Publications by authors named "Michael L Richardson"

106 Publications

Exophytic External Occipital Protuberance Prevalence Pre- and Post-iPhone Introduction: A Retrospective Cohort.

Yale J Biol Med 2021 Mar 31;94(1):65-71. Epub 2021 Mar 31.

Department of Radiology, University of Washington, Seattle, WA, USA.

: In controversial fashion, the presence of an enlarged external occipital protuberance has been recently linked to excessive use of handheld electronic devices. We sought to determine the prevalence of this protuberance in a diverse age group of adults from two separate time periods, before and approximately 10 years after the release of the iPhone, to further characterize this theory, as if indeed valid, such a relationship could direct preventative behavior. : Eighty-two cervical spine radiographs between March 7, 2007 through June 29, 2007 and 147 cervical spine radiographs between October 25, 2017 through January 1, 2018 were reviewed for the presence or absence of an exophytic external occipital protuberance. Influence of sex and age were also assessed. : There were 41/82 (50%) patients within the 2007 pre-iPhone group with an exophytic external occipital protuberance, ranging from 2.7-33.8 mm in length. Twenty-seven out of 82 (32.9%) had an external occipital protuberance at or above 10 mm. There were 49/147 (33.3%) patients within the 2017 post-iPhone group with an exophytic external occipital protuberance, ranging from 4.4-53.8 mm in length. Thirty-three out of 147 (22.4%) had an external occipital protuberance at or above 10 mm. When considering accessibility to the iPhone, sex, and age to the presence of an exophytic external occipital protuberance, only sex has a statistically significant association, p=0.000000033. : We found no significant association with iPhone accessibility and an exophytic external occipital protuberance. Due to inherent limitations in the retrospective nature of the study, future research is needed to better examine the association of handheld electronic devices with exophytic external occipital protuberances.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995952PMC
March 2021

Review of Artificial Intelligence Training Tools and Courses for Radiologists.

Acad Radiol 2021 09 11;28(9):1238-1252. Epub 2021 Mar 11.

Department of Radiology, Yale University, New Haven, Connecticut.

Artificial intelligence (AI) systems play an increasingly important role in all parts of the imaging chain, from image creation to image interpretation to report generation. In order to responsibly manage radiology AI systems and make informed purchase decisions about them, radiologists must understand the underlying principles of AI. Our task force was formed by the Radiology Research Alliance (RRA) of the Association of University Radiologists to identify and summarize a curated list of current educational materials available for radiologists.
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http://dx.doi.org/10.1016/j.acra.2020.12.026DOI Listing
September 2021

Confidence Can Be Measured and Calibrated.

J Grad Med Educ 2021 Feb 13;13(1):138. Epub 2021 Feb 13.

Professor of Radiology and Adjunct Professor of Orthopedic Surgery, University of Washington.

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http://dx.doi.org/10.4300/JGME-D-20-01358.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901637PMC
February 2021

Capsular thinning on magnetic resonance arthrography is associated with intra-operative hip joint laxity in women.

J Hip Preserv Surg 2020 Jul 10;7(2):298-304. Epub 2020 Aug 10.

Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.

Hip microinstability is a recognized cause of hip pain in young patients. Intra-operative evaluation is used to confirm the diagnosis, but limited data exist associating magnetic resonance arthrography (MRA) findings with hip microinstability. To determine if a difference exists in the thickness of the anterior joint capsule and/or the width of the anterior joint recess on MRA in hip arthroscopy patients with and without an intra-operative diagnosis of hip laxity. Sixty-two hip arthroscopy patients were included in the study. Two musculoskeletal radiologists blinded to surgical results reviewed the MRAs for two previously described findings: (i) anterior joint capsule thinning; (ii) widening of the anterior joint recess distal to the zona orbicularis. Operative reports were reviewed for the diagnosis of joint laxity. In all patients with and without intra-operative laxity, there were no significant differences with either MRA measurement. However, twenty-six of 27 patients with intra-operative laxity were women compared with 11 of 35 patients without laxity ( < 0.001). In subgroup analysis of women, the intra-operative laxity group had a higher rate of capsular thinning compared with the non-laxity group (85% versus 45%;  = 0.01). A 82% of women with capsular thinning also had intra-operative laxity, compared with 40% without capsular thinning ( = 0.01). There were no differences regarding the width of the anterior joint recess. In this study, there was an association between capsular thinning and intra-operative laxity in female patients. Measuring anterior capsule thickness on a pre-operative MRA may be useful for the diagnosis of hip microinstability.
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http://dx.doi.org/10.1093/jhps/hnaa018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605766PMC
July 2020

Measuring and Teaching Confidence Calibration Among Radiologists: A Multi-Institution Study.

