Radiology Fellows Research Articles

Post-traumatic spinal hematoma in ankylosing spondylitis.

The purpose of this study is to examine the incidence, location, and magnetic resonance imaging (MRI) features of spinal epidural hematoma (SEH) and spinal subdural hematoma (SSH) in post-traumatic ankylosing spondylitis (AS) patients. A total of 2256 consecutive referrals for urgent and emergency MRI scans of the spine over a period of eight years and ninemonths were manually reviewed for any mentions indicating axial ankylosis and post-traumatic spinal hematoma. We found 164 patients with ankylosed spines complicated by spinal fracture, of whom 32 had AS. Of the 132 excluded patients, 80 had diffuse idiopathic skeletal hyperostosis (DISH). The primary outcome was the presence of spinal hematoma, and the secondary outcome was spinal canal narrowing and spinal cord impingement. Two musculoskeletal radiologists and one fellow in musculoskeletal radiology reviewed the images for the presence of spinal hematoma and related signal characteristics, blinded to one another and initial reports. Of 28 post-traumatic AS patients, 19 had SEHs and five had spinal SSHs. There was a statistically significant difference between Frankel grades before and after surgery in respect of neurological improvement (p = 0.008). Patients who had radiologically proven spinal cord impingement showed more severe neurological deficits (p = 0.012). Hematomas with T1 heterogeneity showed a significantly increased delay (p = 0.047) between injury and imaging, while other signal characteristics were only approximate. Both SEH and SSH are common complications in post-traumatic AS patients. Patients benefit from surgery, but the relevance of spinal hematoma as a separate factor causing neurological deficit remains unclear.

The utility of an under-distended gallbladder on ultrasound in ruling out acute cholecystitis.

To study the association between gallbladder dimensions and acute cholecystitis and to define a sensitive cutoff for excluding the disease. 456 consecutive patients with an abdominal ultrasound performed for right upper quadrant pain, from 1/2019 to 4/2019, were retrospectively collected. Length and width of the gallbladder were measured by a blinded radiology fellow. Patient charts were examined for prospective sonographic findings, clinical data, and pathology from subsequent cholecystectomy or at least 1month of follow-up with symptom resolution. Univariable and multivariable logistic regression analysis were conducted to define the association of gallbladder dimensions and other sonographic and clinical variables with acute cholecystitis. Optimal and sensitive cutoffs of gallbladder widths were defined. The determined sensitive cutoff was validated with a separate cohort of 501 consecutive patients. 319 patients (median age 48 ± 19years) including 11%, 19%, and 70% with acute, chronic, and no cholecystitis were included in the experimental cohort, respectively, and 298 patients (median age 50 ± 19years) including 10%, 12%, and 79% with acute, chronic, and no cholecystitis were included in the validation cohort, respectively. Of all sonographic findings and clinical data, gallbladder width produced the best univariate ROC curve with an AUC of 0.91 (Odds ratio 5.1, 95% CI 3.1-8.5, p < 0.001). 2.2cm was the gallbladder width cutoff below which there were no cases of acute cholecystitis in the experimental cohort. Multivariable logistic regression analysis using sonographic findings only produced an ROC curve with an AUC of 0.94. Applying the 2.2cm cutoff in the validation cohort resulted in 100% sensitivity. Lack of gallbladder distention, defined as a width less than 2.2cm, has potential to serve as a highly sensitive sign for exclusion of acute cholecystitis, regardless of additional sonographic findings and clinical data.

The SCARD Fellowship Policy and the Abdominal Imaging Fellowship: A Follow-up Survey After the First Year

