Effects of night-float shifts on cognitive function among radiology residents.

BACKGROUND: Many radiology programs utilize a night-float system to mitigate the effects of fatigue, improve patient care, and provide faster report turnaround times. Prior studies have demonstrated an increase in discrepancy rates during night-float shifts. OBJECTIVES: This study was performed to examine the effects of night-float shift work on radiology resident cognition. We hypothesized that there would be diminished cognitive function on testing following night-float shifts when compared to testing following day shifts. METHODS: Diagnostic radiology residents in their second to fifth years of residency at a single institution were recruited to participate in this pilot study. Cognitive function was evaluated using the Lumosity Neurocognitive Performance Tests (NCPT), standardized performance tests that provide real-time, objective measurements of cognitive function. Study participants completed the NCPT in 5 sessions following 5 consecutive day shifts to evaluate their baseline cognitive function. The tests were re-administered at the end of consecutive night-float shifts to assess for any changes. Sleep was objectively monitored using actigraphy devices worn around the wrist during all study weeks. Descriptive and summary statistics were performed. RESULTS: 23 prospectively recruited diagnostic radiology residents working night-float shifts took a mean 13.6 (± 5.1) neurocognitive performance tests during the study period. There was a statistically significant decline in 2 of the 6 cognitive tests administered, signifying a decrease in attention, speed, and complex reasoning ability. Night-float shifts were significantly longer than the day shifts and associated with a significantly higher study volume and cross-sectional study volume. Fitbit data demonstrated that there were no significant differences in level of activity while awake. However, participants slept significantly longer during day shifts. CONCLUSIONS: A sample of 23 radiology residents working night-float shifts demonstrated declines in attention, speed, and complex reasoning ability following sequential administration of standardized neurocognitive performance tests. While the sample size is small, these findings demonstrate the potential deleterious effects of night-float shift work and provide evidence to support further inquiry into this phenomenon.

Radiology Training Program Lessons Learned During the COVID-19 Pandemic.

The COVID-19 pandemic had major effects on radiology training programs throughout the country. Many of the challenges were shared, with some variation depending on the size and geographic location of each program. While some initial modifications, such as platoon-type scheduling and redeployment, have been abandoned, other changes such as home workstations and the option of remote conferences have become more permanently incorporated. Remote learning tools and virtual teaching are much more frequently used, although there is emphasis by many programs on preserving in-person training. Programs stressed the importance of communication and adaptability, and getting resident and faculty input is key in optimizing the educational experience.

NCI's publication affiliation conundrum: Reframing innovation to incentivize an equitable path for advocate representation.

Advocacy engagement has been at the forefront of National Cancer Institute (NCI) efforts to advance scientific discoveries and transform medical interventions. Nonetheless, the journey for advocates has been uneven. Case in Point: NCI publication affiliation rules of engagement pose unique equity challenges while raising questions about structural representation in biomedical research. Abiding by the core rationale that publication affiliation should be tailored to employment status, the NCI has systematically denied research advocate volunteers the opportunity to specifically list NCI as an institutional affiliation on academic publications. Unpacking advocate NCI publication affiliation restrictions and its links with advocacy heritage preservation and convergent science goals poses unique diversity, equity, and inclusion challenges and opportunities. Improving the quality of structural representation in biomedical research requires new theories of action and flexible planning to advance, promote and build capacity for strategic advocacy inclusion and equity within publication affiliation initiatives. Here we highlight several opportunities for how leadership might formulate a radically different vision for NCI's approach. This perspective interrogates the best way forward for ensuring that biomedical employee and volunteer advocate workforce publication affiliation intersections are characterized by increased creativity and representation parity. Imbuing the scientist and clinical researcher archetype with social dimensions, we join NCI critical thinkers in urging employees, funded academics, and volunteer citizen scientists to collectively assume the role as paladins of science and integrity who view the triumphs of making a difference in science alongside the social responsibility of promoting transdisciplinary professionalism and the democratization of science.

Imaging review of penile pathologies encountered in the emergency department.

While penile pathology is uncommon, prompt diagnosis and treatment of emergent and urgent penile pathology are necessary to prevent complications. This paper will review the imaging findings of the most common critical penile pathologies, including traumatic, vascular, infectious, foreign body-related, and urethral pathology, in addition to penile prosthesis complications. Each entity will be discussed in the context of presentation and treatment and complications of each pathology will be discussed.

American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings.

