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Larson DB, Flemming DJ, Barr RM, Canon CL, Morgan DE. Redesign of the American Board of Radiology Diagnostic Radiology Certifying Examination. AJR Am J Roentgenol 2023; 221:687-693. [PMID: 37315014 DOI: 10.2214/ajr.23.29585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
On April 13, 2023, the American Board of Radiology (ABR) announced plans to replace the current computer-based diagnostic radiology (DR) certifying examination with a new oral examination to be administered remotely, beginning in 2028. This article describes the planned changes and the process that led to those changes. In keeping with its commitment to continuous improvement, the ABR gathered input regarding the DR initial certification process. Respondents generally agreed that the qualifying (core) examination was satisfactory but expressed concerns regarding the computer-based certifying examination's effectiveness and impact on training. Examination redesign was conducted using input from key groups with a goal of effectively evaluating competence and incentivizing study behaviors that best prepare candidates for radiology practice. Major design elements included examination structure, breadth and depth of content, and timing. The new oral examination will focus on critical findings as well as common and important diagnoses routinely encountered in all diagnostic specialties, including radiology procedures. Candidates will first be eligible for the examination in the calendar year after residency graduation. Additional details will be finalized and announced in coming years. The ABR will continue to engage with interested parties throughout the implementation process.
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Affiliation(s)
- David B Larson
- Department of Radiology, Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Stanford, CA 94304
| | - Donald J Flemming
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | | | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
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2
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Magudia K, Goins S, Bucknor MD, Canon CL, Jagsi R, Arleo EK. Career Trajectory Factors Affecting Gender Diversity in Academic Radiology Department Chairs: Results of a Survey of SCARD Members. AJR Am J Roentgenol 2023; 221:391-395. [PMID: 37073899 DOI: 10.2214/ajr.23.29233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Kirti Magudia
- Duke University School of Medicine, Durham, NC
- University of California, San Francisco, San Francisco, CA, , @KMagudia
| | - Stacy Goins
- Duke University School of Medicine, Durham, NC
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3
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Bonilha HS, Canon CL, O'Rourke A, Tipnis S, Martin-Harris B. Stakeholder Perspectives on Radiation Use and Interdisciplinary Collaboration in Adult Modified Barium Swallow Studies. Dysphagia 2023; 38:23-32. [PMID: 35461361 DOI: 10.1007/s00455-022-10447-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/28/2022] [Indexed: 01/27/2023]
Abstract
The Modified Barium Swallow Study (MBSS) is a videofluoroscopic examination of the anatomy and physiology involved in swallowing. Like other fluoroscopic examinations, the MBSS uses ionizing radiation with related radiation risks. Thus, the procedures and protocols related to MBSSs must balance the benefit of the diagnostic information gained with the risk of radiation exposure. This requires complex decision-making for any given clinician but becomes complicated due to the interprofessional nature of conducting MBSSs, namely the direct involvement of both the speech-language pathologist and radiologist with indirect involvement of the medical physicist and the referring physician. This editorial provides the perspectives of the various stakeholder groups related to radiation use in adult MBSSs, identifies barriers to conducting MBSSs in an evidence-based manner, and suggests areas for improvement.
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Affiliation(s)
- Heather Shaw Bonilha
- Departments of Rehabilitation Sciences, Health Science and Research, and Otolaryngology - Head and Neck Surgery, College of Health Professions, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Ashli O'Rourke
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, 29451, USA
| | - Sameer Tipnis
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Departments of Otolaryngology - Head and Neck Surgery and Radiation Oncology, Feinberg School of Medicine, Northwestern University, Evanston, IL, 60208, USA
- Edward Hines, Jr. VA Hospital, Hines, IL, 60141, USA
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4
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Morgan DE, Zarzour JG, Millette N, Galgano SJ, Smith EN, Canon CL. Accelerated Fellowships Applicable Across all Subspecialty Areas of Diagnostic Radiology as a Catalyst for Academic Recruitment. Acad Radiol 2022:S1076-6332(22)00483-4. [DOI: 10.1016/j.acra.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/01/2022]
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Abstract
Recent disruptions in a pharmaceutical supply chain critical to radiologic imaging has impacted the global availability of iohexol iodinated contrast media (ICM). The shortage of iohexol has created a national crisis in the ability of radiology departments to provide health care to patients needing contrast-enhanced exams. Radiology departments are familiar with crisis management after more than two years of clinical and operational disruptions associated with the COVID-19 pandemic. The implications of this shortage has near-term (weeks), mid-term (months), and long term (years) impact. The purpose of this report is to provide the reader with strategies for dealing with the shortage of ICM in the near term and discuss long-term issues and potential solutions to supply chain problems impacting radiology departments.
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Affiliation(s)
- Thomas M Grist
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Cheri L Canon
- Department of Radiology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Maureen P Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bass RZ, Woodard SA, Colvin SD, Zarzour JG, Porter KK, Canon CL. Childbearing in radiology training and early career: Challenges, opportunities, and finding the best time for you. Clin Imaging 2022; 86:67-70. [PMID: 35344778 DOI: 10.1016/j.clinimag.2022.03.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
For many women, radiology residency occurs during the childbearing years and they often question when is the best time to have children. Anxiety regarding fertility and pregnancy-related complications contribute to early career burnout in women physicians and many have fertility regrets. Supporting radiologists in training and early in their career as they navigate pregnancy and childbearing is critical to achieving a diverse workforce and leadership. Herein, we explore career-related challenges of childbearing and highlight opportunities for radiologists in residency, fellowship, and early in their career, so that they can make an informed childbearing decision.
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Affiliation(s)
- Rachel Z Bass
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Stefanie A Woodard
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Stephanie D Colvin
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA.
