Subscription-based and open access dermatology journals: the publication model dilemma.

Medical journalism and the dissemination of peer-reviewed research serve to promote and protect the integrity of scholarship. We evaluated the publication models of dermatology journals to provide a snapshot of the current state of publishing. A total of 106 actively-publishing dermatology journals were identified using the SCImago Journal Rankings (SJR) citation database. Journals were classified by publication model (subscription-based and open-access), publishing company, publisher type (commercial, professional society, and university), MEDLINE-indexing status, and SJR indicator. Of these, 65 (61.32%) dermatology journals were subscription-based and 41 (38.68%) were open-access. In addition, 59 (55.66%) journals were indexed in MEDLINE and most were subscription-based (N=51) and published by commercial entities (N=54). MEDLINE-indexing status was significantly different across publisher types (P<0.001), access-types (P<0.001), and the top four publishers (P=0.016). Distribution of SJR indicator was significantly different across publisher types (P<0.001) and access-types (all journals, P=0.001; indexed journals only, P=0.046). More than 91% of MEDLINE-indexed titles were published by commercial entities, and among them, four companies controlled the vast majority. Discontinuation of access to any one of the top publishers in dermatology can significantly and disproportionately impact education and scholarship.

4D CT Parathyroid for the General Radiologist: A Pictorial Essay of Illustrative Cases.

Primary hyperparathyroidism is a morbid disease that affects multiple organ systems and causes a multitude of debilitating symptoms if not properly diagnosed and treated. Minimally invasive parathyroidectomy is now the standard of care for the treatment of primary hyperparathyroidism. In the hands of experienced high-volume surgeons, the success rate of this treatment is approximately 95%. Preoperative planning with 4-dimensional computed tomography (4DCT) is becoming increasingly common as a first line imaging modality. It is important for general radiologists to become familiar with this type of study in order to better assist their surgical colleagues. This image-rich review will discuss hyperparathyroidism, benefits, and weaknesses of different imaging modalities, 4DCT imaging protocol, relevant anatomy, expected appearance, and location of parathyroid adenomas, ectopic and atypical appearances, multigland disease and important mimics.

On-call radiology 2020: Where trainees look for help in a high stakes and time sensitive environment.

BACKGROUND: The radiology trainee on-call experience has undergone many changes in the past decade. The development of numerous online information sources has changed the landscape of opportunities for trainees seeking information while on-call. In this study, we sought to understand the current on-call information seeking behaviors of radiology trainees. METHODS: We surveyed radiology fellows and residents at three major metropolitan area academic institutions. Survey topics included demographic information, on-call volumes, on-call resource seeking behaviors, preferred first and second line on-call resources and rationale for particular resource usage. RESULTS: A total of 78 responses from trainees were recorded, 30.5% of the entire surveyed population. 70.5% of trainees preferred Radiopaedia as their first line resource. 26.9% of trainees preferred StatDx as their second line resource. 75.6% of respondents preferred their first line resource because it was easiest and fastest to access. 70.3% of respondents assigned a rating of 4 out of 5 when asked how often information they look for is found while on-call. There was a statistically significant difference according to gender (p = 0.002) with a higher percentage of males listing Radiopaedia as their first line resource compared to females. DISCUSSION: The radiology trainee on-call experience is influenced by various factors. Over the past decade, online resources, particularly the open access resource Radiopaedia and the paid service StatDx, have overwhelmingly become the preferred first and second line options, as demonstrated by our study results.

Business and publication models of radiology journals.