Background Treatment of blunt splenic trauma (BST) continues to evolve with improved imaging for detection of splenic vascular injuries. Purpose To report on treatments for BST from 11 trauma centers, the frequency and clinical impact of splenic vascular injuries, and factors influencing treatment. Materials and Methods Patients were retrospectively identified as having BST between January 2011 and December 2018, and clinical, imaging, and outcome data were recorded. Patient data were summarized descriptively, both overall and stratified by initial treatment received (nonoperative management [NOM], angiography, or surgery). Regression analyses were used to examine the primary outcomes of interest, which were initial treatment received and length of stay (LOS). Results This study evaluated 1373 patients (mean age, 42 years ± 18; 845 men). Initial treatments included NOM in 849 patients, interventional radiology (IR) in 240 patients, and surgery in 284 patients. Rates from CT reporting were 22% (304 of 1373) for active splenic hemorrhage (ASH) and 20% (276 of 1373) for contained vascular injury (CVI). IR management of high-grade injuries increased 15.6%, from 28.6% (eight of 28) to 44.2% (57 of 129) (2011-2012 vs 2017-2018). Patients who were treated invasively had a higher injury severity score (odds ratio [OR], 1.04; 95% CI: 1.02, 1.05; P < .001), lower temperature (OR, 0.97; 95% CI: 0.97, 1.00; P = .03), and a lower hematocrit (OR, 0.96; 95% CI: 0.93, 0.99; P = .003) and were more likely to show ASH (OR, 8.05; 95% CI: 5.35, 12.26; P < .001) or CVI (OR, 2.70; 95% CI: 1.64, 4.44; P < .001) on CT images, have spleen-only injures (OR, 2.35; 95% CI: 1.45, 3.8; P < .001), and have been administered blood product for fewer than 24 hours (OR, 2.35; 95% CI: 1.58, 3.51; P < .001) compared with those chosen for NOM, after adjusting for key demographic and clinical variables. After adjustment, factors associated with a shorter LOS were female sex (OR, 0.84; 95% CI: 0.73, 0.96; P = .009), spleen-only injury (OR, 0.72; 95% CI: 0.6, 0.86; P < .001), higher admission hematocrit (OR, 0.98; 95% CI: 0.6, 0.86; P < .001), and presence of ASH at CT (OR, 0.74; 95% CI: 0.62, 0.88; P < .001). Conclusion Contained vascular injury and active splenic hemorrhage (ASH) were frequently reported, and rates of interventional radiologic management increased during the study period. ASH was associated with a shorter length of stay, and patients with ASH had eight times the odds of undergoing invasive treatment compared with undergoing nonoperative management. © RSNA, 2021 See also the editorial by Patlas in this issue.

Gut wrenching: cases of missed gastrointestinal tumors and their mimics on computed tomography.

Computed tomography (CT) of the abdomen and pelvis is one of the most common imaging studies ordered through the emergency department (ED). Because these studies are ordered for the detection of acute abnormalities and due to the relatively low incidence in patients presenting through the ED, gastrointestinal tumors are commonly missed. Moreover, many CT findings of malignant tumors overlap with benign entities, which can present a diagnostic challenge. This review article will describe the common CT findings of gastric, small bowel, colon, and appendiceal cancer as well as some of the common benign gastrointestinal conditions with similar imaging findings.

Education and Outreach in Physical Sciences in Oncology.

Physical sciences are often overlooked in the field of cancer research. The Physical Sciences in Oncology Initiative was launched to integrate physics, mathematics, chemistry, and engineering with cancer research and clinical oncology through education, outreach, and collaboration. Here, we provide a framework for education and outreach in emerging transdisciplinary fields.

Emergent MRI for acute abdominal pain in pregnancy-review of common pathology and imaging appearance.

Acute abdominal pain in pregnancy remains a clinically challenging presentation, often requiring imaging. The threat of morbidity and mortality to both mother and fetus necessitates quick and accurate imaging diagnosis, often via ultrasound. However, many of the common causes of acute abdominal pain are not readily diagnosed with sonography, and magnetic resonance imaging (MRI) is increasingly favored in this setting. The purpose of this review is to familiarize the reader with common pathologies which may be encountered in pregnant females presenting with acute abdominal pain requiring emergent MRI.

Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: An Updated Series.

