The Role of Contrast-Enhanced Mammography After Cryoablation of Breast Cancer.

Image-guided cryoablation is an emerging therapeutic technique for the treatment of breast cancer and is a treatment strategy that is an effective alternate to surgery in select patients. Tumor features impacting the efficacy of cryoablation include size, location in relation to skin, and histology (e.g., extent of intraductal component), underscoring the importance of imaging for staging and workup in this patient population. Contrast-enhanced mammography (CEM) utilization is increasing in both the screening and diagnostic settings and may be useful for follow-up imaging after breast cancer cryoablation, given its high sensitivity for cancer detection and its advantages in terms of PPV, time, cost, eligibility, and accessibility compared with contrast-enhanced MRI. This Clinical Perspective describes the novel use of CEM after breast cancer cryoablation, highlighting the advantages and disadvantages of CEM compared with alternate imaging modalities, expected benign postablation CEM findings, and CEM findings suggestive of residual or recurrent tumor.

Fostering Organizational Excellence through Inclusive Leadership: Practical Guide for Radiology Leaders.

Inclusive leadership styles value team members, invite diverse perspectives, and recognize and support the contributions of employees. The authors provide guidance to radiology leaders interested in developing inclusive leadership skills and competencies to improve workforce recruitment and retention and unlock the potential of a rapidly diversifying health care workforce. As health care organizations look to attract the best and brightest talent, they will be increasingly recruiting millennial and Generation Z employees, who belong to the most diverse generations in American history. Additionally, radiology departments currently face critical workforce shortages in radiologists, radiology technicians, staff, and advanced practice providers. In the context of these shortages, the costs of employee turnover have emphasized the need for radiology leaders to develop leadership behaviors that promote recruitment and retention. Radiology department leaders who perceive and treat valued employees as replaceable commodities will be forced to deal with the extremely high costs associated with recruitment and training, decreased morale, and increased burnout. The authors review inclusive versus exclusive leadership styles, describe key attributes and skills of inclusive leaders, provide radiology leaders with concrete methods to make their organizations more inclusive, and outline key steps in change management. By adopting and implementing inclusive leadership strategies, radiology groups can position themselves to succeed in rapidly diversifying health care environments. ©RSNA, 2024 See the invited commentary by Siewert in this issue.

Unnecessary Explantation of IDEAL IMPLANT Structured Saline Breast Implants Prompted byRadiologic Misdiagnosis of Rupture.

ABSTRACT: The unique dual-lumen and baffle design of the IDEAL IMPLANT Structured Saline breast implant gives it specific advantages over both silicone gel-filled and the original saline-filled implants. This internal baffle structure also gives it an appearance on various radiologic imaging studies that may be misinterpreted as a rupture because of similarities to the well-known radiologic appearance of a ruptured silicone gel implant. Patients may present with various misinterpreted imaging studies, highlighting the need for plastic surgeons and radiologists to be familiar with the normal appearance of the intact IDEAL IMPLANT and be able to distinguish it from a ruptured IDEAL IMPLANT. The radiology findings must be correlated with the clinical findings, or an intact IDEAL IMPLANT misdiagnosed as ruptured, may cause unnecessary patient worry, and may prompt unnecessary surgery for removal or replacement.

MRI scarcity in low- and middle-income countries.

Since the introduction of MRI as a sustainable diagnostic modality, global accessibility to its services has revealed a wide discrepancy between populations-leaving most of the population in LMICs without access to this important imaging modality. Several factors lead to the scarcity of MRI in LMICs; for example, inadequate infrastructure and the absence of a dedicated workforce are key factors in the scarcity observed. RAD-AID has contributed to the advancement of radiology globally by collaborating with our partners to make radiology more accessible for medically underserved communities. However, progress is slow and further investment is needed to ensure improved global access to MRI.

Implementation of Abbreviated Breast MRI for Screening: AJR Expert Panel Narrative Review.

Abbreviated breast MRI (AB-MRI) is being rapidly adopted to harness the high sensitivity of screening MRI while addressing issues related to access, cost, and workflow. The successful implementation of an AB-MRI program requires collaboration across administrative, operational, financial, technical, and clinical providers. Institutions must be thoughtful in defining patient eligibility for AB-MRI and providing recommendations for screening intervals, as existing practices are heterogeneous. Similarly, there is no universally accepted AB-MRI protocol, though guiding principles should harmonize abbreviated and full protocols while being mindful of scan duration and amount of time patients spend on the MRI table. The interpretation of AB-MRI will be a new experience for many radiologists and may require a phased rollout and a careful audit of performance metrics over time to ensure benchmark metrics are achieved. AB-MRI finances, which are driven by patient self-payment, will require buy-in from hospital administration with the recognition that downstream revenues will be needed to support initial costs. Finally, successful startup of an AB-MRI program requires active engagement with the larger community of patients and referring providers. As AB-MRI becomes more widely accepted and available, best practices and community standards will continue to evolve to ensure high-quality patient care.

