Textbook Of Radiology Research Articles

Testing the Ability and Limitations of ChatGPT to Generate Differential Diagnoses from Transcribed Radiologic Findings.

Background The burgeoning interest in ChatGPT as a potentially useful tool in medicine highlights the necessity for systematic evaluation of its capabilities and limitations. Purpose To evaluate the accuracy, reliability, and repeatability of differential diagnoses produced by ChatGPT from transcribed radiologic findings. Materials and Methods Cases selected from a radiology textbook series spanning a variety of imaging modalities, subspecialties, and anatomic pathologies were converted into standardized prompts that were entered into ChatGPT (GPT-3.5 and GPT-4 algorithms; April 3 to June 1, 2023). Responses were analyzed for accuracy via comparison with the final diagnosis and top 3 differential diagnosis provided in the textbook, which served as the ground truth. Reliability, defined based on the frequency of algorithmic hallucination, was assessed through the identification of factually incorrect statements and fabricated references. Comparisons were made between the algorithms using the McNemar test and a generalized estimating equation model framework. Test-retest repeatability was measured by obtaining 10 independent responses from both algorithms for 10 cases in each subspecialty, and calculating the average pairwise percent agreement and Krippendorff α. Results A total of 339 cases were collected across multiple radiologic subspecialties. The overall accuracy of GPT-3.5 and GPT-4 for final diagnosis was 53.7% (182 of 339) and 66.1% (224 of 339; P < .001), respectively. The mean differential score (ie, proportion of top 3 diagnoses that matched the original literature differential diagnosis) for GPT-3.5 and GPT-4 was 0.50 and 0.54 (P = .06), respectively. Of the references provided in GPT-3.5 and GPT-4 responses, 39.9% (401 of 1006) and 14.3% (161 of 1124; P < .001), respectively, were fabricated. GPT-3.5 and GPT-4 generated false statements in 16.2% (55 of 339) and 4.7% (16 of 339; P < .001) of cases, respectively. The range of average pairwise percent agreement across subspecialties for the final diagnosis and top 3 differential diagnosis was 59%-98% and 23%-49%, respectively. Conclusion ChatGPT achieved the best results when the most up-to-date model (GPT-4) was used and when it was prompted for a single diagnosis. Hallucination frequency was lower with GPT-4 than with GPT-3.5, but repeatability was an issue for both models. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Chang in this issue.

Composing Radiographic Dictionary for Radiology Students and Radiographers

The rapid development of science and technology on radiology requires radiology students in particular and radiographers in general to be able to understand and master the science and technology through books or scientific articles, which are mostly written in English. To help them understand the radiological scientific information easily, a complete basic terminologies dictionary on radiology is needed. This study aimed to analyze the vocabularies contained in radiology textbooks linguistically which then are compiled into a radiological pocket dictionary. This research used a qualitative descriptive method. Data were taken in the form of vocabulary list resulted from previous research conducted by the author on radiology textbooks in 2019. This research had 7 stages of activities which include syntactic, morphological, semantic, and phonetic analysis. In addition, the vocabularies then went through 2 stages of evaluation to check the perfection of words regarding to their writing, meaning, and pronunciation. Furthermore, each vocabulary was given an example of its use in the form of sentences in the context of radiology. Results of the study in the form of a pocket dictionary consisting list of basic radiological vocabulary/terms accompanied by the syntactic categories, the meaning of words in Indonesian language that are in accordance with the scientific context of radiology, phonetic transcription, and examples of the use of words in sentences in the context of radiology are expected to contribute to improving the quality of human resources of radiographers in Indonesia.

On Selecting, Ranking, and Quantifying Features for Building a Liver CT Diagnosis Aiding Computational Intelligence Method

The liver is one of the most common locations for incidental findings during abdominal CT scans. There are multiple types of disease that can arise within the liver and many of them are nodular. The ultimate goal of our research is to develop an expert knowledge-based system using fuzzy signatures, to support decisions during diagnosis of the most frequent of these nodular lesions. Since the literature contains limited information about the graphical properties of CT images that must be taken into consideration and their relationship to one another, in this paper we focused on selecting and ranking the input parameters using expert knowledge and determining their importance. Six visual attributes of lesions (size, shape, density, homogeneity contour, and other features) were selected based on textbooks of radiology and expert opinion. The importance of these attributes was ranked by radiologist experts using questionnaires and a pairwise comparison technique. The most important feature was found to be the density of the lesion on the various CT phases, and the least important was the size, the order of the other attributes was other features, contour, homogeneity, and shape, with a Kendall concordance coefficient of 0.612. Weights for the attributes, to be used in the future fuzzy signatures, were also determined. As a last step, several statistical parameter-based quantities were generated to represent the above abstract attributes and evaluated by comparing them to expert opinions.

