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We established and evaluated a peer learning program in an emergency radiology (ER) division. Peer learning is an alternative to peer review focusing on non-punitive error reporting to mitigate consequences of inevitable human error. The central component is the peer learning conference, where cases are presented, key teaching points are discussed, and process improvement ideas are solicited.We established a prior imaging-based case identification system and a bimonthly remote videoconference where ER faculty discuss 5-15 cases selected for learning or process improvement opportunities. Case identification and conference characteristics were captured. A survey focused on learning and performance outcomes was administered to faculty initially and showed improved scores after 6 months.Cases selected for conference favored perception errors (46%), with great calls (17%) and process improvement (15%) the next most common categories. A variety of anatomical regions were represented, with abdominal (35%) and musculoskeletal (29%) most common. Error detection was improved over peer review. All participants find the system easy to use and prefer peer learning to peer review for learning and process improvement.A peer learning program can be successfully implemented within a busy academic emergency radiology division, as evidenced by increasing buy-in and engagement scores over time. When tied to a departmental peer learning infrastructure, interdisciplinary expertise and robust case identification can be leveraged to increase learning opportunities.

Artificial intelligence (AI) systems play an increasingly important role in all parts of the imaging chain, from image creation to image interpretation to report generation. In order to responsibly manage radiology AI systems and make informed purchase decisions about them, radiologists must understand the underlying principles of AI. Our task force was formed by the Radiology Research Alliance (RRA) of the Association of University Radiologists to identify and summarize a curated list of current educational materials available for radiologists.

Abdominal and pelvic wall hernias are classically defined as a weakness or opening of the muscular wall through which abdominal or pelvic tissues protrude. The aim of this manuscript is to review the imaging findings of abdominal and pelvic wall hernias and their mimics and to discuss pearls and pitfalls for accurately diagnosing and classifying these entities.

Despite the use of imaging in many medical and surgical practices, no universal mandatory radiology component is required by the Liaison Committee on Medical Education. In contrast, United States medical students are required to complete at least one core subinternship during their final year of medical school in medicine, surgery, pediatrics, or family medicine, regardless of their chosen field of interest. Students are expected to perform just below the level of an intern, performing functions such as assisting in writing notes, placing orders, and arranging for appropriate follow-up. To our knowledge, there are few institutions that offer a comparable clinical experience in radiology. In order to address this, we successfully designed and implemented a hands-on medical student advanced radiology elective, which allowed for experiential learning through independent dictation of radiographic examinations and procedure-based practice. Here, we describe the process of developing such an elective, how to implement it at other institutions, and some insight into troubleshooting any potential pitfalls should they arise. Overall, our novel hands-on elective enables a more student-centered, active learning approach, allowing for more in-depth, accurate evaluation of specialty choice while also equipping faculty and residency programs with the skills to best assess student interest, motivation, knowledge, and communication skills.

Rationale and objectives We aimed to create an open access online radiology podcast to educate listeners at any time, from anywhere. To meet learner needs and improve the likelihood of successful implementation and utilization, we assessed radiology trainee attitudes and experiences of podcasts. Materials and methods We developed an educational podcast, From the Viewbox, focused on evergreen themes and practical approaches to radiology. Content categories included Diagnostic Approach, Specific Imaging Diagnoses, Noninterpretive Skills, and Special Topics. We released and promoted episodes on multiple digital platforms. Radiology trainees were surveyed and data were analyzed to assess listener preferences and usage trends. Results Only 19% of our trainees had previously listened to a radiology podcast, yet 81% expressed interest in listening routinely. After initial release, 86% of trainees listened to the podcast and 62% listened routinely. Episodes gained the most plays immediately following release but retained and continued to attract more listeners. The most popular episode discussing COVID-19 diagnosis and imaging, emphasized the importance of selecting high yield content to match listener needs. Most trainees felt the podcast had “very high” or “high” value in educational value, accessibility, and time efficiency. Conclusions From the Viewbox offers efficient and accessible audio-only learning modules that can be used independently or effectively paired with traditional resources to decrease barriers in radiology education and enhance learner productivity. Podcasting is an underutilized asynchronous remote learning tool that can help overcome current challenges of social distancing, and more importantly address the diverse preferences and needs of our learners.

