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Objective The Liver Imaging Reporting and Data System (LI-RADS) has been widely applied to CT and MR liver observations in patients at high-risk for hepatocellular carcinoma (HCC). We investigated the impact of CT vs MR in upgrading LI-RADS 3 to LI-RADS 5 observations using a large cohort of high-risk patients. Methods We performed a retrospective, longitudinal study of CT and MR radiographic reports (June 2013 - February 2017) with an assigned LI-RADS category. A final population of 757 individual scans and 212 high-risk patients had at least one LI-RADS 3 observation. Differences in observation time to progression between modalities were determined using uni- and multivariable analysis. Results Of the 212 patients with a LI-RADS 3 observation, 52 (25%) had progression to LI-RADS 5. Tp ranged from 64 - 818 days (median: 196 days). One hundred and three patients (49%) had MR and 109 patients (51%) had CT as their index study. Twenty-four patients with an MR index exam progressed to LI-RADS 5 during the follow-up interval, with progression rates of 22% (CI:13%-30%) at 1 year and 29% (CI:17%-40%) at 2 years. Twenty-eight patients with a CT index exam progressed to LI-RADS 5 during follow-up, with progression rates of 26% (CI:16%-35%) at 1 year and 31% (CI:19%-41%) at 2 years. Progression rates were not significantly different between patients whose LI-RADS 3 observation was initially diagnosed on MR vs CT (HR: 0.81, P = 0.44). Discussion MR and CT modalities are comparable for demonstrating progression from LI-RADS 3 to 5 for high risk patients.

Psoriasis is a common, chronic and non- infectious skin disease characterized by well defined slightly raised, dry erythamatous macules with silvery scales Modern medicine offers treatment with PUVA, Corticosteroids & Anti mitotic Drugs but therapy gives serious side effects like Bone Marrow depletion, Liver & kidney Failure. While treating Kustha, Ayurvedic Classics especially focused on Panchakarma Treatment. So Vaman, Virechana & Laghu-Manjisthadi Ghan was selected for trial. Total 30 well diagnosed patients were selected & divided in two groups. One group receiving Ayurvedic Treatment & other Allopathic Regimen (Tb.Methotraxate7.5 mg/week) for 2 months & comparative study was done. Assessment was done on improvement in clinical symptoms as well as on Laboratory parameters.

Background: Keloids are benign proliferative condition of dermal broblast. Intralesional corticosteroid improves keloid but associated with signicant adverse effects like dyspigmentation, tissue atrophy and telengectasia and contraindicated in certain conditions like hypertension and diabetes. 5-Fluorouracil (5-FU), a pyrimidine analogue with an inhibitory effect on TGF-β induced broblast proliferation is useful in treatment of keloids but is associated with ulceration and pain. A low dose of Triamcinolone if added to 5-FU injection overcomes these issues. Approach: This study was conducted in a tertiary care hospital. Sixty patients; thirty in each group were included. In group A, once weekly intralesional Triamcinolone and in group B, intralesional injection of Triamcinolone mixed with 5-Flurouracil in 1: 9 dilution were injected for 8 sessions. Parameters of Vancouver scale were noted at the baseline and at the end of treatment. Results: Out of 60 patients enrolled in this study. The combination group was better in improving height (62.11% vs 78%), pliability (44.14% vs 8.81%), and vascularity (55.78% vs 61.30%) and results were statistically signicant (P valve 0.05). Pain and pruritus improved completely (100%) in both the groups at the end of the treatment. Excellent improvement in patient and observer assessment score was seen in 96.67% vs 3.33% in combination group and TAC group respectively. The difference was statistically signicant (P valve

Context: Inguinal skin is prone to various infectious dermatological conditions such as erythrasma, intertrigo, hidradenitis suppurativa, folliculitis, dermatophytic infection, and various sexually transmitted diseases, as compared to the skin elsewhere. Aim: Our study attempts to compare the biophysical profile parameters (BPPs) of the genital skin with that of the rest of the body, while taking skin of the upper back as control. It also attempts to find out if there is a difference in BPPs of the two sites and that how the change in the BPPs, bring about change in microbiome and make inguinal skin more prone to infections. Materials and Methods: This was a hospital-based comparative study conducted over 976 patients (600 males and 376 females) of age group 18–60 years, where BPP parameters such as hydration, skin pH, transepidermal water loss (TEWL), and sebum content were measured over the skin of the upper back and right inguinal region, and the results were summarized and presented as proportions (%). Chi-square test was used to compare abnormal findings. P ≤ 0.05 was taken as statistically significant. MedCalc 16.4 version software was used for all statistical calculations. Results: Significant difference was noted in skin pH and TEWL, where P value came out to be

