Current Problems in Diagnostic Radiology

How many radiographs does it take to screen for femoral cam morphology?: A non-inferiority study Publication date: Available online 12 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Tony T. Wong, Joanna K. Weeks, Firas S. Ahmed, Mark A. Francescone, Michael J. Rasiej, Michael Z. Liu, Jonathan K. Kazam Abstract Purpose To compare a 2-view radiograph series (AP of the pelvis and 45° Dunn of the hip) with a 5-view radiograph series for sensitivity in identifying femoral cam morphology. Materials and Methods This is a retrospective review of consecutive patients with a 5-view radiograph series (AP pelvis and AP, 45° Dunn, frog lateral, and false profile of the affected hip) from 2016-2017. Three fellowship trained radiologists blindly and independently evaluated 2 views (AP pelvis and Dunn) for a femoral cam lesion, acetabular rim calcification, Tonnis grade, and important incidental findings. Two weeks later, the same assessment was made on all 5 views. A noninferiority test of the 2-view series vs. the 5-view series for sensitivity in identifying femoral cam morphology was conducted. Individual reader sensitivity calculations were performed and agreement was determined with the kappa statistic. Results The 2-view series was noninferior to the 5-view series for cam identification (p-value = 0.010). In comparing the 2-view vs. 5-view series for individual readers, there was no difference in the sensitivities (84-100% vs. 85-98%, p = 0.85-1.0) or specificities (11-56% vs. 7-56%, p = 0.58-1.0) for cam identification. There was fair to excellent 2-view intra-reader agreement (k = 0.38-0.93) and similar inter-reader agreement between the 2-view and 5-view (k = 0.33 vs. 0.37). Conclusion A 2-view radiograph series (AP pelvis and Dunn hip) is noninferior to a 5-view radiograph series for sensitivity in identifying femoral cam morphology.

Multiparametric MRI evaluation of complex ovarian masses Publication date: Available online 12 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Veenu Singla, Kapil Dawadi, Tulika Singh, Nidhi Prabhakar, Radhika Srinivasan, Vanita Suri, Niranjan Khandelwal Abstract Objective To assess the role of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) in the categorization of complex ovarian masses into benign and malignant. Material and Methods This prospective study was done on 33 complex ovarian masses. T1 and T2 weighted sequences, DWI, apparent diffusion coefficient (ADC), and DCEMRI were performed on 1.5 Tesla MRI. Time-intensity curves (TIC), tissue signal intensity on unenhanced T1 images (SI0), maximum absolute contrast enhancement (SImax), time to reach SImax (Tmax), maximum relative SI (SIrel = {SImax-SI0}/SI0 X100), maximum Slope (Slopemax = SIrel/Tmax X100) and wash in rate (WIR = {SImax-SI0}/Tmax) were calculated. Histopathological diagnosis was taken as gold standard. Results 20/33 masses were benign, 2/33 were borderline tumours, and 11/33 were malignant. Diffusion restriction was seen in all malignant masses and 13/20 benign masses. The mean ADC values showed a significant difference between malignant and benign, with 81.8% sensitivity and 63.6% specificity. Type III curve showed 100% specificity for malignant lesions. Tmax and Slopemax were useful in differentiating benign and malignant masses; with Tmax cut-off at 73.5 seconds having a high specificity (81.8%) and Slopemax cut-off at 0.83%/seconds having high sensitivity (91%) and negative predictive value (94.4%). Conclusion Multiparametric MRI confers high diagnostic accuracy in stratifying complex ovarian masses.

The integration of active learning teaching strategies into a radiology rotation for medical students improves radiological interpretation skills and attitudes towards radiology Publication date: Available online 12 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Ciaran E Redmond, Gerard M Healy, Hannah Fleming, Jeffrey W McCann, Deirdre E Moran, Eric J Heffernan Abstract Purpose In recent years, there has been increased recognition of the benefits of teaching by active learning. However, there is a paucity of experimental studies utilizing active learning in undergraduate radiology rotations, which is traditionally a passive learning experience. We designed a new radiology rotation that integrated teaching by active learning. We prospectively examined the efficacy of this new rotation compared to our standard rotation in terms of students' radiological competency and attitudes towards radiology, as well as impact on departmental efficiency. Methods This was a prospective cohort study involving fourth year medical students completing a one-week radiology rotation at our department between January and April 2018. One cohort completed a rotational model which incorporated active learning sessions (integrated cohort) while the remainder were taught using traditional passive learning methods (standard cohort). All participants completed a radiology examination before and after the rotation and were surveyed on their attitudes towards radiology. Results 105 students enrolled in the study. The mean post-rotation competency score obtained by the integrated cohort was significantly higher than that obtained by the standard cohort (82% versus 62%; p<0.001). The integrated rotation freed up seven hours of radiologists’ time per week. While the students completing the integrated rotation had a more positive perception of radiology, they were no more likely to express a desire to pursue a career in radiology. Conclusion The integration of active learning sessions into an undergraduate radiology rotation results in an improvement in students' post-rotation radiological competency and attitudes towards radiology.

