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AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 17, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, 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: 328, 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)
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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: 206, SJR: 3.683, h-index: 202)
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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)
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Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
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Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
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Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
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: 128, 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)
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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: 10, SJR: 1.268, h-index: 45)
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Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
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Advances in Ecological Research     Full-text available via subscription   (Followers: 40, 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: 40, 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: 48, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
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: 12)
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: 21, 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: 25)
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: 35, 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: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
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: 6, 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: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
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: 25, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, 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: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
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: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 340, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
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: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, 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: 309, 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: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 400, 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: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, 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: 50, 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: 5, 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: 6)
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: 8, 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: 4, 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: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, 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: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 44, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 36, 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: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, 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: 179, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 55, 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: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 24, 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: 33, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, 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: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 9)
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: 160, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, 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: 153, 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)
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Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
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Journal Cover Academic Radiology
  [SJR: 1.008]   [H-I: 75]   [17 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1076-6332
   Published by Elsevier Homepage  [3042 journals]
  • Looking for a Needle in a Haystack
    • Authors: Sophie Paquerault; Renée M. Howell
      Pages: 792 - 794
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Sophie Paquerault, Renée M. Howell

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.04.006
  • How Does the Display Luminance Level Affect Detectability of Breast
           Microcalcifications and Spiculated Lesions in Digital Breast Tomosynthesis
           (DBT) Images'
    • Authors: Claudio Ferranti; Alessandra Primolevo; Francesco Cartia; Claudia Cavatorta; Chiara Maura Ciniselli; Manuela Lualdi; Silvia Meroni; Emanuele Pignoli; Maddalena Plebani; Claudio Siciliano; Paolo Verderio; Gianfranco Scaperrotta
      Pages: 795 - 801
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Claudio Ferranti, Alessandra Primolevo, Francesco Cartia, Claudia Cavatorta, Chiara Maura Ciniselli, Manuela Lualdi, Silvia Meroni, Emanuele Pignoli, Maddalena Plebani, Claudio Siciliano, Paolo Verderio, Gianfranco Scaperrotta
      Rationale and Objectives This study evaluates the influence of the calibrated luminance level of medical displays in the detectability of microcalcifications and spiculated lesions in digital breast tomosynthesis images. Materials and Methods Four models of medical displays with calibrated maximum and minimum luminance, respectively, ranging from 500 to 1000 cd/m2 and from 0.5 to 1.0 cd/m2, were investigated. Forty-eight studies were selected by a senior radiologist: 16 with microcalcifications, 16 with spiculated lesions, and 16 without lesions. All images were anonymized and blindly evaluated by one senior and two junior radiologists. For each study, lesion presence or absence and localization statements, interpretative difficulty level, and overall quality were reported. Cohen's kappa statistic was computed between monitors and within or between radiologists to estimate the reproducibility in correctly identifying lesions; for multireader-multicase analysis, the weighted jackknife alternative free-response receiver operating characteristic statistical tool was applied. Results Intraradiologist reproducibility ranged from 0.75 to 1.00. Interreader as well as reader-truth agreement values were >0.80 and higher with the two 1000 cd/m2 luminance displays than with the lower luminance displays for each radiologist. Performances in the detectability of breast lesions were significantly greater with the 1000 cd/m2 luminance displays when compared to the display with the lowest luminance value (P value <0.001). Conclusions Our findings highlight the role of display luminance level on the accuracy of detecting breast lesions.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.01.014
  • Automated Breast Density Computation in Digital Mammography and Digital
           Breast Tomosynthesis
    • Authors: Maria Castillo-García; Margarita Chevalier; Julia Garayoa; Alejandro Rodriguez-Ruiz; Diego García-Pinto; Julio Valverde
      Pages: 802 - 810
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Maria Castillo-García, Margarita Chevalier, Julia Garayoa, Alejandro Rodriguez-Ruiz, Diego García-Pinto, Julio Valverde
      Rationale and Objectives The study aimed to compare the breast density estimates from two algorithms on full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) and to analyze the clinical implications. Materials and Methods We selected 561 FFDM and DBT examinations from patients without breast pathologies. Two versions of a commercial software (Quantra 2D and Quantra 3D) calculated the volumetric breast density automatically in FFDM and DBT, respectively. Other parameters such as area breast density and total breast volume were evaluated. We compared the results from both algorithms using the Mann-Whitney U non-parametric test and the Spearman's rank coefficient for data correlation analysis. Mean glandular dose (MGD) was calculated following the methodology proposed by Dance et al. Results Measurements with both algorithms are well correlated (r ≥ 0.77). However, there are statistically significant differences between the medians (P < 0.05) of most parameters. The volumetric and area breast density median values from FFDM are, respectively, 8% and 77% higher than DBT estimations. Both algorithms classify 35% and 55% of breasts into BIRADS (Breast Imaging-Reporting and Data System) b and c categories, respectively. There are no significant differences between the MGD calculated using the breast density from each algorithm. DBT delivers higher MGD than FFDM, with a lower difference (5%) for breasts in the BIRADS d category. MGD is, on average, 6% higher than values obtained with the breast glandularity proposed by Dance et al. Conclusions Breast density measurements from both algorithms lead to equivalent BIRADS classification and MGD values, hence showing no difference in clinical outcomes. The median MGD values of FFDM and DBT examinations are similar for dense breasts (BIRADS d category).

