Publications by authors named "Jonathan A Flug"

44 Publications

The Magnet Is Sometimes "Off"-Practical Strategies for Optimizing Challenging Musculoskeletal MR Imaging.

Curr Probl Diagn Radiol 2021 Mar 17. Epub 2021 Mar 17.

Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ.

To describe practical solutions to the unique technical challenges of musculoskeletal magnetic resonance imaging, including off-isocenter imaging, artifacts from motion and metal prostheses, small field-of-view imaging, and non-conventional scan angles and slice positioning. Unique challenges of musculoskeletal magnetic resonance imaging require a collaborative approach involving radiologists, physicists, and technologists utilizing optimized magnetic resonance protocols, specialized coils, and unique patient positioning, in order to reliably diagnose critical musculoskeletal MR image findings.
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http://dx.doi.org/10.1067/j.cpradiol.2021.03.007DOI Listing
March 2021

Sonography of the post-operative rotator cuff: normal postoperative findings, postsurgical complications and common artifacts.

Curr Probl Diagn Radiol 2021 Feb 7. Epub 2021 Feb 7.

Mayo Clinic Arizona, Phoenix, AZ, 85054.

This review sets forth an approach to performing and interpreting shoulder ultrasound in patients with prior rotator cuff repair and presents a comprehensive review of normal expected findings, postsurgical complications and common artifacts encountered in clinical practice.
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http://dx.doi.org/10.1067/j.cpradiol.2021.02.004DOI Listing
February 2021

Slowly Enlarging Gluteal Mass.

Skeletal Radiol 2021 Sep 26;50(9):1899-1901. Epub 2021 Feb 26.

Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.

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http://dx.doi.org/10.1007/s00256-021-03737-4DOI Listing
September 2021

Slowly enlarging gluteal mass.

Skeletal Radiol 2021 Sep 25;50(9):1915-1917. Epub 2021 Feb 25.

Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.

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http://dx.doi.org/10.1007/s00256-021-03738-3DOI Listing
September 2021

The Chimeric Gracilis and Profunda Artery Perforator Flap: Characterizing This Novel Flap Configuration with Angiography and a Cadaveric Model.

J Reconstr Microsurg 2021 Feb 16. Epub 2021 Feb 16.

Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona.

Objective:  A chimerically configured gracilis and profunda artery perforator (PAP) flap is highly prevalent based on recent computed tomography (CT)-imaging data. The purpose of this study is to further characterize the vascular anatomy of this novel flap configuration and determine the feasibility of flap dissection.

Materials And Methods:  To characterize flap arterial anatomy, lower extremity CT angiograms performed from 2011 to 2018 were retrospectively reviewed. To characterize venous anatomy and determine the feasibility of flap harvest, the lower extremities of cadavers were evaluated.

Results:  A total of 974 lower extremity CT angiograms and 32 cadavers were included for the assessment. Of the 974 CT angiograms, majority (966, 99%) were bilateral studies, yielding a total of 1,940 lower extremities (right-lower-extremity = 970 and left-lower-extremity = 970) for radiographic evaluation. On CT angiography, a chimerically configured gracilis and PAP flap was found in 51% of patients ( = 494/974). By laterality, chimeric anatomy was present in 26% of right lower extremities ( = 254/970) and 25% of left lower extremities ( = 240/970); bilateral chimeric anatomy was found in 12% ( = 112/966) of patients. Average length of the common arterial pedicle feeding both gracilis and PAP flap perforasomes was 31.1 ± 16.5 mm (range = 2.0-95.0 mm) with an average diameter of 2.8 ± 0.7 mm (range = 1.3-8.8 mm).A total of 15 cadavers exhibited chimeric anatomy with intact, conjoined arteries and veins allowing for anatomical tracing from the profunda femoris to the distal branches within the tissues of the medial thigh. Dissection and isolation of the common pedicle and distal vessels was feasible with minimal disruption of adjacent tissues. Chimeric flap venous anatomy was favorable, with vena commitante adjacent to the common pedicle in all specimens.

