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Skeletal Dysplasias

Chapter by: Davisson, Neena A.; Alazraki, Adina L.; Lala, Shailee; Milla, Sarah Sarvis
in: Problem Solving in Pediatric Imaging by
[S.l.] : Elsevier, 2023
pp. 235-253
ISBN: 9780323430456
CID: 5349132

Problem Solving in Pediatric Imaging

Milla, Sarah Sarvis; Lala, Shailee
[S.l.] : Elsevier, 2023
Extent: 1 v.
ISBN: 9780323430456
CID: 5349162

Imaging of pediatric ovarian tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

Behr, Gerald G; Morani, Ajaykumar C; Artunduaga, Maddy; Desoky, Sarah M; Epelman, Monica; Friedman, Jonathan; Lala, Shailee V; Seekins, Jayne; Towbin, Alexander J; Back, Susan J
Ovarian tumors in children are uncommon. Like those arising in the adult population, they may be broadly divided into germ cell, sex cord, and surface epithelium subtypes; however, germ cell tumors comprise the majority of lesions in children, whereas tumors of surface epithelial origin predominate in adults. Diagnostic workup, including the use of imaging, requires an approach that often differs from that required in an adult. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary ovarian malignancy at diagnosis and during follow-up.
PMID: 36184758
ISSN: 1545-5017
CID: 5361452

Imaging of pediatric testicular tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

Behr, Gerald G; Morani, Ajaykumar C; Artunduaga, Maddy; Desoky, Sarah M; Epelman, Monica; Friedman, Jonathan; Lala, Shailee V; Seekins, Jayne; Towbin, Alexander J; Back, Susan J
Primary intratesticular tumors are uncommon in children, but incidence and risk of malignancy both sharply increase during adolescence. Ultrasound is the mainstay for imaging the primary lesion, and cross-sectional modalities are often required for evaluation of regional or distant disease. However, variations to this approach are dictated by additional clinical and imaging nuances. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary testicular malignancy at diagnosis and during follow-up.
PMID: 36184829
ISSN: 1545-5017
CID: 5361462

Congenital lung lesions: a radiographic pattern approach

El-Ali, Alexander Maad; Strubel, Naomi A; Lala, Shailee V
Congenital lung malformations represent a spectrum of abnormalities that can overlap in imaging appearance and frequently coexist in the same child. Imaging diagnosis in the neonatal period can be challenging; however, the recognition of several archetypal radiographic patterns can aid in narrowing the differential diagnosis. Major radiographic archetypes include (1) hyperlucent lung, (2) pulmonary cysts, (3) focal opacity and (4) normal radiograph. Here we review the multimodality imaging appearances of the most commonly seen congenital lung malformations, categorized by their primary imaging archetypes. Along with the congenital lung malformations, we present several important imaging mimickers.
PMID: 34716454
ISSN: 1432-1998
CID: 5042942

Artificial Intelligence Algorithm Improves Radiologist Performance in Skeletal Age Assessment: A Prospective Multicenter Randomized Controlled Trial

