Cinematic rendering in the evaluation of complex vascular injury of the lower extremities: how we do it.

Lower extremity trauma is one of the most common injury patterns seen in emergency medical and surgical practice. Vascular injuries occur in less than one percent of all civilian fractures. However, if not treated promptly, such injuries can lead to ischemia and death. Computed tomography angiography (CTA) is the non-invasive imaging gold standard and plays a crucial part in the decision-making process for treating lower extremity trauma. A novel, FDA-approved 3D reconstruction technique known as cinematic rendering (CR) yields photorealistic reconstructions of lower extremity vascular injuries depicting clinically important aspects of those injuries, aiding in patient workup and surgical planning, and thus improving patient outcomes. In this article, we provide clinical examples of the use of CR in evaluating lower extremity vascular injuries, including the relationship of these injuries to adjacent osseous structures and overlying soft tissues, and its role in management of lower extremity trauma.

Corrigendum to: 'CT of a pulmonary artery intimal sarcoma: A case report' [Radiology Case Reports 18 (2023) 3840-3843].

[This corrects the article DOI: 10.1016/j.radcr.2023.08.029.].

The gap year for college students interested in medicine: Can they contribute to your mission?

Gap years taken between undergraduate completion and entrance into medical school have become increasingly popular. We examine the role of gap years among college graduates interested in medicine and how they might contribute to academic research productivity within clinical environments. Recently, academic faculty have struggled to balance increasing clinical responsibilities with their scholarly endeavors. Academic medical departments may have incentives to hire pre-medical students to help ease the research burden on faculty. Properly motivated pre-medical students may view research positions in academic medical departments as ideal opportunities to learn in areas that will broaden their scientific knowledge and help prepare them for medical school, while greatly enhancing their medical school applications through distinguishing themselves as co-authors published in medical journals. Our experience, with two co-authors working as research associates while preparing for their medical school applications and careers, suggests that pre-medical students can strengthen their medical school applications during their gap year(s) while proving instrumental in enhancing research output thus alleviating the workload of clinical faculty.

CT of a pulmonary artery intimal sarcoma: A case report.

Pulmonary artery intimal sarcomas are rare, malignant tumors often associated with poor prognoses. These highly lethal tumors are difficult to distinguish given their nonspecific symptoms and challenging imaging interpretations, often being misdiagnosed as acute or chronic pulmonary embolisms, tumor emboli, or mediastinal masses. Given the poor survival rate associated with this malignancy and surgical resection is the absolute choice of treatment, early and accurate diagnoses are essential. In this article, we report the case of a 78-year-old female who was diagnosed with a pulmonary artery intimal sarcoma. We focus on optimizing diagnosis and management through the application of radiological imaging modalities, specifically computed tomography angiography scans.

Solving Problems Due to Hurricane Maria and COVID-19: CT Trends in Puerto Rico Before, During, and Beyond Public Health Crises.

Our objective was to evaluate the impact of recent public health crises on radiology CT services in Puerto Rico. We gathered and analyzed CT statistics from 2 of Puerto Rico's major private hospital groups and obtained monthly data from January 2016 to March 2021. We quantified short- and long-term impacts of Hurricane Maria (September 2016-August 2017, September 2017-August 2018, September 2018-August 2019) and COVID-19 (April 2019-March 2020, April 2020-March 2021) by calculating month-to-month and year-to-year percentage differences for each hospital and all hospitals combined for the dates leading up to, in the immediate aftermath, and following these major events. Despite short-term effects throughout September from Hurricane Maria, there were no noticeable year-to-year differences in the total number of CT studies performed. Both March and April 2020 highlighted the instantaneous impact caused by COVID-19; these months contributed less than 6% of the total yearly scans performed between April 2019 and March 2020 and April 2020-March 2021 for all the hospitals individually. Hurricane Maria exerted a short-term impact on CT studies performed throughout September 2017. COVID-19 also demonstrated immediate yet prolonged effects on the number of CT studies performed with all 3 hospitals reporting decreases between a full pandemic year and the year prior. Our results support fortifying medical and societal infrastructure to better prepare for future natural and public health disasters, particularly in Puerto Rico and similarly resourced areas, to maintain steady, if somewhat diminished, radiology services such as CT for regular and emergency purposes.