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.01.011
  • 3D MRI for Quantitative Analysis of Quadrant Percent Breast Density
    • Authors: Jeon-Hor Chen; Fuyi Liao; Yang Zhang; Yifan Li; Chia-Ju Chang; Chen-Pin Chou; Tsung-Lung Yang; Min-Ying Su
      Pages: 811 - 817
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Jeon-Hor Chen, Fuyi Liao, Yang Zhang, Yifan Li, Chia-Ju Chang, Chen-Pin Chou, Tsung-Lung Yang, Min-Ying Su
      Rationale and Objectives Breast cancer occurs more frequently in the upper outer (UO) quadrant, but whether this higher cancer incidence is related to the greater amount of dense tissue is not known. Magnetic resonance imaging acquires three-dimensional volumetric images and is the most suitable among all breast imaging modalities for regional quantification of density. This study applied a magnetic resonance imaging-based method to measure quadrant percent density (QPD), and evaluated its association with the quadrant location of the developed breast cancer. Materials and Methods A total of 126 cases with pathologically confirmed breast cancer were reviewed. Only women who had unilateral breast cancer located in a clear quadrant were selected for analysis. A total of 84 women, including 47 Asian women and 37 western women, were included. An established computer-aided method was used to segment the diseased breast and the contralateral normal breast, and to separate the dense and fatty tissues. Then, a breast was further separated into four quadrants using the nipple and the centroid as anatomic landmarks. The tumor was segmented using a computer-aided method to determine its quadrant location. The distribution of cancer quadrant location, the quadrant with the highest QPD, and the proportion of cancers occurring in the highest QPD were analyzed. Results The highest incidence of cancer occurred in the UO quadrant (36 out of 84, 42.9%). The highest QPD was also noted most frequently in the UO quadrant (31 out of 84, 36.9%). When correlating the highest QPD with the quadrant location of breast cancer, only 17 women out of 84 (20.2%) had breast cancer occurring in the quadrant with the highest QPD. Conclusions The results showed that the development of breast cancer in a specific quadrant could not be explained by the density in that quadrant, and further studies are needed to find the biological reasons accounting for the higher breast cancer incidence in the UO quadrant.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2016.12.016
  • Supine Breast MRI Using Respiratory Triggering
    • Authors: Natasja N.Y. Janssen; Leon C. ter Beek; Claudette E. Loo; Gonneke Winter-Warnars; Charlotte A.H. Lange; Marjolein van Loveren; Tanja Alderliesten; Jan-Jakob Sonke; Jasper Nijkamp
      Pages: 818 - 825
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Natasja N.Y. Janssen, Leon C. ter Beek, Claudette E. Loo, Gonneke Winter-Warnars, Charlotte A.H. Lange, Marjolein van Loveren, Tanja Alderliesten, Jan-Jakob Sonke, Jasper Nijkamp
      Rationale and Objectives This study aims to evaluate if navigator-echo respiratory-triggered magnetic resonance acquisition can acquire supine high-quality breast magnetic resonance imaging (MRI). Materials and Methods Supine respiratory-triggered magnetic resonance imaging (Trig-MRI) was compared to supine non-Trig-MRI to evaluate breathing-induced motion artifacts (group 1), and to conventional prone non-Trig-MRI (group 2, 16-channel breast coil), all at 3T. A 32-channel thorax coil was placed on top of a cover to prevent breast deformation. Ten volunteers were scanned in each group, including one patient. The acquisition time was recorded. Image quality was compared by visual examination and by calculation of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image sharpness (IS). Results Scan time increased from 56.5 seconds (non-Trig-MRI) to an average of 306 seconds with supine Trig-MRI (range: 120–540 seconds). In group 1, the median values (interquartile range) of SNR, CNR, and IS improved from 11.5 (6.0), 7.3 (3.1), and 0.23 (0.2) cm on supine non-Trig-MRI to 38.1 (29.1), 32.8 (29.7), and 0.12 (0) cm (all P < 0.01) on supine Trig-MRI. All qualitative image parameters in group 1 improved on supine Trig-MRI (all P < 0.01). In group 2, SNR and CNR improved from 14.7 (6.8) and 12.6 (5.6) on prone non-Trig-MRI to 36.2 (12.2) and 32.7 (12.1) (both P < 0.01) on supine Trig-MRI. IS was similar: 0.10 (0) cm vs 0.11 (0) cm (P = 0.88). Conclusions Acquisition of high-quality supine breast MRI is possible when respiratory triggering is applied, in a similar setup as during subsequent treatment. Image quality improved when compared to supine non-triggered breast MRI and prone breast MRI, but at the cost of increased acquisition time.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.01.003
  • Is the Internet a Suitable Patient Resource for Information on Common
           Radiological Investigations'
    • Authors: Dermot J. Bowden; Lee-Chien Yap; Declan G. Sheppard
      Pages: 826 - 830
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Dermot J. Bowden, Lee-Chien Yap, Declan G. Sheppard
      Rationale and Objective: This study aimed to assess the quality of Internet information about common radiological investigations. Materials and Methods Four search engines (Google, Bing, Yahoo, and Duckduckgo) were searched using the terms “X-ray,” “cat scan,” “MRI,” “ultrasound,” and “pet scan.” The first 10 webpage results returned for each search term were recorded, and their quality and readability were analyzed by two independent reviewers (DJB and LCY), with discrepancies resolved by consensus. Analysis of information quality was conducted using validated instruments for the assessment of health-care information (DISCERN score is a multi-domain tool for assessment of health-care information quality by health-care professionals and laypeople (max 80 points)) and readability (Flesch-Kincaid and SMOG or Simple Measure of Gobbledygook scores). The search result pages were further classified into categories as follows: commercial, academic (educational/institutional), and news/magazine. Several organizations offer website accreditation for health-care information, and accreditation is recognized by the presence of a hallmark or logo on the website. The presence of any valid accreditation marks on each website was recorded. Mean scores between groups were compared for significance using the Student t test. Results A total of 200 webpages returned (108 unique website addresses). The average DISCERN score was <50 points for all modalities and search engines. No significant difference was seen in readability between modalities or between search engines. Websites carrying validated accreditation marks were associated with higher average DISCERN scores: X-ray (39.36 vs 25.35), computed tomography (45.45 vs 31.33), and ultrasound (40.91 vs 27.62) (P < .01). Academic/government institutions produced material with higher DISCERN scores: X-ray (40.06 vs 22.23), magnetic resonance imaging (44.69 vs 29), ultrasound (46 vs 31.91), and positron emission tomography (45.93 vs 38.31) (P < .01). Commercial websites produced material with lower mean DISCERN scores: X-ray (17.25 vs 31.69), magnetic resonance imaging (20.8 vs 40.1), ultrasound (24.11 vs 42.35), and positron emission tomography (24.5 vs 44.45) (P < .01). Conclusions Although readability is adequate, the overall quality of radiology-related health-care information on the Internet is poor. High-quality online resources should be identified so that patients may avoid the use of poor-quality information derived from general search engine queries.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.01.012
  • Comparative Evaluation of Three Software Packages for Liver and Spleen
           Segmentation and Volumetry
    • Authors: Puskar Pattanayak; Evrim B. Turkbey; Ronald M. Summers
      Pages: 831 - 839
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Puskar Pattanayak, Evrim B. Turkbey, Ronald M. Summers
      Rationale and Objectives This study aims to compare the speed and accuracy of three different software packages in segmenting the liver and the spleen. Materials and Methods The three software packages are Advantage Workstation Solutions (AWS), Claron Technology (Claron) Liver Segmentor, and Vitrea Core Fx (Vitrea). The dataset consisted of abdominal computed tomography scans of 30 patients obtained from the portal venous phase. All but two of the patients had a cancer diagnosis. The livers of 14 patients and the spleens of 24 patients were reported as normal; the remaining livers and spleens contained one or more abnormalities. The initial segmentation times and volumes were recorded in Claron and Vitrea as these created automatic segmentations. The total segmentation times and volumes following corrections were recorded. The livers and spleens were segmented separately by two radiologists who used all three packages. Accuracy was assessed by comparing volumes measured using fully manual segmentation on the AWS. Results Claron could not segment the spleen in four subjects for the first reader and in two subjects for the second reader. The final mean segmentation times for the liver for both readers were 6.5 and 5.5 minutes for AWS, 4.4 and 3.6 minutes for Claron, and 5.1 and 4.2 minutes for Vitrea. The final mean segmentation times for the spleen were 2.7 and 2.1 minutes for AWS, 2.1 and 1.4 minutes for Claron, and 1.8 and 1.2 minutes for Vitrea. No statistically significant difference was found between the organ volumes measured by the two readers when using Vitrea. The mean differences between the initial and final segmentation volumes ranged from −1.2% to 0.4% for the liver and from −4.0% to 9.8% for the spleen. The mean differences between the automated liver segmentation volumes and the AWS volumes were 2.5%–2.9% for Claron and 4.9%–6.6% for Vitrea. The mean differences between the automated splenic segmentation volumes and the AWS volumes were 5.0%–6.2% for Claron and 10.6%–12.0% for Vitrea. Conclusions Both automated packages (Claron and Vitrea) measured liver and spleen volumes that were accurate and quick before manual correction. Volumes for the liver were more accurate than those for the spleen, perhaps due to the much smaller splenic volumes compared to those of the liver. For both liver and spleen, manual corrections were time consuming and for most subjects did not significantly change the volume measurement.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.02.001
  • CT for Acute Nontraumatic Abdominal Pain—Is Oral Contrast Really
    • Authors: Rivka Kessner; Sophie Barnes; Pinchas Halpern; Vadim Makrin; Arye Blachar
      Pages: 840 - 845
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Rivka Kessner, Sophie Barnes, Pinchas Halpern, Vadim Makrin, Arye Blachar
      Rationale and Objectives This study aims to compare the diagnostic performance of abdominal computed tomography (CT) performed with and without oral contrast in patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain. Materials and Methods Between December 2013 and December 2014, 348 adult patients presenting to the ED of a large tertiary medical center with nontraumatic abdominal pain were evaluated. Exclusion criteria for the study were history of inflammatory bowel disease, recent abdominal operation and suspected renal colic, abdominal aortic aneurysm rupture, or intestinal obstruction. All patients underwent intravenous contrast-enhanced abdominal CT on a Philips Brilliance 64-slice scanner using a routine abdomen protocol. The study group included 174 patients who underwent abdominal CT scanning without oral contrast, recruited using convenience sampling. A control group of 174 patients was matched to the cohort groups' gender and age and underwent abdominal CT with oral contrast material during the same time period. The patients' medical records were reviewed for various clinical findings and for the final clinical diagnosis. The CT exams were initially reviewed by a senior attending radiologist to determine the exams' technical adequacy and to decide whether an additional scan with oral contrast was required. Two senior radiologists, blinded to the clinical diagnosis, later performed consensus reading to determine the contribution of oral contrast administration to the radiologists' diagnostic confidence and its influence on diagnosing various radiological findings. Results Each group consisted of 82 men and 92 women. The average age of the two groups was 48 years. The main clinical diagnoses of the pathological examinations were appendicitis (17.5%), diverticulitis (10.9%), and colitis (5.2%). A normal CT examination was found in 34.8% of the patients. There was no significant difference between the groups regarding most of the clinical parameters that were examined. None of the examinations of all of the 174 study group patients was found to be technically inadequate, and therefore no patient had to undergo additional scanning to establish a diagnosis. The consensus reading of the senior radiologists determined that the lack of oral contrast was insignificant in 96.6% of the cases and that contrast material might have been useful in only 6 of 174 study group patients (3.4%). The radiologists found oral contrast to be helpful only in 8 of 174 control group patients (4.6%). There was no significant difference between the clinical and radiological diagnoses in both groups (study group, P = 0.261; control group, P = 0.075). Conclusions Our study shows that oral contrast is noncontributory to radiological diagnosis in most patients presenting to the ED with acute nontraumatic abdominal pain. These patients can therefore undergo abdominal CT scanning without oral contrast, with no effect on radiological diagnostic performance.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.01.013
  • Low Yield of Chest Radiography in General Inpatients and Outpatients with
           “Positive PPD” Results in a Country with Low Prevalence of TB
    • Authors: Ronald L. Eisenberg; Benedikt H. Heidinger
      Pages: 846 - 850
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Ronald L. Eisenberg, Benedikt H. Heidinger
      Rationale and Objectives The purpose of this study was to assess the frequency and spectrum of abnormalities on routine screening chest radiographs among inpatients and outpatients with “positive purified protein derivative (PPD)” in a large tertiary care academic medical center in a country with low prevalence of tuberculosis (TB). Materials and Methods The reports of all chest radiographs of general inpatients and outpatients referred for positive PPD (2010–2014) were evaluated for the frequency of evidence of active or latent TB and the spectrum of imaging findings. The results of additional chest radiographs and computed tomography scans were recorded, as were additional relevant clinical histories and symptoms. Results Of the 2518 patients who underwent chest radiography for positive PPD, the radiographs were normal in 91.3%. The vast majority of the abnormal radiographs demonstrated findings consistent with old tuberculous disease. There were three cases (0.1%) of active TB, all of which were either recent immigrants from an endemic area or had other relevant histories or clinical symptoms suggestive of the disease. Conclusions Universal chest radiography in general inpatient and outpatient populations referred for positive PPD is of low yield for detecting active disease in a country with low prevalence of TB.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2016.12.012
  • Size Measurement and T-staging of Lung Adenocarcinomas Manifesting as
           Solid Nodules ≤30 mm on CT
    • Authors: Benedikt H. Heidinger; Kevin R. Anderson; Eoin M. Moriarty; Daniel B. Costa; Sidhu P. Gangadharan; Paul A. VanderLaan; Alexander A. Bankier
      Pages: 851 - 859
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Benedikt H. Heidinger, Kevin R. Anderson, Eoin M. Moriarty, Daniel B. Costa, Sidhu P. Gangadharan, Paul A. VanderLaan, Alexander A. Bankier
      Rationale and Objectives This study aimed to compare long-axis diameter to average computed tomography (CT) diameter measurements of lung adenocarcinomas manifesting as solid lung nodules ≤30 mm on CT, as referenced to pathologic measurements, and to determine the impact of the two CT measurement approaches on tumor (T)-staging of nodules. Materials and Methods This institutional review board-approved study included all 274 radiologic solid adenocarcinomas resected at our institution over 10 years. Two observers measured long- and short-axis diameters on pre-resection chest CT in lung and mediastinal windows. T-stages were determined. CT measurements and T-stages were compared to pathology measurements and T-stages using Wilcoxon signed rank test and McNemar test. Inter- and intraobserver variability was determined with intraclass correlation coefficients (ICC) and Bland-Altman plots. Results For lung and mediastinal windows, nodule size was significantly larger using long-axis diameter rather than average diameter (16.93 vs. 14.92 mm, P < .001; and 14.02 vs. 12.17 mm, P < .001, respectively). The correlation of CT with pathologic measurements was stronger with long-axis than with average diameter (ICC 0.808 vs. 0.730; and 0.731 vs. 0.621, respectively). Lung window measurements correlated stronger with pathology than mediastinal window measurements. CT T-stages differed from pathology T-stages in more than 20% of nodules (P < .001). Inter- and intraobserver variability was small with long-axis and average diameter (ICC range 0.96–0.991, and 0.970–0.993, respectively), but long-axis diameter showed wider scatter on Bland-Altman plots. Conclusions Long-axis CT diameter is preferable for T-staging because it better reflects the pathology T-stage. Average CT diameter might be used for longitudinal nodule follow-up because it shows less measurement variability and is more conservative in size assessment.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.01.009
  • Cardiovascular Computed Tomography Findings after Pneumonectomy
    • Authors: Maximilian Rauch; Milka Marinova; Hans Heinz Schild; Holger Strunk
      Pages: 860 - 866
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Maximilian Rauch, Milka Marinova, Hans Heinz Schild, Holger Strunk
      Rationale and Objectives To identify and compare cardiovascular findings on computed tomography (CT) scans after pneumonectomy (PNX) with those after lobectomy (LOBX). Materials and Methods Pre- and postoperative CT scans from 25 PNX patients were retrospectively analyzed and compared to those from 30 LOBX patients. The diameter of the main pulmonary artery (PA) and its ratio to the ascending aorta (PA/Ao) were determined. Cardiac morphometry values were ascertained by measuring maximum diameters of the right and left ventricle on axial (RVaxial, LVaxial) and four-chamber (RV4-ch, LV4-ch) views. RVaxial/LVaxial and RV4-ch/LV4-ch ratios were calculated. Vessel stumps were evaluated for thrombosis. Results After PNX, PA (31.1 ± 5.8 mm vs 28.7 ± 5.4 mm, P = 0.003), PA/Ao (0.97 ± 0.15 vs 0.86 ± 0.12, P = 0.0001), and cardiac morphometry values significantly increased (RVaxial 43.6 ± 7.4 vs 39.4 ± 7.1, P = 0.029; RV4-ch 41.1 ± 6.3 vs 37.6 ± 5.7, P = 0.041; RVaxial/LVaxial 1.18 ± 0.27 vs 1.03 ± 0.22, P = 0.04; RV4-ch/LV4-ch 1.17 ± 0.21 vs 1.02 ± 0.16, P = 0.03). There were no significant differences between right and left PNX. One case of PA stump thrombosis was identified after right PNX. LOBX resulted in a significant increase in PA (30.6 ± 4.3 vs 28.7 ± 3.5, P = 0.005) and PA/Ao (0.90 ± 0.09 vs 0.85 ± 0.10, P = 0.017), whereas cardiac morphometry values were not significantly changed compared to baseline values. No vessel stump thrombosis was observed after LOBX. In comparison to LOBX, all ascertained values were significantly elevated after PNX. Conclusions Morphologic alterations of the cardiovascular system following PNX can be identified on CT scans. Alterations are more distinct after PNX compared to LOBX.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.01.020
  • Diagnosis of Spinal Lesions Using Heuristic and Pharmacokinetic Parameters
           Measured by Dynamic Contrast-Enhanced MRI
    • Authors: Ning Lang; Huishu Yuan; Hon J. Yu; Min-Ying Su
      Pages: 867 - 875
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Ning Lang, Huishu Yuan, Hon J. Yu, Min-Ying Su
      Rationale and Objectives This study aimed to evaluate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiation of four spinal lesions by using heuristic and pharmacokinetic parameters analyzed from DCE signal intensity time course. Materials and Methods DCE-MRI of 62 subjects with confirmed myeloma (n = 9), metastatic cancer (n = 22), lymphoma (n = 7), and inflammatory tuberculosis (TB) (n = 24) in the spine were analyzed retrospectively. The region of interest was placed on strongly enhanced tissues. The DCE time course was categorized as the “wash-out,” “plateau,” or “persistent enhancement” pattern. The maximum enhancement, steepest wash-in enhancement, and wash-out slope using the signal intensity at 67 seconds after contrast injection as reference were measured. The Tofts 2-compartmental pharmacokinetic model was applied to obtain Ktrans and kep. Pearson correlation between heuristic and pharmacokinetic parameters was evaluated, and receiver operating characteristic curve analysis was performed for pairwise group differentiation. Results The mean wash-out slope was −22% ± 10% for myeloma, 1% ± 0.4% for metastatic cancer, 3% ± 3% for lymphoma, and 7% ± 10% for TB, and it could significantly distinguish myeloma from metastasis (area under the curve [AUC] = 0.884), lymphoma (AUC = 1.0), and TB (AUC = 1.0) with P = .001, and distinguish metastasis from TB (AUC = 0.741) with P = .005. The kep and wash-out slope were highly correlated (r = 0.92), and they showed a similar diagnostic performance. The Ktrans was significantly correlated with the maximum enhancement (r = 0.71) and the steepest wash-in enhancement (r = 0.85), but they had inferior diagnostic performance compared to the wash-out slope. Conclusions DCE-MRI may provide additional diagnostic information, and a simple wash-out slope had the best diagnostic performance. The heuristic and pharmacokinetic parameters were highly correlated.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2016.12.014
  • Estimation of Observer Performance for Reduced Radiation Dose Levels in CT
    • Authors: Joel G. Fletcher; Lifeng Yu; Jeff L. Fidler; David L. Levin; David R. DeLone; David M. Hough; Naoki Takahashi; Sudhakar K. Venkatesh; Anne-Marie G. Sykes; Darin White; Rebecca M. Lindell; Amy L. Kotsenas; Norbert G. Campeau; Vance T. Lehman; Adam C. Bartley; Shuai Leng; David R. Holmes; Alicia Y. Toledano; Rickey E. Carter; Cynthia H. McCollough
      Pages: 876 - 890
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Joel G. Fletcher, Lifeng Yu, Jeff L. Fidler, David L. Levin, David R. DeLone, David M. Hough, Naoki Takahashi, Sudhakar K. Venkatesh, Anne-Marie G. Sykes, Darin White, Rebecca M. Lindell, Amy L. Kotsenas, Norbert G. Campeau, Vance T. Lehman, Adam C. Bartley, Shuai Leng, David R. Holmes, Alicia Y. Toledano, Rickey E. Carter, Cynthia H. McCollough
      Rationale and Objectives This study aims to estimate observer performance for a range of dose levels for common computed tomography (CT) examinations (detection of liver metastases or pulmonary nodules, and cause of neurologic deficit) to prioritize noninferior dose levels for further analysis. Materials and Methods Using CT data from 131 examinations (abdominal CT, 44; chest CT, 44; head CT, 43), CT images corresponding to 4%–100% of the routine clinical dose were reconstructed with filtered back projection or iterative reconstruction. Radiologists evaluated CT images, marking specified targets, providing confidence scores, and grading image quality. Noninferiority was assessed using reference standards, reader agreement rules, and jackknife alternative free-response receiver operating characteristic figures of merit. Reader agreement required that a majority of readers at lower dose identify target lesions seen by the majority of readers at routine dose. Results Reader agreement identified dose levels lower than 50% and 4% to have inadequate performance for detection of hepatic metastases and pulmonary nodules, respectively, but could not exclude any low dose levels for head CT. Estimated differences in jackknife alternative free-response receiver operating characteristic figures of merit between routine and lower dose configurations found that only the lowest dose configurations tested (ie, 30%, 4%, and 10% of routine dose levels for abdominal, chest, and head CT examinations, respectively) did not meet criteria for noninferiority. At lower doses, subjective image quality declined before observer performance. Iterative reconstruction was only beneficial when filtered back projection did not result in noninferior performance. Conclusion Opportunity exists for substantial radiation dose reduction using existing CT technology for common diagnostic tasks.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2016.12.017
  • Alternative Metrics (“Altmetrics”) for Assessing Article Impact in
           Popular General Radiology Journals
    • Authors: Andrew B. Rosenkrantz; Abimbola Ayoola; Kush Singh; Richard Duszak
      Pages: 891 - 897
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Andrew B. Rosenkrantz, Abimbola Ayoola, Kush Singh, Richard Duszak
      Rationale and Objectives Emerging alternative metrics leverage social media and other online platforms to provide immediate measures of biomedical articles' reach among diverse public audiences. We aimed to compare traditional citation and alternative impact metrics for articles in popular general radiology journals. Materials and Methods All 892 original investigations published in 2013 issues of Academic Radiology, American Journal of Roentgenology, Journal of the American College of Radiology, and Radiology were included. Each article's content was classified as imaging vs nonimaging. Traditional journal citations to articles were obtained from Web of Science. Each article's Altmetric Attention Score (Altmetric), representing weighted mentions across a variety of online platforms, was obtained from Statistical assessment included the McNemar test, the Mann-Whitney test, and the Pearson correlation. Results Mean and median traditional citation counts were 10.7 ± 15.4 and 5 vs 3.3 ± 13.3 and 0 for Altmetric. Among all articles, 96.4% had ≥1 traditional citation vs 41.8% for Altmetric (P < 0.001). Online platforms for which at least 5% of the articles were represented included Mendeley (42.8%), Twitter (34.2%), Facebook (10.7%), and news outlets (8.4%). Citations and Altmetric were weakly correlated (r = 0.20), with only a 25.0% overlap in terms of articles within their top 10th percentiles. Traditional citations were higher for articles with imaging vs nonimaging content (11.5 ± 16.2 vs 6.9 ± 9.8, P < 0.001), but Altmetric scores were higher in articles with nonimaging content (5.1 ± 11.1 vs 2.8 ± 13.7, P = 0.006). Conclusions Although overall online attention to radiology journal content was low, alternative metrics exhibited unique trends, particularly for nonclinical articles, and may provide a complementary measure of radiology research impact compared to traditional citation counts.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2016.11.019
  • Oligoprogression
    • Authors: Steven P. Rowe; Phuoc T. Tran; Elliot K. Fishman; Pamela T. Johnson
      Pages: 898 - 900
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Steven P. Rowe, Phuoc T. Tran, Elliot K. Fishman, Pamela T. Johnson

