A Case a Day Keeps Readers Coming Back

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Case in Point Editor in Chief David R. Pettersson, MD

After 20 years of delivering case-based education (and CME), and with more than half a million cases completed annually, ACR Case in Point continues to deliver bite-sized daily content that keeps ACR members up to date on a variety of presentations, findings and diagnoses.

In 2021, David Pettersson, MD, director of MRI at Oregon Health & Science University, took the reins as editor in chief from Kitt Shaffer, MD, PhD, FACR. Here he discusses what’s next for Case in Point and what he thinks keeps readers coming back.

Tell us about your history with Case in Point. When was the first time you viewed a case, and what made you take on the role of editor in chief?

The first time I looked at a case was during residency, and I thought it was a great tool. But at the time I didn’t consider the importance of CME. CME is a big driver for many of our readers. At the time, what motivated me was the pure educational value — taking those cases and being introduced to more diagnoses.

Fast forward to 2018, I was invited to join as an associate editor, and I loved that role. I still review cases, and I’m learning new things and staying up to date on things myself. I really enjoy developing quality questions that support readers’ understanding of the material. Then when Dr. Shaffer stepped down in 2021, I was invited to join as editor in chief.

The beauty of this role is that I get to put my own touch on the program and move it in the direction that I think is the most valuable.

What changes are in the works for Case in Point?

My biggest contribution to the program so far is to emphasize the importance of differential diagnoses for each case. We’ve rebuilt the case submission form to showcase a new format that asks the submitting authors to identify some feature of their case, whether it’s an anatomic location, a particular imaging finding or a clinical presentation or clinical scenario, and they’ll need to submit differential diagnoses for one of those aspects. I feel like that’s the key function that we as radiologists serve: being able to identify abnormalities and then provide differential diagnoses.

What role does Case in Point play in improving diagnostic skills for radiologists at different levels of training?

I think Case in Point has something for everyone. We get case submissions for diagnoses that are very routine and that highlight common imaging findings. And, of course, those might be more useful for early career radiologists and trainees. Then we also get case submissions that highlight new procedures or new imaging modalities, maybe the diagnosis du jour, and they can make great cases. It really spans the spectrum.

We received feedback that we were becoming what one reader called “a menagerie of zebras.” With this new emphasis on differential diagnoses, we’re encouraging the submission of more routine “bread-and-butter” cases. Cases of rare diseases or other diagnoses are better suited for peer-reviewed journals.

One of the key features of Case in Point is its daily delivery of cases directly to members. How do you think this daily interaction with real-world cases enhances the learning experience for practicing radiologists and trainees?

The word “daily” is key. It’s a habit and, like all habits, if you invest a little bit of time each day into something, you can move mountains over time. A daily case amounts to a ton of learning that you’ve done, and you will have a much broader understanding of radiology for doing it. For those diehards who are doing it seven days a week, it’s a lot of learning,

The ACR Pipeline Initiative for the Enrichment of Radiology (PIER) program offers medical students mentorship opportunities by connecting them with experienced radiologists. How does this mentorship help students deepen their understanding of and interest in diagnostic imaging?

The PIER program is designed to increase the number of radiologists and provide individuals from underrepresented communities exposure to the specialty. Case in Point supports that program. PIER interns are required to work on a case submission with their mentor and submit it to Case in Point for publication, and we fast-track those cases. I think it’s super valuable for the medical students because they’re paired with a radiology mentor to work on the case and, for many of them, this may be their initial foray into some kind of publishing or scholarly work. It’s kind of an introduction to academic medicine — learning how to compose a case discussion, learning how to construct questions well, which is not intuitive for a lot of folks. And, of course, they’re studying a radiology-related topic, too.

What are some of the most significant challenges in curating and presenting these cases, particularly in terms of ensuring educational value and clinical relevance?

We’re fortunate to have a multitiered editorial process. One of our editors reviews the case suggestions, the initial submissions, and makes sure that each suggestion meets the minimum requirements. Once it’s given initial acceptance, the cases are distributed among the subspecialty editors for review. So there are multiple levels of inspection to ensure quality cases.

A lot of the educational value comes from the questions that are asked, both the CME questions at the end of the case and then the questions throughout the case. And that’s where our editors shine — identifying questions that are maybe poorly written and then providing the author with suggestions so that they’re better, more incisive questions.

In your opinion, how has the Case in Point program evolved with advancements in technology and imaging techniques, and how do you see it continuing to evolve in the future?

While we’re trying to steer clear of uber-rare diagnoses and experimental therapies and diagnoses, we fully welcome and do receive submissions for cases that highlight newer but FDA-cleared procedures, imaging techniques and established diagnoses.

It’s really the authors who keep us on the top of that curve. As an example, I was editing a case a couple of months ago that included an interventional procedure, a basivertebral nerve ablation, which is for patients who have low back pain due to degenerative disc disease. It was something that I hadn’t seen before or heard of. And then the next week, at my own institution, I was approached by one of our neurosurgeons with questions related to this very technique. So, Case in Point keeps me ahead of things.

Is there anything else you’d like to share with Bulletin readers?

We’re grateful for our Case in Point readers and our submitting authors. They are what makes the program work and why it continues to be so successful. I’m so grateful to be part of the process.

Interview by Raina Keefer, contributing writer, ACR Press

DID YOU KNOW?

Since 2005, ACR Case in Point’s daily cases have kept ACR members up to date on new and common diagnoses and imaging findings. In 2023, in response to reader requests, ACR began offering cases seven days per week, giving ACR members’ weekends an educational spin. Learn more at ACR Case in Point.