National surveys conducted in 2012 and 2013 of students applying to radiation oncology residency revealed a high degree of variability in radiation oncology clerkship educational experiences [ 1 Golden D.W. Raleigh D.R. Chmura S.J. Koshy M. Howard A.R. Radiation oncology fourth-year medical student clerkships: a targeted needs assessment. Int J Radiat Oncol Biol Phys. 2013; 85: 296-297 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 2 Jagadeesan V.S. Raleigh D.R. Koshy M. Howard A.R. Chmura S.J. Golden D.W. A national radiation oncology medical student clerkship survey: didactic curricular components increase confidence in clinical competency. Int J Radiat Oncol Biol Phys. 2014; 88: 51-56 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar ]. The majority of clerkships had no structured didactic curricula, but students who completed clerkships that included structured didactics reported greater self-perceived preparedness for radiation oncology residency. In response, a structured didactic curriculum was developed and piloted at two institutions [ 3 Golden D.W. Spektor A. Rudra S. et al. Radiation oncology medical student clerkship: implementation and evaluation of a bi-institutional pilot curriculum. Int J Radiat Oncol Biol Phys. 2014; 88: 45-50 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar ]. With the formation of the Radiation Oncology Education Collaborative Study Group, the curriculum was expanded to 22 institutions by 2016. Subjective feedback from participating students was positive, and students who completed at least one clerkship at a Radiation Oncology Education Collaborative Study Group institution reported greater postclerkship radiation oncology knowledge and preparedness for residency [ 4 Oskvarek J.J. Brower J.V. Mohindra P. Raleigh D.R. Chmura S.J. Golden D.W. Educational impact of a structured radiation oncology clerkship curriculum: an interinstitutional comparison. J Am Coll Radiol. 2017; 14: 96-102 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar ]. However, this evidence was subjective. Additionally, with the majority of medical students completing their radiation oncology clerkships at the start of their fourth year, several months pass before residency, which may degrade any impact provided by a structured curriculum. Do radiation oncology clerkships with structured didactics provide an objective improvement to student knowledge that is retained beyond the clerkship experience?

PURPOSE:A structured didactic radiation oncology clerkship curriculum for medical students is in use at multiple academic medical centers. Objective evidence supporting this educational approach over the traditional clerkship model is lacking. This study evaluated the curriculum efficacy using an objective knowledge assessment. METHODS AND MATERIALS:Medical students received the Radiation Oncology Education Collaborative Study Group (ROECSG) curriculum consisting of 3 lectures (Overview of Radiation Oncology, Radiation Biology/Physics, and Practical Aspects of Simulation/Radiation Emergencies) and a radiation oncology treatment-planning workshop. A standardized 20-item multiple choice question (MCQ) knowledge assessment was completed pre- and post-curriculum and approximately 6 months after receiving the curriculum. RESULTS:One hundred forty-six students at 22 academic medical centers completed the ROECSG curriculum from July to November 2016. One hundred nine students completed pre- and post-clerkship MCQ knowledge assessments (response rate 74.7%). Twenty-four students reported a prior rotation at a ROECSG institution and were excluded from analysis. Mean assessment scores increased from pre- to post-curriculum (63.9% vs 80.2%, P < .01). Mean MCQ knowledge subdomain assessment scores all improved post-curriculum (t test, P values < .01). Post-scores for students rotating de novo at ROECSG institutions (n = 30) were higher compared with pre-scores for students with ≥1 prior rotations at non-ROECSG institutions (n = 55) (77.3% vs 68.8%, P = .01), with an effect size of 0.8. Students who completed rotations at ROECSG institutions continued to demonstrate a trend toward improved performance on the objective knowledge assessment at approximately 6 months after curriculum exposure (70.5% vs 65.6%, P = .11). CONCLUSIONS:Objective evaluation of a structured didactic curriculum for the radiation oncology clerkship at early and late time points demonstrated significant improvement in radiation oncology knowledge. Students who completed clerkships at ROECSG institutions performed objectively better than students who completed clerkships at non-ROECSG institutions. These results support including a structured didactic curriculum as a standard component of the radiation oncology clerkship.

