Design and Validation of a Peer-Teacher-Based Musculoskeletal Ultrasound Curriculum

RATIONALE AND OBJECTIVES

To design and validate a peer-teacher based musculoskeletal ultrasound curriculum for radiology residents.

MATERIALS AND METHODS

A musculoskeletal ultrasound curriculum with hands-on scanning workshops was designed for radiology residents. Prior to the workshops, several residents received 3 hours of hands-on training in ultrasound scanning technique which was overseen by an attending musculoskeletal radiologist; these "peer teachers" then led small-group hands-on scanning during the workshops. Participants performed diagnostic ultrasound examinations at the conclusion of the workshops to assess skill acquisition and 2 months following the workshops to quantify skill retention. Participants also completed surveys to determine confidence in performing musculoskeletal ultrasound examinations. Median scores and interquartile range (25-75%) were calculated, and t test was used to compare results.

RESULTS

Thirty seven residents from all years of training and six senior resident or fellow peer teachers participated in four workshops. Diagnostic ultrasound images were obtained in 100% at the conclusion of the workshop and in 79% 2 months later. Prior to the workshops, residents reported low level of musculoskeletal ultrasound knowledge (median 2, interquartile ranges 1-2), and low confidence in performing (1, 1-2) and interpreting (1, 1-2) musculoskeletal ultrasound examinations. There was a significant increase in knowledge (3, 3-4) and confidence performing (3, 3-4) and interpreting (3, 3-4) studies following the workshops (p < 0.001 for all comparisons).

CONCLUSION

Hands-on musculoskeletal ultrasound workshops, utilizing a peer teacher led small group format is an effective method of teaching scanning skills to residents. There was excellent skill acquisition, good skill retention, and significant increase in confidence performing and interpreting these studies following completion of the curriculum.

Ultrasound elastography of the patellar tendon in young, asymptomatic sedentary and moderately active individuals

BACKGROUND

The recent use of ultrasound elastography to study patellar tendon softness has demonstrated increased tendon softness in high-level athletes. We hypothesized that measurable alterations in patellar tendon softness may be present in young asymptomatic subjects engaging in moderate levels of physical activity.

METHODS

This was a cross-sectional study. Gray-scale ultrasound and ultrasound elastography of the right and left patellar tendons were performed in young asymptomatic sedentary subjects and moderately active subjects who engaged in at least 30 min of physical activity 4-5 times weekly. The distribution of soft, intermediate and stiff tissue within each tendon was analyzed. Tendon softness was correlated with subject age, gender and level of athletic activity.

RESULTS

Sixty patellar tendons in 30 subjects were evaluated (18 males, 12 females, mean age 22.5 years). Seventeen subjects were defined as "active" and 13 as "sedentary." All tendons had a normal gray-scale sonographic appearance. Tendon softness was significantly higher in active subjects (P = 0.01) and decreased with age (P = 0.04). In sedentary individuals there was no significant correlation between age and tendon softness (P = 0.404). Similarly, gender showed no correlation with tendon softness (P > 0.05).

CONCLUSIONS

Patellar tendon softness is higher in young subjects and in those engaging in moderate physical activity. This may reflect an adaptation to increased tendon load. Tendon softness in active subjects decreases with age, while it remains at a constant value in sedentary individuals.

LEVEL OF EVIDENCE

Level 3.

Acute left circumflex coronary artery occlusion detected on nongated CT

We describe a patient with chest pain and a nondiagnostic electrocardiogram in whom computed tomographic (CT) aortography demonstrated myocardial hypoperfusion in the distribution of the circumflex artery as well as an abrupt cutoff of contrast in the left circumflex artery. Subsequent cardiac catheterization confirmed occlusion of the circumflex artery and led to revascularization. The diagnosis of acute myocardial infarction on CT can dramatically alter the clinical management of a patient, especially in cases in which other tests are equivocal.

A new, simple method for estimating pleural effusion size on CT scans

BACKGROUND

There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need for imaging guidance for thoracentesis.

METHODS

CT scans of 34 patients demonstrating a wide range of pleural effusion sizes were measured with a volume segmentation tool and reviewed for qualitative and simple quantitative features related to size. A classification rule was developed using the features that best predicted size and distinguished among small, moderate, and large effusions. Inter-reader agreement for effusion size was assessed on the CT scans for three groups of physicians (radiology residents, pulmonologists, and cardiothoracic radiologists) before and after implementation of the classification rule.

RESULTS

The CT imaging features found to best classify effusions as small, moderate, or large were anteroposterior (AP) quartile and maximum AP depth measured at the midclavicular line. According to the decision rule, first AP-quartile effusions are small, second AP-quartile effusions are moderate, and third or fourth AP-quartile effusions are large. In borderline cases, AP depth is measured with 3-cm and 10-cm thresholds for the upper limit of small and moderate, respectively. Use of the rule improved interobserver agreement from κ = 0.56 to 0.79 for all physicians, 0.59 to 0.73 for radiology residents, 0.54 to 0.76 for pulmonologists, and 0.74 to 0.85 for cardiothoracic radiologists.

CONCLUSIONS

A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.

Kounis syndrome secondary to ibuprofen use

Kounis syndrome is the coincidental occurrence of acute coronary syndromes with allergic or hypersensitivity reactions. Clinicians should be aware that various mediators of allergy can cause coronary spasm and even plaque rupture and thrombus formation, thereby causing a serious impact on the course, prognosis and management of the allergic reaction. We report a case of a 20 year old female who developed acute coronary syndrome after anaphylactic reaction to ibuprofen.