Puneet Bhargava

• MD, FAUR FSAR FACR
• Professor at University of Washington

Collaboration is requisite for a successful career in academic radiology. Selecting collaborative team members involves combining individuals with unique skill sets to make effective contributions to the team effort. Conflict resolution and compro-mise for the sake of team success are of paramount importance. Collaborative leaders successfully en-g...

Objective: Our goal was to perform a comparative effectiveness study of intravenous (IV)-only versus IV + enteral contrast in computed tomographic (CT) scans performed for patients undergoing appendectomy across a diverse group of hospitals. Background: Small randomized trials from tertiary centers suggest that en- teral contrast does not improve d...

Liver transplantation is an accepted and successful treatment of patients with end-stage acute or chronic liver disease. Knowledge of the multimodality imaging appearances of both normal and abnormal findings in liver transplant recipients is needed to help the radiologist recognize complications during the early postoperative period and to help gu...

From online textbooks to educational social media posts, digital learning tools are transforming medical education. Spaced repetition programs are a popular tool, with 70% of first-year medical students reporting using the free, open-source flashcard application Anki.1 The Anki program pairs active recall and spaced repetition learning principles w...

As point-of-care ultrasound (POCUS) becomes an integral component of healthcare, both undergraduate and graduate medical POCUS education is urgently necessary in curricula. Despite the apparent need of POCUS curricula, there remains a lingering question: Are there evidence-based benefits to POCUS training in undergraduate and/or graduate medical ed...

Shifting demographics within the United States population will likely continue to increase workplace demands of radiologists over the next decade, highlighting the importance of improving radiologist productivity and efficiency. Macropads may serve to optimize radiologist workstations by assigning complex repetitive tasks to a single press of a but...

Twitter provides students with a centralized platform to learn about numerous opportunities within radiology. The platform can be immensely beneficial to students by providing opportunities to learn, network, connect with mentors, and find events while also preparing applicants for The Match. Having a prominent Twitter presence can pay dividends in...

Given limited exposure to radiology during the pre-clinical and clinical years, it has been challenging to recruit medical students to radiology. Now, many medical students considering radiology as a career are deterred due to misinformation surrounding how AI implementation will affect radiologists in the future. Artificial Intelligence (AI) has t...

Residency programs that effectively utilize social media (SoMe) have the potential to distinguish themselves and improve their resident recruitment. These platforms allow programs to connect with applicants they otherwise might have limited ability to reach before the interview season. We sought to evaluate the presence of SoMe across diagnostic ra...

Radiologists have shouldered a myriad of personal and professional burdens during the ongoing pandemic, leading to high levels of stress and burnout. Herein we discuss a set of strategies known as the 8-point program to help radiologists better cope with these stressors. Although the onus should be on leadership at the workplace to implement meanin...

The duodenum can be affected by a variety of abnormalities because of its development during embryogenesis and its dual intra- and retroperitoneal location. If small bowel embryogenesis is disturbed, congenital errors occur. Although some congenital variants may be asymptomatic and inconsequential to the patient, other anomalies can result in life-...

Aim: We sought to identify predictors of progression of an indeterminate observation (LI-RADS 3) to hepatocellular carcinoma (LI-RADS 5). Methods: Imaging reports with LI-RADS (LR) assignments were identified among patients at the University of Washington, 2013-2017. Patients with an LR3 lesion and follow-up scan within 1 year of LR3 lesion date we...

Radiologists’ personal productivity and efficiency are critically important for both improving patient outcomes and protecting clinician well-being. There are several solutions that individuals can implement to improve personal productivity and efficiency in the radiology workroom. Strategies include understanding the psychology behind productivity...

“Big data” has changed the way businesses operate in finance, insurance, communications, manufacturing, and logistics, with companies reporting successful outcomes from the implementation of data-driven analytics. Health care has slowly started leveraging big data analysis to identify more cost-efficient and effective care for patients. Business in...

New video How to use #FinancialIndependence - A #burnout Antidote. A Grand Rounds Presentation https://lnkd.in/gWnJQnmT via @YouTube - Boglehead's model - Investment Portfolio - Tax efficiency - Asset Protection - Fighting Burnout with FIRE - Fav books #investingtips #investingforbeginners #investing101 #investingstrategy #burnout #moralinjury #...

https://youtu.be/xQYNqjIeX44 via @YouTube Too much focus on #productivity is misguided. Let me know your thoughts!

Objective: The Liver Imaging Reporting and Data System (LI-RADS) has been widely applied to CT and MR liver observations in patients at high-risk for hepatocellular carcinoma (HCC). We investigated the impact of CT vs MR in upgrading LI-RADS 3 to LI-RADS 5 observations using a large cohort of high-risk patients. Methods: We performed a retrospec...

