Board Of Radiology Research Articles

The USMLE Step 1 Pass/Fail Reporting Proposal: Another View

The Association of Program Directors in Radiology recently issued a statement endorsing continued reporting of results of the United States Medical Licensing Examination (USMLE) as a three-digit score. While this position was approved by the Association of Program Directors in Radiology Board of Directors, it does not reflect the opinions of all radiology program directors. Here, we present an argument in support of reporting USMLE results as pass/fail. As a psychometric instrument, the USMLE Step 1 is designed to assess basic science knowledge and intended to inform a binary decision on licensure. Due to a steadily-increasing burden of applications to review, program directors have increasingly relied upon scores for candidate screening. Such use has multiple adverse consequences. Student focus on Step 1 systematically devalues educational content not evaluated on the exam, and the reliance on Step 1 scores almost certainly works against efforts to increase workforce diversity. Moreover, the increasing pressure of "Step 1 Mania" has negative consequences for trainee mental health and wellness. Despite the widespread use of Step 1 scores to select applicants, there are little data to correlate scores to meaningful outcomes related to patient care or clinical practice. We find the current situation untenable, and believe a necessary first step toward reform is making Step 1 a pass/fail only examination.

Predictors for Failing the American Board of Radiology Core Examination.

OBJECTIVE. Since the American Board of Radiology (ABR) instituted its new board certification pathway, our residency program has had more residents fail the core examination than was typical with the prior pathway. We performed a single-center retrospective study to evaluate predictors of ABR core examination failure. MATERIALS AND METHODS. Data regarding U.S. Medical Licensing Examination (USMLE) steps 1 and 2, ACR diagnostic radiology in-training examinations, the number of image interpretations, academic degree (doctor of medicine or doctor of osteopathy), status as an American or foreign medical graduate, and Alpha Omega Alpha national medical honor society status were gathered and evaluated through logistic regression and generalized additive logistic regression. Data were gathered for all residents who took the ABR core examination from 2013 to 2017. RESULTS. Six of 30 residents (20%) failed the ABR core examination on the first attempt. The ACR in-training examination scores for 1st- and 3rd-year residents were significantly related to ABR core examination failure (p = 0.027 and p = 0.035, respectively), with significant nonlinearity (p = 0.037 and p = 0.033, respectively). The suggested baseline percentile score was the 30th percentile for 1st-year residents and the 20th percentile for 3rd-year residents. USMLE step 1 and 2 scores were significantly related to ABR core examination failure (p = 0.041 and p = 0.043, respectively), without significant nonlinearity (p = 0.35 and p = 0.09, respectively). However, residents with scores of less than 220 on USMLE steps 1 and 2 seemed to be at risk. CONCLUSION. Low scores on USMLE steps 1 and 2 and 1st- and 3rd-year ACR in-training examinations were associated with ABR core examination failure. If validated more broadly, these cutoffs may serve as predictors of ABR core examination failure and may facilitate identification and remediation of at-risk residents.

Gender Diversity Within the American Board of Radiology: History, Current Status, and Future Implications

Gender Diversity Within the American Board of Radiology: History, Current Status, and Future Implications

Valerie P. Jackson, MD, President, Radiological Society of North America, 2019.

Valerie P. Jackson, MD, President, Radiological Society of North America, 2019.

The Chiropractic Vertebral Subluxation Part 8: Terminology, Definitions, and Historicity From 1966 to 1980

ObjectiveThe purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) between the years 1966 and 1980, with an emphasis on consensus models and terminology. DiscussionThe consensus models on CVS during this time were an outgrowth of previous model building, research, and practice methods. The first consensus models were developed by the radiology diplomates of the American Chiropractic Board of Radiology. Later work was used to develop Medicare standards. Research and theory were influenced by the 1975 National Institutes of Health conference on spinal manipulation in 1975 and the workshops that followed that meeting. A new historical consciousness about the CVS, developed at the National Institutes of Health conference, which was a turning point for the profession in the use of terminology and the focus on functional pathophysiology associated with CVS. The historical view of CVS developed by Watkins, Haldeman, and Janse led to new integrative and historical developments in the profession. ConclusionTheories during this period included consensus efforts as well as new distinctions about CVS theory and terminology.