Conclusion:  Dissection of a chimeric medial thigh flap consisting of both gracilis and PAP flap tissues is feasible in a cadaveric model. The vascular anatomy of this potential flap appears suitable for future utilization in a clinical setting.
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http://dx.doi.org/10.1055/s-0041-1723824DOI Listing
February 2021

Digital Subtraction Air Arthrography: An Innovative Technique for Needle Tip Location Confirmation.

Curr Probl Diagn Radiol 2021 Jul-Aug;50(4):485-488. Epub 2020 May 13.

Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO.

Purpose: This article describes an innovative technique to confirm needle tip positioning using digital subtraction fluoroscopy and air within a targeted joint.

Materials And Methods: Digital subtraction fluoroscopy with air was utilized to confirm intra-articular needle tip position in 12 joints over a 14-month period at a single institution. Procedural details were recorded for each joint including: joint location, fluoroscopy time, patient age, patient body mass index, and change in subjective pain rating following the injection. Shoulder and hip phantoms were utilized to compare radiation dose differences between fluoroscopy with digital subtraction technique and fluoroscopy without digital subtraction technique.

Results: All of the 12 injections were technically successful with air clearly visualized within each targeted joint and subjective pain ratings either did not change or decreased following the injection. Patient age ranged from 51 to 87 years old and body mass index values ranged from 19.2 to 37.1 kg/m. Fluoroscopy times ranged from 11.1 to 32.9 seconds. There were no complications during or immediately following the injections. The addition of digital subtraction technique increased the skin dose at the shoulder by approximately 2.6 times and at the hip by approximately 2.2 times. Likewise, the cumulative dose at the shoulder increased by approximately 2.7 times and at the hip by 2.0 times.

Conclusion: Fluoroscopic digital subtraction air arthrography is a valuable option for needle tip confirmation when using air as a contrast agent. This novel combination of established fluoroscopic techniques can be incorporated into most clinical practices.
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http://dx.doi.org/10.1067/j.cpradiol.2020.04.003DOI Listing
May 2020

Iatrogenic humeral anatomic neck fracture after intraosseous vascular access.

Skeletal Radiol 2020 Sep 18;49(9):1481-1485. Epub 2020 May 18.

Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA.

Intraosseous infusion has become a key tool in the resuscitation of critically ill or injured patients, both in pre-hospital settings and in emergency departments. Intraosseous access is obtained through the percutaneous placement of a needle into the medullary space of a bone, thereby allowing access into the systemic venous circulation via the medullary space, which is essential to treat patients in shock, cardiac arrest, airway compromise, or major trauma. This becomes critically important when obtaining conventional intravenous access is difficult or impossible. Few cases of iatrogenic fracture have been reported for intraosseous access in the tibia and no case to-date has been reported of iatrogenic fracture secondary to humeral access. We report a case of a 55-year-old patient being resuscitated emergently with proximal humeral intraosseous infusion for cardiac and respiratory arrest secondary to status epilepticus. After successful resuscitation and removal of the intraosseous cannula, the patient noted new-onset shoulder pain. The patient was ultimately diagnosed with an iatrogenic fracture of the anatomic neck of the humerus through the intraosseous needle tract when the appropriate history was obtained in conjunction with cross-sectional imaging. As the use of intraosseous access expands, such fractures may well be seen more frequently. Intraosseous access is limited to the period of resuscitation and the cannula is often not present at the time of imaging. It is important for radiologists to recognize the findings related to intraosseous access as well as this complication with its characteristic locations and morphology.
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http://dx.doi.org/10.1007/s00256-020-03462-4DOI Listing
September 2020

Desmoplastic Fibroblastoma: An Uncommon Tumor With a Relatively Characteristic MRI Appearance.

AJR Am J Roentgenol 2020 07 14;215(1):178-183. Epub 2020 May 14.

American Institute for Radiologic Pathology, Silver Spring, MD.