Palpable Lumps after Mastectomy: Radiologic-Pathologic Review of Benign and Malignant Masses.

Patients who have undergone mastectomy, with or without reconstruction, are not universally screened with mammography or US. Therefore, clinical breast examination by the physician and patient-detected palpable abnormalities are crucial for detecting breast cancer or recurrence. Diagnostic US is the first-line modality for evaluation of postmastectomy palpable masses, with occasional adjunct use of diagnostic mammography for confirming certain benign masses. In the setting of a negative initial imaging evaluation with continued clinical concern, diagnostic MRI may aid in improving sensitivity. Knowledge of the typical multimodality imaging appearances and locations of malignant palpable abnormalities-such as invasive carcinoma recurrence, cancer in residual breast tissue, radiation-induced sarcoma, and metastatic disease-is crucial in diagnosis and treatment of these entities. In addition, familiarity with the range of benign palpable postmastectomy processes-including fat necrosis, fat graft, seroma, granuloma, neuroma, fibrosis, and infection-may help avoid unnecessary biopsies and reassure patients. The authors review common and rare benign and malignant palpable masses in mastectomy patients, describe multimodality diagnostic imaging evaluation of each entity, review radiologic and pathologic correlation, and acquaint the radiologist with management when these findings are encountered. ©RSNA, 2021.

Artificial Intelligence in Low- and Middle-Income Countries: Innovating Global Health Radiology.

Scarce or absent radiology resources impede adoption of artificial intelligence (AI) for medical imaging by resource-poor health institutions. They face limitations in local equipment, personnel expertise, infrastructure, data-rights frameworks, and public policies. The trustworthiness of AI for medical decision making in global health and low-resource settings is hampered by insufficient data diversity, nontransparent AI algorithms, and resource-poor health institutions' limited participation in AI production and validation. RAD-AID's three-pronged integrated strategy for AI adoption in resource-poor health institutions is presented, which includes clinical radiology education, infrastructure implementation, and phased AI introduction. This strategy derives from RAD-AID's more-than-a-decade experience as a nonprofit organization developing radiology in resource-poor health institutions, both in the United States and in low- and middle-income countries. The three components synergistically provide the foundation to address health care disparities. Local radiology personnel expertise is augmented through comprehensive education. Software, hardware, and radiologic and networking infrastructure enables radiology workflows incorporating AI. These educational and infrastructure developments occur while RAD-AID delivers phased introduction, testing, and scaling of AI via global health collaborations.

Should We Ignore, Follow, or Biopsy? Impact of Artificial Intelligence Decision Support on Breast Ultrasound Lesion Assessment.

OBJECTIVE. The objective of this study was to assess the impact of artificial intelligence (AI)-based decision support (DS) on breast ultrasound (US) lesion assessment. MATERIALS AND METHODS. A multicenter retrospective review of 900 breast lesions (470/900 [52.2%] benign; 430/900 [47.8%] malignant) on US by 15 physicians (11 radiologists, two surgeons, two obstetrician/gynecologists). An AI system (Koios DS for Breast, Koios Medical) evaluated images and assigned them to one of four categories: benign, probably benign, suspicious, and probably malignant. Each reader reviewed cases twice: 750 cases with US only or with US plus DS; 4 weeks later, cases were reviewed in the opposite format. One hundred fifty additional cases were presented identically in each session. DS and reader sensitivity, specificity, and positive likelihood ratios (PLRs) were calculated as well as reader AUCs with and without DS. The Kendall τ-b correlation coefficient was used to assess intraand interreader variability. RESULTS. Mean reader AUC for cases reviewed with US only was 0.83 (95% CI, 0.78-0.89); for cases reviewed with US plus DS, mean AUC was 0.87 (95% CI, 0.84-0.90). PLR for the DS system was 1.98 (95% CI, 1.78-2.18) and was higher than the PLR for all readers but one. Fourteen readers had better AUC with US plus DS than with US only. Mean Kendall τ-b for US-only interreader variability was 0.54 (95% CI, 0.53-0.55); for US plus DS, it was 0.68 (95% CI, 0.67-0.69). Intrareader variability improved with DS; class switching (defined as crossing from BI-RADS category 3 to BI-RADS category 4A or above) occurred in 13.6% of cases with US only versus 10.8% of cases with US plus DS (p = 0.04). CONCLUSION. AI-based DS improves accuracy of sonographic breast lesion assessment while reducing inter- and intraobserver variability.

