Bespoke video vignettes - an approach to enhancing reflective learning developed by dental undergraduates and their clinical teachers.

This study explores the selective use of video as a medium to support reflective processes as related to dental undergraduate learning. With the objective of developing and enhancing high-quality adult dental care, the use of compiled video materials created in an undergraduate clinical setting was investigated. Video cameras were used to capture elements of reflection-in-action and reflection-on-action typically found during everyday clinical practice. 'Gold standard' or 'textbook outcomes' are rarely, if ever, fully achieved in dental practice. Real-life clinical experiences offer challenges and opportunities for both teachers and students to engage with reflective learning processes. The materials generated allowed for an experience of individual reflective learning and the creation of a data bank or archive with potential use for the benefit of a wider student cohort. Various aspects of the students' views and comments on the process of reflection were reported and explored by means of a semi-structured focus group moderated by a linked educational advisor.

Invasive aspergillosis in the setting of cardiac transplantation.

Among patients undergoing heart transplantation, Aspergillus is the opportunistic pathogen with the highest attributable mortality. The median time of onset from transplantation for invasive pulmonary aspergillosis (IPA) was 46 days, but the median time to first positive culture result was 104 days among patients with Aspergillus colonization but no invasive disease. Most patients with IPA presented with fever and cough within the first 90 days of transplantation and with single or multiple pulmonary nodules. None of the heart transplant recipients with either IPA or invasive extrapulmonary aspergillosis (IEPA) had associated neutropenia. Human leukocyte antigen A1 locus was found significantly more frequently among patients colonized with Aspergillus than among patients with IPA (P<.006) or IEPA (P<.001). Even in the absence of neutropenia, IPA should be suspected for heart transplant recipients who have fever and respiratory symptoms within the first 3 months of transplantation, have a positive result of culture of respiratory secretions, and have abnormal radiological findings (particularly nodules).

Assessment of pulmonary lesions with 18F-fluorodeoxyglucose positron imaging using coincidence mode gamma cameras.

UNLABELLED: Accurate assessment of lung carcinoma remains a significant clinical problem, often leading to surgical procedures without curative potential. PET with 18F-fluorodeoxyglucose (FDG) has shown promise in differentiating benign from malignant lesions and in staging the extent of disease, resulting in improved treatment at a significant cost savings. This multicenter prospective study used dual-detector coincidence imaging with FDG to categorize pulmonary lesions as benign or malignant. The goal of this study was to determine the sensitivity and specificity of dual-detector coincidence imaging of FDG in patients with pulmonary lesions who were scheduled to have a diagnostic procedure for histopathologic confirmation. METHODS: A total of 96 patients with pulmonary lesions with a lesion size ranging from 1 to 7 cm with a mean of 3.44 cm based on their chest radiograph or CT scan were studied using FDG scans with a dual-detector coincidence detection system. An additional 24 patients were entered as control subjects. The studies of 120 subjects were interpreted in random order by three physicians experienced in the use of FDG in patients with lung cancer. Surgical pathology was used as the standard for identifying malignant lesions. RESULTS: There was 94% agreement between the readers in the independent interpretation of the FDG studies. In the 96 patients with pulmonary lesions, FDG studies were 97% sensitive and 80% specific in identifying proven malignant lesions. CONCLUSION: The results of this prospective study provide evidence that dual-detector coincidence imaging with FDG provides an accurate, sensitive and specific means of diagnosing malignancy in patients with pulmonary lesions.

Bronchiolitis obliterans after lung transplantation: detection using expiratory HRCT.

OBJECTIVE: The objective of this study was to determine if air trapping, as detected on expiratory high-resolution CT (HRCT), is useful as an indicator of bronchiolitis obliterans (BO) in lung transplant recipients. MATERIALS AND METHODS: Corresponding inspiratory and expiratory HRCT images at five different levels and spirometry were obtained in 21 lung transplant recipients. Eleven patients had BO proved by transbronchial biopsy specimens; the remaining 10 patients had no pathologic or functional evidence of airways disease. Two "blinded" observers assessed the inspiratory images for the presence of bronchiectasis and mosaic pattern of lung attenuation, and the expiratory images for presence and extent of air trapping. Statistical comparison of the frequency of HRCT findings between patients with and without BO was performed using Fisher's Exact Test. RESULTS: On inspiratory images, bronchiectasis and mosaic pattern of lung attenuation were present in 4 (36%) and 7 (64%) of 11 patients with BO, and 2 (20%) and 1 (10%) of 10 patients without BO (p>0.05 and p<0.05), respectively. The sensitivity, specificity, and accuracy of bronchiectasis and mosaic pattern for BO were 36%, 80%, and 57%, and 64%, 90%, and 70%, respectively. On expiratory images, air trapping was found in 10 of 11 (91%) patients with BO compared to 2 of 10 (20%) patients without BO (p<0.002). Air trapping was found to have a sensitivity of 91%, specificity of 80%, and accuracy of 86% for BO. Air trapping was identified in one patient with BO who had normal results of baseline spirometric function tests. CONCLUSION: Air trapping, as detected on expiratory HRCT, was the most sensitive and accurate radiologic indicator of BO in the lung transplant population.