We undertook this study to determine the radiologic features of desmo-plastic fibroblastoma. We reviewed available radiologic images for 29 pathologically confirmed desmoplastic fibroblastomas, including images from MRI, radiography, ultrasound (US), and CT. The patient population included 14 women and 15 men (mean age, 60 years; range, 23-96 years). Typically, lesions were oval or lobulated and relatively small (mean, 5.6 cm). In 14 of the 22 cases that included patient histories, lesions had grown slowly, with two eventually causing pain. The remaining eight were discovered incidentally. All lesions involved or were below the deep fascia. Lesions were well-defined and associated with muscle (45%), deep fascia (28%), joint (21%), or tendon (7%). MR images were available in 26 cases; 14 included unenhanced and contrast-enhanced studies. On MRI imaging all lesions were well-defined and adjacent to dense connective tissue. On T1-weighted images, lesions showed varying amounts of low and intermediate signal intensity similar to that of tendon and skeletal muscle, respectively. On fluid-sensitive images, lesions were more heterogeneous, generally showing a wider spectrum of decreased to intermediate signal intensity. On contrast-enhanced MR images, enhancement was characteristically peripheral and septal with patchy areas of homogeneity. In the 10 cases with radiographs, images showed negative findings or a nonmineralized mass. The 10 available ultrasound studies showed mixed echogenicity. In eight patients, unenhanced CT showed lesions having attenuation similar to that of skeletal muscle. Desmoplastic fibroblastoma is an uncommon neoplasm with a relatively characteristic MRI appearance.
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http://dx.doi.org/10.2214/AJR.19.22163DOI Listing
July 2020

Reducing Errors in Radiology Specimen Labeling Through Use of a Two-person Check.

Curr Probl Diagn Radiol 2020 Sep - Oct;49(5):351-354. Epub 2020 Jan 10.

Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ. Electronic address:

Improper specimen labeling of biopsy samples can cause substantial harm to patients through diagnostic delays, administration of inappropriate treatments, and can result in a loss of trust in the healthcare system. Specimen labeling errors are considered a relevant safety metric in our department and tracked on a rolling basis. One imaging section was noted to have nearly completely eliminated these errors through implementation of a 2-person check prior to submission to pathology. The purpose of this intervention was to identify the causes of continued specimen labeling errors in radiology and to standardize the specimen labeling workflow across the department of radiology to include the best practice identified in breast imaging utilizing a 2-person check. Preintervention, 31 specimen labeling errors were reported by the procedural staff over a period of 149 weeks resulting in an error rate of 0.21 errors per week. Postintervention, 3 specimen labeling errors occurred in the next 46 weeks resulting in a rate of 0.07 errors per week, a 68.8% decrease in the specimen labeling error rate. This quality improvement project highlights the process flaws which contribute to medical errors and demonstrates a potential pathway to try and reduce these errors and patient harm without significant investment in capital or new technology.
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http://dx.doi.org/10.1067/j.cpradiol.2020.01.003DOI Listing
April 2021

Taking the professional leap from trainee to attending.

Authors:
Jonathan A Flug

Clin Imaging 2020 Apr 8;60(2):257-259. Epub 2020 Jan 8.

Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, United States of America.. Electronic address:

The transition from trainee to attending can be one of the most difficult transitions in a radiologist's career. Even if a recent graduate is clinically competent, their future successful integration as part of a practice relies on more than just performing correct image interpretation. This article addresses several strategies to help new hires successfully transition to their new practice and become permanent, contributing members of their team.
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http://dx.doi.org/10.1016/j.clinimag.2019.12.019DOI Listing
April 2020

Multiple flexor tendon pulley ruptures in a division 1 collegiate football player.

Orthop Rev (Pavia) 2019 Dec 2;11(4):8316. Epub 2019 Dec 2.

Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ.

Injuries to the hand and digits are common in football players. To our knowledge, there have been no reports on multiple flexor pulley ruptures in football players treated non-operatively through splinting and taping techniques. A 22-year old collegiate defensive lineman sustained an injury resulting in complete disruption of the annular 2, 3, 4, and cruciate 1 and 2 pulleys. The patient was successfully treated with serial custom splints for 12 weeks. Our splinting and taping techniques and timing of these have not been previously described. This case illustrates a successful treatment option in football players with multiple flexor pulley ruptures.
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http://dx.doi.org/10.4081/or.2019.8316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912133PMC
December 2019

A Newly Described, Highly Prevalent Arterial Pedicle Perfuses Both Gracilis and Profunda Artery Perforator Flap Tissues: An Angiographic Study of the Medial Thigh.

