CME Radiology Grand Rounds

Sonar, Science, Scotland and Serendipity: The Birth of Medical Ultrasound

Ultrasound is one of the most important imaging techniques.  The resolution is remarkable, and it has now become a pocket instrument used as part of routine clinical examination. There is no ionizing radiation making its use in pregnancy appropriate. A few decades ago few would have predicted its pivotal role. This lecture digs into the chance situations and interactions that led to the development of medical ultrasound. It focuses on Ian Donald Regius Professor of Midwifery at the University of Glasgow who pioneered the technique.

Aspirations: Stanford’s Efforts to Increase Diversity and Collaboration

— Etta K. Moskowitz Lectureship —

Transparency, Bias and Usefulness in Biomedical Research

Despite having brilliant people working in biomedical research and despite a major investment of resources, a substantial segment of published research yields results that are not reproducible. Moreover, among the results that are credible a large share cannot be translated meaningfully and thus end up being not useful. Many biases have been identified and the scientific process is a continuous effort to prevent and correct biases in the scientific record. The lecture will assess the scope of this evidence and will focus on solutions that have been proposed to make research more reproducible and with greater translational impact and usefulness. Many of these solutions center around optimizing transparency. Different solutions will be discussed with emphasis on biomedical investigation, although the challenges cover all scientific fields and comparative data will be presented across different fields.

Rapid and Quantitative MRI of the Heart

Magnetic Resonance Imaging of the heart is challenging due to cardiac and respiratory motion, and making quantitative measurements of tissue properties using MRI is valuable for physicians but complicated by this motion. This seminar will describe new techniques developed in the Seiberlich Lab at CWRU to accelerate data collection and reconstruction to enable real-time cardiac MRI and visualization, and introduce the Magnetic Resonance Fingerprinting concept and how it is applied for myocardial tissue property mapping.

Dual-Energy CT In The Acute Setting Making A Difference When It Matters Most

This talk will cover a brief introduction of the basic physics of different multi-energy systems in clinical practice. There will be a brief description of material decomposition, material labelling and monoenergetic applications, including liver VNC, bone marrow edema, virtual non-contrast, and virtual brain edema. Finally, these application will be applied to clinical cases illustrating the impact of multi-energy CT (MECT) in the accute setting in improving patient care.

Mining Chest CT Metrics to Improve Patient Outcomes

Non-contrast chest CT has numerous imaging biomarkers that can help improve patient outcomes. The primary one is coronary artery calcium score (CAC). While the outcomes data using CAC are from cardiac gated CT exams, non- gated chest CT ordinal calcium score also correlates with major adverse cardiac events. CT of bone mineralization is rarely commented on in this age of DEXA scanning. Recent work shows that the L1 Hounsfield unit density correlates with risk of fracture. Ordinal scoring of emphysema correlates with mortality risk. These simple metrics, based on HU density, can be used by Artificial Intelligence to mine patient imaging and clinical data to create nomograms and survival curves. The radiology report of the future will better inform patients about their physiologic age and provide a basis for therapeutic intervention where appropriate.

Abbreviated Breast MR: Early Implementaton and Outcomes

Mammography is the only modality which has been shown to reduce breast cancer mortality however, the sensitivity is limited by the anatomic imaging technique. It is well known that as breast density increases, the risk of developing cancer increase and the sensitivity of mammography decreases. Currently, over 50% of U.S. states have legislation mandating that women are notified of their individual breast density. In many states, this notification includes a discussion of supplemental screening to improve cancer detection. The most common modality for supplemental screening is whole breast ultrasound however, recent large, observational studies have shown high rates of false positives and short term follow-up and little to no impact on cancer detection.

Breast MR, with its vascular imaging, is significantly more sensitive in detecting breast cancers than mammography, tomosynthesis, ultrasound, or a combination of both. Currently, guidelines for supplemental screening with breast MR are limited to women with a lifetime risk of >20%. However, recently an abbreviated, or "fast" MR protocol (AB-MR) to be used for screening average risk women with dense breasts has been developed demonstrating excellent sensitivity and specificity. With significantly fewer imaging sequences, AB-MR is expected to increase patient throughput and therefore, significantly reduce cost compared to conventional, full breast MR protocols. Early outcomes, lessons learned and case examples from the early clinical implementation of an AB-MR protocol will be presented.

Professional Cultures In Healthcare: An Anthropologic Look At Turf Wars, Perceived Value, And The Role of Radiology

Humans have an innate tendency to form social groups, which can have distinct ways of thinking, speaking, dressing, and interacting. Healthcare has a wide array of distinct professional cultures from different positions to different specialties that affect our interactions and shared activities. Though we realize that a surgeon is different than an internist, we often underappreciate how much professional cultural differences affect our interactions and perceptions. During this talk, I will share my work exploring how specialty cultures affect turf wars and perceived value. I will then share ongoing work exploring how this understanding can be applied at a macroscopic level as well as an individual level. The talk will conclude with a pitch that radiology is uniquely positioned to use an understanding of specialty cultures to maximize its perceived value among other medical professionals.