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Residency programs that effectively utilize social media (SoMe) have the potential to distinguish themselves and improve their resident recruitment. These platforms allow programs to connect with applicants they otherwise might have limited ability to reach before the interview season. We sought to evaluate the presence of SoMe across diagnostic radiology residency programs and highlight future trends that programs should account for. A list of diagnostic radiology residency programs within the United States was obtained from the American Medical Association (AMA) FREIDA Residency Database. A search for the presence of Twitter, Facebook, and Instagram was performed for each program. Based on the analysis, the most utilized SoMe platform by diagnostic radiology residency programs was Twitter (61.73%), followed by Instagram (47.45%), and then Facebook (37.76%). Given that Twitter was the most utilized, further analysis was done to evaluate the total number of followers and the year of account creation. The results showed that the average program had 1081 ± 1438 followers and the mean year of creation was 2017 ± 2.6 years. Social media is an effective tool to disseminate information efficiently and effectively to prospective residency candidates. It is important that those involved in radiology medical education stay up to date with current and future social media trends while maintaining an active professional presence on these platforms.

Given limited exposure to radiology during the pre-clinical and clinical years, it has been challenging to recruit medical students to radiology. Now, many medical students considering radiology as a career are deterred due to misinformation surrounding how AI implementation will affect radiologists in the future. Artificial Intelligence (AI) has the potential to revolutionize the way in which medicine is practiced, especially in the field of radiology, and will ultimately support radiologists and advance the specialty. We aimed to provide a basic guide for medical students on the application of artificial intelligence in radiology, address misconceptions, highlight the role radiologists will play in AI development, and discuss the challenges faced in the future.

Twitter provides students with a centralized platform to learn about numerous opportunities within radiology. The platform can be immensely beneficial to students by providing opportunities to learn, network, connect with mentors, and find events while also preparing applicants for The Match. Having a prominent Twitter presence can pay dividends in the long term throughout one's training. We aim to provide a guide for medical students on how to create a Twitter account and best utilize the platform.

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.

Radiologists have shouldered a myriad of personal and professional burdens during the ongoing pandemic, leading to high levels of stress and burnout. Herein we discuss a set of strategies known as the 8-point program to help radiologists better cope with these stressors. Although the onus should be on leadership at the workplace to implement meaningful strategies to alleviate burnout, individual strategies such as the 8-point program can be beneficial for optimizing radiologist well-being in the read room.

The duodenum can be affected by a variety of abnormalities because of its development during embryogenesis and its dual intra- and retroperitoneal location. If small bowel embryogenesis is disturbed, congenital errors occur. Although some congenital variants may be asymptomatic and inconsequential to the patient, other anomalies can result in life-threatening emergencies such as malrotation, leading to midgut volvulus. Many infectious processes affect the duodenum, including duodenal ulcers and opportunistic infection in patients with HIV/AIDS or Crohn disease. Small bowel malignancies are uncommon but important to recognize, because the duodenum can be involved in polyposis syndromes or the development of primary adenocarcinoma, neuroendocrine tumors, lymphoma, and metastasis. Although endoscopy is currently the most used diagnostic method to assess the lumen of the upper gastrointestinal tract, fluoroscopy is a valuable adjunct technique and the study of choice for many diseases, specifically those for which anatomic and functional information is required. Fluoroscopy is also commonly used postoperatively to assess for complications such as obstruction and extraluminal leaks. Compared with endoscopy, fluoroscopy is an inexpensive and noninvasive technique that provides salient anatomic information and allows delineation of the duodenal mucosa and assessment of real-time duodenal motility. The authors examine the broad spectrum of conditions that can involve the duodenum, including congenital, infectious, inflammatory, and neoplastic abnormalities, and review their typical appearances at fluoroscopy.