J Reconstr Microsurg 2020 Mar 16;36(3):177-181. Epub 2019 Oct 16.

Division of Plastic and Reconstructive Surgery, Mayo Clinic, Phoenix, Arizona.

Background:  Novel secondary flap options are paramount for patients who are not candidates for common reconstructive methods. The purpose of this study is to identify the prevalence of single arterial pedicle supplying both the gracilis muscle and medial thigh tissue carried in a profunda artery perforator (PAP) flap. Such a pedicle could allow the creation of a chimeric gracilis and PAP flap with a single-arterial anastomosis.

Methods:  We conducted a retrospective review of 157 lower extremity computed tomography (CT) angiograms to assess the vasculature of the thigh soft tissues. Imaging evaluation was supervised by a board-certified musculoskeletal radiologist.

Results:  Prevalence of a single-arterial pedicle to a gracilis and PAP flap in each patient was 59% (31% within the right leg and 28% in the left leg). Furthermore, 16% of patients had a common arterial pedicle in both lower extremities.

Conclusion:  Existence of a single-arterial pedicle to both the gracilis muscle and PAP flap tissues is frequently present in most patients in at least one lower extremity. This chimeric flap configuration could serve as a reconstructive avenue for patients, particularly those who have exhausted other more common flap options. Screening angiography is warranted in patients looking for this anatomic variation to establish its presence.
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http://dx.doi.org/10.1055/s-0039-1698438DOI Listing
March 2020

Limiting Nonradiology Staff MRI Access to Reduce Zone Breach Incidents.

J Am Coll Radiol 2019 Jun;16(6):834-837

Mayo Clinic Arizona, Phoenix, Arizona.

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http://dx.doi.org/10.1016/j.jacr.2018.10.014DOI Listing
June 2019

Sociodemographic Variation in the Use of Conservative Therapy Before MRI of the Lumbar Spine for Low Back Pain in the Era of Public Reporting.

J Am Coll Radiol 2019 Apr;16(4 Pt B):560-569

Mayo Clinic Arizona, Department of Radiology, Phoenix, Arizona.

Purpose: To evaluate the relationship between use of MRI of the lumbar spine for low back pain without prior conservative therapy and sociodemographic factors after the implementation of public reporting for Medicare's Hospital Outpatient Imaging Efficiency Measure for MRI Lumbar Spine for Low Back Pain (OP-8) metric.

Materials And Methods: We conducted a secondary data analysis using a nationally representative sample of 2009 to 2014 Medicare claims to evaluate trends in use of conservative therapy before MRI of the lumbar spine. Continuously enrolled fee-for-service Medicare beneficiaries were included. We applied the same criteria used by Medicare to generate a measure consistent with OP-8. Regression was used to evaluate trends in OP-8 by reporting status (outpatient hospital or clinic) and beneficiary characteristics. Age, sex, and race from the Medicare denominator and area-level socioeconomic measures from the Area Health Resource File were used as covariates.

Results: Use of conservative therapy before MRI increased regardless of OP-8 reporting status. Several sociodemographic characteristics were associated with the likelihood of receiving conservative therapy before MRI; beneficiaries were less likely to receive conservative therapy before MRI if they were male, older, black, Hispanic or Latino; if they lived in the West or in an area with more college graduates; or if they had low incomes. Beneficiaries were more likely to receive conservative therapy before MRI if they had poorer health or lived in areas with higher home values.

Conclusion: Variations in use of conservative therapy according to factors other than clinically relevant factors, such as health status, are worrying. Further strategies are needed to improve appropriateness and equity in the provision of diagnostic imaging.
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http://dx.doi.org/10.1016/j.jacr.2018.12.047DOI Listing
April 2019

Never Events in Radiology and Strategies to Reduce Preventable Serious Adverse Events.

Radiographics 2018 Oct;38(6):1823-1832

From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054.

