Current Practice and Variation in Same-Day Services in Breast Imaging: A Multi-Institutional National Survey of the Society of Breast Imaging Membership.

OBJECTIVE: The availability of same-day services in breast imaging is an important topic given potential advantages for timely diagnoses and patient experiences, but there are potential barriers that lead facilities to not offer these services. We sought to understand current practice patterns and radiologist perspectives on offering same-day services. METHODS: The Society of Breast Imaging (SBI) Patient Care & Delivery Committee developed a 19-question survey that was emailed to all 3449 active members of the SBI in May 2023. An exemption from the institutional review board was obtained at the lead author's institution. The survey consisted of 19 questions that were designed to understand the scope, perceptions, barriers, and logistics of same-day services. Comparisons were made between responses for offering same-day services (screening interpretation, diagnostic examinations, biopsies) and respondent demographics. RESULTS: A total of 437 American and Canadian members participated, yielding a response rate of 12.7%. Respondents were most commonly in private practice (43.0%, 188/437), working in an outpatient medical center-based clinic (41.9%, 183/437), and without trainees (64.5%, 282/437). Respondents estimated 12.1% of screening examinations were interpreted while patients waited, which was significantly more common in free-standing breast imaging clinics (P = .028) and practices without trainees (P = .036). Respondents estimated 15.0% of diagnostic examinations were performed same day, which was more common in academic and private practices (P = .03) and practices without trainees (P = .01). Respondents estimated 11.5% of biopsies were performed the same day as the recommendation, which had no association with practice type/context, presence of trainees, number of mammography units, number of radiologists, or number of technologists. Long patient travel distance and limited patient mobility were the most cited reasons for offering patients same-day services. CONCLUSION: Offering same-day breast imaging services varies among institutions and may be influenced by factors such as practice context and type and the presence of trainees.

Abbreviated Breast MRI Utilization: A Survey of the Society of Breast Imaging.

OBJECTIVE: To survey Society of Breast Imaging (SBI) membership on their use of abbreviated breast MRI to understand variability in practice patterns. METHODS: A survey was developed by the SBI Patient Care and Delivery committee for distribution to SBI membership in July and August 2021. Eighteen questions queried practice demographics and then abbreviated breast MRI practices regarding initial adoption, scheduling and finances, MRI protocols, and interpretations. Comparisons between responses were made by practice demographics. RESULTS: There were 321 respondents (response rate: 15.3%), of whom 25% (81/321) currently offer and 26% (84/321) plan to offer abbreviated breast MRI. Practices in the South (37/107, 35%) and Midwest (22/70, 31%) were more likely to offer abbreviated MRI (P = 0.005). Practices adopted many strategies to raise awareness, most directed at referring providers. The mean charge to patients was $414, and only 6% of practices offer financial support. The median time slot for studies is 20 minutes, with only 15% of practices using block scheduling of consecutive breast MRIs. Regarding MRI protocols, 64% (37/58) of respondents included only a single first-pass post-contrast sequence, and 90% (52/58) included T2-weighted sequences. Patient eligibility was highly varied, and a majority of respondents (37/58, 64%) do not provide any recommendations for screening intervals in non-high-risk women. CONCLUSION: Abbreviated breast MRI utilization is growing rapidly, and practices are applying a variety of strategies to facilitate adoption. Although there is notable variability in patient eligibility, follow-up intervals, and costs, there is some agreement regarding abbreviated breast MRI protocols.

Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know.

Impaired tubal patency accounts for up to 35% of cases of subfertility and infertility. Hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy) represents a first-line test in evaluating fallopian tube patency. Despite the association of HSG with ionizing radiation, HSG is a reference standard in assessing fallopian tube patency and tubal conditions such as tubal occlusion, salpingitis isthmica nodosa, and hydrosalpinx. HSG is widely available and utilizes either a water-soluble contrast medium (WSCM) or an oil-soluble contrast medium (OSCM). Compared with WSCM, HSG with OSCM results in a higher incidence of non-in vitro fertilization pregnancies and, therefore, may be preferred in women younger than 38 years with unexplained subfertility. HSG may also be helpful in assessment after sterilization or before fallopian tube recanalization. US-based tubal tests are free of ionizing radiation and include HyCoSy, with either air-saline or microbubble US contrast material, and hysterosalpingo-foam sonography (HyFoSy), a tubal patency test that utilizes a gel foam. A comprehensive US infertility evaluation of the pelvis and fallopian tubes can be achieved in one setting by adding coronal three-dimensional imaging of the uterus, saline infusion sonohysterography, and HyCoSy or HyFoSy to routine pelvic US. MR HSG and virtual CT HSG also depict tubal patency and uterine and adnexal pathologic conditions and may be considered in select patients. While laparoscopic chromopertubation remains the standard for tubal patency evaluation, its disadvantages are its invasiveness and cost. Knowledge of the different fallopian tube tests and radiologic appearance of normal and abnormal fallopian tubes results in fewer pitfalls, accurate interpretation, and optimal patient care. Online supplemental material is available for this article. ©RSNA, 2021.