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Publisher: Elsevier   (Total: 3031 journals)

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Showing 1 - 200 of 3031 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 302, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 195, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 119, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 303, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 389, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 48, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 173, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 152, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 141, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Academic Radiology
  [SJR: 1.008]   [H-I: 75]   [16 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1076-6332
   Published by Elsevier Homepage  [3031 journals]
  • Lung Mass as the Complement to Lung Air Content in Quantitative CT of the
           COPD Lung
    • Authors: Eric A. Hoffman; John D. Newell
      Pages: 383 - 385
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Eric A. Hoffman, John D. Newell


      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2017.01.016
       
  • Lung Mass in Smokers
    • Authors: George R. Washko; Gregory L. Kinney; James C. Ross; Raúl San José Estépar; MeiLan K. Han; Mark T. Dransfield; Victor Kim; Hiroto Hatabu; Carolyn E. Come; Russell P. Bowler; Edwin K. Silverman; James Crapo; David A. Lynch; John Hokanson; Alejandro A. Diaz
      Pages: 386 - 392
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): George R. Washko, Gregory L. Kinney, James C. Ross, Raúl San José Estépar, MeiLan K. Han, Mark T. Dransfield, Victor Kim, Hiroto Hatabu, Carolyn E. Come, Russell P. Bowler, Edwin K. Silverman, James Crapo, David A. Lynch, John Hokanson, Alejandro A. Diaz
      Rationale and Objective Emphysema is characterized by airspace dilation, inflammation, and irregular deposition of elastin and collagen in the interstitium. Computed tomographic studies have reported that lung mass (LM) may be increased in smokers, a finding attributed to inflammatory and parenchymal remodeling processes observed on histopathology. We sought to examine the epidemiologic and clinical associations of LM in smokers. Materials and Methods Baseline epidemiologic, clinical, and computed tomography (CT) data (n = 8156) from smokers enrolled into the COPDGene Study were analyzed. LM was calculated from the CT scan. Changes in lung function at 5 years' follow-up were available from 1623 subjects. Regression analysis was performed to assess for associations of LM with forced expiratory volume in 1 second (FEV1) and FEV1 decline. Results Subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 chronic obstructive pulmonary disease had greater LM than either smokers with normal lung function or those with GOLD 2–4 chronic obstructive pulmonary disease (P < 0.001 for both comparisons). LM was predictive of the rate of the decline in FEV1 (decline per 100 g, −4.7 ± 1.7 mL/y, P = 0.006). Conclusions Our cross-sectional data suggest the presence of a biphasic radiological remodeling process in smokers: the presence of such nonlinearity must be accounted for in longitudinal computed tomographic studies. Baseline LM predicts the decline in lung function.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.10.011
       
  • Time-Resolved Quantitative Analysis of the Diaphragms During Tidal
           Breathing in a Standing Position Using Dynamic Chest Radiography with a
           Flat Panel Detector System (“Dynamic X-Ray Phrenicography”)
    • Authors: Yoshitake Yamada; Masako Ueyama; Takehiko Abe; Tetsuro Araki; Takayuki Abe; Mizuki Nishino; Masahiro Jinzaki; Hiroto Hatabu; Shoji Kudoh
      Pages: 393 - 400
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Yoshitake Yamada, Masako Ueyama, Takehiko Abe, Tetsuro Araki, Takayuki Abe, Mizuki Nishino, Masahiro Jinzaki, Hiroto Hatabu, Shoji Kudoh
      Rationale and Objectives Diaphragmatic motion in a standing position during tidal breathing remains unclear. The purpose of this observational study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants' demographic characteristics. Materials and Methods One hundred seventy-two subjects (103 men; aged 56.3 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions of and peak motion speeds of the diaphragms. Associations between the excursions and participants' demographics (gender, height, weight, body mass index [BMI], smoking history, tidal volume, vital capacity, and forced expiratory volume) were investigated. Results The average excursion of the left diaphragm (14.9 ± 4.6 mm, 95% CI 14.2–15.5 mm) was significantly larger than that of the right (11.0 ± 4.0 mm, 95% CI 10.4–11.6 mm) (P < 0.001). The peak motion speed of the left diaphragm (inspiratory, 16.6 ± 4.2 mm/s; expiratory, 13.7 ± 4.2 mm/s) was significantly faster than that of the right (inspiratory, 12.4 ± 4.4 mm/s; expiratory, 9.4 ± 3.8 mm/s) (both P < 0.001). Both simple and multiple regression models demonstrated that higher BMI and higher tidal volume were associated with increased excursions of the bilateral diaphragm (all P < 0.05). Conclusions The average excursions of the diaphragms are 11.0 mm (right) and 14.9 mm (left) during tidal breathing in a standing position. The diaphragmatic motion of the left is significantly larger and faster than that of the right. Higher BMI and tidal volume are associated with increased excursions of the bilateral diaphragm.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.014
       
  • Screening Breast MRI Outcomes in Routine Clinical Practice
    • Authors: Roberta M. Strigel; Jennifer Rollenhagen; Elizabeth S. Burnside; Mai Elezaby; Amy M. Fowler; Frederick Kelcz; Lonie Salkowski; Wendy B. DeMartini
      Pages: 411 - 417
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Roberta M. Strigel, Jennifer Rollenhagen, Elizabeth S. Burnside, Mai Elezaby, Amy M. Fowler, Frederick Kelcz, Lonie Salkowski, Wendy B. DeMartini
      Rationale and Objectives The BI-RADS Atlas 5th Edition includes screening breast magnetic resonance imaging (MRI) outcome benchmarks. However, the metrics are from expert practices and clinical trials of women with hereditary breast cancer predispositions, and it is unknown if they are appropriate for routine practice. We evaluated screening breast MRI audit outcomes in routine practice across a spectrum of elevated risk patients. Materials and Methods This Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all consecutive screening breast MRI examinations from July 1, 2010 to June 30, 2013. Examination indications were categorized as gene mutation carrier (GMC), personal history (PH) breast cancer, family history (FH) breast cancer, chest radiation, and atypia/lobular carcinoma in situ (LCIS). Outcomes were determined by pathology and/or ≥12 months clinical and/or imaging follow-up. We calculated abnormal interpretation rate (AIR), cancer detection rate (CDR), positive predictive value of recommendation for tissue diagnosis (PPV2) and biopsy performed (PPV3), and median size and percentage of node-negative invasive cancers. Results Eight hundred and sixty examinations were performed in 566 patients with a mean age of 47 years. Indications were 367 of 860 (42.7%) FH, 365 of 860 (42.4%) PH, 106 of 860 (12.3%) GMC, 14 of 860 (1.6%) chest radiation, and 8 of 22 (0.9%) atypia/LCIS. The AIR was 134 of 860 (15.6%). Nineteen cancers were identified (13 invasive, 4 DCIS, two lymph nodes), resulting in CDR of 19 of 860 (22.1 per 1000), PPV2 of 19 of 88 (21.6%), and PPV3 of 19 of 80 (23.8%). Of 13 invasive breast cancers, median size was 10 mm, and 8 of 13 were node negative (61.5%). Conclusions Performance outcomes of screening breast MRI in routine clinical practice across a spectrum of elevated risk patients met the American College of Radiology Breast Imaging Reporting and Data System benchmarks, supporting broad application of these metrics. The indication of a personal history of treated breast cancer accounted for a large proportion (42%) of our screening examinations, with breast MRI performance in this population at least comparable to that of other screening indications.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.10.014
       
  • Comparison and Optimization of 3.0 T Breast Images Quality of
           Diffusion-Weighted Imaging with Multiple B-Values
    • Authors: Xiaowei Han; Junfeng Li; Xiaoyi Wang
      Pages: 418 - 425
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Xiaowei Han, Junfeng Li, Xiaoyi Wang
      Rationale and Objectives Breast 3.0 T magnetic resonance diffusion-weighted imaging (MR-DWI) of benign and malignant lesions were obtained to measure and calculate the signal-to-noise ratio (SNR), signal intensity ratio (SIR), and contrast-to-noise ratio (CNR) of lesions at different b-values. The variation patterns of SNR and SIR were analyzed with different b-values and the images of DWI were compared at four different b-values with higher image quality. The effect of SIR on the differential diagnostic efficiency of benign and malignant lesions was compared using receiver operating characteristic curves to provide a reference for selecting the optimal b-value. Materials and Methods A total of 96 qualified patients with 112 lesions and 14 patients with their contralateral 14 normal breasts were included in this study. The single-shot echo planar imaging sequence was used to perform the DWI and a total of 13 b-values were used: 0, 50, 100, 200, 400, 600, 800, 1000, 1200, 1500, 1800, 2000, and 2500 s/mm2. On DWI, the suitable regions of interest were selected. The SNRs of normal breasts (SNRnormal), SNRlesions, SIR, and CNR of benign and malignant lesions were measured on DWI with different b-values and calculated. The variation patterns of SNR, SIR, and CNR values on DWI for normal breasts, benign lesions, and malignant lesions with different b-values were analyzed by using Pearson correlation analysis. The SNR and SIR of benign and malignant lesions with the same b-values were compared using t-tests. The diagnostic efficiencies of SIR with different b-values for benign and malignant lesions were evaluated using receiver operating characteristic curves. Results Breast DWI had higher CNR for b-values ranging from 600 to 1200 s/mm2. It had the best CNR at b = 1000 s/mm2 for the benign lesions and at b = 1200 s/mm2 for the malignant lesions. The signal intensity and SNR values of normal breasts decreased with increasing b-values, with a negative correlation (r = −0.945, P < 0.01). The mean SNR values of benign and malignant lesions were negatively correlated (r = −0.982 and −0.947, respectively, and P < 0.01), gradually decreasing with increasing b-values. The mean SIR value of benign lesions gradually decreased with increasing b-values, a negative correlation (r = −0.991, P < 0.01). The mean SIR values of malignant lesions gradually increased with increasing b-values between 0 and 1200 s/mm2, and gradually decreased with increasing b-values ≥ 1500 s/mm2. For b-values of 600, 800, 1000, and 1200 s/mm2, the sensitivity and specificity of SIR in identifying benign and malignant lesions gradually increased with increasing b-values, peaking at 1200 s/mm2. Conclusions Breast DWI had higher image quality for b-values ranging from 600 to 1200 s/mm2, and was best for b-values ranging from 1000 to 1200 s/mm2. The SIR had the highest diagnostic efficiency in differentiating benign and malignant lesions for a b-value of 1200 s/mm2.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.006
       
