Omer Awan - Academia.edu (original) (raw)

Papers by Omer Awan

Journal of Nuclear Medicine Technology, 2017

Introduction Patient satisfaction and perception of health care delivery is essential in contempo... more Introduction Patient satisfaction and perception of health care delivery is essential in contemporary health system. Our study quantitatively measures patient perception of quality and satisfaction in a PET-CT center at the point of care using a psychometrically validated questionnaire, SERVPERF, to guide subsequent quality improvement interventions. SERVPERF is a survey instrument that captures service quality by measuring performance of various services. It has demonstrated reliability and validity across various industries. The standard for measuring patient perception of quality in hospitals, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey does not include questions sensitive to the care received in a typical radiology department and is not obtained at the point of care. Methods 429 patients receiving PET-CT examinations filled out an anonymous modified SERVPERF questionnaire upon completion of imaging and reported level of agreement with each of the 27 items by circling a Likert type scale from 1-7. Each of the items was designed to elicit response regarding patient perception of performance on a metric of quality. Data were summarized as mean of each item. Frequency of low scores (<3) was also calculated. Results The items with the lowest mean score were "The department's physical facilities are visually appealing" (6.158) and "Documentation such as sign-in sheet, handouts and brochure as visually appealing" (6.161). The item with the highest frequency of low scores (<3) was, "The department provides services at the promised time" (11/429 responses). 2 Conclusion Our study showed that patient perception of quality in a diagnostic radiology department can be measured with a standardized survey at the point of care delivery and used to direct patient centered quality improvement interventions.

Journal of Nuclear Medicine Technology, 2018

Statistics Flaws TO THE EDITOR: It was fantastic to participate in the training run for the new J... more Statistics Flaws TO THE EDITOR: It was fantastic to participate in the training run for the new JNMT Twitter-based journal club (@JNMTClub using #JNMTClub). Although only a small number of invited participants were engaged, it promises to be a fantastic medium for nuclear medicine technologists to connect, engage, learn, and participate in continuing education among a global community of colleagues. The format will be of benefit to those experienced in social media and the novice. The JNMT article discussed during the Twitter-based journal club was Dako et al. (1), examining the patients' perception of quality at the point of care in PET. The Twitter discussion asked the question ''Do you think the results of the survey are meaningful?'' The results lack any statistical validity in my opinion. The Likert scale used rendered the data ordinal in nature. The statistical analysis treated the data as though it were continuous data, and this represents a fatal flaw. Ordinal data should not be represented as a mean; the median is the appropriate expression for central tendency (2). Indeed, had the median been cited, it may have given a better insight into any trends. This flaw is easily rectified with appropriate statistical treatment; however, the mean data and associated P values are inappropriate and leave no conclusions that can be reliably drawn. This statistical flaw is not uncommon in the medical literature but represents reputation damage to the research itself, the review process of the journal, the journal, and the broader profession. A working understanding of appropriate use and meaning of common statistical tools is essential for all.

Current Problems in Diagnostic Radiology, 2020

Academic Radiology, 2020

Social media is a ubiquitous part of society and used by many healthcare professionals, including... more Social media is a ubiquitous part of society and used by many healthcare professionals, including radiologists. This article prepared by the 2019-2020 Radiology Research Alliance Social Media Task Force presents different uses and benefits of an online professional social media profile. Physician and healthcare-specific issues along with popular platforms such as LinkedIn, Facebook, Twitter, Instagram, and YouTube are used to explore topics including education, branding, research, mentorship, promotion, and leadership.

Current Problems in Diagnostic Radiology, 2020

Although rare in everyday practice, malignancies that classically arise from bone or cartilage ha... more Although rare in everyday practice, malignancies that classically arise from bone or cartilage have been reported to arise de novo in various soft tissues in the body, resulting in a diagnostic challenge for the clinician, radiologist, and pathologist. Differential diagnoses of bone tumors often depend on anatomic location of the lesion. For example, the classic location of osteosarcoma is in the metaphysis of long bones about the knee. Histologically osteosarcoma is characterized by tumor cells that directly produce osteoid, bone, or cartilaginous matrix. In extraskeletal osteosarcoma, the clinical and radiologic picture is very different from a conventional osteosarcoma. They occur in older patients, present as a soft tissue mass often coincidentally following trauma and have a worse prognosis. The imaging characteristics are often nonspecific with mineralized elements in a welldefined soft tissue mass. The mineralized elements may or may not be visible. Magnetic Resonance sequences demonstrate a well circumscribed soft tissue mass with hemorrhagic and enhancing solid components. The pathologic features of extraskeletal osteosarcoma on a microscopic scale are identical to that of skeletal lesions. Likewise, conventional chondrosarcomas present in older patients with a growing, painful soft tissue prominence most commonly involving the long tubular bones. In extraskeletal chondrosarcoma however, the presentation is in somewhat younger patients with a painful soft tissue prominence typically in the head (meninges), neck, or upper leg. The pathologic features are most often that of a myxoid chondrosarcoma which is characterized by strands of small cells over a myxoid matrix. Imaging features include chondroid matrix, heterogenous contrast enhancement, and amorphous internal calcification on Computed Tomography. On Magnetic Resonance sequences the matrix has a low signal on all sequences, and variable inhomogeneity depending on grade of the lesion. Other extraskeletal bone tumors include Ewing's sarcoma and osteoid osteoma amongst other lesions. Although these malignancies may be rare clinical entities, they often exhibit characteristic clinical, imaging, and histopathological findings although differing in treatment and prognosis. Knowledge of these and other common mimicking lesions will help guide the clinician and radiologist to make an accurate diagnosis.

