Interinstitutional outside imaging transfer: Benefits, challenges, and evolving technology.

The interinstitutional transfer of outside images in radiology is a critical aspect of modern healthcare, enabling seamless collaboration among healthcare institutions and enhancing patient care. This paper explores the significance of interinstitutional image transfer in radiology, its challenges, and the technological advancements that have facilitated efficient image sharing. This practice offers several benefits, such as improving diagnostic accuracy, treatment planning, and patient outcomes. However, we also highlight the ethical and security issues involved in exchanging sensitive medical data between institutions. Through a review of existing literature and case studies, this manuscript discusses the advancements made in interinstitutional image transfer and the future potential of this evolving field.

Analysis of Technical Repeat Studies in Screening Mammography.

Objective: To identify causes of technical repeats, determine whether differences exist between mobile and fixed mammography units, and evaluate the rate of improvement on repeat imaging. Methods: IRB approval was obtained for retrospective review of Enhancing Quality Using the Inspection Program (EQUIP) logs of screening mammography technical repeats performed from March 2017 to December 2018 at a hospital breast imaging center and from April 2017 to December 2018 on mobile mammography units. Frequency tables and Fisher's exact tests were used for statistical analysis. Results: Technical deficiencies were reported in 483 cases and reviewed by two or three auditors. Auditors identified no technical deficiencies in 31 cases, which were excluded. The remaining 452 cases were assigned a technical recall category: motion, positioning/excluded tissue, skin folds, artifacts, undercompression, or contrast (under/overexposure). Motion was the most common technical recall category (253/452, 56.0%). Positioning/excluded tissue was the second most common reason (150/452, 33.2%). Statistically significant differences in technical deficiencies were identified between mammograms performed on mobile versus fixed mammography units for motion (94/143, 65.7% vs 159/309, 51.5%, respectively, P = 0.0058), skin folds (16/143, 11.2% vs 15/309, 4.8%, respectively, P = 0.02), and positioning/excluded tissue (30/143, 21% vs 120/309, 38.8%, respectively, P = 0.00016). Most recalls improved with repeat imaging (auditor 1: 451/483, 93% and auditor 2: 387/483, 80%). Conclusion: Motion and positioning/excluded tissue are the most common reasons for screening mammography technical recalls. The reasons for technical recall differ between patients imaged on mobile and fixed mammography units, likely because of differences in each location's patient population.

Responsive Web-based Breast Imaging Core Curriculum for International Radiology Residents with Self-Assessment: A Pilot Study.

RATIONALE AND OBJECTIVES: Lack of uniformity in radiology resident education is partially attributable to variable access to subspecialty education. Web-based courses improve standardization, but with growing emphasis on competency based education, more evaluation of their effectiveness is needed. We created a responsive web-based breast imaging curriculum for radiology residents including self-assessment and a satisfaction survey. MATERIALS AND METHODS: Two global academic institutions collaboratively developed a breast imaging curriculum to address radiology residents' educational needs. This virtual course comprised 11 video lectures, nine didactic (with attached pre-test and post-test assessments) and two case review sessions. In April 2020, this optional curriculum was made available to all 56 radiology residents in one residency program cluster in Singapore, to be accessed alongside the breast imaging rotation as a supplement. A voluntary anonymous satisfaction survey was provided upon completion. RESULTS: A total of 39 of the 56 radiology residents (70%) completed the course. For the average score of nine lectures (maximum score 5), there was a significant increase in mean pre and post - test scores (mean = 2.2, SD = 0.7), p < 0.001. The proportion of residents with improvement between the pre-test score and the post-test score ranged from 74% to 100% (mean, 84%). Thirty three of the 39 participants (85%) completed the satisfaction survey, and all agreed or strongly agreed that the curriculum increased their knowledge of breast imaging. CONCLUSION: This web based breast imaging curriculum supplement was viewed positively by participating residents and improved their self-assessed knowledge. Curriculum access could be expanded to improve global radiology education.

Retained Localization Wire Fragments in the Breast: Long-term Follow-up.