Breast MRI screening for average-risk women: A monte carlo simulation cost-benefit analysis.

BACKGROUND: Screening high-risk women for breast cancer with MRI is cost-effective, with increasing cost-effectiveness paralleling increasing risk. However, for average-risk women cost is considered a major limitation to mass screening with MRI. PURPOSE: To perform a cost-benefit analysis of a simulated breast cancer screening program for average-risk women comparing MRI with mammography. STUDY TYPE: Population simulation study. POPULATION/SUBJECTS: Five million (M) hypothetical women undergoing breast cancer screening. FIELD STRENGTH/SEQUENCE: Simulation based primarily on Kuhl et al8 study utilizing 1.5T MRI with an axial bilateral 2D multisection gradient-echo dynamic series (repetition time / echo time 250/4.6 msec; flip angle, 90°) with a full 512 × 512 acquisition matrix and a sensitivity encoding factor of two, performed prior to and four times after bolus injection of 0.1 mmol of gadobutrol per kg of body weight (Gadovist; Bayer, Germany). An axial T2 -weighted fast spin-echo sequence with identical anatomic parameters was also included. ASSESSMENT: A Monte Carlo simulation utilizing Medicare reimbursement rates to calculate input variable costs was developed to compare 5M women undergoing breast cancer screening with either triennial MRI or annual mammography, 2.5M in each group, over 30 years. STATISTICAL TESTS: Expected recall rates, BI-RADS 3, BI-RADS 4/5 cases and cancer detection rates were determined from published literature with calculated aggregate costs including resultant diagnostic/follow-up imaging and biopsies. RESULTS: Baseline screening of 2.5M women with breast MRI cost $1.6 billion (B), 3× higher than baseline mammography screening ($0.54B). With subsequent screening, MRI screening is more cost-effective than mammography screening in 24 years ($13.02B vs. $13.03B). MRI screening program costs are largely driven by cost per MRI exam ($549.71). A second simulation model was performed based on MRI Medicare reimbursement trends using a lower MRI cost ($400). This yielded a cost-effective benefit compared to mammography screening in less than 6 years ($3.41B vs. $3.65B), with over a 22% cost reduction relative to mammography screening in 12 years and reaching a 38% reduction in 30 years. DATA CONCLUSION: Despite higher initial cost of a breast MRI screening program for average-risk women, there is ultimately a cost savings over time compared with mammography. This estimate is conservative given cost-benefit of additional/earlier breast cancers detected by breast MRI were not accounted for. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 6 J. Magn. Reson. Imaging 2019.

Biopsy Marker Standardization: What's in a Name?

OBJECTIVE. The purposes of this study were to compile mammographic images in various projections showing commercially available breast biopsy site markers and to provide a standardized nomenclature and marker guide to improve physician communication and patient care. MATERIALS AND METHODS. A retrospective review of all breast biopsy markers encountered at one institution was conducted from January 2012 to January 2018. Markers placed at the facility and those placed at outside institutions with the patient subsequently referred to the study institution were included. Additional drawings and photographs and biopsy marker information were compiled from manufacturers and the literature. Intrinsic properties, features, pitfalls, and biopsy marker mimics were recorded from the institution's experience and the literature. RESULTS. Thirty-eight different biopsy marker shapes available from six manufacturers were identified, and mammograms of 37 were compiled and organized by manufacturer. Nomenclature was compiled on the basis of the manufacturer names of each marker. Potential pitfalls and mimics were identified. Manufacturer-reported marker material composition and carrier properties were summarized, including decreased marker migration, enhanced ultrasound visibility, and varying MRI susceptibility. CONCLUSION. Variability in the appearance and nomenclature of breast biopsy site markers may contribute to misinterpretation, miscommunication, and possibly removal of the incorrect lesion. A comprehensive guide to breast biopsy marker nomenclature is clinically useful, and standardization is necessary.

Calcifications at Digital Breast Tomosynthesis: Imaging Features and Biopsy Techniques.