“Big data” has changed the way businesses operate in finance, insurance, communications, manufacturing, and logistics, with companies reporting successful outcomes from the implementation of data-driven analytics. Health care has slowly started leveraging big data analysis to identify more cost-efficient and effective care for patients. Business intelligence software aims to help with this transition, converting large data sets into useful, actionable information. Radiology practices have used business intelligence toolkits in the past to increase reading room productivity, scanner efficiency, and patient throughput. Although these tactics have driven down costs and increased volumes, an essential aspect of radiology practice growth—consumer satisfaction—remains largely unexplored. The first commandment of marketing is “know thy customer,” which is the key to increasing radiology’s value to referring clinicians who use our services. Our article explores the business case behind a basic business intelligence model, giving any radiologist the instruments to access and draw business conclusions from their radiology information system data.

Purpose To evaluate the impact of environmental and socioeconomic factors on outpatient cancellations and “no-show visits” (NSVs) in radiology. Materials and Methods We conducted a retrospective analysis by collecting environmental factor data related to outpatient radiology visits occurring between 2000 and 2015 at our multihospital academic institution. Appointment attendance records were joined with daily weather observations from the National Oceanic and Atmospheric Administration and estimated median income from the US Census American Community Survey. A multivariate logistic regression model was built to examine relationships between NSV rate and median income, commute distance, maximum daily temperature, and daily snowfall. Results There were 270,574 (8.0%) cancellations and 87,407 (2.6%) NSVs among 3,379,947 scheduled outpatient radiology appointments and 575,206 unique patients from 2000 to 2015. Overall cancellation rates decreased from 14% to 8%, and NSV rates decreased from 6% to 1% as median income increased from $20,000 to $120,000 per year. In a multivariate model, the odds of NSV decreased 10.7% per $10,000 increase in median income (95% confidence interval [CI]: 10.3%-11.1%) and 2.0% per 10°F increase in maximum daily temperature (95% CI: 1.3%-1.6%). The odds of NSV increased 1.4% per 10-mile increase in commute distance (95% CI: 1.3%-1.6%) and 4.5% per 1-inch increase in daily snowfall (95% CI: 3.6%-5.3%). Commute distance was more strongly associated with NSV for those in the two lower tertiles of income than the highest tertile (P Conclusion Environmental factors are strongly associated with patients’ attendance at scheduled outpatient radiology examinations. Modeling of appointment failure risk based on environmental features can help increase the attendance of outpatient radiology appointments.

A strong faculty development program is crucial to recruit, support, and advance early-career faculty members in order to achieve and sustain an exceptional and diverse medical community. There has been increasing appreciation for the importance of fostering intrapersonal "soft-skills" such as leadership, mentorship, resilience, adaptability, and emotional intelligence. These skills allow an individual to better interact with others and their environment, and can facilitate teamwork, time management, decision-making, and conflict resolution. The development of these skills is an ongoing process that is cumulative in nature, and generalizable to any career phase or field of medicine. A comprehensive faculty development program must emphasize these contemporary notions alongside the traditional curriculum, and this includes individual, departmental, institutional, and national level considerations.

We have all been guilty of making ineffective presentations at some point in our career. In this article we explore the key principles behind “Presentation Zen,” an approach intended to decrease cognitive overload, make presentations more visual, natural, and unique; as well as improve the overall impact of our presentations by allowing the listener to process the information while listening to the presenter.

