Publications by authors named "Maitray D Patel"

70 Publications

Medical Education Research Design.

J Am Coll Radiol 2022 Mar 25. Epub 2022 Mar 25.

Director of Undergraduate Medical Education and Chair, Diversity Inclusion and Equity Committee and Diversity Liaison, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Deputy Chief Editor, ACR RadExam; Member, ACR Commission on Publications and Lifelong Learning; and Executive Committee Member, ACR North Carolina Radiological Society. Electronic address:

As with clinical care, radiology education benefits when stakeholders collaborate to gather and analyze data to answer questions and solve issues. Just as importantly, radiology educators benefit academically and professionally when they demonstrate a portfolio of published scholarship to promotion committees and department leaders. The principles and techniques used in the design of medical education research are not well understood by many radiology educators because educational scholarship methodologies have received little attention in our literature. Lack of familiarity and inexperience with research methodologies, particularly qualitative research, are barriers that education researchers can address with knowledge acquisition and practice. This overview surveys the landscape and offers suggested medical education research resources to help researchers explore topics to increase understanding of quantitative, qualitative, mixed-methods, survey, and educational design methodologies.
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http://dx.doi.org/10.1016/j.jacr.2022.01.019DOI Listing
March 2022

Poor Evidence That Endometrial Thickness Underperforms in Detecting Endometrial Cancer in Black Women.

AJR Am J Roentgenol 2022 03 2;218(3):563. Epub 2022 Feb 2.

University of California, San Francisco, San Francisco, CA.

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http://dx.doi.org/10.2214/AJR.21.27055DOI Listing
March 2022

Invited Commentary: Categorizing Adnexal Masses at US, CT, and MRI-the Radiologist's Not-Impossible Mission.

Authors:
Maitray D Patel

Radiographics 2022 Mar-Apr;42(2):E77-E79. Epub 2022 Jan 21.

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

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http://dx.doi.org/10.1148/rg.210196DOI Listing
March 2022

Performance of an algorithm for diagnosing acute cholecystitis using clinical and sonographic parameters.

Abdom Radiol (NY) 2022 02 27;47(2):576-585. Epub 2021 Dec 27.

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

Purpose: Identify an algorithm using clinical and ultrasound (US) parameters with high diagnostic performance for acute cholecystitis.

Methods: Consecutive emergency department (ED) patients from 4/1/2019 to 12/31/2019 were retrospectively reviewed to record non-US parameters and make US observations. Outcomes were categorized as either: (1) acute cholecystitis; or (2) negative acute cholecystitis. Pivot tables identified parameter combinations either not found with acute cholecystitis or with predictive value for acute cholecystitis to establish the algorithm. US Division radiologists finalized an US report prior to ED disposition without use of the algorithm. Radiologist impression and algorithm prediction for acute cholecystitis were categorized as either (1) acute cholecystitis; (2) negative acute cholecystitis; or (3) inconclusive.

Results: Three hundred and sixty-six studies on 357 patients (mean age, 51 yrs ± 20 yrs; 215 women) met the inclusion criteria. 10.9% (40/366) of US studies had acute cholecystitis, 12.6% (46/366) had pathologically identified chronic cholecystitis without acute cholecystitis, and 76.5% (280/366) were negative acute cholecystitis. Algorithm compared to radiologist diagnostic performance was as follows: (1) sensitivity: 90.0% vs. 55.0%, p < 0.001; (2) augmented sensitivity (defined as when inconclusive categorization is considered consistent with acute cholecystitis): 100% vs. 85.0%, p < 0.001; (3) specificity: 93.6% vs. 94.8%, p = 0.50; (4) diagnostic rate (opposite of inconclusive rate): 96.4% vs. 93.2%, p = 0.04; (5) adverse outcome rate: 0.0% vs. 1.6%, p undefined.

