Faculty Bibliography

OBJECTIVE: The number of 4th-year medical student applications to the field of diagnostic radiology has decreased from 2009-2015. The purpose of this study was to learn how radiology departments are recruiting medical students. MATERIALS AND METHODS: An anonymous online survey hyperlink was distributed to the members of the Society of Chairs of Academic Radiology Departments regarding both innovative and proven recruitment strategies. The results were synthesized with a recently published survey of medical students about factors influencing them to go into radiology. RESULTS: Forty of 126 radiology departments completed the survey. Most felt that radiology exposure and curricula require alteration given recent downward trends in medical student applications. A majority (79%) had changed their outreach to medical students in response to these trends. The responding department chairs felt that interactive learning while on rotation was the most important strategy for recruitment. The presence of a diversity program, dedicated medical school educator, or rotating daily assignment for students did not affect the likelihood of filling residency spots in the main match. CONCLUSION: Many radiology departments are changing their outreach to medical students to improve recruitment. Effective strategies to focus on include early active outreach by involving students in the radiology department, thereby framing radiologists as clinicians.

BACKGROUND: To preserve radiology rounds in the changing health care environment, we have introduced virtual radiology rounds, an initiative enabling clinicians to remotely review imaging studies with the radiologist. OBJECTIVE: We describe our initial experience with virtual radiology rounds and referring provider impressions. MATERIALS AND METHODS: Virtual radiology rounds, a web-based conference, use remote sharing of radiology workstations. Participants discuss imaging studies by speakerphone. Virtual radiology rounds were piloted with the Neonatal Intensive Care Unit (NICU) and the Congenital Cardiovascular Care Unit (CCVCU). Providers completed a survey assessing the perceived impact and overall value of virtual radiology rounds on patient care using a 10-point scale. Pediatric radiologists participating in virtual radiology rounds completed a survey assessing technical, educational and clinical aspects of this methodology. RESULTS: Sixteen providers responded to the survey; 9 NICU and 7 CCVCU staff (physicians, nurse practitioners and fellows). Virtual radiology rounds occurred 4-5 sessions/week with an average of 6.4 studies. Clinicians rated confidence in their own image interpretation with a 7.4 average rating for NICU and 7.5 average rating for CCVCU. Clinicians unanimously rated virtual radiology rounds as adding value. NICU staff preferred virtual radiology rounds to traditional rounds and CCVCU staff supported their new participation in virtual radiology rounds. Four of the five pediatric radiologists participating in virtual radiology rounds responded to the survey reporting virtual radiology rounds to be easy to facilitate (average rating: 9.3), to moderately impact interpretation of imaging studies (average rating: 6), and to provide substantial educational value for radiologists (average rating: 8.3). All pediatric radiologists felt strongly that virtual radiology rounds enable increased integration of the radiologist into the clinical care team (average rating: 8.8). CONCLUSION: Virtual radiology rounds are a viable alternative to radiology rounds enabling improved patient care and education of providers.

PURPOSE: The aim of this study was to report the investigators' preliminary experience in the implementation of a "virtual consult" (VC) system enabling consultations between radiologists and referring physicians in physically remote locations throughout their enterprise. METHODS: Referrers and radiologists directly access the VC through the electronic medical record and PACS, respectively. Referrers may click a VC link associated with any examination report to instant message the appropriate subspecialist radiologist, who receives an alert allowing automatic loading of the examination. The radiologist and referrer may then discuss the examination via instant messaging as well as launch a real-time screen-share of the radiologist's PACS display, with the option for either participant to control the display. Radiologists' and referrers' feedback was evaluated after the institution's first 110 VC sessions. RESULTS: Referrers' most common specialties were emergency medicine (27.3%) and internal medicine (13.6%); radiologists' most common subspecialties were abdominal (33.6%) and thoracic (16.4%) imaging. Screen-shares lasted on average 12 +/- 16 minutes. From 80% to 90% of referrers agreed that the VC was easy to use, improved their understanding of the radiology report, affected patient management, and enhanced radiologists' role. Referrers found the VC to be particularly useful when traditional consultation was difficult because of location or time constraints or when seeking a quick response to a targeted question. Radiologists recognized referrers' positive response to the VC, although they tended to view the VC as disruptive to normal workflow. CONCLUSIONS: The VC addresses a key challenge in the current era of digital radiology practice and provides added value to referrers, though continued radiologists' workflow optimization is warranted.