The American Board of Radiology B. Leonard Holman Research Pathway to Initial Certification: Opportunities Lost for Diagnostic Radiology.

In 1998, the American Board of Radiology introduced the B. Leonard Holman Research Pathway (HRP) to initial certification for trainees in diagnostic radiology (DR) and radiation oncology (RO) motivated to pursue research-oriented careers in academic DR and RO. The HRP Committee anticipated that there would be a relatively even distribution between DR and RO participants, but with 18 years of experience that has not been the case. This article focuses on the HRP and DR.

Learning from our Mistakes: Enhancing Radiation Oncology Residents’ Physics Education with an Incident Learning System

One of the major challenges of teaching medical physics to Radiation Oncology residents is making didactic material practical. In a recent American Board of Radiology (ABR) post-exam survey, residents requested more clinical applicability of medical physics examination material. In this study, we hypothesized that near miss events from our department’s Incidental Learning System (ILS) could be developed into physics teaching cases. Our departmental ILS logs over 1,000 near-miss event reports per year submitted by Radiation Oncology staff. For this study 5,152 institutional ILS reports from 2/1/2012 to 12/31/2017 were evaluated. ILS categorizations relating to physics education were identified, including in-vivo dosimetry, Intensity Modulating Radiation Therapy (IMRT), Stereotactic Body Radiation Therapy (SBRT), and Image Guided Radiation Therapy (IGRT). ILS reports under each category were reviewed and selected if it involved a physicist and/or a physician. They were categorized according to the ABR Medical Physics study guide. Overall, 87 reports were identified which presented unique physics concepts. An example is the incorrect placement of bolus around the neck for head-and-neck IMRT. This report (and associated images) could be used as the basis for a teaching case on the dosimetric impact of bolus placement and potential clinical implication. The most common ILS categories for the selected cases were: planning error (n=24, 27.6%), patient setup (20, 23%), and simulation (18, 20.7%). Some reports were tagged under multiple categories and were identified multiple times. This study demonstrates the rich contextual information that is available from an ILS for physics education. Future directions include creating a bank of teaching cases. This method may also be useful in other institutions that use ILS.Abstract TU_18_3075; TableILS cases for physics education under ABR Medical Physics categorizationCategorizationN (%)SubcategorizationN (%)XIV. Assessment of patient setup and verification30 (34.5%)1. Positioning and immobilization methods and device 2. Treatment verification 3. Imaging for treatment delivery/IGRT 4. Respiratory motion management12 (40%) 11 (36.7%) 12 (40%) 13 (43.3%)XII. Treatment planning, ICRU, and beam-related biology30 (34.5%)1. 3D planning, non-coplanar beams 4. Treatment planning systems 5. Plan evaluation 6. SBRT 7. TBI1 (3.3%) 5 (16.7%) 2 (6.7%) 10 (33.3%) 16 (53.3%)IX. Dosimetry of photon beams in a patient24 (27.6%)1. Corrections for patient contour 2. Corrections for tissue inhomogeneities 3. Dose within and around an inhomogeneity 4. Matching of adjacent fields 5. Wedges 6. Parallel-opposed beams 7. Entrance dose and exit dose, including beam-modifying devices 8. Isodose distributions for multiple beams, including mixed modality and arc therapy 9. Compensators for photon beams 10. Off-axis factors8 (33.3%) 6 (25.0%) 4 (16.7%) 2 (8.3%) 1 (4.2%) 2 (8.3%) 6 (25.0%) 1 (4.2%) 5 (20.8%) 3 (12.5%) Open table in a new tab

Alan F. Weissman (Ed). Top Score for the Radiology Boards. Q&A for the Core and Certifying Exams

Alan F. Weissman (Ed). Top Score for the Radiology Boards. Q&A for the Core and Certifying Exams

Top Score for the Radiology Boards: Q&A for the Core and Certifying Exams

Top Score for the Radiology Boards: Q&A for the Core and Certifying Exams

Implementation of an Innovative Tablet-based Curriculum for Radiology Resident Education

