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With the outbreak of Coronavirus Disease 2019 (COVID-19) pandemic, the residency programs were required to conduct virtual/online interviews for recruitment of candidates for their residency programs. While both programs and the candidates had challenges, with the abrupt transition of interviews to online platform, there were some perceived benefits by the applicants. This paper will further review the pros and cons, the challenges and the changes brought about by the online transformation of residency interviews and conclude with tips to the residency applicants and lessons learnt from this transition. Although, residency programs are considering going back to in-person interviews, they may continue to offer virtual interview as well to the candidates in the future. [ABSTRACT FROM AUTHOR]

This study sought to examine the impact of nodule density on recurrence and survival in female patients with lung adenocarcinoma treated by lobectomy or sublobar resection. In this retrospective study of female patients who underwent surgical resection for pathologic stage IA adenocarcinoma, patients with preoperative imaging were included for analysis if the consolidation-to-tumor ratio was 0.5 (solid-predominant ground-glass opacity [GGO]) to 1.0 (solid). Kaplan-Meier curves were generated to estimate overall survival (OS) and disease-free survival (DFS). Risk estimates were calculated using multivariable Cox proportional hazards models. For all 357 patients sublobar resection demonstrated worse 5-year DFS compared with lobectomy (76.4% vs 67.9%, P =.05). Multivariable modeling showed worse DFS with sublobar resection (hazard ratio, 1.55; P =.06) and tumors ≥ 2 cm (hazard ratio, 2.32; P =.05). On radiologic evaluation the solid-predominant GGO group (n = 81) demonstrated a smaller solid component compared with the solid nodule group (n = 163; 1.49 cm vs. 1.84 cm, respectively; P <.001) yet comparable total size. The solid-predominant GGO group showed improved 5-year OS (90.8 vs 76.8, P =.01) and DFS (79.3 vs 67.2, P =.05) compared with the solid nodule group. Additionally the solid-predominant GGO group demonstrated equivalent OS (90.8% vs 90.8%, P =.93) and DFS (76.0% vs 81.7%, P =.60) with sublobar resection compared with lobectomy. In this report of female patients with stage IA adenocarcinoma, sublobar resection was associated with worse DFS compared with lobectomy in whole-group analysis. However patients with solid-predominant GGOs demonstrated improved 5-year OS and DFS compared with patients with solid nodules with equivalent outcomes regardless of resection type. [ABSTRACT FROM AUTHOR]

