Comparison of High-Fidelity Simulation Versus Didactic Instruction as a Reinforcement Intervention in a Comprehensive Curriculum for Radiology Trainees in Learning Contrast Reaction Management: Does It Matter How We Refresh?

RATIONALE AND OBJECTIVES: Simulation-based training has been shown to be a useful adjunct to standard didactic lecture in teaching residents appropriate management of adverse contrast reactions. In addition, it has been suggested that a biannual refresher is needed; however, the type of refresher education has not been assessed. MATERIALS AND METHODS: This was a prospective study involving 31 radiology residents across all years in a university program. All residents underwent standard didactic lecture followed by high-fidelity simulation-based training. At approximately 6 months, residents were randomized into a didactic versus simulation group for a refresher. At approximately 9 months, all residents returned to the simulation center for performance testing. Knowledge and confidence assessments were obtained from all participants before and after each phase. Performance testing was obtained at each simulation session and scored based on predefined critical actions. RESULTS: There was significant improvement in knowledge (P < .002) and confidence (P < .001) after baseline education of combined didactic and simulation-based training. There was no statistical difference between the simulation and didactic groups in knowledge or confidence at any phase of the study. There was no significant difference in tested performance between the groups in either performance testing session. CONCLUSIONS: This study suggests that a curriculum consisting of an annual didactic lecture combined with simulation-based training followed by a didactic refresher at 6 months is an effective and efficient (both cost-effective and time-effective) method of educating radiology residents in the management of adverse contrast reactions.

ACR appropriateness criteria on obstructive voiding symptoms secondary to prostate disease.

Obstructive voiding symptoms are most commonly due to prostatic hyperplasia, but other causes include bladder neck contractures, prostatic carcinomas, neurogenic bladder, and urethral stricture. Symptoms include hesitancy, dribbling, decreased force of stream, and postvoid fullness. Imaging is useful in evaluating the presence and degree of hydronephrosis, estimation of renal function, evaluation of the bladder and prostate, and detection of incidental upper tract malignancies or stones. Various modalities have been used for evaluation of the cause of obstruction. Literature on the indications and usefulness of these radiologic studies for obstructive voiding symptoms in different clinical settings is reviewed.

Incidental pulmonary embolism identified on chest CT during initial trauma evaluation.

Deep venous thrombosis and pulmonary embolism frequently occur after trauma and continue to account for significant morbidity and mortality in this population. Asymptomatic pulmonary emboli are also believed to be quite common, but the incidence as well as the implications of these events is unknown. This case report describes two patients whose pulmonary emboli were found incidentally on the initial trauma workup. Very little has been written concerning this issue and in this case report we review the risk factors and clinical significance of these "incidentally discovered" pulmonary emboli.

Locally advanced leiomyosarcoma of the urinary bladder: near-complete pathologic response to neoadjuvant gemcitabine and docetaxel.

Leiomyosarcoma of the urinary bladder is a rare mesenchymal tumor with distinct pathologic features. Although radical cystectomy is the standard therapy for locally invasive disease, available literature appears to support the benefit of perioperative chemotherapy, similar to that seen with the more conventional urothelial malignancies. We report on a 77-year-old gentleman with locally advanced leiomyosarcoma of the bladder achieving a near-complete pathologic response to neoadjuvant chemotherapy with a unique regimen: gemcitabine and docetaxel. Further study of this anthracycline-sparing regimen is warranted.

Multiple/bilateral renal tumors in patients with Birt-Hogg-Dubé syndrome.

OBJECTIVE: To describe our findings in four patients with multiple/bilateral renal cell carcinoma (RCC) and Birt-Hogg-Dubé (BHD) syndrome. PATIENTS AND METHODS: A series of four patients with BHD syndrome and RCC is analyzed. Patient charts were reviewed for age, sex, presentation, various clinical manifestations, imaging, management and outcome. RESULTS: Patients included 2 males and 2 females. Age ranged from 40 to 65 years (mean 56 years). The interval between the diagnosis of skin lesions characteristic of the disease and the development of renal tumors ranged between 1 and 35 years. Three of the patients had bilateral renal tumors (2 synchronous and one metachronous), one patient had multiple renal tumors in one kidney. In one patient the renal mass was diagnosed with a screening CT scan of the abdomen after the diagnosis of BHD syndrome. One patient had associated spontaneous pneumothorax and thyroid tumor. Only one of the 4 patients had prior family history of BHD syndrome. Renal tumors were clear cell type in 3 patients, and chromophobe tumor in one. Tumor size ranged from 2 to 9 cm. CONCLUSION: BHD syndrome is associated with multiple diseases and tumors. We describe four patients with BHD syndrome with multiple or bilateral RCC. Two of the patients were asymptomatic. A high index of suspicion should be present in patients who present with the characteristic skin lesions of BHD syndrome and screening for the presence of renal tumors should be done in those patients. Long term follow up is necessary after treating renal tumors in these patients.

Isolated late recurrence of renal cell carcinoma in the inferior vena cava.

The occurrence of an isolated late recurrence of renal cell carcinoma within the inferior vena cava (IVC) is a rare event. We present a case of a 55-year-old patient with recurrence in the IVC more than 3 years following her initial nephrectomy. The asymptomatic presentation of this patient with recurrent disease emphasizes the importance of close, long-term surveillance.