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Thomas KL, Zafar H, Parikh P, Korngold E, Canon CL, Sadowski E. Representation of women among leadership and honorees within the Society of Abdominal Radiology, past and present. Abdom Radiol (NY) 2021; 46:5758-5762. [PMID: 33452899 DOI: 10.1007/s00261-020-02922-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/28/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate gender diversity over time within the leadership and honorees of the Society of Abdominal Radiology with comparison to other radiologic societies. METHODS This was a retrospective, observational study of the gender distribution of presidents and gold meal awardees within the Society of Abdominal Radiology (SAR) compared to three national radiology organizations: the American College of Radiology (ACR), the American Roentgen Ray Society (ARRS), and the Radiological Society of North America (RSNA). Data were collected from the inception of each society through 2020. Societies were directly contacted for president and Gold Medal awardee names when this information was not available on society websites. Differences in the proportion of female presidents and Gold Medal awardees before and after 2012, by society, were performed using χ2 test; 2012 was selected as a threshold year as this represented when SAR was created. RESULTS The proportion of female past presidents was 5%, 9%, and 33% for the SGR, SUR, and SAR, respectively, and 5%, 4%, and 7% for the ACR, ARRS, and RSNA, respectively. The proportion of female Gold Medal awardees was 5%, 4%, and 10% for the SGR, SUR, and SAR, respectively, and 5%, 7%, and 7%, respectively, for ACR, ARRS, and RSNA. There was a statistically significant increase in the proportion of women presidents and honorees in all societies after 2012 compared to before 2012, but no significant difference between societies in either time period. CONCLUSION A higher proportion of female presidents and honorees were demonstrated across all societies after 2012.
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Affiliation(s)
- Kerry L Thomas
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| | - Hanna Zafar
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Puja Parikh
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Elena Korngold
- Department of Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Galgano SJ, Kirkland M, Kuhlman T, Khalaf A, Morgan DE, Canon CL, Zarzour JG. Assessing the Impact of Structured Reports for Fluoroscopic Double-Contrast Barium Esophagrams. Dysphagia 2021; 37:1266-1270. [PMID: 34802084 DOI: 10.1007/s00455-021-10382-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
Fluoroscopic barium swallow examinations are a commonly performed radiologic study in the evaluation of dysphagia. These studies remain essential in the diagnostic work-up despite the increasing utilization of endoscopy, but current residents are often less experienced with fluoroscopy. Structured reporting has been demonstrated to improve comprehensiveness of reports in multiple settings, but has not been evaluated for barium swallow examinations. A retrospective review identified patients who underwent barium swallow examinations pre-structured reporting in 2017 and followed a multidisciplinary proposal for and adoption of an optional structured report in 2020. Reports were assessed for comprehensiveness by evaluating presence/absence each element (total of 10 elements). Differences in report elements between groups and multiple subgroups was performed utilizing a Mann-Whitney U test. χ2 tests were also utilized to evaluate inclusion of each individual element of the report. A total of 487 reports from 2020 and 757 reports from 2017 were analyzed. Certain elements showed substantial differences in reporting, with greater than 90% of structured reports including them, but much lower numbers including them in non-structured reports from 2017 and 2020. Reports generated in 2020 had a statistically significant increase in report elements included when compared to 2017 (p < 0.01). This statistically significant increase was also observed in comparison of structured reports and non-structured reports from either period (p < 0.01). Adoption of structured reporting for fluoroscopic barium swallow examinations led to significant increase in report comprehensiveness and should be considered after a multidisciplinary approach to development.
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Affiliation(s)
- Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL, 35249, USA.
| | - Mason Kirkland
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Taylor Kuhlman
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL, 35249, USA
| | - Ahmed Khalaf
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL, 35249, USA
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL, 35249, USA
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL, 35249, USA
| | - Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL, 35249, USA
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Singhal A, Porter KK, Sorace AG, Kennedy KK, Canon CL. Navigating parental leave as a leader in radiology: Commentary on challenges and strategies. Clin Imaging 2021; 82:58-62. [PMID: 34773813 DOI: 10.1016/j.clinimag.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/02/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/03/2022]
Abstract
Navigating parental leave can be challenging in all fields of medicine, but it can be especially challenging for leaders balancing clinical, research, and administrative duties. As women take on more leadership roles, we have the opportunity to better define the current challenges and identify potential strategies for navigating successful parental leave while balancing the demands of leadership. This manuscript provides a commentary on the challenges and strategies for navigating parental leave in leadership positions in radiology, an important topic for shaping how parental leave is both viewed and valued in the future. Specifically, we highlight challenges and strategies for administrative responsibilities, reporting personnel, emails, microaggressions, research, empowerment, and prioritization.
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Affiliation(s)
- Aparna Singhal
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
| | - Anna G Sorace
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
| | - Kierstin K Kennedy
- UAB Hospital Medicine, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35294, USA.
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
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10
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Chertoff JD, Zarzour JG, Morgan DE, Lewis PJ, Canon CL, Harvey JA. The Early Influence and Effects of the Coronavirus Disease 2019 (COVID-19) Pandemic on Resident Education and Adaptations. J Am Coll Radiol 2020; 17:1322-1328. [PMID: 32818485 PMCID: PMC7375309 DOI: 10.1016/j.jacr.2020.07.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 10/26/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) has had a major impact on the education of trainees in the radiology environment. The precipitous drop in patient volumes and sequestering of faculty and trainees to maintain social distancing affects experiential learning. The shift of nearly all teaching settings to a virtual environment has been challenging but may also allow more interaction during teaching sessions than traditional readout sessions or didactic lectures. Faculty development is key in ensuring competence and confidence in this new environment. Recruitment of trainees using a virtual platform will require communication of opportunities as well as the culture of the department and institution as well as the community. Delay of the board examinations has caused angst as well as disruption of the timing of clinical rotations but may ultimately result in a shift of how the examinations are administered. The exceptional disruption of the COVID-19 pandemic allows us to reconsider how the educational aspects of imaging can emerge as improved in the years to come.
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Affiliation(s)
- Jocelyn D Chertoff
- Chair, Department of Radiology; Vice President, Regional Radiology Service Line, Dartmouth-Hitchcock; Professor of Radiology and of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jessica G Zarzour
- Program Director, Diagnostic Radiology Residency, Associate Professor, University of Alabama at Birmingham, Abdominal Imaging Section, Birmingham, Alabama
| | - Desiree E Morgan
- Professor and Vice Chair of Education, UAB Department of Radiology, Abdominal Imaging Section, University of Alabama at Birmingham, Birmingham, Alabama
| | - Petra J Lewis
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Cheri L Canon
- Professor and Chair, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer A Harvey
- Professor and Chair, Department of Imaging Sciences, University of Rochester, Rochester, New York.