To assess resident and fellowship program director (PD) perceptions of the abdominal radiology fellowship application process following the first cycle in which an embargo on interviews until December 1, 2019 was set according to the Society of Chairs of Academic Radiology Departments (SCARD) timeline for the 2021-2022 abdominal imaging fellowship year. Eligible study participants included fellowship PDs of all abdominal imaging programs in the United States and residents that attended the Society of Abdominal Radiology (SAR) 2020 Annual Meeting. A questionnaire was developed by content and survey experts, pilot tested, and administered from May to June 2020. A total of 39% (36/92) of all PDs and 30% (46/152) of all individuals identified as residents with valid email addresses that attended the SAR 2020 Annual Meeting responded to the survey with an overall response rate of 34%. Only 42% of PDs and 33% of residents supported moving to a match, while 62% of PDs and 70% of residents thought that a match would limit the autonomy of applicants. While most PDs and residents also agreed that the first iteration of the SCARD timeline allowed residents to make a more informed choice, the majority of PDs were dissatisfied with their experience. Most PDs and residents additionally want applications to be accepted no earlier than July and/or August of the R3 year (initial SCARD guidelines did not restrict timing), interviews to begin on November 1st or earlier of the R3 year (compared to December 1st set in the first iteration of the guidelines), and a gap of 2-4 weeks between the date of first interviews and notification of first offers (initial SCARD guidelines did not restrict timing). Lastly, an overwhelming majority of PDs and residents agreed that SAR should enforce the abdominal imaging fellowship application process. Following the first cycle of abdominal imaging fellowship applications conducted according to the SCARD guidelines, a majority of trainees and PDs felt the changes were favorable and were opposed to a formal match. Specific suggestions for improvement were elicited from stakeholders and will be incorporated for the next cycle.

The awareness of hindfoot malalignment on non-weight-bearing ankle MRI.

Hindfoot malalignment is a relatively common clinical finding and several studies have suggested that hindfoot valgus can be identified on non-weight-bearing ankle MRI. The aim of this study was to determine the awareness of hindfoot malalignment on ankle MRI amongst consultant musculoskeletal radiologists. All MRI studies referred by Foot and Ankle Unit Consultants reported by one of 14 consultant musculoskeletal radiologists between March 2016 and August 2019 were retrieved from the Hospital Radiology Information System. These were reviewed independently by a radiology fellow and a consultant radiologist. Tibiocalcaneal angle (TCA) was measured, and extra-articular talocalcaneal (EA-TCI) and calcaneofibular impingement (EA-CFI) were recorded. Radiology reports were then analysed for mention of hindfoot malalignment and the presence of EA-TCI and EA-CFI. The study group comprised 129 patients, 46 males and 83 females with a mean age of 46.8 years (range 8-84 years). Based on review, hindfoot valgus was present in 78-80 cases (60.5-62%), EA-TCI in 30-36 cases (23.2-27.9%) and EA-CFI in 18-21 cases (14-16.3%). By comparison, MRI reports mentioned hindfoot valgus in 18 cases (2 incorrectly), EA-TCI in 8 cases (1 incorrectly) and EA-CFI in 10 cases (1 incorrectly). Hindfoot valgus, EA-TCI and EA-CFI were present relatively commonly on review of ankle MRI studies in patients referred from a specialist Foot and Ankle Unit but were commonly under-reported highlighting a relative lack of awareness of hindfoot malalignment on ankle MRI amongst musculoskeletal radiologists, which could impact negatively on patient management.

Comprehensiveness of Breast Radiology Fellowship Online Content.

The content of websites for fellowship programs is an important source of information for residents applying to breast imaging fellowship programs (BIFPs). The purpose of this study is to evaluate the comprehensiveness of online content of BIFPs. A list of BIFPs was obtained from the Society of Breast Imaging website. Each program's website was evaluated for the presence of 19 training-relevant content variables. Impact of program characteristics on comprehensiveness scores was determined. For statistical analysis, Kruskal-Wallis tests were used to assess differences in comprehensiveness scores based upon region, and two-tailed t-tests were used to compare based upon program size. A total of 79 BIFP websites were analyzed. The mean comprehensiveness score of BIFP websites based on meeting the 19 criteria was 44.1% (8.4 ± 2.7/19). Program coordinator contact information (72/79, 91.1%), application requirements (71/79, 89.9%), and faculty information (56/79, 70.9%) appeared on >70% of websites. The majority of fellowships had a dedicated webpage for their program (71/79, 89.9%). Information regarding 12 of the 19 criteria appeared on fewer than 50% of websites. Program region (P = 0.32) and size (P = 0.16) were not associated with any differences in mean comprehensiveness score. Additionally, there was no significant difference in scores associated with filling all available positions for the 2020 match cycle (P = 0.77). There is a paucity of information commonly sought out by applicants on the websites of most BIFPs. Both programs and applicants may mutually benefit from increasing comprehensive online content.

