Publications

PURPOSE: Cardiac imaging is an integral part of modern diagnostic imaging and a subject heavily tested on the Radiology Core exam. Therefore, radiology residency programs should provide adequate training in this area. This study aims to investigate the current state of cardiac imaging training within radiology residency programs in the United States.

MATERIALS AND METHODS: Survey questionnaires using the Research Electronic Data Capture (REDCap) platform were sent to heads of cardiac/cardiothoracic sections in all US radiology residency programs for which valid email addresses were available.

RESULTS: Of 163 questionnaires sent, there were 70 responses, with 82.9% completing the entire survey. In total, 85.9% reported having a cardiac imaging rotation, with 58.8% being 4 weeks, mostly in a single block. Sixteen programs (31.4%) offered a longer cardiac experience (6 to 12 wk). In total, 90.7% reported having a designated person responsible for cardiac imaging, a radiologist in 68.5% and a combined radiologist and cardiologist in 22.2%. The responsible person for reporting cardiac CT was a radiologist in 40.7%, with a combined radiologist and cardiologist in 59.3%. For cardiac MRI studies, there was combined responsibility in 69.0%, either on alternate days of coverage or with the radiologist interpreting noncardiac findings. A total of 65.5% reported having ≥6 cardiac case conferences yearly, and 75.9% had ≥6 cardiac lectures. In total, 65.6% of programs offered cardiothoracic fellowships, with 87.2% dedicating ≥3 months to cardiac imaging. Only 18.6% had dedicated cardiovascular fellowships.

CONCLUSION: Our research offers crucial insights into the current trends in cardiac imaging education and practice within radiology residency programs, so that professional societies can develop guidelines to structure a more uniform and thorough approach toward cardiac imaging education.

Nonpregnant and pregnant women who present with acute pelvic pain can pose a diagnostic challenge in the emergency setting. The clinical presentation is often nonspecific, and the differential diagnosis may be very broad. These symptoms are often indications for pelvic US, which is the primary imaging modality when an obstetric or gynecologic cause is suspected. Interpretation of pelvic US may be challenging and a source of confusion and misinterpretation for radiologists. Additionally, cognitive biases in imaging interpretation can contribute to diagnostic errors. Cognitive biases represent systematic errors due to failure of the mental shortcuts that the brain subconsciously uses to produce quicker judgments. There are multiple different types of cognitive biases, all of which may lead to perceptual and interpretive errors. Familiarity with common and uncommon pelvic US findings in the setting of pelvic pain is imperative to assist with prompt and accurate diagnosis. Awareness of potential biases when interpreting pelvic US findings further helps hone the interpretation. The authors illustrate the imaging findings in several peer learning cases of nonpregnant and first-trimester pregnant patients who presented with acute pelvic pain in the emergency setting. Several nonobstetric and nongynecologic causes of acute pelvic pain are included for which pelvic US was the first imaging modality used in diagnosis. Diagnostic errors and cognitive biases in interpretation related to these cases are highlighted. The radiologist's awareness of potential cognitive biases in image interpretation may help to refine the differential diagnosis and mitigate errors. ©RSNA, 2025 Supplemental material is available for this article.

PURPOSE: Organizing pneumonia is an inflammatory disorder that may co-exist with malignancy in the lung or elsewhere in the body. We aimed to assess patients with a lung biopsy diagnosis of organizing pneumonia for subsequent pathology confirmation of co-existing malignancy.

METHODS: In this retrospective IRB-approved, HIPAA-compliant study, 1314 consecutive patients who underwent CT-guided lung biopsy for suspected lung cancer or metastatic disease from 02/2014 to 04/2022 at a single tertiary referral hospital were identified. In 98/1314 (7.5%) patients, biopsies showed organizing pneumonia, which represented our study cohort. Clinical outcomes, including follow-up imaging and repeat tissue sampling if performed, were evaluated through chart review. Descriptive statistics were calculated.

RESULTS: There were 43/98 (44%) females, mean age was 66 ± 14 years, mean lesion size 2.9 ± 2.1 cm, and 11/98 (11.2%) had prior history of malignancy. Of 98 patients initially diagnosed with organizing pneumonia on lung biopsy, 11 (11.2%) were subsequently found to have malignancy. Among these, 6 (54.5%) had pulmonary metastases and 5 (45.5%) had primary lung cancer. Malignancies were confirmed through percutaneous re-biopsy in 3/11 (27%) and bronchoscopic, endoscopic, or surgical procedures in 8/11 (73%).

