Academic radiology departments have added increasing numbers of entirely remote "work-from-home" or hybrid faculty. This change has presented both an opportunity to recruit and retain faculty as well as a set of challenges to maintaining the full academic mission and educational environment. In this article we describe our experience with creating a remote faculty position and the key elements that we believe made it successful. Guiding principles for the department and faculty member accepting such a position are proposed and discussed.

OBJECTIVE:To determine the most reliable predictor of radiofrequency (RF) ablation zone volume among three-dimensional (3D) volumetric colour Doppler vascular indices in an in vitro blood-perfused bovine liver model.METHODS:3D colour Doppler volume data of the local hepatic parenchyma were acquired from 37 areas of 13 bovine livers connected to an in vitro oxygenated blood perfusion system. Doppler vascular indices of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained from the volume data using 3D volume analysis software. 37 RF ablations were performed at the same locations where the ultrasound data were obtained from. The relationship of these vascular indices and the ablation zone volumes measured from gross specimens were analyzed using a general linear mixed model fit with random effect for liver and backward stepwise regression analysis.RESULTS:FI was significantly associated with ablation zone volumes measured on gross specimens (p = 0.0047), but explained little of the variance (Rβ2 = 0.21). Ablation zone volume decreased by 0.23 cm3 (95% confidence interval: -0.38, -0.08) for every 1 increase in FI. Neither VI nor VFI was significantly associated with ablation zone volumes (p > 0.05).CONCLUSION:Although FI was associated with ablation zone volumes, it could not sufficiently explain their variability, limiting its clinical applicability. VI, FI and VFI are not clinically useful in the prediction of RF ablation zone volume in the liver. Advances in knowledge: Despite a significant association of FI with ablation zone volumes, VI, FI and VFI cannot be used for their prediction. Different Doppler vascular indices need to be investigated for clinical use.

Purpose To investigate the effect of change in portal vein flow rates on the size and shape of ablations created by a bipolar radiofrequency (RF) ablation device. Materials and Methods This study was exempt from institutional animal care and use committee review. An in vitro bovine liver model perfused with autologous blood via the portal vein at three flow rates (60, 80, 100 mL/min per 100 g of liver) was used. Four ablations, two bipolar and two monopolar (control probe), were made in each of five livers perfused at each flow rate. Short- and long-axis diameters were measured from gross specimens, and volume and sphericity index were calculated for each ablation. A general linear mixed model accounting for correlation within the liver was used to evaluate the effects of flow on ablations. Analyses were performed by using software. Results There was no significant difference in the size or shape of ablations created by the bipolar device at the different flow rates (P > .05 for all outcomes). The monopolar device demonstrated the expected inverse association between ablation size and change in flow (P < .01 for all outcomes). The mean ± standard deviation of short-axis diameter, long-axis diameter, volume, and sphericity index of the bipolar ablations was 4.3 cm ± 0.1, 4.2 cm ± 0.1, 41.0 cm3 ± 1.8, and 1.1 ± 0.1, respectively. Conclusion Unlike monopolar RF ablation, change in portal vein flow rates does not have a statistically significant effect on the size or shape of ablations created by the bipolar RF ablation device tested. © RSNA, 2016.

Imaging plays a critical role in the practice of modern medicine, yet it remains underrepresented in undergraduate medical education (UME) [ 1 Saha A. Roland R.A. Hartman M.S. Daffner R.H. Radiology medical student education: an outcome-based survey of PGY-1 residents. Acad Radiol. 2013; 20: 284-289 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar ]. Many graduating physicians feel insufficiently trained in core radiology interpretation and utilization skills, and only 10% to 25% of US medical schools require dedicated radiology clerkships [ 1 Saha A. Roland R.A. Hartman M.S. Daffner R.H. Radiology medical student education: an outcome-based survey of PGY-1 residents. Acad Radiol. 2013; 20: 284-289 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar , 2 Straus C.M. Webb E.M. Kondo K.L. et al. Medical student radiology education: summary and recommendations from a national survey of medical school and radiology department leadership. J Am Coll Radiol. 2014; 11: 606-610 Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar ]. Challenges in imaging education include competition for time in crowded UME curricula, lack of innovative educational methods that meet the needs of millennial learners, and the integration of digital resources and technology into the educational experience [ 3 Ruiz J.G. Mintzer M.J. Leipzig R.M. The impact of e-learning in medical education. Acad Med. 2006; 81: 207-212 Crossref PubMed Scopus (1288) Google Scholar ].

