Professionalism Training in the Post-COVID-19 Era

INTRODUCTION

Professionalism is one of the ACGME core competencies for radiology residency training. The COVID-19 pandemic has changed the way resident education and training occurs. The primary objective of this study was to perform a comprehensive systematic review of the literature pertaining to adapting professionalism training in radiology residency to the post-COVID-19 era education landscape.

METHODS

We reviewed English-language medicine and health services literature for research that described professionalism training in radiology residency in the post-COVID-19 era radiology search terms and key words in PubMed/MEDLINE and Scopus/Elsevier. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS

The search yielded a total 33 articles. We reviewed the citations and abstracts with the initial search yielding 22 articles (without duplicates). Of these, 10 were excluded based on the criteria set forth in the methods. The remaining unique 12 articles were included for qualitative synthesis.

DISCUSSION

This article should provide radiology educators with the tool they need to effectively education and evaluate radiology residents on professionalism in the post-COVID-19 era.

Radiology program director's perspective on a novel hands-on advanced elective

With the advent of the USMLE Step 1 exam moving to a pass/fail status, Radiology Program Directors (PDs) and Associate Program Directors (APDs) need alternative methods of identifying interested and engaged medical students who are applying to their program. Additionally, undergraduate radiology medical education in the United States varies widely from institution to institution with no universal mandatory radiology component. To address these problems, we implemented an advanced fourth year hands-on radiology elective where the students were treated as first year radiology residents (R1s), giving them resident-level access to the Picture Archive and Communication System (PACS) and dictation software, and allowing them to perform entry-level procedures with appropriate supervision. After implementation of the elective, a 5-question online survey was sent to two hundred and ninety-eight PDs and APDs via the Association of Program Directors in Radiology (APDR) listserv, of which seventy-two responses were compiled, yielding a response rate of 24%. The survey focused on how a hands-on medical student elective would help in assessing prospective candidates and predicting R1 performance. Most respondents felt interest in radiology, motivation, and interpersonal skills would be better assessed after such an elective and the vast majority felt hands-on Advanced Elective would be at least slightly predictive of first year resident performance. Based on this information, we believe implementing a hands-on advanced radiology elective would significantly help address the passive nature of traditional radiology electives, providing valuable information to PDs and APDs and giving the best possible radiology experience to our medical students.

Resident Perspective of the Virtual Diagnostic Radiology Residency Interview Process: A National Survey From the Association of Program Directors in Radiology

RATIONALE AND OBJECTIVES

The purpose of this study was to assess differences in first-year radiology resident perception of the match process and early satisfaction with residency programs between those who matched in 2020 versus 2021, the first virtual application cycle after the start of the COVID-19 pandemic.

MATERIALS AND METHODS

A 33-question survey was distributed to first-year diagnostic radiology residents at programs throughout the United States through the Association of Program Directors in Radiology. Responses were collected in June of 2022 from residents who matched in 2020 and in July of 2022 from residents who matched in 2021. Questions were designed to assess applicant demographics, outcomes and attitudes towards the interview process. Comparison was made between the two cohorts.

RESULTS

Of the 2231 matched residents in the 2020 and 2021 match years, 108 residents (4.8%) received, responded, and met inclusion criteria for the survey. Forty-three of 46 (92.5%) respondents that matched in 2020 interviewed in-person compared to one of 60 (1.7%) that matched in 2021 (p < 0.0001). There was no difference in satisfaction of match results, current training programs, work culture, satisfaction with facilities, and depiction of residency structure. Applicants from the 2021 cohort were more likely to express concerns about interview hoarding, having enough time to ask questions on interview days, and ability to accurately present themselves in interviews but were more likely to favor virtual interviews for future cycles.

CONCLUSION

The virtual interview process is perceived neutrally or positively by most early diagnostic radiology residents and produced similar satisfactory results compared to applicants that interviewed in person. Attention should be given to concerns of those who matched virtually if the virtual interview process is to be continued.