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11
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Martin-Harris B, Canon CL, Bonilha HS, Murray J, Davidson K, Lefton-Greif MA. Best Practices in Modified Barium Swallow Studies. Am J Speech Lang Pathol 2020; 29:1078-1093. [PMID: 32650657 PMCID: PMC7844340 DOI: 10.1044/2020_ajslp-19-00189] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 05/22/2023]
Abstract
Purpose The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS. Method State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered. Results This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children. Conclusions The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cheri L. Canon
- Department of Radiology, The University of Alabama at Birmingham School of Medicine
| | - Heather Shaw Bonilha
- Department of Health Science and Research, Medical University of South Carolina, Charleston
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Joseph Murray
- Audiology and Speech-Language Pathology Service, VA Ann Arbor Healthcare System, MI
| | - Kate Davidson
- Department of Otolaryngology—Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Maureen A. Lefton-Greif
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
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12
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Canon CL, Enzmann DR, Grist TM, Meltzer CC, Norbash A, Omary RA, Rawson JV, Recht MP. Society of Chairs of Academic Radiology Departments Statement of Support for Paid Parental Leave. J Am Coll Radiol 2019; 16:271-272. [PMID: 30832826 DOI: 10.1016/j.jacr.2018.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Cheri L Canon
- Professor and Chair Department of Radiology University of Alabama at Birmingham 619 South 19th Street Birmingham, AL 35249-6830.
| | - Dieter R Enzmann
- Chair and Distinguished Professor, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles
| | - Thomas M Grist
- Professor and Chair, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carolyn C Meltzer
- Professor and Chair, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Alexander Norbash
- Professor and Chair, Department of Radiology, University of California, San Diego School of Medicine, La Jolla, California
| | - Reed A Omary
- Professor and Chair, Department of Radiology and Radiological Sciences, Professor of Biomedical Engineering, Vanderbilt University Medical Center & School of Medicine, Nashville, Tennessee
| | - James V Rawson
- Vice Chair of Operations & Special Projects, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael P Recht
- The Louis Marx Professor and Chair, Department of Radiology, NYU Langone Health, New York, New York
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13
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Affiliation(s)
- Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham Birmingham, Alabama
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14
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Wallner PE, Frey GD, Roberts AC, Canon CL, Jackson VP, Wagner BJ. Gender Diversity Within the American Board of Radiology: History, Current Status, and Future Implications. J Am Coll Radiol 2019; 16:1713-1715. [PMID: 31132332 DOI: 10.1016/j.jacr.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Paul E Wallner
- 21st Century Oncology, Inc, Fort Myers, Florida; The American Board of Radiology, Tucson, Arizona.
| | | | - Anne C Roberts
- The American Board of Radiology, Tucson, Arizona; University of California San Diego, San Diego, California
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15
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Deitte LA, McGinty GB, Canon CL, Omary RA, Johnson PT, Slanetz PJ. Shifting From Mentorship to Sponsorship—A Game Changer! J Am Coll Radiol 2019; 16:498-500. [DOI: 10.1016/j.jacr.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
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16
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Canon CL. Using Emotional Intelligence Helps Women Build Trust and Grow Influence. J Am Coll Radiol 2019; 16:255-256. [DOI: 10.1016/j.jacr.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
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Porter KK, Bass RZ, Morgan DE, Canon CL, Zarzour JG. Creating a Culture to Support Radiology Resident Mothers. J Am Coll Radiol 2018; 15:1765-1767. [DOI: 10.1016/j.jacr.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
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Kruskal JB, Patel AK, Levine D, Canon CL, Macura KJ, Allen BJ, Meltzer C. Fostering Diversity and Inclusion: A Summary of the 2017 Intersociety Summer Conference. J Am Coll Radiol 2018; 15:794-802. [DOI: 10.1016/j.jacr.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
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Slanetz PJ, Canon CL, Spalluto LB, Debenedectis CM, Borondy Kitts A, Deitte LA. Fostering Patient- and Family-Centered Care in Radiology Practice. J Am Coll Radiol 2018; 15:784-786. [PMID: 29301725 DOI: 10.1016/j.jacr.2017.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Priscilla J Slanetz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Cheri L Canon
- Department of Radiology, University of Alabama, Birmingham, Alabama
| | - Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, and the Veteran's Health Administration-Tennessee Valley Healthcare System Geriatric, Research Education Center, Nashville, Tennessee
| | - Carolyn M Debenedectis
- Department of Radiology, University of Massachusetts Memorial Medical Center-University Campus, Worcester, Massachusetts
| | | | - Lori A Deitte
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Kalia V, Ortiz DA, Patel AK, Moriarity AK, Canon CL, Duszak R. Leveraging Twitter to Maximize the Radiology Meeting Experience. J Am Coll Radiol 2018; 15:177-183. [DOI: 10.1016/j.jacr.2017.10.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kalia V, Patel AK, Moriarity AK, Canon CL. Authentic Personal Branding. J Am Coll Radiol 2017; 14:1134-1135. [PMID: 28778601 DOI: 10.1016/j.jacr.2017.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Vivek Kalia
- Hospital for Special Surgery, 400 East 71st Street, Apt. 2P, New York, NY 10021.
| | - Amy K Patel
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Andrew K Moriarity
- Michigan State University College of Human Medicine, Advanced Radiology Services, Grand Rapids, Michigan
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Kalia V, Patel AK, Moriarity AK, Canon CL. Personal Branding: A Primer for Radiology Trainees and Radiologists. J Am Coll Radiol 2017; 14:971-975. [PMID: 28476605 DOI: 10.1016/j.jacr.2017.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/20/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 12/11/2022]
Abstract
A radiologist's personal brand is a composite of many parts in one's professional life. In an age where work quality and digital footprints are tracked and measured more than ever before, it behooves radiologists to develop and curate their own individual brands in effective ways. Personal branding consists of the decisions we make, both consciously and unconsciously, which affect our reputation and the likelihood of seeking our services in the future for both patients and referring providers. As hospital systems are increasingly adjusting their systems to cater to better patient experiences, it is imperative that radiologists similarly adjust our practice patterns to accommodate the needs of the new paradigm of value-based care. It is no longer sufficient to only practice excellent clinical radiology; one's service experience to clinical providers, report quality, and digital presence must all be robust and compelling. Defining your brand and promoting your vision and quality standards have become as important to radiologists' future as keeping up with advancements in radiologic technology. One must select the proper platforms and types of interactions in which to engage from available social media options. Developing a consistent brand and presence in the work setting, on social media accounts, and in professional organizations at the local, national, and international levels is the ultimate goal. At present, very little, if any, formal training is provided on personal branding skills such as these in current residency curricula, and it is critical for radiologists to fill their gaps in knowledge through additional means.
