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This paper will review faculty development focus and programming at the early, mid and late career stages. Topics covered include challenges at each career stage, institutional and national programming currently available for the needs of faculty at that stage, and suggested best practices for development of new career focus and potential programs for each stage.

Coronary artery calcium (CAC) is a frequent incidental finding on computed tomography pulmonary angiogram (CTPA) in the evaluation of pulmonary embolism (PE) in the emergency department (ED); however, its prognostic value is unclear. In this study, we interrogate the prognostic value of CAC identified on CTPA in predicting adverse outcomes in the evaluation of PE in the ED.In this retrospective cohort study, we identified 610 patients presenting to the ED in 2013 and evaluated with CTPA for suspected PE. Ordinal CAC scores were evaluated as absent (0), mild (1), moderate (2), or severe (3) in each of the 4 main coronary arteries. Composite CAC scores were subsequently compared against adverse clinical outcomes, defined as intensive care unit admission, hospital stay longer than 72 hours, or death during hospital course or at 6-month follow-up, using univariate and multivariate logistic regression analyses. Relevant exclusion criteria included a history of cardiovascular disease.In all, 365 patients met the inclusion criteria (231 women, mean age 56±16 y) with 132 patients (36%) having some degree of CAC and 16 (4%) having severe CAC. Known malignancy was present in 151 (41%) patients and composite adverse clinical outcomes were observed in 98 patients (32%). Age, presence of acute PE, malignancy, and presence of CAC were significant predictors of adverse outcomes on both univariate and multivariate analyses. CAC was not an independent predictor of short-term adverse outcomes on multivariate analysis ( P =0.06) when all patients were considered. However, when patients with known malignancy were excluded, CAC was an independent predictor of short-term adverse outcomes (odds ratio=2.5, confidence interval=1.1-5.5, P =0.03) independent of age and presence of PE.The presence of CAC on CT PA was predictive of adverse outcomes in patients without known cardiac disease presenting to the ED with suspected PE.

Purpose The aim of this study was to evaluate radiology imaging volumes at distinct time periods throughout the coronavirus disease 2019 (COVID-19) pandemic as a function of regional COVID-19 hospitalizations. Methods Radiology imaging volumes and statewide COVID-19 hospitalizations were collected, and four 28-day time periods throughout the COVID-19 pandemic of 2020 were analyzed: pre-COVID-19 in January, the “first wave” of COVID-19 hospitalizations in April, the “recovery” time period in the summer of 2020 with a relative nadir of COVID-19 hospitalizations, and the “third wave” of COVID-19 hospitalizations in November. Imaging studies were categorized as inpatient, outpatient, or emergency department on the basis of patient location at the time of acquisition. A Mann-Whitney U test was performed to compare daily imaging volumes during each discrete 28-day time period. Results Imaging volumes overall during the first wave of COVID-19 infections were 55% (11,098/20,011; P < .001) of pre-COVID-19 imaging volumes. Overall imaging volumes returned during the recovery time period to 99% (19,915/20,011; P = .725), and third-wave imaging volumes compared with the pre-COVID-19 period were significantly lower in the emergency department at 88.8% (7,951/8,955; P < .001), significantly higher for outpatients at 115.7% (8,818/7,621; P = .008), not significantly different for inpatients at 106% (3,650/3,435; P = .053), and overall unchanged when aggregated together at 102% (20,419/20,011; P = .629). Conclusions Medical imaging rebounded after the first wave of COVID-19 hospitalizations, with relative stability of utilization over the ensuing phases of the pandemic. As widespread COVID-19 vaccination continues to occur, future surges in COVID-19 hospitalizations will likely have a negligible impact on imaging utilization.

Since the first steps of creating the Alliance of Medical Student Educators in Radiology (AMSER) curriculum 20 years ago, dramatic advances in medical imaging, patient care, and medical education have occurred necessitating an update of this valuable resource. The 2020 update of the AMSER curriculum aims to address as many of these changes while providing a succinct resource that will hopefully remain useful for years to come. The updated AMSER curriculum document is freely available for download via the AMSER website at https://www.aur.org/en/affinity-groups/amser/curriculum.

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.

