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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

Visualization of the normal appendix in children: feasibility of a single contrast-enhanced radial gradient recalled echo MRI sequence

Lala, Shailee V; Strubel, Naomi; Nocera, Nicole; Bittman, Mark E; Fefferman, Nancy R
BACKGROUND:Magnetic resonance imaging (MRI) assessment for appendicitis is limited by exam time and patient cooperation. The radially sampled 3-dimensional (3-D) T1-weighted, gradient recalled echo sequence (radial GRE) is a free-breathing, motion robust sequence that may be useful in evaluating appendicitis in children. OBJECTIVE:To compare the rate of detection of the normal appendix with contrast-enhanced radial GRE versus contrast-enhanced 3-D GRE and a multi-sequence study including contrast-enhanced radial GRE. MATERIALS AND METHODS/METHODS:This was a retrospective study of patients ages 7-18 years undergoing abdominal-pelvic contrast-enhanced MRI between Jan. 1, 2012, and April 1, 2016. Visualization of the appendix was assessed by consensus between two pediatric radiologists. The rate of detection of the appendix for each sequence and combination of sequences was compared using a McNemar test. RESULTS:The rate of detection of the normal appendix on contrast-enhanced radial GRE was significantly higher than on contrast-enhanced 3-D GRE (76% vs. 57.3%, P=0.003). The rate of detection of the normal appendix with multi-sequence MRI including contrast-enhanced radial GRE was significantly higher than on contrast-enhanced 3-D GRE (81.3% vs. 57%, P<0.001). There was no significant difference between the rate of detection of the normal appendix on contrast-enhanced radial GRE alone and multi-sequence MRI including contrast-enhanced radial GRE (76% vs. 81.3%, P=0.267). CONCLUSION/CONCLUSIONS:Contrast-enhanced radial GRE allows superior detection of the normal appendix compared to contrast-enhanced 3-D GRE. The rate of detection of the normal appendix on contrast-enhanced radial GRE alone is nearly as good as when the contrast-enhanced radial GRE is interpreted with additional sequences.
PMID: 30783687
ISSN: 1432-1998
CID: 3686192

Multi-institutional implementation of an automated tool to predict pediatric skeletal bone age: How we did it [Meeting Abstract]

Khandwala, N; Eng, D; Milla, S S; Kadom, N; Strubel, N; Lala, S; Fefferman, N; Filice, R; Prabhu, S P; Francavilla, M L; Kaplan, S; Sharp, S E; Towbin, A J; Everist, M; Irani, N; Halabi, S
Purpose or Case Report: Skeletal bone age assessment is a common clinical practice to investigate endocrinology, genetic and growth disorders of children. Clinical interpretation and bone age analyses are time-consuming, labor intensive and often subject to inter-observer variability. Bone age prediction models developed with deep learning methodologies can be leveraged to automate bone age interpretation and reporting. The bone age model developed at our institution was offered to interested health systems and institutions to implement and validate the model. This study discusses the logistical, technical, and clinical issues encountered with this model implementation. Methods & Materials: After IRB approval, multiple U.S. based radiology departments were solicited to adopt and validate the Stanford University bone age model. A total of 8 institutions (4 standalone pediatric hospitals and 4 academic radiology departments) agreed to partner with the primary investigators. IRBs at each institution were required in addition to registration with ClinicalTrials.gov registry. Standardization of the data use agreements was performed. Patient data and protected health information data was retained at each institution. Technical requirements included model hosting at each institution and integration to send images to the model server and results to the interpreting radiologists.
Result(s): Multiple logistical, technical, and clinical issues were encountered. IRBs at the various institutions had different requirements including waiving patient consent. Technical differences between institutions included model hosting, PACS integrations, interfaces with the reporting system, and image preprocessing. Clinical differences included report templates, calculation of bone age standard deviation, use of Brush foundation, and ability to directly send bone predictions to the reporting system (versus displaying the results as a separate interface). The bone age model was successfully implemented at 7 institutions and approximately 190 studies have been evaluated.
Conclusion(s): There are myriad challenges to implementing and validating models developed with deep learning methodologies. As models are developed for various clinical use cases including bone age assessment, it will be incumbent on radiology practices and health information systems to integrate these models into clinical practice
EMBASE:627350054
ISSN: 1432-1998
CID: 3831612

