Introducing the American College of Radiology Appropriateness Criteria to Medical Students to Increase Appropriate Imaging Selection.

INTRODUCTION: Inappropriate radiological imaging contributes significantly to excessive healthcare expenditure and increased radiation exposure. The American College of Radiology (ACR) Appropriateness Criteria (AC) serves as an evidence-based resource to guide appropriate imaging utilization. However, knowledge and utilization of these guidelines is lacking in medical education. We introduce a short curriculum to teach medical students correct imaging selection and familiarize them with the ACR AC. METHODS: Medical students attended a two-part lecture series to learn appropriate imaging selection in common clinical scenarios and the ACR AC. Participants completed a pre- and post-test questionnaire, each consisting of a 10-item test assessing student familiarity with the ACR AC, comfortability in answering, and satisfaction with the curriculum. Improvement in student knowledge and confidence was assessed by statistical analysis using t-tests. RESULTS: Prior to the lecture series, 20.3% of students had no familiarity with the ACR AC, and 41.8% only had slight familiarity. Students demonstrated a statistically significant improvement in the knowledge assessment and in their level of comfort in choosing appropriate imaging modalities. After the lecture series, 97.2% of students responded they would use the ACR AC in the future, with 98.6% of them satisfied with the curriculum. DISCUSSION: This short curriculum is effective at (1) increasing student knowledge of appropriate radiological studies to order in common clinical encounters and (2) increasing student familiarity of the ACR AC. Further studies will be conducted to assess this curriculum's efficacy in the earlier years of medical school and for first-year residents.

Detection and proportion of very early dental caries in independent living older adults.

BACKGROUND AND OBJECTIVES: Dental caries is an important healthcare challenge in adults over 65 years of age. Integration of oral health screening into non-dental primary care practice may improve access to preventive dental care for vulnerable populations such as the elderly. Such integration would require easy, fast, and accurate early caries detection tools. Primary goal of this study was to evaluate the diagnostic performance of optical coherence tomography (OCT) imaging for detecting very early caries in the elderly living in community-based settings. The International Caries Detection and Assessment System (ICDAS) served as gold standard. Secondary goal of this study was to provide baseline prevalence data of very early caries lesions in independent living adults aged 65+ years. MATERIALS AND METHODS: Seventy-two subjects were recruited from three sites in Southern California: a retirement community, a senior health fair, and a convalescent hospital. Clinical examination was performed using the ICDAS visual criteria and this was followed by OCT imaging. The two-dimensional OCT images (B-scan) were analyzed with simple software. Locations with a log of back-scattered light intensity (BSLI) below 2.9 were scored as sound, and areas equaling or exceeding 2.9 BSLI were considered carious. Diagnostic performance of OCT imaging was compared with ICDAS score. RESULTS: OCT-based diagnosis demonstrated very good sensitivity (95.1%) and good specificity (85.8%). 54.7% of dentate subjects had at least one tooth with very early coronal caries. CONCLUSIONS: Early coronal decay is prevalent in the unrestored pits and fissures of coronal surfaces of teeth in independent living adults aged 65+ years. Though OCT imaging coupled with a simple diagnostic algorithm can accurately detect areas of very early caries in community-based settings, existing devices are expensive and not well-suited for use by non-dental health care providers. Simple, inexpensive, fast, and accurate tools for early caries detection by field health care providers working in non-traditional settings are urgently needed to support inter-professional dental health management.

Multimodality imaging of the effects of a novel dentifrice on oral biofilm.

OBJECTIVE: Oral biofilm formation and progression on the surface of the tooth can lead to advanced oral disease such as gingivitis. The purpose of this randomized, controlled, double-blinded study was to evaluate the effects of a novel dental gel on oral plaque biofilm using multimodal imaging techniques. MATERIALS AND METHODS: Twenty-five subjects with moderate gingival inflammation (Löe and Silness Gingival Index ≥2) and pocket depths <4 were randomly assigned to brush twice daily for 21 days with the test or the control dental gel. In vivo multimodality in situ imaging was performed over a 3-week period using in vivo Optical Coherence Tomography (OCT) and Non-Linear Optical microscopy (NLOM). Plaque levels, gingival inflammation and gingival bleeding were also charted on days 0, 7, 14, and 21 using standard clinical indices. RESULTS: After 3 weeks, OCT and NLOM images showed a macroscopic break-up of the plaque layer and smaller, fragmented residual deposits in the test group with no apparent changes in the pellicle. Biofilm was also reduced in the control group, but to a lesser degree with regard to thickness, continuity and surface area. Paralleling these imaging results, clinical indices were significantly improved in both groups (P < 0.05) and significantly lower in the test group (P < 0.05). CONCLUSION: Both dental gels reduced oral biofilm with the test gel showing greater efficacy (P < 0.05) as determined by clinical and imaging parameters.