We aimed to evaluate the impact of collaborative discussion between diagnostic radiologists and radiation oncologists on radiation oncology management for thoracic oncology patients.We reviewed cases presented at multidisciplinary thoracic tumor boards (TTB) (n = 122) and diagnostic radiology/radiation oncology rounds (DR/ROR) (n = 45). Changes in planned radiation management following imaging discussion were categorized-no change, timing change, and treatment volume change. Phase of care was also classified. In DR/ROR, radiation oncologists were surveyed regarding (1) change in radiation oncology management and (2) change in confidence (both 5-point Likert scales).Discussion of imaging with a radiologist changed radiation oncology management in 31.1% of TTB cases and 68.9% of DR/ROR cases (P0.001). Changes to the timing of initiating radiation therapy occurred with similar frequency in the 2 settings (31.1% vs 46.7%, P = 0.063). Changes to target volume occurred more frequently in DR/ROR (35.6% vs1%), P0.001. Over half of imaging discussions in DR/ROR resulted in at least "moderate" change in radiation oncology management, and the level of confidence held by the radiation oncologists increased following discussion with radiologists in 95.6% of cases.Collaborative discussions between radiation oncologists and diagnostic radiologists in a multispecialty tumor board and in targeted 2-specialty rounds are not redundant, but result in different management changes and at different phases of care. Our study emphasizes the importance of consultation with physicians as an area where radiologists can add value, specifically the added benefit of smaller collaborative discussions.

Trauma is the leading cause of death among individuals under 40 years of age, and pulmonary trauma is common in high-impact injuries. Unlike most other organs, the lung is elastic and distensible, with a physiologic capacity to withstand significant changes in contour and volume. The most common types of lung parenchymal injury are contusions, lacerations, and hematomas, each having characteristic imaging appearances. A less common type of lung injury is herniation. Chest radiography is often the first-line imaging modality performed in the assessment of the acutely injured patient, although there are inherent limitations in the use of this modality in trauma. CT images are more accurate for the assessment of the nature and extent of pulmonary injury than the single-view anteroposterior chest radiograph that is typically obtained in the trauma bay. However, the primary limitations of CT concern the need to transport the patient to the CT scanner and a longer processing time. The American Association for the Surgery of Trauma has established the most widely used grading scale to describe lung injury, which serves to communicate severity, guide management, and provide useful prognostic factors in a systematic fashion. The authors provide an in-depth exploration of the most common types of pulmonary parenchymal, pleural, and airway injuries. Injury grading, patient management, and potential complications of pulmonary injury are also discussed. ©RSNA, 2021.

Objective To investigate whether general psychological motivating factors that guide career selection of a medical specialty differ over the course of medical school and to compare differences in motivating factors among students choosing "controllable" lifestyle specialties, students choosing "uncontrollable" lifestyle specialties, and a cohort of radiology residents. Materials and Methods An anonymous survey was distributed to first- through fourth-year medical students and radiology residents at a single institution. Participants were asked to select their top three of seven factors that most influenced their choice of medical specialty. Fourth-year students were asked to designate the specialty to which they had applied. Results The survey was distributed to 259 students and 47 radiology residents with a response rate of 93.8% (243 of 259) and 95.7% (45 of 47), respectively. The top three factors indicated by medical students were finding the daily work fulfilling, work–life balance, and interest in the subject. These top three factors were common to all medical student classes and did not differ between students choosing "controllable" versus "uncontrollable" fields. The factors uncommonly selected were similar personality to others in the field, attending income, competitiveness or prestige, and job market conditions. For radiology residents, the top three motivating factors were the same as for medical students. Conclusion Three out of seven motivating factors were universally important to trainees, regardless of their stage of medical training or their selection of a controllable versus uncontrollable lifestyle specialty. These data suggest the variety of career choices made by students may not derive from differing underlying values.

Rationale and Objectives For both airport baggage screeners and radiologists, low target prevalence is associated with low detection rate, a phenomenon known as “prevalence effect.” In airport baggage screening, the target prevalence is artificially increased with fictional weapons that are digitally superimposed on real baggage. This strategy improves the detection rate of real weapons and also allows airport supervisors to monitor screener performance. A similar strategy using fictional patients could be applied in radiology. The purpose of this study was twofold: (1) to review the psychophysics literature regarding low target prevalence and (2) to survey radiologists' attitudes toward using fictional patients as a quality assurance tool. Materials and Methods We reviewed the psychophysics literature on low target prevalence and airport x-ray baggage screeners. An online survey was e-mailed to all members of the Association of University Radiologists to determine their attitudes toward using fictional patients in radiology. Results Of the 1503 Association of University Radiologists member recipients, there were 153 respondents (10% response rate). When asked whether the use of fictional patients was a good idea, the responses were as follows: disagree (44%), neutral (25%), and agree (31%). The most frequent concern was the time taken away from doing clinical work (89% of the respondents). Conclusions The psychophysics literature supports the use of fictional targets to mitigate the prevalence effect. However, the use of fictional patients is not a popular idea among academic radiologists.

