The Challenge With Clinical Radiology Electives: Student and Faculty Perspectives Identify Areas for Improvement

PurposeTo determine medical students' and radiologists’ attitude toward radiology electives at a distributed medical school and identify specific areas for improvement.MethodsDuring a single academic year, both students and faculty preceptors were surveyed anonymously following a senior radiology elective. The survey was based on an established theoretical framework for studying the educational environment which takes into account domains: (1) goal orientation, (2) organization/regulation, and (3) relationships. Mann-Whitney tests were performed to determine if there was any difference between the overall satisfaction of students and preceptors, responses from the different elective sites and students’ ratings of the domains. Statistical significance was set at P < .05. Thematic analysis was performed on the narrative comments to identify specific challenges.ResultsThe response rate was 82.0% for students (95/116) and 19.5% (31/159) for radiologists. There was no difference in responses based on elective site. Overall, the elective was viewed positively by both groups however students rated their experience as significantly better than their preceptors (P = .0012). Students viewed the relationships domain more positively than both the other two (goal orientation, P = .0001; organization/regulation, P = .0038). Thematic analysis identified that the student challenges were lack of autonomy, structured teaching, and preceptor continuity and the preceptor challenges were ambiguous learning objectives/expectations and insufficient resources.ConclusionsThe radiology elective challenges identified in this study provide educators with specific areas to target when updating radiology electives. A better elective experience may improve students' radiology knowledge and attitude towards the specialty as well as radiologists’ interest in teaching.     

Developing the Evidence Base for M-Learning in Undergraduate Radiology Education: Identifying Learner Preferences for Mobile Apps

PurposeThere is a lack of evidence for developing radiology mobile apps for medical students. This study identifies the characteristics which students perceive as most valuable to teaching radiology with mobile apps (m-learning).MethodsAn online anonymous survey was administered to second- to fourth-year medical students at a single institution. The survey, which was based on established theoretical framework, collected students' preferred content organization, content presentation, and delivery strategies. The Copeland method was used to rank student preferences and a 2-tailed t test was used to determine if student responses were related to their clinical experience, with statistical significance at P < .05.ResultsThe response rate was 25.6% (163/635). For content organization, image interpretation (66.9%), imaging anatomy (61.3%), and common pathological conditions (50.3%) were selected as the most important. For content presentation, quizzes (49.1%) and case presentations (46.0%) were selected as the most useful. Students with clinical experience rated algorithms as more important (P < .01) and quizzes as less important (P = .03). For delivery strategies, ease of use (92.6%), navigation (90.8%), and gestural design (74.8%) were deemed the most applicable.ConclusionThis study documents medical students' preferences for m-learning in radiology. Although learner preferences are not the only feature to consider in the development of educational technology, these provide the initial framework for radiologists wishing to develop and incorporate mobile apps into their teaching.     

Imaging-Based 3-Dimensional Printing for Improved Maxillofacial Presurgical Planning: A Single Center Case Series

Purpose3-D printing is an increasingly widespread technology that allows physical models to be constructed based on cross-sectional medical imaging data. We sought to develop a pipeline for production of 3-dimensional (3-D) models for presurgical planning and assess the value of these models for surgeons and patients.MethodsIn this institutional review board–approved, single-center case series, participating surgeons identified cases for 3-D model printing, and after obtaining patient consent, a 3-D model was produced for each of the 7 participating patients based on preoperative cross-sectional imaging. Each model was given to the surgeon to use during the surgical consent discussion and preoperative planning. Patients and surgeons completed questionnaires evaluating the quality and usefulness of the models.ResultsThe 3-D models improved surgeon confidence in their operative approach, influencing the choice of operative approach in the majority of cases. Patients and surgeons reported that the model improved patient comprehension of the surgery during the consent discussion, including risks and benefits of the surgery. Model production time was as little as 4 days, and the average per-model cost was $350.Conclusions3-D printed models are useful presurgical tools from both surgeon and patient perspectives. Development of local hospital-based 3-D printing capabilities enables model production with rapid turnaround and modest cost, representing a value-added service for radiologists to offer their surgical colleagues.     

Role of Interface Sign and Diffusion-Weighted Magnetic Resonance Imaging in Differential Diagnosis of Exophytic Renal Masses

PurposeWe aimed to investigate the role of interfaces of exophytic solid and cystic renal masses on magnetic resonance imaging (MRI) and the added value of diffusion-weighted imaging in differentiating benign from malignant lesions.MethodsThe Institutional Review Board approved this retrospective study, and informed consent was waived. A total of 265 patients (109 [41%] women and 156 [59%] men) with a mean age of 57 ± 12 (standard deviation) years were enrolled in this study. Preoperative MRI (n = 238) examinations of patients with solid or cystic renal masses and MRI (n = 27) examinations of patients with Bosniak IIF cysts without progression were reviewed. Solid/cystic pattern, interface types and apparent diffusion coefficient (ADC) values were recorded by 2 radiologists. The diagnostic performance of combining normalized ADC values with interface sign were evaluated.ResultsAmong 265 renal lesions (109 cystic and 156 solid), all malignant lesions (n = 192) had a round interface. No malignant lesions showed an angular interface. For prediction of benignity in cystic lesions, sensitivity (82.86% vs 56.16%), negative predictive value (92.50% vs 85.71%), and accuracy (94.50% vs 87.92%) ratios of angular interface were higher compared to all (solid plus cystic) lesions. The best normalized ADC cutoff values for predicting malignancy in lesions with round interface were as follows: for all (solid plus cystic), ≤ 0.75 (AUROC = 0.804); solid, ≤ 0.6 (AUROC = 0.819); and cystic, ≤ 0.8 (AUROC = 0.936).ConclusionsAngular interface can be a predictor of benignity for especially cystic renal masses. The evaluation of interface type with normalized ADC value can be an important clue in differential diagnosis especially in patients avoiding contrast.     