The term never event in medicine was originally coined by Kenneth W. Kizer, MD, MPH, former chief executive officer of the National Quality Forum, to describe particularly shocking medical errors that should never occur, such as wrong-site surgery or death associated with introduction of a metallic object into the MRI area. With time, the National Quality Forum's list of never events, or "serious reportable events," has been expanded to include adverse events that are unambiguous, serious, and usually preventable. In this article, the never event framework has been used to describe (a) the errors that may occur in an imaging department that are serious and usually preventable with a review of the causative factors and (b) strategies to eliminate and reduce the adverse effects of these avoidable errors. These errors are often rooted in communication breakdowns and can only be eliminated with a true shift to a culture of open reporting and patient safety. RSNA, 2018.
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http://dx.doi.org/10.1148/rg.2018180036DOI Listing
October 2018

Erosive Arthritis, Fibromatosis, and Keloids: A Rare Dermatoarthropathy.

Case Rep Rheumatol 2018 22;2018:3893846. Epub 2018 Apr 22.

Division of Plastic Surgery, Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA.

Polyfibromatosis is a rare disease characterized by fibrosis manifesting in different locations. It is commonly characterized by palmar fibromatosis (Dupuytren's contracture) in variable combinations with plantar fibromatosis (Ledderhose's disease), penile fibromatosis (Peyronie's disease), knuckle pads, and keloids. There are only three reported cases of polyfibromatosis and keloids with erosive arthritis. We report one such case and review the existing literature on this rare syndrome.
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http://dx.doi.org/10.1155/2018/3893846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937516PMC
April 2018

Post-operative extra-spinal etiologies of sciatic nerve impingement.

Skeletal Radiol 2018 Jul 8;47(7):913-921. Epub 2018 Feb 8.

Hospital for Special Surgery, New York, NY, USA.

Sciatica is a highly prevalent cause of morbidity, commonly resulting from intra-spinal pathological processes. Many cases can have extra-spinal etiologies and can be clinically challenging. Certain scenarios should suggest an extra-spinal etiology, particularly total and revision hip arthroplasty, surgical hip dislocation, hip arthroscopy, and surgery in the lithotomy position. We review the post-operative clinical scenarios where sciatic neuropathy may occur, along with the pertinent imaging findings.
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http://dx.doi.org/10.1007/s00256-018-2879-7DOI Listing
July 2018

Public Reporting of MRI of the Lumbar Spine for Low Back Pain and Changes in Clinical Documentation.

J Am Coll Radiol 2017 Dec 31;14(12):1545-1551. Epub 2017 Aug 31.

Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado.

Objective: OP-8 is the Medicare imaging efficiency metric for MRI of the lumbar spine for low back pain in the outpatient hospital. We studied trends in exclusion criteria coding over time by site of service after implementation of OP-8 to evaluate provider's response to public reporting.

Materials And Methods: We conducted a secondary data analysis using the Medicare Limited Data Set 5% sample for beneficiaries with MRI lumbar spine and lower back pain during 2009 to 2014. We evaluated the association between excluding condition prevalence and site by using generalized estimating equations regression. We produced model-based estimates of excluding condition prevalence by site and year. As a sensitivity analysis, we repeated the analysis while including additional conditions in the outcome measure.

Results: We included 285,911 MRIs of the lumbar spine for low back pain. Generalized estimating equations regression found that outpatient hospitals had a higher proportion of MRIs with at least one excluding condition documented compared with outpatient clinics (P < .05), but increases in excluding condition prevalence were similar across all sites during 2009 to 2014. Our results were not sensitive to the inclusion of additional conditions.

Conclusion: Documentation of excluding conditions and other clinically reasonable exclusions for OP-8 increased over time for outpatient hospitals and clinics. Increases in documentation of comorbidities may not translate to actual improvement in imaging appropriateness for low back pain. When accounting for all relevant conditions, the proportion of patients with low back pain considered uncomplicated and being measured by OP-8 would be small, reflecting a small proportion of patients with low back pain.
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http://dx.doi.org/10.1016/j.jacr.2017.07.012DOI Listing
December 2017

The Iliofemoral Line: A Radiographic Sign of Acetabular Dysplasia in the Adult Hip.

Am J Sports Med 2017 Sep 13;45(11):2493-2500. Epub 2017 Jun 13.

Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.

Background: Several radiographic parameters utilized for the diagnosis of acetabular dysplasia in adults suffer from poor reproducibility and reliability.

