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INTRODUCTION: Effective communication has been shown to improve patients’ health outcomes. This study utilizes medical improvisation techniques to teach communication skills to an entire medical school class. METHODS: Required workshops were held for entering third-year students from 2005 to 2017. Workshop evaluations were obtained immediately following each session and at 3 months post-workshop for one cohort. RESULTS: Four hundred ninety-four medical students participated in the improvisation workshops. Over 90% of students rated the workshops as above average or excellent. Students reported a gain in insights regarding their role as a physician (≥ 90%), an improvement in their ability to demonstrate effective communication (80–87%), and a positive impact on teamwork (91–93%). At 3 months post-workshop, 84% of students reported they had used at least 1 improvisation skill on their clinical wards (50% response rate). CONCLUSIONS: This study demonstrates that medical improvisation exercises can be scaled to an entire class of medical students versus a self-selected group of students. Further, we found that students felt that it improved their communication. This study also provides new insights regarding specific improvisation exercises that are most useful for the clinical environment.

As I entered the emergency room bay, her scared eyes shouted silently. An elderly female in obvious distress, she was non-verbal except for head nods. No family accompanied her. As a medical student, I felt clinically powerless, but I knew I wanted to assist however possible. As an extrovert, it was natural for me to think in terms of a human connection. I navigated through the crowded room, hearing conversations of suspected infection, and positioned myself at the bedside.

To date, widely generalizable artificial intelligence (AI) programs for medical image analysis have not been demonstrated, including for mammography. Rather than pursuing a strategy of collecting ever-larger databases in the attempt to build generalizable programs, we suggest three possible avenues for exploring a precision medicine or precision imaging approach. First, it is now technologically feasible to collect hundreds of thousands of multi-institutional cases along with other patient data, allowing stratification of patients into subpopulations that have similar characteristics in the manner discussed by the National Research Council in its white paper on precision medicine. A family of AI programs could be developed across different examination types that are matched to specific patient subpopulations. Such stratification can help address bias, including racial or ethnic bias, by allowing unbiased data aggregation for creation of subpopulations. Second, for common examinations, larger institutions may be able to collect enough of their own data to train AI programs that reflect disease prevalence and variety in their respective unique patient subpopulations. Third, high- and low-probability subpopulations can be identified by application of AI programs, thereby allowing their triage off the radiology work list. This would reduce radiologists' workloads, providing more time for interpretation of the remaining examinations. For high-volume procedures, investigators should come together to define reference standards, collect data, and compare the merits of pursuing generalizability versus a precision medicine subpopulation-based strategy.

Academic otolaryngology has historically comprised a tripartite mission of research, education, and clinical care. This mission is greatly strained by the COVID-19 pandemic. Research laboratories are fallow, surgical cases are deferred, and clerkships are canceled. Otolaryngologists are adapting to new circumstances ranging from virtual patient care to urgent procedures in protective gear to deployment to provisional field hospitals. Amid these operational challenges, the specialty is demonstrating extraordinary resilience and grit, discovering new ways to serve learners, colleagues, and communities. Statements from leaders in otolaryngology reveal selfless acts and purposefulness. Necessity has spurred innovation in education, science, and novel models of care. Paragons strike notes of hope, inspiring us to persevere and serve. This commentary explores the present challenges and offers a vision for upholding the academic mission.

Stephen R. Covey's landmark work in the field of effectiveness and professional development delineated first 7, then ultimately eight, habits of highly effective people with applicability to all professions.1 This article describes the eight habits in specific relation to the radiologist, and proposes a ninth habit to help one bring a positive and centered approach during the journey to effectiveness and beyond.

Mentorship plays a critical role in the success of academic radiologists. Faculty members with mentors have better career opportunities, publish more papers, receive more research grants, and have greater overall career satisfaction. However, with the increasing focus on clinical productivity, pressure on turn-around times, and the difficult funding climate, effective mentoring in academic radiology can be challenging. The high prevalence of “burnout” among radiologists makes mentorship even more important. This article reviews benefits and challenges of mentorship in academic radiology, discusses how to institute a faculty mentoring program, examines different types of mentoring, and reviews challenges related to diversity and inclusion.

The purpose of this study was to describe the appearance and ultrasound characteristics of the Gruberi bursa using a cadaveric model and retrospective ultrasound imaging review.For the cadaveric study, ultrasound of the dorsolateral ankle of a foot-ankle specimen was performed and was followed by injection of latex between the extensor digitorum longus (EDL) tendons and the talus and dissection. For the ultrasound imaging review, the radiology database was searched for ultrasound studies performed from September 15, 2000, through April 1, 2015, to identify subjects with a dorsolateral foot or ankle fluid collection detected on ultrasound. Images were retrospectively reviewed to characterize the location and size of the fluid collection, assess for the number of locules, and evaluate the compressibility of the fluid collection. It was determined whether the ultrasound findings were significantly different from chance: CI and p values were obtained from performing a test for one proportion.Dissection of a cadaveric specimen revealed latex within a well-defined region between the EDL tendons and the dorsolateral talus; this location is consistent with a Gruberi bursa. For the image review, the imaging examinations of 162 subjects (age range, 16-88 years; 31 male subjects and 131 female subjects) were reviewed. On the ultrasound images, a fluid collection with its epicenter between the dorsolateral talus and EDL was found in 93% of ankles. Of the fluid collections identified on ultrasound, 98% were unilocular and 94% were anechoic. Of these fluid collections, 133 were assessed for compressibility, and 89% were compressible. The positive findings for a Gruberi bursa that were different from chance (p0.0001) were a fluid collection being located between the EDL tendons and the dorsolateral talus and being unilocular, anechoic, and compressible.The Gruberi bursa characteristically is located between the EDL and the talus; on ultrasound, the Gruberi bursa is most commonly unilocular, anechoic, and compressible.

