Conquering Educational Mountains: Maintaining a Radiology Clinical Education Track.

Establishing a clinical education track as part of a radiology residency is essential in shaping future radiology educators. Many obstacles will be encountered while starting, maintaining, and improving these educational pathways. Hurdles may include recruiting suitable residents for the track, recruiting and supporting faculty advisors, sustaining long-term resident engagement, counteracting educational exclusivity, and providing adequate time and financial support. Although every program and institution may face individualized "mountains" to overcome, they are not insurmountable. The goal of this review is to address different conflicts we have encountered while maintaining the clinical education tract at our institution and to provide tips for overcoming them.

Establishing a Departmental Symposium for Resident Scholarly Activity: How We Did It.

Many radiology departments have successfully increased trainee research involvement by providing protected academic time for research, offering travel funding for conferences, and developing research-focused curriculum via resident research tracks and other mechanisms. A departmental platform for trainees to share their scholarly projects can foster intradepartmental awareness and collaborations, supplement the existing resident research curriculum, encourage peer learning amongst trainees, and allow departmental celebration of their trainees' accomplishments. The authors describe the development of a departmental symposium for resident scholarly activity at their institution and detail a practical framework for implementation and lessons learned, which may serve as a guide for other radiology departments interested in establishing a similar event.

Automated Registration and Color Labeling of Serial 3D Double Inversion Recovery MR Imaging for Detection of Lesion Progression in Multiple Sclerosis.

Automated co-registration and subtraction techniques have been shown to be useful in the assessment of longitudinal changes in multiple sclerosis (MS) lesion burden, but the majority depend on T2-fluid-attenuated inversion recovery sequences. We aimed to investigate the use of a novel automated temporal color complement imaging (CCI) map overlapped on 3D double inversion recovery (DIR), and to assess its diagnostic performance for detecting disease progression in patients with multiple sclerosis (MS) as compared to standard review of serial 3D DIR images. We developed a fully automated system that co-registers and compares baseline to follow-up 3D DIR images and outputs a pseudo-color RGB map in which red pixels indicate increased intensity values in the follow-up image (i.e., progression; new/enlarging lesion), blue-green pixels represent decreased intensity values (i.e., disappearing/shrinking lesion), and gray-scale pixels reflect unchanged intensity values. Three neuroradiologists blinded to clinical information independently reviewed each patient using standard DIR images alone and using CCI maps based on DIR images at two separate exams. Seventy-six follow-up examinations from 60 consecutive MS patients who underwent standard 3 T MR brain MS protocol that included 3D DIR were included. Median cohort age was 38.5 years, with 46 women, 59 relapsing-remitting type MS, and median follow-up interval of 250 days (interquartile range: 196-394 days). Lesion progression was detected in 67.1% of cases using CCI review versus 22.4% using standard review, with a total of 182 new or enlarged lesions using CCI review versus 28 using standard review. There was a statistically significant difference between the two methods in the rate of all progressive lesions (P < 0.001, McNemar's test) as well as cortical progressive lesions (P < 0.001). Automated CCI maps using co-registered serial 3D DIR, compared to standard review of 3D DIR alone, increased detection rate of MS lesion progression in patients undergoing clinical brain MRI exam.

The ADVICER Template for Faculty Reviewer Letters for Promotion and Appointment.

RATIONALE AND OBJECTIVES: Promotion is an important milestone in the career of academic radiologists. Appointments, Promotion and Tenure (APT) committees require multiple letters of support from both internal and external referees. Traditional narrative letters are highly subjective, have high inter-reader variability, are time-intensive, and vulnerable to gender and other biases. The Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER) recognized the need for a standardized template to assist academic faculty, letter writers, and APT committees. MATERIALS AND METHODS: An ADVICER ad hoc committee of six educators with experience serving as external referees was convened to create a standardized template. Committee members performed a search of the relevant literature and internet sites, spoke with stakeholders such as APT chairs, and ultimately developed a template for faculty reviewer letters using the common clinician-educator pathway as a focal point. RESULTS: An open source, modifiable, standardized, template was produced. The template has been made available to ADVICER members and is available on the Association of University Radiologists (AUR) website at: https://www.aur.org/resources/Template-for-Faculty-Reviewer-Letters-for-Promotion-and-Appointment CONCLUSION: This external referee template has the potential to reduce subjectivity, eliminate bias, and provide a flexible, modifiable, comprehensive faculty review letter template which will be useful for academic faculty, letter writers, and promotions committees.

