Tarsometatarsal joint communication during fluoroscopy-guided therapeutic joint injections and relationship with patient age and degree of osteoarthritis.

OBJECTIVE: Although the tarsometatarsal joints are separated into three distinct synovial compartments, communications between adjacent compartments are often noted during image-guided injections. This study aims to determine whether abnormal inter-compartment tarsometatarsal joint communication is associated with patient age or degree of tarsometatarsal osteoarthritis. MATERIALS AND METHODS: One hundred forty tarsometatarsal injections were retrospectively reviewed by two radiologists. Extent of inter-compartment communication and degree of osteoarthritis were independently scored. Univariate and multivariable analyses were performed to assess whether the presence of and number of abnormal joint communications were related to age and degree of osteoarthritis. RESULTS: Forty out of 140 tarsometatarsal joints showed abnormal communication with a separate synovial compartment, and 3 of the 40 showed abnormal communication with two separate compartments. On univariate analysis, higher grade osteoarthritis (p < 0.001) and older age (p = 0.014) were associated with an increased likelihood of abnormal inter-compartment tarsometatarsal communication and a greater number of these abnormal communications. On multivariate analysis, the degree of osteoarthritis remained a significant predictor of the presence of (p < 0.001) and number of (p < 0.001) abnormal communications, while the association of age was not statistically significant. There was significant correlation between age and degree of osteoarthritis (p < 0.001). CONCLUSION: Higher grade osteoarthritis increases the likelihood of abnormal inter-compartment tarsometatarsal joint communication and is associated with a greater number of abnormal communications. Diagnostic injection to localize a symptomatic tarsometatarsal joint may be less reliable in the setting of advanced osteoarthritis.

Adding value to imaging services: a survey of patient and referring physician preferences for direct radiologic reporting of results.

PURPOSE: To identify preferences of patients and referring physicians for direct patient communication and notification of radiologic study results. METHODS: An anonymous survey was conducted of patients undergoing outpatient radiologic imaging studies and their referring physicians. The voluntary surveys elicited responses regarding preferences on a 5-point Likert scale (Strongly disagree, disagree, neutral, agree and strongly agree), as well as indicated by responding yes or no to specific questions. RESULTS: 368 patients completed the survey. 81.5% of patient responders preferred all results communicated from the radiologist within the same day. 65.9% of patients preferred same day results if normal vs 65.8% if abnormal. 34.5% preferred to wait and review normal results with the referring physician. 41.5% preferred to wait and review abnormal results with the referring physician. It was found that patients were more likely to strongly agree with waiting to review results with the referring physician if the results were abnormal, as opposed to normal (18.5% vs 11.9%, respectively; P < 0.014). 64% of physicians did not want results reviewed with their patients; 87.6% did not want a report sent to the patient by the radiologist, even after report was sent to their office. 66.4% of patients surveyed indicated that waiting for imaging results gives them anxiety. CONCLUSIONS: 58-82% of patients preferred same day radiologist communication of their results while 55-87.6% of physicians did not prefer same day radiologist communication of results directly with their patients. 66.4% of patients surveyed indicated that waiting for imaging results gives them anxiety.

A Survey of Academic Radiology Department Chairs on Hiring Recent Graduates as New Attending Physicians.

RATIONALE AND OBJECTIVES: To determine hiring preferences among academic radiology department chairs with emphasis on recent residency and fellowship graduates. MATERIALS AND METHODS: With the assistance of the Society of Chairs of Academic Radiology Departments (SCARD), an anonymous survey was distributed to academic radiology department chairs during the time period December 2014-March 2015, with additional reminder emails during the study period. Varied multiple choice questions were designed to gather information regarding program details; qualities most valued in new attending hires; level of difficulty recruiting subspecialty fellowship-trained radiologists; and the effect of the new ABR certification process on hiring practices. Descriptive statistics and analyses are reported. RESULTS: Surveys were completed by 79 of 184 eligible academic radiology chairs, a response rate of 43%. The most important hiring criteria cited were expertise in subspecialty, fellowship training, and perceived ability to work well with referring physicians. The most popular recruitment tools cited were hiring candidates from a chair's own program, journal ads, and academic networks. A minority of chairs (16%), primarily those of smaller departments, will not hire new graduates before completing board certification under the new certification structure (P = .0143). CONCLUSIONS: Expertise in a candidate's subspecialty was consistently cited as the most important hiring criterion. Changes to the ABR certification process, however, will affect hiring decisions, particularly within smaller academic departments.

Elevated serum potassium values: the role of preanalytic variables.

Potassium is one of the most frequently tested analytes in the clinical laboratory. Because of its critical role in body homeostasis, laboratory errors that cause inaccurate potassium results can significantly affect patient safety. This review is limited to the spurious increase of serum potassium levels (pseudohyperkalemia), ie, instances of elevated potassium results that cannot be explained clinically and do not correspond to the status of the patient; when these specimens are recollected, potassium values usually drop substantially without clinical intervention. Because the workup of falsely elevated potassium levels consumes valuable health care resources and can result in patient care delays, it is essential to identify all variables that can cause pseudohyperkalemia, understand the mechanisms by which these variables affect serum potassium levels, and define corrective actions to ameliorate the problem. In most cases, increases in serum potassium are due to factors in the preanalytic phase of the testing cycle. The effect of patient-specific variables and variables related to specimen acquisition and processing, handling, and transport are discussed.