APDR Healthcare Disparities Curriculum Pilot: Helping Trainees Meet More Than a Milestone

RATIONALE AND OBJECTIVES

In order to help program directors satisfy the Accreditation Council for Graduate Medical Education common program requirement for health care disparities (HCD) education, a comprehensive web-based curriculum on HCDs in Radiology was developed. The curriculum was designed to educate trainees about existing HCDs, stimulate discussion, and spur research about HCDs in radiology. The curriculum was piloted to assess its educational value and feasibility.

MATERIAL AND METHODS

A comprehensive curriculum comprised of four modules (1) Introduction to HCDs in Radiology, (2) Types of HCDs in Radiology, (3) Actions to Address HCDs in Radiology, and (4) Cultural Competency was created and housed on the Associate of Program Directors in Radiology website. Various educational media including recorded lectures or PowerPoint presentations, small group discussions, and journal clubs were employed. A pilot program was initiated to evaluate the benefits of this curriculum for resident education and consisted of a pre- and post-curriculum test for trainees, an experience survey for trainees, and a pre- and post-administration survey for facilitators.

RESULTS

Forty-seven radiology residency programs participated in the pilot of the HCD curriculum. Of those facilitating the curriculum, 83% indicated lack of standardized curriculum as a perceived barrier to implementing a HCD curriculum at their program on the pre-survey. Trainee knowledge scores increased from 65% (pre) to 67% (post) (p = 0.05). Following curriculum participation, residents indicated an increase in adequate understanding of HCDs in Radiology (81% post vs. 45% pre). Most program directors (75%) found the curriculum easy to implement.

CONCLUSION

This pilot study demonstrated that the APDR Health Care Disparities curriculum increased trainee awareness of HCDs. The curriculum also provided a forum for important discussions about HCDs.

Shedding Light on T2 Bright Masses on Breast MRI: Benign and Malignant Causes

While T2 hyperintense masses on breast MRI are often benign, there are several malignant etiologies that can also be T2 hyperintense. Delineation between benign and malignant entities is important for the accurate interpretation of breast MRI. Common benign T2 hyperintense masses include cysts, fibroadenomas, and lymph nodes. Malignant processes that are T2 hyperintense include metastatic lymph nodes, mucinous breast carcinomas, papillary breast carcinomas, and breast cancers with central necrosis. Evaluation of the morphology and enhancement pattern of a T2 hyperintense mass can help to differentiate a benign process from a malignant one. This educational review will present both benign and malignant causes of T2 hyperintense masses on breast MRI and review common imaging findings and pertinent imaging characteristics that can be used to help accurately identify benign entities while also recognizing suspicious lesions that require additional evaluation.

Breaking the Stereotype: Interventions Aimed at Changing Medical Student Misperceptions of Radiology and Increasing the Female Match Rate

BACKGROUND

Although nearly half of medical students are female there is still a significant discrepancy in the number of women specializing in radiology. In 2013, 26.9% of US diagnostic radiology residents were female, a 1% increase in 20 years from 25.5% in 1990.

PURPOSE

The purpose of this project is to determine the effectiveness of the interventions implemented at a single medical school at decreasing negative attitudes about radiology held by medical students of all genders and whether those same interventions will increase the number of female medical students matching into radiology.

METHODS

The interventions were implemented between 2012 and 2016 and included incorporation of radiology into preclinical curriculum, electives in radiology for 3rd year students, a "Women in Radiology Panel," and increase in female radiology faculty visibility. First year medical student participants of all genders used a free text box to write their attitudes about radiology, which were categorized into the "six most common attitudes about radiology." Fourth year medical student participants used a free text box to write the reasons why they did not choose radiology as a specialty, and those answers were then placed into the same six categories. We then analyzed the data using Fisher's Exact Test to determine whether there was a decrease in the negative misperceptions after exposure to the interventions. We also then determined whether there was an increase in the number of women matching into radiology using Chi-Square analysis.

RESULTS

There was a decrease in the negative misperceptions between 1st and 4th years, with the most notable decrease from 51% of 1st years to 0% of 4th years listing radiologists as being antisocial (p < 0.01). There was also a significant increase in the number of female medical students matching into radiology in the years in which students were exposed to 4 years of intervention when compared to three and fewer (0.76%-4.2%, p = 0.01).

