Diagnostic Radiology Training Research Articles

Simulation training in mammography with AI-generated images: a multireader study.

The interpretation of mammograms requires many years of training and experience. Currently, training in mammography, like the rest of diagnostic radiology, is through institutional libraries, books, and experience accumulated over time. We explore whether artificial Intelligence (AI)-generated images can help in simulation education and result in measurable improvement in performance of residents in training. We developed a generative adversarial network (GAN) that was capable of generating mammography images with varying characteristics, such as size and density, and created a tool with which a user could control these characteristics. The tool allowed the user (a radiology resident) to realistically insert cancers within different regions of the mammogram. We then provided this tool to residents in training. Residents were randomized into a practice group and a non-practice group, and the difference in performance before and after practice with such a tool (in comparison to no intervention in the non-practice group) was assessed. Fifty residents participated in the study, 27 underwent simulation training, and 23 did not. There was a significant improvement in the sensitivity (7.43 percent, significant at p-value = 0.03), negative predictive value (5.05 percent, significant at p-value = 0.008) and accuracy (6.49 percent, significant at p-value = 0.01) among residents in the detection of cancer on mammograms after simulation training. Our study shows the value of simulation training in diagnostic radiology and explores the potential of generative AI to enable such simulation training. Using generative artificial intelligence, simulation training modules can be developed that can help residents in training by providing them with a visual impression of a variety of different cases. Generative networks can produce diagnostic imaging with specific characteristics, potentially useful for training residents. Training with generating images improved residents' mammographic diagnostic abilities. Development of a game-like interface that exploits these networks can result in improvement in performance over a short training period.

Radiology Resident Diagnostic In-Training Exam Scores: Impact of Subspecialty Imaging Volume and Rotation Scheduling

PurposeTo determine the relationship between resident imaging volumes and number of subspecialty rotations with Diagnostic Radiology In-Training (DXIT) subspecialty scores. MethodsDXIT-scaled subspecialty scores from a single large diagnostic radiology training program from 2014 to 2020 were obtained. The cumulative number of imaging studies dictated by each resident and specific rotations were mapped to each subspecialty for each year of training. DXIT subspecialty scores were compared against the total subspecialty imaging volume and the total number of rotations in a subspecialty for each resident year. A total of 52 radiology residents were trained during the study period and included in the dataset. ResultsThere was a positive linear relationship between the number of neuro studies and scaled neuro DXIT scores for R1s (Pearson coefficient: 0.29; p-value: 0.034) and between the number of breast studies and the number of neuro studies with DXIT scores for R2s (Pearson coefficients: 0.50 and 0.45, respectively; p-values: 0.001 and 0.003, respectively). Furthermore, a positive significant linear relationship between the total number of rotations in cardiac, breast, neuro, and thoracic subspecialties and their scaled DXIT scores for R2 residents (Pearson coefficients: 0.34, 0.49, 0.33, and 0.32, respectively; p-value: 0.025, 0.001, 0.03, and 0.036, respectively) and between the total number of nuclear medicine rotations with DXIT scores for R3s (Pearson coefficient: 0.41; p-value: 0.016). ConclusionResident subspecialty imaging volumes and rotations have a variable impact on DXIT scores. Understanding the impact of study volume and the number of subspecialty rotations on resident medical knowledge will help residents and program directors determine how much emphasis to place on these factors during residency.

Peering Into the Future: A First Look at the CBME Transition to Practice Stage in Diagnostic Radiology

Queen's University (Kingston, ON, Canada) adopted a competency-based medical education (CBME) curriculum for Diagnostic Radiology residency training in an accelerated manner in 2017, with the curriculum comprised of four stages of training. This article focuses on the final stage (Transition to Practice), during which assessment methods of the new national curriculum (implemented in July 2022) were piloted. This study aims to highlight the challenges and opportunities associated with the implementation of CBME in Diagnostic Radiology training and specific considerations for programs undergoing this curricular transition. Ethics approval was provided by the affiliated hospital Research Ethics Board. All relevant electronic assessments pertaining to all trainees who had completed the Transition to Practice stage (n=3) were collated, deidentified, analyzed, and presented in tabulated format. A total of 39 evaluations completed by 13 assessors were assessed, with an average time of 3minutes and 6seconds to complete an assessment form. Also, 95% of evaluations were rated as entrustments. However, no residents met the minimum number of required entrustments for all five stage-specific Entrustable Professional Activities. These 39 evaluations included 219 milestone rating scores, with 86% rated as "achieved." Following review by the residency program Competence Committee, all three residents were promoted from the Transition to Practice stage. Challenges in CBME implementation include the number and quality of resident assessments. Strategies for success may include providing clear guidelines and training for both faculty and residents, early identification and intervention, and adopting a holistic evaluation strategy. CBME has the potential to enhance medical education quality by emphasizing learner progress toward competency and providing personalized feedback and support.