Conclusion: For acute cholecystitis, an algorithm using non-binary ultrasound and clinical assessments had higher sensitivity, higher diagnostic rate, and fewer adverse outcomes, than subspecialty radiologist impressions.
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http://dx.doi.org/10.1007/s00261-021-03384-2DOI Listing
February 2022

The impact of blood pressure on the risk of major bleeding complication after renal transplant biopsy.

Abdom Radiol (NY) 2022 01 4;47(1):409-415. Epub 2021 Oct 4.

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

Purpose: To assess the impact of elevated blood pressure on the rate of major hemorrhagic complication after renal transplant biopsy.

Methods: Pre-procedural systolic (SBP), diastolic (SBP), and mean arterial (MAP) blood pressure for consecutive patients undergoing US-guided renal transplant biopsies from 08/01/2015 to 7/31/2017 were retrospectively recorded. Patients who had a major bleeding complication were identified. The risk of complication as a function of SBP, DBP, and MAP was statistically analyzed, with significance set at p < 0.05.

Results: Of 1689 biopsies, there were 10 bleeding complications (10/1689, 0.59%). There was no statistically significant difference between biopsies with complication compared to those without complication based on SBP (p = 0.351), DBP (p = 0.088), or MAP (p = 0.132). Using risk dichotomization criteria, the odds ratio for hemorrhagic complication when the patient had SBP ≥ 180 mmHg and DBP ≥ 95 mmHg was 75.63 (95% CI 6.87-516.8, p = 0.002).

Conclusion: The rate of hemorrhagic complication from renal transplant biopsy is low, and there is no statistically significant threshold for increased biopsy risk based on SBP, DBP, or MAP alone. The risk of complication was significantly higher only when both the SBP is ≥ 180 mmHg and DBP is ≥ 95 mmHg.
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http://dx.doi.org/10.1007/s00261-021-03282-7DOI Listing
January 2022

Response to "Reflection on the Evaluation of Radiologists' Performance during Off-Hours Shifts".

Radiology 2021 09 13;300(3):E350. Epub 2021 Jul 13.

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

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http://dx.doi.org/10.1148/radiol.2021210258DOI Listing
September 2021

Senior Authorship in Academic Radiology Journals: Roles, Responsibilities, and Rewards.

Acad Radiol 2022 Jun 13;29(6):914-918. Epub 2021 Mar 13.

Department of Radiology, University of North Carolina School of Medicine Chapel Hill, North Carolina.

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http://dx.doi.org/10.1016/j.acra.2021.03.002DOI Listing
June 2022

Detection of Bleeding Complications After Renal Transplant Biopsy.

AJR Am J Roentgenol 2021 02 16;216(2):428-435. Epub 2020 Dec 16.

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

The purpose of this study was to analyze the timing of major bleeding complications after renal transplant biopsy in the context of a standardized 1-hour postprocedure observation protocol. We retrospectively reviewed the electronic medical records for consecutive patients who underwent ultrasound-guided renal transplant biopsies between January 1, 2012, and December 31, 2017, and were observed according to a newly implemented 1-hour postprocedure observation protocol. The development of a major bleeding complication (Common Terminology Criteria for Adverse Events class 3 or higher) was recorded along with all available details regarding the time course of patient symptoms and presentation. Complications were grouped into one of four categories according to onset time after biopsy: 2 hours or less (timing category 1), more than 2 hours but 4 hours or less (timing category 2), more than 4 hours but 8 hours or less (timing category 3), and more than 8 hours (timing category 4). In 1824 patients (769 women, 1055 men) who underwent 4519 consecutive ultrasound-guided renal transplant biopsies during the study period, 11 class 3 complications were found (11/4519 [0.2%]). Four of the 11 patients (36.4%) had symptoms during the 1-hour observation period. Of these four patients, three (3/11 [27.3%]) had substantial symptoms related to major bleeding and were classified as timing category 1, and one (1/11 [9.1%]) had initially minor symptoms that increased in severity more than 2 hours but within 4 hours and was classified as timing category 2. Seven of the 11 patients (63.6%) did not have any symptoms at 1 hour of observation and were discharged; three (27.3%) were classified as timing category 3, and four (36.4%) were classified as category 4. Major bleeding complications following ultrasound-guided renal transplant biopsy are rare (0.2% of patients in this study). In our study, more than half were not clinically apparent within 4 hours of biopsy. A 1-hour postprocedure recovery period can be safely used after renal transplant biopsy.
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http://dx.doi.org/10.2214/AJR.20.22990DOI Listing
February 2021

Growth Rate of Ovarian Serous Cystadenomas and Cystadenofibromas.

