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Hecht EM, Leyendecker JR, Spieler BM, Chaturvedi A, Fennessy FM, Gadde JA, Horowitz JM, Robbins JB, Shah GV, Desser TS, Lewis PJ. Practical Tips and a Template for Developing Your Curriculum Vitae. Acad Radiol 2023; 30:2761-2768. [PMID: 37208259 DOI: 10.1016/j.acra.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
The Alliance of Leaders in Academic Affairs in Radiology (ALAAR) advocates for a Universal Curriculum Vitae for all medical institutions and to that end, we have developed a template that can be downloaded on the AUR website (ALAAR CV template) that includes all of the elements required by many academic institutions. Members of ALAAR represent multiple academic institutions and have spent many hours reviewing and providing input on radiologists' curricula vitae. The purpose of this review is to help academic radiologists accurately maintain and optimize their CVs with minimal effort and to clarify common questions that arise at many different institutions in the process of constructing a CV.
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Affiliation(s)
- Elizabeth M Hecht
- Department of Radiology, Weill Cornell Medicine, New York, New York (E.M.H.).
| | - John R Leyendecker
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas (J.R.L.).
| | - Bradley M Spieler
- Department of Radiology, University Medical Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana (B.M.S.).
| | - Apeksha Chaturvedi
- Department of Radiology, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, New York (A.C.).
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's, Boston, Massachusetts (F.M.F.).
| | - Judith A Gadde
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois (J.A.G.).
| | - Jeanne M Horowitz
- Department of Radiology, Northwestern University, Chicago, Illinois (J.M.H.).
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (J.B.R.).
| | - Gaurang V Shah
- Department of Radiology, University of Michigan Health, Ann Arbor, Michigan (G.V.S.).
| | - Terry S Desser
- Department of Radiology, Stanford University, Palo Alto, California (T.S.D.).
| | - Petra J Lewis
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (P.J.L.).
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Hecht EM, Robbins JB, Desser TS, Grist TM, Min RJ, Catanzano TM, Slanetz PJ. Defining the Roles and Responsibilities for the Vice Chair for Academic Affairs/Faculty Development in Radiology. Acad Radiol 2023; 30:2728-2733. [PMID: 37059613 DOI: 10.1016/j.acra.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/16/2023]
Abstract
RATIONALE AND OBJECTIVES To inform the development of a job description for Vice-Chairs for academic affairs (VCAA), members of the Alliance of Leaders in Academic Affairs in Radiology (ALAAR) were surveyed to better understand their current job responsibilities and how they would ideally allocate their professional time. MATERIALS AND METHODS Based on a survey of 33 university-affiliated radiology departments and discussion among ALAAR members, the authors developed a detailed job description for the VCAA. The 21-question survey was composed and validated by experts in the field. It was distributed to all members of ALAAR via email with an electronic link and was open for 5 months. Results of the survey were tabulated, and a job description was crafted to represent the foundational roles of academic affairs leaders in radiology. RESULTS The response rate for institutions represented in ALAAR was 73% (33/45). All participants reported that they practiced in a university-affiliated institution. Faculty size varied from ≤49 (30.3%, 10/33), 50-99 faculty (24.2%, 8/33), and ≥100 faculty members (45.5%, 15/33). Only 24% of survey respondents had a detailed job description at the time of hire. More than 40% attested to significant oversight over faculty development programs (45%), mentorship programs (42%, and promotions (45%). Respondents ideally want increased oversight (defined as >10%) over exit interviews, faculty awards, promotions, onboarding, recruitment and hiring, and wellness programming. CONCLUSION The aspirational mission of the VCAA is to oversee components of sequential stages in the professional lifecycle of faculty members but a common job description for this role is lacking.
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Affiliation(s)
- Elizabeth M Hecht
- Department of Radiology, Weill Cornell Medicine, New York, New York.
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Terry S Desser
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert J Min
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Tara M Catanzano
- Department of Radiology, UMass Chan Medical School-Baystate, Springfield, Massachusetts
| | - Priscilla J Slanetz
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Antil N, Wang H, Kaffas AE, Desser TS, Folkins A, Longacre T, Berek J, Lutz AM. In Vivo Ultrasound Molecular Imaging in the Evaluation of Complex Ovarian Masses: A Practical Guide to Correlation with Ex Vivo Immunohistochemistry. Adv Biol (Weinh) 2023; 7:e2300091. [PMID: 37403275 DOI: 10.1002/adbi.202300091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/22/2023] [Indexed: 07/06/2023]
Abstract
Ovarian cancer is the fifth leading cause of cancer-related deaths in women and the most lethal gynecologic cancer. It is curable when discovered at an early stage, but usually remains asymptomatic until advanced stages. It is crucial to diagnose the disease before it metastasizes to distant organs for optimal patient management. Conventional transvaginal ultrasound imaging offers limited sensitivity and specificity in the ovarian cancer detection. With molecularly targeted ligands addressing targets, such as kinase insert domain receptor (KDR), attached to contrast microbubbles, ultrasound molecular imaging (USMI) can be used to detect, characterize and monitor ovarian cancer at a molecular level. In this article, the authors propose a standardized protocol is proposed for the accurate correlation between in- vivo transvaginal KDR-targeted USMI and ex vivo histology and immunohistochemistry in clinical translational studies. The detailed procedures of in vivo USMI and ex vivo immunohistochemistry are described for four molecular markers, CD31 and KDR with a focus on how to enable the accurate correlation between in vivo imaging findings and ex vivo expression of the molecular markers, even if not the entire tumor could can be imaged by USMI, which is not an uncommon scenario in clinical translational studies. This work aims to enhance the workflow and the accuracy of characterization of ovarian masses on transvaginal USMI using histology and immunohistochemistry as reference standards, which involves sonographers, radiologists, surgeons, and pathologists in a highly collaborative research effort of USMI in cancer.
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Affiliation(s)
- Neha Antil
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Huaijun Wang
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Ahmed El Kaffas
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Terry S Desser
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Ann Folkins
- Department of Pathology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Teri Longacre
- Department of Pathology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Jonathan Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Amelie M Lutz
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
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Maxfield CM, Thorpe MP, Desser TS, Heitkamp D, Hull NC, Koontz NA, Welch TJ, Grimm LJ. Can the use of deception be justified in medical education research? A point/counterpoint and case study. Acad Radiol 2022; 29:1091-1094. [PMID: 34172348 DOI: 10.1016/j.acra.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
Deception is a common feature of behavioral research design, although not commonly employed in the medical literature. It can promote scientific validity but is ethically controversial because it compromises subject autonomy and incurs additional costs. In this Point/Counterpoint monograph, we review the nature of deception in research and present arguments for and against its ethical use as a research methodology in behavioral studies. We describe the necessary guidelines, safeguards, and oversight, when deceptive methodology is considered, and report our experiences and lessons learned from conducting a multi-institutional audit study that relied upon deception of academic radiology faculty.
