Management of Mammographic Architectural Distortion Based on Contrast-enhanced MRI and US Correlation.

Objective: The objective was to evaluate outcomes of mammographic architectural distortion (AD) with and without MRI and US correlates.

Methods: A retrospective review of unexplained mammographic AD with subsequent MRI from January 1, 2007 to September 30, 2017 was performed using a reader-based study design. Mammographic, MRI, and US features and outcomes were documented.

Predictors of Breast Cancer Outcome in a Cohort of Women Seeking Care at a Safety Net Hospital.

Rationale And Objectives: This study aimed to identify predictors associated with lower mortality in a population of women diagnosed and treated for breast cancer at a safety net hospital.

Methods: From 2008 to 2014, 1115 patients were treated for breast cancer at our academic safety net hospital. 208 were excluded due to diagnosis at an outside facility, and the remaining 907 (81%) formed the study cohort.

Comparison of Contrast-enhanced Mammography with MRI Utilizing an Enriched Reader Study: A Breast Cancer Study (CONTRRAST Trial).

Background Despite growing interest in using contrast-enhanced mammography (CEM) for breast cancer screening as an alternative to breast MRI, limited literature is available. Purpose To determine whether CEM is noninferior to breast MRI or abbreviated breast MRI (AB MRI) and superior to two-dimensional mammography in an asymptomatic population simulating those who would present for screening and then undergo diagnostic work-up. Materials and Methods This enriched reader study used CEM and MRI data prospectively collected from asymptomatic individuals at a single institution from December 2014 to March 2020.

Demystifying Breast Disease Markers.

Breast imaging radiologists regularly perform image-guided biopsies of suspicious breast lesions based on features that are associated with a likelihood of malignancy ranging from 2% to greater than 95% (Breast Imaging Reporting and Data System categories 4 and 5). As diagnostic partners, pathologists perform histopathologic assessment of these tissue samples to confirm a diagnosis. Correlating the imaging findings with the histopathologic results is an integral aspect of multidisciplinary breast care.

The Impact of Social Determinants of Health on the Time Between Diagnostic Breast Imaging and Biopsy at a Safety Net Hospital.

Purpose: Although social determinants of health (SDH) are thought to be associated with health outcomes, there is limited literature on the direct impact of SDH on delays in breast cancer diagnosis via breast imaging. Identifying SDH associated with longer lapses (defined in this study as a time interval between two events) between imaging and biopsy is essential to early-stage detection of breast cancer, which has a significant impact on survival. Previous work demonstrated associations between both housing and food insecurity with longer lapses between diagnostic imaging and biopsy.

Social determinants of health and the prediction of missed breast imaging appointments.

Background: Predictive models utilizing social determinants of health (SDH), demographic data, and local weather data were trained to predict missed imaging appointments (MIA) among breast imaging patients at the Boston Medical Center (BMC). Patients were characterized by many different variables, including social needs, demographics, imaging utilization, appointment features, and weather conditions on the date of the appointment.

Methods: This HIPAA compliant retrospective cohort study was IRB approved.

Calcified Axillary Lesions on Mammography: Review and Management.

When interpreting mammography, breast radiologists may identify radiopaque densities in the axilla on the mediolateral oblique or lateral projections. When such densities are encountered, true calcifications must be differentiated from pseudocalcifications (artifact). Using imaging, breast radiologists should be able to localize the finding as being dermal, within the soft tissues, within a lymph node, or intramuscular.

Framed and Reframed! The Art of Using Cognitive Behavioral Techniques to Combat Burnout.

The incidence of burnout among radiologists has been increasing exponentially, largely attributed to increased work volumes, expectations for more rapid turn-around times and decreasing interpersonal interactions. While personal wellness activities have been described in the literature, there is little information on the role of cognitive behavioral therapy strategies to mitigate burnout. This manuscript will describe the value of naming automatic negative emotions which can lead to burnout and will provide an overview of strategies that can be used to combat them, using cognitive behavioral therapy techniques.

The Impact of Social Determinants of Health on Lung Cancer Screening Utilization.

Purpose: The purpose of this study was to understand how social determinants of health might influence lung cancer screening (LCS) adherence.

Methods: All LCS low-dose CT appointments scheduled at an urban, tertiary care academic medical center in the New England region between January 1, 2015, and December 31, 2018, were included. Demographics, insurance type, information on social determinants of health, and appointment status were obtained from the electronic medical records.

Monochromatic X-rays: The future of breast imaging.

Purpose: To present details about the innovative and disruptive technology of monochromatic X-rays and its application to breast imaging.

Methods: To analyze results of studies done using a prototype system for breast imaging that generates monochromatic X-rays through fluorescence emission. To assess signal-to-noise ratio (SNR) as a measure of image quality at different doses in breast phantoms of different sizes and review the comparison of parameters with a standard mammography system.

Image-guided Microinvasive Percutaneous Treatment of Breast Lesions: Where Do We Stand?

Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation.

Five Tips for Successful Conflict Negotiation in the Breast Imaging Workplace.