J Ultrasound Med 2021 Oct 15;40(10):2123-2130. Epub 2020 Dec 15.

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

Objectives: We analyzed growth rates of benign ovarian serous cystadenomas and cystadenofibromas to understand what percentage would show a volume doubling time (DT) of less than 3 years, between 3 and 5 years, or greater than 5 years.

Methods: We retrospectively reviewed pathology records (January 1, 2014, to June 30, 2019) to find all surgically excised ovarian serous cystadenomas and cystadenofibromas. Imaging records were then reviewed to identify those that had been confidently identified with ultrasound imaging, magnetic resonance imaging, or computed tomography at least twice before surgical removal, with at least a 60-day interval between studies. Three orthogonal measurements were recorded on the first and last imaging studies on which the mass was detected, with volume calculations by the prolate formula (product of 3 measurements multiplied by 0.52). The volume DT was calculated and grouped into 1 of 5 categories: (1) DT of less than 1 year; (2) DT of 1 to 3 years; (3) DT of 3 to 5 years; (4) DT of 5 to 10 years; and (5) no growth (any mass with a DT >10 years or showing a decrease in volume).

Results: A total of 102 of 536 cystadenomas and 44 of 227 cystadenofibromas met inclusion criteria. Of the 146 tumors, 40 (27.4%) had a DT of less than 1 year; 38 (26.0%) had a DT of 1 to 3 years; 22 (15.1%) had a DT of 3 to 5 years; 10 (6.8%) had a DT of 5 to 10 years; and 36 (24.7%) showed no growth.

Conclusions: A total of 53.4% of ovarian serous cystadenomas/cystadenofibromas have a DT of less than 3 years; 15.1% have a DT between 3 and 5 years; and 31.5% have a DT of greater than 5 years or show no growth.
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http://dx.doi.org/10.1002/jum.15597DOI Listing
October 2021

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

J Am Coll Radiol 2021 01 18;18(1 Pt A):8-9. Epub 2020 Nov 18.

Education Director, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

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http://dx.doi.org/10.1016/j.jacr.2020.10.018DOI Listing
January 2021

Added Benefit and Risk of an Additional Biopsy or Targeting With Contrast-Enhanced Ultrasound for Patients With Renal Transplants.

J Ultrasound Med 2021 Aug 26;40(8):1603-1611. Epub 2020 Oct 26.

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

Objectives: To determine whether renal transplant diagnoses substantially change when 2 biopsy sites are chosen and whether contrast-enhanced ultrasound (CEUS) has value for targeting the second site.

Methods: We prospectively enrolled 40 patients undergoing ultrasound-guided renal transplant biopsy within 2 years of transplant: 20, surveillance; and 20, for cause. A CEUS examination was performed to identify cortical regions with subjectively altered flow. One biopsy was performed at the operator-preferred (primary) site regardless of CEUS findings. Another biopsy was done at a second location, either targeted to an area in which CEUS perfusion findings differed from the primary site (targeted) or at a random location (secondary) if no other area differed. Specimens were randomly labeled A or B; pathologists were blinded to the CEUS result and biopsy location. Location-specific CEUS assessments were recorded. Pathologic results were compared, including acute and chronic Banff scores and any new findings from the targeted or secondary biopsy.