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2016.12.018
  • 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
      Pages: 901 - 907
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      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: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.01.018
  • Artifacts Caused by Breast Tissue Markers in a Dedicated Cone-beam Breast
           CT in Comparison to Full-field Digital Mammography
    • Authors: Susanne Wienbeck; Carsten Nowak; Antonia Zapf; Georg Stamm; Christina Unterberg-Buchwald; Joachim Lotz; Uwe Fischer
      Pages: 908 - 915
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Susanne Wienbeck, Carsten Nowak, Antonia Zapf, Georg Stamm, Christina Unterberg-Buchwald, Joachim Lotz, Uwe Fischer
      Rationale and Objectives The purpose of this ex vivo study was to investigate artifacts in a cone-beam breast computed tomography (CBBCT) caused by breast tissue markers. Materials and Methods Breast phantoms with self-made tissue pork mincemeat were created. Twenty-nine different, commercially available markers with varying marker size, composition, and shape were evaluated. A dedicated CBBCT evaluation of all phantoms was performed with 49 kVp, 50 and 100 mA, and marker orientation parallel and orthogonal to the scan direction. The resultant images were evaluated in sagittal, axial, and coronal view with a slice thickness of 0.5 mm. Additionally, measurements of all markers in the same directions were done with full-field digital mammography. Results All markers were visible in full-field digital mammography without any artifacts. However, all markers caused artifacts on a CBBCT. Artifacts were measured as the length of the resulting streakings. Median length of artifacts was 7.2 mm with a wide range from 0 to 48.3 mm (interquartile range 4.3–11.4 mm) dependent on composition, size, shape, weight, and orientation of the markers. The largest artifacts occurred in axial view with a median size of 12.6 mm, with a range from 0 to 48.3 mm, resulting in a relative artifact length (quotient artifact in mm/real physical length of the marker itself) of 4.1 (interquartile range 2.3–6.1, range 0–8.7). Conclusions Artifacts caused by markers can significantly influence image quality in a CBBCT, thus limiting primary diagnostics and follow-up in breast cancer. The size of the artifacts depends on the marker characteristics, orientation, and the image plane of reconstruction.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2016.11.017
  • Letter to the Editor
    • Authors: Samuel G. Armato; Karen Drukker; Feng Li; Lubomir Hadjiiski; Georgia D. Tourassi; Roger M. Engelmann; Maryellen L. Giger; George Redmond; Keyvan Farahani; Justin S. Kirby; Nicholas A. Petrick
      Pages: 916 - 917
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Samuel G. Armato, Karen Drukker, Feng Li, Lubomir Hadjiiski, Georgia D. Tourassi, Roger M. Engelmann, Maryellen L. Giger, George Redmond, Keyvan Farahani, Justin S. Kirby, Nicholas A. Petrick