Cureus, 2018

Design Thinking is a method for the practical, creative resolution of problems using the strategi... more Design Thinking is a method for the practical, creative resolution of problems using the strategies used during the process of designing. It is increasingly being used in Medical enterprise to develop a solution-based approach to identify ambiguous problems and create alternative paths to the solution. We faced several challenges in the development of a clinical context generation tool and in this article, we retrospectively assess the usefulness of a Design Thinking approach had it been applied to a project related to Medical Imaging-related clinical context generation.

Journal of Computer Assisted Tomography, 2019

Compression of the sciatic nerve in its path along the piriformis muscle can produce sciatica-lik... more Compression of the sciatic nerve in its path along the piriformis muscle can produce sciatica-like symptoms. There are 6 predominant types of sciatic nerve variations with type 1 being the most common (84.2%), followed by type 2 (13.9%). However, there is scarce literature on the prevalence of sciatic nerve variation in those diagnosed with sciatica. Materials and Methods: The charts of 95 patients clinically diagnosed with sciatica who had a magnetic resonance imaging of the pelvis/hip were retrospectively studied. All patients had T1-weighted axial, coronal, and sagittal images. Magnetic resonance imagings were interpreted separately by 2 board-certified fellowship-trained musculoskeletal radiologists to identify the sciatic nerve variant. Results: Seven cases were excluded because of inadequate imaging. Of the remaining 88 patients, 5 had bilateral sciatica resulting in a sample size of 93 limbs. Fifty-two (55.9%) had type 1 sciatic nerve anatomy, 39 (41.9%) had type 2, and 2 (2.2%) had type 3. The proportions of type 1 and 2 variations were significantly different from the normal distribution (P < 0.001), whereas type 3, 4, 5, and 6 variants were not (P = 1.00). Conclusions: There is strong statistical significance regarding the relationship between sciatic nerve variation and the clinical diagnosis of sciatica. Preoperative magnetic resonance imaging can be considered in sciatica patients to prevent iatrogenic injury in pelvic surgery.

Academic Radiology, 2019

With continued technologic advances, it is not surprising that gaming techniques are increasingly... more With continued technologic advances, it is not surprising that gaming techniques are increasingly being used in radiology residency programs. This comprehensive review on gaming in radiology education offers insight into the importance of gaming, types of games and principles utilized in gaming, as well as applications that are inherent in artificial intelligence and continued medical education. The advantages and disadvantages of gaming will be considered, as well as barriers to successful adoption of gaming.

Current Problems in Diagnostic Radiology, 2019

Transitioning from radiology residency to academic faculty presents many challenges. In this revi... more Transitioning from radiology residency to academic faculty presents many challenges. In this review, we discuss the importance of introspection and mentorship to successfully navigate this process. Key points include alignment of goals with those of the institution, formation of a mentorship program, and periodic reassessment of career goals. These tips and tools can help make the transition from residency to academic faculty more seamless.

Emergency Radiology, 2019

Purpose The main purpose of the study is to determine if the presence of a particular computed to... more Purpose The main purpose of the study is to determine if the presence of a particular computed tomography (CT) imaging finding, a bursal lipohematoma, portends the presence of a concomitant rotator cuff tear (RCT) in patients with proximal humerus fractures by reviewing previous CTs. Methods Three hundred eighty-six CT scans were retrospectively reviewed by two board-certified radiologists to determine the presence of a proximal humerus fracture and to assess for the presence of a subacromial/subdeltoid or subcoracoid bursal hematoma. The medical record including operative documentation was then examined in the patients with proximal humerus fractures, with or without a concomitant bursal lipohematoma. Results Of the surgically managed patients, four had an intraoperative diagnosis of RCT. The preoperative CT scans of all of these patients demonstrated a bursal lipohematoma. Additionally, a non-surgically managed patient with a subacromial/ subdeltoid bursal lipohematoma on CT scan was found to have a RCT on subsequent MRI. Of note, a rotator cuff tear was not documented in operative reports of patients with CT scans that were not found to contain a bursal lipohematoma. Conclusions Bursal lipohematoma is a potentially useful preoperative CT sign of full thickness rotator cuff tear in patients with proximal humerus fractures, providing the clinician with more information in the optimization of the management approach.

