A new search pattern for emergency breast exams: the clinical picture.

Distinct breast diseases are readily diagnosed by clinical and ultrasound appearance that radiologists and sonographers may encounter in emergency room and urgent care patient presentations. While it may be impractical or impossible for the on-call emergency radiologist to examine a patient with breast complaints, radiologists can and should adopt the practice pattern to routinely seek out the clinical photographs in the patient's medical record while interpreting breast examinations. Imaging should be interpreted in the context of both the history and the physical findings. Sonographers play important roles in the documentation of visual inspection findings, in addition to performing high quality targeted ultrasound where applicable. This pictorial offers resources to emergency radiologists and sonographers that facilitate rapid accurate diagnosis of ten distinct breast diseases.

Breast cancer in young women: Imaging and clinical course.

The purpose of this study was to characterize presenting imaging findings in women younger than 40 diagnosed with invasive breast cancer in the context of pathology and clinical course. Retrospective chart and imaging reviews were performed in patients under 40 diagnosed with breast cancer between July 1, 2004, and December 31, 2013. Patient demographic, imaging, pathology, and clinical data were collected. Overall and recurrence-free survival were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were performed to identify factors associated with recurrence-free survival. Our study cohort consisted of 110 patients with invasive mammary carcinoma. One hundred one (91.8%) presented with a palpable mass. The mean size of all lesions on imaging was 3.5 cm ± 2.9 cm. Malignant calcifications were present in 54 (49.1%) cases. Imaging demonstrated multifocal or multicentric disease in 45 (40.9%) cases. Seventy four (67.3%) cancers were high grade. Luminal genomic subtypes were the most common (n = 61, 55.5%). At presentation, 4 (3.6%) patients had bilateral malignancy and 8 (7.3%) patients had distant metastatic disease. Ninety seven (88.2%) underwent neoadjuvant chemotherapy and 67 (60.9%) underwent radiation therapy. Seventy five (68.2%) of the patients underwent mastectomy. The restricted mean time to recurrence was 9.01 years (standard error 3.162 months). ER positivity was associated with compromised recurrence-free survival. The overall survival rate was 0.962 at 10 years. Young patients diagnosed with breast cancer typically present with advanced breast imaging findings and undergo aggressive treatment. Recurrence often occurs >5 years from diagnosis, and ER positive subtypes are at increased risk for recurrence.

You'll see it when you know it: granulomatous mastitis.

Granulomatous mastitis (GM) is an under-recognized and under-diagnosed disease. Patients with GM often present to the emergency room with a painful breast mass, nipple retraction, and skin changes. This pictorial essay will review the clinical presentation and imaging appearance of GM, BI-RADS reporting parameters, differential diagnoses, and diagnostic challenges posed by this disease. Early and accurate diagnosis is essential, as misdiagnosis can result in repeated core biopsies, leading to fistulae and sinus tract formation. A classic history and typical sonographic appearance allow the emergency radiologist to confidently make this diagnosis.

Using Rubrics to Evaluate E-Learning Tools in Radiology Education.

Recent trends in medical education with an emphasis on active learning strategies and blended learning techniques have resulted in a growing volume and utilization of online educational resources. Integration of online learning tools into medical curricula has been further necessitated during the COVID-19 pandemic. With access to abundant digital radiology education resources, it has become increasingly important for educators to be able to evaluate the efficacy of e-learning tools for use in radiology education. In this manuscript, the authors describe their successful search for a vetted method to evaluate e-learning tools in radiology education. The selected rubric was designed by educational developers supporting technology to be used as a formative tool in higher education. The rubric was applied in condensed and noncondensed formats to 2 existing popular highly subscribed radiology e-learning resources and results were displayed in narrative and visual formats. More widespread application of this rubric would be beneficial to the content creators and learners alike.

Use of the lateral arm in tomosynthesis-guided SCOUT Reflector placement procedures.

