Canadian Association of Radiologists Journal

Acute radiologic emergencies, primarily severe contrast reactions, are rare but life-threatening events. Given a generalized paucity of formalized or mandated training, studies have shown that radiologists and trainees perform poorly when acutely managing such events. Moreover, skill base, knowledge, and comfort levels precipitously decline over time given the infrequent occurrence of these events during one's daily practice.

The primary aim of this study was to assess radiologists' preparedness for managing acute radiologic emergencies and to determine the efficacy of a high-fidelity simulation based training model in an effort to provide a rationale for similar programs to be implemented on a provincial or national level.

This was a prospective, observational study of radiology residents and attending radiologists throughout the province who were recruited to attend a full-day simulation-based course presenting various cases of acute radiologic emergencies. Participant demographics were collected at the time of commencement of the workshop. Course materials were disseminated 4 weeks prior to the workshop, and a 17-question knowledge quiz was administered before and after the workshop. Likert-type questionnaires were also distributed to survey comfort levels and equipment familiarity. The knowledge quiz and questionnaire were redistributed at 3- and 6-month intervals for acquisition of follow-up data.

A total of 14 attending radiologists and 7 residents attended the workshop, with all participants completing the preworkshop questionnaire and 90.5% (19 of 21) completing the post-workshop questionnaire. Participants' principle locations of practice were as follows: academic institutions (50%), community hospitals (36.9%), and private clinics (13.1%). A significant increase in knowledge was demonstrated, with average scores of 10 out of 17 (59%) and 14.5 out of 17 (85%) (P < .001) before and after the workshop, respectively. A significant increase in participants' comfort levels in recognizing acute anaphylactic reactions (3.5; 4.7, P < .001), commencing initial management for acute radiologic emergencies (3.3; 5.0, P < .001), and administering the correct dose for anaphylactic reactions (2.5; 4.8, P < .001) was also demonstrated. Moreover, participants became increasingly familiar with the contents and equipment found within contrast reaction kits (2.8; 3.8, P < .01). Repeat evaluations at 3 and 6 months found an average knowledge test score of 13.8 out of 17 (81%) and 10.8 out of 17 (64%), respectively. Comfort levels were also reassessed in recognizing acute anaphylactic reactions (4.5; 4.1), commencing initial management (4.0; 3.9) and administering the correct dose of medication (4.0; 3.7) at 3- and 6-month intervals.

Acute radiologic emergencies are rare but life-threatening events that require rapid diagnosis and treatment to mitigate associated morbidity and mortality. Simulation-based workshops are a highly efficacious training model to increase knowledge, comfort levels, and equipment familiarity for radiologists and trainees alike; however, retraining at regular intervals is required.

As medical schools reduce the hours of anatomy teaching, residents in anatomy-intensive residency programs like radiology must independently acquire the anatomy knowledge needed to achieve competency. The purpose of this study was to develop and evaluate a 4-week competency-based self-directed anatomy rotation for junior residents.

Seven post-graduate year 1 (PGY-1) radiology residents completed a 4-week rotation of radiologic anatomy. The objectives were developed from standards, senior residents, and expert opinion, and the competency-based curriculum included self-directed modules. Pre-course and post-course tests were administered and test scores were compared using an unpaired t test. In addition, PGY-1 residents completed a course evaluation and survey regarding their anatomy knowledge and anatomy exposure prior to completing the course.

Out of the 25 points available, the average pre-test score was 10.79 ± 2.78 (range 8–16.5), and the average post-test score was 21.64 ± 2.23 (range 18.5–25). This difference was statistically significant (P < .0001). The PGY-1 residents reported receiving < 10% of dedicated radiologic anatomy teaching prior to residency and felt unprepared for the anatomy required in residency. Overall, residents felt more confident in looking at images after completing the self-directed radiologic anatomy course.