CONCLUSION

Exposure to 4 years of the interventions demonstrated a significant increase in the female match rate into the specialty when compared to female medical students who experienced three or fewer years of intervention. Additionally, it appears that these same interventions decreased the number of students of all genders having some of the common negative misperceptions about the field of radiology.

Ensuring a Smooth Transition for Trainees Returning from Parental Leave - A Guide for Program Directors

Transitioning from parental leave during radiology residency training can be a time of stress and uncertainty. However, there are ways that program directors can help make the transition smoother and less overwhelming. Trainees report numerous stressors upon returning from leave involving childcare, lactation concerns and logistics, and discrimination. Program directors can help alleveate these stressors by counseling trainees returning from parental leave and providing reseources and a supportive enviroment. This article provides a structured frame work with tool for programs directors to ensure the transition from parental leave back to training is a smooth one.

Strategies to Improve Racial and Ethnic Diversity in Breast Imaging Training and Beyond

Diversity and inclusion in breast imaging can improve creativity and innovation, enrich the workplace environment, and enhance culturally appropriate care for an increasingly diverse patient population. Current estimates predict the racial and ethnic demographics of the United States population will change markedly by the year 2060, with increases in representation of the Black demographic projected to comprise 15% of the population (currently 13.3%) and the Hispanic/Latinx demographic projected to comprise 27.5% of the population (currently 17.8%). However, matriculation rates for those who are underrepresented in medicine (URM), defined as "racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population," have remained largely stagnant. Black students comprise only 7.1% of medical student matriculants, and Hispanic/Latinx students comprise only 6.2% of medical school matriculants compared to the general population. The matriculation rate of URM students into diagnostic radiology is even lower, with Black trainees comprising 3.1% of radiology residents and Hispanic/Latinx trainees comprising 4.8% of radiology residents. This lack of URM radiology resident representation leads to a lack of URM potential applicants to breast imaging fellowships due to the pipeline effect. Strategies to improve diversity and inclusion in breast imaging include recruiting a diverse breast imaging workforce, establishing robust mentorship and sponsorship programs, fostering an inclusive training and workplace environment, and retaining and promoting a diverse workforce.

Health Care Disparities in Radiology-A Review of the Current Literature

INTRODUCTION

Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology.

METHODS

We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS

The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis.

DISCUSSION

We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.

American Association for Women in Radiology

For the past 40 years the American Association for Women in Radiology (AAWR) has continued to support efforts to achieve its founding goals of improving the visibility of women in radiology, advancing the professional and academic standing of women in radiology, and identifying and addressing issues faced by women in radiology. In the past 5 years, the AAWR has made great strides to support women in radiology through amplifying the voices of women heard at the American College of Radiology (ACR) Annual Meeting, initiating the AAWR Research & Education Capital Campaign, establishing the fellows of the AAWR, and advocating for practicing radiologists and trainee parental leave. The many accomplishments of the AAWR over the past 40 years and the committed future work of the AAWR ensure the voices of women in radiology are heard and the needs of women in radiology are recognized.

Representation of Women in Diagnostic Radiology Residency Programs: Does National Institutes of Health Program Ranking Matter?

PURPOSE

Women are consistently underrepresented in the radiology workforce. The authors examined recent trends in the gender distribution of residents entering diagnostic radiology residency programs.

METHODS

A retrospective review was performed of residents entering US diagnostic radiology residency programs for graduate medical education years 2009 to 2018. Demographic and program data were obtained from the Association of American Medical Colleges GME Track Resident Survey. National Institutes of Health (NIH) ranking was determined according to the Academy for Radiology & Biomedical Imaging Research. Descriptive statistical analyses were performed to evaluate the gender distribution of residents according to residency program ranking.

RESULTS

The final analytic sample included 11,788 residents who entered diagnostic radiology residency programs during the study period, of whom 3,245 (27.5%) were women and 8,543 (72.5%) were men. A higher percentage of female residents entered programs ranked in NIH rank group 1st to 20th (351 of 1,185 [29.6%]) than entered programs that were ranked lower than 20th or were unranked (1,540 of 5,819 [26.5%]; P = .026).

