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Francis S, Kim E, Jotkowitz A, Huneke M, Taragin BH. COVID-Necessitated Online Radiology Elective Improves Student Imaging Appropriateness in Clinical Case Vignettes. Acad Radiol 2023; 30:2401-2405. [PMID: 37468375 DOI: 10.1016/j.acra.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023]
Abstract
RATIONALE AND OBJECTIVES The use of imaging in medicine has increased considerably over the previous decades, contributing to significant inefficiency of use. Radiology education varies amongst institutions without standardized learning objectives. Consequently, many physicians and student doctors are unprepared to make appropriate choices regarding imaging. In response to COVID-19-engendered restrictions, we created a fully online, image-intensive radiology curriculum to introduce students to clinical radiology and appropriate imaging usage. MATERIALS AND METHODS A 2-week radiology elective curriculum was created that adopted accessible, free, online-based learning to foster student education and patient safety while upholding academic standards. Each unit included an emphasis on imaging appropriateness. Students assembled an elective portfolio including self-assessments and prepared a clinical radiology conference to present as a radiologist in training. Two final assessments were required. One consisted of clinical vignettes based on American College of Radiology (ACR) Appropriateness Criteria (AC). The second was an MRI safety quiz. RESULTS Third and fourth year students at five institutions (N = 97) completed the elective. Examination scores on an assessment adapted from the ACR AC were significantly improved compared to previously published scores of medical students who took ACR AC-based assessments without taking a radiology course. The course was published and shared with medical schools worldwide. CONCLUSION The elective successfully educated students in radiology through a virtual platform and introduced them to the concept of appropriateness in medical imaging. These goals were accomplished using a free, online, easily accessible curriculum. Incorporation of additional topics within the discipline of radiology should be included in the curriculum in the future.
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Affiliation(s)
- Samuel Francis
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Be'er Sheva 8410501, Israel (S.F., A.J., B.H.T.).
| | - Edward Kim
- Healthcare Strategy, Kaufman Hall, Chicago, Illinois (E.K.)
| | - Alan Jotkowitz
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Be'er Sheva 8410501, Israel (S.F., A.J., B.H.T.)
| | | | - Benjamin H Taragin
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Be'er Sheva 8410501, Israel (S.F., A.J., B.H.T.); Department of Pediatric Radiology, Assuta Medical Center, Tel Aviv, Israel (B.H.T.)
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Linet MS, Applegate KE, McCollough CH, Bailey JE, Bright C, Bushberg JT, Chanock SJ, Coleman J, Dalal NH, Dauer LT, Davis PB, Eagar RY, Frija G, Held KD, Kachnic LA, Kiess AP, Klein LW, Kosti O, Miller CW, Miller-Thomas MM, Straus C, Vapiwala N, Wieder JS, Yoo DC, Brink JA, Dalrymple JL. A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools. J Am Coll Radiol 2023; 20:251-264. [PMID: 36130692 PMCID: PMC10578400 DOI: 10.1016/j.jacr.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 12/27/2022]
Abstract
US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.
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Affiliation(s)
- Martha S Linet
- Chief and Senior Investigator, Radiation Epidemiology Branch (retired) and currently NIH Scientist Emerita, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Kimberly E Applegate
- Division Chief and Professor of Pediatric Radiology (retired), University of Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky, and currently Chair of Committee 3 of the International Commission on Radiological Protection, Ottawa, Canada
| | - Cynthia H McCollough
- Brooks-Hollern Professor of Medical Physics and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Janet E Bailey
- Professor of Radiology and Associate Chair for Education in Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Cedric Bright
- Associate Dean for Admissions and Clinical Professor, Department of Internal Medicine, East Carolina's Brody School of Medicine, Greenville, North Carolina
| | - Jerrold T Bushberg
- Clinical Professor of Radiology and Radiation Oncology, University of California Davis School of Medicine, Sacramento, California, and Vice President, National Council of Radiation Protection and Measurements, Bethesda, Maryland
| | - Stephen J Chanock
- Director and Chief of the Cancer Genomics Research Laboratory, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jenna Coleman
- Executive Director of the Medical Educational Council of Pensacola, Pensacola, Florida
| | - Nicole H Dalal
- Resident, Department of Internal Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Lawrence T Dauer
