A survey of breast imaging fellowship programs: current status of curriculum and training in the United States and Canada.

Purpose: The Society of Breast Imaging and the Education Committee of the ACR Breast Commission conducted a survey of breast imaging fellowship programs to determine the status of fellowship curricula, help identify strengths and potential areas for improvement, and assess the current demand for fellowship programs.

Methods: In 2012, a two-part survey was emailed to breast imaging fellowship directors from 72 fellowship programs.

Results: Of the 66 respondents, a total of 115 positions were identified.

An institutional strategy to increase minority recruitment to therapeutic trials.

Purpose: Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We present a framework for institutional enhancement of minority clinical trial accrual.

The ACR/Society of Breast Imaging Resident and Fellowship Training Curriculum for Breast Imaging, updated.

The education committees of the ACR Commission on Breast Imaging and the Society of Breast Imaging have revised the resident and fellowship training curriculum to reflect the current state of breast imaging in the United States. The original curriculum, created by the Society of Breast Imaging in 2000, had been updated only once before, in 2006. Since that time, a number of significant changes have occurred in the way mammography is acquired, how adjunctive breast imaging methods are used, and how pathology is assessed.

Pathologic outcomes of nonmalignant papillary breast lesions diagnosed at imaging-guided core needle biopsy.

Purpose: To determine the upstage rate from nonmalignant papillary breast lesions obtained at imaging-guided core needle biopsy (CNB) and if there are any clinical, imaging, or pathologic features that can be used to predict eventual upstaging to malignancy.

Materials And Methods: This retrospective case review was institutional review board approved and HIPAA compliant, with a waiver of informed consent. A database search (from January 2001 to March 2010) was performed to find patients with a nonmalignant papillary breast lesion diagnosed at CNB.

Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk.

Context: Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography. Magnetic resonance imaging (MRI) may reveal additional breast cancers missed by both mammography and ultrasound screening.

Objective: To determine supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer.

Effect of transition to digital mammography on clinical outcomes.

Purpose: To determine the effect of transition to digital screening mammography on clinical outcome measures, including recall rate, cancer detection rate, and positive predictive value (PPV).

Materials And Methods: Institutional review board approval and the need for informed consent were waived for this HIPAA-complaint study. Practice audit data were obtained for three breast imaging radiologists from 2004 to 2009.

Comparison of soft-copy and hard-copy reading for full-field digital mammography.

Purpose: To compare radiologists' performance in detecting breast cancer when reading full-field digital mammographic (FFDM) images either displayed on monitors or printed on film.

Materials And Methods: This study received investigational review board approval and was HIPAA compliant, with waiver of informed consent. A reader study was conducted in which 26 radiologists read screening FFDM images displayed on high-resolution monitors (soft-copy digital) and printed on film (hard-copy digital).

National trends and practices in breast MRI.

Objective: The objective of our study was to report on the current practices of radiologists involved in the performance and interpretation of breast MRI in the United States.

Materials And Methods: We invited the 1,696 active physician members of the Society of Breast Imaging to participate in a survey addressing whether and how they performed and interpreted breast MRI. Respondents were asked to select one member of their practice to complete the survey.

Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer.

Context: Screening ultrasound may depict small, node-negative breast cancers not seen on mammography.

Objective: To compare the diagnostic yield, defined as the proportion of women with positive screen test results and positive reference standard, and performance of screening with ultrasound plus mammography vs mammography alone in women at elevated risk of breast cancer.

Design, Setting, And Participants: From April 2004 to February 2006, 2809 women, with at least heterogeneously dense breast tissue in at least 1 quadrant, were recruited from 21 sites to undergo mammographic and physician-performed ultrasonographic examinations in randomized order by a radiologist masked to the other examination results.

Educational intervention for women undergoing image-guided breast biopsy: results of a randomized clinical trial.

Background: The process of informed consent has been examined for patients undergoing various procedures but not breast biopsy. Our study was a randomized trial that examined the effect of an educational flip chart as part of the informed consent.

Methods: A total of 122 patients referred for stereotactic or ultrasound-guided core breast biopsy were randomly assigned to receive an informed consent discussion with or without an illustrated flip chart.

American College Of Radiology/Society of Breast Imaging curriculum for resident and fellow education in breast imaging.