CT of noninfectious granulomatous lung disease.

Noninfectious granulomatous diseases of the lung consist of a diverse group of disorders that logically can be subdivided into those with and without associated vasculitis. This article reviews the epidemiologic, clinical, pathologic, and radiologic features of sarcoidosis, hypersensitivity pneumonitis, berylliosis, and the five entities traditionally classified as pulmonary angiitis and granulomatosis.

Radiology of pneumonia.

Chest radiography is the imaging technique of choice in evaluating patients with suspected pneumonia because of its low radiation dose, low cost, and wide accessibility. In daily practice, radiographs are used to confirm the clinical diagnosis of pneumonia, characterize the extent and severity of disease, search for complications such as empyema, monitor the response to therapy, and examine for possible alternative or additional diagnoses. Although CT scan has no defined role in the routine assessment of patients with either community-acquired or nosocomial pneumonias, its advantages of superior contrast resolution and cross-sectional display can often be helpful in the analysis of complex cases, particularly when radiographic evidence of associated central obstruction, cavitation, lymphadenopathy, or empyema is equivocal. In the immunocompromised patient population, high-resolution CT has been shown to be more sensitive than plain film radiography in the early detection of pulmonary infections.

MRI of pulmonary embolism using Gd-DTPA-polyethylene glycol polymer enhanced 3D fast gradient echo technique in a canine model.

This study was to evaluate the accuracy of MR angiography (MRA) using a Gd-DTPA-polyethylene glycol polymer (Gd-DTPA-PEG) with a 3D fast gradient echo (3D fgre) technique in diagnosing pulmonary embolism in a canine model. Pulmonary emboli were created in six mongrel dogs (20-30 kg) by injecting tantalum oxide-doped autologous blood clots into the femoral veins via cutdowns. MRI was performed with a 1.5 T GE Signa imager using a 3D fgre sequence (11.9/2.3/15 degrees) following intravenous injection of 0.06 mmol Gd/kg of Gd-DTPA-PEG. The dogs were euthanized and spiral CT of the lungs were then obtained on the deceased dogs. The MRI images were reviewed independently and receiver-operating-characteristic (ROC) curves were used for statistical analysis using spiral CT results as the gold standard. The pulmonary emboli were well visualized on spiral CT. Out of 108 pulmonary segments in the six dogs, 24 contained emboli >2 mm and 27 contained emboli < or = 2 mm. With unblinded review, MRI detected 79% of emboli >2 mm and only 48% of emboli < or = 2 mm. The blinded review results were significantly worse. Gd-DTPA-PEG enhanced 3D fgre MRI is potentially able to demonstrate pulmonary embolism with fairly high degree of accuracy, but specialized training for the interpretations will be required.

A model for faculty mentoring in academic radiology.

RATIONALE AND OBJECTIVES: The purpose of this report is to describe the development and implementation of a faculty mentoring program in radiology designed to promote the career development of junior faculty and enhance communication in the department. MATERIALS AND METHODS: The mentoring program was implemented in five stages: organizational readiness, participant recruitment, mentor matching and orientation, implementation, and evaluation. Evaluations were based on Likert scale ratings and qualitative feedback. A retrospective analysis was also conducted of the annual performance reviews of junior faculty in the areas of research, teaching, patient care, and overall performance. RESULTS: An average of 83% (19 of 23) of the junior faculty participated in the pilot phase of the mentoring program. During five rounds of testing, the median rating (1 indicates not important; 10, extremely important) from responding junior faculty was 10 for overall value of individual mentoring meetings; the median rating for the mentors responding was 8.75. Research and academic development were identified as the areas of greatest importance to the faculty. Research and patient care were most improved as assessed by faculty peers during performance reviews. The schedule of semiannual formal mentoring meetings was reported to be optimal. CONCLUSION: The program was implemented to the satisfaction of junior faculty and mentors, and longitudinal performance suggests positive effects. Issues to be contended with include confidentiality and the time needed for mentoring beyond already saturated schedules. Overall, the authors propose that mentoring programs can be an asset to academic radiology departments and a key factor in maintaining their vitality.

Spiral CT of the thorax in daily practice: optimization of technique.