Diagrammatic Approach to Delineate Phrenic Nerve in Central Lung Tumors

Incremental use of high-dose radiation therapy (RT) with SABR in thoracic tumors has led to identification of many unusual toxicities (chest wall pain, rib fractures, vascular perforation, brachial plexopathy) and consequently additional organs at risk (OARs; chest wall, ribs, bronchial wall, carotid artery, brachial plexus). Phrenic nerve is another structure that may be affected at any point during its long course from origin until end, although symptomatic toxicities have been reported rarely in the setting of reirradiation, large-volume irradiation such as mantle field, or SABR. We undertook a prospective study to describe the delineation of phrenic nerve course on RT planning computed tomography scan as an OAR. An anonymized RT planning computed tomography scan of neck and thorax (1.5-mm slice thickness, intravenous contrast) was used for the study. Radiology textbooks and publications were reviewed, and the course was delineated with the help of 2 radiologists and 6 radiation oncologists well versed with thoracic radiologic anatomy. A step-by-step description in the form of a pictorial essay is given. The adjacent structures including cervical vertebrae, cervical and mediastinal vessels, lungs, heart, and so on were identified, and the course of phrenic nerve on either side is described in relation to these structures. Delineation of the phrenic nerve as an OAR is challenging but feasible. We recommend routine delineation of the phrenic nerve as an OAR during thoracic RT. Although specific dose constraints are not known yet, unnecessary dose to the same during RT planning should be minimized.

Right External Carotid Artery Originated Right Superior Thyroid Artery in Cadavers of a Medical College in Nepal: A Descriptive Cross-sectional Study.

External carotid artery originated superior thyroid artery are frequently documented in classical anatomical, surgical and radiological textbooks. Knowledge of anatomical variations, proper identification of superior thyroid arteries is very important to avoid major complications during and after neck surgeries. The aim of the study is to find out the prevalence of right superior thyroid artery originating from right external carotid artery in cadavers of a Medical College in Nepal. A descriptive cross-sectional study was carried out at the department of anatomy in Universal College of Medical Sciences, Bhairahawa, Nepal from October 2020 to January 2021 after ethical clearance from the same institution (IRC UCMS, Ref: UCMS/IRC/078/20). Variations in origin of superior thyroid arteries were observed, recorded and photographed. Convenient sampling method was used. Data was analyzed using Microsoft Excel 2016. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage. Out of 30 right superior thyroid arteries of 30 cadavers, 27 (90%) at 90% Confidence Interval (80.22-96.44) originates from right external carotid artery. In our study we observed that almost nine tenths of right superior thyroid arteries originated from the right external carotid artery which was relatively high in comparison to other studies. Thus, Extensive knowledge of variations in origin of superior thyroid artery is important for surgeons prior to various interventional surgeries.

Penggunaan Linguistik Korpus dalam Mempersiapkan Bahan Ajar English For Specific Purpose Di Bidang Radiologi

Minimnya buku ajar English for Specific Purpose yang berkenaan dengan bidang radiologi yang sesuai untuk mahasiswa program studi radiologi di Indonesia menjadi tantangan bagi para dosen pengajar Bahasa Inggris di program studi radiologi Politeknik Al Islam Bandung. Untuk mengantisipasi keterbatasan bahan ajar ESP di bidang radiologi tersebut maka dilakukan penelitian terhadap buku teks radiologi yang berbahasa Inggris dengan menggunakan linguistik korpus sebagai alat untuk mendapatkan kosa kata di bidang radiologi serta gramatika dan fitur kelas kata yang digunakan dalam buku tersebut. Metode yang digunakan dalam penelitian ini adalah metode gabungan antara kuantitatif yang diaplikasikan di awal penelitian serta metode kualitatif yang digunakan pada proses analisis untuk mendapatkan simpulan. Hasil penelitian menunjukkan bahwa terdapat 12.395 kata berbeda yang digunakan dengan total jumlah kata secara keseluruhan termasuk kata yang diulang-ulang adalah sebanyak 428.117 kata. Kata-kata tersebut diklasifikasikan ke dalam kelas kata nomina, verba, ajektiva, adverbia, singkatan, dan lain-lain. Secara garis besar, dari hasil tersebut diantaranya ditemukan adanya penggunaan kalimat aktif dan pasif, tenses yang meliputi present, present continuous tense, past tense, present perfect, auxiliary verbs, countable dan uncountable noun, dan comparative degree. Selanjutnya, hasil analisis ini akan digunakan untuk menyusun bahan ajar ESP bidang radiologi.