© 2017 The Association of University Radiologists Rationale and Objectives Radiology expertise is dependent on the use of efficient search strategies. The aim of this study is to investigate the effect of teaching search strategies on trainee's accuracy in detecting lung nodules at computed tomography. Materials and Methods Two search strategies, “scanning” and “drilling,” were tested with a randomized crossover design. Nineteen junior radiology residents were randomized into two groups. Both groups first completed a baseline lung nodule detection test allowing a free search strategy, followed by a test after scanning instruction and drilling instruction or vice versa. True positive (TP) and false positive (FP) scores and scroll behavior were registered. A mixed-design analysis of variance was applied to compare the three search conditions. Results Search strategy instruction had a significant effect on scroll behavior, F(1.3) = 54.2, P < 0.001; TP score, F(2) = 16.1, P < 0.001; and FP score, F(1.3) = 15.3, P < 0.001. Scanning instruction resulted in significantly lower TP scores than drilling instruction (M = 10.7, SD = 5.0 versus M = 16.3, SD = 5.3), t(18) = 4.78, P < 0.001; or free search (M = 15.3, SD = 4.6), t(18) = 4.44, P < 0.001. TP scores for drilling did not significantly differ from free search. FP scores for drilling (M = 7.3, SD = 5.6) were significantly lower than for free search (M = 12.5, SD = 7.8), t(18) = 4.86, P < 0.001. Conclusions Teaching a drilling strategy is preferable to teaching a scanning strategy for finding lung nodules.

The objective of our study was to assess the frequency and time frame with which CT-guided lung biopsies for suspected infection yield information that can affect patient management.All CT-guided lung biopsies over a 68-month period performed for the purpose of diagnosing a suspected infection were reviewed to determine the proportion that yielded information affecting patient management. Patients were included if infection was the only consideration causing the pulmonary lesion in question.Twenty-one biopsies were performed to identify a specific organism causing infection in patients with suspected infection; all patients were receiving antibiotics, 20 (95%) were immunocompromised, and 15 (71%) had undergone a prior bronchoscopy. Material collected from the biopsy provided a diagnosis in nine (43%) patients, whereas the biopsy results were nondiagnostic in the remaining 12 (57%). Of the nine patients for whom the biopsy yielded a diagnosis, eight biopsies revealed the species causing an infection (38%) and one biopsy (5%) detected posttransplant lymphoproliferative disease. Of the nine diagnoses, management was changed as a result of the biopsy in six patients (29% of all patients). The organisms identified by CT-guided lung biopsy in eight patients were fungi of the order Mucorales (i.e., mucormycosis) (n = 3), Aspergillus (n = 3), Pseudomonas (n = 1), and Nocardia (n = 1). The mean elapsed time between biopsy and pathologic diagnosis was 4 days (median, 3 days). There was no association between prior bronchoscopy and nondiagnostic biopsy results.CT-guided lung biopsies in patients with a high pretest suspicion for infection result in information sufficient to change patient management in 29% of patients. Organisms identified in these patients were most frequently fungi.

Lung cancer, the leading cause of cancer mortality, exhibits heterogeneity that enables adaptability, limits therapeutic success, and remains incompletely understood. Single-cell RNA sequencing (scRNAseq) of metastatic lung cancer was performed using 44 tumor biopsies obtained longitudinally from 27 patients before and during targeted therapy. Over 20,000 cancer and tumor microenvironment (TME) single-cell profiles exposed a rich and dynamic tumor ecosystem. scRNAseq of cancer cells illuminated targetable oncogenes beyond those detected clinically. Cancer cells surviving therapy as residual disease (RD) expressed an alveolar-regenerative cell signature suggesting a therapy-induced primitive cell state transition, whereas those present at on-therapy progressive disease (PD) upregulated kynurenine, plasminogen, and gap junction pathways. Active T-lymphocytes and decreased macrophages were present at RD and immunosuppressive cell states characterized PD. Biological features revealed by scRNAseq were biomarkers of clinical outcomes in independent cohorts. This study highlights how therapy-induced adaptation of the multi-cellular ecosystem of metastatic cancer shapes clinical outcomes.

