Survey on Current Utilization and Perception of Synthesized Mammography.

OBJECTIVE: To assess utilization and perceptions of 2D synthesized mammography (SM) for digital breast tomosynthesis (DBT) among practicing U.S. breast radiologists. METHODS: An IRB-exempt 23-question anonymized survey was developed by the Society of Breast Imaging (SBI) Patient Care and Delivery Committee and emailed to practicing U.S. radiologist SBI members on October 9, 2023. Questions assessed respondents' demographics, current mammographic screening protocol, confidence interpreting SM for mammographic findings, and perceived advantages and disadvantages of SM. RESULTS: Response rate was 13.4% (371/2771). Of 371 respondents, 208 were currently screening with DBT/SM (56.1%), 98 with DBT/SM/digital mammography (DM) (26.4%), 61 with DBT/DM (16.4%), and 4 with DM (1.1%). Most respondents felt confident using DBT/SM to evaluate masses (254/319, 79.6%), asymmetries (247/319, 77.4%), and distortions (265/318, 83.3%); however, confidence was mixed for calcifications (agreement 130/320, 40.6%; disagreement 156/320, 48.8%; neutral 34/320, 10.6%). The most frequently cited disadvantage and advantage of SM were reconstruction algorithm false-positive results (199/347, 57.4%) and lower radiation dose (281/346, 81.2%), respectively. Higher confidence and fewer disadvantages were reported by radiologists who had more SM experience, screened with DBT/SM, or exclusively used Hologic vendor (all P <.05). CONCLUSION: For most survey respondents (56.1%), SM has replaced DM in DBT screening. Radiologists currently screening with DBT/SM or with more SM experience reported greater confidence in SM with fewer perceived disadvantages.

Women in leadership matters: Achieving diversity in radiology residency recruitment.

RATIONALE AND OBJECTIVES: To assess whether academic radiology departments and residency programs with efforts toward supporting and augmenting Diversity, Equity, and Inclusion (DEI) are associated with a higher proportion of residents from diverse backgrounds. MATERIALS AND METHODS: Program Directors within the Radiology Residency Education Research Alliance were surveyed to gather information about program characteristics, incorporation of diversity in resident recruitment, the sponsoring department's commitment to efforts at expanding diversity, and a summary of their current and past residents, staff and faculty members (academic years 2020 and 2023) with respect to a list of diversity characteristics. RESULTS: Survey response rate was 51 %. Sixty-three percent (15/24) of participating programs have departmental committees dedicated to DEI work; 46 % (11/24) of programs' departments have a Vice Chair for DEI. Sixty percent (15/24) of programs use their social media accounts to advertise their DEI programming efforts. Ninety-six percent (23/24) of programs participating in the survey use diversity factors to select candidates for their program. Women Leadership was associated with above-median diversity of residents and faculty. CONCLUSION: This study of radiology residency programs encourages a more prominent role for women in leadership positions within academic radiology departments to drive diversity and inclusion efforts.

Virtual Visiting Professorship Program as an Opportunity for Academic and Clinical Advancement Beyond the COVID-19 Pandemic: A Survey of Participants.

OBJECTIVE: To identify structure, benefits, and shortcomings of a multi-institutional virtual visiting professorship (VVP) program from 2020 to 2022, 2 years after inception and after gradual resumption of an in-person, prepandemic academic environment. METHODS: An IRB-exempt, 70-question survey about structure, benefits, and shortcomings of the VVP program was distributed to its participants (14 breast imaging departments across the U.S.), using the snowball sampling technique. RESULTS: A total of 72 responses were received; 54.2% (32/59) radiologists >5 years of experience, 18.6% (11/59) radiologists <5 years of experience, 15.3% (9/59) residents, and 8.5% (5/59) fellows. Radiologists' attendance increased from 8% (5/59) to 53% (31/59) over 2 years, with 69% (41/59) of respondents supporting continued participation. The most important factors for attendance were expanding breast imaging knowledge (86.4% [51/59]) and the virtual format (76.2% [45/59]). The number of presented lectures increased from 1 to 3 lectures in 43.7% (7/16) of programs in year 1 and from 4 to 9 lectures in 50% (8/16) of programs in year 2. The greatest professional benefits were collaborations on publications for organizers (56.3% [9/16]) and building academic portfolios for presenters (50% [7/14]). For trainees, attending the program increased their knowledge (64.3% [9/14]) and enthusiasm for breast imaging (50% [7/14]). CONCLUSION: The VVP program facilitated scholarly collaboration among breast imaging radiologists, promoted academic portfolios for junior faculty, and increased enthusiasm for breast imaging for trainees. These accomplishments extended beyond the COVID-19 pandemic, as evidenced by the growth of the program after resumption of an in-person academic environment. Future expansion to other programs would benefit more practicing radiologists.