A strong faculty development program is crucial to recruit, support, and advance early-career faculty members in order to achieve and sustain an exceptional and diverse medical community. There has been increasing appreciation for the importance of fostering intrapersonal “soft-skills” such as leadership, mentorship, resilience, adaptability, and e...

We have all been guilty of making ineffective presentations at some point in our career. In this article we explore the key principles behind “Presentation Zen,” an approach intended to decrease cognitive overload, make presentations more visual, natural, and unique; as well as improve the overall impact of our presentations by allowing the listene...

Rationale and Objectives To analyze the trends in international medical graduates (IMGs) matching into diagnostic radiology residency programs in the United States (US). Materials and Methods The National Resident Match Program data was accessed for years 2005–2020 and diagnostic radiology residency-specific data was extracted for US MD, osteopath...

481 Background: We sought to identify predictors of progression of LR3 lesions (i.e. indeterminate for HCC) to LR5 lesions (i.e. definitely HCC) on follow-up imaging among cirrhotic pts. Methods: Imaging reports with LR assignments were identified among pts seen at the University of Washington, 2013-2017. Cirrhotic pts with a LR3 lesion and follow-...

e15667 Background: iHCC is an aggressive disease with poorly characterized treatment outcomes. We sought to describe clinical and radiographic features of iHCC, describe overall survival (OS), and compare outcomes of sorafenib (SOR) use with a cohort of non-infiltrative hepatocellular carcinoma (niHCC) patients. Methods: Radiology reports from the...

e15668 Background: We sought to identify clinical predictors of radiographic progression of a Li-RADS (LR) 3 lesion (i.e. indeterminate for hepatocellular carcinoma (HCC)) to a LR 5 lesion (i.e. definitely HCC) among patients (pts) at high risk of HCC. Methods: Radiology reports from the University of Washington with an LR assignment, 2013-2017, we...

Purpose: To evaluate the impact of environmental and socioeconomic factors on outpatient cancellations and "no-show visits" (NSVs) in radiology. Materials and methods: We conducted a retrospective analysis by collecting environmental factor data related to outpatient radiology visits occurring between 2000 and 2015 at our multihospital academic...

Purpose To investigate performance in detectability of small (≤1 cm) low-contrast hypoattenuating focal lesions by using filtered back projection (FBP) and iterative reconstruction (IR) algorithms from two major CT vendors across a range of 11 radiation exposures. Materials and Methods A low-contrast detectability phantom consisting of 21 low-contr...

Purpose of Review The evaluation of abdominal and pelvic pain in the pregnant patient presents unique challenges due to altered physiology and implications of radiation exposure on the fetus. In many instances, a radiologist must consider the potential risk of fetal injury from ionizing radiation and maintaining diagnostic quality imaging. This art...

Objective: The purpose of this article is to assess the performance of a contrast reaction management checklist for optimal management of a contrast reaction scenario created using a high-fidelity hands-on simulation. Materials and methods: A safety checklist was designed that presented the five adverse events that most commonly occur after admi...

Purpose: To understand why patients "no-show" for imaging appointments, and to provide new insights for improving resource utilization. Materials and methods: We conducted a retrospective analysis of nearly 2.9 million outpatient examinations in our radiology information system from 2000 to 2015 at our multihospital academic institution. No-show...

Stephen R. Covey′s landmark work in the field of effectiveness and professional development delineated first seven, then ultimately eight, habits of highly effective people with applicability to all professions.¹ This article describes the eight habits in specific relation to the radiologist, and proposes a ninth habit to help one bring a positive...

Within a radiology team, members individually lean toward being givers or takers. Radiology leadership must recognize this characteristic and leverage the strengths of givers and takers to best assist the team and to provide effective motivation. Understanding the importance of balancing these qualities within a team improves productivity and moral...

The quality and effect of scientific research is traditionally measured by citation-based metrics. However, the internet and social media revolution has led to radical changes in the way scientific information is shared and how it affects the world. Alternative metrics (altmetrics) is a rapidly evolving measure to quantify social media attention re...

Radiologists serve in leadership roles throughout their career, making leadership education an integral part of their development. A maxim of leadership style is summarized by 360-Degree Leadership, which highlights the ability of a leader to lead from any position within the organization while relying on core characteristics to build confidence fr...

Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International...

No-show appointments are a troublesome, but frequent, occurrence in radiology hospital departments and private practice. Prior work in medical appointment no-show prediction has focused on general practice and has not considered features specific to the radiology environment. We collect data from 16 years of outpatient examinations in a multi-site...

In the last century, rapidly advancing technological innovations have become essential components of modern healthcare, increasing the frequency and necessity of interactions between physicians and industry. These interactions have the potential to bias objectivity and should be approached carefully. A recent JACR article by Harvey et al, highlight...

