Gastrointestinal stromal tumors (GISTs) can be benign or malignant. GISTs of the stomach are more common than GISTs of the small bowel. Lipomas are the third most frequently occurring benign small bowel tumors. Angioectasia is the most common cause of obscure gastrointestinal bleeding and usually occurs in older adults. Small bowel lymphoma constitutes 20% of all malignant small bowel tumors.

Primary sclerosing cholangitis is a cholestatic disease of unknown origin. The human immunodeficiency virus, which causes AIDS, destroys CD4 helper-inducer T lymphocytes. Ampullary carcinomas are rare entities, arising from tissue distal to the confluence of the bile and pancreatic ducts. Mirizzi syndrome is an inflammatory stricture caused by an impacted stone in the cystic duct or neck of the gallbladder. Mucinous cystic neoplasms are rare biliary tumors, typically occurring in women in their late 30s. Klatskin tumor refers to a cholangiocarcinoma involving the upper common hepatic duct. Choledochal cysts are congenital cystic dilatations of the bile ducts.

An optimal esophagram includes all 3 phases of the triphasic esophagram: 1) mucosal relief; 2) double contrast; and 3) full column. Normally, the esophageal lumen is the same size to the level of the gastroesophageal junction. Localized inflammation caused by medication lodged in the esophagus can lead to focal edema, ulceration, and stricture formation. Candidiasis is associated with a spectrum of radiographic findings. Achalasia is a motor disorder characterized by aperistalsis of the distal two-thirds of the esophagus and failure of the lower esophageal sphincter to relax. Lymphomatous involvement of the esophagus is unusual. Knowledge of normal oropharyngeal anatomy is needed to evaluate a swallowing study.

In most cases, ascites is a transudate caused by cirrhosis and portal hypertension. Peritoneal carcinomatosis (metastasis) typically is caused by ovarian, colon, stomach, or pancreatic cancer. Mesothelioma is a rare neoplasm affecting the pleura (75% of cases) and peritoneum (25% of cases). Abdominal tuberculosis is most common in immigrant populations and in patients with AIDS. Cavitary mesenteric lymph node syndrome is an uncommon and poorly understood complication of celiac disease. Endometriosis, a condition affecting women during their reproductive years, is caused by functioning endometrial tissue within the peritoneal cavity. Abdominal hernias can be characterized as external, internal, or diaphragmatic.

The most frequent cause of thickened duodenal folds is peptic ulcer disease due to Helicobacter pylori infection. Duodenal ulcers are common and are encountered 2 to 3 times more often than gastric ulcers. Lymphoma in the duodenum is unusual but can also present as a bulky solitary mass. Gastrinomas are classified as a type of neuroendocrine tumor. Gastric polyps are more common than duodenal polyps. Lipomas are submucosal tumors that nearly always have a smooth surface and are compressible on fluoroscopy. Diverticula can occur anywhere in the duodenum, but they most commonly arise from the medial wall of its second portion.

H pylori infection is the major cause of gastritis, gastric ulcers, and duodenal ulcers. Acute gastritis often presents with symptoms mimicking those of peptic ulcer disease. Giant ulcers are defined as those 3 cm or larger in diameter. Development of carcinoma from gastric polyps is rare. Most gastric polyps are either hyperplastic, adenomatous, or fundic gland polyps. Gastrointestinal stromal tumors are the most common type of submucosal gastric tumor. Most submucosal tumors are removed regardless of size because even small tumors can be cancerous. Granulomatous disease usually results in smooth, tapered narrowing of the antrum.

To report the detection rate of colorectal tumors with computed tomography (CT) performed within 1 year before diagnosis for indications other than colon abnormalities. Strategies to improve cancer detection are reported. Two board-certified, subspecialty-trained abdominal radiologists retrospectively reviewed patient health records and CT images with knowledge of tumor location/size. Patients were classified into 3 groups: prospective (colon abnormality suggesting neoplasm documented in radiologic report), retrospective (not documented in radiologic report but detected in our retrospective review of CT images), and undetected (neither prospectively nor retrospectively detected). Retrospective detection confidence and morphologic characteristics of each tumor were also recorded. Of 209 included patients, 106 (50.7