Designing a Structured System for Mammography Reporting

Background: Breast cancer is among the top causes of cancer-related mortality among females in both developed and developing countries. Screening for breast cancer plays a crucial role in the prevention of disease burden. Among various imaging modalities, mammography is currently considered the first step for the detection of breast lesions. The mammography data of breast cancer patients encompass a wide array of texts related to specific visual findings. Accordingly, unorganized mammography documents usually impede physicians’ efforts to fully review the previous information in follow-up visits; hence, this not only affects clinical judgment and treatment planning adversely, but also adds to the financial burdens and workload imposed on the healthcare system. This further highlights the great potential of structured mammography reporting in the management of breast cancer patients. Methods: In the first step, an expert panel consisting of two attending radiologists and a health informatician (all affiliated to the Shiraz University of Medical Sciences, Shiraz, Iran) reviewed related guidelines to determine the appropriate items, ontologies, and standard formats for data entry. These included radiology textbooks and the systematized nomenclature of medicine (SNOMED). In addition, 100 mammography reports were completely examined for data extraction and the creation of a template report. In the next step, the structure of the data registry was discussed among a group of radiologists and breast cancer surgeons during several sessions using Delphi technique. Results: Overall, 119 fields were selected for data entry. Our survey showed that all of the contributing physicians believed that a structured reporting system for mammography can help standardize and reduce reporting time and errors. Following the completion of the template, a user interface was developed by the expert panel for integration in the cloud software workflow, which will be deployed and assessed in the next phase of the project. Conclusion: Structured mammography reporting helps radiologists and surgeons to efficiently and confidently track the management course of their patients. In addition, with the advancement of artificial intelligence, especially deep learning for image classification, clean and labeled image databases can be used for designing computer-assisted decision support systems without significant data preprocessing.

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.

Improving visual observation skills through the arts to aid radiographic interpretation in veterinary practice: A pilot study.

Radiographic interpretation is a perceptual and cognitive skill. Recently core veterinary radiology textbooks have focused on the cognitive (i.e., the clinical aspects of radiographic interpretation) rather than the features of visual observation that improve identification of abnormalities. As a result, the skill of visual observation is underemphasized and thus often underdeveloped by trainees. The study of the arts in medical education has been used to train and improve visual observation and empathy. The use of the arts to improve visual observation skills in Veterinary Science has not been previously described. Objectives of this pilot study were to adapt the existing Visual Arts in Health Education Program for medical and dental students at the University of Melbourne, Australia to third year Doctor of Veterinary Medicine students and evaluate their perceptions regarding the program's effects on visual observation skills and confidence with respect to radiographic interpretation. This adaptation took the form of a single seminar given to third year Doctor of Veterinary Medicine students. Following the seminar, students reported an improved approach to radiographic interpretation and felt they had gained skills which would assist them throughout their career. In the year following the seminar, written reports of the students who attended the seminar were compared with reports from a matched cohort of students who did not attend the seminar. This demonstrated increased identification of abnormalities and greater description of the abnormalities identified. Findings indicated that explicit training in visual observation may be a valuable adjunct to the radiology training of Doctor of Veterinary Medicine students.

Textbook of radiology for residents and technicians

Textbook of radiology for residents and technicians

Systematic viewing in radiology: seeing more, missing less?