Conflict in the workplace is inevitable and disruptive to the team dynamic, ultimately leading to suboptimal patient outcomes if not addressed. Especially in breast imaging, where an interprofessional team is commonplace, spending time to address conflict is critical to building and maintaining relationships among team members. Although institutions may adopt a just culture, workplace paradigms can be challenged when two or more team members encounter misunderstandings around work-related or personal issues.

Coaching: A Primer for the Radiologist.

The practice of coaching using positive psychology is an emerging and promising approach to address the radiologist burnout epidemic, with the focus on wellness even more urgent given the coronavirus disease 2019 pandemic and other recent stressful events. Coaching uses a strengths-based approach to help radiologists identify and achieve positive emotions, create meaningful relationships, increase engagement and purpose, and develop coping skills for personal and professional stressors, including communication, improving resilience, team building, and mindfulness. Health and wellness coaching promotes healthy behavior change as a means of averting or mitigating chronic lifestyle-related diseases and is a potential treatment for burnout and stress management.

Systemic diseases affecting the breast: Imaging, diagnosis, and management.

Various systemic diseases of benign or malignant etiologies can clinically manifest in the breast. Some imaging findings of breast lesions can be pathognomonic for a given condition, while others are non-specific, mimicking primary breast carcinoma and requiring tissue biopsy for definitive diagnosis. In addition to obtaining a detailed clinical history, radiologists should be familiar with the diverse clinical and imaging characteristics of these conditions to help exclude primary breast cancer and avoid unnecessary interventions.

Longitudinal Resilience and Burnout in Radiology Residents.

Purpose: The aims of this study were to determine resilience levels of radiology residents at the start of radiology residency, investigate changes in resilience and burnout during residency, and assess the relationship between resilience and burnout among radiology residents.

Methods: Diagnostic radiology residents were invited to participate in online surveys from 2016 to 2019. Resilience was assessed using the Connor-Davidson Resilience Scale.

Motivation: how to create a cohort of engaged, energized, and happy radiology trainees.

Burnout among physicians continues to be a "hot topic" as medical culture struggles to adapt to the changing marketplace, where clinical demands are ever increasing but healthcare systems are pivoting to prefer value and cost-savings. To date, many attempts to understand and battle burnout center around the individual physician, rather than the system, limiting the medical community's ability to counter it successfully. The training environment is a common nidus for burnout.

Acceptability of an Interactive Computer-Animated Agent to Promote Patient-Provider Communication About Breast Density: a Mixed Method Pilot Study.

Background: Half of women undergoing mammography have dense breasts. Mandatory dense breast notification and educational materials have been shown to confuse women, rather than empower them.

Objective: This study used a mixed method, multi-stakeholder approach to assess acceptability of an interactive, computer-animated agent that provided breast density information to women and changes in knowledge, satisfaction, and informational needs.

Comparison of Contrast-Enhanced Mammography With Conventional Digital Mammography in Breast Cancer Screening: A Pilot Study.

Purpose: To perform a pilot evaluation of contrast-enhanced mammography (CEM) for screening to determine whether it can improve accuracy and reader confidence in diagnosis.

Methods And Materials: This institutional review board-approved reader study was comprised of 64 de-identified CEM cases acquired from December 1, 2014, to June 7, 2016, including 48 negative, 5 biopsy-proven benign, and 11 biopsy-proven malignancies. Negative cases were followed for at least 2 years without evidence of cancer.

Primary and Secondary Breast Lymphoma: Clinical, Pathologic, and Multimodality Imaging Review.

Breast lymphoma is a rare hematologic neoplasm that originates in the breast lymphoid tissue and includes primary breast lymphoma (PBL) and secondary breast lymphoma (SBL). PBL involves the breast lymphoid tissue in the absence of previously identified extramammary lymphoma and widespread disease. SBL is the most common metastasis to the breast, accounting for 17% of metastatic disease to the breast.

The Road to Wellness: Engagement Strategies to Help Radiologists Achieve Joy at Work.

Physician wellness is recognized as a critical component of enhancing the quality of health care. An epidemic of symptoms related to stress and burnout among medical professionals, including radiologists, in the workplace is threatening not only health care providers at a personal level but also the entire health care system. In this review, the authors highlight recognized stressors in the contemporary radiology workplace and offer practical suggestions for mitigating burnout, improving professional engagement, and promoting wellness.

The role of diffusion weighted imaging as supplement to dynamic contrast enhanced breast MRI: Can it help predict malignancy, histologic grade and recurrence?

Rationale And Objectives: To evaluate the value of adding Diffusion Weighted Imaging (DWI) with Apparent Diffusion Coefficient (ADC) mapping to dynamic contrast enhanced (DCE-MRI) to distinguish benign from malignant pathology subtypes and tumor recurrence.

Method And Materials: In this retrospective IRB approved study, 956 consecutive patients underwent bilateral breast MRI between 1/2015 and 12/2015, with 156 BIRADS 4, 5, or 6 lesions detected in 111 patients. DWI imaging at B0, B100, B600, B1000 was performed with DCE-MRI.