Analysis of radiology education in undergraduate medical doctors training in Europe

Objectives

The purpose of the present study is to describe how undergraduate radiology teaching is organized in Europe and to identify important characteristics of undergraduate radiology curriculum.

Methods

An electronic survey on undergraduate teaching was distributed by the European Society of Radiology (ESR) to 38 national delegates of the ESR Education Committee.

Results

The “classic type” of radiology teaching method is more frequent than the “modular type”. In 38% of medical training centres the first experience with radiology is in pre-clinical years. The students enrolled in the fourth medical year experience the largest involvement in radiology education. The total number of teaching hours (mean 89 h, median 76 h) varies across the countries and differs depending on the radiological topic (mean across all topics 14.8 h, median 13). Written tests and oral exams were the most frequently used examination modes. Clerkships are reported as a key part of training.

Conclusion

This first international comparative study of undergraduate radiological curriculum in Europe identifies a large number of differences in curriculum content and teaching methods throughout Europe. More research is needed to establish the radiological educational competences resulting from these differing curricula's to improve and to standardize the teaching according to (inter)national and institutional needs.     

Integration of interactive three-dimensional image post-processing software into undergraduate radiology education effectively improves diagnostic skills and visual-spatial ability

Purpose

Integrating interactive three-dimensional post-processing software into undergraduate radiology teaching might be a promising approach to synergistically improve both visual-spatial ability and radiological skills, thereby reducing students’ deficiencies in image interpretation. The purpose of this study was to test our hypothesis that a hands-on radiology course for medical students using interactive three-dimensional image post-processing software improves radiological knowledge, diagnostic skills and visual-spatial ability.

Materials and methods

A hands-on radiology course was developed using interactive three-dimensional image post-processing software. The course consisted of seven seminars held on a weekly basis. The 25 participating fourth- and fifth-year medical students learnt to systematically analyse cross-sectional imaging data and correlated the two-dimensional images with three-dimensional reconstructions. They were instructed by experienced radiologists and collegiate tutors. The improvement in radiological knowledge, diagnostic skills and visual-spatial ability was assessed immediately before and after the course by multiple-choice tests comprising 64 questions each. Wilcoxon signed rank test for paired samples was applied.

Results

The total number of correctly answered questions improved from 36.9 ± 4.8 to 49.5 ± 5.4 (p < 0.001) which corresponded to a mean improvement of 12.6 (95% confidence interval 9.9–15.3) or 19.8%. Radiological knowledge improved by 36.0% (p < 0.001), diagnostic skills for cross-sectional imaging by 38.7% (p < 0.001), diagnostic skills for other imaging modalities – which were not included in the course – by 14.0% (p = 0.001), and visual-spatial ability by 11.3% (p < 0.001).

Conclusion

The integration of interactive three-dimensional image post-processing software into undergraduate radiology education effectively improves radiological reasoning, diagnostic skills and visual-spatial ability, and thereby even diagnostic skills for imaging modalities not included in the course.     

The Perceived long-term impact of the radiological curriculum innovation in the medical doctors training at Ghent University

Objectives

How do students experience and perceive the innovative undergraduate radiology curriculum at Ghent University, and what explains differences in student perception?

Methods

A survey was presented to the 2008 cohort of students enrolled in the undergraduate medical curriculum at Ghent University. The survey focused on their experiences and perceptions in relation to the innovative undergraduate radiology teaching.

Results and conclusion

The present research results point at a favorable perception of the innovative radiology curriculum components. The study points - both during pre-clinical and clinical years - at the appreciation for curriculum components that combine traditional curriculum components (ex-cathedra lessons with syllabus) with distance learning components such as E-learning and E-testing. In clinical years - as expected - students switch to the application of knowledge and skills and therefore heavily appreciate practice linked curriculum components.     

National Survey to Identify Subspecialties at Risk for Physician Shortages in Canadian Academic Radiology Departments

Purpose

To identify subspecialty fields in Canadian academic radiology departments that are at risk for future manpower shortages. To determine reasons for the potential shortages and suggest potential solutions.

Methods

An anonymous online survey was sent by e-mail to radiology residents and academic radiology department heads in Canada. The survey was open from April 1 to August 1, 2006. Statistical analysis by using the SAS Frequency Procedure was performed on the results.