- Attending Physicist, Departments of Medical Physics and Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pamela B Davis
- Dean School of Medicine (emerita) and Arline H. and Curtis F. Garvin Research Professor, Center for Community Health Integration, and Professor of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert Y Eagar
- Diagnostic Radiology Resident, Department of Radiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Guy Frija
- Professor of Radiology (Emeritus), Université de Paris, Paris, France
| | - Kathryn D Held
- President of the National Council on Radiation Protection and Measurements, Bethesda, Maryland, and Associate Radiation Biologist, Department of Radiation Oncology, Massachusetts General Hospital and Associate Professor of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Lisa A Kachnic
- Chair, Department of Radiation Oncology, Columbia University Medical Center and the Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Ana P Kiess
- Assistant Professor of Radiation Oncology and Molecular Radiation Sciences and Director of the Residency Program, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lloyd W Klein
- Clinical Professor of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Ourania Kosti
- Senior Program Officer at the Nuclear and Radiation Studies Board of the National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Charles W Miller
- Chief (retired) Radiation Studies Branch, Division of Environmental Hazards and Health Effects, Centers for Disease Control and Prevention, Atlanta, Georgia, and currently a Consultant in Nuclear and Radiological Environmental Health, Atlanta, Georgia
| | - Michelle M Miller-Thomas
- Associate Professor of Radiology and Director of Medical Student Education at Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Christopher Straus
- Associate Professor of Radiology and Director of Medical Student Education, University of Chicago School of Medicine, Chicago, Illinois
| | - Neha Vapiwala
- Professor and Vice Chair of Education, Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica S Wieder
- Director of the Center for Radiation Information and Outreach, US Environmental Protection Agency, Washington, DC
| | - Don C Yoo
- Director of Nuclear Medicine, Miriam Hospital and Professor of Diagnostic Imaging and Clinical Educator, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - James A Brink
- Chair, Department of Radiology, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John L Dalrymple
- Professor of Obstetrics, Gynecology and Reproductive Biology and Associate Dean for Medical Education Quality Improvement, Harvard Medical School, Boston, Massachusetts, and Associate Chair and Vice Chair for Faculty Development and Faculty Affairs and Gynecologic Oncology Fellowship Program Director, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract
Headache represents one of the most common disorders in childhood and leads to nearly half a million visits to the physician's office or emergency department every year. Although the estimated prevalence is around 58.4%, the actual incidence of headache in the pediatric population might be underestimated, given only a percentage of cases seek medical attention. The first step in the evaluation of pediatric headache is a detailed clinical history and relevant clinical examinations. AAN and ACR do not recommend neuroimaging for patients with primary headache. However, neuroimaging becomes mandatory in presence of red flags to rule out the underlying cause.
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Affiliation(s)
- Aline Camargo
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA
| | - Sangam Kanekar
- Radiology Research, Division of Neuroradiology, Penn State Health, Penn State College of Medicine, Mail Code H066 500 University Drive, Hershey, PA 17033, USA.
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Abramson L, Massaro L, Alberty-Oller JJ, Melsaether A. Breast Imaging During Pregnancy and Lactation. J Breast Imaging 2019; 1:342-351. [PMID: 38424810 DOI: 10.1093/jbi/wbz065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/18/2019] [Indexed: 03/02/2024]
Abstract
Breast imaging during pregnancy and lactation is important in order to avoid delays in the diagnosis and treatment of pregnancy-associated breast cancers. Radiologists have an opportunity to improve breast cancer detection by becoming familiar with appropriate breast imaging and providing recommendations to women and their referring physicians. Importantly, during pregnancy and lactation, both screening and diagnostic breast imaging can be safely performed. Here we describe when and how to screen, how to work up palpable masses, and evaluate bloody nipple discharge. The imaging features of common findings in the breasts of pregnant and lactating women are also reviewed. Finally, we address breast cancer staging and provide a brief primer on treatment options for pregnancy-associated breast cancers.
