Pituitary enlargement in a carotid-cavernous fistula: An atypical imaging manifestation.

A carotid-cavernous fistula is a rare abnormal communication between carotid vasculature and the cavernous sinus. Development of a carotid-cavernous fistula often results from trauma, but may be spontaneous in the setting of predisposing risk factors. Suspicion for a spontaneous fistula is understandably low on routine non-contrast imaging. In this article, we present a case of a carotid-cavernous fistula initially presenting with the potentially underrecognized imaging manifestation of diffuse pituitary enlargement identified on a non-contrast CT, later revealed to be due to the presence of the fistula.

Women's and residents' experiences of communication in the diagnostic mammography suite.

OBJECTIVE: To gain understanding of radiology residents' and women's experiences, concerns, information needs, coping strategies and perspectives about optimal communication during diagnostic mammography. METHODS: Qualitative analysis of focus groups of radiology residents and women who had undergone diagnostic mammograms. RESULTS: Five categories of themes emerged from our analysis: information needs, perspectives and ideals, emotional experiences and observations, working together, individual experiences, and others' roles. Women preferred continuous orientation, clear explanations and emotional support by physicians and radiology technologists throughout diagnostic processes. Communication about diagnostic mammogram results evoked the threat of breast cancer and was experienced as "bad news" by women, but not necessarily by all radiology residents. Lack of collaboration among radiologists, technologists and other healthcare professionals engendered confusion and anxiety in patients. Radiology residents felt inadequately prepared to meet the communication challenges of providing information and emotional support tailored to women's needs in this context. CONCLUSION: Women's experiences are influenced by the extent to which they receive clear information and support, and perceive collaboration among professionals involved in the diagnostic mammography process. PRACTICE IMPLICATIONS: Radiology education must address communication with patients and among healthcare professionals involved in the care of patients undergoing diagnostic procedures and interventions.

Communication in the diagnostic mammography suite: implications for practice and training.

RATIONALE AND OBJECTIVES: The diagnostic mammography suite is a microcosm of challenging physician-patient communication in radiology. Little has been written about communication practices in the diagnostic mammography suite, the effect of this communication on both physicians and patients, and implications for radiology training programs. We surveyed radiology residents and staff about communication training, practices, and experiences communicating directly with patients in the diagnostic mammography suite. MATERIALS AND METHODS: We asked the membership of the Association of Program Directors in Radiology to disseminate surveys to radiology residents and staff radiologists in their institutions. We analyzed response frequencies and correlations. RESULTS: We received responses from 142 residents and 120 staff radiologists. More than half of staff respondents spoke personally with every patient who had an abnormal diagnostic mammogram; 37% felt they had inadequate time to do so. Most residents and staff highly rated their own communication skills and confidence in ability to explain results and respond to patients' emotions, but experienced stress doing so. A majority of respondents reported no formal communication skills education after medical school. Twenty-nine percent of staff respondents regularly observed residents' communication with patients and 39% of residents reported receiving feedback about their communication. Residents' opportunities to observe staff communicate with a patient and to receive feedback on their own patient interactions were correlated with self-rated communication skill and confidence in ability to respond to patients' emotions (P < .05). CONCLUSIONS: Radiologists engage in challenging and stressful patient communication interactions. There is a paucity of educational curricula on interpersonal and communication skills in radiology. This has implications for both patient and physician satisfaction and patient outcomes.

Patients as partners in radiology education: an innovative approach to teaching and assessing patient-centered communication.

RATIONALE AND OBJECTIVES: Effective communication is essential for high quality care, yet little is known about radiologists' communication with patients, what constitutes "best communication practices," and how best to teach and evaluate it. We piloted educational strategies and an assessment instrument to teach and evaluate radiologists' communication skills. We focused on communication in the diagnostic mammography suite, where patient-radiologist interactions are often intense and stressful. MATERIALS AND METHODS: We adapted existing instruments to create a Radiology Communication Skills Assessment Tool (RCSAT). We piloted an educational program that included patients as teachers and raters of interpersonal and communication skills, and implemented a radiology objective structured clinical examination (OSCE). We measured radiology residents' self-assessed skills, confidence and stress, as well as patient-rated communication skills using the RCSAT. RESULTS: Residents' baseline self-assessed communication skills regarding abnormal mammograms were fair, confidence in their communication was minimal, and they found this communication stressful. Overall baseline communication skills, rated by patient-teachers using the RCSAT, were 3.62 on a 5-point scale (1 = poor to 5 = excellent). Analysis of post-OSCE debriefing comments yielded nine themes regarding effective radiology communication, as well as residents' reflections on the communication challenges they experience. The themes were integrated into subsequent RCSAT revisions. Residents' reflections were used to inform teaching workshops. CONCLUSION: Educational curricula on communication about difficult information can be implemented in radiology training programs. Radiology residents' performance can be assessed using a communication skills assessment tool during standardized patient-teacher encounters. Further research is necessary in this important domain.