Enhancing Education to Avoid Complications in Endovascular Treatment of Unruptured Intracranial Aneurysms: A Neurointerventionalist's Perspective.

It is of utmost importance to avoid errors and subsequent complications when performing neurointerventional procedures, particularly when treating low-risk conditions such as unruptured intracranial aneurysms. We used endovascular treatment of unruptured intracranial aneurysms as an example and took a survey-based approach in which we reached out to 233 neurointerventionalists. They were asked what they think are the most important points staff should teach their trainees to avoid errors and subsequent complications in endovascular treatment of unruptured intracranial aneurysms. One hundred twenty-one respondents (51.9%) provided answers in the form of free text responses, which were thematically clustered in an affinity diagram and summarized in this Practice Perspectives. The article is primarily intended for neurointerventional radiology fellows and junior staff and will hopefully provide them the opportunity to learn from the mistakes of their more experienced colleagues.

The Role of Weightbearing Computed Tomography Scan in Hallux Valgus.

Hyperpronation of the first metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and to understand its association with other standard measurements. Retrospective evaluation of WBCT and weightbearing radiographs (WBXRs) was performed for 20 patients with HV feet and 20 controls with no such deformity. Axial computed tomography images of both groups were compared for the first metatarsal pronation angle (alpha angle) and tibial sesamoid subluxation (TSS) grades. The HV angle (HVA), first-second intermetatarsal angle (IMA), first metatarsal-medial cuneiform angle (MMCA), Meary's angle, and calcaneal pitch (CP) angle of the study and control groups were compared on both WBXR and the corresponding 2-dimensional images of WBCT. All measurements were independently performed by 1 musculoskeletal radiology fellow and 1 foot and ankle surgical fellow. Measurements were averaged and interobserver reliability was calculated. The HV group demonstrated significantly higher values for TSS grade (P < .001) but not for alpha angle (P = .121) compared with controls. Likewise, significantly elevated HVA and IMA were noted in the HV group on both imaging modalities, while no such differences were observed for the CP angle. Higher MMCA and Meary's angle in the HV group were evident only on WBXR (MMCA, P = .039; Meary's, P = .009) but not on WBCT (MMCA, P = .183; Meary's, P = .171).Among all, the receiver operating characteristic (ROC) curves demonstrated the greatest area under the curve (AUC) for HVA, followed by IMA. The alpha angle performed only just outside the range of chance (AUC, 0.65; 95% CI, 0.52-0.69). The Pearson's correlations of the alpha angle, in the HV group, revealed a significant linear relationship with TSS grade and with HVA on WBXR, and only trended toward a weak linear relationship with IMA and with HVA on WBCT. The alpha angle, a measure of abnormal hyperpronation of the first metatarsal, was an independent factor that may coexist with other parameters in HV, but in isolation had limited diagnostic utility. "Abnormal" alpha angles were even observed in individuals without HV. Increases in IMA and MMCA were not necessarily associated with similar increases in alpha angle, despite moderate correlations with TSS grade and HVA on WBXR. Nevertheless, the WBCT was a useful method for assessing hyperpronation and guiding surgical management in individual cases. Level III, retrospective comparative study.

Radiologists Make More Errors Interpreting Off-Hours Body CT Studies during Overnight Assignments as Compared with Daytime Assignments.

Background There is increasing research attention on the impact of overnight work on radiologist performance. Prior studies on overnight imaging interpretive errors have focused on radiology residents, not on the relative performance of board-eligible or board-certified radiologists at night compared with during the day. Purpose To analyze the rate of clinically important interpretation errors on CT examinations of the abdomen, pelvis, or both ("body CT studies") committed by radiology fellows working off-hours based on day or night assignment. Materials and Methods Between July 2014 and June 2018, attending physicians at one tertiary care institution reviewed all body CT studies independently interpreted off-hours by radiologists in an academic fellowship within 10 hours of initial interpretation. Discrepancies affecting acute or follow-up clinical care were classified as errors. In this retrospective study, the error rate for studies interpreted during the day (between 7:00 am and 5:59 pm) was compared with that of studies interpreted at night (between 6:00 pm and 6:59 am). Error rate in the first half of day and night assignments was compared with error rate in the latter half. Statistical analyses used χ2 tests and general estimating equations; significance was defined as P < .05. Results There were 10 090 body CT studies interpreted by 32 radiologists. Forty-four of 2195 daytime studies (2.0%) had errors compared with 240 of 7895 nighttime studies (3.0%; P = .02). Twenty-two of 32 (69%) radiologists had higher error rates for night cases (P = .03). There were more errors in the last half of a night assignment (125 of 3358, 3.7%; P = .002) compared with the first half (115 of 4537, 2.5%). Conclusion On the basis of a subspecialty review, clinically important off-hours body CT interpretation errors occurred more frequently overnight and more frequently in the latter half of assignments, with more radiologists having worse error rates at night compared with the day. © RSNA, 2020 See also the editorial by Bruno in this issue.

