Role of the Medical Physicist in the Health Care Artificial Intelligence Revolution
A qualified medical physicist (MP) in diagnostic radiology is an expert in the medical application of radiation to form diagnostic images. The MP has extensive knowledge about the regulatory aspects of imaging as well as the theory of image formation and perception. In addition to assessing image quality through routine testing, an MP consults with radiologists and imaging leadership to ensure the optimization of image quality and radiation dose. MPs, especially those who are also active researchers, may possess specific expertise in areas such as informatics, image analysis, advanced mathematics, and statistics. (Source: ...
Source: Journal of the American College of Radiology : JACR - November 13, 2018 Category: Radiology Authors: William F. Sensakovic, Mahadevappa Mahesh Tags: The medical physics consult Source Type: research

The Resident Preliminary Report
Resident preliminary reports are brief interpretations of imaging examinations used to guide clinical care before release of a full report. Historically, preliminary reports have been a mainstay of radiology resident education. Many who have trained under such a system, including residents actively taking part to this day, extol the virtues of learning in an active and  meaningful environment. Unlike daytime radiology staffing models in which trainee reports are commonly sheltered from clinical impact, on-call radiology staffing models generally force residents to render an interpretation that will have an immediate e...
Source: Journal of the American College of Radiology : JACR - November 13, 2018 Category: Radiology Authors: Matthew S. Davenport, Kara Gaetke-Udager, Steven L. Kronick Tags: Quality in practice Source Type: research

Eight Years ’ Experience With a Radiology-Sponsored Medical Student Research Fellowship Program
The pursuit of biomedical research is central to the mission of academic radiology departments in the United States. However, the lack of trained radiologists with the necessary expertise to conduct basic and translational research remains a significant barrier, and documented medical scientist workforce shortages threaten to diminish the supply of physician-scientist radiologists who can advance biomedical research efforts [1]. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 10, 2018 Category: Radiology Authors: Ron C. Gaba, R. Peter Lokken, Jack Zwanziger, Jorge A. Girotti, Charles E. Ray, Kathleen Kashima Tags: Case studies in training and education Source Type: research

Hybrid Model for the Medical Physics Imaging Residency Training
Ever since the ABR, one of the four organizations granting certifications in  diagnostic medical physics in North America, required clinical residency training accredited by the Commission on Accreditation of Medical Physics Education Programs, activity has increased in the opening of the diagnostic imaging physics residency programs. Currently, most of the programs are bas ed in the hospital or university setting, and a few are among the private consulting groups. Even though the two models have been successful in providing the required clinical residency training for diagnostic medical physicists, the number of imag...
Source: Journal of the American College of Radiology : JACR - November 10, 2018 Category: Radiology Authors: Mahadevappa Mahesh Tags: Opinion Source Type: research

To Tweet or Not to Tweet —Social Media in Radiological Practice
Social media offers an immense opportunity for physicians to enhance communication with their patients, to aid in educating generations of aspiring doctors across the globe, and to facilitate population-based research. However, it also poses some potential challenges with regard to privacy, confidentiality, liability, and reimbursement. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 9, 2018 Category: Radiology Authors: Priscilla J. Slanetz, Lori Ann Deitte Tags: Civil discourse Source Type: research

High-Deductible Health Plans and the Challenges They Pose to Radiologists
Patients with high-deductible health plans will increasingly be motivated to contact their hospitals or various websites to try to obtain information about the costs of expensive services like advanced imaging. Unfortunately, they will not find price transparency but rather confusion and opaqueness. Hospital personnel and commercial websites often unwittingly provide erroneous pricing information. The reasons for this are explained. Detailed examples of the erroneous information are provided. State-mandated websites may be somewhat of an improvement, but their methodology seems to vary from state to state, and they too can...
Source: Journal of the American College of Radiology : JACR - November 9, 2018 Category: Radiology Authors: David C. Levin, Vijay M. Rao, Mark D. Hiatt, Margaret Colarossi Tags: Original article Source Type: research