To prevent radiologists from overlooking lesions, radiology textbooks recommend “systematic viewing,” a technique whereby anatomical areas are inspected in a fixed order. This would ensure complete inspection (full coverage) of the image and, in turn, improve diagnostic performance. To test this assumption, two experiments were performed. Both experiments investigated the relationship between systematic viewing, coverage, and diagnostic performance. Additionally, the first investigated whether systematic viewing increases with expertise; the second investigated whether novices benefit from full-coverage or systematic viewing training. In Experiment 1, 11 students, ten residents, and nine radiologists inspected five chest radiographs. Experiment 2 had 75 students undergo a training in either systematic, full-coverage (without being systematic) or non-systematic viewing. Eye movements and diagnostic performance were measured throughout both experiments. In Experiment 1, no significant correlations were found between systematic viewing and coverage, r = −.10, p = .62, and coverage and performance, r = −.06, p = .74. Experts were significantly more systematic than students F2,25 = 4.35, p = .02. In Experiment 2, significant correlations were found between systematic viewing and coverage, r = −.35, p < .01, but not between coverage and performance, r = .13, p = .31. Participants in the full-coverage training performed worse compared with both other groups, which did not differ between them, F2,71 = 3.95, p = .02. In conclusion, the data question the assumption that systematic viewing leads to increased coverage, and, consequently, to improved performance. Experts inspected cases more systematically, but students did not benefit from systematic viewing training.

Interpretive Versus Noninterpretive Content in Top-Selling Radiology Textbooks: What Are We Teaching Medical Students?

There are little data as to whether appropriate, cost effective, and safe ordering of imaging examinations are adequately taught in US medical school curricula. We sought to determine the proportion of noninterpretive content (such as appropriate ordering) versus interpretive content (such as reading a chest x-ray) in the top-selling medical student radiology textbooks. We performed an online search to identify a ranked list of the six top-selling general radiology textbooks for medical students. Each textbook was reviewed including content in the text, tables, images, figures, appendices, practice questions, question explanations, and glossaries. Individual pages of text and individual images were semiquantitatively scored on a six-level scale as to the percentage of material that was interpretive versus noninterpretive. The predominant imaging modality addressed in each was also recorded. Descriptive statistical analysis was performed. All six books had more interpretive content. On average, 1.4 pages of text focused on interpretation for every one page focused on noninterpretive content. Seventeen images/figures were dedicated to interpretive skills for every one focused on noninterpretive skills. In all books, the largest proportion of text and image content was dedicated to plain films (51.2%), with computed tomography (CT) a distant second (16%). The content on radiographs (3.1:1) and CT (1.6:1) was more interpretive than not. The current six top-selling medical student radiology textbooks contain a preponderance of material teaching image interpretation compared to material teaching noninterpretive skills, such as appropriate imaging examination selection, rational utilization, and patient safety.

The early history of odontogenic ghost cell lesions: from Thoma to Gorlin.

To reappraise the early history of odontogenic ghost cell lesions (OGCL), the extensive world literature published from 1838 to 1962 was reviewed. In light of the long history of OGCL, the term "calcifying epithelioma of Malherbe" first appeared in a 1931 French report, and the term "ghost cells" had its origin in two American seminal articles by Thoma and Goldman in 1946. Although Gorlin et al. coined the term "calcifying odontogenic cyst" (COC) in 1962, this type of cyst was initially reported three decades earlier by Rywkind in Russia, and almost concurrently by Blood good in the United States and Sato in Japan. In 1948, Willis provided the initial histological evidence of a peripheral COC in his British pathology textbook. Credit for the earliest clinical presentation of odontoma associated calcifying cystic odontogenic tumor belongs to the American radiology textbook by Thoma in 1917. A Scandinavian journal report published in 1953 by Husted and Pindborg was the first to address a dentinogenic ghost cell tumor, and its peripheral counterpart was originally reported in the Swiss literature 7 years later. The current concept of COC was undoubtedly established by Gorlin et al. but the history of OGCL really started with Thoma's pioneering work about a century ago.

Pocket Atlas of Sectional Anatomy: Computed Tomography and Magnetic Resonance Imaging, Volume I: Head and Neck; Volume II: Thorax, Heart, Abdomen, and Pelvis, 4th edn Edited By Torsten B.Moeller &amp; EmilReif, Vol I: 342 pages, Vol II: 351 pages. Thieme Medical Publishers, Stuttgart, Germany, 2013.