Radiologists' Role in Decolonizing Global Health.

The colonial origins and power imbalances between Western high-income countries and low- and middle-income countries (LMICs) are barriers to self-reliance and sustained structural improvements to health care systems. Radiologists working in global health (global radiologists) are tasked with improving the state of imaging in LMICs while mitigating the effects of colonial structures and processes. To accomplish this, we need to be aware of factors such as colonialism, neocolonialism, parachute research, and brain drain that contribute to global health inequities. Potential solutions to decolonizing global radiology include commitment to understanding local context; strengthening local capacity for technology advancement, research, and development; and policies and educational programs to combat medical brain drain from LMICs. In this article, we describe how the legacies of colonialism can interfere with improving health in LMICS, despite the best intentions, and provide a call to action for decolonizing our field with intentional approaches and equitable partnerships that emphasize investments in sustainable infrastructure, robust training of personnel, and policies that support self-reliance to match true health system strengthening with our passion for addressing health equity.

Designing a Collaborative Breast Radiology Training Program to Tackle Tanzania's Breast Cancer Crisis.

Breast cancer incidence and mortality continue to increase in Africa. In Tanzania, breast cancer is the second leading cause of cancer death for women, and breast cancer incidence and mortality are projected to increase by 80% by 2030. Education gaps among health care workers, delayed presentation, limited screening, and low health literacy all pose significant challenges to providing optimal breast cancer care. Considering these factors, it is imperative to train expert breast radiologists. We present a collaborative breast radiology training program in Tanzania aimed at building local capacity to address national breast cancer challenges. Although cancer control in Africa faces many challenges, developing customized training programs for breast radiology, in conjunction with national cancer programs, may represent a key strategy for addressing breast cancer.

Backlogs in formal interpretation of radiology examinations: a pilot global survey.

OBJECTIVE: Anecdotal reports from imaging facilities globally suggest growing radiology interpretation reporting delays. This pilot study's primary aim was to estimate the backlog of formal interpretation of imaging examinations. METHODS: An online survey was distributed to radiologists globally to gather practice-specific characteristics, imaging volumes, and reporting for 3 types of examinations (brain/head CT scans, chest CT scans, and chest radiographs) at 4 time points: 7, 30, 90 days, and 6 months. RESULTS: We received responses from 49 radiologists in 16 countries on six continents. Unreported examinations (backlog) were present in thirty of 44 (68%) facilities. Backlogs for brain/head CT, chest CT, and chest radiographs were present in, respectively, 48%, 50%, and 59% of facilities at 7 days and 20%, 23%, and 32% of facilities at 6 months. When present, the mean proportion of backlog (range) at 7 days was 17% (1 to 96) for brain/head CT, 18% (3 to 82) for chest CT, and 22% (1 to 99) for chest radiographs. CONCLUSIONS: Our findings from this pilot study show a widespread global backlog in reporting common imaging examinations, and further research is needed on the issue and contributing factors.

Subspecialty Breast Imaging Education in Tanzania; Clinical, Infrastructure, and Logistical Paradigms for Best Practices in the Low- and Middle-Income Settings.

