The clinical anatomy of the inferior vena cava: a review of common congenital anomalies and considerations for clinicians.

Anomalies in the course and drainage of the Inferior Vena Cava (IVC) may complicate normal functioning, correct diagnosis, and therapeutic interventions within the abdomen. Development of the IVC occurs during the 4th to 8th week of gestation, and due to its developmental complexity, there are many opportunities for malformations to occur. Although most IVC anomalies are clinically silent and are usually discovered incidentally on abdominal imaging, aberrations may be responsible for formation of thrombosis, back pain, and anomalous circulation of blood to the heart. In this review, we will discuss the most common variations and abnormalities of the IVC, which include the posterior cardinal veins, the subcardinal veins, the supracardinal veins, persistent left IVC, IVC duplication, situs inversus, left retroaortic renal vein, left circumaortic renal collar, scimitar syndrome, and IVC agenesis. For each abnormality outlined above, we aim to discuss relevant embryology and potential clinical significance with regards to presentation, diagnosis, and treatment as is important for radiologists, surgeons, and clinicians in current clinical practice.

The tori of the mouth and ear: a review.

There is a great deal of literature regarding the tori of the mouth and ear. However, there is controversy regarding the etiology and prevalence of each. The torus palatinus is generally agreed to be the most common oral exostosis and is more frequently found in females. The torus mandibularis is also quite common, is more prevalent in males, and occurs bilaterally in 80% of cases. Far less data have been presented regarding the torus maxillaries primarily due to the lack of consensus regarding its nomenclature and classification. These oral tori are thought to be inherited in an autosomal dominant manner with a relatively high penetrance; however, environmental and functional factors have been postulated that may account for a more complex etiology than simply genetics. The torus auditivus is rarely acknowledged in clinical papers and most data are found in anthropological journals. Although there is an abundance of literature that addresses these traits individually, there is a lack of research that collectively acknowledges these. Therefore, the aim of this study was to present a composite review of the tori with regards to their anatomical features, prevalence, etiology and clinical relevance.

Integration of Art Into Radiological Societies & Educational Conferences: Early Experiences of the 2021 ACR Art Task Force.

Interest in incorporating art into radiology has been growing in recent years. Radiological societies have begun to acknowledge the benefits art can bring to our field. Given this growing interest, a task force was created in 2021 to carry out integration of the arts into the annual American College of Radiology (ACR) meeting. Experiences of this task force are described, including consideration of benefits of integrating art in radiology practice and education as well as strategies, outcomes, and future directions for melding arts with radiology.

Integration of Clinical Skills into Preclinical Medical Curriculum Via a Low-Cost Femoral Triangle Ultrasound Model.

We created a low-cost femoral triangle model that allows first year medical students to practice ultrasound-guided procedures while reinforcing their knowledge of femoral triangle anatomy. Use of this model also increased opportunities for informal near-peer teaching and student involvement in the creation of instructional materials.

Meckel's diverticulum: a review.

Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. This anomaly is due to the incomplete obliteration of the omphalomesenteric duct during the 7th week of gestation and is classically located 2 feet proximal to the ileocecal valve. Variations of this congenital malformation have been recorded based on location, size, and form. While most of the population may be asymptomatic, clinical manifestation, including gastrointestinal bleed and intestinal obstruction, can emerge. Despite the frequency of Meckel's diverticulum, it is commonly misdiagnosed due to its mimicry of appendicitis. This article aimed to review this derailment of embryological development.

Obturator hernia: anatomy, embryology, diagnosis, and treatment.

An obturator hernia is an infrequent but significant cause of intestinal obstruction. The incidence of obturator hernias is between 0.05 and 1.4% of all hernias. The mortality rate can be as high as 70% when acutely incarcerated due to the difficulty in diagnosis and delay in surgical treatment Three progressive stages of obturator herniation have been classified and can be one of three different varieties depending on the pathway the herniated sac follows. Knowledge of the anatomy and pathogenesis of obturator herniation is essential in diagnosis and treatment. The most common clinical presentation is intestinal obstruction (90%) and this is often seen in elderly, emaciated, multiparous women with predisposing conditions. Other classic signs, though not always present include obturator neuralgia, the Howship-Romberg sign and the Hannington-Kiff sign. Computed tomography scan is the most favored diagnostic imaging method. The abdominal surgical approach is most preferred when a diagnosis is uncertain and laparoscopy should be employed in elective early surgeries. This aim of this article is to review the diagnosis and treatment of obturator hernia by describing the anatomy, embryology, clinical presentation, diagnosis, and management currently in use. Increased awareness and proper management of this condition will result in decreased morbidity and mortality.