CONCLUSION: Malignancy can co-exist with organizing pneumonia in a substantial percentage of initial lung biopsies. Therefore, repeat tissue sampling should be considered when there is high clinical suspicion of malignancy despite an initial histopathological diagnosis of organizing pneumonia. This is especially relevant in lesions that demonstrate FDG avidity on PET/CT or an increase in size on interval imaging, or in instances where the biopsy core sizes are small or where the biopsies have intraprocedural complications.

OBJECTIVE: To compare the association of single maximum diameter and average cyst diameter of pancreatic cysts measured on magnetic resonance cholangiopancreatography (MRCP) with segmented cyst volume and secondarily evaluate the effect of average cyst diameter on screening guideline classification.

METHODS: Consecutive patients with pancreatic cysts < 3 cm on MRCP in 2017 were retrospectively identified. The single maximum diameter and perpendicular short axis diameter of pancreatic cysts obtained on coronal MRCP were measured and their average was taken to determine average cyst diameter. Calculated volume approximations based on single maximum diameter and average cyst diameter were compared with segmented cyst volume. Subsequently, patients were classified based on average cyst diameter versus single maximum diameter according to a currently used screening guideline. Intraclass correlation was used to assess interobserver agreement. Williams's test was used to compare between-group correlation coefficients.

RESULTS: The mean value of single maximum diameters and average cyst diameter of the 86 included cysts were 15.4 ± 7.3 mm and 12.6 ± 6.1 mm, respectively. The mean volume of segmented cysts was 1,521 ± 1,983 mm3. Interreader agreement for measurement of cyst diameters was excellent (r = 0.99). The volume calculated based on the average cyst diameter correlated better to segmented cyst volume (r = 0.88) than single maximum diameter (r = 0.73, P < .0001). Of 86 patients, 24 (28%) were classified to a less stringent follow-up strategy by using average cyst diameter.

DISCUSSION: The average cyst diameter more accurately reflects the segmented cyst volume than a single maximum diameter. Utilization of average cyst diameter in existing screening guidelines reclassified 28% of patients into lower-risk screening groups, which would reduce subsequent surveillance imaging overall.

PURPOSE: To test the hypothesis that hand motion analysis can measure the progression of needle and ultrasound probe manipulation skills of interventional radiology trainees in central venous line placement.

MATERIALS AND METHODS: An expert cohort of 6 interventional radiologists and 4 anesthesiologists and a trainee cohort of 6 novice trainees (<50 central lines) and 5 experienced trainees (>50 central lines) performed simulated central venous access. Four novices and 1 experienced trainee repeated the task 1 year later. An electromagnetic motion tracking system tracked the needle hand and ultrasound probe. Path length, translational, and rotational movements were calculated separately for the needle hand and probe sensor. These metrics were used to calculate motion metrics based scores on a scale of 0 to 3 for each sensor. Nonparametric statistics were used, and the data are reported as median ± interquartile range.

RESULTS: Comparing novice and experienced trainees, there was a significant difference in probe scores (experienced vs. novice: 1 ± 2 vs. 0 ± 0, P = 0.04) but not in needle-hand scores (1 ± 1.5 vs. 0 ± 1, P = 0.26). Trainees showed a significant increase in probe scores at the 1-year follow-up (baseline vs. follow-up: 0 ± 1 vs. 2.5 ± 1.8, P = 0.003), but no significant difference was observed in the needle manipulation metrics. Experts differed significantly from experienced trainees for all metrics for both sensors ( P < 0.05), with the exception of the path length of the probe.

CONCLUSIONS: Acquisition of improved dexterity of the probe may occur before improvement in the dexterity with the needle hand for interventional radiology trainees.

PURPOSE: This study aims to compare a commercially available wired and wireless tracker in motion analysis of interventional radiologists performing simulated ultrasound-guided central venous access.

METHODS AND MATERIAL: Interventional radiologists were asked to volunteer for the study. Participants were asked to place central venous lines on a commercially available, standardized manikin as their needle hand and ultrasound probe motion were recorded using electromagnetic trackers. Each participant performed a total of 10 trials, with 5 trials recorded using a wired tracker and 5 using a wireless tracker. Institution-developed software was used to calculate established motion metrics (path length and number of movements). The motion metrics from the two trackers were compared.

RESULTS: Seven interventional radiologists participated in the study. Path length (wireless vs. wired: 773.1 cm ± 85.7 cm vs. 959.5 cm ± 303.6 cm, p < 0.001) and number of movements (193 ± 52 vs. 231 ± 50.5, p = 0.001) differed significantly between the two trackers; however, the time to complete the procedure (51.8 s ± 14.8 s vs. 49.8 s ± 10.5 s, p = 0.68) was similar across trackers.

CONCLUSION: The motion metrics of the same operators differ significantly between wired and wireless trackers. Accounting for the sampling frame rate and the frame efficiency of the wireless sensors can provide comparable motion data.