Academic Radiology Practice Research Articles

Learning, technology and intellectual property: a survey of the philosophies and preferences of our trainees and peers.

Increasing workloads threaten the quality of teaching in academic radiology practices. There is a wealth of unfiltered educational resources for radiology on the internet. As a digital native, today's radiology trainee may have differing opinions from teachers about learning and intellectual property. To identify the preferences and philosophies regarding learning, technology and intellectual property toward the future development of an innovative radiology curriculum. An electronic survey with 22 questions was sent to 2,010 members of the Society for Pediatric Radiology and 100 radiology trainees. Three hundred sixty-one of the 2,110 surveys were returned. All questions were completed in 342 surveys. Fifty-three respondents were trainees (residents and fellows) and 289 respondents were radiologists (teachers). Time needed for a single learning activity in both groups is <30min, but teachers spend less time (P=0.007). The preferred learning environments were point-of-care and outside work hours for both groups. Ideal lecture durations were 31-45min for trainees and 21-30min for teachers (P=0.001). Adoption of new technology showed late majority and laggard trends for both groups (P=0.296). Interest in gadgets was greater in trainees (17%) than teachers (2%) (P<0.001). Interest in lecture recording was greater in trainees (84%) than teachers (61%) (P=0.008). More trainees (61%) than teachers (42%) would not charge money for educational materials (P=0.028); 27% versus 13%, respectively, disagreed with dissemination of those materials beyond the institution (P=0.013). While millennial trainees are adult learners with a stronger comfort with technology, learning styles of trainees and teachers are more similar than was previously believed. Trainees and teachers hold conflicting philosophies about intellectual property. Results herein speak favorably for revising our teaching portfolio to include practical learning materials of short duration available at point-of-care.

Imaging Determinants of Clinical Effectiveness of Lumbar Transforaminal Epidural Steroid Injections

To examine associations between imaging characteristics of compressive lesions and patient outcomes after lumbar transforaminal epidural steroid injections (TFESIs) stratified by steroid formulation (solution versus suspension). Retrospective observational study, academic radiology practice. A 516-patient sample was selected from 2,634 consecutive patients receiving lumbar TFESI for radicular pain. The advanced imaging study(s) preceding sampled TFESI were reviewed. Compressive lesions were described by a) nature of the lesion [disc herniation, fixed stenosis, synovial cyst, epidural fibrosis, no lesion] b) degree of neural compression [4 part scale], and c) presence of a tandem lesion. Associations between 2-month categorical outcomes (responder rates for pain, functional recovery) and imaging characteristics, stratified by steroid formulation, were examined with chi-squared tests of categorical outcomes and multivariable logistic regression models. Disc herniation patients had more responders for functional recovery than patients with fixed lesions (54% versus 38%, P = 0.01). Patients with fixed lesions receiving steroid solution (dexamethasone) had more responders for pain relief, with a similar trend for functional recovery, than patients receiving suspensions (59% versus 40%, P = 0.01). Outcomes for patients with fixed lesions treated with dexamethasone were not statistically different from those for disc herniation patients. Patients with single compressive lesions had more responders than those with tandem lesions (55% versus 41%, P = 0.03). In the entire sample, outcomes for disc herniations were more favorable than for fixed lesions. However, fixed lesions treated with dexamethasone had outcomes indistinguishable from disc herniations. Single lesions had better outcomes than tandem lesions.

The effectiveness of repeat lumbar transforaminal epidural steroid injections.

The aim of this study was to determine 1) if repeat lumbar transforaminal epidural steroid injections (TFESIs) resulted in recovery of pain relief, which has waned since an index injection, and 2) if cumulative benefit could be achieved by repeat injections within 3 months of the index injection. Retrospective observational study with statistical modeling of the response to repeat TFESI. Academic radiology practice. Two thousand eighty-seven single-level TFESIs were performed for radicular pain on 933 subjects. Subjects received repeat TFESIs >2 weeks and <1 year from the index injection. Hierarchical linear modeling was performed to evaluate changes in continuous and categorical pain relief outcomes after repeat TFESI. Subgroup analyses were performed on patients with <3 months duration of pain (acute pain), patients receiving repeat injections within 3 months (clustered injections), and in patients with both acute pain and clustered injections. Repeat TFESIs achieved pain relief in both continuous and categorical outcomes. Relative to the index injection, there was a minimal but statistically significant decrease in pain relief in modeled continuous outcome measures with subsequent injections. Acute pain patients recovered all prior benefit with a statistically significant cumulative benefit. Patients receiving clustered injections achieved statistically significant cumulative benefit, of greater magnitude in acute pain patients. Repeat TFESI may be performed for recurrence of radicular pain with the expectation of recovery of most or all previously achieved benefit; acute pain patients will likely recover all prior benefit. Repeat TFESIs within 3 months of the index injection can provide cumulative benefit.

