Bio

Clinical Focus


  • Residency

Professional Education


  • MD, Stanford School of Medicine, Concentration in bioengineering (2015)
  • BA, Stanford University, Human Biology - with honors (2009)

Publications

All Publications


  • Clinical Care Redesign to Improve Value for Trigger Finger Release: A Before-and-After Quality Improvement Study. Hand (New York, N.Y.) Burn, M. B., Shapiro, L. M., Eppler, S. L., Behal, R., Kamal, R. N. 2019: 1558944719884661

    Abstract

    Background: Trigger finger release (TFR) is a commonly performed procedure. However, there is great variation in the setting, care pathway, anesthetic, and cost. We compared the institutional cost for isolated TFR before and after redesigning our clinical care pathway. Methods: Total direct cost to the health system (excluding the surgeon and anesthesiology costs) and time spent by the patient at the surgery center were collected for 1 hand surgeon's procedures at an ambulatory surgery center over a 3-year period. We implemented a redesigned pathway that altered phases of care and anesthetic use by transitioning from intravenous (IV) sedation to wide awake local anesthesia with no tourniquet. Cost data were reported as percentage change in the median and compared both pre- to post-implementation and with 2 control surgeons using the traditional pathway within the same center. Power analysis was based on prior work on a carpal tunnel pathway. Significance was defined by a P-value < .05. Results: Ten TFRs (90% local with IV sedation) and 44 TFRs (89% local alone) were performed pre- and post-implementation, respectively. From pre- to post-implementation, the study surgeon's total direct cost decreased by 18%, while the control surgeons decreased by 2%. Median time spent at the surgery center decreased by 41 minutes post-implementation with significantly shorter setup time in the operating room (OR), total time in the OR, and time spent in recovery prior to discharge. Conclusions: Redesigning the care pathway for TFR led to a decrease in institutional cost and patient time spent at the surgery center.

    View details for DOI 10.1177/1558944719884661

    View details for PubMedID 31690136

  • The Usability and Feasibility of Conjoint Analysis to Elicit Preferences for DistalRadius Fractures in Patients 55Years andOlder. The Journal of hand surgery Shapiro, L. M., Eppler, S. L., Baker, L. C., Harris, A. S., Gardner, M. J., Kamal, R. N. 2019

    Abstract

    PURPOSE: Eliciting patient preferences is one part of the shared decision-making process-a process of decision making focused on the values and preferences of the patient. We evaluated the usability and feasibility of a point-of-care conjoint analysis tool for preference elicitation for shared decision making in the treatment of distal radius fractures in patients over the age of 55 years.METHODS: Twenty-seven patients 55 years of age or older with a displaced distal radius fracture were recruited from a hand and upper extremity clinic. A conjoint analysis tool was created describing the attributes of care (eg, return of grip strength) of surgical and nonsurgical treatment. This tool was administered to patients to determine their preferences for the treatment attributes when choosing between surgical and nonsurgical treatment. Patients completed a System Usability Scale (SUS) to evaluate usability, and time to complete the tool was measured to evaluate feasibility.RESULTS: Patients considered the conjoint analysis tool to be usable (SUS, 91.4; SD, 10.9). Mean time to complete the tool was 5.1 minutes (SD, 1.4 minutes). The most important attributes driving the decision for surgical treatment were return of grip strength at 1 year and time spent in a cast or brace. The most important attributes driving the decision for nonsurgical treatment were use of anesthesia during treatment and return of grip strength at 1 year.CONCLUSIONS: A point-of-care conjoint analysis tool for distal radius fractures in patients 55 years and older can be used to elicit patient preferences to inform the shared decision-making process. Further investigation evaluating the effect of preference elicitation on treatment choice, involvement in decision making, and patient-reported outcomes are needed.CLINICAL RELEVANCE: A conjoint analysis tool is a simple, structured process physicians can use during shared decision making to highlight trade-offs between treatment options and elicit patient preferences to inform treatment choices.