Developing a Resident-led First-year Radiology Resident Lecture Series.

The first year of radiology residency presents many unique challenges, from transitioning into a completely new, specialized field to preparing for call. Implementation of a longitudinal lecture series dedicated towards the clinical demands of being a first-year radiology resident may improve their knowledge and comfort level, as well as benefit the entire program. In this article, we outline our experience with the development of a resident-led dedicated first-year radiology resident lecture series providing targeted, high-yield instruction on rotation logistics, basic physics and artifacts, examination protocolling, and common and "don't miss" pathology.

Development and Implementation of an Integrated Imaging Informatics Track for Radiology Residents: Our 3-Year Experience.

RATIONALE AND OBJECTIVES: Imaging Informatics is an emerging and fast-evolving field that encompasses the management of information during all steps of the imaging value chain. With many information technology tools being essential to the radiologists' day-to-day work, there is an increasing need for qualified professionals with clinical background, technology expertise, and leadership skills. To answer this, we describe our experience in the development and implementation of an Integrated Imaging Informatics Track (I3T) for radiology residents at our institution. MATERIALS AND METHODS: The I3T was created by a resident-driven initiative funded by an intradepartmental resident grant. Its curriculum is delivered through a combination of monthly small group discussions, operational meetings, recommended readings, lectures, and early exposure to the National Imaging Informatics Course. The track is steered and managed by the I3T Committee, including trainees and faculty advisors. Up to two first-year residents are selected annually based on their curriculum vitae and an interest application. Successful completion of the program requires submission of a capstone project and at least one academic deliverable (national meeting presentation, poster, exhibit, manuscript and/or grant). RESULTS: In our three-year experience, the seven I3T radiology residents have reported a total of 58 scholarly activities related to Imaging Informatics. I3T residents have assumed leadership roles within our organization and nationally. All residents have successfully carried out their clinical responsibilities. CONCLUSION: We have developed and implemented an I3T for radiology residents at our institution. These residents have been successful in their clinical, scholarship and leadership pursuits.

The impact of COVID-19 on dynamic hip screw fixation and training.

COVID-19 has had a profound impact on orthopaedic services and surgical training. AIM: This study aims to identify changes in lag screw position and Tip Apex Distance (TAD) in dynamic hip screw fixation due to changes in practice during the coronavirus pandemic and determine whether the changes resulted in improved patient outcomes and enhanced training opportunities. MATERIALS AND METHODS: Retrospective evaluation of two patient cohorts - pre-covid (n=27) and during covid (n=26) - to evaluate the TAD and lag screw position for each patient and record the grade of operating surgeon. A total of 53 patients were included. RESULTS: A mean TAD of 19.78mm and 19.80mm was calculated for cohort 1 and 2 respectively with no significant difference identified. When considering both key risk factors for lag screw cut-out (lag screw position and TAD) the number of patients with both a "satisfactory position" of the screw and a TAD <20mm, were 8/27 (29.6%) and 11/26 (42.3%), respectively. In cohort 1 3/27 cases had a consultant documented as the primary surgeon, while no consultants were documented as being present for the remaining 24 cases. 21/26 cases in cohort 2 had a consultant present some capacity, either as primary surgeon (15/21) or assistant (6/21). CONCLUSIONS: Changes in practice due to the pandemic have had some positive effects for both patients and trainees. This study has highlighted the importance of Consultant led trauma lists for improving training and surgical outcomes with a demonstrated improvement when considering both key factors associated with screw cut-out together. Ultimately some of the changes in practice should be continued in the post-covid era.

Clinical Applications of Magnetic Resonance Spectroscopy in Brain Tumors: From Diagnosis to Treatment.