A head-to-head comparison of the intra- and interobserver agreement of COVID-RADS and CO-RADS grading systems in a population with high estimated prevalence of COVID-19.

Objective:To evaluate the inter- and intraobserver agreement of COVID-RADS and CO-RADS reporting systems among differently experienced radiologists in a population with high estimated prevalence of COVID-19.Methods and materials:Chest CT scans of patients with clinically–epidemiologically diagnosed COVID-19 were retrieved from an open-source MosMedData data set, randomised, and independently assigned COVID-RADS and CO-RADS grades by an abdominal radiology fellow, thoracic imaging fellow and a consultant cardiothoracic radiologist. The inter- and intraobserver agreement of the two systems were assessed using the Fleiss’ and Cohen’s κ coefficients, respectively.Results:A total of 200 studies were included in the analysis. Both systems demonstrated moderate interobserver agreement, with κ values of 0.51 [95% confidence interval (CI): 0.46–0.56] and 0.55 (95% CI: 0.50–0.59) for COVID-RADS and CO-RADS, respectively. When COVID-RADS and CO-RADS grades were dichotomised at cut-off values of 2B and 4 to evaluate the agreement between grades representing different levels of clinical suspicion for COVID-19, the interobserver agreement became substantial with κ values of 0.74 (95% CI: 0.66–0.82) for COVID-RADS and 0.73 (95% CI: 0.65–0.81) for CO-RADS. The median intraobserver agreement was considerably higher for CO-RADS reaching 0.81 (95% CI: 0.43–0.76) compared with 0.60 (95% CI: 0.43–0.76) of COVID-RADS.Conclusions:COVID-RADS and CO-RADS showed comparable interobserver agreement, which was moderate when grades were compared head-to-head and substantial when grades were dichotomised to better reflect the underlying levels of suspicion for COVID-19. The median intraobserver agreement of CO-RADS was, however, considerably higher compared with COVID-RADS.Advances in knowledge:This paper provides a comprehensive review of the newly introduced COVID-19 chest CT reporting systems, which will help radiologists of all sub-specialties and experience levels make an informed decision on which system to use in their own practice.

The Role of Weight-Bearing Computed Tomography Scan in Hallux Valgus

Category:Midfoot/Forefoot; BunionIntroduction/Purpose:Hyperpronation of the 1st metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and understand its association with other standard measurements.Methods:Retrospective evaluation of WBCT and weightbearing radiographs (WBXR) was performed for 20 patients with hallux valgus (HV) feet and 20 controls with no such deformity. Axial CT images of both groups were compared for 1st metatarsal pronation angle (α angle) and tibial sesamoid subluxation (TSS) grades. The hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), 1st metatarsal-medial cuneiform angle (MMCA), Meary’s angle, and calcaneal pitch (CP) angle of the study and control groups were compared on both WBXR and the corresponding 2D images of WBCT. All the measurements were independently studied by a dedicated musculoskeletal radiology fellow.Results:HV group demonstrated significantly higher values for TSS grade (p < 0.001) but not for α angle (p = 0.19) compared to controls. Pearson’s correlations of the α angle, in the HV group, revealed no significant linear relationship with TSS grades, IMA and MMCA, and only a moderate positive correlation with HVA as per WBXR (r = 0.38, p = 0.014) but not by WBCT (p = 0.084). Also, α angle performed within the range of a chance (AUC 0.64, 95% CI: 0.49 to 0.66) when measured by receiver operating characteristic (ROC) curves.Conclusion:The α angle - a measure of abnormal hyperpronation of the 1st metatarsal - is an independent factor that may co- exist with other parameters in HV, but in isolation has limited diagnostic utility. ‘Abnormal’ α angles may even be observed in individuals without HV deformity. An increase in the HVA, IMA, MMCA or TSS grade is not necessarily associated with a similar increase in the α angle and hence, the severity of HV deformity may not be judged on this parameter alone. The WBCT is a reliable method to assess hyperpronation and guide physicians during surgical management.