To analyze the trends in international medical graduates (IMGs) matching into diagnostic radiology residency programs in the United States (US).The National Resident Match Program data was accessed for years 2005-2020 and diagnostic radiology residency-specific data was extracted for US MD, osteopathic (DO), and IMG applicants. IMGs were categorized into US-citizen IMGs and non-US citizen IMGs per the National Residency Match Program. Variables collected for each year included the number of positions, number of applicants in each group, positions filled/unfilled, and fill rate of each group. Additional data for some years included USMLE Step 1 score, United States Medical Licensing Examination (USMLE) Step 2 clinical knowledge (CK) score, number of research experiences, number of abstracts/publications, and additional degrees obtained. Trends were analyzed using simple linear regression model and p value0.05 was considered significant.The number of diagnostic radiology residency programs increased from 203 (2006) to 212 (2020). The total number of diagnostic radiology residency positions increased from 1011 (2006) to 1113 (2020), with the peak of 1145 in 2014. The overall "match rate," that is, proportion of positions filled to positions available, increased from 96.4% (2006) to 97.3% (2020), with a brief decline to 86.7% in 2015. Among the filled positions, the proportion filled by US medical school graduates significantly declined from 89.7% (2006) to 69.2% (2020) (p0.001), and the proportion of positions filled by osteopathic seniors and graduates significantly increased from 2.2% (2006) to 15.1% (2020; p0.001). The proportion of US IMGs increased from 3.2% (2006) to 5.4% (2020), while the proportion of non-US IMGs increased from 4.4% (2006) to 9.4% (2020), with overall IMG match rate increased significantly from 7.6% to 14.9% (p = 0.009). The mean Step 1 scores of US IMGs and non-US IMGs were 238 and 237.3, and the mean Step 2 CK scores were 241.67 and 241, respectively. Cumulatively over the study period, a total of 736 US IMGs and 1051 non-US IMGs have matched into diagnostic radiology residency.There is an increasing proportion of IMGs, especially the non-US citizen IMGs, matching into US radiology residency programs in the last decade. Diagnostic radiology remains a competitive specialty evidenced by average USMLE scores higher than national average and research experiences of matched candidates.

This study compares the results of Tympanoplasty in terms of graft uptake and hearing improvement in patients with Chronic Otitis Media which are divided on the basis of discharging ear and non discharging ear with perforation at the time of surgery. Total 110 patients were selected suffering from chronic otitis media. Out which 55 patients had discharging ear (wet ear) and 55 patients had non discharging ear (dry ear). Tympanoplasty was performed using temporalis fascia graft. Hearing improvement and graft uptake was seen in both wet and dry ears. No statistically difference is noted in the results between the two. Mucoid ear discharge at the time of surgery is not a contraindication for Tympanoplasty as it has no adverse effects on the outcomes of the surgery in respect to graft uptake and hearing improvement.

Radiologists serve in leadership roles throughout their career, making leadership education an integral part of their development. A maxim of leadership style is summarized by 360-Degree Leadership, which highlights the ability of a leader to lead from any position within the organization while relying on core characteristics to build confidence from within their team. The qualities of leadership discussed can be learned and applied by radiologists at any level. These traits can form a foundation for the leader when faced with unfavorable events, which themselves allow the leader an opportunity to build trust.

Purpose Computed tomography (CT) is a fast and ubiquitous tool to evaluate intra-abdominal organs and diagnose appendicitis. However, traditional CT reporting does not necessarily capture the degree of uncertainty and indeterminate findings are still common. The purpose of this study was to evaluate the reproducibility of a standardized CT reporting system for appendicitis across a large population and the system's impact on radiologists' certainty in diagnosing appendicitis. Methods Using a previously described standardized reporting system, eight radiologists retrospectively evaluated CT scans, blinded to all clinical information, in a stratified random sample of 237 patients from a larger cohort of patients imaged for possible appendicitis (2010-2014). Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were used to evaluate the diagnostic performance of readers for identifying appendicitis. Two-thirds of these scans were randomly selected to be independently read by a second reader, using the original CT reports to balance the number of positive, negative and indeterminate exams across all readers. Inter-reader agreement was evaluated. Results There were 113 patients with appendicitis (mean age 38, 67% male). Using the standardized report, radiologists were highly accurate at identifying appendicitis (AUC=0.968, 95%CI confidence interval: 0.95, 0.99. Inter-reader agreement was >80% for most objective findings, and certainty in diagnosing appendicitis was high and reproducible (AUC=0.955 and AUC=0.936 for the first and second readers, respectively). Conclusions Using a standardized reporting system resulted in high reproducibility of objective CT findings for appendicitis and achieved high diagnostic accuracy in an at-risk population. Predictive tools based on this reporting system may further improve communication about certainty in diagnosis and guide patient management, especially when CT findings are indeterminate.

Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.

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.