Results

Interventional radiology, neuroradiology, mammography, cardiac imaging, and pediatric radiology were identified as areas in which there will be increasing workforce demands. Mammography, pediatric radiology, and cardiac imaging were identified as areas in which there will be a potential decrease in supply. Of the residents, 65.83% intended on pursuing subspecialty training. Priorities were interesting work, job availability, and work schedule. Nuclear medicine, mammography, pediatric radiology, and interventional radiology were identified as the top 4 areas in which residents specifically did not want to pursue further subspecialty training. Only 15% of resident respondents received career counseling during residency, and only 50% of those residents thought it was adequate.

Conclusions

Our survey results indicate that mammography, cardiac imaging, and pediatric radiology are at risk for manpower shortages, and interventional radiology may be at risk. Increased efforts to recruit trainees may be necessary to ensure that these subspecialties maintain their presence in the future. Only 15% of the surveyed residents received career counseling during residency. This is a relatively untapped forum that academic staff could use to help recruit new trainees into these underserved subspecialties.     

Development and Evaluation of a Competency-Based Anatomy Rotation for Diagnostic Radiology Residents During Internship Year: A Canadian Experience

Rationale and Aim

As medical schools reduce the hours of anatomy teaching, residents in anatomy-intensive residency programs like radiology must independently acquire the anatomy knowledge needed to achieve competency. The purpose of this study was to develop and evaluate a 4-week competency-based self-directed anatomy rotation for junior residents.

Diagnostic imaging in undergraduate medical education: an expanding role

Radiologists have been involved in anatomy instruction for medical students for decades. However, recent technical advances in radiology, such as multiplanar imaging, "virtual endoscopy", functional and molecular imaging, and spectroscopy, offer new ways in which to use imaging for teaching basic sciences to medical students. The broad dissemination of picture archiving and communications systems is making such images readily available to medical schools, providing new opportunities for the incorporation of diagnostic imaging into the undergraduate medical curriculum. Current reforms in the medical curriculum and the establishment of new medical schools in the UK further underline the prospects for an expanding role for imaging in medical education. This article reviews the methods by which diagnostic imaging can be used to support the learning of anatomy and other basic sciences.     

Blending online techniques with traditional face to face teaching methods to deliver final year undergraduate radiology learning content

Aim

To review the initial experience of blending a variety of online educational techniques with traditional face to face or contact-based teaching methods to deliver final year undergraduate radiology content at a UK Medical School.

Materials and methods

The Brighton and Sussex Medical School opened in 2003 and offers a 5-year undergraduate programme, with the final 5 spent in several regional centres. Year 5 involves several core clinical specialities with onsite radiology teaching provided at regional centres in the form of small-group tutorials, imaging seminars and also a one-day course. An online educational module was introduced in 2007 to facilitate equitable delivery of the year 5 curriculum between the regional centres and to support students on placement. This module had a strong radiological emphasis, with a combination of imaging integrated into clinical cases to reflect everyday practice and also dedicated radiology cases. For the second cohort of year 5 students in 2008 two additional online media-rich initiatives were introduced, to complement the online module, comprising imaging tutorials and an online case discussion room.

Results

In the first year for the 2007/2008 cohort, 490 cases were written, edited and delivered via the Medical School managed learning environment as part of the online module. 253 cases contained a form of image media, of which 195 cases had a radiological component with a total of 325 radiology images. Important aspects of radiology practice (e.g. consent, patient safety, contrast toxicity, ionising radiation) were also covered. There were 274,000 student hits on cases the first year, with students completing a mean of 169 cases each. High levels of student satisfaction were recorded in relation to the online module and also additional online radiology teaching initiatives.

Conclusion

Online educational techniques can be effectively blended with other forms of teaching to allow successful undergraduate delivery of radiology. Efficient IT links and good image quality are essential ingredients for successful student/clinician engagement.     

Perception of Radiation Exposure and Risk Among Patients,Medical Students,and Referring Physicians at a Tertiary Care Community Hospital

Background

It is important for physicians to be aware of the radiation doses as well as the risks associated with diagnostic imaging procedures that they are ordering.

Methods

A survey was administered to patients, medical students, and referring physicians from a number of specialties to determine background knowledge regarding radiation exposure and risk associated with commonly ordered medical imaging tests.