The aim of this study was to prospectively examine the impact of a tablet-based curriculum on the radiology resident educational experience. A comprehensive tablet-based curriculum was developed by creating subspecialty modules with appropriate content level for each required rotation at our diagnostic radiology residency program. Daily assignments included key learning points, readings, and reference presentation slides, covering all objectives published by the ABR Core Exam Study Guide. Residents were provided with iPad devices preconfigured with the curriculum and online access to most major radiology textbooks available in our institutional digital library. Assessment surveys were administered at baseline and 12 months following curriculum implementation. Twenty-two residents completed both surveys. In comparing the pre versus postsurvey results, 32% versus 73% residents agreed or strongly agreed that study resources were well-organized, 41% versus 91% agreed or strongly agreed that study resources were easily accessible, 27% versus 77% agreed or strongly agreed that the modules encouraged active learning, 18% versus 82% agreed or strongly agreed that resources motivate them to study daily, 36% versus 82% agreed or strongly agreed that the resources adequately prepared the resident for the radiology board exam, and 36% versus 82% agreed or strongly agreed that they were satisfied with the resources provided by the residency program (p < 0.05). Our study demonstrated the positive impact of implementing a complete tablet-based curriculum on radiology resident motivation, satisfaction, and engagement. Use of mobile tablet devices has the potential to dramatically transform content delivery in residency education.

(Lack of) Measurable Clinical or Knowledge Gains From Resident Participation in Noon Conference

The objective of this study was to determine whether noon conference attendance by diagnostic radiology residents is predictive of measurable performance. This single-center retrospective Health Insurance and Portability and Accountability Act (HIPAA)-compliant cross-sectional study was considered "not regulated" by the institutional review board. All diagnostic radiology residents who began residency training from 2008 to 2012 were included (N = 54). Metrics of clinical performance and knowledge were collected, including junior and senior precall test results, American Board of Radiology scores (z-score transformed), American College of Radiology in-training scores (years 1-3), on-call "great call" and minor and major discrepancy rates, on-call and daytime case volumes, and training rotation scores. Multivariate regression models were constructed to determine if conference attendance, match rank order, or starting year could predict these outcomes. Pearson bivariate correlations were calculated. Senior precall test results were moderately correlated with American Board of Radiology (r = 0.41) and American College of Radiology (r = 0.38-0.48) test results and mean rotation scores (r = 0.41), indicating moderate internal validity. However, conference attendance, match rank order, and year of training did not correlate with (r = -0.16-0.16) or predict (P > .05) measurable resident knowledge. On multivariate analysis, neither match rank order (P = .14-.96) nor conference attendance (P = .10-.88) predicted measurable clinical efficiency or accuracy. Year started training predicted greater cross-sectional case volume (P < .0001, β = 0.361-0.516) and less faculty-to-resident feedback (P < 0.0001, β = [-0.628]-[-0.733]). Residents with lower conference attendance are indistinguishable from those who attend more frequently in a wide range of clinical and knowledge-based performance assessments, suggesting that required attendance may not be necessary to gain certain measurable core competencies.

Residency Mini-fellowships in the PGY-5 Year: Is There Added Value?

With the restructuring of radiology board certification, many residencies created PGY-5 "mini-fellowships," during which residents spend focused time pursuing advanced subspecialty training or developing nonclinical skills in leadership, health policy and health-care economics, education, quality improvement, informatics, research, or global health. We surveyed graduates of an academic diagnostic radiology residency to assess the relative value and impact of PGY-5 mini-fellowships on career satisfaction and success. From 2012 to 2016, 39 radiology residents at our institution were offered the opportunity to pursue a 3- to 6-month mini-fellowship during the PGY-5 year. Thirty of 39 radiology residents (77%) participated, whereas 9 of 39 (23%) opted out. Of 39 residents, 13 completed two clinical mini-fellowships, 3 completed research mini-fellowships only, and 14 completed one nonclinical and one clinical mini-fellowship. Through SurveyMonkey, 23 of 39 residents (59%) responded to a questionnaire that collected basic demographic information and asked respondents about the value of this experience as it relates to fellowship choice and career using a five-point Likert scale. Of 23 respondents (14 male, 8 female,1 not specified), 78.3% practice in an academic university-based setting, with 8.7% in a community-based hospital practice, 4.3% in the veterans system, and 4.3% in a private practice setting. Of 23 respondents, the most popular clinical mini-fellowships were magnetic resonance imaging (31.6%), neuroradiology (21.1%), and interventional radiology (15.8%). For nonclinical mini-fellowships, the most popular were research (10.5%), education (10.5%), global health (5.3%), and healthcare economics (5.3%). Of 23 respondents who did mini-fellowships, 95% felt that the mini-fellowship prepared them well for their career, 85% felt it gave them the necessary skills to succeed, 85% cited that it gave them additional skills beyond their peers, and 40% felt it helped them create a life-long connection to a mentor. Ninety-five percent of respondents would choose to do the mini-fellowship again. Respondents suggested increasing the duration to 6-9 months and to develop a more structured curriculum and mentorship component. Only one respondent felt that the nonclinical mini-fellowship took away time from furthering clinical skills. Graduates of a university-affiliated academic radiology residency who participated in clinical and nonclinical mini-fellowships during the PGY-5 year of residency greatly value this experience and uniformly recommend that this type of program continue to be offered to trainees given its ability to develop skills perceived to be vital to ultimate career satisfaction and success.

