An assessment of radiology resident competency in identifying suppurative retropharyngeal lymphadenitis: an examination using the WIDI SIM platform.

BACKGROUND AND PURPOSE: Suppurative retropharyngeal lymphadenitis is a retropharyngeal space infection almost exclusively seen in the young (4-8 years old) pediatric population. It can be misdiagnosed as a retropharyngeal abscess, leading to unnecessary invasive treatment procedures. This retrospective study aims to assess radiology residents' ability to independently identify CT imaging findings and make a definitive diagnosis of suppurative retropharyngeal lymphadenitis in a simulated call environment. MATERIALS AND METHODS: The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a computer-aided emergency imaging simulation proven to be a reliable method for assessing resident preparedness for independent radiology call. The simulation included 65 cases across various imaging modalities of varying complexity, including normal studies, with one case specifically targeting suppurative retropharyngeal adenitis identification. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. RESULTS: A total of 543 radiology residents were tested in three separate years on the imaging findings of suppurative retropharyngeal lymphadenitis using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Suppurative retropharyngeal lymphadenitis was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 3.5% of radiology residents were able to correctly identify suppurative retropharyngeal lymphadenitis on a contrast-enhanced computed tomography (CT). CONCLUSIONS: Our findings underscore a potential gap in radiology residency training related to the accurate identification of suppurative retropharyngeal lymphadenitis, highlighting the potential need for enhanced educational efforts in this area.

Radiology resident competency in detecting basilar artery occlusion: a simulation-based assessment.

PURPOSE: Basilar artery strokes are rare but can have characteristic imaging findings that can often be overlooked. This retrospective study aims to assess radiology residents' ability to identify CT imaging findings of basilar artery occlusion in a simulated call environment. METHODS: The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM)-a tested and reliable computer-aided emergency imaging simulation-was employed to assess resident readiness for independent radiology call. The simulations include 65 cases of varying complexity, including normal studies, with one case specifically assessing basilar artery stroke. Residents were presented with a single, unique case of basilar artery occlusion in two separate years of testing and were only provided with non-contrast CT images. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. RESULTS: A total of 454 radiology residents were tested in two separate years on the imaging findings of basilar artery occlusion using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Basilar artery occlusion was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 14% of radiology residents were able to correctly identify basilar artery occlusion on non-contrast CT. CONCLUSIONS: Our findings underscore a potential gap in radiology residency training related to the detection of basilar artery occlusion, highlighting the potential need for increased educational efforts in this area.

Bubbles in the belly: How well do radiology trainees recognize pneumatosis in pediatric patients on plain film?

OBJECTIVES: Pneumatosis intestinalis is a radiographic finding that refers to the presence of gas within the walls of the small or large bowel. This sign is diagnostic in the setting of premature infants with suspected necrotizing enterocolitis. Earlier detection of NEC on X-ray is vital to improve the overall management in these infants. The identification of pneumatosis intestinalis concerning for necrotizing enterocolitis by the "on-call" trainee is critical in the care of the preterm infant. Our objective was to study trainees' ability to identify pneumatosis on an emergent overnight film. METHODS: The Emergent/Critical Care Imaging SIMulation (WIDI SIM) is a strategically designed computer-aided simulation of an emergency imaging experience that has been rigorously tested and proven to be a reliable means for assessing radiology trainee preparedness to competently and independently cover radiology call. One test case each year included requires the trainee to accurately identify pneumatosis on a plain radiograph of the abdomen in a neonate. RESULTS: A total of 463 radiology trainees from 32 distinct training programs across the country were given a case of pneumatosis using the WIDI simulation web-based testing platform. On average only 28% of radiology trainees were able to correctly identify pneumatosis intestinalis on plain film. Although the sample sizes in the upper-level trainees were smaller, those with greater number years of training performed better. CONCLUSIONS: Further training must be given to radiology trainees to accurately recognize pneumatosis and report concerns for necrotizing enterocolitis. ADVANCES IN KNOWLEDGE: This paper is the first to describe and assess the ability of the "on-call" radiology trainee to accurately recognize pneumatosis and report concerns for necrotizing enterocolitis. Our paper includes the largest cohort of radiology trainees evaluated to this date.