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Affiliation(s)
- Vivek Kalia
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.
| | - Amy K Patel
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Andrew K Moriarity
- Advanced Radiology Services PC, Division of Radiology and Biomedical Imaging, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Thomas JV, Sanyal R, O'Malley JP, Singh SP, Morgan DE, Canon CL. A Guide to Writing Academic Portfolios for Radiologists. Acad Radiol 2016; 23:1595-1603. [PMID: 27742179 DOI: 10.1016/j.acra.2016.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/09/2016] [Revised: 08/04/2016] [Accepted: 08/06/2016] [Indexed: 11/18/2022]
Abstract
The academic educator's portfolio is a collection of materials that document academic performance and achievements, supplementing the curriculum vitae, in order to showcase a faculty member's most significant accomplishments. A decade ago, a survey of medical schools revealed frustration in the nonuniform methods of measuring faculty's medical education productivity. A proposed solution was the use of an academic educator's portfolio. In the academic medical community, compiling an academic portfolio is always a challenge because teaching has never been confined to the traditional classroom setting and often involves active participation of the medical student, resident, or fellow in the ongoing care of the patient. Diagnostic radiology in addition requires a knowledge base that encompasses basic sciences, imaging physics, technology, and traditional and molecular medicine. Teaching and performing research that involves this complex mix, while providing patient care that is often behind the scenes, provides unique challenges in the documentation of teaching, research, and clinical service for diagnostic radiology faculty. An academic portfolio is seen as a way to explain why relevant academic activities are significant to promotions committee members who may have backgrounds in unrelated academic areas and may not be familiar with a faculty member's work. The academic portfolio consists of teaching, research, and service portfolios. The teaching portfolio is a collection of materials that document teaching performance and documents the educator's transition to a more effective educator. A research portfolio showcases the most significant research accomplishments. The service portfolio documents service responsibilities and highlight any service excellence. All portfolios should briefly discuss the educator's philosophy, activities, methods used to implement activities, leadership, mentoring, or committee roles in these respective areas. Recognizing that academic programs have differing needs, this article will attempt to provide some basic guidelines that may help junior faculty in diagnostic radiology develop their teaching, research, and service portfolios.
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Affiliation(s)
- John V Thomas
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 354, Birmingham, AL 35249-6830.
| | - Rupan Sanyal
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 354, Birmingham, AL 35249-6830
| | - Janis P O'Malley
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 354, Birmingham, AL 35249-6830
| | - Satinder P Singh
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 354, Birmingham, AL 35249-6830
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 354, Birmingham, AL 35249-6830
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 354, Birmingham, AL 35249-6830
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Sherry CS, Canon CL. Authors' Reply. J Am Coll Radiol 2014; 11:636-7. [DOI: 10.1016/j.jacr.2014.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/22/2014] [Indexed: 11/26/2022]
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Meltzer CC, Mullins ME, Chertoff JD, Bluth EI, Canon CL. Are we training the right number of radiologists? J Am Coll Radiol 2014; 10:757-9. [PMID: 24091046 DOI: 10.1016/j.jacr.2013.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 08/29/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Carolyn C Meltzer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
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Parise P, Rosati R, Savarino E, Locatelli A, Ceolin M, Dua KS, Tatum RP, Braghetto I, Gyawali CP, Hejazi RA, McCallum RW, Sarosiek I, Bonavina L, Wassenaar EB, Pellegrini CA, Jacobson BC, Canon CL, Badaloni A, del Genio G. Barrett's esophagus: surgical treatments. Ann N Y Acad Sci 2011; 1232:175-95. [PMID: 21950813 DOI: 10.1111/j.1749-6632.2011.06051.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The following on surgical treatments for Barrett's esophagus includes commentaries on the indications for antireflux surgery after medical treatment; the effects of the various procedures on the lower esophageal sphincter; the role of impaired esophageal motility and delayed gastric emptying in the choice of the surgical procedure; indications for associated highly selective vagotomy, duodenal switch, and gastric electrical stimulation; therapeutic strategies for detection and treatment of shortened esophagus; the role of antireflux surgery on the regression of metaplastic mucosa and the risk of malignant progression; the detection of asymptomatic reflux brfore bariatric surgery; the role of non-GERD symptoms on the results of surgery; and the indications of Collis gastroplasty and choice of the type of fundoplication.
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Affiliation(s)
- Paolo Parise
- Department of General Surgery IV, Regional Referal Center for Esophageal Pathology, Pisa, Italy
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Cerfolio RJ, Bryant AS, Canon CL, Dhawan R, Eloubeidi MA. Is botulinum toxin injection of the pylorus during Ivor Lewis [corrected] esophagogastrectomy the optimal drainage strategy? J Thorac Cardiovasc Surg 2009; 137:565-72. [PMID: 19258066 DOI: 10.1016/j.jtcvs.2008.08.049] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 08/07/2008] [Accepted: 08/30/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND The optimal management of the pylorus during esophagogastrectomy is unknown. Pyloromyotomy and pyloroplasty cause early edema and risk long-term bile reflux; however, the lack of pyloric drainage might risk early aspiration. METHODS We performed a retrospective study with a prospective database on patients with esophageal cancer or high-grade dysplasia who underwent Ivor-Lewis esophagogastrectomy. All had one surgeon and similar stomach tubularization, hand-sewn anastomoses, nasogastric tube duration, and postoperative prokinetic agents. Outcomes of postoperative gastric emptying, aspiration, and swallowing symptoms were compared. RESULTS Between January 1997 and June 2008, there were 221 patients. Seventy-one patients had a pyloromyotomy, and gastric emptying judged on postoperative day 4 was delayed in 93% (52% had any morbidity and 14% had respiratory morbidity). Fifty-four patients had no drainage procedure, and gastric emptying was delayed in 96% (59% had any morbidity and 22% had respiratory morbidity). Twenty-eight patients underwent pyloroplasty, and 96% had delayed gastric emptying (50% had any morbidity and 32% had respiratory morbidity). Sixty-eight patients had botulinum toxin injection into the pylorus. Gastric emptying was delayed in only 59% (P = .002, 44% had any morbidity and 13% had respiratory morbidity). Hospital length of stay (P = .015) and operative times (P = .037) were shorter in the botulinum toxin group. Follow-up (mean, 40 months) showed symptoms of biliary reflux to be lowest in the botulinum toxin group (P = .024). CONCLUSION Injection of the pylorus with botulinum toxin at the time of esophagogastrectomy is safe and decreases operative time when compared with pyloroplasty or pyloromyotomy. In addition, it can improve early gastric emptying, decrease respiratory complications, shorten hospital stay, and reduce late bile reflux. A prospective multi-institutional randomized trial is needed.