Cureus, 2018

Introduction Radiology residency programs are increasingly using audience response systems (ARS) ... more Introduction Radiology residency programs are increasingly using audience response systems (ARS) in educational lectures. It is imperative that this is investigated to assess if learning outcomes in trainees are actually improved. Methods The primary objective of this randomized prospective unblinded pilot study was to assess the effect of ARS on long-term learning outcomes, with a secondary objective of understanding perceptions of ARS amongst radiology residents. Twenty-two radiology residents were randomized into two groups of 11 residents each receiving five identical musculoskeletal (MSK) radiology lectures. One group received lectures through ARS and the other through traditional didactics. A pretest and identical posttest were completed by all residents at baseline and eight months later, respectively. Residents also completed a pre and post fivequestion Likert scale survey designed to measure perceptions of ARS. Results Wilcoxon rank sum tests revealed no statistically significant difference between the two groups of residents on the pretest (p = 0.47) or the posttest (p = 0.41). Of the five questions designed to gauge perceptions of ARS, "How often do you study radiology outside of work?" resulted in statistical significance between groups after the lecture series via ordinal logistic regression, with the ARS group six times more likely to study compared to the non-ARS group (Odds ratio = 6.52, P = 0.04, 95% Confidence Interval [1.1, 38.2]). There was no statistical difference in response to this question prior to the lecture series. Discussion Use of ARS was associated with increased likelihood of studying radiology without significant difference in long-term learning outcomes.

Journal of the American College of Radiology : JACR, Mar 20, 2018

Enterprise imaging has channeled various technological innovations to the field of clinical radio... more Enterprise imaging has channeled various technological innovations to the field of clinical radiology, ranging from advanced imaging equipment and postacquisition iterative reconstruction tools to image analysis and computer-aided detection tools. More recently, the advancements in the field of quantitative image analysis coupled with machine learning-based data analytics, classification, and integration have ushered us into the era of radiomics, which has tremendous potential in clinical decision support as well as drug discovery. There are important issues to consider to incorporate radiomics as a clinically applicable system and a commercially viable solution. In this two-part series, we offer insights into the development of the translational pipeline for radiomics from methodology to clinical implementation (Part 1) and from that to enterprise development (Part 2).

Cureus, Jan 10, 2017

Computer-assisted learning (CAL) as a health informatics application is a useful tool for medical... more Computer-assisted learning (CAL) as a health informatics application is a useful tool for medical students in the era of expansive knowledge bases and the increasing need for and the consumption of automated and interactive systems. As the scope and breadth of medical knowledge expand, the need for additional learning outside of lecture hours is becoming increasingly important. CAL can be an impactful adjunct to conventional methods that currently exist in the halls of learning. There is an increasing body of literature that suggests that CAL should be a commonplace and the recommended method of learning for medical students. Factors such as technical issues that hinder the performance of CAL are also evaluated. We conclude by encouraging the use of CAL by medical students as a highly beneficial method of learning that complements and enhances lectures and provides intuitive, interactive modulation of a self-paced curriculum based on the individual's academic abilities.

JCO Clinical Cancer Informatics, 2017

Radiomics is a quantitative approach to medical image analysis targeted at deciphering the morpho... more Radiomics is a quantitative approach to medical image analysis targeted at deciphering the morphologic and functional features of a lesion. Radiomic methods can be applied across various malignant conditions to identify tumor phenotype characteristics in the images that correlate with their likelihood of survival, as well as their association with the underlying biology. Identifying this set of characteristic features, called tumor signature, holds tremendous value in predicting the behavior and progression of cancer, which in turn has the potential to predict its response to various therapeutic options. We discuss the technical challenges encountered in the application of radiomics, in terms of methodology, workflow integration, and user experience, that need to be addressed to harness its true potential.