Objective: During COVID-19, Harvard Medical School pivoted to online learning. A large student cohort took a completely virtual Radiology clerkship with daily programming including virtual small group teaching sessions or "homerooms."Materials and Methods: One hundred and eleven medical students were divided into 12 virtual small group sessions which emphasized foundational concepts. Uniform teaching materials were used across all homerooms in order to deepen understanding and allow insight into the working methods of radiologists. Students evaluated the homeroom learning and teachers for utility and benefit to their educational experience.Results: Most students (93%) felt the homerooms provided an educational benefit and reinforced topics studied (77%). Most students (84%) felt the leaders created an environment conducive to learning. Despite being virtual, students were able to form interpersonal connections with the homeroom leaders.Conclusions: Incorporating virtual small group learning can be a valuable component of a virtual or hybrid Radiology clerkship, solidifying foundational concepts with the homeroom leaders playing a major role. While developed by necessity due to COVID-19, virtual small group learning with engaged leaders is an educational strategy whose benefit can continue even as there is return to in-person learning. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Medical schools were upended by the COVID-19 pandemic, resulting in suspension of all in-person educational activities, and leaving clinical clerkships on hold indefinitely. A virtual curriculum and novel teaching methods were needed to fulfill curricular requirements. We developed a comprehensive virtual radiology clerkship and evaluated the efficacy of this novel method of teaching.Materials and Methods: A 4-week virtual radiology clerkship was designed to accommodate medical students who had not yet completed the required clerkship. The design included online flipped classroom modules, large group didactic lectures, and small group homeroom activities. Student performance was assessed via a standardized online final exam. Feedback from students was collected using online surveys. Student performance was compared to the in-person radiology clerkship.Results: One hundred and eleven medical students were enrolled in the virtual radiology clerkship. Final exam scores were similar to the in-person clerkship. Students indicated that small group homeroom activities had the highest overall satisfaction. Students recognized enthusiastic teachers regardless of class format. Exceptional course content and organization were also noted. Course weaknesses included didactic lecture content which was repetitive or too advanced, the limited opportunity to build personal connections with faculty, and scheduling conflicts with other competing school activities.Conclusion: A completely virtual radiology core clerkship can be a successful educational experience for medical students during a time when remote learning is required. A small group learning environment is most successful for student engagement. Personal connections between faculty and students can be challenging in a virtual course. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To analyze the performances of diameter-based measurements, either using diameters, or by calculating diameter-based volumes, as compared to volume measurements in assessing growth of pulmonary adenocarcinomas manifesting as subsolid nodules on CT.Materials and Methods: In this IRB-approved, retrospective study, 74 pulmonary adenocarcinomas presenting as subsolid nodules and resected in 69 patients (21 men, 48 women, mean age 70 ± 9 years) were included. Three CTs were available for each patient. Nodule size on each CT was assessed with diameter measurements, calculated volume based on diameter measurements, and measured volume. Nodule growth was defined as an increase of measured volume ≥25% between two sequential CTs. Sensitivity, specificity, accuracy, positive and negative predictive values of diameter-based measurements for growth assessment were calculated. Nodule characteristics were compared with nonparametric tests and analysis of variance.Results: There were fewer growing nodules during CT1-CT2 interval (n = 22, 30%) than during CT2-CT3 interval (n = 33, 45%, p =.060). Specificity and negative predictive value of diameter-based measurements for growth assessment ranged respectively from 52 to 77% and 81 to 83% between CT1 and CT2, and from 66 to 76% and 79 to 90% between CT2 and CT3. Nongrowing nodules tended to be larger, regardless how size was measured, and some of these differences in size were statistically significant (p =.002 to .046).Conclusion: For pulmonary adenocarcinomas presenting as subsolid nodules on CT, diameter-based assessment of nodule volume is reasonably accurate at confirming a lack of nodule growth but may overestimate actual growth, as compared to growth assessment based on measured volume. [ABSTRACT FROM AUTHOR]

Objective We have previously described patterns of failure after extrapleural pneumonectomy and multimodality therapy for malignant pleural mesothelioma and sought to update our results with a larger cohort of recent patients. Methods A total of 169 patients underwent extrapleural pneumonectomy without preoperative chemotherapy between 2001 and 2010. Data for treatment, recurrence, and survival were determined from medical records. A thoracic radiologist reviewed postoperative computed tomography or positron emission tomography computed tomography scans to determine sites of recurrence. Time to recurrence was estimated by the Kaplan–Meier method. Rates were compared using the Fisher exact test. Results The median age of patients was 62 years. Histology on final pathology was epithelial for 104 patients (62%) and nonepithelial for 65 patients (38%). A total of 132 patients (78%) received heated intraoperative chemotherapy; 77 patients (45%) received adjuvant chemotherapy, and 71 patients (42%) received adjuvant radiation therapy. Most chemotherapy regimens included platinum or pemetrexed. Median radiation therapy dose was 54 Gy. Among 158 evaluable patients, a recurrence developed in 118 (75%). Median follow-up was 83 months, median time to recurrence was 13.1 months, and median survival was 15 months. Sites of first recurrence were in the ipsilateral hemithorax or mediastinum for 54% of patients, in the abdomen for 39% of patients, in the contralateral hemithorax for 28% of patients, and in other distant sites for 5% of patients. Some patients had simultaneous recurrences in multiple sites. Conclusions The most common site of recurrence after extrapleural pneumonectomy and planned multimodality therapy remains the ipsilateral hemithorax (including mediastinum), and true distant failure (other than the abdomen or contralateral hemithorax) remains unusual. The distribution of recurrences is strikingly similar to our prior report. [ABSTRACT FROM AUTHOR]