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.03.015
  • Response to the Letter from LUNGx Challenge
    • Authors: Mizuho Nishio
      First page: 918
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Mizuho Nishio

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.04.003
  • International Experience in Radiology Education
    • Authors: Radya Osman; Abdelmoneim Alattaya; Richard B. Gunderman
      Pages: 919 - 920
      Abstract: Publication date: July 2017
      Source:Academic Radiology, Volume 24, Issue 7
      Author(s): Radya Osman, Abdelmoneim Alattaya, Richard B. Gunderman

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.02.016
  • Radiology Education
    • Authors: Aine Marie Kelly; Priscilla J. Slanetz
      Pages: 655 - 656
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      Author(s): Aine Marie Kelly, Priscilla J. Slanetz

      PubDate: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2017.03.007
  • Anonymity and Electronics
    • Authors: Teresa Chapman; Janet R. Reid; Erin E. O'Conner
      Pages: 657 - 663
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      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: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2017.01.008
  • Application of the Balanced Scorecard for Faculty Development
    • Authors: Jacob Smith; Somnath J. Prabhu; Puneet Bhargava
      Pages: 664 - 666
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      Author(s): Jacob Smith, Somnath J. Prabhu, Puneet Bhargava

      PubDate: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2016.04.014
  • A Simplified Approach to Encephalitis and Its Mimics
    • Authors: Colin D. McKnight; Aine M. Kelly; Myria Petrou; Anna E. Nidecker; Matthew T. Lorincz; Duaa K. Altaee; Stephen S. Gebarski; Bradley Foerster
      Pages: 667 - 676
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      Author(s): Colin D. McKnight, Aine M. Kelly, Myria Petrou, Anna E. Nidecker, Matthew T. Lorincz, Duaa K. Altaee, Stephen S. Gebarski, Bradley Foerster
      Rationale and Objectives Infectious encephalitis is a relatively common cause of morbidity and mortality. Treatment of infectious encephalitis with antiviral medication can be highly effective when administered promptly. Clinical mimics of encephalitis arise from a broad range of pathologic processes, including toxic, metabolic, neoplastic, autoimmune, and cardiovascular etiologies. These mimics need to be rapidly differentiated from infectious encephalitis to appropriately manage the correct etiology; however, the many overlapping signs of these various entities present a challenge to accurate diagnosis. A systematic approach that considers both the clinical manifestations and the imaging findings of infectious encephalitis and its mimics can contribute to more accurate and timely diagnosis. Materials and Methods Following an institutional review board approval, a health insurance portability and accountability act (HIPAA)-compliant search of our institutional imaging database (teaching files) was conducted to generate a list of adult and pediatric patients who presented between January 1, 1995 and October 10, 2013 for imaging to evaluate possible cases of encephalitis. Pertinent medical records, including clinical notes as well as surgical and pathology reports, were reviewed and correlated with imaging findings. Clinical and imaging findings were combined to generate useful flowcharts designed to assist in distinguishing infectious encephalitis from its mimics. Key imaging features were reviewed and were placed in the context of the provided flowcharts. Results Four flowcharts were presented based on the primary anatomic site of imaging abnormality: group 1: temporal lobe; group 2: cerebral cortex; group 3: deep gray matter; and group 4: white matter. An approach that combines features on clinical presentation was then detailed. Imaging examples were used to demonstrate similarities and key differences. Conclusions Early recognition of infectious encephalitis is critical, but can be quite complex due to diverse pathologies and overlapping features. Synthesis of both the clinical and imaging features of infectious encephalitis and its mimics is critical to a timely and accurate diagnosis. The use of the flowcharts presented in this article can further enable both clinicians and radiologists to more confidently differentiate encephalitis from its mimics and improve patient care.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2016.04.013
  • Hands-on Physics Education of Residents in Diagnostic Radiology
    • Authors: Jie Zhang; Peter A. Hardy; David J. DiSantis; M. Elizabeth Oates
      Pages: 677 - 681
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      Author(s): Jie Zhang, Peter A. Hardy, David J. DiSantis, M. Elizabeth Oates
      Rationale and Objectives The American Board of Radiology Core Examination integrates assessment of physics knowledge into its overall testing of clinical radiology, with an emphasis on understanding image quality and artifacts, radiation dose, and patient safety for each modality or subspecialty organ system. Accordingly, achieving a holistic approach to physics education of radiology residents is a huge challenge. The traditional teaching of radiological physics—simply through didactic lectures—was not designed for such a holistic approach. Admittedly, time constraints and clinical demands can make incorporation of physics teaching into clinical practice problematic. We created and implemented a week-long, intensive physics rotation for fledgling radiology residents and evaluated its effectiveness. Materials and Methods The dedicated physics rotation is held for 1 week during the first month of radiology residency. It comprises three components: introductory lectures, hands-on practical clinical physics operations, and observation of clinical image production. A brief introduction of the physics pertinent to each modality is given at the beginning of each session. Hands-on experimental demonstrations are emphasized, receiving the greatest allotment of time. The residents perform experiments such as measuring radiation dose, studying the relationship between patient dose and clinical practice (eg, fluoroscopy technique), investigating the influence of acquisition parameters (kV, mAs) on radiographs, and evaluating image quality using computed tomography, magnetic resonance imaging, ultrasound, and gamma camera/single-photon emission computed tomography/positron emission tomography phantoms. Quantitative assessment of the effectiveness of the rotation is based on an examination that tests the residents' grasp of basic medical physics concepts along with written course evaluations provided by each resident. Results The pre- and post-rotation tests show that after the physics rotation, the average correct score of 25 questions improved from 13.6 ± 2.4 to 19 ± 1.2. The survey shows that the physics rotation during the first week of residency is favored by all residents and that 1 week's duration is appropriate. All residents are of the opinion that the intensive workshop would benefit them in upcoming clinical rotations. Residents acknowledge becoming more comfortable regarding the use of radiation and providing counsel regarding radiation during pregnancy. Conclusions An immersive, short-duration, clinically oriented physics rotation is well received by new or less experienced radiology trainees, correlates basic physics concepts with their relevance to clinical imaging, and more closely parallels expectations of the American Board of Radiology Core Examination.