Results

A total of 127 patients, 32 referring physicians, and 30 medical students completed the survey. The majority of patients (92%) were not informed of the radiation risks associated with tests that they were scheduled to receive and had false perceptions about the use of radiation and its associated risks. Physicians and medical students had misconceptions about the use of ionizing radiation in a number of radiologic examinations; for example, 25% and 43% of physicians and medical students, respectively, were unaware that interventional procedures used ionizing radiation, and 28% of physicians were unaware that mammography used ionizing radiation. Computed tomographies and barium studies were thought to be associated with the least ionizing radiation among physicians.

Conclusion

There is a need for educating the public, medical students, and referring physicians about radiation exposure and associated risk so that (1) patients receiving multiple medical imaging tests are aware of the radiation that they are receiving and (2) physicians and future physicians will make informed decisions when ordering such tests to limit the amount of radiation that patients receive and to promote informed consent among patients.     

Contrast-enhanced cadaver-specific computed tomography in gross anatomy teaching

Objectives

To establish contrast-enhanced (CE) cadaver-specific post-mortem computed tomography (PMCT) in first-year gross anatomy teaching and quantitatively evaluate its learning benefit.

Methods

132 first-year medical students were included in this IRB-approved study and randomly assigned to an intervention group (n=59) provided with continuous access to CE and non-enhanced (NE) cadaver-specific PMCT-scans during the first-semester gross anatomy course, and a control group (n=73) that had only NE cadaver-specific PMCT data available. Four multiple-choice tests were carried out (15 questions each) subsequent to completion of the corresponding anatomy module: Head and neck anatomy, extremities, thorax, and abdomen. Median test results were compared in each module between the groups using the Wilcoxon rank-sum test. Additionally, participants of the intervention group answered a 15-item feedback-questionnaire.

Results

The intervention group achieved significantly higher test scores in head and neck anatomy (median=12.0, IQR=10.0–13.0) versus the control group (median=10.5, IQR=9.0–12.0) (p<0.01). There were no significant differences in the comparison of other modules. CEPMCT was highly appreciated by undergraduate medical students.

Conclusions

The incorporation of contrast-enhanced cadaver-specific PMCT-scans in gross anatomy teaching was proven to be feasible in the framework of the medical curriculum and significantly improved the students’ learning performance in head and neck anatomy.

Key Points

? Cadaver-specific contrast-enhanced post-mortem CT (CEPMCT) is feasible in the medical curriculum. ? CEPMCT yields significantly improved learning performance in head and neck anatomy (p<0.01). ? CEPMCT is highly appreciated by medical students and used in tutor- or self-guided modes.

     

Specialising in radiology in Switzerland: Still attractive for medical school graduates?

Purpose

To gain insight into the professional characteristics of radiologists in Switzerland and to determine how to enhance the attractiveness of radiology to medical graduates as a specialty.

Materials and methods

Data from 262 members of the Swiss Society of Radiology (m:f = 76:24%) obtained in a questionnaire survey were analysed regarding socio-demographic variables, working status, specialty, main fields of interest, career success, mentoring and reasons for the shortage of radiologists.

Results

35 (56.4%) female and 85 (45.5%) male radiologists were aged ≤45 years. 228 (87%) were board-certified; 44 (17.9%) had completed a sub-specialisation. Men worked part-time mostly just before retirement, while women worked part-time at a younger age. As reasons for specialty choice, the wide range of clinical work and the combination of technology and medicine were ranked highest. Women reported significantly less career success and support. To improve the attractiveness of radiology to graduates, radiology should be visible on medical school curricula.

Conclusion

In Switzerland, more female radiologists work part-time than male ones, and there is less career success and support for women. In order to make radiology more attractive to medical graduates as a specialty, structured residency programmes and reliable gender-respecting career support are needed.     

Los elementos decorativos ambientales en el Área de Imagen Médica mejoran la percepción de agradabilidad del paciente

Objectives

To evaluate the sensation of pleasantness perceived by patients attended in the radiology department in response to decorative elements hung on the walls in the waiting rooms and in the hallways of the imaging area.

Material and methods

The material resources comprised works of art in the form of “magic windows” representing scenes from nature installed on the ceilings and walls of the waiting area and hallways of the imaging area. Patients were given a brief questionnaire with general data and questions (sadness-cheerfulness, coldness-warmth, darkness-light, and pessimism-optimism) about their perception of the decorative elements.