Full-field digital mammography (FFDM), the standard of care for breast cancer screening, has some limitations. With the advent of digital breast tomosynthesis (DBT), improvements including decreased recall rates and increased cancer detection rates have been observed. The quasi-three-dimensional capability of DBT reduces breast tissue overlap, a significant limitation of FFDM. However, early studies demonstrate that a few cancers detected at FFDM may not be diagnosed at DBT-only screening, and lesions with calcifications as the dominant feature may look less suspicious at DBT or not be visible at all. These findings support the use of combined FFDM and DBT protocols to optimize screening performance. However, this combination would approximately double the patient's radiation exposure. The development of computer algorithms that generate two-dimensional synthesized mammography (SM) views from DBT has improved calcification conspicuity and sensitivity. Therefore, SM may substitute for FFDM in screening protocols, reducing radiation exposure. DBT plus SM demonstrates significantly better performance than that of FFDM alone, although there are reports of missed malignant calcifications. Thus, some centers continue to perform FFDM with DBT. Use of DBT in breast imaging has also necessitated the development of DBT-guided biopsy. DBT-guided biopsy may have a higher success rate than that of stereotactic biopsy, with a shorter procedure time. While DBT brings substantial improvements to breast cancer imaging, it is important to be aware of its strengths and limitations regarding detection of calcifications. This article reviews the imaging appearance of breast calcifications at DBT, discusses calcification biopsy techniques, and provides an overview of the current literature. Online supplemental material is available for this article. ©RSNA, 2019 An earlier incorrect version of this article appeared online. This article was corrected on February 13, 2019.

Barriers to mammography screening in Nigeria: A survey of two communities with different access to screening facilities.

Delayed presentation of breast cancer is a common theme in most low- and middle-income countries. This study evaluates barriers to mammography screening in two Nigerian communities with different geographic access to screening facilities. A 35 item questionnaire was administered to women, 40 years and older, 1,169 (52.6%) in Ife Central Local Government where mammography services are offered and 1,053 (47.4%) in Iwo Local Government where there are no mammography units. Information on breast cancer screening practices and barriers to mammography screening were compared between the two communities. Most women had heard of breast cancer (Ife 94%, Iwo 97%), but few were aware of mammography (Ife 11.8%, Iwo 11.4%). Mammography uptake in Ife Central was 2.8% and 1.8% in Iwo, despite the former offering mammography services. Knowledge and practice of mammography were not statistically different between the two communities (p = 0.74, 0.1). Lack of awareness was the commonest reason cited for not having mammography in both communities. Others include lack of perceived need and cost. Awareness creation to ensure optimal utilisation of existing facilities, as well as innovative measures to address the barrier of cost, is required to improve breast cancer screening uptake in Nigeria.

Does breast MRI background parenchymal enhancement indicate metabolic activity? Qualitative and 3D quantitative computer imaging analysis.

PURPOSE: To investigate whether the degree of breast magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) is associated with the amount of breast metabolic activity measured by breast parenchymal uptake (BPU) of 18F-FDG on positron emission tomography / computed tomography (PET/CT). MATERIALS AND METHODS: An Institutional Review Board (IRB)-approved retrospective study was performed. Of 327 patients who underwent preoperative breast MRI from 1/1/12 to 12/31/15, 73 patients had 18F-FDG PET/CT evaluation performed within 1 week of breast MRI and no suspicious findings in the contralateral breast. MRI was performed on a 1.5T or 3.0T system. The imaging sequence included a triplane localizing sequence followed by sagittal fat-suppressed T2 -weighted sequence, and a bilateral sagittal T1 -weighted fat-suppressed fast spoiled gradient-echo sequence, which was performed before and three times after a rapid bolus injection (gadobenate dimeglumine, Multihance; Bracco Imaging; 0.1 mmol/kg) delivered through an IV catheter. The unaffected contralateral breast in these 73 patients underwent BPE and BPU assessments. For PET/CT BPU calculation, a 3D region of interest (ROI) was drawn around the glandular breast tissue and the maximum standardized uptake value (SUVmax ) was determined. Qualitative MRI BPE assessments were performed on a 4-point scale, in accordance with BI-RADS categories. Additional 3D quantitative MRI BPE analysis was performed using a previously published in-house technique. Spearman's correlation test and linear regression analysis was performed (SPSS, v. 24). RESULT: The median time interval between breast MRI and 18F-FDG PET/CT evaluation was 3 days (range, 0-6 days). BPU SUVmax mean value was 1.6 (SD, 0.53). Minimum and maximum BPU SUVmax values were 0.71 and 4.0. The BPU SUVmax values significantly correlated with both the qualitative and quantitative measurements of BPE, respectively (r(71) = 0.59, P < 0.001 and r(71) = 0.54, P < 0.001). Qualitatively assessed high BPE group (BI-RADS 3/4) had significantly higher BPU SUVmax of 1.9 (SD = 0.44) compared to low BPE group (BI-RADS 1/2) with an average BPU SUVmax of 1.17 (SD = 0.32) (P < 0.001). On linear regression analysis, BPU SUVmax significantly predicted qualitative and quantitative measurements of BPE (ß = 1.29, t(71) = 3.88, P < 0.001 and ß = 19.52, t(71) = 3.88, P < 0.001). CONCLUSION: There is a significant association between breast BPU and BPE, measured both qualitatively and quantitatively. Increased breast cancer risk in patients with high MRI BPE could be due to elevated basal metabolic activity of the normal breast tissue, which may provide a susceptible environment for tumor growth. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:753-759.