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Affiliation(s)
- Charles M Maxfield
- Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | | | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | | | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas A Koontz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Yamashita R, Kapoor T, Alam MN, Galimzianova A, Syed SA, Ugur Akdogan M, Alkim E, Wentland AL, Madhuripan N, Goff D, Barbee V, Sheybani ND, Sagreiya H, Rubin DL, Desser TS. Toward Reduction in False-Positive Thyroid Nodule Biopsies with a Deep Learning-based Risk Stratification System Using US Cine-Clip Images. Radiol Artif Intell 2022; 4:e210174. [PMID: 35652118 PMCID: PMC9152684 DOI: 10.1148/ryai.210174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/16/2022] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To develop a deep learning-based risk stratification system for thyroid nodules using US cine images. MATERIALS AND METHODS In this retrospective study, 192 biopsy-confirmed thyroid nodules (175 benign, 17 malignant) in 167 unique patients (mean age, 56 years ± 16 [SD], 137 women) undergoing cine US between April 2017 and May 2018 with American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS)-structured radiology reports were evaluated. A deep learning-based system that exploits the cine images obtained during three-dimensional volumetric thyroid scans and outputs malignancy risk was developed and compared, using fivefold cross-validation, against a two-dimensional (2D) deep learning-based model (Static-2DCNN), a radiomics-based model using cine images (Cine-Radiomics), and the ACR TI-RADS level, with histopathologic diagnosis as ground truth. The system was used to revise the ACR TI-RADS recommendation, and its diagnostic performance was compared against the original ACR TI-RADS. RESULTS The system achieved higher average area under the receiver operating characteristic curve (AUC, 0.88) than Static-2DCNN (0.72, P = .03) and tended toward higher average AUC than Cine-Radiomics (0.78, P = .16) and ACR TI-RADS level (0.80, P = .21). The system downgraded recommendations for 92 benign and two malignant nodules and upgraded none. The revised recommendation achieved higher specificity (139 of 175, 79.4%) than the original ACR TI-RADS (47 of 175, 26.9%; P < .001), with no difference in sensitivity (12 of 17, 71% and 14 of 17, 82%, respectively; P = .63). CONCLUSION The risk stratification system using US cine images had higher diagnostic performance than prior models and improved specificity of ACR TI-RADS when used to revise ACR TI-RADS recommendation.Keywords: Neural Networks, US, Abdomen/GI, Head/Neck, Thyroid, Computer Applications-3D, Oncology, Diagnosis, Supervised Learning, Transfer Learning, Convolutional Neural Network (CNN) Supplemental material is available for this article. © RSNA, 2022.
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Soloff EV, Al-Hawary MM, Desser TS, Fishman EK, Minter RM, Zins M. Imaging Assessment of Pancreatic Cancer Resectability After Neoadjuvant Therapy: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 218:570-581. [PMID: 34851713 DOI: 10.2214/ajr.21.26931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite important innovations in the treatment of pancreatic ductal adenocarcinoma (PDAC), PDAC remains a disease with poor prognosis and high mortality. A key area for potential improvement in the management of PDAC, aside from earlier detection in patients with treatable disease, is the improved ability of imaging techniques to differentiate treatment response after neoadjuvant therapy (NAT) from worsening disease. It is well established that current imaging techniques cannot reliably make this distinction. This narrative review provides an update on the imaging assessment of pancreatic cancer resectability after NAT. Current definitions of borderline resectable PDAC, as well as implications for determining likely patient benefit from NAT, are described. Challenges associated with PDAC pathologic evaluation and surgical decision making that are of relevance to radiologists are discussed. Also explored are the specific limitations of imaging in differentiating the response after NAT from stable or worsening disease, including issues relating to protocol optimization, tumor size assessment, vascular assessment, and liver metastasis detection. The roles of MRI as well as PET and/or hybrid imaging are considered. Finally, a short PDAC reporting template is provided for use after NAT. The highlighted methods seek to improve radiologists' assessment of PDAC treatment response after NAT.
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Affiliation(s)
- Erik V Soloff
- Department of Radiology, University of Washington, Seattle, WA
| | - Mahmoud M Al-Hawary
- Department of Radiology and Internal Medicine, Michigan Medicine, Ann Arbor, MI
| | - Terry S Desser
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Elliot K Fishman
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Marc Zins
- Department of Radiology, Groupe Hospitalier Paris Saint Joseph, 185 Rue R Losserand, Paris 75014, France
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Yamashita R, Bird K, Cheung PYC, Decker JH, Flory MN, Goff D, Morimoto LN, Shon A, Wentland AL, Rubin DL, Desser TS. Automated Identification and Measurement Extraction of Pancreatic Cystic Lesions from Free-Text Radiology Reports Using Natural Language Processing. Radiol Artif Intell 2022; 4:e210092. [PMID: 35391762 DOI: 10.1148/ryai.210092] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/26/2021] [Accepted: 12/02/2021] [Indexed: 01/04/2023]
Abstract
Purpose To automatically identify a cohort of patients with pancreatic cystic lesions (PCLs) and extract PCL measurements from historical CT and MRI reports using natural language processing (NLP) and a question answering system. Materials and Methods Institutional review board approval was obtained for this retrospective Health Insurance Portability and Accountability Act-compliant study, and the requirement to obtain informed consent was waived. A cohort of free-text CT and MRI reports generated between January 1991 and July 2019 that covered the pancreatic region were identified. A PCL identification model was developed by modifying a rule-based information extraction model; measurement extraction was performed using a state-of-the-art question answering system. The system's performance was evaluated against radiologists' annotations. Results For this study, 430 426 free-text radiology reports from 199 783 unique patients were identified. The NLP model for identifying PCL was applied to 1000 test samples. The interobserver agreement between the model and two radiologists was almost perfect (Fleiss κ = 0.951), and the false-positive rate and true-positive rate were 3.0% and 98.2%, respectively, against consensus of radiologists' annotations as ground truths. The overall accuracy and Lin concordance correlation coefficient for measurement extraction were 0.958 and 0.874, respectively, against radiologists' annotations as ground truths. Conclusion An NLP-based system was developed that identifies patients with PCLs and extracts measurements from a large single-institution archive of free-text radiology reports. This approach may prove valuable to study the natural history and potential risks of PCLs and can be applied to many other use cases.Keywords: Informatics, Abdomen/GI, Pancreas, Cysts, Computer Applications-General (Informatics), Named Entity Recognition Supplemental material is available for this article. © RSNA, 2022See also commentary by Horii in this issue.
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Affiliation(s)
- Rikiya Yamashita
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Kristen Bird
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Philip Yue-Cheng Cheung
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Johannes Hugo Decker
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Marta Nicole Flory
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Daniel Goff
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Linda Nayeli Morimoto
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Andy Shon
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Andrew Louis Wentland
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Daniel L Rubin
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Terry S Desser
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
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Chen D, Ayoob A, Desser TS, Khurana A. Review of Learning Tools for Effective Radiology Education During the COVID-19 Era. Acad Radiol 2022; 29:129-136. [PMID: 34799258 PMCID: PMC8542451 DOI: 10.1016/j.acra.2021.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has significantly disrupted medical education around the world and created the risk of students missing vital education and experience previously held within actively engaging in-person activities by switching to online leaning and teaching activities. To retain educational yield, active learning strategies, such as microlearning and visual learning tools are increasingly utilized in the new digital format. This article will introduce the challenges of a digital learning environment, review the efficacy of applying microlearning and visual learning strategies, and demonstrate tools that can reinforce radiology education in this constantly evolving digital era such as innovative tablet apps and tools. This will be key in preserving and augmenting essential medical teaching in the currently trying socially and physically distant times of COVID-19 as well as in similar future scenarios.
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Affiliation(s)
- David Chen
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Andres Ayoob
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St, HX 316, Lexington, KY 40536
| | - Terry S Desser
- Department of Radiology, Stanford University, Stanford, California
| | - Aman Khurana
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St, HX 316, Lexington, KY 40536.
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Tiyarattanachai T, Bird KN, Lo EC, Mariano AT, Ho AA, Ferguson CW, Chima RS, Desser TS, Morimoto LN, Kamaya A. Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) Visualization Score: a reliability analysis on inter-reader agreement. Abdom Radiol (NY) 2021; 46:5134-5141. [PMID: 34228197 DOI: 10.1007/s00261-021-03067-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIM The American College of Radiology Ultrasound Liver Imaging Reporting and Data System (ACR US LI-RADS) Visualization Score conveys the expected level of sensitivity of screening and surveillance ultrasound exams in patients at risk for hepatocellular carcinoma (HCC). We sought to determine inter-reader agreement of the Visualization Score which is currently unknown. METHODS Consecutive 6998 ultrasound HCC screening and surveillance studies in 3115 patients from 2017 to 2020 were retrospectively retrieved. Of these, 6154 (87.9%) studies were Visualization A (No or minimal limitations), 709 (10.1%) were Visualization B (Moderate limitations), and 135 (1.9%) were Visualization C (Severe limitations). Randomly sampled 90 studies, with 30 studies in each Visualization category, were included for analysis. Nine radiologists (3 senior attendings, 3 junior attendings and 3 body imaging fellows) blinded to the original categorization independently reviewed each study and assigned a Visualization Score. Intraclass correlation coefficient (ICC) was used to quantify inter-reader agreement. RESULTS ICC among all 9 radiologists was 0.70 (95% CI 0.63-0.77). ICCs among senior attendings, junior attendings and body imaging fellows were 0.68 (CI 0.58-0.76), 0.72 (CI 0.62-0.80) and 0.76 (CI 0.68-0.83), respectively. Subgroup analysis by liver parenchyma was further performed. ICC was highest in the patient group with normal liver parenchyma (0.69, CI 0.56-0.81), followed by steatosis (0.66, CI 0.54-0.79) and cirrhosis (0.58, CI 0.43-0.73), respectively. CONCLUSIONS US LI-RADS Visualization Score is a reliable tool with good inter-reader agreement that can be used to indicate the expected level of sensitivity of a screening and surveillance ultrasound examination for detecting focal liver observations.