Purpose: This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute non-traumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic.Methods: This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute non-traumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control.Results: During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). Conclusions: Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current outbreak of Coronavirus disease 2019 (COVID-19). Although imaging should not be used for first-line screening or diagnosis, radiologists need to be aware of its imaging features, and those of common conditions that may mimic COVID-19 pneumonia. In this Pictorial Essay, we review frequently encountered conditions with imaging features that overlap with those that are typical of COVID-19 (including other viral pneumonias, chronic eosinophilic pneumonia, and organizing pneumonia), and those with features that are indeterminate for COVID-19 (including hypersensitivity pneumonitis, pneumocystis pneumonia, diffuse alveolar hemorrhage, pulmonary edema, and pulmonary alveolar proteinosis).

Purpose This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute nontraumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic. Methods This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute nontraumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently, and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control. Results During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). Conclusions Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

We deem a computer to exhibit artificial intelligence (AI) when it performs a task that would normally require intelligent action by a human. Much of the recent excitement about AI in the medical literature has revolved around the ability of AI models to recognize anatomy and detect pathology on medical images, sometimes at the level of expert physicians. However, AI can also be used to solve a wide range of noninterpretive problems that are relevant to radiologists and their patients. This review summarizes some of the newer noninterpretive uses of AI in radiology.

Spinal cord injury often times is a catastrophic result of trauma. Delay in diagnosis may result in increased morbidity and mortality. Cross-sectional imaging is now increasingly used as a first-line diagnostic modality in the setting of trauma for recognition of spine fractures and ligamentous injuries that might be missed on routine radiographs. The learning objectives of this article are to review the anatomy of the spine and understand the mechanisms of injury in the cervical, thoracic, and lumbosacral column by applying easy and reproducible classification systems to guide clinical management.

To review the classification of testicular tumors, describe the sonographic and pathologic features of each tumor type, and discuss the mimics, diagnostic pitfalls, and management of testicular tumors. Method consists of pictorial review. We review sonographic and pathologic findings of several testicular tumors and tumorlike entities. Although ultrasound is the first-line imaging modality to differentiate between intratesticular and extratesticular location of an intrascrotal mass, it is not specific for intratesticular lesion characterization. Therefore, correlation with histology sampling is often necessary.

To determine the diagnostic accuracy of an abbreviated magnetic resonance imaging (MRI) protocol of the foot for the diagnosis of osteomyelitis in patients with acute foot infection. This retrospective study evaluated adult patients (age 18 and over) visiting an academic medical center from 1 January 2013 to 31 December 2015 who were imaged with MRI for suspected acute pedal osteomyelitis. Examinations were performed utilizing the departmental standard protocol. All examinations were retrospectively interpreted by five radiologists under two protocols: a reference standard protocol consisting of all non-contrast sequences obtained at initial acquisition and an abbreviated protocol consisting of only coronal T1-weighted and sagittal T2-weighted fast multiplanar inversion-recovery (FMPIR) sequences. Interpretation of the two imaging subsets was separated in time by at least 6 weeks for each reader. Each examination was assigned a score to represent one of four diagnostic categories: normal; soft tissue infection without bone changes or bone changes specific to a non-infectious etiology; nonspecific bone marrow changes; or bone changes specific for osteomyelitis. Diagnostic accuracy of both protocols was determined based on clinical diagnosis and treatment of osteomyelitis, and histopathology when available. One hundred and two MRI examinations met inclusion criteria; participants ranged in age from 26 to 91 years, with a mean age of 59 years. Seventy examinations were performed for male participants (69%) and 32 for female participants (31%). Thirty-five had a confirmed diagnosis of osteomyelitis, while the remainder (n = 67) did not. An average of 6 non-contrast sequences was performed during each examination. The most common protocol (53/102 examinations) was comprised of the following 6 sequences: axial T1-weighted, axial fat-saturated proton density, sagittal T1-weighted, sagittal T2-weighted FMPIR, coronal T1-weighted, and coronal fat-saturated proton density. After patient positioning, the abbreviated protocol sequences (sagittal T2-weighted FMPIR and coronal T1-weighted) were performed in an average total of 8 min. The reference standard protocol required an average of 22 min to complete 6 sequences. Averaged across all readers, the AUC for the reference standard full protocol and the abbreviated protocols were 0.843 and 0.873, respectively. The difference in AUC between protocols was not statistically significant (p = 0.1297), with the abbreviated protocol showing a non-significantly greater AUC. An abbreviated MRI protocol, including only coronal T1-weighted and sagittal T2-weighted FMPIR images, is non-inferior to standard MRI protocol for the diagnosis of acute pedal osteomyelitis. It should be considered as a diagnostic alternative for reducing imaging time and improving patient access to MRI.

