Left Ventricular Hypertrophy: Evaluation with Cardiac MRI Publication date: Available online 14 September 2019 Source: Current Problems in Diagnostic Radiology Author(s): Karen G Grajewski, Jadranka Stojanovska, El-Sayed H Ibrahim, Mohamed Sayyouh, Anil Attili Abstract Objective Left ventricular hypertrophy (LVH) is a frequent problem in clinical practice and can be caused by diverse conditions including hypertension, aortic stenosis, hypertrophic cardiomyopathy, athletic training, infiltrative heart muscle disease, storage and metabolic disorders. Identification of the precise etiology can be challenging and is a common cause of referral for cardiac MRI (CMR). In this article, CMR findings in various causes of LVH will be reviewed with an emphasis on determination of etiology and emerging role of CMR in risk stratification. Conclusions In patients with LVH, CMR allows precise determination of the severity and distribution of hypertrophy, evaluation of ventricular function, and tissue characterization. The information obtained from CMR enables identification of the etiology of LVH and may aid in determining prognosis and therapy.

Improving Pediatric Chest Radiograph Collimation: A Quality Initiative Publication date: Available online 14 September 2019 Source: Current Problems in Diagnostic Radiology Author(s): Cory M Pfeifer

Syndesmotic ligaments of the ankle: Anatomy, multimodality imaging, and patterns of injury Publication date: Available online 13 September 2019 Source: Current Problems in Diagnostic Radiology Author(s): Andrew L. Chang, Jacob C. Mandell Abstract Injuries to the syndesmotic ligaments of the ankle or “high ankle sprains” are common in acute ankle trauma but can be difficult to diagnose both clinically and on imaging. Missed injuries to the syndesmosis can lead to chronic ankle instability, which can cause persistent pain and lead to early osteoarthritis. This review will illustrate the anatomy of the syndesmotic ligamentous complex, describe radiographic, CT, and MR imaging of the syndesmosis, demonstrate typical mechanisms of injuries and associated fracture patterns, and provide an overview of important management considerations.

Reducing Burnout Among Radiology Trainees: A Novel Residency Retreat Curriculum to Improve Camaraderie and Personal Wellness – 3 Strategies for Success Publication date: Available online 13 September 2019 Source: Current Problems in Diagnostic Radiology Author(s): Matthew A. Haber, Glenn C. Gaviola, Jessica R. Mann, Jisoo Kim, Fiona E. Malone, Shanna A. Matalon, Sona A. Chikarmane, Jennifer W. Uyeda Abstract Objectives To describe a residency retreat curriculum established to improve wellness and reduce burnout within a radiology residency. Methods A wellness retreat was created and implemented within a large academic medical center's radiology residency. The retreat curriculum was designed by a Radiology Residency Wellness Committee and was supported by departmental funding. The retreat curriculum centered on three strategies for success: teambuilding and bonding, Design Thinking, and guided reflection. A questionnaire was distributed at the end of the retreat, asking 12 questions in 5-point Likert format to assess resident satisfaction with different components of the retreat, as well as open-ended questions to more deeply assess the effects of the retreat on the residency experience and personal wellness in our radiology residency. Questionnaire results were summarized using frequency and percentages. Open-ended responses were qualitatively analyzed using the constant comparative method. Results Thirty-seven of 41 residents (90%) in our radiology residency participated in the retreat. Thirty-five of the 37 residents (95%) participated in the post-retreat questionnaire, with 33 of 37 residents (89%) completing the entire questionnaire. Thirty-two of 33 responders (97%) anticipated the retreat would improve their residency experience, and 27 of 33 responders (82%) indicated the retreat would improve their personal wellness. Based upon the open-ended responses, improved camaraderie was the major benefit of the retreat cited by the majority of residents. Conclusion A departmentally sponsored radiology residency retreat may improve personal wellness and reduce burnout.