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Maxfield CM, Montano-Campos JF, Chapman T, Desser TS, Ho CP, Hull NC, Kelly HR, Kennedy TA, Koontz NA, Knippa EE, McLoud TC, Milburn J, Mills MK, Morgan DE, Morgan R, Peterson RB, Salastekar N, Thorpe MP, Zarzour JG, Reed SD, Grimm LJ. Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment. J Am Coll Radiol 2021; 18:1572-1580. [PMID: 34332914 DOI: 10.1016/j.jacr.2021.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Reporting of United States Medical Licensing Examination Step 1 results will transition from a numerical score to a pass or fail result. We sought an objective analysis to determine changes in the relative importance of resident application attributes when numerical Step 1 results are replaced. METHODS A discrete choice experiment was designed to model radiology resident selection and determine the relative weights of various application factors when paired with a numerical or pass or fail Step 1 result. Faculty involved in resident selection at 14 US radiology programs chose between hypothetical pairs of applicant profiles between August and November 2020. A conditional logistic regression model assessed the relative weights of the attributes, and odds ratios (ORs) were calculated. RESULTS There were 212 participants. When a numerical Step 1 score was provided, the most influential attributes were medical school (OR: 2.35, 95% confidence interval [CI]: 2.07-2.67), Black or Hispanic race or ethnicity (OR: 2.04, 95% CI: 1.79-2.38), and Step 1 score (OR: 1.8, 95% CI: 1.69-1.95). When Step 1 was reported as pass, the applicant's medical school grew in influence (OR: 2.78, 95% CI: 2.42-3.18), and there was a significant increase in influence of Step 2 scores (OR: 1.31, 95% CI: 1.23-1.40 versus OR 1.57, 95% CI: 1.46-1.69). There was little change in the relative influence of race or ethnicity, gender, class rank, or clerkship honors. DISCUSSION When Step 1 reporting transitions to pass or fail, medical school prestige gains outsized influence and Step 2 scores partly fill the gap left by Step 1 examination as a single metric of decisive importance in application decisions.
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Affiliation(s)
- Charles M Maxfield
- Vice-Chair of Education, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | - J Felipe Montano-Campos
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Teresa Chapman
- Residency Program Director, Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Christopher P Ho
- Residency Program Director, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Hillary R Kelly
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nicholas A Koontz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Emily E Knippa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Theresa C McLoud
- Vice-Chair of Education, Residency Program Director, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Milburn
- Residency Program Director, Department of Radiology, Ochsner Health System, New Orleans, Louisiana
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Desiree E Morgan
- Vice-Chair of Education, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rustain Morgan
- Residency Program Director, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ryan B Peterson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ninad Salastekar
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York
| | | | - Jessica G Zarzour
- Radiology Residency Program Director, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Maxfield CM, Thorpe MP, Desser TS, Heitkamp D, Hull NC, Johnson KS, Koontz NA, Mlady GW, Welch TJ, Grimm LJ. Awareness of implicit bias mitigates discrimination in radiology resident selection. Med Educ 2020; 54:637-642. [PMID: 32119145 DOI: 10.1111/medu.14146] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/25/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Implicit bias is common and is thought to drive discriminatory behaviour. Having previously demonstrated discrimination against specific applicant demographics by academic radiology departments in a simulated resident selection process, the authors sought to better understand the relationship between implicit bias and discrimination, as well as the potential and mechanisms for their mitigation. METHODS A total of 51 faculty reviewers at three academic radiology departments, who had participated in a 2017 audit study in which they were shown to treat applicants differently based on race or ethnicity and physical appearance, were invited to complete testing for implicit racial and weight bias using the Implicit Association Test in 2019. Respondents were also surveyed regarding awareness of their own personal racial and weight biases, as well as any prior participation in formal diversity training. Comparisons were made between implicit bias scores and applicant ratings, as well as between diversity training and self-awareness of bias. RESULTS A total of 31 out of 51 faculty reviewers (61%) completed and submitted results of race and weight Implicit Association Tests. A total of 74% (23/31) reported implicit anti-obese bias, concordant with discrimination demonstrated in the resident selection simulation, in which obese applicants were rated 0.40 standard deviations (SDs) lower than non-obese applicants (P < .001). A total of 71% (22/31) reported implicit anti-Black bias, discordant with application ratings, which were 0.47 SDs higher for Black than for White applicants (P < .001). A total of 84% (26/31) of participants reported feeling self-aware of potential racial bias at the time of application review, significantly higher than the 23% (7/31) reporting self-awareness of potential anti-obese bias (P < .001). Participation in formal diversity training was not associated with implicit anti-Black or anti-fat bias, nor with self-reported awareness of potential racial or weight-based bias (all P > .2). CONCLUSIONS These findings suggest that implicit bias, as measured by the Implicit Association Test, does not inevitably lead to discrimination, and that personal awareness of implicit biases may allow their mitigation.
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Affiliation(s)
- Charles M Maxfield
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California, USA
| | | | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karen S Johnson
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicholas A Koontz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gary W Mlady
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Timothy J Welch
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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Maxfield CM, Thorpe MP, Desser TS, Heitkamp DE, Hull NC, Johnson KS, Koontz NA, Mlady GW, Welch TJ, Grimm LJ. Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive? Acad Med 2019; 94:1774-1780. [PMID: 31149924 DOI: 10.1097/acm.0000000000002813] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE To evaluate for appearance-based discrimination in the selection of radiology residents. METHOD A deception study simulating the resident selection process examined the impact of attractiveness and obesity on resident selection. Seventy-four core faculty from 5 academic radiology departments reviewed mock residency applications in September and October 2017. Each application included demographic information and a photograph, representing a prespecified distribution of facial attractiveness and obesity, combined with randomized academic and supporting variables. Reviewers independently scored applications for interview desirability. Reviewer scores and application variables were compared using linear mixed fixed- and random-effects models. RESULTS Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive vs unattractive, B = 0.30 [SE = 0.056]; neutral vs unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (vs not obese) (B = -0.14 [SE = 0.024]). CONCLUSIONS Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees should invoke strategies to detect and manage appearance-based bias.
