Science of Learning: AJR Podcast Series on Training and Education, Episode 4.

In this episode of the AJR Podcast Series on Training and Education, Eric Tung, MD, joins host Monica Cheng, MD, to discuss the value of clinician educator tracks, peer teaching, and evidence-based learning principles to maximize successful learning outcomes.

Humanism: AJR Podcast Series on Training and Education, Episode 3.

In this episode of the AJR Podcast Series on Training and Education, Richard Gunderman, MD, PhD, joins host Monica Cheng, MD, to discuss humanism in radiology, emphasizing compassionate patient care, stewardship, the role of personal and larger narratives, and maintaining human connection amidst rising clinical volumes and evolving radiology practices.

Insights Into Radiology Residency Education and Recruitment: AJR Podcast Series on Training and Education, Episode 2.

In this episode of the AJR Podcast Series on Training and Education, Shaunagh McDermott, MBBCH, BAO, radiology residency program director at Massachusetts General Hospital, joins host Monica Cheng, MD, to share insights into radiology residency education, recruitment, and ways to cultivate a culture of learning and growth.

Leading the Way: AJR Podcast Series on Training and Education, Episode 1.

In this episode of the AJR Podcast Series on Training and Education, Pamela Schaefer, MD, joins host Monica Cheng, MD, to discuss incorporating education into radiology careers. Dr. Schaefer shares her journey, the role of leadership, and advice for aspiring educators.

In this episode of the AJR Podcast Series on Training and Education, Pamela Schaefer, MD, joins host Monica Cheng, MD, to discuss incorporating education into radiology careers. Dr. Schaefer shares her journey, the role of leadership, and advice for aspiring educators.

Sarcomatoid renal cell carcinoma: MRI features and their association with survival.

OBJECTIVE: To evaluate MRI features of sarcomatoid renal cell carcinoma (RCC) and their association with survival. METHODS: This retrospective single-center study included 59 patients with sarcomatoid RCC who underwent MRI before nephrectomy during July 2003-December 2019. Three radiologists reviewed MRI findings of tumor size, non-enhancing areas, lymphadenopathy, and volume (and percentage) of T2 low signal intensity areas (T2LIA). Clinicopathological factors of age, gender, ethnicity, baseline metastatic status, pathological details (subtype and extent of sarcomatoid differentiation), treatment type, and follow-up were extracted. Survival was estimated using Kaplan-Meier method and Cox proportional-hazards regression model was used to identify factors associated with survival. RESULTS: Forty-one males and eighteen females (median age 62 years; interquartile range 51-68) were included. T2LIAs were present in 43 (72.9%) patients. At univariate analysis, clinicopathological factors associated with shorter survival were: greater tumor size (> 10 cm; HR [hazard ratio] = 2.44, 95% CI 1.15-5.21; p = 0.02), metastatic lymph nodes (present; HR = 2.10, 95% CI 1.01-4.37; p = 0.04), extent of sarcomatoid differentiation (non-focal; HR = 3.30, 95% CI 1.55-7.01; p < 0.01), subtypes other than clear cell, papillary, or chromophobe (HR = 3.25, 95% CI 1.28-8.20; p = 0.01), and metastasis at baseline (HR = 5.04, 95% CI 2.40-10.59; p < 0.01). MRI features associated with shorter survival were: lymphadenopathy (HR = 2.24, 95% CI 1.16-4.71; p = 0.01) and volume of T2LIA (> 3.2 mL, HR = 4.22, 95% CI 1.92-9.29); p < 0.01). At multivariate analysis, metastatic disease (HR = 6.89, 95% CI 2.79-16.97; p < 0.01), other subtypes (HR = 9.50, 95% CI 2.81-32.13; p < 0.01), and greater volume of T2LIA (HR = 2.51, 95% CI 1.04-6.05; p = 0.04) remained independently associated with worse survival. CONCLUSION: T2LIAs were present in approximately two thirds of sarcomatoid RCCs. Volume of T2LIA along with clinicopathological factors were associated with survival.

Fat-containing adnexal masses on MRI: solid tissue volume and fat distribution as a guide for O-RADS Score assignment.