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Affiliation(s)
- Robert James Cerfolio
- Department of Surgery, Section of Thoracic Surgery, Division of Cardio-Thoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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Morgan DE, Texada JC, Canon CL, Lockhart ME, Posey JA, Vickers SM. Multidetector computed tomography during combined therapy for pancreatic adenocarcinoma. Clin Gastroenterol Hepatol 2008; 6:842-848.e3. [PMID: 18585978 DOI: 10.1016/j.cgh.2008.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 03/15/2008] [Accepted: 03/27/2008] [Indexed: 02/07/2023]
Abstract
By using experimental combined adjuvant and neoadjuvant therapies in pancreatic ductal adenocarcinoma patients, progress has been made in survival, clinical benefit response, and even downstaging of tumors to allow surgical resection. The use of combined modality approaches in pancreatic ductal adenocarcinoma is associated with increased gastrointestinal toxicity, which may manifest as bowel wall abnormalities and peripancreatic inflammatory changes on multiphasic multidetector computed tomography and affect assessment of the pancreatic tumor. During preoperative neoadjuvant therapy, occult metastatic disease may be given the opportunity to manifest, thus preventing the morbidity of attempted resection or laparotomy. Although advances in the neoadjuvant and adjuvant treatment of patients with pancreatic carcinoma have thus far yielded only a modest impact on prognosis, in the future greater numbers of patients will undergo these treatments in searching for cure. As therapy with targeted agents evolves, the team of gastroenterologists, oncologists, surgeons, and radiologists caring for these complex patients should become familiar with the varied tumor response and host reactions to newer therapies that may be depicted on multiphase multidetector computed tomography.
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Affiliation(s)
- Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
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Abstract
The role of double-contrast barium enema examination (DCBE) in screening for colorectal carcinoma has evolved considerably in recent years. This review will discuss the current indications for DCBE and contrast fluoroscopy of the colon and the anticipated future role of these studies.
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Affiliation(s)
- Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama 35249-6830, USA.
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Affiliation(s)
- S Varadarajulu
- Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Varadarajulu S, Wilcox CM, Tamhane A, Eloubeidi MA, Blakely J, Canon CL. Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc 2007; 66:1107-19. [PMID: 17892874 DOI: 10.1016/j.gie.2007.03.1027] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 03/12/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increasingly, peripancreatic fluid collections (PFCs) are managed endoscopically with conventional transmural drainage (CTD). The role of interventional EUS in drainage of PFCs requires further clarification, because the procedure is technically challenging, with limited availability. OBJECTIVE Identify characteristics that determine the need for drainage of PFC by CTD versus EUS. PATIENTS Consecutive patients with symptomatic PFCs (types: pseudocyst, abscess, and necrosis) referred for endoscopic drainage. STUDY DESIGN Prospective study. SETTING Tertiary-referral center. METHODS After ERCP, transmural drainage was attempted by CTD. If unsuccessful, drainage by EUS was then attempted. Findings on contrast-enhanced CT and endoscopy were collected to identify characteristics that predict the need for CTD versus EUS drainage. MAIN OUTCOME MEASUREMENTS Identify characteristics to determine whether CTD or EUS is best suited for drainage of a particular PFC. Technical outcomes and safety of both techniques were also compared. RESULTS Of 53 patients with PFCs, CTD was technically successful in 30 (57%) and failed in 23 (43%). PFC regional location was the pancreatic head in 16, the body in 20, and the tail in 17; in these locations, CTD was successful in 13 (81%), 17 (85%), and 0, respectively. The causes of failed CTD were absence of luminal compression (LC) in 20, difficulty with scope positioning in 2, and bleeding with attempted drainage (portal hypertension) in 1. One PFC drained by CTD was later diagnosed as necrotic sarcoma. Of the 23 patients who failed CTD and underwent EUS, an alternate diagnosis of mucinous neoplasm was made in 2 patients, and EUS-guided drainage was successful in the other 21 patients (100%). Although CTD failed in all PFCs in the tail, all were successfully drained by EUS. In the pancreatic-head region, only those PFCs superior to pancreas and extending into porta hepatis (n = 3) required drainage by EUS. In the pancreatic body, only PFCs that developed bleeding from a transmural puncture or without definitive LC because of gastric mural edema (albumin <1.5 mg/dL, n = 2) required EUS drainage. When compared with PFCs at other locations, those in the tail were best accessed by EUS (P < .001). Patients with luminal compression at CT were significantly more likely to undergo successful drainage by CTD (adjusted odds ratio [OR] 13.6; P = .02). When compared with CTD, EUS drainages were longer in duration (40 versus 75 minutes; P < .001), with similar rates of PFCs resolution (90% versus 95%). Although bleeding occurred in 1 patient in the CTD group, no complications were encountered in patients who underwent EUS-guided drainage. PFCs located at the tail of the pancreas were more likely to require drainage by EUS than CTD (adjusted OR 22.9, P = .003) when adjusted for the presence of luminal compression at CT, size of the PFC, serum albumin, and etiology of pancreatitis. LIMITATIONS Nonrandomized study. CONCLUSIONS Because a majority of PFCs can be drained by CTD in a shorter duration, with comparable outcomes, EUS-guided drainage should be reserved mainly for PFCs located at the pancreatic tail, because these are unlikely to cause luminal compression or are technically difficult to access. Also, all pseudocyst-type PFCs must be evaluated by EUS before any attempts at endoscopic drainage, because EUS identifies an alternate diagnosis in 5% of such patients.