Whitepaper: Training in Diagnostic and Interventional Breast Radiology.

Breast imaging represents an integral part of radiology and is subject to strict quality controls. Regarding this, precise diagnostics including multimodal assessment by mammography, sonography, and MRI, including image-guided biopsy and localization procedures, is often decisive and must be performed by experts with profound knowledge and skills in all of these procedures.However, due to numerous restructurings, breast imaging has been shifted more and more towards large, specialized centers, resulting in less patient exposition and training opportunities for radiologists in smaller sites. The following whitepaper summarizes the current circumstances and discusses opinions of the participating societies. Under the leadership of the German Roentgen Society (DRG) and with the participation of the DRG's AG Mammadiagnostik, the CAFRAD (Chefarztforum Radiologie), the KLR (Konferenz der Lehrstuhlinhaber für Radiologie e. V.), the DRG's Forum Junge Radiologie (FJR) and the Berufsverband der Deutschen Radiologen e. V. (BDR), possible solutions were discussed and consented for a structured training in breast radiology in the future. In addition to the teaching provided at the primary workplace, qualified training should be ensured through flexible, multi-institutional, interdisciplinary, and cross-sectoral collaboration. Furthermore, the integration of online case collections and close cooperation with certified breast cancer centers and mammography screening units is recommended. It is indispensible that online courses and case collections adhere to the standards of the national societies and include a maximum of one third of the required cases. In order to provide training in breast radiology at a high professional level, a paradigm shift with closer cooperation of all participants is necessary. This includes close collaboration of the breast imaging societies with the federal medical associations to establish new teaching concepts like e-learning in the training schedule of radiologists. · Breast diagnostics is an integral part of radiology training.. · Due to recent restructurings, smaller training centers have difficulties in meeting the case numbers demanded by the Specialist Training Regulations (WBO). Improved integration of the new structures and their adaptation to the needs of education are necessary to guarantee standardized high-quality training of young radiologists.. · The integration of certified case collections enables quality-assured training, even across regions in online-based formats. In accordance with the "blended learning principle", up to one-third of the required number of patient studies can be substituted with cases from a certified case collection.. · Legally secured short- and medium-term internships may complement training in radiology.. · Sauer ST, Bley TA, Wenkel E et al. Whitepaper: Training in Diagnostic and Interventional Breast Radiology. Fortschr Röntgenstr 2023; 195: 699 - 706.

The Impact of the Dobbs Decision on Diagnostic Radiology Applicants, Residents, and Program Directors

In the Dobbs decision the United States Supreme Court overturned Roe v. Wade, returning the issue of abortion to the states. To date, there is little published data on the impact this might have on where future residents choose to pursue graduate medical education. We investigated the potential effects of the resultant varied political landscape of abortion care access laws with respect to influence on the selection of prospective diagnostic radiology training programs by medical students, comparing application rates for the 2022 recruitment cycle to the prior 4 years across a geographically diverse group of 22 academic and community sites across the United States. We provide strategies for program directors to consider in dealing with topics related to this continually evolving issue as it pertains to resident recruitment and retention.

Gamification: Basic concepts and applications in radiology

Gamification is the use of elements from games in non-game environments, such as education. It is an alternative educational focus that promotes students’ motivation and participation in the learning process. Gamification had proven effective in training health professionals and can play an important role in diagnostic radiology training, both at the undergraduate and postgraduate levels. Gamification activities can be carried out in real environments, such as classrooms or session rooms, but there are also interesting online modalities that favor remote access and user management. The possibilities of gamification in virtual worlds to teach undergraduate students radiology are very promising and deserve to be explored in training residents. This article aims to review general concepts in gamification and to present the main types of gamification used in medical training, pointing out its applications and advantages and disadvantages and emphasizing experiences in radiology education.

