Acing the Fundamentals of Radiology: An Online Series for Medical Students and Interns.

PURPOSE: The current undergraduate radiology education predominantly integrates radiology with other disciplines during preclerkship years and is often taught by nonradiologists. Early exposure to radiology and profound understanding of scientific fundamentals of imaging modalities and techniques are essential for a better understanding and interest in the specialty. Furthermore, the COVID-19 pandemic-related impact on in-person medical education aggravated the need for alternative virtual teaching initiatives to provide essential knowledge to medical students. METHODS: The authors designed an online 7-session course on the principles of imaging modalities for medical students and fresh graduates in the United States and abroad. The course was delivered online and taught by radiologists from different US institutions. Pretests and posttests were delivered before and after each session, respectively, to assess change in knowledge. At the end of the course, a survey was distributed among students to collect their assessment and feedback. RESULTS: A total of 162 students and interns initially enrolled in the program by completing a sign-up interest form. An average of 65 participants attended each live session, with the highest attendance being 93 live attendees. An average of 44 attendees completed both the pretest and posttest for each session. There was a statistically significant increase in posttest scores compared with pretest scores ( P < 0.01) for each session; on average, the posttest scores were 48% higher than the pretest scores. A total of 84 participants answered the end-of-course survey. A total of 11% of the respondents described themselves as first year, 17% as second year, 18% as third year, 21% as fourth year, and 33% as "other." Attendees were enrolled in medical schools across 21 different countries with 35% of the respondents studying medicine in the United States. More than 76% of the respondents stated that they "strongly agree" that the program increased their understanding of radiology, increased their interest in radiology, and would be useful in their clinical practice in the future. Eighty-three percent of the respondents stated that they "strongly agree" that "this course was a worthwhile experience." Particularly, more than 84% of the respondents stated that among the most important components in enhancing their understanding of radiology were "the interpretation of normal imaging" and "interpretation of clinical cases." Ninety-two percent of the respondents stated that "the amount of effort to complete the requirements for this program was just right." Participants were also asked to rate each of the 8 sessions using the following scale: poor = 1 point, fair = 2, good = 3, and excellent = 4. The average rating for all 8 sessions was 3.61 points (SD = 0.55), which translates to 96% of the sessions being rated good or excellent. Eighty percent of the participants reported that the topics presented in the program were "excellent and clinically important to learn," and 20% of the participants reported that the topics presented were "good and somewhat important to learn." The participants were asked to evaluate their confidence regarding basic radiology skills before and after the program using the following scale: not confident at all = 1 point, somewhat confident = 2, moderately confident = 3, and very confident = 4. Figure 2 summarizes the responses of the participants. CONCLUSIONS: An online course to teach the fundamentals of imaging modalities could be delivered through a webinar format to medical students and interns in several countries to address the potential gaps in radiology education, therefore increasing their understanding of the different imaging modalities and their proper use in medicine.

Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons.

The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to the diagnosis and management of patients with pelvic floor conditions, but they approach, evaluate, and treat such patients with their own unique perspectives given the differences in their respective training. The PFDC was formed to bridge gaps and enable collaboration between these specialties. The goal of the PFDC is to develop and evaluate educational programs, create clinical guidelines and algorithms, and promote high quality of care in this unique patient population. The recommendations included in this article represent the work of the PFDC Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.

New Job, New Challenges: Life After Radiology Training.

OBJECTIVE: Beginning a new job after radiology training is exciting but can also be nerve-racking. The key challenge remains making the strange familiar and assimilating with the new practice as soon as possible. This process is complicated and may require learning new policies, getting to know new colleagues, adapting to new surroundings, and learning new skills. CONCLUSION: This article provides strategies to navigate professionally and adapt to a new environment.

Magnetic Resonance Enterography (MRE): The role of imaging in the management of adult patients with Crohn's disease.

Crohn's disease, an inflammatory bowel disease with devastating complications, often requires frequent imaging to detect active disease and its complications. Endoscopy, which is the gold standard for diagnosis, is contraindicated in come patients and has limited role in detecting deep submucosal/mesenteric disease, mid small bowel disease and intra-abdominal complications. Magnetic Resonance Enterography (MRE) has evolved as a complimentary non-invasive, radiation free, high resolution imaging modality in evaluating these patients, with clinical studies haveing shown MRE to help in the diagnosis and follow up of these patients. Its major advantage over CT Enterography is the absence of radiation.

