ACR Appropriateness Criteria® Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis).

Noncontrast CT (NCCT) is the imaging study of choice for initial evaluation of patients with acute onset of flank pain and suspicion of stone disease without known prior stone disease. NCCT can reliably characterize the location and size of an offending ureteral calculus, identify complications, and diagnose alternative etiologies of abdominal pain. Although less sensitive in the detection of stones, ultrasound may have a role in evaluating for signs of obstruction. Radiography potentially has a role, although has been shown to be less sensitive than NCCT. For patients with known disease and recurrent symptoms of urolithiasis, NCCT remains the test of choice for evaluation. In pregnancy, given radiation concerns, ultrasound is recommended as the initial modality of choice with potential role for noncontrast MRI. In scenarios where stone disease suspected and initial NCCT is inconclusive, contrast-enhanced imaging, either with MRI or CT/CT urogram may be appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Developing a Late-Career Roadmap to Continued Career Engagement.

Professional development needs span the entirety of a radiologist's career. Great strides have been made in the creation of an infrastructure for early career development. Work is ongoing to develop such resources for mid-career radiologists, given the recent recognition of the needs of this group. Unfortunately, even less attention has been paid to late-career radiologist development needs as a bridge to retirement. As part of the Career Conversations series, this article will highlight the needs and currently available resources for this group.

Defining the Roles and Responsibilities for the Vice Chair for Academic Affairs/Faculty Development in Radiology.

RATIONALE AND OBJECTIVES: To inform the development of a job description for Vice-Chairs for academic affairs (VCAA), members of the Alliance of Leaders in Academic Affairs in Radiology (ALAAR) were surveyed to better understand their current job responsibilities and how they would ideally allocate their professional time. MATERIALS AND METHODS: Based on a survey of 33 university-affiliated radiology departments and discussion among ALAAR members, the authors developed a detailed job description for the VCAA. The 21-question survey was composed and validated by experts in the field. It was distributed to all members of ALAAR via email with an electronic link and was open for 5 months. Results of the survey were tabulated, and a job description was crafted to represent the foundational roles of academic affairs leaders in radiology. RESULTS: The response rate for institutions represented in ALAAR was 73% (33/45). All participants reported that they practiced in a university-affiliated institution. Faculty size varied from ≤49 (30.3%, 10/33), 50-99 faculty (24.2%, 8/33), and ≥100 faculty members (45.5%, 15/33). Only 24% of survey respondents had a detailed job description at the time of hire. More than 40% attested to significant oversight over faculty development programs (45%), mentorship programs (42%, and promotions (45%). Respondents ideally want increased oversight (defined as >10%) over exit interviews, faculty awards, promotions, onboarding, recruitment and hiring, and wellness programming. CONCLUSION: The aspirational mission of the VCAA is to oversee components of sequential stages in the professional lifecycle of faculty members but a common job description for this role is lacking.

Commentary: A Radiologist's Guide to Peer-Reviewing Manuscripts.

ABSTRACT: Reviewers play an important role in the publishing of radiology articles. When done well, reviewers help editors identify which articles to accept and improve them through their recommendations. In this commentary, we provide a step-by-step guide to reviewing both original science and review articles.

Radiology Training Program Lessons Learned During the COVID-19 Pandemic.

The COVID-19 pandemic had major effects on radiology training programs throughout the country. Many of the challenges were shared, with some variation depending on the size and geographic location of each program. While some initial modifications, such as platoon-type scheduling and redeployment, have been abandoned, other changes such as home workstations and the option of remote conferences have become more permanently incorporated. Remote learning tools and virtual teaching are much more frequently used, although there is emphasis by many programs on preserving in-person training. Programs stressed the importance of communication and adaptability, and getting resident and faculty input is key in optimizing the educational experience.

Virtual Interviewing for Radiology Residency: Pluses, Minuses, and A Review of the Literature.

This article reviews current medical literature to assess the benefits and drawbacks of virtual interviews for radiology residencies as well as the downstream effects of these changes, best practices, and potential future recruitment methods. Topics covered include the effects of remote recruitment in promoting accessibility and applicant diversity and equality as well as fiscal, environmental, and time savings in combination with technical challenges, the complications of over application, challenges in assessment of program culture and location, impact on morale, and hidden financial and emotional costs. Learnings from other medical specialties are highlighted in addition to the process of signaling, guidelines for conducting and participating in virtual interviews, and matters for future consideration.