Summary Lung cancer, the leading cause of cancer mortality, exhibits heterogeneity that enables adaptability, limits therapeutic success, and remains incompletely understood. Single-cell RNA sequencing (scRNA-seq) of metastatic lung cancer was performed using 49 clinical biopsies obtained from 30 patients before and during targeted therapy. Over 20,000 cancer and tumor microenvironment (TME) single-cell profiles exposed a rich and dynamic tumor ecosystem. scRNA-seq of cancer cells illuminated targetable oncogenes beyond those detected clinically. Cancer cells surviving therapy as residual disease (RD) expressed an alveolar-regenerative cell signature suggesting a therapy-induced primitive cell-state transition, whereas those present at on-therapy progressive disease (PD) upregulated kynurenine, plasminogen, and gap-junction pathways. Active T-lymphocytes and decreased macrophages were present at RD and immunosuppressive cell states characterized PD. Biological features revealed by scRNA-seq were biomarkers of clinical outcomes in independent cohorts. This study highlights how therapy-induced adaptation of the multi-cellular ecosystem of metastatic cancer shapes clinical outcomes., Graphical Abstract, Highlights • scRNA-seq is feasible in metastatic human NSCLCs and reveals a rich tumor ecosystem • Individual tumors and cancer cells exhibit substantial molecular diversity • Cancer and tumor microenvironment cells exhibit marked therapy-induced plasticity • scRNA-seq of metastatic NSCLCs unveils new opportunities to improve clinical outcomes, Analysis of metastatic lung cancer biopsies before and after targeted therapy reveals molecular and immune adaptations that shape clinical outcomes.

Left atrial appendage occlusion with the Watchman® device requires pre and post procedure imaging. Currently, transesophageal echocardiography is the recommended modality, though cardiac computed tomography angiography may be an acceptable alternative. Cardiac computed tomography angiography can be used to safely and accurately predict Watchman® device sizing. It can also be used to detect post procedure complications similar to, or better than, transesophageal echocardiography. Cardiac computed tomography angiography is a viable alternative imaging modality for pre and post procedure evaluation for the Watchman device.

Rationale and Objectives With the introduction of new communication channels, such as encrypted messaging and online electronic medical record patient portals, there are ever-increasing ways for patients and their families to access their medical information. While patient preferences regarding how they receive the results of their radiology examinations have been assessed in the adult population, there is limited data on parent preferences for pediatric radiology patients. Materials and Methods The aim of this study was to determine how the parents of pediatric radiology patients prefer to receive the results of their child's imaging studies. The study design was an institutional review board-approved anonymous voluntary survey distributed to parents in a pediatric radiology waiting room. Results Of the current possible ways to receive radiology results, most parents preferred to receive their child's radiology results from the referring doctor (65%). A minority of parents preferred to receive the results from a radiologist in-person (16%) or via the radiology report (16%). In multiple hypothetical scenarios, parents also preferred to receive radiology results from the referring doctor rather than the radiologist, with the single exception being when no subsequent appointment with the referring doctor was planned. When asked to prioritize the most important aspect of receiving radiology test results, most parents prefer having results available quickly (65%). Conclusion This survey suggests that in the pediatric radiology realm, efforts toward timely reporting will likely have a greater impact on patient satisfaction than prioritizing more in-person radiologist-patient communication.

