Curricula for Teaching MRI Safety,and MRI and CT Contrast Safety to Residents: How Effective Are Live Lectures and Online Modules?

PurposeThe advent of the diagnostic radiology core examination and the new ACGME “milestone” evaluation system for radiology residents places new emphasis on topics in MRI and CT safety, and MRI and CT contrast agents. We evaluated whether either lecture-based teaching or online modules would improve baseline resident knowledge in these areas, and assessed which intervention was more effective.MethodsBefore didactic intervention, 2 cohorts were created from 57 radiology residents, with equal numbers and a matched level of training. The residents were tested on their baseline knowledge of MRI, MRI contrast safety, and CT contrast safety, using a multiple-choice examination. One group attended a live, 1-hour lecture on the preceding topics. The other engaged in 3 short online educational modules. After 6 weeks, the residents were again tested with the same questions to assess for improvement in their understanding.ResultsBoth the module and lecture cohorts demonstrated a statistically significant increase in questions answered correctly on CT contrast safety (13.1%, P < .001, and 19.1%, P < .001, respectively), and on MRI and MRI contrast safety (12.9%, P < .001, and 14.4%, P < .001). The preintervention and postintervention scores, and degree of improvement postintervention, were similar for the module versus lecture groups, without a statistically significant difference (P = .70). Resident confidence improved in both groups, for both modalities.ConclusionsFocused didactic intervention improves resident knowledge of MRI and CT safety, and MRI and CT contrast agents. Live lectures and online modules can be equally effective, allowing residency programs flexibility.     

The impact of COVID-19 quarantine efforts on emergency radiology and trauma cases

ObjectiveAmidst COVID-19 pandemic, many states have issued stay at home advisories and non-essential business closures to limit public exposure. During this “quarantine” period, it is important to understand the volume and types of emergency/trauma radiology cases to better prepare for the continuing and future pandemics. This study demonstrates new trends in pathologies and an overall increase in positive exams.MethodsA retrospective review of emergency department's imaging during the initial two weeks of this state's quarantine period, 3/23/2020–4/5/2020 was compared to similar dates of the previous year (“pre-quarantine” period), 3/25/2019–4/7/2019. One thousand emergency radiology and 991 trauma cases were evaluated. Of the emergency radiology cases 500 studies from each period were assessed, and from the trauma cases, 783 cases from pre-quarantine and 315 from the quarantine period were examined. Chi-square analysis was performed to assess for statistical significance.ResultsOverall there were 43.0% fewer emergency radiology studies performed during the quarantine period (n = 4530) compared to pre-quarantine period (n = 2585). Additionally, the number of positive cases was significantly higher (P = 0.0001) during the quarantine period (43.0%) compared to the pre-quarantine period (30.2%). Several trends in types of trauma were observed, including a significant increase in domestic violence during the quarantine period (P = 0.0081).DiscussionDifferent volumes and types of emergency/trauma imaging cases were observed during the recent quarantine period. Findings may assist emergency radiology departments to plan for future pandemics or COVID-19 resurgences by offering evidence of the types and volume of emergency radiology cases one might expect.     

Longitudinal Resilience and Burnout in Radiology Residents

PurposeThe aims of this study were to determine resilience levels of radiology residents at the start of radiology residency, investigate changes in resilience and burnout during residency, and assess the relationship between resilience and burnout among radiology residents.MethodsDiagnostic radiology residents were invited to participate in online surveys from 2016 to 2019. Resilience was assessed using the Connor–Davidson Resilience Scale. Burnout was assessed using the Maslach Burnout Inventory–Human Services Survey. For each data set, genders’ scores were compared using either analysis of variance or Kruskal–Wallis tests. Pearson correlation coefficients were calculated to explore the correlations between resilience and burnout.ResultsWomen and men had no statistically significant difference among baseline resilience scores (P = .78). However, there was a statistically significant overall decrease in resilience scores among women (P = .002). Baseline Maslach Burnout Inventory–Human Services Survey scores indicated that residents began residency without frequent symptoms of burnout. There was no statistically significant temporal change across subjects among burnout scores in any scale (P ≥ .09 for all) or between women and men (P ≥ .37 for all interactions). However, among women, there was a statistically significant difference in depersonalization scores during training (P = .009). Additionally, higher resilience scores were associated with a greater sense of personal achievement (r = .52) and less emotional exhaustion (r = −.56) and depersonalization (r = −.59).ConclusionsThe results of this study demonstrate that gender differences in resilience and burnout occur during radiology residency and that resilience has a protective effect against experiencing symptoms of burnout. Radiology residency programs should consider building longitudinal resilience for all trainees, especially women.     

