1
|
Labranche R, Lapierre C, Trop I. How Well Are Radiology Residents Prepared for Practice After Training? A Survey of French-Speaking Quebec Recent Graduates and Department Chiefs. Can Assoc Radiol J 2021; 72:359-371. [PMID: 32106689 DOI: 10.1177/0846537119899525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Radiology residents must fulfill a standardized curriculum to complete residency and pass a certification exam before they are granted a licence to practice. We sought to evaluate how well residency prepares trainees for practice as perceived by recent graduates and their department chiefs. Subjects and Methods: Radiologists who graduated from the 4 Quebec radiology residency programs between 2005 and 2016 (n = 237) and Quebec radiology department chiefs (n = 98) were anonymously surveyed. Two electronic surveys were created, for recent graduates (74 questions) and for department chiefs (11 questions), with multiple-choice questions and open questions covering all fields of radiology. Surveys were administered between April and June 2016 using the Association des radiologistes du Québec database. RESULTS Response rate was 75 (31.6%) of 237 from recent graduates and 96% rated their training as excellent or good. Satisfaction with training in computed tomography and magnetic resonance imaging was high, with musculoskeletal (MSK) imaging, particularly MSK ultrasound (US), as well as pediatric, cardiac, and vascular imaging needing more training. Thirty-nine (39.8%) of 98 department chiefs answered the survey and highlighted weaknesses in the interpretation of conventional radiography, obstetrical US, and invasive procedures, as well as limited leadership and administrative skills. Recent graduates and department chiefs both reported difficulties in the ability to interpret daily volume of examinations as scheduled and invasive procedure competency. CONCLUSION This survey highlights areas of the radiology curriculum which may benefit from more emphasis during training. Adjustments in the residency program would ensure graduates are successful both in their certification exams and clinical practice.
Collapse
Affiliation(s)
- Roxanne Labranche
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, University of Montreal, Québec, Canada
| | - Chantale Lapierre
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, University of Montreal, Québec, Canada
- Department of Radiology, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Isabelle Trop
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, University of Montreal, Québec, Canada
- Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| |
Collapse
|
2
|
Russo V, Sportoletti C, Scalas G, Attinà D, Buia F, Niro F, Modolon C, De Luca C, Monteduro F, Lovato L. The triple rule out CT in acute chest pain: a challenge for emergency radiologists? Emerg Radiol 2021; 28:735-742. [PMID: 33604768 PMCID: PMC8280047 DOI: 10.1007/s10140-021-01911-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain. METHODS Between July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist-CR, an emergency senior radiologist-SER, and an emergency junior radiologist-JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software. RESULTS Concordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (<50%), CS concordance rates were 97.98%, 90.91%, and 97.18%, respectively, for CR, SER, and JER; for obstructive CS (>50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one. CONCLUSIONS Our study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The "undedicated" radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.
Collapse
Affiliation(s)
- Vincenzo Russo
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy.
| | - Camilla Sportoletti
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| | - Giulia Scalas
- Emergency Department, Radiology Unit, University Hospital S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Domenico Attinà
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| | - Francesco Buia
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| | - Fabio Niro
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| | - Cecilia Modolon
- Emergency Department, Radiology Unit, University Hospital S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Carlo De Luca
- Emergency Department, Radiology Unit, University Hospital S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Francesco Monteduro
- Emergency Department, Radiology Unit, University Hospital S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Luigi Lovato
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, Block 23, Via Massarenti 9, 40138, Bologna, Italy
| |
Collapse
|
3
|
Higashigaito K, Hinzpeter R, Baumueller S, Benz D, Manka R, Keller DI, Alkadhi H, Morsbach F. Chest pain CT in the emergency department: Watch out for the myocardium. Eur J Radiol Open 2018; 5:202-208. [PMID: 30456219 PMCID: PMC6232643 DOI: 10.1016/j.ejro.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/21/2018] [Indexed: 12/31/2022] Open
Abstract
Hypodense myocardium (HM) can be observed often in chest pain CT examinations of patients presenting to the emergency department with chest pain. There is benefit when the myocardium is also analyzed for the presence of HM, even when the heart and coronary arteries were not specifically asked-for. Sensitivity, specificity, PPV and NPV for the detection of acute myocardial infarction by assessing HM was 52%, 100%, 100% and 95% respectively. Assessment of hypodense myocardium may increase the diagnostic confidence in ambiguous coronary findings in chest pain CT.
Rationale and Objectives To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED). Material and Methods In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CTcoronary, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CTw/o coronary, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium. Results HM was identified in 27/300 patients (9%): 12/179 in chest-pain CTw/o coronary (7%) and 15/121 in chest-pain CTcoronary (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p < 0.001), with a mean difference of 61 ± 19 HU. In 15/27 patients (55.6%) with HM, the final diagnosis was acute MI, and in the remaining 12/27 patients (44.4%) previous MI was found in the patients’ history. Chest-pain CTw/o coronary identified HM in 10/15 patients (66.6%) with a final diagnosis of acute MI. Conclusion HM indicating acute MI are often encountered in chest pain CT in the ED, also in chest-pain CTw/o coronary when MI is not suspected. This indicates that the myocardium should always be analyzed for hypodense regions even when MI not suspected.