  • Association Between Imaging Characteristics and Different Molecular
           Subtypes of Breast Cancer
    • Authors: Mingxiang Wu; Jie Ma
      Pages: 426 - 434
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Mingxiang Wu, Jie Ma
      Rationale and Objective Breast cancer can be divided into four major molecular subtypes based on the expression of hormone receptor (estrogen receptor and progesterone receptor), human epidermal growth factor receptor 2, HER2 status, and molecular proliferation rate (Ki67). In this study, we sought to investigate the association between breast cancer subtype and radiological findings in the Chinese population. Materials and Methods Medical records of 300 consecutive invasive breast cancer patients were reviewed from the database: the Breast Imaging Reporting and Data System. The imaging characteristics of the lesions were evaluated. The molecular subtypes of breast cancer were classified into four types: luminal A, luminal B, HER2 overexpressed (HER2), and basal-like breast cancer (BLBC). Univariate and multivariate logistic regression analyses were performed to assess the association between the subtype (dependent variable) and mammography or 15 magnetic resonance imaging (MRI) indicators (independent variables). Results Luminal A and B subtypes were commonly associated with “clustered calcification distribution,” “nipple invasion,” or “skin invasion” (P < 0.05). The BLBC subtype was more commonly associated with “rim enhancement” and persistent inflow type enhancement in delayed phase (P < 0.05). HER2 overexpressed cancers showed association with persistent enhancement in the delayed phase on MRI and “clustered calcification distribution” on mammography (P < 0.05). Conclusion Certain radiological features are strongly associated with the molecular subtype and hormone receptor status of breast tumor, which are potentially useful tools in the diagnosis and subtyping of breast cancer.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.012
       
  • Prevalence and Predictive Value of BI-RADS 3, 4, and 5 Lesions Detected on
           Breast MRI
    • Authors: Sona A. Chikarmane; Ryan Tai; Jack E. Meyer; Catherine S. Giess
      Pages: 435 - 441
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Sona A. Chikarmane, Ryan Tai, Jack E. Meyer, Catherine S. Giess
      Rationale and Objectives This study aims to determine the prevalence and predictive value of Breast Imaging Reporting and Data System (BI-RADS) 3, 4, and 5 findings on breast magnetic resonance imaging (MRI) and to evaluate the impact of study indication on the predictive value of BI-RADS categories. Materials and Methods This institutional review board approved, Health Insurance Portability and Accountability Act (HIPAA) compliant retrospective review of our breast MRI database from 2009 to 2011, of 5778 contrast-enhanced studies in 3360 patients was performed. At our institution, each breast receives an individual BI-RADS assessment. Breast MRI reports and electronic medical records were reviewed to obtain BI-RADS assessment, patient demographics, and outcomes. Univariate analysis was performed with Fisher exact and chi-square tests. Results A total of 9216 BI-RADS assessments were assigned during the study period: 7879 (85.5%) BI-RADS 1 and 2, 567 (6.2%) BI-RADS 3, 715 (7.8%) BI-RADS 4, and 55 (0.6%) BI-RADS 5 assessments. The frequency of BI-RADS 3, 4, and 5 assessments was higher in studies performed for diagnostic (7.8%, 14.6%, 1.6%, respectively) than screening (5.2%, 4.0%, 0.1%) indications (P < 0.01). A total of 663 BI-RADS 4 and 5 lesions were biopsied with 209 (31.5%) malignant and 454 (68.5%) benign outcomes. The overall cancer rate for BI-RADS 3 findings was 1.9% (11 of 567) with no difference observed by study indication (diagnostic, 1.6%; screening, 2.3%; P = 0.76). The positive predictive value (PPV2) of BI-RADS 4 and 5 was higher for diagnostic (29.1%, 154 of 530) than for screening (22.9%, 55 of 240) indications. Conclusions Abnormal interpretation rates and PPV2 for MRIs performed for diagnostic indications are higher than for screening indications. Similar to mammography, breast MRI audits should be separated by study indication.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.008
       
  • Fixated and Not Fixated Regions of Mammograms
    • Authors: Suneeta Mall; Patrick Brennan; Claudia Mello-Thoms
      Pages: 442 - 455
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Suneeta Mall, Patrick Brennan, Claudia Mello-Thoms
      Rationale and Objectives Visual search is an inhomogeneous yet efficient sampling process accomplished by the saccades and the central (foveal) vision. Areas that attract the central vision have been studied for errors in interpretation of medical imaging. In this study, we extend existing visual search studies to understand what characterizes areas that receive direct visual attention and elicit a mark by the radiologist (True and False Positive decisions) from those that elicit a mark but were captured by the peripheral vision. We also investigate if there are any differences between these areas and those that are never fixated by radiologists. Materials and Methods Eight radiologists participated in this fully crossed multi-reader multi-case visual search study of digital mammography (DM) involving 120 two-view cases (59 cancers). From these DM images, 3 types of areas, namely Fixated Clusters (FC), Marked Peripherally Fixated Clusters (MPFC) and Never Fixated Clusters (NFC), were extracted and analysed using statistical information theory (in the form of third and fourth-order cumulants and polyspectrum [specifically bispectrum and trispectrum]) in addition to traditional second-order statistics (in the form of power spectrum) and other nonspectral features to characterize these types of areas. Results Our results suggest that energy profiles of FC, MPFC, and NFC areas are distinct. We found evidence that energy profiles and dwell time of these areas influence radiologists' decisions (and confidence in such decisions). We also noted that foveated areas are selected on the basis of being most informative. Conclusion We show that properties of these areas influence radiologists' decisions and their confidence in the decisions made.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.020
       
  • The Use of High-Risk Criteria in Screening Patients for Blunt
           Cerebrovascular Injury
    • Authors: Xiao Wu; Ajay Malhotra; Howard P. Forman; Diego Nunez; Pina Sanelli
      Pages: 456 - 461
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Xiao Wu, Ajay Malhotra, Howard P. Forman, Diego Nunez, Pina Sanelli
      Rationale and Objectives Blunt cerebrovascular injury (BCVI) is uncommon, but delayed detection can have disastrous consequences. The Denver criteria are the most commonly used screening criteria. We aim to examine the utilization of screening criteria in the emergency department (ED) of our institution and assess whether patients with risk factors were imaged. Materials and Methods A survey questionnaire was sent out to radiologists in a large academic institution. A search was performed in the database on the use of CT angiography (CTA) and MR angiography (MRA) among patients with risk factors in the last 11 years. Results The survey was sent to 173 radiologists, with 41 responses (35 complete). Most of the physicians (30 out of 35) surveyed selected CTA as their preferred modality to screen for BCVI, whereas the remaining physicians selected MRA. None of the respondents reported routine use of Denver screening criteria or grading scale in their readouts. Only five respondents selected risk factors in the Denver criteria correctly. In the institution search, among the 1331 patients with blunt trauma and risk factors for BCVI, 537 underwent at least one angiographic study (40.3%). There was an increase in the screening rate after February 2010 in all risk factors, but only statistically significant among patients with foramen transversarium fractures and C1–C3 fractures. Conclusions Both the Denver screening criteria and grading scale of vascular injury have been underutilized in the ED for patients with risk factors. Greater awareness and utilization of imaging can potentially result in decreased incidence of subsequent stroke in patients with blunt injury.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.010
       
  • Improving Image Quality of Coronary Computed Tomography Angiography Using
           Patient Weight and Height-Dependent Scan Trigger Threshold
    • Authors: Deqiang Kang; Haiqin Hua; Nan Peng; Jing Zhao; Zhiqun Wang
      Pages: 462 - 469
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Deqiang Kang, Haiqin Hua, Nan Peng, Jing Zhao, Zhiqun Wang
      Rationale and Objectives We aim to improve the image quality of coronary computed tomography angiography (CCTA) by using personalized weight and height-dependent scan trigger threshold. Materials and Methods This study was divided into two parts. First, we performed and analyzed the 100 scheduled CCTA data, which were acquired by using body mass index-dependent Smart Prep sequence (trigger threshold ranged from 80 Hu to 250 Hu based on body mass index). By identifying the cases of high quality image, a linear regression equation was established to determine the correlation among the Smart Prep threshold, height, and body weight. Furthermore, a quick search table was generated for weight and height-dependent Smart Prep threshold in CCTA scan. Second, to evaluate the effectiveness of the new individual threshold method, an additional 100 consecutive patients were divided into two groups: individualized group (n = 50) with weight and height-dependent threshold and control group (n = 50) with the conventional constant threshold of 150 HU. Image quality was compared between the two groups by measuring the enhancement in coronary artery, aorta, left and right ventricle, and inferior vena cava. By visual inspection, image quality scores were performed to compare between the two groups. Results Regression equation between Smart Prep threshold (K, Hu), height (H, cm), and body weight (BW, kg) was K = 0.811 × H + 1.917 × BW − 99.341. When compared to the control group, the individualized group presented an average overall increase of 12.30% in enhancement in left main coronary artery, 12.94% in proximal right coronary artery, and 10.6% in aorta. Correspondingly, the contrast-to-noise ratios increased by 26.03%, 27.08%, and 23.17%, respectively, and by 633.1% in contrast between aorta and left ventricle. Meanwhile, the individualized group showed an average overall decrease of 22.7% in enhancement of right ventricle and 32.7% in inferior vena cava. There was no significant difference of the image noise between the two groups (P > .05). By visual inspection, the image quality score of the individualized group was higher than that of the control group. Conclusion Using personalized weight and height-dependent Smart Prep threshold to adjust scan trigger time can significantly improve the image quality of CCTA.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.013
       
