ACR TI-RADS: Pitfalls, Solutions, and Future Directions.

The high prevalence of thyroid nodules combined with the generally indolent growth of thyroid cancer present a challenge for optimal patient care. Risk classification models based on US features have been created by multiple professional societies, including the American College of Radiology (ACR), which published the Thyroid Imaging Reporting and Data System (TI-RADS) in 2017. ACR TI-RADS uses a standardized lexicon for assessment of thyroid nodules to generate a numeric scoring of features, designate categories of relative probability of benignity or malignancy, and provide management recommendations, with the aim of reducing unnecessary biopsies and excessive surveillance.

Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach.

Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include mass-forming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm.

MRI of common penile pathologies and penile prostheses.

MRI can delineate finer details of penile anatomy and pathology due to inherent higher soft-tissue contrast and spatial resolution. It can characterize inflammation and identify abscesses, localize penile fractures, guide surgical planning in penile fibrosis and Peyronie's disease, and depict components of the penile prosthesis and its complications. MRI is a great investigative tool for penile neoplasms, including locally infiltrative neoplasms where clinical examination is limited, and local staging is crucial for surgical planning.

Hepatic complications of oral contraceptive pills and estrogen on MRI: Controversies and update - Adenoma and beyond.

Hepatic complications of oral contraceptive pills and exogenous estrogens include intrahepatic canalicular cholestasis, neoplasm formation and vascular pathologies. While it remains controversial as to whether estrogen plays a role in focal nodular hyperplasia, hemangioma or hamartoma, exposure to oral contraceptive pills and estrogen has a strong association with hepatic adenomas. Four different subgroups of adenomas have been described: Inflammatory, HNF-1α-mutated, β-catenin-mutated and unclassified.

The LACSEMS: what radiologists need to know.

Endoscopic drainage is increasingly used in lieu of percutaneous or surgical drainage of pancreatitis-related fluid collections. The lumen-apposing, covered, self-expanding, metallic stent (LACSEMS) is a newly produced stent for the transmural drainage of such fluid collections. The use of LACSEMS devices requires close coordination between knowledgeable radiologic and gastrointestinal providers.

New Job, New Challenges: Life After Radiology Training.

Objective: Beginning a new job after radiology training is exciting but can also be nerve-racking. The key challenge remains making the strange familiar and assimilating with the new practice as soon as possible. This process is complicated and may require learning new policies, getting to know new colleagues, adapting to new surroundings, and learning new skills.

The Incentive Dilemma: Intrinsic Motivation and Workplace Performance.

Incentive plans are a core component of many radiology positions and are often considered a major factor in the ability to recruit and retain high-performing radiologists. Financial incentives are widely thought to be effective at motivating individuals, but there is considerable evidence to the contrary. In this report, the authors examine basic assumptions about financial incentives and debate the potential negative impact of financial incentive systems on performance at radiology practices.

Fundamentals of Diagnostic Error in Imaging.

Imaging plays a pivotal role in the diagnostic process for many patients. With estimates of average diagnostic error rates ranging from 3% to 5%, there are approximately 40 million diagnostic errors involving imaging annually worldwide. The potential to improve diagnostic performance and reduce patient harm by identifying and learning from these errors is substantial.

Overnight Resident versus 24-hour Attending Radiologist Coverage in Academic Medical Centers.

Academic medical centers have long relied on radiology residents to provide after-hours coverage, which means that they essentially function with autonomy. In this approach, attending radiologist review of resident interpretations occurs the following morning, often by subspecialist faculty. In recent years, however, this traditional coverage model in academic radiology departments has been challenged by an alternative model, the 24-hour attending radiologist coverage.

Diagnostic Error Categorization at Abdominal Imaging Peer Learning Conference.

Recognizing and preventing diagnostic errors is an increasingly emphasized topic across medicine, and abdominal imaging is no exception. Peer-learning strives for quality improvement through understanding why errors occur and identifying opportunities to prevent errors from recurring. In an effort to learn from mistakes, our abdominal imaging section initiated a Peer Learning Conference, where errors are discussed and compartmentalized into one or more of the following categories: Observation, Interpretation, Communication, and Inadequate Data Gathering.

Knife wielding radiologist: A case report of primary pancreatic lymphoma.

Majority of malignant pancreatic neoplasms are epithelial in origin and mostly arise from exocrine gland. Ductal adenocarcinoma compromises the major histological type of such tumors. Primary non-epithelial tumors of exocrine pancreatic gland are extremely rare and incorporate lymphoma and sarcoma.