Beyond Wires and Seeds: Reflector-guided Breast Lesion Localization and Excision.

Purpose To evaluate outcomes of Savi Scout (Cianna Medical, Aliso Viejo, Calif) reflector-guided localization and excision of breast lesions by analyzing reflector placement, localization, and removal, along with target excision and rates of repeat excision (referred to as re-excision). Materials and Methods A single-institution retrospective review of 100 women who underwent breast lesion localization and excision by using the Savi Scout surgical guidance system from June 2015 to May 2016 was performed. By using image guidance 0-8 days before surgery, 123 nonradioactive, infrared-activated, electromagnetic wave reflectors were percutaneously inserted adjacent to or within 111 breast targets. Twenty patients had two or three reflectors placed for bracketing or for localizing multiple lesions, and when ipsilateral, they were placed as close as 2.6 cm apart. Target and reflector were localized intraoperatively by one of two breast surgeons who used a handpiece that emitted infrared light and electromagnetic waves. Radiographs of the specimen and pathologic analysis helped verify target and reflector removal. Target to reflector distance was measured on the mammogram and radiograph of the specimen, and reflector depth was measured on the mammogram. Pathologic analysis was reviewed. Re-excision rates and complications were recorded. By using statistics software, descriptive statistics were generated with 95% confidence intervals (CIs) calculated. Results By using sonographic (40 of 123; 32.5%; 95% CI: 24.9%, 41.2%) or mammographic (83 of 123; 67.5%; 95% CI: 58.8% 75.1%) guidance, 123 (100%; 95% CI: 96.4%, 100%) reflectors were placed. Mean mammographic target to reflector distance was 0.3 cm. All 123 (100%; 95% CI: 96.4%, 100%) targets and reflectors were excised. Pathologic analysis yielded 54 of 110 malignancies (49.1%; 95% CI: 39.9%, 58.3%; average, 1.0 cm; range, 0.1-5 cm), 32 high-risk lesions (29.1%; 95% CI: 21.4%, 38.2%), and 24 benign lesions (21.8%; 95% CI: 115.1%, 30.4%). Four of 54 malignant cases (7.4%; 95% CI: 2.4%, 18.1%) demonstrated margins positive for cancer that required re-excision. Five of 110 radiographs of the specimen (4.5%; 95% CI: 1.7%, 10.4%) demonstrated increased distance between the target and reflector distance of greater than 1.0 cm (range, 1.1-2.6 cm) compared with postprocedure mammogram the day of placement, three of five were associated with hematomas, two of five migrated without identifiable cause. No related postoperative complications were identified. Conclusion Savi Scout is an accurate, reliable method to localize and excise breast lesions with acceptable margin positivity and re-excision rates. Bracketing is possible with reflectors as close as 2.6 cm. Savi Scout overcomes many limitations of other localization methods, which warrants further study. © RSNA, 2017.

Breast carcinoma in augmented breasts: MRI findings.