Guaranteed: if you are a medical student, you will at some point be presented with a radiograph or imaging display by a resident doctor or consultant asking that time-honored apprehension-inducing question: can you tell me what you see? If you are a resident doctor or consultant, chances are you will at some point be presented with a referral letter and a radiograph or imaging report by a patient asking that time-honored question: can you tell me what is wrong? On such occasions, most students or resident doctors would perhaps wish that they had an atlas in their pocket. It is in the pockets of white coats that Drs. Torsten Moeller and Emil Reif of the Radiology department in Marienhaus Klinikum, Germany hope their Pocket Atlas of Sectional Anatomy will establish natural and perpetual residence. The authors have just released the fourth edition of a 3-volume set of computed tomography and magnetic resonance images of the body of which volumes 1 and 2 were provided for this review. Volume 1 covers the Head and Neck region, contains 792 illustrations and weighs in at 342 pages while volume 2 contains 599 illustrations in 351 pages that deal with the Thorax, Abdomen and Pelvis. Special magnetic resonance imaging such as cholangiopancreatography and urography, as well as MR angiography and MR mammography also receive attention in the book. In keeping with current trends, both volumes are available as printed copies or else as digital download files. Use of digital versions requires the proprietary application VitalSource BookShelf which is available free to download for desktop or tablets; in my hands, I found the application easy and straightforward enough to use on desktop and tablet. However, the digital versions of the book are associated with an annual subscription. Dr. Moeller has done an extraordinary job of rendering the radiographic images in illustrated color diagrams. Presentation of the images is systematic and uniform. Only normal anatomy is depicted in the images. Every plane is addressed: sagittal, coronal, axial, and transverse. Each CT or MR slice is laid out on 2 pages. The first page shows the image, the plane and level at which the slice was obtained, and in many instances a minimally annotated miniature (thumbnail) illustration that demonstrates lymph nodes and organ segments. The second page shows a larger fully annotated colored illustration that demonstrates and identifies all the anatomical structures depicted on the image. Muscles, bones, nerves, vessels and lymph nodes are all depicted in the illustrations and appropriately colored. Care was also taken in conforming to anatomical and clinical conventions for numbering cardiac vessels and mediastinal lymph nodes. Anyone expecting to see traditional regional anatomy groupings of the material in the book may be a bit disappointed. Images from planes through the face are collectively classified with the ‘Neck’, while imaging of the head is classified with ‘Cranium’ which includes the brain. So to whom are the books directed at? As anatomy atlases go, it is quite good. It does an excellent job of placing all of the complex interpretation of radiological imaging of morphology in one location. Anatomists will find the books especially useful for teaching radiographic anatomy and correlation. Medical students taking anatomy and rotating through radiology clerkships will find this book very useful because of the way the imaging is tied to detailed diagrammatic representation of the anatomy. Along with resident doctors and imaging specialists, they will also find the book helpful for reference. The absence however of explanatory text in this atlas means that its value is greatest as an accompanying resource to a textbook of radiology or radiographic anatomy. In my opinion, the books successfully strike a very good balance between needs and trends. It displays imaging modalities that are part of the practice of modern medicine today, ties that to detailed interpretative and correlative anatomy, contains excellently illustrated anatomy of the body, and is available in hard copy and electronic formats for today's mobile digital age. It certainly should be part of the collection for anatomists who teach radiographic anatomy and clinicians who need ready and rapid access to reference information on imaging. Once Dr. Moeller has had a chance to recover from the exertions of the incredibly wonderful use of the thenar, hypothenar, lumbrical and interosseous muscles that went into the making of these books, I wonder whether Drs. Moeller and Reif could be persuaded to consider publishing an atlas of imaging for clinico-pathological conditions and diseases?

Prevertebral Soft Tissue Thickness among Pediatric Patients

Objective: This study aimed to determine the prevertebral soft tissue thickness among normal patients aged 0-14 years old in a tertiary government training hospital, to compare these values with divergent criteria in the standard otorhinolaryngology and radiology texts used in our institution, and to recommend adoption of a set of criteria based on the results. &#x0D; Methods&#x0D; Study Design: Descriptive Study&#x0D; Setting: Tertiary Government Hospital &#x0D; Subjects and Methods: Lateral cervical radiographs taken from May 2007 to August 2009 which were initially read as normal were collected. Fifty (50) patients, 39 males and 11 females, aged 0-14 years old meeting inclusion criteria were reviewed and prevertebral soft tissue thicknesses (PVST) and cervical vertebral body diameter at levels C2, C5, C6 were measured and compared to criteria set by standard otorhinolaryngology and radiology textbooks. &#x0D; Results: The average PVST at C2 ranged from 4.02 mm for 2–3 year-olds (n= 2) to 8.16 mm for 1 –2 year-olds (n=2). The average PVST at C5 ranged from 8.11mm for 1–2 year-olds to 10.75 mm for for 0-1 year-olds. The average PVST at C6 ranged from 7.13 mm for 1 – 2 year-olds to 10.36 mm for 0-1 year-olds. Only 12% of the patients satisfied the criteria set by Keats and Lusted, while 100% satisfied Duncan’s criteria, 94% and 98% satisfied Wippold’s 1st and 2nd criteria respectively. &#x0D; Conclusion: All of the PVST criteria mentioned in Cummings’ Textbook of Otorhinolaryngology Head and Neck Surgery had a more than 90% accuracy compared to only 12% for those mentioned in Keats and Lusted’s Atlas of Roentgenographic Measurement. Therefore, we recommend the use of any criteria for PVST contained in the former over the latter. &#x0D; Keywords: Prevertebral soft tissue thickness, cervical vertebra