Results

Of the 150 questionnaires collected, 142 were filled out correctly. The overall health of these patients was good in 84 (56%), not bad in 58 (39%), and poor in 8 (5%). The idea seemed very good to 70 patients (47%), good to 58 (39%), not bad to 8 (5%), indifferent to 11 (7%), bad to 1 (1%), and very bad to 2 (1%). As far a patients’ mobility, 119 patients (79%) walked into the department, 18 (12%) were wheeled in on beds, and 13 (9%) needed wheelchairs.

Conclusions

We found a high level of satisfaction with the decorative elements.     

The Usefulness of Gadolinium-Enhanced Images on a Follow-up Magnetic Resonance Image in Suspected Multiple Sclerosis

Purpose

Multiple sclerosis diagnostic criteria include the presence of gadolinium-enhancing lesions when determining dissemination in space and time. Gadolinium is expensive, increases scan time and patient discomfort, and can, rarely, cause serious adverse effects. Our objective was to determine the usefulness of including gadolinium-enhanced images as part of a follow-up brain magnetic resonance imaging (MRI) in patients with a clinically isolated syndrome.

Methods

Consecutive patients seen between 2008 and 2010 with a clinically isolated syndrome suggestive of multiple sclerosis were prospectively enrolled, had a non–gadolinium-enhanced brain MRI, and consented to a follow-up gadolinium-enhanced brain MRI. The primary outcome was a comparison of the number of patients diagnosed with multiple sclerosis compared with the number who would have been diagnosed without the gadolinium-enhanced images.

Results

Twenty-one patients enrolled, and 2 withdrew. Follow-up MRIs were performed a median of 241 days after the initial MRI. Eleven patients met the primary outcome and were diagnosed with multiple sclerosis: 6 as a result of a second clinical attack and 5 by using imaging criteria for dissemination in space and time. If the gadolinium-enhanced images had not been obtained, then there would have been no change in the primary outcome.

Conclusions

In Canadian centers with similar MRI waiting times to those in our study, the routine use of gadolinium as part of a follow-up MRI in patients with suspected multiple sclerosis may not be clinically useful. Gadolinium-enhanced images could still be obtained on an as-needed basis for specific clinical indications.     

Magnetic Resonance Imaging of the Temporal Lobe: Normal Anatomy and Diseases

Objective

This pictorial essay will review the magnetic resonance imaging anatomy of the temporal lobes and describe the major pathologic processes of this complex area.

Conclusions

Magnetic resonance imaging is an essential tool in the investigation of a patient with suspected temporal lobe pathology. Various conditions may affect this anatomic region, and, therefore, classification of imaging findings into specific groups may help provide a more focused differential diagnosis.     

The quality and impact of computer supported collaborative learning (CSCL) in radiology case-based learning

Objective

The aim of this research was to explore (1) clinical years students’ perceptions about radiology case-based learning within a computer supported collaborative learning (CSCL) setting, (2) an analysis of the collaborative learning process, and (3) the learning impact of collaborative work on the radiology cases.

Methods

The first part of this study focuses on a more detailed analysis of a survey study about CSCL based case-based learning, set up in the context of a broader radiology curriculum innovation. The second part centers on a qualitative and quantitative analysis of 52 online collaborative learning discussions from 5th year and nearly graduating medical students. The collaborative work was based on 26 radiology cases regarding musculoskeletal radiology.

Results

The analysis of perceptions about collaborative learning on radiology cases reflects a rather neutral attitude that also does not differ significantly in students of different grade levels. Less advanced students are more positive about CSCL as compared to last year students. Outcome evaluation shows a significantly higher level of accuracy in identification of radiology key structures and in radiology diagnosis as well as in linking the radiological signs with available clinical information in nearly graduated students. No significant differences between different grade levels were found in accuracy of using medical terminology.

Conclusion

Students appreciate computer supported collaborative learning settings when tackling radiology case-based learning. Scripted computer supported collaborative learning groups proved to be useful for both 5th and 7th year students in view of developing components of their radiology diagnostic approaches.     

Avoidable surgical consultations in women with a positive screening mammogram: Experience from a southern region of the Dutch breast screening programme

Introduction

According to current Dutch guidelines, all women with a positive screening mammogram are referred for a full hospital assessment, which includes surgical consultation and radiological assessment. Surgical consultation may be unnecessary for many patients. Our objective was to determine how often surgical consultations can be avoided by radiological pre-assessment.

Materials and methods

All women with a positive screening mammogram, referred to our radiology department between 2002 and 2007, were included (n = 1014). Percentage of women that was downstaged to BI-RADS category 1 or 2 by radiological pre-assessment was calculated. Negative predictive value (NPV) for malignancy was estimated from the in-hospital follow-up, which was available up to September 2012.

