The integration of digital data from imaging, pathology, genomics, and other fields creates an opportunity to produce information-rich diagnoses, especially for complex patients. Technology exists today to create a "diagnostic cockpit" that can accept inputs from multiple sources, analyze them using artificial intelligence and other quantitative tools, and produce a precision diagnosis. Although barriers to creation and dissemination of such a cockpit exist, the metaphor provides a glimpse into the diagnostic processes of the future.

To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV). A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution’s violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns. The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19–76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients. /advances in knowledge. The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.

Medical image interpretation is central to detecting, diagnosing, and staging cancer and many other disorders. At a time when medical imaging is being transformed by digital technologies and artificial intelligence, understanding the basic perceptual and cognitive processes underlying medical image interpretation is vital for increasing diagnosticians’ accuracy and performance, improving patient outcomes, and reducing diagnostician burnout. Medical image perception remains substantially understudied. In September 2019, the National Cancer Institute convened a multidisciplinary panel of radiologists and pathologists together with researchers working in medical image perception and adjacent fields of cognition and perception for the “Cognition and Medical Image Perception Think Tank.” The Think Tank’s key objectives were to identify critical unsolved problems related to visual perception in pathology and radiology from the perspective of diagnosticians, discuss how these clinically relevant questions could be addressed through cognitive and perception research, identify barriers and solutions for transdisciplinary collaborations, define ways to elevate the profile of cognition and perception research within the medical image community, determine the greatest needs to advance medical image perception, and outline future goals and strategies to evaluate progress. The Think Tank emphasized diagnosticians’ perspectives as the crucial starting point for medical image perception research, with diagnosticians describing their interpretation process and identifying perceptual and cognitive problems that arise. This article reports the deliberations of the Think Tank participants to address these objectives and highlight opportunities to expand research on medical image perception.

To describe the imaging findings of intimate partner violence (IPV)–related injury and to evaluate the role of longitudinal imaging review in detecting IPV. Radiology studies were reviewed in chronological order and IPV-related injuries were recorded among 400 victims of any type of abuse (group 1) and 288 of physical abuse (group 2) from January 2013 to June 2018. The likelihood of IPV was assessed as low/moderate/high based on the review of (1) current and prior anatomically related studies only and (2) longitudinal imaging history consisting of all prior studies. The first radiological study date with moderate/high suspicion was compared to the self-reported date by the victim. A total of 135 victims (33.8%) in group 1 and 144 victims (50%) in group 2 demonstrated IPV-related injuries. Musculoskeletal injury was most common (58.2% and 44.5% in groups 1 and 2, respectively; most commonly lower/upper extremity fractures), followed by neurologic injury (20.9% and 32.9% in groups 1 and 2, respectively; most commonly facial injury). With longitudinal imaging history, radiologists were able to identify IPV in 31% of group 1 and 46.5% of group 2 patients. Amongst these patients, earlier identification by radiologists was provided compared to the self-reported date in 62.3% of group 1 (median, 64 months) and in 52.6% of group 2 (median, 69.3 months). Musculoskeletal and neurological injuries were the most common IPV-related injuries. Knowledge of common injuries and longitudinal imaging history may help IPV identification when victims are not forthcoming. • Musculoskeletal injuries were the most common type of IPV-related injury, followed by neurological injuries. • With longitudinal imaging history, radiologists were able to better raise the suspicion of IPV compared to the selective review of anatomically related studies only. • With longitudinal imaging history, radiologists were able to identify IPV earlier than the self-reported date by a median of 64 months in any type of abuse, and a median of 69.3 months in physical abuse.