J Am Coll Radiol 2020 Oct 30;17(10):1314-1321. Epub 2020 Jul 30.

Department of Radiology, University of Miami Health System, Miami, Florida.

Objective: Our purpose was to assess the calibration of resident, fellow, and attending radiologists on a simple image classification task (presence or absence of an anterior cruciate ligament [ACL] tear based on interpretation of sagittal proton density, fat-saturated MR images) and to assess whether teaching residents could improve their calibration.

Methods: We created a test containing 30 randomized, sagittal, proton density, fat-saturated MR images of the ACL (15 normal, 15 torn). This test was administered in person to 20 trainees and 3 attendings at one medical center in one state. An online version of the test was given to 23 trainees and 14 attendings from 11 other medical centers in nine other states. Subjects were asked to give their confidence level (0%-100%) that each ACL was torn.

Results: Cross-sectional data were collected from 60 radiologists (mean time after medical school = 9.3 years, minimum = 1 year, maximum = 36 years). This demonstrated a statistically significant improvement in calibration as a function of increasing experience (P = .020). Longitudinal data were collected from 12 trainees at the start and end of their musculoskeletal radiology rotation, with an intervening review of the primary and secondary signs of ACL tear on MR. A statistically significant improvement in calibration was noted during the rotation (P = .028).

Conclusions: Confidence calibration is a promising tool for quality improvement and radiologist self-assessment. Our study showed that calibration loss improves with experience in radiologists tested on a common and clinically important image classification task. We also demonstrated that calibration can be successfully taught to residents over a relatively short period (2-4 weeks).
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http://dx.doi.org/10.1016/j.jacr.2020.06.035DOI Listing
October 2020

Deep Learning Improves Predictions of the Need for Total Knee Replacement.

Radiology 2020 09 23;296(3):594-595. Epub 2020 Jun 23.

From the Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Seattle, WA 98105.

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http://dx.doi.org/10.1148/radiol.2020202332DOI Listing
September 2020

Noninterpretive Uses of Artificial Intelligence in Radiology.

Acad Radiol 2021 09 12;28(9):1225-1235. Epub 2020 Feb 12.

Department of Medicine, Santa Clara Valley Medical Center, Santa Clara, California.

We deem a computer to exhibit artificial intelligence (AI) when it performs a task that would normally require intelligent action by a human. Much of the recent excitement about AI in the medical literature has revolved around the ability of AI models to recognize anatomy and detect pathology on medical images, sometimes at the level of expert physicians. However, AI can also be used to solve a wide range of noninterpretive problems that are relevant to radiologists and their patients. This review summarizes some of the newer noninterpretive uses of AI in radiology.
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http://dx.doi.org/10.1016/j.acra.2020.01.012DOI Listing
September 2021

Confidence Calibration: An Introduction With Application to Quality Improvement.

J Am Coll Radiol 2020 May 10;17(5):620-628. Epub 2020 Jan 10.

Department of Radiology, University of Washington, Seattle, Washington.

A probabilistic forecast is one that assigns a probability (or likelihood) to the occurrence of an event. Radiologists commonly make probabilistic judgments in their reports, even if these predictions are not explicitly expressed as numbers. There are calls for radiologists to commit to their probabilistic predictions in a standardized fashion; however, without a mechanism for feedback, there is no opportunity for improvement. Analysis techniques familiar to radiologists (eg, calculation of sensitivity and specificity and construction of receiver operating characteristics curves) have a blind spot with regard to calibration of these probabilities to reality and are the main obstacle to improvement along this axis. We review statistical and graphical methods for calibration analysis in wider use outside the medical literature and present a framework for implementation of these techniques for quality improvement and radiologist self-assessment.
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http://dx.doi.org/10.1016/j.jacr.2019.12.009DOI Listing
May 2020

Peer Learning Through Multi-Institutional Web-based Case Conferences: Perceived Value (and Challenges) From Abdominal, Cardiothoracic, and Musculoskeletal Radiology Case Conference Participants.