E.A. Dunnebier: Imaging for otolaryngologists

This is a paperback atlas of radiology for otolaryngologists that covers both normal anatomy and frequent pathological findings. The interesting background is that this book was written by an otolaryngologist supplemented by two radiologists. Therefore, the text focuses on the practical needs of otolaryngological surgeons and avoids the usual plethora of nice but irrelevant illustrations that are usually to be found in radiological textbooks. Instead, it summarizes the key concepts of head and neck imaging in a highly readable and easily accessible way. The basic range of essential otolaryngologic imaging is discussed. However, ultrasound, PET and PET–CT, angiography and magnetic resonance angiography are not covered at all. The central focus is on essential radiological anatomy and image interpretation, including disease-specific characteristics of CT and MRI, the features necessary for successful diagnosis, and the implications for surgery. CT is discussed in more detail than MRI. Each of the 465 high-quality images is clearly labeled, and where appropriate comparisons are made between CT scans and MR images to show complementary functions and limitations. Unfortunately, the section on neck imaging focuses on CT only, while MRI imaging is only discussed for salivary gland disorders. The text is divided into five sections that guide the reader through basic considerations regarding imaging techniques and interpretation, the temporal bone, skull base, nose and paranasal sinuses, and neck structures. All clinical sections are consistently structured for easy reading: normal anatomy is given in separate sections, followed by frequent/common diseases and then less frequent yet instructive entities. The presentation of each disease follows a standardized layout with concise explanatory text on how to choose the most appropriate imaging modality, potential differential diagnoses, and points of evaluation. The author concentrates on key topics that are of immediate interest to otolaryngologists, particularly on the choice of imaging modalities, interpretation of relevant findings, and topographical analysis. In his preface, the author states that ‘‘this book is an illustrated guide to radiologic anatomy of the head and neck as visualized on the most frequently used radiological modalities, that is, conventional radiography, computed tomography, and magnetic resonance imaging. For residents, knowledge of normal radiologic anatomy is a first step in recognizing pathology in this field, diagnosing diseases, and planning surgical procedures. For specialists, this book provides an opportunity to update their knowledge and refine their radiologic diagnostic skill in a time of rapidly progressing radiologic techniques.’’ The book surely keeps his promise. Having used it for the interpretation of a couple of clinical cases, this portable guide continues to serve as an indispensible tool in my daily clinical practice. Besides, it would be ideally suited to prepare for clinical exams in oto-rhino-laryngology, like the European Board Exams. A sample chapter can be found on the internet at http://www.lehmanns.de/media/20777902. Unfortunately, this pdf document does not provide the high quality of illustrations seen in the book, but it gives a nice impression on how chapters are structured. See for yourself!

Digital interactive learning of oral radiographic anatomy

Studies reporting high number of diagnostic errors made from radiographs suggest the need to improve the learning of radiographic interpretation in the dental curriculum. Given studies that show student preference for computer-assisted or digital technologies, the purpose of this study was to develop an interactive digital tool and to determine whether it was more successful than a conventional radiology textbook in assisting dental students with the learning of radiographic anatomy. Eighty-eight dental students underwent a learning phase of radiographic anatomy using an interactive digital tool alongside a conventional radiology textbook. The success of the digital tool, when compared to the textbook, was assessed by quantitative means using a radiographic interpretation test and by qualitative means using a structured Likert scale survey, asking students to evaluate their own learning outcomes from the digital tool. Student evaluations of the digital tool showed that almost all participants (95%) indicated that the tool positively enhanced their learning of radiographic anatomy and interpretation. The success of the digital tool in assisting the learning of radiographic interpretation is discussed in the broader context of learning and teaching curricula, and preference (by students) for the use of this digital form when compared to the conventional literate form of the textbook. Whilst traditional textbooks are still valued in the dental curriculum, it is evident that the preference for computer-assisted learning of oral radiographic anatomy enhances the learning experience by enabling students to interact and better engage with the course material.