Journal of Digital Imaging, 2017

In the era of value-based healthcare, many aspects of medical care are being measured and assesse... more In the era of value-based healthcare, many aspects of medical care are being measured and assessed to improve quality and reduce costs. Radiology adds enormously to health care costs and is under pressure to adopt a more efficient system that incorporates essential metrics to assess its value and impact on outcomes. Most current systems tie radiologists' incentives and evaluations to RVU-based productivity metrics and peer-review-based quality metrics. In a new potential model, a radiologist's performance will have to increasingly depend on a number of parameters that define Bvalue,^beginning with peer review metrics that include referrer satisfaction and feedback from radiologists to the referring physician that evaluates the potency and validity of clinical information provided for a given study. These new dimensions of value measurement will directly impact the cascade of further medical management. We share our continued experience with this project that had two components: RESP (Referrer Evaluation System Pilot) and FRACI (Feedback from Radiologist Addressing Confounding Issues), which were introduced to the clinical radiology workflow in order to capture referrer-based and radiologist-based feedback on radiology reporting. We also share our insight into the principles of design thinking as applied in its planning and execution.

Skeletal Radiology, 2016

Bizarre parosteal osteochondromatous proliferation (Nora lesion) of the metacarpal.

Cureus, 2015

We share our experience with serial PET/CT imaging on a patient with extranodal Rosai-Dorfman dis... more We share our experience with serial PET/CT imaging on a patient with extranodal Rosai-Dorfman disease (RDD) with hepatopancreatic involvement. RDD is a benign proliferative disorder of histiocytes mainly involving the lymph nodes. It typically presents with fever and painless cervical lymphadenopathy in young adults and less than half of RDS cases demonstrate extranodal involvement. RDD involvement of the liver and pancreas is extremely rare, and this case highlights the role of PET/CT in its management.

Cureus, 2015

Neurolymphomatosis (NL) is a rare disease characterized by malignant lymphocytes infiltrating var... more Neurolymphomatosis (NL) is a rare disease characterized by malignant lymphocytes infiltrating various structures of the nervous system. It typically manifests as a neuropathy involving the peripheral nerves, nerve roots, plexuses, or cranial nerves. It often presents as a complication of lymphoma, but it can be the presenting feature of recurrent lymphoma. It is essential to identify and initiate treatment early with chemotherapy and/or radiation therapy in all cases of nodal or visceral (including neural) involvement with lymphoma. There are various diagnostic tests that can be used for its detection, such as cerebrospinal spinal fluid (CSF) cytology, electromyography (EMG), magnetic resonance imaging (MRI), and positron-emission tomography/computed tomography (PET/CT). FDG-PET/CT is the standard of care in lymphoma staging, restaging, and therapy response assessment, but has an inherent limitation in the detection of disease involvement in the central nervous system. While that is mostly true for visual assessment, there are quantitative methods to measure variation in the metabolic activity in the brain, which in turn helps detect the occurrence of neurolymphomatosis.

Cureus, 2015

Neurolymphomatosis (NL) is a rare condition associated with lymphomas in which various structures... more Neurolymphomatosis (NL) is a rare condition associated with lymphomas in which various structures of the nervous system are infiltrated by malignant lymphocytes. Rarely, it may be the presenting feature of recurrence of lymphoma otherwise deemed to be in remission. It is crucial, as is the case with all types of nodal or visceral involvement of lymphoma, to identify the disease early and initiate treatment with chemotherapy and/or radiation therapy. Positron emission tomography-computed tomography (PET-CT) has been shown to be a sensitive modality for staging, restaging, biopsy guidance, therapy response assessment, and surveillance for recurrence of lymphoma. Magnetic resonance imaging (MRI) is another useful imaging modality, which, along with PET/CT, compliment cerebrospinal spinal fluid (CSF) cytology and electromyography (EMG) in the diagnosis of NL. Performing nerve biopsies to confirm neurolymphomatosis can be challenging and with associated morbidity. The case presented herein illustrates the practical usefulness of these tests in detecting NL as a heralding feature of lymphoma recurrence, especially in the absence of histopathologic correlation.

Cureus, 2015

Nuclear protein testis (NUT) midline carcinoma is a rare malignancy involving predominantly the m... more Nuclear protein testis (NUT) midline carcinoma is a rare malignancy involving predominantly the midline structures of the body. It is characterized by its genotypic feature of BRD4-NUT translocation, which is in contrast with other malignant processes that are usually categorized based on their histologic/phenotypic features. As these tumors may vary in their histologic presentation, they can be misdiagnosed as poorly differentiated carcinomas. Moreover, they are often very aggressive and associated with high mortality. Therefore, it is extremely important to diagnose them early using computed tomography (CT) and magnetic resonance imaging (MRI) and perform staging and restaging using 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT), in addition to accurately identifying them at a microscopic and molecular level. We report a unique case of a sinonasal NUT midline carcinoma that was diagnosed with CT, staged with PET/CT, and restaged using PET/CT and MRI.

