Medical students who choose a radiology elective: career decisions, motivations, and intentions.

RATIONALE AND OBJECTIVES: A national survey of American medical students was conducted to determine the effects of taking a radiology elective. The survey also probed attitudes of students not planning a career in radiology relative to the interpretation of medical images independently of radiologists. METHODS: The names of all students taking an elective in radiology in 1993-1994 were solicited from all American medical schools. Eighty-one of 124 radiology elective programs responded, and 3872 questionnaires were returned to the 81 medical schools for delivery to the students. Approximately 25% of the questionnaires were returned, and data were derived from these. RESULTS: Rarely did the radiology elective influence a change (2.1%) from another specialty or primary care to radiology. Eighty-nine percent of the students sampled indicated that the elective had no effect on their decision. Of students who were undecided about their careers, 13.2% indicated that the elective changed their career choice, but 63.2% said the elective had no effect. The data revealed that there are multiple, often overlapping, reasons for a medical student not planning a career in radiology to choose a radiology elective. Most of the students (93.5%) expected to interpret radiographs or other medical images themselves and then correlate their impression with a radiologic report. However, 30% of the students planned to interpret some radiographs independently of radiologists, and another 15% expected to interpret medical images other then plain radiographs without a radiologic consultation. CONCLUSION: Our data suggest that attitudes regarding interpretation of radiographs or other medical images without involvement of a radiologist are ingrained in medical students and correspond to attitudes among practicing clinicians. There is an expectation among medical students that taking a 4-week elective is useful or even necessary to independently interpret radiographs in future clinical practice. The effect of these attitudes on the cost and quality of future medical care should engender considerable concern. A basic conceptual change in the structure and content of the radiology elective is suggested.

Melanoma metastatic to the bronchus: radiologic features in two patients.

Two patients with cutaneous melanoma metastatic to the bronchus are described. Chest radiographs revealed only indirect signs of bronchial obstruction. Computed tomography (CT) clearly demonstrated the intraluminal lesion. Magnetic resonance (MR) imaging signal characteristics were not specific for melanoma.

Computer-assisted analysis of mammographic clustered calcifications.

A total of 127 biopsy-proven clustered mammographic calcifications were diagnosed and evaluated using multiple parameters. The results were subjected to computer analysis. The number of calcifications/cm2 was the most important parameter. Less than 10 calcifications/cm2 resulted in an 82% chance of being benign while 10 or more calcifications/cm2 had a 44% chance of being malignant. The average distance between the calcifications in the cluster was also significant, with a 92% chance of being benign if greater than 1 mm and a 52% chance of being malignant if less than 1 mm. The remaining parameters did not yield statistically significant results, but there were trends which suggest that less than 10 clustered calcifications that are regular in size and shape and orderly in appearance tend to be benign while disorderly clusters tend to be malignant. In order to decrease the number of false positive biopsies and improve the cost-effectiveness of screening mammography, radiologists should consider 6-month follow-up mammography as a reasonable alternative for clustered calcifications that appear benign.

Idiopathic hypertrophic subaortic stenosis. By Irwin M. Freundlich, J. Thomas McMurray, J. Stauffer Lehman, 1967.

In patients with a systolic ejection murmur and without a history of rheumatic fever, a probable diagnosis of idiopathic hypertrophic subaortic stenosis (IHSS) can be made from the roentgenologic findings. Left ventricular enlargement, associated at times with minimal left atrial enlargement, without intracardiac calcification and with a normal ascending aorta are the most frequent roentgen findings. For a positive diagnosis, a pressure gradient within the left ventricle and hypertrophic muscular obstruction should be demonstrated by angiocardiography.

Preoperative radiographic diagnosis of a Spigelian hernia containing large and small bowel.

A case is reported in which the preoperative diagnosis of a Spigelian hernia containing both large and small bowel was made by radiographic means. The anatomy, clinical findings, and radiologic picture of this condition are discussed.

Thermographic, radionuclide, and radiographic detection of bone metastases.

The sensitivity of thermography to osseous metastases is compared to 99mTc bone scanning using the specificity of radiographic skeletal survey as proof of metastases. Thirty-five patients with suspected disease were selected for study. Bone scans detected 94.4% while thermograms detected 22.2%. Thermography proved quite insensitive to osseous metastases. Radionuclide bone scanning is the method of choice for the present.