Incorporating Patient- and Family-Centered Care Into Radiology Residency Training Through an Experiential Curriculum
Patient- and family-centered care (PFCC) can best be defined as a partnership between physicians, patients, and their families in all aspects of medical care and health care decision making. It relies on three main premises: (1) embracing dignity and respect for patient and family values, culture, and beliefs; (2) openly sharing information to more effectively involve patients and their families in their medical care; and (3) fostering collaboration between providers and patients in care delivery, research, facility design, and professional education [1]. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 8, 2018 Category: Radiology Authors: Carolynn M. DeBenedectis, David Sarkany, Michael Morrow, Danielle Del Re, Devon DiVito, Stephen D. Brown, Priscilla J. Slanetz Tags: Case studies in training and education Source Type: research

Use of Novel Anthropomorphic Breast Ultrasound Phantoms for Radiology Resident Education
This study evaluated the training and assessment role of anthropomorphic breast ultrasound phantoms that simulated both the morphological and sonographic characteristics of breast tissue, including lesions, in a group of radiology residents at a large academic medical center. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 5, 2018 Category: Radiology Authors: Jacinta E. Browne, Chris Gu, Robert T. Fazzio, Andrew J. Fagan, Donald J. Tradup, Nicholas J. Hangiandreou Tags: Original article Source Type: research

A Bright Future for Nuclear Medicine
In a recent Point/Counterpoint, Graham et  al [1] and Guiberteau and Oates [2] seemingly agree on a solitary issue: the decline of nuclear medicine (NM) in the United States. We vehemently disagree that there is an existential threat to NM. Rather, the field is as strong as ever. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 5, 2018 Category: Radiology Authors: George M. Segall, Daniel A. Pryma, Joanna R. Fair Tags: Opinion Source Type: research

Lost to Follow-Up: Analysis of Never-Viewed Radiology Examinations
The combination of radiology PACS networks and electronic medical records (EMRs) provides clinicians with a means to view both the images and the radiology report on their own without the radiologist. Clinicians ’ independent access to these two components allows them to measure the “value” of the images (accessed by the PACS) versus the “value” of the radiologists who provide reports (accessed via the EMR) [1,2]. It also allows one to detect “missing cases,” where neither the report nor the i mages are reviewed by the clinical services. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 2, 2018 Category: Radiology Authors: Anthony Galinato, Matthew D. Alvin, David M. Yousem Tags: Case studies in clinical practice management Source Type: research