Characterizing T2 iso- and hypo-intense renal masses on MRI: Can templated algorithms improve accuracy?

PurposeTo assess if a templated algorithm can improve the diagnostic performance of MRI for characterization of T2 isointense and hypointense renal masses.MethodsIn this retrospective study, 60 renal masses with histopathologic diagnoses that were also confirmed as T2 iso- or hypointense on MRI were identified (mean ± standard deviation, range: 3.9 ± 2.5, 1.0–13.7 cm). Two semi-quantitative diagnostic algorithms were created based on MRI features of renal masses reported in the literature. Three body-MRI trained radiologists provided clinical diagnoses based on their experience and separately provided semiquantitative data for each components of the two algorithms. The algorithms were applied separately by a radiology trainee without additional interpretive input. Logistic regression was used to compare the accuracy of the three methods in distinguishing malignant versus benign lesions and in diagnosing the exact histopathology. Inter-reader agreement for each method was calculated using Fleiss' kappa statistics.ResultsThe accuracy of the two algorithms and clinical experience were similar (70%, 69%, and 64%, respectively, p = 0.22–0.32), with fair to moderate inter-reader agreement (Fleiss's kappa: r = 0.375, r = 0.308, r = 0.375, respectively, all p < 0.0001). The accuracy of the two algorithms and clinical experience in diagnosing specific histopathology were also no different from each other (34%, 29%, and 32%, respectively, p = 0.49–0.74), with fair to moderate inter-reader agreement (Fleiss's kappa: r = 0.20, r = 0.28, r = 0.375, respectively, all p < 0.0001).ConclusionSemi-quantitative templated algorithms based on MRI features of renal masses did not improve the ability to diagnose T2 iso- and hypointense renal masses when compared to unassisted interpretation by body MR trained subspecialists.     

Medical student education in the time of COVID-19: A virtual solution to the introductory radiology elective

Rationale and objectivesDuring the COVID-19 pandemic, medical educators and students are facing unprecedented challenges while navigating the new virtual landscape that social-distancing policies mandate. In response to these challenges, a new virtual introduction to radiology elective was established with unique online resources and curriculum.Materials and methodsA previously in-person 2-week introductory radiology elective was converted into a completely virtual experience using an internally developed, open-source, peer-reviewed, web-based teaching modules combined with virtual lectures, interdisciplinary conferences, and readout sessions of de-identified cases loaded to a DICOM viewer. Students from the first four months of course enrollment completed a multiple choice pre- and post-course knowledge assessments and a 5-point Likert Scale survey as part of their educational experience.ResultsIn total, 26 4th-year medical students participated over 4 separate 2-week sessions from July to October of 2020. This included 12 students from the home intuition and 14 visiting students. On average, students scored 62.2% on the 55-question pre-test and 89.0% on the same test upon completion of the course, a statistically significant increase (p < 0.001). All 26 students felt engaged throughout the course. All 26 agreed (23 “strongly agreed”) that they were more comfortable looking at imaging studies following the course. All 26 also agreed (21 “strongly agreed”) that the course helped them prepare for their future clinical rotations and careers.ConclusionInitial pilot program using unique web-based resources and student encounters during a two-week virtual introductory radiology elective proved to be a positive educational experience for the first 26 students enrolled.     