TPS3121 Background: Stereotactic body radiotherapy (SBRT) and immuno-oncology (IO) have been associated with improved oncologic outcomes when given as monotherapy for advanced solid tumors. Furthermore, preclinical studies have suggested synergistic interactions between SBRT and IO agents with enhanced anti-tumor activity possibly mediated by the induction of CD8+ T-cells. Additionally, patients with advanced melanoma receiving dual IO therapy in the absence of SBRT experienced longer overall survival than patients receiving single-agent IO therapy. Given these findings, it is reasonable to hypothesize that dual IO therapy in combination with SBRT may be more efficacious than any of these treatments alone. However, the safety of multiple IO agents given in combination with SBRT is unknown. Methods: The study is a single-center, phase 1, open-label, two-arm, non-randomized clinical trial for patients with advanced solid tumors and at least 1 measurable site of disease after receiving ≤ 3 prior systemic therapies. Enrolled patients receive either (1) concurrent nivolumab (anti-PD-1, 240 mg IV flat dose every 2 weeks) + urelemab (anti-CD137, 8 mg flat dose IV every 4 weeks) + SBRT or (2) concurrent nivolumab (240 mg IV flat dose every 2 weeks) + cabiralizumab (anti-CSF1R, 4 mg/kg IV every 2 weeks) + SBRT. SBRT is delivered to 1-4 sites to a maximum target volume of 65 cc/site. Dual IO therapy is continued until progression or fulfilment of discontinuation criteria. We expect 42-72 patients to be enrolled on study until 5 separate organ sites receiving SBRT have accrued at least 6 participants for evaluation of dose-limiting toxicity at the starting dose and a de-escalated dose if necessary. The primary endpoint is dose-limiting toxicity defined as > 33% rate of grade ≥3 toxicity. Secondary endpoints include response rate, PFS, and OS. Exploratory analyses include investigation of candidate biomarkers (e.g., PD-L1 status, circulating tumor DNA, gut microbiome data) for treatment efficacy. Enrollment is ongoing. Clinical trial information: NCT03431948.

The purpose of our study was to assess resident and fellow patient care competency related to chest port catheter insertion after implementation of an educational program and completion of a certification checklist. Furthermore, we aimed to measure the impact of this intervention on early infection rates. Methods: Baseline early infection rates as defined by the CDC were obtained in 152 consecutive patients. These were segregated by primary operator and timeframe. Following establishment of a baseline infection rate, formalized training of residents and fellows was undertaken. This included a hands-on suture workshop and satisfactory completion of a skill set with attending level certification. To evaluate competency, a procedure competency checklist was developed by the interventional radiology faculty. The checklist consisted of 17 detailed steps considered important for chest port catheter insertion. Following the training period, infection rates of 415 consecutive patients were calculated and compared to the baseline infection rates. Results: Four out of eight (50%) residents satisfactorily demonstrated competency and were certified as primary operators for port insertion. In addition, both of the two interventional radiology fellows were certified. The early infection rates of chest port catheters placed by residents slightly decreased from 3.0% to 2.2% following the intervention compared to baseline, although this decrease was not statistically significant. Total infection rates also decreased slightly from 2.6% to 1.4%. Conclusions: In our study, the rate of early infections after port insertion decreased following the educational intervention and certification process, although this was not statistically significant.

Accessory ossicles are common incidental findings on radiographs of the ankle and foot. While typically asymptomatic and of no clinical significance, they are sometimes associated with local pain or even mistaken for pathological conditions such as fractures. Given the potential for misinterpretation, it is important to understand their typical locations and appearances. This case highlights an exceptionally rare accessory ossicle called the os cuboideum secundarium, located adjacent to the cuboid and calcaneus. Interestingly, this case demonstrates the potential for this rare ossicle to mimic a mass on magnetic resonance imaging (MRI). Furthermore, despite the significant improvements in the understanding of musculoskeletal pathology afforded by advancements in cross-sectional imaging techniques, this case is a reminder of certain pitfalls that remain. Lastly, it highlights the importance of radiographs as an initial diagnostic study in evaluating foot pain.

BACKGROUND:The discovery of genetic mutations in children with inherited syndromes of intrahepatic cholestasis allows for diagnostic specificity despite similar clinical phenotypes. Here, we aimed to determine whether mutation screening of target genes could assign a molecular diagnosis in children with idiopathic cholestasis. PATIENTS AND METHODS:DNA samples were obtained from 51 subjects with cholestasis of undefined etiology and surveyed for mutations in the genes SERPINA1, JAG1, ATP8B1, ABCB11, and ABCB4 by a high-throughput gene chip. Then, the sequence readouts for all 5 genes were analyzed for mutations and correlated with clinical phenotypes. Healthy subjects served as controls. RESULTS:Sequence analysis of the genes identified 14 (or 27%) subjects with missense, nonsense, deletion, and splice site variants associated with disease phenotypes based on the type of mutation and/or biallelic involvement in the JAG1, ATP8B1, ABCB11, or ABCB4 genes. These patients had no syndromic features and could not be differentiated by biochemical markers or histopathology. Among the remaining subjects, 10 (or ∼20%) had sequence variants in ATP8B1 or ABCB11 that involved only 1 allele, 8 had variants not likely to be associated with disease phenotypes, and 19 had no variants that changed amino acid composition. CONCLUSIONS:Gene sequence analysis assigned a molecular diagnosis in 27% of subjects with idiopathic cholestasis based on the presence of variants likely to cause disease phenotypes.