CT of malignant peripheral nerve sheath tumor.

Malignant peripheral nerve sheath tumors are soft tissue sarcomas that typically arise from a neurofibroma. Patients with neurofibromatosis type 1 represent approximately half of the population diagnosed with these tumors. This autosomal-dominant genetic disorder is distinguished by loss-of-function mutations in the neurofibromin 1 gene, which ultimately promotes atypical cellular proliferation. These biologically aggressive tumors are associated with a poor prognosis as they are resistant to available therapies and have high rates of recurrence, progression, and mortality. In this article, we report the case of a 45-year-old male with a history of neurofibromatosis type 1 who was diagnosed with a malignant peripheral nerve sheath tumor. We focus on optimizing diagnosis and treatment through the application of radiological imaging modalities, including cinematic rendering.

CT of Castleman disease in the mediastinum.

Castleman disease is a rare lymphoproliferative disease commonly occurring as a benign localized mass of lymph nodes in the mediastinum. Given that Castleman disease presents as asymptomatic or through non-specific thoracic symptoms, detection is considered complex. Ultimately, surgical resection is the preferred course of action with a greater than 90% relapse-free survival and no malignant transformation reported. In this article, we describe the case of a 34-year-old male with an unclear smoking history who was diagnosed with hyaline-vascular Castleman disease. We focus on optimizing diagnosis and management through the application of radiological imaging modalities, including computed tomography scans.

From medical school through residency applications: Puerto Ricans may face ignorance and prejudice.

It is not that unusual to find that Americans are unaware that Puerto Rico is a territory of the United States, and, like them, Puerto Ricans are U.S citizens enjoying the same liberties, freedoms, and rights. It may be less expected to face such incognizance or ignorance within the medical community as careers in medicine offer healthcare professionals the opportunity to serve patients spanning race, ethnicity, gender, sexual orientation, religion, and other demographic differences. Unfortunately, some of the personal experiences of the primary author have prompted us to cull four personal narratives of Puerto Rican individuals (Boricuas), who comprise 20.8% of the Hispanic, Latino, or Spanish Origin applicants to U.S. medical schools, during various early stages of a medical career. Of course, these personal anecdotes, offered in response to just a few general questions about recent experiences of bias in medical applications or in early training, do not indicate pervasive bias. Similarly, these instances may be more common than people in the medical community would prefer to believe. In the brief narratives that follow, Boricuas at different junctures in their medical educations highlight the bias that they have faced and their reactions to it. We present this information with the hope of promoting awareness of potential biases at different stages of medical education.

Corrigendum to "Response to letter to the editor Re: Case report CT of rhabdomyolysis as a sequela of drug abuse" [Radiology Case Reports 18 (2023) 729].

[This corrects the article DOI: 10.1016/j.radcr.2022.11.028.].

CT of pancreatic schwannoma.

Schwannomas are a type of nerve sheath tumor formed by Schwann cells. They typically occur in the head and neck area, the trunk, and flexor surfaces of the upper and lower extremities. Schwannomas are often benign, and pancreatic schwannomas are extremely uncommon. Given the rarity of these tumors and their clinical similarity to other pancreatic lesions, however, pancreatic schwannomas are challenging to diagnose preoperatively. In this article, we report the case of a 69-year-old female who was diagnosed with a pancreatic schwannoma. We focus on optimizing diagnosis and management through the application of radiological imaging modalities, specifically computed tomography scans with cinematic rendering.

A Primer on the Role of iPhone Apps in Medical and Radiology Education and How to Develop Them.