Eng, David K; Khandwala, Nishith B; Long, Jin; Fefferman, Nancy R; Lala, Shailee V; Strubel, Naomi A; Milla, Sarah S; Filice, Ross W; Sharp, Susan E; Towbin, Alexander J; Francavilla, Michael L; Kaplan, Summer L; Ecklund, Kirsten; Prabhu, Sanjay P; Dillon, Brian J; Everist, Brian M; Anton, Christopher G; Bittman, Mark E; Dennis, Rebecca; Larson, David B; Seekins, Jayne M; Silva, Cicero T; Zandieh, Arash R; Langlotz, Curtis P; Lungren, Matthew P; Halabi, Safwan S
Background Previous studies suggest that use of artificial intelligence (AI) algorithms as diagnostic aids may improve the quality of skeletal age assessment, though these studies lack evidence from clinical practice. Purpose To compare the accuracy and interpretation time of skeletal age assessment on hand radiograph examinations with and without the use of an AI algorithm as a diagnostic aid. Materials and Methods In this prospective randomized controlled trial, the accuracy of skeletal age assessment on hand radiograph examinations was performed with (n = 792) and without (n = 739) the AI algorithm as a diagnostic aid. For examinations with the AI algorithm, the radiologist was shown the AI interpretation as part of their routine clinical work and was permitted to accept or modify it. Hand radiographs were interpreted by 93 radiologists from six centers. The primary efficacy outcome was the mean absolute difference between the skeletal age dictated into the radiologists' signed report and the average interpretation of a panel of four radiologists not using a diagnostic aid. The secondary outcome was the interpretation time. A linear mixed-effects regression model with random center- and radiologist-level effects was used to compare the two experimental groups. Results Overall mean absolute difference was lower when radiologists used the AI algorithm compared with when they did not (5.36 months vs 5.95 months; P = .04). The proportions at which the absolute difference exceeded 12 months (9.3% vs 13.0%, P = .02) and 24 months (0.5% vs 1.8%, P = .02) were lower with the AI algorithm than without it. Median radiologist interpretation time was lower with the AI algorithm than without it (102 seconds vs 142 seconds, P = .001). Conclusion Use of an artificial intelligence algorithm improved skeletal age assessment accuracy and reduced interpretation times for radiologists, although differences were observed between centers. Clinical trial registration no. NCT03530098 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Rubin in this issue.
PMID: 34581608
ISSN: 1527-1315
CID: 5079132

E-peer learning: Our multi-institution experience [Meeting Abstract]

Schenker, K; Miller, A; Silva, C; Moote, D; Lala, S; Milla, S; Loewen, J; Epelman, M
Background: Recently there has been a shift in radiology away from a peer review model toward a peer learning model, focusing more on collaborative learning, creating an environment more accepting of medical errors and embracing learning opportunities. As stated in the 2015 Institute of Medicine report, organizations that embrace error as learning opportunities outperform those that do not.
Purpose(s): To create an e-Peer Learning group to increase collaborative sharing of learning opportunities across institutions and assess the utility of the program among participants.
Material(s) and Method(s): The e-Peer Learning group consists of radiologists from 6 different pediatric radiology institutions. The representative members have exchanged short presentations of 1-3 learning cases monthly since 11/2017, including missed, difficult, classic, or unusual diagnoses. The format is of the case and imaging, followed by a few important learning points. Cases are then shared more widely amongst all the radiologists at the participating institutions. We recently distributed a survey to participants for feedback about the program.
Result(s): 60 radiologists participated in the survey, representing each participating institution. Participants were asked a few questions on a scale of 1-5 (1 highest; 5 lowest). Regarding the educational value of the cases, 40 participants (67.8%) answered the highest educational value of 1, and another 13 (22%) gave a value of 2. Regarding howmuch new information was learned, 34 participants (56.67%) gave a rating of 1 (learned a lot) while another 18 (30%) gave a value of 2. 29 participants (48.33%) said the cases have changed their practice. Overall, 58/60 (96.67%) stated that they wish to continue receiving cases.
Conclusion(s): Our e-Peer Learning group has successfully created a non-punitive, collaborative learning environment across multiple institutions. Our survey has shown that participants value the program and have learned new information that may potentially change clinical practice. We believe this model can be expanded or adapted to other groups
EMBASE:636152632
ISSN: 1432-1998
CID: 5024972

Impact on Participants of Family Connect, a Novel Program Linking COVID-19 Inpatients' Families With the Frontline Providers