The new interventional radiology (IR) pathways have generated much discussion with articles and editorials pointing out perceived advantages and disadvantages compared to the current pathways. To briefly review, under the new system, there are three pathways to enter IR: the integrated (INT) IR residency, the independent (IND) IR residency, and the early specialization in interventional radiology (ESIR) program. The pathways have been designed to provide maximum flexibility to programs for implementation and to radiology residents for planning their subspecialty training. As a result, there are many potential permutations for these training programs, and understanding the variety of options can be a challenge at first. We offer three potential solutions, based on the different circumstances or requirements a department might face. The first two solutions involve integrated programs created through newly funded and converted diagnostic radiology slots, respectively. The third involves establishing ESIR and IND programs only. Hopefully, the examples provided will be useful for those currently planning for the future of their IR training programs.

PURPOSE: Incidental ovarian cysts are frequently detected on imaging. Despite published follow-up consensus statements, there remains variability in radiologist follow-up recommendations and clinician practice patterns. The aim of this study was to evaluate if collaborative ovarian cyst management recommendations and a radiologist decision support tool can improve adherence to follow-up recommendations. METHODS: Gynecologic oncologists and abdominal radiologists convened to develop collaborative institutional recommendations for the management of incidental, asymptomatic simple ovarian cysts detected on ultrasound, CT, and MRI. The recommendations were developed by modifying the published consensus recommendations developed by the Society of Radiologists in Ultrasound on the basis of local practice patterns and the experience of the group members. A less formal process involved the circulation of the published consensus recommendations, followed by suggestions for revisions and subsequent consensus, in similar fashion to the ACR Incidental Findings Committee II. The recommendations were developed by building on the published work of experienced groups to provide the authors' medical community with a set of recommendations that could be endorsed by both the Department of Gynecology and the Department of Radiology to provide supportive guidance to the clinicians who manage incidental ovarian cysts. The recommendations were integrated into a radiologist decision support tool accessible from the dictation software. Nine months after tool launch, institutional review board approval was obtained, and radiology reports mentioning ovarian cysts in the prior 34 months were retrospectively reviewed. For cysts detected on ultrasound, adherence rates to Society of Radiologists in Ultrasound recommendations were calculated for examinations before tool launch and compared with adherence rates to the collaborative institutional recommendations after tool launch. Additionally, electronic medical records were reviewed to determine the follow-up chosen by the clinician. RESULTS: For cysts detected on ultrasound, radiologist adherence to recommendations improved from 50% (98 of 197) to 80% (111 of 139) (P < .05). Overmanagement decreased from 34% (67 of 197) to 10% (14 of 139) (P < .05). A recommendation was considered "overmanaged" if the radiologist recommended follow-up when it was not indicated or if the recommended follow-up time was at a shorter interval than indicated. Clinician adherence to radiologist recommendations showed statistically nonsignificant improvement from 49% (36 of 73) to 57% (27 of 47) (P = .5034). CONCLUSIONS: Management recommendations developed through collaboration with clinicians may help standardize follow-up of ovarian cysts and reduce overutilization.

Burnout is a concern for radiologists. The burnout rate is greater among diagnostic radiologists than the mean for all physicians, while radiation oncologists have a slightly lower burnout rate. Burnout can result in unprofessional behavior, thoughts of suicide, premature retirement, and errors in patient care. Strategies to reduce burnout include addressing the sources of job dissatisfaction, instilling lifestyle balance, finding reasons to work other than money, improving money management, developing a support group, and seeking help when needed.

PURPOSE: The aim of this study was to survey fourth-year medical students, both those choosing and those not choosing diagnostic radiology as their specialty, regarding factors influencing their choice of specialty and their perceptions of radiology. METHODS: A voluntary anonymous online survey hyperlink was sent to 141 US medical schools for distribution to fourth-year students. Topics included demographics, radiology education, specialty choice and influencing factors, and opinions of radiology. RESULTS: A representative sampling (7%) of 2015 fourth-year medical students (n = 1,219; 51% men, 49% women) participated: 7% were applying in radiology and 93% were not. For respondents applying in radiology, the most important factor was intellectual challenge. For respondents applying in nonradiology specialties, degree of patient contact was the most important factor in the decision not to choose radiology; job market was not listed as a top-three factor. Women were less likely than men to apply in radiology (P < .001), with radiology selected by 11.8% of men (56 of 476) and only 2.8% of women (13 of 459). Respondents self-identifying as Asian had a significantly higher (P = .015) likelihood of selecting radiology (19 of 156 [12.2%]) than all other races combined (44 of 723 [6.1%]). Respondents at medical schools with required dedicated medical imaging rotations were more likely to choose radiology as a specialty, but most schools still do not require the clerkship (82%). CONCLUSIONS: The reasons fourth-year medical students choose, or do not choose, diagnostic radiology as a specialty are multifactorial, but noncontrollable factors, such as the job market, proved less compelling than controllable factors, such as taking a radiology rotation.