Blind spots on CT imaging of the head: Insights from 5 years of report addenda at a single institution

BackgroundErrors of detection (“misses”) are the major source of error in radiology. There is sparse prior literature describing patterns of detection error on CT head imaging.PurposeThe objective of this study was to gain insight to areas on CT head imaging where radiologists are most likely to miss clinically relevant findings.MethodsWe performed a cross-sectional study of consecutive reports of CT imaging of the head at a single institution spanning 5/1/2013–5/1/2018 (5 years). Detection errors described in addenda were categorized according to anatomic location, type of pathology, and potential impact on management. Blind spots were defined by the most common sites of missed findings.ResultsA total of 165,943 reports for CT head imaging were obtained. Addenda were found in 1658 (~1%) of reports, of which 359 (21.7%) described errors of detection. Within the extracranial soft tissues (n = 73) the most common “misses” were at incidentally imaged parotid glands and the frontal scalp. Within osseous structures (n = 149), blind spots included the nasal and occipital bones. Vascular lesions (n = 47) which passed detection were most common at the distal MCA, carotid terminus and sigmoid sinus/jugular bulb. No predisposition was seen for anatomic subsites within the CSF space (n = 60) and brain parenchyma (n = 65).ConclusionsConsistent patterns of blind spots are revealed. Radiologic teaching and search patterns to account for these sites of error may accelerate trainee competence and improve accuracy in the practice of radiology.     

Lack of Timely Follow-Up of Abnormal Imaging Results and Radiologists’ Recommendations

PurposeAbnormal imaging results may not always lead to timely follow-up. We tested whether certain aspects of communication in radiology reports influence the response of the referring providers, and hence follow-up on abnormal findings.MethodsWe focused on 2 communication-related items that we hypothesized could affect follow-up: expressions of doubt in the radiology report, and recommendations for further imaging. After institutional review board approval, we conducted a retrospective review of 250 outpatient radiology reports from a multispecialty ambulatory clinic of a tertiary-care Veterans Affairs facility. The selected studies included 92 cases confirmed to lack timely follow-up (ie, further tests or consultations, treatment, and/or communication to the patient within 4 weeks), as determined in a previous study. An additional 158 cases with documented timely follow-up served as controls. Doubt in the narrative was measured by the presence of key phrases (eg, “unable to exclude,” “cannot exclude,” “cannot rule out,” “possibly,” and “unlikely”), in the absence of which we used reviewer interpretation. A physician blinded to follow-up outcomes collected the data.ResultsPatients whose reports contained recommendations for further imaging were more likely to have been lost to follow-up at 4 weeks compared with patients without such recommendations (P = .01). Language in the report suggestive of doubt did not affect the timeliness of follow-up (P = .59).ConclusionsAbnormal imaging results with recommendations for additional imaging may be more vulnerable to lack of timely follow-up. Additional safeguards, such as tracking systems, should be developed to prevent failure to follow up on such results.     

Clinical assessment of oral malodor using autofluorescence of tongue coating

ObjectivesThe aim of this study was to evaluate whether a new method using quantitative light-induced fluorescence-digital (QLF-D) was appropriate for the diagnosis of oral malodor by quantifying the fluorescence of tongue coating.MethodsThis study examined 103 healthy subjects who have an oral malodor as a main complaint. The levels of oral malodor were measured by organoleptic scores (OLS) and volatile sulfur compound (VSC) levels. The fluorescent tongue coating images captured by QLF-D were quantified as the integrated fluorescence score (IF score) by multiplying the intensity and area of fluorescence. The correlations between the fluorescence parameters and OLS as well as VSC levels and the diagnostic accuracy of the IF score were evaluated.ResultsThe IF score of tongue coating showed a significant positive correlation with the OLS (r = 0.54, p < 0.01) and the VSC levels (r = 0.49, p < 0.01). This score was significantly differed with the level of oral malodor (p < 0.001), and its AUC was 0.72 in identifying the patient with definite oral malodor (≥OLS 2).ConclusionsA new method quantifying tongue coating fluorescence detected by QLF-D can be used to diagnose oral malodor and assess its severity in the clinical practice.     