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Affiliation(s)
- Charles M Maxfield
- C.M. Maxfield is vice chair of education, Department of Radiology, Duke University Medical Center, Durham, North Carolina. M.P. Thorpe is a radiology resident, Department of Radiology, Duke University Medical Center, Durham, North Carolina. T.S. Desser is professor, Department of Radiology, Stanford University Medical Center, Stanford, California. D.E. Heitkamp is staff radiologist and associate residency program director, Florida Hospital, Orlando, Florida. N.C. Hull is assistant professor, Department of Radiology, Mayo Clinic, Rochester, Minnesota. K.S. Johnson is residency program director, Department of Radiology, Duke University Medical Center, Durham, North Carolina. N.A. Koontz is director of fellowship programs, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana. G.W. Mlady is chair, Department of Radiology, University of New Mexico, Albuquerque, New Mexico. T.J. Welch is associate chair of education, Department of Radiology, Mayo Clinic, Rochester, Minnesota. L.J. Grimm is assistant professor, Department of Radiology, Duke University Medical Center, Durham, North Carolina
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14
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Galimzianova A, Siebert SM, Kamaya A, Desser TS, Rubin DL. Toward Automated Pre-Biopsy Thyroid Cancer Risk Estimation in Ultrasound. AMIA Annu Symp Proc 2018; 2017:734-741. [PMID: 29854139 PMCID: PMC5977620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We propose a computational framework for automated cancer risk estimation of thyroid nodules visualized in ultrasound (US) images. Our framework estimates the probability of nodule malignancy using random forests on a rich set of computational features. An expert radiologist annotated thyroid nodules in 93 biopsy-confirmed patients using semantic image descriptors derived from standardized lexicon. On our dataset, the AUC of the proposed method was 0.70, which was comparable to five baseline expert annotation-based classifiers with AUC values from 0.72 to 0.81. Moreover, the use of the framework for decision making on nodule biopsy could have spared five out of 46 benign nodule biopsies at no cost to the health of patients with malignancies. Our results confirm the feasibility of computer-aided tools for noninvasive malignancy risk estimation in patients with thyroid nodules that could help to decrease the number of unnecessary biopsies and surgeries.
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Affiliation(s)
| | - Sean M Siebert
- Stanford University School of Medicine, Stanford, CA, USA
| | - Aya Kamaya
- Stanford University School of Medicine, Stanford, CA, USA
| | - Terry S Desser
- Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel L Rubin
- Stanford University School of Medicine, Stanford, CA, USA
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Chang ST, Menias CO, Lubner MG, Mellnick VM, Hara AK, Desser TS. Molecular and Clinical Approach to Intra-abdominal Adverse Effects of Targeted Cancer Therapies. Radiographics 2017; 37:1461-1482. [PMID: 28753381 DOI: 10.1148/rg.2017160162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Targeted cancer therapies encompass an exponentially growing number of agents that involve a myriad of molecular pathways. To excel within this rapidly changing field of clinical oncology, radiologists must eschew traditional organ system-based approaches of cataloging adverse effects in favor of a conceptual framework that incorporates molecular mechanisms and associated clinical outcomes. Understanding molecular mechanisms that underlie imaging manifestations of adverse effects and known associations with treatment response allows radiologists to more effectively recognize adverse effects and differentiate them from tumor progression. Radiologists can therefore more effectively guide oncologists in the management of adverse effects and treatment decisions regarding continuation or cessation of drug therapy. Adverse effects from targeted cancer therapies can be classified into four categories: (a) category 1, on-target adverse effects associated with treatment response; (b) category 2, on-target adverse effects without associated treatment response; (c) category 3, off-target adverse effects; and (d) category 4, tumor necrosis-related adverse effects. This review focuses on adverse effects primarily within the abdomen and pelvis classified according to established or hypothesized molecular mechanisms and illustrated with images of classic examples and several potential emerging toxic effects. ©RSNA, 2017.
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Affiliation(s)
- Stephanie T Chang
- From the Department of Radiology, VA Palo Alto Health Care System, Palo Alto, Calif (S.T.C.); Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307 MC 5621, Stanford, CA 94305 (S.T.C., T.S.D.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.)
| | - Christine O Menias
- From the Department of Radiology, VA Palo Alto Health Care System, Palo Alto, Calif (S.T.C.); Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307 MC 5621, Stanford, CA 94305 (S.T.C., T.S.D.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.)
| | - Meghan G Lubner
- From the Department of Radiology, VA Palo Alto Health Care System, Palo Alto, Calif (S.T.C.); Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307 MC 5621, Stanford, CA 94305 (S.T.C., T.S.D.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.)
| | - Vincent M Mellnick
- From the Department of Radiology, VA Palo Alto Health Care System, Palo Alto, Calif (S.T.C.); Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307 MC 5621, Stanford, CA 94305 (S.T.C., T.S.D.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.)
| | - Amy K Hara
- From the Department of Radiology, VA Palo Alto Health Care System, Palo Alto, Calif (S.T.C.); Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307 MC 5621, Stanford, CA 94305 (S.T.C., T.S.D.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.)
| | - Terry S Desser
- From the Department of Radiology, VA Palo Alto Health Care System, Palo Alto, Calif (S.T.C.); Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307 MC 5621, Stanford, CA 94305 (S.T.C., T.S.D.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.)
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Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol 2017; 14:587-595. [PMID: 28372962 DOI: 10.1016/j.jacr.2017.01.046] [Citation(s) in RCA: 1146] [Impact Index Per Article: 163.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/21/2016] [Accepted: 01/30/2017] [Indexed: 02/06/2023]
Abstract
classification that is widely used in breast imaging, their authors chose to apply the acronym TI-RADS, for Thyroid Imaging, Reporting and Data System. In 2012, the ACR convened committees to (1) provide recommendations for reporting incidental thyroid nodules, (2) develop a set of standard terms (lexicon) for ultrasound reporting, and (3) propose a TI-RADS on the basis of the lexicon. The committees published the results of the first two efforts in 2015. In this article, the authors present the ACR TI-RADS Committee's recommendations, which provide guidance regarding management of thyroid nodules on the basis of their ultrasound appearance. The authors also describe the committee's future directions.
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Affiliation(s)
- Franklin N Tessler
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Edward G Grant
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jenny K Hoang
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Lincoln L Berland
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sharlene A Teefey
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - John J Cronan
- Department of Diagnostic Imaging Brown University, Providence, Rhode Island
| | - Michael D Beland
- Department of Diagnostic Imaging Brown University, Providence, Rhode Island
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lynwood W Hammers
- Hammers Healthcare Imaging, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ulrike M Hamper
- Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Jill E Langer
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carl C Reading
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Leslie M Scoutt
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - A Thomas Stavros
- Department of Radiology, University of Texas Health Sciences Center, San Antonio, Texas
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Park HS, Desser TS, Jeffrey RB, Kamaya A. Doppler Ultrasound in Liver Cirrhosis: Correlation of Hepatic Artery and Portal Vein Measurements With Model for End-Stage Liver Disease Score. J Ultrasound Med 2017; 36:725-730. [PMID: 28026900 DOI: 10.7863/ultra.16.03107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine whether hepatic arterial and portal venous Doppler ultrasound measurements of the liver in cirrhotic patients correlate with patients' Model for End-Stage Liver Disease (MELD) scores, splenomegaly, or ascites. MATERIALS AND METHODS Sonographic images and reports were reviewed of 264 patients with hepatic cirrhosis who underwent abdominal ultrasound with Doppler in this internal review board-approved retrospective study. MELD scores were recorded at the time of ultrasound. On gray-scale ultrasound, spleen length was measured and the presence of ascites was noted. Hepatic arterial velocity (HAv) with angle correction, hepatic arterial resistive index, and portal vein velocity with angle correction were measured on Doppler ultrasound. Correlation of hepatic arterial and portal venous Doppler values with MELD score, presence of splenomegaly, and presence of ascites was tested using linear or binary logistic regression analysis. Diagnostic performance of Doppler parameters for high-risk MELD was assessed. RESULTS The HAv statistically significantly correlated with the MELD score (P = .0001), spleen size (P =.027), and presence of ascites (P =.0001), whereas the hepatic arterial resistive index and portal vein velocity did not correlate with these factors. For MELD scores greater than 19, an HAv greater than 120 cm/s showed accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 74, 42, 90, 67, and 76%, respectively. With an HAv greater than 160 cm/s, the odds ratio for MELD scores greater than 19 was 42.1. CONCLUSIONS We found a statistically significant correlation with elevated HAv and increasing MELD scores, splenomegaly, and presence of ascites in patients with cirrhotic liver disease; this may be a useful imaging biomarker in the evaluation of patients with cirrhosis.