Context: Recently, there has been an increase in the number of chronic, recurrent, and recalcitrant dermatophytosis. Many factors implicated are barrier defects, aberrant host immune response, application of steroids or other irrational combination creams, transmission within family, occlusive clothing, poor hygienic conditions, poor compliance, drug resistance and virulence of the infecting strain. Transepidermal water loss (TEWL) is an important index in accessing the barrier function of skin. Aim: To ascertain the role of TEWL from the lesional skin and its effect on the cure rate and relapse in patients of tinea cruris. Materials and Method: A hospital based prospective comparative study was conducted for 1 year. A total of 200 patients of tinea cruris diagnosed clinically and by KOH examination, were included in the study. TEWL was calculated using Tewameter TM300 open chamber probe of Courage and Khazaka, Cologne, Germany. Patients were classified according to the TEWL values into Group A (patients with abnormal TEWL) and Group B (normal TEWL). Both groups were given oral itraconazole and antihistamines for 4 weeks. The cure rates and recurrence rates of both the groups were analyzed and compared. Results: In the Group A, i.e., patients of tinea cruris with abnormal TEWL, only 28% of the patients showed clinical improvement at the end of 1 month. Out of those cured, 78.57% of the cases showed recurrence after 2 months of completion of therapy. In Group B, i.e., patients of tinea cruris with normal TEWL, 69% (n = 69) of the patients showed clinical improvement at the end of 1 month. Out of those cured, only 21.74% of the cases (n = 15) showed recurrence. Conclusion: The cases of tinea cruris with abnormal TEWL show significant decrease in cure rates and significant relapse rates among those initially cured.

In the beginning of the COVID-19 pandemic when we were still getting used to the rising cases every day and limited resources to deal them with, the focus was to get a hold of the situation as quickly as possible. Seven months into the pandemic, the cases are still on the rise but we have gathered some knowledge through the researches getting published every day, most of which are focused on the involvement of respiratory system, cardiovascular system, central nervous system, and gastrointestinal system. Dermatological manifestations have not been given their due importance. Lately, many patients have started presenting with dermatological manifestation sometimes preceding or sometimes during COVID-19 infection with or without involvement of other systems. This may be beneficial to clinicians all over the world, to determine potential dermatological signs in COVID-19 and also help in earlier suspection of the COVID-19 infection. Many cutaneous adverse drug reactions (ADR) to drugs advocated in COVID-19 treatment are also being reported every day, which are discussed in this review.Here we attempt to review dermatological manifestations of COVID-19 infections and drug reactions by the drugs advocated for its treatment and an understanding in its path mechanisms reported thus far. This will help clinicians to get an insight into what to expect and when to expect in terms of dermatological manifestation of COVID-19 and its drugs.

Background: Alopecia areata (AA) is a common, recurrent form of nonscarring alopecia which often presents as circumscribed patches of spontaneous hair loss. The global prevalence of this disease varies from 0.1% to 0.2% in general population and 7–30 cases per 1000 dermatological patients. The etiology of AA still remains uncertain; however, genetic or environmental factor and autoimmunity are claimed responsible for it. Various autoimmune diseases, such as Hashimoto's thyroiditis, diabetes mellitus, vitiligo, and lupus erythematosus, have been reported in association with AA. Aim: The index study was aimed at estimation of serum T3, T4, thyroid-stimulating hormone, and antithyroid peroxidase (TPO) antibodies. Material and Methods: Similar age/sex-matched AA patients and controls (110 in each group). Enhanced chemiluminescence immunoassay for thyroid profile and anti-TPO antibody level estimation in veinous blood sample. Observations: The mean/standard deviation (SD) of T3 was 3.30 ± 0.84 pg/ml in AA while 3.27 ± 0.67 pg/ml in controls (P = 0.302). Serum mean/SD of T4 level was1.23 ± 0.76 ng/dl in AA patients while 1.17 ± 0.34 ng/dl in controls (P = 0.522). The mean/SD of anti-TPO levels in AA patients was 21.52 ± 35.09 while 56.43 ± 140.72 in controls (P = 0.136). Limitation: The limitation of this study was moderate number of AA patients and different genotype of study population. Conclusion: Occurrence of thyroid dysfunction and evidence of anti-TPO antibodies in AA is rare event in this study population.

It is an important task for leadership to identify the motivating factors for employees and motivate them to fulfill their individual and organizational goals. Although there are several motivational factors (extrinsic and intrinsic), intrinsic motivational factors such as autonomy, mastery, and purpose are more important for deeper lasting job satisfaction and higher performance. In this article, the authors discuss how an understanding of these factors that influence motivation has the potential to transform an organization.