    View details for DOI 10.1016/j.jhsa.2019.07.010

    View details for PubMedID 31495523

  • The Use of Preoperative Antibiotics in Elective Soft-Tissue Procedures in the Hand: A Critical Analysis Review. JBJS reviews Shapiro, L. M., Zhuang, T., Li, K., Kamal, R. N. 2019

    View details for DOI 10.2106/JBJS.RVW.18.00168

    View details for PubMedID 31436581

  • Financial Distress Is Associated With Delay in Seeking Care for Hand Conditions. Hand (New York, N.Y.) Zhuang, T., Eppler, S. L., Shapiro, L. M., Roe, A. K., Yao, J., Kamal, R. N. 2019: 1558944719866889

    Abstract

    Background: As medical costs continue to rise, financial distress due to these costs has led to poorer health outcomes and patient cost-coping behavior. Here, we test the null hypothesis that financial distress is not associated with delay of seeking care for hand conditions. Methods: Eighty-seven new patients presenting to the hand clinic for nontraumatic conditions completed our study. Patients completed validated instruments for measuring financial distress, pain catastrophizing, and pain. Questions regarding delay of care were included. The primary outcome was self-reported delay of the current hand clinic visit. Results: Patients who experience high financial distress differed significantly from those who experience low financial distress with respect to age, race, annual household income, and employment status. Those experiencing high financial distress were more likely to report having delayed their visit to the hand clinic (57% vs 30%), higher pain catastrophizing scores (17.7 vs 7.6), and higher average pain in the preceding week (4.5 vs 2.3). After adjusting for age, sex, and pain, high financial distress (adjusted odds ratio [OR] = 4.90) and pain catastrophizing score (adjusted OR = 0.96) were found to be independent predictors of delay. Financial distress was highly associated with annual household income in a multivariable linear regression model. Conclusions: Patients with nontraumatic hand conditions who experience higher financial distress are more likely to delay their visit to the hand clinic. Within health care systems, identification of patients with high financial distress and targeted interventions (eg, social or financial services) may help prevent unnecessary delays in care.

    View details for DOI 10.1177/1558944719866889

    View details for PubMedID 31409138

  • The Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger JOURNAL OF HAND SURGERY-AMERICAN VOLUME Shapiro, L. M., Eppler, S. L., Kamal, R. N. 2019; 44 (6): 480-+
  • The Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger. The Journal of hand surgery Shapiro, L. M., Eppler, S. L., Kamal, R. N. 2019

    Abstract

    PURPOSE: Shared decision making is an approach where physicians and patients collaborate to make decisions based on patient values. This requires eliciting patients' preferences for each treatment attribute before making decisions; a structured process for preference elicitation does not exist in hand surgery. We tested the feasibility and usability of a ranking tool to elicit patient preferences for the treatment of trigger finger. We hypothesized that the tool would be usable and feasible at the point of care.METHODS: Thirty patients with a trigger finger without prior treatment were recruited from a hand surgery clinic. A preference elicitation tool was created that presented 3 treatment options(surgical release, injection, and therapy and orthosis) and described attributes of each treatment extracted from literature review (eg, success rate, complications). We presented these attributes to patients using the tool and patients ranked the relative importance (preference)of these attributes to aid in their decision making. The System Usability Scale and tool completion time were used to evaluate usability and feasibility, respectively.RESULTS: The tool demonstrated excellent usability (System Usability Scale: 88.7). The mean completion time was 3.05 minutes. Five (16.7%) patients chose surgery, 20 (66.7%) chose an injection, and 5 (16.7%) chose therapy and orthosis. Patients ranked treatment success and cost as the most and least important attributes, respectively. Twenty-nine (96.7%) patients were very to extremely satisfied with the tool.CONCLUSIONS: A preference elicitation tool for patients to rank treatment attributes by relative importance is feasible and usable at the point of care. A structured process for preference elicitation ensures that patients understand the trade-offs between choices and can assist physicians in aligning treatment decisions with patient preferences.CLINICAL RELEVANCE: A ranking tool is a simple, structured process physicians can use to elicit preferences during shared decision making and highlight trade-offs between treatment options to inform treatment choices.

