Objectives/Hypothesis: Our objectives were to determine genotype-phenotype correlations in patients with sensorineural hearing loss (SNHL) who undergo testing for GJB2 mutations and to examine the relationship of temporal bone anomalies seen on computed tomography (CT) and GJB2 mutations.Study design: We conducted a retrospective review of all children diagnosed with SNHL and who underwent GJB2 testing from 1997 to 2006.Results: Of 840 patients, 146 (17.4%) had mutations. Seventy-six (9.1%) had biallelic GJB2 mutations and 70 (8.3%) had heterozygous mutations. When biallelic mutations were categorized as missense or nonsense mutations, the presence of at least one missense mutation was associated with mild or moderate SNHL. Biallelic nonsense mutations were associated with severe to profound SNHL. Among patients with GJB2 mutations, those with heterozygous mutations (n = 14 [20%]) had a higher rate of asymmetric SNHL loss than those with biallelic mutations (n = 6 [7.9%], P = .03). Those with heterozygous mutations were more likely to experience progression than were those with biallelic mutations, though this difference was only marginally significant (26.5% vs. 12.3%, respectively; P = .06). Patients who were wild type for GJB2 were more likely to have an enlarged vestibular aqueduct (EVA) than were those with biallelic and heterozygous mutations (29% vs. 11.9%, respectively; P = .004). Compared to patients who were wild type, those with biallelic mutations had a significantly lower rate of EVA.Conclusions: This is the largest single-institution study of pediatric patients with GJB2 mutations and SNHL. The functional consequences of GJB2 mutations correlated with the degree of hearing loss. Patients with M34T mutations and/or mild SNHL had a low risk of progression. Temporal bone anomalies were uncommon in patients with GJB2 mutations.

OBJECTIVE. The objective of this article is to describe the development, launch, and outcomes studies of a paperless workflow management system (WMS) that improves radiology workflow in a filmless and speech-recognition environment.MATERIALS AND METHODS. The WMS prioritizes cases automatically on the basis of medical and operational acuity factors, automatically facilitates communication of critical radiology results, and provides permanent documentation of these results and communications. It runs in parallel with an integrated radiology information system (RIS)-PACS and speech-recognition system. Its effects on operations, staff stress and satisfaction, and patient satisfaction were studied.RESULTS. Despite an increase in caseload volume after the launch of the WMS, case turnaround times, defined as the time between case availability on PACS and signing of the final radiology staff interpretation, decreased for all case types. Median case turnaround time decreased by 33 minutes (22%) for emergency department, 47 minutes (37%) for inpatient, and 22 minutes (38%) for outpatient radiology cases. All reductions were significant at a p value of < 0.05. Interruptions were reduced, consuming an estimated 28% less radiology staff time, after implementation. Patient perceptions of radiology service timeliness showed modest improvement after the WMS was implemented. Staff satisfaction showed no significant change.CONCLUSION. There is room for improvement in radiology workflow even in departments with integrated RIS -PACS and speech-recognition systems. This study has shown that software tools that coordinate decentralized workflow and dynamically balance workloads can increase the efficiency and efficacy of radiologists. Operational benefits, such as reduced reading times, improvements in the timeliness of care (both actual and as perceived by patients), and reduced interruptions to radiologists, further reinforce the benefits of such a system. Secondary benefits, such as documenting communication about a case and facilitating review of results, can also promote more timely and effective care. Although use of the system did not result in a substantial improvement in staff perceptions, neither did it reduce their satisfaction, suggesting that these operational improvements were not achieved as a trade-off against the quality of the work environment.

ObjectiveThe study goal was to determine the prevalence and clinical significance of a large vestibular aqueduct (LVA) in children with sensorineural hearing loss (SNHL).Study Design and SettingWe conducted a retrospective review of a pediatric SNHL database. One hundred seven children with SNHL were selected and their radiographic and audiometric studies were evaluated. Radiographic comparisons were made to a group of children without SNHL.ResultsA vestibular aqueduct (VA) larger than the 95th percentile of controls was present in 32% of children with SNHL. Progressive SNHL was more likely to occur in ears with an LVA and the rate of progressive hearing loss was greater than in ears without an LVA. The risk of progressive SNHL increased with increasing VA size as determined by logistic regression analysis.ConclusionsAn LVA is defined as one that is ≥2mm at the operculum and/or ≥1 mm at the midpoint in children with nonsyndromic SNHL. An LVA appears to be more common than previously reported in children with SNHL. A linear relationship is observed between VA width and progressive SNHL.SignificanceThe finding of an LVA in children with SNHL provides diagnostic as well as prognostic information. © 2007 American Academy of Otolaryngology‐Head and Neck Surgery Foundation. All rights reserved.

