Assessing surgical residents' imaging interpretation skills

Anatomical Ignorance Resulting in Iatrogenic Causes of Human Morbidity

This article discusses how inadequate anatomy education contributes to iatrogenic causes of human morbidity and mortality. Through a review of the relevant literature, high-yield clinical cases were identified in which a lack of sufficient anatomical knowledge contributed to patient morbidity, such as abscess formation and neuropathy as a result of improper intramuscular injections, superior gluteal nerve injuries due to surgical procedures, and misdiagnoses due to physicians' inability to examine and correlate clinical and radiological findings. The importance of a multimodal learning approach in anatomy education for medical students, which includes the utilization of the cadaveric dissection approach to emphasize spatial understanding, is crucial for the development of competent physicians with a deep-rooted foundational knowledge of anatomy and related concepts, such as physiology, pathology, and radiology. It cannot be understated that anatomy education and a lack of knowledge of anatomy and related concepts may influence iatrogenic causes of human morbidity and mortality. Therefore, all efforts should be made to ensure that students develop a strong foundational anatomy knowledge during their preclinical years.

Building an Efficient Peritoneal Surface Malignancies Program Despite the Lower-Middle-Income Barriers: Ukraine Experience

PURPOSE

Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) programs are often limited to centers in developed countries because of extensive requirements. We aimed to analyze efficacy and challenges of CRS/HIPEC centers in lower-middle-income settings in the Ukraine example.

METHODS

A multicenter descriptive study was conducted using data sets (2008-2022) from Kyiv, Lviv, and Odesa centers. Patients with appendiceal neoplasm (AN); colorectal cancer (CRC); malignant peritoneal mesothelioma (MPM); and epithelial ovarian, fallopian tube, and primary peritoneal cancer (EOC) treated with CRS ± HIPEC were included. Overall survival (OS) was analyzed for N ≥ 20 cohorts using the Kaplan-Meier method.

RESULTS

We included 596 patients. At Kyiv and Lviv centers, 37 and 28 patients with AN had completeness of cytoreduction (CC-0/1) rates of 84% and 71%, respectively. Thirty-day major morbidity stood at 24% and 18%, respectively. Median OS was not reached (NR) at both centers. Nineteen patients with CRC from Kyiv, 11 from Lviv, and 156 from Odesa had CC-0/1 rates of 84%, 91%, and 86%, respectively. Thirty-day major complications occurred in 16%, 18%, and 8%, respectively. Median OS in the Odesa cohort was 35 (95% CI, 32 to 38) months. Among 15 Kyiv, five Lviv, and six Odesa patients with MPM, CC-0/1 rates were 67%, 80%, and 100%, respectively, while major complications occurred in 13%, 0%, and 17%, respectively. OS was not analyzed because of small MPM cohorts. At Kyiv, Lviv, and Odesa centers, 91, 40, and 89 patients, respectively, had primary EOC. CC-0/1 rates were 79%, 100%, and 80%, and 30-day major morbidity rates were 23%, 5%, and 6%, respectively. Median OS was NR, 71 (95% CI, 32 to 110), and 67 (95% CI, 61 to 73) months, respectively.

CONCLUSION

CRS/HIPEC programs in lower-middle-income environment can achieve safety and survival that meet global standards. Our discussion highlights common obstacles in such settings and proposes effective overcoming strategies.

Influence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study

OBJECTIVES

Imaging studies are a significant and integral part of the initial assessment of patients admitted to the emergency department. Developing imaging diagnostic abilities early in residency is of paramount importance. The purpose of this study was to evaluate and compare diagnosis accuracy of common musculoskeletal X-rays (XR) between residency disciplines and seniority.

METHODS

A multicenter study which evaluated orthopedic surgery, emergency medicine (EM), and radiology residents, through a test set of common MSK XR. Residents were classified as "beginner" or "advanced" according to postgraduate year per residency. Residents were asked to answer whether the radiograph shows normal or pathological findings (success rate) and what is the diagnosis ("diagnosis accuracy"). Residents' answers were analyzed and assessed compared to experts' consensus.

RESULTS

A total of 100 residents (62% beginners) participated in this study. Fifty-four were orthopedic surgeons, 29 were EM residents and 17 were radiologists. The entire cohort's overall success rate was 88.5%. The overall mean success rates for orthopedic, EM, and radiology residents were 93.2%, 82.8%, and 83.3%, respectively, and were significantly different (p < 0.0001). Orthopedic residents had significantly higher diagnostic accuracy rates compared with both radiology and EM residents (p < 0.001). Advanced orthopedic and EM residents demonstrated higher diagnostic accuracy rates compared to beginner residents (p = 0.001 and p = 0.03, respectively).

CONCLUSION

Orthopedic residents presented higher diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on diagnosis accuracy. The development of an educational program on MSK XR is necessary to enhance the competency of physicians in their daily practice.

Pediatric patient-specific three-dimensional virtual models for surgical decision making in resection of hepatic and retroperitoneal tumors

PURPOSE

Typically, preoperative imaging is viewed in two dimensions (2D) only, but three-dimensional (3D) virtual models may improve viewers' anatomical perspective by permitting them to interact with the imaging through manipulating it in space. Research into the utility of these models in most surgical specialties is growing rapidly. This study investigates the utility of 3D virtual models of complex pediatric abdominal tumors for clinical decision making, particularly the decision to proceed with surgical resection or not.

METHODS

3D virtual models of tumors and adjacent anatomy were created from CT images of pediatric patients scanned for Wilms tumor, neuroblastoma or hepatoblastoma. Pediatric surgeons individually assessed the resectability of the tumors. First, they assessed resectability using the standard protocol of viewing imaging on conventional screens and then reassessed resectability after being presented with the 3D virtual models. Inter-physician agreement on resectability for each patient was analyzed using Krippendorff's alpha. Inter-physician agreement was used as a surrogate for correct interpretation. Participants were also surveyed afterward on the utility and practicality of the 3D virtual models for clinical decision making.