The lymphatic system: a historical perspective.

The study of the lymphatic system has a lengthy history, with many notable medical minds making important contributions. We now appreciate that this system is an essential component of the immune system, as well as vital to the maintenance of fluid homeostasis within the body. A good knowledge of the lymphatic system is clinically important concerning cancer, edema, surgery, and the immune response. This article reviews the history of the evolution and discovery of the lymphatic system.

Advanced, Interactive, Image-based Education: Technology and Pedagogy.

An audience response system (ARS) is an excellent tool for improving interactive learning in radiology residents. Traditional ARSs have long allowed text-based interactions between teacher and students. However, little attention has been given to techniques which allow students in large groups to interact directly with an image. Fortunately, a growing number of ARSs are beginning to add this ability. However, it is not the technology but the pedagogy that matters the most. The purpose of this article is to review those ARSs, and to present an array of pedagogical techniques that can take advantage of this technology.

An Objective Structured Clinical Examination for Medical Student Radiology Clerkships: Reproducibility Study.

BACKGROUND: Objective structured clinical examinations (OSCEs) are a useful method to evaluate medical students' performance in the clerkship years. OSCEs are designed to assess skills and knowledge in a standardized clinical setting and through use of a preset standard grading sheet, so that clinical knowledge can be evaluated at a high level and in a reproducible way. OBJECTIVE: This study aimed to present our OSCE assessment tool designed specifically for radiology clerkship medical students, which we called the objective structured radiology examination (OSRE), with the intent to advance the assessment of clerkship medical students by providing an objective, structured, reproducible, and low-cost method to evaluate medical students' radiology knowledge and the reproducibility of this assessment tool. METHODS: We designed 9 different OSRE cases for radiology clerkship classes with participating third- and fourth-year medical students. Each examination comprises 1 to 3 images, a clinical scenario, and structured questions, along with a standardized scoring sheet that allows for an objective and low-cost assessment. Each medical student completed 3 of 9 random examination cases during their rotation. To evaluate for reproducibility of our scoring sheet assessment tool, we used 5 examiners to grade the same students. Reproducibility for each case and consistency for each grader were assessed with a two-way mixed effects intraclass correlation coefficient (ICC). An ICC below 0.4 was deemed poor to fair, an ICC of 0.41 to 0.60 was moderate, an ICC of 0.6 to 0.8 was substantial, and an ICC greater than 0.8 was almost perfect. We also assessed the correlation of scores and the students' clinical experience with a linear regression model and compared mean grades between third- and fourth-year students. RESULTS: A total of 181 students (156 third- and 25 fourth-year students) were included in the study for a full academic year. Moreover, 6 of 9 cases demonstrated average ICCs more than 0.6 (substantial correlation), and the average ICCs ranged from 0.36 to 0.80 (P<.001 for all the cases). The average ICC for each grader was more than 0.60 (substantial correlation). The average grade among the third-year students was 11.9 (SD 4.9), compared with 12.8 (SD 5) among the fourth-year students (P=.005). There was no correlation between clinical experience and OSRE grade (-0.02; P=.48), adjusting for the medical school year. CONCLUSIONS: Our OSRE is a reproducible assessment tool with most of our OSRE cases showing substantial correlation, except for 3 cases. No expertise in radiology is needed to grade these examinations using our scoring sheet. There was no correlation between scores and the clinical experience of the medical students tested.

Male Breast Disease: What the Radiologist Needs to Know.