OBJECTIVE: Traditional and open-access publication models have been increasingly scrutinized, particularly in light of the recent impasse regarding cost and access between Elsevier and the University of California. Peer-reviewed publications are the main source through which science is disseminated, yet the industry remains an enigma to most. Our aim was to determine radiology publisher market-share, access type, geographic distribution and relative research impact in order to better understand the traditionally opaque realm of academic publishing. METHODS: During April 2020, Scopus was queried to extract all entries in the "Radiology, Nuclear Medicine and Imaging" subcategory of "Medicine." Journal name, publisher, SCImago Journal Ranking (SJR) score, country and publication model were cataloged. Publishers were grouped by their ownership type and journals were grouped by their publication model. Overall trends were assessed across publisher type, publication model, and geographic location. RESULTS: Commercial publishers are used by 82% (239 of 293) of radiology journals. Elsevier and Springer Nature together published 40% (118/293) of journal titles within the category. Approximately one fourth (77/293) of radiology journals were open-access. On average, SJRs were highest for journals published commercially. Mean SJR across the top 10 publishers and publication model were similar (p = 0.06 and p = 0.48, respectively). DISCUSSION: Radiology journal publication is heavily consolidated amongst a few global commercial organizations. Most radiology journals were subscription-based, but their impact did not differ significantly from open-access counterparts. Further disputes between universities and publishers could influence future manuscript submission, review, and citation, which has the potential to destabilize traditional publication models.

Canadian and American Emergency Radiology Fellowship Websites: An Evaluation of Content.

PURPOSE: The internet is commonly employed by Radiology trainees to investigate and learn about potential fellowship programs. As a new and emerging subspecialty, Emergency Radiology requires strong internet presence and training program website content. This is vital to ensure good exposure of the fellowship programs to inform medical students, radiology trainees, and program directors, highlight unique aspects of a fellowship and raise awareness of the discipline at large. METHODS: To assess the standard and depth of information available online, Canadian and American Radiology fellowship websites were evaluated for content. Thirty-six criteria related to application process and recruitment, departmental structure, incentives, education, and research and clinical training were evaluated for presence or absence. RESULTS: Sixteen Emergency Radiology fellowship program websites were assessed from the United States and Canada for 36 criteria across 5 individual areas; application process and recruitment, departmental structure, incentives, education and research, and clinical training. Overall there was an absence of information found across all 5 areas. In particular areas for improvement were identified in education and research, and incentives both with median values of 12.5% of criteria present. CONCLUSION: Most Emergency Radiology fellowship program websites demonstrate several information deficiencies. This relative lack of comprehensive information represents an actionable opportunity for individual programs and the field to better educate trainees, program directors and the public about the unique training of Emergency Radiologists.

Evaluation of Pediatric Radiology Fellowship Website Content in USA and Canada.

PURPOSE: Prospective radiology fellows often rely on the internet to obtain valuable information regarding the application process as well as the unique qualities and aspects of different fellowship programs. The aim of this study was to analyze the content of Accreditation Council for Graduate Medical Education (ACGME) Pediatric Radiology Fellowship websites within the USA and Canadian Accredited Pediatric Radiology Fellowship program websites. METHODS: All active ACGME Pediatric Radiology fellowship websites as of October 2018 were evaluated using 26 criteria in the following domains: application process, recruitment, program structure, education, research, clinical care, and incentives. Fellowships without websites were excluded from the study. Canadian programs were compiled from a list obtained as of October 2018 from the Canadian Association of Radiologists fellowship directory. Each fellowship program was evaluated using the same 26 criteria as the US programs. RESULTS: 45 active ACGME Pediatric Radiology fellowship programs and 9 Canadian programs were identified. 43 of the US fellowships (96%), and 8 of the Canadian fellowships (89%) had dedicated fellowship websites available for analysis. For US data, websites on average contained 8 out of the 26 data points (31%). Whereas, in Canada, websites on average contained 11 out of the 26 data points (41%). CONCLUSION: Most fellowship websites demonstrate several information deficiencies. This presents an actionable opportunity for individual programs to better inform trainees, promote Pediatric Radiology, and attract the highest quality applicants.

An Evaluation of the Content of Canadian and American Nuclear Medicine Fellowship Websites.