Magnetic resonance spectroscopy (MRS) is a valuable tool for imaging brain tumors, primarily as an adjunct to conventional imaging and clinical presentation. MRS is useful in initial diagnosis of brain tumors, helping differentiate tumors from possible mimics such as metastatic disease, lymphoma, demyelination, and infection, as well as in the subsequent follow-up of patients after resection and chemoradiation. Unfortunately, the spectroscopic appearance of many pathologies can overlap, and ultimately follow-up or biopsy may be required to make a definitive diagnosis. Future developments may continue to increase the value of MRS for initial diagnosis, treatment planning, and early detection of recurrence.

Vice Chair for Education: Twelve Roles to Provide a Framework for Success.

RATIONALE AND OBJECTIVES: An increase in the administrative work in our healthcare system has led to an increase in the number of administrative positions in radiology departments. Many of these are Vice Chair roles, including Vice Chair for Education (VCEd). The responsibility of this position has expanded, often far beyond the original definition. This article defines the role and expectations of the Vice Chair for Education and provides suggestions for success. MATERIALS AND METHODS: This article will review 12 vital roles that a Vice Chair for Education must play to be an effective advocate for radiology education within a department. RESULTS: Key attributes of an educational leader are delineated, divided into 12 areas or roles. CONCLUSION: This article summarizes key leadership skills needed by Vice Chairs for Education in order for them to be effective in their role.

The Use of Descriptive Terms for Ventricular Size on Noncontrast Head CT Radiology Reports.

BACKGROUND AND PURPOSE: Multiple radiographic terms can be used to describe enlarged ventricles on noncontrast head computed tomography (CTs); however, precise terminology is important to determine etiology and clinical management. The purpose of this study was to characterize how ventricular size was described in radiology reports, especially in the setting of hydrocephalus. MATERIALS AND METHODS: A retrospective review of adult patients with at least 2 consecutive noncontrast head CTs from 2010 to 2016 was performed. Reports were grouped based on ventricular descriptions into 3 categories: "acceptable," "unclear," and "not acceptable." An additional subgroup was created for an examination indication of "hydrocephalus." Descriptive statistics and subgroup analysis were performed. RESULTS: A total of 270 patients with noncontrast head CTs were included, of which 53.3% (n = 144) used "acceptable" terms, 18.2% (n = 49) "unclear," and 28.5% (n = 77) "not acceptable." Ventricle size was reported as normal in 21.1% (n = 57) of cases. "Hydrocephalus" was given as an indication for 57 exams, of which 84.2% (n = 48) were categorized as "acceptable," 7.0% (n = 4) "unclear," and 8.8% (n = 5) "not acceptable." Chi-square test of independence revealed a significant relation between "acceptable" terminology and "hydrocephalus" indication (χ2 = 27.68, P< 0.001). CONCLUSION: Approximately half of radiology reports had an "acceptable" description of the ventricles. When "hydrocephalus" was in the indication, the report was more likely to have an "acceptable" description. Accurate clinical indications, and standardized terminology may improve the clinical utility of radiology reports for patients with hydrocephalus.

Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020.

There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.

Quantitative Improvement in Brain Tumor MRI Through Structured Reporting (BT-RADS).

RATIONALE AND OBJECTIVES: Determine the objective benefits of structured reporting of brain tumors through Brain tumor-RADS (BT-RADS) by analyzing discrete quantifiable metrics of the reports themselves. MATERIALS AND METHODS: Following Institutional Review Board approval, post-treatment glioma reports were acquired from two matched 3-month time periods for pre- and postimplementation of BT-RADS. The reports were analyzed for presence of history words, such as "Avastin" and "methylguanine-DNA methyltransferase," as well as hedge words, such as "Possibly" and "Likely." The word counts of the total report and of the impression section were also assessed, as well as whether or not the report contained addenda. RESULTS: In total, 211 pre-BT-RADS and 172 post-BT-RADS reports were analyzed. Post-BT-RADS reports demonstrated greater reporting of history words, including "Avastin" (7.6% vs. 20.9%, p < 0.001) and "methylguanine-DNA methyltransferase" (10.9% vs. 31.4%, p < 0.0001). They also demonstrated reduced usage of hedge words, including "Possibly" (3.8% vs. 0.6%, p < 0.05) and "Likely" (49.8% vs. 28.5%, p < 0.01). Furthermore, post-BT-RADS reports possessed fewer words in total report length (389 vs. 245.2, p < 0.001), as well as in the impression section (53.7 vs. 42.6, p < 0.01). Finally, fewer post-BT-RADS reports contained addenda (10% vs. 1.2%, p < 0.01). CONCLUSION: Following implementation of BT-RADS, glioma reports demonstrated greater consistency and completeness of clinical history, less ambiguity, and more conciseness.