PURPOSE:Medical imaging is an increasingly important source of radiation exposure for the general population, and there are risks associated with such exposure; however, recent studies have demonstrated poor understanding of medical radiation among various groups of health care providers. This study had two aims: (1) analyze physicians' knowledge of radiation exposure and risk in diagnostic imaging across multiple specialties and levels of training, and (2) assess the effectiveness of a brief educational presentation on improving physicians' knowledge. METHODS:From 2014 to 2016, 232 health care providers from multiple departments participated in an educational presentation and pre- and postpresentation tests evaluating knowledge of radiation exposure and risk at a large academic institution. RESULTS:Knowledge of radiation exposure and risk was relatively low on the prepresentation test, including particularly poor understanding of different imaging modalities, with 26% of participants unable to correctly identify which modalities expose patients to ionizing radiation. Test scores significantly increased after the educational presentation. Radiologists had higher prepresentation test scores than other specialties, and therefore less opportunity for improvement, but also demonstrated improvement in radiation safety knowledge after education. Aside from radiology, there was no significant difference in initial knowledge of radiation exposure and risk among the other specialties. CONCLUSIONS:Providers' knowledge of radiation exposure and risk was low at baseline but significantly increased after a brief educational presentation. Efforts to educate ordering providers about radiation exposure and risk are needed to ensure that providers are appropriately weighing the risks and benefits of medical imaging and to ensure high-quality, patient-centered care.

Due to increasing rates of international travel, hepatic fascioliasis is appearing in nonendemic areas, where diagnosis can be difficult. We present two confirmed cases of hepatic fascioliasis in a nonendemic region. The purposes of this report are to discuss computed tomography (CT) findings of hepatic fascioliasis and to review the literature. While travel history is most important, characteristic findings of hypoattenuating tracts extending from liver capsule into the parenchyma on contrast-enhanced CT scan strongly suggest hepatic fascioliasis.

The membership of the Intersociety Committee convened to consider how best to continue to stimulate, nurture, and support innovation in radiologic research and education in the face of ever increasing clinical demands and financial constraints. The topic was chosen in recognition that the growth and success of radiology over the past 50-plus years have been driven by spectacular technological developments in imaging and intervention and that the future relevance of the specialty will hinge on how the specialty continues to evolve. To keep radiology a dynamic and vital component of the health care enterprise will require continued innovation in technology and the requisite education that goes with it.

Emergency department (ED) utilization of radiologic services is growing in the setting of an expanding ED population [ 1 Levin D.C. Rao V.M. Parker L. et al. Continued growth in emergency department imaging is bucking the overall trends. J Am Coll Radiol. 2014; 11: 1044-1047 Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar , 2 Trzeciak S. Rivers E.P. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003; 20: 402-405 Crossref PubMed Scopus (586) Google Scholar ]. This growth has been attributed to changing standards of care in the setting of rapidly improving radiologic technology and an increasing severity of illness of the population of patients served by EDs nationwide [ 2 Trzeciak S. Rivers E.P. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003; 20: 402-405 Crossref PubMed Scopus (586) Google Scholar , 3 Richards J.R. Derlet R.W. Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000; 35: 63-68 Abstract Full Text Full Text PDF PubMed Scopus (754) Google Scholar ].

PURPOSE:To investigate the effect of change in portal venous blood flow rates on the size and shape of ablations created by a 2.45-GHz microwave ablation device.MATERIALS AND METHODS:This study was exempt from review by the institutional animal care and use committee. An in vitro bovine liver model perfused with autologous blood via the portal vein at five flow rates (60, 70, 80, 90, and 100 mL/min per 100 g of liver) was used to evaluate the effect of change in flow rates on the size and shape of coagulation created by a 2.45-GHz, 140-W microwave ablation device operated for 5 and 10 minutes. Three ablations per ablation time were conducted in each of 10 livers, with two livers perfused at each flow rate. Short- and long-axis diameters were measured from gross specimens, and volume and sphericity index were calculated. General linear mixed models that accounted for correlations within the liver were used to evaluate the effects of lobe, flow, and ablation time on size and sphericity index of ablations.RESULTS:Flow did not have a significant effect on the size or shape of coagulation created at 5 or 10 minutes (P > .05 for all tests). The mean short- and long-axis diameters and volume were 3.2 cm (95% confidence interval [CI]: 3.1, 3.3), 5.6 cm (95% CI: 5.4, 5.8), and 30.2 cm(3) (95% CI: 28.4, 32.1) for the 5-minute ablations and 3.8 cm (95% CI: 3.7, 3.9), 6.5 cm (95% CI: 6.3, 6.7), and 49.3 cm(3) (95% CI: 47.5, 51.2), for the 10-minute ablations, respectively. The mean sphericity index for both 5- and 10-minute ablations was 34.4% (95% CI: 32%, 36.7%).CONCLUSION:Change in portal venous blood flow rates did not have an effect on the size and shape of ablations created by a 2.45-GHz microwave ablation device.