Enhanced gait variability index and cognitive performance in Asian adults: Results from the Yishun Study

BackgroundAlthough gait variability has been linked to cognitive decline among older adults, the lack of a comprehensive composite gait variability score has dampened the application of gait variability.Research questionDoes the enhanced gait variability index (EGVI) - a composite score gait variability index - provide differential and useful information on cognitive decline in community-dwelling adults from that using gait speed?MethodsHealthy community-dwelling adults (n = 311) aged 21–90 were individually administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Habitual gait speed and spatiotemporal parameters were measured using a 6 m instrumented walkway system. The EGVI for each participant was calculated from five spatiotemporal parameters - step length(cm), step time(s), stance time(s), single support time(s) and stride velocity(cm/s). Linear regression models, controlling for age, gender, and education, were built to examine the independent effects of EGVI or gait speed on global cognition and individual domains.ResultsMultiple regression revealed that gait speed contributed significantly to the performance of the domain “Attention” (p = 0.04) whereas EGVI contributed significantly for the performance of the domain “Visuospatial” (p = 0.04) and “Delayed Memory” (p = 0.02).SignificanceEGVI provides differential and useful information from using gait speed alone. The EGVI may offer a solution to measure or track GV changes in relation to cognitive changes.     

Cross-cultural adaptation and measurement properties of the VISA-A questionnaire for Chinese patients with Achilles Tendinopathy

ObjectiveTo culturally adapt the VISA-A into a simplified Chinese version (VISA-A-CHN) and test its measurement properties.DesignMethodological study;SettingHospital and university laboratory.Participants240 subjects were divided into the healthy (n = 80), at-risk (n = 80), and tendinopathy groups (n = 80).Main outcomes measuresThe internal consistency, test-retest reliability, construct validity, and the floor and ceiling effect of the VISA-A-CHN.ResultsThe VISA-A-CHN showed adequate internal consistency (Cronbach's α = 0.73, 95% CI 0.63 to 0.81), excellent test-retest reliability (ICC_3A,1 = 0.97, 95%CI = 0.95 to 0.98), standard error of measurement of 2.2 points, minimum detectable change of 6.0 points, with no floor and ceiling effects. Two factors (pain/symptoms and physical function/activity) were extracted in exploratory factor analysis. There were moderate associations of VISA-A-CHN score with scores of Lower Extremity Functional Scale and SF-36 physical components (r_s = 0.53–0.74, P < 0.01) but low associations with SF-36 mental components (r_s = 0.12–0.22, P > 0.05). VISA-A-CHN mean score of Achilles tendinopathy group was significantly lower than those of healthy and at-risk groups (P < 0.01).ConclusionsThe VISA-A-CHN is equivalent to the original version in terms of language and measurement properties. It can be used as the outcome measure for Chinese patients with Achilles tendinopathy.     

Interventional Radiology Education for Improving Primary Care Provider Awareness

To evaluate the effectiveness of a lecture series in increasing awareness and knowledge about common interventional radiology (IR) procedures amongst emergency medicine and internal medicine residents at a tertiary care academic medical center.A series of two 60-minute lectures was presented at both the Emergency and Internal Medicine weekly didactic conferences for the respective residency programs. The lectures covered the indications, contraindications, imaging, pre-procedure preparation, complications, and follow-up of common IR procedures, including both didactics as well as interactive question and answer segments. The first lecture included central venous access, IVC filters, and image-guided biopsies, and the second lecture covered biliary interventions, genitourinary interventions, and vascular embolization. Pre/post lecture assessments were given evaluating participant knowledge, and paired one-tailed t-tests were elucidated for evaluating differences in the mean scores.A total of 77 emergency and internal medicine resident physicians participated in assessments of the lecture series. There were significantly increased scores (P<0.001) after both of the lectures (36% to 82% on the first lecture and 44% to 65% on the second lecture), suggesting increased knowledge of the common IR procedures discussed in the lecture.This work demonstrated that educational initiatives such as lecture series implementation are effective methods to increase knowledge of common IR procedures and raise awareness of the specialty among referring providers.     