Interstitial nephritis: Two pediatric cases with atypical radiological features

Connors, Joseph; Aronov, Rachel; Malaga-Dieguez, Laura; Vento, Suzanne; Pehrson, Laura Jane; Wu, Ming; Lala, Shailee; Trachtman, Howard
Interstitial nephritis (IN) is a relatively rare entity in children and adolescents that can be caused by a range of disorders including infection, medications, inflammatory bowel disease, and sarcoid. There is no proven therapy for this condition. We present 2 cases of biopsy-proven interstitial nephritis, of which 1 case was with granulomatous features that presented with unusual sonographic findings of discrete mass lesions in the kidney parenchyma bilaterally. Although a precise cause could not be identified in either case, 1 patient progressed to end-stage kidney disease (ESKD) and the other is in the early stages of treatment. We suggest that recognition of the atypical imaging features of interstitial nephritis may enable early recognition of this condition and avoid confusion with neoplastic or infectious processes.
PMCID:6090006
PMID: 30116463
ISSN: 1930-0433
CID: 3241102

Comparison of hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging and positron emission tomography/computed tomography for evaluation of peripheral nerve sheath tumors in patients with neurofibromatosis type 1

Raad, Roy A; Lala, Shailee; Allen, Jeffrey C; Babb, James; Mitchell, Carole Wind; Franceschi, Ana M; Yohay, Kaleb; Friedman, Kent P
Rapidly enlarging, painful plexiform neurofibromas (PN) in neurofibromatosis type 1 (NF1) patients are at higher risk for harboring a malignant peripheral nerve sheath tumor (MPNST). Fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been used to support more invasive diagnostic and therapeutic interventions. However, PET/CT imparts an untoward radiation hazard to this population with tumor suppressor gene impairment. The use of FDG PET coupled with magnetic resonance imaging (MRI) rather than CT is a safer alternative but its relative diagnostic sensitivity requires verification. Ten patients (6 females, 4 males, mean age 27 years, range 8-54) with NF1 and progressive PN were accrued from our institutional NF Clinic. Indications for PET scanning included increasing pain and/or progressive disability associated with an enlarging PN on serial MRIs. Following a clinically indicated whole-body FDG PET/CT, a contemporaneous PET/MRI was obtained using residual FDG activity with an average time interval of 3-4 h FDG-avid lesions were assessed for both maximum standardized uptake value (SUVmax) from PET/CT and SUVmax from PET/MR and correlation was made between the two parameters. 26 FDG avid lesions were detected on both PET/CT and PET/MR with an accuracy of 100%. SUVmax values ranged from 1.4-10.8 for PET/CT and from 0.2-5.9 for PET/MRI. SUVmax values from both modalities demonstrated positive correlation (r = 0.45, P < 0.001). PET/MRI radiation dose was significantly lower (53.35% ± 14.37% [P = 0.006]). In conclusion, PET/MRI is a feasible alternative to PET/CT in patients with NF1 when screening for the potential occurrence of MPNST. Reduction in radiation exposure approaches 50% compared to PET/CT.
PMCID:6216733
PMID: 30505221
ISSN: 1450-1147
CID: 3520172

Pelvis MRI and MR lumbosacral neurography: Impact on ultrasound-guided pelvic perineural injections [Meeting Abstract]

Lala, S; Walter, W; Adler, R; Burke, C
Purpose: Assess the impact of MR pelvic and lumbosacral neuorgraphy on ultrasound-guided pelvic perineural injections. Materials and Methods: A retrospective review of all ultrasound-guided pelvic perineural injections with prior MR pelvic and/or lumbosacral neurographic imaging over a 5-year period was performed. Demographics, presence of structural pathology on imaging, and immediate and interval pain relief was recorded. Results: 30 total injections were performed among 20 patients accounting for multiple injections in a single visit or multiple visits [mean age at injection: 52.03 (range 23-77), female (n= 24, 80%) male (n=6; 20%)]. In 24 cases a combination of steroid and anesthetic solution was administered. In the remaining 6 cases, only anesthetic solution was administered. Most commonly, injections involved the sciatic nerve (n = 21; 70%). Other injections in our series include pudendal (n=5, 16.7%), genitofemoral (n=2; 6.7%), lateral femoral cutaneous (n=1, 3.3%) and ilioinguinal (n= 1, 3.3%) nerves. Concurrent therapeutic procedures were performed in 10 cases (33%). Pre-procedure MR imaging revealed structural abnormality of the nerve or adjacent soft tissues in 11 of 22 MRIs performed amongst the 20 patients (50%). Pre-procedure ultrasound revealed structural abnormalities associated with the nerve in 9 cases of 19 cases that had complete documentation (47%). Of 26 injections with complete documentation, immediate improvement of symptoms was reported in 22 cases (85%). The remaining 4 cases either began with no pain (n=3), or reported no change in symptoms (n=1). Variable degrees of long-term symptom relief was achieved in 4 injections out of 11 steroid injections for which follow-up was available (37%). Conclusion: Ultrasound-guided perineural injections can be performed for treatment of a variety of pelvic neuropathies. MR imaging prior to sonographic intervention demonstrated an abnormality in nearly half of cases, and is a useful tool to appropriately target perineural injections
EMBASE:620615504
ISSN: 1432-2161
CID: 2959282