The current initiative to reform health care from both a quality and a cost perspective has already had a profound impact on the radiology enterprise. We have seen a decrease in the utilization of imaging studies, a reduction in reimbursement, a declining payer mix, shrinking incomes, a proliferation of performance indices, creation of radiology mega-groups, growth of national radiology companies, and increasing turf incursions. Our cheese is clearly on the move, and we must take action to reengineer the radiology enterprise. In keeping with general health care reform, we must be patient-centric, data driven, and outcome based. We must create a radiology enterprise that adheres to the value equation of providing the highest quality health care, for the lowest possible cost, for all citizens.

This study was exempt from review by the institutional animal care and use committee. An in vitro bovine liver model perfused with autologous blood via the portal vein at five flow rates (60, 70, 80, 90, and 100 mL/min per 100 g of liver) was used to evaluate the effect of change in flow rates on the size and shape of coagulation created by a 2.45-GHz, 140-W microwave ablation device operated for 5 and 10 minutes. Three ablations per ablation time were conducted in each of 10 livers, with two livers perfused at each flow rate. Short- and long-axis diameters were mea sured from gross specimens, and volume and sphericity index were calculated. General linear mixed models that accounted for correlations within the liver were used to evaluate the effects of lobe, flow, and ablation time on size and sphericity index of ablations. Results: Flow did not have a significant effect on the size or shape of coagulation created at 5 or 10 minutes (P . .05 for all tests). The mean short- and long-axis diameters and volume were 3.2 cm (95% confidence interval [CI]: 3.1, 3.3), 5.6 cm (95% CI: 5.4, 5.8), and 30.2 cm3 (95% CI: 28.4, 32.1) for the 5-minute ablations and 3.8 cm (95% CI: 3.7, 3.9), 6.5 cm (95% CI: 6.3, 6.7), and 49.3 cm3 (95% CI: 47.5, 51.2), for the 10-minute ablations, respectively. The mean sphericity index for both 5- and 10-minute ablations was 34.4% (95% CI: 32%, 36.7%).

Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.

PURPOSE:This study outlines the design and fabrication techniques for two portal vein flow phantoms.METHODS:A materials study was performed as a precursor to this phantom fabrication effort and the desired material properties are restated for continuity. A three-dimensional portal vein pattern was created from the Visual Human database. The portal vein pattern was used to fabricate two flow phantoms by different methods with identical interior surface geometry using computer aided design software tools and rapid prototyping techniques. One portal flow phantom was fabricated within a solid block of clear silicone for use on a table with Ultrasound or within medical imaging systems such as MRI, CT, PET, or SPECT. The other portal flow phantom was fabricated as a thin walled tubular latex structure for use in water tanks with Ultrasound imaging. Both phantoms were evaluated for usability and durability.RESULTS:Both phantoms were fabricated successfully and passed durability criteria for flow testing in the next project phase.CONCLUSIONS:The fabrication methods and materials employed for the study yielded durable portal vein phantoms.

The ACR Task Force on Medical Student Education in Radiology, in partnership with the Alliance of Medical Student Educators in Radiology, investigated the current status of how and to what extent medical imaging was being taught in medical schools. The task force executed a 3-part survey of medical school deans, radiology department chairs, and intern physicians. The results provided an updated understanding of the status of radiology education in medical schools in the United States. This summary includes recommendations about how individual radiology departments and ACR members can assist in advancing the specialty of diagnostic radiology through medical student education.