Purpose: To define and validate a novel radiographic parameter (the iliofemoral line [IFL]) for the detection of frank and borderline hip dysplasia and to compare the sensitivity and specificity of this radiographic marker to those of previously validated qualitative parameters.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: A consecutive cohort of 222 adult patients (436 hips) undergoing hip preservation surgery was included. The IFL, which extends from the lateral femoral neck through the inner cortical lip of the iliac crest, intersects the femoral head in cases of dysplasia. Percent medialization of the IFL was defined as the horizontal distance of the exposed femoral head lateral to the IFL, relative to the horizontal femoral head width at the center of the femoral head.

Results: Percent medialization of the IFL was strongly correlated to the lateral center edge angle ( P < .0001). Values of percent medialization ranging from 15% to 22% predicted the presence of borderline hip dysplasia with a sensitivity of 62% and specificity of 89%, while values exceeding 22% predicted the presence of frank acetabular dysplasia with a sensitivity of 77% and specificity of 94%. By comparison, abnormality of the Shenton line demonstrated a sensitivity of 3.7% and specificity of 97% for the detection of borderline dysplasia and a sensitivity of 16% and specificity of 99% for the detection of frank acetabular dysplasia. Compared with the Shenton line, percent medialization of the IFL was significantly more sensitive for the detection of both borderline and frank acetabular dysplasia (both P < .0001). The intraobserver and interobserver reproducibility of the horizontal difference outside the IFL were 0.99 and 0.96, respectively.

Conclusion: Percent medialization of the IFL is a reliable and accurate radiographic marker of frank acetabular dysplasia and, to a lesser extent, borderline dysplasia. The use of this radiographic parameter as an additional tool may enable the earlier detection of borderline and frank hip dysplasia in young adults presenting with hip pain.
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http://dx.doi.org/10.1177/0363546517708983DOI Listing
September 2017

Imaging of Cartilage in the Athlete.

Clin Sports Med 2017 Jul 2;36(3):427-445. Epub 2017 Apr 2.

Department of Radiology, University of Colorado Hospital, 12605 East 16th Avenue, Aurora, CO 80045, USA.

MRI remains the optimal imaging modality to evaluate cartilage injuries in the athlete. As these injuries have no intrinsic healing capacity, early and accurate noninvasive diagnosis remains integral to determining the most appropriate treatment option in this class of patients. Although surgical success depends primarily on clinical outcomes, MRI evaluation can provide pertinent information regarding the status of the surgical repair and the progression of cartilage disease.
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http://dx.doi.org/10.1016/j.csm.2017.02.002DOI Listing
July 2017

Mentorship in Radiology.

Curr Probl Diagn Radiol 2017 Sep - Oct;46(5):385-390. Epub 2017 Feb 20.

Department of Radiology, Winthrop-University Hospital, Mineola, NY; Department of Radiology, Stony Brook University School of Medicine, Stony Brook, NY. Electronic address:

Mentoring is an extremely important component of academic medicine, including radiology, yet it is not specifically emphasized in radiology training, and many academic radiology departments in the United States, Canada, and elsewhere do not have formal mentoring programs for medical students, residents, fellows, or junior faculty. The purpose of this article is to overview the current status of mentorship in radiology, to discuss the importance of mentorship at multiple levels and its potential benefits in particular, as well as how to conduct a successful mentor-mentee relationship. The literature on mentorship in radiology and in academic medicine in general is reviewed.
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http://dx.doi.org/10.1067/j.cpradiol.2017.02.008DOI Listing
November 2017

The Roles of Organized Radiology in Career Development for Trainees and Junior Attending Radiologists: A Road Map.

AJR Am J Roentgenol 2017 Jun 16;208(6):1271-1277. Epub 2017 Mar 16.

1 Department of Radiology, The University of Colorado, 12631 E 17th Ave, Mail Stop 8200, Aurora, CO 80045.

Objective: The full spectrum of organized radiology consists of numerous organizations with varied missions targeting their respective members.

Conclusion: This article highlights many of these organizations, discusses the benefits they can provide to radiology trainees and junior faculty, and provides a road map for progressive participation among trainees to junior faculty as they advance through training.
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http://dx.doi.org/10.2214/AJR.16.17234DOI Listing
June 2017

A Picture of Burnout: Case Studies and Solutions Toward Improving Radiologists' Well-being.