Interparietal bone (Os Incae) in craniosynostosis

The interparietal bone, Os Incae, is formed in a persistent mendosal suture. This suture is a normal variant in the human skull, well-known in anatomy and radiology textbooks. We report 11 children with craniosynostosis in the presence of an interparietal bone, five from Children's Hospital at Montefiore and six children from Children's Hospital Boston. The true incidence of an interparietal bone in patients with craniosynostosis or craniofacial anomalies is not known; nor are there recognized sequelae of an interparietal bone (bathrocephaly). Hypotheses regarding mechanisms that may contribute to the formation of an interparietal bone are discussed.

Clinical Emergency Radiology

Clinical Emergency Radiology . Edited by J. Christian Fox . New York, NY : Cambridge University Press , 2008 ; 649 pp; $150.00 (hardcover) . Emergency physicians (EPs) with enough shifts worked undoubtedly have experienced the sense of anxiety and trepidation when a colleague says, “Do you remember that patient you saw last week?” Concerned over morbidity and mortality, the dread is seemingly worse when the call comes from the radiologist for the missed fracture that you failed to splint or the small pneumothorax that just left the emergency department (ED). While not necessarily radiologic experts, we are responsible for viewing films and making rapid clinical decisions based on our findings. We should be pretty good with emergency radiology, and Clinical Emergency Radiology from J. Christian Fox and Cambridge University Press could aid you in becoming savvier in this segment of our field. As the title indicates, this is an emergency medicine (EM)-focused reference. Classically sized and shaped in the same vein as Rosen’s or Roberts and Hedges’, this textbook and its 649 pages are divided into four parts based on the fundamental radiology modalities utilized in EM—plain radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Each modality gets seemingly equal billing in terms of page distribution. In general, chapters are anatomically based, but several special chapters are included to address issues specific to radiology, such as the “Physics of Ultrasound” or “CT in the ED: Special Considerations.” Excluding these special topic areas, individual chapters are regularly broken down into the following sections: indications, diagnostic capabilities, imaging pitfalls/limitations, and clinical images. Without an abundance of writing in these sections, the bulk of the material is clinical images with associated details annotating the photos. Clinical Emergency Radiology is educational and focused, providing only the necessary direction. It gives a breadth of information, including imaging decision rules, radiographic pearls, and commonly used eponyms. Valuable information is presented about the findings that an EP is likely to come across. It also addresses all radiologic modalities available to the majority of EPs, as well as the most concerning diagnoses that could arise during the average shift. In several chapters, the clinical images are adjacent to the schematic view, rather than the classic drawing, demonstrating the important anatomic locations. Despite the worthwhile change from other emergency radiology references, this is unfortunately only used in the normal variants and would be beneficial with the abnormal findings and anomalies. When considering the book’s faults, one weakness is structural. The individual pages are substantial and should be able to stand up to long-term daily use in a busy ED, but the bindings unfortunately do not have the strength. After only two shifts, the bindings tore and began to break down. This is unfortunate, as emergency radiology books are best served by finding a place in the ED, near the “view box.” Emergency radiology focuses on the discovery of a life-threatening condition that reveals itself on the ordered images. When writing and printing an emergency radiology textbook, more high-quality images are seemingly better, allowing the reader to view multiple versions of the same problem. Despite the large size, the pages have considerable amounts of unused space, which would be amenable to another view of a subarachnoid hemorrhage or an abdominal aortic aneurysm. In comparison to other emergency radiology texts, this product is more readable but lacks depth, becoming another book of images of questionable quality. Despite the price tag, this book is ideal for medical student and resident education. With relatively brief chapters and images with detailed descriptions, the learner could be directed to read or do a review of a selected chapter in preparation for a clinical shift and then be asked to apply the knowledge gleaned when viewing films of the day’s patient evaluations. For the attending, Clinical Emergency Radiology provides the overview, but is not the text you would necessarily choose for the details. For the cost, alternative references exist.