The motor function of the gastrointestinal tract relies on the enteric nervous system, which includes neurons spanning from the esophagus to the internal anal sphincter. Disorders of gastrointestinal motility arise as a result of disease within the affected portion of the enteric nervous system and may be caused by a wide array of underlying diseases. The etiology of motility disorders may be primary or due to secondary causes related to infection or inflammation, congenital abnormalities, metabolic disturbances, systemic illness, or medication-related side effects. The symptoms of gastrointestinal dysmotility tend to be nonspecific and may cause diagnostic difficulty. Therefore, evaluation of motility disorders requires a combination of clinical, radiologic, and endoscopic or manometric testing. Radiologic studies including fluoroscopy, CT, MRI, and nuclear scintigraphy allow exclusion of alternative pathologic conditions and serve as adjuncts to endoscopy and manometry to determine the appropriate diagnosis. Additionally, radiologist understanding of clinical evaluation of motility disorders is necessary for guiding referring clinicians and appropriately imaging patients. New developments and advances in imaging techniques have allowed improved assessment and diagnosis of motility disorders, which will continue to improve patient treatment options. Online supplemental material is available for this article. ©RSNA, 2022.

HomeRadiologyVol. 300, No. 3 PreviousNext CommunicationsFree AccessLetters to the EditorResponse to "Reflection on the Evaluation of Radiologists' Performance during Off-Hours Shifts"Maitray D. Patel , Victor J. Pizzitola, C. Daniel JohnsonMaitray D. Patel , Victor J. Pizzitola, C. Daniel JohnsonAuthor AffiliationsDepartment of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054e-mail: [email protected]Maitray D. Patel Victor J. PizzitolaC. Daniel JohnsonPublished Online:Jul 13 2021https://doi.org/10.1148/radiol.2021210258MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In We thank Drs Flink and Kaplan (https://pubs.rsna.org/doi/10.1148/radiol.2021203771) for their interest in our study (1). Two comments merit clarification.One cannot conclude from our data that some radiologists perform better at night than during the day because our study was not powered to show individual differences in error rates. What we can and did conclude is that, in aggregate, radiologists had statistically significant lower error rates during the day than during overnight assignments.Drs Flink and Kaplan believe fellows should not provide off-hours coverage and they incorrectly assume we share that belief. We do not. Our radiology department is committed to providing subspecialty care by ensuring that subspecialists interpret all studies regardless of whether the study was performed during the day or during the night. This objective is balanced by the reality that providing initial subspecialty interpretation of all studies performed off-hours is prohibitively expensive. We do not conclude or advocate that radiology organizations abandon using nonspecialized radiologists—including rotating residents, fellows, partners, employee radiologists, or radiologists practicing teleradiology—to provide initial interpretations for off-hour examinations; rather, we conclude that those off-hour interpretations benefit most from careful, timely subspecialty review by subspecialty radiologists who are not subject to circadian misalignment.Other radiology organizations may choose to have dedicated emergency radiologists work overnight to interpret studies that do not get reviewed by a subspecialist, an investment commonly requiring compensation with 2 weeks off for every working week. We have no evidence to know if outcomes are just as good without subspecialty interpretation, but our concern with this approach has been previously articulated (2): If subspecialty interpretation does not add value, the logical conclusion is that all studies—day and night—should be interpreted once by an emergency radiologist.Ultimately, every radiology organization pursues the model that helps them reach the highest value, yielding high quality at low cost. In pursuit of that goal, our study showing that nonspecialized radiologists who do not usually work at night make more errors at night is an important consideration for designing processes to mitigate patient harm.Disclosures of Conflicts of Interest: M.D.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed board membership for the Society of Radiologists in Ultrasound; disclosed royalties from UpToDate. Other relationships: disclosed no relevant relationships. V.J.P. disclosed no relevant relationships. C.D.J. disclosed no relevant relationships.References1. Patel AG, Pizzitola VJ, Johnson CD, Zhang N, Patel MD. Radiologists Make More Errors Interpreting Off-Hours Body CT Studies during Overnight Assignments as Compared with Daytime Assignments. Radiology 2020;297(2):374–379. Link, Google Scholar2. Dym RJ, Forman HP, Scheinfeld MH. Night and Day: Confounding Factors Complicate Comparison and Generalizability of Radiology Error Rates. Radiology 2021;298(2):E115–E116. Link, Google ScholarArticle HistoryPublished online: July 13 2021Published in print: Sept 2021 FiguresReferencesRelatedDetailsRecommended Articles Radiologists Make More Errors Interpreting Off-Hours Body CT Studies during Overnight Assignments as Compared with Daytime AssignmentsRadiology2020Volume: 297Issue: 2pp. 374-379Quantifying Radiology Resident Fatigue: Analysis of Preliminary ReportsRadiology2021Volume: 298Issue: 3pp. 632-639Perceived Realism of High-Resolution Generative Adversarial Network–derived Synthetic MammogramsRadiology: Artificial Intelligence2020Volume: 3Issue: 2Effect of Shift, Schedule, and Volume on Interpretive Accuracy: A Retrospective Analysis of 2.9 Million Radiologic ExaminationsRadiology2017Volume: 287Issue: 1pp. 205-212The Road to Wellness: Engagement Strategies to Help Radiologists Achieve Joy at WorkRadioGraphics2018Volume: 38Issue: 6pp. 1651-1664See More RSNA Education Exhibits Artificial Intelligence Applications in Breast Imaging and Challenges for Digital Breast TomosynthesisDigital Posters2020Know Your Dark Horse in Imaging: Acquisition and Physics Behind Dual-Energy CT and Its Application in Cardiac ImagingDigital Posters2019Friend or Foe: How to Suppress and Measure fat in Abdominal MRI?Digital Posters2020 RSNA Case Collection Occipital condyle fractureRSNA Case Collection2020Quadriceps fat pad impingement syndromeRSNA Case Collection2020Adductor Insertion Avulsion SyndromeRSNA Case Collection2021 Vol. 300, No. 3 Metrics Altmetric Score PDF download