The ACR and the Society of Breast Imaging have revised the curriculum for resident and fellow education in breast imaging on the basis of substantial changes in breast imaging practice since the initial curriculum was published in 2000. This curriculum provides guidance to academic chairs, residency program directors, and academic section chiefs in assessing and improving their residency and fellowship training programs and indicates to residents and breast imaging fellows the topics they need to learn and the experience they should try to acquire during their training. Radiologists already in practice also may find the curriculum useful in outlining the material they need to know to remain up to date in the practice of breast imaging.

Professional and economic factors affecting access to mammography: a crisis today, or tomorrow? Results from a national survey.

Background: Objective data and anecdotal reports have suggested that access to mammography may be declining because of facility closures and difficulty in recruiting and retaining radiologists and radiologic technologists. To gain insight into the practice patterns, use of emerging technologies, and concerns of breast imagers in current practice, the Society of Breast Imaging (SBI) conducted a national survey of breast imaging practices in the U.S.

Screening mammography practice essentials.

A successful screening mammography practice has three directives. The first directive is quality mammography interpretation, which results in detection of a high percentage of early stage breast cancers, an acceptable recall rate, and an acceptable biopsy rate and yield. The second directive is providing a cost-efficient service.

Rural-urban differences in ductal carcinoma in situ as a proxy for mammography use over time.

Context: With emphasis on increasing use of mammography, the rate of ductal carcinoma in situ (DCIS) of the breast has increased dramatically in the United States starting in the early 1980s. It is unclear if rural and urban women have experienced similar increases.

Purpose: To describe differences in incidence of DCIS between rural and urban women 50 to 69 years of age over time.

Survey of radiology residents: breast imaging training and attitudes.

Purpose: To investigate the training and attitudes of residents regarding breast imaging.

Materials And Methods: A telephone survey was conducted with 201 4th-year residents (postgraduate medical school year 5) and 10 3rd-year residents (postgraduate medical school year 4) at 211 accredited radiology residencies in the United States and Canada. Survey topics included organization of the breast imaging section, residents' role in the section, clinical practice protocols of the training institution, residents' personal thoughts about breast imaging, and their interest in performing breast imaging in the future.

An introduction to economic issues in breast imaging.

Marked increases in national health care costs, along with governmental coverage of health care costs for the elderly under Medicare, have resulted in increased government regulation of medical reimbursement rates. Private insurers and HMOs now provide reimbursements that are frequently the same or lower than those from Medicare. Reimbursement rates for mammography have been particularly restricted.

Reasons for failure of a mammography unit at clinical image review in the American College of Radiology Mammography Accreditation Program.

Purpose: To identify the most common deficiencies in the quality of mammograms submitted for clinical image evaluation (evaluation of image from actual patient referred for mammography).

Materials And Methods: In 1997, the American College of Radiology Mammography Accreditation Program reviewed clinical images for 2,341 mammography units. For each mammography unit, the facility submitted bilateral mediolateral oblique and craniocaudal mammograms obtained in a woman with fatty breasts and a woman with dense breasts.

Multifeature analysis of Gd-enhanced MR images of breast lesions.

The objective of this study was to determine whether linear discriminant analysis of different independent features of MR images of breast lesions can increase the sensitivity and specificity of this technique. For MR images of 23 benign and 20 malignant breast lesions, three independent classes of features, including characteristics of Gd-DTPA-uptake curve, boundary, and texture were evaluated. The three classes included five, four and eight features each, respectively.

Mammography quality assurance from A to Z.

Quality assurance (QA) refers to all planned, systematic activities that instill confidence that quality mammography is being performed. Quality control (QC) refers only to the technical aspects of the examination. Standardized labeling of mammograms and the format for mammographic reports are important parts of a QA program; recommendations for both have been published by the American College of Radiology.

MR imaging of the breast in patients with silicone-gel implants: spectrum of findings.

Because of recent concerns about the potential dangers of rupture and leakage of silicone-gel implants, radiologists are often requested to evaluate the integrity of normal breast implants. Clinical studies suggest that MR imaging can accurately depict implant rupture. The purpose of this pictorial essay is to illustrate the spectrum of MR appearances of breasts in patients with silicone-gel implants.

Strategies for implementation and quality assurance for mammographic screening.

Compliance with screening mammography guidelines is affected by complex factors, including cost, accessibility, education, and attitudes of referring physicians. High-volume mammography facilities have lower fees and higher quality. Quality assurance is the focus of the voluntary American College of Radiology Mammography Accreditation Program, and over half of all mammography units are accredited.