This study demonstrates the feasibility of creating a self-directed course for radiology residents that significant improves their anatomy knowledge. Given the trend in medical undergraduate education away from dedicated anatomy teaching, residency programs should consider addressing anatomy education more formally for junior residents to ensure that trainees receive the foundational knowledge required for residency.

Physician burnout is on the rise compared to the average population, and radiology burnout rates are ranked high compared to other specialties. We aim to assess radiologist and radiology trainee burnout in Canada.

A survey using the abbreviated 7-item Maslach Burnout Inventory that characterizes burnout symptoms into personal accomplishment, emotional exhaustion, and depersonalization was sent to all eligible members of the Canadian Association of Radiologists in January 2018. The anonymous survey was hosted on SurveyMonkey for 1 month. A reminder e-mail was sent halfway through the survey period.

Overall, 262 of 1401 invited radiology trainees and radiologists completed the survey (response rate 18.7%). With regards to personal accomplishment, we observed that (1) burnout in this domain improved with increased years worked and (2) milder symptoms were observed in community radiologists compared with their academic counterparts. In comparison with other studies of radiologist burnout, we found mild burnout symptoms in personal accomplishment, but severe symptoms in the burnout domains of both emotional exhaustion and depersonalization.

Canadian radiologists and radiology trainees reported above average burnout symptoms with regard to both emotional exhaustion and depersonalization. Future research directions include exploring etiologies of burnout and implementation of treatment strategies based on these identified problem areas.

The aim of this study was to evaluate the radiation dose and image quality at low tube-voltage pediatric chest computed tomographic angiography (CTA) that applies the same contrast-to-noise ratio (CNR) index as the standard tube voltage technique.

Contrast-enhanced chest CTA scans of 100 infants were acquired on a 64-row multidetector computed tomography (MDCT) scanner. In the retrospective study, we evaluated 50 images acquired at 120 kVp; the image noise level was set at 25 Hounsfield units. In the prospective study, we used an 80-kVp protocol; the image noise level was 40 Hounsfield units because the iodine contrast was 1.6 times higher than on 120-kVp scans; the CNR was as in the 120-kVp protocol. We compared the CT number, image noise, CT dose index volume (CTDI_vol), and the dose-length product on scans acquired with the 2 protocols. A diagnostic radiologist and a pediatric cardiologist visually evaluated all CTA images.

The mean CTDI_vol and the mean dose-length product were 0.5 mGy and 7.8 mGy-cm for 80- and 1.2 mGy and 20.8 mGy-cm for 120-kVp scans, respectively (P < .001). The mean CTDI_vol was 42% lower at 80 kVp than at 120 kVp, and there was no significant difference in the visual scores assigned to the CTA images (P = .28).

With the CNR index being the same at 80-kVp and 120-kVp imaging, the radiation dose delivered to infants subjected to chest CTA can be reduced without degradation of the image quality.

To determine whether an ultrasonography (US)-defined thyroid volume can accurately predict substernal extension or tracheal narrowing.

After research ethics approval, we identified patients with thyroid nodules investigated with both US and computed tomography (CT). Reviewers assigned scores for both substernal extension and tracheal compression on CT using pre-established classification systems. Statistical analysis with receiver operating characteristic curve analysis was performed to find the US-determined thyroid volume thresholds that correlated with each substernal extension and tracheal compression.

This study included 120 patients (mean age 63.4 years; SD ± 15.9; 67% female). Thirty-five patients (29%) had substernal extension. The mean US total thyroid gland volume in patients with and without substernal extension were 92.4 and 37.6 cm³, respectively (P < .001). 86% of patients with substernal extension had tracheal narrowing vs. 27% of patients without substernal extension (P < .0001). A cutoff dominant gland volume of ≥37.5 cm³ showed 83% sensitivity and 79% specificity for substernal extension (area under the curve [AUC] = 0.84). A total thyroid gland volume threshold of ≥37.8 cm³ showed 89% sensitivity and 87% specificity for any degree of tracheal narrowing (AUC = 0.90).