Disorders of the kidney and urinary collecting system are common encountered in the acute care setting. Computed tomography has progressively replaced intravenous pyelography for the evaluation of most urinary tract pathology including acute flank pain, suspected malignancy, congenital abnormalities, anatomical variants, and inflammatory/vascular conditions through evaluation of the "nephrogram" produced by intravenous contrast material filtering through the kidneys. In this review, we describe the most common types of abnormal nephrograms seen on renal computed tomography, and highlight the salient features and conditions associated with them, in addition to a pictorial review with specific and interesting related cases. The types of abnormal nephrograms reviewed are absent, unilateral delayed, striated, spotted, and persistent.

Pancreaticobiliary injury is an uncommon entity which more often occurs in the setting of blunt than penetrating trauma. We present cases of pancreaticobiliary traumatic injuries from our Level 1 trauma center to illustrate an imaging update on the spectrum of injuries and correlation with current grading systems.

Thoracic injury results from penetrating and blunt trauma and is a major contributor to overall trauma morbidity and mortality in the United States. Modern imaging algorithms utilize ultrasound, chest radiograph, and computed tomography with intravenous contrast to accurately diagnose and effectively treat patients with acute thoracic trauma. This review focuses on the etiologies, signs and symptoms, imaging, and management of several life-threatening thoracic injuries including tracheobronchial rupture, pulmonary parenchymal injury, hemothorax, pneumothorax, diaphragmatic rupture, and axial skeleton injury.

In this article, we discuss the challenges in the diagnosis of acute abdominopelvic pain in pregnant patients, role of imaging, and advantages of MRI over other modalities. Methods consist of pictorial review. We review the differential diagnoses and illustrate the MRI findings in pregnant patients with acute abdominopelvic pain, including gastrointestinal, gynecologic, urologic, and vascular etiologies.

Background Reference values and age-related changes of the wall thickness of the abdominal aorta have not been described in the general population. We characterized age-, race-, and gender-specific distributions, and yearly rates of change of mean aortic wall thickness (MAWT), and associations between MAWT and cardiovascular risk factors in a multi-ethnic population-based probability sample. Methods Magnetic resonance imaging measurements of MAWT were performed on 2466 free-living white, black, and Hispanic adult subjects. MAWT race/ethnicity- and gender-specific percentile values across age were estimated using regression analyses. Results MAWT was greater in men than in women and increased linearly with age in all the groups and across all the percentiles. Hispanic women had the thinnest and black men the thickest aortas. Black men had the highest and white women the lowest age-related MAWT increase. Age, gender, ethnicity, smoking status, systolic blood pressure, low-density lipoprotein-cholesterol levels, high-density lipoprotein-cholesterol levels, and fasting glucose levels were independent predictors of MAWT. Conclusions Age, gender, and racial/ethnic differences in MAWT distributions exist in the general population. Such differences should be considered in future investigations assessing aortic atherosclerosis and the effects of anti-atherosclerotic therapies.

Purpose To assess the agreement between three methods of calculation of mean aortic wall thickness (MAWT) using magnetic resonance imaging (MRI). Materials and Methods High-resolution MRI of the infrarenal abdominal aorta was performed on 70 subjects with a history of coronary artery disease who were part of a multi-ethnic population-based sample. MAWT was calculated as the mean distance between the adventitial and luminal aortic boundaries using three different methods: average distance at four standard positions (AWT-4P), average distance at 100 automated positions (AWT-100P), and using a mathematical computation derived from the total vessel and luminal areas (AWT-VA). Bland-Altman plots and Passing-Bablok regression analyses were used to assess agreement between methods. Results Bland-Altman analyses demonstrated a positive bias of 3.02 ± 7.31% between the AWT-VA and the AWT-4P methods, and of 1.76 ± 6.82% between the AWT-100P and the AWT-4P methods. Passing-Bablok regression analyses demonstrated constant bias between the AWT-4P method and the other two methods. Proportional bias was, however, not evident among the three methods. Conclusion MRI methods of measurement of MAWT using a limited number of positions of the aortic wall systematically underestimate the MAWT value compared with the method that calculates MAWT from the vessel areas. J. Magn. Reson. Imaging 2009;29:576–582. © 2009 Wiley-Liss, Inc.

