Active Surveillance for Atypical Ductal Hyperplasia and Ductal Carcinoma In Situ.

Atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) are relatively common breast lesions on the same spectrum of disease. Atypical ductal hyperblasia is a nonmalignant, high-risk lesion, and DCIS is a noninvasive malignancy. While a benefit of screening mammography is early cancer detection, it also leads to increased biopsy diagnosis of noninvasive lesions.

Problem-solving Breast MRI.

Breast MRI has high sensitivity and negative predictive value, making it well suited to problem solving when other imaging modalities or physical examinations yield results that are inconclusive for the presence of breast cancer. Indications for problem-solving MRI include equivocal or uncertain imaging findings at mammography and/or US; suspicious nipple discharge or skin changes suspected to represent an abnormality when conventional imaging results are negative for cancer; lesions categorized as Breast Imaging Reporting and Data System 4, which are not amenable to biopsy; and discordant radiologic-pathologic findings after biopsy. MRI should not precede or replace careful diagnostic workup with mammography and US and should not be used when a biopsy can be safely performed.

Breast Cancer Screening in Survivors of Childhood Cancer.

Women who survived childhood cancers or cancers at a young age are at high risk for breast cancer later in life. The accentuated risk is notable among those treated at a young age with a high radiation dose but also extends to survivors treated with therapies other than or in addition to radiation therapy. The predisposing risk factors are complex.

MRI in the Setting of Neoadjuvant Treatment of Breast Cancer.

Neoadjuvant therapy may reduce tumor burden preoperatively, allowing breast conservation treatment for tumors previously unresectable or requiring mastectomy without reducing disease-free survival. Oncologists can also use the response of the tumor to neoadjuvant chemotherapy (NAC) to identify treatment likely to be successful against any unknown potential distant metastasis. Accurate preoperative estimations of tumor size are necessary to guide appropriate treatment with minimal delays and can provide prognostic information.

Differences between human and machine perception in medical diagnosis.

Deep neural networks (DNNs) show promise in image-based medical diagnosis, but cannot be fully trusted since they can fail for reasons unrelated to underlying pathology. Humans are less likely to make such superficial mistakes, since they use features that are grounded on medical science. It is therefore important to know whether DNNs use different features than humans.

Impact of Longitudinal Focused Academic Time on Resident Scholarly Activity.

Rationale And Objectives: Meeting the Accreditation Council for Graduate Medical Education scholarly activity requirement can be challenging for residents. Time to engage in research is one of the commonly perceived barriers. To address this barrier, our residency program implemented a focused academic time initiative of a half day per week that can be taken while on rotation.

Artificial intelligence system reduces false-positive findings in the interpretation of breast ultrasound exams.

Though consistently shown to detect mammographically occult cancers, breast ultrasound has been noted to have high false-positive rates. In this work, we present an AI system that achieves radiologist-level accuracy in identifying breast cancer in ultrasound images. Developed on 288,767 exams, consisting of 5,442,907 B-mode and Color Doppler images, the AI achieves an area under the receiver operating characteristic curve (AUROC) of 0.

Incorporation of a Social Virtual Reality Platform into the Residency Recruitment Season.

Rationale And Objectives: The Covid-19 pandemic ushered a sudden need for residency programs to develop innovative socially distant and remote approaches to effectively promote their program. Here we describe our experience using the social virtual reality (VR) platform Mozilla Hubs for the pre-interview social during the 2020-2021 radiology residency virtual recruitment season, provide results of a survey sent to assess applicants' attitudes towards the VR pre-interview social, and outline additional use-cases for the emerging technology.

Materials And Methods: A VR Meeting Hall dedicated to the pre-interview social was designed in Mozilla Hubs.

Screening Breast MRI Primer: Indications, Current Protocols, and Emerging Techniques.

Breast dynamic contrast-enhanced MRI (DCE-MRI) is the most sensitive imaging modality for the detection of breast cancer. Screening MRI is currently performed predominantly in patients at high risk for breast cancer, but it could be of benefit in patients at intermediate risk for breast cancer and patients with dense breasts. Decreasing scan time and image interpretation time could increase cost-effectiveness, making screening MRI accessible to a larger group of patients.

Impact on Participants of Family Connect, a Novel Program Linking COVID-19 Inpatients' Families With the Frontline Providers.

Purpose: With clinical volumes decreased, radiologists volunteered to participate virtually in daily clinical rounds and provide communication between frontline physicians and patients with coronavirus disease 2019 (COVID-19) and their families affected by restrictive hospital visitation policies. The purpose of this survey-based assessment was to demonstrate the beneficial effects of radiologist engagement during this pandemic and potentially in future crises if needed.

Methods: After the program's completion, a survey consisting of 13 multiple-choice and open-ended questions was distributed to the 69 radiologists who volunteered for a minimum of 7 days.

Assessing the impact of an orientation week on acclimation to radiology residency.

Purpose: Acclimating residents to radiology residency requires attention to new responsibilities, educational material, and social cohesion. To this end, we instituted a structured orientation week for incoming residents and assessed its impact.

Procedures: During the first weeks of July 2016 and 2017, first year residents attended a five day orientation free of clinical duties, consisting of didactics, hands-on training sessions, and social events.