    View details for PubMedID 30797655

  • Can the FEAR Index Be Used to Predict Microinstability in Patients Undergoing Hip Arthroscopic Surgery? The American journal of sports medicine Truntzer, J. N., Hoppe, D. J., Shapiro, L. M., Safran, M. R. 2019: 363546519876105

    Abstract

    Atraumatic hip instability, or microinstability, is a challenging diagnosis for clinicians to make. Several radiographic parameters have been proposed to help identify patients with instability as a means to direct treatment. The Femoro-epiphyseal Acetabular Roof (FEAR) index was recently offered as a parameter to predict instability in a borderline dysplastic population.To evaluate the FEAR index in a series of predominantly nondysplastic patients undergoing hip arthroscopic surgery to determine if it can accurately predict patients with diagnosed microinstability at the time of surgery.Cohort study (diagnosis); Level of evidence, 2.A consecutive series of 200 patients undergoing hip arthroscopic surgery were evaluated for microinstability intraoperatively. Microinstability was diagnosed based on previously published criteria. Retrospectively, radiographic parameters were measured including the lateral center edge angle of Wiberg (LCEA), Tönnis angle, physeal scar angle, and FEAR index. Patients were excluded if they previously had any type of bony procedures performed, underwent prior open hip surgery or total hip arthroplasty of the ipsilateral hip, had osteoarthritis (Tönnis grade >1), or had any radiographic features of moderate-to-severe acetabular dysplasia including an LCEA <18°.After applying exclusion criteria, 167 hips in 150 patients were analyzed. Based on an intraoperative assessment, 96 hips (57.5%) were considered stable, and 71 hips (42.5%) had signs of microinstability (unstable group). Patients in the unstable group had fewer radiographic findings of femoroacetabular impingement and higher rates of borderline dysplasia. All 4 measured angles were found to have excellent interobserver agreement. The FEAR index was significantly more positive in the unstable group compared with the stable group (-7.8° vs -11.3°, respectively; P = .004). A more positive FEAR index was also found in patients meeting intraoperative criteria for instability, with the exception of chondral wear pattern. Unstable nondysplastic patients (LCEA ?25°, Tönnis angle ?10°) also were found to have higher FEAR index values (-9.0° vs -12.0°, respectively; P = .012). A FEAR index cut-off of -5.0° was associated with a specificity of 92.4% and accuracy of 69.4% for predicting instability in a nondysplastic population.The FEAR index was validated to improve the recognition of unstable patients preoperatively across a population with both borderline dysplastic and nondysplastic features.

    View details for DOI 10.1177/0363546519876105

    View details for PubMedID 31603694

  • Can the QuickDASH PROM be Altered by First Completing the Tasks on the Instrument? Clinical orthopaedics and related research Shapiro, L. M., Harris, A. H., Eppler, S. L., Kamal, R. N. 2019

    Abstract

    Health systems and payers use patient-reported outcome measures (PROMs) to inform quality improvement and value-based payment models. Although it is known that psychosocial factors and priming influence PROMs, we sought to determine the effect of having patients complete functional tasks before completing the PROM questionnaire, which has not been extensively evaluated.(1) Will QuickDASH scores change after patients complete the tasks on the questionnaire compared with baseline QuickDASH scores? (2) Will the change in QuickDASH score in an intervention (task completion) group be different than that of a control group? (3) Will a higher proportion of patients in the intervention group than those in the control group improve their QuickDASH scores by greater than a minimally clinically important difference (MCID) of 14 points?During a 2-month period, 140 patients presented at our clinic with a hand or upper-extremity problem. We approached patients who spoke and read English and were 18 years old or older. One hundred thirty-two (94%) patients met the inclusion criteria and agreed to participate (mean ± SD age, 52 ± 17 years; 60 men [45%], 72 women [55%]; 112 in the intervention group [85%] and 20 in the control group [15%]). First, all patients who completed the QuickDASH PROM (at baseline) were recruited for participation. Intervention patients completed the functional tasks on the QuickDASH and completed a followup QuickDASH. Control patients were recruited and enrolled after the intervention group completed the study. Participants in the control group completed the QuickDASH at baseline and a followup QuickDASH 5 minutes after (the time required to complete the functional tasks). Paired and unpaired t-tests were used to evaluate the null hypotheses that (1) QuickDASH scores for the intervention group would not change after the tasks on the instrument were completed and (2) the change in QuickDASH score in the intervention group would not be different than that of the control group (p < 0.05). To evaluate the clinical importance of the change in score after tasks were completed, we recorded the number of patients with a change greater than an MCID of 14 points on the QuickDASH. Fisher's exact test was used to evaluate the difference between groups in those reaching an MCID of 14.In the intervention group, the QuickDASH score decreased after the intervention (39 ± 24 versus 25 ± 19; mean difference, -14 points [95% CI, 12 to 16]; p < 0.001). The change in QuickDASH scores was greater in the intervention group than that in the control group (-14 ± 11 versus -2 ± 9 [95% CI, -17 to -7]; p < 0.001). A larger proportion of patients in the intervention group than in the control group demonstrated an improvement in QuickDASH scores greater than the 14-point MCID ([43 of 112 [38%] versus two of 20 [10%]; odds ratio, 5.4 [95% CI, 1 to 24%]; p = 0.019).Reported disability can be reduced, thereby improving PROMs, if patients complete QuickDASH tasks before completing the questionnaire. Modifiable factors that influence PROM scores and the context in which scores are measured should be analyzed before PROMs are broadly implemented into reimbursement models and quality measures for orthopaedic surgery. Standardizing PROM administration can limit the influence of context, such as task completion, on outcome scores and should be used in value-based payment models.Level II, therapeutic study.