Abstract No. 111 Current Status of Diagnostic Radiology and Interventional Radiology Training in Latin America

Abstract No. 111 Current Status of Diagnostic Radiology and Interventional Radiology Training in Latin America

Gamificación: conceptos básicos y aplicaciones en Radiología

Gamification is the use of elements from games in non-game environments, such as education. It is an alternative educational focus that promotes students’ motivation and participation in the learning process. Gamification had proven effective in training health professionals and can play an important role in diagnostic radiology training, both at the undergraduate and postgraduate levels. Gamification activities can be carried out in real environments, such as classrooms or session rooms, but there are also interesting online modalities that favor remote access and user management. The possibilities of gamification in virtual worlds to teach undergraduate students radiology are very promising and deserve to be explored in training residents. This article aims to review general concepts in gamification and to present the main types of gamification used in medical training, pointing out its applications and advantages and disadvantages and emphasizing experiences in radiology education.

Opportunities for Excellence in Interventional Radiology Training: A Qualitative Study.

The training experience in interventional radiology (IR) residency programs varies widely across the country. The introduction of an IR training pathway has provided the impetus for the specialty to better define outstanding IR education and for programs to rethink how their curricula prepare IR trainees for real-world practice. Although ACGME competencies define several training components that are necessary for independent practice, few quantitative or qualitative studies have explored current perceptions on what constitutes optimal IR training. Our goal was to qualitatively explore program training features deemed most important to adequately prepare IR physicians for practice and assess whether there were differences in perception between academic and nonacademic practices. Semistructured interviews were conducted with 71 IR attending physicians, trainees, and support staff across the United States. All interviews were performed over the telephone by a single researcher for consistency and systematically coded by two independent coders for common themes. Frequency and prevalence of themes and facilitating features were analyzed. The most frequently perceived facilitating features included longitudinal patient care experience, practice-building education, interspecialty collaboration exposure, broad case mix, clinical decision-making exposure, diagnostic radiology training, procedural skills training, and graduated autonomy. Comparing nonacademic versus academic practice settings, significantly more nonacademic IR attending physicians expressed practice-building education (prevalence 72% versus 42%, frequency 2.2 versus 0.7, P < .01) as an important training experience. An understanding of perceived facilitating features for optimal IR trainee preparation, including potentially different needs between academic and nonacademic practices, can help programs prepare their trainees for a successful transition into practice.

Pulmonary interstitial emphysema and complications: incidence and CT findings in COVID-19.

Background and Objectives:There are scant data available in the published literature providing chest computed tomography (CT) findings on pulmonary interstitial emphysema (PIE), complications and associated parenchymal abnormalities. We report the incidence of PIE and complications by chest CT in patients with COVID-19.Methods:We retrospective analyzed 897 chest CT scans performed with 64-slice CT scanners during the COVID-19 pandemic period from March 2020 to September 2021. Two radiologists and two physicians in training in diagnostic radiology, independently and in consensus, assessed PIE as air within the perilobular (low-attenuation area) and perivascular interstitium such as its complications, parenchymal anomalies and pleural effusion; in addition, the complications of PIE, parenchymal anomalies and pleural effusion were evaluated. Descriptive statistics were used to summarize the data, and the results were expressed as counts and percentages.Results:PIE was revealed in 25 out of 897 patients (2.8%) and associated with pneumomediastinum, subcutaneous emphysema, and pneumothorax in 25 (100%), 16 (64%), and 7 (28%), patients, respectively. Out of 25 patients, 24 patients had ground-glass opacity (GGO), 23 patients had crazy paving, 22 patients had consolidation and 2 patients had pleural effusion. Eighteen out of 25 patients had noninvasive ventilation before CT scan, initially treated with continuous positive airway pressure (positive end expiratory pressure [PEEP] of 10 cmH2O) and subsequently with bilevel positive airway pressure (range PEEP of 8–12 cmH2O). The remaining seven patients had invasive mechanical ventilation via orotracheal intubation (pressure plateau at approximately 25 cmH2O). Six out of 25 (24%) patients died.Conclusion:Chest CT allows the detection of complications associated with PIE and parenchyma abnormalities. The timely detection of PIE and minimal pneumomediastinum could aid the optimization of ventilation modalities and parameters based on patients clinical status therefore potentially reducing complications.

