American Board of Radiology certifying examination: oral versus computer-based format.

Objective: This pilot study of a computer-based examination for primary certification by the American Board of Radiology was designed to acquire comparative data on candidates that were measures of individual performance on the oral examination compared with the computer-based examination.

Materials And Methods: The pilot computer-based pediatric radiology examination was designed by experienced oral board examiners and the pediatric subspecialty trustees. Images were chosen from the examination repository of the American Board of Radiology.

Challenges and opportunities in restructuring radiology residencies: the APDR Residency Restructuring Committee report.

Changes to the ABR certification process are imminent, with a core examination after 36 months of training and a certifying examination 15 months after the completion of training replacing the current examination structure for residents entering training in July 2010 and beyond. The Residency Restructuring Committee of the Association of Program Directors in Radiology was developed to analyze the challenges and opportunities of these upcoming changes and provide recommendations to programs. The guidelines included in this article represent a summary of the work of this committee to date.

Computed tomography angiography with three-dimensional reconstruction for pulmony venous definition in high-risk infants with congenital heart disease.

Background: Pulmonary venous anomalies may be difficult to define in small, critically ill infants using standard echocardiography. In many centers, invasive cardiac catheterization is used if the diagnosis remains inconclusive. We evaluated computed tomography angiography (CTA) as a low-risk alternative to cardiac catheterization in these infants.

American Board of Radiology Maintenance of Certification - Part IV: practice quality improvement for radiation oncology.

Maintenance of Certification is a physician-based response to public concerns about the quality of medical care and physician competency in a rapidly evolving, technically demanding specialty. The American Board of Radiology (ABR) has previously described the first three components of the Maintenance of Certification. The ABR is currently developing a program in practice performance, completing Part IV of the competencies.

Radiologist recruitment and retention: how can we improve?

Although recent data suggest that the shortage of radiologists is beginning to ease, radiologists remain in high demand. Academic and private radiology practices can take specific steps both to encourage the recruitment of new radiologists and to enhance the retention of existing staff members. The authors review the history of the current workforce shortage and describe steps they have taken within their own practice that have proved successful in helping fill staff positions and prevent the significant loss of staff members over the past several years.

Diseases associated with childhood obesity.

Objective: Radiologists can play an active role in children's health by increasing awareness of diseases associated with obesity. This article reviews key imaging findings in obesity-related diseases, current issues in imaging obese children, and treatment strategies.

Conclusion: There has been a well-documented pediatric obesity epidemic and a dramatic increase in clinical diseases associated with it.

Establishing a program to promote professionalism and effective communication in radiology.

Effective health care delivery systems rely heavily on high degrees of skill in professionalism and communication. These skills are essential to all of the missions of a successful radiology department. Until recently, there was a lack of emphasis on the importance of these issues and a lack of efforts in setting expectations and measuring performance.

The frequency of radiology reporting of childhood obesity.

Objective: The purpose of our study was to review the current practice of radiologists with respect to dictating the presence of obesity in imaging reports.

Materials And Methods: Over 1 million radiology reports dictated at a large pediatric hospital from 1994 to 2002 were analyzed for several keywords relating to obesity. The number of cases in which the keywords appeared was recorded for each year, and a percentage was calculated.

Performance-based assessment of radiology faculty: a practical plan to promote improvement and meet JCAHO standards.

Objective: The objective of this article is to describe the process of implementing a program for performance-based assessment of clinical faculty.

Conclusion: A performance-based assessment of clinical faculty program facilitated quality improvements in our department, improved communication concerning our reappointment process, and was well received by faculty. The presence of measures on a scorecard stresses what is important for clinical care and facilitates process improvement in these areas.

The impact of a clinical guideline on imaging children with hypertrophic pyloric stenosis.

Purpose: The purpose of the study was to evaluate the impact of a clinical pathway on the volume of imaging studies performed in children with suspected clinical diagnosis of hypertrophic pyloric stenosis. The pathway suggested referral to surgeons for clinical evaluation for palpation of the olive prior to ordering imaging studies. Only those children in whom the olive could not be palpated would be referred for imaging, and it was anticipated that imaging volume would be reduced following guideline implementation.

Diagnostic errors by radiology residents in interpreting pediatric radiographs in an emergency setting.

Background: There are few data regarding the frequency and type of diagnostic errors made by radiology residents and fellows ("trainees"). However, increasing interest in reducing medical errors highlights the need to analyze which areas of medical knowledge are most problematic for physicians-in-training, including radiology trainees. Once these areas are identified, they can be emphasized during training.

Is the frontal radiograph alone sufficient to evaluate for pneumonia in children?

Background: In our cost- and radiation-conscious environment, the feasibility of performing only a frontal radiograph for the diagnosis of pneumonia in children needs to be reassessed.

Objective: To determine the diagnostic efficacy of the frontal radiograph alone in comparison to the frontal and lateral combined radiographs for the radiographic diagnosis of pneumonia in children.

Materials And Methods: Three radiologists retrospectively and independently reviewed the frontal radiographs alone and separately reviewed the frontal and lateral radiographs of 1,268 children referred from the emergency room for chest radiographs.

Is sedation safe during dynamic sleep fluoroscopy of children with obstructive sleep apnea?

Objective: Airway compromise is considered a relative contraindication for pediatric sedation. This contraindication presents a paradoxical problem when patients require sedation in preparation for imaging performed to evaluate the cause of airway obstruction. We use dynamic sleep fluoroscopy in the evaluation of children who have obstructive sleep apnea.

Three-dimensional MR microscopy of a transgenic mouse model of dilated cardiomyopathy.

Background: Scientists are now able to alter the genetics of vertebrate embryos routinely to produce animal models of human developmental diseases. However, our understanding of structural changes in these animal models is limited by current methodologies. Histological techniques, although providing great anatomic detail, display only "static" data (one time point only) in two dimensions.

Glossoptosis (posterior displacement of the tongue) during sleep: a frequent cause of sleep apnea in pediatric patients referred for dynamic sleep fluoroscopy.

Objective: The purpose of this study was to evaluate the frequency of glossoptosis (posterior displacement of the tongue) as a cause of sleep apnea in pediatric patients referred for fluoroscopic sleep studies.

Materials And Methods: Seventy consecutive dynamic fluoroscopic sleep studies performed to evaluate sleep apnea were reviewed. All patients had been sedated and examined with lateral fluoroscopy during sleep.