The impact of adjunctive tomosynthesis on screening mammography outcomes in two widely diverse radiology practices.

To determine the effect of adjunctive digital breast tomosynthesis screening on dissimilar mammography practices. We compared the outcomes of breast cancer screening with digital mammography versus digital mammography combined with tomosynthesis in two independent breast imaging practices from June 1, 2015, to May 31, 2016. Institution one was a hospital-based academic practice of breast imaging specialists and institution two was a community-based practice with academic affiliation served by general radiologists. Screening mammography was linked to subsequent diagnostic imaging and pathology. Subject characteristics and performance metrics were compared via t test for continuous variables and the chi-square test for categorical variables. A two-sided z test was performed to test modality differences for assessment and pathology subtype. Of the 54 638 women, 54% (n = 29 295) were from institution one and 55% (n = 30 013) underwent digital mammography alone. Women undergoing mammography with tomosynthesis were older (60.8 years vs 56.9 years, P < .001) and had slightly less dense breast composition (P = .001). Performance metrics varied substantially between institutions. At both institutions the biopsy rate, positive predictive value of screening (PPV1 ), and invasive cancer detection rate increased significantly with adjunctive tomosynthesis. At institution one, the biopsy rate increased from 1.4% to 1.9%, the PPV1 from 6.0% to 8.2%, and the invasive cancer detection rate from 3.4 to 4.9/1000 women screened. At institution two, the respective increases were from 0.7% to 1.0%, 5.5% to 11.0%, and 2.3% to 4.1/1000. Tomosynthesis recalled asymmetry less and mass more and resulted in fewer BI-RADS 1 and 2 assessments than screening with mammography alone. Adjunctive tomosynthesis appears to have a consistent impact on breast cancer screening performance metrics despite marked variation in breast imaging practice. Combined tomosynthesis screening has a significantly higher PPV1 , leads to a greater number of biopsies, and detects more invasive cancer than screening with digital mammography.

Breast Radiology Advocacy: Responding to the Call-to-Action.

In an increasingly competitive and passionate health care environment, radiology advocacy is imperative, now more than ever. Arguably, it is particularly more crucial in the world of breast cancer, as we as a breast cancer community are tirelessly assembling to advocate for our patients on a variety of levels, whether it is including but not limited to, breast cancer screening, diagnosis, and treatment, access-to-care, education, or research funding. As breast radiologists, it is no longer simply enough to clock in our normal work hours; we must ALL make a concerted effort to vociferously advocate for our patients and profession.

Imaging Findings in Transgender Patients after Gender-affirming Surgery.

Gender-affirming surgeries expand the options for physical transition among transgender patients, those whose gender identity is incongruent with the sex assigned to them at birth. Growing medical insight, increasing public acceptance, and expanding insurance coverage have improved the access to and increased the demand for gender-affirming surgeries in the United States. Procedures for transgender women, those patients with feminine gender identity, include breast augmentation using implants and genital reconstruction with vaginoplasty. Some transgender women receive medically unapproved silicone injections for breast augmentation or other soft-tissue contouring procedures that can lead to disfigurement, silicone pulmonary embolism, systemic reactions, and even death. MRI is preferred over CT for postvaginoplasty evaluation given its superior tissue contrast resolution. Procedures for transgender men, patients with a masculine gender identity, include chest masculinization (mastectomy) and genital reconstruction (phalloplasty or metoidioplasty, scrotoplasty, and erectile device implantation). Urethrography is the standard imaging modality performed to evaluate neourethral patency and other complications, such as leaks and fistulas. Despite a sizeable growth in the surgical literature about gender-affirming surgeries and their outcomes, detailed descriptions of the imaging features following these surgeries remain sparse. Radiologists must be aware of the wide variety of anatomic and pathologic changes unique to patients who undergo gender-affirming surgeries to ensure accurate imaging interpretation. Online supplemental material is available for this article. ©RSNA, 2019.

The Radiology Twitterverse: A Starter's Guide to Utilization and Success.