The 25 years development of the Moscow Center for Diagnostics: through an eyewitness

Today, on the eve of the 25th anniversary of the leader in the Moscow radiological service, Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department (used to be the Research and Practical Center of Medical Radiology until 2019), the bright quarter-century history of this institution comes to life in our me-mory, day after day has passed by since the opening of the Center, our weekdays, scientific breakthroughs, and celebrations.&#x0D; We would like to present to our readers a brief history of one of the aspects of the Centers complex activities, the development of professional education of radiologists. We observe a period from its launching to its recognition as the authority in radiology. The Education Department of the Moscow Center for Diagnostics and Telemedicine Technologies is currently appointed by the Ministry of Health of the Russian Federation as an expert to participate in addressing the current challenges of professional training and certification in diagnostic radiology.&#x0D; The article is devoted to well-known scientists and teachers, professors, and leading specialists in the industry, who are actively involved in the development of continuing education of radiologists and other specialists in diagnostic radiology at different stages of the centers existence. Specialists of the Training Center strive for the compliance of the provided professional training following the Bologna Declaration (1999), thereby creating conditions for Russian professionals to obtain European diplomas.

Can training in diagnostic radiology be moved online during the COVID-19 pandemic? UK trainee perceptions of the Radiology-Integrated Training Initiative (R-ITI) e-learning platform

AIMTo assess trainee perceptions of the Radiology-Integrated Training Initiative (R-ITI)) e-learning modules.MATERIALS AND METHODSA mixed methodology approach was used, with triangulation between a thematic analysis of eight semi-structured interviews from radiology trainees and trainers, and a contextual analysis of 60 free-text feedback comments and module ratings from trainees after completion of R-ITI modules.RESULTSThree broad themes emerged: “learning the subject matter”, “learning the role,” and “e-learning preferences”. Superficial learning techniques were prevalent when “learning the subject matter” during early training, with e-learning resources providing a good pedagogical fit for this learning. Much of what was considered “learning the role” of the radiologist was learned at the workplace. This included topics with inherent subjectivity, which were difficult to convey with e-learning. Trainees' “e-learning preferences” favoured modules that incorporated many imaging cases with layer annotation, clinical relevance, and self-assessment.CONCLUSIONSThe ease of reproducing imaging studies using the R-ITI platform represents a huge potential for e-learning. Content tailored to the learning needs of the trainee, the appropriateness of the subject matter for an online platform, and the design of the e-learning modules are important considerations. Radiology training also involves important tacit learning and discussions around subjective topics, which are difficult to capture on this platform.

Evolution of the Interventional Radiology (IR) Pathway-Various Changes and Interrelation to Diagnostic Radiology (DR)

Interventional radiology continues to evolve into a more robust and clinically dynamic specialty underpinned by significant advancements in training, education, and practice. This article, prepared by members of the 2020-2021 Association of University Radiologists' task force of the Radiology Research Alliance, will review these developments, highlighting the evolution of interventional radiology pathways with attention to growing educational differences, interrelation to diagnostic radiology training, post-training practice patterns, distribution of procedures and future trends, amongst other key features important to those pursuing a career in interventional radiology as well as those in practice.

“What Program Directors Think” V: Results of the 2019 Spring Survey of the Association of Program Directors in Radiology (APDR)

