CT-Guided Core Needle Biopsy of Nonspinal Bone Lesions: Comparison of Occult and Visible Bone Lesions.

CT guidance may be used for biopsy of indeterminate bone lesions detected by MRI or PET/CT that are not visible (i.e., occult) on CT owing to equipment-, patient-, and operator-related factors.

Safety of omitting routine bleeding tests prior to image-guided musculoskeletal core needle biopsy.

Purpose: To evaluate the safety of withholding preprocedure international normalized ratio (INR) and platelet testing in patients undergoing musculoskeletal (MSK) core needle biopsy (CNB).

Material And Methods: Initially, a retrospective review of 1,162 consecutive patients undergoing MSK CNB with preprocedural INR and platelet testing was performed. Clinical (age, gender, bleeding disorder, liver disease, anticoagulation use, INR > 2, platelet count <50,000/ul) and biopsy factors (imaging modality, lesion type, biopsy needle gauge, number biopsy samples) were tested for association with bleeding complications.

Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain.

Purpose: To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients.

Method And Materials: Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting. The frontal chest radiograph and dedicated rib series were sequentially reviewed in consensus by two fellowship-trained musculoskeletal radiologists blinded to the initial report.

Radiology Research in Quality and Safety: Current Trends and Future Needs.

Promoting quality and safety research is now essential for radiology as reimbursement is increasingly tied to measures of quality, patient safety, efficiency, and appropriateness of imaging. This article provides an overview of key features necessary to promote successful quality improvement efforts in radiology. Emphasis is given to current trends and future opportunities for directing research.

The Science of Quality Improvement.

Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs.

JOURNAL CLUB: Utility of Repeat Core Needle Biopsy of Musculoskeletal Lesions With Initially Nondiagnostic Findings.

Objective: The purpose of the present study is to assess the utility of repeat image-guided core needle biopsy (CNB) of musculoskeletal lesions in the setting of initially nondiagnostic CNB findings.

Materials And Methods: A retrospective review was conducted of 1302 consecutive CNBs performed on bone or soft-tissue lesions at a single institution. Pediatric cases and spine lesions were not included.

How-I-Do-It: Teaching Root Cause Analysis.

We describe our method of exposing radiology residents to root cause analysis. Our interactive case-based, small-group teaching session uses a flipped classroom approach which allows the session to focus primarily on working through the case in small groups. This methodology can be easily integrated at other institutions.

Teaching Principles of Patient-Centered Care During Radiology Residency.

Rationale And Objectives: Patient-centered healthcare delivery has become increasingly established as a cornerstone of quality medical care, but teaching these principles in a radiology residency setting is often difficult and ineffective in a traditional lecture format. We developed a novel educational session in which actual patient letters about a healthcare provider are used to facilitate a case-based discussion of key principles of patient-centered care.

Materials And Methods: A novel patient letter-facilitated, case-based session was conducted at two different university-based teaching institutions.

Comparison of Battery-Powered and Manual Bone Biopsy Systems for Core Needle Biopsy of Sclerotic Bone Lesions.

Objective: The purpose of this study was to compare manual and battery-powered bone biopsy systems for diagnostic yield and procedural factors during core needle biopsy of sclerotic bone lesions.

Materials And Methods: A total of 155 consecutive CT-guided core needle biopsies of sclerotic bone lesions were performed at one institution from January 2006 to November 2014. Before March 2012, lesions were biopsied with manual bone drill systems.

A Practical Guide to MR Imaging Safety: What Radiologists Need to Know.

Magnetic resonance (MR) imaging can provide critical diagnostic and anatomic information while avoiding the use of ionizing radiation, but it has a unique set of safety risks associated with its reliance on large static and changing magnetic fields, high-powered radiofrequency coil systems, and exogenous contrast agents. It is crucial for radiologists to understand these risks and how to mitigate them to protect themselves, their colleagues, and their patients from avoidable harm and to comply with safety regulations at MR imaging sites. Basic knowledge of MR imaging physics and hardware is necessary for radiologists to understand the origin of safety regulations and to avoid common misconceptions that could compromise safety.

Reflective Practice: Assessing Its Effectiveness to Teach Professionalism in a Radiology Residency.

Rationale And Objectives: Professionalism can be challenging to teach during residency training. We undertook this study to evaluate the impact of a case-based, reflective practice (RP) curriculum on the attitudes of radiology residents about professionalism.

Materials And Methods: We developed a case-based radiology-specific RP curriculum focused on topics related to professionalism and ethics.

Imaging of adult flatfoot: correlation of radiographic measurements with MRI.

OBJECTIVE. The purpose of this study is to determine whether radiographic foot measurements can predict injury of the posterior tibial tendon (PTT) and the supporting structures of the medial longitudinal arch as diagnosed on MRI. MATERIALS AND METHODS.

Radiographic scoring system to evaluate union of distal radius fractures.

