Faculty Bibliography

OBJECTIVE:Although some research and publication practices are clearly unethical, including fraud and plagiarism, other areas of research and publication, such as informed consent and conflicts of interest, fall into grayer areas. CONCLUSION/CONCLUSIONS:The purposes of this article are, therefore, to review a variety of relevant ethical issues in radiology-related journalism, peer review, and research; to review the radiology literature to date that has addressed these issues; and to present position statements and potential solutions to these problems.

PURPOSE/OBJECTIVE:The purpose of the study was to describe and present outcomes of the track embolization technique with absorbable hemostat gelatin powder during percutaneous computed tomography (CT)-guided lung biopsy and/or fiducial marker placement versus the standard of care (no track embolization) in an attempt to decrease rates of pneumothorax (PTX), chest tube placement, hemorrhage and/or complications, and average cost per patient. MATERIALS AND METHODS/METHODS:An institutional review board-approved, case-control, retrospective study was performed in which 125 consecutive patients who underwent track embolization were compared with 124 consecutive controls at one institution. For subjects in whom the track embolization technique was utilized, it was performed passively through a coaxial needle as it was removed. All procedures were performed by one of three attending interventional radiologists. For each group, medical records and procedure images were reviewed for PTX occurring postprocedure, PTX requiring chest tube placement, and occurrence of minor or major complication and/or hemorrhage. Comparison was made with published complication rates, and a cost-per-patient analysis was performed. Statistical analysis was performed utilizing Fisher's Exact Test. RESULTS:In track embolization cases versus controls, there were statistically significant reduction in PTX (8.8% vs. 21%; P=.007) and reduction in PTX requiring chest tube placement (4% vs. 8.1%; P=.195). This compares favorably to previously published rates of PTX and chest tube placement of 8%-64% and 1.6%-17%, respectively. None of the pneumothoraces occurring at time of needle placement increased in size with use of the track embolization technique. There were no major complications (including neurological sequela) in the track embolization group. In track embolization cases versus controls, there was a statistically significant reduction in both the rate of major hemorrhage (0% vs. 4%; P=.029) and average cost per patient ($262.40 vs. $352.07; P=.044). CONCLUSIONS:CT-guided percutaneous lung biopsy and/or fiducial marker placement were safer utilizing the track embolization technique during trocar removal. In addition, this technique was cost effective in the study population.

Over the past 10 years, there has been increased attending-level image interpretation during what has typically been considered the on-call period. The purpose of this study is to survey radiology attending physicians and assess their perceptions about how the presence of radiology attending physicians during the on-call period affects patient care and resident education. Two hundred eighty-eight radiology attendings completed the online survey. 70% believe that after hours final reads by radiology attendings improves patient care. 56% believe that this additional attending presence has a negative impact on the ability of graduating residents to efficiently interpret studies independently. A majority of radiology attending physicians in this study believe that increased in-house radiology attending coverage is harming resident training across the United States, yet also believe this attending presence is important for patient care. Additional studies are needed to quantify and further evaluate this effect, and develop strategies to address potential negative impacts on radiology resident education.

OBJECTIVE:We detail the association of sedentary behavior with a variety of health problems and provide the radiologist with a number of simple activities and techniques that can improve overall health while still meeting the productivity demands of a high-volume practice. Although these techniques are well known and recognized in the fitness and nutrition literature, they are not widely used in the radiology reading room. The computer- and workstation-based work routinely performed by diagnostic radiologists typically occurs in the seated position, leading to more than 8 hours per day of sitting. Studies have found that even for those who exercise regularly, spending increased time sitting can negate the healthful effects of exercise. Time spent in a seated or sedentary position leads to slowing of one's metabolism, with negative resultant effects. CONCLUSION/CONCLUSIONS:The concept of nonexercise activity thermogenesis (NEAT) will be described, with examples given of how to burn more calories while at work and, therefore, improve the health of the diagnostic radiologist. NEAT refers to the energy expended during activities of daily living, excluding sportlike or intentional exercise. The concept of NEAT must be understood by radiologists, because it allows the development of multiple strategies to combat the ill effects of sitting while working. Adding intermittent movement and stretching exercises throughout the day can stimulate metabolism. An understanding of the association of sedentary work behavior with a number of health risks is crucial for radiologists so that they can implement basic changes into their work routine, allowing them to increase activity to address and avoid these potential health hazards.

Atypical hemangioma (including sclerosing and/or hyalinizing hemangioma) of the liver is a rare variant of hepatic hemangioma, which is the most common benign hepatic tumor. Atypical hemangioma can be indistinguishable from malignancy, primary, or metastatic, based on imaging characteristics. We describe a case of a 70-year-old man with weight loss, occasional bloody stool, change in caliber of stool, and laboratory abnormalities who was found to have multiple hepatic lesions concerning for metastases. We demonstrate that knowledge of the appearance of atypical hemangioma and its inclusion in the differential diagnosis of hepatic lesions can alter patient management and be important to consider before invasive therapies are planned.

The diagnostic radiology match process has become less competitive over the past 5 years, and fewer U.S. medical students are choosing to pursue careers in diagnostic radiology. The current composition of the diagnostic radiology residency applicant pool reflects this change. Although many possible explanations exist for the decreased interest in radiology, all radiologists should have a vested interest in ensuring that radiology continues to attract the best and brightest medical students. Young and early career radiologists are in a particularly unique position to connect with medical students, and can have substantial effect on recruiting the brightest medical students into radiology. The purpose of this article is to review why young radiologists are vital to this recruitment and mentoring process, and provide multiple simple ways to advocate for radiology and share our passion for radiology with medical students.

The relative value unit (RVU) is an important measuring tool for the work performed by physicians, and is currently used in the United States to calculate physician reimbursement. An understanding of radiology RVUs and current procedural terminology codes is important for radiologists, trainees, radiology managers, and administrators, as this knowledge would help them to understand better their current productivity and reimbursement, as well as controversies regarding reimbursement, and permit them to adapt to reimbursement changes that may occur in the future. This article reviews the components of the RVU and how radiology payment is calculated, highlights trends in RVUs and resultant payment for diagnostic and therapeutic imaging and examinations, and discusses current issues involving RVU and current procedural terminology codes.

Aggregomas are rare localized masses of monoclonal nonamyloid immunoglobulin light-chain deposits. To date, there have been only a few reports of isolated aggregomas, with the majority detailing renal, lymph node and brain deposition. We present a rare case of paraspinal aggregoma in a 67-year-old female who presented with a complaint of cough and chest pain. Imaging demonstrated a left-sided paravertebral mass extending from T7-T10. Pathological analysis showed lamellar deposition of extracellular eosinophilic material with an associated lymphoplasmacytic nonamyloid infiltrate. To our knowledge, this is the first report of a paraspinal aggregoma. While exceedingly rare, this tumor can be included in the radiologic differential diagnosis of paravertebral soft tissue tumors in adults. The observation of our case adds to the limited understanding of the etiology, pathogenesis, natural history, and treatment of nonamyloid light-chain depositions.