Radiology program director's perspective on a novel hands-on advanced elective.

With the advent of the USMLE Step 1 exam moving to a pass/fail status, Radiology Program Directors (PDs) and Associate Program Directors (APDs) need alternative methods of identifying interested and engaged medical students who are applying to their program. Additionally, undergraduate radiology medical education in the United States varies widely from institution to institution with no universal mandatory radiology component. To address these problems, we implemented an advanced fourth year hands-on radiology elective where the students were treated as first year radiology residents (R1s), giving them resident-level access to the Picture Archive and Communication System (PACS) and dictation software, and allowing them to perform entry-level procedures with appropriate supervision. After implementation of the elective, a 5-question online survey was sent to two hundred and ninety-eight PDs and APDs via the Association of Program Directors in Radiology (APDR) listserv, of which seventy-two responses were compiled, yielding a response rate of 24%. The survey focused on how a hands-on medical student elective would help in assessing prospective candidates and predicting R1 performance. Most respondents felt interest in radiology, motivation, and interpersonal skills would be better assessed after such an elective and the vast majority felt hands-on Advanced Elective would be at least slightly predictive of first year resident performance. Based on this information, we believe implementing a hands-on advanced radiology elective would significantly help address the passive nature of traditional radiology electives, providing valuable information to PDs and APDs and giving the best possible radiology experience to our medical students.

Splenic Artery Embolization for Unstable Patients with Splenic Injury: A Retrospective Cohort Study.

PURPOSE: To compare the outcomes of splenic artery embolization (SAE) for acute splenic injury (ASI) between patients who are hemodynamically stable (HDS) and hemodynamically unstable (HDU). Nonoperative management with SAE has become an accepted practice for patients who are HDS with ASI; however, SAE for the treatment of patients who are HDU with ASI has not been well studied. MATERIALS AND METHODS: A retrospective cohort study was performed, including 52 patients who were HDU and HDS who underwent SAE for ASI at a Level 1 trauma center. HDU was defined as the lowest recorded systolic blood pressure prior to intervention <90 mm Hg. Utilizing the American Association for Surgery of Trauma (AAST) splenic injury scale, AAST Grades 1-3 were defined as low grade, and Grades 4-5 were defined as high grade. The primary outcomes were survival at 30 days and the need for subsequent splenectomy. RESULTS: Seventy-five percent (n = 39) of the patients were HDS, and 25% (n = 13) were HDU. The majority (69%) of patients who were HDU who underwent SAE did not require splenectomy, compared with 95% of patients who were HDS (P = .03). No significant difference in 30-day survival between patients who were HDU and HDS was noted. No major adverse events were recorded. There was no significant difference in 30-day patient survival or the rate of subsequent splenectomy between high-grade and low-grade splenic injuries. CONCLUSIONS: In this retrospective cohort study, there was no statistically significant difference in the adverse events or 30-day post-SAE survival rates between patients who were HDS and HDU with ASI. The authors conclude that SAE can be a safe and effective treatment option for patients who are HDU with ASI, including high-grade splenic injury.

Interventional oncology update.

Interventional Oncology (IO) is a subspecialty field of Interventional Radiology bridging between diagnostic radiology and the clinical oncology team, addressing the diagnosis and treatment of cancer. There have been many exciting advancements in the field of IO in recent years; far too many to cover in a single paper. To give each topic sufficient attention, we have limited the scope of this review article to four topics which we feel have the potential to drastically change how cancer is treated managed in the immediate future.

The long-lasting effect of ferumoxytol on abdominal magnetic resonance imaging.

Ferumoxytol is a parenteral iron therapy that the Food and Drug Administration recently approved for the treatment of iron-deficiency anemia. The form of the iron, ultrasmall superparamagnetic iron oxide nanoparticles, causes T1, T2, and T2* shortening on magnetic resonance imaging, which can mimic hemosiderosis. We report such a case, with laboratory findings that demonstrate normal iron stores, and discuss the potential implications.