OBJECTIVE To correlate genetic and audiometric findings with a detailed radiologic analysis of the temporal bone in patients with enlarged vestibular aqueduct (EVA) to ascertain the contribution of SLC26A4 gene mutations to this phenotype. DESIGN A retrospective review of patients with EVA identified in a database of pediatric hearing-impaired patients. SETTING A tertiary care pediatric referral center. PATIENTS Seventy-one children with EVA and screening results for SLC26A4 mutations. MAIN OUTCOME MEASURES Genetic screening results, audiometric thresholds, and radiographic temporal bone measurements. RESULTS Seventy-one children with EVA were screened for SLC26A4 mutations. Mutations were found in 27% of children overall, while only 8% had biallelic mutations. The mean initial pure-tone average (PTA) was 59 dB; the mean final PTA was 67 dB. A bilateral EVA was found in 48 (67%) of the children; a unilateral EVA was found in 23 (33%). Progressive hearing loss (in at least 1 ear) was seen in 29 (41%) of the patients. The strongest genotype-phenotype interaction was seen in children with a bilateral EVA. Among children with SLC26A4 mutations, there was a significantly wider vestibular aqueduct at the midpoint and a wider vestibule width (P < .05) than in children without the mutation. Among patients with a bilateral EVA, children with any SLC26A4 mutation were more likely to have a more severe final PTA (64 dB vs 32 dB), larger midpoint measurement (2.1 vs 1.1 mm), and larger operculum measurement (3.0 vs 2.0 mm) than those without the mutation in their better-hearing ear (P < .05). CONCLUSIONS In a population of pediatric patients with an EVA and hearing loss, SLC26A4 mutations are a contributor to the phenotype. Our data suggest that other genetic factors also have important contributions to this phenotype. The presence of an abnormal SLC26A4 allele, even in the heterozygous state, was associated with greater enlargement of the vestibular aqueduct, abnormal development of the vestibule, and possibly a stable hearing outcome.

We have previously reported the development and use of an interactive model for teaching emergency pediatric radiography [ 1 Halsted M.J. Perry L.A. Perry D.J. Benton C. Development of an interactive module for teaching emergency pediatric radiography: preliminary report. J Am Coll Radiol. 2005; 2: 701-703 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ]. Since developing and using the model, additional investigations have found that, at our institution, when interpreting emergency pediatric head computed tomographic (CT) scans, the most common error made by radiology residents and fellows is overlooking intracranial hemorrhage (unpublished data). In an effort to improve trainees’ accuracy in making this important diagnosis, we used the new instructional tool [ 1 Halsted M.J. Perry L.A. Perry D.J. Benton C. Development of an interactive module for teaching emergency pediatric radiography: preliminary report. J Am Coll Radiol. 2005; 2: 701-703 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ]. We then conducted a randomized controlled study of the effectiveness of this teaching model.

Errors in reading radiologic images create health risks to patients and can adversely affect physicians through litigation and increased insurance costs. This study assessed the usefulness of a radiology teaching database for training physicians to improve their diagnostic accuracy. This tool is particularly important in pediatric radiology because children have unique anatomies and pathologies, and most physicians are generally more familiar with adults. The case collection consisted of normal cases and cases that had changes in the initial interpretations from an existing database of pediatric radiologic images at the Cincinnati Children's Hospital Medical Center. Physicians in the radiology department were surveyed regarding their opinions on the case collections. The most frequent users of the collection were residents and fellows, who used the collection primarily for learning and reference. Attending radiologists used the collection for teaching and daily film reading. The most commonly used cases involved head computed tomography, brain magnetic resonance, and skull radiography. All respondents recognized the value of the database for the enhancement of residents' and fellows' training. Residents and fellows expressed the desire to add complete abnormal and frequently missed case collections to the normal collection. Physicians who used the collections did so very frequently, but many experienced physicians never accessed the collection. Inexperienced physicians' reliance on reference books compared with Internet resources highlights a need for computer-based teaching and reference tools. This study illustrates that easy-to-use computer-based teaching files are useful for training physicians and as reference tools for experienced physicians.