CONCLUSIONS

The present findings confirm repeated reports that women are underrepresented in radiology. The results indicate a need for further study on why a greater proportion of female residents are entering programs with higher NIH rankings. Better understanding of factors and interventions that led to this rise in the percentage of women in higher ranked programs provides an opportunity to expand gender diversity across the field of radiology.

Integrating art museum visits into the radiology curriculum: A program to encourage engagement, observation and analytic skills among millennial learners

Millennial learners have unique educational preferences and expectations, many of which vary significantly from those of their predecessors. To aid in the preparation and training of the next generation of radiologists, we have been exploring a teaching technique using an art observation training workshop to foster engagement of millennial radiology residents to pay closer attention to image detail, clearly state the observations and synthesize the "story" of the patient's condition. Fine tuning these visual skills is crucial as research shows that over 70% of errors in interpreting diagnostic imaging studies are related to visual perception errors.

Mitigating Unconscious Bias in Recruitment and Hiring

Unconscious biases in recruitment and hiring can limit the potential for building a diverse academic and private radiology practice. In the private practice environment of radiology, especially in smaller firms, in which a dysfunctional team can lead to a dysfunctional practice overall, it is especially essential to find the best candidates for the team. Many strategies for mitigating these biases can be employed strategically at multiple levels of the hiring process.

Educational Strategies to Achieve Equitable Breast Imaging Care

As the population of the United States becomes increasingly diverse, radiologists must learn to both understand and mitigate the impact of health disparities. Significant health disparities persist in radiologic care, including breast imaging. Racial and ethnic minorities, women from lower socioeconomic status, those living in rural areas, and the uninsured bear a disproportionate burden of breast cancer morbidity and mortality. Currently, there is no centralized radiology curriculum focusing on breast health disparities available to residents, breast imaging fellows, or practicing breast radiologists. While patient-, provider-, and system-level initiatives are necessary to overcome disparities, our purpose is to describe educational strategies targeted to breast imaging radiologists at all levels to provide equitable care to a diverse population. These strategies may include, but are not limited to, diversifying the breast imaging workforce, understanding the needs of a diverse population, cultural sensitivity and bias training, and fostering awareness of the existing issues in screening mammography access, follow-up imaging, and clinical care.

Still Coming Out of the Dark: Enduring Effects of Simulation-Based Communication Skills Training for Radiology Residents-Four-Year Follow-Up

PURPOSE

To evaluate the long-term efficacy of simulation-based communication skills training for radiology residents.

METHOD AND MATERIALS

The simulation-based communication skills training curriculum was developed in 2014. The curriculum included a teaching module based on the essential elements of communication. Two sets of 6 communication scenarios encountered by radiologist were created. First and fourth year radiology residents reviewed the teaching module and completed the 6 simulated scenarios. They then underwent debriefing sessions, received faculty and staff evaluations. Four years later, the former first year residents (now fourth years) reviewed the teaching module again and repeated the simulation. They again underwent debriefing sessions after the simulation. This time the residents' communication skills were evaluated by faculty and staff.

RESULTS

A total of 5 residents participated in this simulation-based skills training. The resident performance 4 years after initial training show not only that residents maintained their improved scores, but also that their scores improved further as compared to after the initial training. The average overall score for all but 1 resident increased at the 4 year follow-up simulation. From 2014 to 2018, the average score of all the residents increased from 72.4% to 81.4%. Comparison of the average scores of each student across 6 stations from 2014 to 2018 showed a statistically significant difference between the scores after 4 years (P = 0.014).

CONCLUSIONS

Simulation-based communication skills training is effective and long lasting.

COVID-19 Impact on Well-Being and Education in Radiology Residencies: A Survey of the Association of Program Directors in Radiology

RATIONALE AND OBJECTIVES

The COVID-19 pandemic has forced rapid evolution of the healthcare environment. Efforts to mitigate the spread of the virus through social distancing and shelter-at-home edicts have unintended consequences upon clinical and educational missions and mental well-being of radiology departments. We sought to understand the impact of the COVID-19 pandemic on radiology residencies with respect to the educational mission and perceptions of impact on well-being.