Pancreatic Walled-Off Necrosis Eroding into the Inferior Vena Cava Publication date: September–October 2019 Source: Current Problems in Diagnostic Radiology, Volume 48, Issue 5 Author(s): Anupama Ramachandran, Sanchit Sharma, Shalimar, Raju Sharma, Kumble Seetharama Madhusudhan Walled-off necrosis (WON) is a well-known delayed local complication of acute necrotizing pancreatitis. Occasionally, WON may spontaneously rupture into the gastrointestinal tract or peritoneal cavity. However, erosion of a WON to a systemic vein has not been reported in literature so far. We report an unusual case of a 63-year-old male with acute necrotizing pancreatitis in whom WON was eroding into the inferior vena cava resulting in its thrombosis. Our patient also had a bunch of other well-described complications of pancreatitis including splanchnic venous thrombosis.

Variability in the Management Recommendations Given for High-risk Breast Lesions Detected on Image-guided Core Needle Biopsy at U.S. Academic Institutions Publication date: September–October 2019 Source: Current Problems in Diagnostic Radiology, Volume 48, Issue 5 Author(s): Eniola Falomo, Catherine Adejumo, Kathryn A. Carson, Susan Harvey, Lisa Mullen, Kelly Myers Abstract The purpose of this study was to describe and compare the management recommendations provided in the setting of a high-risk lesion diagnosed on core needle biopsy of the breast at academic institutions across the United States. We contacted breast imagers at U.S. academic institutions via email and asked them to complete a voluntary online survey. The survey consisted of eight questions regarding the management recommendations given when core biopsy yields various high-risk lesions. We received survey responses from 41 of the 59 institutions contacted (69% response rate). Surgical excision was the most frequently reported recommendation given for all high-risk lesions; however, the proportion varied from 95% for atypical ductal hyperplasia and papilloma with associated atypia, 76% for flat epithelial atypia, 73% for radial scar/complex sclerosing lesion, 71% for lobular carcinoma in-situ, 61% for atypical lobular hyperplasia, to 39% for intraductal papilloma without atypia. Our study demonstrates inconsistency in the management recommendations given for high-risk lesions detected on core needle biopsy at academic institutions nationally. This outcome suggests that patients may benefit from the creation of consensus recommendations for the management of high-risk lesions detected on core needle biopsy.

Three-Dimensional Printing Facilitates Creation of a Biliary Endoscopy Phantom for Interventional Radiology-Operated Endoscopy Training Publication date: September–October 2019 Source: Current Problems in Diagnostic Radiology, Volume 48, Issue 5 Author(s): Jacob J. Bundy, William J. Weadock, Jeffrey Forris Beecham Chick, Rajiv N. Srinivasa, Nishant Patel, Evan Johnson, Mamdouh Khayat, Brian Jeffers, Joseph J. Gemmete, Ravi N. Srinivasa Purpose To create a three-dimensional endoscopic model of the biliary tract from magnetic-resonance cholangiopancreatography imaging and to evaluate its effectiveness as a tool for training in endoscopic biliary interventions. Materials and Methods A magnetic-resonance cholangiopancreatography study was performed on a patient with biliary obstruction secondary to a distal bile duct cholangiocarcinoma. Using Vitrea, a three-dimensional volume-rendered image was created, and exported as a standard tessellated language file. The standard tessellated language model was then edited with MeshMixer. Three cylindrical entry ports were created. The ports were aligned and overlapped with the dominant ducts in three separate areas of the model and fused to the model. A 0.2 cm shell was created around the model and the model was hollowed. The ends of the ports were cut off, allowing access to the hollowed-out model. The model was printed at 125% scale to allow easy access with a 9.5-French (≤3.23 mm) endoscope. The model was printed using a Stratasys Dimension Elite Plus printer. After printing, the model was post-processed to remove support materials. A 10-question survey was administered to all trainees before and after use of the printed phantom to practice endoscopy skills. Results 11 trainees participated in the three-dimensional endoscopy simulation with most of the trainees (73%) having no prior formal endoscopy training. Using a 10-point Likert scale, the mean comfort-level of the trainees to use endoscopy alone for cholecystostomy, percutaneous biliary drainage, percutaneous nephrostomy, and percutaneous gastrostomy increased by 38.9%, 32.8%, 32.8%, and 34.3%, respectively, following the training experience. Conclusion The use of a three-dimensionally printed endoscopic model as a simulation tool has the potential to improve trainee comfort using endoscopy during interventional radiology procedures.