Radiologists' personal productivity and efficiency are critically important for both improving patient outcomes and protecting clinician well-being. There are several solutions that individuals can implement to improve personal productivity and efficiency in the radiology workroom. Strategies include understanding the psychology behind productivity, using personal productivity methodologies to accomplish daily tasks, and learning to modulate stress to optimize performance. Institutional infrastructure requirements include a robust departmental commitment to information technology and informatics, including universal log-in systems, internal websites, and dashboards. The workstation itself can be optimized by utilizing hanging protocols, customized keyboard shortcuts, hotkeys, advanced scripts, gaming mice, and other input devices. Personal devices like smartphones can be harnessed to maximize productivity by using online storage applications and radiology-specific applications to augment knowledge. Reading room layouts must be designed to minimize interruptions and workstations must consider ergonomics to prevent fatigue and strain. High-efficiency teams also need to be created to allow radiologists to delegate non-clinical tasks to reduce administrative burdens. Lastly, continued advances in artificial intelligence including the use of smart report templates will lead to substantial gains in radiologists' productivity and efficiency.

“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.

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.

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.

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.

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.

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.

Two siblings, a 19-year-old woman and an 18-year-old man, born to apparently normal parents of second-degree consanguineous marriage, presented to the Department of Dermatology, Sawai Man Singh Medical College Hospital, Jaipur, India, with recurrent skin ulcers of the hands and feet since early childhood. The ulcers were spontaneous, slow to heal, and caused deformities. On initial examination, they were found to have distal sensory loss, predominantly to pain and temperature. The patients were diagnosed with hereditary sensory and autonomic neuropathy of ulceromutilating type (Type 2) based on clinical evidences, nerve studies, and neuropathology. Although clinical features were distinct, due to slow progression of the disease and lack of clinical suspicion, diagnosis was delayed until adulthood when complications developed leading to deformities. Through this report, the authors intend to familiarize readers with this rare disease that can present with trophic ulcers.

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.

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.

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.

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.

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.

Coronary artery aneurysms are an uncommon manifestation of systemic lupus erythematosus (SLE), with only 14 cases reported previously in the literature. Herein, we report a 29-year-old woman with SLE who developed clinical and serologic evidence of an SLE flare and presented with chest pain and elevated serum troponin-T level. Cardiac computed tomography was performed and demonstrated fusiform aneurysmal enlargement of the proximal and middle portions of the coronary arteries and a beaded appearance of the distal coronary arteries. Extensive intercostal artery aneurysms were also noted. Several areas of abnormal myocardial perfusion were also noted. The patient improved after treatment with steroid pulses and cyclophosphamide. This case report is the first description of the appearance of lupus coronary vasculitis on cardiac computed tomography.

The skeleton is one of the most common sites for metastatic disease, particularly from breast and prostate cancer. Bone metastases are associated with considerable morbidity, and accurate imaging of the skeleton is important in determining the appropriate therapeutic plan. Sodium fluoride labeled with fluorine 18 (sodium fluoride F 18 [(18)F-NaF]) is a positron-emitting radiopharmaceutical first introduced several decades ago for skeletal imaging. (18)F-NaF was approved for clinical use as a positron emission tomographic (PET) agent by the U.S. Food and Drug Administration in 1972. The early use of this agent was limited, given the difficulties of imaging its high-energy photons on the available gamma cameras. For skeletal imaging, it was eventually replaced by technetium 99m ((99m)Tc)-labeled agents because of the technical limitations of (18)F-NaF. During the past several years, the widespread availability and implementation of hybrid PET and computed tomographic (CT) dual-modality systems (PET/CT) have encouraged a renewed interest in (18)F-NaF PET/CT for routine clinical use in bone imaging. Because current PET/CT systems offer high sensitivity and spatial resolution, the use of (18)F-NaF has been reevaluated for the detection of malignant and nonmalignant osseous disease. Growing evidence suggests that (18)F-NaF PET/CT provides increased sensitivity and specificity in the detection of bone metastases. Furthermore, the favorable pharmacokinetics of (18)F-NaF, combined with the superior imaging characteristics of PET/CT, supports the routine clinical use of (18)F-NaF PET/CT for oncologic imaging for skeletal metastases. In this article, a review of the indications, imaging appearances, and utility of (18)F-NaF PET/CT in the evaluation of skeletal disease is provided, with an emphasis on oncologic imaging.