This study suggests that US volumes may be used as a predictor to identify those patients with thyroid enlargement who are most at risk of substernal extension and tracheal compression and who may benefit from preoperative CT imaging for optimal surgical and anesthetic planning.

To analyze the utilization, indications, and outcomes of dual-energy computed tomography (DECT) gout imaging in clinical practice.

This retrospective study was ethics approved. Radiology reports of DECT gout scans between 2007 and 2016 were analyzed for trends of utilization, referral pattern, indication, and diagnosis.

DECT gout referrals increased substantially (2007: 37; 2008: 72; 2016: 385; total: 1877). The largest number of referrals were from rheumatology (1160), emergency medicine (283), and family medicine (177). Most referrals (92%) were requested to aid an initial diagnosis of gout. Other reasons included estimating the disease burden (6%) or monitoring disease progression and effectiveness of treatment (2%). Rheumatology accounted for most referrals for the latter two reasons (81% and 97%). Imaging findings of urate presence were similar in referrals from rheumatology (62%), family medicine (62%), and other medical specialties (62%). The urate positive rates were slightly lower in referrals from emergency medicine (47%) and surgical specialties (41%). The most common differential diagnoses by referring specialties were calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and other inflammatory or erosive arthritides (rheumatology, family medicine), CPPD and infections (other medical specialties), infections and fractures (emergency medicine), neoplasm and infections (surgical specialties).

The increasing utilization of DECT for gout imaging validates its clinical value. Varying clinical presentation could explain differences of urate positive rates among specialties. Our results support a multispecialty collaborative approach to the diagnosis and management of gout, with direct access to DECT gout imaging provided to various physician specialties.

To evaluate whether mediopatellar plica and knee morphometric measurements obtained from magnetic resonance imaging (MRI) studies are associated with isolated medial patellofemoral osteoarthritis in young adults.

MRI studies from 60 patients with isolated medial patellofemoral osteoarthritis and 90 control patients with normal knee MRI studies were reviewed. The presence of mediopatellar plica, the presence of edema in the superolateral aspect of Hoffa's fat pad and suprapatellar fat pad, quadriceps and patellar tendinosis, and axial and sagittal alignment of the patellar and trochlear morphology were assessed using MRI. The relationship between mediopatellar plica, alignment, or morphology and the presence of isolated medial patellofemoral osteoarthritis was evaluated using logistic regression.

Superolateral Hoffa's fat pad edema (odds ratio [OR] = 3.4, P = .009) and decreased trochlear sulcal angle (OR = 0.95, P = .045) were associated with increased odds of isolated medial patellofemoral osteoarthritis. Decreased lateral patellar tilt (OR = 0.93, P = .087) and patellar tendinosis (OR = 4.13, P = .103) trended toward being associated with increased odds of isolated medial patellofemoral osteoarthritis but were not statistically significant. No significant association was seen between the presence of mediopatellar plica and medial patellofemoral osteoarthritis (OR = 0.95, P = .353).

Medial patellofemoral osteoarthritis is associated with trochlear morphology and patellar alignment but not with mediopatellar plica.

To determine if saline tract injection and rapid patient rollover following computed tomography (CT)–guided transthoracic needle biopsy (TTNB) affects pneumothorax incidence and size.

A retrospective cohort design was used to compare 278 patients who underwent post-biopsy saline injection and rapid rollover so that the biopsy site was dependent (N = 180) to a control group with routine post-biopsy care (N = 98). Post-procedure radiographs and CT were assessed for presence and size of pneumothorax, as well as requirement for chest tube placement.

Pneumothorax size as estimated on post-procedure CT was 3.33% in the treatment group and 6.63% in the control group (P < .05). There was also a reduction in chest tube placements in the treatment group (3.9% vs 10%, P < .05). On post-procedure radiographs, pneumothorax rates were 20% in the treatment group, and 25% in the control group (P > .05).

Saline injection with rapid patient rollover following TTNB significantly decreased pneumothorax size and chest tube placement but not incidence.