How and how well do pediatric radiology fellows learn ultrasound skills? A national survey.

BACKGROUND: Ultrasound (US) comprises a significant portion of pediatric imaging. Technical as well as interpretive skills in US imaging are consequently fundamental in training pediatric radiologists. Unfortunately, formalized technical education regarding US imaging in pediatric fellowships has lagged. OBJECTIVE: We surveyed pediatric fellows and program directors regarding US scanning education to improve this experience moving forward. MATERIALS AND METHODS: We conducted an online survey from February 2011 to March 2011 of all United States pediatric radiology body imaging fellows and fellowship program directors. Questions posed to fellows assessed their educational US experiences during their residencies and fellowships. Directors were asked to evaluate US educational opportunities in their programs. RESULTS: Among the respondents, 43.9% of fellows undertook on-call US scanning without a sonographer during residency, 23.3% during fellowship; 41.8% of fellows and 58.6% of program directors reported that their fellowship had a dedicated curriculum to facilitate independent US scanning. Both fellows and program directors cited the volume of cases requiring immediate dictation as an obstacle to scanning. Fewer program directors than fellows identified lack of sufficient staffing as an obstacle, but more identified fellow disinterest. Program directors and fellows alike rated independent US scanning as highly important to pediatric radiologists' future success. CONCLUSION: Pediatric radiology fellowship directors and fellows agree that technical US skills are crucial to the practice of pediatric radiology. However, the groups identify different obstacles to training. As US instruction is developing in undergraduate medicine and subspecialists are acquiring point-of-care US skills, pediatric radiology education should address the obstacles to US training and formalize a curriculum at the fellowship level.

Radiologic-pathologic correlation in acute appendicitis: can we use it as a quality measure to assess interpretive accuracy of radiologists?

Radiologic-pathologic correlation was evaluated as a quality assurance tool by documenting error rates of 18 radiologists interpreting computed tomographic (CT) scans for acute appendicitis in 763 patients. The departmental error rate was 3.1%. Meaningful individual error rates could be determined in only the seven radiologists who interpreted ≥30 CT scans for acute appendicitis. Radiologic-pathologic correlation is an effective departmental monitor of interpretive accuracy, but individual accuracy can be assessed only for radiologists reading a large number of cases with pathologic proof.

Low molecular weight heparin in the treatment of venous and arterial thromboses in the premature infant.

OBJECTIVE: Thrombosis in the preterm newborn is a growing problem, a result of improved survival of the smallest and sickest infants. Treatment with low molecular weight heparin (LMWH) has potential advantages, including predictable pharmacokinetics, subcutaneous administration, and minimal monitoring. However, studies with LMWH in term infants demonstrate the need for higher doses as compared with older children and adults. Physiologic differences suggest the need for gestational age-appropriate treatment strategies. Because of the relatively small numbers of infants affected each year, large-scale prospective studies have not been feasible. With the goal of establishing treatment guidelines within our own institution, we reviewed retrospectively our experience with LMWH for the treatment of thrombosis in the preterm infant. METHODS: Medical and pharmacy records of the intensive care nursery were used to identify preterm infants with venous and arterial thrombosis. Chart documentation, orders, pharmacy records, and radiologic studies were used to develop a retrospective database to assess efficacy and safety of the treatment. Main outcome measures were the dose of LMWH required for therapeutic levels, anti-factor Xa levels achieved, bleeding complications, resolution of thrombosis, additional thromboembolic events, and death from all causes. RESULTS: Ten preterm infants (mean gestational age: 26 weeks) who were treated with LMWH were identified. Mean patient weight at diagnosis of thrombosis was 1215 g (range: 565-1950 g). All 10 patients had either a current or recent history of a central venous or arterial catheter. Mean starting dose of enoxaparin was 1.25 mg/kg per 12 hours (range: 0.8-2 mg/kg). Therapeutic anti-factor Xa levels were achieved in only 5 patients. Mean time to therapeutic range was 33 days (range: 14-63 days). The mean dose of enoxaparin required to achieve therapeutic levels was 2.27 mg/kg per 12 hours (dose range: 2.0-3.5 mg/kg per 12 hours). Clot resolution was observed in all but 2 patients, both of whom died of complications of their thromboembolic events. No bleeding events that necessitated a change in treatment strategy occurred. CONCLUSIONS: Higher doses of LMWH are required in the preterm infant as compared with the healthy term neonate. Once therapeutic levels are achieved, continued regular monitoring and dose adjustments are required to maintain anticoagulation in therapeutic range.