    View details for DOI 10.1097/CORR.0000000000000731

    View details for PubMedID 31107324

  • Hip arthroscopy in the United States: an update following coding changes in 2011 JOURNAL OF HIP PRESERVATION SURGERY Truntzer, J. N., Shapiro, L. M., Hoppe, D. J., Abrams, G. D., Safran, M. R. 2017; 4 (3): 250?57

    Abstract

    The purpose of this study is to define the incidence of hip arthroscopy-related procedures in the United States prior to and following 2011 and to determine if the rise in incidence has coincided with an increase in the complexity and diversity of procedures performed. Patients who underwent hip arthroscopy were identified from a publicly available US database. A distinction was made between 'traditional' and 'extended' codes. CPT-29999 (unlisted arthroscopy) was considered extended and counted only if associated with a hip pathology diagnosis. Codes directed toward femoroacetabular impingement pathology were also considered extended codes and were analyzed separately based on increased technical skill. Unpaired student t-tests and z-score tests were performed. From 2007 to 2014, there were a total of 2581 hip arthroscopies performed in the database (1.06 cases per 10 000 patients). The number of hip arthroscopies increased 117% from 2007 to 2014 (P < 0.001) and 12.5% from 2011 to 2014 (P?=?0.045). Hip arthroscopies using extended codes increased 475% from 2007 to 2014 (P < 0.001) compared to 24% for traditional codes (P < 0.001). Codes addressing femoroacetabular impingement (FAI) pathology increased 55.7% between 2011 to 2014 (P < 0.001). The ratio of labral repair to labral debridement in patients younger than 50 years exceeded?>1.0 starting in 2011 (P < 0.001). The total number of hip arthroscopies in addition to the complexity and diversity of hip arthroscopy procedures performed in the United States continues to rise. FAI-based procedures and labral repairs are being performed more frequently in younger patients, likely reflecting both improved technical ability and current evidence-based research.

    View details for PubMedID 28948037

  • Complication Rates for Hip Arthroscopy Are Underestimated: A Population-Based Study. Arthroscopy Truntzer, J. N., Hoppe, D. J., Shapiro, L. M., Abrams, G. D., Safran, M. 2017