Objective: Comparative analysis of expression of lupus erythematosus (LE) in geriatrics versus adults. Materials and Methods: We analyzed and compare the patient's records attending our department between June 2017 and June 2019, diagnosed clinically and immunologically as LE between the two groups. Results: Sixty patients, 30 in each group, met ACRA criteria, were enrolled with mean age of presentation for early-onset was 28 ± 9.8 years and late-onset, 59 ± 4.8 years. Most of the patients were females with decrease in sex ratio with age. The most common presentations were malar rash, photosensitivity, and oral ulcers. Joint complaints, lung and cardiac involvement, and nonscarring alopecia were more common in the elderly. Direct Coombs test positive hemolytic anemia, renal involvement in forms of proteinuria and lupus nephritis, and neurological involvement were seen more commonly in adults. In immunological parameters, antinuclear antibody, anti-double standard DNA antibody (AntiDsDNA), and anti-smith antibody testing were done. AntiDsDNA positivity was more in adults correlate with disease severity. We calculate the systemic LE disease activity index 2000 score was higher in the adult population. Conclusion: Our study illustrated that disease activity and damage are more in adults in comparison to geriatrics. However, geriatrics had more organ damage that may be attributable to associated comorbidities. Although the connective tissue diseases in the elderly needs less aggressive management, it requires more attention for possible organ damage due to associated comorbidities.

Radiology is no exception to the ubiquitous presence of change in every aspect of our life. Managing change is a challenge, with a high probability of failure if not properly implemented. While change management is not part of the radiology curriculum, it is a highly specialized discipline in the business world. It has been extensively researched and has emerged as a vital skillset in the management of major projects. In this article, the authors discuss how these change management strategies of the business world can be put to use in the radiologists's practice.

481 Background: We sought to identify predictors of progression of LR3 lesions (i.e. indeterminate for HCC) to LR5 lesions (i.e. definitely HCC) on follow-up imaging among cirrhotic pts. Methods: Imaging reports with LR assignments were identified among pts seen at the University of Washington, 2013-2017. Cirrhotic pts with a LR3 lesion and follow-up scan within 1 year (yr) of LR3 lesion date were included (n = 313). Clinical features were abstracted from chart review. Survival analyses employing interval censoring were performed. Variables as potentially predictive of LR3 progression were identified in univariate analyses, with backwards elimination done (p < 0.05) to obtain the final multivariate model. Results: 20.4% of LR3 lesions progressed to LR5 within 1 yr; 73% were still LR3, 8% progressed to LR4. The population was predominantly male (61%), Caucasian (71%), older than 55 (63%). The most common cirrhotic etiologies were HCV (46.7%), alcohol (32.6%), and NASH (12.8%), not mutually exclusive. AFP at the time of LR3 scan was low if available (39% with AFP 2cm. Men (HR 2.0, p = 0.02), earlier scan yr (HR 0.47 per yr, p < 0.0001), older age (HR 1.42 per 15 yr, p = 0.047), lesion size (HR 1.21 for 2cm+, global p = 0.02) appeared as independent predictors of LR3 to LR5 progression based on the final model. Of 16 variables examined, men were more likely to have chronic HCV, history of alcohol use and less likely to have autoimmune hepatitis. No other differences were seen. In an a priori analysis, risk of male sex (HR 1.99, p = 0.03) persisted despite control for HCV, alcohol, age, race, scan yr, lesion size, and number of lesions. Conclusions: Identification of clinical factors associated with LR3 progression may allow for risk modeling tools that may assist in determining imaging frequency and timing of intervention. The increased risk among men vs women is not explained by clinical or radiographic features listed above.