HomeRadiologyVol. 298, No. 1 PreviousNext CommunicationsFree AccessLetters to the EditorRadiologist Errors at Night: Are We Still in the Dark?David Little David Little Author AffiliationsDepartment of Radiology, Royal United Hospitals Bath, Combe Park, Bath, BA1 3NG, Englande-mail: [email protected]David Little Published Online:Nov 17 2020https://doi.org/10.1148/radiol.2020203489MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Editor:I read with interest the study by Dr Patel and colleagues published in the November 2020 issue of Radiology (1). This is an interesting study designed to assess the difference in radiology fellow error rates between day and night reporting. It is a common belief that error rates are higher at night but this is notoriously difficult to measure and the authors make a good effort.However, I am left with questions that may render the results unreliable:Was there a difference in the difficulty of the case mix between the daytime and nighttime cases? The authors describe in the methods that these cases were inpatient and emergency department cases. In my practice in the United Kingdom, patients imaged overnight are often sicker, requiring an urgent scan that arguably may be more difficult to interpret. This could account for some of the difference in error rate. No assessment of case mix difficulty is provided in the paper.Were the reviewing attending radiologists blinded with respect to the time of the study? If not there is definite potential for bias here, which may affect the reliability of the results.Is there anything that could account for the fact that some fellows performed better at night? What can be learned from this group?The authors state an assumption that acute care providers may prefer a quick report over a correct report. Do the authors have any evidence to support that accusation? I am sure our acute care provider colleagues would take issue with this allegation and it is entirely unnecessary within an otherwise interesting and well-balanced paper.Although this study does add to the evidence that errors are more likely in examinations reported overnight, it does not offer any evidence with respect to the causes of this variation in error rate. The authors assume this is related to fatigue and circadian rhythm, but I suspect it is not that simple and we are still somewhat in the dark. Double reporting would obviously go some way to correcting this variation but does have significant resource and cost implications.Disclosures of Conflicts of Interest: D.L. disclosed no relevant relationships.Reference1. Patel AG, Pizzitola VJ, Johnson CD, Zhang N, Patel MD. Radiologists make more errors interpreting off-hours body CT studies during overnight assignments as compared with daytime assignments. Radiology 2020. 10.1148/radiol.2020201558. Published online August 18, 2020. Link, Google ScholarReference1. Patel AG, Pizzitola VJ, Johnson CD, Zhang N, Patel MD. Radiologists make more errors interpreting off-hours body CT studies during overnight assignments as compared with daytime assignments. Radiology 2020. 10.1148/radiol.2020201558. Published online August 18, 2020. Link, Google ScholarReference1. Patel AG, Pizzitola VJ, Johnson CD, Zhang N, Patel MD. Radiologists make more errors interpreting off-hours body CT studies during overnight assignments as compared with daytime assignments. Radiology 2020. 