The impact of professional turf battles on radiology resident education: perspectives from the radiology class of 2005.

PURPOSES: To assess residents' exposure to professional turf battles, via a survey of the radiology residency class of 2005, and to assess perceptions about the causes, solutions, and impact of turf battles on resident education. METHODS: An electronic survey composed by the ACR Resident and Fellow Section was completed by 168 senior residents (a 18.9% response rate) enrolled in allopathic radiology residency programs from across the United States. RESULTS: The majority of respondents (153 of 168, 91.1%) perceive a loss of professional turf from nonradiologists. Areas most often perceived as being affected by lost professional turf were interventional radiology (136/168, 81.0%), cardiothoracic imaging (106 of 168, 63.1%), and ultrasound (88 of 168, 52.4%). The sense of lost professional turf was most often attributed to inadequate residency training in the affected subspecialities (87 of 168, 51.8%). The most commonly cited motivation for ongoing turf battles was reimbursement for diagnostic imaging and image-guided procedures as a motivator for nonradiologists. The majority of residents feel that the most effective ways to counter professional turf battles include the promotion of national physician-training standards for diagnostic imaging and image-guided therapies, the mandatory accreditation of all imaging facilities, and the development of performance standards that providers of imaging services must meet to qualify for reimbursement. CONCLUSIONS: The majority of resident respondents feel that professional turf battles have had a significant impact on their education. Methods recommended to counter professional turf battles mirror recent proposals by the ACR to support mandatory national quality, safety, and training standards for providers of diagnostic imaging.

The digital curriculum vitae.

The curriculum vitae (CV) has been the traditional method for radiologists to illustrate their accomplishments in the field of medicine. Despite its presence in medicine as a standard, widely accepted means to describe one's professional career and its use for decades as an accomplice to most applications and interviews, there is relatively little written in the medical literature regarding the CV. Misrepresentation on medical students', residents', and fellows' applications has been reported. Using digital technology, CVs have the potential to be much more than printed words on paper and offers a solution to misrepresentation. Digital CVs may incorporate full-length articles, graphics, presentations, clinical images, and video. Common formats for digital CVs include CD-ROMs or DVD-ROMs containing articles (in Adobe Portable Document Format) and presentations (in Microsoft PowerPoint format) accompanying printed CVs, word processing documents with hyperlinks to articles and presentations either locally (on CD-ROMs or DVD-ROMs) or remotely (via the Internet), or hypertext markup language documents. Digital CVs afford the ability to provide more information that is readily accessible to those receiving and reviewing them. Articles, presentations, videos, images, and Internet links can be illustrated using standard file formats commonly available to all radiologists. They can be easily updated and distributed on an inexpensive media, such as a CD-ROM or DVD-ROM. With the availability of electronic articles, presentations, and information via the Internet, traditional paper CVs may soon be superseded by their electronic successors.

The radiology class of 2005: postresidency plans.

PURPOSE: To examine the postresidency plans of the radiology residency class of 2005, including influences on and trends in the decision to pursue subspecialty fellowship training after residency. METHODS: An electronic survey composed by the ACR Resident and Fellow Section was completed by 416 senior residents (a 46.9% response rate) enrolled in allopathic radiology residency programs from across the United States, representing approximately 41.2% of the entire residency class. RESULTS: Eighty-seven percent (95% confidence interval 83.8% to 90.2%) of respondents plan to do fellowships immediately after residency, representing an increasing number, compared with published figures from the 1990s. Increasing age at the completion of residency was independently and significantly correlated with the decision not to pursue a fellowship. There has been a shift in the most popular fellowships, with an increased interest in musculoskeletal radiology fellowships and decreased interest in interventional radiology. Among residents not pursuing immediate fellowship training, the most common plans were private practice positions (48.1%), military obligations (22.2%), and nighthawk positions (9.3%). CONCLUSION: An increasing number of residents are electing to pursue subspecialty training after the completion of residency. Close monitoring of the postresidency plans of current residents may portend important trends in education, residency training, and changes in the radiology workforce.