The Association of Program Directors in Radiology (APDR) surveys its membership annually on hot topics and new developments in radiology residency training. Here we report the results of that annual survey. A web-based survey was posed to the APDR membership in the Fall of 2018. Members were asked 43 questions on program staffing, resident education resources/funding, impact of the integrated-Interventional Radiology residency program on Diagnostic Radiology program resources, resident interest in imaging informatics, Accreditation Council for Graduate Medical Education requirements on resident practice habits data reporting, institutional reliance on residents for clinical coverage, teaching format in the post-oral board era, resident conference attendance, confidentiality of the Match rank list, Early Specialization in Interventional Radiology pathway recruitment and selection, Diagnostic Radiology and Interventional Radiology program relationships, independent resident call, pediatric radiology training, diversity and unconscious bias training, and social media in radiology education. Responses were collected electronically, results were tallied using Qualtrics software, and qualitative responses were tabulated or summarized as comments. There were 86 respondents with a response rate of 31.3%. Survey result highlights include perceived resident interest in imaging informatics with the vast majority of residency programs offering an informatics curriculum; the provision of resident practice habits data by nearly all residency programs despite lack of clarity surrounding this Accreditation Council for Graduate Medical Education requirement; continued use of case-taking in the post-oral boards era; frequent disclosure of the Match rank list to departmental and hospital administration; low penetration of unconscious bias training in academic radiology; and finally, the successful integration of interventional and diagnostic radiology training programs.

Diagnostic Radiology in Nigeria: A Country Report

Nigeria is located in West Africa. The Nigerian healthcare system is stratified into three tiers corresponding to the three tiers of government: primary (local), secondary (state), and tertiary (federal). In addition to this public health structure, private facilities play a significant role in healthcare delivery. Nigeria has a shortage of healthcare equipment and personnel, with a doctor per 1,000 population ratio of 0.17, which is one of the lowest on the African continent. Despite these challenges, a wide range of medical imaging services is available in the country, through a network of public and private facilities. The public healthcare system, which serves the majority of Nigerians, is weak due to lack of adequate funding, personnel and equipment. This gap is closely bridged by private healthcare facilities, which account for 70% of health services coverage in the country. Training in diagnostic radiology is evolving, with two postgraduate colleges being responsible for the regulation of radiology training in the country: the National Postgraduate Medical College of Nigeria and the West African College of Surgeons. There are also higher institutions of learning which are responsible for the training of other imaging professionals. The major challenges of radiology practice in Nigeria are the unavailability of constant electricity as well as the problems of equipment availability and repair.

US Trainee and Faculty Perspectives on Exposure to Nuclear Medicine/Molecular Imaging During Medical School

(1) To identify key factors, especially during medical school, driving trainees to pursue nuclear medicine/molecular imaging (NM/MI) as a career. (2) To understand the current state of medical student exposure to NM/MI. We disseminated 2 surveys by email. The first surveyed NM/MI trainees about motivations for choosing the specialty. The second survey was sent to US medical school faculty responsible for student education and NM/MI residency program directors to gauge the current state of NM/MI didactics at their institution. Seventy-eight trainees and 44 faculty responded. Most trainees reported becoming first interested in NM/MI after medical school (80%, 56/70). Trainees reported little NM/MI exposure during medical school (65%, 49/75), despite faculty reporting that they provide NM/MI didactics (76%, 32/42, P = 0.005). Imaging clerkships, research, and mentorship experiences were important influences for trainee's specialty choice. Most respondents thought that NM/MI should be pursued in conjunction with Diagnostic Radiology training (trainees 67%, 45/69; faculty 80%, 32/40). Survey results highlight the need to improve medical student engagement in NM/MI. It also identified factors that motivate current NM/MI trainees to enter the field and highlight a potential opportunity to increase medical student exposure to NM/MI. Targets for curricular and extra-curricular development that may increase effective NM/MI exposure during medical school were identified to guide future outreach efforts.

4:21 PM Abstract No. 217 What medical students think about interventional radiology: motivations and deterrents