Clinical orthopedic examination findings in the upper extremity: correlation with imaging studies and diagnostic efficacy.

Different orthopedic tests are used to evaluate internal derangements of joints. Radiologic examinations like magnetic resonance (MR) imaging are ordered on the basis of results of these tests to narrow the clinical diagnosis and formulate a treatment plan. Although these tests are clinically useful, the test terminology can be confusing and the significance of the tests not clearly understood. This article helps explain the clinical jargon of tests performed for the major joints of the upper extremity and their proper use and diagnostic value in conjunction with MR imaging. The article presents a structured algorithmic approach to explain the tests. For each joint, a hierarchy of clinical tests is performed, starting with general observation and range of motion, followed by more specific tests tailored to evaluate individual or grouped anatomic structures. MR imaging findings and clinical tests complement each other in making a final diagnosis. However, because of the varied sensitivity and specificity of the clinical tests and MR imaging, it is important to be familiar with their diagnostic value before making clinical decisions. Knowledge of clinical jargon and the proper use and diagnostic value of orthopedic tests can aid in interpretation of radiologic images by focusing search patterns, thus allowing comprehensive evaluation and optimized reporting. It also enhances communication with the orthopedist, thereby helping maintain continuity of care. Online supplemental material is available for this article.

Clinical orthopedic examination findings in the lower extremity: correlation with imaging studies and diagnostic efficacy.

The lower-extremity anatomy is complex and normal function is dependent on intact osteochondral, musculotendinous, and ligamentous structures. Injury may result in pain and functional limitation. Specific clinical tests are used to help isolate and define the pathoanatomy; however, their terminology may be confusing to the radiologist and the diagnostic value of these tests may not be well understood. This article presents an algorithmic approach to evaluation of the hip, knee, and ankle to improve the radiologist's understanding of lower-extremity physical examination. Knowledge of test terminology, clinical utility, and diagnostic accuracy will improve clinical and radiologic correlation. The article reviews the common clinical tests used to evaluate the lower extremity and provides an algorithm to establish a clinical examination road map and rapidly review the clinical utility and study hierarchy of a particular test. The sensitivity and specificity of the clinical tests and magnetic resonance (MR) imaging are reviewed because these parameters vary, and an understanding of the diagnostic utility of both the clinical and imaging tests is important in accurately formulating a definitive diagnosis. The structured algorithmic approach to lower-extremity examination described here, knowledge of test jargon, and familiarity with the diagnostic accuracy of the clinical and MR imaging examinations may help the radiologist focus image search patterns and provide detailed and clinically relevant reports. Online supplemental material is available for this article.

Integrated residency training leading to radiology and nuclear medicine board certification: the Arkansas experience.

The pool of qualified nuclear medicine (NM) physicians is declining as fewer choose to enter the specialty. In June 2012, we began developing an integrated categorical residency training position satisfying the requirements of both the American Board of Radiology (ABR) and the American Board of Nuclear Medicine (ABNM). Termed "NuRad," this was listed and filled in the 2013 NRMP match. We found it to be more attractive to qualified applicants than our traditional, three year NM residency. This approach may play a significant role in the future in ensuring the training of physicians expert in NM and molecular imaging.

MR imaging findings in diabetic muscle infarction.

Diabetic muscle infarction is a rare, often unrecognized complication seen in patients with poorly controlled Diabetes Mellitus. The diagnosis is often missed and leads to unnecessary invasive investigations and inappropriate treatment. The patients usually present with unilateral thigh pain and swelling. MRI typically demonstrates diffuse swelling and increased T2 signal intensity within the affected muscles. The condition is self-limiting and is treated conservatively with bed rest and analgesics. Recurrences have been reported in the same or contralateral limb. We report a case of diabetic muscle infarction with spontaneous resolution of symptoms and imaging abnormality with recurrence on the contralateral side.