Results: Forty patients were enrolled between January 2016 and December 2018. No location-specific pathologic differences correlated with differences in CEUS assessments. The second biopsy provided additional information that changed management in 4 of 40 patients (10.0% [95% confidence interval, 2.8%-23.7%]). Major bleeding complications occurred in 3 of 40 (7.5%) patients.

Conclusions: Contrast-enhanced ultrasound targeting was not useful. Major bleeding complications were higher than expected, possibly due to the additional biopsy away from the operator-preferred location. Obtaining a second renal transplant biopsy from a substantially different area than the initial operator-preferred location provided additional clinically useful information in 10% of patients.
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http://dx.doi.org/10.1002/jum.15544DOI Listing
August 2021

Neck Procedures: Thyroid and Parathyroid.

Radiol Clin North Am 2020 Nov 17;58(6):1085-1098. Epub 2020 Sep 17.

Department of Radiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.

Fine-needle aspiration (FNA) and core biopsy of masses in the neck predominantly include samples from thyroid nodules, parathyroids and lymph nodes. The diagnostic rate of a thyroid nodule FNA improves up to 6 passes and then does not significantly change. Thyroid FNA can be performed on patients who are anticoagulated. Appropriate transducer selection is essential for visualization of the needle. Lymph node biopsies can be additionally sampled for thyroglobulin assay to improve sensitivity for detection of recurrent carcinoma. Parathyroid FNA usually involves additional estimation of parathyroid hormone concentration in needle washouts. Biopsies of the neck are simple procedures with minimal complications.
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http://dx.doi.org/10.1016/j.rcl.2020.07.005DOI Listing
November 2020

Mapping the Ultrasound Landscape to Define Point-of-Care Ultrasound and Diagnostic Ultrasound: A Proposal From the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound.

J Am Coll Radiol 2021 Jan 30;18(1 Pt A):42-52. Epub 2020 Sep 30.

Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.

Current descriptions of ultrasound evaluations, including use of the term "point-of-care ultrasound" (POCUS), are imprecise because they are predicated on distinctions based on the device used to obtain images, the location where the images were obtained, the provider who obtained the images, or the focus of the examination. This is confusing because it does not account for more meaningful distinctions based on the setting, comprehensiveness, and completeness of the evaluation. In this article, the Society of Radiologists in Ultrasound and the members of the American College of Radiology Ultrasound Commission articulate a map of the ultrasound landscape that divides sonographic evaluations into four distinct categories on the basis of setting, comprehensiveness, and completeness. Details of this classification scheme are elaborated, including important clarifications regarding what ensures comprehensiveness and completeness. Practical implications of this framework for future research and reimbursement paradigms are highlighted.
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http://dx.doi.org/10.1016/j.jacr.2020.09.013DOI Listing
January 2021

Radiology residency program management post-pandemic-peak: looking down the curve and around the bend.

Clin Imaging 2021 Jan 19;69:243-245. Epub 2020 Sep 19.

Mayo Clinic, Department of Radiology, 5777 E. Mayo Blvd., Phoenix, AZ 85054, United States of America. Electronic address:

The three stage model set forth by the ACGME, which provides a framework for pandemic residency program management, is insufficient and could best be expanded to 5 stages to include post-pandemic-peak residency program management. Stage 4, "Increased non-COVID clinical demands," present the challenge of an increased clinical workload in the setting of social distancing while reengaging the educational mission of the residency program. In Stage 5, "Business as usual, redefined," the residency program must learn to adapt to new challenges including uncertainty surrounding the American Board of Radiology (ABR) Core examination, uncertainty in the job market, and potential diminished medical student interest in radiology. Despite these challenges, this post-pandemic environment offers tremendous opportunity to build on and enhance the residency program now and into the future.
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http://dx.doi.org/10.1016/j.clinimag.2020.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501832PMC
January 2021

Impact of Uterine Sliding Sign in Routine United States Ultrasound Practice.

J Ultrasound Med 2021 Jun 7;40(6):1091-1096. Epub 2020 Sep 7.