Purpose To investigate performance in detectability of small (≤1 cm) low-contrast hypoattenuating focal lesions by using filtered back projection (FBP) and iterative reconstruction (IR) algorithms from two major CT vendors across a range of 11 radiation exposures. Materials and Methods A low-contrast detectability phantom consisting of 21 low-contrast hypoattenuating focal objects (seven sizes between 2.4 and 10.0 mm, three contrast levels) embedded into a liver-equivalent background was scanned at 11 radiation exposures (volume CT dose index range, 0.5-18.0 mGy; size-specific dose estimate [SSDE] range, 0.8-30.6 mGy) with four high-end CT platforms. Data sets were reconstructed by using FBP and varied strengths of image-based, model-based, and hybrid IRs. Sixteen observers evaluated all data sets for lesion detectability by using a two-alternative-forced-choice (2AFC) paradigm. Diagnostic performances were evaluated by calculating area under the receiver operating characteristic curve (AUC) and by performing noninferiority analyses. Results At benchmark exposure, FBP yielded a mean AUC of 0.79 ± 0.09 (standard deviation) across all platforms which, on average, was approximately 2% lower than that observed with the different IR algorithms, which showed an average AUC of 0.81 ± 0.09 (P = .12). Radiation decreases of 30%, 50%, and 80% resulted in similar declines of observer detectability with FBP (mean AUC decrease, -0.02 ± 0.05, -0.03 ± 0.05, and -0.05 ± 0.05, respectively) and all IR methods investigated (mean AUC decrease, -0.00 ± 0.05, -0.04 ± 0.05, and -0.04 ± 0.05, respectively). For each radiation level and CT platform, variance in performance across observers was greater than that across reconstruction algorithms (P = .03). Conclusion Iterative reconstruction algorithms have limited radiation optimization potential in detectability of small low-contrast hypoattenuating focal lesions. This task may be further complicated by a high degree of variation in radiologists' performances, seemingly exceeding real performance differences among reconstruction algorithms. © RSNA, 2018 Online supplemental material is available for this article.

The purpose of this article is to assess the performance of a contrast reaction management checklist for optimal management of a contrast reaction scenario created using a high-fidelity hands-on simulation.A safety checklist was designed that presented the five adverse events that most commonly occur after administration of IV contrast medium as well as their step-by-step management. Forty-three radiology residents were randomized into two groups, a checklist group (n = 22) and a control group (n = 21), as stratified by postgraduate year. Participants took written tests involving multiple-choice questions 2 months before and immediately after participating in the high-fidelity simulation scenario, which was videotaped and independently evaluated by three graders.Both groups had similar scores on the multiple-choice question tests taken before and after participation in the simulation (p = 0.35 and p = 0.62, respectively). In the simulation, the checklist group scored significantly higher than the control group with regard to their overall management of a severe contrast reaction (85.1% vs 64.8%; p = 0.001), including individual scores for first-line treatment of bronchospasm (97.0% vs 91.3%; p = 0.035) and use of the correct route of administration and dose of epinephrine (77.3% vs 45.2%; p = 0.021).A standardized contrast reaction management checklist can reduce the number of treatment errors that occur during a simulated severe contrast reaction, particularly with regard to proper administration of epinephrine and treatment of bronchospasm. Such a checklist could be used by radiologists, technologists, and nurses to improve patient safety as a result of improved contrast reaction management and teamwork skills.

Hepatocellular carcinoma is a common malignancy for which prevention, screening, diagnosis, treatment, and surveillance demand a multidisciplinary approach. Knowledge of the underlying pathophysiology as well as advances in clinical management should be employed by radiologists to effectively communicate with hepatologists, surgeons, and oncologists. In this review article, we present recent developments in the clinical management of hepatocellular carcinoma.

Today’s radiologists in training will soon be entering the workforce and will spend most of their professional careers in this new health care environment. They will be the specialty’s future leaders and will determine if radiologists remain relevant and valued. The ACR’s Imaging 3.0� initiative was created as a valuable resource to help guide our specialty through these changing times and urges radiologists to “participate actively in patient care as an engaged member of the healthcare team” [5]. As of yet, specific strategies have not focused on preparing residents for these new challenges, and they may be left ill prepared for an era of patient-centered radiology. Many of today’s residents are not training in environments that have adopted these proposed future practice models. In this article, we discuss 3 potentially underutilized educational opportunities for trainees to increase clinical knowledge, improve communication skills, interact with patients, and ultimately emphasize the value of radiologists via patientcentered radiology.

Endovascular aneurysm repair has been used to repair abdominal aortic aneurysms but necessitates surveillance to diagnose the delayed possibility of endoleak formation. Multi-detector computer tomography (MDCT) of the abdomen is one imaging technique used to diagnose enlargement of the aneurysm sac that may be indicative of endoleaks. MDCT has a role in identifying the initial endoleak formation and providing signs suggestive of the specific endoleak subtype; thus it is necessary for radiologists to be familiar with the findings of endoleak seen on MDCT. In this pictorial review, we explore the various types of endoleaks and their appearance on MDCT.

Magnetic resonance imaging (MRI) is currently the modality of choice to evaluate liver lesions in patients with cirrhosis and hepatitis B and C. Hepatocellular carcinoma demonstrates typical imaging findings on contrast-enhanced MRI, which are usually diagnostic. Unfortunately, a subgroup of hepatocellular carcinoma presents with atypical imaging features, and awareness of these atypical presentations is important in ensuring early diagnosis and optimal patient outcomes. Herein, we review some of the more common atypical presentations with a focus on MRI.