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Affiliation(s)
- Shyam Varadarajulu
- Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA
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Varadarajulu S, Wilcox CM, Tamhane A, Eloubeidi MA, Blakely J, Canon CL. Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc 2007. [PMID: 17892874 DOI: 10.1016/j.giw.2007.03.1027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND Increasingly, peripancreatic fluid collections (PFCs) are managed endoscopically with conventional transmural drainage (CTD). The role of interventional EUS in drainage of PFCs requires further clarification, because the procedure is technically challenging, with limited availability. OBJECTIVE Identify characteristics that determine the need for drainage of PFC by CTD versus EUS. PATIENTS Consecutive patients with symptomatic PFCs (types: pseudocyst, abscess, and necrosis) referred for endoscopic drainage. STUDY DESIGN Prospective study. SETTING Tertiary-referral center. METHODS After ERCP, transmural drainage was attempted by CTD. If unsuccessful, drainage by EUS was then attempted. Findings on contrast-enhanced CT and endoscopy were collected to identify characteristics that predict the need for CTD versus EUS drainage. MAIN OUTCOME MEASUREMENTS Identify characteristics to determine whether CTD or EUS is best suited for drainage of a particular PFC. Technical outcomes and safety of both techniques were also compared. RESULTS Of 53 patients with PFCs, CTD was technically successful in 30 (57%) and failed in 23 (43%). PFC regional location was the pancreatic head in 16, the body in 20, and the tail in 17; in these locations, CTD was successful in 13 (81%), 17 (85%), and 0, respectively. The causes of failed CTD were absence of luminal compression (LC) in 20, difficulty with scope positioning in 2, and bleeding with attempted drainage (portal hypertension) in 1. One PFC drained by CTD was later diagnosed as necrotic sarcoma. Of the 23 patients who failed CTD and underwent EUS, an alternate diagnosis of mucinous neoplasm was made in 2 patients, and EUS-guided drainage was successful in the other 21 patients (100%). Although CTD failed in all PFCs in the tail, all were successfully drained by EUS. In the pancreatic-head region, only those PFCs superior to pancreas and extending into porta hepatis (n = 3) required drainage by EUS. In the pancreatic body, only PFCs that developed bleeding from a transmural puncture or without definitive LC because of gastric mural edema (albumin <1.5 mg/dL, n = 2) required EUS drainage. When compared with PFCs at other locations, those in the tail were best accessed by EUS (P < .001). Patients with luminal compression at CT were significantly more likely to undergo successful drainage by CTD (adjusted odds ratio [OR] 13.6; P = .02). When compared with CTD, EUS drainages were longer in duration (40 versus 75 minutes; P < .001), with similar rates of PFCs resolution (90% versus 95%). Although bleeding occurred in 1 patient in the CTD group, no complications were encountered in patients who underwent EUS-guided drainage. PFCs located at the tail of the pancreas were more likely to require drainage by EUS than CTD (adjusted OR 22.9, P = .003) when adjusted for the presence of luminal compression at CT, size of the PFC, serum albumin, and etiology of pancreatitis. LIMITATIONS Nonrandomized study. CONCLUSIONS Because a majority of PFCs can be drained by CTD in a shorter duration, with comparable outcomes, EUS-guided drainage should be reserved mainly for PFCs located at the pancreatic tail, because these are unlikely to cause luminal compression or are technically difficult to access. Also, all pseudocyst-type PFCs must be evaluated by EUS before any attempts at endoscopic drainage, because EUS identifies an alternate diagnosis in 5% of such patients.
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Affiliation(s)
- Shyam Varadarajulu
- Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA
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Lockhart ME, Tessler FN, Canon CL, Smith JK, Larrison MC, Fineberg NS, Roy BP, Clements RH. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol 2007; 188:745-50. [PMID: 17312063 DOI: 10.2214/ajr.06.0541] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the sensitivity and specificity of seven CT signs in the diagnosis of internal hernia after laparoscopic Roux-en-Y gastric bypass. MATERIALS AND METHODS With institutional review board approval, the CT scans of 18 patients (17 women, one man) with surgically proven internal hernia after laparoscopic Roux-en-Y gastric bypass were retrieved, as were CT studies of a control group of 18 women who had undergone gastric bypass but did not have internal hernia at reoperation. The scans were reviewed by three radiologists for the presence of seven CT signs of internal hernia: swirled appearance of mesenteric fat or vessels, mushroom shape of hernia, tubular distal mesenteric fat surrounded by bowel loops, small-bowel obstruction, clustered loops of small bowel, small bowel other than duodenum posterior to the superior mesenteric artery, and right-sided location of the distal jejunal anastomosis. Sensitivity and specificity were calculated for each sign. Stepwise logistic regression was performed to ascertain an independent set of variables predictive of the presence of internal hernia. RESULTS Mesenteric swirl was the best single predictor of hernia; sensitivity was 61%, 78%, and 83%, and specificity was 94%, 89%, and 67% for the three reviewers. The combination of swirled mesentery and mushroom shape of the mesentery was better than swirled mesentery alone, sensitivity being 78%, 83%, and 83%, and specificity being 83%, 89%, and 67%, but the difference was not statistically significant. CONCLUSION Mesenteric swirl is the best indicator of internal hernia after laparoscopic Roux-en-Y gastric bypass, and even minor degrees of swirl should be considered suspicious.
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Affiliation(s)
- Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, 619 19th St. S, Birmingham, AL 35249-6830, USA.
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Morgan DE, Lockhart ME, Canon CL, Holcombe MP, Bynon JS. Polycystic liver disease: multimodality imaging for complications and transplant evaluation. Radiographics 2006; 26:1655-68; quiz 1655. [PMID: 17102042 DOI: 10.1148/rg.266065013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Polycystic liver disease (PLD) is usually associated with polycystic kidney disease but may also occur as an isolated finding in a rarer genetically distinct disease. In either case, the cyst burden will progress over time and, in rare cases, may affect liver function or become symptomatic due to massive hepatomegaly. The character, distribution, location, and size of hepatic cysts are important. Computed tomography, magnetic resonance imaging, or ultrasonography may provide the surgeon with valuable preoperative information, such as the location of infected or hemorrhagic cysts that may be responsible for symptoms. Less invasive cyst aspiration or fenestration may provide temporary relief from dominant or symptomatic cysts, but these cysts will recur in up to 75% of patients. Cyst fenestration with partial hepatic resection and liver transplantation are two therapies that provide more permanent resolution of symptoms in patients with extensive hepatic involvement. However, the higher risk of complications associated with more aggressive surgical therapy must be considered when determining the appropriate therapy for a given patient. Knowledge of the cyst patterns and available treatment options in patients with PLD will help the radiologist provide the referring clinician with important information for therapeutic decision making.
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Affiliation(s)
- Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, JTN322, 619 S 19th St, Birmingham, AL 35233, USA.
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Abstract
Learning how to perform endovaginal pelvic ultrasound is often challenging for novices in a busy clinical practice. In this article, we describe a program in which we hired female patient models to help residents acquire basic endovaginal scanning skills.