BothForty-one consecutive patients with high-grade gliomas (20 with grade IV gliomas and 21 with grade III gliomas) underwent a standardized tumor protocol performed using an integrated 3-T PET-MRI scanner. Quantitative measures of standardized uptake value, plasma volume, and permeability were obtained from segmented whole-tumor volumes of interest and targeted ROIs. ROC curve analysis and the Youden index were used to identify optimal cutoffs for FDG PET and DCE-MRI. Two-by-two contingency tables and percent agreement were used to assess accuracy and concordance. Twenty-six patients (63%) from the cohort underwent next-generation sequencing for tumor genetics.The best-performing FDG PET and DCE-MRI cutoffs achieved sensitivities of 94% and 91%, respectively; specificities of 56% and 89%, respectively; and accuracies of 80% and 83%, respectively. FDG PET and DCE-MRI findings were discordant for 11 patients (27%), with DCE-MRI findings correct for six of these patients (55%). Tumor grade, tumor volume, bevacizumab exposure, and time since radiation predicted discordance between FDG PET and DCE-MRI findings, with an ROC AUC value of 0.78. Isocitrate dehydrogenase gene and receptor tyrosine kinase gene pathway mutations increased the ROC AUC value to 0.83.FDG PET and DCE-MRI show comparable accuracy and sensitivity in identifying tumor progression. These modalities were shown to have discordant findings for more than a quarter of the patients assessed. Tumor genetics may contribute to perfusion-metabolism discordance, warranting further investigation.

© 2016 Elsevier Inc. Acute lung injury (ALI) is the clinical syndrome associated with histopathologic diffuse alveolar damage. It is a common cause of acute respiratory symptoms and admission to the intensive care unit. Diagnosis of ALI is typically based on clinical and radiographic criteria; however, because these criteria can be nonspecific, diagnostic uncertainty is common. A multidisciplinary approach that synthesizes clinical, imaging, and pathologic data can ensure an accurate diagnosis. Radiologists must be aware of the radiographic and computed tomographic findings of ALI and its mimics. This article discusses the multidisciplinary diagnosis of ALI from the perspective of the imager.

© 2016 The Association of University Radiologists Rationale and Objectives We aimed to evaluate whether implementation of a low-dose computed tomography (CT)-guided lung biopsy protocol, with the support of individual radiologists in the section, would lead to immediate and sustained decreases in radiation dose associated with CT-guided lung biopsies. Materials and Methods A low-dose CT-guided lung biopsy protocol was developed with modifications of kilovoltage peak, milliamperes, and scan coverage. Out of 413 CT-guided lung biopsies evaluated over a 3-year period beginning in 2009, 175 performed with a standard protocol before the development of a low-dose protocol, and 238 performed with a low-dose protocol. The dose-length product (DLP) was recorded for each lung biopsy and retrospectively compared between the two protocols. Individual radiologist level DLPs were also compared before and after the protocol change. Results The mean biopsy dose decreased by 64.4% with the low-dose protocol (113.8 milligray centimeters versus 319.7 milligray centimeters; P

Rationale and Objectives This study aimed to determine the degree of involvement of radiologists in ultrasound education in medical schools in the United States. Materials and Methods An online survey was sent to 129 directors of medical student education in radiology, identified by the Alliance of Medical Student Educators in Radiology. Each survey recipient represented a unique medical school. Results There was a 31% survey completion rate. Radiology education was incorporated into the majority of respondents' medical school curricula (95%). Ultrasound images were used in preclinical education in the majority of schools (76%). Students were trained to perform hands-on ultrasound examinations in half of schools (49%), and a minority of schools offered a dedicated point-of-care ultrasound elective (14%). Radiology and emergency medicine were the most involved departments in teaching ultrasound to medical students (88% and 75% of medical schools, respectively). Conclusions Ultrasound imaging was incorporated into the curricula of most of the responding medical schools, although actual hands-on training was less widespread.

© 2016, Springer Science+Business Media Dordrecht. To evaluate the association between aortic morphology and elasticity with aortic regurgitation in surgically corrected of tetralogy of Fallot (TOF) patients. We retrospectively identified 72 consecutive patients with surgically corrected TOF and 27 healthy controls who underwent cardiac MRI evaluation. Velocity-encoded cine MRI was used to quantify degree of aortic regurgitation (AR) in TOF patients. Ascending aorta diameters were measured at standard levels on MRA images. Aortic pulse-wave velocity (PWV) was quantified with MRI. Morphological and functional MRI variables were compared between groups of TOF patients with and without clinically relevant AR and controls. The association between aortic morphology and elasticity with the presence of AR was evaluated using univariate and multivariate logistic regression. The majority of TOF patients had only trace AR. Nine TOF patients (12 %) had an AR fraction higher than 15 %. Indexed aorta diameter at the sinotubular junction (p = 0.007), at the RPA level (p = 0.006), and low left ventricular ejection fraction (LVEF) (p = 0.015) showed the strongest associations with the presence of at least mild AR, which persisted after controlling for age and gender. Increased ascending aorta dimension is associated with AR in patients after repair of TOF. LVEF was also low in the group of patients with relevant AR compared to those without, suggesting even mild to moderate AR may contribute to LV dysfunction in these patients. Enlarged ascending aorta may be an indication for precise quantification of regurgitant fraction with MRI, since symptomatic patients may need aortic valve repair when moderate regurgitation is present.