Perception of Breast Oncologists and Physician Extenders on Imaging Consultation Service at a Tertiary Cancer Institute Publication date: September–October 2019 Source: Current Problems in Diagnostic Radiology, Volume 48, Issue 5 Author(s): Pamela J. DiPiro, Sree Harsha Tirumani, Nikhil H. Ramaiya Abstract Objective To evaluate the perception and ease of utilization of the imaging consultation service by different types of referring clinicians and physician extenders within the breast oncology disease center at our tertiary cancer institute using a survey-based questionnaire. Methods An institutional review board-exempted survey was created using a freely available online survey software and questionnaire tool. The survey was sent to 83 clinicians associated with the breast oncology disease center at our tertiary cancer center through an institutional e-mail list. The survey included 2 questions about demographics and 8 statements regarding various aspects of the consultation service scored on a 5-point Likert-type scale. “1’’ being “agree completely,” “3” being “neutral/neither agree nor disagree,” and “5” being “disagree completely.” The survey was sent online and was answered anonymously. Responses were tallied and analyzed. Results A total of 56 responses (67%) were received. The weighted average of each Likert item ranged from 1.07 to 1.58. Highest positive concordance (95%) pertained to the access to the consult radiologist having a positive impact on patient care. The least concordant statement (78%), though still strong (with weighted average of 1.58% and 78% of respondents agreeing or agreeing completely) pertained to the role of direct consultation with radiologist in clinical management. Although there was variability of agreement to all statements (including responders feeling neutral), there was no one that disagreed with any of the Likert items. The mean Likert score for all the statements together was 1.23 (range: 1.07-1.58). Conclusion Presence of dedicated oncologic imaging consultation service is perceived positively by the breast oncology team at our tertiary cancer center.

Radiology and Political Advocacy: Characterizing Radiology Political Action Committee Donors Publication date: September–October 2019 Source: Current Problems in Diagnostic Radiology, Volume 48, Issue 5 Author(s): Michael J. Drabkin, Jeffrey Donaldson, Joshua Fogel, Junjian Huang, Andrew Klobuka, Mohammed Faisal Loya, Marwan Moussa, Karan Patel, Alexander Misono Purpose To identify factors associated with radiologist donations to radiology political action committees (PACs). Materials and Methods A survey was emailed to 4474 radiologists. Factors investigated include demographics, donor history, and knowledge of the federal advocacy process. Logistic regression analysis was performed to determine factors associated with donor behavior. Results In total, 336 radiologists completed the survey. Overall, 152 (46.2%) radiologists reported donating to a radiology PAC in the past year. Those with annual personal income ≥$450,000 had greater odds to donate than those with annual personal income <$450,000 (odds ratio [OR]: 2.58, 95% confidence interval [CI]: 1.47-4.52; p < 0.001). More than three-quarters (77.2%, n = 254) reported limited or no knowledge of the federal advocacy process. Those with good or excellent knowledge of the federal advocacy process had greater odds to donate than those with no knowledge (OR: 2.63, 95% CI: 1.01-6.84; p = 0.047). Those with awareness that membership dues and foundation funds do not fund Society of Interventional Radiology Political Action Committee had greater odds to donate (OR: 3.54, 95% CI: 2.00, 6.25; p < 0.001). Conclusions Radiologists’ personal income and knowledge of the federal advocacy process were identified as key factors influencing donations. PAC donation may benefit from raising awareness of the federal advocacy process, as well as from targeted fundraising strategies aimed at higher earners.

Reshaping Radiology Precall Preparation: Integrating a Cloud-Based PACS Viewer Into a Flipped Classroom Model Publication date: September–October 2019 Source: Current Problems in Diagnostic Radiology, Volume 48, Issue 5 Author(s): Payam Sajedi, Noriko Salamon, Jason Hostetter, Stellios Karnezis, Arvind Vijayasarathi Abstract Preparing residents for the on-call experience in Radiology is one of the most important aspects of education within a training program. Traditionally, this preparation has occurred via a combination of case conferences and didactic lectures by program faculty, daily teaching at the workstation, and precall assessments. Recently, a blended curricular model referred to as the flipped classroom has generated a lot of attention within the realm of graduate medical education. We applied this technique to resident precall education in the subspecialty of Neuroradiology, and surveyed the participants about their perceptions of the course. The structure, implementation, and web-based platform used to create the flipped classroom experience is described herein.