The male breast is susceptible to a variety of benign and malignant processes, many of which clinically present as a palpable finding, focal pain, or breast enlargement. Gynecomastia is the most common abnormality in the male breast and must be distinguished from malignancy. Imaging of the symptomatic male breast begins with a diagnostic mammogram in a patient ≥25 years and targeted ultrasound in a patient <25 years. If the breast finding is incompletely imaged or occult at mammography, targeted ultrasound must be performed. Similarly, if the breast finding is suspicious at targeted ultrasound in a younger patient, mammography must be performed. After a complete diagnostic evaluation, suspicious findings require biopsy because of overlap in clinical and imaging features of benign and malignant pathologies. Although no breast cancer screening program exists for men due to the <1% incidence of breast cancer, transgender male to female patients >50 years and treated with exogenous hormone therapy for >5 years should undergo breast cancer screening. This paper will review the anatomy of the male breast, appropriate imaging of the symptomatic male breast, gynecomastia and other benign conditions, and male breast cancer and other malignant conditions. Finally, we will discuss imaging of the transgender patient.

Gastrointestinal manifestations of dermatologic disorders.

The skin and the gastrointestinal tract may be affected concurrently by the same diseases. Pathogenetically, these conditions may be primarily dermatologic diseases involving the gastrointestinal (GI) tract or systemic diseases involving the skin, GI tract, and liver simultaneously. The correct diagnosis of such conditions relies on the ability of the gastroenterologist to recognize the underlying dermatologic disorder. The goal of this clinical review article is to increase gastroenterologists' awareness and understanding of some of these conditions. Case vignettes are presented and the relevant literature reviewed for epidermolysis bullosa, mastocytosis, hereditary hemorrhagic telangiectasia, and melanoma. This review focuses on increasing gastroenterologists' ability to recognize, diagnose, comprehend, and manage patients with these dermatologic conditions who have GI manifestations. Advances in molecular genetics that provide insight into the underlying pathophysiology and histopathology of these lesions are highlighted.

Choosing a specialty in medicine: female medical students and radiology.

OBJECTIVE: The purpose of this study was to determine whether there are identifiable factors that dissuade female medical students from entering the field of radiology. MATERIALS AND METHODS: An anonymous survey was completed by medical students at the end of their third- or fourth-year radiology clinical clerkships at five institutions. In addition to demographic data and residency choice, respondents ranked 10 factors in order of importance to their choice of career. For respondents who did not consider radiology a possible career, a second set of eight factors was ranked for importance in dissuading them. RESULTS: Two hundred eighty-eight respondents completed the survey, 152 (53%) men and 136 (47%) women. Both men and women reported direct patient contact and intellectual stimulation as the most important factors in deciding on a specialty. For those who chose radiology, intellectual stimulation and use of emerging technology were significantly (p < 0.05) more important than other factors. The factor that most strongly (96%) dissuaded men and women from a career in radiology was lack of direct patient contact. There was no significant difference between men and women in ranking factors that dissuaded them from applying to radiology residencies; however, nearly one third of the female respondents cited competitiveness of the residency process as important. CONCLUSION: Patient contact remains an important factor for medical students choosing a career. To attract high-caliber students, medical schools should expose students to areas of radiology involving patient interaction. Academically qualified women should be identified early during their careers and encouraged to apply for radiology residencies.

Explaining Breast Density Recommendations: An Introductory Workshop for Breast Health Providers.

Introduction: High breast density is an independent risk factor for breast cancer and can decrease the sensitivity of mammography. However, evidence surrounding recommendations for patient risk stratification and supplemental screening is evolving, and providers receive limited training on breast density counseling. Methods: We implemented an introductory, interactive workshop about breast density including current evidence behind supplemental screening and risk stratification. Designed for providers who counsel women on breast health, this workshop was evaluated with internal medicine providers, primary care residents, and radiology residents. We surveyed participants about knowledge and attitudes at baseline, postintervention (residents and providers), and 3-month follow-up (providers only). We compared baseline and postintervention scores and postintervention and 3-month follow-up scores using paired t tests and McNemar's tests. Results: Internal medicine providers had significant gains in knowledge when comparing baseline to postintervention surveys (6.5-8.5 on a 10-point scale, p < .0001), with knowledge gains maintained when comparing postintervention to 3-month follow-up surveys (p = .06). Primary care and radiology residents also had significant gains in knowledge when comparing baseline to postintervention surveys (p < .004 for both). All learner groups reported increases in their confidence regarding counseling women about breast density and referring for supplemental screening. Discussion: Through this breast density session, we showed trends for increased knowledge and change in attitudes for multiple learner groups. Because we aim to prepare providers with the best currently available recommendations, these materials will require frequent updating as breast density evidence and national consensus evolve.