OBJECTIVE: The objective of our study was to characterize the MRI features of breast carcinomas detected in augmented breasts. MATERIALS AND METHODS: A review of the MRI database identified 54 patients with biopsy-proven breast carcinoma in augmented breasts. The images were reviewed for the type and location of the implant and for the characteristics of the carcinoma. The cases included 46 (85%) invasive cancers (invasive ductal carcinoma, n = 35; invasive lobular carcinoma, n = 7; and mixed features, n = 4) and eight (15%) ductal carcinomas in situ. RESULTS: The median age of the patients at diagnosis was 49 years (range, 28-72 years). Thirty-eight of the 54 cancers (70%) were palpable. The mean tumor size was 2.8 cm (range, 0.6-9.6 cm). Of the 54 cancers, 34 (63%) presented as masses and 20 (37%) as nonmass enhancement on MRI. There was no detectable difference between implant position and lesion morphology (p = 0.55) or tumor size (p = 1.00). Twenty of 54 (37%) carcinomas abutted the implant, 13 (24%) abutted the pectoralis major muscle, and two (4%) invaded the pectoralis major muscle. Of the tumors abutting the implant, 18 of 20 (90%) spread along the implant capsule for more than 0.5 cm. This pattern of tumor spread was more common in breasts with retroglandular implants (9/16, 56%) than in those with retropectoral implants (9/38, 24%) (p = 0.03). MRI detected the index carcinoma in 16 of 54 (30%) cases, showed a greater extent of disease than was visible on mammography or ultrasound in 21 of 52 (40%) cases, and detected an unsuspected contralateral carcinoma in three of 54 (6%) cases. CONCLUSION: In augmented breasts, breast cancer often contacts either the implant or the pectoralis major muscle. Tumor spread along the implant contour is more often seen with retroglandular implants than with retropectoral implants. MRI should be considered to assess disease extent in women with augmented breasts before surgery.

Artificial intelligence in breast ultrasound: application in clinical practice.

Ultrasound (US) is a widely accessible and extensively used tool for breast imaging. It is commonly used as an additional screening tool, especially for women with dense breast tissue. Advances in artificial intelligence (AI) have led to the development of various AI systems that assist radiologists in identifying and diagnosing breast lesions using US. This article provides an overview of the background and supporting evidence for the use of AI in hand held breast US. It discusses the impact of AI on clinical workflow, covering breast cancer detection, diagnosis, prediction of molecular subtypes, evaluation of axillary lymph node status, and response to neoadjuvant chemotherapy. Additionally, the article highlights the potential significance of AI in breast US for low and middle income countries.

Artificial Intelligence Decision Support for Triple-Negative Breast Cancers on Ultrasound.

OBJECTIVE: To assess performance of an artificial intelligence (AI) decision support software in assessing and recommending biopsy of triple-negative breast cancers (TNBCs) on US. METHODS: Retrospective institutional review board-approved review identified patients diagnosed with TNBC after US-guided biopsy between 2009 and 2019. Artificial intelligence output for TNBCs on diagnostic US included lesion features (shape, orientation) and likelihood of malignancy category (benign, probably benign, suspicious, and probably malignant). Artificial intelligence true positive was defined as suspicious or probably malignant and AI false negative (FN) as benign or probably benign. Artificial intelligence and radiologist lesion feature agreement, AI and radiologist sensitivity and FN rate (FNR), and features associated with AI FNs were determined using Wilcoxon rank-sum test, Fisher's exact test, chi-square test of independence, and kappa statistics. RESULTS: The study included 332 patients with 345 TNBCs. Artificial intelligence and radiologists demonstrated moderate agreement for lesion shape and orientation (k = 0.48 and k = 0.47, each P <.001). On the set of examinations using 6 earlier diagnostic US, radiologists recommended biopsy of 339/345 lesions (sensitivity 98.3%, FNR 1.7%), and AI recommended biopsy of 333/345 lesions (sensitivity 96.5%, FNR 3.5%), including 6/6 radiologist FNs. On the set of examinations using immediate prebiopsy diagnostic US, AI recommended biopsy of 331/345 lesions (sensitivity 95.9%, FNR 4.1%). Artificial intelligence FNs were more frequently oval (q < 0.001), parallel (q < 0.001), circumscribed (q = 0.04), and complex cystic and solid (q = 0.006). CONCLUSION: Artificial intelligence accurately recommended biopsies for 96% to 97% of TNBCs on US and may assist radiologists in classifying these lesions, which often demonstrate benign sonographic features.

Building Radiology Equity: Themes from the 2023 RAD-AID Conference on International Radiology and Global Health.

Low- and middle-income countries are significantly impacted by the global scarcity of medical imaging services. Medical imaging is an essential component for diagnosis and guided treatment, which is needed to meet the current challenges of increasing chronic diseases and preparedness for acute-care response. We present some key themes essential for improving global health equity, which were discussed at the 2023 RAD-AID Conference on International Radiology and Global Health. They include (1) capacity building, (2) artificial intelligence, (3) community-based patient navigation, (4) organizational design for multidisciplinary global health strategy, (5) implementation science, and (6) innovation. Although not exhaustive, these themes should be considered influential as we guide and expand global health radiology programs in low- and middle-income countries in the coming years.