Web review: Contrast media in radiology and imaging

Few web-based sites related to contrast media in radiology and imaging, available at the moment, are reviewed below. Introduction to Intravenous Radiographic Contrast is a concise summary of the subject by Romell Dhadha. Featured as a part of the Department of Radiology Short Clerkship: Lectures at University of Iowa, the material is available at http://www.radiology.uiowa.edu/Radshortclerkship/RadShortClkship/LectureNotes/Dhada.htm. A Simple Guide to the Basics of Contrast Media is available in the form of Guide notes at http://www.e-radiography.net/contrast_media/contrast_media_introduction.htm. The material includes iodinated intravascular contrast agents, barium sulfate, computerized tomography (CT) contrast agents, biliary contrast agents and reactions, allergic emergencies. From eMedicine, comprehensive educative material on radiographic iodinated contrast media is obtainable at http://www.emedicine.com/radio/byname/contrast-medium-reactions-recognition-and-treatment.htm. The webportal Chest Xray.com deals concisely with radiology contrast at http://www.chestx-ray.com/Practice/Contrast.html. The following sections are covered: general, non-ionic vs ionic, risk factors, severity of reactions, renal toxicity, screening creatinine and treatment. Incidentally, the portal chest Xray.com at http://www.chestx-ray.com/ covers areas related to research, education, practice and resources. Contrast Media in Diagnostic Radiology from the Textbook of Radiology at http://www.medcyclopaedia.com/library/radiology/chapter07.aspx is an up-to-date feature from Medcyclopaedia™. Medcyclopaedia™ is a “unique combination of a scientific library and a handy toolbox on the internet.” In addition, the site features the complete online edition of The Encyclopaedia of Medical Imaging, the complete online edition of A Global Textbook of Radiology, GE Healthcare's Expanded Medical Imaging Glossary, clinical cases for training purposes and a complete e-learning solution in normal imaging anatomy. A Symposium on Ultrasound Contrast for Radiological Diagnosis titled Bubbles in Radiology - The State of the Art is available at http://www.sunnybrook.utoronto.ca/bubble/. The site requires a mandatory registration. Additionally, ‘A Handbook of Contrast Echocardiography’ authored by Harald Becher and Peter N Burns is available at http://www.sunnybrook.utoronto.ca/EchoHandbook/. Within this, there is an Interactive Glossary of Contrast Ultrasound at http://www.sunnybrook.utoronto.ca/EchoHandbook/bookindex.htm. Controversies and Consensus in Imaging and Interventions is a journal for medical imaging professionals, focusing on current issues in radiology, imaging and interventional radiology/cardiology and CT radiology. This website, sponsored by an educational grant from GE Healthcare, has a section on contrast media that is available at http://www.c2i2.org/contrast_media.asp. An educative supplement on Issues in Contrast and CT Angiography with Multislice CT is featured in Applied Radiology (Mar 2002), accessible at http://www.appliedradiology.com/backissues/issue.asp?ID=71, after a compulsory registration. The material covers important topics such as optimizing contrast use in multislice CT, fast CT in neurological imaging: contrast issues, contrast multiplies cardiac CT applications, CTA of extremities: new approaches to scanning, contrast use, new contrast administration protocols: safety considerations. A panel discussion is also available at the end. Guidelines and manuals on the use of contrast media in radiology are issued periodically from reputed professional bodies. Currently available comprehensive references include American College of Radiology Contrast Manual on Contrast Media version 6/2008, which is available at http://www.acr.org/SecondaryMainMenuCategories/quality_safety/contrast_manual.aspx. ACR Practice Guideline for the Use of Intravascular Contrast Media, which is accessible at http://www.acr.org/s_acr/bin.asp?CID=541andDID=12241andDOC=FILE.PDF. European Society of Urogenital Radiology (ESUR) Guidelines on Contrast Media, available from http://www.esur.org/fileadmin/Guidelines/ESUR_2007_Guideline_6_Kern_Ubersicht.pdf. Royal College of Radiology Standards for Iodinated Intravascular Contrast Agent Administration to Adult Patient, available from http://www.rcr.ac.uk/docs/radiology/pdf/IVcontrastPrintFinal.pdf. Review Articles/Citations on Contrast media in Radiology: There are numerous articles on contrast media in radiology available from various journals. From these, a handy ‘must read’ list of review articles on this subject, published in recent times and available online, is given below in Table 1. Table 1 Review articles/citations on contrast media in radiology