BACKGROUND: Radiology trainees frequently use the Internet to research potential fellowship programs across all subspecialties. For a field like nuclear medicine, which has multiple training pathways, program websites can be an essential resource for potential applicants. This study aimed to analyze the online content of Canadian and American Nuclear Medicine fellowship websites. MATERIALS AND METHODS: The content of all active Canadian and American Nuclear Medicine fellowship websites was evaluated using 26 criteria in the following subdivisions: application, recruitment, education, research, clinical work, and incentives. Fellowships without websites were excluded from the study. Scores were summed per program and compared by geographic region and ranking. RESULTS: A total of 42 active Canadian and American Nuclear Medicine fellowship programs were identified, of which 39 fellowships had dedicated fellowship websites available for the analysis. On average, fellowship websites contained 34.4% (9 ± 3.3) of the 26 criteria. Programs did not score differently on the criteria by geographical distribution (P = .08) nor by ranking (P = .18). CONCLUSION: Most Canadian and American Nuclear Medicine fellowship websites are lacking content relevant to prospective fellows. Addressing inadequacies in online content may support programs to inform and recruit residents into fellowship programs.

Evaluating Radiology Result Communication in the Emergency Department.

PURPOSE: To assess the pattern of result communication that occurs between radiologists and referring physicians in the emergency department setting. METHODS: An institutional review board-approved prospective study was performed at a large academic medical center with 24/7 emergency radiology cover. Emergency radiologists logged information regarding all result-reporting communication events that occurred over a 168-hour period. RESULTS: A total of 286 independent result communication events occurred during the study period, the vast majority of which occurred via telephone (232/286). Emergency radiologists spent 10% of their working time communicating results. Similar amounts of time were spent discussing negative and positive cross-sectional imaging examinations. In a small minority of communication events, additional information was gathered through communication that resulted in a change of interpretation from a normal to an abnormal study. CONCLUSIONS: Effective and efficient result communication is critical to care delivery in the emergency department setting. Discussion regarding abnormal cases, both in person and over the phone, is encouraged. However, in the emergency setting, time spent on routine direct communication of negative examination results in advance of the final report may lead to increased disruptions, longer turnaround times, and negatively impact patient care. In very few instances, does the additional information gained from the communication event result in a change of interpretation?

Learning from COVID-19: Sub-specialty radiologists should maintain general radiology skillset.

The recent COVID-19 pandemic has impacted every facet of life and placed a significant strain on healthcare resources worldwide. One of the emerging themes of medicine's response to the outbreak is doing more with less. In certain parts of the world, the toll on healthcare workers has been immense, and practicing outside one's traditional scope and comfort zone has become the rule rather than the exception. For Radiology as a discipline, the stress of COVID-19 may be comparatively small when measured against the frontline physicians and nurses in the Emergency Department and Intensive Care Unit. Still, it is incumbent upon all disciplines to learn and grow from the challenges encountered during this crisis.

Early-Career Radiologists' Perceptions of National Corporations in Radiology.

PURPOSE: Radiology, like many medical specialties, has experienced an increase in nationalized corporatization. The most vulnerable cohorts affected by this trend are early-career radiologists (ECRs), including trainees and recent graduates, particularly those entering or who have recently entered private practice. The aims of this study were to examine the awareness and perspectives of ECRs regarding this trend and to share salient examples of the impact of corporatization. METHODS: From February 20, 2019, through May 28, 2019, an online survey of the members of the ACR's Resident and Fellow Section and Young and Early Career Professional Section was conducted. Respondents were queried about their awareness of corporatization, their opinions of how it affects radiology, their preferred practice type, whether they know other ECRs affected by corporatization, and whether they worry about their practices or future practices being acquired. A free-response opportunity was also provided for respondents to share their relevant personal experiences. RESULTS: A total of 602 ECRs returned completed surveys. Of this total, 85% of respondents were aware of national corporatization, 86% believe that corporate entities harm radiology as a specialty, 83% prefer to join independent private practices with 79% wanting to be involved in leadership or business, and 72% worry about their practices or future practices being acquired by national entities. Twenty-five percent of respondents submitted unique free responses regarding their experiences with corporatization. CONCLUSIONS: The majority of ECRs surveyed have negative perceptions of corporatization in radiology, prefer to join independent practices, and worry about their practices selling to national corporations.