Purpose The purpose of this study is to evaluate the prevalence of intimate partner violence (IPV)-related upper extremity fractures (UEF) in women presenting to US emergency departments (ED) and compare their anatomic location to those due to accidental falls or strikes. Methods An Institutional Review Board exempt, retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System’s All Injury Program data from 2005 through 2015 for all UEF sustained in women 15 to 54 years old. Injuries based on reported IPV versus accidental falls or strikes were analyzed accounting for the weighted, stratified nature of the data. Results IPV-related UEF represented 1.7% of all UEF and 27.2% of all IPV fractures. The finger was the most common fracture site in IPV (34.3%) and accidental striking (53.3%) but accounted for only 10% of fall-related UEF. There was a higher proportion of shoulder fractures in IPV (9.2%) compared to accidental falls (7.4%) or strikes (2.9%). The odds of a finger fracture were 4.32 times greater in IPV than falling and of a shoulder fracture were 3.65 greater in IPV than accidental striking ( p < 0.0001). Conclusions While the finger is the most common site for IPV UEF, it is also the most common location for accidental striking. A lower proportion of finger fractures in fall and of shoulder/forearm fractures in accidental striking should prompt the radiologist to discuss the possibility of IPV with the ED physician in any woman presenting with a finger fracture due to fall and a shoulder/forearm fracture with a vague history of accidental striking.

Rationale and Objectives: To address existing educational gaps in the business of radiology and medicine, we developed, implemented, and evaluated an Academic Radiology Business Series (ARBS) as part of a longitudinal noninterpretive skills curriculum in our radiology residency program.Materials and Methods: Mixed lecture-and discussion-based sessions were prepared and taught by content experts and radiologist -leaders at our institution in the style of a typical MBA curriculum, drawing on five core pillars: strategy, management, operations, finance, and health policy and economics. The series concluded with an interactive discussion of a Harvard Business School case study. To study the effectiveness of the curriculum, Wilcoxon rank-sum test was used to compare survey results before and after the curriculum.Results: Nearly 80% of the pre-curriculum survey respondents were not satisfied with the current training offered in the business of medi-cine. Although 94% of trainees were interested in pursuing leadership positions in healthcare, they have self-reported knowledge gaps in the fundamentals of the business of medicine. There were significant improvements in satisfaction with their training in the business of medicine and perceived improvements in knowledge of important concepts in the business of medicine after participating in the curricu-lum (p < 0.001).Conclusion: Radiology trainees have strong interest in the business of radiology and appreciate its importance yet feel inadequately pre-pared during training. Intentional training incorporated into residency education in the form of an innovative educational initiative that brings radiology trainees together and utilizes an institution's own leaders to teach is feasible and effective.

Purpose This study aimed to assess the incidence of intimate partner violence (IPV) in women with isolated ulnar fractures and compare the injury characteristics in victims of IPV with those who sustained the same fractures due to other causes. Methods Electronic health records from three level I trauma centers were queried to identify a cohort of women, aged 18 to 50, sustaining isolated ulnar fractures from 2005 to 2019. Radiographs were reviewed for fracture location, comminution, and displacement. Demographic data, number of visits to the emergency department, and documentation of IPV were also collected. Patients were stratified into four groups based on clinical chart review: confirmed IPV, possible IPV, not suspected for IPV, and not IPV. Historical imaging analysis for IPV prediction was also performed. Results There were 62 patients, with a mean age of 31 years (IPV: 12 confirmed, 8 possible, 8 suspected not IPV, 34 confirmed not IPV). Comparative analysis with and without suspected cases demonstrated IPV to be associated with nondisplaced fractures (95% versus 43%; P < .001 and 91% versus 44%; P = .012). Confirmed cases were also associated with homelessness (46% versus 0%; P < .001), and the number of documented emergency department visits (median 7.0; interquartile range 2.0-12.8 versus 1.0; interquartile range 1.0-2.0; P < .001). Formal documentation of IPV evaluation was completed in only 14 of 62 (22.5%) patients. Historical imaging analysis predicted IPV in 8 of 12 (75%) confirmed IPV cases. Conclusion Up to one-third of adult women sustaining isolated ulnar fractures may be the victims of IPV. Lack of displacement on radiographs, frequent emergency department visits, and homelessness would favor IPV etiology.

Well-being can be defined as feeling connected through mutually supportive relationships and productivity in the workplace [ 1 Thoits P.A. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011; 52: 145-161 Crossref PubMed Scopus (2415) Google Scholar , 2 Brough P. Pears J. Evaluating the influence of the type of social support on job satisfaction and work related psychological well-being. Int J Org Behav. 2004; 8: 472-485 Google Scholar ]. An extended response to the coronavirus disease 2019 (COVID-19) pandemic will likely lead to a magnification of stress and burnout, with negative consequences in the workplace in terms of engagement and productivity. A positive and proactive approach to radiologist well-being is necessary now more than ever. Acknowledging that there are many strategies for increasing physician well-being, such as better communication, self-check-ins, and a supportive, blame-free work culture [ 3 National Academy of MedicineResources from the Action Collaborative on Clinician Well-Being and Resilience. https://nam.edu/resources-from-the-action-collaborative-on-clinician-well-being-and-resilience/Date accessed: November 19, 2020 Google Scholar ], in this opinion piece we focus on potential measures to foster engagement and nurture professional connections among radiologists at a time when the unpredictable demands and stressors of the COVID-19 pandemic continue to evolve.