      PubDate: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2017.01.015
  • Emotional Wellness of Current Musculoskeletal Radiology Fellows
    • Authors: Jack Porrino; Michael J. Mulcahy; Hyojeong Mulcahy; Annemarie Relyea-Chew; Felix S. Chew
      Pages: 682 - 693
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      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: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2016.12.024
  • Attending Radiologist Variability and Its Effect on Radiology Resident
           Discrepancy Rates
    • Authors: Joseph C. Wildenberg; Po-Hao Chen; Mary H. Scanlon; Tessa S. Cook
      Pages: 694 - 699
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      Author(s): Joseph C. Wildenberg, Po-Hao Chen, Mary H. Scanlon, Tessa S. Cook
      Rationale and Objectives Discrepancy rates for interpretations produced in a call situation are one metric to evaluate residents during training. Current benchmarks, reported in previous studies, do not consider the effects of practice pattern variability among attending radiologists. This study aims to investigate the impact of attending variability on resident discrepancy rates to determine if the current benchmarks are an accurate measure of resident performance and, if necessary, update discrepancy benchmarks to accurately identify residents performing below expectations. Materials and Methods All chest radiographs, musculoskeletal (MSK) radiographs, chest computed tomographies (CTs), abdomen and pelvis CTs, and head CTs interpreted by postgraduate year-3 residents in a call situation over 5 years were reviewed for the presence of a significant discrepancy and composite results compared to prior findings. Simulations of the expected discrepancy distribution for an “average resident” were then performed using Gibbs sampling, and this distribution was compared to the actual resident distribution. Results A strong inverse correlation between resident volume and discrepancy rates was found. There was wide variability among attendings in both overread volume and propensity to issue a discrepancy, although there was no significant correlation. Simulations show that previous benchmarks match well for chest radiographs, abdomen and pelvis CTs, and head CTs but not for MSK radiographs and chest CTs. The simulations also demonstrate a large effect of attending practice patterns on resident discrepancy rates. Conclusions The large variability in attending practice patterns suggests direct comparison of residents using discrepancy rates is unlikely to reflect true performance. Current benchmarks for chest radiographs, abdomen and pelvis CTs, and head CTs are appropriate and correctly flag residents whose performance may benefit from additional attention, whereas those for MSK radiographs and chest CTs are likely too strict.

      PubDate: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2016.12.004
  • Development and Assessment of a Novel Task Trainer and Targeting Tasks for
           Ultrasound-guided Invasive Procedures
    • Authors: Joshua F. Nitsche; Kristina M. Shumard; Brian C. Brost
      Pages: 700 - 708
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      Author(s): Joshua F. Nitsche, Kristina M. Shumard, Brian C. Brost
      Rationale and Objectives The American Institute of Ultrasound in Medicine (AIUM) recommends that all providers performing ultrasound-guided invasive procedures be competent in a core set of guidance skills common to all ultrasound-guided procedures, including in-plane and out-of-plane needle guidance and needle imaging optimization techniques such as probe translation, rotation, and heel-toe standoff. To allow for the practice and assessment of these core skills, we have created a novel task trainer and set of targeting tasks, and sought to obtain validity evidence in the content and response process domains for this training and assessment system according to the Standards for Educational and Psychological Testing. Materials and Methods We have constructed an ultrasound-guided invasive procedure training system and five targeting tasks that focused on the needle guidance skills outlined by the AIUM. All tasks were performed by obstetrics and gynecology or maternal-fetal medicine physicians with and without experience in ultrasound-guided invasive procedures during a series of simulation workshops. All participants completed a survey regarding the trainer's and the tasks' usefulness in the training of inexperienced physicians. Results The physicians who completed the tasks had favorable views of task trainer and curriculum. The targeting curriculum was felt to allow practice of all of the core guidance skills outlined by the AIUM. The average response provided for all of the tasks was 4.0 or greater, with half of the items having an average response of 4.5 or higher. Conclusions We have constructed a task trainer that incorporates all of the core skills outlined by the AIUM. All five tasks received very favorable reviews from both experienced and inexperienced providers. Taken together, our findings suggest they have strong content and response process validity evidence.

      PubDate: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2016.10.008
  • Self-Study
    • Authors: Jessica B. Robbins; David Sarkany
      Pages: 721 - 724
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      Author(s): Jessica B. Robbins, David Sarkany
      The Accreditation Council for Graduate Medical Education (ACGME) self-study is a new process for ACGME accredited radiology programs. This article serves to provide the reader with the evolution of ACGME accreditation leading to the conception of the self-study process, detail the self-study method, and offer practical advice to programs embarking upon their inaugural self-study.

      PubDate: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2016.10.015
  • The Evolving Role of the Program Coordinator
    • Authors: Joseph Stuckelman; Sylvia E. Zavatchen; Sally A. Jones
      Pages: 725 - 729
      Abstract: Publication date: June 2017
      Source:Academic Radiology, Volume 24, Issue 6
      Author(s): Joseph Stuckelman, Sylvia E. Zavatchen, Sally A. Jones
      As ACGME (Accreditation Council for Graduate Medical Education) requirements have expanded and become increasingly more complex, so has the role of the program coordinator. Over the last decade, the knowledge and skills required to capably administer residency and fellowship training programs have increased in both volume and complexity. Today's coordinators are responsible for more than clerical tasks. They also function as managers and have greater roles in the development and implementation of program initiatives, policies, and outcomes. As a result, coordinators' roles and responsibilities have evolved to include management skills. To keep pace with the rapid and continuing change, it is imperative that coordinators continue to develop these skill sets to add value to their programs, institutions, and careers.

      PubDate: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2016.12.021
  • High-ability Learners
    • Authors: Richard B. Gunderman
      Abstract: Publication date: Available online 30 June 2017
      Source:Academic Radiology
      Author(s): Richard B. Gunderman

      PubDate: 2017-07-02T09:45:03Z
      DOI: 10.1016/j.acra.2017.05.016
  • “Rounding” the Size of Pulmonary Nodules
    • Authors: Benedikt H. Heidinger; Ursula Nemec; Kevin R. Anderson; Daniel B. Costa; Sidhu P. Gangadharan; Paul A. VanderLaan; Alexander A. Bankier
      Abstract: Publication date: Available online 27 June 2017
      Source:Academic Radiology
      Author(s): Benedikt H. Heidinger, Ursula Nemec, Kevin R. Anderson, Daniel B. Costa, Sidhu P. Gangadharan, Paul A. VanderLaan, Alexander A. Bankier
      Rationale and Objectives The objective of this study was to quantify the impact of different rounding methods on size measurements of pulmonary nodules and to determine the number of nodules that change management categories as a result of rounding. Materials and Methods For this retrospective institutional review board-approved study, we included 503 incidental pulmonary nodules (308 solid and 195 subsolid) from a data repository. Long and short axes were measured. Average diameters were calculated using four different rounding methods (method 1: no rounding; method 2: rounding only the average diameter to the closest millimeter; method 3: rounding only short and long axes; and method 4: rounding short and long axes and the average diameter to the closest millimeter). Nodules were classified for each rounding method according to the 2017 Fleischner Society guideline management categories. Measurements were compared among the four rounding methods using analysis of variance. Results Without rounding, the average nodule diameter was 15.67 ± 5.97 mm. This increased between 0.03  and 0.29 mm using rounding methods 2–4 (range: P < 0.001–0.017). The nodule size was more frequently rounded up (range: 52.1%–77.5%) than rounded down (range: 17.7%–42.5%) using rounding methods 2–4, as compared to no rounding. In the 308 solid nodules, up to 2.9% of the nodules changed management category, whereas none of the 195 subsolid nodules changed category. Conclusions Rounding methods have a small absolute but statically significant effect on nodule size, impacting management category in less than 3% of the nodules. This suggests that, in clinical practice, any rounding method can be used for determining nodule size without substantially biasing individual nodules toward given management categories.