  • Monitoring Disease Activity in Patients with Aortitis and Chronic
           Periaortitis Undergoing Immunosuppressive Therapy by Perfusion CT
    • Authors: Georg Bier; Mustafa Kurucay; Jörg Henes; Theodoros Xenitidis; Heike Preibsch; Konstantin Nikolaou; Marius Horger
      Pages: 470 - 477
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Georg Bier, Mustafa Kurucay, Jörg Henes, Theodoros Xenitidis, Heike Preibsch, Konstantin Nikolaou, Marius Horger
      Rationale and Objectives To evaluate the role of perfusion CT for monitoring inflammatory activity in patients with aortitis and chronic periaortitis undergoing immunosuppressive therapy. Materials and Methods Seventeen symptomatic patients (median age 68.5 years) who underwent perfusion-based computed tomography (CT) monitoring after diagnostic contrast-enhanced CT were retrospectively included in this study. Blood flow (BF), blood volume (BV), volume transfer constant (k-trans), time to peak, and mean transit time were determined by setting circular regions of interest in prominently thickened parts of the vessel wall or perfused surrounding tissue at sites where the perfusion CT color maps showed a maximum BF value. Differences in CT perfusion and, morphological parameters, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were tested for significance during therapy. Results In all patients BF and BV dropped at second perfusion CT (P < 0.05). In aortitis patients, CRP dropped from 3.86 ± 5.31 mg/dL to 0.9 ± 1.37 mg/dL and in periaortitis patients from 1.78 ± 2.25 mg/dL to 0.79 ± 1.55 mg/dL, whereas ESR dropped from 45.71 ± 37.59 seconds to 8.57 ± 3.1 seconds and 36.78 ± 34.67 seconds to 17.22 ± 21.82 seconds in aortitis and in periaortitis, respectively. Conclusions The course of perfusion CT parameters in aortitis and chronic periaortitis undergoing immunosuppressive therapy dropped at different extent after therapy.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.10.013
       
  • Clinical Application of Dual-Energy Spectral Computed Tomography in
           Detecting Cholesterol Gallstones From Surrounding Bile
    • Authors: Chuang-bo Yang; Shuang Zhang; Yong-jun Jia; Hai-feng Duan; Guang-ming Ma; Xi-rong Zhang; Yong Yu; Tai-ping He
      Pages: 478 - 482
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Chuang-bo Yang, Shuang Zhang, Yong-jun Jia, Hai-feng Duan, Guang-ming Ma, Xi-rong Zhang, Yong Yu, Tai-ping He
      Rationale and Objective This study aimed to investigate the clinical value of spectral computed tomography (CT) in the detection of cholesterol gallstones from surrounding bile. Materials and Methods This study was approved by the institutional review board. The unenhanced spectral CT data of 24 patients who had surgically confirmed cholesterol gallstones were analyzed. Lipid concentrations and CT numbers were measured from fat-based material decomposition image and virtual monochromatic image sets (40–140 keV), respectively. The difference in lipid concentration and CT number between cholesterol gallstones and the surrounding bile were statistically analyzed. Receiver operating characteristic analysis was applied to determine the diagnostic accuracy of using lipid concentration to differentiate cholesterol gallstones from bile. Results Cholesterol gallstones were bright on fat-based material decomposition images yielding a 92% detection rate (22 of 24). The lipid concentrations (552.65 ± 262.36 mg/mL), CT number at 40 keV (−31.57 ± 16.88 HU) and 140 keV (24.30 ± 5.85 HU) for the cholesterol gallstones were significantly different from those of bile (−13.94 ± 105.12 mg/mL, 12.99 ± 9.39 HU and 6.19 ± 4.97 HU, respectively). Using 182.59 mg/mL as the threshold value for lipid concentration, one could obtain sensitivity of 95.5% and specificity of 100% with accuracy of 0.994 for differentiating cholesterol gallstones from bile. Conclusions Virtual monochromatic spectral CT images at 40 keV and 140 keV provide significant CT number differences between cholesterol gallstones and the surrounding bile. Spectral CT provides an excellent detection rate for cholesterol gallstones.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.10.006
       
  • Radiology Workflow Dynamics
    • Authors: Matthew H. Lee; Andrew J. Schemmel; B. Dustin Pooler; Taylor Hanley; Tabassum Kennedy; Aaron Field; Douglas Wiegmann; John-Paul J. Yu
      Pages: 483 - 487
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Matthew H. Lee, Andrew J. Schemmel, B. Dustin Pooler, Taylor Hanley, Tabassum Kennedy, Aaron Field, Douglas Wiegmann, John-Paul J. Yu
      Rationale and Objectives The study aimed to assess perceptions of reading room workflow and the impact separating image-interpretive and nonimage-interpretive task workflows can have on radiologist perceptions of workplace disruptions, workload, and overall satisfaction. Materials and Methods A 14-question survey instrument was developed to measure radiologist perceptions of workplace interruptions, satisfaction, and workload prior to and following implementation of separate image-interpretive and nonimage-interpretive reading room workflows. The results were collected over 2 weeks preceding the intervention and 2 weeks following the end of the intervention. The results were anonymized and analyzed using univariate analysis. Results A total of 18 people responded to the preintervention survey: 6 neuroradiology fellows and 12 attending neuroradiologists. Fifteen people who were then present for the 1-month intervention period responded to the postintervention survey. Perceptions of workplace disruptions, image interpretation, quality of trainee education, ability to perform nonimage-interpretive tasks, and quality of consultations (P < 0.0001) all improved following the intervention. Mental effort and workload also improved across all assessment domains, as did satisfaction with quality of image interpretation and consultative work. Conclusion Implementation of parallel dedicated image-interpretive and nonimage-interpretive workflows may improve markers of radiologist perceptions of workplace satisfaction.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.08.027
       
  • The Power of Promotion
    • Authors: Saad Ranginwala; Alexander J. Towbin
      Pages: 488 - 496
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Saad Ranginwala, Alexander J. Towbin
      The emergence of social media has provided medical practices with a new means of delivering content to a wide and varied audience. There are a number of different social media channels; however, each allows users to interact with each other, sharing and consuming content in a manner governed by rules unique to the specific social media platform. In this paper, we will introduce several common platforms, describe the advantages and disadvantages of each, and discuss how we have used each platform to connect to a target audience, highlight our department's educational content, and showcase our research.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.011
       
  • Peripheral Non-atherosclerotic Arterial Disorders
    • Authors: Tariq Ali; Miltiadis E. Krokidis; Andrew Winterbottom
      Pages: 497 - 505
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Tariq Ali, Miltiadis E. Krokidis, Andrew Winterbottom
      Peripheral non-atherosclerotic arterial disorders (NAADs) are a heterogeneous group of rather uncommon conditions that tend to manifest in subjects without atherosclerosis. Each of these conditions has distinctive pathophysiology; however, there are some common clinical and radiological characteristics and in some cases a common treatment approach that unifies these conditions to a specific group, hence the NAADs. Clinicians and radiologists often fail to recognize NAADs, and there might be a delay in the management of such patients; this may result in seriously adverse outcomes that could otherwise have been avoided or minimized. Knowledge of these conditions and of their radiological appearances is therefore important to help establish a correct diagnosis to allow the prompt initiation of treatment. The purpose of this pictorial review is to present a selection of NAADs cases and to discuss the radiological characteristics and the most common lines of therapeutic approaches.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.11.009
       
  • Teaching Radiology to Medical Students—There Is a Need for Change to
           Better Prepare Students for Clinical Practice
    • Authors: Brian M. Moloney; Christine E. McCarthy; Dara Byrne; Terri P. McVeigh; Michael J. Kerin; Peter A. McCarthy
      Pages: 506 - 513
      Abstract: Publication date: April 2017
      Source:Academic Radiology, Volume 24, Issue 4
      Author(s): Brian M. Moloney, Christine E. McCarthy, Dara Byrne, Terri P. McVeigh, Michael J. Kerin, Peter A. McCarthy
      Rationale and Objectives Deriving maximum benefit from radiology rotations in medical schools is challenging. Lack of education on appropriate imaging renders students feeling unprepared. This study compares the ability of undergraduate medical students to identify appropriate radiological investigations, both at the beginning and end of their final year of education, to those of residents in their first year of clinical practice. Materials and Methods Twelve scenarios were extracted from the American College of Radiology's Appropriateness Criteria (ACR-AC) and a questionnaire was generated. One topic was selected from each of the 10 sections in the diagnostic section and two from the interventional section. The questionnaire was distributed to three groups. Group A was composed of medical students at the beginning of final year. Group B was composed of medical students at the end of final year. Group C was composed of residents at the end of their first year of clinical practice. Radiology residents were surveyed to assess familiarity with the ACR-AC among trainees in Ireland. Results The total cohort included 160 participants. Group C (n = 35) performed significantly better than group A (n = 72) and group B (n = 53). There was no statistical difference in the mean scores achieved by group A and group B. Sixteen (73%) of 22 radiology trainees were familiar with the ACR-AC. Conclusions A minimal improvement in the knowledge of medical students in requesting radiological investigations over the course of the final medical year, yet a significant impact of a relatively short period of “on-the-job” learning in the clinical setting, was indicated. Emphasis on education on appropriateness may offer an improvement in the utilization of radiology services and improve patient care.

      PubDate: 2017-03-09T05:13:07Z
      DOI: 10.1016/j.acra.2016.10.009
       
  • Service Learning in Radiology Education
    • Authors: Pauley T. Gasparis; William D. Kerridge; Richard B. Gunderman
      Pages: 514 - 515
      Abstract: Publication date: Available online 28 February 2017
      Source:Academic Radiology
      Author(s): Pauley T. Gasparis, William D. Kerridge, Richard B. Gunderman


      PubDate: 2017-03-03T04:27:59Z
      DOI: 10.1016/j.acra.2017.01.006
       
  • International Experience in Radiology Education
    • Authors: Radya Osman; Abdelmoneim Alattaya; Richard B. Gunderman
      Abstract: Publication date: Available online 21 April 2017
      Source:Academic Radiology
      Author(s): Radya Osman, Abdelmoneim Alattaya, Richard B. Gunderman


