The Radiology Resident as Teaching Consultant: An Innovative Peer-to-Peer Teaching Consultation Service to Strengthen Relationships With Referring Colleagues in the Era of Imaging 3.0.

BACKGROUND: The American College of Radiology Imaging 3.0 paradigm emphasizes the need for radiologists to serve as imaging consultants to their referring colleagues. However, outside the reading room, teaching interactions between radiology and nonradiology residents are limited. Internal Medicine Morning Report (IMMR) is a resident-run educational program widely employed by internal medicine (IM) residencies. Although medical imaging is regularly discussed in IMMR, radiology residents are not typically involved in case preparation. We aimed to develop a peer-to-peer imaging teaching consultation service (TCS) incorporated into the well-established structure of IMMR. By creating illustrative, "dynamic" teaching slides for use at these conferences, we sought to provide salient radiology teaching material, demystify jargon, discuss appropriate imaging use, and review relevant anatomy. We hypothesized that TCS could improve the quality of IMMR as perceived by the IM presenter. METHODS: TCS was piloted over a 7-month period. Each referred case was reviewed by a senior radiology resident who produced a set of "dynamic" teaching slides for each case. These included patient imaging overlayed with extensive annotations and animations highlighting teaching points, with particular attention to radiologic terminology. Slides were shared with the IM presenter, who could use them for preparation and include the animations in the talk if desired. TCS effectiveness was evaluated with a survey distributed to participating IM residents. RESULTS: In the pilot period, 12 TCS requests were received and 10 were performed in collaboration with 6 IM residents. Survey results indicated that most IM residents did not consult radiologists prior to TCS (5/6, 83%). IM residents used the "dynamic" teaching slides to both prepare for and present at IMMR (5/6, 83%). TCS improved IM residents' perceived ability to engage their audience (6/6, 100%), confidence in teaching radiology material (4/6, 67%), ability to understand radiology reports (4/6, 67%) and appreciation for what radiologists do (6/6, 100%). CONCLUSIONS: The TCS pilot resulted in successful radiology-IM collaboration and improved knowledge and confidence in teaching imaging concepts. Continuous program evaluation will be performed and future work will assess the effect of TCS on radiologist confidence in real-world clinical consultations.

Preparing Radiologists to Lead in the Era of Artificial Intelligence: Designing and Implementing a Focused Data Science Pathway for Senior Radiology Residents.

Artificial intelligence and machine learning (AI-ML) have taken center stage in medical imaging. To develop as leaders in AI-ML, radiology residents may seek a formative data science experience. The authors piloted an elective Data Science Pathway (DSP) for 4th-year residents at the authors' institution in collaboration with the MGH & BWH Center for Clinical Data Science (CCDS). The goal of the DSP was to provide an introduction to AI-ML through a flexible schedule of educational, experiential, and research activities. The study describes the initial experience with the DSP tailored to the AI-ML interests of three senior radiology residents. The authors also discuss logistics and curricular design with common core elements and shared mentorship. Residents were provided dedicated, full-time immersion into the CCDS work environment. In the initial DSP pilot, residents were successfully integrated into AI-ML projects at CCDS. Residents were exposed to all aspects of AI-ML application development, including data curation, model design, quality control, and clinical testing. Core concepts in AI-ML were taught through didactic sessions and daily collaboration with data scientists and other staff. Work during the pilot period led to 12 accepted abstracts for presentation at national meetings. The DSP is a feasible, well-rounded introductory experience in AI-ML for senior radiology residents. Residents contributed to model and tool development at multiple stages and were academically productive. Feedback from the pilot resulted in establishment of a formal AI-ML curriculum for future residents. The described logistical, planning, and curricular considerations provide a framework for DSP implementation at other institutions. Supplemental material is available for this article. © RSNA, 2020.

Dual energy CT for evaluation of polycystic kidneys: a multi reader study of interpretation time and diagnostic confidence.

PURPOSE: To compare dual-energy CT (DECT) iodine overlay images with renal mass protocol CT in the evaluation of polycystic kidneys with respect to reading time, diagnostic confidence, and detection of renal lesions that are not definitively benign. METHODS: Following IRB approval, portal venous phase dual-source DECT scans performed between September 2013 and February 2016 from 55 patients (mean age 67 ± 15 years, 31 male, 24 female) with polycystic kidneys (4 or more cysts) were included. For each patient, two image sets were created: (1) DECT post-processed iodine overlay images and (2) simulated renal mass protocol CT images (virtual noncontrast and mixed images). Two radiologists independently retrospectively reviewed both sets at separate time points, evaluating for the presence of lesions that were not definitively benign (enhancing lesions or Bosniak IIF cysts), as well as reading times and Likert scale diagnostic confidence ratings (scaled 1-5) for the presence of non-benign lesions. Reading times were compared with a t test, diagnostic confidence with a McNemar test, and lesion number detection with Cohen's kappa test. RESULTS: Iodine overlay images were read faster (mean 55 ± 26 s) than renal mass protocol (mean 105 ± 51 s) (p < 0.001). Readers assigned the highest diagnostic confidence rating in 64% using iodine overlay series, compared to 17% using renal mass protocol (p < 0.0001). The proportion of patients with recorded lesions was not significantly different between methods (p = 0.62). CONCLUSIONS: DECT improves lesion assessment in polycystic kidneys by decreasing reading times and increasing diagnostic confidence, without affecting lesion detection rates.

Acute Nonhemorrhagic Adrenal Infarction in Pregnancy: 10-Year MRI Incidence and Patient Outcomes at a Single Institution.

OBJECTIVE: The purpose of this study was to retrospectively investigate the MRI incidence of nonhemorrhagic adrenal infarction in pregnant women undergoing MRI evaluation of acute abdominal or flank pain, assess the MRI features quantitatively, and report patient outcomes. MATERIALS AND METHODS: All abdominal MRI examinations of pregnant women with acute pain at one institution from May 2005 to April 2015 were reviewed. The adrenals were evaluated for abnormal morphologic and signal intensity characteristics described in the literature characterizing nonhemorrhagic adrenal infarction and were compared with the contralateral adrenal by paired t tests. The findings were correlated with clinical presentation. Patient demographics and outcomes were gathered from the medical record. RESULTS: Findings of nonhemorrhagic adrenal infarction were present in 5 of 379 (1.3%) examinations of four pregnant patients (mean age, 28 years; range, 20.8-33.9 years; mean gestational age, 26 weeks; range, 16-35 weeks). MRI features included lengthening (mean, 39.8 versus 21.2 mm) (p = 0.005) and increased T2 signal intensity (p = 0.001) of the infarcted adrenal with surrounding edema and without T1 signal intensity suggesting hemorrhage. No alternative diagnosis was identified. All patients presented with severe acute abdominal or flank pain on the same side as the MRI findings, tenderness to palpation, and mild leukocytosis. All women delivered healthy infants. CONCLUSION: Unilateral nonhemorrhagic adrenal infarction was identified in 1.3% of abdominal MRI examinations performed for pregnant women with acute abdominal or flank pain. Knowledge of the MRI characteristics of this entity is important for recognizing it and may prevent further potentially invasive tests, procedures, or missed diagnoses.