Imaging findings of subcutaneous human dirofilariasis Publication date: Available online 12 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Syed Intakhab Alam, Pankaj Nepal, Song Chi Lu, Ahmed Elramadi, Joshua M. Sapire Abstract Dirofilariasis is an emerging helminthic zoonosis seldom reported. Humans are accidental hosts and rarely affected. We report a case of dirofilariasis presenting as a subcutaneous nodule in the uncommon location in the thigh with concealed history of dog meat handler. Of the cases published in literature, imaging findings of this disease have been few and far between. In this article, we describe multi-modality imaging findings of dirofilariasis in the thigh.

CHEST MRI USING MULTIVANE XD, A NOVEL T2 WEIGHTED FREE BREATHING MR SEQUENCE Publication date: Available online 11 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Savinay Kapur, Manisha Jana, Lalit Gupta, Ashu Seith Bhalla, Priyanka Naranje, Arun Kumar Gupta Abstract Objective To compare image quality of free-breathing T2 weighted MultiVane-XD (MVXD) sequence (non-Cartesian k-space filling using radial rectangular blades) with conventional MR sequences (Short tau inversion recovery (STIR), Balanced True Field Echo (BTFE), T1 in phase fast field echo (T1 FFE) and T1- fat saturated post gadolinium (T1PG)) in MR imaging of chest. Materials and Methods Twenty one patients (10 men and 11 women) underwent chest MRI including T2W MVXD, STIR, BTFE (18/21), T1 FFE, T1PG (10/21) sequences at 1.5T. Two reviewers (A.S.B and M.J. with 20 and 10 years of experience in pulmonary imaging, respectively) evaluated each sequence with respect to overall image quality, image sharpness, definition of mediastinal vessels including the aorta, pulmonary arteries, superior vena cava, intrapulmonary vessels; trachea, main bronchi, intrapulmonary airways; lung- mediastinal interface, pulmonary lesion detection and artefacts in the upper, middle and lower third of chest using five-point scales. No sedation was given. Pairwise comparisons between T2W MVXD and the four conventional sequences were made using unpaired student's T-test. Results Mean age of patients was 30.67 years (range- 6-60 years). T2 MVXD showed significantly better overall image quality and sharpness than STIR, T1 FFE and T1PG (p <0.01) while it was comparable to BTFE. Mediastinal vessels were significantly better visualised on T2 MVXD as compared to STIR and T1 (p <0.003). However, BTFE and T1PG were superior to T2 MVXD for visualisation of great vessels, SVC and intrapulmonary vessels (p <0.01). Visualisation of trachea, major bronchi, intrapulmonary airways as well as intrapulmonary lesion detection was significantly better on T2 MVXD images in comparison to any of the other four sequences (p <0.03). Intrapulmonary artefacts were significantly lesser in BTFE images as compared to T2 MVXD (p <0.01). No significant difference was found between the severity of intrapulmonary artefacts in other MR sequences as compared to T2 MVXD. Conclusion By virtue of its better overall image quality, sharpness, superior visualisation of mediastinal airways and lesion detection, T2 MultiVane XD promises to be a robust addition in the armamentarium of thoracic radiologists.