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

Objectives: The study aim was to evaluate the diagnostic performance of the uterine sliding sign in predicting deeply infiltrating endometriosis in the setting of non-physician sonographers performing but not interpreting the maneuver. The impact of uterine sliding sign has not been previously demonstrated in this practice setting.

Methods: Physicians' remote interpretations of transvaginal ultrasound examinations in 2016, before uterine sliding sign, were compared to examinations in 2019 after addition of uterine sliding sign to determine the diagnostic rates. Surgical and histopathological results were reviewed to determine sensitivity and specificity of the respective exam techniques.

Results: Two hundred eighty-five transvaginal ultrasounds were performed in 2016 and 390 sliding sign ultrasounds in 2019. The number of deeply infiltrating endometriosis cases identified increased significantly from 2% to 6% during the study period (chi-square, Fisher's exact test p = .012). The sensitivity and specificity of routine pelvic sonography for detecting deeply infiltrating endometriosis improved from 36%/94% to 68%/98%.

Conclusions: Uterine sliding sign videos should be included in the standard sonographic protocol for patients presenting with chronic pelvic pain, endometriosis history, or sonographic evidence of endometriosis in the setting of physicians interpreting sonographic images obtained by non-physicians.
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http://dx.doi.org/10.1002/jum.15484DOI Listing
June 2021

Authors' Reply Re: Reassessing US Medical Licensing Examination and ABR Core Examination Correlation.

J Am Coll Radiol 2021 01 3;18(1 Pt A):7-8. Epub 2020 Sep 3.

Education Director, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

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http://dx.doi.org/10.1016/j.jacr.2020.08.007DOI Listing
January 2021

The Flipped Ovary Sign in Ovarian Torsion.

J Ultrasound Med 2021 Apr 1;40(4):839-843. Epub 2020 Sep 1.

Department of Radiology, Division of Ultrasound, Mayo Clinic, Scottsdale, Arizona, USA.

The diagnosis of ovarian torsion is challenging and relies mostly on morphologic findings. Occasionally, women or children with acute pelvic pain who have undergone an initial ultrasound (US) evaluation with results interpreted as negative for ovarian torsion will return with recurrent or increasing pain, prompting an US reevaluation. The flipped ovary sign refers to a demonstrable change in the orientation of the ovary on follow-up US examinations, recognized by changing positions of ovarian landmarks established by follicles, cysts, or masses. This sign is valuable for identifying ovarian torsion in these patients, even in the absence of classic morphologic or Doppler features of ovarian torsion.
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http://dx.doi.org/10.1002/jum.15462DOI Listing
April 2021

Radiologists Make More Errors Interpreting Off-Hours Body CT Studies during Overnight Assignments as Compared with Daytime Assignments.

Radiology 2020 Nov 18;297(2):374-379. Epub 2020 Aug 18.

From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (A.G.P., V.J.P., C.D.J., M.D.P.); and Department of Health Science Research, Section of Biostatistics, Mayo Clinic Arizona, Scottsdale, Ariz (N.Z.).

Background There is increasing research attention on the impact of overnight work on radiologist performance. Prior studies on overnight imaging interpretive errors have focused on radiology residents, not on the relative performance of board-eligible or board-certified radiologists at night compared with during the day. Purpose To analyze the rate of clinically important interpretation errors on CT examinations of the abdomen, pelvis, or both ("body CT studies") committed by radiology fellows working off-hours based on day or night assignment. Materials and Methods Between July 2014 and June 2018, attending physicians at one tertiary care institution reviewed all body CT studies independently interpreted off-hours by radiologists in an academic fellowship within 10 hours of initial interpretation. Discrepancies affecting acute or follow-up clinical care were classified as errors. In this retrospective study, the error rate for studies interpreted during the day (between 7:00 am and 5:59 pm) was compared with that of studies interpreted at night (between 6:00 pm and 6:59 am). Error rate in the first half of day and night assignments was compared with error rate in the latter half. Statistical analyses used χ tests and general estimating equations; significance was defined as < .05. Results There were 10 090 body CT studies interpreted by 32 radiologists. Forty-four of 2195 daytime studies (2.0%) had errors compared with 240 of 7895 nighttime studies (3.0%; = .02). Twenty-two of 32 (69%) radiologists had higher error rates for night cases ( = .03). There were more errors in the last half of a night assignment (125 of 3358, 3.7%; = .002) compared with the first half (115 of 4537, 2.5%). Conclusion On the basis of a subspecialty review, clinically important off-hours body CT interpretation errors occurred more frequently overnight and more frequently in the latter half of assignments, with more radiologists having worse error rates at night compared with the day. © RSNA, 2020 See also the editorial by Bruno in this issue.
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http://dx.doi.org/10.1148/radiol.2020201558DOI Listing
November 2020

