The ACR’s American Institute for Radiologic Pathology (AIRP®) provides a unique training experience that emphasizes how knowledge of disease processes is crucial to improved radiologic interpretation. The Institute’s educational offerings include a four-week radiology-pathology (rad-path) correlation course for residents to get an in-depth look at a broad range of diseases and their pathological basis from every organ system.
As part of the admissions process, students actually provide the teaching materials before the course even begins. A component of the course tuition includes a requirement for the resident to submit a case report demonstrating rad-path correlation. In addition to offering an introduction to rad-path correlation, the submission process encourages multidisciplinary interaction among surgical and pathology colleagues. While faculty ultimately choose to present cases in the rad-path course that offer extraordinary teaching points, each case report is automatically submitted to the AIRP archive database — a valuable educational and research resource for studying the imaging features of disease processes with pathologic correlation.
Two faculty from the course, Mark D. Murphey, MD, FACR, AIRP’s physician-in-chief, AIRP section chief of MSK imaging, and professor of radiology at the Uniformed Services University of the Health Sciences in Bethesda, Md., and David M. Biko, MD, pediatric section head at AIRP and director of cardiovascular and lymphatic imaging at Children’s Hospital of Philadelphia, spoke with the Bulletin about their experience teaching residents and why case submission is vital to enhancing the science of radiology.
Why are case submissions essential to the AIRP’s rad-path course?
MM: These case submissions continue to replenish and revitalize the archive. The involvement of the residents in this process ensures that the course is up-to-date and relevant. It also helps us optimize our teaching methods. We have developed the archive over more than 50 years, and it’s a rich resource for teaching the residents in both current and future courses. It also allows us to draw inferences from a large collection of a certain diagnosis so we can teach and perform scientific research about why things look the way they do on imaging, which provides benefit to the entire radiologic community.
DB: For AIRP faculty creating a course, we have an archive of material we can use. I can pull out the best example of a certain tumor that really shows the pathologic aspects of that tumor and can correlate with the imaging. So, residents are giving the cases to us and we’re giving back to them through teaching.
What happens after a case is submitted?
MM: After cases are submitted, each faculty member often spends approximately 30 minutes reviewing the case and looking at the imaging from a radiologic perspective. About 1,400 cases are submitted annually, so that’s a lot of work. After the initial review, we look at the case a second time with a pathology colleague — that’s our opportunity to ask why a case looks the way it does. This is different than a typical clinical practice, where it is the specific diagnosis that is emphasized. We’re looking at the imaging and trying to determine what are reasonable differential diagnoses — we’re trying to learn and glean information as to what are consistent imaging appearances to aid in diagnosis, limit differential diagnosis, and increase diagnostic confidence based on the underlying pathology.
It’s only through the residents’ and programs’ generous sharing of the cases that we’re able to continue the high level of excellence of the AIRP rad-path course and provide the superb experience that we do.
How can residents prepare the process?
MM: In clinical work, many faculty members will hopefully alert first-year residents when they see a potentially good AIRP case that will be going to the operating room. The surgeon will usually be more than happy to take pictures in the operating room or after they resect the lesion or have the radiology resident in the operating room to observe. This process also alerts the pathologist to be more attuned to providing images of the sectioned gross specimen. This way, it doesn’t become as onerous as compared to trying to organize and submit a case at the last minute.
What is the AIRP using these cases for?
MM: Many of the AIRP faculty use cases from the current resident class attending the rad-path course, include the submitters’ names on the slide, and thank them for sharing their material. It’s only through the residents’ and programs’ generous sharing of the cases that we’re able to continue the high level of excellence of the AIRP rad-path course and provide the superb experience that we do. We also use these cases as material for scientific research.
What are some deliverables that have resulted from these submissions?
MM: The section heads and faculty at AIRP have written innumerable scientific articles adding to our understanding of the imaging appearance of disease, many for RadioGraphics that have been derived from the archives. In my area of expertise, MSK imaging, there are several articles listed below as references. The larger the number of cases that you have, the more likely it’s going to be reflective of that diagnosis. If one of our faculty wanted to do a research project on a certain diagnosis, they can search the archive by diagnosis and use our series of imaging. This way, we give back to our profession. We package these images, along with information that’s useful to radiology, and it helps our clinical colleagues and our patients.
How do residents benefit from submitting?
DB: The submissions are helpful to residents as an introduction to rad-path correlation, which is what the AIRP course is all about. The course stresses that physicians need to have a vital understanding of the pathology and learn why a tumor appears the way it does on a CT or MRI.
MM: It may be the first chance that a resident has to understand the potential significance of rad-path correlation. We want them to get their surgical and pathology resident colleagues involved in working on the case. We really want it to be a positive learning experience for all involved.