The Relationship Between MRI Findings and Molecular Subtypes in Women with Breast Cancer Publication date: Available online 9 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Dr. Veli Süha Öztürk, Assist. Prof. Dr. Yasemin Durum Polat, Assoc Prof. Dr. Aykut Soyder, Dr. Ahmet Tanyeri, Prof. Dr. Can Zafer Karaman, Prof. Dr. Füsun Taşkın

Creating the Black Box: A Primer on Convolutional Neural Network Use in Image Interpretation Publication date: Available online 9 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Toshimasa Clark, Eric Nyberg Convolutional neural networks have been shown to demonstrate high diagnostic performance in radiologic image interpretation tasks ranging from recognition of acute stroke on computed tomography to identification of tuberculosis on plain radiographs. To a radiologist not immersed in computer science jargon, it may seem that this inscrutable black box is best treated warily, at arm's length. In this work, we illustrate how a radiologist without a deep background in computer science may be able to set up a state-of-the-art convolutional neural network for image interpretation tasks through transfer learning. This technique is relatively simple to implement, has been shown to demonstrate equivalent performance to neural networks specifically trained on medical image data, and offers a chance for the interested-but-intimidated radiologist to deep her toe in the water without becoming overwhelmed.

Structured Curriculum Vitae Scoring as a Standardized Tool for Selecting Interview Candidates for Academic Neuroradiology Faculty Positions Publication date: Available online 9 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Maria Braileanu, Benjamin B. Risk, Nadja Kadom, Mark E. Mullins, Elizabeth A. Krupinski, Amit M. Saindane, Brent D. Weinberg Abstract 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.

Still Coming Out of the Dark: Enduring Effects of Simulation Based Communication Skills Training for Radiology Residents - Four Year Follow Up Publication date: Available online 9 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Sana Majid, Jean-Marc Gauguet, Lacey MacIntosh, George Watts, Max P. Rosen, Carolynn M. DeBenedectis Abstract PURPOSE To evaluate the long-term efficacy of simulation-based communication skills training for radiology residents. METHOD AND MATERIALS The simulation-based communication skills training curriculum was developed in 2014. The curriculum included a teaching module based on the essential elements of communication. Two sets of 6 communication scenarios encountered by radiologist were created. First and Fourth year radiology residents reviewed the teaching module and completed the 6 simulated scenarios. They then underwent debriefing sessions, received faculty and staff evaluations. Four years later, the former 1st year residents (now 4th years) reviewed the teaching module again and repeated the simulation. They again underwent debriefing sessions after the simulation. This time the residents’ communication skills were evaluated by faculty and staff. RESULTS A total of 5 residents participated in this simulation-based skills training. The resident performance 4 years after initial training show not only that residents maintained their improved scores, but also that their scores improved further as compared to after the initial training. The average overall score for all but one resident increased at the 4 year follow up simulation. From 2014 to 2018, the average score of all the residents increased from 72.4% to 81.4%. Comparison of the average scores of each student across six stations from 2014 to 2018 showed a statistically significant difference between the scores after four years (p = 0.014). CONCLUSION Simulation based communication skills training is effective and long-lasting

Why patients decline digital breast tomosynthesis: results from a patient survey in an urban academic breast center Publication date: Available online 9 July 2019 Source: Current Problems in Diagnostic Radiology Author(s): Kellie Chiu, Nikki Tirada, Prasann Vachhani, Luke Robinson, Gauri Khorjekar Abstract Background Despite the advantages of reduced callback rates, higher sensitivity, and higher specificity associated with digital breast tomosynthesis (DBT) over traditional full-field digital mammography (FFDM), many patients declined DBT at our urban academic breast center. Most states also do not have mandated insurance coverage for DBT. Methods A patient survey was conducted at our breast center from February 2017 to April 2017. All patients were informed regarding the potential benefits of DBT as well as the potential additional charge related to DBT, which depended on the insurance coverage. The survey aimed to examine why the patient declined the DBT option. Reasons included cost, increased radiation risk, anxiety about newer technology, discomfort associated with the exam, lack of education about potential benefits, or patient belief that she will not benefit from DBT. We also inquired if patients would change their opinion about DBT if cost were removed. Patients answered each question by rating their responses on a scale of 1-5, from strongly disagree, disagree, neutral, agree, and strongly agree. Results Potential additional cost associated with tomosynthesis had the highest influence on patient decision to decline DBT with an average score of 4.68 out of 5. Other factors as described above had less impact on the patient decision with an average score ranging from 1.53-1.72 out of 5. Conclusion Potential out-of-pocket costs for patients remains one of the major obstacles in adoption of DBT as standard of care for breast cancer screening.