Understanding Why Patients No-Show: Observations of 2.9 Million Outpatient Imaging Visits Over 16 Years

PurposeTo understand why patients “no-show” for imaging appointments, and to provide new insights for improving resource utilization.Materials and MethodsWe conducted a retrospective analysis of nearly 2.9 million outpatient examinations in our radiology information system from 2000 to 2015 at our multihospital academic institution. No-show visits were identified by the “reason code” entry “NOSHOW” in our radiology information system. We restricted data to radiography, CT, mammography, MRI, ultrasound, and nuclear medicine examinations that included all studied variables. These variables included modality, patient age, appointment time, day of week, and scheduling lead time. Multivariate logistic regression was used to identify factors associated with no-show visits.ResultsOut of 2,893,626 patient visits that met our inclusion criteria, there were 94,096 no-shows during the 16-year period. Rates of no-show visits varied from 3.36% in 2000 to 2.26% in 2015. The effect size for no-shows was strongest for modality and scheduling lead time. Mammography had the highest modality no-show visit rate of 6.99% (odds ratio [OR] 5.38, P < .001) compared with the lowest modality rate of 1.25% in radiography. Scheduling lead time greater than 6 months was associated with more no-show visits than scheduling within 1 week (OR 3.18, P < .001). Patients 60 years and older were less likely to miss imaging appointments than patients under 40 (OR 0.70, P < .001). Mondays and Saturdays had significantly higher rates of no-show than Sundays (OR 1.52 and 1.51, P < .001).ConclusionModality type and scheduling lead time were the most predictive factors of no-show. This may be used to guide new interventions such as targeted reminders and flexible scheduling.     

Radiology Imaging Volume Changes During Discrete COVID-19 Pandemic Waves: Implications for the Delta Variant of Coronavirus and Future Pandemics

PurposeThe aim of this study was to evaluate radiology imaging volumes at distinct time periods throughout the coronavirus disease 2019 (COVID-19) pandemic as a function of regional COVID-19 hospitalizations.MethodsRadiology imaging volumes and statewide COVID-19 hospitalizations were collected, and four 28-day time periods throughout the COVID-19 pandemic of 2020 were analyzed: pre–COVID-19 in January, the “first wave” of COVID-19 hospitalizations in April, the “recovery” time period in the summer of 2020 with a relative nadir of COVID-19 hospitalizations, and the “third wave” of COVID-19 hospitalizations in November. Imaging studies were categorized as inpatient, outpatient, or emergency department on the basis of patient location at the time of acquisition. A Mann-Whitney U test was performed to compare daily imaging volumes during each discrete 28-day time period.ResultsImaging volumes overall during the first wave of COVID-19 infections were 55% (11,098/20,011; P < .001) of pre–COVID-19 imaging volumes. Overall imaging volumes returned during the recovery time period to 99% (19,915/20,011; P = .725), and third-wave imaging volumes compared with the pre–COVID-19 period were significantly lower in the emergency department at 88.8% (7,951/8,955; P < .001), significantly higher for outpatients at 115.7% (8,818/7,621; P = .008), not significantly different for inpatients at 106% (3,650/3,435; P = .053), and overall unchanged when aggregated together at 102% (20,419/20,011; P = .629).ConclusionsMedical imaging rebounded after the first wave of COVID-19 hospitalizations, with relative stability of utilization over the ensuing phases of the pandemic. As widespread COVID-19 vaccination continues to occur, future surges in COVID-19 hospitalizations will likely have a negligible impact on imaging utilization.     

What the Patient Wants: An Analysis of Radiology-Related Inquiries From a Web-Based Patient Portal