One of the most morbid postoperative complications after a lobectomy or a pneumonectomy is a bronchopleural fistula (BPF). The diagnosis and identification of BPF may be challenging, often requiring repeat imaging and invasive tests, including bronchoscopy, thoracoscopic exploration, or even open exploration. The purpose of this article is to review the types and presentations of BPF and to describe the role of noninvasive imaging for diagnosis and surgical treatment planning. We focused on multidetector computed tomography and advanced postprocessing applications such as multiplanar reconstructions, virtual bronchoscopy, and volume rendering images, including minimum-intensity and maximum-intensity projections. Both multidetector computed tomography and nuclear scintigraphy are reliable noninvasive imaging modalities that can be used expeditiously in an outpatient setting and may prove to be a more cost-effective strategy to identify the fistula as well as conduct postoperative surveillance. These modalities can be used for accurate and efficient testing for earlier diagnosis and treatment planning, thereby significantly improving patient outcome. Additional advanced postprocessing techniques using already acquired imaging data can provide complementary information that is both visually accessible and anatomically meaningful for the surgeon. Better understanding of the potential uses and benefits of these techniques will eventually improve the diagnostic accuracy, optimize preoperative planning, and facilitate follow-up for patients with BPF with improved patient outcomes. [Copyright &y& Elsevier]

There remains an extensive debate over lung cancer screening, with lobbying for and against screening for very compelling reasons. The National Lung Screening Trial, International Early Lung Cancer Program, and other major screening studies favor screening with low-dose CT scans and have shown a reduction in lung cancer–specific mortality. The increasing incidence of lung cancer and the dismal survival rate for advanced disease despite improved multimodality therapy have sparked an interest in the implementation of national lung cancer screening. Concerns over imaging workflow, radiation dose, management of small nodules, overdiagnosis bias, lead-time and length-time bias, emerging new technologies, and cost-effectiveness continue to be debated. The authors address each of these issues as they relate to radiologic practice. [Copyright &y& Elsevier]

Objective: Local recurrence limits long-term survival in patients with malignant pleural mesothelioma. We investigated whether hyperthermic intraoperative cisplatin chemotherapy lavage affects the interval to recurrence and overall survival among patients with favorable prognostic factors. Methods: Using a preoperative risk assessment algorithm we had previously developed and validated, we retrospectively identified a cohort of patients treated with cytoreductive surgery from 2001 to 2009. The patients had epithelial histologic findings on biopsy and were characterized as having a low risk of early recurrence and death (ie, tumor volume ≤500 cm3 and were either men with a hemoglobin level of ≥13 g/dL or were women). Those patients who had received hyperthermic intraoperative cisplatin chemotherapy were compared with a comparison group of those who had not. Fisher’s exact test was used to determine the balance of prognostic factors. The Kaplan-Meier method and log-rank tests were used to estimate and compare the interval to recurrence and overall survival. Cox proportional hazards regression was used for multivariate analysis. Results: The cohort criteria identified 103 patients: 72 who received hyperthermic intraoperative cisplatin chemotherapy and 31 who did not. The groups were balanced for prognostic factors, except for the use of neoadjuvant chemotherapy (more common in the comparison group). The hyperthermic intraoperative cisplatin chemotherapy group exhibited a significantly longer interval to recurrence (27.1 vs 12.8 months) and overall survival (35.3 vs 22.8 months) than the comparison group. The improved interval to recurrence and overall survival for the hyperthermic intraoperative cisplatin chemotherapy group were particularly evident among the subgroups of patients who had not received hemithoracic radiotherapy and who had pathologic stage N1 or N2 lymph node metastases. Conclusions: A favorable outcome and minimal incremental morbidity support the incorporation of hyperthermic intraoperative cisplatin chemotherapy into multimodality treatment strategies for patients with low-risk epithelial malignant pleural mesothelioma. [Copyright &y& Elsevier]

Rationale and Objectives: The role of transthoracic needle biopsy (TTNB) in patients with hematologic malignancies, particularly in discriminating between malignant and benign etiologies, has not been well studied. Hence, the diagnostic efficacy and safety of computed tomography–guided TTNB were retrospectively evaluated in this population. Materials and Methods: The records of 53 patients with hematologic malignancies who underwent TTNB from August 1, 1999, to July 31, 2007, were reviewed. Potential factors for increased diagnostic yield and risk for complications were collected and analyzed, including the status of neutropenia, thrombocytopenia, chemotherapy, and transplant as well as lesion size and location. Both cytopathologic and microbiologic results were assessed. Results: The most common underlying hematologic malignancy was non-Hodgkin lymphoma, in 20 patients (37.7%). Lesions were most frequently located in the left upper lobe (16 [30.2%]); 33 lesions were pleural based (63.5%), and nine had cavitation (17.0%). TTNB established specific diagnoses in 22 patients (41.5%): malignancies was found in 12 (22.6%) and infections in 10 (18.9%). Sensitivity for detecting malignancy was 50.0%, and sensitivity for the detection of a specific infection was 40.0%. There were no false-positive results. Complications occurred in nine patients (17.0%): self-limited small-volume hemoptysis in one patient (1.9%) and pneumothorax in eight patients (15.1%), one requiring chest tube placement. The results of TTNB led to changes in antimicrobial therapy for eight of the 22 patients with specific diagnoses (36.4%). Conclusions: TTNB is a safe diagnostic procedure in patients with hematologic malignancies and has the potential of making specific diagnoses with minimal morbidity. [Copyright &y& Elsevier]

