ISSUE 78 May 2017 I NSIDE THI S

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1 ISSUE 78 May 2017 Great news, hot off the press: St Joe s exams are now available on the HHS PACS!!! We have been waiting for this integration for years and now it is here. Congratulations to all who made this happen, and a great thank you to our PACS teams for their hard work. This is a great step forward, and will make life much better for our residents, radiologists and clinicians. A lot about Informatics this month, but to start with, I want to go back to the HHS Digital Plan for the next 3 to 5 years, that I mentioned last month. For Diagnostic Imaging, the plan is to: implement a computerized provider order entry with clinical decision support, which includes electronic order entry for radiology, part of the Hospital Information System. update and consolidate the disparate diagnostic imaging systems in place at HHS into one platform, and store images. Improved communication with secure messaging and unified communication system. The annual meeting of the Canadian Association of Radiologists was on April 21 in Montreal, with a very interesting schedule. Congratulations to our 3 residents who presented: Ibraheem Afzal and a special mention to Natasha Larocque and Patrick Kennedy who had to brave adversity and reached Montreal against all odds. CHAR, the group of 16 Canadian Heads of Academic Radiology, has now a website that I invite you to visit at: radheads.ca ; you will find resources pertaining to education, research and leadership in radiology in Canada and it will give you access through a single point of entry to residency and fellowship information from all Universities in the country. Research Day was Wednesday, April 26, and once more, we had excellent presentations from our residents and fellows, and it must have been a difficult task for our judges to make their selection. Sincere congratulations to our winners. Dr Rogalla gave us a very interesting talk on ultra low dose abdomen CT to replace X-rays of the abdomen. MIIT took place at Liuna Station on Friday, April 28, part of Hamilton Health Innovation Week. Among the speakers, Eliot Siegel from University of Maryland and Veteran Affairs gave us a very interesting talk on Machine Learning and Artificial Intelligence. He quoted a number of reputed scientists such as Ezekiel Emanuel MD PhD, founding chair of the Clinical Center of the National Institute of Health, and Geoffrey Hinton, Professor University of Toronto and Google employee, who all predicted the end of radiology as we know it and advised that we stop training radiologists now. But Eliot Siegel was reassuring and clearly stated that we are far from being replaced. There are thousands of artificial intelligence algorithms developed on multiple different platforms and they don t communicate, they are not integrated, and it will still take a long, long time before we harvest enough data and consume these algorithms to get a working FDA approved solution. I also want to mention the new free service that Canada Safe Imaging has released at CAR, a number that patients and healthcare providers can call to get expert opinion on radiation exposure. And last but not least, join me to thank very sincerely our Nurses for their hard work and great support during Nurses Week, May 6 to 12. All the best, David Koff Chair, Department of Radiology, FHS I NSIDE THI S Educational News 2 Rounds Calendar 3 Residents Page 4 Research Day 5 6 PGY5 Graduation Save the Date 7 Radiologist 8 Farewells 8 9 Conferences Research Corner 12 THE LAST PAGE 13

2 EDUCATIONAL NEWS VISITING PROFESSOR SERIES Tuesday May 9 th and Wednesday May 10 th, 2017 Annual W Peter Cockshott Lecture Dr. Linda Probyn Associate Professor Division of Musculoskeletal Imaging, Sunnybrook Hospital Vice Chair of Education Director of Admissions and Evaluation Post Graduate Medical Education University of Toronto Tuesday, May 9 th, 2017, 6:00 p.m. St. Joseph s Healthcare Hamilton Approach to Depositional Arthropathies CAMPBELL Auditorium Level 2 Room T2202 Juravinski Innovation Tower Carpal Instability Date: Wednesday, May 10 th, 2017 Location: SJHH: Campbell Auditorium Level 2 - Room T2202 Juravinski Tower Time: 7:30 am Atypical Femoral Fractures: What s so Atypical? Date: Wednesday, May 10 th, 2017 Location: SJHH: Campbell Auditorium Level 2 - Room T2202 Juravinski Tower Time: 12:00 pm Dr. Tan-Lucien Mohammed, Visiting Professor in April. Visit our Visiting Professor Program web page to view all of Visiting Professor group photos with our Radiology Residents at: M E D I C A L I M A G I N G B U L L E T I N