Curr Probl Diagn Radiol 2017 Sep - Oct;46(5):365-368. Epub 2016 Dec 15.

Department of Radiology, University of Colorado SOM, Aurora, CO.

This article uses case fictional case vignettes as a vehicle to discuss the complex way organizational and individual factors contribute to physician burnout. The article incorporates a review of the current literature on physician burnout focusing on work place inefficiency and ineffective leadership.
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http://dx.doi.org/10.1067/j.cpradiol.2016.12.006DOI Listing
November 2017

Double Fellowships in Radiology: A Survey of 2014 Graduating Fellows.

Curr Probl Diagn Radiol 2017 Jul - Aug;46(4):263-266. Epub 2016 Nov 12.

Department of Musculoskeletal Radiology, University of Colorado, Aurora, CO.

Purpose: Radiology fellowship training has evolved from being an uncommon option to being a near requisite for post-training employment in the United States. A subset of fellows elect to pursue second fellowships with potentially substantial implications on both the private sector and academic radiology workforce. The purpose of this study was to assess the proportion of current radiology fellows pursuing multiple years of post-residency fellowship training.

Materials And Methods: After obtaining IRB approval, an anonymous web-based survey was emailed to 1,269 radiology fellows listed as "completing fellowship" in the American College of Radiology database in June 2014. Questions were asked regarding current fellowship training, post-fellowship employment plans, and individual experience pursuing employment. Results were analyzed using the survey analytical software.

Results: There were 219 responses received, representing a 17.3% response rate. Ten-percent of respondents were currently completing their second radiology fellowship. Of those completing their first year of fellowship training, 11% indicated plans to complete a second radiology fellowship.

Conclusion: This survey provides a snapshot of the percentage of radiology trainees who pursue a second year of fellowship training, currently in the range of 10%. Pursuing a second radiology fellowship may represent a safety net to a substantial subset of fellows who are not able to obtain satisfactory employment following training. Academic programs who rely heavily on fellows should be aware of the proportion of fellows pursuing two fellowships and should be prepared to adapt should this change over time.
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http://dx.doi.org/10.1067/j.cpradiol.2016.11.003DOI Listing
August 2017

Behavioral Interviewing: Integrating ACGME Competency-Based Questions Into the Radiology Resident Selection Process.

Curr Probl Diagn Radiol 2017 Mar - Apr;46(2):91-94. Epub 2016 Nov 10.

Department of Diagnostic Radiology, The University of Colorado, Aurora, CO.

The practice of radiology is continually evolving with external pressures increasing the involvement of the radiologist as an integrated member of the multidisciplinary care delivery team and not just image interpreters working in isolation. Radiologists need to be comfortable interacting directly with patients and practicing "patient and family-centered care" and "value-based medicine." Despite this evolving role of the radiologist, medical training and the residency selection process have not significantly adapted to accommodate these new demands. In order to develop and hire radiologists who can excel in this role, the selection and interview process must be adapted to prospectively identify those candidates who can thrive in this changing role. Behavior-based interviewing is a tool that can help identify those candidates who may excel in the future. Though there are reports of it being used in the United States medical schools and residency programs across the nation, it has not become a mainstay for medical residency and professional medical interviewing.
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http://dx.doi.org/10.1067/j.cpradiol.2016.11.004DOI Listing
November 2017

Postoperative Imaging in the Setting of Hip Preservation Surgery.

Radiographics 2016 Oct;36(6):1746-1758

From the Department of Musculoskeletal Imaging and Intervention (M.K.M., C.D.S., M.K.J., P.A.L., J.A.F.) and Department of Sports Medicine (O.M.D.), University of Colorado School of Medicine, Aurora, Colo.