      PubDate: 2017-04-23T13:46:03Z
      DOI: 10.1016/j.acra.2017.02.016
       
  • Can CT and MR Shape and Textural Features Differentiate Benign Versus
           Malignant Pleural Lesions'
    • Authors: Elena Pena; MacArinze Ojiaku; Joao R. Inacio; Ashish Gupta; D. Blair Macdonald; Wael Shabana; Jean M. Seely; Frank J. Rybicki; Carole Dennie; Rebecca E. Thornhill
      Abstract: Publication date: Available online 20 April 2017
      Source:Academic Radiology
      Author(s): Elena Pena, MacArinze Ojiaku, Joao R. Inacio, Ashish Gupta, D. Blair Macdonald, Wael Shabana, Jean M. Seely, Frank J. Rybicki, Carole Dennie, Rebecca E. Thornhill
      Rationale and Objectives The study aimed to identify a radiomic approach based on CT and or magnetic resonance (MR) features (shape and texture) that may help differentiate benign versus malignant pleural lesions, and to assess if the radiomic model may improve confidence and accuracy of radiologists with different subspecialty backgrounds. Materials and Methods Twenty-nine patients with pleural lesions studied on both contrast-enhanced CT and MR imaging were reviewed retrospectively. Three texture and three shape features were extracted. Combinations of features were used to generate logistic regression models using histopathology as outcome. Two thoracic and two abdominal radiologists evaluated their degree of confidence in malignancy. Diagnostic accuracy of radiologists was determined using contingency tables. Cohen's kappa coefficient was used to assess inter-reader agreement. Using optimal threshold criteria, sensitivity, specificity, and accuracy of each feature and combination of features were obtained and compared to the accuracy and confidence of radiologists. Results The CT model that best discriminated malignant from benign lesions revealed an AUCCT = 0.92 ± 0.05 (P < 0.0001). The most discriminative MR model showed an AUCMR = 0.87 ± 0.09 (P < 0.0001). The CT model was compared to the diagnostic confidence of all radiologists and the model outperformed both abdominal radiologists (P < 0.002), whereas the top discriminative MR model outperformed one of the abdominal radiologists (P = 0.02). The most discriminative MR model was more accurate than one abdominal (P = 0.04) and one thoracic radiologist (P = 0.02). Conclusion Quantitative textural and shape analysis may help distinguish malignant from benign lesions. A radiomics-based approach may increase diagnostic confidence of abdominal radiologists on CT and MR and may potentially improve radiologists' accuracy in the assessment of pleural lesions characterized by MR.

      PubDate: 2017-04-23T13:46:03Z
      DOI: 10.1016/j.acra.2017.03.006
       
  • Patients' Use and Evaluation of an Online System to Annotate Radiology
           Reports with Lay Language Definitions
    • Authors: Tessa S. Cook; Seong Cheol Oh; Charles E. Kahn
      Abstract: Publication date: Available online 19 April 2017
      Source:Academic Radiology
      Author(s): Tessa S. Cook, Seong Cheol Oh, Charles E. Kahn
      Rationale and Objectives The increasing availability of personal health portals has made it easier for patients to obtain their imaging results online. However, the radiology report typically is designed to communicate findings and recommendations to the referring clinician, and may contain many terms unfamiliar to lay readers. We sought to evaluate a web-based interface that presented reports of knee MRI (magnetic resonance imaging) examinations with annotations that included patient-oriented definitions, anatomic illustrations, and hyperlinks to additional information. Materials and Methods During a 7-month observational trial, a statement added to all knee MRI reports invited patients to view their annotated report online. We tracked the number of patients who opened their reports, the terms they hovered over to view definitions, and the time hovering over each term. Patients who accessed their annotated reports were invited to complete a survey. Results Of 1138 knee MRI examinations during the trial period, 185 patients (16.3%) opened their report in the viewing portal. Of those, 141 (76%) hovered over at least one term to view its definition, and 121 patients (65%) viewed a mean of 27.5 terms per examination and spent an average of 3.5 minutes viewing those terms. Of the 22 patients who completed the survey, 77% agreed that the definitions helped them understand the report and 91% stated that the illustrations were helpful. Conclusions A system that provided definitions and illustrations of the medical and technical terms in radiology reports has potential to improve patients' understanding of their reports and their diagnoses.

      PubDate: 2017-04-23T13:46:03Z
      DOI: 10.1016/j.acra.2017.03.005
       
  • Radiology Education
    • Authors: Aine Marie Kelly; Larry D. Gruppen; Patricia B. Mullan
      Abstract: Publication date: Available online 14 April 2017
      Source:Academic Radiology
      Author(s): Aine Marie Kelly, Priscilla J. Slanetz


      PubDate: 2017-04-15T12:13:44Z
      DOI: 10.1016/j.acra.2017.02.004
       
  • Beyond Correlations, Sensitivities, and Specificities
    • Authors: Frank I. Lin; Erich P. Huang; Lalitha K. Shankar
      Abstract: Publication date: Available online 11 April 2017
      Source:Academic Radiology
      Author(s): Frank I. Lin, Erich P. Huang, Lalitha K. Shankar
      Although advanced imaging is an important component of oncology clinical trials, there has not been a lot of success in advancing its use from a research perspective. One likely reason is the lack of consensus on the methodology used to study advanced imaging in trials, which results in a disconcerted research effort and produces data that are difficult to collate for use in validating the imaging components being studied. Imaging is used in cancer clinical trials for various indications, and the study design needed to evaluate the imaging in a particular indication will vary. Through case examples, this paper will discuss how advanced imaging is currently being investigated in oncology clinical trials, categorized by the potential clinical indication for the imaging tool and offer suggestions on how development should proceed to further evaluate imaging in the given indication. Available National Cancer Institute resources that can assist in this process will also be discussed.

      PubDate: 2017-04-15T12:13:44Z
      DOI: 10.1016/j.acra.2016.11.024
       
  • Improved Estimation of Coronary Plaque and Luminal Attenuation Using a
           Vendor-specific Model-based Iterative Reconstruction Algorithm in
           Contrast-enhanced CT Coronary Angiography
    • Authors: Yoshinori Funama; Daisuke Utsunomiya; Kenichiro Hirata; Katsuyuki Taguchi; Takeshi Nakaura; Seitaro Oda; Masafumi Kidoh; Hideaki Yuki; Yasuyuki Yamashita
      Abstract: Publication date: Available online 7 April 2017
      Source:Academic Radiology
      Author(s): Yoshinori Funama, Daisuke Utsunomiya, Kenichiro Hirata, Katsuyuki Taguchi, Takeshi Nakaura, Seitaro Oda, Masafumi Kidoh, Hideaki Yuki, Yasuyuki Yamashita
      Rationale and Objectives To investigate the stabilities of plaque attenuation and coronary lumen for different plaque types, stenotic degrees, lumen densities, and reconstruction methods using coronary vessel phantoms and the visualization of coronary plaques in clinical patients through coronary computed tomography (CT) angiography. Materials and Methods We performed 320-detector volume scanning of vessel tubes with stenosis and a tube without stenosis using three types of plaque CT numbers. The stenotic degrees were 50% and 75%. Images were reconstructed with filtered back projection (FBP) and two types of iterative reconstructions (AIDR3D and FIRST [forward-projected model-based iterative reconstruction solution]), with stenotic CT number of approximately 40, 80, and 150 HU (Hounsfield unit), respectively. In each case, the tubing of the coronary vessel was filled with diluted contrast material and distilled water to reach the target lumen CT numbers of approximately 350 HU and 450 HU, and 0 HU, respectively. Peak lumen and plaque CT numbers were measured to calculate the lumen–plaque contrast. In addition, we retrospectively evaluated the image quality with regard to coronary arterial lumen and the plaque in 10 clinical patients on a 4-point scale. Results At 50% stenosis, the plaque CT number with contrast enhancement increased for FBP and AIDR3D, and the difference in the plaque CT number with and without contrast enhancement was 15–44 HU for FBP and 10–31 HU for AIDR3D. However, the plaque CT number for FIRST had a smaller variation and the difference with and without contrast enhancement was −12 to 8 HU. The visual evaluation score for the vessel lumen was 2.8 ± 0.6, 3.5 ± 0.5, and 3.7 ± 0.5 for FBP, AIDR3D, and FIRST, respectively. Conclusions The FIRST method controls the increase in plaque density and the lumen–plaque contrast. Consequently, it improves the visualization of coronary plaques in coronary CT angiography.

      PubDate: 2017-04-08T12:05:24Z
      DOI: 10.1016/j.acra.2017.02.006
       
  • Improving Care and Education Through a Radiology Resident-driven Clinical
           Consultation Service
    • Authors: Gayle R. Salama; Courtney Sullivan; Daniel Holzwanger; Ashley E. Giambrone; Robert J. Min; Keith D. Hentel
      Abstract: Publication date: Available online 6 April 2017
      Source:Academic Radiology
      Author(s): Gayle R. Salama, Courtney Sullivan, Daniel Holzwanger, Ashley E. Giambrone, Robert J. Min, Keith D. Hentel
      Rationale and Objective As health care moves toward bundled payment systems and merit-based incentive models, increasing awareness of the value of the radiologist is essential. A resident-driven clinical imaging rounds (CIR) program initiated at our institution allows radiologists to actively and directly participate in the team-based medical model. A retrospective review of survey data evaluated the qualitative and quantitative effects of CIR on clinical management, communication, and education of referring providers and radiology residents. Materials and Methods The initial 10 months of a resident-organized CIR were evaluated in a retrospective study. Twenty radiology residents and 150 internal medicine physicians and medical students participated in imaging rounds. An anonymous survey of participants was performed and results were analyzed. Results Eighty-five percent of radiology resident participants completed the survey (N = 17). Approximately 30% of internal medicine participants completed the survey (N = 45). There was an overwhelming positive review of imaging rounds, with a large majority of all groups agreeing that imaging rounds improve education, communication, and patient care. Conclusions Resident-driven imaging rounds provide a valuable opportunity to improve communication, education, and patient care. We have created a CIR with a sustainable workflow that allows direct and regularly scheduled imaging-medicine consultation valued by both radiologists and internal medicine physicians, improving the quality of patient care and providing education to our radiology residents in value-based care.