MATERIALS AND METHODS

This study was IRB exempt. An anonymous 22 question survey regarding the impact of COVID-19 pandemic on educational and clinical missions of residencies, its perceived impact upon morale of radiologists and trainees and a query of innovative solutions devised in response, was emailed to the Association of Program Directors in Radiology membership. Survey data were collected using SurveyMonkey (San Mateo, California).

RESULTS

Respondents felt the COVID-19 pandemic has negatively impacted their residency programs. Regarding the educational mission impact, 70.1% (75/107) report moderate/marked negative impact and 2.8% (3/107) that educational activities have ceased. Regarding the pandemic's impact on resident morale, 44.8% (48/107) perceive moderate/marked negative effect; perceived resident morale in programs with redeployment is significantly worse with 57.1% (12/21) reporting moderate/marked decrease. Respondents overwhelmingly report adequate resident access to mental health resources during the acute phase of the pandemic (88.8%, 95/107). Regarding morale of program directors, 61% (65/106) report either mild or marked decreased morale. Program innovations reported by program directors were catalogued and shared.

CONCLUSION

The COVID-19 pandemic has markedly impacted the perceived well-being and educational missions of radiology residency programs across the United States.

The Relationship Between US Medical Licensing Examination Step Scores and ABR Core Examination Outcome and Performance: A Multi-institutional Study

PURPOSE

We analyzed multi-institutional data to understand the relationship of US Medical Licensing Examination (USMLE) Step scores to ABR Core examination performance to identify Step score tiers that stratify radiology residents into different Core performance groups.

METHODS

We collected USMLE Step scores and ABR Core examination outcomes and scores for anonymized residents from 13 different diagnostic radiology residency programs taking the ABR Core examination between 2013 and 2019. USMLE scores were grouped into noniles using z scores and then aggregated into three tiers based on similar Core examination pass-or-fail outcomes. Core performance was grouped using standard deviation from the mean and then measured by the percent of residents with scores below the mean. Differences between Step tiers for Core outcome and Core performance were statistically evaluated (P < .05 considered significant).

RESULTS

Differences in Step 1 terciles Core failure rates (45.9%, 11.9%, and 3.0%, from lowest to highest Step tiers; n = 416) and below-mean Core performance (83.8%, 54.1%, and 21.1%, respectively; n = 402) were significant. Differences in Step 2 groups Core failure rates (30.0%, 10.6%, and 2.0%, from lowest to highest Step tiers; n = 387) and below-mean Core performance (80.0%, 43.7%, and 14.0%, respectively; n = 380) were significant. Step 2 results modified Core outcome and performance predictions for residents in Step 1 terciles of varying statistical significance.

CONCLUSIONS

Tiered scoring of USMLE Step results has value in predicting radiology resident performance on the ABR Core examination; effective stratification of radiology resident applicants can be done without reporting numerical Step scores.

Global Radiology Training Prevalence Among Radiology Residency Programs

OBJECTIVE

Global Radiology aims to enhance access to medical imaging services and education, worldwide. To date, few reports have evaluated Global Radiology Training (GRT) in radiology residency programs. Here, we examined how radiology residency programs perceive and incorporate GRT into their curriculum, and how this information is promoted online.

METHODS

Two methods were used to examine the current state of GRT. First, radiology residency program directors (identified via the Association of Program Directors in Radiology) were surveyed on topics including: Electives, institutional partnerships, resident and faculty involvement, inquiry by prospective residents, and barriers to implementation. Second, radiology residency program websites (n = 193) were examined for existing GRT on the programs' publicly available webpages.

RESULTS

There were 62 survey responses (response rate of 19%). Thirty-eight percent (24/62) of residency programs offered a Global Radiology elective to their residents within the past academic year and 27% (17/62) of programs have active affiliations with medical institutions outside of the United States. Eighty-four percent of program directors (52/62) received questions from residency applicants regarding opportunities to participate in Global Radiology. Furthermore, only 13% (26/193) of all radiology residency programs listed at least one GRT elective on their webpage.