OBJECTIVE: Historically, wire localization was the most widely utilized procedure for preoperative breast lesion localization. Occasionally a portion of the wire is retained in the breast. When recognized intraoperatively, the fragment can be removed immediately, but some cases are identified during post-surgical mammographic follow-up. There is little research detailing long-term stability of retained wire fragments, associated complications, or management options for cases requiring removal. We aimed to determine how often retained wire fragments remained stable, the frequency with which intervention was required, and methods available for fragment removal. METHODS: Following IRB approval, we conducted a retrospective review of patients with a retained wire localization fragment identified by EMR search seen at our institution between January 1990 and July 2019. Mammograms, localization images, specimen radiographs, and relevant clinical notes were reviewed. Information collected included breast tissue density, patient age, associated pathology, length of time the fragment was retained, presence and/or absence of fragment migration or other complications, and management of removed fragments. RESULTS: Eighteen eligible patients were identified with 19 retained wire fragments. Fragments ranged in length from 1 mm -33 mm. Twelve wire fragments had mammograms available to evaluate stability. All twelve fragments were stable mammographically for an average of 96.9 months. Seven wire fragments had no follow-up mammograms available. Eight wire fragments were surgically excised. None were excised due to migration. CONCLUSION: Localization wire fragments retained in the breast are at low risk for clinically significant migration and can be safely followed mammographically rather than undergoing immediate surgical excision or imaging-guided percutaneous removal.

Imaging Follow-up Versus Surgical Excision for Radial Scars Identified on Tomosynthesis-Guided Core Needle Biopsy.

RATIONALE AND OBJECTIVES: We investigated if imaging or pathology features could determine when imaging follow-up is appropriate after diagnosis of radial scar on digital breast tomosynthesis (DBT)-guided core needle biopsy (CNB). MATERIALS AND METHODS: We conducted a retrospective review of all patients diagnosed with radial scars on DBT-guided CNB at our institution between November 2014 and December 2016. Cases were excluded if DCIS or invasive malignancy was present in the same core specimens. Patient age; needle size; number of cores; visibility on full-field digital mammography versus DBT; lesion size; presence of architectural distortion, mass, or calcifications; imaging stability; presence or absence of atypia; length of imaging follow-up, and excisional pathology were collected. RESULTS: Of 45 eligible biopsies, 6 cases had radial scars with associated atypia and 39 cases had no associated atypia. Twenty-four patients underwent surgical excision, including all patients with atypia on CNB. One case (4%) was upstaged to DCIS on surgical excision after CNB revealed a radial scar with associated ADH. There was also a case without atypia on CNB, but excisional pathology revealed associated ADH. In cases with radial scars and associated atypia on CNB, the upstage rate was 17%. In cases without atypia on CNB that underwent surgical excision, the upstage rate was 0%. Imaging follow-up was available in 13 patients who did not undergo surgical excision, with stability in all 13 with a median follow-up of 18 months. CONCLUSION: Annual imaging follow-up appears reasonable in selected patients with radial scars but no atypia on DBT-guided CNB.

Immediate Migration of Biopsy Clip Markers After Upright Digital Breast Tomosynthesis-Guided Vacuum-Assisted Core Biopsy.

RATIONALE AND OBJECTIVES: The goal of this retrospective study was to evaluate the rate of immediate post-biopsy clip migration on an upright digital tomosynthesis-guided vacuum-assisted core biopsy unit and determine if any factors were associated with immediate clip migration. MATERIALS AND METHODS: We performed a retrospective review of patients who had undergone a biopsy performed at one facility from November 1, 2014 to September 30, 2016. Post-biopsy mammograms were reviewed to assess immediate clip position relative to the targeted lesion. The effects of age, lesion type, breast density, biopsy approach, number of samples, size of the biopsy chamber, and clip type on clip migration were examined using logistic regression analysis. RESULTS: One hundred ninety-seven biopsies were performed on 188 patients for calcifications (n = 159), architectural distortions (n = 29), masses (n = 5), and asymmetries (n = 4). The clip migration rate was 38% as defined as greater than 0.5 cm from the site of the biopsied lesion. The only independently predictive variable of clip migration was breast density in a numeric covariate in the logistic regression model, as migration was more likely with decreased breast density. The estimated odds ratio for a single level increase in BI-RADS breast density was 0.60 (95% confidence interval: 0.40, 0.91) with p = 0.018. CONCLUSION: Immediate clip migration following biopsy was more likely with decreased breast density. Radiologists should be aware of immediate clip migration as correct clip location guides preoperative localization and allows the biopsy site to be monitored for changes on future mammograms.

