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Rationale and Objectives The ABR announced changes to the board examinations for the resident class entering in 2010. These changes can allow the fourth year to be focused on subspecialization. During the restructuring process at the authors' institution, residents were queried about fourth-year design. The goal was to create a curriculum that would best meet residents' expectations while balancing clinical and educational needs. Materials and Methods Issues from the literature about the fourth-year curriculum were identified. An anonymous and voluntary survey based on these was developed and sent to 36 residents who made up the study group. Answers were reviewed for trends and significant unique responses before curricular development. Results Twenty-two of 36 residents (61%) responded. The most often selected electives were cardiac (91%), body MRI (77%), body interventional procedures (68%), neuroradiologic MRI (59%), musculoskeletal procedures (59%), and musculoskeletal imaging (54%). Fifty percent wanted 6 months in one area. Forty-five percent felt that the length of time in one area (most with a threshold of 9 months) would affect their decisions to pursue fellowships. The majority (73%) planned to use the fourth year to do rotations different from their planned fellowship areas. Conclusion The majority of residents indicate that they would like to have at least half of their fourth year in one area, and most selected similar rotations to one another. The ability to do this extended time on one service may result in a decrease in the number of residents pursuing fellowships. However, most saw the fourth year as a way to broaden their radiologic knowledge.

Contrast-induced acute kidney injury (AKI) (also known as contrast-induced nephropathy) is an abrupt deterioration in renal function that can be associated with use of iodinated contrast medium. Although the increase in serum creatinine concentration is transient in most cases, contrast-induced AKI may lead to increased morbidity and mortality rates in selected at-risk populations. This review summarizes the findings of a multidisciplinary panel composed of computed tomography radiologists, interventional radiologists, cardiologists, and nephrologists convened to address the specialty-specific issues associated with minimizing the incidence of contrast-induced AKI. As part of this initiative, the panel developed specialty-specific protocols for preventing contrast-induced AKI, taking into account, for example, the variations in patient risk profile, inpatient or outpatient status, and staffing resources that characterize various clinical settings. The 3 protocols, each reflecting a consensus of expert opinion, address the prevention of contrast-induced AKI in interventional radiology, diagnostic computed tomography radiology, and interventional cardiology settings. The protocols are presented in the context of a review of recent guidelines and published reports of trials that discuss contrast-induced AKI and its prevention. The panel reviewed materials retrieved by a PubMed search covering the period January 1990 through January 2008 and used combinations of key words associated with the prevention and treatment of contrast-induced AKI. In addition, the panel reviewed the reference lists of selected articles and the tables of contents posted on the Web sites of selected journals for relevant publications not retrieved in the PubMed searches.

The purpose of this study was to assess the compromise between CT technical parameters and the accuracy of CT quantification of lung attenuation.Materials that simulate water (0 H), healthy lung (-650 H), borderline emphysematous lung (-820 H), and severely emphysematous lung (-1,000 H) were placed at both the base and the apex of the lung of an anthropomorphic phantom and outside the phantom. Transaxial CT images through the samples were obtained while the effective tube current was varied from 440 to 10 mAs, kilovoltage from 140 to 80 kVp, and slice thickness from 0.625 to 10 mm. Mean +/- SD attenuation within the samples and the standard quantitative chest CT measurements, the percentage of pixels with attenuation less than -910 H and 15th percentile of attenuation, were computed.Outside the phantom, variations in CT parameters produced less than 2.0% error in all measurements. Within the anthropomorphic phantom at 30 mAs, error in measurements was much larger, ranging from zero to 200%. Below approximately 80 mAs, mean attenuation became increasingly biased. The effects were most pronounced at the apex of the lungs. Mean attenuation of the borderline emphysematous sample of apex decreased 55 H as the tube current was decreased from 300 to 30 mAs. Both the 15th percentile of attenuation and percentage of pixels with less than -910 H attenuation were more sensitive to variations in effective tube current than was mean attenuation. For example, the -820 H sample should have 0% of pixels less than -910 H, which was true at 400 mA. At 30 mA in the lung apex, however, the measurement was highly inaccurate, 51% of pixels being below this value. Decreased kilovoltage and slice thickness had analogous, but lesser, effects.The accuracy of quantitative chest CT is determined by the CT acquisition parameters. There can be significant decreases in accuracy at less than 80 mAs for thin slices in an anthropomorphic phantom, the most pronounced effects occurring in the lung apex.