Taffel, Myles T; Hochman, Katherine A; Chhor, Chloe M; Alaia, Erin F; Borja, Maria J; Sondhi, Jaya; Lala, Shailee V; Tong, Angela
PURPOSE/OBJECTIVE:With clinical volumes decreased, radiologists volunteered to participate virtually in daily clinical rounds and provide communication between frontline physicians and patients with coronavirus disease 2019 (COVID-19) and their families affected by restrictive hospital visitation policies. The purpose of this survey-based assessment was to demonstrate the beneficial effects of radiologist engagement during this pandemic and potentially in future crises if needed. METHODS:After the program's completion, a survey consisting of 13 multiple-choice and open-ended questions was distributed to the 69 radiologists who volunteered for a minimum of 7 days. The survey focused on how the experience would change future practice, the nature of interaction with medical students, and the motivation for volunteering. The electronic medical record system identified the patients who tested positive for or were suspected of having COVID-19 and the number of notes documenting family communication. RESULTS:In all, 69 radiologists signed or cosigned 7,027 notes. Of the 69 radiologists, 60 (87.0%) responded to the survey. All found the experience increased their understanding of COVID-19 and its effect on the health care system. Overall, 59.6% agreed that participation would result in future change in communication with patients and their families. Nearly all (98.1%) who worked with medical students agreed that their experience with medical students was rewarding. A majority (82.7%) chose to participate as a way to provide service to the patient population. CONCLUSION/CONCLUSIONS:This program provided support to frontline inpatient teams while also positively affecting the radiologist participants. If a similar situation arises in the future, this communication tool could be redeployed, especially with the collaboration of medical students.
PMCID:7534665
PMID: 33091384
ISSN: 1558-349x
CID: 4663492

Medical Student Engagement and Educational Value of a Remote Clinical Radiology Learning Environment: Creation of Virtual Read-Out Sessions in Response to the COVID-19 Pandemic

Alpert, Jeffrey B; Young, Matthew G; Lala, Shailee V; McGuinness, Georgeann
RATIONALE AND OBJECTIVES/OBJECTIVE:The need for social distancing has resulted in rapid restructuring of medical student education in radiology. While students traditionally spend time learning in the reading room, remote clinical learning requires material shared without direct teaching at the radiology workstation. Can remote clinical learning meet or exceed the educational value of the traditional in-person learning experience? Can student engagement be matched or exceeded in a remote learning environment? MATERIALS AND METHODS/METHODS:To replace the in-person reading room experience, a small-group learning session for medical students named Virtual Read-Out (VRO) was developed using teleconferencing software. After Institutional Review Board approval, two student groups were anonymously surveyed to assess differences in student engagement and perceived value between learning environments: "Conventional" students participating in the reading room (before the pandemic) and "Remote" students participating in VRO sessions. Students reported perceived frequency of a series of five-point Likert statements. Based on number of respondents, an independent t-test was performed to determine the significance of results between two groups. RESULTS:Twenty-seven conventional and 41 remote students responded. Remote students reported modest but significantly higher frequency of active participation in reviewing radiology exams (p < 0.05). There was significantly lower frequency of reported boredom among Remote students (p < 0.05). There was no significant difference in perceived educational value between the two groups. CONCLUSION/CONCLUSIONS:Students report a high degree of teaching quality, clinical relevance, and educational value regardless of remote or in-person learning format. Remote clinical radiology education can be achieved with equal or greater student interaction and perceived value in fewer contact hours than conventional learning in the reading room.
PMID: 33268209
ISSN: 1878-4046
CID: 4694252

Ovarian neoplasms of childhood

Lala, Shailee V; Strubel, Naomi
Ovarian neoplasms are rare in children. Although usually asymptomatic, they sometimes present with abdominal pain, abdominal distension or palpable mass. The distribution of neoplasms in the pediatric population is different from in adults; benign mature cystic teratoma is the most common ovarian tumor in children. Radiologists should be familiar with the variable sonographic, CT and MRI findings of ovarian neoplasms. Although the less frequently encountered ovarian malignancies cannot be reliably distinguished by imaging alone, it does play an important role in workup. This review discusses the imaging and relevant clinical manifestations of the more commonly encountered pediatric ovarian neoplasms.
PMID: 31620847
ISSN: 1432-1998
CID: 4140562