3 ROUNDS CALENDAR JURAVINSKI HOSPITAL & CANCER CENTRE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 0800 Resident Rounds (all rounds in DI Conf. Rm.) 1200 Rad/Path Breast Rds (Rm 106 E Wing) 0800 MSK Rounds 1200 Resident Rounds 0800 Resident Rounds 0800 Multidisciplinary Breast Rounds DST (3-88 JCC) 0700 Hepatobiliary Rounds 8:00 CNS Tumor Board 10:00 Neuro Onc Rds (Fellows) 1200 Resident Rds 11:00 Head/Neck Rds JCC 1200 Interesting Case Rounds HAMILTON GENERAL 12:15 DI DST Rds 14:00 GIUP Rds 1200 Radiology Teaching Rounds 0700 Spine Rds 0800 Regional Cardiology Rds (David Braley Centre, General Campus, Auditorium) 1200 Radiology Teaching Rounds 1200 Combined Stroke Rounds, DI Classroom, Rm Trauma Rds (Theatre Auditorium) M&M Rounds 1st Tues. of mo Vascular Rounds (5N Teaching Room) 0800 Arrhythmia Rds. (Theatre Auditorium, HGH) 1230 M&M Rds. (DI Classroom), set once a month 1310 Sarcoma Rounds - (3rd floor conference room) JCC 0800 Stroke Rds.(David Braley Centre, General Campus, Auditorium) 0800 CNS Tumor Rds. HGH (DI Classroom) once a month 1200 Radiology Rds. Interesting Cases 1200 Dr. Bradley s Rds, every 3 rd Thurs. each month. (notify residents call Dr. Bradley & Med. Resident on 8 South) 0800 Neuroscience Rds. David Braley Centre, General Campus, Auditorium) 1200 Radiology Teaching Rounds MUMC 0800 Resident Rds 0800 Tumor Brd (3F) 1200 OB Rds (Dr. Mohide) Rm 2S Neuroradiology Rds Rm 3N Resident Rds 1230 Neuro-oncology Rds 3F 1445 Neonatal (US) Rds Rm 2S Resident Rounds (TBA) 0800 Adult GI Rounds, Rm.2S RPC (3 rd Wed ea. mo.) Rm 2S Resident Rounds 0800 Surg/Rad/ Path (SRP) Rds 4 th Thurs. of ea. mo. Rm 2S Rheumatology - ev.other wk Rm TBA 15:00 Clinical Teaching Unit (CTU) Every 4 th Thursday, Room 2S Resident Rounds 1200 GI Ped Rounds Room 2S32 ST. JOSEPH S HEALTHCARE HAMILTON (All rounds in DI Conference Room T0102, unless otherwise specified) 12:00 Ultrasound Rounds 1:00 2:00 p.m. Resident Hot Seat Rounds Indicated by an (*) asterisk on the weekly rad schedule Small Renal Tumour Board Rounds - 1st Tues. of each mo Vascular Difficult Access Rounds 1st Tues. of ea mo Interesting Case Rounds Resident Hot Seat Rounds Head & Neck MCC Rounds 4th Wed. of ea. Mo MSK Radiology Rheumatology Rounds, Radiology Residents Half Day Presentations Rotating sites Thyroid Malignancy Endocrine MCC Rounds 1st Wed. of ea. Mo Colorectal Rounds Breast Pathology Rounds Resident Hot Seat Rounds, Radiology Respirology Rds, 2nd Fri. of ea. mo, Lung MCC Rounds Resident Hot Seat Rds, More info can be found on the McMaster ETA website: M E D I C A L I M A G I N G B U L L E T I N