An Evaluation of the Content of Canadian Radiology Fellowship Websites.

PURPOSE: Prospective radiology fellows utilize the internet to apply for radiology fellowship programs. The aim of this study was to analyze the online content of Canadian radiology fellowship websites. METHODS: The content of all active Canadian radiology fellowship websites were evaluated using 30 criteria in the following domains: application, recruitment, education and research, clinical work and benefits. Fellowships without websites were excluded from the study. The prevalence of assessed elements was compared to geography and Canadian medical school ranking. RESULTS: We identified 107 active Canadian radiology fellowship programmes, of which 102 university fellowships (95.3%) had dedicated fellowship websites available for analysis. Of these 102 programs, the median score was 13/30 (43.0%). Websites of fellowship programs affiliated with top ranked medical schools contained more of the assessed criteria than middle and lower ranked schools (17.0 vs 13.0 vs 9.0, p < 0.0001)). Geographical difference was identified across Canada with Atlantic and Central Canada fellowship programs having significantly more criteria than Western programs (15.5 vs 16.0 vs 10.0, p < 0.001). CONCLUSIONS: Most Canadian radiology fellowship websites are devoid of content pertinent to prospective radiology fellows. Addressing deficiencies in online content may assist programs to inform and recruit residents into radiology fellowship programs.

How Radiologists Can Benefit From Direct Communication With Patients.

Effective communication is foundational to Radiology. Historically, radiologists have been considered "doctors' doctors," communicating primarily with referring physicians and other radiologists. Aside from interventional radiology and breast imaging, direct communication between radiologists and patients has typically been limited. In recent years, major radiology professional societies have launched initiatives aimed toward increasing direct radiologist and patient communication. These include the American College of Radiology's Imaging 3.0 and Radiological Society of North America's Radiology Cares initiatives. Prior work has highlighted potential patient benefits of increased communication by demonstrating patient preferences for speaking with imaging experts about the results of their imaging studies and introducing strategies to harness existing information technology resources to achieve this goal. In this review, we explore the unique benefits that radiologists can derive from communicating with patients in regular and meaningful ways.

24/7/365 Neuroradiologist Coverage Improves Resident Perception of Educational Experience, Referring Physician Satisfaction, and Turnaround Time.

PURPOSE: To quantitatively and qualitatively assess the impact of attending neuroradiology coverage on radiology resident perceptions of the on-call experience, referring physician satisfaction, and final report turnaround times. MATERIALS AND METHODS: 24/7/365 attending neuroradiologist coverage began in October 2016 at our institution. In March 2017, an online survey of referring physicians, (emergency medicine, neurosurgery, and stroke neurology) and radiology residents was administered at a large academic medical center. Referring physicians were queried regarding their perceptions of patient care, report accuracy, timeliness, and availability of attending radiologists before and after the implementation of overnight neuroradiology coverage. Radiology residents were asked about their level of independence, workload, and education while on-call. Turnaround time (TAT) was measured over a 5-month period before and after the implementation of overnight neuroradiology coverage. RESULTS: A total of 28 of 64 referring physicians surveyed responded, for a response rate of 67%. Specifically, 19 of 23 second (junior resident on-call) and third year radiology residents (senior resident on-call) replied, 4 of 4 stroke neurology fellows replied, 8 of 21 neurosurgery residents, and 16 of 39 emergency medicine residents replied. Ninety-five percent of radiology residents stated they had adequate independence on call, 100% felt they have enough faculty support while on call, and 84% reported that overnight attending coverage has improved the educational value of their on-call experience. Residents who were present both before and after the implementation of TAT metrics thought their education, and independence had been positively affected. After overnight neuroradiology coverage, 85% of emergency physicians perceived improved accuracy of reports, 69% noted improved timeliness, and 77% found that attending radiologists were more accessible for consultation. The surveyed stroke neurology fellows and neurosurgery residents reported positive perception of the TAT, report quality, and availability of accessibility of attending radiologist. CONCLUSIONS: In concordance with prior results, overnight attending coverage significantly reduced turnaround time. As expected, referring physicians report increased satisfaction with overnight attending coverage, particularly with respect to patient care and report accuracy. In contrast to some prior studies, radiology residents reported both improved educational value of the on-call shifts and preserved independence. This may be due to the tasking the overnight neuroradiology attending with dual goals of optimized TAT, and trainee growth. Unique implementation including subspecialty trained attendings may facilitate radiology resident independence and educational experience with improved finalized report turnaround.