Orthotopic liver transplantation is the preferred treatment for end stage liver disease. Imaging plays an important role in the follow up of transplant recipients by identifying a variety of complications. Post-transplant liver imaging can be challenging with altered vascular and non-vascular post-operative findings closely mimicking pathologies. A...

https://acrbulletin.org/current-issue/1120-improving-time-management

Purpose: To assess the performance of interprofessional teams of radiologists, technologists, and nurses trained with high-fidelity hands-on (HO) simulation and computer-based (CB) simulation training for contrast reaction management (CR) and teamwork skills (TS). Methods: Nurses, technologists, and radiology residents were randomized into 11 te...

Purpose: Urgent appendectomy has long been the standard of care for acute appendicitis. Six randomized trials have demonstrated that antibiotics can safely treat appendicitis, but approximately 1 in 4 of these patients eventually requires appendectomy. Overall treatment success may be limited by complex disease including perforation. Patients׳ suc...

Hepatocellular carcinoma (HCC) is the second largest cause of cancer mortality in the world, with vascular invasion being one of the most important prognostic factors. HCC with tumor thrombus was traditionally considered to have very limited treatment options. However, multiple promising treatment strategies have emerged in recent years, with diagn...

Objective: The purpose of our study was to determine the current practice patterns of U.S. radiologists in imaging pregnant or potentially pregnant patients with acute abdominal and pelvic conditions. Materials and methods: After obtaining an Institutional Review Board waiver, all members of the Association of University Radiologists, the Associ...

It is an important task for leadership to identify the motivating factors for employees and motivate them to fulfill their individual and organizational goals. Although there are several motivational factors (extrinsic and intrinsic), intrinsic motivational factors such as autonomy, mastery, and purpose are more important for deeper lasting job sat...

The utility of MR imaging in evaluating abdominal and pelvic pain in the pregnant patient is discussed. Details regarding the indications, technical aspects, and imaging findings of various common abdominal and pelvic abnormalities in pregnancy are reviewed.

Liver transplant is the treatment of choice for end-stage liver disease. Management of transplant patients requires a multidisciplinary approach, with radiologists playing a key role in identifying complications in both symptomatic and asymptomatic patients. Ultrasonography remains the investigation of choice for the initial evaluation of symptomat...

Renal transplant complications are categorized as those related to the transplant vasculature, collecting system, perinephric space, renal parenchyma, and miscellaneous complications including posttransplant lymphoproliferative disorder. Many of these renal transplant complications are diagnosed with imaging. Medical complications including rejecti...

The placenta has a fundamental role in fetal health and functions as an important bridge to normal fetal development throughout pregnancy. A complete fetal ultrasound (US) survey should include full assessment of the placenta for any possible abnormalities. Placental diseases range from abnormal morphology, size, location, extent, and degree of pla...

Before the advent of ultrasound, percutaneous pericardiocentesis was associated with relatively high mortality and complication rates (6% and 20-50%, respectively) [1-3]. Ultrasound (US)-guided pericardiocentesis has dramatically decreased the incidence of complications by direct visualization of the heart and other adjacent vital structures. US he...

Clear-cell chondrosarcoma is a rare, low-grade variant of chondrosarcoma characterized by slow growth, low metastatic potential, and a predilection for local recurrence long after treatment. We report an unusually aggressive case of clear-cell chondrosarcoma of the humerus with early metastasis to multiple bony sites including femur, thoracic and l...

Hepatocellular carcinoma is a common malignancy for which prevention, screening, diagnosis, treatment, and surveillance demand a multidisciplinary approach. Knowledge of the underlying pathophysiology as well as advances in clinical management should be employed by radiologists to effectively communicate with hepatologists, surgeons, and oncologist...

Objectives: To illustrate the imaging appearances of a spectrum of renal collision and composite tumors. Occurrence of collision and composite tumors in the genitourinary tract is rare compared to the usual occurrence of synchronous tumors. Methods: Case studies were chosen that represent the different tumors. Analysis was made on both the imagi...

Objective: The purpose of this article is to familiarize radiologists with uncommon presentations of hepatocellular carcinoma (HCC) with an emphasis on the CT spectrum of atypical appearances. Conclusion: HCC is the fifth most common neoplasm worldwide and the second most common cause of cancer-related death. In many cases, HCC can be confidentl...

Today’s radiologists in training will soon be entering the workforce and will spend most of their professional careers in this new health care environment. They will be the specialty’s future leaders and will determine if radiologists remain relevant and valued. The ACR’s Imaging 3.0� initiative was created as a valuable resource to help guide our...

Arteriovenous fistulae and grafts for hemodialysis access are a lifeline in patients with end-stage renal disease. A significant cause of morbidity and mortality in this population is dialysis access dysfunction. Duplex ultrasound imaging is an excellent modality to evaluate arteriovenous fistulae and grafts, the 2 main types of long-term hemodialy...