Development and Assessment of Early Utilization of the Standardized Letter of Recommendation for Use in the Radiology Residency Match.

RATIONALE AND OBJECTIVES: Letters of recommendation are essential for residency applications. Traditionally, narrative letters have been used. Standardized letters of recommendation (SLOR) have been developed and have benefits to the writer and reader. The goal was to develop an informative, meaningful, and efficient SLOR for the radiology residency Match and to assess its early use. MATERIALS AND METHODS: An Association of University Radiologists (AUR) Research and Education Venture Fund Grant was awarded for the development of a SLOR for use in the radiology residency Match. Grant recipients developed the letter and modifications were based on feedback from the Alliance of Medical Student Educators in Radiology (AMSER) SLOR task force and a larger task force including additional AUR and Association of Program Directors in Radiology (APDR) members. AUR and APDR members were surveyed in 2020 to assess the radiology SLOR. RESULTS: The radiology SLOR became available for use in September 2018. It highlights the top six traits or abilities deemed most valued in a resident candidate and guides the writer to develop a concrete narrative. Top perceived benefits of the Radiology SLOR are ease of reading and interpretation. Top perceived drawbacks are an impersonal format and concerns regarding program directors' perceptions of the new SLOR. SLOR utilization increased in the second year of availability. CONCLUSION: The radiology SLOR was developed and first used in 2018. Its use increased over two years and will likely continue to increase given the perceived benefits and increasing awareness of the SLOR.

A 15-Year Analysis of International Medical Graduates Matching Into Diagnostic Radiology Residency Programs in the United States.

RATIONALE AND OBJECTIVES: To analyze the trends in international medical graduates (IMGs) matching into diagnostic radiology residency programs in the United States (US). MATERIALS AND METHODS: The National Resident Match Program data was accessed for years 2005-2020 and diagnostic radiology residency-specific data was extracted for US MD, osteopathic (DO), and IMG applicants. IMGs were categorized into US-citizen IMGs and non-US citizen IMGs per the National Residency Match Program. Variables collected for each year included the number of positions, number of applicants in each group, positions filled/unfilled, and fill rate of each group. Additional data for some years included USMLE Step 1 score, United States Medical Licensing Examination (USMLE) Step 2 clinical knowledge (CK) score, number of research experiences, number of abstracts/publications, and additional degrees obtained. Trends were analyzed using simple linear regression model and p value <0.05 was considered significant. RESULTS: The number of diagnostic radiology residency programs increased from 203 (2006) to 212 (2020). The total number of diagnostic radiology residency positions increased from 1011 (2006) to 1113 (2020), with the peak of 1145 in 2014. The overall "match rate," that is, proportion of positions filled to positions available, increased from 96.4% (2006) to 97.3% (2020), with a brief decline to 86.7% in 2015. Among the filled positions, the proportion filled by US medical school graduates significantly declined from 89.7% (2006) to 69.2% (2020) (p < 0.001), and the proportion of positions filled by osteopathic seniors and graduates significantly increased from 2.2% (2006) to 15.1% (2020; p < 0.001). The proportion of US IMGs increased from 3.2% (2006) to 5.4% (2020), while the proportion of non-US IMGs increased from 4.4% (2006) to 9.4% (2020), with overall IMG match rate increased significantly from 7.6% to 14.9% (p = 0.009). The mean Step 1 scores of US IMGs and non-US IMGs were 238 and 237.3, and the mean Step 2 CK scores were 241.67 and 241, respectively. Cumulatively over the study period, a total of 736 US IMGs and 1051 non-US IMGs have matched into diagnostic radiology residency. CONCLUSION: There is an increasing proportion of IMGs, especially the non-US citizen IMGs, matching into US radiology residency programs in the last decade. Diagnostic radiology remains a competitive specialty evidenced by average USMLE scores higher than national average and research experiences of matched candidates.

Imaging After Locoregional Therapy for Hepatocellular Carcinoma with Emphasis on LIRADS Treatment Response Assessment Criteria.