    Abstract

    To identify major and minor complication rates associated with hip arthroscopy from a payer-based national database and compare with the rates reported in the existing literature.Patients who underwent hip arthroscopy between 2007 and 2014 were identified using PearlDiver, a publicly available database. Rates of major and minor complications, as well as conversion to total hip arthroscopy (THA), were determined by using Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9), codes. Incidence rates of select major complications across the entire database were used as a comparison group. Statistical significance was set at P < .05.Of 18 million patients screened from 2007 to 2014, a total of 2,581 hip arthroscopies were identified. The rates of major and minor complications within a 1-year postoperative period were 1.74% and 4.22%, respectively. Complications included heterotopic ossification (2.85%), bursitis (1.23%), proximal femur fracture (1.08%), deep vein thrombosis (0.79%), and hip dislocation (0.58%). The rate of conversion to THA within 1 year was 2.85%. When compared to rates in the general population, the relative risks [RRs] of requiring a THA (age <50 years, RR = 57.66, P < .001; age >50 years, RR = 22.05, P < .001), sustaining a proximal femur fracture (age <50 years, RR = 18.02, P < .001; age >50 years, RR = 2.23, P < .001), or experiencing a hip dislocation (RR 19.60, P < .001) at 1 year after hip arthroscopy were significantly higher in all age groups.Higher major complication rates after hip arthroscopy were observed using a national payer-based database than previously reported in the literature, especially in regard to hip dislocations and proximal femur fractures. Rates of total hip arthroplasty were similar to prior studies, whereas the rates of revision hip arthroscopy were higher.Level IV, case series.

    View details for DOI 10.1016/j.arthro.2017.01.021

    View details for PubMedID 28259588

  • Diagnostic Accuracy of 3 Physical Examination Tests in the Assessment of Hip Microinstability. Orthopaedic journal of sports medicine Hoppe, D. J., Truntzer, J. N., Shapiro, L. M., Abrams, G. D., Safran, M. R. 2017; 5 (11): 2325967117740121

    Abstract

    Hip microinstability is a diagnosis gaining increasing interest. Physical examination tests to identify microinstability have not been objectively investigated using intraoperative confirmation of instability as a reference standard.To determine the test characteristics and diagnostic accuracy of 3 physical examination maneuvers in the detection of hip microinstability.Cohort study (diagnosis); Level of evidence, 2.A review was conducted of 194 consecutive hip arthroscopic procedures performed by a sports medicine surgeon at a tertiary-care academic center. Physical examination findings of interest, including the abduction-hyperextension-external rotation (AB-HEER) test, the prone instability test, and the hyperextension-external rotation (HEER) test, were obtained from prospectively collected data. The reference standard was intraoperative identification of instability based on previously published objective criteria. Test characteristics, including sensitivity, specificity, positive and negative predictive values, and accuracy, were calculated for each test as well as for combinations of tests.A total of 109 patients were included in the analysis. The AB-HEER test was most accurate, with a sensitivity of 80.6% (95% CI, 70.8%-90.5%) and a specificity of 89.4% (95% CI, 80.5%-98.2%). The prone instability test had a low sensitivity (33.9%) but a very high specificity (97.9%). The HEER test performed second in both sensitivity (71.0%) and specificity (85.1%). The combination of multiple tests with positive findings did not yield significantly greater accuracy. All tests had high positive predictive values (range, 86.3%-95.5%) and moderate negative predictive values (range, 52.9%-77.8%). When all 3 tests had positive findings, there was a 95.0% (95% CI, 90.1%-99.9%) chance that the patient had microinstability.The AB-HEER test most accurately predicted hip instability, followed by the HEER test and the prone instability test. However, the high specificity of the prone instability test makes it a useful test to "rule in" abnormalities. A positive result from any test predicted hip instability in 86.3% to 90.9% of patients, but a negative test result did not conclusively rule out hip instability, and other measures should be considered in making the diagnosis. The use of these tests may aid the clinician in diagnosing hip instability, which has been considered a difficult diagnosis to make because of its dynamic nature.

    View details for PubMedID 29226163

  • Cytokines as a predictor of clinical response following hip arthroscopy: minimum 2-year follow-up. Journal of hip preservation surgery Shapiro, L. M., Safran, M. R., Maloney, W. J., Goodman, S. B., Huddleston, J. I., Bellino, M. J., Scuderi, G. J., Abrams, G. D. 2016; 3 (3): 229-235