Preoperative localization procedures are important for guiding surgical excision of non-palpable findings in the breast. The SCOUT Reflector (Merit Medical, South Jordan UT, USA) is a non-wire-based localization device that has been incorporated into clinical use with great success. SCOUT Reflectors can be placed using several imaging modalities, including tomosynthesis. One drawback to SCOUT Reflector placement under tomosynthesis guidance is an inability to directly visualize the introducer needle tip, a factor that limits precision. In this brief communication, we describe the use of a lateral arm attachment for tomosynthesis guided SCOUT Reflector placement. Precise SCOUT Reflector placement can be achieved using the lateral arm due to the ability to clearly visualize the introducer needle and the SCOUT Reflector within the introducer needle bore prior to deployment.

Classic illustrations of benign and malignant phyllodes breast tumors in two patients.

Phyllodes tumors, World Health Organization fibroepithelial tumors, are classified as benign, borderline, or malignant based on histopathology. Phyllodes must be distinguished from benign fibroadenomas, also WHO fibroepithelial tumors. The distinction of phyllodes from fibroadenomas can be challenging clinically, as these tumors may mirror one another. Here, we present 2 cases, classic clinical and imaging examples of benign and malignant phyllodes, to review the current epidemiology, classification, diagnosis, and treatment of phyllodes tumors.

Commentary on Ultrasound Instruction in Undergraduate Medical Education: Perspective from Two Students.

Background: Ultrasound integration in undergraduate medical education (UME) has been a focused endeavor in recent years. According to the American Institute of Ultrasound in Medicine, more than a third of all US medical schools have adopted a focused ultrasound training program for medical students. Medical student perspectives on best practices in ultrasound education are lacking in the literature. Curricula Experiences: Two students' reflections are presented regarding two different didactic approaches, flipped classroom and self-study learning models, to teaching ultrasound in the pre-clinical medical education curriculum. Students present reflections on these didactic approaches to facilitate further improvement in ultrasound education curricula. Discussion: The self-directed learning model enabled students to learn foundational ultrasound exam techniques efficiently in a low-stress environment and subsequently optimized the efficiency of later faculty-led learning events. However, we noted that in both the flipped classroom and self-study learning models of education, the training on basic physical properties of ultrasound, tissue characteristics, and probe manipulation was limited. Conclusion: A self-study learning model ultrasound curricula improves perceived learning efficiency and student confidence, especially when followed by faculty-guided didactics and scanning opportunities. We suggest a framework for ultrasound education curricula that includes components of both formats of ultrasound education alongside faculty-led sessions as an ideal model of ultrasound education. Further, we propose the added benefit of inanimate object scanning to optimize students' knowledge of waveform physics (image acquisition and physical properties of materials) early in the ultrasound education process.

Near-Peer Teaching in Radiology Symposia: A Success Story in Residents as Teachers.

INTRODUCTION: Peer learning and near-peer teaching have been described in many specialties, less so in Radiology. We present near-peer teaching whereby residents present a series of didactic sessions at the course outset in the form of "symposia" and perform a scholarly activity in the form of teaching. We aim to demonstrate how near-peer teaching in symposia front-loaded within an introductory radiology course can improve medical student satisfaction. METHOD: A total of 169 students were enrolled over a period of 3 years, 55 before (2017-2018) and 114 (2018-2020) after the introduction of the symposium. Anonymous course evaluations were collected from all students. In addition, 240 fourth-year medical students who also attended symposium lectures received satisfaction surveys in 2019 and 2020. RESULTS: All (169/169, 100%) students taking the course evaluated it. Overall evaluation scores rose from 8.3/10 to 9.0/10 post-symposia. Among student satisfaction surveys, 89/240 (37%) specifically commented on symposia; 91% (80/89) of those found symposia very or extremely informative. 29/71 (41%) of all residents were able to participate in the symposia, 20/29 in multiple years throughout residency, allowing them to fulfill the Accreditation Council for Graduate Medical Education interpersonal and communication skills core competencies and meet scholarly activity requirements. CONCLUSION: Near-peer teaching in the form of resident-taught interactive didactics grouped in symposia can have a positive outcome on medical student satisfaction.