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Affiliation(s)
- Lisa Abramson
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY
| | - Lindsey Massaro
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY
| | | | - Amy Melsaether
- Icahn School of Medicine at Mount Sinai, Department of Radiology, New York, NY
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Qdaisat A, Yeung SJ, Variyam DE, Badugu P, Ghaly F, Rice TW, Halm JK, Carter BW, Sun J, Gonzalez CE, Viets-Upchurch J, Steele JR, Wu CC. Evaluation of Cancer Patients With Suspected Pulmonary Embolism: Performance of the American College of Physicians Guideline. J Am Coll Radiol 2020; 17:22-30. [PMID: 31376398 DOI: 10.1016/j.jacr.2019.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Accurate risk stratification of pulmonary embolism (PE) can reduce unnecessary imaging. We investigated the extent to which the American College of Physicians (ACP) guideline for evaluation of patients with suspected PE could be applied to cancer patients in the emergency department of a comprehensive cancer center. MATERIALS AND METHODS Data from cancer patients who underwent CT pulmonary angiography (CTPA) between August 1, 2015, and October 31, 2015, were collected. We assessed each patient's diagnostic workup for its adherence to the ACP guideline in terms of clinical risk stratification and age-adjusted d-dimer level and the degree to which these factors were associated with PE. RESULTS Of the 380 patients identified, 213 (56%) underwent CTPA indicated per the ACP guideline, and 78 (21%) underwent CTPA not indicated per the guideline. Only one of the patients who underwent nonindicated CTPA had a PE. Fifty-seven patients underwent unnecessary d-dimer evaluation, and 71 patients with negative d-dimer test results underwent nonindicated CTPA. PEs were found in 6 of 108 (6%) low-risk patients, 22 of 219 (10%) intermediate-risk patients, and 13 of 53 (25%) high-risk patients. The ACP guideline had negative predictive value of 99% (95% confidence interval: 93%-100%) and sensitivity of 97% (95% confidence interval: 86%-100%) in predicting PE. CONCLUSION The ACP guideline has good sensitivity for detecting PE in cancer patients and thus can be applied in this population. Compliance with the ACP guideline when evaluating cancer patients with suspected PE could reduce the use of unnecessary imaging and laboratory studies.
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European Society of Radiology (ESR). Summary of the proceedings of the international forum 2016: "Imaging referral guidelines and clinical decision support - how can radiologists implement imaging referral guidelines in clinical routine?". Insights Imaging 2017; 8:1-9. [PMID: 28044260 DOI: 10.1007/s13244-016-0523-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 01/26/2023] Open
Abstract
The International Forum is held once a year by the ESR and its international radiological partner societies with the aim to address and discuss selected subjects of global relevance in radiology. In 2016, the issue of implementing imaging referral guidelines in clinical routine was analysed. The legal environment in the USA requires that after January 1, 2017, physicians must consult government-approved, evidence-based appropriate-use criteria through a clinical decision support system when ordering advanced diagnostic imaging exams. The ESR and the National Decision Support Company are developing "ESR iGuide", a clinical decision support system for European imaging referral guidelines using ESR imaging referral guidelines based on ACR Appropriateness Criteria. In many regions of the world, the situation is different and quite diverse, depending on the specific features of health care systems in different countries, but there are, unlike in the USA and EU, no legal obligations to implement imaging referral guidelines into the clinical practice. Imaging referral guidelines and clinical decision support implementation is a complex issue everywhere and the legal environment surrounding it even more so; how they will be implemented into the clinical practice in different areas of the world needs yet to be decided. MAIN MESSAGES • Implementation of imaging referral guidelines in clinical routine is needed. • Potential benefits are improved appropriateness in referrals and reduction of unnecessary radiation exposure. • The educational benefits include new insights through data collection and reporting. • The system will potentially highlight the lack in quality or availability of equipment.
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Stein MW, Frank SJ, Roberts JH, Finkelstein M, Heo M. Integrating the ACR Appropriateness Criteria Into the Radiology Clerkship: Comparison of Didactic Format and Group-Based Learning. J Am Coll Radiol 2016; 13:566-70. [PMID: 26908202 DOI: 10.1016/j.jacr.2015.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to determine whether group-based or didactic teaching is more effective to teach ACR Appropriateness Criteria to medical students. METHODS An identical pretest, posttest, and delayed multiple-choice test was used to evaluate the efficacy of the two teaching methods. Descriptive statistics comparing test scores were obtained. RESULTS On the posttest, the didactic group gained 12.5 points (P < .0001), and the group-based learning students gained 16.3 points (P < .0001). On the delayed test, the didactic group gained 14.4 points (P < .0001), and the group-based learning students gained 11.8 points (P < .001). The gains in scores on both tests were statistically significant for both groups. However, the differences in scores were not statistically significant comparing the two educational methods. CONCLUSIONS Compared with didactic lectures, group-based learning is more enjoyable, time efficient, and equally efficacious. The choice of educational method can be individualized for each institution on the basis of group size, time constraints, and faculty availability.
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