ACR Appropriateness Criteria ® Acute Nonlocalized Abdominal Pain
The range of pathology in adults that can produce abdominal pain is broad and necessitates an imaging approach to evaluate many different organ systems. Although localizing pain prompts directed imaging/management, clinical presentations may vary and result in nonlocalized symptoms. This review focuses on imaging the adult population with nonlocalized abdominal pain, including patients with fever, recent abdominal surgery, or neutropenia. Imaging of the entire abdomen and pelvis to evaluate for infectious or inflammatory processes of the abdominal viscera and solid organs, abdominal and pelvic neoplasms, and screen for isc...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Gastrointestinal Imaging:, Christopher D. Scheirey, Kathryn J. Fowler, Jaclyn A. Therrien, David H. Kim, Waddah B. Al-Refaie, Marc A. Camacho, Brooks D. Cash, Kevin J. Chang, Evelyn M. Garcia, Avinash R. Kambadakone, Drew L. Lambert, Angel Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Acute Pyelonephritis
Pyelonephritis refers to infection involving the renal parenchyma and renal pelvis. In most patients, uncomplicated pyelonephritis is diagnosed clinically and responds quickly to appropriate antibiotic treatment. If treatment is delayed, the patient is immunocompromised, or for other reasons, microabscesses that form during the acute phase of pyelonephritis may coalesce, forming a renal abscess. Patients with underlying diabetes are more vulnerable to complications, including emphysematous pyelonephritis in addition to abscess formation. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Urologic Imaging:, Paul Nikolaidis, Vikram S. Dogra, Stanley Goldfarb, John L. Gore, Howard J. Harvin, Marta E. Heilbrun, Matthew T. Heller, Gaurav Khatri, Andrei S. Purysko, Stephen J. Savage, Andrew D. Smith, Myles T. Taffel, Zhen J. Wan Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Acute Respiratory Illness in Immunocompetent Patients
Acute respiratory illness, defined as cough, sputum production, chest pain, and/or dyspnea (with or without fever), is a major public health issue, accounting for millions of doctor office and emergency department visits every year. While most cases are due to self-limited viral infections, a significant number of cases are due to more serious respiratory infections where delay in diagnosis can lead to morbidity and mortality. Imaging plays a key role in the initial diagnosis and management of acute respiratory illness. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Thoracic Imaging:, Clinton Jokerst, Jonathan H. Chung, Jeanne B. Ackman, Brett Carter, Patrick M. Colletti, Traves D. Crabtree, Patricia M. de Groot, Mark D. Iannettoni, Fabien Maldonado, Barbara L. McComb, Robert M. Steiner, Jeffrey P. Ka Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Breast Imaging of Pregnant and Lactating Women
Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-associated breast cancer (PABC) is increasing as more women delay child bearing into the fourth decade of life, and imaging of clinical symptoms should not be delayed. PABC may present as a palpable lump, nipple discharge, diffuse breast enlargement, focal pain, or milk rejection. Breast imaging during lactation is very similar to breast imaging in women who are not breast feeding. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Breast Imaging:, Roberta M. diFlorio-Alexander, Priscilla J. Slanetz, Linda Moy, Paul Baron, Aarati D. Didwania, Samantha L. Heller, Anna I. Holbrook, Alana A. Lewin, Ana P. Lourenco, Tejas S. Mehta, Bethany L. Niell, Ashley R. Stuckey, Da Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Breast Pain
Breast pain is a common complaint. However, in the absence any accompanying suspicious clinical finding (eg, lump or nipple discharge), the association with malignancy is very low (0%-3.0%). When malignancy-related, breast pain tends to be focal (less than one quadrant) and persistent. Pain that is clinically insignificant (nonfocal [greater than one quadrant], diffuse, or cyclical) requires no imaging beyond what is recommended for screening. In cases of pain that is clinically significant (focal and noncyclical), imaging with mammography, digital breast tomosynthesis (DBT), and ultrasound are appropriate, depending on th...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Breast Imaging:, Anna I. Holbrook, Linda Moy, Esma A. Akin, Paul Baron, Aarati D. Didwania, Samantha L. Heller, Huong T. Le-Petross, Alana A. Lewin, Ana P. Lourenco, Tejas S. Mehta, Bethany L. Niell, Priscilla J. Slanetz, Ashley R. Stuckey Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Chronic Dyspnea-Noncardiovascular Origin
This article discusses guidelines for the initial imaging of six variants for chronic dyspnea of noncardiovascular origin: (1) Chronic dyspnea of unclear etiology; (2) Chronic dyspnea with suspected chronic obstructive pulmonary disease; (3) Chronic dyspnea with suspected central airways disease; (4) Chronic dyspnea with suspected interstitial lung disease; (5) Chronic dyspnea with suspected disease of the pleura or chest wall; and (6) Chronic dyspnea with suspected diaphragm dysfunction. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Thoracic Imaging:, Barbara L. McComb, James G. Ravenel, Robert M. Steiner, Jonathan H. Chung, Jeanne B. Ackman, Brett Carter, Patrick M. Colletti, Traves D. Crabtree, Patricia M. de Groot, Mark D. Iannettoni, Clinton Jokerst, Fabien Maldon Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Chronic Knee Pain
Chronic knee pain is a condition that is frequently encountered. Imaging often plays an important role in narrowing down the potential causes and determining the most effective next steps. The ACR Appropriateness Criteria for Chronic Knee Pain provides clinicians with the best practices for ordering imaging examinations. The following narrative and accompanying tables should serve as useful guides to any clinician.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. (Source: Journal of the Am...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Musculoskeletal Imaging:, Michael G. Fox, Eric Y. Chang, Behrang Amini, Stephanie A. Bernard, Tetyana Gorbachova, Alice S. Ha, Ramesh S. Iyer, Kenneth S. Lee, Darlene F. Metter, Pekka A. Mooar, Nehal A. Shah, Adam D. Singer, Stacy E. Smith Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Evaluation of the Symptomatic Male Breast