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Affiliation(s)
- Louis W Lucas
- From the Department of Radiology, University of Alabama School of Medicine, Birmingham, AL 35233, USA
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Canon CL, Morgan DE, Einstein DM, Herts BR, Hawn MT, Johnson LF. Surgical approach to gastroesophageal reflux disease: what the radiologist needs to know. Radiographics 2006; 25:1485-99. [PMID: 16284130 DOI: 10.1148/rg.256055016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gastroesophageal reflux disease (GERD) is defined as gastroesophageal reflux resulting in symptoms or in injury to the esophageal epithelium. Although the medical management of GERD has improved, an increasing number of laparoscopic antireflux surgical procedures are being performed. Barium studies, endoscopy, manometry, and pH monitoring are all integral components of preoperative evaluation. Barium swallow examination must allow critical evaluation of esophageal peristalsis, the presence and extent of gastroesophageal reflux, and complications including esophagitis, stricture, and Barrett esophagus. It is crucial to identify and characterize hiatal hernia and longitudinal stricture, which can result in a shortened esophagus. In such cases, it becomes necessary for the surgeon to incorporate an esophageal lengthening procedure prior to fundoplication; otherwise, poor surgical outcome is likely. Normal postfundoplication radiographic findings as well as postoperative complications (eg, tight wrap, perforation, abscess, complete or partial dehiscence, recurrent stricture, recurrent hernia, intrathoracic migration of the wrap) must also be recognized and clearly understood by the radiologist. Given the chronic nature and prevalence of symptomatic GERD and the increasing number of patients undergoing surgical intervention, it is imperative that the radiologist understand the pre- and postsurgical evaluation of affected patients.
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Affiliation(s)
- Cheri L Canon
- Division of Gastroenterology, Department of Radiology, University of Alabama, Birmingham, AL 35249-6830, USA.
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Canon CL, Stanley RJ, Pierce R, Koehler RE. Faculty Development Program for Residents: An Incentive to Faculty Recruitment. J Am Coll Radiol 2006; 3:220-2. [PMID: 17412045 DOI: 10.1016/j.jacr.2005.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Indexed: 11/25/2022]
Affiliation(s)
- Cheri L Canon
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL 35249-6830, USA.
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Katasani VG, Leeth RR, Tishler DS, Leath TD, Roy BP, Canon CL, Vickers SM, Clements RH. Water-soluble upper GI based on clinical findings is reliable to detect anastomotic leaks after laparoscopic gastric bypass. Am Surg 2005; 71:916-8; discussion 918-9. [PMID: 16372609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Anastomotic leak after laparoscopic Roux-en-Y gastric bypass (LGB) is a major complication that must be recognized and treated early for best results. There is controversy in the literature regarding the reliability of upper GI series (UGI) in diagnosing leaks. LGB was performed in patients meeting NIH criteria for the surgical treatment of morbid obesity. All leaks identified at the time of surgery were repaired with suture and retested. Drains were placed at the surgeon's discretion. Postoperatively, UGI was performed by an experienced radiologist if there was a clinical suspicion of leak. From September 2001 until October 2004, a total of 553 patients (age 40.4 +/- 9.2 years, BMI 48.6 +/- 7.2) underwent LGB at UAB. Seventy-eight per cent (431 of 553) of patients had no clinical evidence suggesting anastomotic leak and were managed expectantly. Twenty-two per cent (122 of 553) of patients met at least one inclusion criteria for leak and underwent UGI. Four of 122 patients (3.2%) had a leak, two from anastomosis and two from the perforation of the stapled end of the Roux limb. No patient returned to the operating room without a positive UGI. High clinical suspicion and selectively performed UGI based on clinical evidence is reliable in detecting leaks.
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Affiliation(s)
- V G Katasani
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0016, USA
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Manchikalapati P, Canon CL, Jhala N, Eloubeidi MA. Gastrointestinal zygomycosis complicating heart and lung transplantation in a patient with Eisenmenger's syndrome. Dig Dis Sci 2005; 50:1181-3. [PMID: 15986881 DOI: 10.1007/s10620-005-2731-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
RATIONALE AND OBJECTIVE To organize and implement a mock oral examination for radiology residents in an attempt to prepare them for the American Board of Radiology Oral Examination. MATERIALS AND METHODS A mock oral examination was administered to junior and senior radiology residents by radiology faculty. All participants completed postexamination surveys. RESULTS The mock oral examination process not only provided practice for preboard residents, but also determined areas of deficiency in their fund of knowledge and presenting skills. Additionally, it provided faculty members with areas of curricular weakness. CONCLUSION Administration of a mock oral examination reaps multiple benefits, which far exceed the task of its implementation.
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Affiliation(s)
- Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, 619 South 19th Street, Birmingham, AL 35249-6830, USA.
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Hawn MT, Canon CL, Lockhart ME, Gonzalez QH, Shore G, Bondora A, Vickers SM. Serum lactic acid determines the outcomes of CT diagnosis of pneumatosis of the gastrointestinal tract. Am Surg 2004; 70:19-23; discussion 23-4. [PMID: 14964540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Computed tomography (CT) diagnosis of pneumatosis involving the gastrointestinal tract can represent a broad range of clinical entities from a benign process to ischemic bowel. The purpose of this study is to define the significance and outcome of pneumatosis intestinalis (PI). All CT scans from 5/93 to 12/01 with the finding of PI were reviewed. Eighty-six CT scans had the finding of PI, with the colon being the most frequent location (51%), followed by small bowel (36%) and gastric (9%). Forty per cent of patients underwent surgery, with an overall mortality rate of 42 per cent and a surgical mortality rate of 47 per cent. Univariate analysis demonstrated significant correlation between serum lactic acid (LA) > 2.0 mmol/L [odds ratio (OR) = 23.4; 95% confidence interval (C.I.), 7.21-75.92] and serum creatinine > 1.5 mg/dL (OR = 3.05; 95% C.I., 1.25-7.42) with mortality. Age was suggestive but not a significant risk factor for mortality (P = 0.09). Multivariate analysis found serum LA > 2.0 (OR = 30.37; 95% C.I., 7.31-126.2) to be the only significant predictor of mortality. CT diagnosis of PI is associated with significant in-hospital mortality, especially in the elderly. Serum LA level > 2.0 mmol/L at time of diagnosis is associated with a greater than 80 per cent mortality. Surgical consultation is necessary to determine which patients need urgent surgical intervention.