Ultrasonography (US) has become a first-line modality for the evaluation of the peripheral nerves of the upper extremity. The benefits of US over magnetic resonance (MR) imaging include higher soft-tissue resolution, cost effectiveness, portability, real-time and dynamic imaging, and the ability to scan an entire extremity quickly and efficiently. US can be performed on patients who are not eligible for MR imaging. Metallic implant artifacts are usually not problematic. US has been shown to have equal specificity and greater sensitivity than MR imaging in the evaluation of peripheral nerves. Any abnormal findings can be easily compared with the contralateral side. The published literature has shown that US has demonstrated clinical utility in patients with suspected peripheral nerve disease by guiding diagnostic and therapeutic decisions as well as by confirming electrodiagnostic findings. Common indications for upper extremity peripheral nerve US are the evaluation for injury due to penetrating trauma, entrapment by scar tissue, and tumor. US of the upper extremity is most commonly performed to evaluate carpal and cubital tunnel syndrome. It is important for the radiologist or sonographer to have a detailed knowledge of anatomy and specific anatomic landmarks for each nerve to efficiently and accurately perform an examination. The goal of this article is to introduce readers to the basics of US of the peripheral nerves of the upper extremity with a focus on the median, ulnar, and radial nerves. Common sites of disease and the location of important anatomic landmarks will be reviewed.

Scientism can be defined as a passionate belief in the universal applicability of the scientific method and approach, and the view that empirical science constitutes the most authoritative worldview or most valuable part of human learning, to the exclusion of other viewpoints. At this level of generality, it is not difficult to show that scientism poses some distinct dangers, putting a damper as it does on the validity and usefulness of other kinds of knowledge and/or ways of learning. But this has not dissuaded some from thinking that scientism might still be of value in medicine. The popularity of evidence based medicine (EMB) attests to the fact that many so believe. We argue, to the contrary, that clinical practice relies on other kinds of knowledge, and that this is attainable only if we admit consideration of other kinds of learning. We conclude that scientism may be dangerous to your health.

Traumatic abdominal injury can lead to multiple complications including laceration of major organs such as kidneys. Contrast-enhanced Computed Tomography (CT) is the primary imaging modality for evaluating kidney injury. However, the traditional visual examination of CT scans is time consuming, non-quantitative, prone to human error, and costly. In this work we propose a kidney segmentation method using machine learning and active contour modeling. We first detect an initialization mask inside the kidney and then evolve its boundary. This model is specifically developed and evaluated on trauma cases. Our experimental results show the average recall score of 92.6% and average Dice similarity value of 88.9%.

Leadership is much discussed but also often misunderstood. For radiologists, leadership may seem irrelevant or, even worse, an onerous addition to their busy careers. It is important that radiologists understand the relevance and importance of good leadership for the success of departments and groups. There are many obstacles to radiologists becoming effective leaders, including personal resistance that is due to myths and misunderstandings, the time and effort (and money) required to learn to lead well, as well as others including the shift in perspective that comes from focusing on organizational success rather than individual career success. This manifesto will explore the what, the why, and the how of becoming a leader in radiology and why it is critical for individuals, their organizations, academic departments, private practice groups, and others, as well as the larger house of radiology.

Automated segmentation of the spleen in CT volumes is difficult due to variations in size, shape, and position of the spleen within the abdominal cavity as well as similarity of intensity values among organs in the abdominal cavity. In this paper we present a method for automated localization and segmentation of the spleen within axial abdominal CT volumes using trained classification models, active contours, anatomical information, and adaptive features. The results show an average Dice score of 0.873 on patients experiencing various chest, abdominal, and pelvic traumas taken at different contrast phases.

OBJECTIVE. Patients who undergo knee MRI for presumed musculoskeletal disease can have unexpected vascular findings or pathology in the imaged field. Some vascular processes are limb threatening and affect treatment planning and patient outcome. CONCLUSION. Unexpected vascular findings on knee MRI can range from incidental to symptomatic and can include such processes as variant anatomy, aneurysm, traumatic injury, and neoplasm. The assessment for vascular pathology should be a key component of every radiologist's search pattern when evaluating knee MRI.

Case studies have a long and significant history of contributing to medical knowledge and medical education. More recently they have declined in popularity given a focus on larger data sets and statistical power. We discuss the history and value of clinical case reports and place this discussion in the context of prevailing trends. In addition, we note a strong role for nonclinical case studies such as those reporting insights and experiences in the realm of medical leadership. We discuss the many benefits of medical students engaging in case reports on leadership topics, and we offer a nonclinical case study in medical student leadership.

Aims: The purpose of this study was to evaluate the ability of ultrasound in detecting subscapularis tendon pathology with operative correlation. Methodology: A retrospective study was conducted on 86 patients who had shoulder ultrasound prior to surgical repair from January 2006 to August 2008. All sonographic examinations and surgical reports were reviewed. Sonographic evaluation of subscapularis tendon, including normal, tendinosis, partial thickness tear, full thickness tear, and complete tear were correlated to operative reports. Results: Of the 86 patients, 19 patients had surgically proven abnormal subscapularis tendons. There was 100% ultrasound concordance in tendinosis (n = 1), 100 % ultrasound concordance in partial thickness tears (n =3), 88 % ultrasound concordance in full thickness tears (n = 8), 57 % ultrasound concordance in complete tears (n = 7). Overall, there was 79% ultrasound concordance