    Abstract

    Hip arthroscopy in patients with osteoarthritis has been shown to have suboptimal outcomes. Elevated cytokine concentrations in hip synovial fluid have previously been shown to be associated with cartilage pathology. The purpose of this study was to determine whether a relationship exists between hip synovial fluid cytokine concentration and clinical outcomes at a minimum of 2 years following hip arthroscopy. Seventeen patients without radiographic evidence of osteoarthritis had synovial fluid aspirated at time of portal establishment during hip arthroscopy. Analytes included fibronectin-aggrecan complex as well as a multiplex cytokine array. Patients completed the modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index and the International Hip Outcomes Tool pre-operatively and at a minimum of 2 years following surgery. Pre and post-operative scores were compared with a paired t-test, and the association between cytokine values and clinical outcome scores was performed with Pearson's correlation coefficient with an alpha value of 0.05 set as significant. Sixteen of seventeen patients completed 2-year follow-up questionnaires (94%). There was a significant increase in pre-operative to post-operative score for each clinical outcome measure. No statistically significant correlation was seen between any of the intra-operative cytokine values and either the 2-year follow-up scores or the change from pre-operative to final follow-up outcome values. No statistically significant associations were seen between hip synovial fluid cytokine concentrations and 2-year follow-up clinical outcome assessment scores for those undergoing hip arthroscopy.

    View details for DOI 10.1093/jhps/hnw013

    View details for PubMedID 27583163

  • Approach to MR Imaging of the Elbow and Wrist: Technical Aspects and Innovation. Magnetic resonance imaging clinics of North America Johnson, D., Stevens, K. J., Riley, G., Shapiro, L., Yoshioka, H., Gold, G. E. 2015; 23 (3): 355-366

    Abstract

    Wrist and elbow MR imaging technology is advancing at a dramatic rate. Wrist and elbow MR imaging is performed at medium and higher field strengths with more specialized surface coils and more variable pulse sequences and postprocessing techniques. High field imaging and improved coils lead to an increased signal-to-noise ratio and increased variety of soft tissue contrast options. Three-dimensional imaging is improving in terms of usability and artifacts. Some of these advances have challenges in wrist and elbow imaging, such as postoperative patient imaging, cartilage mapping, and molecular imaging. This review considers technical advances in hardware and software and their clinical applications.

    View details for DOI 10.1016/j.mric.2015.04.008

    View details for PubMedID 26216768

  • Approach to MR Imaging of the Elbow and Wrist: Technical Aspects and Innovation. Magnetic resonance imaging clinics of North America Johnson, D., Stevens, K. J., Riley, G., Shapiro, L., Yoshioka, H., Gold, G. E. 2015; 23 (3): 355-366

    Abstract

    Wrist and elbow MR imaging technology is advancing at a dramatic rate. Wrist and elbow MR imaging is performed at medium and higher field strengths with more specialized surface coils and more variable pulse sequences and postprocessing techniques. High field imaging and improved coils lead to an increased signal-to-noise ratio and increased variety of soft tissue contrast options. Three-dimensional imaging is improving in terms of usability and artifacts. Some of these advances have challenges in wrist and elbow imaging, such as postoperative patient imaging, cartilage mapping, and molecular imaging. This review considers technical advances in hardware and software and their clinical applications.

    View details for DOI 10.1016/j.mric.2015.04.008

    View details for PubMedID 26216768

    View details for PubMedCentralID PMC4518502

  • Mechanisms of osteoarthritis in the knee: MR imaging appearance. Journal of magnetic resonance imaging Shapiro, L. M., McWalter, E. J., Son, M., Levenston, M., Hargreaves, B. A., Gold, G. E. 2014; 39 (6): 1346-1356

    Abstract

    Osteoarthritis has grown to become a widely prevalent disease that has major implications in both individual and public health. Although originally considered to be a degenerative disease driven by "wear and tear" of the articular cartilage, recent evidence has led to a consensus that osteoarthritis pathophysiology should be perceived in the context of the entire joint and multiple tissues. MRI is becoming an increasingly more important modality for imaging osteoarthritis, due to its excellent soft tissue contrast and ability to acquire morphological and biochemical data. This review will describe the pathophysiology of osteoarthritis as it is associated with various tissue types, highlight several promising MR imaging techniques for osteoarthritis and illustrate the expected appearance of osteoarthritis with each technique.