We present subspecialty radiologist training for breast imaging at an Academic center in Dar Es Salaam, Tanzania. The training incorporates remote, in-person, asynchronous and synchronous teaching methods and multidisciplinary conferences. We use a team of US academic faculty under the auspices of the Radiological Society of North America Global Learning centers paradigm. Trainees are Tanzanian radiologists who are pursuing an additional specialization degree in Women's imaging, utilizing an approved 2-year curriculum. Challenges and opportunities in providing image-guided intervention and diagnosis training in the low- and middle-income settings are presented.

Mobile Mammography Services and Underserved Women.

Breast cancer, the second most common cause of cancer in women, affects people across different ages, ethnicities, and incomes. However, while all women have some risk of breast cancer, studies have found that some populations are more vulnerable to poor breast cancer outcomes. Specifically, women with lower socioeconomic status and of Black and Hispanic ethnicity have been found to have more advanced stages of cancer upon diagnosis. These findings correlate with studies that have found decreased use of screening mammography services in these underserved populations. To alleviate these healthcare disparities, mobile mammography units are well positioned to provide convenient screening services to enable earlier detection of breast cancer. Mobile mammography services have been operating since the 1970s, and, in the current pandemic, they may be extremely helpful. The COVID-19 pandemic has significantly disrupted necessary screening services, and reinstatement and implementation of accessible mobile screenings may help to alleviate the impact of missed screenings. This review discusses the history and benefits of mobile mammography, especially for underserved women.

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.

Estimation of genetic parameter for feed efficiency and resilience traits in three pig breeds.

Recently, automatic feeders have become popular for collecting daily feed intake data in the pig industry, making it possible to evaluate genetic effects on feed efficiency and resilience traits, expressed as day-to-day fluctuations in feeding records. This study aimed to understand the influence of genetic factors on feed efficiency traits, including residual intake and BW gain (RIG), and resilience traits, as well as to compare the differences in genetic parameter estimates among three purebred pig breeds. A total of 6 103 pigs from three breeds (Large White: 1 193 pigs, Landrace: 3 010 pigs, and Duroc: 1 900 pigs) were raised in a specific pathogen-free environment. The growth and feed intake records during the testing period were obtained using automatic feeders, and the average daily gain (ADG) and average feed intake (AFI) were calculated. Feed conversion ratio (FCR), residual feed intake (RFI), residual gain, and RIG were calculated as feed efficiency traits, and the log-transformed variance of deviation for the daily feed intake (LnVar_FI), daily occupation time (LnVar_OC), and the daily number of visits to the feeder (LnVar_VT) was calculated as resilience traits. After estimating the genetic parameters for each breed, a meta-analysis was performed to obtain the weighted mean of heritability estimates (hm2) and genetic correlation estimates (GCm) for the three breeds. The hm2 were moderate and ranged from 0.31 to 0.39 for feed efficiency traits and 0.31 to 0.40 for resilience traits, and there were no significant differences in heritability estimates among the three breeds except for AFI, RFI, and RIG. For feed efficiency traits, the FCR and RIG showed favourably moderate GCm with AFI (0.29 and -0.33, respectively) and ADG (-0.39 and 0.31, respectively). For resilience traits, the LnVar_FI and LnVar_VT showed favourably low to moderate GCm with FCR (0.33 and 0.28, respectively) and RIG (-0.37 and 0.28, respectively), and there were no genetic relationships of LnVar_OC with FCR and RIG (the absolute value of GCm was 0.01). There was no significant difference in the genetic correlation estimates among the three breeds for feed efficiency and resilience traits. Our results suggest that feed efficiency and resilience traits were heritable, and resilience traits showed favourable or no genetic correlation with feed efficiency traits. In addition, the influence of genetic factors on feed efficiency and resilience traits could be the same among breeds.

Imaging Features of Triple Negative Breast Cancer and the Effect of BRCA Mutations.

