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European Journal of Cancer (Oxford,... Nov 2019Radiation therapy (RT) is an essential component of effective cancer care and is used across nearly all cancer types. The delivery of RT is becoming more precise through... (Review)
Review
Radiation therapy (RT) is an essential component of effective cancer care and is used across nearly all cancer types. The delivery of RT is becoming more precise through rapid advances in both computing and imaging. The direct integration of magnetic resonance imaging (MRI) with linear accelerators represents an exciting development with the potential to dramatically impact cancer research and treatment. These impacts extend beyond improved imaging and dose deposition. Real-time MRI-guided RT is actively transforming the work flows and capabilities of virtually every aspect of RT. It has the opportunity to change entirely the delivery methods and response assessments of numerous malignancies. This review intends to approach the topic of MRI-based RT guidance from a vendor neutral and international perspective. It also aims to provide an introduction to this topic targeted towards oncologists without a speciality focus in RT. Speciality implications, areas for physician education and research opportunities are identified as they are associated with MRI-guided RT. The uniquely disruptive implications of MRI-guided RT are discussed and placed in context. We further aim to describe and outline important future changes to the speciality of radiation oncology that will occur with MRI-guided RT. The impacts on RT caused by MRI guidance include target identification, RT planning, quality assurance, treatment delivery, training, clinical workflow, tumour response assessment and treatment scheduling. In addition, entirely novel research areas that may be enabled by MRI guidance are identified for future investigation.
Topics: Humans; Magnetic Resonance Imaging; Quality Assurance, Health Care; Radiation Oncology; Radiotherapy, Image-Guided
PubMed: 31614288
DOI: 10.1016/j.ejca.2019.07.021 -
Abdominal Radiology (New York) Mar 2016Many economists and policy makers believe that United States healthcare costs are rising at an unsustainable rate. In response, newer payment systems such as bundled... (Review)
Review
Many economists and policy makers believe that United States healthcare costs are rising at an unsustainable rate. In response, newer payment systems such as bundled payments, accountable care organizations, and population health management have been proposed. These new paradigms all aim to encourage collaboration between health care providers to conserve costs and increase quality. To succeed in this evolving environment, radiologists should consider embracing change by working to standardize radiology practice, participating in radiology utilization management, working with vendors to increase storage of radiology imaging data to improve access and interconnectivity, and exploring targeted screening in high risk populations.
Topics: Accountable Care Organizations; Health Care Costs; Health Care Reform; Health Expenditures; Humans; Radiologists; Radiology; United States
PubMed: 26960723
DOI: 10.1007/s00261-016-0674-2 -
Radiologic Technology Mar 2023To examine radiologic science programs' contingency planning related to the COVID-19 pandemic.
PURPOSE
To examine radiologic science programs' contingency planning related to the COVID-19 pandemic.
METHODS
Using a mixed-methods approach, educators in magnetic resonance, medical dosimetry, radiation therapy, and radiography programs were surveyed to identify curricular changes, policy implementation, and financial implications related to pandemic recovery efforts. Quantitative data were summarized using descriptive statistics and percentages. Thematic analyses were performed on the qualitative responses.
RESULTS
Continued curricular changes involved using technology to teach in the online environment and ensuring the safety and protection of students during clinical rotations. Institutional policies implemented because of the pandemic included social distancing guidelines, mask requirements, and availability of vaccine. The greatest financial implication witnessed among the sample of educators at their respective institutions was the halting of employer-related travel. Faced with the spontaneous shift to online learning while not being equipped with the appropriate training, most of the educator participants experienced COVID-19 fatigue and burnout related to teaching online.
DISCUSSION
Social distancing guidelines make it difficult for large classes to meet in person, so virtual lectures using video conferencing platforms were an essential part of teaching during the pandemic. Most educators in this study selected recording technology for lectures as the most useful educational technology tool integrated into the didactic portion of their program. For many educators, having administration realize the adoption of technology is integral to and viable for radiologic science programs was a positive outcome of COVID-19. The pandemic caused educators in the study to experience fatigue and burnout related to online learning; however, the educators also expressed a high degree of comfort with using technology in the online learning environment. This implies that the source of fatigue and burnout was likely not associated with the technology, but with the focused and swift transition to predominately online learning.
CONCLUSION
Although educators in this sample felt moderately prepared to handle future viral outbreaks and extremely comfortable using technology in the virtual classroom, additional research is needed to develop viable contingency plans and explore pedagogical approaches to content delivery beyond the traditional, in-person structure.