I.C.A.R.U.S. in Flight: A Radiology Simulator Teaches Imaging Appropriateness, Anatomy, and Image Interpretation Skills.

RATIONALE AND OBJECTIVES: The Interactive Clinical Anatomy and Radiology Utilization Simulator (ICARUS) was created in 2012 as a novel simulation program with 25 peer reviewed electronic modules combining simulated patient encounters, American College of Radiology appropriateness criteria, radiologic anatomy, and basic imaging interpretation and patient safety topics. ICARUS integrates a gaming approach to improve student engagement. MATERIALS AND METHODS: ICARUS modules have been used in the undergraduate medical curriculum at the lead author's institution since its pilot in 2012. Since completion of the full complement of 25 modules, modules have been used in the radiology clerkship (2012- 2015), in the integrated longitudinal curriculum (2015-present), and in various radiology electives (2015-present), including the inaugural virtual radiology electives at all authors' institutions (July 2020-present). Student evaluations were formally solicited in 2014 and again in 2020. RESULTS: During the introductory radiology clerkship in 2014, 107 students were enrolled. Students were assigned 4 ICARUS modules. During the 2-week virtual elective from July-October 2020, 26 students were enrolled. Students were assigned all 25 modules. The majority of survey respondents "agreed" or "strongly agreed" that the modules were interactive, enjoyable, and self-directed, fostered critical thinking, provided practical value, met goals and objectives of the course, and seemed practical to their future practice. CONCLUSION: ICARUS integrates key educational concepts in radiology with high fidelity simulation of clinical decision support software and PACS simulation image display to create a highly engaging learning environment that most accurately reflects future clinical experiences.

Web-Based Radiology Learning Module Design: The Author Perspective.

RATIONALE AND OBJECTIVES: Over recent years, e-learning has become an integral component of radiology education. While demands for innovative, interactive e-learning resources have increased, the availability of viable solutions have not kept pace. As a result, many educators are authoring their own e-learning content. This study describes the six-year experience of faculty clinician educators and residents who participated in this authoring process. MATERIALS AND METHODS: From 2014 to 2020, 62 radiology faculty and residents created a total of 89 peer reviewed web-based learning modules. Authors were given instructions and materials to support their design process. Following completion of their module(s), authors were asked to complete an anonymous and voluntary survey on their perspective. RESULTS: Hundred percent of survey respondents reported that they enjoyed creating their module and 97.8% would recommend the experience to others. Reported educational value of authoring a learning module was 4.18 per 5, with 65% of resident authors reporting that they felt more likely to retain the information they learned through authoring a module rather than reading a chapter on the same topic. A total of 77.3% of respondents reported that the experience would make them more likely to teach medical students in the future. CONCLUSION: With the appropriate resources and support, radiology faculty and residents succeed in authorship of innovative e-learning modules for medical student learners. In addition to enhancing subject matter knowledge and satisfying Accreditation Council for Graduate Medical Education requirements for teaching and scholarly activity, authorship provides mentoring opportunities and cultivates interest in medical student education.

Medical Education Research Design.

As with clinical care, radiology education benefits when stakeholders collaborate to gather and analyze data to answer questions and solve issues. Just as importantly, radiology educators benefit academically and professionally when they demonstrate a portfolio of published scholarship to promotion committees and department leaders. The principles and techniques used in the design of medical education research are not well understood by many radiology educators because educational scholarship methodologies have received little attention in our literature. Lack of familiarity and inexperience with research methodologies, particularly qualitative research, are barriers that education researchers can address with knowledge acquisition and practice. This overview surveys the landscape and offers suggested medical education research resources to help researchers explore topics to increase understanding of quantitative, qualitative, mixed-methods, survey, and educational design methodologies.

Great Question! The Art and Science of Crafting High-Quality Multiple-Choice Questions.