White Paper: Corporatization in Radiology.

Consolidation in health care has been widely recognized as having significant impact in the United States. A related trend is the corporatization of medical professional practices by companies in capital markets. Several medical subspecialties have been identified as attractive corporatization candidates, including radiology. The purpose of the white paper is to present information about the trend of corporatization in radiology. The real, recognized, and potential influences of capital investors in radiology need to be acknowledged as evolving and important considerations. Many radiologists and practices have already realized significant change as a result of corporatization. Corporatization presents significant practical, financial, ethical, and moral implications for those in and related to radiology.

Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers.

PURPOSE: To investigate the pathological change of the glymphatic system in idiopathic normal pressure hydrocephalus (iNPH) using diffusion tensor imaging (DTI) analysis. MATERIALS AND METHODS: 24 right-handed patients were referred to our hydrocephalus clinic for assessment of ventriculomegaly and gait impairment. 12 of 24 were diagnosed as pseudo-iNPH (piNPH) based on assessment by a neurologist. Diffusivity maps in the direction of the x-axis (right-to-left) (Dx), y-axis (anterior-to-posterior) (Dy), and z-axis (inferior-to-superior) (Dz) were computed. The diffusion map was coregistered to International Consortium for Brain Mapping (ICBM) DTI-81 atlas. The analysis along the perivascular space (ALPS) index was defined as mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where Dxpro and Dxasc are Dx values in the projection and association fiber areas, respectively. Evans index and callosal angle were also assessed on each case. RESULTS: ALPS indexes of the control, piNPH, and iNPH cases were 1.18 ± 0.08, 1.08 ± 0.03, and 0.94 ± 0.06, respectively, and there were significant differences among the groups (control vs. piNPH, P = 0.003; control vs. iNPH P < 0.001; piNPH vs. iNPH, P < 0.001). Area under curve (AUC) was 0.92, 1.00, and 1.00 on control vs. piNPH, control vs. iNPH, and piNPH vs. iNPH on ROC analysis. Between piNPH and NPH, ALPS index has higher diagnostic performance than Evans index and callosal angle (AUC = 1.00 vs. 0.84, P = 0.028; AUC = 1.00 vs. 0.74, P = 0.016). CONCLUSION: Atlas-based ALPS index using the DTI method differentiated among iNPH, piNPH, and controls clearly.

Novel Geographic Thematic Study of the Largest Radiology Societies Globally: How Is Gender Structure Biased Within Editorial Boards?

OBJECTIVE. Radiology has traditionally been a male-dominated medical specialty, and this is also reflected in the authorship of radiology publications and the composition of radiology journal editorial boards. The purpose of this study was to quantify the extent of the gender disparities reflected within the journal editorial boards of the largest international radiologic societies. MATERIALS AND METHODS. Methods were crafted to generate a geographically based gender analysis of the editorial boards of the largest general radiologic societies globally. All editorial board members of journals that were published by societies included in the study and that had an impact factor of 1 or greater were assessed to determine the gender composition of the board and the research productivity and career advancement of its members. Analyzed metrics included gender, academic rank, departmental leadership positions, subspecialty, total number of peer-reviewed publications, total number of citations, the h-index, and total number of years of active research. RESULTS. Significant gender disparity was noted across the six journal editorial boards included. Overall, 80.87% of editorial board members were men and 19.13% were women. Men were more prevalent than women across all academic ranks. Male editorial board members had longer publishing careers (22.5 vs 18 years; p = 0.015), a higher total number of publications (110 vs 65 publications; p < 0.001), and a higher h-index (25 vs 19; p < 0.001) than their female counterparts. Female editorial board members at higher academic ranks were less represented on editorial boards and were also less likely to have formal departmental leadership titles. CONCLUSION. Editorial boards have significant gender disparities, with no specific geographic regional variation noted. Male editorial board members published more, had higher h-indexes, and held more departmental leadership positions than their female counterparts.