USMLE Step 3 Scores Have Value in Predicting ABR Core Examination Outcome and Performance: A Multi-institutional Study.

Acad Radiol 2021 05 7;28(5):726-732. Epub 2020 Aug 7.

Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

Rationale And Objectives: We analyzed multi-institutional data to determine if Step 3 performance tiers can identify radiology residents with increased risk of Core examination failure and submean performance.

Materials And Methods: We collected Step 3 scores (USMLE Step 3 or COMLEX Level 3) and American Board of Radiology (ABR) Core examination outcomes and scores for anonymized residents from 13 different Diagnostic Radiology residency programs taking the ABR Core examination between 2013 and 2019. Step 3 scores were converted to percentiles based on Z-score, with Core outcome and performance analyzed for Step 3 groups based on 50th percentile and based on quintiles. Core outcome was scored as fail when conditionally passed or failed. Core performance was measured by the percent of residents with scores below the mean. Differences between Step 3 groups for Core outcome and Core performance were statistically evaluated.

Results: Data were available for 342 residents. The Core examination failure rate for 121 residents with Step 3 scores <50th percentile was 19.8% (fail relative risk = 2.26), significantly higher than the 2.7% failure rate for the 221 other residents. Of 42 residents with Step 3 scores in the lowest quintile, the Core failure rate increased to 31.0% (fail relative risk = 3.52). Core performance improved with higher Step 3 quintiles.

Conclusion: Step 3 licensing scores have value in predicting radiology resident performance on the ABR Core examination, enabling residency programs to target higher risk residents for early assessment and intervention.
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http://dx.doi.org/10.1016/j.acra.2020.06.032DOI Listing
May 2021

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

Acad Radiol 2020 08 13;27(8):1162-1172. Epub 2020 Jun 13.

University of North Carolina School of Medicine, Chapel Hill, North Carolina.

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

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

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

Conclusion: The COVID-19 pandemic has markedly impacted the perceived well-being and educational missions of radiology residency programs across the United States.
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http://dx.doi.org/10.1016/j.acra.2020.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293482PMC
August 2020

The Relationship Between ACR Diagnostic Radiology In-Training Examination Scores and ABR Core Examination Outcome and Performance: A Multi-Institutional Study.

J Am Coll Radiol 2020 Dec 29;17(12):1663-1669. Epub 2020 May 29.

Education Director, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

Purpose: We analyzed multi-institutional data to understand the relationship of ACR Diagnostic Radiology In-Training Examination (DXIT) scores to ABR Core examination performance.

Methods: We collected DXIT rank scores and ABR Core examination outcomes and scores for anonymized residents from 12 different diagnostic radiology residency programs taking the ABR Core examination between 2013 and 2019. DXIT scores were grouped into quintiles based on rank score for residency year 1 (R1), residency year 2 (R2), and residency year 3 (R3) residents. Core outcome was scored as fail when conditionally passed or failed. Core performance was grouped using SD from the mean and measured by the percent of residents with scores below the mean. Differences between DXIT score quintiles for Core outcome and Core performance were statistically evaluated.