Effective utilization of spiral computed tomography (CT) technology in imaging of the thorax requires an understanding of technical parameters that affect image and scan quality. This article discusses how operator-controlled scan parameters can be optimized to achieve diagnostic and cost-effective examinations appropriate for daily clinical practice.

Radiologic findings: pulmonary infections after bone marrow transplantation.

Pulmonary infections are a significant source of morbidity and mortality in the bone marrow transplant population. This pictorial essay reviews the typical time period and imaging findings associated with common pulmonary pathogens that affect bone marrow transplant recipients.

Primary bronchogenic carcinoma after heart or lung transplantation: radiologic and clinical findings.

Chronic immunosuppression in organ transplant recipients predisposes to the development of malignant disease. The authors describe their 29-year institutional experience of bronchogenic carcinoma developing after heart and lung transplantation. Seven cases of bronchogenic carcinoma were diagnosed in 1,119 heart and lung transplant recipients. Computed tomography scans and radiographs at time of diagnosis, as well as prior radiographs available in six patients were retrospectively analyzed by two radiologists in consensus. The seven cases involved six heart and one lung transplant recipients. Six patients were smokers with a mean smoking history of 66 pack-years. Mean time interval from transplantation to cancer detection was 25 months. Radiologic findings consisted of a solitary pulmonary nodule (n = 3), mass with satellite nodules (n = 1), and obstructive pneumonitis (n = 1). In the sixth patient, the cancer was not radiographically visible because of obscuration by adjacent fibrosis. On review, radiographic abnormalities were present a mean of 12 months prior to diagnosis in 66% of patients. In the heart or lung transplant population, bronchogenic carcinoma develops in recipients with extensive smoking histories. It presents radiographically as a nodule, mass, or obstructive pneumonitis, and is usually visible on radiographs before the time of diagnosis.

Primary malignant pulmonary hemangiopericytoma.

A primary malignant pulmonary hemangiopericytoma was diagnosed in a 45-year-old woman who complained of 10 months of cough and exertional dyspnea. One year after resection of the mass, a metastatic lesion was removed from the contralateral lung. The literature on this unusual pulmonary lesion is reviewed.

Clinics in diagnostic imaging (27). Sarcoidosis.

A 44-year-old Caucasian man presented with third-degree heart block. Chest radiograph and high-resolution computed tomography (HRCT) of the thorax showed mediastinal and bilateral hilar lymphadenopathy associated with a diffuse, bilateral micronodular pattern. The HRCT findings and differential diagnosis of sarcoidosis are reviewed.

Why do general dental practitioners become involved in clinical teaching? A pilot study exploring the views of part-time practitioner teachers, King's College London.

INTRODUCTION: Dental schools in the United Kingdom are becoming increasingly reliant on the services of part-time teachers to deliver the clinical educational component of the dental course. Their background is predominantly from general dental practice but the opportunities to progress in the system are limited. The aim of this study was to ascertain the views and perceptions of such teachers at a dental school. MATERIALS AND METHODS: An anonymous, non-incentivised online survey was used to obtain both qualitative and quantitative views of the part timers. RESULTS: The department has n = 40 part-time teachers and there was a response rate of 78%. Overall 73% were satisfied with their current teaching position, whereas the remaining 27% of teachers were seeking higher rewards both in terms of recognition and status. CONCLUSIONS: This study demonstrated the need for formal teaching skills and training to be made available to part-time clinical teachers. Allied to this is the requirement for a clearly defined and achievable career pathway.

Perceptions of a simulated general dental practice facility - reported experiences from past students at the Maurice Wohl General Dental Practice Centre 2001-2008.

UNLABELLED: This article assesses the perceived value of a simulated general dental practice centre as reported by past undergraduates over five years. Various aspects of teaching and related outcomes are explored based on responses received from anonymous questionnaires. A team based approach to cooperative learning led by current practitioners experienced in primary dental care was seen as pivotal to the huge success of the teaching model. Moreover the role of cooperative learning and its influence on building individual clinical confidence and acumen was considered highly beneficial as part of the transition from novice to expert. METHODOLOGY: An anonymous questionnaire was distributed to students six months after qualification for a period of five years. The last registered postal address held by the Institute was used for this purpose. The years surveyed were: 2001-2002, 2002-2003, 2003-2004, 2005-2006 and 2007-2008. The questionnaire provided for both qualitative aspects of feedback and a quantitative representation of the overall perception of effectiveness of the General Dental Practice Centre, as expressed by a visual analogue scale. RESULTS: In total 135 questionnaires were returned representing a return rate of 53%. From the responses received 99% of the students reported that they enjoyed their sessions at the Centre with 96% expressing satisfaction with the teaching regime. The mean visual analogue scale rating the centre overall was reported as 83%, with a year on year increase ranging from 76-92%. Rich qualitative data were derived from free text responses. CONCLUSION: A simulated general dental practice centre was highly rated by past dental students in terms of the overall learning experience received and its relevance to later vocational training. By far the most consistently reported attribute was the opportunity to practise close support four handed dentistry with a nurse. Training in practice management and organisational skills were viewed as important with effective teamwork and a friendly environment seen as conducive to building up knowledge and confidence. The role of experienced current primary care practitioners as teachers was seen to be very effective in this setting.