Background Although computed tomography lung-screening programs report a 31% to 51% incidence of subcentimeter pulmonary nodules, 85% are too small to biopsy or interrogate with positron emission spectroscopy scans. We developed a technique using transthoracic percutaneous radiotracer injection with thoracoscopic radioprobe localization and excision for small pulmonary nodules. This report describes our series of the first 46 patients evaluated with this technique. Methods Forty-six patients (79% smokers; 52% males; median age, 64 years) were evaluated. Patient selection was based on the surgeon's anticipated difficulty in thoracoscopically locating small nodules because of lesion size or location. Computed tomographic-guided injection of radiotracer solution was made into or adjacent to the nodule the day of surgery. Intraoperative gamma probe localization, followed by thoracoscopic excision of the lesion, was subsequently performed. Results Median nodule size was 9 mm (range, 3 to 22 mm), and median depth was 5 mm (range, 0 to 50 mm). Forty-four (96%) of the lesions were successfully localized and excised. Median time from injection to surgery was 270 minutes. Failures were the result of inadvertent pleural or chest wall radiotracer placement. Forty-six percent (21 of 46) of the lesions were malignant, of which 71% (15 of 21) were primary lung cancers. Patients with lung cancer underwent lobectomy or segmentectomy. Fourteen of 15 were stage IA, whereas 1 was stage IIIB (6 mm primary with 4 mm intralobar metastasis). Complications were three pneumothoraces at the time of radiotracer injection. Conclusions Computed tomography-guided radiotracer localization of small pulmonary nodules combined with thoracoscopic excisional biopsy is feasible and safe. This technique successfully localized and excised the nodule in 96% of cases.

Background The purpose of this study was to develop and evaluate radiotracer-guided localization of small or ill-defined pulmonary nodules for thoracoscopic excisional biopsy. Methods This study consisted of two parts: a laboratory study in rats to determine the most suitable radiotracer, and a pilot study in humans to determine the feasibility of radiotracer lung nodule localization. The right lung of 12 rats was injected with a technetium 99m (Tc 99m) based radiotracer solution: 4 each with macroaggregated albumin (MAA), unfiltered sulfur colloid (SC), and pertechnetate (TcO 4 ). Serial imaging was performed using a small animal gamma camera for 4 hours following injection. In 13 patients, computed tomographic (CT) guided injection of Tc 99m MAA solution was made into or adjacent to a pulmonary nodule suspicious for primary lung cancer. Gamma probe localization of the nodule was performed during subsequent thoracoscopic surgery. Results In the animal model, MAA provided more precise localization than SC or TcO 4 and was selected for the human study. In the human series, all 13 patients had successful gamma probe localization of their lesion. There were no radiologic or surgical complications. Seven of 13 nodules were malignant, and five of these nodules were stage IA primary lung carcinomas. Conclusions Computed tomographic-guided radiotracer localization of small or ill-defined pulmonary nodules using Tc 99 m MAA before thoracoscopic excisional biopsy is feasible and may make excisional biopsy the preferred management strategy for the management of small pulmonary nodules in patients at high risk for malignancy.