Assessment of medical knowledge is essential to determine the progress of an adult learner. Well-crafted multiple-choice questions are one proven method of testing a learner's understanding of a specific topic. The authors provide readers with rules that must be followed to create high-quality multiple-choice questions. Common question writing mistakes are also addressed to assist readers in improving their item-writing skills.

It Takes a Village: A Multimodal Approach to Addressing Radiologist Burnout.

Burnout is a significant issue confronting the medical profession, to which radiology is no exception. Addressing burnout demands a full-spectrum response, in keeping with its complexity, prevalence, and significance. This manuscript brings together key techniques at the individual, peer, and institutional levels to offer a multifaceted approach to ameliorating radiologist burnout. Such an approach would begin by equipping physicians with the skillset necessary to identify signs of burnout in themselves and others. Institutions can work to validate the radiologists they employ and work toward mitigating the impact of occupational stressors. Lastly, engaging in conversations about burnout throughout the course of one's medical career can affect a sea change in the way burnout is envisioned, and treated.

The Short and the Long of It: Transitioning to a Blended Longitudinal Curriculum in Radiology.

PURPOSE: The aim of this study was to demonstrate that the transition from a stand-alone radiology clerkship block to a longitudinally integrated radiology curriculum leverages newer teaching tools favored by today's learners. METHODS: In 2013 and 2014, medical students attended a dedicated 1-week radiology clerkship course. In 2015, the block clerkship model for radiology transitioned to a vertically integrated curriculum. By 2019, radiology content was integrated into many of the health illness and disease course blocks. Pre- and postcourse multiple-choice question tests as well as anonymous surveys were administered for both clerkship and integrated curriculum blocks. The student survey questions assessed perceptions regarding interpretation skills, imaging modality knowledge, and radiologists' roles. RESULTS: Among 197 total students in the clerkship block, surveys were completed by 170 respondents, yielding a response rate of 86.3%. Among 106 students in the longitudinal course, surveys were completed by 71 respondents, yielding a response rate of 67%. For both clerkship and longitudinally integrated courses, the average number of correct responses after completion of the courses was significantly greater than the average number of correct precourse responses. Compared with students in the clerkship block curriculum, students in the longitudinal curriculum demonstrated a significantly greater frequency of agreement in response to survey questions regarding significant exposure to radiology, feeling comfortable interpreting CT images, and being familiar with how to use the ACR Appropriateness Criteria. CONCLUSIONS: Transitioning from a single clerkship block to a more integrated format allows a more effective patient-centered clinical approach to medical imaging.

A rare case of myofibroblastoma in an older male.

Myofibroblastoma is a rare benign breast stromal tumor comprised of fibroblasts and myofibroblasts, most commonly presenting in postmenopausal women and older men. This report discusses the case of a 69-year-old male diagnosed with myofibroblastoma after mammography, targeted ultrasound, and core needle biopsy of a retroareolar mass. The features of myofibroblastoma are presented.

Mentoring Medical Education Research: Guidelines from a Narrative Review.

Mentorship is critical to develop research scholars. Current literature provides mentorship guidance for biomedical research; however, mentorship for educational research is scarce. We explored literature to offer evidence-based guidance for medical education research mentors. A librarian searched peer-reviewed literature from 2001 to 2021 to identify guidelines for research mentors. Thirty-five articles were included in this narrative review. Our results identified attributes of mentors, overlapping roles, and barriers and benefits of mentoring. The structures and processes related to mentoring are reviewed and applicability to medical education research mentorship is summarized. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01565-2.

Online Hide and Seek: Allopathic US Medical Schools' Radiology Education Virtual Presence.