      PubDate: 2017-04-08T12:05:24Z
      DOI: 10.1016/j.acra.2017.01.023
       
  • A Response to Dr. Zhang and Dr. Rubin
    • Authors: Katrin Skerl; Sarah Vinnicombe; Andrew Evans
      Abstract: Publication date: Available online 6 April 2017
      Source:Academic Radiology
      Author(s): Katrin Skerl, Sarah Vinnicombe, Andrew Evans


      PubDate: 2017-04-08T12:05:24Z
      DOI: 10.1016/j.acra.2017.03.004
       
  • Less Is More
    • Authors: Nicholas Koontz; Richard Wiggins Megan Mills Michael McLaughlin Elaine Pigman
      Abstract: Publication date: Available online 3 April 2017
      Source:Academic Radiology
      Author(s): Nicholas A. Koontz, Richard H. Wiggins, Megan K. Mills, Michael S. McLaughlin, Elaine C. Pigman, Yoshimi Anzai, Lubdha M. Shah
      Rationale and Objectives Emergency department (ED) patients with acute low back pain (LBP) may present with ambiguous clinical findings that pose diagnostic challenges to exclude cauda equina syndrome (CES). As a proof of concept, we aimed to determine the efficacy of a rapid lumbar spine (LS) magnetic resonance imaging (MRI) screening protocol consisting of a single 3D-T2 SPACE FS (3D-T2 Sampling Perfection with Application optimized Contrasts using different flip angle Evolution fat saturated) sequence relative to conventional LS MRI to exclude emergently treatable pathologies in this complex patient population. Materials and Methods LS MRI protocol including a sagittal 3D-T2 SPACE FS pulse sequence was added to the routine for ED patients presenting with acute atypical LBP over a 12-month period. Imaging findings were categorically scored on the 3D-T2 SPACE FS sequence and separately on the reference standard conventional LS MRI sequences. Patients' symptoms were obtained from review of the electronic medical record. Descriptive test statistics were performed. Results Of the 206 ED patients who obtained MRI for acute atypical LBP, 118 (43.3 ± 13.5 years of age; 61 female) were included. Specific pathologies detected on reference standard conventional MRI included disc herniation (n = 30), acute fracture (n = 3), synovial cyst (n = 3), epidural hematoma (n = 2), cerebrospinal fluid leak (n = 1), and leptomeningeal metastases (n = 1), and on multiple occasions these pathologies resulted in nerve root impingement (n = 36), severe spinal canal stenosis (n = 13), cord/conus compression (n = 2), and cord signal abnormality (n = 2). The 3D-T2 SPACE FS sequence was an effective screen for fracture (sensitivity [sens] = 100%, specificity [spec] = 100%), cord signal abnormality (sens = 100%, spec = 99%), and severe spinal canal stenosis (sens = 100%, spec = 96%), and identified cord compression not seen on reference standard. Motion artifact was not seen on the 3D-T2 SPACE FS but noted on 8.5% of conventional LS MRI. Conclusions The 3D-T2 SPACE FS sequence MRI is a rapid, effective screen for emergently actionable pathologies that might be a cause of CES in ED patients presenting with acute atypical LBP. As this abbreviated, highly sensitive sequence requires a fraction of the acquisition time of conventional LS MRI, it has the potential of contributing to increased efficiencies in the radiology department and improved ED throughput.

      PubDate: 2017-04-08T12:05:24Z
       
  • Radiology Abroad
    • Authors: Neda I. Sedora Román; Teodora Bochnakova
      Abstract: Publication date: Available online 31 March 2017
      Source:Academic Radiology
      Author(s): Neda I. Sedora Román, Teodora Bochnakova
      Objective The purpose of this article is to share our experience conducting a global health outreach initiative in the Radiology Department of the Georgetown Public Hospital in Guyana alongside RAD-AID, a nonprofit organization whose mission is to increase the availability of medical imaging services in developing countries. Conclusion The collaboration between RAD-AID and the Guyanese Ministry of Health has resulted in significant strides for radiology, including the introduction of new resources such as updated sonography and, for the first time, computed tomography for the public sector. In addition, collaboration with the Georgetown Public Hospital has strengthened the clinical management of patients and radiological education of health-care workers in Guyana.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2016.09.027
       
  • Toward a Framework for Benefit-Risk Assessment in Diagnostic Imaging
    • Authors: Maria Agapova; Brian W. Bresnahan; Ken F. Linnau; Louis P. Garrison; Mitchell Higashi; Larry Kessler; Beth Devine
      Abstract: Publication date: Available online 31 March 2017
      Source:Academic Radiology
      Author(s): Maria Agapova, Brian W. Bresnahan, Ken F. Linnau, Louis P. Garrison, Mitchell Higashi, Larry Kessler, Beth Devine
      Rationale and Objectives Diagnostic imaging has many effects and there is no common definition of value in diagnostic radiology. As benefit-risk trade-offs are rarely made explicit, it is not clear which framework is used in clinical guideline development. We describe initial steps toward the creation of a benefit-risk framework for diagnostic radiology. Materials and Methods We performed a literature search and an online survey of physicians to identify and collect benefit-risk criteria (BRC) relevant to diagnostic imaging tests. We operationalized a process for selection of BRC with the use of four clinical use case scenarios that vary by diagnostic alternatives and clinical indication. Respondent BRC selections were compared across clinical scenarios and between radiologists and nonradiologists. Results Thirty-six BRC were identified and organized into three domains: (1) those that account for differences attributable only to the test or device (n = 17); (2) those that account for clinical management and provider experiences (n = 12); and (3) those that capture patient experience (n = 7). Forty-eight survey participants selected 22 criteria from the initial list in the survey (9–11 per case). Engaging ordering physicians increased the number of criteria selected in each of the four clinical scenarios presented. We developed a process for standardizing selection of BRC in guideline development. Conclusion These results suggest that a process relying on elements of comparative effectiveness and the use of standardized BRC may ensure consistent examination of differences among alternatives by way of making explicit implicit trade-offs that otherwise enter the decision-making space and detract from consistency and transparency. These findings also highlight the need for multidisciplinary teams that include input from ordering physicians.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.002
       
  • Diagnosing Sarcopenia on Thoracic Computed Tomography
    • Authors: Ursula Nemec; Benedikt Heidinger; Claire Sokas; Louis Chu; Ronald L. Eisenberg
      Abstract: Publication date: Available online 30 March 2017
      Source:Academic Radiology
      Author(s): Ursula Nemec, Benedikt Heidinger, Claire Sokas, Louis Chu, Ronald L. Eisenberg
      Rationale and Objectives This study aims to assess the use of skeletal muscle mass measurements at two thoracic levels to diagnose sarcopenia on computed tomography (CT) chest examinations and to analyze the impact of these measurements on clinical outcome parameters following transcatheter aortic valve replacement. Materials and Methods This study retrospectively included 157 patients who underwent preoperative CT examinations. The total muscle area was measured on transverse CT images at the 3rd lumbar and 7th and 12th thoracic levels with skeletal muscle indices (SMIs) calculated at each level. SMIs were then compared to clinical outcome parameters, and thoracic cutoff values for sarcopenia at the 7th and 12th thoracic levels were calculated. Results Correlation between SMIs at the third lumbar vertebra (L3) and the 12th thoracic vertebra (T12) was stronger (r = 0.724, P < 0.001) than that between L3 and the seventh thoracic vertebra (T7) (r = 0.594, P < 0.001). SMIs at L3 and T12 significantly correlated with prolonged length of stay. Thoracic cutoff values for the 12th thoracic level were 42.6 cm2/m2 (men) and 30.6 cm2/m2 (women), and those for the 7th thoracic level were 46.5 cm2/m2 (men) and 32.3 cm2/m2 (women). Conclusions Skeletal muscle measurements at the T12 level could permit the diagnosis of sarcopenia and could be used to correlate sarcopenia with outcome parameters in patients undergoing CT limited to the chest.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.008
       
  • Chart-stimulated Recall as a Learning Tool for Improving Radiology
           Residents' Reports
    • Authors: Naila Nadeem; Abdul Mueed Zafar; Sonia Haider; Rukhsana W. Zuberi; Muhammad Nadeem Ahmad; Vijayanadh Ojili
      Abstract: Publication date: Available online 29 March 2017
      Source:Academic Radiology
      Author(s): Naila Nadeem, Abdul Mueed Zafar, Sonia Haider, Rukhsana W. Zuberi, Muhammad Nadeem Ahmad, Vijayanadh Ojili
      Rationale and Objectives Workplace-based assessments gauge the highest tier of clinical competence. Chart-stimulated recall (CSR) is a workplace-based assessment method that complements chart audit with an interview based on the residents' notes. It allows evaluation of the residents' knowledge and heuristics while providing opportunities for feedback and self-reflection. We evaluated the utility of CSR for improving the radiology residents' reporting skills. Materials and Methods Residents in each year of training were randomly assigned to an intervention group (n = 12) or a control group (n = 13). Five pre-intervention and five post-intervention reports of each resident were independently evaluated by three blinded reviewers using a modified Bristol Radiology Report Assessment Tool. The study intervention comprised a CSR interview tailored to each individual resident's learning needs based on the pre-intervention assessment. The CSR process focused on the clinical relevance of the radiology reports. Student's t test (P < .05) was used to compare pre- and post-intervention scores of each group. Results A total of 125 pre-intervention and 125 post-intervention reports were evaluated (total 750 assessments). The Cronbach's alpha for the study tool was 0.865. A significant improvement was seen in the cumulative 19-item score (66% versus 73%, P < .001) and the global rating score (59% versus 72%, P < .001) of the intervention group after the CSR. The reports of the control group did not demonstrate any significant improvement. Conclusion CSR is a feasible workplace-based assessment method for improving reporting skills of the radiology residents.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.013
       
  • An Interprofessional Learning Workshop for Mammography and Sonography
           Students Focusing on Breast Cancer Care and Management Via Simulation
    • Authors: Eileen M. Giles; Nayana Parange; Bronwyn Knight
      Abstract: Publication date: Available online 29 March 2017
      Source:Academic Radiology
      Author(s): Eileen M. Giles, Nayana Parange, Bronwyn Knight
      Rationale and Objectives The literature surrounding interprofessional education claims that students who learn with, from, and about one another in well-designed interprofessional programs will practice together collaboratively upon graduation, given the skills to do so. The objective of this study was to examine attitudes to interprofessional practice before and after an interprofessional learning (IPL) activity. Materials and Methods A total of 35 postgraduate medical imaging students attended a week-long mammography workshop. The sessions provided a range of didactic sessions related to diagnosis and management of breast cancer. An IPL session was incorporated on completion of the workshop to consolidate learning. Props and authentic resources were used to increase the fidelity of the simulation. Participants completed pre- and post-workshop questionnaires comprising an interprofessional education and collaboration scale and a quiz to gauge knowledge of specific content related to professional roles. Responses to each statement in the scale and quiz score, pre or post workshop, were compared, whereas responses to open-ended questions in post-workshop survey were thematically analyzed. Results Seventeen paired surveys were received. There was a significant total improvement of 10.66% (P = .036). After simulation, there was a statistically significant improvement in participants' understanding (P < .05) that IPL offers holistic care to the patient and that teamwork is useful for reducing errors in patient care. Simulation helped participants develop more awareness of their role within the profession, improve their understanding of other professionals, and gain more realistic expectations of team members. Conclusion This pilot study confirmed learning within an IPL simulation improved attitudes toward shared learning, teamwork, and communication. Simulation provides opportunities for learning in a safe environment, and technology can be used in diverse ways to provide authentic learning.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.015
       