Journal of Nuclear Medicine Technology, 2017

Introduction Patient satisfaction and perception of health care delivery is essential in contempo... more Introduction Patient satisfaction and perception of health care delivery is essential in contemporary health system. Our study quantitatively measures patient perception of quality and satisfaction in a PET-CT center at the point of care using a psychometrically validated questionnaire, SERVPERF, to guide subsequent quality improvement interventions. SERVPERF is a survey instrument that captures service quality by measuring performance of various services. It has demonstrated reliability and validity across various industries. The standard for measuring patient perception of quality in hospitals, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey does not include questions sensitive to the care received in a typical radiology department and is not obtained at the point of care. Methods 429 patients receiving PET-CT examinations filled out an anonymous modified SERVPERF questionnaire upon completion of imaging and reported level of agreement with each of the 27 items by circling a Likert type scale from 1-7. Each of the items was designed to elicit response regarding patient perception of performance on a metric of quality. Data were summarized as mean of each item. Frequency of low scores (<3) was also calculated. Results The items with the lowest mean score were "The department's physical facilities are visually appealing" (6.158) and "Documentation such as sign-in sheet, handouts and brochure as visually appealing" (6.161). The item with the highest frequency of low scores (<3) was, "The department provides services at the promised time" (11/429 responses). 2 Conclusion Our study showed that patient perception of quality in a diagnostic radiology department can be measured with a standardized survey at the point of care delivery and used to direct patient centered quality improvement interventions.

Journal of Nuclear Medicine Technology, 2018

Statistics Flaws TO THE EDITOR: It was fantastic to participate in the training run for the new J... more Statistics Flaws TO THE EDITOR: It was fantastic to participate in the training run for the new JNMT Twitter-based journal club (@JNMTClub using #JNMTClub). Although only a small number of invited participants were engaged, it promises to be a fantastic medium for nuclear medicine technologists to connect, engage, learn, and participate in continuing education among a global community of colleagues. The format will be of benefit to those experienced in social media and the novice. The JNMT article discussed during the Twitter-based journal club was Dako et al. (1), examining the patients' perception of quality at the point of care in PET. The Twitter discussion asked the question ''Do you think the results of the survey are meaningful?'' The results lack any statistical validity in my opinion. The Likert scale used rendered the data ordinal in nature. The statistical analysis treated the data as though it were continuous data, and this represents a fatal flaw. Ordinal data should not be represented as a mean; the median is the appropriate expression for central tendency (2). Indeed, had the median been cited, it may have given a better insight into any trends. This flaw is easily rectified with appropriate statistical treatment; however, the mean data and associated P values are inappropriate and leave no conclusions that can be reliably drawn. This statistical flaw is not uncommon in the medical literature but represents reputation damage to the research itself, the review process of the journal, the journal, and the broader profession. A working understanding of appropriate use and meaning of common statistical tools is essential for all.

Current Problems in Diagnostic Radiology, 2020

Academic Radiology, 2020

Social media is a ubiquitous part of society and used by many healthcare professionals, including... more Social media is a ubiquitous part of society and used by many healthcare professionals, including radiologists. This article prepared by the 2019-2020 Radiology Research Alliance Social Media Task Force presents different uses and benefits of an online professional social media profile. Physician and healthcare-specific issues along with popular platforms such as LinkedIn, Facebook, Twitter, Instagram, and YouTube are used to explore topics including education, branding, research, mentorship, promotion, and leadership.

Current Problems in Diagnostic Radiology, 2020

Although rare in everyday practice, malignancies that classically arise from bone or cartilage ha... more Although rare in everyday practice, malignancies that classically arise from bone or cartilage have been reported to arise de novo in various soft tissues in the body, resulting in a diagnostic challenge for the clinician, radiologist, and pathologist. Differential diagnoses of bone tumors often depend on anatomic location of the lesion. For example, the classic location of osteosarcoma is in the metaphysis of long bones about the knee. Histologically osteosarcoma is characterized by tumor cells that directly produce osteoid, bone, or cartilaginous matrix. In extraskeletal osteosarcoma, the clinical and radiologic picture is very different from a conventional osteosarcoma. They occur in older patients, present as a soft tissue mass often coincidentally following trauma and have a worse prognosis. The imaging characteristics are often nonspecific with mineralized elements in a welldefined soft tissue mass. The mineralized elements may or may not be visible. Magnetic Resonance sequences demonstrate a well circumscribed soft tissue mass with hemorrhagic and enhancing solid components. The pathologic features of extraskeletal osteosarcoma on a microscopic scale are identical to that of skeletal lesions. Likewise, conventional chondrosarcomas present in older patients with a growing, painful soft tissue prominence most commonly involving the long tubular bones. In extraskeletal chondrosarcoma however, the presentation is in somewhat younger patients with a painful soft tissue prominence typically in the head (meninges), neck, or upper leg. The pathologic features are most often that of a myxoid chondrosarcoma which is characterized by strands of small cells over a myxoid matrix. Imaging features include chondroid matrix, heterogenous contrast enhancement, and amorphous internal calcification on Computed Tomography. On Magnetic Resonance sequences the matrix has a low signal on all sequences, and variable inhomogeneity depending on grade of the lesion. Other extraskeletal bone tumors include Ewing's sarcoma and osteoid osteoma amongst other lesions. Although these malignancies may be rare clinical entities, they often exhibit characteristic clinical, imaging, and histopathological findings although differing in treatment and prognosis. Knowledge of these and other common mimicking lesions will help guide the clinician and radiologist to make an accurate diagnosis.