Radiographic appearance of central venous catheters.

Central venous catheters (CVCs) are defined as venous access devices whose tips terminate in the superior or inferior vena cava, regardless of insertion site. CVCs allo reliable, painless, and repeated entry into the venous system and are commonly used for the administration of IV therapy, parenteral nutrition, and blood products as well as for the periodic blood sampling, hemodynamic monitoring, and hemodialysis. Catheter composition and design vary and depend on the duration of intended use and specific functions required. The purpose of this essay is to illustrate commonly used catheters, discuss factors governing catheter selection, and review important catheter-related complications.

Parenchymal opacification in chronic infiltrative lung diseases: CT-pathologic correlation.

To correlate areas of parenchymal opacification on thin-section computed tomographic (CT) scans with histologic findings in patients with chronic infiltrative lung disease, the CT and histologic findings were evaluated in 29 patients with 11 such diseases. Open-lung biopsy was performed after CT. The area of predominant involvement was classified as air space, interstitium, or a mixture of both. A pathologic score of disease activity was assigned, and the extent of fibrosis was assessed whenever fibrosis was present. Parenchymal opacification on CT scans corresponded to abnormalities that affected mainly the air spaces in three patients (10%), the interstitium in 13 patients (45%), or both to a similar degree in 13 patients (45%). In 25 of 29 patients (86%), parenchymal opacification was associated with potentially treatable or reversible disease. Abnormalities considered irreversible were seen in three patients with end-stage fibrosis and one patient with talcosis. Parenchymal opacification on thin-section CT scans is a nonspecific finding in diseases that affect the air spaces, interstitium, or both but usually indicates potentially treatable or reversible disease.

CT in differential diagnosis of diffuse pleural disease.

The CT features of benign and malignant pleural diseases have been described. However, the accuracy of these features in the differential diagnosis of diffuse pleural disease has not been assessed before. Without knowledge of clinical or pathologic data, we reviewed the CT findings in 74 consecutive patients with proved diffuse pleural disease (39 malignant and 35 benign). The patients included 53 men and 21 women 23-78 years old. Features that were helpful in distinguishing malignant from benign pleural disease were (1) circumferential pleural thickening, (2) nodular pleural thickening, (3) parietal pleural thickening greater than 1 cm, and (4) mediastinal pleural involvement. The specificities of these findings were 100%, 94%, 94%, and 88%, respectively. The sensitivities were 41%, 51%, 36%, and 56%, respectively. Twenty-eight of 39 malignant cases (sensitivity, 72%; specificity, 83%) were identified correctly by the presence of one or more of these criteria. Malignant mesothelioma (n = 11) could not be reliably differentiated from pleural metastases (n = 24). We conclude that CT is helpful in the differential diagnosis of diffuse pleural disease, particularly in differentiation of malignant from benign conditions.

Chronic diffuse infiltrative lung disease: comparison of diagnostic accuracy of high-resolution and conventional CT.

We compared the accuracies of high-resolution CT (HRCT) and conventional CT in determining the specific diagnoses in 75 consecutive patients with chronic diffuse infiltrative lung disease. Without knowledge of clinical or pathologic data, two reviewers independently assessed three separate sets of CT scans in random order: three HRCT scans, three 10-mm collimation CT scans obtained at the same levels as the HRCT scans, and a complete conventional CT scan. The HRCT scans were obtained at the level of the aortic arch, tracheal carina, and 1 cm above the right hemidiaphragm by using 1.5-mm collimation and a high spatial resolution algorithm. Observers gave the most likely diagnosis along with their degree of diagnostic confidence. The correct diagnosis, irrespective of confidence level, was reached with 71% of the HRCT scans and with 72% of both the corresponding 10-mm and complete conventional CT scans. Confidence level 1 (definite) was reached with 49% of HRCT scans, 31% of corresponding 10-mm scans, and 43% of complete conventional CT examinations; the correct diagnosis was made in 92%, 96%, and 94% of those examinations, respectively. In none of the patients were findings on the limited HRCT scan normal when findings on the conventional CT scan were abnormal. We conclude that in most patients with chronic infiltrative lung disease a specific diagnosis can be made by obtaining a limited number of HRCT scans.