The Internet has changed the practice of medicine in many ways, from enabling telemedicine to making the scientific literature easily accessible and searchable. Medical education also has changed and benefited a great deal from the Internet. Lectures, tutorials, and other educational materials readily available online to medical students, residents, and other physicians have increased the opportunities for self-study. Radiology, more than any other medical specialty, is extremely well suited to Webbased study. Just as a surgeon gains experience from performing surgery and an internist gains experience from caring for patients, a radiologist gains experience from examining many radiologic images. Although it is less helpful for teaching image-guided therapies, the Web lends itself to self-study of visual materials and provides an easily accessible resource for gaining experience in radiologic interpretation. Sifting through the numerous radiologic Web sites for useful teaching tools, however, may require more time than a student or resident can spend. Many sites must be explored to find useful teaching material, because the quality of online educational resources is uneven. A student or resident interested in radiologic self-study may be deterred by these obstacles. We therefore have identified and reviewed a number of Web sites offering useful materials, listing them in three categories: those offering teaching files (Table 1), those offering tutorials (Table 2), and those sponsored by radiologic organizations offering a variety of educational resources (Table 3). Our purpose is to provide an easily accessible and understandable reference for residents and medical students who wish to explore Web-based self-study in radiology. The information outlined here should allow students to spend more time learning rather than surfing the Internet. These site listings are snapshots in time. Web resources are truly moving targets. Soon after one describes the current status of resources on the Web, that status may change. Therefore, there is no possible guarantee of the future accuracy of these sites. The future likely holds more resources, perhaps of even higher quality. One major asset of Web-based resources, however, is that they are available anywhere and at any time. These resources can also provide outreach to practitioners in underdeveloped countries who may be unable to afford printed materials or travel to continuing medical education courses. In addition, these resources can be updated according to current practice and are not bound by a printing date. It is an ongoing challenge to keep abreast of the availability of current and new Web sites. Sites were reviewed for this article from the perspective of a 1st-year radiology resident or 4th-year medical student. The comments are meant to help users find sites that best fit their needs. Program directors are encouraged to bookmark useful sites on resident workstations, making the gateway available to any resident or medical student with a spare minute to find a site and learn. These resources can be incorporated into picture archiving and communication system workstations of the future, so that when the queue of pending cases is exhausted and e-mails are answered, a few cases or a structured teaching session can occupy the available minutes until more cases are ready. The Radiological Society of North America (RSNA) has an extensive portal page for radiology education. We used this portal and popular Web search engines (eg, Google, Yahoo, MSN, and Excite) to compile a large list of sites to explore. The search terms that consistently produced the best results were “radiology” and “teaching.” Two types of education pages were sought: teaching files, to allow practice in radiographic diagnosis, and Webbased tutorials, to provide a more basic education in radiology. The teaching file Web sites were assessed according to several criteria, including the number of files, the ability to view the cases as both known and unknown diagnoses, the depth of case discussion, image quality, the Acad Radiol 2003; 10(suppl 1):S81–S86

Rationale and Objectives. This purpose of this study was to determine if a 1-month, mandatory research rotation results in resident interest and productivity in research. Materials and Methods. A survey composed primarily of closed-end questions was constructed to evaluate the opinions and experience of 24 residents who completed the research rotation during a 3½-year period. Results. All 24 residents filled out the survey. Seventeen residents did clinical projects, two did bench research, and two did projects that were socioeconomic or legal in nature. Thirteen residents presented data at a meeting, and three of these presentations won awards. Resident research projects resulted in 18 manuscripts at the time of the survey (seven published, eight in preparation, and three in revision or review). Seventeen residents thought the experience was worthwhile and the research month should be continued; two residents did not. Ten residents reported that in retrospect, they would have done the rotation even if it had not been required, and eight reported the experience increased their appreciation of the value of research in medicine. Conclusion. A 1-month, mandatory resident research rotation produces resident interest in research and enhances departmental research productivity.

The efficacy of contrast-enhanced magnetic resonance imaging (MRI) for detecting and characterizing, or excluding, hepatic masses was assessed in 404 patients, following the intravenous administration of mangafodipir trisodium (MnDPDP) injection, a hepatic MRI contrast agent. An initial contrast-enhanced computed tomography (CT) examination was followed by unenhanced MRI, injection of MnDPDP (5 μmol/kg IV), and enhanced MRI at 15 minutes post injection. Agreement of the radiologic diagnoses with the patients' final diagnoses was higher for enhanced MRI and for the combined unenhanced and enhanced MRI evaluations than for unenhanced MRI alone or enhanced CT using the clinical diagnosis as the gold standard. Mangafodipir-enhanced MRI uniquely provided additional diagnostic information in 48% of the patients, and patient management was consequently altered in 6% of the patients. MnDPDP-enhanced MRI was comparable or superior to unenhanced MRI and enhanced CT for the detection, classification, and diagnosis of focal liver lesions in patients with known or suspected focal liver disease. J. Magn. Reson. Imaging 2000;12:689–701. © 2000 Wiley-Liss, Inc.