  • Iterative Reconstructions in Reduced-Dose CT
    • Authors: Bastien Pauchard; Kai Higashigaito; Aicha Lamri-Senouci; Jean-Francois Knebel; Dominik Berthold; Francis Robert Verdun; Hatem Alkadhi; Sabine Schmidt
      Abstract: Publication date: Available online 29 March 2017
      Source:Academic Radiology
      Author(s): Bastien Pauchard, Kai Higashigaito, Aicha Lamri-Senouci, Jean-Francois Knebel, Dominik Berthold, Francis Robert Verdun, Hatem Alkadhi, Sabine Schmidt
      Rationale and Objectives To compare adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR) algorithms for reduced-dose computed tomography (CT). Materials and Methods Forty-four young oncology patients (mean age 30 ± 9 years) were included. After routine thoraco-abdominal CT (dose 100%, average CTDIvol 9.1 ± 2.4 mGy, range 4.4–16.9 mGy), follow-up CT was acquired at 50% (average CTDIvol 4.5 ± 1.2 mGy, range 2.2–8.4 mGy) in 29 patients additionally at 20% dose (average CTDIvol 1.9 ± 0.5 mGy, range 0.9–3.4 mGy). Each reduced-dose CT was reconstructed using both ASIR and MBIR. Four radiologists (two juniors and two seniors) blinded to dose and technique read each set of CT images regarding objective and subjective image qualities (high- or low-contrast structures), subjective noise or pixilated appearance, diagnostic confidence, and lesion detection. Results At all dose levels, objective image noise was significantly lower with MBIR than with ASIR (P < 0.001). The subjective image quality for low-contrast structures was significantly higher with MBIR than with ASIR (P < 0.001). Reduced-dose abdominal CT images of patients with higher body mass index (BMI) were read with significantly higher diagnostic confidence than images of slimmer patients (P < 0.001) and had higher subjective image quality, regardless of technique. Although MBIR images appeared significantly more pixilated than ASIR images, they were read with higher diagnostic confidence, especially by juniors (P < 0.001). Conclusions Reduced-dose CT during the follow-up of young oncology patients should be reconstructed with MBIR to ensure diagnostic quality. Elevated body mass index does not hamper the quality of reduced-dose CT.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.012
       
  • Role of Health Services Research in Radiology
    • Authors: James V. Rawson; Paul Cronin
      Abstract: Publication date: Available online 28 March 2017
      Source:Academic Radiology
      Author(s): James V. Rawson, Paul Cronin


      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.003
       
  • Characteristics, Trends, and Quality of Systematic Review and
           Meta-Analysis in General Radiology between 2007 and 2015
    • Authors: Ju Yong Park; Kyung Hee Lee; You Jin Ku; Soon Gu Cho; Yeo Ju Kim; Ha Young Lee; Jun Ho Kim
      Abstract: Publication date: Available online 28 March 2017
      Source:Academic Radiology
      Author(s): Ju Yong Park, Kyung Hee Lee, You Jin Ku, Soon Gu Cho, Yeo Ju Kim, Ha Young Lee, Jun Ho Kim
      Rationale and Objectives To evaluate the trends, characteristics, and quality of systematic review and meta-analysis in general radiology journals. Materials and Methods We performed a PubMed search to identify systematic reviews and meta-analyses that had been carried out in the field of radiology between 2007 and 2015. The following data were extracted: journal, impact factor, type of research, year of publication, radiological subspecialty, imaging modalities used, number of authors, affiliated department of the first and corresponding authors, presence of a radiologist and a statistician among the authors, discordance between the first and corresponding authors, funding, country of first author, methodological quality, methods used for quality assessment, and statistics. Results Ultimately, we included 210 articles from nine general radiology journals. The European Journal of Radiology was the most common journal represented (47 of 210; 22.4%). Meta-analyses (n = 177; 84.3%) were published about five times more than systematic reviews without meta-analysis (n = 33; 15.7%). Radiology of the gastrointestinal tract was the most commonly represented subspecialty (n = 49, 23.3%). The first authors were most frequently located in China (n = 64; 30.3%). In terms of modality, magnetic resonance imaging was used most often (n = 59; 28.1%). The number of authors tended to progressively increase over time, and the ratio of discordance between the first and corresponding authors also increased significantly, as did the proportion of research that has received funding from an external source. The mean AMSTAR assessment score improved over time (5.87/11 in 2007–2009, 7.11/11 in 2010–2012, and 7.49/11 in 2013–2015). In this regard, the journal Radiology had the highest score (7.59/11). Conclusions The quantity and quality of radiological meta-analyses have significantly increased over the past 9 years; however, specific weak areas remain, providing the opportunity for quality improvement.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.009
       
  • Using the Analytic Hierarchy Process for Prioritizing Imaging Tests in
           Diagnosis of Suspected Appendicitis
    • Authors: Maria Agapova; Brian W. Bresnahan; Ken F. Linnau; Louis P. Garrison; Mitchell Higashi; Larry Kessler; Beth Devine
      Abstract: Publication date: Available online 28 March 2017
      Source:Academic Radiology
      Author(s): Maria Agapova, Brian W. Bresnahan, Ken F. Linnau, Louis P. Garrison, Mitchell Higashi, Larry Kessler, Beth Devine
      Rationale and Objectives In clinical guideline or criteria development processes, such as those used in developing American College of Radiology Appropriateness Criteria (ACR AC), experts subjectively evaluate benefits and risks associated with imaging tests and make complex decisions about imaging recommendations. The analytic hierarchy process (AHP) decomposes complex decisions into structured smaller decisions, incorporates quantitative evidence and qualitative expert opinion, and promotes structured consensus building. AHP may supplement and/or improve the transparency of expert opinion contributions to developing guidelines or criteria. Materials and Methods To conduct an empirical test using health services research tools, we convened a mock ACR AC panel of emergency department radiology and nonradiology physicians to evaluate by multicriteria decision analysis, the relative appropriateness of imaging tests for diagnosing suspected appendicitis. Panel members selected benefit-risk criteria via an online survey and assessed contrast-enhanced computed tomography, magnetic resonance imaging, and ultrasound using an AHP-based software. Participants were asked whether the process was manageable, transparent, and improved shared understanding. Priority scores were converted to rankings and compared to the rank order of ACR AC ratings. Results When compared to magnetic resonance and ultrasound imaging, participants agreed with the ACR AC that contrast-enhanced computed tomography is the most appropriate test. Contrary to the ACR AC ratings, study results suggest that magnetic resonance is preferable to ultrasound. When compared to nonradiologists, radiologists' priority scores reflect a stronger preference for computed tomography. Conclusions Study participants addressed decision-making challenges using a relatively efficient data collection mechanism, suggesting that AHP may benefit the ACR AC guideline development process in identifying the relative appropriateness of imaging tests. With additional development, AHP may improve transparency when expert opinion is used in clinical guideline or appropriateness criteria development.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.01.001
       
  • Variation in Patients' Travel Times among Imaging Examination Types at a
           Large Academic Health System
    • Authors: Andrew B. Rosenkrantz; Yu Liang; Richard Duszak; Michael P. Recht
      Abstract: Publication date: Available online 27 March 2017
      Source:Academic Radiology
      Author(s): Andrew B. Rosenkrantz, Yu Liang, Richard Duszak, Michael P. Recht
      Rationale and Objectives Patients' willingness to travel farther distances for certain imaging services may reflect their perceptions of the degree of differentiation of such services. We compare patients' travel times for a range of imaging examinations performed across a large academic health system. Materials and Methods We searched the NYU Langone Medical Center Enterprise Data Warehouse to identify 442,990 adult outpatient imaging examinations performed over a recent 3.5-year period. Geocoding software was used to estimate typical driving times from patients' residences to imaging facilities. Variation in travel times was assessed among examination types. Results The mean expected travel time was 29.2 ± 20.6 minutes, but this varied significantly (p < 0.001) among examination types. By modality, travel times were shortest for ultrasound (26.8 ± 18.9) and longest for positron emission tomography-computed tomography (31.9 ± 21.5). For magnetic resonance imaging, travel times were shortest for musculoskeletal extremity (26.4 ± 19.2) and spine (28.6 ± 21.0) examinations and longest for prostate (35.9 ± 25.6) and breast (32.4 ± 22.3) examinations. For computed tomography, travel times were shortest for a range of screening examinations [colonography (25.5 ± 20.8), coronary artery calcium scoring (26.1 ± 19.2), and lung cancer screening (26.4 ± 14.9)] and longest for angiography (32.0 ± 22.6). For ultrasound, travel times were shortest for aortic aneurysm screening (22.3 ± 18.4) and longest for breast (30.1 ± 19.2) examinations. Overall, men (29.9 ± 21.6) had longer (p < 0.001) travel times than women (27.8 ± 20.3); this difference persisted for each modality individually (p ≤ 0.006). Conclusions Patients' willingness to travel longer times for certain imaging examination types (particularly breast and prostate imaging) supports the role of specialized services in combating potential commoditization of imaging services. Disparities in travel times by gender warrant further investigation.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.017
       