    View details for DOI 10.1002/jmri.24562

    View details for PubMedID 24677706

    View details for PubMedCentralID PMC4016127

  • Predictors of an academic career on radiology residency applications. Academic radiology Grimm, L. J., Shapiro, L. M., Singhapricha, T., Mazurowski, M. A., Desser, T. S., Maxfield, C. M. 2014; 21 (5): 685-690

    Abstract

    To evaluate radiology residency applications to determine if any variables are predictive of a future academic radiology career.Application materials from 336 radiology residency graduates between 1993 and 2010 from the Department of Radiology, Duke University and between 1990 and 2010 from the Department of Radiology, Stanford University were retrospectively reviewed. The institutional review boards approved this Health Insurance Portability and Accountability Act-compliant study with a waiver of informed consent. Biographical (gender, age at application, advanced degrees, prior career), undergraduate school (school, degree, research experience, publications), and medical school (school, research experience, manuscript publications, Alpha Omega Alpha membership, clerkship grades, United States Medical Licensing Examination Step 1 and 2 scores, personal statement and letter of recommendation reference to academics, couples match status) data were recorded. Listing in the Association of American Medical Colleges Faculty Online Directory and postgraduation publications were used to determine academic status.There were 72 (21%) radiologists in an academic career and 264 (79%) in a nonacademic career. Variables associated with an academic career were elite undergraduate school (P = .003), undergraduate school publications (P = .018), additional advanced degrees (P = .027), elite medical school (P = .006), a research year in medical school (P < .001), and medical school publications (P < .001). A multivariate cross-validation analysis showed that these variables are jointly predictive of an academic career (P < .001).Undergraduate and medical school rankings and publications, as well as a medical school research year and an additional advanced degree, are associated with an academic career. Radiology residency selection committees should consider these factors in the context of the residency application if they wish to recruit future academic radiologists.

    View details for DOI 10.1016/j.acra.2013.10.019

    View details for PubMedID 24629444

  • Fibronectin-aggrecan complex as a marker for cartilage degradation in non-arthritic hips. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Abrams, G. D., Safran, M. R., Shapiro, L. M., Maloney, W. J., Goodman, S. B., Huddleston, J. I., Bellino, M. J., Scuderi, G. J. 2014; 22 (4): 768-773

    Abstract

    To report hip synovial fluid cytokine concentrations in hips with and without radiographic arthritis.Patients with no arthritis (Tonnis grade 0) and patients with Tonnis grade 2 or greater hip osteoarthritis (OA) were identified from patients undergoing either hip arthroscopy or arthroplasty. Synovial fluid was collected at the time of portal establishment for those undergoing hip arthroscopy and prior to arthrotomy for the arthroplasty group. Analytes included fibronectin-aggrecan complex (FAC) as well as a standard 12 cytokine array. Variables recorded were Tonnis grade, centre-edge angle of Wiberg, as well as labrum and cartilage pathology for the hip arthroscopy cohort. A priori power analysis was conducted, and a Mann-Whitney U test and regression analyses were used with an alpha value of 0.05 set as significant.Thirty-four patients were included (17 arthroplasty, 17 arthroscopy). FAC was the only analyte to show a significant difference between those with and without OA (p < 0.001). FAC had significantly higher concentration in those without radiographic evidence of OA undergoing microfracture versus those not receiving microfracture (p < 0.05).There was a significantly higher FAC concentration in patients without radiographic OA. Additionally, those undergoing microfracture had increased levels of FAC. As FAC is a cartilage breakdown product, no significant amounts may be present in those with OA. In contrast, those undergoing microfracture have focal area(s) of cartilage breakdown. These data suggest that FAC may be useful in predicting cartilage pathology in those patients with hip pain but without radiographic evidence of arthritis.Diagnostic, Level III.

    View details for DOI 10.1007/s00167-014-2863-2

    View details for PubMedID 24477496

  • Advances in musculoskeletal MRI: Technical considerations JOURNAL OF MAGNETIC RESONANCE IMAGING Shapiro, L., Harish, M., Hargreaves, B., Staroswiecki, E., Gold, G. 2012; 36 (4): 775-787

    Abstract

    The technology of musculoskeletal magnetic resonance imaging (MRI) is advancing at a dramatic rate. MRI is now done at medium and higher field strengths with more specialized surface coils and with more variable pulse sequences and postprocessing techniques than ever before. These innumerable technical advances are advantageous as they lead to an increased signal-to-noise ratio and increased variety of soft-tissue contrast options. However, at the same time they potentially produce more imaging artifacts when compared with past techniques. Substantial technical advances have considerable clinical challenges in musculoskeletal radiology such as postoperative patient imaging, cartilage mapping, and molecular imaging. In this review we consider technical advances in hardware and software of musculoskeletal MRI along with their clinical applications.