The short-term safety of mangafodipir trisodium (MnDPDP) injection was studied in 546 adults with known or suspected focal liver lesions. An initial contrast-enhanced computed tomography examination was followed by unenhanced magnetic resonance imaging (MRI), injection of MnDPDP (5 micromol/kg), and enhanced MRI. Adverse events were reported for 23% of the patients; most were mild to moderate in intensity, did not require treatment, and were not drug related. The most commonly reported adverse events were nausea (7%) and headache (4%). The incidence of serious adverse events was low (nine events in six patients) and not drug related. Injection-associated discomfort was reported for 69% of the patients, and the most commonly reported discomforts included heat (49%) and flushing (33%). Changes in laboratory values and vital signs were generally transient, were not clinically significant, and did not require treatment. There were no clinically significant short-term risks from exposure to MnDPDP.

Winter, W. Christopher, Tom Gampper, Spencer B. Gay, and Paul M. Suratt. Lateral pharyngeal fat pad pressure during breathing in anesthetized pigs. J. Appl. Physiol. 83(3): 688–694, 1997.—It has been hypothesized that the pressure in tissues surrounding the upper airway is one of the determinants of the size and shape of the upper airway. To our knowledge, this pressure has not been measured. The purpose of this study was to test whether the pressure in a tissue lateral to the upper airway, the lateral pharyngeal fat pad pressure (Pfp), differs from atmospheric and pharyngeal pressures and whether it changes with breathing. We studied six male lightly sedated pigs by inserting a transducer tipped catheter into their fat pad space by using computerized tomographic scan guidance. We measured airflow with a pneumotachograph attached to a face mask and pharyngeal pressure with a balloon catheter. Pfp differed from atmospheric pressure, generally exceeding it, and from pharyngeal pressure. Pfp correlated positively with airflow and with pharyngeal pressure, decreasing during inspiration and increasing during expiration. Changes in Pfp with ventilation were eliminated by oropharyngeal intubation. We conclude that Pfp differs from atmospheric and pharyngeal pressures and that it changes with breathing.

Many physicians believe that ultrasound has limited usefulness in chest disease. Our clinical experiences and a review of the literature in preparation for this monograph have convinced us that sonography can be a very useful and versatile tool for thoracic diagnosis and intervention. Although there are some limitations caused by interposed ribs and air-containing lung, almost all of the compartments of the chest can be evaluated with ultrasound, which gives unique and clinically useful information. Ultrasound guidance for biopsy and drainage does take some time to learn, but we feel that the effort is very worthwhile. The same advantages ultrasound enjoys for other body regions make it a modality that will see increased use in the chest as well. We hope that this monograph will stimulate our colleagues to explore and expand upon the techniques described.

Purpose In 1993, the University of Virginia instituted a separate research residency program in the Residency Match (one resident per year). As part of the program, research residents took their second year away from clinical service for research under mentors and enrolled in a postgraduate educational program. This article evaluates what fraction of these residents eventually chose research careers. Methods The article reviews the career choices of 51 residents (8 research residents, 43 conventional clinical residents) who entered residency training between 1993 (the year the research residency program began) and 1999 (the last year for which postfellowship data were available) and compares the rates of research residents and conventional clinical residents choosing academic careers. Results Of the 8 research residents, 5 are currently in academic practice, but 2 of the 8 were dismissed from the program for poor clinical performance. Of the 43 clinical residents, all but 2 are in community practice; 6 of these residents either were dismissed or left the program voluntarily. Research residents had greater difficulty with board examinations than clinical residents. Conclusions A dedicated research residency can increase the rate of trainees ultimately choosing academic careers, but there are significant risks for these trainees that they will not be able to sufficiently accommodate both clinical and research training roles.