Malignant pleural mesothelioma (MPM) is an aggressive pleural tumor with a complex growth pattern. Imaging plays a crucial role in diagnosis and management. Computed tomography (CT) has been the mainstay in the clinical evaluation of MPM; however it underestimates early chest wall invasion, peritoneal involvement, and has well-known limitations in nodal metastatic evaluation. Perfusion CT can evaluate the microvasculature of tumors; however its disadvantages, such as high radiation exposure and side effects from iodinated contrast, have limited its use to research settings. Magnetic resonance imaging (MRI) is superior to CT, both in the differentiation of malignant from benign pleural disease and in the assessment of chest wall and diaphragmatic involvement. Perfusion and diffusion MRI are promising new techniques for the assessment of tumor cellularity and microvasculature and can be used for quantitative and qualitative assessment of treatment response. Fluorodeoxyglucose positron emission tomography (FDG-PET) is useful for the differentiation of benign from malignant lesions, for staging, and for monitoring response to therapy. PET-CT is superior to other imaging modalities in detecting more extensive disease involvement and identifying unsuspected occult distant metastases. This review focuses on the practical aspects of the radiological assessment of MPM, highlighting the role of the radiologist in preoperative and postoperative evaluation with a multimodality approach. [Copyright &y& Elsevier]

We present a rare case of coexisting intralobar pulmonary sequestration and ipsilateral subphrenic extralobar sequestration in a 40-year-old woman. This variant of duplicated sequestration is very rare, although cases of simultaneous intralobar and extralobar sequestration have been reported, as have rare instances of subphrenic sequestration. In this case, preoperative imaging defined both intralobar and extralobar sequestrations, and after lobectomy for the symptomatic intralobar sequestration, the asymptomatic subdiaphragmatic sequestration is being managed conservatively. [Copyright &y& Elsevier]

There remains an extensive debate over lung cancer screening, with lobbying for and against screening for very compelling reasons. The National Lung Screening Trial, International Early Lung Cancer Program, and other major screening studies favor screening with low-dose CT scans and have shown a reduction in lung cancer-specific mortality. The increasing incidence of lung cancer and the dismal survival rate for advanced disease despite improved multimodality therapy have sparked an interest in the implementation of national lung cancer screening. Concerns over imaging workflow, radiation dose, management of small nodules, overdiagnosis bias, lead-time and length-time bias, emerging new technologies, and cost-effectiveness continue to be debated. The authors address each of these issues as they relate to radiologic practice. [ABSTRACT FROM AUTHOR]

Abstract: Malignant pleural mesothelioma (MPM) is an aggressive tumor that arises from the pleura and frequently extends to adjacent structures. MPM cells produce and respond to many angiogenic factors, such as vascular endothelial growth factor (VEGF). VEGF expression in MPM is correlated with microvascular density, which is associated with poor survival. CT has been widely used as the primary imaging modality for the clinical evaluation of MPM. Major findings include nodular pleural thickening, unilateral pleural effusion, and tumor invasion of adjacent structures. CT tends to underestimate early chest wall invasion and peritoneal involvement and has well-known limitations in the evaluation of lymph node metastases. Perfusion CT can evaluate the microvasculature of tumors, while its disadvantages, such as high radiation exposure or side effects from iodinated contrast, limit its use in both research and clinical settings. MRI can provide additional information to CT. Because of its excellent contrast resolution, MRI is superior to CT, both in the differentiation of malignant from benign pleural disease, and in the assessment of chest wall and diaphragmatic involvement. Perfusion MRI is the most promising technique for the assessment of the tumor microvasculature. In MPM, therapeutic effects of chemotherapy can be monitored with perfusion MRI. It has been shown that FDG–PET is useful for the differentiation of benign from malignant lesions, for staging and monitoring metabolic response to therapy against MPM, and that it has prognostic value. An initial report on PET/CT imaging of MPM has shown increased accuracy of overall staging, improving the assessment of tumor resectability. PET/CT seems to be superior to other imaging modalities in detecting more extensive disease involvement, and identifying unsuspected occult distant metastases. [Copyright &y& Elsevier]