Objectives To recognize most common patterns of upper extremity (UE) injuries in victims of Intimate Partner Violence (IPV). Methods Radiological review of 308 patients who reported physical IPV at our institution from January 2013 to June 2018, identified 55 patients with 88 unique UE injuries. Demographic data and injury patterns and associations were collected from the electronic medical records. Results The cohort included 49 females and 6 males (age 19–63, mean 38). At the time of injury, IPV was reported in 15/88 (17%) and IPV screening was documented for 22/88 (25%) injuries. There were 46 fractures, 8 dislocations or subluxations, and 34 isolated soft tissue injuries, most commonly involving the hand (56/88). Fractures most commonly involved the fingers (21/46, 46%) and the 5th digit (8/27, 30%). Medial UE fractures (5th digit, 4th digit) constituted 44% of hand and finger fractures (12/27) and 26% of all fractures (12/46). Comminuted and displaced fractures were rare (8/46, 17%). Head and face injuries were the most common concomitant injuries (9/22, 41%) and subsequent injuries (21/61, 35%). Of 12 patients with recurrent UE injuries, 6 had recurrent injuries of the same hand. Five of 6 non-acute fractures (83%) were of the hand. Conclusions Hand and finger injuries are the most common UE injuries in patients with IPV, with finger being the most common site and medial hand the most common region of fracture. Repeated injuries involving the same site and a combination of medial hand and head or face injuries could indicate IPV. Key Points • Upper extremity injuries in victims of intimate partner violence are most commonly seen in the hand and fingers. • Fingers are the most common site of fracture and the medial hand is the most common region of fracture in the upper extremity in victims of intimate partner violence. • In intimate partner violence victims with upper extremity injuries, concomitant injuries and subsequent injuries are most commonly seen in the head and neck region.

On 25 November 2018, the United Nations chillingly reported that the most dangerous place for women is inside their own homes. Each year more than half of female homicides are committed by current or former intimate partners or family members.1 Intimate partner violence (IPV), within the domestic violence spectrum, is defined as physical, sexual or emotional violence between partners or former partners.2 It is a serious public health concern with millions of people experiencing violence at the hands of an intimate partner. WHO recognizes IPV as a global issue, prevalent at epidemic proportions in every society, socioeconomic and educational group. According to the National Intimate Partner and Sexual Violence Survey, one in four women and one in nine men in USA have reported severe form of physical violence by an intimate partner during their lifetime.3 Despite the high prevalence and urgency of this critical public health issue, IPV continues to be profoundly underdiagnosed and is considered a persistent hidden epidemic. In addition to physical injuries, IPV has both short-term and long-term negative health consequences including asthma, irritable bowel syndrome, diabetes, poor reproductive health, chronic pain syndrome and mental health problems.4 With victims of IPV seeking medical care more often, healthcare providers can play a vital role in reducing the devastating impact of IPV by representing a trusting source of divulging abuse. The major obstacle to its early detection and intervention is victim under-reporting of physical violence to healthcare providers. Screening for IPV can be an effective tool for detecting and preventing future violence. However, several barriers limit the use and success of these screening programs. Due to shame, privacy, economic dependency, fear of retaliation, legal factors or lack of trust of providers, a patient may not self-report and even fabricate the history of her injury.5 …

Health care costs have risen at an unprecedented rate over the past 40 years, placing a significant burden on the US economy. These costs amounted to nearly 18% of US gross domestic product in 2016 [ 1 Papanicolas I. Woskie L.R. Jha A.K. Health care spending in the United States and other high-income countries. JAMA. 2018; 319: 1024-1039 Google Scholar ]. Over the years, advances in medical imaging have represented one of the fastest growing components of health care expenditures [ 2 Lang K. Huang H. Lee D.W. Federico V. Menzin J. National trends in advanced outpatient diagnostic imaging utilization: an analysis of the medical expenditure panel survey 2000-2009. BMC Med Imaging. 2013; 13: 40 Google Scholar ]. This fact has placed radiology at the forefront of health care economic discussions.