DISCUSSION

GRT in radiology residency is more widely available than previously reported and has been underrepresented on residency program websites. In the present survey, the majority of radiology residency program directors reported that radiology is an important component of Global Health, one-third of whom have already incorporated the subject into their curriculum. However, most common barriers to GRT include, perceived lack of time in the curriculum and lack of faculty interest. The high prevalence of inquiry from residency program applicants about GRT suggests that it may be a notable factor for applicants during the ranking process. Programs build up GRT may choose to share related information seeking to may choose to emphasize work in Global Radiology on their program webpages.

Should Radiology Delay the Start of Fellowships? A Survey of the APDR

RATIONALE AND OBJECTIVES

Several major medical specialties have recently considered delaying the start date of their fellowship training programs to allow for completion of their trainees' residency obligations. Radiology program directors (PDs) have voiced the need for a similar solution, as fellowship start dates at some institutions now occur well before the end of residency training. The objectives of this study are to assess the current state of the radiology fellowship transition and understand its impact on residency programs and clinical services.

MATERIALS AND METHODS

Survey Monkey (Palo Alto, CA) was used to create a survey consisting of 9 multiple choice and 2 free text questions. The survey was approved by the survey committee of the Association of Program Directors in Radiology (APDR) and distributed via email to all 240 APDR members in November 2018. The survey was closed after 30 days.

RESULTS

The response rate was 67% (160/240). Fifty-nine percent of respondents indicated some of their residents are asked to arrive at fellowships before July 1, often several days early for orientation and picture archiving and communication system (PACS) training. Sixteen percent of respondents said their own institutions ask incoming fellows to arrive early. Sixty-four percent of respondents indicated that this causes staffing problems. Seventy-eight percent of respondents supported considering a delay to the start of radiology fellowships.

CONCLUSION

Most APDR members claim that residents are asked to arrive at fellowships early to complete orientation and training before July 1, and most say that this produces staffing problems on services. A significant majority of respondents support a discussion regarding delaying fellowship start dates.

Teaching Communication Skills in Breast Imaging

Breast radiologists communicate life-changing results to patients every day. It is critical for breast radiologists to be effective communicators and to deliver difficult and good news effectively and empathetically. Communication skills can be just as important as image interpretation and procedural skills in breast imaging. Breast radiologists can learn effective communication through practice. In addition, simulation-based communication skills training can help our trainees practice their communication skills in a low-stakes environment and become more comfortable with communicating difficult results. This manuscript sets out to familiarize breast radiologists with what effective communication skills are, as well as how to learn and teach them.

Benign Breast Cyst in a Young Male

Simple benign breast cysts are commonly diagnosed in female breasts and may present as palpable masses. However, they are extremely uncommon in the male breast and are rarely reported in the literature. Here, we report a case of a simple benign cyst of the breast in a relatively healthy 37-year-old man. The patient initially presented with a palpable 2-3 mm tender left breast lump. Further evaluation with mammography and ultrasound revealed a mass most consistent with a simple benign cyst. However, considering the rarity of breast cysts in males, the lesion was biopsied to rule out malignancy. Pathology results from ultrasound-guided core needle biopsy demonstrated fibro-adipose tissue with a benign cyst lined by foamy cells with apocrine features, consistent with a diagnosis of a benign epithelial cyst and concordant with the radiological findings. To our knowledge, this is the youngest case of a benign breast cyst in a male that has been reported in the literature. In this case report, we discuss the typical features and presentation of breast cysts in males, associated imaging findings on mammography and ultrasound, and the necessity for pathological confirmation with biopsy in this population.

Transitioning from Radiology Training to Academic Faculty: Defining Your Role and Interests

Transitioning from radiology training to academic faculty presents many challenges. In this review, we discuss strategies to navigate this process and to facilitate success through appropriate selection of career tracks. Various modern avenues include roles as a Clinician-Educator, Clinician-Investigator, and Clinician-Administrator. Selection of the appropriate career track based on personal interests and institutional culture is critical for early and long-term career satisfaction.

Transitioning From Radiology Training to Academic Faculty: The Importance of Mentorship

Transitioning from radiology residency to academic faculty presents many challenges. In this review, we discuss the importance of introspection and mentorship to successfully navigate this process. Key points include alignment of goals with those of the institution, formation of a mentorship program, and periodic reassessment of career goals. These tips and tools can help make the transition from residency to academic faculty more seamless.

