While radiographic findings of frank hip dysplasia are well defined, there is a lack of diagnostic criteria for patients with radiographically 'normal' hips who have borderline morphologic deficits and clinical instability. In this study, we aim to define and validate a new radiographic finding associated with hip instability known as the upsloping lateral sourcil (ULS). Patients (316) were reviewed for lateral center edge angles, generalized joint laxity assessed with the Beighton Hypermobility Score and the presence of the ULS. The ULS was defined as a caudal-to-cranial inclination of the middle-to-far lateral aspect of the acetabular sourcil with loss of the normal lateral acetabular concavity. The prevalence of the ULS correspondingly increased with the degree of under-coverage as defined by LCEA. Within the normal coverage group, hips with a ULS had smaller LCEAs than those without ULS (29° versus 32°, P < 0.001). Among hips with a ULS, 59.00% had generalized joint laxity. The association between the ULS finding and generalized joint laxity was statistically significant (P < 0.01). The ULS is seen with higher prevalence in patients with clinical hip laxity and radiographically decreasing LCEA and may serve as an adjunctive finding in patients presenting with hip pain and instability. The ULS may help to characterize patients with borderline hip dysplasia and laxity that fall outside conventional imaging criteria for dysplasia.

Double Fellowships in Radiology: A Survey of 2014 Graduating Fellows.

PURPOSE: Radiology fellowship training has evolved from being an uncommon option to being a near requisite for post-training employment in the United States. A subset of fellows elect to pursue second fellowships with potentially substantial implications on both the private sector and academic radiology workforce. The purpose of this study was to assess the proportion of current radiology fellows pursuing multiple years of post-residency fellowship training. MATERIALS AND METHODS: After obtaining IRB approval, an anonymous web-based survey was emailed to 1,269 radiology fellows listed as "completing fellowship" in the American College of Radiology database in June 2014. Questions were asked regarding current fellowship training, post-fellowship employment plans, and individual experience pursuing employment. Results were analyzed using the survey analytical software. RESULTS: There were 219 responses received, representing a 17.3% response rate. Ten-percent of respondents were currently completing their second radiology fellowship. Of those completing their first year of fellowship training, 11% indicated plans to complete a second radiology fellowship. CONCLUSION: This survey provides a snapshot of the percentage of radiology trainees who pursue a second year of fellowship training, currently in the range of 10%. Pursuing a second radiology fellowship may represent a safety net to a substantial subset of fellows who are not able to obtain satisfactory employment following training. Academic programs who rely heavily on fellows should be aware of the proportion of fellows pursuing two fellowships and should be prepared to adapt should this change over time.