Structured Curriculum Vitae Scoring as a Standardized Tool for Selecting Interview Candidates for Academic Neuroradiology Faculty Positions.

BACKGROUND AND PURPOSE: Interview selection of candidates for academic radiology faculty positions is variable and subject to unconscious biases. The purpose of this study was to retrospectively apply a quantitative curriculum vitae (CV) rubric as a screening tool to identify qualified candidates for further consideration in the hiring process. MATERIALS AND METHODS: Archived CVs submitted by applicants between 2012 and 2017 for neuroradiology faculty positions at our institution were anonymized. One blinded reviewer scored resumes based on categories that included education, work experience, extracurricular/teaching experience, and research. Logistic regression and receiver operating characteristics analysis were performed. This study was IRB exempted. RESULTS: Of the total 102 applicants, 17 interviews were conducted and 10 candidates were offered a position. Maximum score of the model was 24 points. Mean score was 14 ± 4 (n = 102, range 5-22). Higher total CV score (P = 0.01), medical school ranking (P = 0.03), and number of published manuscripts (P = 0.03) were significantly associated with interview selection. The area under the curve in the ROC analysis for differentiating interview selection based on total CV scoring was 0.69 (95% confidence interval 0.56-0.82). At a cutoff of 14, the model is 82.4% sensitive, and 54.1% specific. CONCLUSION: Standardized CV scoring is feasible with a cut-off score of 14 points providing high sensitivity in identifying candidates eligible for interview. This tool can potentially be applied in the future to the hiring process as it is neutral to factors such as gender and race and provides an opportunity to address diversity in academic medicine.

Neuroimaging of Patients in the Intensive Care Unit: Pearls and Pitfalls.

A brief introduction is provided of the different imaging modalities encountered in the intensive care unit (ICU). The spectrum of intracranial pathology as well as potential postsurgical complications is reviewed, with a focus on pearls and pitfalls. A brief overview also is provided of imaging of the spine in an ICU patient.

The USMLE Step 1 Pass/Fail Reporting Proposal: The APDR Position.

BACKGROUND: The National Board of Medical Examiners (NBME) and the United States Medical Licensing Examination (USMLE) has convened a conference of "key stakeholders" on March 11-12, 2019 to consider reporting the results of the USMLE Step 1 as pass/fail. DISCUSSION: While the original purpose of the USMLE Step 1 was to provide an objective basis for medical licensing, the score is increasingly used in residency applicant screening and selection because it is an objective, nationally recognized metric allowing comparison across medical schools in and outside the United States. Excessive reliance on the Step 1 score in the matching process has led to "Step 1 Culture" that drives medical schools to "teach to the test," increases medical student anxiety, and disadvantages minorities that have been shown to score lower on the USMLE Step 1 examination. The outsize role of the USMLE Step 1 score in resident selection is due to lack of standardization in medical school transcripts, grade inflation, and the lack of class standing in many summative assessments. Furthermore, the numeric score allows initial Electronic Residency Application Service filtering, commonly used by programs to limit the number of residency applications to review. CONCLUSION: The Association of Program Directors in Radiology (APDR) is concerned that pass/fail reporting of the USMLE Step 1 score would take away an objective measure of medical student's knowledge and the incentive to acquire as much of it as possible. Although the APDR is not in favor of the Step 1 exam being used as a screening tool, in the absence of an equal or better metric for applicant comparison the APDR opposes the change in Step 1 reporting from the numeric score to pass/fail.