Women's response to state-mandated language in dense breast notification

Many states require radiologists to notify women of dense breast status. Our aim was to elicit women's response to state-mandated dense breast notification language. Of respondents, 82% report that current notification does not inform them of additional screening studies available, and 41% report notification does not inform them of next steps. Open-ended responses indicate three main areas of patient concern: Decisional Needs, Decision Quality, and Decision Support. We modified an existing Decision Support framework to capture additional themes specific to dense breast decisions. The developed framework can be used to revise and improve current breast density reporting methods.

A Review of Resources and Methodologies Available for Teaching and Assessing Patient-Related Communication Skills in Radiology

ACGME expectations for radiology trainees' proficiencies in communication skills pose a challenge to program directors who wish to develop curricula addressing these competencies. Numerous educational resources and pedagogical approaches have emerged to address such competencies specifically for radiology, but have yet to be systematically catalogued. In this paper, we review and compile these resources into a toolkit that will help residencies develop curricula around patient-centered communication. We describe numerous web-based resources and published models that have incorporated innovative, contemporary pedagogical techniques. In undertaking this compilation, our hope is to kindle discussion about the development of formalized or standardized communication curricula or guides for radiology residencies.

Logistics of Three-dimensional Printing: Primer for Radiologists

The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.

Clinical Applications of 3D Printing: Primer for Radiologists

Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.

Rosai-Dorfman Disease of the Breast

Rosai-Dorfman disease (also known as sinus histiocytosis with massive lymphadenopathy) is a rare benign proliferative disorder of histiocytes that typically involves the lymph nodes and can also involve extranodal sites. Rosai-Dorfman disease confined to the breast is extremely rare, but important to recognize as it can mimic malignancy. We present the case of a 63-year-old woman who presented with a palpable breast lump that was highly suspicious for malignancy based on mammogram and ultrasound appearance. Biopsy revealed inflammatory tissue with lymphoplasmacytic and histiocytic predominance. The diagnosis of Rosai-Dorfman was made based on characteristic staining of histiocytes with S-100 and the presence of emperipolesis. Early recognition of this benign disease entity spared the patient further investigation and surgical intervention.

Conventional Medical Education and the History of Simulation in Radiology

Simulation is a promising method for improving clinician performance, enhancing team training, increasing patient safety, and preventing errors. Training scenarios to enrich medical student and resident education, and apply toward competency assessment, recertification, and credentialing are important applications of simulation in radiology. This review will describe simulation training for procedural skills, interpretive and noninterpretive skills, team-based training and crisis management, professionalism and communication skills, as well as hybrid and in situ applications of simulation training. A brief overview of current simulation equipment and software and the barriers and strategies for implementation are described. Finally, methods of measuring competency and assessment are described, so that the interested reader can successfully implement simulation training into their practice.

MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes

Clinical diagnosis of the cause of abdominal pain in a pregnant patient is particularly difficult because of multiple confounding factors related to normal pregnancy. Magnetic resonance (MR) imaging is useful in evaluation of abdominal pain during pregnancy, as it offers the benefit of cross-sectional imaging without ionizing radiation or evidence of harmful effects to the fetus. MR imaging is often performed specifically for diagnosis of possible appendicitis, which is the most common illness necessitating emergency surgery in pregnant patients. However, it is important to look for pathologic processes outside the appendix that may be an alternative source of abdominal pain. Numerous entities other than appendicitis can cause abdominal pain during pregnancy, including processes of gastrointestinal, hepatobiliary, genitourinary, vascular, and gynecologic origin. MR imaging is useful in diagnosing the cause of abdominal pain in a pregnant patient because of its ability to safely demonstrate a wide range of pathologic conditions in the abdomen and pelvis beyond appendicitis.

Utility of iodinated contrast medium in hydrodissection fluid when performing renal tumor ablation

In 21 patients undergoing percutaneous renal tumor ablation, hydrodissection with use of a mixture of 5% dextrose in water and iodinated contrast medium was performed to prevent thermal injury to adjacent structures. This technique allows for the movement of adjacent organs as well as improved differentiation among the hydrodissection fluid, renal tumor, and adjacent tissues.