Topics: Humans; COVID-19; Pandemics; Radiology; Curriculum; Surveys and Questionnaires
PubMed: 36973033
DOI: No ID Found -
Radiology Feb 2021Radiation therapy (RT) continues to be one of the mainstays of cancer treatment. Considerable efforts have been recently devoted to integrating MRI into clinical RT... (Review)
Review
Radiation therapy (RT) continues to be one of the mainstays of cancer treatment. Considerable efforts have been recently devoted to integrating MRI into clinical RT planning and monitoring. This integration, known as MRI-guided RT, has been motivated by the superior soft-tissue contrast, organ motion visualization, and ability to monitor tumor and tissue physiologic changes provided by MRI compared with CT. Offline MRI is already used for treatment planning at many institutions. Furthermore, MRI-guided linear accelerator systems, allowing use of MRI during treatment, enable improved adaptation to anatomic changes between RT fractions compared with CT guidance. Efforts are underway to develop real-time MRI-guided intrafraction adaptive RT of tumors affected by motion and MRI-derived biomarkers to monitor treatment response and potentially adapt treatment to physiologic changes. These developments in MRI guidance provide the basis for a paradigm change in treatment planning, monitoring, and adaptation. Key challenges to advancing MRI-guided RT include real-time volumetric anatomic imaging, addressing image distortion because of magnetic field inhomogeneities, reproducible quantitative imaging across different MRI systems, and biologic validation of quantitative imaging. This review describes emerging innovations in offline and online MRI-guided RT, exciting opportunities they offer for advancing research and clinical care, hurdles to be overcome, and the need for multidisciplinary collaboration.
Topics: Humans; Magnetic Resonance Imaging; Neoplasms; Radiation Oncology; Radiology, Interventional
PubMed: 33350894
DOI: 10.1148/radiol.2020202747 -
Academic Radiology Feb 2023The response to pandemic-related teaching disruption has revealed dynamic levels of learning and teaching flexibility and rapid technology adoption of radiology... (Review)
Review
The response to pandemic-related teaching disruption has revealed dynamic levels of learning and teaching flexibility and rapid technology adoption of radiology educators and trainees. Shutdowns and distancing requirements accelerated the adoption of technology as an educational tool, in some instances supplanting in-person education entirely. Despite the limitations of remote interaction, many educational advantages were recognized that can be leveraged in developing distance learning paradigms. The specific strategies employed should match modern learning science, enabling both students and educators to mutually grow as lifelong learners. As panel members of the "COVID: Faculty perspective" Task Force of the Association of University Radiologists Radiology Research Alliance, we present a review of key learning principles which educators can use to identify techniques that enhance resident learning and present an organized framework for applying technology-aided techniques aligned with modern learning principles. Our aim is to facilitate the purposeful integration of learning tools into the training environment by matching these tools to established educational frameworks. With these frameworks in mind, radiology educators have the opportunity to re-think the balance between traditional curricular design and modern digital teaching tools and models.
Topics: Humans; COVID-19; Radiology; Learning; Radiography; Technology; Teaching
PubMed: 35551855
DOI: 10.1016/j.acra.2022.03.019 -
Journal of Nuclear Medicine : Official... Jul 2019The diagnosis and subsequent therapy of neuroendocrine neoplasms (NENs) have long relied on somatostatin receptor (SSTR) expression. The field of theranostics now uses... (Review)
Review
The diagnosis and subsequent therapy of neuroendocrine neoplasms (NENs) have long relied on somatostatin receptor (SSTR) expression. The field of theranostics now uses newer SSTR-based PET imaging with Ga-DOTATATE or Ga-DOTATOC as a prerequisite for the administration of peptide receptor radionuclide therapy (PRRT). In the United States, Food and Drug Administration approval of Lu-DOTATATE, a form of PRRT, in 2018 for use in gastroenteropancreatic NENs was obtained on the basis of prolonged progression-free survival versus high-dose octreotide long-acting release in a phase III clinical trial of well-differentiated midgut NENs. Well-differentiated grade 1 and grade 2 NENs have a low proliferation index (Ki-67 < 20%) and longer overall survival (>10 y), whereas higher-grade (grade 3 [G3]) NENs have a high Ki-67 (>20%) and shorter overall survival (<1 y). Here, we present a review on the role of SSTR-based imaging and PRRT in G3 NENs, including a discussion of well-differentiated G3 NENs, the newest histologic classification. Some studies suggest that G3 NENs are less likely to be positive on SSTR-based imaging (but more likely on F-FDG PET) than are well-differentiated NENs, but these data are limited. We found only 13 studies mentioning the use of PRRT in G3 NENs and a total of only 151 patients across these studies in whom radiologic response was measured. Of these 151 patients, 99 (66%) demonstrated at least stable disease or a partial response, indicating that some G3 NENs can be responsive to PRRT. We suggest that patients with G3 NENs should receive both F-FDG PET and SSTR-based imaging to aid in both diagnosis and treatment selection, as positivity on SSTR-based imaging helps with patient identification for PRRT and discordance may suggest important clues to tumor biology and prognosis. However, prospective studies are needed to fully understand the role of PRRT in G3 NENs, especially in well- versus poorly differentiated G3 disease.
Topics: Humans; Neoplasm Grading; Neuroendocrine Tumors; Nuclear Medicine
PubMed: 30850504
DOI: 10.2967/jnumed.118.217851 -
AJNR. American Journal of Neuroradiology Aug 2020A uniform policy on parental leave in radiology training programs is lacking. Although previous publications have addressed the status of parental leave policy among...
BACKGROUND AND PURPOSE
A uniform policy on parental leave in radiology training programs is lacking. Although previous publications have addressed the status of parental leave policy among radiology residency programs, the state of parental leave in radiology fellowships has not been addressed to date. Our aim was to determine the state of parental leave policies in American neuroradiology fellowship programs.