The radiology class of 2005: the fellowship application process and perceptions of the NRMP fellowship match.

PURPOSE: To assess experiences and perceptions of the fellowship application process of the radiology residency class of 2005, including the 2005 National Resident Matching Program (NRMP) Radiology Fellowship Match. METHODS: An electronic survey composed by the ACR Resident and Fellow Section was completed by 416 senior residents (a 46.9% response rate) enrolled in allopathic radiology residency programs from across the United States. RESULTS: Residents generally agree with the timing of the current fellowship application calendar in the spring of the third year of residency. Respondents were divided over the issue of permitting internal candidates to fill positions outside of the match, although the majority felt that the process influences both applicants and programs to favor their own institutions to avoid the match process. Residents support requiring fellowship programs to declare the number of positions being filled through the match before applications are due (72.6%) or before rank lists are due (79.8%). Residents noted match rule violations, which threaten to undermine residents' confidence in the process. Residents were split over the future of the match: 23.1% favored continuing the match in its current form, 28.8% favored continuing the match with modifications, and 34.4% favored discontinuing the match entirely. CONCLUSION: Although the NRMP Fellowship Match was created to improve and standardize the fellowship application process, and although a majority of residents support continuing the match in some form, there are areas of concern, including adherence to the letter and spirit of the match rules, which must be addressed to galvanize support among residents in the future and ensure a fair process for fellowship applicants.

The effects of tumescent solutions containing lidocaine and epinephrine on skin flap survival in rats.

The effects of tumescent solutions consisting of lidocaine and epinephrine on skin flap survival in rats were studied. Dorsal skin flaps of rats were infiltrated using lidocaine (1%) with epinephrine in concentrations of 1:100,000, 1:200,000, 1:400,000, and 1:800,000 prior to elevating flaps of the different experimental groups. The solutions were applied intradermally or subcutaneously, and the flaps were raised "immediately" or "delayed" after injection in the different groups. Control flaps were infiltrated by lidocaine (1%) only. The survival of the flaps was assessed on the seventh day after the operation. As a result, the flaps showed higher necrosis rates in the groups injected by lidocaine with epinephrine in concentration of 1:100,000 and 1:200,000 than of the other experimental or all control groups (P < 0.01). In conclusion, lidocaine with epinephrine in concentrations of 1:400,000 and 1:800,000 was found safe on skin flap survival for tumescent technique in rats.

Computed tomographic angiography of endovascular abdominal aortic stent-grafts.

The treatment of aortic abdominal aneurysms with endovascular repair provides a treatment alternative for high-risk surgical candidates. Computed Tomographic Angiography (CTA) has become the preferred imaging modality for preoperative evaluation of abdominal aortic aneurysms, postoperative assessment of endovascular repair and complications, and long term surveillance. Accurate evaluation of these devices and identification of endoleaks and other complications by the radiologist is critical to assuring successful outcomes.

Clinical applications of three-dimensional photography in breast surgery.

Three-dimensional imaging in breast surgery has several uses clinically. The most practical applications are for the evaluation of breast asymmetries, both congenital and acquired, and for the evaluation of factors affecting breast shape in augmentation mammaplasty. Other uses of three-dimensional imaging that we have found clinically helpful are for evaluation of patients desiring reduction mammaplasty and for evaluation of patients undergoing unilateral breast reconstruction to determine the expander and permanent implant size that gives the best symmetry with the contralateral breast. We present five cases in which we investigate the use of three-dimensional imaging clinically by using the images to determine quantitative information about the breast, such as volume or projection. Overall, three-dimensional imaging is very helpful in providing objective information about the breast for use in preoperative planning. In addition, by analyzing clinical cases, it can provide objective data about the breast and surgical mammaplasty (especially augmentation mammaplasty) that may help surgeons better understand those factors that contribute to breast shape and influence surgical outcomes. There are currently some limitations of this system, influenced by patients with significant ptosis or obesity, which may introduce errors into the three-dimensional data, making them unreliable. However, we believe three-dimensional imaging has great clinical potential in surgical mammaplasty.