Rationale and Objectives. We surveyed diagnostic radiology group preferences and considerations in hiring radiologists and compared these findings with those of a survey performed in 1990. We sought to identify changes in hiring practices that might have occurred because of socioeconomic changes. We also sought to identify features of job candidates that make them more attractive to hiring groups. Methods. One hundred surveys were mailed to a stratified random sample of diagnostic radiology groups identified by the American College of Radiology. We solicited information on the importance of various attributes and the level of experience of a candidate, the fellowship training considered, most desirable, and the effect of changes in the health care socioeconomic environment. The responses were weighted by group size and geographic location to estimate what results might have been obtained if we had surveyed all groups in the United States. Results. Seventy-five groups returned the survey. The two most important factors in choosing a candidate were motivation and radiologic knowledge. The fellowships that groups that were hiring considered, to be the most desirable were body imaging, neuroradiology, and angiography/interventional radiology. Groups overwhelmingly preferred recent training over long experience. Conclusion. Fellowship training increases a candidate's marketability, but the two factors that hiring groups consider the most important are motivation and radiologic knowledge.

Computed tomography (CT)-guided interventions such as biopsy, drainage, and ablation may be significant sources of radiation exposure in both patients and radiologists. Simple CT techniques to reduce radiation dose may be employed without increasing the procedure time or significantly degrading image quality. To develop low-dose protocols, it is important to understand the key concepts of delivered radiation dose to patients and physicians during CT-guided interventions. Patient dose estimates are easily followed and are provided at CT workstations. Familiarity with dose estimates, which are expressed as CT dose index and dose-length product, is also important. Methods to reduce radiation exposure in patients and physicians include performing proper preprocedure planning and paying careful attention to technique during the planning stage, making use of personal protective equipment, performing CT fluoroscopy intermittently instead of in real time, and optimizing needle visualization. Representative examples of these techniques have resulted in dose reductions of as much as 89%. Alternative imaging technologies that do not use ionizing radiation, such as virtual and ultrasonographic guidance, may also be used to reduce radiation dose. Understanding dose contribution strategies to reduce radiation dose provides a safer, more efficient environment for patients and the radiology team.

PURPOSE.The breath-holding capabilities of various groups of individuals were evaluated to develop protocols so that patients undergoing spiral computed tomography (CT), digital angiography, and breath-hold magnetic resonance imaging (MRI) can be studied successfully.METHODS.Twenty-five outpatients

RATIONALE AND OBJECTIVES A multi-institutional study was developed to evaluate whether having preradiology clinical training has an effect on the quality of performance of radiology residents assessed both after 1 year of training and at the end of the 4-year residency. MATERIAL AND METHODS Five faculty members from each of nine collaborating institutions that accept residents both directly from medical school and with postgraduate clinical training completed 1,015 evaluation forms on their 203 residents who had just completed their first year of radiology training or had finished training in the past 2 years. Each resident was evaluated by two senior faculty, two junior faculty, and the residency program director using a cross-institutionally validated, behavior-oriented, standardized instrument that assessed five behavioral characteristics: conscientiousness, curiosity, interpersonal skills, confidence, and recognition of limits. The differences between residents who did and did not have preradiology clinical training were evaluated by analysis of variance and by simple effects testing. RESULTS At the conclusion of training, no significant differences in resident performance were found between residents who did and did not have postgraduate clinical training before radiology residency. Among residents who had just finished their first year of training, those who had had clinical training scored significantly higher on four of the five behavioral scales. CONCLUSIONS Clinical training before radiology residency does not correlate with any measurable benefit in performance at the end of radiology residency. Training programs should consider elimination of this requirement.

Multidetector computed tomography (CT) represents a significant advance in CT technology and can allow the accurate assessment of trauma patients, including the detection of traumatic retroperitoneal injuries, many of which are clinically occult. Retroperitoneal injuries include duodenal, pancreatic, vascular, renal, and adrenal injuries. Abnormal blood, fluid, or air within the retroperitoneal spaces may be isolated findings but can also occur in association with these injuries, and their recognition is the key to correctly identifying the injury. Accurate characterization of injury with CT can affect clinical management and can help minimize unnecessary laparotomies. Equivocal findings at initial abdominal CT should prompt close clinical follow-up with possible imaging follow-up, particularly for suspected occult duodenal and pancreatic injuries.

