Tips for Addressing Screening Concerns: "Harms of Screening".

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.

Breast Implant Imaging Surveillance Practice: Survey of Breast Imaging Radiologists in the Society of Breast Imaging.

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.

The Radiology Journal Club: An Update on Best Practices and Lessons Learned From Other Specialties.

The discussion and critical appraisal of medical literature in a group setting has been incorporated in health care education for over a century and remains one of the structured didactic activities in Accreditation Council for Graduate Medical Education radiology residency educational requirements. The panel members of the "Radiology Journal Club: Best Practice from Across the Country" Task Force of the Association of University Radiologists Radiology Research Alliance have collated best practices from radiology and other medical specialties to help radiology departments to establish or resume journal club as part of their residency or fellowship educational program. Key components include a leadership team to designate mentors, facilitators, and ad hoc content experts; to establish the scope, goals and learning objectives; to identify the target audience and level of faculty and trainee involvement; and establish appropriate meeting frequency. Providing relevant and easily accessible resources, mentoring and other preparatory materials can build trainee skill in critical appraisal of the medical literature, foster innovation, and advance radiological knowledge in this ever-evolving discipline.

What's in the Shadows? Formal Analysis: Art History Method to Improve Interpretation Skills for Mammography and Chest Radiographs in Resident Education.

RATIONALE AND OBJECTIVES: To assess the feasibility of using an art history tool of formal analysis in resident education for interpretations of mammography and chest radiographs METHODS: In a pre-post study design, residents were shown pre-selected 10 mammograms and 10 chest radiographs for a total of 20 unique anonymized patient cases. After the pretest, residents attended four formal analysis art history lessons. The formal elements included line, light, dark, shade, proportion and balance. The post-tests were administered utilizing the same set of images given during the pre-test. After the completion of the pre- and post-tests, the participants filled out a written survey. RESULTS: On average, participants improved their image descriptions for a mean of 30% of the total number of mammographic images they evaluated, and similarly they improved their image diagnoses for a mean of 31% of the mammographic images. On average, participants improved their image descriptions for a mean of 37% of the total number of chest radiographs they evaluated, while improving their image diagnoses for a mean of 52% of the chest X-rays. Of the 20 participants, 14 (70%) completed the post study survey. Almost all of the respondents endorsed agreement in understanding the application of formal analysis to radiologic interpretation. Eight out of 14 (57%) participants self-reported improvement in identifying abnormalities and contriving descriptors. CONCLUSION: This pilot study shows that formal art analysis used by art historians may improve radiologic learners' ability to perceive and describe relevant radiologic abnormalities which in turn would lead to a more accurate radiologic differential diagnosis. The formal analysis process trains the eye to detect and categorize the underlying structure of images. This method provides an alternative arts intervention specifically designed to improve fundamental visual skills in radiology education.

Creativity, Connection, and Community: Reimagining the Radiology Society Meeting.

RATIONALE AND OBJECTIVES: With the shifting needs of radiologists due to escalating healthcare demands, the impetus for an increased focus on wellness and the benefits of the humanities in medicine inspired a novel approach to curricular planning of the 2023 Association of University Radiologists (AUR) annual meeting. In this manuscript, we describe the creative process behind planning and executing this innovative meeting format. MATERIALS AND METHODS: Reimagining the annual meeting was a collaborative effort centered around the development of an innovative Arts and Wellness Program, with the goal of integrating opportunities for artistic expression and experiential wellness throughout the meeting. RESULTS: Of the 1313 meeting attendees, 423 (32.2%) completed the annual meeting evaluation, of which 244 were in-person and 61 attended virtually. 178 of 423 respondents (42.1%) participated in the arts and wellness programming. 160 of 203 respondents (78.9%) reported that the arts and wellness programming enhanced the overall meeting experience. 164 of 197 respondents (83.2%) gained greater appreciation for the talents of radiology colleagues. 97 of 195 respondents (49.7%) stated that the programming gave them ideas as to how to cope effectively with stress. CONCLUSION: The incorporation of art, music, and other wellness activities into a national radiology meeting was well-received by meeting attendees. For many radiologists who participated in the various musical and artistic offerings at the AUR 2023 meeting, sharing artistic talents with the radiology community and colleagues represented the most fundamental way to be fully seen, express authenticity, and connect with others.

Fibrocystic Changes of the Breast: Radiologic-Pathologic Correlation of MRI.

Breast MRI provides high sensitivity but modest positive predictive value for identifying breast cancers, with approximately 75% of MRI-guided biopsies returning benign pathologies. Fibrocystic change (FCC) is a descriptive term used colloquially by many radiologists (and falling out of favor with many pathologists) to refer to several benign entities encountered in the breast. Many of the benign entities believed to comprise FCC can show enhancement on MRI. Recognizing the pathologic correlates of these enhancing lesions should help guide management after such a result on MRI-guided biopsy. Premenopausal women may present with clinical symptoms attributed to FCC, including pain, nipple discharge, breast lumps, or discrete masses. Benign entities associated with FCC include proliferative lesions such as usual ductal hyperplasia and sclerosing adenosis, and nonproliferative lesions including cysts, apocrine metaplasia, and stromal fibrosis. Fibrocystic change can be diffuse or focal. Diffuse FCC usually presents as non-mass enhancement (NME), often with persistent kinetics. Focal FCC can present as an irregular mass or focus with variable enhancement patterns including washout kinetics. Following a benign concordant MRI-guided biopsy result of one or more of the above entities, follow-up with MRI in 12 months is reasonable. Accurate radiologic-pathologic correlation can be achieved when careful review of histologic findings is carried out in the context of MRI features.