Grassroots Approach to Forming a Diversity, Equity, and Inclusion Committee in an Academic Radiology Department.

Radiology is among the medical specialties that have made the fewest gains in closing the gap in underrepresented minorities and women. Diversity, equity, and inclusion (DEI) initiatives are important for promoting healthy learning environments for trainees, health equity for patients, and equitable career development opportunities for employees, all of which contribute to innovation in today's competitive health care environment. DEI committees can self-organize or form from institutional directives. These committees can implement impactful projects in multiple domains in education, recruitment and retention, department culture, and health equity research. This article describes the formation of a grassroots DEI committee, key initiatives and strategies, and structures for accountability. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Number of cores needed to diagnose prostate cancer during MRI targeted biopsy decreases after the learning curve.

INTRODUCTION: We hypothesized that the number of cores needed to detect prostate cancer would decrease with increasing MRI-targeted biopsy (TBx) experience. METHODS: All patients undergoing TBx at our institution from May 2017 to August 2019 were enrolled in a prospectively maintained database. Five biopsy cores were obtained from each lesion ≥3 on PI-RADS v2.0 followed by a systematic 12-core biopsy. To assess learning curve, the study population was divided into quartiles by sequential biopsies. Clinically significant prostate cancer (csPC) was defined as Gleason Grade Group 2 or higher. RESULTS: 377 patients underwent prostate biopsy (533 lesions); 233 lesions (44%) were positive for prostate cancer and 173 lesions (32%) were csPC. There was a significant decline in the number of cores required for diagnosing any cancer (P < 0.001) and csPC (P < 0.05) after the first quartile. There was no difference when stratifying by PI-RADS score or lesion volume. Within the first quartile, limiting the biopsy to 3 cores would miss 16.2% of csPC, decreasing to 6.6% after approximately 100 patients. CONCLUSION: MRI TBx is associated with a learning curve of approximately 100 cases. Four or 5 cores should be considered during the initial experience, but thereafter, 3 cores per lesion is sufficient to detect csPC.

Do patients with a PI-RADS 5 lesion identified on magnetic resonance imaging require systematic biopsy in addition to targeted biopsy?

INTRODUCTION: Magnetic Resonance Imaging (MRI)-targeted prostate biopsy (MRI-TB) improves the detection of prostate cancer. These biopsies typically involve both a 12-core systematic biopsy (SB) and MRI-TB of the lesion. Since the majority of PI-RADS 5 lesions represent clinically significant cancers, the utility of SB in addition to MRI-TB is unclear. We evaluate the utility of SB in the setting of PI-RADS 5 lesions in biopsy naïve and active surveillance patients. METHODS: Patients undergoing MRI-TB+SB with a PI-RADS 5 lesion were retrospectively reviewed in a prospectively collected database. Pathology obtained from the MRI-TB was then compared to that of the SB, and each was reported based on the highest Gleason Grade from the sample. In patients with a prior biopsy, we identified instances in which the MRI-TB+SB resulted in upgraded pathology and further subdivided these patients based on whether the pathology upgrade was a result of the TB or the SB. RESULTS: We identified PI-RADS 5 lesions in 97 patients. All lesions biopsied were found to be prostate cancer, and 86.9% were clinically significant. Gleason Grade from the MRI-TB of the PI-RADS 5 lesions was the same or higher to that of the SB in all but 3 cases (3.1%). Among 59 patients with a prior prostate biopsy, 54 had upgraded pathology from MRI-TB+SB (91.5%). Of these 54 patients, MRI-TB pathology of the PI-RADS 5 lesion was the same or higher to that of the SB in 52 patients (96.3%). In all patients with higher Gleason Grade on SB than MRI-TB, the MRI-TB demonstrated GG3 or higher and SB did not change subsequent clinical management. CONCLUSION: In the presence of a PI-RADS 5 lesion, SB offers minimal additional clinical value and could potentially be omitted when performing MRI-TB.

Optimizing MRI-targeted prostate biopsy: the diagnostic benefit of additional targeted biopsy cores.

INTRODUCTION: The optimal number of biopsy cores to obtain during MRI-targeted prostate biopsy remains ill-defined. This study sought to determine the optimal number of targeted biopsy cores to obtain from a region of interest to maximize detection of clinically significant prostate cancer. MATERIALS AND METHODS: Consecutive patients undergoing MRI-targeted prostate biopsy at a single institution that newly implemented a targeted biopsy pathway from May 2017 to February 2018 were prospectively enrolled. Five biopsy cores were obtained and individually analyzed from each region rated ≥3 on PI-RADS v2.0 to determine the incremental diagnostic benefit of each additional targeted biopsy core. Variables associated with increasing Grade Group from the first to fifth biopsy core were assessed. RESULTS: One hundred and four patients (79% for elevated PSA) were enrolled, 82% of which had a prior biopsy. Men with a PI-RADS >3 lesion were more likely to have pathologic upgrading with additional targeted biopsy cores (OR:4.76; 95% CI:2.34-9.70; P < 0.0001), particularly to Grade Group ≥2 (OR:5.16; 95% CI:2.17-12.29; P = 0.0002), compared to men with PI-RADS 3 lesions. Detection of clinically significant cancer increased from 26% to 44% to 52% when comparing the first, third, and fifth biopsy cores amongst men with a PI-RADS >3 lesion and from 1% to 4% to 9% for PI-RADS 3 lesions. Urinary retention was the most common complication, occurring in 6 (5.7%) patients. CONCLUSION: Clinically significant prostate cancer detection is improved with increased number of MRI-targeted biopsy cores, particularly for urologists early in their learning curve.

Durability of second-generation extensively porous-coated stems in patients age 50 and younger.

UNLABELLED: Early versions of uncemented femoral total hip stems were often associated with thigh pain thought to be due to micromotion between the implant and bone in the distal uncoated regions. An extensively coated stem was introduced in 1992 to reduce that risk. We therefore asked whether second-generation extensively porous-coated cementless femoral stems in patients younger than 50 years of age would (1) be durable in terms of revisions; (2) provide high functional scores and reduce thigh pain; and (3) show radiographic signs of durability, including a reduction in stress shielding. We prospectively followed all 100 patients (115 hips) age 50 and younger treated with primary cementless total hip arthroplasties using a second-generation extensively porous-coated femoral stem between June 1994 and December 1999. The average age was 39.6 years (range, 17-50 years). The stems were mated to cementless acetabular components. Ninety patients were followed for a minimum of 5 years (mean, 8.6 years; range, 5-10 years). One stem was revised after a periprosthetic fracture. None were revised for loosening and all stems demonstrated bony ingrowth at last followup. No acetabular shell was revised for loosening and none was radiographically loose. Six acetabular liners were revised for wear (three each were 22-mm and 26-mm heads). This second-generation extensively porous-coated stem was durable at 5- to 10-year followup in this young active population. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Imaging pitfalls of pancreatic serous cystic neoplasm and its potential mimickers.

The aim of this article is to clarify diagnostic pitfalls of pancreatic serous cystic neoplasm (SCN) that may result in erroneous characterization. Usual and unusual imaging findings of SCN as well as potential SCN mimickers are presented. The diagnostic key of SCN is to look for a cluster of microcysts (honeycomb pattern), which may not be always found in the center. Fibrosis in SCN may be mistaken for a mural nodule of intraductal papillary mucinous neoplasm (IPMN). The absence of cyst wall enhancement may be helpful to distinguish SCN from mucinous cystic neoplasm. However, oligocystic SCN and branch duct type IPMN may morphologically overlap. In addition, solid serous adenoma, an extremely rare variant of SCN, is difficult to distinguish from neuroendocrine tumor.