Among the numerous innovations implemented in medical education since the beginning of the 21st century, small-group learning experiences have worked well for modern students and the application of computer technology provided access to thousands of lectures, images, and slides via the internet. This has helped to build an electronic foundation on which further educational adaptations have arisen in the current era, coupled with the altered communications landscape represented by Apple's introduction of the iPhone and Google's subsequent entrance onto the playing field. With the advent of smartphone applications (apps), education has taken on an even more personalized approach. Data show that the use of educational apps has been embraced by today's nursing and medical students, notably including radiology students. We survey recent research on the use and desirability of medical apps and offer practical tips for those ready to embark on developing medical, particularly radiology, educational apps including how to assess and hone them for optimal use.

Which Types of Facebook Posts Yield the Best Response for Radiology Education: A One-Year Analysis of What We Learned.

RATIONALE AND OBJECTIVES: We post several times daily on our Facebook page, CTisus, to educate radiology students and professionals globally. We aimed to determine how our data compared for different types of posts and ascertain the popularity of videos versus case images, illustrations versus case images, and whether cinematic rendering performed better than traditional computed tomography. MATERIALS AND METHODS: We exported data for one year's worth of Facebook posts (November 1, 2020 to October 31, 2021) and categorized posts into 18 types. Our primary outcome was popularity of each post, measured by "reach" and "engagement" counts provided by Facebook. RESULTS: Among the 9057 posts exported, "just for fun" posts performed the best, followed by quiz images. Case images performed significantly better than instructional videos (p < 0.0001). However, the opposite was true for engagement, where instructional videos performed significantly better than case images (p = 0.0012). For both reach and engagement, case images performed better than medical illustrations (p < 0.0001). For both reach (p < 0.0005) and engagement (p < 0.0001), traditional computed tomography performed significantly better than cinematic rendering. All video types had better engagement than case images and medical illustrations (p < 0.0001) and both had significantly better engagement than text (p < 0.0001). CONCLUSION: Our results may help other educators choose what types of content to create and post on social media to achieve the best impact on learners.

Colorectal leiomyosarcoma: A case report.

Leiomyosarcomas are rare aggressive smooth muscle tumors that represent 0.1% of all colorectal malignancies. The lack of literature available concerning leiomyosarcomas presents a challenge when diagnosing and treating these tumors, thus it is crucial that we differentiate them from gastrointestinal stromal tumors (GIST), the most common type of mesenchymal neoplasms of the gastrointestinal (GI) tract, especially when considering leiomyosarcoma's high prevalence of recurrence and malignancy. In this article, we present a case of a 74-year-old male with a diagnosis of colonic leiomyosarcoma. We analyze the tumor's CT imaging findings as well as correlation with the patient's pathological findings including immunostains, size, and mitotic activity, as well as the patient's risk for recurrence.

Distinct cases of gangliocytic paraganglioma in the duodenum: Two case reports.

Gangliocytic paraganglioma (GP) is a rare, benign neuroendocrine tumor that commonly arises in the second portion of the duodenum. Despite its favorable prognosis, there have been instances of lymph node and liver metastasis as well as 1 reported fatal case. The immunohistochemical and morphological resemblance between GP and neuroendocrine tumor G1 makes it critical to properly recognize and differentiate between the 2. In this article, we present 2 distinct cases of GP: a 70-year-old male with a GP tumor in the ampulla, and a 46-year-old male with a GP near the ampulla whose tumor was excised using a robotic Whipple procedure. We focus on optimizing diagnosis and management through the application of radiological modalities and pathological analysis.

Wandering spleen with torsion and infarction: A case report.

Wandering spleen, also known as ectopic spleen, is a rare condition in which the spleen's anatomical location is other than its fixed position in the abdomen's left upper quadrant. The cause of such an abnormality could be due to congenital or acquired factors, which could ultimately lead to torsion and splenic infarct. Given the nonspecific clinical symptoms and the potential complications associated with wandering spleen, computed tomography scans provide a crucial means for proper diagnosis. In this article, we report the case of a 16-year-old female with a diagnosis of wandering spleen with torsion and splenic infarct.