Retrievable Inferior Vena Cava Filters: A Tertiary Centre Perspective and Quality Assurance Study

PurposeTo conduct a retrospective review and quality assurance study of inferior vena cava (IVC) filter retrieval over a two-year period at a tertiary care centre.MethodsPatients who underwent IVC filter placement or retrieval over a two-year period were identified. Medical records were reviewed for patient characteristics, filter indication, time to filter retrieval, and complications.ResultsIVC filters were placed in 229 patients between January 1, 2015 and December 31, 2016. 113 retrievals were attempted and 101 filters were successfully retrieved (89.4%). Median time to first retrieval attempt was 48 days (range of 5–728). Seventy-one patients died in the interval after filter insertion before a retrieval attempt at a median time of 27 days (range of 3–430). In 17 patients, retrieval was complicated by or delayed because of penetration of IVC wall (n = 6), large thrombus burden trapped by filter (n = 5), filter tilt or migration (n = 3), and unclear reasons (n = 3). Time-to-first unsuccessful retrieval attempt was 141 days (median). Of all filters placed, 55.9% were never retrieved. Excluding deceased patients with in-situ filters (n = 71) and unsuccessful retrievals left in-situ as permanent filters (n = 5), there remains 52 patients (33%), with a median filter in-situ time of 488 days.ConclusionOur study indicates that as many as 33% of patients may have been lost to follow-up of their in-situ IVC filter. Considering widespread reports of long-term complications and the recent safety alert issued by Health Canada, it is evident that a unified strategy is needed to track patients post filter insertion.     

Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging for Differentiation Between Parotid Neoplasms

PurposeThis study was designed to evaluate the role of multiparametric magnetic resonance imaging (MRI) for differentiation of parotid gland neoplasms.MethodsProspective study was conducted upon 52 consecutive patients (30 men, 22 women; aged 24–78 years; mean, 51 years) with parotid tumours that underwent multiparametric MRI using combined static MRI, dynamic contrast enhanced (DCE) MRI, and diffusion-weighted imaging (DWI). The static MRI parameter, time signal intensity curves (TIC) derived from DCE-MRI, and apparent diffusion coefficient (ADC) values of parotid tumours were correlated with histopathological findings.ResultsStatic MRI revealed a significant difference between both benign and malignant lesions in regards to margin definition (P < .001) and T2 hypointensity (P < .013), with a diagnostic accuracy 95% and 78.33% respectively. Study of the TIC type on DCE-MRI revealed statistically significant difference between benign and malignant lesions (P < .001) and diagnostic accuracy 96.55%. There was no statistically significant difference (P = .181) between the ADC values of benign and malignant lesions. ROC curve analysis revealed that by using ADC cut-off value of 1 × 10^?3 mm²/s had accuracy of 84.62% respectively for differentiating Warthin from malignant tumours that could be modified to higher value (94.28%) by excluding lymphoma from malignant lesions. By using cutoff value of 1.3 × 10^?3 mm²/s to differentiate pleomorphic adenoma from malignancy, ROC curve analysis had high accuracy of 97.06%.ConclusionMultiparametric MRI can be used for differentiation of malignant from benign parotid tumours and characterization of some benign parotid tumours.     

Sharing De-identified Medical Images Electronically for Research: A Survey of Patients' Opinion Regarding Data Management

PurposeSecondary usage of patient data has recently become of increasing interest for the development and application of computer analytic techniques. Strict oversight of these data is required and the individual patients themselves are integral to providing guidance. We sought to understand patients' attitudes to sharing their imaging data for research purposes. These images could provide a great wealth of information for researchers.MethodsPatients from the Greater Toronto Area attending Sunnybrook Health Sciences Centre for imaging (magnetic resonance imagining, computed tomography, or ultrasound) examination areas were invited to participate in an electronic survey.ResultsOf the 1083 patients who were approached (computed tomography 609, ultrasound 314, and magnetic resonance imaging 160), 798 (74%) agreed to take the survey. Overall median age was 60 (interquartile range = 18, Q1 = 52, Q3 = 70), 52% were women, 42% had a university degree, and 7% had no high school diploma. In terms of willingness to share de-identified medical images for research, 76% were willing (agreed and strongly agreed), while 7% refused. Most participants gave their family physicians (73%) and other physicians (57%) unconditional data access. Participants chose hospitals/research institutions to regulate electronic images databases (70%), 89% wanted safeguards against unauthorized access to their data, and over 70% wanted control over who will be permitted, for how long, and the ability to revoke that permission.ConclusionsOur study found that people are willing to share their clinically acquired de-identified medical images for research studies provided that they have control over permissions and duration of access.