Osteoarthritis of the hip remains a prevalent disease condition that influences ever-changing treatment options. Procedures performed to correct anatomic variations, and, in turn, prevent or slow the progression of osteoarthritis, are aptly referred to as types of hip preservation surgery (HPS). Conditions that predispose individuals to femoroacetabular impingement (FAI), including pincer- and cam-type morphology, and hip dysplasia are specifically targeted in HPS. Common surgical interventions include acetabuloplasty, osteochondroplasty, periacetabular osteotomy (PAO), and derotational femoral osteotomy (DFO). The radiologist's understanding of the surgical approach, pre- and postoperative imaging findings, and common complications of HPS are paramount to providing value to the patient and surgeon. Acetabuloplasty and osteochondroplasty are performed to address pincer- and cam-type morphology in patients with FAI. With both of these HPS techniques, the goal is to restore the normal morphology by resecting excess bone in the acetabulum or femoral head or neck. As a result, a frequently encountered complication is incomplete or excessive resection. Excessive resection can predispose the patient to dislocation in the case of acetabuloplasty and fracture in the case of osteochondroplasty. Iatrogenic injury to adjacent structures such as the ischiofemoral ligament and acetabular cartilage also may occur. Although rare, especially when an arthroscopic approach is used, avascular necrosis remains a risk. Femoral head undercoverage in hip dysplasia is corrected by using PAO, which may be performed as the sole procedure or in conjunction with DFO. Incomplete or excessive rotation during surgery can result in postprocedural complications. As with any orthopedic procedure involving osteotomy, nonhealing is a risk. Iatrogenic injury in the form of fracture or hardware failure also may be seen. RSNA, 2016.
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http://dx.doi.org/10.1148/rg.2016160021DOI Listing
October 2016

The A3 Quality Improvement Project Management Tool for Radiology.

J Am Coll Radiol 2016 Apr 19;13(4):408-10. Epub 2016 Feb 19.

Department of Radiology, Johns Hopkins University, Baltimore, Maryland. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2015.12.028DOI Listing
April 2016

Teaching Imaging Metrics to Radiology Trainees.

Authors:
Jonathan A Flug

Radiographics 2016 Jan-Feb;36(1):308

Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Mail Stop 8200, Academic Office One, 12631 E 17th Ave, Room 2412, Aurora, CO 80045.

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http://dx.doi.org/10.1148/rg.2016150183DOI Listing
May 2016

Medicare Policy Initiatives and the Relative Utilization of "Double-Scan" CT.

J Am Coll Radiol 2016 Feb 30;13(2):137-43. Epub 2015 Oct 30.

Harvey L. Neiman Health Policy Institute, Reston, Virginia; Emory University School of Medicine, Atlanta, Georgia.

Purpose: Commonly called "double scans" by the media, combined pre- and postcontrast thoracic and abdominal CT examinations have been the focus of recent CMS policy initiatives. The aim of this study was to examine trends in the relative utilization of double-scan CT before and after 2006 legislation mandating relevant Medicare reporting initiatives.

Methods: Medicare Physician Supplier Procedure Summary Master Files from 2001 through 2012 were used to identify claims for thoracic and abdominal CT examinations. Double-scan rates by billing physician specialty and place of service were analyzed over time. Rates of double-scan CT between radiologists and nonradiologists were compared using t tests.

Results: From 2001 to 2006, double-scan rates for thoracic and abdominal CT examinations declined by 1.7% and 7.5% for radiologists, respectively (from 6.0% to 5.9% and from 22.6% to 20.9%) but increased by 15.8% and 23.6% for nonradiologists (from 5.7% to 6.6% and from 28.8% to 35.6%). From 2006 through 2012, double-scan rates declined by 42.3% and 35.2% (from 5.9% to 3.4% and from 20.9% to 13.5%) for radiologists but only by 31.8% and 8.1% (from 6.6% to 4.5% and from 35.6% to 32.7%) for nonradiologists. Double-scan rates were significantly lower for radiologists than nonradiologists for all years for abdominal CT (P < .001) and for all years after 2006 legislation for thoracic CT (P < .05).

Conclusions: Reductions in thoracic and abdominal CT double-scan rates followed legislation mandating CMS initiatives designed to reduce costs and radiation. For nonradiologists, double-scan rates were consistently higher and declined more slowly than those for radiologists. Medicare policy initiatives directed toward imaging utilization seem to influence behavior differently for radiologists compared with nonradiologists.
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http://dx.doi.org/10.1016/j.jacr.2015.09.026DOI Listing
February 2016
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