Hamstring origin–anatomy, angle of origin and its possible clinical implications

IntroductionThe posterior compartment of the thigh is composed of three major muscles collectively known as the hamstring muscles. These consist of the biceps femoris short and long head, semimembranosus and semitendinosus. Excluding the short head of biceps femoris, the hamstrings contribute to the movement of the hip and the knee joints as they span across both joints. Our hypothesis is that the nature of the conjoint tendon -ischial angle predisposes to an increased risk of tearing in this hamstring component. We therefore aim to look at the anatomy of the hamstring origin at the ischial tuberosity and spatial relationship between the long head of biceps, semitendinosus and semimembranosus in the form of vector angles. Material and methods100 consecutive pelvic MRIs in patients under the age of 40 years were reviewed by musculoskeletal radiology fellow and a consultant musculoskeletal radiologist with more than 10 years’ experience in musculoskeletal radiology and measured the angle of origin of conjoined tendon and semimembranosus at its ischial origin. P value using a paired t-test was less than 0.0001 confirming that the difference in the vector angle of the different hamstring components was statistically significant. ResultsThe median angle of origin of conjoined tendon was 12° and for semimembranosus was 6°. Applying the concept of Newton’s second law to the angles calculated we demonstrated that an increase of 9% force applied to the conjoint tendon origin when compared to the semimembranosus tendon. ConclusionWe hypothesis that the difference in the angle of origin of the components of hamstrings might be one of the reasons for the difference in the incidence and patterns of the injuries of the various muscles of the hamstrings.

Radiologic predictors of in-hospital mortality after traumatic craniocervical dissociation.

Traumatic craniocervical dissociation (CCD) is the forcible dislocation of the skull from the vertebral column. Because most CCD patients die on scene, prognostication for those who arrive alive to hospital is challenging. The study objective was to determine if greater dissociation, based on radiologic measurements of CCD, is predictive of in-hospital mortality among patients surviving to the emergency department. All trauma patients arriving to our Level 1 trauma center (January 2008 to April 2019) with CCD were retrospectively identified and included. Transfers and patients without computed tomography head/cervical spine were excluded. Study patients were dichotomized into groups based on in-hospital mortality. Radiologic measurements of degree of CCD were performed based on the index computed tomography scan by an attending radiologist with Emergency Radiology fellowship training. Measurements were compared between patients who died in-hospital versus those who survived. After exclusions, 36 patients remained: 12 (33%) died and 24 (67%) survived. Median age was 55 years (30-67 years) versus 44 (20-61 years) (p = 0.199). Patients who died had higher Injury Severity Score (39 [31-71] vs. 27 [14-34], p = 0.019) and Abbreviated Injury Scale head/neck score (5 [5-5] vs. 4 [3-4], p = 0.001) than survivors. The only radiologic measurement that differed between groups was greater soft tissue edema at mid C1 among patients who died (12.37 [7.60-14.95] vs. 7.86 [5.25-11.61], p = 0.013). Receiver operating characteristic curve analysis of soft tissue edema at mid C1 and mortality revealed 10.86 mm or greater of soft tissue width predicted mortality with sensitivity and specificity of 0.75. All other radiologic parameters, including the basion-dens interval, were comparable between groups (p > 0.05). Among patients who arrive alive to hospital after traumatic CCD, greater radiologic dissociation is not associated with increased mortality. However, increased soft tissue edema at the level of mid C1, particularly 10.86 mm or greater, is associated with in-hospital death. These findings improve our understanding of this highly lethal injury and impart the ability to better prognosticate for patients arriving alive to hospital with CCD. Prognostic and Epidemiological, Level III.