Teaching methods in anatomy courses in North American medical schools the role of radiology.

RATIONALE AND OBJECTIVES: We sought to determine the current and anticipated future status of anatomy education in medical schools in North America, with particular emphasis on the role of radiologists and imaging in the curriculum. MATERIALS AND METHODS: A Web-based survey was sent to all schools identified using the AAMC Web site to find e-mail addresses for deans and course directors. RESULTS: Responses were obtained from approximately 50% of schools. Most courses are taught over a semester, and most are directed by anatomists. Only one is directed by a radiologist. Dissection is still the major teaching method, with radiologic anatomy averaging about 5% of total teaching time. Most directors anticipate a decrease in teaching time over the next 5 years and an increase in use of digital methods and teaching of radiologic anatomy. CONCLUSION: The role of radiologists will probably increase in future teaching of anatomy.

Using 3D Modeling Techniques to Enhance Teaching of Difficult Anatomical Concepts.

RATIONALE AND OBJECTIVES: Anatomy is an essential component of medical education as it is critical for the accurate diagnosis in organs and human systems. The mental representation of the shape and organization of different anatomical structures is a crucial step in the learning process. The purpose of this pilot study is to demonstrate the feasibility and benefits of developing innovative teaching modules for anatomy education of first-year medical students based on three-dimensional (3D) reconstructions from actual patient data. MATERIALS AND METHODS: A total of 196 models of anatomical structures from 16 anonymized computed tomography datasets were generated using the 3D Slicer open-source software platform. The models focused on three anatomical areas: the mediastinum, the upper abdomen, and the pelvis. Online optional quizzes were offered to first-year medical students to assess their comprehension in the areas of interest. Specific tasks were designed for students to complete using the 3D models. RESULTS: Scores of the quizzes confirmed a lack of understanding of 3D spatial relationships of anatomical structures despite standard instruction including dissection. Written task material and qualitative review by students suggested that interaction with 3D models led to a better understanding of the shape and spatial relationships among structures, and helped illustrate anatomical variations from one body to another. CONCLUSIONS: The study demonstrates the feasibility of one possible approach to the generation of 3D models of the anatomy from actual patient data. The educational materials developed have the potential to supplement the teaching of complex anatomical regions and help demonstrate the anatomical variation among patients.

Breast cancer screening in women previously treated for Hodgkin's disease: a prospective cohort study.

PURPOSE: Young women who are exposed to chest irradiation for Hodgkin's disease (HD) are at increased risk of breast cancer; this study investigated patient awareness of breast cancer risk and patient screening behavior and assessed the utility of mammographic screening in HD survivors. PATIENTS AND METHODS: This is a prospective cohort study of 90 female long-term survivors of HD who had been treated > or = 8 years previously with mantle irradiation (current age, 24 to 51 years). Participants completed surveys of their perceptions of breast cancer risk and screening behaviors and received written recommendations for breast examinations and mammography. Annual follow-up was conducted through medical records, telephone, and/or mailed questionnaires. RESULTS: At baseline, women were often unaware of their increased risk of breast cancer; 40% (35 of 87) reported themselves to be at equal or lower risk than women of the same age. Only 47% (41 of 87) reported having had a mammogram in the previous 24 months. Women who had received information from an oncologist were more likely to assess correctly their risk than women who received information from other sources (P <.001). Ten women developed 12 breast cancers (ductal carcinoma-in-situ [n = 2], invasive ductal carcinoma [n = 10]) during the study; two were diagnosed at study entry, and 10 during follow-up (median, 3.1 years). All cancers were evident on mammogram, and eight of 10 invasive cancers were node negative. CONCLUSION: Practitioners who care for women after HD therapy need to educate patients regarding their risks and begin early screening. Screening by mammography can detect small, node-negative breast cancers in these patients.