OBJECTIVE. Hepatocellular carcinomas (HCCs) that arise in noncirrhotic livers have several histologic and biochemical features that distinguish them from HCCs occurring in the setting of cirrhosis. Because the presentation, management, and prognosis of these entities are distinct, the accurate preoperative characterization of these lesions is of great clinical significance. We review the pathogenesis, imaging appearance, and clinical implications of noncirrhotic HCCs as they pertain to the clinical radiologist. CONCLUSION. HCCs that develop in noncirrhotic patients have distinct etiologic, cytogenetic, histopathologic, and clinical features. Despite a larger tumor burden at the time of HCC diagnosis, noncirrhotic patients with HCC have better overall survival and disease-free survival than cirrhotic patients with HCC. Knowledge of the precise clinical and imaging features of this entity and of other diagnostic considerations for the noncirrhotic liver is essential for improved patient care.

Tumoral pulmonary emboli from hepatocellular carcinoma (HCC) have rarely been described, although invasion of the portal and hepatic venous systems is a well-known complication. HCC originating in a noncirrhotic liver in the absence of chronic hepatitis B infection is also uncommon. We present a case of a patient with chronic hepatitis C infection without hepatic cirrhosis who developed angioinvasive HCC with intracardiac extension and tumoral pulmonary emboli. Differential considerations, including combined HCC-cholangiocarcinoma, other hepatic mesenchymal tumors, and metastasis, are discussed. Owing to poor prognosis, no resection was attempted. Autopsy was performed because of the unusual clinical presentation, and immunohistochemistry of the hepatic tumor, the intracardiac extension, and the pulmonary emboli were concordant with hepatocellular origin. Even though definitive diagnosis may not affect patient outcome, it is important for radiologists and clinicians to be aware that angioinvasive HCC may arise in the absence of cirrhosis.

The academic portfolio has become an integral part of the promotions process. Creating and maintaining an academic portfolio in paper-based or web-based formats can be a cumbersome and time-consuming task. In this article, we describe an alternative way to efficiently organize an academic portfolio using a reference manager software, and discuss some of the afforded advantages. The reference manager software Papers (Mekentosj, Amsterdam, The Netherlands) was used to create an academic portfolio. The article outlines the key steps in creating and maintaining a digital academic portfolio. Using reference manager software (Papers), we created an academic portfolio that allows the user to digitally organize clinical, teaching, and research accomplishments in an indexed library enabling efficient updating, rapid retrieval, and easy sharing. To our knowledge, this is the first digital portfolio of its kind.

Hepatocellular carcinomas are highly vascular tumors, showing progressive hypervascularity by the process of neoangiogenesis. Tumor angiogenesis is critical for tumor growth as well as metastatic spread therefore, imaging and quantification of tumor neo-angiogenesis is essential for monitoring response to targeted therapies and predicting disease progression. Sorafenib is a molecular targeting agent used for treating hypervascular tumors. This drug is now the standard of care in treatment of patients with advanced hepatocellular carcinoma. Due to its anti-angiogenic and anti-proliferative actions, imaging findings following treatment with Sorafenib are quite distinct when compared to conventional chemotherapeutic agents. Liver MRI is a widely adopted imaging modality for assessing treatment response in hepatocellular carcinoma and imaging features may reflect pathophysiological changes within the tumor. In this mini-review, we will discuss MRI findings after Sorafenib treatment in hepatocellular carcinoma and review the feasibility of MRI as an early biomarker in differentiating responders from non-responders after treatment with molecular targeting agents.

In an era of declining reimbursements and tightening of the job market, today's radiologists are forced to "make do with less." With the rollout of the Patient Protection and Affordable Care Act, commonly called "Obamacare," radiologists will be expected not only to interpret studies but to also take on many additional roles, adding a new layer of complexity to already demanding daily duties. These changes make it more important than ever to develop a personal workflow management system incorporating some of the most potent productivity tools. In this article, the authors discuss current productivity techniques and related software with the most potential to help radiologists keep up with the ever increasing demands on their time at the work place and help us lead more balanced lives.