Parental Leave and Neuroradiology Fellowships.

A uniform policy on parental leave in radiology training programs is lacking. Although previous publications have addressed the status of parental leave policy among radiology residency programs, the state of parental leave in radiology fellowships has not been addressed to date. Our aim was to determine the state of parental leave policies in American neuroradiology fellowship programs. An Internet survey was sent to the directors of neuroradiology fellowship programs listed on the Accreditation Council for Graduate Medical Education Web site (n = 87) in January 2020. The questionnaire assessed the policies of the fellowship programs and Program Directors' attitudes toward maternal and paternal leave. Four reminders were sent during the 3 weeks before closing data collection. The response rate was 76% (66/87). Ninety-four percent (62/66) of program directors claimed to have a maternal leave policy, of which 51/62 (82%) were written and 53/62 (85%) were paid. Additionally, 77% (51/66) had a policy for paternal leave, of which 80% (41/51) were written and 76% (39/51) were paid. The average length of paid leave was 6.7 ± 3.25 weeks for new mothers and 2.9 ± 2 weeks for new fathers. Unpaid leave was mostly based on the Family and Medical Leave Act. Fellows were responsible for making up call duties during the parental leave in 47% of the programs. Radiation exposure was restricted in 89% of the programs during pregnancy. Policies addressed breast feeding and untraditional parenthood in just 41% of the responding programs. Most program directors supported the development of a unified national policy on maternal (83%) and paternal (79%) leave. Most neuroradiology fellowship programs have explicit maternal and paternal leave policies that grant paid leave to trainees. Some also offer unpaid leave, mostly through Family and Medical Leave Act guidelines. A uniform policy derived from the Accreditation Council for Graduate Medical Education and/or American Board of Radiology would be useful and overwhelmingly accepted.

Non-interventional Radiology Fellowship Programs: What Is Out There?

ObjectiveTo determine the spectrum of non-interventional radiology fellowship programs in institutions that offer both a radiology residency program and one or more non-interventional radiology fellowship programs. MethodsInstitutions offering both radiology residency and non-interventional radiology fellowship programs were identified using publicly available websites. The non-interventional radiology fellowship programs were categorized into “traditional” (neuroradiology, breast imaging, abdominal imaging, musculoskeletal imaging, thoracic imaging, pediatric radiology, and nuclear medicine) and “nontraditional” fellowship programs. The nontraditional programs were stratified into four categories: a) Combinations of traditional fellowships; b) Focused nontraditional fellowships; c) Combinations of traditional and focused nontraditional fellowships (excluding traditional-traditional combinations); and d) Mandatory two-year fellowships. The distributions of the different types of traditional and nontraditional fellowship programs were evaluated. Results555 fellowship programs were identified in 113 institutions that offered both radiology residency and non-interventional radiology fellowship programs. 73.33% (407/555) of the programs were traditional fellowships, and 26.66% (148/555) were nontraditional fellowships. The 148 nontraditional fellowship programs were comprised of 41 different types of programs, 23 types of which were unique to and offered exclusively at specific institutions. 38.08% of the traditional fellowship programs were Accreditation Council for Graduate Medical Education (ACGME) accredited, while only 16.21% (24/148) of the nontraditional fellowship programs were ACGME-accredited. ConclusionsThe nontraditional non-interventional radiology fellowship programs are formed by a heterogeneous group of programs, some of which are offered exclusively at a single institution. Awareness of the types of existing programs would help radiology residents in making a more informed decision regarding their fellowship training.

How well do we represent ourselves: an analysis of musculoskeletal radiology fellowships website content in Canada and the USA.