Characterize the motivations for and deterrents from pursuing interventional radiology (IR) for medical students The study was reviewed by the IRB and deemed exempt. A 19-item survey link was sent to all matriculates of five medical schools which varied by region, public/private, class size, and NIH research ranking. Participants were incentivized with an opportunity to receive one of ten $50 Amazon gift cards. Data were collected using REDCap from October 2018 to January 2019. All analyses were conducted using generalized linear mixed modeling nesting by medical school assuming a binomial distribution with SAS GLIMMIX. 25.5% (604/2370) of medical students (MS) completed the survey. MS considering IR (IR-Y) compared to MS not seriously considering IR (IR-N) had higher motivation for the job market (mean [m] = 3.3 vs. 3.0, P = 0.0196) and procedural practice (m = 3.2 vs. 2.8, P = 0.0229) and had lower motivation for direct patient care (DPC) (m = 2.8 vs. 3.4, P <0.0001) and longitudinal patient care (LPC) (m = 2.7 vs. 2.9, P <0.0001). Outpatient practice, salary, and work-life balance were not significantly different motivations. Significant deterrents for IR-N compared to IR-Y were 3-4 years of training in diagnostic radiology (m = 1.6 vs. 1.0, P = 0.001), LPC (m = 2.0 vs. 1.1, P <0.0001), lack of outpatient practice (m = 1.5 vs. 0.9, P <0.0001), wearing lead (m = 1.1 vs. 0.8, P = 0.0007), surgical preliminary year (m = 1.6 vs. 0.9, P = 0.0005), and 6-7-year training length (m = 2.1 vs. 1.5, P = 0.0001). Emergent off-hours call and research were not significantly different deterrents. MS considering IR are more motivated by job market and procedural practice than their colleagues. MS are deterred by inherent factors of IR but also by misconceptions that it lacks clinical practice. IR educators should focus medical student outreach for those interested in procedural practice and emphasize the importance of longitudinal patient care and outpatient practice in a comprehensive clinical IR practice.

3:27 PM Abstract No. 211 Results of a novel integrated technology incubator and innovation curriculum in interventional and diagnostic radiology training programs: the MESH incubator

3:27 PM Abstract No. 211 Results of a novel integrated technology incubator and innovation curriculum in interventional and diagnostic radiology training programs: the MESH incubator

Developing Diagnostic Radiology Training in Low Resource Countries

As interest in global health increases, so does interest in supporting primary care clinicians with global radiology. Concomitant with this are opportunities for radiologists to participate in global health. In this paper we review the types of opportunities available and make recommendations for expanding the global radiology workforce in an ethical and sustainable manner. We review the literature to evaluate capabilities and opportunities. There are too few radiologists in resource-poor countries, and there are also too few training programs. As in many other specialties, most radiology global outreach programs are not set up to provide sufficient longevity and create sustainability. We describe how features of a radiology residency that we helped design in Rwanda will lead to a successful, long-term educational program. In this paper we note the growing interest in and need for global imaging along with the insufficient number of radiologists and radiology training programs in resource-limited countries. We make recommendations for and describe a model of ethical radiology educational outreach.

03:00 PM Abstract No. 344 Bridging the gap: why aren’t underrepresented minorities pursuing careers in interventional radiology?

The purpose of this study was to understand the attitudes and perceptions of underrepresented minority (URM) medical students towards interventional radiology (IR) and to identify the deterrents to pursuing careers in the field. In this IRB-approved prospective study, we surveyed medical students at 4 institutions that have been identified as having a high percentage of URM students. Unweighted descriptive summaries were calculated for all categorical variables. Chi-squared analysis was used to asses for statistically significant differences for categorical variables. To quantify the association between URM status and key survey items, a logistic regression model was constructed in which each dichotomized survey item was regressed on URM status. URM status was defined as students who are Hispanic or Latino, African American, Native American or Multiracial/Other. A total of 353 responses were received. 65.3% were underrepresented minorities (39.2% African American; 19.3% Hispanic or Latino; 0.3% Native American; and 6.5% multiracial or other). Compared to non-URM medical students, URMs were less likely to agree that they understand what interventional radiologists do (OR=0.52, P=0.009) or that they know when to consult IR (OR=0.52, P=0.023). 59.2% indicated that they are not aware of opportunities for exposure to IR. Overall, 13% of all respondents indicated interest in pursuing IR, with no difference in interest between URMs and non-URMs (χ2=0.75; P=0.687). URMs were less likely to agree that long length of training (OR=0.58, P=0.029), or that required diagnostic radiology training (OR=0.52, P=0.042) were deterrents to pursuing IR. URMs were more likely to agree or answer neutrally that radiation exposure is a deterrent to pursuing a career in IR (OR=2.46, P=0.004). URM medical students are less likely to agree that they understand the role of interventional radiologists or when to consult IR and are more likely to consider radiation exposure as a deterrent to pursuing a career in the field. Implementation of targeted programming to increase exposure and education about IR for URMs is essential to increase their recruitment into the specialty.