Rate of resident recognition of nonaccidental trauma: how well do residents perform?

BACKGROUND: A resident working under the entrustable professional activity of a graduated independent coverage model must identify nonaccidental trauma and notify clinicians of this concern to facilitate potential removal of the child from harm. The resident's role in identifying child abuse has not previously been studied. OBJECTIVE: The purpose of this study was to assess radiology residents' ability to identify radiographic imaging findings of nonaccidental trauma in a simulated call environment. MATERIALS AND METHODS: The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a strategically designed computer-aided simulation of an emergency imaging experience that has been rigorously tested and proven to be a reliable means for assessing resident preparedness to competently and independently cover radiology call. The residents are provided with 65 cases of varying difficulty, including normal studies. Those cases include ones that require the resident to accurately identify skeletal findings of nonaccidental trauma. The residents respond using free text that is then scored manually by faculty members utilizing a robust grading rubric. Missed cases are then categorized by observation error and/or interpretative errors. RESULTS: A total of 675 radiology residents were given a case of nonaccidental trauma using the WIDI simulation web-based test platform between 2014 and 2017. Child abuse was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. Correct diagnostic score averages per year ranged from 10% to 79%. In year 1, 71% of residents correctly diagnosed nonaccidental trauma with a total of 101 participants. In year 2, 130 residents participated with only 20% answering correctly. In year 3, there were 201 participants with 79% correctly diagnosing nonaccidental trauma. In year 4, only 10% of 243 residents accurately diagnosed nonaccidental trauma. Residents from various stages of training were tested. Cases used with leading histories provided, accounted for a higher correct call rate. CONCLUSION: Radiology residency programs may be deficient in teaching residents to accurately recognize and report child abuse. This deficiency has potential implications for programs where a radiology attending is not present after hours as it raises the concern that child abuse may be missed by residents taking independent call. These data further question whether graduating radiologists are competent to recognize nonaccidental trauma and demonstrates the need for additional mandatory training during radiology residency.

The Echogenic Liver: Steatosis and Beyond.

ABSTRACT: Ultrasound is the most common modality used to evaluate the liver. An echogenic liver is defined as increased echogenicity of the liver parenchyma compared with the renal cortex. The prevalence of echogenic liver is approximately 13% to 20%. In most clinical settings, increased liver echogenicity is simply attributed to hepatic steatosis. It is important to recognize other hepatic and systemic diseases including cirrhosis, viral hepatitis, glycogen storage disease, and hemochromatosis that may also cause an echogenic liver and to identify the associated findings to distinguish them from hepatic steatosis.

Congenital Pulmonary Artery Anomalies: A Review and Approach to Classification.

Congenital pulmonary artery anomalies are infrequent but given improved prenatal diagnosis and care, and neonatal surgical advances, over the past two decades are not uncommonly encountered by cardiothoracic imagers. An understanding of their etiology, classifications, associated anomalies, and surgical management can be helpful to avoid under or overdiagnosis. Timely diagnosis assisted by familiarity with imaging findings across modalities and recognition of surgical findings allows for medical management and surgical planning for these patients, with more patients reaching adulthood than ever before.

An "accidental" discovery: Incidentally found metanephric adenofibroma in a 5-year-old male trauma patient.

Metanephric adenofibroma is a rare pediatric renal tumor, which should be considered in cases of solid renal lesions that mimic Wilms tumor on both imaging and histology. We present a case of an incidentally found left renal lesion on a trauma computed tomography scan in a 5-year-old male patient. The patient underwent total nephrectomy, and the diagnosis of metanephric adenofibroma was made on histology. Radiologists should consider this entity in the differential for an incidentally found solitary renal mass in a pediatric patient. Prompting the pathologic diagnosis of this entity can spare patients from unnecessary chemotherapy and allow for nephron-sparing surgery.