Acad Radiol 2020 11 14;27(11):1641-1646. Epub 2019 Dec 14.

UCSF, San Francisco, California.

Rationale And Objectives: Peer learning is a case-based group-learning model intended to improve performance. In this descriptive paper, we describe multi-institutional, multi-subspecialty, web-based radiology case conferences and summarize the participants' experiences.

Materials And Methods: A semi-structured, 27-question survey was administered to radiologists participating in abdominal, cardiothoracic, and musculoskeletal case conferences. Survey questions included demographics, perceived educational value and challenges experienced. Survey question formats were continuous, binary, five-point Likert scale or text-based. The measures of central tendencies, proportions of responses and patterns were tabulated.

Results: From 57 responders, 12/57 (21.1%) were abdominal, 16/57 (28.1%) were cardiothoracic, and 29/57 (50.8%) were musculoskeletal conference participants; 50/56 (89.3%) represented academic practice. Median age was 45 years (range 35-74); 43/57 (75.4%) were male. Geographically, 16/52 (30.8%) of participants were from the East Coast, 16/52 (30.8%) Midwest, 18/52 (34.6%) West Coast, and 2/52 (3.8%) International. The median reported educational value was 5/5 (interquartile range 5-5). Benefits of the case conference included education (50/95, 52.6%) and networking (39/95, 41.1%). Participants reported presenting the following cases: "great call" 32/48 (66.7%), learning opportunity 32/48 (66.7%), new knowledge 41/49 (83.7%), "zebras" 46/49 (93.9%), and procedural-based 16/46 (34.8%). All 51/51 (100%) of responders reportedly gained new knowledge, 49/51 (96.1%) became more open to group discussion, 34/51 (66.7%) changed search patterns, and 50/51 (98%) would continue to participate. Reported challenges included time zone differences and support from departments for a protected time to participate.

Conclusion: Peer learning through multi-institutional case conferences provides educational and networking opportunities. Current challenges and desires include having department-supported protected time and ability to receive continuing medical education credit.
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http://dx.doi.org/10.1016/j.acra.2019.11.009DOI Listing
November 2020

MR Protocol Optimization With Deep Learning: A Proof of Concept.

Curr Probl Diagn Radiol 2021 Mar-Apr;50(2):168-174. Epub 2019 Oct 21.

Department of Radiology, University of Washington, Seattle, WA. Electronic address:

Purpose: This study was performed to demonstrate that a properly trained convolutional neural net (CNN) can provide an acceptable surrogate for human readers when performing a protocol optimization study. Tears of the anterior cruciate ligament (ACL) were used as a proof of concept for this study.

Methods: Following institutional review board approval, a curated set of 2007 paired knee MR images was extracted from the author's picture archival and communications system for 1523 normal knees and 484 knees with torn ACLs. A pair (1 fat-saturated (FS) and 1 non-fat-saturated (NFS)) of midline sagittal images was extracted from each knee. CNNs were trained for both the FS and NFS image sets and used to make predictions on a previously unseen test set of images.

Results: Receiver operating characteristic area under the curve for the NFS and FS CNNs were, respectively, 0.9983 and 0.9988. Specificity was identical (0.993) for both NFS and FS images. FS sensitivity (0.98) and NFS sensitivity (0.88) were statistically significantly different (P = 0.0253).

Conclusions: Both FS and NFS performed very well for the diagnosis of ACL tears, although FS sensitivity was superior to NFS sensitivity. The CNNs provided an acceptable surrogate for a human reader in this study. Pulse sequence optimization studies such as this can be opportunistically performed on image sets collected for many other machine learning purposes.
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http://dx.doi.org/10.1067/j.cpradiol.2019.10.004DOI Listing
October 2019

Immunogenicity of a rheumatoid arthritis protective sequence when acquired through microchimerism.

Proc Natl Acad Sci U S A 2019 09 9;116(39):19600-19608. Epub 2019 Sep 9.

Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109.