Although the majority of male breast problems are benign with gynecomastia as the most common etiology, men with breast symptoms and their referring providers are typically concerned about whether or not it is due to breast cancer. If the differentiation between benign disease and breast cancer cannot be made on the basis of clinical findings, or if the clinical presentation is suspicious, imaging is indicated. The panel recommends the following approach to breast imaging in symptomatic men. In men with clinical findings consistent with gynecomastia or pseudogynecomastia, no imaging is routinely recommended. (Source: Journ...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Breast Imaging:, Bethany L. Niell, Ana P. Lourenco, Linda Moy, Paul Baron, Aarati D. Didwania, Roberta M. diFlorio-Alexander, Samantha L. Heller, Anna I. Holbrook, Huong T. Le-Petross, Alana A. Lewin, Tejas S. Mehta, Priscilla J. Slanetz, Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Imaging of Mesenteric Ischemia
Mesenteric ischemia is an uncommon condition resulting from decreased blood flow to the small or large bowel in an acute or chronic setting. Acute ischemia is associated with high rates of morbidity and mortality; however, it is difficult to diagnose clinically. Therefore, a high degree of suspicion and prompt imaging evaluation are necessary. Chronic mesenteric ischemia is less common and typically caused by atherosclerotic occlusion or severe stenosis of at least two of the main mesenteric vessels. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panels on Vascular Imaging and Gastrointestinal Imaging:, Michael Ginsburg, Piotr Obara, Drew L. Lambert, Michael Hanley, Michael L. Steigner, Marc A. Camacho, Ankur Chandra, Kevin J. Chang, Kenneth L. Gage, Christine M. Peterson, Thomas Ptak, Nupu Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Management of Vertebral Compression Fractures
Vertebral compression fractures (VCFs) have various causes, including osteoporosis, neoplasms, and acute trauma. As painful VCFs may  contribute to general physical deconditioning, management of painful VCFs has the potential for improving quality of life and preventing superimposed medical complications. Various imaging modalities can be used to evaluate a VCF to help determine the etiology and guide intervention. The first-lin e treatment of painful VCFs has been nonoperative or conservative management as most VCFs show gradual improvement in pain over 2 to 12 weeks, with variable return of function. (Source: Journa...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panels on Neurological Imaging, Interventional Radiology, and Musculoskeletal Imaging:, Lubdha M. Shah, Jack W. Jennings, Claudia F.E. Kirsch, Eric J. Hohenwalter, Francesca D. Beaman, R. Carter Cassidy, Michele M. Johnson, A. Tuba Kendi, Simon She Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Hearing Loss and/or Vertigo
This article presents guidelines for imaging utilization in patients presenting with hearing loss or vertigo, symptoms that sometimes occur concurrently due to proximity of receptors and neural pathways responsible for hearing and balance. These guidelines take into account the superiority of CT in providing bony details and better soft-tissue resolution offered by MRI. It should be noted that a dedicated temporal bone CT rather than a head CT best achieves delineation of disease in many of these patients. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Neurologic Imaging:, Aseem Sharma, Claudia F.E. Kirsch, Joseph M. Aulino, Santanu Chakraborty, Asim F. Choudhri, Isabelle M. Germano, A. Tuba Kendi, H. Jeffrey Kim, Ryan K. Lee, David S. Liebeskind, Michael D. Luttrull, Toshio Moritani, Gr Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Chronic Chest Pain-Noncardiac Etiology Unlikely-Low to Intermediate Probability of Coronary Artery Disease
Chronic chest pain (CCP) of a cardiac etiology is a common clinical problem. The diagnosis and classification of the case of chest pain has rapidly evolved providing the clinician with multiple cardiac imaging strategies. Though scintigraphy and rest echocardiography remain as appropriate imaging tools in the diagnostic evaluation, new technology is available. Current evidence supports the use of alternative imaging tests such as coronary computed tomography angiography (CCTA), cardiac MRI (CMRI), or Rb-82 PET/CT. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Cardiac Imaging:, Amar B. Shah, Jacobo Kirsch, Michael A. Bolen, Juan C. Batlle, Richard K.J. Brown, Robert T. Eberhardt, Lynne M. Hurwitz, Joao R. Inacio, Jill O. Jin, Rajesh Krishnamurthy, Jonathon A. Leipsic, Prabhakar Rajiah, Satinder Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Postmenopausal Subacute or Chronic Pelvic Pain
Pelvic pain is common in both reproductive age and postmenopausal women, and the major etiologies change throughout the life cycle. Chronic pain is defined as lasting for at least 6 months. There are many gastrointestinal and urinary disorders associated with chronic pain in this age group, which are not discussed in this guideline. Pain may be localized to the deep pelvis, with potential causes including pelvic congestion syndrome, intraperitoneal adhesions, hydrosalpinx, chronic inflammatory disease, or cervical stenosis. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Women ’s Imaging:, Katherine E. Maturen, Esma A. Akin, Mark Dassel, Sandeep Prakash Deshmukh, Kika M. Dudiak, Tara L. Henrichsen, Lee A. Learman, Edward R. Oliver, Liina Poder, Elizabeth A. Sadowski, Hebert Alberto Vargas, Therese M. Web Tags: Appropriate use criteria Source Type: research