The digital and online revolution is having a profound impact on radiology journals, forcing a migration from print to online publication and altering traditional revenue streams needed to sustain the journals. The 2013 Intersociety Committee Summer Conference attendees reviewed the history of the development of radiology journals, explored the forces driving the transition from print to electronic publication, and examined the impact of the alteration of the traditional revenue streams, such as subscription and advertisement dollars, on the financial sustainability of journals. The attendees also discussed the international movement toward open access to journal content and its impact on a journal's financial viability. Lastly, the committee explored the perceived value of radiology journals based on readership type: academic, private practice, or industry.

The "new online" (Web 2.0) world is evolving rapidly, and the digital information, education, and networking resources available to radiologists have exploded over the past 2 decades. The 2012 Intersociety Committee Summer Conference attendees explored the online resources that have been produced by societies, universities, and commercial entities. Specific attention was given to identifying the best products and packaging them in tablet computers for use by residents and practicing radiologists. The key functions of social networking websites and the possible roles they can play in radiology were explored as well. It was the consensus of the attendees that radiologic digital resources and portable electronic devices have matured to the point that they should become an integral part of our educational programs and clinical practice.

PURPOSE:This study investigated the ultrasound, MRI, and CT imaging characteristics of several industrial casting and molding compounds as a precursor to the future development of durable and anatomically correct flow phantoms.METHODS:A set of usability and performance criteria was established for a proposed phantom design capable of supporting liquid flow during imaging. A literature search was conducted to identify the materials and methods previously used in phantom fabrication. A database of human tissue and casting material properties was compiled to facilitate the selection of appropriate materials for testing. Several industrial casting materials were selected, procured, and used to fabricate test samples that were imaged with ultrasound, MRI, and CT.RESULTS:Five silicones and one polyurethane were selected for testing. Samples of all materials were successfully fabricated. All imaging modalities were able to discriminate between the materials tested. Ultrasound testing showed that three of the silicones could be imaged to a depth of at least 2.5 cm (1 in.). The RP-6400 polyurethane exhibited excellent contrast and edge detail for MRI phantoms and appears to be an excellent water reference for CT applications. The 10T and 27T silicones appear to be usable water references for MRI imaging.CONCLUSIONS:Based on study data and the stated selection criteria, the P-4 silicone provided sufficient material contrast to water and edge detail for use across all imaging modalities with the benefits of availability, low cost, dimensional stability, nontoxic, nonflammable, durable, cleanable, and optical clarity. The physical and imaging differences of the materials documented in this study may be useful for other applications.

Despite growing research funds to foster advances in imaging, a majority of academic departments around the country remained poorly funded at the turn of the 21st century. This raised concerns about the vitality of academic research among radiology departments and the sustainability of academic contributions to the advancement of imaging. In response, radiologists and academic programs were challenged to address the issue, from which efforts to train research-oriented academic radiologists and investigators arose.

PURPOSETo assess whether there is a significant difference in the effect of incremental changes of portal venous blood flow rates on the size of radiofrequency (RF) versus microwave (MW) ablation lesions in an ex vivo blood-perfused bovine liver model.MATERIALS AND METHODSThis study was exempt from approval by the Institutional Animal Care and Use Committee. Sixty ablations (30 MW and 30 RF ablations) were performed ex vivo in 15 bovine livers perfused with autologous blood via the portal vein at 60, 70, 80, 90, and 100 mL/min per 100 g of liver tissue (three livers were used for each flow rate). Long-axis diameter (LAD), short-axis diameter (SAD), and volume were measured for each ablation lesion. A general linear mixed model was used to examine the effect of location, ablation device, and flow rate on LAD, SAD, and volume. Results were considered to indicate a significant difference at P less than .05.RESULTSLocation was not a significant predictor of LAD, SAD, or volume (P ≥ .4). The slope of the relationship between flow rate and LAD, SAD, and volume was significantly different according to ablation device (P < .0001). For RF ablation lesions, the mean LAD, SAD, and volume demonstrated a significant inverse relationship with flow rate, while the measurements for MW ablation did not change with variation in flow rates.CONCLUSIONThe size of RF ablation lesions is highly variable, with a significant inverse relationship to the rate of portal venous blood flow. Conversely, the size of MW ablation lesions is unaffected by changes in portal venous blood flow. The consistency of the size of MW ablation lesions could translate into a higher local tumor eradication rate than that reported with RF ablation.