Career paths in diagnostic radiology: scope and effect of part-time work.

PURPOSE: To determine the extent and consequences of part-time work in radiology. MATERIALS AND METHODS: A survey was mailed to 1,500 male and 1,500 female radiologists. Questions assessed part-time work and its effect on professional and family issues. The effects of education, radiology practice characteristics, organizational support, human resource practices, and family responsibilities on career and professional satisfaction were studied. RESULTS: Ten and a half percent of the radiologists surveyed--7.4% of the men and 30.2% of the women--were working part-time. The part-time radiologists reported earning 56.3% of the income earned by full-time radiologists and working 56.9% of the hours worked by their full-time counterparts, with disproportionately fewer benefits. Part-time private practice radiologists were significantly less likely to be partners. For academic radiologists, having worked part-time at any time was significantly associated with lower academic rank. CONCLUSION: The motivation for working part-time differed significantly according to gender and age. Benefits were disproportionate, and radiologists who had worked part-time were less likely to be partners or full professors.

Training in obstetric sonography for radiology residents and fellows in the United States.

OBJECTIVE: The purpose of our study was to assess the current experience of radiology residents and fellows in obstetric sonography. SUBJECTS AND METHODS: Written surveys were sent to the directors of 206 accredited radiology residency programs and 85 fellowship programs in the United States. The surveys encompassed obstetric sonographic experience during routine working hours and after hours, the level of supervision, the types of scanning performed, and the extent of formal lectures available during training. Additional questions concerned the relative knowledge of laboratory accreditation processes and training of faculty covering obstetric sonography. RESULTS: Sixty (29%) of 206 accredited radiology residency programs and 24 (28%) of 85 fellowship programs returned surveys. The experience among residency programs was similar, providing fewer than 4 weeks per year of obstetric sonography, usually within their own department of radiology. Residents were more likely to be sent to outside departments for second or third trimester sonography experience. A decrease in scanning assistance was reported for examinations performed after hours, more so for second or third trimester studies. Lecture topics revealed similar deficiencies for residency and fellowship programs. CONCLUSION: Greater emphasis on the performance of prenatal sonographic examinations may be warranted during formal sonography rotations. Current levels of experience in obstetric sonography may not be providing sufficient experience to allow residents to appropriately manage call cases or for practicing radiologists to provide such services after their training is completed.

Accuracy of prenatal sonography for detecting circumvallate placenta.

OBJECTIVE: We determined the accuracy of prenatal sonography for detecting placental circumvallation, a placental abnormality associated with increased fetal morbidity and mortality. MATERIALS AND METHODS: We analyzed 62 healthy pregnant (range, 18-36 weeks) patients with focused placental sonography for detection of morphologic abnormality using the published criteria for circumvallate placenta (irregular edge, uplifted margin, or placental sheet or shelf). Placental marginal sonograms were taken at 30 degrees intervals around the entire placental margin. Five experienced sonologists who were unaware of the pathologic findings independently reviewed the placental images and graded the placentas from 1 (definitely normal) to 5 (definitely circumvallate). Receiver operating characteristic (ROC) curves and area under the ROC curve were calculated for each reader. Gross and microscopic pathology was used as the gold standard for all cases. RESULTS: In the 62 patients, sonography revealed 49 normal placentas (79%), 12 partially circumvallate placentas (19%), and one completely circumvallate placenta (2%). ROC curves for the reviewers resulted in values for area under the curve ranging from .39 to .58. The sonologist who achieved the highest value for the area under the curve classified the 13 cases of proven circumvallation as one case of definite circumvallation, four cases as uncertain or equivocal, and eight cases as probably or definitely normal placentas. Of the normal placentas, 35% were graded as probably or definitely circumvallate by at least one sonologist. All sonologists misgraded the case of complete circumvallation as normal. CONCLUSION: Focused placental sonograms interpreted by experienced sonologists fail to detect the placental edge abnormality in most cases of circumvallation. In our study, 17 of 49 normal placentas were diagnosed as probably or definitely circumvallate by one or more observers. Our sonologists' interpretations of sonograms showed that complete circumvallation was difficult to assess. Although our study had a limited number of patients, the accuracy of sonography of the placenta for revealing circumvallation appears to be limited.

Psychodynamic assessment and treatment of traumatized patients.

This article describes how psychodynamic assessment and treatment of traumatized patients can improve clinical acuity. The author describes an ego psychological, psychodynamic approach that involves 1) assessing the impact of trauma on the patient's ego defensive functioning and 2) elucidating the dynamic meaning of both the patient's presenting symptoms and the traumatic events that precipitated them. Clinical descriptions illustrate the ways in which psychodynamic psychotherapy may be particularly useful with patients whose acute symptoms develop following specific events. The author points out the advantages of an ego psychological, psychodynamic approach for her patients and the limitations of more symptom-based diagnostic assessments and treatments.

Dacarbazine, cisplatin and carmustine, with or without tamoxifen, for metastatic melanoma: 5-year follow-up.

Metastatic melanoma has a grim prognosis. Response rates and survival of patients treated with combination chemotherapy are not superior to single-agent chemotherapy. This study seeks to evaluate the objective response rate and survival of patients with metastatic melanoma treated with multiagent chemotherapy, with or without tamoxifen. Forty-two patients with metastatic melanoma were treated from March 1982 to February 1988 with dacarbazine, cisplatin and carmustine, with or without tamoxifen. An overall objective response rate of 43% was seen (complete response rate 17%; partial response rate, 26%). The response rate was 54% for patients treated with tamoxifen and 25% for patients treated without tamoxifen, but the results did not achieve statistical significance. Median overall survival was 412 days, and was significantly longer in the tamoxifen-treated group. Combination chemotherapy as described in this study is well-tolerated. The observation that tamoxifen appears to impact on survival should be interpreted with great caution due to the deficiencies in the design of the trial and small patient numbers. A randomized trial of this regimen vs single-agent chemotherapy is indicated and is currently being conducted.

Rebound thymic hyperplasia five years after chemotherapy for Wilms' tumor.

Rebound thymic hyperplasia following chemotherapy is well documented, usually occurring within the first year. A delayed presentation makes distinction from an anterior mediastinal mass problematic in view of the increased risk of a second primary malignancy in pediatric cancer survivors. An unusual case of rebound thymic hyperplasia is described, presenting five years after completion of chemotherapy for Wilms' tumors.

Negative oedipal transference of a male patient to his female analyst during the termination phase.

There has been some debate in the literature concerning the ability of the male patient to experience his paternal, and particularly negative oedipal, transference feelings directly toward his female analyst. In this context, the author describes paternal transference manifestations evident throughout her male patient's analysis, and presents detailed process material from the termination phase. At this time the patient's obsessional neurosis was revived in the context of setting a termination date, and transference to the negative oedipal father could be clearly demonstrated. The paper illustrates that even the negative oedipal component of the paternal transference can be experienced directly in the male patient/female analyst, dyad, and interpretation of this material can bring it into clearer focus. The author discusses some possible influences of her sex on the timing and intensity of the material.