Providing an adequate method of distance learning is a challenge faced by many multicenter residency programs. The delivery of live didactics over the Internet is a convenient means of providing a uniform and equivalent educational experience to residents at distant sites. An application called MedCast has been developed with use of existing technologies, without the need for costly commercial products or equipment. MedCast captures the presenter's computer screen and audio from a microphone source to produce a streaming video that is transmitted online and archived on a local server. Offsite residents can view broadcasts in real time or access archived conference sessions for later viewing. MedCast is available for download at no cost and offers several advantages, including a user-friendly graphical display interface, near-perfect preservation of image quality, and cost efficiency. Future plans include objective assessment of the efficacy of MedCast by comparing postlecture examinations to help evaluate for any differences between on- and offsite residents in terms of knowledge gained. A movie clip to supplement this article is available online at http://radiographics.rsnajnls.org/cgi/content/full/285085701/DC1.

Background and Objectives The study was designed to determine the prevalence of extracardiac findings discovered during multidetector computed tomography (CT) (MDCT) examinations before atrial fibrillation ablation. Multidetector CT has become a valuable tool in detailing left atrial anatomy before catheter ablation. The incidence of extracardiac findings has been reported for electron beam CT calcium scoring and coronary MDCT, but no data exist for the prevalence of extracardiac findings discovered before atrial fibrillation ablation with MDCT. Methods and Results Clinical reports from MDCT examinations before atrial fibrillation ablation and interpretations by 2 radiologists blinded to the clinical reports were reviewed for significant additional extracardiac findings and recommendations for follow-up. In 149 patients who underwent MDCT, the mean age was 55.9 ± 11.0 years, 75% were men, and 47% had a history of smoking. Extracardiac findings were identified in 69% of patients with clinical, 90% of reader 1, and 97% of reader 2 interpretations (κ = 0.086). Follow-up was recommended in 30% of clinical, 50% of reader 1, and 38% of reader 2 interpretations (κ = 0.408). Pulmonary nodules were the most common additional finding and reason for suggested follow-up for all interpreters. Conclusions The prevalence of extracardiac abnormalities detected by MDCT is considerable. Significant variability in their identification exists between interpreters, but there is good agreement about the need for further follow-up. It is important that those who interpret these examinations are adequately trained in the identification and interpretation of both cardiac and extracardiac findings.

Electronic evaluation systems are becoming more commonplace in radiology residencies. This article describes the authors' experience in the development of such a system and a method that a residency program or graduate medical education office could use to evaluate commercially available programs.

Rationale and Objectives. The purpose of this study was to assess the effect of Health Care Financing Administration (HCFA) regulations on radiology fellowship training. Materials and Methods. Surveys were sent to 157 fellowship program directors in body imaging and vascular/interventional radiology. Questions addressed program accreditation status, faculty supervision of fellows, and any change in faculty supervision of fellows in response to HCFA's revised plan for Medicare Part B reimbursement. Results. Eighty of 157 (51%) surveys were returned. Thirty (37%) respondents indicated supervision of fellows had changed after institution of the new HCFA rules in July 1996. Vascular/interventional program directors (n = 25, 49%) were more likely to have changed their practice than body imaging program directors (n = 5, 17%). Nearly all respondents (29 of 30, 97%) indicating a change stated supervision had increased. Twenty-seven (33%) respondents also indicated faculty supervision was beyond that necessary for patient care and house staff education; most of these respondents (21 of 27, 78%) stated the new HCFA regulations were responsible. Many program directors also expressed concern the HCFA regulations might prevent fellows from obtaining sufficient experience to effectively learn independent clinical decision-making. Conclusion. HCFA regulations intended to address attending physician billing practices at teaching institutions may have had the unintended effect of substantively altering the training of radiology fellows.

Rationale and Objectives. We evaluated whether a breast biopsy phantom device would aid in the development of skills in freehand ultrasound liver biopsy. Methods. Three radiologists who were inexperienced in freehand biopsy of the liver were observed. Each radiologist was timed and scored during attempts to biopsy lesions created in a beef liver. The time required for biopsy and the success of each pass was recorded. A commercially available breast biopsy phantom was then used by each of these radiologists during two 20-min practice sessions. Posttraining testing on the beef liver was performed in the same manner as pretraining testing. Results. Freehand biopsy practice using the breast biopsy phantom resulted in a reduction in the mean time required for biopsy from 32 to 17 sec. Each of the three subjects reduced the mean time required for successful biopsy after training using the breast biopsy phantom. The total number of lesions missed was reduced from 14 of 43 to 0 of 45. Conclusion. Practice using the ultrasound breast biopsy phantom improves performance in freehand ultrasound biopsy of the liver.