Imaging of malignant pleural mesothelioma is essential to patient management, prognostication, and response assessment. From animal models to clinical trials, the gamut of research activities and clinical standards relies on imaging to provide information on lesion morphology and the growing number of physiologic characteristics amenable to capture through imaging techniques. The complex morphology, growth pattern, and biological mechanisms of mesothelioma, however, present challenges for image acquisition and interpretation. Nevertheless, novel approaches to image acquisition and subsequent image analysis have expanded the opportunities for (as well as the need for) imaging in this disease. This paper summarizes the imaging-based research presented orally at the 2014 International Conference of the International Mesothelioma Interest Group (iMig) in Cape Town, South Africa, October 2014. Presented topics include the imaging of hypoxia in a murine model through positron emission tomography (PET), the use of diffusion-weighted magnetic resonance imaging (MRI) to assess the histologic composition of biphasic mesothelioma and to assess early response to chemotherapy, the correlation of CT-based tumor volume with the volume of the post-surgical tumor specimen, the development of volumetric tumor response criteria, and pre-treatment tumor volume growth considerations for tumor response assessment. [ABSTRACT FROM AUTHOR]

Abstract: Imaging of malignant pleural mesothelioma (MPM) is essential to the diagnosis, assessment, and monitoring of this disease. The complex morphology and growth pattern of MPM, however, create unique challenges for image acquisition and interpretation. These challenges have captured the attention of investigators around the world, some of whom presented their work at the 2012 International Conference of the International Mesothelioma Interest Group (iMig 2012) in Boston, Massachusetts, USA, September 2012. The measurement of tumor thickness on computed tomography (CT) scans is the current standard of care in the assessment of MPM tumor response to therapy; in this context, variability among observers in the measurement task and in the tumor response classification categories derived from such measurements was reported. Alternate CT-based tumor response criteria, specifically direct measurement of tumor volume change and change in lung volume as a surrogate for tumor response, were presented. Dynamic contrast-enhanced CT has a role in other settings, but investigation into its potential use for imaging mesothelioma tumor perfusion only recently has been initiated. Magnetic resonance imaging (MRI) and positron-emission tomography (PET) are important imaging modalities in MPM and complement the information provided by CT. The pointillism sign in diffusion-weighted MRI was reported as a potential parameter for the classification of pleural lesions as benign or malignant, and PET parameters that measure tumor activity and functional tumor volume were presented as indicators of patient prognosis. Also reported was the use of PET/CT in the management of patients who undergo high-dose radiation therapy. Imaging for MPM impacts everything from initial patient diagnosis to the outcomes of clinical trials; iMig 2012 captured this broad range of imaging applications as investigators exploit technology and implement multidisciplinary approaches toward the benefit of MPM patients. [Copyright &y& Elsevier]

Abstract: Background: Desmoid tumours are rare neoplasms characterised by clonal proliferation of myofibroblasts that do not metastasise, but often exhibit an infiltrative pattern and functional impairment. When desmoids arise in the intestinal mesentery, surgical resection is seldom possible without life-altering loss of intestinal function. Methods: Retrospective review of the clinical management of 52 consecutive patients treated for desmoids of the intestinal mesentery from January 2001 to August 2006. A multidisciplinary treatment plan was developed based on primary disease extent, tumour behaviour and resectability. Patients with stable but unresectable disease were observed without treatment. Patients with resectable disease underwent surgery, and patients with unresectable progressing disease received chemotherapy, most commonly liposomal doxorubicin, followed by surgery if chemotherapy rendered the disease resectable. Results: At a median follow-up of 50.0months (range 4.6–212), 50 patients (96%) have either no recurrence or radiographically stable disease. No patient requires total parenteral nutrition. Conclusion: These data indicate that the extent of disease; tumour behaviour and resectability are the important factors when defining a treatment plan for mesenteric desmoid tumours. A multidisciplinary approach of surgery combined with chemotherapy is an effective and function-sparing strategy for managing this disease. [Copyright &y& Elsevier]