Distinguishing Osteomyelitis From Ewing Sarcoma on Radiography and MRI.

OBJECTIVE: The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases. MATERIALS AND METHODS: Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical examination findings, laboratory findings, biopsy type, and biopsy results were recorded. Individual imaging and clinical parameters and combinations of these parameters were tested for correlation with findings from histologic analysis. The diagnostic accuracy of biopsy was also determined. RESULTS: On radiography, the presence of joint or metaphyseal involvement, a wide transition zone, a Codman triangle, a periosteal reaction, or a soft-tissue mass, when tested individually, was more likely to be noted in subjects with EWS (p ≤ 0.05) than in subjects with osteomyelitis. On MRI, permeative cortical involvement and soft-tissue mass were more likely in subjects with EWS (p ≤ 0.02), whereas a serpiginous tract was more likely to be seen in subjects with osteomyelitis (p = 0.04). African Americans were more likely to have osteomyelitis than EWS (p = 0). According to the results of multiple regression analysis, only ethnicity and soft-tissue mass remained statistically significant (p ≤ 0.01). The findings from 100% of open biopsies (18/18) and 58% of percutaneous biopsies (7/12) resulted in the diagnosis of osteomyelitis, whereas the findings from 88% of open biopsies (22/25) and 50% of percutaneous biopsies (3/6) resulted in a diagnosis of EWS. CONCLUSION: Several imaging features are significantly associated with either EWS or osteomyelitis, but many features are associated with both diseases. Other than ethnicity, no clinical feature improved diagnostic accuracy. Compared with percutaneous biopsy, open biopsy provides a higher diagnostic yield but may be inconclusive, especially for cases of EWS. Our findings underscore the need for better methods of diagnosing these disease processes.

Competitiveness of the match for interventional radiology and neuroradiology fellowships.

PURPOSE: Overall resident interest in certain subspecialties changes with time. We sought to investigate the latest 6-year trend in interventional radiology (IR) and neuroradiology fellowship applications and how it has affected competitiveness in obtaining a position. METHODS: We analyzed statistics published by the National Resident Matching Program in Results and Data: Specialties Matching Service from 2008 to 2013. From these data, we calculated the positions per IR applicant (PPIRA) and positions per neuroradiology applicant (PPNRA) for each year. RESULTS: The number of positions per applicant is one way to assess specialty competitiveness on a supply-and-demand basis. A lower PPIRA or PPNRA indicates a more competitive year. PPIRA has decreased every year, from 1.71 to the present 0.84, and contributed to 52 applicants being unmatched in 2013, up from 9 in 2008. Accordingly, the number of unfilled positions has decreased from 86 in 2008 to 8 in 2013. PPNRA waxed and waned from 2008 to 2010 but stabilized at around 1.15 thereafter. The number of unfilled positions has never dropped below 46. The number of unmatched applicants was consistently in the teens, except in 2011, when it increased to 23. CONCLUSIONS: Interest in IR fellowship has increased significantly over the past 6 years, whereas interest in neuroradiology fellowships has plateaued. IR fellowships have become increasingly competitive, leading to many unmatched residents.

How competitive is the match for radiology residency? Present view and historical perspective.

PURPOSE: Interest in radiology as a career among US medical students has changed. The aim of this study was to investigate the recent and historical trends in residency applications and how they have affected competitiveness in obtaining a position. METHODS: Statistics published by the National Resident Matching Program in "Results and Data: Main Residency Match" for 1991 to 2013 were analyzed. RESULTS: The number of radiology residency positions has trended upward over the past 23 years; however, the number of applicants from US medical schools has been widely variable. The number of applicants peaked in 2009 but has since decreased every year. The number of positions per US senior applicant (PPUSA) is a judge of specialty competitiveness on a supply-and-demand basis. A lower PPUSA indicates a more competitive specialty. Radiology saw its most competitive year in 2001, with only 0.91 PPUSA. PPUSA has been on the rise every year since 2009. From 2009 to 2013, the number of residency positions increased by 56, but there were 241 fewer US senior medical students preferring radiology. In 2013, there were 1,143 residency positions available for only 845 US senior medical students who preferred the specialty. The PPUSA was 1.35, making 2013 the least competitive year in obtaining a radiology residency position since 1998. Over the past 23 years, 5.5% of all US senior medical students have applied to radiology for residency. Interest reached an all-time high in 2009, at almost 7%. In 2013, only 4.8% of all US seniors preferred radiology, the lowest since 1999. The historical (1991-2013), current (2011-2013), and most recent (2013) PPUSAs for radiology were 1.19, 1.29, and 1.35, respectively. For comparison, the current PPUSAs for the following specialties were: 0.74 for plastic surgery, 0.83 for orthopedic surgery, 0.95 for dermatology, 1.10 for general surgery, 1.24 for obstetrics and gynecology, 1.31 for anesthesiology, 1.42 for pediatrics, and 1.80 for internal medicine (1.80). CONCLUSIONS: Although radiology residency positions have continued to increase, interest among US seniors has dropped every year since 2009. The 2013 match was the least competitive since 1998. Over the past 3 years, the competitiveness of matching radiology on a supply-and-demand basis has been close to that of obstetrics and gynecology and anesthesiology.