Visualization of the normal appendix in children on MRI using radial vibe - A contrast enhanced, free-breathing, radially sampled, 3D T1-weighted, gradient-echo sequence [Meeting Abstract]

Lala, S; Nocera, N; Bittman, M; Strubel, N; Babb, J; Fefferman, N
Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Current MRI evaluation of appendicitis is limited by duration of examination and patient cooperation. The radially sampled 3D T1 weighted, gradient recalled echo sequence (radial VIBE) is a free-breathing, motion robust sequence that may prove useful in the evaluation of appendicitis in children. The purpose of this investigation is to determine the detection rate of the normal appendix with contrast enhanced (CE) radial VIBE alone compared with CE conventional 3D gradient recalled echo volumetric interpolated breath-hold examination (conventional VIBE) alone and multi-sequence abdominal pelvic MRI including CE radial VIBE. Methods& Materials:We conducted a retrospective, HIPAA compliant and IRB approved study of patients between 7 and 18 years of age who underwent an abdominal and pelvic contrast enhanced MRI between January 1, 2012 and April 1, 2016. Patients with active right lower quadrant inflammation, pelvic masses, or history of appendectomy were excluded. Visualization of the appendix was assessed by two pediatric radiologists with Certificates of Added Qualification by consensus on the following sequences: CE radial VIBE only, CE conventional VIBE only, and multi-sequence MRI which included CE radial VIBE and at least an axial or coronal single shot fast spin echo (SSFSE) or axial T2 weighted spin echo with fat suppression. The detection rates of the appendix for each sequence or combination of sequences were compared with a McNemar test. Results: Ninety-six patients met inclusion criteria. The detection rate of the normal appendix on CE radial VIBE was significantly higher than on CE conventional VIBE (76% vs 57.3%, p=0.003). The detection rate of the normal appendix with multi-sequence MRI was significantly higher than on CE conventional VIBE (81.3% vs 57%, p<0.001). There was no significant difference between the detection rate of the normal appendix on CE radial VIBE and multi-sequence MRI (76% vs 81.3%, p=0.267). When the appendix was not visualized on the CE radial VIBE (n=23) but detected on the multi-sequence MRI (n=9), it was most often visualized on SSFSE (n=8). Conclusions: CE radial VIBE allows superior detection of the normal appendix compared to CE conventional VIBE. The detection rate of the normal appendix on CE radial VIBE alone is nearly as good as when the CE radial VIBE is interpreted with additional sequences
EMBASE:615734017
ISSN: 1432-1998
CID: 2550212

Anti-NMDA receptor encephalomyelitis

Park, Joe Y.; Mittal, Khushbakhat; Lala, Shailee; Patel, Shohil
ISI:000390897900007
ISSN: 0160-9963
CID: 2975412

Fetal and Postnatal Magnetic Resonance Imaging of Unilateral Cystic Renal Dysplasia in a Neonate with Tuberous Sclerosis

Tyagi, Vineet; Bornstein, Eran; Schacht, Robert; Lala, Shailee; Milla, Sarah
Tuberous sclerosis (TS) is an autosomal dominant condition associated with mutations in the TSC1 and/or TSC2 genes. Clinical manifestations are multisystemic, and they often include lesions in the brain, skin, heart, kidneys, and bones. TSC2 gene mutations can be seen concomitantly with autosomal dominant polycystic kidney disease gene mutations. We present a case of a fetus with prenatal diagnosis of TS that had unique asymmetrical distribution of renal cystic disease. We describe the extensive work up with both fetal and neonatal magnetic resonance imaging with correlating images of the unilateral polycystic renal disease in addition to typical TS brain findings.
PMID: 24495558
ISSN: 1875-9572
CID: 1612112