Radiology residents review information available on fellowship program websites for shortlisting programs and for applying for fellowships. The aim of this study was to evaluate the comprehensiveness of musculoskeletal (MSK) fellowship program websites. The content of US and Canadian MSK fellowship program websites was evaluated using 25 distinct criteria in the following domains: application, recruitment, research, clinical, education, clinical work, benefits. Programs without websites were excluded from analysis. In Canada and the USA, there were 100 MSK fellowship programs, 90 of them having dedicated websites. The average score across all programs was 9.5/25 or 38%. The most comprehensive program included 18/25 items or 72%. The least comprehensive program included only 1/25 items or 4%. The median score across all programs was 9/25 or 36%.More programs included information on the application process (65.5/90, 72.8%; SD 24.7%) than in education/research (24/90, 26.7%; SD 17.3%) or incentives (12.5/90, 13.9%; SD 7.8%).Mean scores amongst US schools did not differ based on geographical distribution (p = 0.32), although they did by rank; schools ranked in the bottom tier scored lower than the unranked, middle, and top tier schools (p < 0.05). The majority of MSK fellowship program websites are not comprehensive. Areas that needed the most improvement include incentives, education/research, clinical teaching, and recruitment information. Addressing these insufficiencies can help programs in easing the application process for prospective fellows and enhance recruitment.

Advertise Right by Addressing the Concerns: An Evaluation of Women's/Breast Imaging Radiology Fellowship Website Content for Prospective Fellows

PurposeFellowship is an important part of postgraduate medical training as it facilitates advanced training in a subspecialty of interest. Internet is the most readily available and frequently used tool for acquiring information about the fellowship programs by residents worldwide. The aim of this study was to analyze the content of the websites of American and Canadian breast/women's imaging fellowship programs. MethodsThe content of active Canadian and American breast/women's imaging fellowship websites was collected and analyzed in August 2019 using 27 different criteria in the categories of application process, recruitment, education, research, clinical work, and incentives. The fellowship program without a webpage were excluded from the study. ResultsOut of 76 active breast/women's imaging Radiology fellowship programs in the US and Canada, 75 had dedicated fellowship websites available for analysis. One program was excluded due to lack of a dedicated website. On average, websites showcased 11 of the 27 criteria (40.0%). The category with the least prevalent information was incentives especially career placement after completion of the fellowship (1/75, 1.3%). Majority of the programs around 80.0% (60/75) had adequate information about the application process and requirements.The mean number of schools satisfying the different groups of criteria differed (P< 0.01); more schools satisfied the application criteria (60.5/75; 79.6% ± 20.3%) than the incentives (12.8/75; 16.8% ± 8.2%) and recruitment (24.5/75; 32.2% ± 29.7%) criteria. ConclusionMajority of the breast and women's imaging fellowship websites lack important information. Providing comprehensive online information about the program and application process may help the applicants to choose the best suited program for their academic needs and career progression.

Canadian and American Emergency Radiology Fellowship Websites: An Evaluation of Content

PurposeThe internet is commonly employed by Radiology trainees to investigate and learn about potential fellowship programs. As a new and emerging subspecialty, Emergency Radiology requires strong internet presence and training program website content. This is vital to ensure good exposure of the fellowship programs to inform medical students, radiology trainees, and program directors, highlight unique aspects of a fellowship and raise awareness of the discipline at large. MethodsTo assess the standard and depth of information available online, Canadian and American Radiology fellowship websites were evaluated for content. Thirty-six criteria related to application process and recruitment, departmental structure, incentives, education, and research and clinical training were evaluated for presence or absence. ResultsSixteen Emergency Radiology fellowship program websites were assessed from the United States and Canada for 36 criteria across 5 individual areas; application process and recruitment, departmental structure, incentives, education and research, and clinical training. Overall there was an absence of information found across all 5 areas. In particular areas for improvement were identified in education and research, and incentives both with median values of 12.5% of criteria present. ConclusionMost Emergency Radiology fellowship program websites demonstrate several information deficiencies. This relative lack of comprehensive information represents an actionable opportunity for individual programs and the field to better educate trainees, program directors and the public about the unique training of Emergency Radiologists.

Interobserver Reliability of the Coronary Artery Disease Reporting and Data System in Clinical Practice.

