Genomic profiling informs diagnoses and treatment in vascular anomalies.

Vascular anomalies are malformations or tumors of the blood or lymphatic vasculature and can be life-threatening. Although molecularly targeted therapies can be life-saving, identification of the molecular etiology is often impeded by lack of accessibility to affected tissue samples, mosaicism or insufficient sequencing depth. In a cohort of 356 participants with vascular anomalies, including 104 with primary complex lymphatic anomalies (pCLAs), DNA from CD31+ cells isolated from lymphatic fluid or cell-free DNA from lymphatic fluid or plasma underwent ultra-deep sequencing thereby uncovering pathogenic somatic variants down to a variant allele fraction of 0.15%. A molecular diagnosis, including previously undescribed genetic causes, was obtained in 41% of participants with pCLAs and 72% of participants with other vascular malformations, leading to a new medical therapy for 63% (43/69) of participants and resulting in improvement in 63% (35/55) of participants on therapy. Taken together, these data support the development of liquid biopsy-based diagnostic techniques to identify previously undescribed genotype-phenotype associations and guide medical therapy in individuals with vascular anomalies.

Hands-On Ultrasound Training for Radiology Residents: The Impact of an Ultrasound Scanning Curriculum.

RATIONALE AND OBJECTIVES: Radiologists are responsible for interpreting ultrasound (US) images accurately, troubleshooting, aiding sonographers, and advancing technology and research. Despite this, most radiology residents do not feel confident performing US independently. The purpose of this study is to evaluate the impact of an abdominal US scanning rotation and digital curriculum on radiology residents' confidence and skills in performing US. MATERIALS AND METHODS: All residents who were rotating in pediatric US at our institution for the first time were included (PGY 3-5). Those who agreed to participate were recruited sequentially from July 2018 to 2021 into (A) control and (B) intervention. B had a 1-week US scanning rotation and US digital course. Both groups completed a pre-and post-confidence self-assessment. Pre-and post-skills were objectively assessed by an expert technologist while participants scanned a volunteer. At completion, B completed an evaluation of the tutorial. Descriptive statistics summarized the demographics and closed questions. Pre-and post-test results were compared using paired-T tests, and effect size (ES) with Cohen's d. Open-ended questions were thematically analyzed. RESULTS: PGY-3 and 4 residents participated, and were enrolled in A (N = 39) and B (N = 30). Scanning confidence significantly improved in both groups, with a greater ES in B (p < 0.01). Scanning skills significantly improved in B (p < 0.01) but not A. Eighty per cent of questionnaire responders used the integrative US tutorial and found it helpful. Free text responses were grouped into themes: 1) Technical issues, 2) Didn't complete course, 3) Didn't understand project, 4) Course was detailed and thorough. CONCLUSIONS: Our scanning curriculum improved residents' confidence and skills in pediatric US and may encourage consistency in training, thus promoting stewardship of high-quality US.

Artificial Intelligence Curriculum Needs Assessment for a Pediatric Radiology Fellowship Program: What, How, and Why?

RATIONALE AND OBJECTIVES: Artificial intelligence (AI) holds enormous potential for improvements in patient care, efficiency, and innovation in pediatric radiology practice. Although there is a pressing need for a radiology-specific training curriculum and formalized AI teaching, few resources are available. The purpose of our study was to perform a needs assessment for the development of an AI curriculum during pediatric radiology training and continuing education. MATERIALS AND METHODS: A focus group study using a semistructured moderator-guided interview was conducted with radiology trainees' and attending radiologists' perceptions of AI, perceived competence in interpretation of AI literature, and perceived expectations from radiology AI educational programs. The focus group was audio-recorded, transcribed, and thematic analysis was performed. RESULTS: The focus group was held virtually with seven participants. The following themes we identified: (1) AI knowledge, (2) previous training, (3) learning preferences, (4) AI expectations, and (5) AI concerns. The participants had no previous formal training in AI and variability in perceived needs and interests. Most preferred a case-based approach to teaching AI. They expressed incomplete understanding of AI hindered its clinical applicability and reiterated a need for improved training in the interpretation and application of AI literature in their practice. CONCLUSION: We found heterogeneity in perspectives about AI; thus, a curriculum must account for the wide range of these interests and needs. Teaching the interpretation of AI research methods, literature critique, and quality control through implementation of specific scenarios could engage a variety of trainees from different backgrounds and interest levels while ensuring a baseline level of competency in AI.