      PubDate: 2017-07-02T09:45:03Z
      DOI: 10.1016/j.acra.2017.05.013
  • The Reproducibility of Changes in Diagnostic Figures of Merit Across
           Laboratory and Clinical Imaging Reader Studies
    • Authors: Frank W. Samuelson; Craig K. Abbey
      Abstract: Publication date: Available online 27 June 2017
      Source:Academic Radiology
      Author(s): Frank W. Samuelson, Craig K. Abbey
      Rationale and Objectives In this paper we examine which comparisons of reading performance between diagnostic imaging systems made in controlled retrospective laboratory studies may be representative of what we observe in later clinical studies. The change in a meaningful diagnostic figure of merit between two diagnostic modalities should be qualitatively or quantitatively comparable across all kinds of studies. Materials and Methods In this meta-study we examine the reproducibility of relative measures of sensitivity, false positive fraction (FPF), area under the receiver operating characteristic (ROC) curve, and expected utility across laboratory and observational clinical studies for several different breast imaging modalities, including screen film mammography, digital mammography, breast tomosynthesis, and ultrasound. Results Across studies of all types, the changes in the FPFs yielded very small probabilities of having a common mean value. The probabilities of relative sensitivity being the same across ultrasound and tomosynthesis studies were low. No evidence was found for different mean values of relative area under the ROC curve or relative expected utility within any of the study sets. Conclusion The comparison demonstrates that the ratios of areas under the ROC curve and expected utilities are reproducible across laboratory and clinical studies, whereas sensitivity and FPF are not.

      PubDate: 2017-07-02T09:45:03Z
      DOI: 10.1016/j.acra.2017.05.007
  • Implementation of Upright Digital Breast Tomosynthesis-guided Stereotactic
    • Authors: Toma S. Omofoye; Sarah Martaindale; Davis C. Teichgraeber; Jay R. Parikh
      Abstract: Publication date: Available online 27 June 2017
      Source:Academic Radiology
      Author(s): Toma S. Omofoye, Sarah Martaindale, Davis C. Teichgraeber, Jay R. Parikh
      With growing adoption of digital breast tomosynthesis, an increasing number of imaging abnormalities are being identified only by tomosynthesis. Upright digital breast tomosynthesis-guided stereotactic biopsy is a proven method for sampling these abnormalities as well as abnormalities traditionally evaluated using conventional stereotactic biopsy. In this article, we describe the technique of upright digital breast tomosynthesis-guided stereotactic biopsy and outline a systematic operational approach to implementation of this technique in clinical radiology practices.

      PubDate: 2017-07-02T09:45:03Z
      DOI: 10.1016/j.acra.2017.05.010
  • Evaluation of Texture Analysis Parameter for Response Prediction in
           Patients with Hepatocellular Carcinoma Undergoing Drug-eluting Bead
           Transarterial Chemoembolization (DEB-TACE) Using Biphasic
           Contrast-enhanced CT Image Data
    • Authors: Christopher Kloth; Wolfgang M. Thaiss; Rainer Kärgel; Rainer Grimmer; Jan Fritz; Sorin Dumitru Ioanoviciu; Dominik Ketelsen; Konstantin Nikolaou; Marius Horger
      Abstract: Publication date: Available online 23 June 2017
      Source:Academic Radiology
      Author(s): Christopher Kloth, Wolfgang M. Thaiss, Rainer Kärgel, Rainer Grimmer, Jan Fritz, Sorin Dumitru Ioanoviciu, Dominik Ketelsen, Konstantin Nikolaou, Marius Horger
      Rationale and Objectives This study aimed to evaluate the potential role of computed tomography texture analysis (CTTA) of arterial and portal-venous enhancement phase image data for prediction and accurate assessment of response of hepatocellular carcinoma undergoing drug-eluting bead transarterial chemoembolization (TACE) by comparison to liver perfusion CT (PCT). Materials and Methods Twenty-eight patients (27 male; mean age 67.2 ± 10.4) with 56 hepatocellular carcinoma-typical liver lesions were included. Arterial and portal-venous phase CT data obtained before and after TACE with a mean time of 39.93 ± 62.21 days between examinations were analyzed. TACE was performed within 48 hours after first contrast-enhanced CT. CTTA software was a prototype. CTTA analysis was performed blinded (for results) by two observers separately. Combined results of modified Response Evaluation Criteria In Solid Tumors (mRECIST) and PCT of the liver were used as the standard of reference. Time to progression was additionally assessed for all patients. CTTA parameters included heterogeneity, intensity, average, deviation, skewness, and entropy of co-occurrence. Each parameter was compared to those of PCT (blood flow [BF], blood volume, arterial liver perfusion [ALP], portal-venous perfusion, and hepatic perfusion index) measured before and after TACE. Results mRECIST + PCT yielded 28.6% complete response (CR), 42.8% partial response, and 28.6% stable disease. Significant correlations were registered in the arterial phase in CR between changes in mean heterogeneity and BF (P = .004, r = −0.815), blood volume (P = .002, r = −0.851), and ALP (P = .002, r = −0.851), respectively. In the partial response group, changes in mean heterogeneity correlated with changes in ALP (P = .003) and to a lesser degree with hepatic perfusion index (P = .027) in the arterial phase. In the stable disease group, BF correlated with entropy of nonuniformity (P = .010). In the portal-venous phase, no statistically significant correlations were registered in all groups. Receiver operating characteristic analysis of CTTA parameters yielded predictive cutoff values for CR in the arterial contrast-enhanced CT phase for uniformity of skewness (sensitivity: 90.0%; specificity: 45.8%), and in the portal-venous phase for uniformity of heterogeneity (sensitivity: 92.3%; specificity: 81.8%). Conclusions Significant correlations exist between CTTA parameters and those derived from PCT both in the pre- and the post-TACE settings, and some of them have predictive value for TACE midterm outcome.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.05.006
  • The Efficacy of Low-intensity Vibration to Improve Bone Health in Patients
           with End-stage Renal Disease Is Highly Dependent on Compliance and Muscle
    • Authors: Chamith S. Rajapakse; Mary B. Leonard; Elizabeth A. Kobe; Michelle A. Slinger; Kelly A. Borges; Erica Billig; Clinton T. Rubin; Felix W. Wehrli
      Abstract: Publication date: Available online 23 June 2017
      Source:Academic Radiology
      Author(s): Chamith S. Rajapakse, Mary B. Leonard, Elizabeth A. Kobe, Michelle A. Slinger, Kelly A. Borges, Erica Billig, Clinton T. Rubin, Felix W. Wehrli
      Rational and Objectives Low intensity vibration (LIV) may represent a nondrug strategy to mitigate bone deficits in patients with end-stage renal disease. Materials and Methods Thirty end-stage renal patients on maintenance hemodialysis were randomized to stand for 20 minutes each day on either an active or placebo LIV device. Analysis at baseline and completion of 6-month intervention included magnetic resonance imaging (tibia and fibula stiffness; trabecular thickness, number, separation, bone volume fraction, plate-to-rod ratio; and cortical bone porosity), dual-energy X-ray absorptiometry (hip and spine bone mineral density [BMD]), and peripheral quantitative computed tomography (tibia trabecular and cortical BMD; calf muscle cross-sectional area). Results Intention-to-treat analysis did not show any significant changes in outcomes associated with LIV. Subjects using the active device and with greater than the median adherence (70%) demonstrated an increase in distal tibia stiffness (5.3%), trabecular number (1.7%), BMD (2.3%), and plate-to-rod ratio (6.5%), and a decrease in trabecular separation (−1.8%). Changes in calf muscle cross-sectional area were associated with changes in distal tibia stiffness (R = 0.85), trabecular bone volume/total volume (R = 0.91), number (R = 0.92), and separation (R = −0.94) in the active group but not in the placebo group. Baseline parathyroid hormone levels were positively associated with increased cortical bone porosity over the 6-month study period in the placebo group (R = 0.55) but not in the active group (R = 0.01). No changes were observed in the nondistal tibia locations for either group except a decrease in hip BMD in the placebo group (−1.7%). Conclusion Outcomes and adherence thresholds identified from this pilot study could guide future longitudinal studies involving vibration therapy.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.05.014
  • The Importance of Combined Teaching Methods in Radiology Resident
    • Authors: Teresa Chapman; Janet R. Reid; Erin E. O'Connor
      Abstract: Publication date: Available online 21 June 2017
      Source:Academic Radiology
      Author(s): Teresa Chapman, Janet R. Reid, Erin E. O'Connor