Rationale and Objectives. The authors' purpose was to evaluate radiology residents' assessment of their own computer skills for potential development of computer training in a residency curriculum. Methods. The authors conducted a survey to evaluate the attitudes of radiology residents concerning personal computing. Surveys were completed by 136 radiology residents from six academic institutions. Results. Sixty percent of residents surveyed considered themselves to be computer literate and 93% would like further computer training. Fifty-six percent had a computer at home and 9% had a laptop. Almost all residents had access to a computer at work. Word processing and medical literature searches were the most common computer tasks performed by residents. Image processing was the least common task performed. Although all hospitals surveyed were connected to the Internet, only 26% of residents used the Internet and 14% used Internet teaching files. Most residents expressed a preference for self-paced, on-line evening training sessions. Conclusion. Most radiology residents believed they possessed adequate computer skills. This proportion has markedly increased over that found in previous surveys. Radiology residents desire and could likely benefit from computer training included as part of the residency curriculum.

D iagnostic radiology and its graduate medical education programs are experiencing unprecedented change and uncertainty. Radiologists completing residencies and/or fellowships find securing permanent employment increasingly difficult, and training programs face the prospect of significant reductions in financial support and growing pressure to train fewer specialists. Together, these realities have produced calls to reduce the number of residency positions. The Accreditation Council for Graduate Medical Education (ACGME) and its Residency Review Committee in Diagnostic Radiology (RRC) are often mentioned as vehicles to accomplish such reductions. Any such action may carry potential antitrust liability under federal law as represented by the Sherman Act.

Rationale and Objectives. This survey was compiled to provide current data on the structure and content of radiology residency programs and the role of the residency program director. Methods. A survey, created in electronic form and on paper, was distributed to all United States academic, private, and military radiology residency program directors. Results. Of the 202 survey forms distributed, 168 (83%) were completed and returned. Eighty percent of respondents support national curriculum guidelines, but most do not favor national curriculum requirements. About half (53%) of programs spend 6 months in “view box” nuclear medicine; others provide some experience by lectures and on-call time. Most programs (60%) relieve residents of some call during the senior year. Some programs (28%) allow seniors time away from clinical duties to study for the oral board exam, and 17% permit time away to study for the written boards. Seventy-eight percent of programs have had a “problem resident,” and 47% have asked a resident to leave the program. Directors' most frequently expressed concern was threat of diminished residency numbers due to decreased funding.

A 71-year-old man who underwent a coronary artery bypass using a saphenous vein bypass graft (SVG) in 1977 presented with a new mediastinal mass on chest radiography. A variety of imaging techniques were applied and magnetic resonance imaging (MRI) provided excellent anatomic detail of an aneurysm of the previously placed SVG. This condition was successfully treated with repeat operation, aneurysm resection, and placement of new bypass grafts. We recommend that any patient with a history of previous coronary artery grafting who presents with a mediastinal mass be evaluated for the possibility of a graft aneurysm. The best mediastinal imaging technique for this purpose appears to be an MRI scan.

At many institutions, three-dimensional magnetic resonance imaging (MRI) is routinely used for examination of the knee. Multiplanar reconstruction (MPR) is a method of displaying three-dimensional datasets. The authors assessed the usefulness of MPR for evaluating knee MRI datasets by comparing readers' performance using MPR and conventional film MRIs.Eight patients with internal derangement of the knee were studied. All had MRI datasets acquired in the sagittal plane using a three-dimensional gradient-echo fast imaging with steady-state precession (FISP) sequence. Arthroscopic surgery after MRI confirmed the presence of 6 anterior cruciate ligament (ACL) tears, 11 meniscal tears, and 5 normal menisci in this group. Four blinded readers, experienced in MRI of the knee, evaluated the images. The MRI datasets were then loaded onto a three-dimensional workstation and interpreted by the same readers using MPR. The MRI findings were correlated with arthroscopy.For diagnosis of tears of the ACL, sensitivity was 96% and specificity was 100% for both films and MPR. For detecting meniscal tears, sensitivity was 55% and specificity was 90%, using the filmed images, versus 64% and 85%, respectively, with MPR. These differences were not statistically significant by the sign test. Total time (technologist processing time plus radiologist reading time) for MPR was greater than for film interpretation by a factor of 1.12 (P.05), and radiologist reading time for MPR was greater by a factor of 1.88 (P.05).For sagittal three-dimensional FISP MRI datasets, real-time MPR is comparable with film interpretation for evaluation of ACL and meniscal injuries, but it increases the time required for diagnosis.

