Implementation of training level-specific self-study guides for diagnostic radiology residents.

INTRODUCTION: Currently, there is no universally accepted diagnostic radiology curriculum for self-studying, so diagnostic radiology residents often have a challenging time knowing where to begin their independent studying away from work. In an effort to meet the needs of today's residents, we attempted to provide structured, comprehensive self-studying suggestions in a digestible and personalized format. MATERIALS AND METHODS: Each radiology division attempted to create an optimal learning resource form for the residents to use for self-studying while on each rotation. Each self-study guide included hyperlinks to easily accessible online resources. RESULTS: Training level-specific week-by-week recommendations were provided based on the expected types of cases a resident would typically encounter during that timeframe. All of the neuroradiology rotation forms and several of the other subspecialty forms were originally made available to the residents and faculty electronically on July 1, 2022. The forms are now distributed to newly rotating residents on a monthly basis. DISCUSSION: There is a fine balance between providing residents with comprehensive review material and promoting realistic expectations. In addition, educators must keep in mind financial limitations of their residents and institutions. Learning resources must be affordable to be accessible to all residents. As radiology and technology continuously advance, there will undoubtedly be more and more excellent resources for trainees to learn from. To optimize self-studying, retention of information, and wellness, it is imperative to provide our residents with a structured, personalized, manageable curriculum including easily accessible high-yield resources.

The American Board of Radiology's Alternate Pathway for Diagnostic Radiology: What the Programs and the Applicants Need to Know.

The American Board of Radiology (ABR) developed the international medical graduate alternate pathway to give foreign trained radiologists an alternate route to independent radiology practice without having to undergo radiology residency in the United States. After 4 years of fellowship/faculty experience in the same training institution, the foreign trained radiologist becomes eligible to sit for the radiology board examinations conducted by the ABR. As this pathway is not offered at every radiology training program, many training institutions are unfamiliar with the fundamentals of this pathway. At the same time, both the training institutions and the applying foreign-trained physicians face a plethora of confusing choices on the state and federal level. In this paper, we review the main factors which both the international medical graduate radiologists and training programs must consider before embarking on the diagnostic radiology ABR Alternate Pathway, namely, eligibility, visa options, state medical licensure requirements, their costs and implications for future employment opportunities.

How to Use YouTube for Radiology Education.

YouTube, the most commonly used free video-sharing platform globally, is increasingly being used as an educational tool in Radiology. Trainees worldwide now have the opportunity to learn about medical imaging at their own pace in the comfort of their homes, without geographical and financial constraints. Unfortunately, because YouTube is an easily accessible platform, it also incurs the risk of disseminating erroneous medical information or low-quality educational content. This article outlines the primary considerations when creating educational content on YouTube, including technical aspects, best practices, and measures to maximize effectiveness and success. Additionally, we discuss the current usage of the platform for Radiology education and its advantages and disadvantages and list some of the most popular Radiology YouTube channels.

Twig-like middle cerebral arteries: Clinical and radiological findings.

BACKGROUND AND PURPOSE: Aplastic or twig-like middle cerebral artery (MCA) is a rare vascular anomaly characterized by replacement of the M1 segment by a plexiform network of small vessels. Though rare, familiarity with this entity and ability to differentiate it from radiological mimics such as moyamoya changes and steno-occlusive diseases are important. We review the clinical and radiological manifestations of patients diagnosed with twig-like MCA on cerebral angiograms over a five-year period. MATERIALS AND METHODS: Retrospective review of all patients diagnosed with twig-like MCA on cerebral angiograms was performed from January 2015 to January 2020. This was the inclusion criterion for this retrospective study. For each patient, demographic data, clinical presentation, imaging findings and management strategies were reviewed. RESULTS AND CONCLUSIONS: Between January 2015 and January 2020, three patients with twig-like MCA were identified from 657 patients who underwent four-vessel diagnostic cerebral angiograms (0.45%). In all three cases, the involvement was unilateral (two left-sided and one right- sided). Two patients were male, and one was female. Patients ages were 25, 26 and 46 years. Two of the three patients presented with headache and the third patient with pulsatile tinnitus. There were otherwise no ischemic or hemorrhagic changes. No other vascular anomaly was identified. Twig-like MCA is a rare anatomical variant in which a plexiform network of small vessels replaces the M1 segment of the MCA. Accurate diagnosis and distinguishing this entity from radiological mimics such as moyamoya and steno-occlusive diseases are important for appropriate management and to prevent unnecessary investigations.

Brave New World: Challenges and Opportunities in the COVID-19 Virtual Interview Season.

The COVID-19 pandemic has forced the transition of the traditional residency interview to a virtual format. This new interview format creates additional challenges and opportunities for both programs and applicants. The specific challenges of the virtual interview format are described, as well as means to mitigate those challenges. In addition, opportunities to improve residency selection from the program end are described.

Prevalence and Reporting Rates of Incidental Dental Disease on Head CT Examinations.

RATIONALE AND OBJECTIVES: Routine head computed tomography (CT) examinations often inadvertently include dental pathology which is often overlooked. The purpose of this study is to examine the prevalence of dental disease incidentally present and detected on head CT examinations, and to determine the effect of the institution of a dental disease field or macro in a standardized head CT dictation template on the rate of reporting dental disease. MATERIALS AND METHODS: Head CT examinations were retrospectively and randomly selected from all examinations performed 6 months before, and 6 months after the institution of a dental disease field in a standardized head CT template. Dental findings were recorded from the initial finalized report. Examination images were subsequently reviewed for the presence of dental disease by two neuroradiologists who were blinded to the original reports and to each other's findings. RESULTS: One hundred examinations were reviewed in the analysis. At our institution, 33% of the randomly selected head CT examinations included the level of the teeth (100/307). Dental disease was determined to be present in 40%-41% of these cases. Only 11% of the initial reports mentioned dental disease (P < .01). Addition of a dental disease field in the dictation template resulted in no significant difference in reporting dental disease (14% vs 8%, P = .371). CONCLUSIONS: Incidental dental disease is common and frequently underreported. Inclusion of a dental disease field in a standardized template does not significantly improve the rate of reporting dental disease.

Magnetic Resonance Imaging of Trauma Patients Treated With Contemporary External Fixation Devices: A Multicenter Case Series.

OBJECTIVES: To report the safety and clinical outcomes of placing current magnetic resonance imaging (MRI) components inside and outside the MRI bore during MRIs. DESIGN: Retrospective case series. SETTING: Four trauma centers (3 Level I and 1 Level II), from January 2005 to January 2015. PATIENTS: All patients who had MRIs with external fixators in place either inside or outside the MRI bore. INTERVENTION: MRI of patients with external fixator in place. MAIN OUTCOME MEASUREMENTS: Adverse events were defined as catastrophic pullout of the external fixator during the MRI, thermal injury to the skin, severe field distortions precluding the intended imaging, alterations of the magnetic field, or visible structural damage to the magnet casing. RESULTS: Thirty-eight patients with 44 external fixators were identified who had MRI with the fixator inside or outside the MRI bore. Twelve patients with 13 external fixators had MRI with the external fixator inside the MRI bore. Twenty-seven patients with 32 external fixators had MRI with the external fixator outside the MRI bore. There were no adverse events. CONCLUSIONS: Although no universal guidelines exist, there are circumstances in which obtaining MRIs of patients with external fixators can be safe. This is the first clinical series with the primary outcome of safety when placing modern external components both inside and outside an MRI bore during a scan. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Spinal Intradural, Extramedullary Ependymoma with Astrocytoma Component: A Case Report and Review of the Literature.