Timelines and Case Use Metrics for the ACR Appropriateness Criteria ®
The Appropriateness Criteria ® (AC) team members have completed one of the most productive semesters that I can remember in my 13 years of service to our wonderful committee. The November 2018 JACR supplement includes 20 topics that span a diverse, important scope of radiology practice. These include Lung Cancer Screening [1] , Acute Nonlocalized Abdominal Pain [2], Breast Pain [3], and the Imaging of Mesenteric Ischemia [4]. This publication tally does not include the 17 “Patient-Friendly” publications to date by our Patient Engagement Subcommittee [5] and the new important publication on Validation o...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Frank J. Rybicki Tags: Introduction Source Type: research

ACR Appropriateness Criteria ® Lung Cancer Screening
Lung cancer remains the leading cause of cancer death in both men and women. Smoking is the single greatest risk factor for the development of lung cancer. For patients between the age of 55 and 80 with 30 or more pack years smoking history who currently smoke or who have quit within the last 15 years should undergo lung cancer screening with low-dose CT. In patients who do not meet these criteria but who have additional risk factors for lung cancer, lung cancer screening with low-dose CT is controversial but may be appropriate. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Thoracic Imaging:, Edwin F. Donnelly, Ella A. Kazerooni, Elizabeth Lee, Travis S. Henry, Phillip M. Boiselle, Traves D. Crabtree, Mark D. Iannettoni, Geoffrey B. Johnson, Archana T. Laroia, Fabien Maldonado, Kathryn M. Olsen, Kyungran Shim Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Suspected Lower Extremity Deep Vein Thrombosis
Suspected lower extremity deep venous thrombosis is a common clinical scenario which providers seek a reliable test to guide management. The importance of confidently making this diagnosis lies in the 50% to 60% risk of pulmonary embolism with untreated deep vein thrombosis and subsequent mortality of 25% to 30%, balanced with the risks of anticoagulation. The ACR Appropriateness Criteria Expert Panel on Vascular Imaging reviews the current literature regarding lower extremity deep venous thrombosis and compared various imaging modalities including ultrasound, MR venography, CT venography, and catheter venography. (Source:...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Vascular Imaging:, Michael Hanley, Michael L. Steigner, Osmanuddin Ahmed, Ezana M. Azene, Shelby J. Bennett, Ankur Chandra, Benoit Desjardins, Kenneth L. Gage, Michael Ginsburg, David M. Mauro, Isabel B. Oliva, Thomas Ptak, Richard Strax, Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Sinusitis-Child
Sinusitis is common in children that usually resolves spontaneously. Imaging is not part of the standard of care for initial diagnosis, however may be necessary in cases with persistent or chronic sinusitis to guide surgical intervention, or to rule out intracranial and vascular complications of sinusitis. Computed tomography (CT) and magnetic resonance imaging (MRI) are the leading imaging modalities. In this article, appropriateness in use of imaging modalities are discussed under common/clinically relevant scenarios. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Pediatric Imaging:, Aylin Tekes, Susan Palasis, Daniel J. Durand, Sumit Pruthi, Timothy N. Booth, Nilesh K. Desai, Jeremy Y. Jones, Nadja Kadom, H. F. Samuel Lam, Sarah S. Milla, David M. Mirsky, Sonia Partap, Richard L. Robertson, Maura E Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Acutely Limping Child Up To Age 5
Imaging plays in important role in the evaluation of the acutely limping child. The decision-making process about initial imaging must consider the level of suspicion for infection and whether symptoms can be localized. The appropriateness of specific imaging examinations in the acutely limping child to age 5 years is discussed with attention in each clinical scenario to the role of radiography, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging. Common causes of limping such as toddler ’s fracture, septic arthritis, transient synovitis, and osteomyelitis are discussed. (Source: Journal...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Pediatric Imaging:, Nabile M. Safdar, Cynthia K. Rigsby, Ramesh S. Iyer, Adina L. Alazraki, Sudha A. Anupindi, Dianna M.E. Bardo, Brandon P. Brown, Sherwin S. Chan, Tushar Chandra, Jonathan R. Dillman, Scott R. Dorfman, Matthew D. Garber, Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Suspected New-Onset and Known Nonacute Heart Failure
While there is no single diagnostic test for heart failure (HF), imaging plays a supportive role beginning with confirmation of HF, especially by detecting ventricular dysfunction (Variant 1). Ejection fraction (EF) is important in HF classification, and imaging plays a subsequent role in differentiation between HF with reduced EF (HFrEF) versus preserved EF (HFpEF) (Variant 2). Once HFrEF is identified, distinction between ischemic and nonischemic etiologies with imaging support (Variant 3) facilitates further planning. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Cardiac Imaging:, Richard D. White, Jacobo Kirsch, Michael A. Bolen, Juan C. Batlle, Richard K.J. Brown, Robert T. Eberhardt, Lynne M. Hurwitz, Joao R. Inacio, Jill O. Jin, Rajesh Krishnamurthy, Jonathon A. Leipsic, Prabhakar Rajiah, Amar Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Shoulder Pain-Atraumatic
Shoulder pain is one of the most common reasons for musculoskeletal-related physician visits. Imaging plays an important role in identifying the specific cause of atraumatic shoulder pain. This review is divided into two parts. The first part provides a general discussion of various imaging modalities (radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI) and their usefulness in evaluating atraumatic shoulder pain. The second part focuses on the most appropriate imaging algorithms for specific shoulder conditions including: rotator cuff disorders, labral tear/instability, bursitis, adhesive capsulitis, bice...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Musculoskeletal Imaging:, Kirstin M. Small, Ronald S. Adler, Shaan H. Shah, Catherine C. Roberts, Jenny T. Bencardino, Marc Appel, Soterios Gyftopoulos, Darlene F. Metter, Douglas N. Mintz, William B. Morrison, Naveen Subhas, Ralf Thiele, Tags: Appropriate use criteria Source Type: research