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.05.015
  • Improving Abnormality Detection on Chest Radiography Using Game-Like
           Reinforcement Mechanics
    • Authors: Po-Hao Chen; Howard Roth; Maya Galperin-Aizenberg; Alexander T. Ruutiainen; Warren Gefter; Tessa S. Cook
      Abstract: Publication date: Available online 21 June 2017
      Source:Academic Radiology
      Author(s): Po-Hao Chen, Howard Roth, Maya Galperin-Aizenberg, Alexander T. Ruutiainen, Warren Gefter, Tessa S. Cook
      Rationale and Objectives Despite their increasing prevalence, online textbooks, question banks, and digital references focus primarily on explicit knowledge. Implicit skills such as abnormality detection require repeated practice on clinical service and have few digital substitutes. Using mechanics traditionally deployed in video games such as clearly defined goals, rapid-fire levels, and narrow time constraints may be an effective way to teach implicit skills. Materials and Methods We created a freely available, online module to evaluate the ability of individuals to differentiate between normal and abnormal chest radiographs by implementing mechanics, including instantaneous feedback, rapid-fire cases, and 15-second timers. Volunteer subjects completed the modules and were separated based on formal experience with chest radiography. Performance between training and testing sets were measured for each group, and a survey was administered after each session. Results The module contained 74 cases and took approximately 20 minutes to complete. Thirty-two cases were normal radiographs and 56 cases were abnormal. Of the 60 volunteers recruited, 25 were “never trained” and 35 were “previously trained.” “Never trained” users scored 21.9 out of 37 during training and 24.0 out of 37 during testing (59.1% vs 64.9%, P value <.001). “Previously trained” users scored 28.0 out of 37 during training and 28.3 out of 37 during testing phases (75.6% vs 76.4%, P value = .56). Survey results showed that 87% of all subjects agreed the module is an efficient way of learning, and 83% agreed the rapid-fire module is valuable for medical students. Conclusions A gamified online module may improve the abnormality detection rates of novice interpreters of chest radiography, although experienced interpreters are less likely to derive similar benefits. Users reviewed the educational module favorably.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.05.005
  • Characterization of Breast Masses in Digital Breast Tomosynthesis and
           Digital Mammograms
    • Authors: Heang-Ping Chan; Mark A. Helvie; Lubomir Hadjiiski; Deborah O. Jeffries; Katherine A. Klein; Colleen H. Neal; Mitra Noroozian; Chintana Paramagul; Marilyn A. Roubidoux
      Abstract: Publication date: Available online 21 June 2017
      Source:Academic Radiology
      Author(s): Heang-Ping Chan, Mark A. Helvie, Lubomir Hadjiiski, Deborah O. Jeffries, Katherine A. Klein, Colleen H. Neal, Mitra Noroozian, Chintana Paramagul, Marilyn A. Roubidoux
      Rationale and Objectives This study aimed to compare Breast Imaging Reporting and Data System (BI-RADS) assessment of lesions in two-view digital mammogram (DM) to two-view wide-angle digital breast tomosynthesis (DBT) without DM. Materials and Methods With Institutional Review Board approval and written informed consent, two-view DBTs were acquired from 134 subjects and the corresponding DMs were collected retrospectively. The study included 125 subjects with 61 malignant (size: 3.9–36.9 mm, median: 13.4 mm) and 81 benign lesions (size: 4.8–43.8 mm, median: 12.0 mm), and 9 normal subjects. The cases in the two modalities were read independently by six experienced Mammography Quality Standards Act radiologists in a fully crossed counterbalanced manner. The readers were blinded to the prevalence of malignant, benign, or normal cases and were asked to assess the lesions based on the BI-RADS lexicon. The ratings were analyzed by the receiver operating characteristic methodology. Results Lesion conspicuity was significantly higher (P << .0001) and fewer lesion margins were considered obscured in DBT. The mean area under the receiver operating characteristic curve for the six readers increased significantly (P = .0001) from 0.783 (range: 0.723–0.886) for DM to 0.911 (range: 0.884–0.936) for DBT. Of the 366 ratings for malignant lesions, 343 on DBT and 278 on DM were rated as BI-RADS 4a and above. Of the 486 ratings for benign lesions, 220 on DBT and 206 on DM were rated as BI-RADS 4a and above. On average, 17.8% (65 of 366) more malignant lesions and 2.9% (14 of 486) more benign lesions would be recommended for biopsy using DBT. The inter-radiologist variability was reduced significantly. Conclusion With DBT alone, the BI-RADS assessment of breast lesions and inter-radiologist reliability were significantly improved compared to DM.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.04.016
  • Practical Considerations for the Use of Breast MRI for Breast Cancer
           Evaluation in the Preoperative Setting
    • Authors: Debra L. Monticciolo
      Abstract: Publication date: Available online 21 June 2017
      Source:Academic Radiology
      Author(s): Debra L. Monticciolo
      Preoperative contrast-enhanced (CE) breast magnetic resonance imaging (MRI) remains controversial in the newly diagnosed breast cancer patient. Additional lesions are frequently discovered in these patients with CE breast MRI. As staging and treatment planning evolve to include more information on tumor biology and aggression, so should our consideration of extent of disease. Directing CE breast MRI to those patients most likely to have additional disease may be beneficial. We sought to develop practical guidance for the use of preoperative CE breast MRI in the newly diagnosed breast cancer patient based on recent scientific data. Our review suggests several populations for whom preoperative breast MRI is most likely to find additional disease beyond that seen on conventional imaging. These can be viewed in three categories: (1) tumor biology—patients with invasive lobular carcinoma or aggressive tumors such as triple negative breast cancer (estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 (HER2) negative) and HER2 positive tumors; (2) patient characteristics—dense breast tissue or younger age, especially those age <60; and (3) clinical scenarios—patients with more sonographic disease than expected or those who are node positive at initial diagnosis. Focusing breast MRI on patients with any of the aforementioned characteristics may help utilize preoperative breast MRI where it is likely to have the most impact.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.05.012
  • Diagnostic Medical Imaging in Pediatric Patients and Subsequent Cancer
    • Authors: David J. Mulvihill; Sachin Jhawar; John B. Kostis; Sharad Goyal
      Abstract: Publication date: Available online 20 June 2017
      Source:Academic Radiology
      Author(s): David J. Mulvihill, Sachin Jhawar, John B. Kostis, Sharad Goyal
      The use of diagnostic medical imaging is becoming increasingly more commonplace in the pediatric setting. However, many medical imaging modalities expose pediatric patients to ionizing radiation, which has been shown to increase the risk of cancer development in later life. This review article provides a comprehensive overview of the available data regarding the risk of cancer development following exposure to ionizing radiation from diagnostic medical imaging. Attention is paid to modalities such as computed tomography scans and fluoroscopic procedures that can expose children to radiation doses orders of magnitude higher than standard diagnostic x-rays. Ongoing studies that seek to more precisely determine the relationship of diagnostic medical radiation in children and subsequent cancer development are discussed, as well as modern strategies to better quantify this risk. Finally, as cardiovascular imaging and intervention contribute substantially to medical radiation exposure, we discuss strategies to enhance radiation safety in these areas.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.05.009
  • Pulmonary 3He Magnetic Resonance Imaging Biomarkers of Regional Airspace
           Enlargement in Alpha-1 Antitrypsin Deficiency
    • Authors: Eric Lessard; Heather M. Young; Anurag Bhalla; Damien Pike; Khadija Sheikh; David G. McCormack; Alexei Ouriadov; Grace Parraga
      Abstract: Publication date: Available online 20 June 2017
      Source:Academic Radiology
      Author(s): Eric Lessard, Heather M. Young, Anurag Bhalla, Damien Pike, Khadija Sheikh, David G. McCormack, Alexei Ouriadov, Grace Parraga
      Rationale and Objectives Thoracic x-ray computed tomography (CT) and hyperpolarized 3He magnetic resonance imaging (MRI) provide quantitative measurements of airspace enlargement in patients with emphysema. For patients with panlobular emphysema due to alpha-1 antitrypsin deficiency (AATD), sensitive biomarkers of disease progression and response to therapy have been difficult to develop and exploit, especially those biomarkers that correlate with outcomes like quality of life. Here, our objective was to generate and compare CT and diffusion-weighted inhaled-gas MRI measurements of emphysema including apparent diffusion coefficient (ADC) and MRI-derived mean linear intercept (Lm) in patients with AATD, chronic obstructive pulmonary disease (COPD) ex-smokers, and elderly never-smokers. Materials and Methods We enrolled patients with AATD (n = 8; 57 ± 7 years), ex-smokers with COPD (n = 8; 77 ± 6 years), and a control group of never-smokers (n = 5; 64 ± 2 years) who underwent thoracic CT, MRI, spirometry, plethysmography, the St. George's Respiratory Questionnaire, and the 6-minute walk test during a single 2-hour visit. MRI-derived ADC, Lm, surface-to-volume ratio, and ventilation defect percent were generated for the apical, basal, and whole lung as was CT lung area ≤−950 Hounsfield units (RA950), low attenuating clusters, and airway count. Results In patients with AATD, there was a significantly different MRI-derived ADC (P = .03), Lm (P < .0001), and surface-to-volume ratio (P < .0001), but not diffusing capacity of carbon monoxide, residual volume or total lung capacity, or CT RA950 (P > .05) compared to COPD ex-smokers with a significantly different St. George's Respiratory Questionnaire. Conclusions In this proof-of-concept demonstration, we evaluated CT and MRI lung emphysema measurements and observed significantly worse MRI biomarkers of emphysema in patients with AATD compared to patients with COPD, although CT RA950 and diffusing capacity of carbon monoxide were not significantly different, underscoring the sensitivity of MRI measurements of AATD emphysema.

