Radiology Commons^™

Procedural Competency Training During Diagnostic Radiology Residency: Time To Go Beyond “See One, Do One, Teach One”!, Driss Raissi, Qiong Han, Michael A. Winkler, Edward J. Escott

Radiology Faculty Publications

Objectives: Achieving procedural competency during diagnostic radiology residency can impact the radiologist's future independent practice after graduation, especially in a private practice setting. However, standardized procedure competency training within most radiology residency programs is lacking, and overall procedural skills are still mainly acquired by the traditional “see one, do one, teach one” methodology. We report the development of a simple standardized procedural training protocol that can easily be adopted by residency programs currently lacking any form of structured procedural training.

Materials and Methods: An ad hoc resident procedural competency committee was created in our radiology residency program. A procedural certification …

Bezoar: Imaging Findings & Case Study Of A Rare Pathology, Tanya M. Custer, Kim Michael

Posters and Presentations: Medical Imaging & Therapeutic Sciences

A bezoar is a hard, indigestible mass of material that forms within the alimentary canal, most commonly the stomach.1 Bezoars are classified according to composition. The most common type of bezoar is a phytobezoar composed of indigestible food fibers that occur in fruits & vegetables, including celery, pumpkin, prunes, raisins, & sunflower-seed shells. Other common types of bezoars include trichobezoars, composed of hair, & pharmacobezoars, made of undissolved medications.

A number of risk factors have been associated with bezoar development. Patients who have undergone gastric surgery, such as partial gastrectomy, are at an increased risk of developing a bezoar due …

Renal Granulomatosis Post Intravesical Bacillus Calmette-Guerin Therapy For Non-Muscle-Invasive Bladder Cancer, Karen Tran-Harding, Rashmi T. Nair, Halemane S. Ganesh

Radiology Faculty Publications

Intravesical Bacillus Calmette–Guerin (BCG) immunotherapy is a proven, effective treatment for intermediate- and high-risk non-muscle-invasive bladder cancer. Minor side effects are common and expected but systemic effects can occur in < 5% of treated patients. We present a rare case of a 49-year-old male that presented with fever and chills after 3 weeks of intravesical BCG therapy post transurethral resection of bladder tumor. New renal lesions were present on contrast-enhanced computed tomography scan which was histologically proven to be necrotizing renal granulomatosis.

Evaluation Of Hepatocellular Carcinoma Transarterial Chemoembolization Using Quantitative Analysis Of 2d And 3d Real-Time Contrast Enhanced Ultrasound., Kibo Nam, Maria Stanczak, Andrej Lyshchik, Priscilla Machado, Yuko Kono, Flemming Forsberg, Colette M. Shaw, John R. Eisenbrey

Department of Radiology Faculty Papers

Quantitative 2D and 3D contrast-enhanced ultrasound (CEUS) was assessed to evaluate early transarterial chemoembolization (TACE) treatment response. Seventeen patients scheduled for TACE for the treatment of hepatocellular carcinoma participated in the study. 2D and 3D CEUS were performed for each patient at three time points: Prior to TACE, 1-2 weeks post TACE, and 1 month post TACE. Peak-intensities of the tumor and surrounding liver tissue were calculated from 2D and 3D data before and after TACE and used to evaluate tumor treatment response. Residual tumor percentages were calculated from 2D and 3D CEUS acquired 1-2 weeks and 1 month post …

Optimizing Vaccine Immunotherapy For Prostate Cancer, G. Hattier, E. K. Bongiorno, C. Portocarrero, Trevor R. Baybutt, Adam E. Snook, U. Rodeck

Sigma Xi Student Research Day

Introduction: Treatment options for metastatic prostate cancer are limited and cures are rare. In other cancers immunotherapy has shown remarkable efficacy in certain patient subsets particularly when combined with other treatment modalities. Our previous work showed that combining radiation and vaccine therapy slows the growth of syngeneic prostate cancer in mice more effectively than single modality treatment arms. Here we tested the hypothesis that addition of immune checkpoint inhibitors targeting the PD1/PD-L1 axis further improves efficacy of the dual radiation/vaccine treatment.

Methods: Mice were injected with tumor cells expressing human prostate specific antigen (TPSA-23). The mice were divided into six …

Stochastic Modeling Of Radiation-Induced Dendritic Damage On In Silico Mouse Hippocampal Neurons, Eliedonna Cacao, Vipan K. Parihar, Charles L. Limoli, Francis A. Cucinotta

Health Physics and Diagnostic Sciences Faculty Research

Cognitive dysfunction associated with radiotherapy for cancer treatment has been correlated to several factors, one of which is changes to the dendritic morphology of neuronal cells. Alterations in dendritic geometry and branching patterns are often accompanied by deficits that impact learning and memory. The purpose of this study is to develop a novel predictive model of neuronal dendritic damages caused by exposure to low linear energy transfer (LET) radiation, such as X-rays, gamma-rays and high-energy protons. We established in silico representations of mouse hippocampal dentate granule cell layer (GCL) and CA1 pyramidal neurons, which are frequently examined in radiation-induced cognitive …