The rise of social media use in medicine has changed how health care organizations and providers communicate with patients and interact with other members of the medical community. Active social media engagement has been associated with improvements in patient outreach, peer-to-peer interactions, and medical education. In radiology, however, social media is predominantly used among trainees, with significantly lower rates seen in attending physicians who have been in practice for greater than 15 years. Twitter (Twitter.com, San Francisco, California), along with other social media platforms, puts a face to radiology, helping both patients and other health care professionals understand contributions of radiologists to patient care, research, education, and public health. We aim to provide a starter's guide for radiologists unfamiliar with Twitter (1) to highlight benefits of active Twitter involvement and (2) to remove perceived barriers to active Twitter use.

Characteristics of Federal Political Contributions of Self-Identified Radiologists Across the United States.

PURPOSE: As federal legislation increasingly influences health care delivery, the impact of election funding has grown. We aimed to characterize US radiologist federal political contributions over recent years. METHODS: After obtaining 2003 to 2016 finance data from the Federal Election Commission (FEC), we extracted contribution data for all self-identified radiologists. Contributions were classified by recipient group and FEC-designated political party and then analyzed temporally and geographically, in aggregate, and by individual radiologist. RESULTS: Between 2003 and 2016, the FEC reported 35,408,584 political contributions. Of these, 36,474 (totaling $16,255,099) were from 7,515 unique self-identified radiologists. Total annual radiologist contributions ranged from $480,565 in 2005 to $1,867,120 in 2012. On average, 1,697 radiologists made political contributions each year (range 903 in 2005 to 2,496 in 2016). On average, contributing radiologists gave $2,163 ± $4,053 (range $10-$121,836) over this time, but amounts varied considerably by state (range $865 in Utah to $4,325 in Arkansas). Of all radiologist dollars, 76.3% were nonpartisan, with only 14.8% to Republicans, 8.5% to Democrats, and 0.4% to others. Most radiologist dollars went to political action committees (PACs) rather than candidates (74.6% versus 25.4%). Those PAC dollars were overwhelmingly (92.5%) directed to the Radiology Political Action Committee (RADPAC), which saw self-identified radiologist contributions grow from $351,251 in 2003 to $1,113,966 in 2016. CONCLUSION: Radiologist federal political contributions have increased over 3-fold in recent years. That growth overwhelmingly represents contributions to RADPAC. Despite national political polarization, the overwhelming majority of radiologist political contributions are specialty-focused and nonpartisan.

Fostering Diversity and Inclusion: A Summary of the 2017 Intersociety Summer Conference.

The 39th radiology Intersociety Committee reviewed the current state of diversity among trainees and in our workplaces and addressed future strategies for fostering diversity through inclusion. The assembled participants addressed the imperatives and drivers for diversity and developed a road map to foster diversity. Themes included the need to be proactive in increasing awareness of our own biases and their potential impact on workplace decisions, overcoming blind spots, and being culturally sensitive. The need to identify and eliminate barriers to diversity was discussed at both the organizational and practice level and included efforts to break down structural and clinical barriers, such as training in multicultural awareness. Additional strategies that were addressed included building inclusive work environments; facilitating debate, conversations, and community building; and pipelining medical students through mentoring pathways. The conference ended with a call to action to develop toolkits with effective resources to support the necessary diversity and inclusion initiatives we must all undertake.

Leveraging Twitter to Maximize the Radiology Meeting Experience.

Over recent years, social media engagement has proliferated among physicians, health care systems, scientific journals, professional societies, and patients. In radiology, Twitter (Twitter Inc, San Francisco, California) has rapidly become the preferred social media engagement tool and is now an essential activity at many large radiology society meetings. Twitter offers a versatile, albeit simple, platform for anyone interested in engaging with others, regardless of title, stature, or geography. In radiology and other medical specialties, year-after-year increases in Twitter engagement before, during, and after professional society meetings continue with widespread positive feedback. This short-form messaging tool also allows users to connect and interact with high-impact individuals and organizations on an ongoing basis (rather than once a year during large meetings). Through live-polling, Twitter also has the power to gather global opinions on issues highly relevant to radiology's future, such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) or breast cancer screening. Also increasingly popular is "live-tweeting" of curated meeting content, which makes information from the meeting accessible to a global audience. Despite the promise of growing professional networks and enabling discussions that cross geographic boundaries, the risks of Twitter use during radiology meetings must be recognized and mitigated. These include posting of unpublished data without consent (eg, slide content captured on camera phones), propagation of misinformation, and copyright infringement. Despite these issues and with an eye towards professionalism, Twitter can nonetheless be used effectively to increase engagement among radiologists, radiology societies, and patients.