4 Residents Medical Staff Association announced that Dr. Christopher (Eli) Greybiel has been named Outstanding Resident 2017 for Diagnostic Imaging. Join with us in congratulating him on his excellent work. Canadian Association of Radiologists Annual Meeting in Montreal with strong representation from our resident group who participated in the Clinical Audit and CAR Radiologist In Training competitions. Patrick Kennedy (PGY4) - Hepatic Artery Pseudoaneurysm Audit Ibraheem Afzal (PGY4) - CT Pulmonary Angiogram Audit Natasha Larocque (PGY2) - A Needs Assessment of Senior Medical Student Radiology Electives: Where are the Gaps and What Can We Improve? Submitted by Dr. Landry, Program Director Left to right: Dr. Landry, Dr. Ibraheem Afzal, Dr. Natasha 4 4 M E D I C A L I M A G I N G B U L L E T I N

5 RADIOLOGY RESEARCH DAY Undergraduate: Zachary Hugh Radiology Teaching Files: A Literature Review and Novel Android Application Development. Resident: 1st Prize: Natasha Larocque Development, Implementation, and Evaluation of Senior Medical Student Radiology Electives 2nd Prize: Rebecca Zhu Image Gently reduction of radiation from Pediatric Intensive Care Unit (PICU) chest x- rays with appropriate image field size selection a quality assurance initiative. Fellows: 1st Prize: Hillel Maresky MRI Measurements of the Optic Pathway in Pediatric Patients 2nd Prize: Alex Omiccioli Ultrasound Guided Plantar Fascia Fenestration as a Treatment for Plantar Fasciopathy Graduate Students: 1st Prize: Nourhan Shalaby Differentiation of Tumour and Normal Breast Tissue using Fluorescence and Diffuse Reflectance Spectroscopy 2nd Prize: Paul Polak Evaluation of reduced sampling schemes with 3D radial projections for 23 Na MRI Judges with Dr. Koff From left to right: Dr. Roxanna Vlad Dr. Karen Finlay Dr. David Koff Dr. Patrik Rogalla 5 5 M E D I C A L I M A G I N G B U L L E T I N

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8 Radiologists Dr. Patlas became a Fellow of the Society of Abdominal Radiology, As per selection criteria, "An applicant for Fellow status shall have made a significant contribution to the field of abdominal radiology". He also has two articles published: 1. Academic and Community Radiology Practice Integration: The Canadian Experience in the Journal of American College of Radiology. 2. Invited Commentary on Multidectctor CT of Surgically Proven Blunt Bowel and Mesenteric Injury in the March issue of RadioGraphics. Hamilton General The staff celebrated with Dr. Stella his last day on IR rotation at the General on Thursday, April 27th. Dr. Chiavaras with Dr. Alex Omiccioli congratulating him on his second place win on Research Day. 8 8 M E D I C A L I M A G I N G B U L L E T I N

9 Juravinski Hospital Radiology had a farewell tea last week April 27 in honor of Dr. Hoshang Zakaria.We will miss Zak at JHCC he will be moving to Edmonton AB to further his career in Radiology. Left to Right: Dr. Ramonis, Dr. Roth, Dr. Zacharia, Dr. Golev We had to say goodbye to one of our fulltime clerical staff, Diane Polak. Diane is looking forward to enjoying her new found freedom! On Monday May 1st we celebrated Doctor s Day at JHCC. The radiologists were spoiled with treats and homemade chicken chili. A Big thank you to all our wonderful Juravinski Rads.You deserve it 9 9 M E D I C A L I M A G I N G B U L L E T I N

10 Conference News DON'T DELAY! REGISTER SOON! Earn 12 CME Credit Hours! To register/access the course brochures, please click on the following : M E D I C A L I M A G I N G B U L L E T I N