  • Showcasing Our Profession to the Future Physician Workforce
    • Authors: Sravanthi Reddy; Yoshimi Anzai; Gary J. Whitman; Tudor Hughes; Smyrna Tuburan; Alison L. Chetlen; Alexander Norbash; Bibb Allen; William Thorwarth; James A. Brink; Stephanie Taylor; Christopher M. Straus
      Abstract: Publication date: Available online 27 March 2017
      Source:Academic Radiology
      Author(s): Sravanthi Reddy, Yoshimi Anzai, Gary J. Whitman, Tudor Hughes, Smyrna Tuburan, Alison L. Chetlen, Alexander Norbash, Bibb Allen, William Thorwarth, James A. Brink, Stephanie Taylor, Christopher M. Straus
      Rationale and Objectives There has been waxing and waning of popularity of radiology as a career choice over the last few years. These fluctuations may in part be due to misconceptions such as the perceived lack of patient contact, as well as the perception of decreasing numbers of entry-level jobs. To address such misconceptions, it is important to reach medical students early in their training, both to give them a comprehensive and balanced understanding of radiology practice, and to appropriately frame radiologists as clinicians. Realizing the benefits of direct student outreach, a number of medical specialties are moving toward more direct recruitment efforts often through student interest groups and career fairs. The Medical Student Radiology Expo (MSRE) was proposed and executed by the Alliance of Medical Students Educators in Radiology, which was supported by the Association of University Radiologists (AUR) and the American College of Radiology. The MSRE was held immediately after the 2016 AUR annual meeting and hosted at the Moores Cancer Center at the University of California, San Diego. The goals of the MSRE were threefold: (1) to showcase radiology as a distinct and exciting specialty to all medical students, (2) to foster an interest in pursuing a career in radiology among medical students, and (3) to create a distributable and customizable combined symposium and workshop that could be easily replicated elsewhere. Methods The activities of this 1-day expo started with a morning of didactic elements, including a session identifying inaccurate myths surrounding radiology, specific details of interest pertaining to diagnostic radiology and interventional radiology residency programs, followed by interactive imaging diagnosis games, and question and answer sessions. A casual lunch with faculty members and attendees provided for more sustained direct and informal interactions between the students and the faculty. During the afternoon sessions, students participated in hands-on workshops, including ultrasound, imaging-guided biopsies, catheter manipulation, and post-processing image analysis, as well as roundtable discussions about radiology with the faculty. Results The results from the post-program survey of the medical students were overall positive. Conclusions The MSRE, with the combined efforts of multiple organizations, was successful. A customizable, modular toolkit has been posted on the AUR website. Using this toolkit as a template, this recruitment and informational activity can be replicated at individual institutions, local radiology chapters, multidisciplinary meetings, and radiology meetings.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.02.005
       
  • Evaluation of Plaque Morphology by 64-Slice Coronary Computed Tomographic
           Angiography Compared to Intravascular Ultrasound in Nonocclusive Segments
           of Coronary Arteries
    • Authors: Manoj Kesarwani; Rine Nakanishi; Tae-Young Choi; David M. Shavelle; Matthew J. Budoff
      Abstract: Publication date: Available online 27 March 2017
      Source:Academic Radiology
      Author(s): Manoj Kesarwani, Rine Nakanishi, Tae-Young Choi, David M. Shavelle, Matthew J. Budoff
      Rationale and Objectives Although intravascular ultrasound (IVUS) is the current gold standard for plaque characterization, noninvasive coronary computed tomographic angiography (CCTA) requires further evaluation. The ability to detect plaque morphology by CCTA remains unclear. The purpose of this study was to evaluate the diagnostic accuracy of CCTA for plaque detection and morphology. Materials and Methods Thirty-one patients underwent cardiac catheterization with IVUS and CCTA. The presence of plaque was evaluated by both modalities in nonocclusive segments (<50% stenosis) of the left anterior descending artery, left circumflex artery, and right coronary artery. Plaque morphology was classified as (1) normal, (2) soft or fibrous, (3) fibrocalcific, or (4) calcific. Results by IVUS and CCTA were compared blindly on a segment-to-segment basis with subgroup analysis based on CCTA tube voltage. Results Among the 31 patients (mean age 56.2 ± 8.6 years, 27% female), 152 segments were analyzed. Of these segments, 42% were in the left anterior descending artery, 32% were in the left circumflex artery, and 26% were in the right coronary artery. Plaque morphology by IVUS identified 103 segments as fibrous (68%), 31 as fibrocalcific (20%), and 6 as calcific (4.0%); 12 segments were normal (8.0%). To evaluate for the presence of plaque, CCTA had an overall sensitivity and specificity of 99% and 75%, respectively. In patients who underwent CCTA with a tube voltage of 100 kV, both sensitivity and specificity were 100%. The sensitivity and specificity of CCTA to identify plaque as calcified (fibrocalcific or calcific) vs noncalcified (soft or fibrous) were 87% and 96%, respectively. Overall, the accuracy of CCTA to detect the presence of plaque was 97%; the accuracy to detect plaque calcification was 94%. Conclusions CCTA offers excellent sensitivity and accuracy for plaque detection and morphology characterization in nonocclusive coronary segments. In addition, diagnostic accuracy is preserved with a reduced tube voltage protocol.

      PubDate: 2017-04-02T14:19:12Z
      DOI: 10.1016/j.acra.2017.03.001
       
  • Academic Remediation
    • Authors: Carol M. Rumack; Jeannette Guerrasio; Alicia Christensen; Eva M. Aagaard
      Abstract: Publication date: Available online 23 March 2017
      Source:Academic Radiology
      Author(s): Carol M. Rumack, Jeannette Guerrasio, Alicia Christensen, Eva M. Aagaard
      At our institution, we have developed a remediation team of strong, focused experts who help us with struggling learners in making the diagnosis and then coaching on their milestone deficits. It is key for all program directors to recognize struggling residents because early recognition and intervention gives the resident the best chance of success.

      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2016.12.022
       
  • A Tribute to Mark Richard Robbin, MD
    • Authors: Mark E. Mullins; Pablo R. Ros
      Abstract: Publication date: Available online 23 March 2017
      Source:Academic Radiology
      Author(s): Mark E. Mullins, Pablo R. Ros


      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2017.02.014
       
  • Glottis Closure Influences Tracheal Size Changes in Inspiratory and
           Expiratory CT in Patients with COPD
    • Authors: Nicholas Landini; Stefano Diciotti; Monica Lanzetta; Francesca Bigazzi; Gianna Camiciottoli; Mario Mascalchi
      Abstract: Publication date: Available online 22 March 2017
      Source:Academic Radiology
      Author(s): Nicholas Landini, Stefano Diciotti, Monica Lanzetta, Francesca Bigazzi, Gianna Camiciottoli, Mario Mascalchi
      Rationale and Objectives The opened or closed status of the glottis might influence tracheal size changes in inspiratory and expiratory computed tomography (CT) scans. We investigated if the glottis status makes the tracheal collapse differently correlate with lung volume difference between inspiratory and expiratory CT scans. Materials and Methods Forty patients with chronic obstructive pulmonary disease whose glottis was included in the acquired scanned volume for lung CT were divided into two groups: 16 patients with the glottis closed in both inspiratory and expiratory CT, and 24 patients with the glottis open in at least one CT acquisition. Lung inspiratory (Vinsp) and expiratory (Vexp) volumes were automatically computed and lung ΔV was calculated using the following formula: (Vinsp − Vexp)/Vinsp × 100. Two radiologists manually measured the anteroposterior diameter and cross-sectional area of the trachea 1 cm above the aortic arch and 1 cm above the carina. Tracheal collapse was then calculated and correlated with lung ΔV. Results In the 40 patients, the correlations between tracheal Δanteroposterior diameter and Δcross-sectional area at each level and lung ΔV ranged between 0.68 and 0.74 (ρ) at Spearman rank correlation test. However, in the closed glottis group, the correlations were higher for all measures at the two levels (ρ range: 0.84–0.90), whereas in the open glottis group, correlations were low and not statistically significant (ρ range: 0.29–0.34) at the upper level, and moderate at the lower level (ρ range: 0.51–0.55). Conclusions A closed or open glottis influences the tracheal size change in inspiratory and expiratory CT scans. With closed glottis, the tracheal collapse shows a stronger correlation with the lung volume difference between inspiratory and expiratory CT scans.

      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2017.01.018
       
  • A Response to Skerl et al. (2016)
    • Authors: Man Zhang; Jonathan M. Rubin
      Abstract: Publication date: Available online 22 March 2017
      Source:Academic Radiology
      Author(s): Man Zhang, Jonathan M. Rubin


      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2017.02.007
       
  • Dorsal Muscle Attenuation May Predict Failure to Respond to Interleukin-2
           Therapy in Metastatic Renal Cell Carcinoma
    • Authors: Bamidele Otemuyiwa; Brian A. Derstine; Peng Zhang; Sandra L. Wong; Michael S. Sabel; Bruce G. Redman; Stewart C. Wang; Ajjai S. Alva; Matthew S. Davenport
      Abstract: Publication date: Available online 22 March 2017
      Source:Academic Radiology
      Author(s): Bamidele Otemuyiwa, Brian A. Derstine, Peng Zhang, Sandra L. Wong, Michael S. Sabel, Bruce G. Redman, Stewart C. Wang, Ajjai S. Alva, Matthew S. Davenport
      Rationale and Objectives To explore whether the sarcopenia body type can help predict response to interleukin-2 (IL-2) therapy in metastatic renal cell carcinoma (RCC). Materials and Methods Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective cohort study of 75 subjects with metastatic RCC who underwent pretreatment contrast-enhanced computed tomography within 1 year of initiating IL-2 therapy. Cross-sectional area and attenuation of normal-density (31–100 Hounsfield units [HU]) and low-density (0–30 HU) dorsal muscles were obtained at the T11 vertebral level. The primary outcome was partial or complete response to IL-2 using RECIST 1.1 criteria at 6 weeks. A conditional inference tree was used to determine an optimal HU cutoff for predicting outcome. Bonferroni-adjusted multivariate logistic regression was conducted to investigate the independent associations between imaging features and response after controlling for demographics, doses of IL-2, and RCC prognostic scales (eg, Heng and the Memorial Sloan Kettering Cancer Center [MSKCC]). Results Most subjects had intermediate prognosis by Heng (65% [49 of 75]) and the MSKCC (63% [47 of 75]) criteria; 7% had complete response and 12% had partial response. Mean attenuation of low-density dorsal muscles was a significant univariate predictor of IL-2 response after Bonferroni correction (P = 0.03). The odds of responding to treatment were 5.8 times higher for subjects with higher-attenuation low-density dorsal muscles (optimal cutoff: 18.1 HU). This persisted in multivariate analysis (P = 0.02). Body mass index (P = 0.67) and the Heng (P = 0.22) and MSKCC (P = 0.08) clinical prognostic scales were not significant predictors of response. Conclusions Mean cross-sectional attenuation of low-density dorsal muscles (ie, sarcopenia) may predict IL-2 response in metastatic RCC. Clinical variables are poor predictors of response.