Imaging of pediatric extragonadal pelvic soft tissue tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper.

The most common pediatric extragonadal pelvic cancers include germ cell tumors, sacrococcygeal teratomas, and rhabdomyosarcomas (arising from the urinary bladder, prostate, paratesticular tissues, vagina, uterus, and perineum). This paper describes the radiological and nuclear medicine features of these entities and provides consensus-based recommendations for the assessment at diagnosis, during, and after treatment.

The impacts of the COVID-19 shock on sustainability and farmer livelihoods in Sri Lanka.

The COVID-19 pandemic and its handling in Sri Lanka has affected vegetable farmers in numerous ways and these impacts will constrain the country's move towards sustainable development. A field level study with vegetable farmers and key informants was carried out using exploratory research to understand, describe and analyze the impact of COVID-19 on the livelihoods of vegetable farmers and its relevance in achieving SDG 1. Data were supplemented by an extensive literature review. The analysis showed that the pandemic's impact on vegetable farmers in Sri Lanka is multidimensional and will increase vulnerability among vegetable farmers, for the long run. Adapting alternative inputs and marketing strategies, provision of immediate financial support, promoting innovative technology and service provision, and implementing intervention strategies tailored to farmer heterogeneity will improve farmer livelihoods and the prosperity of the sector.

Communication - a lost art?

The field of radiology has benefited greatly from the technological boom that has brought greater precision, efficiency and utilization amid an exponential growth in medical science. The downside is that the same technology that has allowed the field to grow is contributing to an erosion of interpersonal communication and connection with patients and referring physicians. Remote reading has displaced us from the communal reading room, where much interaction and teaching used to take place. The "invisible" radiologist must transcend these barriers in order to preserve and strengthen the role of radiology in medical care. With modest adaptation, radiologists can regain their identity as consultants, where they have the greatest chance to show their value and thwart the drive toward commoditization.

Elevating Radiology Education Research Through a Dedicated Research Fellowship: Adding Professional Identity as Essential for Success.

RATIONALE AND OBJECTIVES: Education research has been undervalued in radiology, with few radiology journals having dedicated space for such research and barriers to production including dedicated time, resources, grant funding, and mentorship. As radiologists, we have an opportunity to study education in our unique learning environments and create more effective ways to teach that are grounded in established education theory, solid assessment methodologies, and a focus on merit as well as worth. MATERIALS AND METHODS: The growth of education research in our field requires a two-pronged approach; We must cultivate leaders in education research from within our specialty, and continue to submit high quality work to radiology journals to increase exposure of the reviewers and readership to education methodologies. RESULTS: We have created the first radiology education research fellowship to this end. This manuscript details the fellowship creation process, the first education research fellow experience, and in-depth analysis of the inaugural year via a qualitative program review. CONCLUSION: We were successful in supporting an inaugural fellow in attaining the knowledge and skills to become a productive education researcher. Beyond this, the fellowship experience was a catalyst in developing her unique professional identity as an education master which will further raise the status of education research in pediatric radiology.

Building a biofoundry.

A biofoundry provides automation and analytics infrastructure to support the engineering of biological systems. It allows scientists to perform synthetic biology and aligned experimentation on a high-throughput scale, massively increasing the solution space that can be examined for any given problem or question. However, establishing a biofoundry is a challenging undertaking, with numerous technical and operational considerations that must be addressed. Using collated learnings, here we outline several considerations that should be addressed prior to and during establishment. These include drivers for establishment, institutional models, funding and revenue models, personnel, hardware and software, data management, interoperability, client engagement and biosecurity issues. The high cost of establishment and operation means that developing a long-term business model for biofoundry sustainability in the context of funding frameworks, actual and potential client base, and costing structure is critical. Moreover, since biofoundries are leading a conceptual shift in experimental design for bioengineering, sustained outreach and engagement with the research community are needed to grow the client base. Recognition of the significant, long-term financial investment required and an understanding of the complexities of operationalization is critical for a sustainable biofoundry venture. To ensure state-of-the-art technology is integrated into planning, extensive engagement with existing facilities and community groups, such as the Global Biofoundries Alliance, is recommended.