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12 RESEARCH CORNER As you may have heard, a new Canadian Initiative called Canada Safe Imaging (CSI), which Dr. Koff and I are both a part of, is focused on promoting reduction in medical radiation. CSI, which is supported by organizations such as CAR, CAMRT, and COMP, has a focus on education and knowledge translation in patient dose reduction. As such, during the recent Radiology Research Day, the project by Rebecca Zhu et al. titled, Image gently - reduction of radiation from Pediatric Intensive Care Unit (PICU) chest x-rays with appropriate image field size selection - a quality assurance initiative was of particular interest to me. Dr. Zhu, along with Dr. Ainsworth, Dr. Takrouri and undergraduate student Yusuf Hassan evaluated the extent of unintentional x-ray exposure performed during chest x-rays in the PICU patients due to inappropriate field size. According to the established International Standards, the ideal field of view for a pediatric chest x-ray is from the lower cervical spine (C5/C6) to the level of T12/L1. The acceptable maximum field of view is up to 1 cm beyond the cranial and caudal edges for a neonate (<28 D) or 2 cm for an infant/child (>28 D). PICU chest x-rays performed in January 2017 were retrospectively reviewed. The distances of the x-ray fields exceeding the acceptable maximum limit were measured. The researchers reviewed 59 chest x-rays of 28 patients. 24 (41%) and 51 (86%) chest x-rays exceeded the acceptable cranial and caudal limits respectively. 20 (34%) examinations exceeded both the cranial and caudal limits. 4 (7%) chest x-rays met the standard for both cranial and caudal limits. The average excess field distance was 1.0 cm (Median: 0.9 cm; Range: 0.2 cm 3.0 cm) and 3.0 cm (Median: 1.9 cm; Range: 0.1 cm 11.5 cm) cranially and caudally respectively. There are a number of clinical difficulties that make measurement in this field of view challenging including lack of patient cooperation as well as anatomical versus radiographic landmarks. Moving forward, the researchers will be providing information and training sessions to the department to educate everyone on the ideal field of view for pediatric chest x-ray. In addition, the results from this study will facilitate the needed discussion between the radiologists, x-ray technologists and the radiation safety officer on how we can work to reduce radiation in all of our patients M E D I C A L I M A G I N G B U L L E T I N

13 THE BACK PAGE Most rainbows we see will be a "primary rainbow" whereby the color red can be seen on the outer edge through to violet on the inner edge. The sky within a primary rainbow is brighter than the sky outside of the arc. This is due to the fact that the millions of droplets needed to make a rainbow are spherical and overlap to create white light. At the edge however, these colored discs don't overlap so display their individual colors producing the rainbow arc. We have all heard about that pot of gold at the end of the rainbow, but what do we really know about rainbows. Here are a few interesting facts about rainbows: A rainbow is a multi-colored arc that forms in the sky. Rainbows are created by both reflection and refraction (bending) of light in water droplets in the atmosphere, which results in a spectrum of light appearing. A rainbow is in fact a full circle of light. However, due to most people viewing a rainbow on the ground we only see a semicircle or arc of the rainbow. A rainbow is not situated at a specified distance, instead it will always be visible to a person at the precise angle freshwater droplets reflect the light which is 42 degrees in the opposite direction of the sun. A rainbow is not an object, it cannot be approached or physically touched. No two people see the same rainbow, in fact even our individual eyes see slightly different rainbows. If someone appears to be standing under a rainbow you can see, they will see a different rainbow at the same angle but further away. Rainbows can be seen not just in rain but also mist, spray, fog, and dew, whenever there are water drops in the air and light shining from behind at the right angle. A "double rainbow" is where a second, much fainter arc can be seen outside of the primary arc. This is caused by the light reflecting twice inside the water droplets. As a result of this double reflection the colors of the second arc are inverted with violet on the outer edge and red on the inner edge. The dark, unlit sky between the primary arc and secondary arc is called Alexander's band, after Alexander of Aphrodisias who first described it in 200 AD. Very rarely, light can be reflected 3 or 4 times within a water droplet which produces even fainter tertiary (third) and quaternary (fourth) rainbows in the direction of the sun. A "moonbow" is a rare lunar rainbow or night time rainbow produced by light from the moon. Our eyes see it as white even though all colors are faintly present. A "fogbow" is formed by cloud and fog droplets, they are almost white with very faint colors visible. Fogbows are quite large and much broader than a rainbow. Sir Isaac Newton identified the 7 colors of the visible spectrum that together make up white light. All of which are present in a rainbow in the order red, orange, yellow, green, blue, indigo and violet (the acronym or name ROY G BIV is a good way to remember these colors and their order). Submissions to: Marguerite Jackson, McMaster Site, HSC - Room 4N-49 jacksonmar@hhsc.ca M E D I C A L I M A G I N G B U L L E T I N