HLA class II genes provide the strongest genetic contribution to rheumatoid arthritis (RA). alleles encoding the sequence DERAA are RA-protective. Paradoxically, RA risk is increased in women with DERAA children born prior to onset. We developed a sensitive qPCR assay specific for DERAA, and found 53% of DERAA women with RA had microchimerism (Mc; pregnancy-derived allogeneic cells) carrying DERAA (DERAA-Mc) vs. 6% of healthy women. DERAA-Mc quantities correlated with an RA-risk genetic background including DERAA-binding alleles, early RA onset, and aspects of RA severity. CD4 T cells showed stronger response against DERAA vs. DERAA allogeneic cell lines in vitro, in line with an immunogenic role of allogeneic DERAA. Results indicate a model where DERAA-Mc activates DERAA-directed T cells that are naturally present in DERAA individuals and can have cross-reactivity against joint antigens. Moreover, we provide an explanation for the enigmatic observation that the same HLA sequence differentially affects RA risk through Mendelian inheritance vs. microchimeric cell acquisition.
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http://dx.doi.org/10.1073/pnas.1904779116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765309PMC
September 2019

Disease progression in relation to pre-onset parity among women with rheumatoid arthritis.

Semin Arthritis Rheum 2020 02 18;50(1):1-6. Epub 2019 Jun 18.

Division of Rheumatology, University of Washington, Box 356428, Seattle, WA 98195 USA; Division of Clinical Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., PO Box 19024, Seattle, WA 98109 USA.

Objective: Rheumatoid arthritis (RA) often ameliorates during pregnancy and flares postpartum, but the relationship of pregnancy and childbirth to RA prognosis is unclear. We examined RA severity for association with parity prior to RA onset and asked whether time from birth (latency) and/or the mother's HLA genotype influenced results.

Methods: A cohort study was conducted of 222 women previously identified in a prospective study of newly diagnosed RA, who returned for follow-up evaluation a median of 8 years later. Stratified analyses using Mantel-Haenszel methods were conducted to evaluate 5 RA severity measures based on hand and wrist radiographs, physical exams, and Health Assessment Questionnaires for association with parity.

Results: Overall, we observed little evidence of altered risk of progression to severe RA in relation to pre-onset parity, adjusting for RA onset age and time to follow-up. Stratifying parous women who had only live births by latency (<15 years/15+ years) showed no difference in risk of severe RA compared to nulligravid women. Live birth deliveries were significantly protective for women with 0 but not for those with 1 or 2 copies of the RA risk-associated HLA-DRB1 shared epitope sequence for erosion score (RR 0.26 95% CI 0.09-0.89) and joint count (RR 0.28 95% CI 0.09-0.87).

Conclusion: We observed little evidence of difference in severe RA by pre-onset parity overall. However, among women not predisposed to RA by possessing the risk-associated HLA genotype, parous women who had only live births had lower risk of progression to severe RA as measured by erosion score and joint count.
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http://dx.doi.org/10.1016/j.semarthrit.2019.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918003PMC
February 2020

Advanced, Interactive, Image-based Education: Technology and Pedagogy.

Curr Probl Diagn Radiol 2020 Mar - Apr;49(2):74-81. Epub 2019 Jun 13.

School of Medicine, Tufts University, Boston, MA. Electronic address:

An audience response system (ARS) is an excellent tool for improving interactive learning in radiology residents. Traditional ARSs have long allowed text-based interactions between teacher and students. However, little attention has been given to techniques which allow students in large groups to interact directly with an image. Fortunately, a growing number of ARSs are beginning to add this ability. However, it is not the technology but the pedagogy that matters the most. The purpose of this article is to review those ARSs, and to present an array of pedagogical techniques that can take advantage of this technology.
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http://dx.doi.org/10.1067/j.cpradiol.2019.06.003DOI Listing
November 2020

A Review of Innovative Teaching Methods.

Acad Radiol 2019 01 9;26(1):101-113. Epub 2018 May 9.

Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Seattle, WA 98105. Electronic address:

Teaching is one of the important roles of an academic radiologist. Therefore, it is important that radiologists are taught how to effectively educate and, in turn, to act as role models of these skills to trainees. This is reinforced by the Liaison Committee on Medical Education which has the requirement that all residents who interact with and teach medical students must undergo training in effective methods of teaching. Radiologists are likely familiar with the traditional didactic lecture-type teaching format. However, there are many newer innovative teaching methods that could be added to the radiologist's teaching repertoire, which could be used to enhance the traditional lecture format. The Association of University Radiologists Radiology Research Alliance Task Force on Noninterpretive Skills therefore presents a review of several innovative teaching methods, which include the use of audience response technology, long-distance teaching, the flipped classroom, and active learning.
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http://dx.doi.org/10.1016/j.acra.2018.03.025DOI Listing
January 2019

Practical Presentation Pearls: Evidence-based Recommendations From the Psychology and Physiology Literature.