This morning, on the way to school, my 7-year-old daughter and I were discussing the fact that she had slept through the ringing of her alarm clock. “It wasn’t my fault,” she contended. “Well, it wasn’t intentional, and it was a mistake, but it was certainly no one else’s fault, so it must have been yours,” I countered. I reassured her that I was not angry at her but that she ought to learn from the experience and try harder to wake up the next time her alarm sounded.

PURPOSE:The authors describe the development of an interactive digital teaching module designed to help prepare residents to diagnose emergency pediatric radiology cases.METHODS:Cases were identified using the authors' own dictation search software. Cases were selected that depicted common conditions that had been misdiagnosed by the radiology resident who had first interpreted them clinically. Normal cases involving similar anatomic regions were also collected. Images from these cases were captured from the picture archiving and communication system. "Hotspots" were superimposed on abnormalities to highlight them. Example dictations were captured. A simple user interface was developed for the teaching module, and a database was built to log all user responses.RESULTS:The system has been well received at the authors' institution. It has been incorporated into the standard orientation for all incoming residents. Residents' diagnostic performance has subjectively improved since the module was launched.CONCLUSIONS:The module is interactive, easy to use, and subjectively improves incoming residents' diagnostic accuracy. A prospective, controlled study assessing its impact on short-term and long-term diagnostic performance is under way.

Pediatric radiologists must interpret studies in the context of patients’ age. Because of constant changes in anatomy and physiology during growth in children, normal findings at one age may be abnormal at other ages. This dynamic substrate makes pediatric radiology interesting, but it also makes the interpretation of pediatric radiology images difficult for trainees or those who do not regularly see pediatric studies. Even for experienced pediatric radiologists, it is sometimes challenging to interpret whether a given finding is normal for a particular patient at a specific age.

Although recent data suggest that the shortage of radiologists is beginning to ease, radiologists remain in high demand. Academic and private radiology practices can take specific steps both to encourage the recruitment of new radiologists and to enhance the retention of existing staff members. The authors review the history of the current workforce shortage and describe steps they have taken within their own practice that have proved successful in helping fill staff positions and prevent the significant loss of staff members over the past several years. The authors believe that these steps can be helpful to any institution, private or academic, seeking to recruit and retain radiologists.

Departmental peer review is a requirement of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) [1], whose guidelines allow considerable flexibility in specific implementation strategies. The radiology department at the Cincinnati Children's Hospital Medical Center sought to use the JCAHO requirement as an opportunity to improve patient care.

Radiology education has evolved significantly in the past several decades, but there is considerable room for improvement. While some improvements depend on the availability of new technology, others are low tech, requiring merely that we be aware of and apply findings in the education literature. We teachers of radiology could benefit from recent studies investigating the processes underlying adult learning to improve the methods we use to train residents and fellows, and to improve the way we teach our colleagues and even ourselves. In this review, adult learning and the expert learner are briefly discussed, as are the important elements of effective learning tools. The strengths and weaknesses of radiology education as it is commonly practiced today are explored. Specific suggestions for improving education in radiology using both low tech and high tech methods are then discussed.

Background There are few data regarding the frequency and type of diagnostic errors made by radiology residents and fellows (“trainees”). However, increasing interest in reducing medical errors highlights the need to analyze which areas of medical knowledge are most problematic for physicians-in-training, including radiology trainees. Once these areas are identified, they can be emphasized during training . Objective To quantify the diagnostic errors made by radiology trainees interpreting radiographs from a pediatric emergency department. Materials and methods A total of 23,273 dictations of emergency radiographs performed over a 1-year period at a pediatric hospital were analyzed for corrections after staff interpretation and for type and incidence of missed abnormalities by radiology trainees. Errors were categorized by type of pathology and anatomic region. Results Of the 80 errors detected, 90% were false negatives and 69% were recurrent. Most errors (69%) involved the diagnosis of fractures and/or dislocations. Sixty-one percent of all recurrent errors involved buckle, Salter II, avulsion, and transverse fractures—yet these cases constituted only 3% of all cases seen during the study period. Conclusion The most common errors made by radiology trainees can be identified. By targeting these errors, training programs can improve the quality and relevance of the education they provide.