Alan F. Weissman: Top score for the Radiology Boards Q&amp;A for the Core and Certifying Exams

Alan F. Weissman: Top score for the Radiology Boards Q&amp;A for the Core and Certifying Exams

Khan's Treatment Planning in Radiation Oncology, 4th Edition. Editor: Faiz M.Khan, John P.Gibbons, Paul W.Sperduto. Lippincott Williams &amp; Wilkins (Wolters Kluwer), Philadelphia, PA, 2016. 648 pp. Price: $215.99. ISBN: 9781469889979. (Hardcover) (*)

The classic with a modern touch! Since the publication of the first edition of this clinical treatise in 1998, the field of radiation oncology has seen changes in all modalities, most notably, in the treatment planning and delivery subprocesses. Beginning with the advent of intensity modulated radiation therapy (IMRT) which revolutionized the field, there have been important developments in image-guided radiotherapy (IGRT), volumetric modulated arc therapy (VMAT), stereotactic body radiotherapy (SBRT), and proton therapy. The book captures the essence of these technologies from a practitioner's viewpoint. The latest edition comes only five short years after the last one, but is timely, considering the rapid advances in radiation oncology. The book's main focus is treatment planning and it presents this area brilliantly from perspectives of physics, biology, and clinical practice. Important treatment planning-related topics in these areas have been highlighted for the reader. However, like the previous editions, the book's main focus remains unchanged: improved patient care through effective and efficient use of new technologies. The book's intended audience is the radiation oncology team: radiation oncologists, medical physicists, and dosimetrists. The inclusion of Key Points (chapter summary) and Study Questions at the end of each chapter should appeal to residents preparing for their board examination. The fourth edition of the book has been completely updated and is accompanied by an e-book with enhanced navigation tools including fully searchable text. All chapters have been revised and most re-written by new authors chosen for their expertise in the field. The new edition also includes an expanded coverage of proton therapy and SBRT. Owing to its increasing and somewhat controversial use, there is also a chapter devoted to comparing the role of protons versus photons in radiation oncology. The book is divided into two sections. Section 1 consists of 23 chapters addressing the physics and biology of treatment planning. This section provides a systematic and logical refresher on pertinent topics, starting with patient imaging, treatment simulation, and a discussion of treatment planning algorithms used for photons, protons, electrons, and brachytherapy. This is followed by a chapter on quality assurance and commissioning of treatment planning systems. The second half of this section is devoted to technical and radiobiological considerations related to various treatment modalities. Section 1 concludes with an important chapter on treatment plan evaluation. Section 2 has 11 chapters devoted to treatment planning for site specific cancers presented from a clinical perspective. The book is clearly written and easy to read—a hallmark of all books penned by Dr. Khan. It provides a ready resource for finding answers to treatment planning related questions in radiation oncology. Perhaps, owing to size limitations, some topics are not covered in detail; however, ample references are provided for the interested reader. It is my hope that the book's future edition will include an expanded list of Study Questions. It is also hoped that the next edition will cover topics related to the evolving, yet important, field of MR-based treatment planning and delivery. In summary, the book is a joy to read and should appeal to all readers interested in radiation oncology. Anil Sethi is an Associate Professor in Radiation Oncology at Loyola University Health System, Chicago, IL. He is board certified by the American Board of Medical Physics (ABMP) and the American Board of Radiology (ABR). He is teaching medical physics to residents and clinical physicists and his research interests are in IMRT, IGRT, and all special procedures in RT especially SRS and SBRT.