Radiologists play an essential role in assessing hepatocellular carcinoma treatment response and help guide further clinical management of patients. Interpretation of treatment response after locoregional therapy is challenging. The post-treatment imaging findings vary and depend on the type of treatment, the degree of treatment response, time interval after treatment and several other factors. Given the widespread use of local-regional therapies, understanding the appearance of treated lesions has become crucial to allow for a more accurate interpretation of post-treatment imaging. Several response criteria including the recently introduced Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA) are currently used to assess treatment response. This review article describes the imaging assessment of HCC treatment response after several locoregional therapies using various response assessment criteria, emphasizing the LI-RADS treatment algorithm.

Imaging After Locoregional Therapy for Hepatocellular Carcinoma With Emphasis on LIRADS Treatment Response Assessment Criteria.

The Liver Imaging Reporting and Data System (LI-RADS) is a set of algorithms designed to provide a standardized, comprehensive framework for the interpretation of surveillance and diagnostic imaging in patients at high risk for hepatocellular carcinoma. LI-RADS is the result of a multidisciplinary collaboration between radiologists, hepatologists, hepatobiliary surgeons and pathologists and has recently been incorporated into the practice guidelines for the American Association for the Study of Liver Diseases (AASLD) and made congruent with the Organ Procurement and Transplantation Network (OPTN) criteria. This manuscript illustrates the common ultrasound, computed tomography, and magnetic resonance imaging appearances of hepatocellular carcinoma and describes how these findings can be properly categorized using the LI-RADS system.

A Late Presentation of COVID-19 Vaccine-Induced Myocarditis.

With the introduction of the coronavirus disease 2019 (COVID-19) mRNA vaccines, the incidence of severe infection has significantly decreased. While the vaccines have been shown to be effective and safe, there have been few case reports of acute myocarditis within 3-5 days following the second dose of the vaccine. We report a case of an elderly man who presented with acute-onset chest pain after three months of receiving the second dose of the mRNA vaccine. He was found to have acute myocarditis on cardiac magnetic resonance imaging (CMRI), which was attributed to exposure to the COVID-19 vaccine in the absence of any other risk factors. Our patient demonstrated quick resolution of symptoms and was discharged within 72 hours. We review the literature and summarize published case reports on COVID-19 vaccine-associated myocarditis. The present case report provides new evidence regarding the possible subacute presentation of myocarditis post-COVID-19 vaccine, and further highlights the favorable outcome in this newly described clinical entity.

Coronary-Cameral Fistula, Thebesian Veins, and Anomalous Coronary Vein on Cardiac Computed Tomography.

A 63-year-old female with a history of hypertension presented with progressively worsening shortness of breath. She underwent a cardiac catheterization and was found to have prominent Thebesian veins as well as anomalous connections between the proximal right coronary artery and the right ventricle. Cardiac computed tomography was ordered for further evaluation and showed a coronary fistula to the right ventricular outflow tract confirming the diagnosis of a coronary-cameral fistula (CCF). CCF are rare congenital anomalous communications that occur between coronary arteries and a cardiac chamber. They are usually an incidental finding and patients are rarely symptomatic. As the use of coronary computed tomography angiography is rapidly expanding, the detection of CCF will likely increase in the general population.

Meshy business: MRI and ultrasound evaluation of pelvic floor mesh and slings.

Pelvic floor disorders are a complex set of conditions including but not limited to stress urinary incontinence and pelvic organ prolapse that generally affect older and multiparous women. Of the several surgical options available for treatment of these conditions, synthetic mid-urethral slings for stress urinary incontinence and vaginal mesh for pelvic organ prolapse are amenable to imaging evaluation by ultrasound and magnetic resonance imaging techniques. Ultrasound can evaluate the sub- and immediate peri-urethral portions of sling due to its ability to differentiate synthetic material from native tissues with real-time imaging, while MRI is able to better depict the global pelvic floor anatomy and assess the more distant components of mesh and slings material. Given the high prevalence of pelvic floor disorders and complications after surgical repair, it is important that radiologists familiarize themselves with normal and abnormal imaging findings after these procedures. This article provides a review of the spectrum of imaging findings in patients after pelvic floor repair with synthetic mid-urethral slings and vaginal mesh.