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Affiliation(s)
- Hee Sun Park
- Konkuk University School of Medicine, Seoul, Korea
| | - Terry S Desser
- Stanford University Medical Center, Stanford, California, USA
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California, USA
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18
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Abstract
Thyroid cancer incidence is rapidly increasing due to increased detection and diagnosis of indolent thyroid cancer, i.e. cancer that is likely to be clinically insignificant. Clinical, radiologic, and pathologic features predicting indolent behavior of thyroid cancer are still largely unknown and unstudied. Existing clinicopathologic staging systems are useful for providing prognosis in the context of treated thyroid cancer but are not designed for and are inadequate for predicting indolent behavior. Ultrasound studies have primarily focused on discrimination between malignant and benign nodules; some studies show promising data on using sonographic features for predicting indolence but are still in their early stages. Similarly, molecular studies are being developed to better characterize thyroid cancer and improve the yield of fine needle aspiration biopsy, but definite markers of indolent thyroid cancer have yet to be identified. Nonetheless, active surveillance has been introduced as an alternative to surgery in the case of indolent thyroid microcarcinoma, and protocols for safe surveillance are in development. As increased detection of thyroid cancer is all but inevitable, increased research on predicting indolent behavior is needed to avoid an epidemic of overtreatment.
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Affiliation(s)
- Lewis D Hahn
- 1Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H-1307, Mail code 5621, Stanford, CA 94305 USA
| | - Christian A Kunder
- 2Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Michelle M Chen
- 3Department of Otolaryngology, Stanford University School of Medicine, Stanford, USA
| | - Lisa A Orloff
- 3Department of Otolaryngology, Stanford University School of Medicine, Stanford, USA
| | - Terry S Desser
- 1Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H-1307, Mail code 5621, Stanford, CA 94305 USA
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19
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Abstract
Thyroid cancer incidence is rapidly increasing due to increased detection and diagnosis of indolent thyroid cancer, i.e. cancer that is likely to be clinically insignificant. Clinical, radiologic, and pathologic features predicting indolent behavior of thyroid cancer are still largely unknown and unstudied. Existing clinicopathologic staging systems are useful for providing prognosis in the context of treated thyroid cancer but are not designed for and are inadequate for predicting indolent behavior. Ultrasound studies have primarily focused on discrimination between malignant and benign nodules; some studies show promising data on using sonographic features for predicting indolence but are still in their early stages. Similarly, molecular studies are being developed to better characterize thyroid cancer and improve the yield of fine needle aspiration biopsy, but definite markers of indolent thyroid cancer have yet to be identified. Nonetheless, active surveillance has been introduced as an alternative to surgery in the case of indolent thyroid microcarcinoma, and protocols for safe surveillance are in development. As increased detection of thyroid cancer is all but inevitable, increased research on predicting indolent behavior is needed to avoid an epidemic of overtreatment.
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Affiliation(s)
- Lewis D Hahn
- 1Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H-1307, Mail code 5621, Stanford, CA 94305 USA
| | - Christian A Kunder
- 2Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Michelle M Chen
- 3Department of Otolaryngology, Stanford University School of Medicine, Stanford, USA
| | - Lisa A Orloff
- 3Department of Otolaryngology, Stanford University School of Medicine, Stanford, USA
| | - Terry S Desser
- 1Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H-1307, Mail code 5621, Stanford, CA 94305 USA
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Kamaya A, Yu PC, Lloyd CR, Chen BH, Desser TS, Maturen KE. Sonographic Evaluation for Endometrial Polyps: The Interrupted Mucosa Sign. J Ultrasound Med 2016; 35:2381-2387. [PMID: 27629758 DOI: 10.7863/ultra.15.09007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate the interrupted mucosa sign for identification of endometrial polyps, using pathologic confirmation as the reference standard, compared to other accepted sonographic findings. METHODS We reviewed 195 patients referred for pelvic sonographic evaluations for suspected endometrial polyps in this retrospective Institutional Review Board-approved study. Of these, 82 had tissue sampling of the endometrium and constituted the final study group. Patient data, including age, menopausal status, last menstrual period, and final pathologic diagnosis, were recorded. Sonograms were reviewed by 2 blinded board-certified radiologists for endometrial features, including thickness, echogenicity, vascularity, presence of a mass, and the interrupted mucosa sign. Descriptive statistics and multivariate logistic regression analysis were performed. RESULTS The mean age of the patients was 44.99 (SD, 9.88) years, 79.1% of whom were premenopausal. Pathologic diagnosis confirmed polyps in 58 (70.73%). A single feeding vessel was visualized in 36 patients with polyps (62.07%), whereas the interrupted mucosa sign was visualized in 34 (58.62%). The presence of a feeding vessel, the interrupted mucosa sign, or both detected 48 (82.76%) of the polyps. In the multivariate analysis, only the interrupted mucosa sign was a statistically significant predictor of pathologic diagnosis of a polyp (P= .035), with an odds ratio of 3.83 (95% confidence interval, 1.10-13.29). Other sonographic findings were not independent predictors of a polyp: mass (P = .35), single feeding vessel (P = .31), endometrial thickness (P = .88), and endometrial echogenicity (P = .45). The sensitivity, specificity, and positive predictive value of the interrupted mucosa sign were 59%, 75%, and 85%, respectively. CONCLUSIONS The interrupted mucosa sign is a promising sonographic sign for identification of endometrial polyps, with greater predictive power than previously described signs. It has the potential to improve the diagnostic performance of sonography, especially when used in combination with other described signs.
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Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University Medical Center, Stanford California USA
| | - Pauline Chang Yu
- Department of Obstetrics and Gynecology, Kaiser Permanente, Santa Clara, CA
| | | | - Bertha H Chen
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford California USA
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford California USA
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Abstract
Critically ill patients are commonly imaged for liver dysfunction. An often fatal condition, secondary sclerosing cholangitis, is an important and likely under-recognized hepatic condition in these patients. In presenting this case report, we hope to raise awareness of this condition amongst radiologists as well as other physicians caring for the critically ill.
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Affiliation(s)
- Krista E Weiss
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Juergen K Willmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Terry S Desser
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Boas FE, Kamaya A, Do B, Desser TS, Beaulieu CF, Vasanawala SS, Hwang GL, Sze DY. Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans. J Digit Imaging 2016; 28:213-23. [PMID: 25183580 DOI: 10.1007/s10278-014-9725-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.
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Affiliation(s)
- F Edward Boas
- Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA,
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Kamaya A, Tahvildari AM, Patel BN, Willmann JK, Jeffrey RB, Desser TS. Sonographic Detection of Extracapsular Extension in Papillary Thyroid Cancer. J Ultrasound Med 2015; 34:2225-2230. [PMID: 26518279 DOI: 10.7863/ultra.15.02006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To identify and evaluate sonographic features suggestive of extracapsular extension in papillary thyroid cancer. METHODS Three board-certified radiologists blinded to the final pathologic tumor stage reviewed sonograms of pathologically proven cases of papillary thyroid cancer for the presence of extracapsular extension. The radiologists evaluated the following features: capsular abutment, bulging of the normal thyroid contour, loss of the echogenic capsule, and vascularity extending beyond the capsule. RESULTS A total of 129 cases of pathologically proven thyroid cancer were identified. Of these, 51 were excluded because of lack of preoperative sonography, and 16 were excluded because of pathologic findings showing anaplastic carcinoma, follicular carcinoma, or microcarcinoma (<10 mm). The final analysis group consisted of 62 patients with papillary thyroid carcinoma, 16 of whom had pathologically proven extracapsular extension. The presence of capsular abutment had 100% sensitivity for detection of extracapsular extension. Conversely, lack of capsular abutment had a 100% negative predictive value (NPV) for excluding extracapsular extension. Contour bulging had 88% sensitivity for detection of extracapsular extension and when absent had an 87% NPV. Loss of the echogenic capsule was the best predictor of the presence of extracapsular extension, with an odds ratio of 10.23 (P = .034). This sonographic finding had 75% sensitivity, 65% specificity, and an 88% NPV. Vascularity beyond the capsule had 89% specificity but sensitivity of only 25%. CONCLUSIONS Sonographic features of capsular abutment, contour bulging, and loss of the echogenic thyroid capsule have excellent predictive value for excluding or detecting extracapsular extension and may help in biopsy selection, surgical planning, and treatment of patients with papillary thyroid cancer.