Comparison of knowledge and perspectives toward cone-beam computed tomography among dentists in three Middle East regions: A cross-sectional study

Objective: The aim of the current study was to investigate awareness, general attitudes and perspectives of a sample of dentists from Saudi Arabia, Egypt, and Jordan regarding their knowledge and future expectations of cone-beam computed tomography. Materials and Methods: The study included a convenience sample of dentists from different specialties throughout the three regions. They were contacted through E-mail and dental social discussion groups and completed an online questionnaire. The data were collected, sorted, cross-tabulated, and analyzed in view of the objectives of the study, using descriptive analysis and Chi-square tests of significance. Results: Age, sex, and years of experience had no effect on cone-beam computed tomography (CBCT) knowledge, whereas education level and place of work had a significant effect (P = 0.001 and P = 0.05, respectively). A change in diagnosis or treatment plan was also significantly related to the need for CBCT (P = 0.01 and P = 0.015, respectively). Requesting a dentomaxillofacial radiology (DMFR) board program was significantly related to the dentist's concern about medicolegal issues but not to the decision to refer the patient to a radiologist. Conclusions: This study showed that having a higher education level and being in a tertiary workplace improved CBCT knowledge, and better knowledge about CBCT increased the number of patient referrals when the indications justified it. With the increasing demand for CBCT, there have been more changes in diagnoses and treatment plans, and thus, more dentists are requesting DMFR board programs in the region to avoid medicolegal issues.

The European Board of Interventional Radiology Examination: A Cross-Sectional Web-Based Survey.

The Cardiovascular and Interventional Radiology Society of Europe established the European Board of Interventional Radiology (EBIR) as an international examination in Interventional Radiology (IR), in 2010. The main objective of this study was to examine candidates' variables which could influence examination success. The secondary objective was to evaluate candidate feedback. This study was a cross-sectional web-based survey incorporating 30 questions which reviewed candidates' demographics; use of English language; education; and radiology training. Free-text responses provided perspective on the examination process and any potential career implications. This survey was distributed via SurveygizmoTM and emailed to 227 candidates, and the results were then anonymised and analysed. A total of 115 candidates responded to the survey. 4.4% (N=5/115) of candidates were women, and 38.3% (N=44/115) of candidates were fluent in English. Over 45.2% (N=52/115) of the respondents achieved a distinction, or >70% equivalent in their medical degree, and 60.8% (N=70/115) achieved some form of higher degree after medical school. 54.8% (N=63/115) spent time in other medical specialties, of which the majority (33.8%, N=39/115) was in surgery. 67.5% (N=77/114) completed a dedicated fellowship in IR. 61.9% (70/113) felt the EBIR qualification helped their career, for example with academic promotion or increased clinical privileges. EBIR applicants were predominantly male (>95%). Clinical training, prior to radiology training, was very common in this cohort. Overall, most candidates expressed satisfaction with the examination process, and many felt this qualification helped their career. The recent recognition by national accreditation bodies should hopefully improve the profile of the examination greatly.

Does the Oral “Mock Board” Examination Still Have a Role as a Training Tool?

The American Board of Radiology has adopted a new standardized board examination and the traditional oral examination has been abandoned. Although many programs have changed their educational efforts to reflect the new test format, some faculty members and residents have expressed a desire to keep an oral examination as a component of education and evaluation in radiology residency programs. An oral comprehensive examination including all the appropriate subspecialties was administered to each second year and third year resident in our training program by faculty members. Both the resident examinees and faculty examiners were surveyed after the examination to gauge the perceived value of the experience. Residents were divided in their perceptions of the fairness and utility of an oral examination as a tool to aid in board preparation and as an assessment of their knowledge and communication skill. Faculty members were universal in their endorsement of the oral examination and suggested continued use of the technique. Residents and faculty members have differing perceptions of an oral examination delivered during training to assess knowledge and communication skill. The value of an oral examination in providing actionable feedback to trainees and the possibility of detecting struggling residents made it useful in our training program, and it thus it has been implemented for future years. Whether resident performance measured by this technique is predictive of success on American Board of Radiology examinations remains unclear.