    View details for DOI 10.1002/jmri.23629

    View details for Web of Science ID 000308884300002

    View details for PubMedID 22987756

    View details for PubMedCentralID PMC3448292

  • Magnetic Resonance Imaging of the Knee: Optimizing 3 Tesla Imaging SEMINARS IN ROENTGENOLOGY Shapiro, L., Staroswiecki, E., Gold, G. 2010; 45 (4): 238-249

    View details for DOI 10.1053/j.ro.2009.12.007

    View details for Web of Science ID 000281363000003

    View details for PubMedID 20727453

    View details for PubMedCentralID PMC2941506

  • Advances in musculoskeletal magnetic resonance imaging. Topics in magnetic resonance imaging Gold, G., Shapiro, L., Hargreaves, B., Bangerter, N. 2010; 21 (5): 335-338

    Abstract

    The technology of musculoskeletal magnetic resonance imaging is advancing at a dramatic rate. Magnetic resonance imaging is now done at medium and higher field strengths with more specialized surface coils and with more variable pulse sequences and postprocessing techniques than ever before. These numerable technical advances are advantageous because they lead to an increased signal-to-noise ratio and increased variety of soft tissue contrast options. However, at the same time, they potentially produce more imaging artifacts when compared with past techniques. Substantial technical advances have considerable clinical challenges in musculoskeletal radiology such as postoperative patient imaging, cartilage mapping, and molecular imaging. In this review, we consider technical advances in hardware and software of musculoskeletal magnetic resonance imaging along with their clinical applications.

    View details for DOI 10.1097/RMR.0b013e31823cd195

    View details for PubMedID 22129646

  • Cartilage Morphology at 3.0T: Assessment of Three-Dimensional Magnetic Resonance Imaging Techniques JOURNAL OF MAGNETIC RESONANCE IMAGING Chen, C. A., Kijowski, R., Shapiro, L. M., Tuite, M. J., Davis, K. W., Klaers, J. L., Block, W. F., Reeder, S. B., Gold, G. E. 2010; 32 (1): 173-183

    Abstract

    To compare six new three-dimensional (3D) magnetic resonance (MR) methods for evaluating knee cartilage at 3.0T.We compared: fast-spin-echo cube (FSE-Cube), vastly undersampled isotropic projection reconstruction balanced steady-state free precession (VIPR-bSSFP), iterative decomposition of water and fat with echo asymmetry and least-squares estimation combined with spoiled gradient echo (IDEAL-SPGR) and gradient echo (IDEAL-GRASS), multiecho in steady-state acquisition (MENSA), and coherent oscillatory state acquisition for manipulation of image contrast (COSMIC). Five-minute sequences were performed twice on 10 healthy volunteers and once on five osteoarthritis (OA) patients. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured from the volunteers. Images of the five volunteers and the five OA patients were ranked on tissue contrast, articular surface clarity, reformat quality, and lesion conspicuity. FSE-Cube and VIPR-bSSFP were compared to IDEAL-SPGR for cartilage volume measurements.FSE-Cube had top rankings for lesion conspicuity, overall SNR, and CNR (P < 0.02). VIPR-bSSFP had top rankings in tissue contrast and articular surface clarity. VIPR and FSE-Cube tied for best in reformatting ability. FSE-Cube and VIPR-bSSFP compared favorably to IDEAL-SPGR in accuracy and precision of cartilage volume measurements.FSE-Cube and VIPR-bSSFP produce high image quality with accurate volume measurement of knee cartilage.

    View details for DOI 10.1002/jmri.22213

    View details for Web of Science ID 000279439600021

    View details for PubMedID 20578024

    View details for PubMedCentralID PMC3065186

Footer Links:

Stanford Medicine Resources: