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Early detection of breast cancer from regular screening substantially reduces breast cancer mortality and morbidity. Multiple different imaging modalities may be used to screen for breast cancer. Screening recommendations differ based on an individual's risk of developing breast cancer. Numerous factors contribute to breast cancer risk, which is frequently divided into three major categories: average, intermediate, and high risk. For patients assigned female at birth with native breast tissue, mammography and digital breast tomosynthesis are the recommended method for breast cancer screening in all risk categories. In addition to the recommendation of mammography and digital breast tomosynthesis in high-risk patients, screening with breast MRI is recommended. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Neoplasias da Mama , Detecção Precoce de Câncer , Medicina Baseada em Evidências , Sociedades Médicas , Humanos , Neoplasias da Mama/diagnóstico por imagem , Feminino , Detecção Precoce de Câncer/métodos , Estados Unidos , Mamografia/normas , Mamografia/métodos , Medição de Risco , Programas de Rastreamento/métodosRESUMO
Early detection of breast cancer from regular screening substantially reduces breast cancer mortality and morbidity. Multiple different imaging modalities may be used to screen for breast cancer. Screening recommendations differ based on an individual's risk of developing breast cancer. Numerous factors contribute to breast cancer risk, which is frequently divided into three major categories: average, intermediate, and high risk. For patients assigned female at birth with native breast tissue, mammography and digital breast tomosynthesis are the recommended method for breast cancer screening in all risk categories. In addition to the recommendation of mammography and digital breast tomosynthesis in high-risk patients, screening with breast MRI is recommended. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer , MamografiaRESUMO
Early detection decreases deaths from breast cancer. Yet, there are conflicting recommendations about screening mammography by major professional medical organizations, including the age and frequency with which women should be screened. The controversy over breast cancer screening is centered on 3 main points: the impact on mortality, overdiagnosis, and false positive results. Some studies claim that adverse psychological effects such as anxiety or distress are caused by screening mammography. The purpose of this article is to address negative breast cancer screening concerns including overdiagnosis and overtreatment, effect on mortality, false positive results, mammography-related anxiety, and fear of radiation.
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OBJECTIVE: The objectives of this Society of Breast Imaging (SBI)-member survey study were to assess the current imaging patterns for evaluation of symptomatic and asymptomatic breast implant integrity, including modalities used and imaging intervals. METHODS: A 12-question survey assessing the frequency of imaging modalities used to evaluate implant integrity, approximate number of breast implant integrity studies requested per month, intervals of integrity studies, and referring provider and radiology practice characteristics was distributed to members of the SBI. RESULTS: The survey response rate was 7.6% (143/1890). Of responding radiologists, 54.2% (77/142) were in private, 29.6% (42/142) in academic, and 16.2% (23/142) in hybrid practice. Among respondents, the most common initial examination for evaluating implant integrity was MRI without contrast at 53.1% (76/143), followed by handheld US at 46.9% (67/143). Of respondents using US, 67.4% (91/135) also evaluated the breast tissue for abnormalities. Among respondents, 34.1% (46/135) reported being very confident or confident in US for diagnosing implant rupture. There was a range of reported intervals for performing implant integrity studies: 39.1% (43/110) every 2-3 years, 26.4% (29/110) every 4-5 years, 15.5% (17/110) every 6-10 years, and 19.1% (21/110) every 10 years. CONCLUSION: For assessment of implant integrity, the majority of respondents (53.2%, 76/143) reported MRI as initial imaging test. US is less costly, but the minority of respondents (34.1%, 46/135) had confidence in US performance. Also, the minority of respondents (39.1%, 43/110) performed implant integrity evaluations every 2-3 years per the FDA recommendations for asymptomatic surveillance.
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Implantes de Mama , Imageamento por Ressonância Magnética , Padrões de Prática Médica , Humanos , Feminino , Imageamento por Ressonância Magnética/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários , Radiologistas/estatística & dados numéricos , Sociedades Médicas , Ultrassonografia Mamária/estatística & dados numéricos , Falha de PróteseRESUMO
What is play and why does it matter for radiologists? Play can take many forms in the workplace, including organic, managed, task-related, diversionary, and resistive forms of play, and play may also take the form of authentic self-expression and creation. In this review article, we will discuss the benefits of play including improved problem solving, gaining perspective, and stress reduction, and also provide low-tech and high-tech examples of beneficial play for the radiology team in work and personal contexts.
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Radiologistas , Local de Trabalho , HumanosRESUMO
Moral distress is a term used to describe the cognitive-emotional dissonance that is experienced when one is compelled to act contrary to one's moral requirements. This occurs as a result of systemic constraints that prevent an individual from taking actions that they perceive as morally right, resulting in a perceived violation of one's core values and duties. There has been a growing interest in the prevalence of moral distress in healthcare, particularly as a root cause of burnout. A recent national survey on moral distress in radiology found that 98% of respondents experienced at least some degree of moral distress with 18% of respondents having left a position due to moral distress. One of the scenarios associated with the highest degree of moral distress related to the conflict that arises when one feels unable to fulfill teaching responsibilities due to high clinical demands. Now more than ever, clinician-educators are asked to do more with less time, fewer resources, and in an increasingly demanding work environment that is often discordant with providing quality education to their learners. In this manuscript, we aim to discuss the factors contributing to moral distress in radiologist clinician-educators as a framework to better understand the implications of these drivers, and to offer our perspective on potential mitigating measures.
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Esgotamento Profissional , Princípios Morais , Radiologistas , Humanos , Radiologistas/psicologia , Esgotamento Profissional/psicologia , Docentes de Medicina/psicologia , Radiologia/educação , Estresse Psicológico/psicologia , Angústia PsicológicaRESUMO
This document discusses the appropriate initial imaging in both asymptomatic and symptomatic patients with breast implants. For asymptomatic patients with saline implants, no imaging is recommended. If concern for rupture exists, ultrasound is usually appropriate though saline rupture is often clinically evident. The FDA recently recommended patients have an initial ultrasound or MRI examination 5 to 6 years after initial silicone implant surgery and then every 2 to 3 years thereafter. In a patient with unexplained axillary adenopathy with current or prior silicone breast implants, ultrasound and/or mammography are usually appropriate, depending on age. In a patient with concern for silicone implant rupture, ultrasound or MRI without contrast is usually appropriate. In the setting of a patient with breast implants and possible implant-associated anaplastic large cell lymphoma, ultrasound is usually appropriate as the initial imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Implantes de Mama , Humanos , Implantes de Mama/efeitos adversos , Medicina Baseada em Evidências , Mamografia , Silicones , Sociedades Médicas , Estados UnidosRESUMO
The National Academy of Medicine Plan for Health Workforce Well-Being identifies seven priority areas, including creating positive work environments, addressing burnout and stress, promoting transparency and equity in compensation, providing education and training to promote resilience, enhancing community and social support systems, addressing the stigma associated with seeking help for mental health and substance use disorders and fostering leadership commitment and accountability for workforce well-being. This paper will explore the National Plan for Health Workforce Well-Being, providing an overview of the seven priority areas and offering strategies for implementation in radiology.
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Palpable masses in women are the most common symptom associated with breast cancer. This document reviews and evaluates the current evidence for imaging recommendations of palpable masses in women less than 30 to over 40 years of age. There is also a review of several different scenarios and recommendations after initial imaging. Ultrasound is usually the appropriate initial imaging for women under 30 years of age. If ultrasound findings are suspicious or highly suggestive of malignancy (BIRADS 4 or 5), it is usually appropriate to continue with diagnostic tomosynthesis or mammography with image-guided biopsy. No further imaging is recommended if the ultrasound is benign or negative. The patient under 30 years of age with a probably benign ultrasound may undergo further imaging; however, the clinical scenario plays a role in the decision to biopsy. For women between 30 to 39 years of age, ultrasound, diagnostic mammography, tomosynthesis, and ultrasound are usually appropriate. Diagnostic mammography and tomosynthesis are the appropriate initial imaging for women 40 years of age or older, as ultrasound may be appropriate if the patient had a negative mammogram within 6 months of presentation or immediately after mammography findings are suspicious or highly suggestive of malignancy. If the diagnostic mammogram, tomosynthesis, and ultrasound findings are probably benign, no further imaging is necessary unless the clinical scenario indicates a biopsy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Neoplasias da Mama , Sociedades Médicas , Humanos , Feminino , Estados Unidos , Adulto , Pessoa de Meia-Idade , Lactente , Medicina Baseada em Evidências , Mamografia , Neoplasias da Mama/diagnóstico por imagemRESUMO
Given that 20% to 40% of women who have percutaneous breast biopsy subsequently undergo breast surgery, knowledge of imaging women with a history of benign (including high-risk) disease or breast cancer is important. For women who had surgery for nonmalignant pathology, the surveillance recommendations are determined by their overall risk. Higher-than-average risk women with a history of benign surgery may require screening mammography starting at an earlier age before 40 and may benefit from screening MRI. For women with breast cancer who have undergone initial excision and have positive margins, imaging with diagnostic mammography or MRI can sometimes guide additional surgical planning. Women who have completed breast conservation therapy for cancer should get annual mammography and may benefit from the addition of MRI or ultrasound to their surveillance regimen. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Neoplasias da Mama , Mamografia , Feminino , Humanos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Detecção Precoce de Câncer , Sociedades Médicas , Medicina Baseada em EvidênciasRESUMO
RATIONALES AND OBJECTIVES: The purpose is to describe a hybrid teleradiology solution utilized in an academic medical center and its outcomes on radiology report turnaround time (RTAT) and physician wellness. MATERIALS AND METHODS: During coronavirus disease 2019, we utilized an alternating teleradiology solution with procedural and education attendings working in the hospital and other faculty remote to keep the worklist clean. RTAT data was collected for remote vs. in house emergency department (ED) and inpatient cases over a 6-month period. Pre and post implementation burnout surveys were administered. RESULTS: RTAT significantly improved for ED and inpatient MR and CT, and inpatient US and radiographs when interpreted remotely compared to in-hospital. Physician wellness scores improved and open-ended comments reflected positive feedback about the hybrid work solution. 74% enjoyed the autonomy and flexibility, and 51% said the solution positively influences my desire to remain in my current institution and improves their clinical and/or academic productivity. CONCLUSION: Hybrid work from home solutions allow faculty autonomy and flexibility with work-life balance, improving wellness. It is important to alternate the at-home faculty to maintain interdepartmental relations, particularly for junior faculty, and prevent isolation. The hybrid solution also demonstrated improved patient care metrics, possibly due to decreased distractions at home compared to the reading room.
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Esgotamento Profissional , COVID-19 , Médicos , Telerradiologia , Humanos , Esgotamento Profissional/prevenção & controle , Centros Médicos AcadêmicosRESUMO
RATIONALE AND OBJECTIVES: Promotion is an important milestone in the career of academic radiologists. Appointments, Promotion and Tenure (APT) committees require multiple letters of support from both internal and external referees. Traditional narrative letters are highly subjective, have high inter-reader variability, are time-intensive, and vulnerable to gender and other biases. The Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER) recognized the need for a standardized template to assist academic faculty, letter writers, and APT committees. MATERIALS AND METHODS: An ADVICER ad hoc committee of six educators with experience serving as external referees was convened to create a standardized template. Committee members performed a search of the relevant literature and internet sites, spoke with stakeholders such as APT chairs, and ultimately developed a template for faculty reviewer letters using the common clinician-educator pathway as a focal point. RESULTS: An open source, modifiable, standardized, template was produced. The template has been made available to ADVICER members and is available on the Association of University Radiologists (AUR) website at: https://www.aur.org/resources/Template-for-Faculty-Reviewer-Letters-for-Promotion-and-Appointment CONCLUSION: This external referee template has the potential to reduce subjectivity, eliminate bias, and provide a flexible, modifiable, comprehensive faculty review letter template which will be useful for academic faculty, letter writers, and promotions committees.
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Docentes , Radiologia , Mobilidade Ocupacional , Docentes de Medicina , Humanos , Radiologia/educaçãoRESUMO
OBJECTIVE: Although the Affordable Care Act eliminated cost sharing for screening mammography, a concern is that grandfathered plans, diagnostic mammograms, and follow-up testing may still lead to out-of-pocket (OOP) spending. Our study examines how OOP spending among women at their baseline screening mammogram may impact the decision to receive subsequent screening. METHODS: The study included commercially insured women aged 40 to 41 years with a screening mammogram between 2011 and 2014. We estimated multivariate linear probability models of the effect of OOP spending at the baseline mammogram on subsequent screening 12 to 36 months later. RESULTS: Having any OOP payments for the baseline screening mammogram significantly reduced the probability of screening in the subsequent 12 to 24 months by 3.0 percentage points (pp) (95% confidence interval [CI]: 1.1-4.8 pp decrease). For every $100 increase in the OOP expenses for the baseline mammogram, the likelihood of subsequent screening within 12 to 24 months decreased by 1.9 pp (95% CI: 0.8-3.1 pp decrease). Similarly, any OOP spending for follow-up tests resulting from the baseline screening led to a 2.7 pp lower probability of screening 12 to 24 months later (95% CI: 0.9-4.1 pp decrease). Higher OOP expenses were associated with significantly lower screening 24 to 36 months later (coefficient = -0.014, 95% CI: -0.025 to -0.003). DISCUSSION: Although cost sharing has been eliminated for screening mammograms, OOP costs may still arise, particularly for diagnostic and follow-up testing services, both of which may reduce rates of subsequent screening. For preventive services, reducing or eliminating cost sharing through policy and legislation may be important to ensuring continued adherence to screening guidelines.
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Neoplasias da Mama , Gastos em Saúde , Adulto , Neoplasias da Mama/diagnóstico por imagem , Custo Compartilhado de Seguro , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia , Patient Protection and Affordable Care Act , Estados UnidosRESUMO
RATIONALE AND OBJECTIVES: Physician wellness and burnout mitigation strategies have become priority practices in recent years. Despite these efforts, however, physicians living with the psychological effects of the current COVID-19 global pandemic, political stressors, and social injustices, face ever increasing threats to their personal and professional well-being. This manuscript investigates the process of storytelling as a self-care practice for radiologists. MATERIALS AND METHODS: The AUR Well Being Ad-Hoc Committee introduced and approved Storytelling Geek Week, a virtual workshop held by The Moth, a Peabody award-winning storytelling nonprofit group. Nineteen AUR members applied and were selected for participation in the workshop which occurred over 5 days in November 2020. Anonymous electronic surveys were sent to participants before and after the workshop to gather feedback on their experience. RESULTS: Of the 19 AUR member participants, 12 (63%) completed the pre-workshop survey and 8 (42%) completed the post-workshop survey. Participant current state of well-being was found to be increased between the pre- and post-course surveys, with a statistically significant adjusted P-value of 0.017. All 8 post-workshop respondents reported that they would recommend the workshop to others. With regard to how participation in the workshop impacted their wellbeing, representative free text responses include, "helped with processing emotions," and "felt more connected to strangers." Regarding shifts in perspective as a result of workshop participation, representative free text responses include, "more empathetic" and "started focusing on hope and gratitude rather than sadness and anxiety." CONCLUSION: Participants in a storytelling workshop reported a positive impact on their perceived sense of well-being. Respondents also reports shifts in their sense of empathy and connectedness to others. This type of intervention may help to mitigate burnout and build community during challenging times.
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Esgotamento Profissional , COVID-19 , Esgotamento Profissional/prevenção & controle , Estudos de Viabilidade , Humanos , Radiologistas , Autocuidado , Inquéritos e QuestionáriosRESUMO
Feedback is a critical part of the learning process and is a valuable tool to empower adult learners. Modern feedback theory places the learner at the center of the feedback encounter. Individual and institutional barriers to effective giving and receiving of feedback can be overcome through education and attention to the form and content of feedback. We review the elements of effective feedback and address issues of framing, environmental, and social factors which aid in providing psychological safety and trust, as necessary elements to create a culture of feedback in radiology training programs. We provide practical strategies to empower learners with the necessary skills to solicit, receive, and reflect on feedback.
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Radiologia , Estudantes de Medicina , Adulto , Retroalimentação , Humanos , Aprendizagem , Estudantes de Medicina/psicologiaRESUMO
INTRODUCTION: Many states have mandated breast density notification and insurance coverage for additional screening; yet, the association between such legislation and stage of diagnosis for breast cancer is unclear. This study investigates this association and examines the differential impacts among different age and race/ethnicity subgroups. METHODS: The Surveillance, Epidemiology, and End Results database was queried to identify patients with breast cancer aged 40-74 years diagnosed between 2005 and 2016. Using a difference-in-differences multinomial logistic model, the odds of being diagnosed at different stages of cancer relative to the localized stage depending on legislation and individual characteristics were examined. Analyses were conducted in 2020-2021. RESULTS: The study included 689,641 cases. Overall, the impact of notification legislation was not significant, whereas insurance coverage legislation was associated with 6% lower odds (OR=0.94, 95% CI=0.91, 0.96) of being diagnosed at the regional stage. The association between insurance coverage legislation and stage of diagnosis was even stronger among women aged 40-49 years, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.96) of being diagnosed at the regional stage and 12% lower odds (OR=0.88, 95% CI=0.81, 0.96) of being diagnosed at the distant stage. Hispanic women benefited from notification laws, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.97) of being diagnosed at distant stage. Neither notification nor supplemental screening insurance coverage legislation showed a substantial impact on Black women. CONCLUSIONS: The findings imply that improving insurance coverage is more important than being notified overall. Raising awareness is important among Hispanic women; improving communication about dense breasts and access to screening might be more important than legislation among Black women.
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Densidade da Mama , Neoplasias da Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia , Programas de RastreamentoRESUMO
RATIONALE AND OBJECTIVES: At our institution, a new medical student elective was designed and implemented by the department of radiology to teach medical students about diagnostic error. The purpose of this article is to describe the diagnostic error elective structure and implementation, present objective and subjective evaluations of the elective, and provide a model for other radiology departments to run their own electives. MATERIALS AND METHODS: Starting in January 2018, a 2-week in-person career exploration session elective was offered for third year medical students. In 2020 due to the COVID pandemic, the elective was expanded to fourth year medical students. All students were required to complete a project that addressed diagnostic error. Subjective comments were recorded, and objective measurements obtained from student evaluations. RESULTS: A total of 11 sessions were held, consisting of 3 fourth year and 26 third year students. A total of 12 projects (11 groups) were completed, seven of which have been accepted for presentation at national meetings. On a 1 to 5 scale (5 highest), students rated their educational experience at a mean score of 4.61. Subjective comments focused on the benefit of exposure to new topics, mentorship by radiologists, and ability to complete a project in such a short time. CONCLUSION: Diagnostic errors and solutions are vague, new concepts to medical students and even facilitator faculty. This course allowed students to gain awareness of diagnostic error and could easily be replicated at other institutions with interested faculty and medical school support.
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Currículo , Educação de Graduação em Medicina , Dano ao Paciente , Estudantes de Medicina , COVID-19 , Atenção à Saúde , Humanos , Dano ao Paciente/prevenção & controleRESUMO
RATIONALE AND OBJECTIVES: An increase in the administrative work in our healthcare system has led to an increase in the number of administrative positions in radiology departments. Many of these are Vice Chair roles, including Vice Chair for Education (VCEd). The responsibility of this position has expanded, often far beyond the original definition. This article defines the role and expectations of the Vice Chair for Education and provides suggestions for success. MATERIALS AND METHODS: This article will review 12 vital roles that a Vice Chair for Education must play to be an effective advocate for radiology education within a department. RESULTS: Key attributes of an educational leader are delineated, divided into 12 areas or roles. CONCLUSION: This article summarizes key leadership skills needed by Vice Chairs for Education in order for them to be effective in their role.
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Serviço Hospitalar de Radiologia , Radiologia , Centros Médicos Acadêmicos , Docentes de Medicina , Humanos , LiderançaRESUMO
Medical errors have a significant impact on patient care, worker safety, and health care finances. Breast imaging has the most common cause of organ-related misdiagnosis subject to malpractice suits. In order to effectively develop strategies to prevent errors, breast imaging radiologists must first understand the underlying causes of the errors that occur in the breast imaging setting. Errors in breast imaging can be related to errors in interpretation, improper workup of imaging findings, procedural errors, or errors in communication to the patient or other medical staff. The Yorkshire contributory factors framework was developed to identify factors that contribute to the errors in a hospital setting and can be adapted for use in the breast imaging setting. Within this framework, active failures refer to errors that directly affect the patient. Active errors include slips (including biases), lapses, and mistakes. The framework describes how active errors often result from factors that occur uphill from these active errors at different levels within the system. Once error causes are understood, there are concrete strategies and tools that breast imaging radiologists can implement to decrease adverse events, reduce medical errors, and promote a safety environment in the breast imaging clinic. Error mitigation tools can be summarized using the acronym SAFE, which includes support the team, ask questions, focus on a task, and effectively communicate/ensure equipment optimization/safe environment. Knowledge of errors commonly seen in a breast imaging clinic represent an opportunity for constructive changes and, ultimately, improved health care delivery.