ACR Appropriateness Criteria ® Right Lower Quadrant Pain-Suspected Appendicitis
Appendicitis remains the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in  sensitivity and specificity as this technology becomes more widely available and utilization increases. (Source: Jo...
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Expert Panel on Gastrointestinal Imaging:, Evelyn M. Garcia, Marc A. Camacho, Daniel R. Karolyi, David H. Kim, Brooks D. Cash, Kevin J. Chang, Barry W. Feig, Kathryn J. Fowler, Avinash R. Kambadakone, Drew L. Lambert, Angela D. Levy, Daniele Marin, Courtn Tags: Appropriate use criteria Source Type: research

Cover
(Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Source Type: research

Table of Contents
(Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Source Type: research

The ABZs of Pediatric CT
The ABZs of pediatric CT? Is this a typo? Why a hybrid between the ABCs and A through Zs? The first  representation is a fundamental guide and the latter a comprehensive missive; which is it? (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Donald P. Frush Tags: Radiation sensibilities Source Type: research

Hey, Can We Talk?
A colleague comes into your office, gently shuts the door, and says “Hey, can we talk?” Her tone of sincere concern tells you it’s not a question. “One of the residents is struggling.” She details how the resident is failing to meet the standards in knowledge, interpretation, and procedural skills expected for his level. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - November 1, 2018 Category: Radiology Authors: Stephanie P.F. Yen Tags: Opinion Source Type: research

Radiologists as Changemakers: The Last Straw
What is a changemaker? It is someone “who can see the patterns around them, identify the problems in any situation, figure out ways to solve the problem, organize fluid teams, lead collective action, and then continually adapt as situations change” [1]. Bill Drayton invented the term “social entrepreneur.” He also founded Ashok a, an organization that supports social entrepreneurs in 93 countries [2]. Drayton believes that we are in a time of transition and that the central challenge of our time is to make everyone a changemaker [1,2]. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 31, 2018 Category: Radiology Authors: Margaret M. Fynes Tags: Opinion Source Type: research