RATIONALE AND OBJECTIVES: To highlight radiology's merits and boost appeal to medical students in the digital era, it is increasingly important for radiology departments to be readily accessible to medical students. We report the results of a multivariate analysis of the virtual presence of radiology medical student education of 152 allopathic United States (US) medical schools, the first report of its kind to the authors' knowledge. We detail eight elements to include when optimizing a radiology medical student education website. METHODS: In August 2020, the Department of Radiology websites at 152 allopathic US medical schools were assessed for the presence of a medical student radiology education website and accessibility of collated information about preclinical and clinical course offerings, radiology interest groups, and outreach initiatives in the form of student radiology mentorship, shadowing, and research opportunities. RESULTS: 65.1% (99/152) of allopathic US medical schools' radiology departments have a dedicated medical student radiology education website, one of which was excluded from further review due to password protected content. 58.2% (57/98) of departmental websites include information about preclinical radiology coursework and 90.8% (89/98) of departments provide information about clinical courses. Details about interest groups were found on 26.5% (26/98) of departmental websites. Information about mentorship and shadowing was identified on less than half of departmental websites. 51% (50/98) of Department of Radiology websites provide information about research opportunities for students. CONCLUSIONS: This study demonstrates that the majority of allopathic US medical schools' radiology departments lack full information of relevance to medical students. To engage today's and tomorrow's medical learners digitally, there is opportunity and need to improve the online availability of information about preclinical and clinical radiology courses, student interest groups, shadowing opportunities, student mentorship, and student research. We detail eight elements to include when optimizing a radiology medical student education website. In most instances, this can be accomplished by revising an existing radiology department website in a manner that engages, educates, and recruits medical students. As a specialty, radiology must expand our digital footprint to reach tomorrow's colleagues and leaders.

Talking Points: Enhancing Communication Between Radiologists and Patients.

Radiologists communicate along multiple pathways, using written, verbal, and non-verbal means. Radiology trainees must gain skills in all forms of communication, with attention to developing effective professional communication in all forms. This manuscript reviews evidence-based strategies for enhancing effective communication between radiologists and patients through direct communication, written means and enhanced reporting. We highlight patient-centered communication efforts, available evidence, and opportunities to engage learners and enhance training and simulation efforts that improve communication with patients at all levels of clinical care.

Virtual Journal Club Beyond the Pandemic: An Enduring and Fluid Educational Forum.

OBJECTIVE: Since its inception, journal club has been a cornerstone to the life-long process of medical education. The virtual journal club (VJC), initiated as a robust solution to many educational challenges encountered during COVID-19 pandemic-related distance learning, provides an enduring and fluid forum for multilevel teaching and learning. MATERIALS AND METHODS: In this manuscript we share our institutions' reasoning and methods to implement a VJC for multi-level learners. A standardized format applicable to all VJC sessions was adopted to ensure reproducibility from presenter to presenter. Sessions were held via video conference platforms. Pedagogy regularly emphasized in undergraduate medical education was adopted. Informal assessment of each session's strengths and areas for improvement was performed. RESULTS: A total of 30 sessions were held prior to manuscript submission, including discussion of 36 refereed journal articles from March 26, 2020, to April 20, 2021. The virtual journal club was very well received by all participants. The medical students and residents found the information current and engaging. The fellows stated that the journal club strengthened their knowledge base and enhanced communication and teaching skills. The attendings learned from its encouraged frank discussion of differing practice patterns. The format of these sessions offers an ideal setting to teach medical students and residents how to evaluate and employ evidence-based medicine and meets multiple LCME and ACGME requirements. CONCLUSIONS: This VJC forum allows for development of essential nonclinical skills including lifelong active learning and analysis, peer collaboration, and technology adaptation and usage.

Interprofessional Education - A Mandate for Today's Radiology Curriculum.

Interprofessional education (IPE) brings educators and learners from two or more health professions together in a collaborative learning environment, specifically assuring that learners function as a team to provide patient-centered care, with each team member contributing a unique perspective. The Liaison Committee on Medical Education, the Accreditation Council for Graduate Medical Education, and the American Board of Radiology have endorsed interprofessional and team communication as essential core competencies. Radiology educators must understand, include, and optimize IPE in their pedagogy; as a specialty, radiology must innovate more interprofessional experiences for medical students, residents and other allied health professions.