Collapse
Key Words
- AAC/AHA, American College of Cardiology / American Heart Association
- AAS, acute aortic syndrome
- ACS, acute coronary syndrome
- Acute chest pain
- BPM, beats per minute
- CAD, coronary artery disease
- CI, confidence interval
- CT, computed tomography
- CX, circumflex artery
- Cardiac
- Computed tomography
- ECG, electrocardiography
- ED, emergency department
- Emergency department
- HU, hounsfield unit
- ICC, intraclass correlation coefficients
- LAD, left anterior descending artery
- MH, hypodense myocardium
- MI, myocardial infarction
- NPV, negative predictive value
- NSTEMI, non-ST elevation myocardial infarction
- PE, pulmonary embolism
- PPV, positive predictive value
- RCA, right coronary artery
- ROI, region of interest
Collapse
Affiliation(s)
- Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Stephan Baumueller
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - David Benz
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.,Department of Cardiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Dagmar I Keller
- Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Fabian Morsbach
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| |
Collapse
|
4
|
Added value of double reading in diagnostic radiology,a systematic review. Insights Imaging 2018; 9:287-301. [PMID: 29594850 PMCID: PMC5990995 DOI: 10.1007/s13244-018-0599-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 01/10/2023] Open
Abstract
Objectives Double reading in diagnostic radiology can find discrepancies in the original report, but a systematic program of double reading is resource consuming. There are conflicting opinions on the value of double reading. The purpose of the current study was to perform a systematic review on the value of double reading. Methods A systematic review was performed to find studies calculating the rate of misses and overcalls with the aim of establishing the added value of double reading by human observers. Results The literature search resulted in 1610 hits. After abstract and full-text reading, 46 articles were selected for analysis. The rate of discrepancy varied from 0.4 to 22% depending on study setting. Double reading by a sub-specialist, in general, led to high rates of changed reports. Conclusions The systematic review found rather low discrepancy rates. The benefit of double reading must be balanced by the considerable number of working hours a systematic double-reading scheme requires. A more profitable scheme might be to use systematic double reading for selected, high-risk examination types. A second conclusion is that there seems to be a value of sub-specialisation for increased report quality. A consequent implementation of this would have far-reaching organisational effects. Key Points • In double reading, two or more radiologists read the same images. • A systematic literature review was performed. • The discrepancy rates varied from 0.4 to 22% in various studies. • Double reading by sub-specialists found high discrepancy rates. Electronic supplementary material The online version of this article (10.1007/s13244-018-0599-0) contains supplementary material, which is available to authorised users.
Collapse
|
5
|
Di Marco L, Rosset M, Zhang-Yin J, Ohana M. [Multimodal imaging of ischemic heart diseases: A 2015 update]. Rev Med Interne 2016; 37:350-62. [PMID: 26775644 DOI: 10.1016/j.revmed.2015.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/08/2015] [Accepted: 12/08/2015] [Indexed: 11/26/2022]
Abstract
Current realities and future possibilities of imaging in the ischemic heart diseases are very broad and constantly evolving, with the improvement of existing technologies and the introduction of new features such as dual-energy CT, strain ultrasound, multimodality fusion or perfusion MRI. Regular collaboration between prescribing clinicians, cardiologists, radiologists and nuclear radiologists is therefore essential to tailor the examination to the specific clinical question. The indications for each modality will therefore depend on its diagnostic performance, cost, acquisition and post-processing times and eventual radiation exposure. This review will detail principles and applications of current cardiac imaging examinations: echocardiography, nuclear medicine, MRI, CT and coronary angiography, emphasizing their current strengths and weaknesses in the ischemic heart diseases management.
Collapse
Affiliation(s)
- L Di Marco
- Imagerie, Bocage Central, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - M Rosset
- Cardiologie, hôpital Louis-Pradel, 28, avenue du Doyen-Jean-Lépine, 69500 Bron, France
| | - J Zhang-Yin
- Médecine nucléaire, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
| | - M Ohana
- Imagerie, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67000 Strasbourg, France
| |
Collapse
|
6
|
Overnight shift work: factors contributing to diagnostic discrepancies. Emerg Radiol 2015; 23:41-47. [DOI: 10.1007/s10140-015-1355-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
|
7
|
Radiology education: keeping pace with changing times, new technology, and increased challenges. Acad Radiol 2014; 21:827-8. [PMID: 24928156 DOI: 10.1016/j.acra.2014.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 04/21/2014] [Accepted: 04/28/2014] [Indexed: 11/23/2022]
|