To understand why patients "no-show" for imaging appointments, and to provide new insights for improving resource utilization.We conducted a retrospective analysis of nearly 2.9 million outpatient examinations in our radiology information system from 2000 to 2015 at our multihospital academic institution. No-show visits were identified by the "reason code" entry "NOSHOW" in our radiology information system. We restricted data to radiography, CT, mammography, MRI, ultrasound, and nuclear medicine examinations that included all studied variables. These variables included modality, patient age, appointment time, day of week, and scheduling lead time. Multivariate logistic regression was used to identify factors associated with no-show visits.Out of 2,893,626 patient visits that met our inclusion criteria, there were 94,096 no-shows during the 16-year period. Rates of no-show visits varied from 3.36% in 2000 to 2.26% in 2015. The effect size for no-shows was strongest for modality and scheduling lead time. Mammography had the highest modality no-show visit rate of 6.99% (odds ratio [OR] 5.38, P.001) compared with the lowest modality rate of 1.25% in radiography. Scheduling lead time greater than 6 months was associated with more no-show visits than scheduling within 1 week (OR 3.18, P.001). Patients 60 years and older were less likely to miss imaging appointments than patients under 40 (OR 0.70, P.001). Mondays and Saturdays had significantly higher rates of no-show than Sundays (OR 1.52 and 1.51, P .001).Modality type and scheduling lead time were the most predictive factors of no-show. This may be used to guide new interventions such as targeted reminders and flexible scheduling.

The purpose of this study was to assess the use of semiquantitative contrast-enhanced parameter analysis as an objective criteria for improving the magnetic resonance (MR) evaluation of hepatocellular carcinoma (HCC) in patients with cirrhosis. Contrast-enhanced MR examination findings from 19 patients with 21 pathologically proven HCC were evaluated using a dedicated liver image postprocessing workstation. Contrast-enhancement kinetic curves were created for each lesion, and 4 enhancement parameters (arterial wash-in slope, arterial-portal slope, arterial-equilibrium slope, and portal-equilibrium slope) were defined from the signal intensity-time plots. The accuracy of each enhancement parameter for the characterization of HCC was assessed. Statistical analysis revealed that an arterial-phase wash-in slope percentage value >1.35 per sec had a sensitivity of 86%, a specificity of 71%, and an accuracy of 79% for the correct characterization of HCC, whereas an arterial-equilibrium wash-out slope percentage value

Idiopathic calcinosis cutis is very rare and difficult to treat. Various medical modalities of treatment described with inconsistent results include chelating agents, colchicine, and probenecid. Calcium channel blockers are known to work by inhibiting intracellular entry of calcium. We successfully treated a case of idiopathic calcinosis cutis using oral diltiazem.

The quality and impact of scientific research is traditionally measured by citation-based metrics. However, the internet and social media revolution has led to radical changes in the way scientific information is shared and how it impacts the world. Alternative metrics (altmetrics) is a rapidly evolving measure to quantify social media attention received by a scientific work. It is a complement to the conventional metrics, and has tremendous potential in enabling faster alternative ways of evaluating research impact. We discuss the Altmetric Score and the growing role of altmetrics for measuring research impact.

Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic mass can arise from any tissue present within the pelvis. Although most masses in the female pelvis arise from the reproductive organs, masses may also arise from the gastrointestinal tract, urinary system, adjacent soft tissues, peritoneum, etc. It may not always be possible to determine the site of origin or distinguish these masses based on imaging characteristics. However, familiarity with the clinicopathologic and MRI features of most common pelvic masses helps in narrowing the differential diagnosis. Diagnosis of these masses needs a holistic approach as required for any tumor including clinical history, laboratory data, and imaging characteristics. We focus on MRI characteristics of commonly encountered pelvic masses. A compartmental imaging approach is discussed in this article that helps in identifying and characterizing these masses.

Within a radiology team, members individually lean toward being givers or takers. Radiology leadership must recognize this characteristic and leverage the strengths of givers and takers to best assist the team and to provide effective motivation. Understanding the importance of balancing these qualities within a team improves productivity and morale and reduces burnout.