Acad Radiol 2019 01 9;26(1):93-100. Epub 2018 Aug 9.

Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.

Oral presentations remain a common teaching method in academic radiology. The goal of these presentations is to transfer knowledge from the presenter's brain to brains in the audience in a way that sticks. A number of studies from the recent psychological and physiological literature offer some rather practical and evidence-based advice on ways to optimize our oral presentations. The purpose of this paper is to summarize this work, and to give examples of how it can be harnessed to increase the efficacy of radiology presentations, whether they are for resident education, a continuing medical education course, or for a scientific presentation at a national radiology meeting.
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http://dx.doi.org/10.1016/j.acra.2018.04.008DOI Listing
January 2019

The Relevance of Ulnar-Sided Contrast Extravasation During Radiocarpal Joint Wrist Arthrography.

AJR Am J Roentgenol 2019 03 15;212(3):614-619. Epub 2019 Jan 15.

2 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, PO Box 208042, New Haven, CT 06520-8042.

Objective: Contrast material often extends from the radiocarpal joint into the proximal soft tissues adjacent to the ulnar aspect of the ulnar styloid during single-compartment radiocarpal joint MR arthrography of the wrist. The hypothesis of this study was that this is a common finding unrelated to symptoms or examination technique.

Materials And Methods: Wrist MR arthrograms were retrospectively reviewed in consensus by two radiologists. The presence or absence of ulnar-sided contrast extravasation was documented, whether this extravasation appeared contained or dispersed, as was the overall degree of proximal extension of the extravasated contrast material. Patient age, sex, wrist sidedness, volume of contrast material administered, location of symptoms reported clinically, and aberrant contrast material also apparent within the midcarpal space or distal radioulnar joint on the MR images reviewed were documented to determine potential association with ulnar-sided contrast extravasation.

Results: Ninety-nine examinations met the inclusion criteria. Ulnar-sided contrast extravasation after single-compartment radiocarpal joint injection was present in 56 of the 99 wrists (57%). This finding was statistically more common in right versus left wrists. No other statistically significant associations were identified.

Conclusion: Contrast extravasation along the ulnar aspect of the distal ulna after single-compartment radiocarpal joint injection is common. In this study it had no statistically significant association with the location of a patient's wrist pain or abnormal findings evaluated at MR arthrography.
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http://dx.doi.org/10.2214/AJR.18.20304DOI Listing
March 2019

Gymnast's wrist in a 12-year-old female with MRI correlation.

Radiol Case Rep 2019 Mar 14;14(3):360-364. Epub 2018 Dec 14.

University of Washington, Department of Radiology, Musculoskeletal Radiology Division, UW Medical Center - Roosevelt, 4245 Roosevelt Way NE Box 354755, Seattle, WA 98109, USA.

We describe a case of chronic overuse injury of the distal radial physis (gymnast's wrist). While the radiographic appearance of this entity has been reported, there are limited studies highlighting the MR appearance of this entity. This lesion is being seen with increasing frequency in young, elite gymnasts. If this injury goes unrecognized, there is potential for abnormal osseous development, with premature physeal fusion, abnormal joint inclination and even Madelung deformity.
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http://dx.doi.org/10.1016/j.radcr.2018.09.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297268PMC
March 2019

Some new angles on the magic angle: what MSK radiologists know and don't know about this phenomenon.

Skeletal Radiol 2018 Dec 11;47(12):1673-1681. Epub 2018 Jul 11.

Department of Radiology, University of Washington, Seattle, WA, USA.

Purpose: Magic angle effects (MAE) are well-recognized in musculoskeletal (MSK) MRI. With short TE acquisitions, the signal intensity of tendons, ligaments, and menisci depend on their orientation relative to the main magnetic field (B). An interactive resident physics teaching module simulating MR imaging of a tendon forced us to identify and correct several misconceptions we had about MAE. We suspected these misconceptions were shared by other MSK radiologists.