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.05.008
  • Andragogic Approaches to Continuing Medical Education
    • Authors: Christian W. Cox; Richard B. Gunderman
      Abstract: Publication date: Available online 20 June 2017
      Source:Academic Radiology
      Author(s): Christian W. Cox, Richard B. Gunderman

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.05.004
  • Radiology Resident Education
    • Authors: Ciaran E. Redmond; Gerard M. Healy; Simon Clifford; Eric J. Heffernan
      Abstract: Publication date: Available online 19 June 2017
      Source:Academic Radiology
      Author(s): Ciaran E. Redmond, Gerard M. Healy, Simon Clifford, Eric J. Heffernan

      PubDate: 2017-06-27T09:15:03Z
      DOI: 10.1016/j.acra.2017.04.015
  • Sub-solid Nodule Detection Performance on Reduced-dose Computed Tomography
           with Iterative Reduction
    • Authors: Yukihiro Nagatani; Masashi Takahashi Mitsuru Ikeda Tsuneo Yamashiro Hisanobu Koyama
      Abstract: Publication date: Available online 9 June 2017
      Source:Academic Radiology
      Author(s): Yukihiro Nagatani, Masashi Takahashi, Mitsuru Ikeda, Tsuneo Yamashiro, Hisanobu Koyama, Mitsuhiro Koyama, Hiroshi Moriya, Satoshi Noma, Noriyuki Tomiyama, Yoshiharu Ohno, Kiyoshi Murata, Sadayuki Murayama
      Rationale and Objectives This study aimed to compare sub-solid nodule detection performances (SSNDP) on chest computed tomography (CT) with Adaptive Iterative Dose Reduction using Three Dimensional Processing (AIDR 3D) between 7 mAs (0.21 mSv) and 42 mAs (1.28 mSv) in total and in subgroups classified by nodular size, characteristics, and location, and analyze the association of SSNDP with size-specific dose estimate (SSDE). Materials and Methods As part of the Area-detector Computed Tomography for the Investigation of Thoracic Diseases Study, a Japanese multicenter research project, 68 subjects underwent chest CT with 120 kV, 0.35 seconds per rotation, and three tube currents: 240 mA (84 mAs), 120 mA (42 mAs), and 20 mA (7 mAs). The research committee of the study project outlined and approved our study protocols. The institutional review board of each institution approved this study. Axial 2-mm-thick CT images were reconstructed using AIDR 3D. Standard reference was determined by CT images at 84 mAs. Four radiologists recorded SSN presence by continuously distributed rating on CT at 7 mAs and 42 mAs. Receiver operating characteristic analysis was used to evaluate SSNDP at both doses in total and in subgroups classified by nodular longest diameter (LD) (≥5 mm), characteristics(pure and part-solid), and locations (ventral, intermediate, or dorsal; central or peripheral; and upper, middle, or lower). Detection sensitivity was compared among five groups of SSNs classified based on particular SSDE to nodule on CT with AIDR 3D at 7 mAs. Results Twenty-two part-solid and 86 pure SSNs were identified. For larger SSNs (LD ≥ 5 mm) as well as subgroups classified by nodular locations and part-solid nodules, SSNDP was similar in both methods (area under the receiver operating characteristics curve: 0.96 ± 0.02 in CT at 7 mAs and 0.97 ± 0.01 in CT at 42 mAs), with acceptable interobserver agreements in five locations. For larger SSNs (LD ≥ 5 mm), on CT at 42 mAs, no significant differences in detection sensitivity were found among the five groups classified by SSDE, whereas on CT with 7 mAs, four groups with SSDE of 0.65 or higher were superior in detection sensitivity to the other group, with SSDE less than 0.65 mGy. Conclusions For SSNs with 5 mm or more in cases with normal range of body habitus, CT at 7 mAs was demonstrated to have comparable SSNDP to CT at 42 mAs regardless of nodular location and characteristics, and SSDE higher than 0.65 mGy is desirable to obtain sufficient SSNDP.

      PubDate: 2017-06-10T04:15:03Z
  • A Diagnostic Accuracy Meta-analysis of CT and MRI for the Evaluation of
           Small Bowel Crohn Disease
    • Authors: Wenhong Liu; Jincai Liu; Wenlian Xiao; Guanghua Luo
      Abstract: Publication date: Available online 5 June 2017
      Source:Academic Radiology
      Author(s): Wenhong Liu, Jincai Liu, Wenlian Xiao, Guanghua Luo
      Rationale and Objectives This study aimed to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) in assessing small bowel (SB) Crohn disease (CD). Materials and Methods We systematically searched PubMed, Elsevier, ScienceDirect, Karger, Web of Science, Wiley Online Library, and Springer for studies in which CT or MRI were evaluated to assess SB CD. Bivariate random effect meta-analytic methods were used to estimate pooled sensitivity, specificity, and receiver operating characteristic curves. Diagnostic odds ratios (DORs) in a per-patient–based analysis were estimated. The area under the receiver operating characteristic curve was also calculated to measure the diagnostic accuracy. Results Twenty-one studies involving 913 patients were included in this meta-analysis. There was no significant difference observed between modalities. The diagnostic performances (lnDOR) for CT and MRI also showed no significant difference. Subgroup analysis was performed for MR imaging (MR enteroclysis, MR enterography, and CT enterography). The diagnostic performances (lnDOR) for MR enteroclysis, MR enterography, and CT enterography did not show a significant difference among them. No significant difference was found between these techniques. Deeks funnel plot asymmetry test for publication bias showed that no significant publication bias was observed in this analysis. Conclusions This meta-analysis suggests that both MRI and CT have high diagnostic accuracy in detecting SB CD. MRI has the potential to be the first-line radiation-free modality for SB CD imaging.

      PubDate: 2017-06-10T04:15:03Z
      DOI: 10.1016/j.acra.2017.04.013
  • Passing the Baton
    • Authors: N. Reed Dunnick
      Abstract: Publication date: Available online 18 May 2017
      Source:Academic Radiology
      Author(s): N. Reed Dunnick

      PubDate: 2017-05-21T02:24:40Z
      DOI: 10.1016/j.acra.2017.05.001
  • From Strength to Strength
    • Authors: Steven Seltzer
      Abstract: Publication date: Available online 17 May 2017
      Source:Academic Radiology
      Author(s): Steven Seltzer

      PubDate: 2017-05-21T02:24:40Z
      DOI: 10.1016/j.acra.2017.04.004
  • A Leadership Intervention to Further the Training of Female Faculty
           (LIFT-OFF) in Radiology
    • Authors: Lucy B. Spalluto; Stephanie E. Spottswood; Lori A. Deitte; Alexander Chern; Charlene M. Dewey
      Abstract: Publication date: Available online 16 May 2017
      Source:Academic Radiology
      Author(s): Lucy B. Spalluto, Stephanie E. Spottswood, Lori A. Deitte, Alexander Chern, Charlene M. Dewey
      Rationale and Objectives Women are under-represented in the field of radiology, occupy a minority of leadership positions, and, at our institution, have not achieved the same level of academic success as their male counterparts. Consequently, the authors designed, implemented, and evaluated the Leadership Intervention to Further the Training of Female Faculty (LIFT-OFF) program to (1) improve access to opportunities for women's faculty development and advancement, and (2) improve clarification of expectations about the role and path of advancement. Materials and Methods LIFT-OFF was developed based on the results of a needs assessment survey. The results generated 14 priority topics, which served as the basis for educational modules conducted by expert speakers. Module effectiveness was assessed with pre- and postsurveys to elicit participant knowledge about the targeted subject matter. A formative program evaluation was performed at the completion of year 1 of 2 to assess outcomes and impacts to date. Results Seventeen of 55 (31%) educational module post-survey questions demonstrated a statistically significant (P < 0.05) increase in “yes” responses, indicating an improved understanding of targeted information. At year 1, 75% of the participants indicated that the program improved access to faculty development opportunities and 62% reported improved access to career advancement opportunities. Satisfaction with pace of professional advancement increased from 25% to 46% for junior women faculty (P = 0.046). Conclusions Faculty development programs such as LIFT-OFF can provide career development opportunities and executive skills necessary for women to achieve academic career success and assume leadership positions.

      PubDate: 2017-05-21T02:24:40Z
      DOI: 10.1016/j.acra.2016.12.025
  • Privacy, Trainee Rights, and Accountability in Radiology Education
    • Authors: Cory M. Pfeifer
      Abstract: Publication date: Available online 16 May 2017
      Source:Academic Radiology
      Author(s): Cory M. Pfeifer
      Rationale and Objectives Academic radiologists commonly hold multiple simultaneous roles within the landscape of physician training. This paper analyzes theoretical scenarios describing relationships between medical students, residents, and physician educators in radiology. Materials and Methods The scenarios presented involve medical student supervision, radiology resident recruitment, and resident termination with respect to relevant ethical, regulatory, and legal considerations. Legal precedents and the medical social contract are addressed. Results The Family Educational Rights and Privacy Act defines a framework for the privacy practices of medical schools, but it does not confer individual rights. Resident physicians rarely win wrongful termination lawsuits. Physician educators are ethically bound to act in the best interest of society. Conclusions Courts have ruled that medicine is intended to be a self-regulatory profession. Such a power requires that physicians remain accountable to the public while providing a fair learning environment for medical trainees.

      PubDate: 2017-05-21T02:24:40Z
      DOI: 10.1016/j.acra.2016.09.028
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