The Pivotal Role Of Mri In The Diagnosis Of Listeria Rhomboencephalitis, K.R Uprety, M Reza Taheri

GW Research Days 2016 - 2020

Sixty-six year-old female presented to the Emergency Department with history of several days of headache, malaise, chills, and fatigue with accompanying nausea, vomiting, and inability to tolerate oral intake. She had no history of fever and remained afebrile at the time of presentation. Physical exam and immediate lab values were non-contributory; CSF was obtained and sent for analysis. The patient was placed preemptively on acyclovir, as viral meningitis was the admitting diagnosis. MRI of the brain showed abnormal FLAIR signal hyperintensity and enhancement involving the entire cisternal segment of the left trigeminal nerve, which extended dorsally along the nerve fiber …

Breast Lesions Detected Via Molecular Breast Imaging: Physiological Parameters Affecting Interpretation, Jason Ching, Rachel Brem

GW Research Days 2016 - 2020

Rationale and Objectives:

To evaluate correlations between molecular breast imaging (MBI) descriptor characteristics and positive predictive value (PPV) in detecting breast cancer.

Materials and Methods:

A retrospective review was performed on 193 suspicious findings from 153 women (31-81 years) with positive MBI examinations. We assessed associations between: (i) lesion pattern (mass vs. non-mass) and PPV; (ii) lesion pattern and suspected likelihood of cancer (low vs. moderate vs. high); (iii) background parenchymal uptake (BPU) (homogeneous vs. heterogeneous) and PPV; (iv) breast density (dense vs. non-dense) and PPV; (v) BPU and density.

Results:

One hundred ten of 153 patients were diagnosed with …

Enriching The Medical Student Radiology Clerkship: Simulating The Radiologist’S Experience, Liqi Shu, Faraien Bahri, Navid Mostaghni, Ramin Javan

GW Research Days 2016 - 2020

Background

Current radiology training in medical schools is still predominantly limited to passively observing the radiologist at the workstation and through lectures, textbooks and online sources. Evaluation is also mainly limited on still image interpretation or knowledge-based multiple-choice questions. Furthermore, students may have specific interests based on their choice of residency. In order to create a tailored and active learning experience, and to evaluate students’ ability in image interpretation, we utilized an open-source web-based Picture archiving and communication system (PACS) named "Weasis" and integrated a report system.

Method

We establish a new PACS teaching system by utilizing the open-source PACS …

Experiences Of The Breast Cancer Patients Undergoing Radiotherapy At A Public Hospital Peshawar Pakistan, Gulzar Habibullah, Raisa Raisa, Shanaz Hussein Cassum, Rehana Elahi

School of Nursing & Midwifery

Objective: This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan.
Methods: This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually.
Results: Four main categories emerged from data analysis, which were: …

Radiation Dose Measurements In A 256-Slice Computed Tomography Scanner, Victor J. Weir, Jie Zhang

Radiology Faculty Publications

Purpose: The purpose of this study is to compare computed tomography (CT) radiation dose measurement methods proposed by TG111, International Electrotechnical Commission (IEC), and a direct dose profile integral (DPI) measurement method. Methods: Pencil and Farmer ion chambers are used for integrating dose profiles at different beam widths in a 60 cm long body phantom. Resulting DPI is used to calculate CT dose index (CTDI) at each beam width. Measurements are also done for a pencil chamber inserted into a 15 cm body phantom at the reference beam width. The reference measurement is scaled with pencil chamber measurements in air …

Diagnostic Accuracy Of Pelvic Mri For Determination Of The Cervical Involvement In Endometrial Cancer., Imrana Masroor, Sadia Rashid, Shaista Afzal Saeed, Saira Naz, Muhammad Azeemuddin

Department of Radiology

OBJECTIVE: To determine the diagnostic accuracy of pelvic MRI for assessment of the cervical involvement in endometrial cancer.

STUDY DESIGN: Cross-sectional analytical study.

PLACE AND DURATION OF STUDY: Radiology Department of the Aga Khan University Hospital, Karachi from January 2014 to December 2015.

METHODOLOGY: Patients with biopsy-proven endometrial cancer were included, who had both their MRI and histopathological diagnosis performed at our institution. Those patients treated with chemo/radiotherapy or had incomplete medical records, were excluded. The extent of cervical involvement by endometrial carcinoma was seen on T2WI images, and findings were correlated after surgery taking histopathology as the gold standard. …

Myocardial Perfusion Imaging: The Gatekeeper And Advisor, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Compressed Sensing For Few-View Multi-Pinhole Spect With Applications To Preclinical Imaging, Benjamin Michael Rizzo

Dissertations (1934 -)

Single Photon Emission Computed Tomography (SPECT) can be used to identify and quantify changes in molecular and cellular targets involved in disease. A radiopharmaceutical that targets a specific metabolic function is administered to a subject and planar projections are formed by imaging emissions at different view angles around the subject. The reconstruction task is to determine the distribution of radioactivity within the subject from the projections. We present a reconstruction approach that utilizes only a few view angles, resulting in a highly underdetermined system, which could be used for dynamic imaging applications designed to quantify physiologic processes altered with disease. …