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Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.).
| | - Ali M Tahvildari
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
| | - Bhavik N Patel
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
| | - Juergen K Willmann
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California USA (A.K., J.K.W., R.B.J., T.S.D.); VA Palo Alto Health Care System, Palo Alto, California USA (A.M.T.); and Department of Radiology, Duke University, Durham, North Carolina USA (B.N.P.)
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Grant EG, Tessler FN, Hoang JK, Langer JE, Beland MD, Berland LL, Cronan JJ, Desser TS, Frates MC, Hamper UM, Middleton WD, Reading CC, Scoutt LM, Stavros AT, Teefey SA. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol 2015; 12:1272-9. [PMID: 26419308 DOI: 10.1016/j.jacr.2015.07.011] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
Ultrasound is the most commonly used imaging technique for the evaluation of thyroid nodules. Sonographic findings are often not specific, and definitive diagnosis is usually made through fine-needle aspiration biopsy or even surgery. In reviewing the literature, terms used to describe nodules are often poorly defined and inconsistently applied. Several authors have recently described a standardized risk stratification system called the Thyroid Imaging, Reporting and Data System (TIRADS), modeled on the BI-RADS system for breast imaging. However, most of these TIRADS classifications have come from individual institutions, and none has been widely adopted in the United States. Under the auspices of the ACR, a committee was organized to develop TIRADS. The eventual goal is to provide practitioners with evidence-based recommendations for the management of thyroid nodules on the basis of a set of well-defined sonographic features or terms that can be applied to every lesion. Terms were chosen on the basis of demonstration of consistency with regard to performance in the diagnosis of thyroid cancer or, conversely, classifying a nodule as benign and avoiding follow-up. The initial portion of this project was aimed at standardizing the diagnostic approach to thyroid nodules with regard to terminology through the development of a lexicon. This white paper describes the consensus process and the resultant lexicon.
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Affiliation(s)
- Edward G Grant
- Keck School of Medicine, University of Southern California, Los Angeles, California.
| | | | - Jenny K Hoang
- Duke University School of Medicine, Durham, North Carolina
| | - Jill E Langer
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Terry S Desser
- Stanford University Medical Center, Stanford, California
| | | | - Ulrike M Hamper
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
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Grimm LJ, Desser TS, Bailey JE, Maxfield CM. Applicant to Residency Program Translation Guide. J Am Coll Radiol 2015; 12:622-3. [DOI: 10.1016/j.jacr.2014.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/28/2014] [Indexed: 11/30/2022]
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Kamaya A, Lewis GH, Liu Y, Akatsu H, Kong C, Desser TS. Atypia of undetermined significance and follicular lesions of undetermined significance: sonographic assessment for prediction of the final diagnosis. J Ultrasound Med 2015; 34:767-774. [PMID: 25911708 DOI: 10.7863/ultra.34.5.767] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine whether radiologic assessment of thyroid nodules can potentially help guide clinical management after a cytologic diagnosis of atypia of undetermined significance or a follicular lesion of undetermined significance. METHODS We identified 41 patients with 41 thyroid nodules initially diagnosed as atypia or follicular lesions of undetermined significance on fine-needle aspiration that were subsequently definitively diagnosed by either surgical resection or repeated fine-needle aspiration. All sonograms of nodules were reviewed by 2 blinded board-certifiedradiologists. Lesions were assessed in 3 ways: (1) Mayo pattern classification as benign, indeterminate, or worrisome for malignancy (Ultrasound Q 2005; 21:157-165); (2) thyroid imaging reporting and data system scores (scale of 1-5) based on 2 different previously published scoring criteria (Park et al [Thyroid 2009; 19:1257-1264] and Kwak et al [Radiology 2011; 260:892-899]); and (3) binary classification as benign or malignant. RESULTS Of the 41 nodules, 25 had benign histologic findings, and 16 were malignant. Mayo pattern classification was 100% accurate for the benign score. Lesions with a Mayo score of indeterminate were malignant in 21% of cases (6 of 28) and benign in 79% (22 of 28). Lesions with a Mayo score of malignant were malignant in 91% of cases (10 of 11) and benign in 9% (1 of 11). Thyroid imaging reporting and data system scores had area under the receiver operating characteristic curve values of 0.827 for Park scores and 0.822 for Kwak scores. Radiologist binary classification of thyroid nodules showed 88% overall accuracy. CONCLUSIONS Radiologist assessment of thyroid nodules in cases of atypia of undetermined significance or follicular lesions of undetermined significance is highly predictive of the final diagnosis and can help guide management of thyroid nodules of these pathologic types.
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Affiliation(s)
- Aya Kamaya
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.).
| | - Gloria Huang Lewis
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Yi Liu
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Haruko Akatsu
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Christina Kong
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
| | - Terry S Desser
- Departments of Radiology (A.K., T.S.D.), Pathology (G.H.L., C.K.), and Medicine and Endocrinology (H.A.), Stanford University Medical Center, Stanford, California USA; and Department of Biomedical Informatics, Stanford University, Stanford, California USA (Y.L.)
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Chang ST, Desser TS, Gayer G, Menias CO. Metastatic Melanoma in the Chest and Abdomen: The Great Radiologic Imitator. Semin Ultrasound CT MR 2014; 35:272-89. [DOI: 10.1053/j.sult.2014.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Grimm LJ, Shapiro LM, Singhapricha T, Mazurowski MA, Desser TS, Maxfield CM. Predictors of an academic career on radiology residency applications. Acad Radiol 2014; 21:685-90. [PMID: 24629444 DOI: 10.1016/j.acra.2013.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate radiology residency applications to determine if any variables are predictive of a future academic radiology career. MATERIALS AND METHODS Application materials from 336 radiology residency graduates between 1993 and 2010 from the Department of Radiology, Duke University and between 1990 and 2010 from the Department of Radiology, Stanford University were retrospectively reviewed. The institutional review boards approved this Health Insurance Portability and Accountability Act-compliant study with a waiver of informed consent. Biographical (gender, age at application, advanced degrees, prior career), undergraduate school (school, degree, research experience, publications), and medical school (school, research experience, manuscript publications, Alpha Omega Alpha membership, clerkship grades, United States Medical Licensing Examination Step 1 and 2 scores, personal statement and letter of recommendation reference to academics, couples match status) data were recorded. Listing in the Association of American Medical Colleges Faculty Online Directory and postgraduation publications were used to determine academic status. RESULTS There were 72 (21%) radiologists in an academic career and 264 (79%) in a nonacademic career. Variables associated with an academic career were elite undergraduate school (P = .003), undergraduate school publications (P = .018), additional advanced degrees (P = .027), elite medical school (P = .006), a research year in medical school (P < .001), and medical school publications (P < .001). A multivariate cross-validation analysis showed that these variables are jointly predictive of an academic career (P < .001). CONCLUSIONS Undergraduate and medical school rankings and publications, as well as a medical school research year and an additional advanced degree, are associated with an academic career. Radiology residency selection committees should consider these factors in the context of the residency application if they wish to recruit future academic radiologists.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University Hospital, Box 3808, Durham, NC 27710.
| | - Lauren M Shapiro
- Department of Radiology, Stanford University Medical Center, Stanford, CA
| | - Terry Singhapricha
- Department of Radiology, Duke University Hospital, Box 3808, Durham, NC 27710
| | - Maciej A Mazurowski
- Carl E. Ravin Advanced Imaging Laboratories, Duke University Hospital, Durham, NC
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, CA
| | - Charles M Maxfield
- Department of Radiology, Duke University Hospital, Box 3808, Durham, NC 27710
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29
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Kamaya A, Machtaler S, Safari Sanjani S, Nikoozadeh A, Graham Sommer F, Pierre Khuri-Yakub BT, Willmann JK, Desser TS. New technologies in clinical ultrasound. Semin Roentgenol 2014; 48:214-23. [PMID: 23796372 DOI: 10.1053/j.ro.2013.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
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Abstract
Ultrasound of the thyroid has become increasingly common, with evaluation of thyroid nodules representing the main indication for its use. While detection of thyroid nodules with modern high-resolution sonographic equipment is generally not a challenge, pitfalls may occur by which normal structures or pathology in neighboring organs are mistaken for thyroid nodules. Numerous reports in the literature describe various sonographic features of nodules in an attempt to stratify lesions into benign or malignant categories. While neither nodule size nor number is reliable, echogenicity, microcalcifcation, shape, and composition have been reported to be helpful in classifying thyroid nodules. No single feature should be used in isolation, and consensus guidelines have been established as to when fine-needle aspiration is indicated. Pitfalls remain in the evaluation of thyroid nodules demonstrating atypical features, such as cystic papillary carcinomas. Focal presentation of typically diffuse processes, such as Graves' disease and Hashimoto thyroiditis, may mimic malignant nodules, but carcinomas occur in these settings as well as in a background of normal thyroid parenchyma. Finally, because ultrasound is commonly used for surveillance of patients with thyroid carcinoma after thyroidectomy, sonographers should be familiar with the ultrasound appearance of disease recurrence and its mimics.