RESULTS

Inter-physician agreement when using CT imaging alone was "fair" (Krippendorff's alpha α = 0.399), while inter-physician agreement when using 3D virtual models increased to "moderate" (Krippendorff's alpha α = 0.532). When surveyed about model utility, all 5 participants considered them helpful. Two participants felt the models would be practical for clinical use in most cases, while 3 felt they would be practical for select cases only.

CONCLUSION

This study demonstrates the subjective utility of 3D virtual models of pediatric abdominal tumors for clinical decision making. The models are an adjunct that can be particularly useful in complicated tumors that efface or displace critical structures that may impact resectability. Statistical analysis demonstrates the improved inter-rater agreement with the 3D stereoscopic display over the 2D display. The use of 3D displays of medical images will increase over time, and evaluation of their potential usefulness in various clinical settings is necessary.

Augmented Reality in HBP surgery. Technology at your fingertips

Augmented reality is a technology that opens new possibilities in surgery. We present our experience in a hepatobiliary-pancreatic surgery unit in terms of preoperative planning, intraoperative support and teaching. For surgical planning, we have used 3D CT and MRI reconstructions to evaluate complex cases, which has made the interpretation of the anatomy more precise and the planning of the technique simpler. At an intraoperative level, it provides for remote holographic connection between specialists, the substitution of physical elements for virtual elements, and the use of virtual consultation models and surgical guides. In teaching, new lessons include sharing live video of surgery with the support of virtual elements for a better student understanding. As the experience has been satisfactory, augmented reality could be applied in the future to improve the results of hepatobiliary-pancreatic surgery.

Medical imaging education opportunities for junior doctors and non-radiologist clinicians: A review

Medical imaging plays a critical role in clinical decision-making across disciplines, and as such, there is frequent need for non-radiologist clinicians to interact with medical imaging. This review examines the literature about the delivery of medical imaging education to non-radiologist clinicians, spanning junior doctors, advanced trainees and specialists. Knowledge of medical imaging among non-radiologist clinicians is paramount to the quality of patient care, with calls for formal implementation of radiology education into non-imaging specialty training programmes. Overall, there is a demand across non-imaging disciplines for greater formalised medical imaging education. Concerns are raised that too great a reliance on informal methods of teaching radiology, for example in ward settings, results in greater variation in the quality and volume of educational opportunities and risks the perpetuation of erroneous attitudes and practices. The evolution of the medical imaging workplace and increasing utilisation of remote reporting has distanced the collaborative relationship between radiologists and their non-imaging colleagues, diminishing opportunities for ad hoc learning and engagement in larger formalised educational collaborations. Ideally, radiologists should be directly involved in the development and delivery of medical imaging education to post-graduate doctors to not only benefit patient care but also foster inter-specialty relationships and respect. Evidence supports the value of structured radiological teaching opportunities, including tutorials, lectures and electronic resources, in improving medical imaging skills among non-radiologist clinicians. There is wide scope for growth in the e-learning arena to address this demand for quality and accessible imaging education for our non-radiology colleagues.

Current Status of Radiology Training in Otolaryngology Residency Programs

Importance

Otolaryngologists use head and neck imaging on a daily basis. However, little is known about the training residents receive on the subject. Understanding the current training environment is important to identify areas of improvement for resident education.

Objective

To assess the current state of radiology training in otolaryngology residency programs.

Design, Setting, and Participants

This was a cross-sectional survey of 106 otolaryngology residency program directors involving multiple academic institutions.

Main Outcomes and Measures

The main outcome of this study is the number of US otolaryngology residency programs that have a radiology curriculum. Measured outcomes were obtained from an anonymous online survey and reported as a percent of total respondents.

Results

Program directors from 39 of 106 (37%) US otolaryngology residency training programs responded to the survey. Twenty-eight of 39 (71%) have a focused radiology curriculum; 18 of 28 (64%) conduct sessions on a monthly basis, 8 of 28 (29%) on a quarterly basis, and 2 of 28 (7%) on a weekly basis. The predominant format (20 of 27 programs [74%]) is a mix of case-based review of inpatient studies and standard lectures. The largest proportion of sessions were run by radiologists (13 of 28 [46%]), with a mix of radiology and otolaryngologists close behind (11 of 28 [39%]). Twenty-two of 39 residency programs (56%) have a dedicated radiology rotation within their educational curriculum, of which 17 of 22 (77%) occur in postgraduate year 1 (PGY-1) of training, 3 of 22 (14%) in PGY-3, and 2 of 22 (9%) in PGY-4. Rotation lengths range from 1 week to 3 months, with most running 1 to 4 weeks. Thirty-two of 38 of US program directors (84%) believe that a formal radiology curriculum would benefit their residents. Thirty-five of 39 believe that this should be a case-based review of images. Twenty-four of 38 believe this should be done on a monthly basis. Fifteen of 39 responding program directors (39%) believe the optimal time is during the PGY-3 of training, 36% (14 of 38) favor the PGY-2, and 23% (9 of 38) in PGY-1.

Conclusions and Relevance

Despite no standardized requirements from the Accreditation Council for Graduate Medical Education (ACGME), 71% of US otolaryngology residency program directors who responded to our survey have a radiology curriculum. Most run didactics sessions at the desired frequency, setting, and format preferred by responding program directors. More than half of programs provide a dedicated radiology rotation, mostly during PGY-1, while identifying PGY-2 and PGY-3 as the optimal time for such an experience. These results highlight the need for a more thorough review of radiology education requirements from the ACGME to improve the training of otolaryngology residents across the country.