MATERIALS AND METHODS
An Internet survey was sent to the directors of neuroradiology fellowship programs listed on the Accreditation Council for Graduate Medical Education Web site ( = 87) in January 2020. The questionnaire assessed the policies of the fellowship programs and Program Directors' attitudes toward maternal and paternal leave. Four reminders were sent during the 3 weeks before closing data collection.
RESULTS
The response rate was 76% (66/87). Ninety-four percent (62/66) of program directors claimed to have a maternal leave policy, of which 51/62 (82%) were written and 53/62 (85%) were paid. Additionally, 77% (51/66) had a policy for paternal leave, of which 80% (41/51) were written and 76% (39/51) were paid. The average length of paid leave was 6.7 ± 3.25 weeks for new mothers and 2.9 ± 2 weeks for new fathers. Unpaid leave was mostly based on the Family and Medical Leave Act. Fellows were responsible for making up call duties during the parental leave in 47% of the programs. Radiation exposure was restricted in 89% of the programs during pregnancy. Policies addressed breast feeding and untraditional parenthood in just 41% of the responding programs. Most program directors supported the development of a unified national policy on maternal (83%) and paternal (79%) leave.
CONCLUSIONS
Most neuroradiology fellowship programs have explicit maternal and paternal leave policies that grant paid leave to trainees. Some also offer unpaid leave, mostly through Family and Medical Leave Act guidelines. A uniform policy derived from the Accreditation Council for Graduate Medical Education and/or American Board of Radiology would be useful and overwhelmingly accepted.
Topics: Education, Medical, Graduate; Fellowships and Scholarships; Female; Humans; Internship and Residency; Male; Parental Leave; Pregnancy; Radiologists; Radiology; Surveys and Questionnaires; United States
PubMed: 32646942
DOI: 10.3174/ajnr.A6648 -
Current Problems in Diagnostic Radiology 2020An audience response system (ARS) is an excellent tool for improving interactive learning in radiology residents. Traditional ARSs have long allowed text-based... (Review)
Review
An audience response system (ARS) is an excellent tool for improving interactive learning in radiology residents. Traditional ARSs have long allowed text-based interactions between teacher and students. However, little attention has been given to techniques which allow students in large groups to interact directly with an image. Fortunately, a growing number of ARSs are beginning to add this ability. However, it is not the technology but the pedagogy that matters the most. The purpose of this article is to review those ARSs, and to present an array of pedagogical techniques that can take advantage of this technology.
Topics: Computer-Assisted Instruction; Humans; Internship and Residency; Radiology; Simulation Training; Students, Medical
PubMed: 31300178
DOI: 10.1067/j.cpradiol.2019.06.003 -
Seminars in Nuclear Medicine Sep 2023Academic integrity in both higher education and scientific writing has been challenged by developments in artificial intelligence. The limitations associated with... (Review)
Review
Academic integrity in both higher education and scientific writing has been challenged by developments in artificial intelligence. The limitations associated with algorithms have been largely overcome by the recently released ChatGPT; a chatbot powered by GPT-3.5 capable of producing accurate and human-like responses to questions in real-time. Despite the potential benefits, ChatGPT confronts significant limitations to its usefulness in nuclear medicine and radiology. Most notably, ChatGPT is prone to errors and fabrication of information which poses a risk to professionalism, ethics and integrity. These limitations simultaneously undermine the value of ChatGPT to the user by not producing outcomes at the expected standard. Nonetheless, there are a number of exciting applications of ChatGPT in nuclear medicine across education, clinical and research sectors. Assimilation of ChatGPT into practice requires redefining of norms, and re-engineering of information expectations.
Topics: Humans; Artificial Intelligence; Nuclear Medicine
PubMed: 37225599
DOI: 10.1053/j.semnuclmed.2023.04.008 -
European Radiology Jul 2021This review provides an overview of current applications of deep learning methods within breast radiology. The diagnostic capabilities of deep learning in breast... (Review)
Review
This review provides an overview of current applications of deep learning methods within breast radiology. The diagnostic capabilities of deep learning in breast radiology continue to improve, giving rise to the prospect that these methods may be integrated not only into detection and classification of breast lesions, but also into areas such as risk estimation and prediction of tumor responses to therapy. Remaining challenges include limited availability of high-quality data with expert annotations and ground truth determinations, the need for further validation of initial results, and unresolved medicolegal considerations. KEY POINTS: • Deep learning (DL) continues to push the boundaries of what can be accomplished by artificial intelligence (AI) in breast imaging with distinct advantages over conventional computer-aided detection. • DL-based AI has the potential to augment the capabilities of breast radiologists by improving diagnostic accuracy, increasing efficiency, and supporting clinical decision-making through prediction of prognosis and therapeutic response. • Remaining challenges to DL implementation include a paucity of prospective data on DL utilization and yet unresolved medicolegal questions regarding increasing AI utilization.
Topics: Artificial Intelligence; Breast; Deep Learning; Humans; Prospective Studies; Radiology
PubMed: 33449174
DOI: 10.1007/s00330-020-07640-9