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Affiliation(s)
- Mary T Hawn
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0016, USA
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Hawn MT, Canon CL, Lockhart ME, Gonzalez QH, Shore G, Bondora A, Vickers SM. Serum Lactic Acid Determines the Outcomes of CT Diagnosis of Pneumatosis of the Gastrointestinal Tract. Am Surg 2004. [DOI: 10.1177/000313480407000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Computed tomography (CT) diagnosis of pneumatosis involving the gastrointestinal tract can represent a broad range of clinical entities from a benign process to ischemic bowel. The purpose of this study is to define the significance and outcome of pneumatosis intestinalis (PI). All CT scans from 5/93 to 12/01 with the finding of PI were reviewed. Eighty-six CT scans had the finding of PI, with the colon being the most frequent location (51%), followed by small bowel (36%) and gastric (9%). Forty per cent of patients underwent surgery, with an overall mortality rate of 42 per cent and a surgical mortality rate of 47 per cent. Univariate analysis demonstrated significant correlation between serum lactic acid (LA) >2.0 mmol/L [odds ratio (OR) = 23.4; 95% confidence interval (C.I.), 7.21–75.92] and serum creatinine >1.5 mg/dL (OR = 3.05; 95% C.I., 1.25–7.42) with mortality. Age was suggestive but not a significant risk factor for mortality ( P = 0.09). Multivariate analysis found serum LA >2.0 (OR = 30.37; 95% CI., 7.31–126.2) to be the only significant predictor of mortality. CT diagnosis of PI is associated with significant in-hospital mortality, especially in the elderly. Serum LA level >2.0 mmol/L at time of diagnosis is associated with a greater than 80 per cent mortality. Surgical consultation is necessary to determine which patients need urgent surgical intervention.
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Affiliation(s)
- Mary T. Hawn
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cheri L. Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark E. Lockhart
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Quintin H. Gonzalez
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregg Shore
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony Bondora
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Selwyn M. Vickers
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Canon CL, Smith JK, Morgan DE, Jones BC, Fell SC, Kenney PJ, Ferrante D, Lockhart ME, Westfall AO, Koehler RE. Double Reading of Barium Enemas:Is It Necessary? AJR Am J Roentgenol 2003; 181:1607-10. [PMID: 14627582 DOI: 10.2214/ajr.181.6.1811607] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the effectiveness, clinical impact, and feasibility of double reading barium enemas. MATERIALS AND METHODS Independent double readings of 1,003 consecutive barium enemas (822 double- and 181 single-contrast examinations) were prospectively performed. From this pool of 1,003 examinations, 994 were included in our study. Examinations showing at least one polyp or carcinoma 5 mm or larger were considered to have positive results. For combined readings, results were considered positive if either of the two interpreters reported finding a polyp or carcinoma. A McNemar test was used to compare the first reader's results with the combined results of the first and second readers. Results were retrospectively correlated with endoscopic or surgical results in 360 patients, and agreement between first and combined readings and endoscopic results was determined. RESULTS Adding a second reader increased the number of positive results on examinations from 249 to 315 (p < 0.0001) and resulted in potential alteration of clinical treatment in 98 patients (9.9%). Sensitivity of the first and combined readings for detection of all lesions was identical, 76.3% (95% CI, 65.4-87.1%). Specificity decreased from 91.0% (95% CI, 87.9-94.3%) for the first reading to 86.4% (95% CI, 82.2-90.0%) for the combined reading. The overall measurement of agreement decreased from a kappa value of 61.8 (95% CI, 51.2-72.4%) for the first reading to 52.9 (95% CI, 42.2-63.6%) for the combined reading. The second reading required an average of 3.3 min. Sensitivity for the detection of adenocarcinomas was 100%. CONCLUSION Although feasible, double reading of barium enemas does not improve sensitivity for detection of polyps and produces a higher false-positive rate.
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Affiliation(s)
- Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
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Lockhart ME, Robbin ML, Berland LL, Smith JK, Canon CL, Stanley RJ. The sonographer practitioner: one piece to the radiologist shortage puzzle. J Ultrasound Med 2003; 22:861-864. [PMID: 14510256 DOI: 10.7863/jum.2003.22.9.861] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Eloubeidi MA, Borlaza RF, Canon CL, Wilcox CM. Aorto-esophageal fistula. Gastrointest Endosc 2002; 56:417. [PMID: 12196783 DOI: 10.1067/mge.2002.126702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
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Canon CL, Levine MS, Cherukuri R, Johnson LF, Smith JK, Koehler RE. Intramural tracking: a feature of esophageal intramural pseudodiverticulosis. AJR Am J Roentgenol 2000; 175:371-4. [PMID: 10915677 DOI: 10.2214/ajr.175.2.1750371] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our purpose was to determine the frequency of intramural tracking in patients with esophageal intramural pseudodiverticulosis and to characterize the morphologic features of this finding on barium studies. MATERIALS AND METHODS A review of radiology files at two institutions revealed 30 cases of esophageal intramural pseudodiverticulosis diagnosed at esophagography. In all cases, the radiographs were reviewed retrospectively to determine the frequency and morphologic features of intramural tracking in these patients. The number and distribution of pseudodiverticula and the presence or absence of strictures or esophagitis were also noted. RESULTS Fifteen (50%) of 30 patients with esophageal intramural pseudodiverticulosis had intramural tracking on esophagography. The tracks had an average length of 1.2 cm (length range, 0.3-7 cm) and an average width of 1.6 mm (width range, 1-4 mm). The pseudodiverticula were more numerous and had a more diffuse distribution in patients with tracking than in patients without tracking. Although patients with and without tracking had a similar frequency of strictures and esophagitis, patients with tracking were more likely to have strictures involving the upper or mid esophagus, whereas patients without tracking were more likely to have strictures in the distal esophagus. These findings indicate that intramural tracking is more likely to occur in patients with the diffuse form of esophageal intramural pseudodiverticulosis. CONCLUSION Intramural tracking was detected on esophagography in 50% of patients with esophageal intramural pseudodiverticulosis, so this type of tracking is a more common radiographic finding than has previously been recognized. Although intramural tracking has little or no known clinical significance, it is important to be aware of this finding so that it is not mistaken for a large flat ulcer in the esophagus or for an extramural collection associated with esophageal peridiverticulitis.
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Affiliation(s)
- C L Canon
- Department of Radiology, University of Alabama at Birmingham, 35249-6830, USA
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Affiliation(s)
- M E Lockhart
- Department of Radiology, University of Alabama at Birmingham, 35249-6830, USA
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