Expanding our concept of simulation in radiology: a "Radiology Requesting" session for undergraduate medical students.

Objectives: Whilst radiology is central to the modern practice of medicine, graduating doctors often feel unprepared for radiology in practice. Traditional radiological education focuses on image interpretation. Key areas which are undertaught include communication skills relating to the radiology department. We sought to design teaching to fill this important gap. Methods: We developed a small group session using in situ simulation to enable final and penultimate year medical students to develop radiology-related communication and reasoning skills. Students were given realistic cases, and then challenged to gather further information and decide on appropriate radiology before having the opportunity to call a consultant radiologist on a hospital phone and simulate requesting the appropriate imaging with high fidelity. We evaluated the impact of the teaching through before-and-after Likert scales asking students about their confidence with various aspects of requesting imaging, and qualitatively through open-ended short answer questionnaires. Results: The session was delivered to 99 students over 24 sessions. Self-reported confidence in discussing imaging increased from an average of 1.7/5 to 3.4/5 as a result of the teaching (p < 0.001) and students perceived that they had developed key skills in identifying and communicating relevant information. Conclusions: The success of this innovative session suggests that it could form a key part of future undergraduate radiology education, and that the method could be applied in other areas to broaden the application of simulation. Advances in knowledge: This study highlights a gap in undergraduate medical education. It describes and demonstrates the effectiveness of an intervention to fill this gap.

Relationship between enlarged cardiac silhouette on chest X-ray and left ventricular size on transthoracic echocardiography.

The diagnostic accuracy of the cardiothoracic ratio on chest X-ray to detect left ventricular (LV) enlargement has not been well defined despite its traditional association with cardiomegaly. We aimed to determine whether the cardiothoracic ratio can accurately predict LV enlargement based on indexed linear measurements of the LV on transthoracic echocardiography (TTE). We included consecutive patients who had a TTE and a posteroanterior chest X-ray performed within 90 days of each other at a tertiary care center. LV size was determined by measuring the LV end-diastolic dimension (LVEDD) and LV end-diastolic dimension indexed (LVEDDI) to body surface area. The cardiothoracic ratio was calculated by dividing the maximum transverse diameter of the cardiac silhouette by the maximum transverse diameter of the right and left lung boundaries. 173 patients were included in the study (mean age 68 ± 15 years, 49.1% female). Mean cardiothoracic ratio was 0.56 ± 0.09, and the mean LVEDD and indexed LVEDDI were of 47 ± 8.6 mm and dimension of 27 ± 4.5 mm/m2 respectively. There was no significant correlation between the cardiothoracic ratio measured on chest X-ray and either the LVEDD or LVEDDI measured on TTE (r = 0.011, p = 0.879; r = 0.122, p = 0.111). The ability of the cardiothoracic ratio to predict LV enlargement (defined as LVEDDI > 30 mm/m2) was not statistically significant. The cardiothoracic ratio on chest X-ray is not a predictor of LV enlargement based on indexed linear measurements of the LV by TTE.

Multimodality imaging of a pulmonary artery sarcoma.

Pulmonary artery sarcoma is a rare malignant neoplasm. Here, we describe a patient with a pulmonary artery sarcoma, which was only subtly visible and therefore not fully appreciated on initial transthoracic echocardiogram. Characterization of the tumor was aided by the use of multimodality imaging that included computed tomography, magnetic resonance imaging, and positron emission tomography. Familiarity with its appearance on multiple imaging modalities including echocardiography is important to ensure timely diagnosis, although the optimal treatment strategy is still unknown, and the prognosis remains poor.

Rapidly growing cardiac mass: a rare case of left atrial intramural hematoma complicating coronary artery stenting.

Formation of an intramural left atrial hematoma (ILAH) is a rare complication of coronary artery stenting. Rapid diagnosis with noninvasive multimodality imaging can potentially be lifesaving. We report a case of ILAH that resulted in left ventricular inflow obstruction and pericardial tamponade in a 55-year-old male who presented with hemodynamic instability and worsening dyspnea three weeks after seemingly uncomplicated left circumflex artery stenting. We demonstrate features on transthoracic echocardiography with contrast and cardiac computed tomography that were used for diagnosis and management.