Writing Good True-False Questions: A Brief Guide for Radiologists.

This guide provides a brief how-to compilation of widely accepted recommendations for creating good true-false questions for self-assessment continuing medical education exercises.

Consensus Statement of Society of Abdominal Radiology Disease-Focused Panel on Barium Esophagography in Gastroesophageal Reflux Disease.

OBJECTIVE: The Society of Abdominal Radiology established a panel to prepare a consensus statement on the role of barium esophagography in gastroesophageal reflux disease (GERD), as well as recommended techniques for performing the fluoroscopic examination and the gamut of findings associated with this condition. CONCLUSION: Because it is an inexpensive, noninvasive, and widely available study that requires no sedation, barium esophagography may be performed as the initial test for GERD or in conjunction with other tests such as endoscopy.

Journal Club: Prevalence of flawed multiple-choice questions in continuing medical education activities of major radiology journals.

OBJECTIVE: The purpose of this study was to assess whether the continuing medical education (CME) multiple-choice questions (MCQs) in three major radiology journals adhere to standard question-writing principles. MATERIALS AND METHODS: All CME MCQs (total of 181) in the January 2013 editions of the AJR, RadioGraphics, and Radiology composed the test sample. Each question was evaluated by three reviewers for compliance with seven MCQ-writing guidelines that have been documented in the medical education literature as associated with frequent flaws in medical CME. RESULTS: Seventy-eight of the 181 (43%) questions contained one to four flaws. CONCLUSION: A large fraction of radiology CME questions violate standard question-writing principles.

Esophagopericardial Fistula Causing Pyopneumopericardium.

An esophagopericardial fistula is a rare complication of esophageal malignancy, trauma, or surgery. Imaging is a cornerstone of diagnosis, with detection of pneumopericardium or hydropneumopericardium at imaging raising suspicion for pyopneumopericardium and prompting immediate search for the causative pathologic process. Given the high associated mortality rate of over 50% for patients with esophagopericardial fistulas, early diagnosis and intervention are vital. Supplemental material is available for this article. © RSNA, 2020.

Eosinophilic esophagitis: imaging features with endoscopic and pathologic correlation.

OBJECTIVE: We aim to review the imaging features of eosinophilic esophagitis on fluoroscopy and present how they can correlate with endoscopic and pathologic findings. RESULTS: Eosinophilic esophagitis is a chronic immune-mediated disease that results in esophageal dysfunction. Upper esophagogastroduodenoscopy is high yield and required for biopsies to demonstrate the hallmark histologic findings of eosinophil-predominant inflammation. While esophagogastroduodenoscopy is currently mandatory for diagnosis, imaging findings can provide valuable information regarding the structural and functional properties of the esophagus. In addition, fluoroscopic studies may be very helpful in the setting of subtle findings and to evaluate fibrotic remodeling changes. CONCLUSION: Radiologic examinations are a valuable tool in the assessment of eosinophilic esophagitis and can highlight changes of fibrostenotic disease, as overall narrowing can be more conspicuous fluoroscopically than endoscopically. As the disease increases in prevalence, it is critical that physicians recognize this condition and facilitate diagnosis and treatment.

MR enterography in the management of patients with Crohn disease.

Crohn disease is a complex pathologic process with an unpredictable lifelong course that includes frequent relapses. It often affects young patients, who are most vulnerable to the potential adverse effects of repeated exposure to ionizing radiation from computed tomography performed for diagnosis and surgical planning. The small intestine is the bowel segment that is most frequently affected, but it is the least accessible with endoscopic techniques. Magnetic resonance (MR) enterography has the potential to safely and noninvasively meet the imaging needs of patients with Crohn disease without exposing them to ionizing radiation. Appropriate use of MR enterography requires a carefully crafted protocol to depict signs of active inflammation as well as complications such as bowel obstruction, fistulas, and abscesses. Interpretation of MR enterographic images requires familiarity with the imaging signs and mimics of active bowel inflammation and stenosis. Although MR enterography currently is helpful for management in individual patients, the standardization of acquisition protocols and interpretive methods would increase its usefulness for more rigorous, systematic assessments of Crohn disease treatment regimens.

Simplified imaging approach for evaluation of the solid renal mass in adults.

Current patterns of imaging utilization lead to frequent serendipitous discovery of renal lesions. Today, the majority of solid renal masses that are ultimately proved to be renal cell carcinomas were incidental findings on imaging studies performed for non-urinary tract symptoms. While earlier discovery has led to treatment of smaller and earlier-stage malignancies, the percentage of benign lesions discovered has also increased. A strategy for characterization of solid masses in adults based on the lesion's growth pattern, the "ball" versus the "bean," is presented. Common and uncommon renal masses, in concert with clinical and other imaging clues, are reviewed within the context of a renal ball or bean.

Gastrointestinal fluoroscopy: what are we still doing?

OBJECTIVE: We used Medicare data to quantify trends in gastrointestinal fluoroscopy volume. CONCLUSION: Although overall gastrointestinal fluoroscopy procedures continue to decline, the fall is not uniform. Nationwide Medicare data from 2001 to 2006 reveal that the volumes of barium enema and upper gastrointestinal studies suffered a steep drop, but the numbers of esophagograms and swallowing studies actually increased. These numbers highlight the challenge facing gastrointestinal fluoroscopy training and offer guidance for modifying curricula.