Results

423 of 1014 women (42%) were downstaged to BI-RADS category 1 or 2 by radiological pre-assessment. During follow-up, 8 of these 423 women (2%) developed a malignancy in the same breast. At least 6 of these malignancies were located at a different location as the original screening findings which led to the initial referral. The estimated NPV for malignancy was 99.5% (95%CI, 98.3–99.9).

Conclusion

By referring women with a positive screening mammogram to the radiology department for pre-assessment, a surgical consultation was avoided in 42%, with an estimated NPV of 99.5% for malignancy.     

An analysis of radiological research publications in high impact general medical journals between 1996 and 2010

Objective

To evaluate scientific papers published by radiologists in high impact general medical journals between 1996 and 2010.

Methods

A MEDLINE search was performed in five high impact general medical journals (AIM, BMJ, JAMA, Lancet, and NEJM) for all articles of which a radiologist was the first author between 1996 and 2010. The following information was abstracted from the original articles: radiological subspecialty, imaging technique used, type of research, sample size, study design, statistical analysis, study outcome, declared funding, number of authors, collaboration, and country of the first author.

Results

Of 216 (0.19%) articles were published by radiologists in five general medical journals between 1996 and 2010, 83 were original articles. Fifteen (18.1%) original articles were concerned with the field of vascular/interventional radiology, 24 (28.9%) used combined imaging techniques, 76 (91.6%) were clinical research, 63 (75.9%) had a sample size of >50, 65 (78.3%) were prospective, 78 (94.0%) performed statistical analysis, 83 (100%) showed positive study outcomes, 57 (68.7%) were funded, 49 (59.0%) had from four to seven authors, and 79 (95.2%) were collaborative studies.

Conclusions

A very small number (0.19%) in five high impact general medical journals was published by radiologists between 1996 and 2010.     

Does PACS improve diagnostic accuracy in chest radiograph interpretations in clinical practice?

Objectives

To assess the impact of a Picture Archiving and Communication System (PACS) on the diagnostic accuracy of the interpretation of chest radiology examinations in a “real life” radiology setting.

Materials and methods

During a period before PACS was introduced to radiologists, when images were still interpreted on film and reported on paper, images and reports were also digitally stored in an image database. The same database was used after the PACS introduction. This provided a unique opportunity to conduct a blinded retrospective study, comparing sensitivity (the main outcome parameter) in the pre and post-PACS periods.We selected 56 digitally stored chest radiograph examinations that were originally read and reported on film, and 66 examinations that were read and reported on screen 2 years after the PACS introduction. Each examination was assigned a random number, and both reports and images were scored independently for pathological findings. The blinded retrospective score for the original reports were then compared with the score for the images (the gold standard).

Results

Sensitivity was improved after the PACS introduction. When both certain and uncertain findings were included, this improvement was statistically significant. There were no other statistically significant changes.

Conclusion

The result is consistent with prospective studies concluding that diagnostic accuracy is at least not reduced after PACS introduction. The sensitivity may even be improved.     

The role of advanced MRI techniques in differentiating typical,from atypical and malignant meningiomas

Background

Meningiomas are the commonest primary, non-glial intracranial tumors. The diagnosis is often correctly predicted from characteristic imaging appearances. Some meningiomas have atypical imaging appearance that may cause diagnostic confusion.

Aim

Is to evaluate the role of advanced MR imaging techniques in differentiating typical from atypical and malignant meningiomas before surgery.

Patient

Thirty patients were retrospectively included in this study. They were referred from Neurosurgery Department and all of them suspected to have intracranial meningioma according to the contrast enhanced CT.

Methods

All patients were subjected to conventional magnetic resonance imaging followed by advanced magnetic resonance imaging in the form of diffusion weighted imaging, perfusion weighted imaging and MR spectroscopy by single-voxel techniques.

Results

The overall results based on differentiation of typical from atypical and malignant meningiomas by advanced MRI techniques. Twenty four patients had typical meningioma and 6 patients had atypical and malignant Meningiomas by advanced MRI techniques.

Conclusion

Appearance of meningiomas on DWIs and the calculation of ADC values could be correlated with their histopathological grading. On MRS, alanine was not found to be increased in all meningiomas, so MRS cannot reliably differentiate typical intracranial meningomas from atypical meningiomas.