In an era of unprecedented technological advances across the eld of medical imaging, it is critically important to understand the cognitive and perceptual functioning of the “human in the loop.” These are the clinicians who make the nal decisions on detection, diagnosis, and treatment. However, research on the cognitive and perceptual processes underlying clinician performance is chronically understudied.In September 2019, the National Cancer Institute (NCI) convened the “Cognition and Medical Image Perception Think Tank” in order to advance research on medical image perception 1 and cognition. The Think Tank brought radiologists and pathologists together with researchers working in medical image perception and adjacent elds of cognition and perception, along with representatives from interested federal government agencies (including NCI, National Institute of Biomedical Imaging and Bioengineering …

Intimate partner violence (IPV) is the physical, sexual, or emotional violence between current or former partners. It is a major public health issue that affects nearly one out of four women. Nonetheless, IPV is greatly underdiagnosed. Imaging has played a significant role in identifying cases of nonaccidental trauma in children, and similarly, it has the potential to enable the identification of injuries resulting from IPV. Radiologists have early access to the radiologic history of such victims and may be the first to diagnose IPV on the basis of the distribution and imaging appearance of the patient's currrent and past injuries. Radiologists must be familiar with the imaging findings that are suggestive of injuries resulting from IPV. Special attention should be given to cases in which there are multiple visits for injury care; coexistent fractures at different stages of healing, which may help differentiate injuries related to IPV from those caused by a stranger; and injuries in defensive locations and target areas such as the face and upper extremities. The authors provide an overview of current methods for diagnosing IPV and define the role of the radiologist in cases of IPV. They also describe a successful diagnostic imaging-based approach for helping to identify IPV, with a specific focus on the associated imaging findings and mechanisms of injuries. In addition, current needs and future perspectives for improving the diagnosis of this hidden epidemic are identified. This information is intended to raise awareness among radiologists, with the ultimate goal of improving the diagnosis of IPV and thus reducing the devastating effects on victims' lives. ©RSNA, 2020.

Advances in machine learning in medical imaging are occurring at a rapid pace in research laboratories both at academic institutions and in industry. Important artificial intelligence (AI) tools for diagnostic imaging include algorithms for disease detection and classification, image optimization, radiation reduction, and workflow enhancement. Although advances in foundational research are occurring rapidly, translation to routine clinical practice has been slower. In August 2018, the National Institutes of Health assembled multiple relevant stakeholders at a public meeting to discuss the current state of knowledge, infrastructure gaps, and challenges to wider implementation. The conclusions of that meeting are summarized in two publications that identify and prioritize initiatives to accelerate foundational and translational research in AI for medical imaging. This publication summarizes key priorities for translational research developed at the workshop including: (1) creating structured AI use cases, defining and highlighting clinical challenges potentially solvable by AI; (2) establishing methods to encourage data sharing for training and testing AI algorithms to promote generalizability to widespread clinical practice and mitigate unintended bias; (3) establishing tools for validation and performance monitoring of AI algorithms to facilitate regulatory approval; and (4) developing standards and common data elements for seamless integration of AI tools into existing clinical workflows. An important goal of the resulting road map is to grow an ecosystem, facilitated by professional societies, industry, and government agencies, that will allow robust collaborations between practicing clinicians and AI researchers to advance foundational and translational research relevant to medical imaging.

On behalf of the past and present leadership of the Academy for Radiology and Biomedical Imaging Research (the “Academy”), it is our pleasure to introduce a new column in this issue of Academic Radiology, which will inform you about the efforts of the Academy to advocate for strong and consistent federal government investment into medical imaging research.