Bleeding Stomal Varices In Portal Hypertension, Karen Tran-Harding, Michael A. Winkler, Driss Raissi

Radiology Faculty Publications

We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS) and concomitant embolization of the stomal varices via the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol. Although stomal variceal bleeding is uncommon, this entity can have up to 40% mortality upon initial presentation, given the challenges in diagnosis and management. Currently, there are no established standard treatments for stomal variceal bleeding. In addition, …

Accuracy Of Specimen Radiography In Assessing Complete Local Excision With Breast-Conservation Surgery, Saira Naz, Imrana Masroor, Shaista Afzal Saeed, W. Akhtar, Sehrish Butt, Zafar Sajjad, Anwar Ahmad

Department of Radiology

OBJECTIVE: The aim of this study was to evaluate the accuracy of “X- ray examination of surgically resected specimen‘‘ in assessing complete local excision (CLE).

MATERIALS AND METHODS: In this retrospective cross sectional study, data were collected for all female breast cancer cases who underwent breast-conserving surgery after needle localization of mammographically visible disease. Males, patients with mammographically invisible disease and cases with benign or inconclusive histopathology, those undergoing modified radical mastectomy and individuals with dense breast parenchyma were excluded. We evaluated radiography of resected specimens to assess margin spiculation, distance of mass/microcalcification from the excised margin, presence of a …

Massive Tumor Thrombus In Left Renal Vein Andiinferior Vena Cava In Renal Cell Carcinoma On 18-Fluorodeoxyglucose Positron Emission Tomography/Computerized Tomography: "Suspension Bridge Sign"., Maseeh Uz Zaman, Nosheen Fatima, Unaiza Zaman, Rabia Tahseen, Sidra Zaman

Department of Radiology

Tumor thrombosis is a relatively uncommon complication of renal cell carcinoma (RCC), and its diagnosis has therapeutic and prognostic implication. Computerized tomography (CT) is the primary imaging modality for staging RCC, but it has low sensitivity to differentiate between tumor thrombus and bland or benign thrombus. 18-fluorodeoxyglucose positron emission tomography/CT (PET/CT) has a limited role in diagnosis and staging of RCC, but its diagnostic accuracy is considerably high for detection of metabolically active tumor thrombus. We are presenting a case of metastatic left-sided RCC with massive hypermetabolic tumor thrombus extending from left kidney to left renal vein and inferior vena …

Resolution Of Symptomatic Secondary Empty Sella Syndrome Following Lumbar-Peritoneal Shunt., Waseem Mehmood Nizamani, Mubbashira Siddiqui, Sehrish Nizar Ali Momin, Waqas Muhammad, Rashid Jooma

Department of Radiology

Background: Post‑surgical empty sella is related to the removal of pituitary tumors either from the transcranial or transphenoidal route, rendering diaphragma sellae incompetent at the end of the procedure. This subsequently leads to herniation of the third ventricle and optic apparatus into the empty sella. Studies have shown that in 50% of the cases, individuals with primary and secondary empty sella syndrome have developed defects in the visual fields. Benign increased intracranial pressure, cerebrospinal rhinorrhea, papilledema, and abnormalities affecting visual acuity may also occur as a result of empty sella.

Case Description: This case report discusses a rare treatment …

A Variant Of Crossed Pulmonary Arteries In Association With Coarctation Of Aorta, Rabail Raza, Kumail Khandwala, Hafsa Qayyum, Muhammad Anwar Saeed, Anwar Ahmad

Department of Radiology

Crossed or "crisscross" pulmonary arteries (CPA) are a result of an anomalous origin and course of both the pulmonary arteries from the main pulmonary trunk in which the left pulmonary artery (PA) ostium usually lies directly superior and to the right PA ostium after which they cross each other and supply their respective lungs. This condition is usually associated with conotruncal malformations and genetic syndromes. We describe a case report of an infant, suspected to have Down syndrome, who was diagnosed with CPA and coarctation of aorta on computed tomography (CT) angiography. Our case is unusual because in our patient …

Electrophysiological Signatures Of Spatial Boundaries In The Human Subiculum., Sang Ah Lee, Jonathan F. Miller, Andrew J. Watrous, Michael R. Sperling, Ashwini Sharan, Gregory A. Worrell, Brent M. Berry, Joshua P. Aronson, Kathryn A. Davis, Robert E. Gross, Bradley Lega, Sameer Sheth, Sandhitsu R. Das, Joel M. Stein, Richard Gorniak, Daniel S. Rizzuto, Joshua Jacobs

Department of Radiology Faculty Papers

Environmental boundaries play a crucial role in spatial navigation and memory across a wide range of distantly related species. In rodents, boundary representations have been identified at the single-cell level in the subiculum and entorhinal cortex of the hippocampal formation. Although studies of hippocampal function and spatial behavior suggest that similar representations might exist in humans, boundary-related neural activity has not been identified electrophysiologically in humans until now. To address this gap in the literature, we analyzed intracranial recordings from the hippocampal formation of surgical epilepsy patients (of both sexes) while they performed a virtual spatial navigation task and compared …