Transthoracic needle biopsy (TTNB) is a common diagnostic tool with expanding clinical indications. While most literature on this topic has focused on complications and techniques, this review will examine the evidence for periprocedural care specific to lung biopsy. Review of the literature reveals great heterogeneity in clinical practice regarding periprocedural management of TTNB, for example, in terms of post-procedural monitoring as well as strategies for dealing with potential complications of TTNB. This is on the basis of a relative paucity of systematic clinical studies to guide management specific to the procedure. Further studies focused on periprocedural management in TTNB are needed to establish evidence-based guidelines that address the unique clinical aspects and complications of this procedure.

About 30% of all chest computed tomography (CT) scans contain one or more pulmonary nodules.[1][1] Larger nodules can also be seen on chest radiographs.[2][2] The most common cause of a pulmonary nodule is a previous infection. Other benign entities include active infection and hamartomas.[2][2]

Rationale and Objectives: Medical imaging education often has limited representation in formal medical student curricula. Although the need for greater inclusion of radiology material is generally agreed on, the exact skillset that should be taught is less clear. The purpose of our study was to perform a needs assessment for a national radiology curriculum for medical students. Materials and Methods: We analyzed data from previous unpublished portions of the American College of Radiology/Alliance of Medical Student Educators in Radiology survey of Deans and Radiology Chairs regarding prevalence of radiology curricular revisions, assessment tools, use of the American College of Radiology Appropriateness Criteria, and resources used in curriculum revision. We also performed a literature search through both PubMED and a general search engine (Google) to identify available resources for designing and implementing imaging curricula and curricular revisions. Results: Medical school deans and chairs reported a need for more overall radiology content; one of every six programs (15%) reported they had no recognized imaging curriculum. Of schools currently with imaging curricula, 82% have undergone revision in the last 10 years using a variety of different resources, but there is no universally agreed on guide or standard curriculum. The PubMED and Google searches identified only 23 and eight resources, respectively, suggesting a sizable deficit in available guidance; however, a single published medical student radiology curriculum is available through the Alliance of Medical Student Educators in Radiology. Conclusions: There is a need, but few available resources, to guide educators in adding imaging content to medical school curricula. We postulate that a standardized national curriculum directed by a focused skillset may be useful to educators and could result in greater uniformity of imaging skills among graduating US medical students. A proposed skillset to guide a national curriculum in radiology is described.

Rationale and Objectives Studies show that problems with interprofessional collaboration can result in adverse patient outcomes. These problems are common in the field of radiology, where technology has decreased opportunities for direct communication and collaboration with referring physicians. To our knowledge, critical reflection has not been studied as an intervention to better understand one's own and/or others' roles in the context of an interprofessional team, or more specifically, to improve interprofessional collaboration between radiologists and other physicians. Materials and Methods We trialed a reflective journaling assignment in our fourth year medical student general radiology elective. Student journal content was scored by percentage of comments reflecting on elective experiences versus recounting events. Content was categorized as “reflection” using an established measurement tool. Reflective content was evaluated to identify common themes. Results A total of 31 journals (178 entries and 26,749 words) were analyzed. Reflective content accounted for 43% of overall content and was subdivided into three categories: insight into one's own role and responsibilities as an ordering physician (20%), insight into a radiologist's role and responsibilities (12%), and thoughts on improving interprofessional collaboration with radiologists (11%). Conclusions Reflective writing allows students to explore their own role and responsibilities in the context of an interprofessional team and may improve interprofessional teamwork with radiologists.

