Current Practices in Anticoagulation Management for Patients Undergoing Percutaneous Image-guided Breast Procedures.

Objective: Given variability in how practices manage patients on antithrombotic medications, we undertook this study to understand the current practice of antithrombotic management for patients undergoing percutaneous breast and axillary procedures. Methods: A 20-item survey with multiple-choice and write-in options was emailed to 2094 active North American members of the Society of Breast Imaging (SBI) in March 2021. Data were collected anonymously and analyzed quantitatively, with free-text responses categorized by themes. Results: Three-hundred twenty-six of 2094 members (15.6%) completed the survey. Eighty-seven percent (274/313) reported having a policy for managing antithrombotic medications. Fifty-nine percent (185/312) reported routinely withholding medications before biopsy, more commonly in the Northeast and South (P = 0.08). Withholding of medications did not vary by lesion location (182/308, 59%, breast vs 181/308, 58.7%, axillary; P = 0.81). Respondents were statistically more likely to withhold medications if using a vacuum-assisted device for all classes of antithrombotic medications (P < 0.001). Up to 50.2% (100/199) on warfarin and 33.6% (66/196) on direct oral anticoagulants had medications withheld more stringently than guidelines suggest. Conclusion: Based on a survey of SBI members, breast imaging practices vary widely in antithrombotic management for image-guided breast and axillary procedures. Of the 60% who withhold antithrombotic medications, a minority comply with recommended withhold guidelines, placing at least some patients at potential risk for thrombotic events. Breast imaging radiologists should weigh the risks and benefits of withholding these medications, and if they elect to withhold should closely follow evidence-based guidelines to minimize the risks of this practice.

Incorporating Peer Learning Into Your Breast Imaging Practice.

Traditional score-based peer review has come under scrutiny in recent years, as studies have demonstrated it to be generally ineffective at improving quality. Many practices and programs are transitioning to a peer learning model to replace or supplement traditional peer review. Peer learning differs from traditional score-based peer review in that the emphasis is on sharing learning opportunities and creating an environment that fosters discussion of errors in a nonpunitive forum with the goal of improved patient care. Creating a just culture is central to fostering successful peer learning. In a just culture, mistakes can be discussed without shame or fear of retribution and the focus is on systems improvement rather than individual blame. Peer learning, as it pertains to breast imaging, can occur in many forms and venues. Examples of the various formats in which peer learning can occur include through individual colleague interaction, as well as divisional, multidisciplinary, department-wide, and virtual conferences, and with the assistance of artificial intelligence. Incorporating peer learning into the practice of breast imaging aims to reduce delayed diagnoses of breast cancer and optimize patient care.

Conspicuity of liver hemangiomas: short tau inversion recovery, T1, and T2 imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid.

PURPOSE: To compare conspicuity of liver hemangiomas on STIR, T1-weighted, and T2-weighted magnetic resonance (MR) images before and after administration of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) (hepatocellular contrast agent), using contrast-to-noise ratios (CNRs). MATERIALS AND METHODS: Thirteen hemangiomas were imaged using breath-hold gradient echo (GRE) T1, fat-saturated turbo spin echo (TSE)-T2, and short tau inversion recovery (STIR) sequences. Background noise and signal-to-noise ratios (SNRs) for liver and hemangioma, along with CNR for normal liver and hemangioma, were measured on each sequence before and after administration of Gd-EOB-DTPA. Hemangioma conspicuity was also evaluated qualitatively. RESULTS: After Gd-EOB-DTPA administration, the quantitative liver SNR decreased 54% on STIR, increased 45% on T1-weighted images, and increased 14.5% on TSE-T2-weighted images. The CNR for liver and hemangioma increased 50% on STIR images (P < 0.0001), increased 46% on T1-weighted imaging (P = 0.0033), and increased 22% on TSE-T2-weighted MR imaging (MRI) (P = 0.0083). After contrast, the CNR for TSE-T2 images was greater than those for both the T1 and STIR images (P < 0.0001 for both). Qualitatively, signal change was visually apparent in the liver on T1 and STIR, but not on T2 images or in the hemangiomas on any sequence. CONCLUSION: Despite the statistically significant T1 and STIR increase in CNR, liver hemangiomas were most conspicuous on TSE-T2 images after Gd-EOB-DTPA. This pilot study with hemangiomas highlights the newly recognized potential benefit of TSE-T2 imaging with hepatocellular contrast.