Results: DXIT and Core outcome data were available for 446 residents. The Core examination failure rate for the lowest quintile R1, R2, and R3 DXIT scores was 20.3%, 34.2%, and 38.0%, respectively. Core performance improved with higher R3 DXIT quintiles. Only 2 of 229 residents with R3 DXIT score ≥ 50th percentile failed the Core examination, with both failing residents having R2 DXIT scores in the lowest quintile.

Conclusions: DXIT scores are useful evaluation metrics to identify a subgroup of residents at significantly higher risk for Core examination failure and another subgroup of residents at significantly lower risk for Core examination failure, with increasing predictive power with advancing residency year. These scores enable identification of approximately one-half of R3 residents whose risk of Core examination failure is negligible.
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http://dx.doi.org/10.1016/j.jacr.2020.04.032DOI Listing
December 2020

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

J Am Coll Radiol 2020 Aug 24;17(8):1037-1045. Epub 2020 Mar 24.

Education Director Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

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

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

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

Conclusions: Tiered scoring of USMLE Step results has value in predicting radiology resident performance on the ABR Core examination; effective stratification of radiology resident applicants can be done without reporting numerical Step scores.
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http://dx.doi.org/10.1016/j.jacr.2020.02.017DOI Listing
August 2020

Sonographer-acquired ultrasound protocol for deep endometriosis.

Abdom Radiol (NY) 2020 06;45(6):1659-1669

Mayo Clinic, Phoenix, AZ, USA.

Endovaginal sonographic imaging has been shown to reliably identify pelvic endometriosis, but most United States imaging practices do not adequately assess locations and features of endometriosis beyond ovarian endometrioma. In this article, we propose a protocol for sonographer-acquired images and maneuvers to be interpreted subsequently by sonologists (radiologists or gynecologists). The purpose is to improve the sensitivity of endovaginal sonography for the detection of endometriosis in imaging practices that involve the non-physician sonographer as part of their workflow.
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http://dx.doi.org/10.1007/s00261-019-02341-4DOI Listing
June 2020

Management of Incidental Adnexal Findings on CT and MRI: A White Paper of the ACR Incidental Findings Committee.

J Am Coll Radiol 2020 Feb 30;17(2):248-254. Epub 2019 Nov 30.

Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.

The ACR Incidental Findings Committee (IFC) presents recommendations for managing adnexal masses incidentally detected on CT and MRI. These recommendations represent an update of those provided in our previous JACR 2013 white paper. The Adnexal Subcommittee, which included six radiologists with subspecialty expertise in abdominal imaging or ultrasound and one gynecologist, developed this algorithm. The recommendations draw from published evidence and expert opinion and were finalized by iterative consensus. Algorithm branches successively categorize adnexal masses based on patient characteristics (eg, pre- versus postmenopausal) and imaging features. They terminate with a management recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. Our goal is to improve quality of care by providing guidance on how to manage incidentally detected adnexal masses.
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http://dx.doi.org/10.1016/j.jacr.2019.10.008DOI Listing
February 2020

Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting.

Radiology 2019 11 24;293(2):359-371. Epub 2019 Sep 24.

From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, Mass GU, US02215 (D.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); 1425 S. Main St, Walnut Creek, Calif 94596 (E.J.S.B.); 2115 Sharondale Dr, Nashville, Tenn 37215 (R.F.A.); One Brookline Place, Brookline, Mass 02445 (B.R.B.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.B.B.); UNC Chapel Hill Medical Center, Chapel Hill, NC (W.B.); Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (P.M.D.); 530 First Avenue, Suite 10N, New York, NY 10016 (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Mass (J.L.H.); Einstein Medical Center, Philadelphia, Pa (M.M.H.); Columbia University Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, New York, NY (H.C.H.); 1848 Century Valley Road NE, Rochester, Minn 55906 (M.L.M.); OB/GYN UKMC, 800 Rose St, Lexington, Ky 40536 (E. Pavlik); 6310 San Vicente, Suite 520, Los Angeles, Calif 90048 (L.D.P.); Wayne State University, C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Detroit, Mich and InVia Fertility, Hoffman Estates, Ill (E. Puscheck); 350 Parnassus Ave, Suite 307C, San Francisco, Calif 94143 (R.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.).

