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Objectives: This study is an evaluation of the emergency department (ED) satisfaction with the current radiologic reporting system used at a major Northeastern academic medical center. The radiology reports are the main form of communication and usually the final product of any radiological investigation delivered to clinicians. The aim of this study was to improve current radiology reporting practices and to better tailor reports to match the needs and expectations of ED clinicians. Methods: A 9-question online survey was sent to ED residents, fellows, faculty, and nurse practitioners/advanced practice providers at a major Northeastern academic medical center in the United States. For the open-ended section, coding and emergent theme categorization was conducted for quantification of responses. The survey was designed to evaluate the attitudes toward the structure, style, form, and wording used in reports. Results: The response rate was 48.6% (68/140). The ED respondents were generally satisfied with radiology reports, their language, vocabulary, and clarity. They preferred the impression section to be before the findings in simple examinations and to stratify the reports according to emergency status for complex examinations. They did not like extended differential, hedge terms, and delayed reporting. Additionally, ED respondents recommended focused, fast reporting with considerable changes toward a more standardized report. Conclusions: This evaluation delivered a list of actionable recommendations. The top recommendation is to standardize reporting structure, style, and lexicon, in addition to being focused, timely, and brief.

Malignant triton tumors are an extremely aggressive form of malignant peripheral nerve sheath tumor that display rhabdomyosarcomatous features. While these tumors are extremely rare, they have a much higher incidence in patients with neurofibromatosis-1. We present a case of a 64-year-old male with neurofibromatosis-1 who presented to the hospital with sudden worsening of shortness of breath and dysphagia to solids. Radiological examination revealed a large mass in the anterior mediastinum causing significant narrowing and displacement of the upper trachea and esophagus. Biopsy of the mass, done by interventional radiology, demonstrated features of an MTT. The mass was subsequently resected but without confirmation of tumor-free margins and the patient underwent adjuvant radiation therapy. Repeat radiological examination approximately four months later revealed growing malignancy and new metastases, which eventually contributed to the patient's death seven months after his presentation to the hospital.

Diagnostic errors in neuroradiology are inevitable, yet potentially avoidable. Through extensive literature search, we present an up-to-date review of the psychology of human decision making and how such complex process can lead to radiologic errors. Our focus is on neuroradiology, so we augmented our review with multiple explanatory figures to show how different errors can reflect on real-life clinical practice. We propose a new thematic categorization of perceptual and cognitive biases in this article to simplify message delivery to our target audience: emergency/general radiologists and trainees. Additionally, we highlight individual and organizational remedy strategies to decrease error rate and potential harm.

After participating in this activity, the radiologist should be better able to evaluate the imaging features of primary central nervous system lymphoma and to differentiate them from those of central nervous system infection, glioma, and metastasis using conventional and advanced imaging techniques.The incidence of central nervous system (CNS) lymphoma is increasing, and it is important to raise this suspicion preoperatively because lymphomas will need only stereotactic biopsy for tissue typing as compared with a more extensive resection in other forms of brain tumors. Moreover, if the diagnosis of CNS lymphoma is unknown preoperatively, inadvertent administration of preoperative corticosteroids can lead to a false biopsy histopathologic interpretation. The imaging appearance of CNS lymphoma depends on the immunity status of the patient and can be confused easily with CNS infection, glioma, or metastasis. This CME activity emphasizes that the use of more advanced imaging techniques now has an important role in diagnosing CNS lymphoma, and, therefore, helps to avoid unnecessary, extensive surgical procedures needed to obtain a more accurate diagnosis. This review article will concentrate not only on how the diagnostic radiologist can use conventional and advanced imaging techniques to diagnose CNS lymphoma, but also how these techniques can help in the follow-up management of CNS lymphoma.Central nervous system (CNS) lymphoma can be classifi ed into 2 subtypes: secondary CNS lymphoma (SCNSL) with involvement by systemic lymphoma, and primary CNS lymphoma (PCNSL) with involvement of lymphoma restricted to the brain, leptomeninges, spinal cord, or eyes, without evidence of lymphoma outside the CNS. 1 PCNSL is less common than SCNSL. In 90% of PCNSL cases, the cause is a diffuse, large B-cell lymphoma, usually high grade, and an uncommon form of extranodal non-Hodgkin lymphoma. Less common histologic types are Burkitt lymphoma and T-cell lymphoma. 2 The highest risk group is patients age 60 years or older. There is also a high incidence among immunocompromised patients. 1 However, with the use of highly active antiretroviral therapy, PCNSL in the HIV-affected population has declined. PCNSL accounts for 1% to 5% of all brain tumors and 1% of all non-Hodgkin lymphomas. The differential diagnosis of PCNSL includes glioblastoma multiforme, metastasis, tumefactive demyelination, abscess, and subacute stroke (Table 1).V o l u m e 3 5 • N u m b e r 2 1 O c t o b e r 1 5 , 2 0 1 2 Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, ans...