Background— Elevated levels of C-reactive protein (CRP) are associated with increased risk for incident cardiovascular events on the basis of observations from several prospective epidemiological studies. However, less is known regarding the relationship between CRP levels and atherosclerotic burden. Methods and Results— We measured CRP in 3373 subjects 30 to 65 years of age who were participating in the Dallas Heart Study, a multiethnic, population-based, probability sample. Electron-beam CT scans were used to measure coronary artery calcification (CAC) in 2726 of these subjects, and MRI was used to measure aortic plaque in 2393. CRP levels were associated with most traditional cardiovascular risk factors. Subjects with CAC had higher median CRP levels than those without CAC (men: median, 2.4 versus 1.8 mg/L, P P P for trend=0.003) but not in women ( P for trend=0.08). Male subjects with aortic plaque also had higher CRP levels than those without (median, 2.3 versus 1.8; P Conclusions— In a large, population-based sample, subjects with higher CRP levels had a modest increase in the prevalence of subclinical atherosclerosis, but this association was not independent of traditional cardiovascular risk factors. CRP is a poor predictor of atherosclerotic burden.

Objectives— The purpose of this study was to evaluate the associations between plasma levels of soluble CD40 ligand (sCD40L), atherosclerosis risk factors, and evidence of subclinical atherosclerosis. Methods and Results— Plasma levels of sCD40L were measured in 2811 subjects from the Dallas Heart Study, a multiethnic population-based cross-sectional study. Electron Beam Computed Tomography measurements of coronary artery calcium (CAC) and MRI measurements of aortic plaque were performed in 2198 and 1965 subjects, respectively. No association was observed between quartiles of sCD40L and age, sex, race, body mass index, diabetes, smoking, creatinine clearance, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or C-reactive protein. In contrast, weak but statistically significant associations were observed between sCD40L and total cholesterol and triglycerides. The prevalence of detectable CAC (CAC score ≥10) and aortic plaque did not differ across sCD40L quartiles, and individuals with CAC scores 100 to 400, and >400 had similar sCD40L levels. Conclusions— In a large and representative multiethnic population-based sample, sCD40L was not associated with most atherosclerotic risk factors or with subclinical atherosclerosis. These findings suggest that sCD40L will not be useful as a tool to screen for the presence of subclinical atherosclerosis in the population. Further evaluation of this biomarker should focus on settings in which platelet activation is common, such as following acute coronary syndromes or coronary revascularization procedures.

In this article we demonstrate the use of an automated technique to visualize lesions in the abdominal aorta, gathered from MRI imagery, and displayed as a stained pathology specimen. We have developed this technique in response to the suggestion from clinical colleagues that such a representation of the data is more understandable to the pathologist than presentation of axial MRI slices, even if the atheroma is of high contrast and very thick. This virtual dissection relies on an initial manual segmentation of the inner and outer walls of the vessel, which I achieved using a commercial cardiac analysis package. The algorithm consists of a) decoding the file that describes the contours; b) generating a center for each slice; c) determining the appropriate posterior position on all slices; d) interpolating along the (approximately circular) lumen and through all slices; e) false color presentation of the wall thickness as a pathological stain. Keywords: MRI, aorta, lesion, virtual dissection, pathology specimen. 1. INTRODUCTION Modern radiological modalities such as magnetic resonance imaging (MRI) make possible the visualization of pathology of various types, using completely non-invasive protocols. An example that is explored in this work is that of lipid-containing lesions in the abdominal aorta. Such lesions are visible on T1- or T2-weighted sequences. An example is shown in figure 1. The aorta is shown in the center of the image, and a lesion is visible at the 3 o’clock position. Lipid-like components in the spin al column are also visible in this image. While this pr esentation is acceptable to many radiologists and other clinicians, in th e pathology lab the more familiar presenta tion would be as a dissected specimen, quite possibly stained for lipids (see e.g. [2]). Creating a display of this format would be possible if the endothelium and epithelium of the aorta could be identified in all of the acqui red slices. From these outlines a series of steps could then be taken to, in effect, dissect the aorta from the acquired slices, and present it as a cut specimen. The use of false color display techniques, such as are commonly used in nuclear medicine, could be used to improve specificity beyond that achieved by using the wall thickness as a grayscale. In this work we present the steps that we took to perform such a virtual dissection. Our Institution has, over the last four years, conducted the Dallas Heart Study [1], in which 3500 adults from the Dallas area were selected at random and were subjected to several examinations, including MRI scans of the heart and abdomen. We therefore have a large pool of data with which to test our algorithm. All the MRI exams are stored in a searchable repository with a Web-enabled interface [3], therefore a degree of automation of the entire process to large batches is possible. The dissection process is not particularly compute intensive so could be applied to hundreds of scans in a reasonably short amount of time. 2. METHODS There are four main stages to the virtual dissection process, and we will describe each stage below. 2.1. Obtaining the contours The first stage is to detect the e ndothelium and epithelium of the aorta in each acquired slice. This stage is