Trainee Knowledge of Imaging Appropriateness and Safety: Results of a Series of Surveys From a Large Academic Medical Center.

OBJECTIVE: In order to provide high quality care to their patients and utilize imaging most judiciously, physician trainees should possess a working knowledge of appropriate use, radiation dose, and safety. Prior work has suggested knowledge gaps in similar areas. We aimed to evaluate the knowledge of imaging appropriateness, radiation dose, and MRI and contrast safety of physician trainees across a variety of specialties. METHODS: Between May 2016 and January 2017, three online surveys were distributed to all interns, residents, and fellows in ACGME accredited training programs at a large academic institution over two academic years. RESULTS: Response rates to three surveys ranged from 17.2% (218 of 1266) for MRI and contrast material safety, 19.1% (242 of 1266) for imaging appropriateness, to19.9% (246 of 1238) for radiation dose. Overall 72% (509 of 706) of survey respondents reported regularly ordering diagnostic imaging examinations, but fewer than half (47.8%; 470 of 984) could correctly estimate radiation dose across four commonly performed imaging studies. Only one third (34%; 167 of 488) of trainees chose appropriate imaging in scenarios involving pregnant patients. Trainee post-graduate year was not significantly correlated with overall radiation safety scores, and no significant difference was found between radiation safety or appropriate imaging scores of those who participated in a medical school radiology elective vs. those who did not. A total of 84% (57 of 68) of radiology trainees and 43% (269 of 630) of non-radiology trainees considered their knowledge adequate but that correlated only weakly correlated to actual knowledge scores (p<0.001). Most trainees (73%, 518 of 706) agreed that more training in these areas would have beneficial effects on patient care. CONCLUSIONS: Knowledge gaps pertaining to appropriateness and imaging safety exist among many trainees. In order to enhance the value of imaging at the population level, further work is needed to assess the most appropriate method and stage of training to address these knowledge gaps.

Reshaping Radiology Precall Preparation: Integrating a Cloud-Based PACS Viewer Into a Flipped Classroom Model.

Preparing residents for the on-call experience in Radiology is one of the most important aspects of education within a training program. Traditionally, this preparation has occurred via a combination of case conferences and didactic lectures by program faculty, daily teaching at the workstation, and precall assessments. Recently, a blended curricular model referred to as the flipped classroom has generated a lot of attention within the realm of graduate medical education. We applied this technique to resident precall education in the subspecialty of Neuroradiology, and surveyed the participants about their perceptions of the course. The structure, implementation, and web-based platform used to create the flipped classroom experience is described herein.

Strategies for Patient-Centered Communication in the Digital Age.

Recently, the major professional societies in Radiology have embarked upon a campaign to increase the patient-centeredness of Radiology. At the foundation of this initiative is direct communication between radiologist and patient, an area that has long been a deficiency for the field. Historically, there have been a number of barriers to effective radiologist-patient communication including logistical challenges, a negative impact on efficiency, and uncertainty of the role of the radiologist in discussing results with patients. The ubiquity of the internet and the wealth of applications that allow the safe transmission of robust information provide a number of opportunities for the radiologist. The purpose of this article is to review key web-based platforms that can improve communication, highlight unique initiatives being employed by thought leaders, and emphasize why radiologist-patient communication is paramount to the patient centered imaging experience.