The value of a medical student radiology triage program in enhancing clinical education and skills.

RATIONALE AND OBJECTIVES: The Medical Student Radiology Triage Program (MSRTP) at Dartmouth-Hitchcock Medical Center recruits third- and fourth-year medical students to streamline imaging workflow for on-call radiology residents. We sought to evaluate the benefit of this program for improving medical student education. MATERIALS AND METHODS: Members of the program were surveyed anonymously from 2010 to 2012 using a web-based survey. The survey asked the students to rate the program in several categories from 1 (very poor) to 5 (very good). Students also indicated if they are learning any of the identified skills. RESULTS: Thirty of 54 (56%) former and current members responded to the survey. Support from on-call residents (mean rating 4.7) and interactions with residents (mean rating 4.7) were rated the highest of the categories. Students ranked training provided (4.2), interactions with technologists (4.2), and interactions with clinicians (4.1) the lowest. The medical training experience and overall experience were graded with means of 4.4 and 4.5, respectively. Ninety-six percent of students felt they acquired triaging skills, whereas 92% of students developed communication skills. Sixty-nine and sixty-two percent of students stated that they gained radiologic knowledge and general medical knowledge, respectively. Sixty-five and fifty percent of students developed imaging appropriateness criteria and image interpretation skills, respectively. The most popular reason for joining the program was for financial compensation (number of students = 12), followed by exposure to radiology (n = 8), radiology education (n = 8), and clinical exposure (n = 7). Major strengths of the program included interactions with residents, learning experience, and triaging of workflow. Students listed the top two problems with the program as computed tomography technologists and clinicians not wanting to speak to them. CONCLUSIONS: The MSRTP serves as a valuable clinical learning experience as well as being highly beneficial to resident workflows on call. Participants of MSRTP gain clinical skills that they will use during residency.

Radiology ExamWeb: development and implementation of a national web-based examination system for medical students in radiology.

RATIONALE AND OBJECTIVES: Faculty are often limited in time, knowledge, and resources to develop efficient, effective, and valid computer-based examinations to evaluate students. Our purpose was to develop a web-based pool of standardized National Board of Medical Examiners (NBME)-format, peer-reviewed, and peer-tested questions based on the Alliance of Medical Student Educators in Radiology (AMSER) National Medical Student Curriculum to evaluate the radiologic knowledge of medical students. MATERIALS AND METHODS: Members of the AMSER Electronics Committee submitted questions they had written for their institutions and later developed a 113-question standardized examination. Questions were edited by 24 subspeciality editors and then further edited by the authors to NBME recommendations. Software was developed using commercially available software (www.ExamWeb.com) with extensive modifications and additions following initial deployment. Students take examinations online and receive their scores immediately. Items were validated by identifying those answered >30 times and analyzing the following: number of times deployed, number of times correctly answered, distractor-specific breakdown, difficulty level (P), and point biserial coefficient (rbi). RESULTS: Radiology ExamWeb (REW) is available online with 3500 registered students from 65 institutions and 1800 active questions. Instructors can create examinations or use "shared examinations" made by another instructor but enabled for other institutions to administer or modify. More than 300 shared examinations have been developed. The AMSER curriculum was converted into database format and crosschecked with question items to ensure that the question pool adequately covered the spectrum of the curriculum. An AMSER standardized examination has been developed and deployed within REW. CONCLUSIONS: REW has provided medical student educators with the means to evaluate students in a systematic way, using a nationally edited and regularly reviewed web-based process.