ADIOLOGY REVIEW is a text-based computer program designed to allow radiologists to review differential diagnoses quickly and easily. Acquiring skills in differential diagnosis is an important goal of radiology training; perhaps in no other residency is the physician expected to be versed in such a wide range of topics. To this end, a comprehensive and concise body of factual information is invaluable for study and review. Moreover, its value is enhanced if it can be frequently reviewed and revised. Conventional publications are of limited use in serving these needs, but personal computers can fulfill them admirably. More sophisticated computer programs than this-known as "expert system" software--are available or are in development? '2 These programs attempt to relate statistical and clinical data to decision trees and may even critique the user's decision. This program gives the radiologist quick and ready access to a core of data. Some 400 radiological entities are covered, presented as lists of differential diagnoses with occasional comments. In the current version of the prograto, a Topic Finder option allows the user to search any section, of the entire data base, for occurrences of a word or phrase; the name of a syndrome, for example, could be entered so that radiological manifestations of that syndrome in any of the sections could be revealed. A printout of any or all of the sections may be obtained for review away from the computer. A significant feature of our program is that the data presented may be modified and expanded by the user; the program is in fact a functional carrier for these data. It is our hope that the useful life of the program will be determined by its inherent simplicity of operation combined with a commitment by users to maintain the data.

We have implemented an MR technique that employs a rapid gradient echo sequence, preceded by magnetization preparation pulses to provide T1- and T2-weighted tissue contrast. With this technique, which can be identified as a member of a new family of pulse sequences, generically named Magnetization Prepared RApid Gradient Echo (MP-RAGE), very short repetition times are used, allowing acquisition times of less than one second and images virtually free of motion-induced artifacts during quiet respiration. Fifteen patients with known liver lesions (metastases, hemangiomas, and cysts) were examined using T1- and T2-weighted 2-dimensional MP-RAGE sequences, and the images were compared with conventional T1- and multi-echo T2-weighted spin-echo (SE) sequences. Signal difference-to-noise ratios (SD/Ns) of the lesions were calculated for all pulse sequences using corresponding axial images and were normalized for voxel volume. The mean normalized SD/Ns of the MP-RAGE sequences were generally comparable to those for the SE sequences. In addition, there were no noticeable respiratory artifacts on the MP-RAGE images whereas these were clearly present on the T2-weighted SE images and to a lesser degree on the T1-weighted SE images. It is concluded that the MP-RAGE technique could become an important method for evaluating the liver for focal disease.

Ascites is found in a variety of conditions, both acute and chronic, and computed tomography (CT) is usually successful in detecting its presence. We reviewed the CT images from a three-month window of patients in order to evaluate the prevalence and utility of a new radiographic sign for diagnosing ascites.

High-resolution computed tomographic (CT) scanning and, more recently, magnetic resonance imaging (MRI) have provided more accurate evaluation of the extent of head and neck neoplasms. With increasing experience, better methodology is being developed to improve imaging accuracy. We present a series of patients with clinically proven neoplasms of the oropharynx and larynx, evaluated by MR using T1-weighted, T2-weighted, and post-gadolinium (Gd)-DTPA T1-weighted imaged. The concept behind the use of Gd-DTPA was that it might permit the use of only pre- and postcontrast T1-weighted sequences, reducing examination time and increasing the sensitivity of the examination. It was also anticipated that Gd-DTPA could increase tumor conspicuity and edge definition. Imaging planes were chosen to best define the tumor extent and axial images were performed to evaluate adenopathy. The imaging results were compared with the clinical evaluation and with non-Gd-enhanced MRI. We present examples of the significantly improved soft tissue contrast with Gd-DTPA T1-weighted images and discuss the improved tumor margin definition with Gd-DTPA. Those cases in which it does not provide improved information will also be presented.