Materials And Methods: We surveyed members of the Society of Academic Bone Radiologists (SABR) regarding which pulse sequences, acquisition parameters, tissues and angles relative to B were most likely to produce MAE.

Results: Survey respondents knew that MAE strongly depend on TE and commonly appear on T1W, FSE and PD sequences, but were less aware that MAE may also appear on T2W, STIR and DWI sequences. They knew of MAE effects in tendons, ligaments and cartilage, but were less aware of those in entheses, peripheral nerves and intervertebral discs. Respondents underestimated the wide angular range (full-width at half-maximum ≈ 40) over which significant MAE can be seen with short TE.

Conclusions: Collagen-containing tissues with parallel molecular alignment exhibit increased signal intensity when oriented at 55 relative to B. Experienced MSK radiologists were found to underestimate the combinations of image parameters, pulse sequences, tissues and collagen orientations in which significant MAE may be seen. Our survey results highlight the need for ongoing MR physics education for practicing radiologists.
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http://dx.doi.org/10.1007/s00256-018-3011-8DOI Listing
December 2018

Teaching Radiology Physics Interactively with Scientific Notebook Software.

Acad Radiol 2018 06;25(6):801-810

Department of Radiology, M. D. Anderson Cancer Center, Houston, Texas.

Rationale And Objectives: The goal of this study is to demonstrate how the teaching of radiology physics can be enhanced with the use of interactive scientific notebook software.

Methods: We used the scientific notebook software known as Project Jupyter, which is free, open-source, and available for the Macintosh, Windows, and Linux operating systems.

Results: We have created a scientific notebook that demonstrates multiple interactive teaching modules we have written for our residents using the Jupyter notebook system.

Conclusions: Scientific notebook software allows educators to create teaching modules in a form that combines text, graphics, images, data, interactive calculations, and image analysis within a single document. These notebooks can be used to build interactive teaching modules, which can help explain complex topics in imaging physics to residents.
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http://dx.doi.org/10.1016/j.acra.2017.11.024DOI Listing
June 2018

Progressive retraction of a fractured os peroneum suggesting repetitive injury to the peroneus longus tendon.

Radiol Case Rep 2018 Feb 9;13(1):216-219. Epub 2017 Dec 9.

Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA.

The os peroneum is an accessory ossicle within the peroneus longus tendon. Prior reports have discussed fracture of the os peroneum with associated tears of the peroneus longus tendon. When the ossicle fractures, there can be varying degrees of retraction of the tendon, which can be diagnosed by malposition of the ossicle or the ossicle fragments. We report a case of a man with recurrent eversion ankle injuries with progressive retraction of a fractured os peroneum, implying injuries to the superior and inferior peroneal retinacula and the peroneus longus tendon.
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http://dx.doi.org/10.1016/j.radcr.2017.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826682PMC
February 2018

Scientific Notebook Software: Applications for Academic Radiology.

Curr Probl Diagn Radiol 2018 Nov 18;47(6):368-377. Epub 2017 Sep 18.

Department of Radiology, M.D. Anderson Cancer Center, Houston, TX.

Objectives: The goal of this article is to introduce the concept of scientific notebook software, and to illustrate how it can be used to document a research project, to perform image analysis and to create interactive teaching tools.

Methods: We describe the installation of scientific notebook software known as Project Jupyter, which is free, open-source and available for the Macintosh, Windows and Linux operating systems.

Results: We have created 2 scientific notebooks that demonstrate applications germane to radiologists, particularly those in academic radiology. The first notebook provides a tutorial that summarizes basic features of the Project Jupyter notebook, and gives numerous examples of how the notebooks can display explicatory text, perform statistical computations, and display plots, interactive graphics, and audio files. The second notebook provides a toolbox for viewing and manipulating images in the Digital Imaging and Communications in Medicine format.

Conclusions: Scientific notebook software allows its users to document their work in a form that combines text, graphics, images, data, interactive calculations and image analysis within a single document. Scientific notebooks also provide interactive teaching tools, which are can help explain complex topics in imaging physics to residents.
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http://dx.doi.org/10.1067/j.cpradiol.2017.09.005DOI Listing
November 2018

Clinical Applications of 3D Printing: Primer for Radiologists.

Acad Radiol 2018 Jan 10;25(1):52-65. Epub 2017 Oct 10.

Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.

Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.
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http://dx.doi.org/10.1016/j.acra.2017.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404775PMC
January 2018

Logistics of Three-dimensional Printing: Primer for Radiologists.

Acad Radiol 2018 Jan 10;25(1):40-51. Epub 2017 Oct 10.

Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, Florida.

The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.
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http://dx.doi.org/10.1016/j.acra.2017.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467477PMC
January 2018

Association of Tibial Plateau Fracture Morphology With Ligament Disruption in the Context of Multiligament Knee Injury.

Curr Probl Diagn Radiol 2018 Nov 12;47(6):410-416. Epub 2017 Sep 12.

Department of Orthopaedics, University of Washington, Seattle, WA.

Background: We identified common morphologies of tibial plateau fractures that arise with multiligament knee injuries (MLKIs), and investigated the relationship of the fracture with ligament tears. We also evaluated the correlation of 3 tibial plateau fracture classification systems (Schatzker, AO, and Duparc).

Methods: Over a 2-year period, a single orthopaedic surgeon at our institution managed 90 MLKIs. Images of those knees with a tibial plateau fracture were retrospectively reviewed and classified per Schatzker, AO, and Duparc systems. Correlation among the 3 systems was evaluated using Spearman nonparametric correlation coefficient. Associations between fracture grading system and ligament tears were estimated using logistic regression. Associations between ligament tears and tibial plateau fracture location (medial vs lateral) were estimated using exact logistic regression.

Results: A total of 19 of 90 knees suffered tibial plateau fractures. There was reasonable correlation among the 3 tibial plateau classification systems. Increasing grade under the Schatzker system showed statistically significant associations with medial collateral ligament (MCL) (P = 0.056) and posterolateral corner (PLC) (P = 0.035) tears. Increasing grade under the Duparc system showed statistically significant associations with MCL (P = 0.032) and PLC (P = 0.058) tears. PLC tears had a statistically significant association with medial plateau fractures (P = 0.003); odds ratio of 121.1 (95% CI: 2.2-∞). MCL tears had a statistically significant association with lateral plateau fractures (P = 0.004); odds ratio of 18.4 (95% CI: 2.1-∞). Although not statistically significant, 8 out of 9 knees with a lateral plateau fracture demonstrated tear of the anterior cruciate ligament (ACL).

Conclusions: As the grade of designation increases within the Schatzker and Duparc tibial plateau fracture classifications, as does the likelihood of MCL and PLC tear. The majority of tibial plateau fractures that occur in the context of MLKI are either isolated to the medial or lateral tibial plateau. Medial tibial plateau fractures are associated with PLC tears. Lateral tibial plateau fractures are associated with MCL tears, and although not statistically significant in our small sample size, 8 out of 9 knees also demonstrated a tear of the ACL.
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http://dx.doi.org/10.1067/j.cpradiol.2017.09.001DOI Listing
November 2018

Predicting Adverse Neonatal Outcome Especially When Gestational Age Is Uncertain: Utility of Sonographic Measurement of Fetal Abdominal Wall Thickness.

Ultrasound Q 2017 Sep;33(3):208-212

Department of Radiology, University of Washington, Seattle, WA.

Early and accurate prenatal diagnosis of intrauterine growth restriction is important. Commonly used biometric parameters have limited specificity and require accurate dating. Fetal abdominal wall thickness (AWT) could be a useful supplemental parameter. We performed a retrospective study of 100 third trimester ultrasound exams and compared the sensitivity and specificity of AWT to those of weight percentile (WP) in predicting adverse perinatal outcome.There is a statistically significant difference between the AWT of patients with normal perinatal outcome and that of patients with adverse outcome (P < 0.01). When compared with WP across the entire range of the receiver operating characteristics curve, AWT [area under the curve (AUC), 0.76] has an efficacy similar to that of WP (AUC, 0.72; P = 0.30). However, AWT has superior performance over WP (AUC, 0.72 vs AUC, 0.61, respectively, P = 0.04) in the high specificity range (70%-100%) of the receiver operating characteristics curve, where the consequences of a false negative greatly outweigh those of a false positive. In our study population, with a cutoff value of 4 mm, AWT was a useful and more specific predictor of adverse perinatal outcome than WP. Abdominal wall thickness may be more useful in situations when dating is uncertain.
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http://dx.doi.org/10.1097/RUQ.0000000000000310DOI Listing
September 2017

Pathologies of the shoulder and elbow affecting the overhead throwing athlete.