Pelvic floor imaging with MR defecography: correlation with gynecologic pelvic organ prolapse quantification.

PURPOSE: Pelvic organ prolapse (POP) is assessed differently by gynecologists and radiologists. It is clinically staged by physical examination using the POP-Q (Pelvic Organ Prolapse Quantification) system and radiologically staged by modalities such as by Magnetic Resonance Defecography (MRD). The purpose of this study was to correlate the two methods of staging pelvic organ prolapse for each pelvic compartment by comparing correlative anatomic points and differences in technique. This understanding will help synthesize information from two different perspectives and bridge the gap between multiple specialists who participate in the care of patients with complex pelvic floor disorders. METHODS: A retrospective single institution study comparison of patients who underwent both dynamic magnetic resonance pelvic floor imaging and pelvic organ prolapse quantification (POP-Q) at our medical center was done. Two urogynecologists performed the POP-Q and one fellowship-trained radiologist interpreted the MRD and both staged pelvic organ prolapse independently. RESULTS: A total of 280 patients underwent magnetic resonance imaging (MRI) of the pelvic floor from 1/2013 to 12/2017, of whom 68 met our inclusion criteria. When compared to POP-Q, MRI has strong, moderate, and weak correlation for quantification of anterior, middle, and posterior compartment prolapse, respectively. POP-Q measurements Aa, Ba, C, and D are analogous to true pelvic anatomical landmarks which are directly and consistently measurable by MRI, hence accounting for the better correlation in anterior and middle compartments when compared to measurements Ap and Bp which do not correlate with true anatomical landmarks, and hence can explain the weak correlation for posterior compartment prolapse. CONCLUSION: When comparing POP-Q to MRI, anterior and middle compartment prolapse have better correlation than posterior compartment prolapse. Inherent differences that exist in technique and anatomic landmarks used for staging pelvic organ prolapse by clinical exam and imaging criteria account for this. MRD, however, still provides anatomic details on static images, real time simultaneous overview of multi-compartmental prolapse, characterizes contents of cul-de-sac hernias and rectal evacuation on dynamic imaging. Corroborative information derived from both methods of staging organ will result in optimum patient care.

Diagnostic Radiology Residency Program Director Workforce in the United States: A Descriptive Analysis.

PURPOSE: To investigate and describe the demographics, academic background, and scholarly activity of Diagnostic Radiology (DR) residency program directors in the United States. METHODS: A list of all DR residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and corresponding program directors (PD) was obtained from ACGME website. Information about each PD was obtained from publicly available sources including program websites, Healthgrades and Doximity. Demographic and academic data including age, sex, educational background, subspecialty, tenure, interval between residency completion and appointment as PD, terms served, additional degrees, academic rank, prior leadership positions and metrics of scholarly activity were recorded. Nonparametric statistics including Mann-Whitney U and Kruskal-Wallis tests were applied to compare differences between groups. Results are considered statistically significant at p < 0.05. RESULTS: A total of 197 PDs were included in the study of which 139 (70.6%) were male. Average age of PDs was 47.56 years (SD 8.29, median 45, range 35-77). There was no significant difference in median age of male vs female PDs (45 vs 44.5, p = 0.655). Majority of PDs attended American medical schools (181/197, 91.9%), and 16/197 attended international medical schools. Nine PDs received DO degrees (9/197, 4.6%). Academic rank was available for 137 PDs, of which 4 (2.9%) were instructors, 63 (46.0%) were assistant professors, 47 (34.3%) were associate professors and 23 (16.8%) were professors. Fellowship information was available for 183 PDs, of which the most common subspecialties were neuroradiology (24.5%), musculoskeletal radiology (15.8%), abdominal radiology (10.3%), and interventional radiology (9.8%). Female PDs had a significantly higher median publications (13.5 vs 6.0, p = 0.003), median citations (133 vs 37, p = 0.19) and median h-index compared to male PDs (6 ± 3, p = 0.005). CONCLUSION: Radiology PDs are mostly males who graduated from US allopathic medical schools. Female PDs had significantly higher scholarly metrics compared to male PDs. Twenty three percent PDs were appointed in the last 1 year.