A Guide to Midrotation Feedback
Feedback during trainee rotations is a well-accepted component of current radiology teaching strategies [1-3]. If studying medicine without books is like sailing an uncharted sea, learning radiology without individualized correction is like learning how to sail without a captain. Constructive critiques during a rotation keep the trainee on course and lead to improved trainee satisfaction with the learning experience [4]. But is all feedback the same? What can be done to make it more effective? (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 30, 2018 Category: Radiology Authors: Matthew A. Morgan, Lisa P. Jones Tags: Case studies in training and education Source Type: research

The Role of the FDA in Ensuring the Safety and Efficacy of Artificial Intelligence Software and  Devices
The FDA is charged with protecting the public health by “ensuring the safety, efficacy, and security” of a wide range of health care products, including medical devices [1]. The FDA classifies and regulates medical devices on the basis of the degree of risk to the public, with the least risky class I devices subject to the lowest level of regulatory controls and class III devices subject to the highest level of regulatory controls. Class I devices include simple medical supplies, such as gloves. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 30, 2018 Category: Radiology Authors: Bibb Allen Tags: Data science in radiologic practice Source Type: research

The Incentive Dilemma: Intrinsic Motivation and Workplace Performance
In this report, the authors examine basic assumptions about financial incentives and debate the potential negative impact of financial incentive systems on performance at radiology practices. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 30, 2018 Category: Radiology Authors: Jason N. Itri, Michael A. Bruno, Neeraj Lalwani, Reginald F. Munden, Rafel Tappouni Tags: Original article Source Type: research

Authorship and Impact of Gender-Specific Research in Major Radiology Journals
The purpose of this study is to quantify the relationship between author gender and publication topic, as well as the impact of gender-related research. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 26, 2018 Category: Radiology Authors: James C. Campbell, Sora C. Yoon, Lars J. Grimm Tags: Original article Source Type: research

Lactation Policy and Resources for Trainees in the Department of Radiology
The benefits of breastfeeding are well established for both lactating mothers and their children. Breast milk has been shown to improve infant health outcomes across a number of different measures, including respiratory tract infections, gastrointestinal tract infections, allergies, obesity, and mortality [1], while breastfeeding has been demonstrated to improve health outcomes for mothers, including decreasing the risk for type 2 diabetes and breast and ovarian cancer [1,2]. Given these significant benefits, the American Academy of Pediatrics, World Health Organization, and Institute of Medicine all recommend breastfeedin...
Source: Journal of the American College of Radiology : JACR - October 26, 2018 Category: Radiology Authors: Jessica B. Robbins, Sarah P. Shubeck, Arielle E. Kanters, Gina M. Greenwood Tags: Case studies in training and education Source Type: research

Using Wellness Days to Mitigate Resident Burnout
Burnout has been described as a work-related syndrome that can lead to emotional exhaustion, depersonalization, and decreased feelings of personal accomplishment [1]. Radiology residents report one of the highest burnout rates of all medical subspecialties, with up to 85% burnout rates reported [2,3]. Resident burnout can remain undetected because faculty members and other members of the educational leadership are poor at predicting burnout in residents and  tend to underestimate its prevalence [3,4]. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 26, 2018 Category: Radiology Authors: Dexter Mendoza, Anna Holbrook, Frederic Bertino, David Theriot, Christopher Ho Tags: Case studies in training and education Source Type: research

The Impending Insolvency of Medicare: Implications for Radiology
The estimated depletion date for the HI trust fund is 2026, 3 years earlier than in last year ’s report. As in past years, the Trustees have determined that the fund is not adequately financed over the next 10 years.—Medicare Trustees Annual report, June 5, 2018 [1] (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 26, 2018 Category: Radiology Authors: Rakesh A. Shah Tags: Opinion Source Type: research