Tumor imaging instruction and assessment at chiropractic colleges in North America: a pilot study with implications for National Board of Chiropractic Examiners content.

This pilot study tested a survey instrument pertaining to the instruction and assessment of tumor imaging in chiropractic training programs. The secondary purpose was to gather data regarding credentials of lead instructors, textbook and resource use, and tumors taught and assessed. An electronic survey was distributed to lead tumor imaging instructors at all chiropractic colleges in the United States and Canada. A focus group of tumor imaging instructors was conducted to clarify ambiguous data. Diplomate status with the American Chiropractic Board of Radiology was held by 87.5% of the instructor respondents. There were similarities in course content and assessment across institutions. A total of 26 tumors were considered clinically significant by more than 65% of instructors, 9 tumors were identified as not clinically significant by more than 65%, and 4 tumors were considered clinically significant by 35% to 65% of instructors. There was correlation between those instructors who evaluated on various tumors and those who feel it is important to evaluate such tumors (rS = 0.94, p < .001). The focus group addressed the 4 equivocal tumors and recommended 3 be added to the list of clinically insignificant tumors. The survey instrument is ready to be used to conduct a study of all clinical areas of the chiropractic curriculum. A total of 12 tumors were recommended for removal from National Board of Chiropractic Examiners tests. The authors recommend that the Academics Committee of the American Chiropractic Board of Radiology share information regarding learning libraries to allow for a richer learning experience across all campuses.

Intercountry analysis of breast density classification using visual grading.

Disagreement in mammographic breast density (MBD) assessment can impact breast cancer risk stratification, choices of further breast cancer screening intervals and pathways. This study examines whether intercountry MBD expectations and assessment approaches are associated with differences in MBD assessment. 20 American Board of Radiology (ABR) examiners and 24 UK practitioners using the 4th edition BI-RADS® lexicon assessed 40 mammogram cases of 20 females. 26 Royal Australian and New Zealand College of Radiologists (RANZCR) registered radiologists also assessed the same cases. Interobserver correlation and agreement were assessed using Spearman's correlation (ρ) and weighted kappa (κw), respectively. Strong positive correlation was observed between the study cohorts on a binary scale (1-2 vs 3-4) [ABR examiners and RANZCR radiologists (ρ = 0.950); ABR examiners and UK practitioners (ρ = 0.940); and RANZCR radiologists and UK practitioners (ρ = 0.958)]. ABR and RANZCR radiologists demonstrated slight agreement [κw = 0.10; 95% confidence interval (CI) = -1.13-0.43], whereas ABR and UK practitioners showed a fair agreement [κw = 0.25; 95% CI = -0.42-0.61], and an almost perfect agreement was observed between RANZCR radiologists and UK practitioners [κw = 0.95; 95% CI = 0.91-0.97]. Findings demonstrate wide international and interobserver variability in MBD assessment. This level of variability underscores the need for automation and standardization of MBD assessment. Advances in knowledge: Intercountry analysis of MBD assessment shows variations, with less variation on the binary scale than on the 4-point scale. With this level of variation, automation and standardization of MBD assessment becomes more appropriate.

Comparison of computed tomography shielding design methods using RadShield

Purpose. To comprehensively compare four computed tomography (CT) scanner shielding design methods using RadShield, a Java-based graphical user interface (GUI). Methods. RadShield, a floor plan based GUI, was extended to calculate air kerma and barrier thickness using accepted methods from the National Council on Radiation Protection and Measurements (NCRP), the British Institute of Radiology, and a method using isodose maps, for spatially distributed points beyond user defined barriers. For a stationary CT scanner, the overall shielding recommendations found using RadShield were also compared to those found by American Board of Radiology certified diagnostic medical physicists using the conventional NCRP dose length product method and the isodose map method. Results. The results between methods differed significantly for calculation point locations beyond the gantry and to the rear of the gantry. Overall shielding design recommendations across the four methods yielded similar average air kerma and thickness values for the barriers. Conclusions. RadShield was extended to perform CT shielding design and proved reliable using four methods.