Pancreatic cancer in patient with groove pancreatitis: Potential pitfalls in diagnosis.

Pancreatic cancer is among the leading causes of cancer death in the United States of America. Early detection and intervention are critical as a large majority of patients have either local or distant metastatic disease at the time of diagnosis. However, groove pancreatitis, a rare form of chronic pancreatitis, presents as a challenge for adequate and efficient differential diagnosis of pancreatic cancer as a result of similar clinical symptoms and imaging features. Furthermore, intraductal papillary mucinous neoplasms and pancreatic intraepithelial neoplasia are 2 of the precursor lesions that have been identified with pancreatic ductal adenocarcinoma. Intraductal papillary mucinous neoplasms are cystic tumors of the pancreas characterized by excessive mucin production in either the main pancreatic duct or its branches. Conversely, pancreatic intraepithelial neoplasia are microscopic lesions in the smaller pancreatic ducts. In this article, we report the case of a 46-year-old male with a diagnosis of groove pancreatitis, main duct intraductal papillary mucinous neoplasm, and pancreatic intraepithelial neoplasia whose tumor was excised by means of a Whipple procedure. We focus on optimizing diagnosis and treatment through the application of radiological modalities.

Radiology Without Borders: Identifying Global Reach of Radiology Social Media in Africa.

OBJECTIVE: To examine our website and social media audience data to define the number of African users and review the effects of COVID-19 on our viewership from Africa, and look ahead to potential opportunities. METHODS: Google Analytics was used to investigate the number of CTisus.com users from Africa across a three-year period: April 2018-March 2019, April 2019-March 2020, and April 2020-March 2021. The percent difference between 18/19 - 19/20 and 19/20 - 20/21 was identified. Each country was categorized into North, South, East, West, or Central Africa, based on the United Nations Statistical Division, and the percent difference was calculated for all five regions. The number of followers of our YouTube, Facebook, and Twitter channels in each African country was also analyzed, again classifying each country into regions. RESULTS: Forty-six of the fifty-four countries in Africa, and all four territories, accessed CTisus.com between April 2018 to March 2021. Northern Africa represented 49.87% of our website visits from all African countries. Southern Africa constituted 18.84% of our traffic and Eastern Africa 18.60%, while Western and Central Africa provided 11.90% and 0.79%, respectively. We found a 27% increase in website traffic from Africa between a non-COVID year and a complete pandemic year. Facebook statistics revealed that 20,782 likes to our page came from Africa, and 20,987 of our followers. Similarly, 15,391 of our YouTube views and 728 of our Twitter followers came from Africa. CONCLUSION: We have been successful in achieving a 27% increase in website traffic from Africa to our radiology social media offerings. This increase since the onset of the COVID-19 pandemic is encouraging, especially when noting that we do not have any paid advertising. We look forward to reaching a larger African audience to deliver radiology education in the future.

CT of rhabdomyolysis as a sequela of drug abuse.

Rhabdomyolysis is distinguished by the breakdown of skeletal muscle and the subsequent release of intracellular components into the bloodstream. Necrosis, which commonly manifests as muscle swelling, weakness, and myalgia, is a symptom associated with both traumatic and non-traumatic rhabdomyolysis. The etiology may be considered acquired, including trauma, infections, and drugs, or genetic, such as myopathies or enzyme deficiencies. Diagnosed by exceedingly high creatine kinase levels, rhabdomyolysis can lead to increased serum levels or more worrisome complications such as life-threatening acute kidney injury. In this article, we report the case of a 56-year-old male with a diagnosis of severe rhabdomyolysis and acute renal failure. We focus on optimizing diagnosis through the application of radiological modalities.