Purpose: To evaluate the intra- and interobserver reliability of a scoring system for distal radius fracture union based on specific radiographic parameters obtainable from x-rays.

Methods: Two sets of 35 anteroposterior and lateral x-rays were obtained by retrospective review of consecutive patients with distal radius fractures (AO types A and C) treated by a single surgeon in 2009. One set was assembled for those patients treated nonsurgically and 1 set for those treated with open reduction and internal fixation (ORIF) with volar plating.

Spectrum and detection of musculoskeletal findings on trauma-related CT torso examinations.

This study aims (1) to evaluate the spectrum of musculoskeletal (MSK) findings detected on trauma-related torso CT exams performed in the emergency department and (2) to identify the findings of high clinical importance that are underreported. Following IRB approval, two fellowship-trained MSK radiologists independently reviewed 200 consecutive trauma CT torso examinations performed at a level 1 trauma center, focusing on MSK findings. Discrepancies were resolved by consensus.

Mobile computing for radiology.

The rapid advances in mobile computing technology have the potential to change the way radiology and medicine as a whole are practiced. Several mobile computing advances have not yet found application to the practice of radiology, while others have already been applied to radiology but are not in widespread clinical use. This review addresses several areas where radiology and medicine in general may benefit from adoption of the latest mobile computing technologies and speculates on potential future applications.

Resident iPad use: has it really changed the game?

Purpose: The purpose of this study was to assess residents' usage patterns and opinions of the iPad as a tool for radiology education and clinical practice at an academic medical center.

Methods: All 38 radiology residents in our radiology program (postgraduate years 2 to 5) were provided with iPad 2 tablets and subscriptions to e-Anatomy and STATdx. After 6 months of device use, residents were surveyed to assess their opinions regarding the technology as a tool for education and clinical practice.

Lipomatosis of the sciatic nerve secondary to compression by a desmoid tumor.

Lipomatosis of nerve is a rare benign tumor-like process characterized by infiltration of the epineurium by adipose and fibrous tissue leading to nerve enlargement. We describe a case of lipomatosis of the sciatic nerve compressed by an adjacent desmoid tumor. This case supports the hypothesis that lipomatosis of nerve may form as a result of irritation or compression by adjacent structures.

Misrepresentation of publications by radiology residency applicants: is it really a problem?

Purpose: The aim of this study was to determine whether the previous relatively high rate of misrepresentation of publications is still a problem with current applicants for radiology residency.

Methods: The publications submitted by a sample of 300 applicants for a radiology residency in 2011 were assessed using PubMed and an extensive Internet search to verify whether the articles were in print and had the applicants listed as authors and in the same positions of authorship. Whether the applicants graduated from US or international medical schools was recorded.

On-call musculoskeletal radiographs: discrepancy rates between radiology residents and musculoskeletal radiologists.

Objective: The purpose of this study was to determine the rate of discrepancy between radiology residents and attending musculoskeletal radiologists in interpretation of on-call musculoskeletal radiographs.

Materials And Methods: We performed a retrospective review of 2219 consecutive musculoskeletal radiology reports on patients who visited the emergency department between January 2009 and December 2010. The images were initially interpreted overnight by on-call residents (postgraduate years 3-5), and a final interpretation was rendered the next morning by a musculoskeletal radiologist.

Resident and attending physician attitudes regarding an audience response system.

Purpose: Audience response system (ARS) technology is increasingly being incorporated into radiology education. The aim of this study was to gauge resident and attending physician attitudes regarding the use of an ARS in resident conferences.

Methods: An anonymous survey was sent to 38 residents and 57 attending physicians to gauge their attitudes regarding the use of an ARS in resident lectures using a 5-point, Likert-type scale (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, and 5 = strongly agree).

Reflective practice as a tool to teach digital professionalism.

Rationale And Objectives: Digital professionalism is increasingly being integrated into postgraduate medical education. We developed a small-group, reflective practice-based session incorporating radiology-specific cases to heighten residents' awareness about digital professionalism.

Materials And Methods: Case-based, radiology-specific scenarios were created for a small-group, reflective practice-based session on digital professionalism.

Clinical and radiologic predictive factors of septic hip arthritis.

Objective: The purpose of our study was to identify the clinical and radiologic factors associated with a positive culture during image-guided hip joint aspiration.

Materials And Methods: We performed a retrospective analysis of 167 consecutive hip aspirations for septic arthritis at a large tertiary medical center. Chart review was performed on the following clinical factors: serum WBC count≥11×10(3)/μL, serum erythrocyte sedimentation rate (ESR)≥20 mm/h, C-reactive protein (CRP)≥100 mg/L, synovial fluid WBC count, synovial fluid polymorphonuclear (PMN) leukocytes≥90%, fever, immunosuppression, antibiotic use, diabetes, presence of a prosthesis, and IV drug use (IVDU).