Gastropericardial fistula: radiologic findings and literature review.

Background: Gastropericardial fistula, a rare condition characterized by an abnormal communication between the stomach and the pericardium, is an emergency as sequelae such as cardiac tamponade and sepsis may lead to hemodynamic instability and death. We aimed to summarize the surgical and radiologic findings of the reported cases published to date, describe their pertinent surgical history, and present an algorithm for diagnosis.

Methods: The Pubmed database was searched using the terms: gastropericardial, pericardiogastric, pneumopericardium, pericardial, and pneumopericardium with the term "fistula" added to each term.

Surgical diverticulitis is not associated with defects in the expression of wound healing genes.

Purpose: The development of diverticuli may represent defects in collagen vascular tissue integrity possibly from a genetic predisposition. We evaluated the tissue expression of wound healing genes in sigmoid tissue from youthful patients undergoing surgery for diverticulitis and thus would more likely suffer from a genetic predisposition (SD mean age 39 ± 0.9) versus controls in the form of patients over the age of 50 (mean age 52.

Risk factors for the development of an incisional hernia after sigmoid resection for diverticulitis: an analysis of 33 patients, operative and disease-associated factors.

Incisional hernia (IH) is a relatively common sequelae of sigmoidectomy for diverticulitis. The aim of this study was to investigate factors that may predict IH in diverticulitis patients. Two hundred and one diverticulitis patients undergoing sigmoidectomy between January 2002 and December 2012 were identified (mean follow-up 5.

Measurement of visceral fat on preoperative computed tomography predicts complications after sigmoid colectomy for diverticular disease.

Background: Visceral and subcutaneous abdominal fat parameters have been associated with worse surgical outcomes in colorectal cancer but have not been investigated in diverticulitis.

Methods: Volumetric fat parameters were measured on preoperative computed tomography scans from 211 diverticulitis patients. Primary outcome was a serious postoperative complication (Clavien-Dindo grades 2-4).

Circumportal pancreas: a review of the literature and image findings.

Purpose: Fused pancreatic tissue encasing the portal and/or superior mesenteric vein, circumportal pancreas, is a congenital anomaly that has been associated with operative complications in resections involving the head of the pancreas. We describe this anomaly and highlight its pathophysiology and surgical outcomes through a review of the literature to date, drawings and a computed tomography example.

Methods: A literature search was undertaken using Pubmed and the search terms "circumportal pancreas," "annular pancreas" and "pancreatic anomaly.

Volumetric fat ratio and not body mass index is predictive of ileocolectomy outcomes in Crohn's disease patients.

Background: Crohn's disease (CD) patients are typically underweight; however, a growing cohort of overweight CD patients is emerging. The current study investigates whether body mass index (BMI) or volumetric fat parameters can be used to predict morbidity after ileocolectomy for CD.

Methods: One hundred and forty-three CD patients who underwent elective ileocolectomy were identified from our Inflammatory Bowel Disease (IBD) Registry.

Circumportal pancreas: imaging findings in 40 patients.

Purpose: To analyze the CT and MR imaging features of circumportal pancreas (CP) with emphasis on the relative frequency of variants of parenchymal fusion, ductal anatomy, and vascular anatomy.

Methods: A retrospective review of CT and MR imaging findings of 40 patients with CP was performed. CT and MR images were reviewed by two radiologists in consensus.

CT colonography: effect of computer-aided detection of colonic polyps as a second and concurrent reader for general radiologists with moderate experience in CT colonography.

Objectives: To assess the effectiveness of computer-aided detection (CAD) as a second reader or concurrent reader in helping radiologists who are moderately experienced in computed tomographic colonography (CTC) to detect colorectal polyps.

Methods: Seventy CTC datasets (34 patients: 66 polyps ≥6 mm; 36 patients: no abnormalities) were retrospectively reviewed by seven radiologists with moderate CTC experience. After primary unassisted evaluation, a CAD second read and, after a time interval of ≥4 weeks, a CAD concurrent read were performed.

Radiologic evaluation of postoperative gastropericardial fistula.

Laparoscopic Nissen fundoplication is the current standard surgical option for complicated GERD and symptomatic hiatal hernia. Though comparable in safety, short-term efficacy, and patient satisfaction when compared with open operation, laparoscopic Nissen fundoplication has demonstrated shorter hospital stays and recuperative times. Commonly reported complications include gastric or esophageal injury, splenic injury, pneumothorax, bleeding, pneumonia, fever, wound infections, and dysphagia.