Cureus, 2018

Design Thinking is a method for the practical, creative resolution of problems using the strategi... more Design Thinking is a method for the practical, creative resolution of problems using the strategies used during the process of designing. It is increasingly being used in Medical enterprise to develop a solution-based approach to identify ambiguous problems and create alternative paths to the solution. We faced several challenges in the development of a clinical context generation tool and in this article, we retrospectively assess the usefulness of a Design Thinking approach had it been applied to a project related to Medical Imaging-related clinical context generation.

Journal of Computer Assisted Tomography, 2019

Compression of the sciatic nerve in its path along the piriformis muscle can produce sciatica-lik... more Compression of the sciatic nerve in its path along the piriformis muscle can produce sciatica-like symptoms. There are 6 predominant types of sciatic nerve variations with type 1 being the most common (84.2%), followed by type 2 (13.9%). However, there is scarce literature on the prevalence of sciatic nerve variation in those diagnosed with sciatica. Materials and Methods: The charts of 95 patients clinically diagnosed with sciatica who had a magnetic resonance imaging of the pelvis/hip were retrospectively studied. All patients had T1-weighted axial, coronal, and sagittal images. Magnetic resonance imagings were interpreted separately by 2 board-certified fellowship-trained musculoskeletal radiologists to identify the sciatic nerve variant. Results: Seven cases were excluded because of inadequate imaging. Of the remaining 88 patients, 5 had bilateral sciatica resulting in a sample size of 93 limbs. Fifty-two (55.9%) had type 1 sciatic nerve anatomy, 39 (41.9%) had type 2, and 2 (2.2%) had type 3. The proportions of type 1 and 2 variations were significantly different from the normal distribution (P < 0.001), whereas type 3, 4, 5, and 6 variants were not (P = 1.00). Conclusions: There is strong statistical significance regarding the relationship between sciatic nerve variation and the clinical diagnosis of sciatica. Preoperative magnetic resonance imaging can be considered in sciatica patients to prevent iatrogenic injury in pelvic surgery.

Academic Radiology, 2019

With continued technologic advances, it is not surprising that gaming techniques are increasingly... more With continued technologic advances, it is not surprising that gaming techniques are increasingly being used in radiology residency programs. This comprehensive review on gaming in radiology education offers insight into the importance of gaming, types of games and principles utilized in gaming, as well as applications that are inherent in artificial intelligence and continued medical education. The advantages and disadvantages of gaming will be considered, as well as barriers to successful adoption of gaming.

Current Problems in Diagnostic Radiology, 2019

Transitioning from radiology residency to academic faculty presents many challenges. In this revi... more Transitioning from radiology residency to academic faculty presents many challenges. In this review, we discuss the importance of introspection and mentorship to successfully navigate this process. Key points include alignment of goals with those of the institution, formation of a mentorship program, and periodic reassessment of career goals. These tips and tools can help make the transition from residency to academic faculty more seamless.

Emergency Radiology, 2019

Purpose The main purpose of the study is to determine if the presence of a particular computed to... more Purpose The main purpose of the study is to determine if the presence of a particular computed tomography (CT) imaging finding, a bursal lipohematoma, portends the presence of a concomitant rotator cuff tear (RCT) in patients with proximal humerus fractures by reviewing previous CTs. Methods Three hundred eighty-six CT scans were retrospectively reviewed by two board-certified radiologists to determine the presence of a proximal humerus fracture and to assess for the presence of a subacromial/subdeltoid or subcoracoid bursal hematoma. The medical record including operative documentation was then examined in the patients with proximal humerus fractures, with or without a concomitant bursal lipohematoma. Results Of the surgically managed patients, four had an intraoperative diagnosis of RCT. The preoperative CT scans of all of these patients demonstrated a bursal lipohematoma. Additionally, a non-surgically managed patient with a subacromial/ subdeltoid bursal lipohematoma on CT scan was found to have a RCT on subsequent MRI. Of note, a rotator cuff tear was not documented in operative reports of patients with CT scans that were not found to contain a bursal lipohematoma. Conclusions Bursal lipohematoma is a potentially useful preoperative CT sign of full thickness rotator cuff tear in patients with proximal humerus fractures, providing the clinician with more information in the optimization of the management approach.