Ependymomas are common spinal lesions, with the vast majority arising in an intramedullary location. Several cases have been described in the literature of ependymomas in an intradural, extramedullary location. The authors present a case of a 56-year-old female who presented with several weeks of lower back pain and weakness. MRI revealed an intradural, extramedullary enhancing mass at L1-L2. The mass was successfully resected surgically. Pathologic evaluation revealed a low grade glioma with components of both ependymoma and pilocytic astrocytoma with MUTYH G382D mutation. Extramedullary ependymomas are very rare tumors. To the authors' knowledge, this is the first case of ependymoma/astrocytoma collision tumors described in an extramedullary location.

Teaching the Healthcare Economics Milestones to Radiology Residents: Our Pilot Curriculum Experience.

RATIONALE AND OBJECTIVES: Since July 2013, the Accreditation Council for Graduate Medical Education (ACGME) has required radiology residency programs to implement a set of educational milestones to track residents' educational advancement in six core competencies, including Systems-based Practice. The healthcare economics subcompetency of Systems-based Practice has traditionally been relatively neglected, and given the new increased ACGME oversight, will specifically require greater focused attention. MATERIALS AND METHODS: A multi-institutional health-care economics pilot curriculum combining didactic and practical components was implemented across five residency programs. The didactic portion included a package of online recorded presentations, reading, and testing materials developed by the American College of Radiology (ACR's) Radiology Leadership Institute. The practical component involved a series of local meetings led by program faculty with the production of a deliverable based on research of local reimbursement for a noncontrast head computed tomography. The capstone entailed the presentation of each program's deliverable during a live teleconference webcast with a Radiology Leadership Institute content expert acting as moderator and discussion leader. RESULTS: The pilot curriculum was well received by residents and faculty moderators, with 100% of survey respondents agreeing that the pilot met its objective of introducing how reimbursement works in American radiology in 2015 and how business terminology applies to their particular institutions. CONCLUSION: A health-care economics curriculum in the style of a Massive Open Online Course has strong potential to serve as many residency programs' method of choice in meeting the health-care economics milestones.

Reliability of the modified Tufts Lumbar Degenerative Disc Classification between neurosurgeons and neuroradiologists.

Cross-specialty inter-rater reliability has not been explicitly reported for imaging characteristics that are thought to be important in lumbar intervertebral disc degeneration. Sufficient cross-specialty reliability is an essential consideration if radiographic stratification of symptomatic patients to specific treatment modalities is to ever be realized. Therefore the purpose of this study was to directly compare the assessment of such characteristics between neurosurgeons and neuroradiologists. Sixty consecutive patients with a diagnosis of lumbago and appropriate imaging were selected for inclusion. Lumbar MRI were evaluated using the Tufts Degenerative Disc Classification by two neurosurgeons and two neuroradiologists. Inter-rater reliability was assessed using Cohen's κ values both within and between specialties. A sensitivity analysis was performed for a modified grading system, which excluded high intensity zones (HIZ), due to poor cross-specialty inter-rater reliability of HIZ between specialties. The reliability of HIZ between neurosurgeons and neuroradiologists was fair in two of the four cross-specialty comparisons in this study (neurosurgeon 1 versus both radiologists κ=0.364 and κ=0.290). Removing HIZ from the classification improved inter-rater reliability for all comparisons within and between specialties (0.465⩽κ⩽0.576). In addition, intra-rater reliability remained in the moderate to substantial range (0.523⩽κ⩽0.649). Given our findings and corroboration with previous studies, identification of HIZ seems to have a markedly variable reliability. Thus we recommend modification of the original Tufts Degenerative Disc Classification by removing HIZ in order to make the overall grade provided by this classification more reproducible when scored by practitioners of different training backgrounds.

Radiology Resident Remediation: Five Important Questions to Ask.

OBJECTIVE: Residents needing remediation are difficult to recognize, assess, and address. The purposes of this article are to review common signs that a resident needs remediation and the causes of the deficiencies and to detail a checklist for preparing to approach the resident. CONCLUSION: Radiology residents who need remediation generally have either academic or professionalism deficits, and their remediation programs should be tailored to the deficit. Having a clear definition of the problem while eliciting the resident's thoughts on the nature of and solution to the problem are instrumental in the solution.