      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2017.03.003
       
  • Teaching and Assessing Professionalism in Radiology Resident Education
    • Authors: Aine Marie Kelly; Larry D. Gruppen; Patricia B. Mullan
      Abstract: Publication date: Available online 22 March 2017
      Source:Academic Radiology
      Author(s): Aine Marie Kelly, Larry D. Gruppen, Patricia B. Mullan
      Radiologists in teaching hospitals and in practices with residents rotating through are involved in the education of their residents. The Accreditation Council for Graduate Medical Education requires evidence that trainees are taught and demonstrate competency not only in medical knowledge and in patient care—the historic focus of radiology education—but also in the so-called non-interpretative core competencies, which include professionalism and interpersonal skills. In addition to accreditation agencies, the prominent assessment practices represented by the American Board of Radiology core and certifying examinations for trainees, as well as Maintenance of Certification for practitioners, are planning to feature more non-interpretative competency assessment, including professionalism to a greater extent. Because professionalism was incorporated as a required competency in medical education as a whole, more clarity about the justification and expected content for teaching about competence in professionalism, as well as greater understanding and evidence about appropriate and effective teaching and assessment methods, have emerged. This article summarizes justifications and expectations for teaching and assessing professionalism in radiology residents and best practices on how to teach and evaluate professionalism that can be used by busy radiology faculty in their everyday practice supervising radiology residents.

      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2017.02.004
       
  • Oligoprogression
    • Authors: Steven P. Rowe; Phuoc T. Tran; Elliot K. Fishman; Pamela T. Johnson
      Abstract: Publication date: Available online 21 March 2017
      Source:Academic Radiology
      Author(s): Steven P. Rowe, Phuoc T. Tran, Elliot K. Fishman, Pamela T. Johnson


      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2016.12.018
       
  • Emotional Wellness of Current Musculoskeletal Radiology Fellows
    • Authors: Jack Porrino; Michael J. Mulcahy; Hyojeong Mulcahy; Annemarie Relyea-Chew; Felix S. Chew
      Abstract: Publication date: Available online 21 March 2017
      Source:Academic Radiology
      Author(s): Jack Porrino, Michael J. Mulcahy, Hyojeong Mulcahy, Annemarie Relyea-Chew, Felix S. Chew
      Rationale and Objectives Burnout is a psychological syndrome composed of emotional exhaustion, depersonalization, and sense of lack of personal accomplishment, as a result of prolonged occupational stress. The purpose of our study was to determine the prevalence of burnout among current musculoskeletal radiology fellows and to explore causes of emotional stress. Materials and Methods A 24-item survey was constructed on SurveyMonkey using the Maslach Burnout Inventory. We identified 82 musculoskeletal radiology fellowship programs. We recruited subjects indirectly through the program director or equivalent. Results Fifty-eight respondents (48 male, 10 female) identified themselves as current musculoskeletal radiology fellows and completed the survey. Comparison of the weighted subscale means in our data to the Maslach normative subscale thresholds for medical occupations indicates that musculoskeletal radiology fellows report relatively high levels of burnout with regard to lack of personal accomplishment and depersonalization, whereas emotional exhaustion levels in our sample are within the average range reported by Maslach. Although male musculoskeletal radiology fellows experience relatively high levels in two of the three dimensions of burnout (depersonalization and personal accomplishment), female musculoskeletal radiology fellows experience relatively high burnout across all three dimensions. Job market-related stress and the effort required providing care for dependents significantly affect personal accomplishment. Conversely, imbalances in the work-life relationship and feelings of powerlessness are significantly associated with depersonalization and emotional exhaustion. Conclusions Musculoskeletal radiology fellows report relatively high levels of burnout. Because the consequences of burnout can be severe, early identification and appropriate intervention should be a priority.

      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2016.12.024
       
  • Diagnostic Performance of Automated Breast Volume Scanning (ABVS) Compared
           to Handheld Ultrasonography With Breast MRI as the Gold Standard
    • Authors: Constanze Schmachtenberg; Thomas Fischer; Bernd Hamm; Ulrich Bick
      Abstract: Publication date: Available online 20 March 2017
      Source:Academic Radiology
      Author(s): Constanze Schmachtenberg, Thomas Fischer, Bernd Hamm, Ulrich Bick
      Rationale and Objectives This study aimed to compare the diagnostic value of automated breast volume scanning (ABVS) to that of handheld ultrasonography (HHUS) using breast magnetic resonance imaging (MRI) as the gold standard. Materials and Methods Twenty-eight patients with 39 examined breasts with at least one lesion visible in breast MRI underwent HHUS and ABVS. Detection rate, localization, maximum diameter, and Breast Imaging Reporting and Data System classification were compared. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value were calculated for HHUS and ABVS. Lesion localization and maximum diameters based on HHUS and ABVS were compared to size measurement in MRI. Breast Imaging Reporting and Data System categories based on each method were compared to the MRI diagnosis (malignant or benign) or, if available (21 cases), with the histologic diagnosis. Results MRI detected 72 lesions, ABVS 59 lesions, and HHUS 54 lesions. Malignancy was proven histopathologically in 15 cases. There was no significant difference between ABVS and HHUS in terms of sensitivity (93.3% vs. 100%), specificity (83.3% vs. 83.3%), diagnostic accuracy (87.2% vs. 89.7%), positive predictive value (77.8% vs. 78.9%), and negative predictive value (95.2% vs. 100%). Agreement regarding lesion localization (same quadrant) was 94.3% for ABVS and MRI and 91.2% for HHUS and MRI. Lesion size compared to MRI lesion size was assessed correctly (+/− 3 mm) in 79.4% (HHUS) and 80% (ABVS). The correlation of size measurement was slightly higher for ABVS-MRI (r = 0.89) than for HHUS-MRI (r = 0.82) with P < .001. Conclusions ABVS can be used as an alternative to HHUS. ABVS has the advantage of operator independence and better reproducibility although it is limited in evaluating axillary lymph nodes and lacks Doppler or elastrography capabilities, which sometimes provide important supplementary information in HHUS.

      PubDate: 2017-03-26T21:04:36Z
      DOI: 10.1016/j.acra.2017.01.021
       
  • Anonymity and Electronics
    • Authors: Teresa Chapman; Janet R. Reid; Erin E. O'Conner
      Abstract: Publication date: Available online 18 March 2017
      Source:Academic Radiology
      Author(s): Teresa Chapman, Janet R. Reid, Erin E. O'Conner
      Rationale and Objectives Diagnostic radiology resident assessment has evolved from a traditional oral examination to computerized testing. Teaching faculty struggle to reconcile the differences between traditional teaching methods and residents' new preferences for computerized testing models generated by new examination styles. We aim to summarize the collective experiences of senior residents at three different teaching hospitals who participated in case review sessions using a computer-based, interactive, anonymous teaching tool, rather than the Socratic method. Materials and Methods Feedback was collected from radiology residents following participation in a senior resident case review session using Nearpod, which allows residents to anonymously respond to the teaching material. Results Subjective resident feedback was uniformly enthusiastic. Ninety percent of residents favor a case-based board review incorporating multiple-choice questions, and 94% favor an anonymous response system. Conclusions Nearpod allows for inclusion of multiple-choice questions while also providing direct feedback to the teaching faculty, helping to direct the instruction and clarify residents' gaps in knowledge before the Core Examination.

      PubDate: 2017-03-19T19:37:33Z
      DOI: 10.1016/j.acra.2017.01.008
       
  • Missteps in Estimates of Cancer Overdiagnosis
    • Authors: Archie Bleyer
      Abstract: Publication date: Available online 8 February 2017
      Source:Academic Radiology
      Author(s): Archie Bleyer


      PubDate: 2017-02-11T02:13:21Z
      DOI: 10.1016/j.acra.2017.01.010
       
  • Measuring Interobserver Disagreement in Rating Diagnostic Characteristics
           of Pulmonary Nodule Using the Lung Imaging Database Consortium and Image
           Database Resource Initiative
    • Authors: Hongli Lin; Changxing Huang; Weisheng Wang; Jiawei Luo; Xuedong Yang; Yuling Liu
      Abstract: Publication date: Available online 3 February 2017
      Source:Academic Radiology
      Author(s): Hongli Lin, Changxing Huang, Weisheng Wang, Jiawei Luo, Xuedong Yang, Yuling Liu
      Rationale and Objectives The purpose of this study was to measure and analyze interobserver disagreement in rating diagnostic characteristics of pulmonary nodules on computed tomography scans using the Lung Imaging Database Consortium and Image Database Resource Initiative (LIDC/IDRI) database, and then to provide investigators with understanding the variability in rating diagnostic characteristics among radiologists. Materials and Methods A histogram-based accumulated nodule-level approach is proposed to measure interobserver disagreement in rating diagnostic characteristics of pulmonary nodules among radiologists. The mean rating differences of radiologists on nodule level are calculated; next, a histogram of the accumulated nodule-level disagreements is constructed; and finally, mean, variance, skewness, and kurtosis statistics based on the histogram are extracted to analyze and summary interobserver disagreement in terms of the assessment of diagnostic characteristics of radiologists. Using the developed computer scheme, the disagreement of radiologists in rating all of 1880 distinct nodules from 1018 computed tomography scans are analyzed using original ratings as well as combined ratings according to the LIDC/IDRI instruction. Results The interobserver disagreement in rating diagnostic characteristics according to the defined categories of the LIDC/IDRI is substantial. The mean values of disagreement range from 0.0052 to 0.2341. The highest disagreement lies in rating subtlety characteristics, whereas internal structure receives the lowest disagreement of 0.0052. The calcification, texture, spiculation, lobulation, malignancy, sphericity, and margin receive disagreements of 0.0393, 0.1351, 0.1616, 0.1943, 0.2144, 0.2174, and 0.2228, respectively. Conclusions Disagreements exist across radiologists in rating diagnostic characteristics of pulmonary nodules, and the disagreement levels vary from each other. Agreement among radiologists is improved by combining ratings according to the LIDC/IDRI instruction. For investigators, understanding and appreciating the disagreement level of each diagnostic characteristic is required when using them in related researches.

      PubDate: 2017-02-05T01:25:10Z
      DOI: 10.1016/j.acra.2016.11.022
       
 
 
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