PurposeWith the development of patient portals, the opportunity exists to identify gaps in practice by analyzing priorities patients place on the receipt and comprehension of radiology reports. Our purpose was to describe the nature of radiology-specific patient information requests by analysis of patient-initiated messages submitted through a web-based electronic patient portal.MethodsInstitutional review board approval was obtained and informed consent waived for this HIPAA-compliant retrospective cross-sectional study. All patient-initiated messages submitted to the web-based patient portal at a large academic medical center between October 1, 2014 and December 11, 2014 were analyzed. Messages containing radiology-specific key terms including “x-ray,” “xray,” “xr,” “ct,” “cat,” “mri,” “scan,” “ultrasound,” “image,” and “radiology” were identified and messages categorized by content. The demographics of message writers were also analyzed. Diagnostic imaging studies performed during this period were tabulated by modality. Proportions were compared with χ² tests.ResultsDuring the time period studied, there were 1,597 messages from 1,489 patients inquiring about 1,609 examinations. Messages containing ≥1 radiology-specific keyword were significantly more likely to originate from women than from men (64% [946/1,489] versus 36% [543/1,489], P < .0001), with 53% of studies (52,322/98,897) performed on female patients and 47% (46,575/98,897) on male patients. The relative percentages of modality-specific patient inquiries were significantly discrepant (P < .001) from actual scan volume for some modalities (MRI: 38% [607/1,609] versus 11% [11,152/98,897], CT: 25% [400/1,609] versus 19% [19,032/98,897], plain radiography: 23% [368/1,609] versus 55% [54,497/98,897]). The most common inquiry was for imaging results (33% [521/1,597], P < .001); these were submitted a median of 5 days (range: 0-368 days) after imaging. The radiology turnaround time (between exam completion in the Radiology Information System and signoff on report) was 5 hours, versus 70 hours for referring provider review. Inquiries about radiation dose or radiation risk represented 0.1% (2/1,597) of all inquiries.ConclusionPatients submitting radiology-specific messages through an electronic patient portal are most concerned about imaging results, particularly those pertaining to advanced (CT and MRI) imaging studies.     

Relation entre la puissance maximale anaérobie mesurée lors de l'épreuve charge–vitesse,la détente verticale et le 5-jump test chez le garçon entraîné

Purpose. – The aim of this study was to investigate the relationship between maximal anaerobic power measured by force-velocity test and performances in vertical jump and in 5-jump test in young boys.Methods. – 18 trained boys participated in this study (mean age 12 ± 0.4 years). They performed three anaerobic tests: force-velocity test, vertical jump test and 5-jump test. Anthropometric measurements were made to estimate the muscle volume of the lower limbs. Peak anaerobic power (Watts, Watts/kg and Watts/l of muscle) was measured during a force-velocity test on a Monark ergocycle. Performances were measured during vertical jump test with a force platform and during the 5-jump test.Results. – We found a significant correlation between the peak anaerobic power measured during force-velocity test (W) and body mass (r = 0,80; P < 0,001). The peak power (W, W/kg) was also correlated to muscle volume (r = 0.89; P < 0.001; r = 0.63; P < 0.01 respectively). Furthermore, peak anaerobic power (W/kg) was significantly correlated with performance in vertical jump (r = 0.64; P < 0.01) and with the 5-jump test (r = 0.74; P < 0.001). Vertical jump was also correlated to the 5-jump test (r = 0.63; P < 0.01).Conclusion. – This study shows significant correlations between peak anaerobic power, body mass and muscle volume in trained young boys. Furthermore, correlations observed between the Force-velocity test and performances in both vertical jump and the 5-jump test suggest that the 5-jump test is a good tool to estimate muscular anaerobic power of legs and a very practical means of selection and/or orientation of young people to explosive sports.     

Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: Feasibility,image quality,radiation dose,and effect of iterative reconstruction