© American Roentgen Ray Society. OBJECTIVE. Cost-effectiveness analyses (CEAs) contribute to informed decision making, at both the practitioner and societal levels; therefore, understanding CEAs is valuable for radiologists. In light of the recently published National Lung Cancer Screening Trial (NLST) CEA, we aim to explain the terminology, methods, and heterogeneity of CEAs. CONCLUSION. We compared the NLST results to two example lung cancer screening CEAs (which do not rely on NLST data). Both examples assessed screening but reached substantially different conclusions

Rationale and Objectives: There are little data as to whether appropriate, cost effective, and safe ordering of imaging examinations are adequately taught in US medical school curricula. We sought to determine the proportion of noninterpretive content (such as appropriate ordering) versus interpretive content (such as reading a chest x-ray) in the top-selling medical student radiology textbooks. Materials and Methods: Weperformedanonlinesearchto identifya rankedlistofthesix top-selling generalradiology textbooksfor medical students. Each textbook was reviewed including content in the text, tables, images, figures, appendices, practice questions, question explanations, and glossaries. Individual pages of text and individual images were semiquantitatively scored on a six-level scale as to the percentage of material that was interpretive versus noninterpretive. The predominant imaging modality addressed in each was also recorded. Descriptive statistical analysis was performed. Results: All six books had more interpretive content. On average, 1.4 pages of text focused on interpretation for every one page focused on noninterpretive content. Seventeen images/figures were dedicated to interpretive skills for every one focused on noninterpretive skills. In all books, the largest proportion of text and image content was dedicated to plain films (51.2%), with computed tomography (CT) a distant second (16%). The content on radiographs (3.1:1) and CT (1.6:1) was more interpretive than not. Conclusions: The current six top-selling medical student radiology textbooks contain a preponderance of material teaching image interpretation compared to material teaching noninterpretive skills, such as appropriate imaging examination selection, rational utilization, and patient safety.

PET and magnetic resonance (MR) imaging have each become essential tools in the workup and management of cardiac patients. Combined PET/MR systems have recently been developed, allowing for single-session imaging using both modalities. This new technology holds great promise for cardiac applications given the different, yet complementary, information each modality provides. Research in this area is still nascent, although early studies have been promising.

For both airport baggage screeners and radiologists, low target prevalence is associated with low detection rate, a phenomenon known as "prevalence effect." In airport baggage screening, the target prevalence is artificially increased with fictional weapons that are digitally superimposed on real baggage. This strategy improves the detection rate of real weapons and also allows airport supervisors to monitor screener performance. A similar strategy using fictional patients could be applied in radiology. The purpose of this study was twofold: (1) to review the psychophysics literature regarding low target prevalence and (2) to survey radiologists' attitudes toward using fictional patients as a quality assurance tool.We reviewed the psychophysics literature on low target prevalence and airport x-ray baggage screeners. An online survey was e-mailed to all members of the Association of University Radiologists to determine their attitudes toward using fictional patients in radiology.Of the 1503 Association of University Radiologists member recipients, there were 153 respondents (10% response rate). When asked whether the use of fictional patients was a good idea, the responses were as follows: disagree (44%), neutral (25%), and agree (31%). The most frequent concern was the time taken away from doing clinical work (89% of the respondents).The psychophysics literature supports the use of fictional targets to mitigate the prevalence effect. However, the use of fictional patients is not a popular idea among academic radiologists.

Purpose: Integrated interventional radiology (IR) residencies recently underwent their second year in the match, the first year of which involved only a limited number of programs. Now that students can choose to enter IR directly, student perceptions of IR vs diagnostic radiology (DR) are of paramount importance. Methods: We surveyed first- through fourth-year medical students and radiology residents regarding interest in IR vs DR. Results: Students considering a radiological career expressed more interest in IR than DR. Conversely, residents expressed more interest in DR. Conclusions: Medical student advisors and IR programs should continue to anticipate a high number of applications for integrated IR positions.

PurposeComputed tomography (CT) use in emergency departments represents a significant contribution to pediatric patients' exposure to ionizing radiation. Here, we evaluate whether ultralow-dose chest CT can be diagnostically adequate for other diagnoses and whether model-based iterative reconstruction (MBIR) can improve diagnostic adequacy compared to adaptive statistical iterative reconstruction (ASIR) at ultralow doses.MethodsTwenty children underwent chest CTs: 10 standard-dose reconstructed with ASIR and 10 ultralow-dose reconstructed with ASIR and MBIR. Four radiologists assessed images for their adequacy to exclude five hypothetical diagnoses: foreign body, fracture, lung metastasis, pulmonary infection, and interstitial lung disease. Additionally, pairwise comparison for subjective image quality was used to compare ultralow-dose chest CT with ASIR and MBIR. Radiation dose and objective image noise measures were obtained.ResultsFor exclusion of an airway foreign body, the adequacy of ultralow-dose CT was comparable to standard-dose (p=0.6). For the remaining diagnoses, ultralow-dose CT was inferior to standard-dose (p=0.03