10.1148/radiol.2020201558. Published online August 18, 2020. Link, Google ScholarResponseMaitray D. Patel , Victor J. Pizzitola, C. Daniel JohnsonMaitray D. Patel , Victor J. Pizzitola, C. Daniel JohnsonAuthor AffiliationsDepartment of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054e-mail: [email protected]We thank Dr Little for his comments. We know of no standardized measures of case difficulty, but our practice experience does not support differences in case complexity as a function of time. As reported, we are a tertiary referral center, not a trauma center (1).Attending radiologists were required to review cases within 10 hours, so they were not blinded to interpretation time. However, one struggles to understand how this introduces bias. Our study was retrospective; the fact that data would be analyzed was unknown, let alone the study method. Moreover, it would be quite remarkable for attending physicians to collectively conspire to mark more night cases in error, given the downstream clinical effort this engenders.Our statistical method evaluated the difference in error rate for the entire data. There was no claimed statistical significance for the error rate difference for any individual fellow, and we find none on review. We cannot conclude fellow F01 is less affected by night work than fellow F32 (Table 1); we found significant difference in the error rate at night compared with the day for the entire group (P = .02).That providers can be frustrated by report revisions is certainly understandable; it increases their work. In our practice, we have ongoing stakeholder dialogue regarding the value of subspecialty review of studies initially interpreted after hours by so-called generalists. In those discussions, we are not surprised that acute care providers favor workflows in which final generalist reports have no subspecialty review, to limit revisions. We are surprised by Dr Little’s rebuke that this is accusatory; does his experience differ? Quite frankly, if acute care providers did not prefer reports after hours that are not subject to revision, there would be no pressure to provide them.Making no claim of direct evidence of the cause of error variation, we suggest a role for fatigue and circadian misalignment because fellows had higher error rates after midnight despite lower work intensity overnight compared with the day and duty hour accommodations promoting rest. We agree, it is not simple; with our study, we learn more but not enough. Knowledge is incremental. Disclosures of Conflicts of Interest: M.D.P. disclosed no relevant relationships. V.J.P. disclosed no relevant relationships. C.D.J. disclosed no relevant relationships.Reference1. Patel AG, Pizzitola VJ, Johnson CD, Zhang N, Patel MD. Radiologists make more errors interpreting off-hours body CT studies during overnight assignments as compared with daytime assignments. Radiology 2020. 10.1148/radiol.2020201558. Published online August 18, 2020. Link, Google ScholarArticle HistoryPublished online: Nov 17 2020Published in print: Jan 2021 FiguresReferencesRelatedDetailsRecommended Articles Fare Thee Well and Let the Good Times RollRadioGraphics2020Volume: 40Issue: 1pp. 1-7Quantifying Radiology Resident Fatigue: Analysis of Preliminary ReportsRadiology2021Volume: 298Issue: 3pp. 632-639Contemporary Risk Management for RadiologistsRadioGraphics2018Volume: 38Issue: 6pp. 1717-1728Should Artificial Intelligence Tell Radiologists Which Study to Read Next?Radiology: Artificial Intelligence2021Volume: 3Issue: 2Evaluating AI Clinically—It’s Not Just ROC AUC!Radiology2020Volume: 298Issue: 1pp. 47-48See More RSNA Education Exhibits The On-Call Radiology Residents Guide to Managing the Reading Room: Distractions, Downtimes, and DiscussionsDigital Posters2019Immersive Imaging: Structure and Outcomes from a Novel One-year Medical Student Fellowship in RadiologyDigital Posters2022Preventing Physician Burnout in Breast Imaging: Scope of the Problem and Keys to SuccessDigital Posters2019 RSNA Case Collection COVID-19 presents with cough and diarrhea RSNA Case Collection2020Fourth branchial cleft cystRSNA Case Collection2021Biliary Hamartomas in Cirrhotic LiverRSNA Case Collection2021 Vol. 298, No. 1 Metrics Altmetric Score PDF download