Purpose: To compare the accuracy of an optimized 3D TSE (SPACE) sequence using SPARSE-SENSE (SS) acceleration with 2D TSE sequences for the detection of internal derangement of the knee. Materials and Methods: An optimized accelerated SPACE sequence prototype was developed using avariable-density poisson-disc undersampling pattern of the two phase-encoding dimensions. Optimized parameters were: TR1100, TE22, TF28, variable flip angle evolution for PD weighting, SS undersampling factor of 9, fat suppression, presence of an optimized MT module, and 0.5 x 0.5 x 0.6 mm3 voxel size. This sequence (TA 4:57) was added to our conventional knee examination (sagittal PD and FS T2, coronal PD and FS PD, axial FS T2 2D TSE sequences (TA 10:56)) for 579 patients undergoing knee MR examinations imaged on a 3T scanner (Magnetom Skyra, Siemens Healthcare). An iterative SS reconstruction [2] was performed by enforcing sparsity in the wavelet representation of the knee images. Images were then reformatted in all 3 orthogonal planes at 1.5mmthickness. 50 of the 579 patients underwent arthroscopy of the knee and two experienced MSK radiologists blindly reviewed the SS SPACE sequence and the conventional 2D TSE sequences of these 50 patients at separate sittings to evaluate for the presence of meniscal or ligamentous tears. Results: 38 patients hadmedialmeniscal tears, 23 had lateral meniscal tears, and 16 had ACL tears. There was only 1 MCLand PCL tear and there were no LCL tears. The sensitivity, specificity, and accuracy for medial meniscal, lateral meniscal, and ACL tears on the 2D TSE images and SS Space images for each reader are presented below. Sensitivity Specificity Accuracy Sensitivity Specificity Accuracy Conclusion: An optimized and accelerated 3D TSE sequence has the potential to replace 2D TSE sequences for evaluation of internal derangement of the knee. If substantiated in larger clinical studies, this could lead to significant shortening of exam time, potentially enlarging the indication and utilization of knee MR as well as decreasing its cost

Purpose: To characterize the utility of shoulder imaging in the outpatient setting; Define predictor variables for useful shoulder imaging in terms of guiding the selection of the primary diagnosis and treatment Materials and Methods: We conducted a retrospective review of adult patients over a 32 month period evaluated and imaged for a primary complaint of shoulder pain in one of three outpatient settings: (1) orthopaedics, (2) emergency department [ED], and (3) internal medicine [IM]. Our sample population was chosen through a review of electronic medical records, using shoulder related ICD-9 codes and physician names. The main outcome variable for this study was imaging utility. A useful imaging examination was defined as a study that satisfied at least one of the following 4 criteria: changed the clinical diagnosis, guided a change in treatment selection, provided a final diagnosis, or guided definitive treatment. A utility score was assigned to each study based on the number of criteria satisfied (range 0-4) with a score of 0 defined as no utility, 1 low utility, 2 moderate utility, and score of > 3 high utility. For patients receiving multiple sequential imaging studies during their workup, each study was included and scored separately. The potential predictor variables evaluated for useful imaging included age, gender, trauma history, symptom chronicity, and injury setting (sports vs. non-sports). Statistical analysis included 95 % confidence intervals and binary logistic regression. Results: A total of 122 patients (70 female/52 male; mean age 47 years (range 18-84)) underwent a total of 171 imaging studies (109 radiographs/57 MRIs/3 CT/2 ultrasound) as part of their initial workup. 106 studies were ordered from orthopaedics, 64 from ED, and 1 from IM. CT and ultrasound utility were not assessed due to low number of cases. Overall, 95.9 % of the imaging studies met the minimum criteria for utility, most commonly helping guide the selection of a definitive treatment (71.9 %). 30.4 % of the studies were categorized as moderately useful, while 12.9 % were classified as highly useful. 95.4 % of radiographs met the criteria for utility, the majority of which were categorized as low utility (78.9 %). Both sports related injury history and trauma were predictive of at least moderate utility for radiographs (p = 0.039, p = 0.004). Younger age was a significant predictor of at least moderate utility for radiographs, most commonly in patients under 32 (p=0.003, AUC 0.748). 96.5 % of MRIs met the criteria for utility, the majority of which were categorized as moderate or high utility (84.2 %). None of the variables investigated were found to significantly predict MRI utility. For patients undergoing radiographs and MRI, MRI was found more useful than radiographs in 53 % of patients with an average utility score of 2.1. Equal utility was found in 42 % of cases, while radiographs were found most useful in 5 % of patients. Conclusion: Our study suggests that both radiographs and MRI have utility in the outpatient evaluation of shoulder pain. This serves as a potential first step towards the development of evidence based imaging algorithms that can be used and tested in future studies