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Affiliation(s)
- Bhavik N Patel
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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31
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Sellmyer MA, Desser TS, Maturen KE, Jeffrey RB, Kamaya A. Physiologic, Histologic, and Imaging Features of Retained Products of Conception. Radiographics 2013; 33:781-96. [DOI: 10.1148/rg.333125177] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Singh A, Desser TS, Ferucci J. Imaging of Small Bowel. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Intraabdominal fat is a metabolically active tissue that may undergo necrosis through a number of mechanisms. Fat necrosis is a common finding at abdominal cross-sectional imaging, and it may cause abdominal pain, mimic findings of acute abdomen, or be asymptomatic and accompany other pathophysiologic processes. Common processes that are present in fat necrosis include torsion of an epiploic appendage, infarction of the greater omentum, and fat necrosis related to trauma or pancreatitis. In addition, other pathologic processes that involve fat may be visualized at computed tomography, including focal lipohypertrophy, pathologic fat paucity (lipodystrophies), and malignancies such as liposarcoma, which may mimic benign causes of fat stranding. Because fat necrosis and malignant processes such as liposarcoma and peritoneal carcinomatosis may mimic one another, knowledge of a patient's clinical history and prior imaging studies is essential for accurate diagnosis.
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Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Room H1307, Stanford, CA 94305, USA
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Saxon P, Badler RL, Desser TS, Tublin ME, Katz DS. Segmental testicular infarction: report of seven new cases and literature review. Emerg Radiol 2012; 19:217-23. [PMID: 22252203 DOI: 10.1007/s10140-011-0999-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 11/11/2011] [Indexed: 01/08/2023]
Abstract
Segmental testicular infarction is a relatively rare acute or subacute condition which is infrequently thought of in the differential diagnosis for testicular pain. However, missing or misdiagnosing this entity on clinical evaluation and/or imaging has significant implications for patients as they may undergo unnecessary surgery for suspected testicular torsion or tumor. Knowledge and recognition of the features of segmental testicular infarction on ultrasound and MRI will aid in the diagnosis of this disease early in the patient's course. The common imaging features of segmental testicular infarction and the clinical literature are reviewed, with an emphasis on ultrasound, utilizing seven recent cases from three institutions.
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Affiliation(s)
- Penny Saxon
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501-3987, USA.
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35
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Kothary N, Ghatan CE, Hwang GL, Kuo WT, Louie JD, Sze DY, Hovsepian DM, Desser TS, Hofmann LV. Renewing Focus on Resident Education: Increased Responsibility and Ownership in Interventional Radiology Rotations Improves the Educational Experience. J Vasc Interv Radiol 2010; 21:1697-702. [DOI: 10.1016/j.jvir.2010.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 06/22/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022] Open
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Liu YI, Kamaya A, Desser TS, Rubin DL. A Controlled Vocabulary to Represent Sonographic Features of the Thyroid and its application in a Bayesian Network to Predict Thyroid Nodule Malignancy. Summit Transl Bioinform 2009; 2009:68-72. [PMID: 21347173 PMCID: PMC3041558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
It is challenging to distinguish benign from malignant thyroid nodules on high resolution ultrasound. Many ultrasound features have been studied individually as predictors for thyroid malignancy, none with a high degree of accuracy, and there is no consistent vocabulary used to describe the features. Our hypothesis is that a standard vocabulary will advance accuracy. We performed a systemic literature review and identified all the sonographic features that have been well studied in thyroid cancers. We built a controlled vocabulary for describing sonographic features and to enable us to unify data in the literature on the predictive power of each feature. We used this terminology to build a Bayesian network to predict thyroid malignancy. Our Bayesian network performed similar to or slightly better than experienced radiologists. Controlled terminology for describing thyroid radiology findings could be useful to characterize thyroid nodules and could enable decision support applications.
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Affiliation(s)
- Yueyi I Liu
- Department of Radiology, Stanford University, Stanford, CA
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Liu YI, Kamaya A, Desser TS, Rubin DL. A Bayesian classifier for differentiating benign versus malignant thyroid nodules using sonographic features. AMIA Annu Symp Proc 2008; 2008:419-423. [PMID: 18999209 PMCID: PMC2656040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 07/14/2008] [Indexed: 05/27/2023]
Abstract
Thyroid nodules are a common, yet challenging clinical problem. The vast majority of these nodules are benign; however, deciding which nodule should undergo biopsy is difficult because the imaging appearance of benign and malignant thyroid nodules overlap. High resolution ultrasound is the primary imaging modality for evaluating thyroid nodules. Many sonographic features have been studied individually as predictors for thyroid malignancy. There has been little work to create predictive models that combine multiple predictors, both imaging features and demographic factors. We have created a Bayesian classifier to predict whether a thyroid nodule is benign or malignant using sonographic and demographic findings. Our classifier performed similar to or slightly better than experienced radiologists when evaluated using 41 thyroid nodules with known pathologic diagnosis. This classifier could be helpful in providing practitioners an objective basis for deciding whether to biopsy suspicious thyroid nodules.
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Affiliation(s)
- Yueyi I Liu
- Department of Radiology, Stanford University, Stanford, CA, USA
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Schellenberg D, Goodman KA, Lee F, Chang S, Kuo T, Ford JM, Fisher GA, Quon A, Desser TS, Norton J, Greco R, Yang GP, Koong AC. Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2008; 72:678-86. [PMID: 18395362 DOI: 10.1016/j.ijrobp.2008.01.051] [Citation(s) in RCA: 265] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 12/12/2007] [Accepted: 01/21/2008] [Indexed: 02/07/2023]
Abstract
PURPOSE Fractionated radiotherapy and chemotherapy for locally advanced pancreatic cancer achieves only modest local control. This prospective trial evaluated the efficacy of a single fraction of 25 Gy stereotactic body radiotherapy (SBRT) delivered between Cycle 1 and 2 of gemcitabine chemotherapy. METHODS AND MATERIALS A total of 16 patients with locally advanced, nonmetastatic, pancreatic adenocarcinoma received gemcitabine with SBRT delivered 2 weeks after completion of the first cycle. Gemcitabine was resumed 2 weeks after SBRT and was continued until progression or dose-limiting toxicity. The gross tumor volume, with a 2-3-mm margin, was treated in a single 25-Gy fraction by Cyberknife. Patients were evaluated at 4-6 weeks, 10-12 weeks, and every 3 months after SBRT. RESULTS All 16 patients completed SBRT. A median of four cycles (range one to nine) of chemotherapy was delivered. Three patients (19%) developed local disease progression at 14, 16, and 21 months after SBRT. The median survival was 11.4 months, with 50% of patients alive at 1 year. Patients with normal carbohydrate antigen (CA)19-9 levels either at diagnosis or after Cyberknife SBRT had longer survival (p <0.01). Acute gastrointestinal toxicity was mild, with 2 cases of Grade 2 (13%) and 1 of Grade 3 (6%) toxicity. Late gastrointestinal toxicity was more common, with five ulcers (Grade 2), one duodenal stenosis (Grade 3), and one duodenal perforation (Grade 4). A trend toward increased duodenal volumes radiated was observed in those experiencing late effects (p = 0.13). CONCLUSION SBRT with gemcitabine resulted in comparable survival to conventional chemoradiotherapy and good local control. However, the rate of duodenal ulcer development was significant.