BackgroundLow tube voltage reduces radiation exposure in coronary CT angiography (CTA). Using 70 kVp tube potential has so far not been possible because CT systems were unable to provide sufficiently high tube current with low voltage.ObjectiveWe evaluated feasibility, image quality (IQ), and radiation dose of coronary CTA using a third-generation dual-source CT system capable of producing 450 mAs tube current at 70 kVp tube voltage.MethodsCoronary CTA was performed in 26 consecutive patients with suspected coronary artery disease, selected for body weight <100 kg and heart rate <60 beats/min. High-pitch spiral acquisition was used. Filtered back projection (FBP) and iterative reconstruction (IR) algorithms were applied. IQ was assessed using a 4-point rating scale (1 = excellent, 4 = nondiagnostic) and objective parameters.ResultsMean age was 62 ± 9 years (46% males; mean body mass index, 27.7 ± 3.8 kg/m²; mean heart rate, 54 ± 5 beats/min). Mean dose-length product was 20.6 ± 1.9 mGy × cm; mean estimated effective radiation dose was 0.3 ± 0.03 mSv. Diagnostic IQ was found in 365 of 367 (FBP) and 366 of 367 (IR) segments (P nonsignificant). IQ was rated “excellent” in 53% (FBP) and 86% (IR) segments (P = .001) and “nondiagnostic” in 2 (FBP) and 1 segment (IR) (P nonsignificant). Mean IQ score was lesser in FBP vs IR (1.5 ± 0.4 vs 1.1 ± 0.2; P < .001). Image noise was lower in IR vs FBP (60 ± 10 HU vs 74 ± 8 HU; P < .001).ConclusionIn patients <100 kg and with a regular heart rate <60 beats/min, third-generation dual-source CT using high-pitch spiral acquisition and 70 kVp tube voltage is feasible and provides both robust IQ and very low radiation exposure.     

Women in Radiology: Exploring the Gender Disparity

PurposeIn 2015, only 1.5% of female Canadian medical students pursued radiology as a specialty, versus 5.6% of men. The aim of this study was to determine what factors attract and deter Canadian medical students from pursuing a career in radiology, and why fewer women than men pursue radiology as a specialty.MethodsAn anonymous online survey was e-mailed to English-speaking Canadian medical schools, and 12 of 14 schools participated. Subgroup analyses for gender and radiology interest were performed using the Fisher exact test (P < .05).ResultsIn total, 917 students (514 women; 403 men) responded. Direct patient contact was valued by significantly more women who were not considering specialization in radiology (87%), compared with women who were (70%; P < .0001). Physics deterred more women (47%) than it did men (21%), despite similar educational backgrounds for the two gender groups in physical sciences (P < .0001). More women who were considering radiology as a specialty rated intellectual stimulation as being important to their career choice (93%), compared with women who were not (80%; P = .002). Fewer women who were not interested in radiology had done preclinical observerships in radiology (20%), compared with men who were not interested in radiology (28%; P = .04).ConclusionsA perceived lack of direct patient contact dissuades medical students from pursuing radiology as a career. Women have less preclinical radiology exposure than do men. Programs that increase preclinical exposure to radiology subspecialties that have greater patient contact should be initiated, and an effort to actively recruit women to such programs should be made.     

Analyse et interprétation du questionnaire de la Société française de médecine du sport pour la détection de signes précoces de surentraînement : étude multicentrique

Objective. – The group of consensus of the French Society of Sport Medicine prepared a questionnaire in order to detect early stage of overtraining. This questionnaire includes 54 items which the subjects have to answer by “yes” or by “not”. A score is then established by summing the “yes”. Taking into account the formulation of the questions, this score will increase with the training load. The aim of our study is to propose a score of overtraining, and also to highlight the importance of some items or groups of items.Methods. – Our population consisted of French sportsmen of both sexes, from different geographical origins, age, sporting practice and level. A multicentric analysis was carried out on the basis of 1984 collected questionnaires. We analysed the evolution of the percentage of subjects, the weight of various parameters (age, overtraining) and the evolution of the frequency of each item as a function of the score.Results. – A score of 20 was proposed as an overtraining state threshold, which has to be confirmed on the basis of correlations with biological indices, in particular with a state of clinically established overtraining. Sixteen items present a linear evolution traducing an increase of tiredness according to the overload. Six items have a logarithmic increase, traducing a kind of “background noise”. The others items (N = 32) presenting a non-linear increase are sign of a decompensation phenomenon.Conclusion. – This analysis by item make possible an improve of the questionnaire, by selecting items groups which may give an orientation on the type of tiredness. It also confirms the usefulness of this questionnaire as a tool for the follow-up of the training state of sportsmen, a score equal to or higher than 20 constituting the overtraining threshold.