This multidisciplinary consensus update aligns prior Society of Radiologists in Ultrasound (SRU) guidelines on simple adnexal cysts with recent large studies showing exceptionally low risk of cancer associated with simple adnexal cysts. Most small simple cysts do not require follow-up. For larger simple cysts or less well-characterized cysts, follow-up or second opinion US help to ensure that solid elements are not missed and are also useful for assessing growth of benign tumors. In postmenopausal women, reporting of simple cysts greater than 1 cm should be done to document their presence in the medical record, but such findings are common and follow-up is recommended only for simple cysts greater than 3-5 cm, with the higher 5-cm threshold reserved for simple cysts with excellent imaging characterization and documentation. For simple cysts in premenopausal women, these thresholds are 3 cm for reporting and greater than 5-7 cm for follow-up imaging. If a cyst is at least 10%-15% smaller at any time, then further follow-up is unnecessary. Stable simple cysts at initial follow-up may benefit from a follow-up at 2 years due to measurement variability that could mask growth. Simple cysts that grow are likely cystadenomas. If a previously suspected simple cyst demonstrates papillary projections or solid areas at follow-up, then the cyst should be described by using standardized terminology. These updated SRU consensus recommendations apply to asymptomatic patients and to those whose symptoms are not clearly attributable to the cyst. These recommendations can reassure physicians and patients regarding the benign nature of simple adnexal cysts after a diagnostic-quality US examination that allows for confident diagnosis of a simple cyst. Patients will benefit from less costly follow-up, less anxiety related to these simple cysts, and less surgery for benign lesions.
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http://dx.doi.org/10.1148/radiol.2019191354DOI Listing
November 2019

A Program Director's Guide to Cultivating Diversity and Inclusion in Radiology Residency Recruitment.

Acad Radiol 2020 06 28;27(6):864-867. Epub 2019 Aug 28.

Department of Radiology, Zucker School of Medicine at Hofstra Northwell, Staten Island University Hospital Northwell Health, Staten Island, New York.

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http://dx.doi.org/10.1016/j.acra.2019.07.027DOI Listing
June 2020

The Association of Program Directors in Radiology Well-Being 2019 Survey: Identifying Residency Gaps and Offering Solutions.

J Am Coll Radiol 2019 Dec 11;16(12):1702-1706. Epub 2019 Jul 11.

AdventHealth Imaging, Orlando, Florida.

Purpose: The Well-Being subcommittee of the Association of Program Directors in Radiology (APDR) Common Program Requirements (CPR) Ad Hoc Committee and the APDR Academic Output Task Force jointly conducted a study of APDR members' current level of understanding and implementation of the 2017 ACGME CPR regarding well-being.

Methods: A survey instrument consisting of 10 multiple-choice and open-ended questions was distributed to the 322 active members of the APDR. The survey focused on three main content areas: APDR member knowledge of the 2017 CPR, composition of department well-being curricula, and residency well-being innovations.

Results: In all, 121 members (37.6%) responded to the survey. Of those, 67% rated their knowledge of requirements as incomplete. Responses also indicated that 74% of departments have not implemented a comprehensive well-being curriculum; 53% of programs do not offer the mandated self-screening tool; 15% of respondents do not offer residents protected time for medical, mental health, and dental appointments; and 42% do not offer their trainees access to an institutional mental health clinic. Survey comments offer numerous individual well-being initiatives from across the membership.

Conclusions: The results of the APDR Well-Being Survey indicate that many programs have substantial work remaining to achieve ACGME compliance. Well-being innovations were included in an effort to share best practices.
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http://dx.doi.org/10.1016/j.jacr.2019.06.017DOI Listing
December 2019
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