HomeRadiologyVol. 279, No. 3 PreviousNext CommunicationsIn MemoriamHerbert Leroy Abrams, MDSteven E. SeltzerSteven E. SeltzerSteven E. SeltzerPublished Online:May 16 2016https://doi.org/10.1148/radiol.2016164014MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished online: May 16 2016Published in print: June 2016 FiguresReferencesRelatedDetailsCited ByRadiopaedia.orgDanielBell, OmarBazzaz2018Recommended Articles Alexander R. Margulis, MDRadiology2018Volume: 289Issue: 3pp. 884David C. Levin, MDRadiology2020Volume: 295Issue: 1pp. 251-252Frederick J. Bonte, MDRadiology2017Volume: 286Issue: 1pp. 366A. Everette James, Jr, MDRadiology2017Volume: 285Issue: 2pp. 696Morton A. Bosniak, MDRadiology2017Volume: 282Issue: 2pp. 616See More RSNA Education Exhibits How We Got Here: A Review Of Anti-Black Discrimination And Inequities In RadiologyDigital Posters2021Imaging of Suspected Pulmonary Embolism and Deep Venous Thrombosis in Obese PatientsDigital Posters2020Combining Radioembolization And Immune Checkpoint Inhibitors For The Treatment Of Hepatocellular Carcinoma: Mutually Beneficial Therapies For A Challenging DiseaseDigital Posters2021 RSNA Case Collection Small cell lung carcinomaRSNA Case Collection2020Pancreatic lymphomaRSNA Case Collection2020"Cold" Sentinel Lymph Node in Cutaneous Melanoma RSNA Case Collection2020 Vol. 279, No. 3 Metrics Altmetric Score PDF download

HomeRadiologyVol. 279, No. 3 Previous CommunicationsIn MemoriamFerenc A. Jolesz, MDClare M.C. Tempany-Afdhal, Steven E. SeltzerClare M.C. Tempany-Afdhal, Steven E. SeltzerClare M.C. Tempany-AfdhalSteven E. SeltzerPublished Online:May 16 2016https://doi.org/10.1148/radiol.2016164011MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished online: May 16 2016Published in print: June 2016 FiguresReferencesRelatedDetailsRecommended Articles Alexander R. Margulis, MDRadiology2018Volume: 289Issue: 3pp. 8842016 RSNA Outstanding ResearcherRadiology2016Volume: 281Issue: 3pp. 663-664Frederick J. Bonte, MDRadiology2017Volume: 286Issue: 1pp. 366A. Everette James, Jr, MDRadiology2017Volume: 285Issue: 2pp. 696Morton A. Bosniak, MDRadiology2017Volume: 282Issue: 2pp. 616See More RSNA Education Exhibits Intraoperative Neuromonitoring: How to Predict and Prevent Nerve Injury During Embolization and Sclerotherpy of Vascular MalformationsDigital Posters2020The Mysterious Mesentery: Building A Differential For Solid And Cystic MassesDigital Posters2021Function And Fibers - Functional MRI And DTI Fiber Tractography Application In Brain Tumor ResectionDigital Posters2021 RSNA Case Collection Pancreatic lymphomaRSNA Case Collection2020Embryonal rhabdomyosarcomaRSNA Case Collection2021HepatoblastomaRSNA Case Collection2021 Vol. 279, No. 3 Metrics Altmetric Score PDF download

Advances in cancer care over the past decade have significantly changed treatment algorithms and life expectancies. Time from cancer diagnosis to death is rapidly increasing, as new, targeted therapies are developed, many prolonging life even in advanced disease. Tumors are now genotyped at diagnosis, allowing personalization of treatment. The FDA is continually approving new drugs that quickly become the standard of care for common tumors; the impact of these drugs and their side effects is monitored with imaging, and accurate interpretation of imaging studies has become essential as these patients live longer. Oncologists rely on radiologists to understand new patterns of treatment response and novel drug side effects that are associated with new drug classes, increasing the knowledge required for accurate image interpretation. These factors have led to the demand for dedicated cancer imaging training for radiologists, who can integrate findings throughout the body on various imaging modalities. In addition, we need to expand radiology's focus beyond diagnosis, staging, and restaging of tumors, and include education about the influence of genomics on tumor characterization and guidance for cancer care, the spectrum of treatment response, and the imaging characteristics of adverse events associated with various therapies. The time has come, therefore, to formally incorporate, as part of radiology residency, a distinct cancer imaging curriculum that is standardized, tested, and will allow the new generation of radiologists to effectively communicate with and assist their oncologic colleagues and optimally contribute to the care of patients with cancer.