Framed and Reframed! The Art of Using Cognitive Behavioral Techniques to Combat Burnout.

The incidence of burnout among radiologists has been increasing exponentially, largely attributed to increased work volumes, expectations for more rapid turn-around times and decreasing interpersonal interactions. While personal wellness activities have been described in the literature, there is little information on the role of cognitive behavioral therapy strategies to mitigate burnout. This manuscript will describe the value of naming automatic negative emotions which can lead to burnout and will provide an overview of strategies that can be used to combat them, using cognitive behavioral therapy techniques.

Overcoming Midcareer Malaise: The Value of Personal Rediscovery.

Midcareer faculty development is critical for continued career vitality and retention. However, limited formal programming exists to meet the needs of this group, which is at risk of experiencing a lack of career self-identity and a sense of being stuck. These feelings may lead radiologists to consider a change in practice type or location or even to exit the radiologist workforce. This viewpoint describes stressors and potential solutions to assist midcareer radiologists in regaining workplace engagement.

Role of Dual-energy Computed Tomography in Diagnosis of Acute Pulmonary Emboli, a Review.

Prompt diagnosis of pulmonary embolism is essential to avert morbidity and mortality. There are a number of diagnostic options for identification of a pulmonary embolism, including laboratory and imaging investigations. While computed tomography pulmonary angiography (CTPA) has largely supplanted nuclear medicine ventilation/perfusion studies, there remain significant limitations in the optimal performance of CTPA. Dual-energy computed tomography has the ability to overcome many of the limitations of standard of care CTPA, including rescue of poor contrast boluses and the ability to evaluate pulmonary perfusion defects.

Great Question! The Art and Science of Crafting High-Quality Multiple-Choice Questions.

Assessment of medical knowledge is essential to determine the progress of an adult learner. Well-crafted multiple-choice questions are one proven method of testing a learner's understanding of a specific topic. The authors provide readers with rules that must be followed to create high-quality multiple-choice questions. Common question writing mistakes are also addressed to assist readers in improving their item-writing skills.

Talking Points: Enhancing Communication Between Radiologists and Patients.

Radiologists communicate along multiple pathways, using written, verbal, and non-verbal means. Radiology trainees must gain skills in all forms of communication, with attention to developing effective professional communication in all forms. This manuscript reviews evidence-based strategies for enhancing effective communication between radiologists and patients through direct communication, written means and enhanced reporting. We highlight patient-centered communication efforts, available evidence, and opportunities to engage learners and enhance training and simulation efforts that improve communication with patients at all levels of clinical care.

Meeting Faculty Development Needs: Review of Current Resources and Opportunities for Program Development.

This paper will review faculty development focus and programming at the early, mid and late career stages. Topics covered include challenges at each career stage, institutional and national programming currently available for the needs of faculty at that stage, and suggested best practices for development of new career focus and potential programs for each stage.

Affecting Change: Enhancing Feedback Interactions with Radiology Trainees.

Feedback is a critical part of the learning process and is a valuable tool to empower adult learners. Modern feedback theory places the learner at the center of the feedback encounter. Individual and institutional barriers to effective giving and receiving of feedback can be overcome through education and attention to the form and content of feedback. We review the elements of effective feedback and address issues of framing, environmental, and social factors which aid in providing psychological safety and trust, as necessary elements to create a culture of feedback in radiology training programs. We provide practical strategies to empower learners with the necessary skills to solicit, receive, and reflect on feedback.

Key Components of a Robust Faculty Development Program: An Emphasis on Contemporary Programming Events.

A strong faculty development program is crucial to recruit, support, and advance early-career faculty members in order to achieve and sustain an exceptional and diverse medical community. There has been increasing appreciation for the importance of fostering intrapersonal "soft-skills" such as leadership, mentorship, resilience, adaptability, and emotional intelligence. These skills allow an individual to better interact with others and their environment, and can facilitate teamwork, time management, decision-making, and conflict resolution. The development of these skills is an ongoing process that is cumulative in nature, and generalizable to any career phase or field of medicine. A comprehensive faculty development program must emphasize these contemporary notions alongside the traditional curriculum, and this includes individual, departmental, institutional, and national level considerations.