This study aimed to evaluate interobserver reproducibility between cardiothoracic radiologists applying the Coronary Artery Disease Reporting and Data System (CAD-RADS) to describe atherosclerotic burden on coronary computed tomography angiography. Forty clinical computed tomography angiography cases were retrospectively and independently evaluated by 3 attending and 2 fellowship-trained cardiothoracic radiologists using the CAD-RADS lexicon. Radiologists were blinded to patient history and underwent initial training using a practice set of 10 subjects. Interobserver reproducibility was assessed using an intraclass correlation (ICC) on the basis of single-observer scores, absolute agreement, and a 2-way random-effects model. Nondiagnostic studies were excluded. ICC was also performed for CAD-RADS scores grouped by management recommendations for absent (0), nonobstructive (1 to 2), and potentially obstructive (3 to 5) CAD. Interobserver reproducibility was moderate to good (ICC: 0.748, 95% confidence interval [CI]: 0.639-0.842, P<0.0001), with higher agreement among cardiothoracic radiology fellows (ICC: 0.853, 95% CI: 0.730-0.922, P<0.0001) than attending radiologists (ICC: 0.711, 95% CI: 0.568-0.824, P<0.0001). Interobserver reproducibility for clinical management categories was marginally decreased (ICC: 0.692, 95% CI: 0.570-0.802, P<0.0001). The average percent agreement between pairs of radiologists was 84.74%. Percent observer agreement was significantly reduced in the presence (M=62.22%, SD=15.17%) versus the absence (M=80.91%, SD=17.97%) of modifiers, t(37.95)=3.566, P=0.001. Interobserver reliability and agreement with the CAD-RADS terminology are moderate to good in clinical practice. However, further investigations are needed to characterize the causes of interobserver disagreement that may lead to differences in management recommendations.

Evaluation of Musculoskeletal Radiology Fellowship Websites

ObjectiveMaintaining a complete musculoskeletal (MSK) radiology fellowship website is important for recruiting residents, particularly given implementation of the new MSK Match. The purpose of this study was to evaluate the comprehensiveness of MSK fellowship program websites during the first MSK Fellowship Match. Materials and MethodsA list of MSK fellowships was obtained from the Society for Skeletal Radiology website. Each program's website was searched for the presence of 23 criteria previously identified as important for radiology residents applying to fellowships (Table 1); including information about the application process, program benefits, clinical and research training, and current fellows and faculty. We used t-tests and ANOVA to compare mean number of criteria present on websites between ACGME nonaccredited and accredited programs. ResultsOf 89 MSK fellowship programs (15 accredited vs 74 nonaccredited), 81 (91%) had a dedicated MSK fellowship website. Only 6 (7%) assessed at least two-thirds of criteria. The most frequently included information included contact information (100%, 89/89), program description (97%, 86/89), application requirements (92%, 82/88), and length of fellowship (91%, 81/89). The least common information included elective offerings (11%, 10/89), moonlighting opportunities (9%, 8/89), social life (9%, 9/89), and a listing of fellow/faculty publications (9%, 8/89). Nonaccredited programs reported significantly more items than accredited programs (12.3 vs 10.2, P = 0.022). ConclusionsMSK fellowship websites are inadequately comprehensive, with less than half of assessed criteria present, on average. Inclusion of key factors known to be important to radiology residents can serve as opportunities for MSK fellowship websites to better recruit residents.

Analysis of musculoskeletal radiology fellowship websites.

Due to the relative lack of standardization in the fellowship application processes for musculoskeletal radiology, program websites are of paramount importance as application resources. This study evaluates the comprehensiveness of these websites and the potential effects of program ACGME accreditation, region, and size on website comprehensiveness. The websites of musculoskeletal fellowship programs listed on the Society of Skeletal Radiology website were assigned a validated comprehensiveness score based on the presence of 19 specific informative components pertaining to the program's characteristics. The correlations of comprehensiveness scores with program ACGME accreditation, region, and size were evaluated. A total of 90 musculoskeletal radiology fellowship program websites were reviewed, yielding a mean comprehensiveness score of 55.1% (10.5 out of 19 criteria). Only 3 of the 19 criteria-application information (88.9%), stand-alone webpage (87.8%), and affiliated hospital information (84.4%)-were present in more than 80% of all websites. Eleven criteria, most notably away rotation information (6.7% presence) and case log (0.0% presence), were absent from at least 50% of all websites. Program ACGME accreditation was correlated with significantly higher website comprehensiveness scores compared with non-accreditation (p = 0.087). There is lack of sufficient, useful information and standardization on the websites of MSK fellowship programs throughout the country. According to our review and analysis, addition of specific information regarding each fellowship program and implementing some type of standardization may optimize fellowship matching for both applicants and the programs.