PURPOSE: Reoperative pyeloplasty is commonly used in children with recurrent obstruction after pyeloplasty. We previously reported on reoperative robot-assisted laparoscopic repair for failed pyeloplasty in 16 children and concluded that short-term and intermediate outcomes were comparable to open reoperative repair. In this updated series we describe longer term outcomes from an extended study. MATERIALS AND METHODS: We retrospectively reviewed outcomes of consecutive children with prior failed primary pyeloplasty who underwent robot-assisted laparoscopic reoperative repair at a single institution from January 2008 to June 2018. RESULTS: Overall, 36 children 0.6 to 15.2 years old (median 3.7) underwent robot-assisted laparoscopic reoperative repair (pyeloplasty in 31, ureterocalicostomy in 5) at a median of 24.3 months (range 3.9 to 136.7) after primary repair. Median reoperative time was 285.0 minutes (range 207 to 556) and median length of stay was 1 day (1 to 8). Crossing vessels were present in 8 of 30 children (26.7%) with prior open repair and in 0 of 6 with prior minimally invasive repair. Clavien-Dindo grade 1 to 2 perioperative complications occurred in 4 children (11.1%) and grade 3 to 5 complications in 2 (5.6%). Median followup was 35.3 months (range 1.4 to 108.3), with 18 children (50.0%) being followed for more than 3 years. Postoperative ultrasound in 34 children revealed improvement in 31 (91.2%), stability in 2 (5.9%) and worsening hydronephrosis in 1 (2.9%). All 11 children undergoing preoperative and postoperative diuretic renography demonstrated stable or improved differential renal function. All children were symptom-free at last followup. CONCLUSIONS: To our knowledge, this is the largest series of robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children. Our results indicate the feasibility, efficacy, safety and durability of this procedure.

The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis.

PURPOSE: While serial renal ultrasound is often used as an alternative to functional renal imaging in children followed for hydronephrosis, it is unclear whether a lack of hydronephrosis progression safeguards against loss of renal function. In this study we characterize the association between findings on serial renal ultrasound and diuretic renography in children with severe unilateral hydronephrosis. MATERIALS AND METHODS: We retrospectively reviewed imaging among patients younger than 18 years old with a history of severe unilateral hydronephrosis, 2 renal ultrasounds and 2 diuretic renograms. Each pair of renal ultrasounds was interpreted by an independent blinded diagnostic radiologist and compared to a contemporaneous diuretic renogram. Change in hydronephrosis was considered as 1) a change in hydronephrosis grade or 2) any change by radiologist interpretation. A 5% or greater change in split differential function was considered significant. Chi-square and Spearman correlation analyses were performed. RESULTS: A total of 85 children were evaluated. Increased hydronephrosis was noted in 11.8% of children by grade and 32.9% by radiologist interpretation. Split differential renal function worsened by 5% or more in 17.6% of children. Overall, 13.3% of children with stable or decreased hydronephrosis demonstrated worsening split differential function at an average of 11.8 months. When renal ultrasound and diuretic renograms were directly compared, the Spearman correlation was poor (r = 0.24, 95% CI 0.03 to 0.43). CONCLUSIONS: The overall correlation between imaging modalities was poor, and 13.3% of children with stable or decreased hydronephrosis had worsening of split differential renal function. These findings are important to consider when counseling nonoperatively managed children followed without diuretic renography.

Science + dance = bodystorming.

In everyday life, gravity and inertial forces often dominate our movements; in the cell, these forces pale in comparison to thermal forces. The violent, collisional world of the cell, where water moves faster than a jet airliner, can be difficult to imagine. To develop our intuitive understanding of cellular and molecular processes, we are exploring the concept of 'bodystorming', where human 'movers' act as molecules that diffuse, undergo reactions, and generate/absorb forces.

Impact of resident call eligibility on major discrepancy rate.

RATIONALE AND OBJECTIVES: The Resident Review Committee (RRC) recently changed the policy concerning first-year resident call. Our study is intended to evaluate whether the additional 6 months of training before a resident's first call made a significant difference in the resident's ability to provide patient care. To evaluate this, we assessed the discrepancy rates between preliminary interpretations made by residents and final reports by attendings. MATERIALS AND METHODS: All cross-sectional imaging interpreted by on-call residents (5 PM to 8 AM) during the first 6 months of call duties was reviewed for discrepant findings between the preliminary resident report and the final interpretation by an attending. Only major discrepancies were evaluated. A major discrepancy was defined as a change made to the resident preliminary report by an attending radiologist where a delay in communicating that finding had the potential to negatively affect clinical outcomes. Major discrepancy rates between groups were then compared. RESULTS: During the second 6 months of the 2008-2009 academic year, first-year residents interpreted 3331 studies. Fifty-nine of those were declared to be discrepancies after an attending over-read, a rate of 1.8%. During the first 6 months of the 2009-2010 academic year, second-year residents interpreted 4649 studies with 49 discrepancies, a rate of 1.0%. This difference is statistically significant (P = .008). CONCLUSIONS: The recent RRC policy change requiring 6 additional months of training before assuming independent on-call responsibilities has significantly decreased the major discrepancy rate at our institution.