Breast Imaging in Transgender Patients: What the Radiologist Should Know.

is the umbrella term for individuals whose gender identity and/or gender expression differs from their assigned sex at birth. With the rise in patients undergoing gender-affirming hormone therapy and gender-affirming surgery, it is increasingly important for radiologists to be aware of breast imaging considerations for this population. While diagnostic imaging protocols for transgender individuals are generally similar to those for cisgender women, screening guidelines are more variable.

Frequency and outcomes of biopsy-proven fibroadenomas recommended for surgical excision.

Our aim was to investigate the outcomes of fibroadenomas recommended for surgical excision due to large size (>2cm) or interval growth. A retrospective review of our institutional radiology database from 2007 to 2015 was performed. We identified 167 biopsy-proven fibroadenomas recommended for surgical consultation.

Comparison between qualitative and quantitative assessment of background parenchymal enhancement on breast MRI.

Background: Potential clinical implications of the level of background parenchymal enhancement (BPE) on breast MRI are increasing. Currently, BPE is typically evaluated subjectively. Tests of concordance between subjective BPE assessment and computer-assisted quantified BPE have not been reported.

Ductal Carcinoma In Situ: The Whole Truth.

Objective: Ductal carcinoma in situ (DCIS) is a noninvasive malignant breast disease traditionally described as a precursor lesion to invasive breast cancer. With screening mammography, DCIS now accounts for approximately 20% of newly diagnosed cancer cases. DCIS is not well understood because of its heterogeneous nature.

Magnetic Resonance Imaging-Directed Ultrasound Imaging of Non-Mass Enhancement in the Breast: Outcomes and Frequency of Malignancy.

Objectives: This study was performed to determine the frequency, predictors, and outcomes of ultrasound (US) correlates for non-mass enhancement.

Methods: From January 2005 to December 2011, a retrospective review of 5837 consecutive breast magnetic resonance imaging examinations at our institution identified 918 non-mass enhancing lesions for which follow-up or biopsy was recommended. Retrospective review of the images identified 879 of 918 lesions (96%) meeting criteria for non-mass enhancement.

Clinical applicability and relevance of fibroglandular tissue segmentation on routine T1 weighted breast MRI.

Purpose: To evaluate clinical applicability of fibroglandular tissue (FGT) segmentation on routine T1 weighted breast MRI and compare FGT quantification with radiologist assessment.

Methods: FGT was segmented on 232 breasts and quantified, and was assessed qualitatively by four breast imagers.

Results: FGT segmentation was successful in all 232 breasts.

Metastatic carcinoid tumor to the breast: report of two cases and review of the literature.

The breast is an unusual site for carcinoid metastasis. Due to increasing survival rates for carcinoid tumors, however, awareness of their rare complications is important. Carcinoid metastasis to the breast typically presents as a palpable breast mass or a mass on screening mammogram.

Abbreviated MRI Protocols: Wave of the Future for Breast Cancer Screening.

Objective: The purpose of this article is to describe the use of abbreviated breast MRI protocols for improving access to screening for women at intermediate risk.

Conclusion: Breast MRI is not a cost-effective modality for screening women at intermediate risk, including those with dense breast tissue as the only risk. Abbreviated breast MRI protocols have been proposed as a way of achieving efficiency and rapid throughput.

Frequency and Outcomes of Incidental Breast Lesions Detected on Abdominal MRI Over a 7-Year Period.

Objective: Our aim was to evaluate the frequency and outcomes of incidental breast lesions detected on abdominal MRI examinations.

Materials And Methods: Abdominal MRI reports for 11,462 women imaged at our institution from November 2007 through December 2014 were reviewed to identify those reporting an incidental breast lesion. Available breast imaging and pathology results were assessed to identify outcomes in these lesions.

Integrating Customer Intimacy Into Radiology to Improve the Patient Perspective: The Case of Breast Cancer Screening.

Objective: The customer intimacy business model has emerged as a key operational approach for health care organizations as they move toward patient-centered care. The question arises how the customer intimacy approach can be implemented in the clinical setting and whether it can help practitioners address problems and improve quality of care.

Conclusion: Breast cancer screening and its emphasis on the patient perspective provides an interesting case study for understanding how the customer intimacy approach can be integrated into radiologic practice to improve the patient experience.

Polyacrylamide gel breast augmentation: report of two cases and review of the literature.

Polyacrylamide gel (PAAG) injection remains an uncommon method of breast augmentation. Providers must recognize the clinical and radiological manifestations to optimize management. The clinical and radiological findings of PAAG injection may mimic malignancy and silicone breast augmentation.

"Empty" sac in pregnant women with bleeding: are measurements answering the right question?

Purpose: To assess the percentage of first-trimester pregnancies with bleeding that demonstrate a visible sac but lack an identifiable embryo and have a mean sac diameter (MSD) in the controversial range of 16-20 mm.

Methods: Retrospective study of all first-trimester sonograms among women with vaginal bleeding during a 4-year interval.

Results: The study cohort consisted of 546 first- trimester sonograms.

Five-millimeter and smaller embryos without embryonic cardiac activity: outcomes in women with vaginal bleeding.

Objective: The purpose of this study was to assess outcomes in embryos with a crown-rump length (CRL) of 5 mm or less without embryonic cardiac activity (ECA) among pregnant women with vaginal bleeding in the first trimester.

Methods: A retrospective study of all first-trimester sonograms in women with vaginal bleeding from 1999 to 2002 was conducted.

Results: Thirty-seven embryos without detectable ECA that had a CRL of 5 mm or less were identified.