Male Breast Magnetic Resonance Imaging: When is it Helpful? Our Experience Over the Last Decade.

Currently, there are no clear indications or guidelines for performing breast magnetic resonance imaging (MRI) in male patients diagnosed with primary breast cancer. The literature is also very limited on the usage of breast MRI in male patients. Although it is not common or recommended as a routine clinical practice to perform breast MRI in male patients even in the setting of a diagnosis of breast cancer, there are few instances where MRI may help clinicians and surgeons. With a comprehensive review of cases that was performed at our institution over the last 10 years, the readers may achieve better understanding of when it may be helpful to perform breast MRI in male patients.

Tomosynthesis-Guided Core Biopsy of the Breast: Why and How to Use it.

Digital breast tomosynthesis (DBT) has become an important tool in breast imaging. It decreases the call-back rate while increasing the cancer detection rate on screening mammography and is useful for diagnostic examination of noncalcified lesions and for the evaluation of patients presenting with clinical symptoms. Management challenges and dilemmas that are encountered with abnormalities detected on DBT and lacking a sonographic correlate can now be addressed with tomosynthesis-guided core biopsy.

Breast MR Imaging: Atlas of Anatomy, Physiology, Pathophysiology, and Breast Imaging Reporting and Data Systems Lexicon.

The latest edition of the Breast Imaging Reporting and Data Systems lexicon, copyrighted in 2013, contains several changes to the breast MR imaging section. Most changes were implemented to standardize descriptors across breast imaging modalities. New sections on special topics and implant evaluation are included. We review basic MR imaging breast anatomy and a detailed pictorial review of the Breast Imaging Reporting and Data Systems lexicon, including these new sections. In each section we discuss which descriptors are more concerning for malignancy and information radiologists can use to better categorize findings as lower risk or benign.

Implementation of Upright Digital Breast Tomosynthesis-guided Stereotactic Biopsy.

With growing adoption of digital breast tomosynthesis, an increasing number of imaging abnormalities are being identified only by tomosynthesis. Upright digital breast tomosynthesis-guided stereotactic biopsy is a proven method for sampling these abnormalities as well as abnormalities traditionally evaluated using conventional stereotactic biopsy. In this article, we describe the technique of upright digital breast tomosynthesis-guided stereotactic biopsy and outline a systematic operational approach to implementation of this technique in clinical radiology practices.

The Impact of Patient Demographics on the Selection of Breast Imaging Centers.

OBJECTIVE: Studies show that health care tailored to patient preferences results in significant improvements in physician performance, patient satisfaction, and health outcomes. Limited information in the literature exists on the factors driving patient preferences for establishing care at specific breast imaging centers. In this study, we identified factors that drive cohort preferences in the selection of a breast imaging center. MATERIALS AND METHODS: An 18-question survey was deployed in a large metropolitan area to gather information on patient demographics and preferences for breast imaging center location and radiologist training level. Cluster analysis and the K-means method were used to classify patients into groups on the basis of their answers about preference. Clusters were tested for significant differences by location, reason for visit, age, education, marital status, ethnicity, insurance, history of cancer, and income. RESULTS: A total of 1682 survey responses (18% of total patient visits) were obtained. Four distinct cohorts (comprising 876 patients) based on patient care preferences were identified: convenience optimizers (n = 109, 12.4%), ambivalent patients (n = 237, 27.1%), medical center seekers (n = 324, 37.0%), and expertise seekers (n = 206, 23.5%). Each cohort showed distinct preferences for imaging center location and radiologist training. Cohorts were differentiated on the basis of patient education level, ethnicity, and patient cancer history. Across the cohorts, there were no significant differences in age, marital status, insurance, income, and other demographic factors. CONCLUSION: Patient preferences for breast imaging care and location vary and are correlated with specific demographic characteristics. An understanding of these population characteristics can shape organizational strategies for improving patient-centered care and outcomes.