Pediatric magnetic resonance imaging training versus job-readiness: using education research tools to re-align.

BACKGROUND: Fellows begin MRI training with variable experience and expertise. To better serve patients, pediatric radiology fellows should gain competence in MRI that enables seamless transition to independent practice. OBJECTIVE: We implemented a needs assessment survey and conducted a focus group discussion to identify knowledge gaps and inform creation of a curriculum for pediatric body MRI. MATERIALS AND METHODS: We electronically distributed a comprehensive anonymous needs assessment survey in October 2016 to current fellows and recent (<5 years) graduates from Accreditation Council for Graduate Medical Education (ACGME)-accredited pediatric radiology fellowships, with follow-up in January 2017. We conducted a focus group discussion among current fellows at our institution in October 2017 to inform a better understanding of the results. RESULTS: Eighty-one pediatric radiologists (8 fellows/73 attendings) completed the survey (24%); 5 current fellows participated in the focus group. The technical issues most commonly identified with limited or no instruction during training included setting up an MR service, accessory equipment (coil) selection and MRI field inhomogeneity correction. Areas needing increased attention and inclusion within the curriculum included coil choice/patient positioning (n=42, 52%), contrast agents (n=40, 49%), field strength (n=33, 41%) and strategies for motion correction (n=33, 41%). Most fellows were uncomfortable with setting up an MR service (n=57, 70%), correcting field inhomogeneity (n=56, 69%) and improving image quality (n=50, 62%). The focus group showed consensus that there was insufficient MR training in residency to prepare them for fellowship. The group also preferred shorter lectures and streaming via video education/tutorials. CONCLUSION: While traditional instruction emphasizes image interpretation, trainees in pediatric radiology need a curriculum that also emphasizes technical and non-interpretive aspects of MRI.

RADIAL: leveraging a learning management system to support radiology education.

Increasing volume and complexity of cases in academic radiology and the drive toward pediatric sub-specialization have threatened knowledge assimilation for radiologists. There is a clear need for a system that retrieves vetted information from the excess available on the internet. Partnered with an interdisciplinary team from the Graduate School of Education, the authors created the first comprehensive learning management system (LMS) for radiology, implemented in the reading room to augment image interpretation and point-of-care education. The LMS supports quantitative analysis using a robust analytics platform to evaluate user statistics, facilitating improved quality of patient care by revolutionizing the way radiologists assimilate knowledge. This integration promises to enhance workflow and point-of-care teaching and to support the highest quality of care.

Job-Readiness After Pediatric Neuroradiology Training: Defining Trainee Needs.

RATIONALE AND OBJECTIVES: To describe and analyze the pediatric neuroradiology implicit curriculum for general-pediatric and neuro-pediatric radiology fellowship training in order to define specific trainee needs and inform an explicit pediatric neuroradiology curriculum. MATERIALS AND METHODS: A focus group of pediatric radiologists, pediatric neuroradiologists and fellows was conducted to create a needs assessment questionnaire that focused on training experience, current job, and a list of essential competency items. The questionnaire was distributed to 175 members of the Society for Pediatric Radiology. Data were derived from categorical and continuous survey variables. Using an inductive approach, we analyzed and systematically inspected the data to derive themes regarding trainee needs and how they might inform an explicit curriculum. RESULTS: Fifty-seven pediatric radiologists (response rate of 33%) responded to the survey. Sixty-three percent of respondents were fellowship trained in general pediatric radiology, 21% in pediatric neuroradiology, and 16% in both. In their current jobs, 75% of respondents were responsible for interpreting some pediatric neuroradiology. 50% or greater reported limited or no fellowship instruction in five areas of imaging interpretation: fetal neuroimaging; ear and/or nose and/or throat imaging; head and neck imaging; neuroembryology; neuro-spectroscopy and four areas of technical skills and/or image quality: reducing imaging time; choice of contrast agents; sedation; understanding clinical management pathways. CONCLUSION: Trainees endorse inadequate training in certain aspects of imaging interpretation and technical skills which are known to remain a significant and vital aspect of pediatric neuroradiology practice, revealing an opportunity to emphasize these aspects in an explicit curriculum and dedicate educational resources towards this cause.