Rewarding Authors in a Digital Era: Assigning Academic Credit for Contributions to Digital Articles, Web Sites, Teaching Files, and LecturesMark J. Halsted1Audio Available | Share

OBJECTIVE. We describe a simple method for creating teaching cases from clinical data, radiologic images, surgical images, and images from pathologic slides that are presented at tumor board conferences.CONCLUSION. The resulting interdisciplinary case files are of educational value both during and after conference presentations and can be used by clinicians to gather appropriate historical, laboratory, imaging, surgical, and pathologic data on their patients. This system improves the efficiency and accuracy in gathering patient histories when care is transferred among clinics, the emergency department, and wards.

OBJECTIVEDilute Hypaque Sodium is generally well accepted as an oral contrast agent for CT of pediatric patients who have experienced recent blunt abdominal trauma. However, Hypaque can cause complications. Using water as a substitute contrast agent eliminates these potential complications. The purpose of our study was to compare the performance of water with that of dilute Hypaque as an oral contrast agent. Our hypothesis was that we would find no significant difference in performance between the two agents in defining anatomic details of the hollow gastrointestinal tract.MATERIALS AND METHODSWe performed a retrospective review of 74 CT scans obtained in infants and children who had received blunt abdominal trauma, scoring the quality of visualization of bowel structures, the presence of non-bowel-related findings, and the confidence level in making each assessment. The date range of the scans reviewed overlapped with the period in which the oral contrast material used for scanning such patients was switched from dilute Hypaque to water. Of the 74 CT scans that we reviewed, 53 were obtained with dilute Hypaque and 21 were obtained with water. The sex distribution between the two groups was compared using a chi-square test, whereas the mean age was compared using a two-sample two-sided Student's t test. A two-sample one-sided Student's t test of equivalence was used to analyze the data.RESULTSSex distribution for the two groups of patients was not significantly different (69.81% of the group who received dilute Hypaque were boys; 68.18% of the group who received water were boys). Furthermore, the difference in the mean age for the two groups was not statistically significantly (dilute Hypaque group, 8.86 years; water group, 10.18 years). No statistically significant difference in performance of the contrast agents was found with respect to the detection of intraabdominal abnormality. As an oral contrast material, water performed as well as dilute Hypaque in facilitating visualization of all intraabdominal anatomic structures.CONCLUSIONIn defining anatomic details of the hollow gastrointestinal tract, water is as effective as dilute Hypaque as an oral contrast agent for CT in the setting of acute blunt abdominal trauma in pediatric patients.

6:30 – 7:30 a.m. Continental Breakfast 7:00 – 8:30 a.m. Workshops Session III PACS Beyond PACS: Opening Doors to Electronic Teaching Mark J. Halsted, MD, Moderator RESEARCH Developing a Basic Research Program Scott K. Holland, PhD, Stephan D. Voss, MD, PhD, Moderators EDUCATION New Ideas in Residency Education Janet R. Reid, MD, Moderator BUSINESS Alternative Practice Models for Pediatric Sedation J. Damien Grattan-Smith, MD, Marvin D. Nelson, Jr., MD, Moderators MASTERS CASE SESSION Fetal and Pediatric Sonography Harris L. Cohen, MD, Moderator INTERVENTIONAL Vascular Interventional Josée Dubois, MD, James S. Donaldson, MD, Moderators 8:30 – 10:00 a.m. Scientific Papers IV 10:00 – 10:30 a.m. Break 10:30 a.m. – 12:00 p.m. Scientific Papers V 12:00 – 1:30 p.m. Business Meeting (SPR Members) Lunch Break 1:30 – 3:00 p.m. Workshops – Session IV PACS PACS Discussion Forum For Those Without a PACS (‘‘Open Microphone’’) Neil D. Johnson, MD, Moderator RESEARCH – Effective Screening: Criteria and Applications Marilyn J. Siegel, MD, Diego Jaramillo, MD, Vicente Gilsanz, MD, Moderators EDUCATION Pediatric Radiology Resources on the Internet Michael P. D’Alessandro, MD, Moderator BUSINESS Managing Change in a Pediatric Radiology Department George A. Taylor, MD, Robert T. Bramson, MD, Moderators MASTERS CASE SESSION Genitourinary Robert L. Lebowitz, MD, Moderator INTERVENTIONAL Abdominal Intervention Peter G. Chait, MD, Moderator 3:00 – 3:30 p.m. Break 3:30 – 5:30 p.m. Scientific Papers VI 6:30 – 11:00 p.m. Annual Reception & Banquet The Fairmont Hotel San Francisco