How Structured Use Cases Can Drive the Adoption of Artificial Intelligence Tools in Clinical  Practice
An artificial intelligence (AI) “use case” is more than just an idea for what an AI algorithm should do. A structured AI use case includes a narrative description and flowcharts that define exactly how an AI algorithm takes in images and/or other information from the clinical workflow and provides specific output to end users. Structured AI use cases also include parameters for how algorithms are trained, tested, and validated for regulatory approval and clinical use; how they are deployed into clinical workflows; and how their effectiveness can be monitored in clinical practice. (Source: Journal of the America...
Source: Journal of the American College of Radiology : JACR - October 26, 2018 Category: Radiology Authors: Bibb Allen Tags: Data science and radiologic practice Source Type: research

Establishing Nonprofit Status for an Interventional Radiology Student Interest Group
With the recent establishment of the interventional radiology (IR) residency and the overall current competitiveness in the field, networking has become incredibly important. As the IR residencies continue to expand and mature, student interest groups (SIGs) are becoming more important. However, SIGs are constrained by institutional requirements for funding events such as clear educational benefit to institution, what the funding may be spent on, as well as monetary limits. Therefore, it is important that an IR SIG have discretionary funds to host such events. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 25, 2018 Category: Radiology Authors: Michael Boulous, Michael Andrew Schacht, W. Brooks Davis Tags: Opinion Source Type: research

Achieving Joint Commission Regulatory Compliance: Quality Improvement Process for CT Protocol Review and Dose Alert Reduction
Radiation from CT constitutes a large component of annual population exposure and has created national focus on monitoring and reducing radiation dose due to CT [1,2]. Despite increased awareness of CT exposure, considerable variability continues to exist in radiation doses within the same health system and across institutions [3,4]. The Joint Commission now requires that accredited institutions track dose indices for all CT examinations. In addition, institutions are required to perform regular protocol review and  analyze CT examinations when the radiation dose index exceeds a predetermined threshold [5]. (Sour...
Source: Journal of the American College of Radiology : JACR - October 25, 2018 Category: Radiology Authors: Matthew E. Zygmont, Rebecca Neill, Shalmali Dharmadhikari, Pratik Raach, Phuong-Anh T. Duong Tags: Case studies in clinical practice management Source Type: research

Patient-Centered Outcomes Related to Imaging Testing in US Primary Care
This study explores patients ’ experiences and subsequent outcomes of imaging tests most notable to patients. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 25, 2018 Category: Radiology Authors: Monica L. Zigman Suchsland, Elizabeth Witwer, Anjali R. Truitt, Danielle C. Lavallee, Ying Zhang, Philip Posner, Brian Do, Patrick M. Bossuyt, Victoria Hardy, Matthew J. Thompson Tags: Original article Source Type: research

Your Mother Is Ill
Your mother is chronically ill and lives in another state. Your family relies on you for help in understanding what is happening and for making decisions regarding her care. This is occupying a great deal of your time, energy, and emotions. You fear it is interfering with your ability to lead. How would you handle this? (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 25, 2018 Category: Radiology Authors: David Fessell, Frank J. Lexa Tags: Devilish dilemma Source Type: research

Management of Diabetes Mellitus Before 18F-Fluorodeoxyglucose PET/CT: A Nationwide Patient-Centered Assessment of Approaches to Examination Preparation
The aim of this study was to perform, from the patient ’s point of view, a nationwide assessment of nuclear medicine practices regarding diabetic management before 18F-fluorodeoxyglucose (FDG) PET/CT for oncologic indications. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 19, 2018 Category: Radiology Authors: Andrew Kaiser, Richard Brown, Kirk Frey, Matt Davenport, Bennett Greenspan Tags: Original article Source Type: research

Between-Race Differences in Supplemental Breast Cancer Screening Before and After Breast Density Notification Law
We examined supplemental screening (ie, MRI, ultrasound, or tomosynthesis within 6 months of screening mammogram) among a sample of 2,764 African American (AA) and 691 European American (EA) women with negative or benign screening mammograms for whom we had data from both before and after implementation of breast density notification laws in the state of Michigan. (Source: Journal of the American College of Radiology : JACR)
Source: Journal of the American College of Radiology : JACR - October 17, 2018 Category: Radiology Authors: Mark Manning, Terrance L. Albrecht, Suzanne O ’Neill, Kristen Purrington Tags: Original article Source Type: research