Faculty Bibliography

PURPOSE/OBJECTIVE:To examine trends in female authorship in the journal Emergency Radiology from January 1994 to December 2014. METHODS:We obtained institutional review board approval for our study. We retrospectively reviewed a total of 1617 articles published in the journal Emergency Radiology over a 20-year period. Original articles, case reports, review articles, and pictorial essays were included. The first and last position author's gender was categorized as female or male. We analyzed trends by comparing the first and last position authors of original articles from the first and last year reviewed. We utilized Chi-square test for statistical analysis, with a p value <0.05 noted as significant. RESULTS:One thousand four hundred twenty articles met our inclusion criteria. There were 1420 first position authors and 1295 last position authors. There were 125 articles that had a sole author-these authors were considered as first position authors only. We determined, as best as possible, the gender of 96% of the authors. Overall, female authors were 21% of first position authors (290 of 1368) and 15% of last position authors (183 of 1246). Thirty-two percent of articles with female last position authors also had female first position authors (58 of 183). There was a statistically significant increase in female last position authors, from 12.9% in 1994 to 21.3% in 2014 (p = 0.026), a non-significant increase in female first position authors, from 17.5% in 1994 to 20.9% in 2014 (p = 0.514), and a non-significant increase in articles with both a first and last female author, from 25% in 1994 to 35% in 2014 (p = 0.593). CONCLUSION/CONCLUSIONS:Over the last 20 years, there has been a statistically significant upward trend in female last position authors publishing in the journal Emergency Radiology.

We highlight what we believe are 2 major areas of weakness in current Canadian radiology training programs: insufficient community radiology training and limited preparation of residents for the job market. Although focusing on Canadian radiology programs, we suspect that these are also 2 areas of substantial concern for radiology training programs in the United States and other countries. We offer suggestions to address these deficiencies, particularly by using pre-existing hybrid radiology practices and by making relatively small changes to the current curricula of radiology residency programs.

Ureteral injuries are uncommon in trauma patients, accounting for fewer than 1% of all injuries to the urinary tract. These uncommon, yet problematic, injuries can often be overlooked in the standard search pattern on abdominal and pelvic multi-detector CT (MDCT) images, as radiologists focus on more immediate life-threatening injuries. However, early diagnosis and management are vital to reduce potential morbidity. If there is a high clinical index of suspicion for ureteral injuries with penetrating or blunt trauma, or if there is suspected iatrogenic ureteral injury, delayed-phase/urographic-phase MDCT images are essential for confirming the diagnosis. Moreover, making the distinction between partial and complete ureteral transection is critical, as it will guide management. The aim of this pictorial review is to overview the key imaging findings in blunt and penetrating traumatic and iatrogenic injuries of the ureter, as well as to discuss the advantages and disadvantages of different imaging modalities for accurately and rapidly establishing or excluding the diagnosis of ureteral injuries, with an emphasis on MDCT. The potential causes of missed ureteral injuries will also be discussed.

Mentoring is an extremely important component of academic medicine, including radiology, yet it is not specifically emphasized in radiology training, and many academic radiology departments in the United States, Canada, and elsewhere do not have formal mentoring programs for medical students, residents, fellows, or junior faculty. The purpose of this article is to overview the current status of mentorship in radiology, to discuss the importance of mentorship at multiple levels and its potential benefits in particular, as well as how to conduct a successful mentor-mentee relationship. The literature on mentorship in radiology and in academic medicine in general is reviewed.

The failure to diagnose acute appendicitis (AA) is the third most common medical malpractice allegation related to gastrointestinal disease. There is a paucity of detailed data on this topic; however, publications by Whang et al and by Berlin and Berlin, which analyzed all types of malpractice suits against radiologists, have shown that the incidence of litigation has increased over time in the United States. This is likely true for cases of AA as well. The misinterpretation of cross-sectional imaging in patients with suspected appendicitis may be caused by suboptimal technique, errors of omission, i.e, missing key findings, failure to review a portion of the examination, and satisfaction of search error. This article summarizes the published legal, clinical, and imaging literature regarding litigation in cases of missed AA, and reviews optimized multidetector computed tomography and magnetic resonance imaging protocols for the diagnosis of AA, with examples shown of challenging cases.

BACKGROUND/PURPOSE/OBJECTIVE:Pediatric colonic volvulus is both rare and underreported. Existing literature consists only of case reports and small series. We present an analysis of cases (n=11) over 15 years at a single institution, focusing on workup and diagnosis. METHODS:This was an institutional review board approved single-institution retrospective chart review of 11 cases of large bowel volvulus occurring over 15 years (2000-2015). RESULTS:In our series, the most common presenting symptoms were abdominal pain and distention. Afflicted patients often had prior abdominal surgery, a neurodevelopmental disorder or chronic constipation. Of the imaging modalities utilized in the 11 patients studied, colonic volvulus was correctly diagnosed by barium enema in 100% of both cases, CT in 55.6% of cases and by plain radiography of the abdomen in only 22.2%of cases. Colonic volvulus was confirmed by laparotomy in all cases. The cecum (n=5) was the most often affected colonic segment, followed by the sigmoid (n=3). Operative treatment mainly consisted of resection (63.6%) and ostomy creation (36.4%). Colopexy was performed in 18.2% of cases. CONCLUSIONS:Plain abdominal radiography may be performed as an initial diagnostic study, however, it should be followed CT or air or contrast enema in children where there is high clinical suspicion and who do not have indications for immediate laparotomy. CT may be the most specific and useful test in diagnosis of colonic volvulus and has the added advantage of detection of complications including bowel ischemia. We demonstrate a range of diagnostic and therapeutic modalities for pediatric colonic volvulus. This underscores the need for further study to draft standard best practices for this life-threatening condition. LEVEL OF EVIDENCE/METHODS:Prognosis Study: Level IV. Study of a Diagnostic Test: Level III.

OBJECTIVE:The full spectrum of organized radiology consists of numerous organizations with varied missions targeting their respective members. CONCLUSION/CONCLUSIONS:This article highlights many of these organizations, discusses the benefits they can provide to radiology trainees and junior faculty, and provides a road map for progressive participation among trainees to junior faculty as they advance through training.

PURPOSE/OBJECTIVE:Radiology fellowship training has evolved from being an uncommon option to being a near requisite for post-training employment in the United States. A subset of fellows elect to pursue second fellowships with potentially substantial implications on both the private sector and academic radiology workforce. The purpose of this study was to assess the proportion of current radiology fellows pursuing multiple years of post-residency fellowship training. MATERIALS AND METHODS/METHODS:After obtaining IRB approval, an anonymous web-based survey was emailed to 1,269 radiology fellows listed as "completing fellowship" in the American College of Radiology database in June 2014. Questions were asked regarding current fellowship training, post-fellowship employment plans, and individual experience pursuing employment. Results were analyzed using the survey analytical software. RESULTS:There were 219 responses received, representing a 17.3% response rate. Ten-percent of respondents were currently completing their second radiology fellowship. Of those completing their first year of fellowship training, 11% indicated plans to complete a second radiology fellowship. CONCLUSION/CONCLUSIONS:This survey provides a snapshot of the percentage of radiology trainees who pursue a second year of fellowship training, currently in the range of 10%. Pursuing a second radiology fellowship may represent a safety net to a substantial subset of fellows who are not able to obtain satisfactory employment following training. Academic programs who rely heavily on fellows should be aware of the proportion of fellows pursuing two fellowships and should be prepared to adapt should this change over time.