Cureus, 2018

Introduction Radiology residency programs are increasingly using audience response systems (ARS) ... more Introduction Radiology residency programs are increasingly using audience response systems (ARS) in educational lectures. It is imperative that this is investigated to assess if learning outcomes in trainees are actually improved. Methods The primary objective of this randomized prospective unblinded pilot study was to assess the effect of ARS on long-term learning outcomes, with a secondary objective of understanding perceptions of ARS amongst radiology residents. Twenty-two radiology residents were randomized into two groups of 11 residents each receiving five identical musculoskeletal (MSK) radiology lectures. One group received lectures through ARS and the other through traditional didactics. A pretest and identical posttest were completed by all residents at baseline and eight months later, respectively. Residents also completed a pre and post fivequestion Likert scale survey designed to measure perceptions of ARS. Results Wilcoxon rank sum tests revealed no statistically significant difference between the two groups of residents on the pretest (p = 0.47) or the posttest (p = 0.41). Of the five questions designed to gauge perceptions of ARS, "How often do you study radiology outside of work?" resulted in statistical significance between groups after the lecture series via ordinal logistic regression, with the ARS group six times more likely to study compared to the non-ARS group (Odds ratio = 6.52, P = 0.04, 95% Confidence Interval [1.1, 38.2]). There was no statistical difference in response to this question prior to the lecture series. Discussion Use of ARS was associated with increased likelihood of studying radiology without significant difference in long-term learning outcomes.

Journal of the American College of Radiology : JACR, Mar 20, 2018

Enterprise imaging has channeled various technological innovations to the field of clinical radio... more Enterprise imaging has channeled various technological innovations to the field of clinical radiology, ranging from advanced imaging equipment and postacquisition iterative reconstruction tools to image analysis and computer-aided detection tools. More recently, the advancements in the field of quantitative image analysis coupled with machine learning-based data analytics, classification, and integration have ushered us into the era of radiomics, which has tremendous potential in clinical decision support as well as drug discovery. There are important issues to consider to incorporate radiomics as a clinically applicable system and a commercially viable solution. In this two-part series, we offer insights into the development of the translational pipeline for radiomics from methodology to clinical implementation (Part 1) and from that to enterprise development (Part 2).

Cureus, Jan 10, 2017

Computer-assisted learning (CAL) as a health informatics application is a useful tool for medical... more Computer-assisted learning (CAL) as a health informatics application is a useful tool for medical students in the era of expansive knowledge bases and the increasing need for and the consumption of automated and interactive systems. As the scope and breadth of medical knowledge expand, the need for additional learning outside of lecture hours is becoming increasingly important. CAL can be an impactful adjunct to conventional methods that currently exist in the halls of learning. There is an increasing body of literature that suggests that CAL should be a commonplace and the recommended method of learning for medical students. Factors such as technical issues that hinder the performance of CAL are also evaluated. We conclude by encouraging the use of CAL by medical students as a highly beneficial method of learning that complements and enhances lectures and provides intuitive, interactive modulation of a self-paced curriculum based on the individual's academic abilities.

JCO Clinical Cancer Informatics, 2017

Radiomics is a quantitative approach to medical image analysis targeted at deciphering the morpho... more Radiomics is a quantitative approach to medical image analysis targeted at deciphering the morphologic and functional features of a lesion. Radiomic methods can be applied across various malignant conditions to identify tumor phenotype characteristics in the images that correlate with their likelihood of survival, as well as their association with the underlying biology. Identifying this set of characteristic features, called tumor signature, holds tremendous value in predicting the behavior and progression of cancer, which in turn has the potential to predict its response to various therapeutic options. We discuss the technical challenges encountered in the application of radiomics, in terms of methodology, workflow integration, and user experience, that need to be addressed to harness its true potential.