Skeletal Radiol 2017 Jul 16;46(7):873-888. Epub 2017 Mar 16.

University of Washington Medical Center, 1959 N.E. Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA.

The overhead-throwing athlete is susceptible to a variety of predictable disease entities affecting the shoulder and elbow. While the pathophysiology and nomenclature of these diseases are ubiquitous throughout the clinical literature, this information is sparse within the radiology domain. We provide a comprehensive review of these unique injuries with accompanying imaging features in an effort to enhance the role of the radiologist during the management of the overhead thrower. When appropriately recognized and described, the imaging features aid in establishing a diagnosis and ultimately the implementation of appropriate clinical management.
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http://dx.doi.org/10.1007/s00256-017-2627-4DOI Listing
July 2017

"Tennis leg": gastrocnemius injury is a far more common cause than plantaris rupture.

Radiol Case Rep 2017 Mar 29;12(1):120-123. Epub 2016 Nov 29.

Department of Radiology, University of Washington, 4245 Roosevelt Way N.E., Seattle, WA 98105, USA.

We report a typical case of "tennis leg", in which the main finding was a fluid collection between the medial head of the gastrocnemius and soleus muscles. Since the first clinical description of this entity in 1883, the injury has been attributed to rupture of the plantaris tendon. However, recent studies of this condition with sonography and magnetic resonance imaging have shown that most of these cases are actually due to injury to the gastrocnemius and/or soleus muscles, and up to 10% are due to deep venous thrombosis masquerading as muscle injury. The plantaris muscle and tendon are only rarely involved in this injury.
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http://dx.doi.org/10.1016/j.radcr.2016.10.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310238PMC
March 2017

Characterization and Epidemiology of the Carpal Boss Utilizing Computed Tomography.

J Wrist Surg 2017 Feb 9;6(1):22-32. Epub 2016 May 9.

Department of Radiology, University of Washington, Seattle, Washington.

 The carpal boss is an osseous protuberance occurring variably along the dorsum of the second or third metacarpal base, lacking a standardized definition.  We sought to characterize the dorsal second and third carpometacarpal joints in the general population on computed tomography (CT) to better define this variant anatomy.  A total of 129 wrist CT studies were reviewed. Note was made of the dorsal second/third carpometacarpal osseous anatomy, the presence of regional bursitis or tenosynovitis, and relationship of the extensor carpi radialis brevis attachment to the base of the third metacarpal.  Out of the 129 wrists, 106 (82.2%) demonstrated a dorsal protuberance arising from the base of the third metacarpal, in isolation. Out of the 129 wrists, 14 (10.9%) lacked a dorsal protuberance or nonunited ossicle at the level of the second or third carpometacarpal joint. Out of the 129 wrists, 9 (7%) wrists demonstrated more complex anatomy-8 wrists (6.2%) with a dorsal protuberance at the base of the third metacarpal seen in combination with an adjacent nonunited ossicle and/or dorsal protuberance arising from the capitate, and 1 wrist (0.8%) with an isolated ossicle at the base of the third metacarpal. Of these nine wrists, eight (6.2%) demonstrated arthritis at the resultant pseudoarticulation(s).  The majority of wrists demonstrated an isolated protuberance arising from the dorsal base of the third metacarpal, with a small minority with a nonunited ossicle at this level and/or dorsal protuberance of the capitate. The presence of secondary arthritis (8 out of 129 wrists, 6.2%) may reflect a pain generator.  Cross-sectional study; level 2.
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http://dx.doi.org/10.1055/s-0036-1583941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5258131PMC
February 2017

Chinese Foot Binding: Radiographic Findings and Case Report.

Radiol Case Rep 2009 4;4(1):270. Epub 2016 Oct 4.

A 99-year-old Chinese woman presented to our emergency department after a fall. Due to lower extremity pain, radiographs of both feet were obtained. No fractures were noted, but these images did reveal prominent pes cavus deformities and foreshortening of the feet, consistent with foot binding as a child. The radiographic findings associated with foot binding are described and other associated health consequences are discussed.
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http://dx.doi.org/10.2484/rcr.v4i1.270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106533PMC
October 2016
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