Purpose: High-value care is becoming increasingly important as the United States shifts toward a more sustainable health care system. Lifestyle medicine (LM) may be the highest-value model of care. Surprisingly, however, it is taught in a minority of medical schools. In this article, we describe a pilot project of introducing a brief LM course taught within the Mayo Clinic Alix School of Medicine in Arizona. The main purpose of the course was to introduce the students to LM as a specialty practice and to provide students with foundational knowledge of the pillars of LM. Results: Students reported improved personal health habits and increased confidence in LM competencies.

Background There is increasing research attention on the impact of overnight work on radiologist performance. Prior studies on overnight imaging interpretive errors have focused on radiology residents, not on the relative performance of board-eligible or board-certified radiologists at night compared with during the day. Purpose To analyze the rate of clinically important interpretation errors on CT examinations of the abdomen, pelvis, or both ("body CT studies") committed by radiology fellows working off-hours based on day or night assignment. Materials and Methods Between July 2014 and June 2018, attending physicians at one tertiary care institution reviewed all body CT studies independently interpreted off-hours by radiologists in an academic fellowship within 10 hours of initial interpretation. Discrepancies affecting acute or follow-up clinical care were classified as errors. In this retrospective study, the error rate for studies interpreted during the day (between 7:00 am and 5:59 pm) was compared with that of studies interpreted at night (between 6:00 pm and 6:59 am). Error rate in the first half of day and night assignments was compared with error rate in the latter half. Statistical analyses used χ2 tests and general estimating equations; significance was defined as P < .05. Results There were 10 090 body CT studies interpreted by 32 radiologists. Forty-four of 2195 daytime studies (2.0%) had errors compared with 240 of 7895 nighttime studies (3.0%; P = .02). Twenty-two of 32 (69%) radiologists had higher error rates for night cases (P = .03). There were more errors in the last half of a night assignment (125 of 3358, 3.7%; P = .002) compared with the first half (115 of 4537, 2.5%). Conclusion On the basis of a subspecialty review, clinically important off-hours body CT interpretation errors occurred more frequently overnight and more frequently in the latter half of assignments, with more radiologists having worse error rates at night compared with the day. © RSNA, 2020 See also the editorial by Bruno in this issue.

Since the introduction of CT colonography (CTC) in the mid-1990s, there have been continuous advancements in the examination technique and advanced visualization software for interpretation. This review will cover the origins of CTC as a natural extension of abdominal CT imaging, and discuss the evolution of CTC through the subsequent clinical phases of feasibility, validation, and implementation.

This first issue of Abdominal Radiology marks the continued evolution of the Journal to meet the professional needs of the Abdominal Radiologist.With this change in title from Abdominal Imaging, the inclusion and welcoming of interventional radiology manuscripts into the Journal is formalized.Many abdominal radiologists have had an active interventional practice for years, but without a central academic home for their education and publications.As the official journal of the Society of Abdominal Radiologists (SAR) that is inclusive of interventional radiologists, it is only fitting to expand the vision of the journal to include these important components of our practice.Readers should look for a growing presence of interventional articles in the future, and authors should consider sending us their interventional manuscripts for consideration.Beginning in 2016, Abdominal Radiology will become a monthly publication, secondary to your strong support of submitting many high quality manuscripts for consideration.Please continue to send us your best work.

Background: Current American Cancer Society recommendations for colon cancer screening include optical colonoscopy every 10 years or computed tomography colonography (CTC) every 5 years. Bowel preparation (BP) is currently required for both screening modalities.Purpose: To compare ACRIN 6664: the National CT Colonography Trial (NCTCT) participant experiences with CTC and optical colonoscopy (OC), procedure preference, and willingness to return for each procedure.Materials and methods: Participants from fifteen NCTCT sites, who underwent CTC followed by OC under sedation, were invited to complete questionnaires 2 weeks postexam, asking about procedure preference, physical discomfort, and embarrassment experienced and whether that discomfort and embarrassment was better or worse than expected during BP, CTC, and OC, as well as willingness to return for repeat CTC and OC at different time intervals. Results: A total of 2,310 of 2,600 patients (89%) returned their questionnaires. Of patients reporting a preference, 1,058 (46.6%) preferred CTC, 569 (25.0%) preferred OC, and 626 (27.6%) reported no preference. Participant-reported discomfort worse than expected differed significantly between CTC (32.9%) and OC (5.0%) (P<0.001). About 79.3% were willing to be screened again with CTC in 5 years, and 96.6% with OC in 10 years. Discomfort and embarrassment worse than expected with OC were associated with increased intention to adhere with CTC in the future. Conversely, embarrassment experienced during CTC and discomfort worse than expected on CTC were associated with increased intention to adhere with OC in the future.Conclusion: While a larger proportion of participants indicated that they preferred CTC to OC, willingness to undergo repeat CTC compared to OC was limited by unanticipated exam discomfort and embarrassment and CTC's shorter screening interval.