Journal of Digital Imaging, 2017

In the era of value-based healthcare, many aspects of medical care are being measured and assesse... more In the era of value-based healthcare, many aspects of medical care are being measured and assessed to improve quality and reduce costs. Radiology adds enormously to health care costs and is under pressure to adopt a more efficient system that incorporates essential metrics to assess its value and impact on outcomes. Most current systems tie radiologists' incentives and evaluations to RVU-based productivity metrics and peer-review-based quality metrics. In a new potential model, a radiologist's performance will have to increasingly depend on a number of parameters that define Bvalue,^beginning with peer review metrics that include referrer satisfaction and feedback from radiologists to the referring physician that evaluates the potency and validity of clinical information provided for a given study. These new dimensions of value measurement will directly impact the cascade of further medical management. We share our continued experience with this project that had two components: RESP (Referrer Evaluation System Pilot) and FRACI (Feedback from Radiologist Addressing Confounding Issues), which were introduced to the clinical radiology workflow in order to capture referrer-based and radiologist-based feedback on radiology reporting. We also share our insight into the principles of design thinking as applied in its planning and execution.

Skeletal Radiology, 2016

Bizarre parosteal osteochondromatous proliferation (Nora lesion) of the metacarpal.

Cureus, 2015

We share our experience with serial PET/CT imaging on a patient with extranodal Rosai-Dorfman dis... more We share our experience with serial PET/CT imaging on a patient with extranodal Rosai-Dorfman disease (RDD) with hepatopancreatic involvement. RDD is a benign proliferative disorder of histiocytes mainly involving the lymph nodes. It typically presents with fever and painless cervical lymphadenopathy in young adults and less than half of RDS cases demonstrate extranodal involvement. RDD involvement of the liver and pancreas is extremely rare, and this case highlights the role of PET/CT in its management.

Cureus, 2015

Neurolymphomatosis (NL) is a rare disease characterized by malignant lymphocytes infiltrating var... more Neurolymphomatosis (NL) is a rare disease characterized by malignant lymphocytes infiltrating various structures of the nervous system. It typically manifests as a neuropathy involving the peripheral nerves, nerve roots, plexuses, or cranial nerves. It often presents as a complication of lymphoma, but it can be the presenting feature of recurrent lymphoma. It is essential to identify and initiate treatment early with chemotherapy and/or radiation therapy in all cases of nodal or visceral (including neural) involvement with lymphoma. There are various diagnostic tests that can be used for its detection, such as cerebrospinal spinal fluid (CSF) cytology, electromyography (EMG), magnetic resonance imaging (MRI), and positron-emission tomography/computed tomography (PET/CT). FDG-PET/CT is the standard of care in lymphoma staging, restaging, and therapy response assessment, but has an inherent limitation in the detection of disease involvement in the central nervous system. While that is mostly true for visual assessment, there are quantitative methods to measure variation in the metabolic activity in the brain, which in turn helps detect the occurrence of neurolymphomatosis.

Cureus, 2015

Neurolymphomatosis (NL) is a rare condition associated with lymphomas in which various structures... more Neurolymphomatosis (NL) is a rare condition associated with lymphomas in which various structures of the nervous system are infiltrated by malignant lymphocytes. Rarely, it may be the presenting feature of recurrence of lymphoma otherwise deemed to be in remission. It is crucial, as is the case with all types of nodal or visceral involvement of lymphoma, to identify the disease early and initiate treatment with chemotherapy and/or radiation therapy. Positron emission tomography-computed tomography (PET-CT) has been shown to be a sensitive modality for staging, restaging, biopsy guidance, therapy response assessment, and surveillance for recurrence of lymphoma. Magnetic resonance imaging (MRI) is another useful imaging modality, which, along with PET/CT, compliment cerebrospinal spinal fluid (CSF) cytology and electromyography (EMG) in the diagnosis of NL. Performing nerve biopsies to confirm neurolymphomatosis can be challenging and with associated morbidity. The case presented herein illustrates the practical usefulness of these tests in detecting NL as a heralding feature of lymphoma recurrence, especially in the absence of histopathologic correlation.

Cureus, 2015

Nuclear protein testis (NUT) midline carcinoma is a rare malignancy involving predominantly the m... more Nuclear protein testis (NUT) midline carcinoma is a rare malignancy involving predominantly the midline structures of the body. It is characterized by its genotypic feature of BRD4-NUT translocation, which is in contrast with other malignant processes that are usually categorized based on their histologic/phenotypic features. As these tumors may vary in their histologic presentation, they can be misdiagnosed as poorly differentiated carcinomas. Moreover, they are often very aggressive and associated with high mortality. Therefore, it is extremely important to diagnose them early using computed tomography (CT) and magnetic resonance imaging (MRI) and perform staging and restaging using 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT), in addition to accurately identifying them at a microscopic and molecular level. We report a unique case of a sinonasal NUT midline carcinoma that was diagnosed with CT, staged with PET/CT, and restaged using PET/CT and MRI.