MRI for Response Assessment of Extensive Lymphatic Malformations in Children Treated With Sirolimus.

BACKGROUND. Extensive lymphatic malformations (LMs) may cause substantial morbidity. The mammalian target of rapamycin (mTOR) inhibitor sirolimus shows promise for treating vascular anomalies, although response assessment is not standardized. OBJECTIVE. The purpose of this study was to retrospectively characterize changes seen on MRI of children with extensive LMs treated with sirolimus. METHODS. Twenty-five children treated with sirolimus for extensive LMs were included. Baseline MRI was defined as the MRI examination performed closest to therapy initiation; follow-up MRI was defined as the most recent MRI examination performed while the patient was receiving therapy. Two pediatric radiologists independently determined MRI lesion volume by tracing lesion contours on all slices (normalized to patient body surface area expressed in square meters) and determined signal by placing an ROI on the dominant portion of the lesions (normalized to CSF signal) on baseline and follow-up T2-weighted MRI sequences. Interreader agreement was determined, and values were averaged for further analysis. Volume and signal changes were compared with patient, lesion, and treatment characteristics. RESULTS. The mean (± SD) interval between initiation of sirolimus treatment and follow-up MRI was 22.1 ± 13.8 months. The mean lesion volume index on baseline and follow-up MRI was 728 ± 970 and 345 ± 501 mL/m2, respectively (p < .001). Ninety-two percent of children showed a decrease in lesion volume index that was greater than 10% (mean volume change, -46.4% ± 28.2%). Volume change was inversely correlated with age (r = -0.466; p = .02). The mean volume change was -64.7% ± 25.4% in children younger than 2 years old versus -32.0% ± 21.6% in children 2 years old or older (p = .008). The mean volume change was -58.1% ± 24.0% for craniocervical lesions versus -35.5% ± 28.2% for lesions involving the trunk and/or extremities (p = .03). Mean lesion signal ratio on baseline and follow-up MRI was 0.81 ± 0.29 and 0.59 ± 0.26, respectively (p < .001). Mean signal ratio change was -23.8% ± 22.7%. Volume and signal changes were moderately correlated (r = 0.469; p = .02). Volume and signal changes were not associated with sex, lesion subtype, serum concentration of sirolimus, or the interval between sirolimus initiation and follow-up MRI (p > .05). Interreader agreement for volume index change was excellent (intraclass correlation coefficient, 0.983), and that for signal ratio change was moderate to good (intraclass correlation coefficient, 0.764). CONCLUSION. Sirolimus treatment of extensive LMs in children is associated with significant reductions in volume and signal on T2-weighted MRI. The decrease in volume is greater in younger children and craniocervical lesions. CLINICAL IMPACT. The results may facilitate development of standardized MRI-based criteria for assessing the response of vascular malformations to pharmacotherapy.

Preserving the value of legacy film-based teaching files in pediatric radiology.

Senior pediatric radiologists who have spent a major portion of their careers interpreting conventional film-screen radiographic studies have collected a wealth of hard-copy teaching material that is at risk of becoming obsolete. The teaching value and usefulness of analog film teaching files can be preserved using available hardware and standard software. The final product can be made available in a high-quality digital format to students, trainees and faculty without complicated search-and-retrieval methodology. This paper describes a relatively simple and low-cost procedure to preserve and use this source of wisdom and experience. It also emphasizes the role that such a resource can play as part of a comprehensive educational program.