OBJECTIVE: The purpose of this study is to review the mammographic and the ultrasound features of triple negative breast cancer (TNBC) patients and to investigate the potential effect of BRCA mutations on the imaging features of these patients. METHODS: One hundred and seven patients with TNBC were enrolled in a retrospective study following IRB approval and approval of waiver of informed consent. BRCA mutations were assessed using genetic testing. Imaging features on mammography and ultrasound (US) as well as pathology and clinical information were retrospectively reviewed and characterized according to the BI-RADS lexicon (fifth edition). The relationships between BRCA mutations and the imaging findings were examined. RESULTS: TNBC commonly presented as an irregular mass with obscured margins on mammography and as an irregular hypoechoic mass with microlobulated or angular margins on US. Approximately two thirds of TNBC cases had a parallel orientation and approximately one third had posterior enhancement, features often associated with benign masses. There was no statistically significant difference in the mammographic and the US features of BRCA positive and BRCA negative triple negative tumors. CONCLUSION: TNBC may have a parallel orientation and posterior enhancement, which are features often seen with benign masses. BRCA mutations do not affect the imaging features of triple negative breast tumors.

Alveolar ridge dimensional changes after two socket sealing techniques. A pilot randomized clinical trial.

OBJECTIVES: This pilot study aimed to assess dimensional changes following two different alveolar socket sealing techniques. MATERIAL AND METHODS: Twenty-one patients requiring tooth extraction and implant placement were randomly allocated to two different alveolar ridge preservation techniques. In the control group, demineralized bovine bone mineral (DBBM) and a gingival soft tissue punch were used to fill and seal the socket, whereas in the test group, the extraction socket was filled with DBBM and sealed with a hemostatic gelatin sponge. Digitalized impressions were taken before and 6 months after tooth extraction. The comparison was made on horizontal and vertical dimensional changes. RESULTS: The mean vertical loss was 0.8 ± 0.6 mm for the control group and 0.7 ± 0.5 mm for the test one. No statistical difference was found between groups for the vertical shrinkage. The horizontal dimensional narrowing of the alveolar socket was respectively 7.1/4.0/2.5 mm at levels 1, 3, and 5 mm from a coronal reference level for the control group. The test group showed dimensional changes of 4.8/2.3/1.3 mm at the three different levels, respectively. A significant difference was found at levels 3 and 5 mm. Referring to a visual analog pain scale, patients reported more severe pain in the control group (5.7/10) when compared with the test group (2.8/10). The difference was statistically highly significant (P ≤ 0.001). CONCLUSIONS: A significant difference was found between control and test groups regarding the horizontal dimensional changes and the post-operative pain. CLINICAL RELEVANCE: Regarding this primary result, the socket sealing technique with a hemostatic sponge provides an effective and inexpensive protocol with less post-operative pain.

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.

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.

Role of Breast Imaging Radiologists as Advocates for Screening Mammography.

The objective of this article is to outline opportunities for breast imaging radiologists to advocate for screening mammography. Despite breast cancer being the second most common cancer in women and screening mammography's ability to reduce mortality from this disease, there remains suboptimal utilization in the community. The different guidelines for screening presented by respected organizations has created confusion for patients and referring clinicians and the eventual underutilization of screening mammography. As experts in the value of early detection, breast radiologists are well suited to take on the role of screening advocates. Using specific action steps and examples, we create a template for a radiologist to utilize in the promotion of screening among the breast imaging team, clinicians, administrators, and the community at large. By deliberately filling the role of screening mammography advocate, one can satisfy the mandate for radiologists to bring increased value to the health care team while contributing to community health and patient satisfaction.

How to survive and thrive as a new breast imager: what they don't teach in fellowship.

PURPOSE: To provide practical tips to assist new breast imagers succeed in their first job after fellowship training. METHODS: Transitioning from fellowship to a practicing breast radiologist is daunting for the new radiologist. There is a void in the literature addressing this transition. Practical tips are described based on various roles a new breast radiologist must navigate and highlights skills that can help ensure a successful transition and career. RESULTS: Proficiency in clinical acumen may be assisted by becoming familiar with sentinel works and feedback based on the medical outcome audit. Noninterpretive skills that can assist the transition include communication skills, delegation of tasks, and implementing hanging protocols. Depending on the practice, skills in research, education, administration, teamwork, and community engagement may also assist the successful transition. CONCLUSION: Practical strategies can assist the new breast radiologist to become proficient at essential skills that will assist the radiologist to survive and thrive in clinical practice.