Orthotopic liver transplantation is the preferred treatment for end-stage liver disease. Imaging plays an important role in the follow-up of transplant recipients by identifying a variety of complications. Posttransplant liver imaging can be challenging with altered vascular and nonvascular postoperative findings closely mimicking pathologies. A thorough knowledge of these common imaging findings in a posttransplant liver is essential for the radiologist to avoid erroneous diagnoses and unnecessary workup. We focus on such imaging findings and provide tips to avoid misinterpretation.

No-show appointments are a troublesome, but frequent, occurrence in radiology hospital departments and private practice. Prior work in medical appointment no-show prediction has focused on general practice and has not considered features specific to the radiology environment. We collect data from 16 years of outpatient examinations in a multi-site hospital radiology department. Data from the radiology information system (RIS) are fused with patient income estimated from U.S. Census data. Features were categorized into three groups: Patient, Exam, and Scheduling. Models based on the total feature set and separately on each feature group were developed using logistic regression to assess the per-appointment likelihood of no-show. After five-fold cross-validation, no-show prediction using the total feature set from 554,611 appointments yielded an area under the curve (AUC) of 0.770 ± 0.003. Feature groups that were most informative in the prediction of no-show appointments were those based on the type of exam and on scheduling attributes such as the lead time of scheduling the appointment. A data-driven no-show prediction model like the one presented here could be useful to schedulers in the implementation of an automated scheduling policy or the assignment of examinations with a high risk of no-show to lower impact appointment slots.

Data-driven methods have proved their utility in radiology workflow optimization and reporting. These capabilities of natural language processing, machine learning, content extraction, and image processing largely mirror, at a conceptual level, what we as radiologists do. Traditional image processing techniques are employed to segment images into identifiable regions much like human visual processing would. More recently, deep learning researchers have emulated neural architectures to perform automated image segmentation and textural feature-based classification following training on large datasets of medical images. Imaging appropriateness, scheduling efficiency, and image interpretation performance all represent realms in which we may be able to use big data to improve our practices, in terms of throughput, diagnostic accuracy, and patient satisfaction.

Doppler ultrasound plays an important role in the postoperative management of hepatic transplantation, by enabling early detection and treatment of various vascular complications. This article describes the normal Doppler findings following liver transplantation and reviews the imaging appearances of various vascular complications associated with it. The article also discusses transient waveform abnormalities, often seen on a post-transplant Doppler examination, and the importance of differentiating them from findings suggestive of ominous vascular complications.

Pancreatic transplantation, performed alone or in conjunction with kidney transplantation, is an effective treatment for advanced type I diabetes mellitus and select patients with type II diabetes mellitus. Following advancements in surgical technique, postoperative management, and immunosuppression, pancreatic transplantation has significantly improved the length and quality of life for patients suffering from pancreatic dysfunction. While computed tomography (CT) and magnetic resonance imaging (MRI) have more limited utility, ultrasound is the preferred initial imaging modality to evaluate the transplanted pancreas; gray-scale assesses the parenchyma and fluid collections, while Doppler interrogation assesses vascular flow and viability. Ultrasound is also useful to guide percutaneous interventions for the transplanted pancreas. With knowledge of the surgical anatomy and common complications, the abdominal radiologist plays a central role in the perioperative and postoperative evaluation of the transplanted pancreas.

Small bowel transplantation, alone or with other organs as multivisceral transplantation, is performed for patients with chronic intestinal failure. With advancing surgical techniques and improved post-surgical management, survival of these patients has increased tremendously in the last two decades. The radiologist has an important role in the preoperative and postoperative management of these patients. Knowledge of surgical techniques and post-surgical complications seen in the transplant recipient is necessary for adequate management of these patients.

Stem cell transplant has been the focus of clinical research for a long time given its potential to treat several incurable diseases like hematological malignancies, diabetes mellitus, and neuro-degenerative disorders like Parkinson disease. Hematopoietic stem cell transplantation (HSCT) is the oldest and most widely used technique of stem cell transplant. HSCT has not only been used to treat hematological disorders including hematological malignancies, but has also been found useful in treamtent of genetic, immunological, and solid tumors like neuroblastoma, lymphoma, and germ cell tumors. In spite of the rapid advances in stem cell technology, success rate with this technique has not been universal and many complications have also been seen with this form of therapy. The key to a successful HSCT therapy lies in early diagnosis and effective management of complications associated with this treatment. Our article aims to review the role of imaging in diagnosis and management of stem cell transplant complications associated with HSCT.