PURPOSE: To explore ways to improve O-RADS MRI scoring for fat-containing adnexal masses, by investigating methods for quantifying solid tissue volume and fat distribution and evaluating their associations with malignancy. METHODS: This retrospective, single-center study included patients with fat-containing adnexal masses on MRI during 2008-2021. Two radiologists independently reviewed overall size (Sizeoverall), size of any solid tissue (Sizeanysolid), size of solid tissue that was not Rokitansky nodule (Sizenon-Rokitansky), and fat distribution. Wilcoxon test, Fisher-exact test, and ROC curve analysis were performed. Reference standard was pathology or follow-up > 24 months. RESULTS: 188 women (median age 35 years) with 163 benign and 25 malignant lesions were included. Sizeoverall (R1, 9.9 cm vs 5.9 cm; R2, 12.4 cm vs 6.0 cm), Sizeanysolid (R1, 5.1 cm vs 1.2 cm; R2, 3.2 cm vs 0.0 cm), Sizenon-Rokitansky (R1, 5.1 cm vs 0.0 cm; R2, 3.1 cm vs 0.0 cm), and fat distribution differed significantly between malignant and benign lesions (p < 0.01). Area under ROC curve was greatest using Sizenon-Rokitansky (R1, 0.83; R2, 0.86) vs Sizeoverall (R1, 0.78; R2, 0.81) or Sizeanysolid (R1, 0.79; R2, 0.81), though differences were non-significant (p = 0.48-0.93). Cutoffs for Sizenon-Rokitansky (R1, ≥ 1.2 cm; R2, ≥ 1.0 cm) yielded sensitivity and specificity of 0.72 and 0.93 (R1) and 0.76 and 0.95 (R2). Among immature teratomas, 85.7% displayed scattered fat. CONCLUSION: Overall size, size of (any or non-Rokitansky-nodule) solid tissue, and fat distribution differed between benign and malignant fat-containing adnexal masses. Incorporating these would constitute simple and practical approaches to refining O-RADS MRI scoring.

Medication Complexity Among Older Adults with HF: How Can We Assess Better?

Medical management of heart failure (HF) has evolved and has achieved significant survival benefits, resulting in highly complex medication regimens. Complex medication regimens create challenges for older adults, including nonadherence and increased adverse drug events, especially associated with cognitive impairment, physical limitations, or lack of social support. However, the association between medication complexity and patients' health outcomes among older adults with HF is unclear. The purpose of this review is to address how the complexity of HF medications has been assessed in the literature and what clinical outcomes are associated with medication regimen complexity in HF. Further, we aimed to explore how older adults were represented in those studies. The Medication Regimen Complexity Index was the most commonly used tool for assessment of medication regimen complexity. Rehospitalization was most frequently assessed as the clinical outcome, and other studies used medication adherence, quality of life, healthcare utilization, healthcare cost, or side effect. However, the studies showed inconsistent results in the association between the medication regimen complexity and clinical outcomes. We also identified an extremely small number of studies that focused on older adults. Notably, current medication regimen complexity tools did not consider a complicated clinical condition of an older adult with multimorbidity, therapeutic competition, drug interactions, or altered tolerance to the usual dose strength of the medications. Furthermore, the outcomes that studies assessed were rarely comprehensive or patient centered. More studies are required to fill the knowledge gap identifying more comprehensive and accurate medication regimen complexity tools and more patient-centered outcome assessment.

Highly variable biodistribution of 68Ga labeled somatostatin analogues 68Ga-DOTA-NOC and 68Ga-DOTA-TATE in neuroendocrine tumors: clinical implications for somatostatin receptor directed PET/CT.

Background: Somatostatin receptor (SSTR)-targeted positron emission tomography/computed tomography (PET/CT) imaging has risen to the forefront for neuroendocrine tumor (NET) detection and management, yet the variability of significant uptake variability (SUV) as a semiquantitative measure of disease detection and tumor response to treatment has not been fully explored. Methods: We assess the reproducibility and interscan variability of SUV metrics of normal tissue and NET in serial 68Ga-DOTA-NOC and 68Ga-DOTA-TATE PET imaging to clinically monitor disease state. Eighty-one patients were enrolled in this retrospective study. Results: Both primary and metastatic hepatic lesions demonstrated SUV (SUVmean 16.5±8.0). The median SUVmean was 16 for the spleen, 9.7 for the pituitary, 12.6 for the adrenal glands, and 4.8 for the liver. The normal pituitary gland demonstrates focal homogenous uptake with SUVmax range of 4.5-23. The adrenal gland showed uptake with SUVmax range of 4.1-29.4, which is more than two times greater than liver uptake (SUVmean range, 2.3-12.4). Highest physiological uptake seen in the spleen (average SUVmean of 17.3, range of 5.4-34.4). Conclusions: The highly variable nature of regional SUVmean and SUVmax in both physiologic tissue and lesions suggests the need for incorporation of more reliable quantitative measures for clinical decision making.