Rationale and Objectives Modern radiology clerkships require a rigorous, in-depth curriculum usually involving a variety of educational activities. With increasingly constrained faculty time and departmental resources, finding activities that are easy to implement and of high educational value can be a challenge. Materials and Methods We introduced a novel educational activity to our radiology clerkship in which students created independent learning modules (ILMs) that were reviewed by their classmates. Feedback surveys were used to assess the activity and guide a revision to the program. Feedback surveys after the revision were used to assess the overall perceived value of the program. Results Twenty-seven students in two successive sessions of our elective radiology clerkship completed the ILM activity and provided feedback. Sixty-four students in five subsequent sessions completed a modified version of the activity and provided feedback. Students in this final group rated the activity's educational value at 8.3/10, with most describing both the creation and reviewing of the ILMs as similarly or more educationally valuable than lectures (41 of 64 [64%], 48 of 64 [75%], respectively). Students indicated the target ILM length of 15 minutes was “about right” (61 of 64 [95%]), and that the overall proportion of the course dedicated to the ILM activity was appropriate (49 of 64 [77%]). Conclusions A novel student-created ILM activity was highly reviewed by radiology elective students, both with regard to the educational value of creating and taking the ILMs. Clerkship directors wishing to supplement their curricula with an easy-to-implement high-value activity may consider adding a student-created ILM assignment.

Rationale and Objectives Ultrasound is used increasingly in medical practice as a tool for focused bedside diagnosis and technical assistance during procedures. Widespread availability of small portable units has put this technology into the hands of many physicians and medical students who lack dedicated training, leaving the education and introduction of this key modality increasingly to physicians from other specialties. We developed a radiology-led program to teach ultrasound skills to preclinical medical students. Materials and Methods To develop this new ultrasound program we 1) established a program leader, 2) developed teaching materials, 3) created a hands-on interactive program, and 4) recruited the necessary instructors. The program was piloted with the first-year medical student class of 154 students. The introductory session was assessed by pre- and post-activity Likert scale–based surveys. Results Of 154 (68.8%) students, 106 completed a voluntary online survey before starting the program and 145 students (94.2%) completed a voluntary survey after the session. Students found the program educationally valuable (4.64 of 5) and reported that it improved their understanding of ultrasound imaging (4.7 of 5). Students' reported confidence in identifying abdominal organs, intra-abdominal fluid, and Morison pouch that was significantly higher on the postactivity survey compared to the presurvey ( P Conclusions We piloted a radiology-led program to teach ultrasound skills to preclinical medical students. Students found the experience enjoyable and educationally valuable.

Rationale and Objectives Most fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography with computed tomography (PET/CT) studies are performed on cancer patients. These patients are at increased risk of pulmonary embolism (PE). In this retrospective review, we determined the rate of PE, and the prevalence of associated FDG-PET findings on intravenous (IV) contrast-enhanced PET/CT. Materials and Methods We identified all PET/CT studies performed at our institution with a reported finding of PE between January 2005 and October 2012. The medical record was reviewed for symptoms, which were identified after the diagnosis of PE, and whether the patients received treatment. The prevalence of associated FDG-PET findings was determined. Results A total of 65 total cases of PE (of 182,72 total PET/CT examinations) were identified of which 59 were previously unknown. This gives an incidental PE (IPE) rate of 0.32%. Of the patients where sufficient clinical information was available, 34 of 36 (94%) were treated either with therapeutic anticoagulation or inferior vena cava filter, and 30 of 36 (83%) were asymptomatic in retrospect. Of the patients with IPE, we found nine (15.2%) with associated focal pulmonary artery hypermetabolism, three (5.1%) with hypermetabolic pulmonary infarction, and one with increased isolated right ventricular FDG uptake (1.7%). One case of chronic PE demonstrated a focal hypometabolic filling defect in a pulmonary artery on PET. Conclusions We found IPE in 0.32% of PET/CT scans. Focal pulmonary artery hypermetabolism or hypometabolism, and hypermetabolic pulmonary artery infarction with the “rim sign” were uncommonly associated with PE. These findings could raise the possibility of IPE in non-IV contrast-enhanced PET/CT studies.