Career Development for Residents and Beyond: Filling in the Gaps

AJR:196, January 2011 Three of these new radiology residents could instantly answer the question, “What specialty and career track do you want to pursue?” However, unless one is like B and has a nepotistic spot reserved even before interpreting the first chest radiograph, few new residents in real life know how best to reach their specific goals or even what they want to do for the three or more decades of their imaging careers. Academic training programs expend tremendous efforts to teach the intricacies of imaging to their residents and fellows, but little time is spent preparing trainees to make vital career-planning decisions. Obviously, they need to learn diagnostic radiology well enough to pass the board examinations. But how should they try to structure their residency experience? What electives should they take? How should they select a faculty mentor? Should they consider spending a month as a volunteer in a developing country? Is being a chief resident worth the time and effort involved? Would undertaking a meaningful research project during residency be of any value for someone who is aiming for a private practice career? How should the undecided resident who enjoys every subspecialty rotation choose a fellowship? Is there a way to determine whether one is better suited for academic radiology or private practice, and is there an easy way to switch from one to another if the first choice does not work out? What qualities does it take to succeed in a busy private practice? What are the qualities that indicate a good private practice, and which features should be a warning to not even consider a practice opportunity? Should one consider being a night or day teleradiologist, or is that merely a sentence of solitary confinement? Is a career in emergency radiology merely a ticket to rapid burnout? What are the potential dangers to the specialty posed by the increasing corporatization of radiology? And what is the Career Development for Residents and Beyond: Filling in the Gaps

An “A la Carte” Academic Radiology Compensation Plan: Something for Everyone

The mechanism used to compensate faculty members within academic radiology practice poses a complex challenge to radiology administrative leaders. In this article, the authors discuss a novel compensation plan model that addresses many of the demands faced by modern academic radiology practices.

Apathy in Academic Radiology Practice

There is a sense that apathy pervades our specialty. This discussion is about apathy in academic radiology departments, what the root causes may be, how apathy affects organized radiology, and what the ACR can do to address the problem.

Factors That Influence Radiologists' Career Choices

Rationale and Objectives The authors performed this study to examine the factors, particularly the modifiable factors, that influence the career choices of radiologists immediately after graduation from residency and later. Materials and Methods A survey was sent to 119 radiologists who had graduated from a large academic training program between 1981 and 2000. The graduates were asked to classify their first job and any subsequent jobs in academic radiology or private practice and to identify the reasons for their initial job choices and any job changes. A nested cohort study was performed to evaluate the effect of research experience on career choice. Results Seventy-nine (66%) graduates responded to the survey. Forty-three (54%) of the respondents had chosen academic positions as their first jobs. Those who had published during their residency were 26.4 times more likely to choose an academic position as a first job. Twenty-four graduates had since left their academic jobs for private practice. Although the discrepancy in financial rewards between academic radiology and private practice was the main reason for the job switch in 71% of these cases, 33% of the respondents cited difficulty with research as a reason. In addition, only 25% of current academic radiologists were satisfied with their research activities. Conclusion An exodus from academic radiology to private practice is evident among graduates from this large academic residency program, with greater financial reward being the primary motivation. However, a positive research experience during residency could persuade more graduates to choose and to continue in an academic career.

Managing predefined templates and macros for a departmental speech recognition system using common software.

The authors have developed a networked database system to create, store, and manage predefined radiology report definitions. This was prompted by complete departmental conversion to a computer speech recognition system (SRS) for clinical reporting. The software complements and extends the capabilities of the SRS, and 2 systems are integrated by means of a simple text file format and import/export functions within each program. This report describes the functional requirements, design considerations, and implementation details of the structured report management software. The database and its interface are designed to allow all radiologists and division managers to define and update template structures relevant to their practice areas. Two key conceptual extensions supported by the template management system are the addition of a template type construct and allowing individual radiologists to dynamically share common organ system or modality-specific templates. In addition, the template manager software enables specifying predefined report structures that can be triggered at the time of dictation from printed lists of barcodes. Initial experience using the program in a regional, multisite, academic radiology practice has been positive.

Digital cameras in academic radiology practice

Digital cameras in academic radiology practice

Radiologist-patient interactions: implications for picture archiving and communications systems and teleradiology.

We analyzed radiologist-patient interactions and found that radiologic examinations can be classified into three categories: those involving direct interaction of the radiologist with each patient, those involving interaction of the radiologist with some of the patients, and those that do not involve interaction between the radiologist and the patient. We then analyzed the staff assignments of a large academic radiology practice and a moderate-sized radiology department. Both departments include a full range of inpatient and outpatient procedures. We concluded that about 50% of the radiologists in these practices could interpret examinations at a location independent of the site where the examination was performed. This type of analysis can be helpful in planning for the reengineering of radiology processes following implementation of picture archiving and communications systems (PACS) and teleradiology.