ACR Bulletin

Covering topics relevant to the practice of radiology

Case History

After a decade of developing one of the ACR’s most beloved resources, the editor-in-chief for Case in Point® describes what’s next for the daily cases.

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My favorite CiP cases are those that combine something rare with something common, so a very rare final diagnosis, with a long differential of other more common entities.

—Kitt Shaffer, MD, PhD, FACR
October 25, 2021

For more than 10 years, ACR’s popular case-based educational tool Case in Point® (CiP) has been led by Editor-in-Chief Kitt Shaffer, MD, PhD, FACR, professor of radiology and anatomy/neurobiology at Boston University Medical Center. After overseeing the publication of more than 4,000 cases, Shaffer stepped down as editor-in-chief in October, as her successor, David R. Pettersson, MD, associate professor of neuroradiology at Oregon Health and Science University, took the helm. The Bulletin recently spoke to Shaffer, who will continue working with CiP as associate editor, to learn more about what makes the program so successful.

Why do you think CiP has flourished in its 15 years at ACR?

CiP has been a flagship educational product for ACR. You can spend 10 minutes and get a little chunk of learning that fits into even a busy day in clinic. That was the way it was set up from the beginning, but one of the things I have tried to emphasize during my time as editor-in-chief is to keep it that way — not to let the cases get too long and dragged out. They need to be short and to the point.

What are some of the more memorable CiP cases?

My favorite CiP cases are those that combine something rare with something common, so a very rare final diagnosis, with a long differential of other more common entities. I also like cases that unfold like a real case does: first some history (possibly misleading or incomplete) followed by a detection question, then a discussion of what that finding might represent (including common and rare choices), then perhaps a bit more information that allows you to narrow the differential, and finally a surprise twist that leads to the unusual diagnosis but allows a discussion that includes more common possibilities.

What are your plans after you are no longer editor-in-chief?

I will continue as an associate editor. I do enjoy the editing part. I’m winding down my clinical work, so I probably won’t be a practicing radiologist very much longer. I love teaching, so I would like to continue to teach. I’d also like to get involved in the ACR Senior and/or Retired Section, which sounds fulfilling and interesting.

You have been involved with medical students and residents via both the ACR PIER internship and the Amazing Case Race. What advice would you give to medical students and radiology residents who are just starting out?

Clearly, there are a lot of decision points — there’s diagnostic or interventional, academic or private practice, and full-time or part-time. The best thing they can really do is to get exposed to as much radiology as they possibly can and take every opportunity to be in the reading room. If they can visualize themselves in that environment and decide if that’s something they would enjoy — that’s going to be the most important decision-maker for them.

Regarding CiP, if medical students or residents have any inclination whatsoever toward academics, then putting a case together is a great way to learn a little bit about it — without too much pain and with a very good chance of success. It’s a small writing project compared to an actual scientific article, but it has a lot of the same features: You have to think about how to structure it, you have to choose figures, you have to write figure legends, you have to select appropriate references, and you have to have teaching points.

How has the pandemic changed how students learn and digest information?

It’s been pretty dramatic, I have to say — and it all happened so quickly. Videoconferencing has been my go-to resource. I love in-person teaching, but I think there are situations and topic areas in which virtual is still better. Some of the lessons COVID-19 has taught us about distance learning are too valuable to discard. For example, I love using the chat feature to allow all participants to answer questions. I also use the annotate function a lot, allowing participants to draw on the images just like I do. The view for each participant is better with Zoom than in an auditorium — everyone has a front-row seat. I do all of my teaching as interactive case-based discussions, usually with a flipped classroom model. I post preview images of the cases on my website, with questions for students to ponder, so they can come to class with questions, ready to discuss and participate.

I understand you’re an avid artist. How do you approach teaching from an artist’s perspective?

I have always approached teaching from an artist’s perspective and have used drawing as a method of illustrating findings on the fly, since my early days as an educator. In the past, I used actual films and dry-erase markers to allow me to draw anatomic structures and illustrate findings when discussing cases. When radiology converted to digital images, I reproduced this same teaching methodology using Photoshop versions of images and a digital drawing tablet. Most recently, an amazing student who saw me teach offered to develop a website that would allow me to do this same thing in a simpler way. So now, I use my own website that lets me upload teaching images that I can draw on with my iPad and an Apple pencil. This is more portable than a laptop and drawing tablet and simpler to use. My teaching has translated into the Zoom world very easily and I find that this is actually better in many ways than the old traditional teaching.

Is there anything else that you’d like to share with us?

It’s been an amazing ride. There have been challenges and fabulous rewards. And the team on the publication end is the absolute best. I can’t thank them enough for making my job so pleasurable. It’s hard to think about not doing this because it has been a big part of my life for over a decade, but I think a little fresh blood will be helpful. I’m looking forward to seeing what Dr. Pettersson is going to do with CiP.

Author Interview by Melanie Padgett Powers  Freelance Writer, ACR Press