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Affiliation(s)
- Devin Schellenberg
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Simulation-based training methods have been widely adopted in hazardous professions such as aviation, nuclear power, and the military. Their use in medicine has been accelerating lately, fueled by the public's concerns over medical errors as well as new Accreditation Council for Graduate Medical Education requirements for outcome-based and proficiency-based assessment methods. This article reviews the rationale for simulator-based training, types of simulators, their historical development and validity testing, and some results to date in laparoscopic surgery and endoscopic procedures. A number of companies have developed endovascular simulators for interventional radiologic procedures; although they cannot as yet replicate the experience of performing cases in real patients, they promise to play an increasingly important role in procedural training in the future.
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Affiliation(s)
- Terry S Desser
- Department of Radiology, Stanford University School of Medicine, Stanford, California 94305, USA.
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Abstract
Lesions in the spleen may be encountered in a variety of clinical settings ranging from asymptomatic patients to patients who are critically ill. Etiologies for multifocal splenic lesions include infectious and inflammatory processes, primary vascular and lymphoid neoplasms, metastatic disease, vascular processes, and systemic diseases. There is often overlap in the imaging appearance alone, so the clinical setting is very helpful in differential diagnosis. In the immunocompromised patient, multiple small splenic lesions usually represent disseminated fungal disease and microabscesses. The spleen is a relatively rare site for metastatic disease; patients with metastatic lesions in the spleen usually have disease in other sites as well. Breast, lung, ovary, melanoma, and colon cancer are common primary tumors that metastasize to the spleen. Vascular neoplasms of the spleen represent the majority of the nonhematologic/nonlymphoid neoplasms and commonly produce multifocal lesions. Splenic infarcts may be seen with localized processes such as portal hypertension or pancreatitis, or may arise from an embolic source. Radiologists should be aware of the spectrum of processes that may involve the spleen and the clinical context in which they occur.
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Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Kirkpatrick IDC, Desser TS, Nino-Murcia M, Jeffrey RB. Small cystic lesions of the pancreas: clinical significance and findings at follow-up. ACTA ACUST UNITED AC 2006; 32:119-25. [PMID: 16944031 DOI: 10.1007/s00261-006-9080-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2005] [Accepted: 08/25/2005] [Indexed: 01/01/2023]
Abstract
BACKGROUND Our purpose was to correlate the imaging findings of small cystic pancreatic lesions to the incidence of growth on follow-up imaging and their pathologic diagnoses. METHODS CT images for 159 patients with cystic pancreatic lesions were retrospectively evaluated and lesions were assessed for size, number, connection to the main pancreatic duct (MPD), MPD dilatation, and any presence of loculation, wall irregularity, thick septations, or solid components. A total of 86 patients had follow-up imaging with time periods of less than 6 months (n = 21), 6-12 months (n = 22), 1-2 years (n = 14), and greater than 2 years (n = 29). Lesion histology was available in 20 patients. RESULTS Lesions with pathologic correlation proved to be: side branch intraductal papillary mucinous neoplasm or tumor (IPMT) (n = 5), combined type IPMT (n = 4), nonmucinous cyst (n = 4), chronic pancreatitis (n = 2), and reactive atypia with nonmucinous fluid (n = 1), combined type IMPT with foci of adenocarcinoma (n = 1), mucinous adenocarcinoma (n = 2), and nonmucinous adenocarcinoma (n = 1). Lesions with solid components were significantly more likely to grow and be malignant (P < 0.05). The presence of MPD dilatation was more common in patients with combined type IPMTs or malignancies. No other factors were predictive of malignancy. CONCLUSIONS Solid components are predictive of malignancy, and MPD dilatation should prompt consideration of surgery. Other cystic lesions can be followed.
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Alvarez A, Gold GE, Tobin B, Desser TS. Software tools for interactive instruction in radiologic anatomy. Acad Radiol 2006; 13:512-7. [PMID: 16554232 DOI: 10.1016/j.acra.2005.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 10/07/2005] [Accepted: 10/07/2005] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES To promote active learning in an introductory Radiologic Anatomy course through the use of computer-based exercises. MATERIALS AND METHODS DICOM datasets from our hospital PACS system were transferred to a networked cluster of desktop computers in a medical school classroom. Medical students in the Radiologic Anatomy course were divided into four small groups and assigned to work on a clinical case for 45 minutes. The groups used iPACS viewer software, a free DICOM viewer, to view images and annotate anatomic structures. The classroom instructor monitored and displayed each group's work sequentially on the master screen by running SynchronEyes, a software tool for controlling PC desktops remotely. RESULTS Students were able to execute the assigned tasks using the iPACS software with minimal oversight or instruction. Course instructors displayed each group's work on the main display screen of the classroom as the students presented the rationale for their decisions. The interactive component of the course received high ratings from the students and overall course ratings were higher than in prior years when the course was given solely in lecture format. CONCLUSIONS DICOM viewing software is an excellent tool for enabling students to learn radiologic anatomy from real-life clinical datasets. Interactive exercises performed in groups can be powerful tools for stimulating students to learn radiologic anatomy.
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Affiliation(s)
- Antonio Alvarez
- Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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Desser TS, Rubin DL, Schraedley-Desmond P. Coverage of emergency after-hours ultrasound cases: survey of practices at U.S. Teaching hospitals. Acad Radiol 2006; 13:249-53. [PMID: 16428062 DOI: 10.1016/j.acra.2005.09.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 09/22/2005] [Accepted: 09/24/2005] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Diagnostic ultrasound examinations may be performed after-hours by physicians if technologists are not available or cases are complex. Our experience suggested there is wide variability in how ultrasound coverage is provided after-hours, which motivated us to conduct a formal survey of teaching programs around the country. METHODS Four hundred five members of the Association of Program Directors in Radiology were contacted by e-mail and sent a link to a five-part questionnaire posted on the Web. Respondents were asked whether ultrasound cases after-hours are performed in their institutions by radiology residents, technologists on the premises after-hours, technologists on-call, or some combination. Data on the type of program, number of beds in the primary hospital, number of residents in the program, and geographic location of the program were recorded. Responses were automatically written to a data file stored on a Web server and the imported into an Excel spreadsheet for data analysis. A chi(2) analysis was performed to assess associations among the variables and statistical significance. RESULTS A total of 79 programs responded to the survey. Of those, 32% provided coverage with ultrasound technologists on call, 24% by ultrasound technologists on the premises, 13% provided combination coverage, and 10% provided coverage solely with residents on call. There was no association among number of residents in the program, location of the program, or type of program (university, community, or affiliated) and type of coverage provided. CONCLUSION There is wide variability in methods for providing coverage of after-hours ultrasound cases. However, on-site or on-call coverage of emergency cases by technologists did not appear to depend significantly on program location, program type, or program size.
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Affiliation(s)
- Terry S Desser
- Department of Radiology, Stanford University School of Medicine, CA 94305, USA
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Abstract
The purpose of this study was to determine whether queueing theory would allow prediction of optimal number of schedule slots to be reserved for urgent computed tomography (CT) and ultrasonography (US). Institutional review board approval was obtained; informed consent was exempted. Emergency studies were modeled as a Poisson process; slots were reserved such that rate of rescheduling of routine studies to accommodate emergencies was predicted to be below a certain level. Model was tested with 3 years of emergency US and CT requests. US and CT requests showed Poisson distribution. US rescheduling was near that predicted. CT rescheduling exceeded that predicted, which reflected increasing CT use. By using more recent CT data for prediction, a more concordant rescheduling rate resulted.
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Affiliation(s)
- Shreyas S Vasanawala
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5105, USA.
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Affiliation(s)
- Terry S Desser
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., Mail Code 5621, Stanford, CA 94305, USA
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