Impact of Breast Density Legislation on Breast Cancer Risk Assessment and Supplemental Screening: A Survey of 110 Radiology Facilities.

Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound (WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management.

Postthrombotic syndrome: feasibility of a strategy of imaging-guided endovascular intervention.

PURPOSE: To describe the short-term efficacy of a strategy of imaging-guided endovascular intervention for the treatment of patients with established postthrombotic syndrome (PTS). MATERIALS AND METHODS: The medical records of 183 patients with venous disease who were seen in a single interventional radiology clinic were retrospectively reviewed. Study inclusion criteria were (i) endovascular intervention performed to treat established PTS from January 1, 2000, to March 10, 2009; (ii) patient age greater than 18 years; and (iii) availability of follow-up records. A total of 44 patients (20 men, 24 women; mean age, 42.2 y ± 14.1) with PTS who had received 72 interventions (iliac vein stent placement [n = 52] and endovenous laser ablation [EVLA; n = 20]) were identified. A reviewer who did not participate in their care evaluated the follow-up records; recorded the presence or absence of pain, swelling, and active ulceration; and categorized the degree of symptom improvement. RESULTS: Of 45 treated limbs in 40 patients with available follow-up, complete, partial, or no improvement of overall symptoms was observed in 46.7%, 33.3%, and 20.0%, respectively. The proportions of limbs with pain (35.0% after treatment vs 82.5% before; McNemar test, P < .01) and swelling (50.0% after treatment vs 90.0% before; P < .01) were significantly reduced after treatment with iliac vein stent placement and/or EVLA. Six of seven ulcerated limbs showed significant healing. CONCLUSIONS: The use of an endovascular strategy to treat patients with established PTS was associated with complete or partial symptom relief in 80% of patients at short-term follow-up.

Audience response systems in medical student education benefit learners and presenters.

RATIONALE AND OBJECTIVES: We sought to assess how the use of an audience response system (ARS) in medical student radiology instruction affects the self-confidence, ability to gauge mastery, and insights for future preparation in students when they participate as audience members and when they give peer teaching presentations. MATERIALS AND METHODS: Twenty-seven medical students discussed radiology case files in groups and used an ARS to present their assigned cases to peers. Students' views of interactive audience response versus traditional pedagogy were surveyed using a 5-point Likert scale (1, strongly agree; 2, agree; 3, neither agree nor disagree; 4, disagree; 5, strongly disagree). RESULTS: Students reported that instruction with interactive ARS lectures gave them more confidence to verbally answer questions in subsequent lectures when compared to instruction with standard didactic lectures, where a presenter asks questions and a single student responds (2.35 versus 3.14, p < .024). Students found it easier to gauge their level of mastery of material by answering ARS questions than by hearing classmates' verbal responses to questions posed in lecture (1.77 versus 2.68, p < .002). When giving peer teaching presentations, students reported that the ARS lecture format helped them to gauge their audience's level of understanding (1.55, 95% CI [1.27-1.82], p < .001). CONCLUSION: Radiology instruction utilizing an ARS can help build students' confidence, knowledge of self-mastery, and insights for future studying. Similarly, student presenters using an ARS improve their confidence, better gauge their audience, and develop helpful insights for future teaching presentations.

Gene therapy for heart failure.

Congestive heart failure (CHF) remains a leading cause of morbidity and mortality in the United States and in many other countries. Current heart failure therapies, including multidrug treatment regimens, biventricular pacing, and mechanical support such as left ventricular assist devices, are often hindered by limited benefits or significant associated procedural complications or side effects. Therefore, new forms of treatment, which could ideally target the underlying biological processes affecting the ailing cardiomyocyte, would be of significant potential benefit to the population of individuals with CHF. Gene transfer strategies, including modification of cellular contractile signaling and regulatory pathways, represent a promising new form of such biologic therapy for heart disease.

A picture is worth a thousand words: needs assessment for multimedia radiology reports in a large tertiary care medical center.

RATIONALE AND OBJECTIVES: Radiology reports are the major, and often only, means of communication between radiologists and their referring clinicians. The purposes of this study are to identify referring physicians' preferences about radiology reports and to quantify their perceived value of multimedia reports (with embedded images) compared with narrative text reports. MATERIALS AND METHODS: We contacted 1800 attending physicians from a range of specialties at large tertiary care medical center via e-mail and a hospital newsletter linking to a 24-question electronic survey between July and November 2012. One hundred sixty physicians responded, yielding a response rate of 8.9%. Survey results were analyzed using Statistical Analysis Software (SAS Institute Inc, Cary, NC). RESULTS: Of the 160 referring physicians respondents, 142 (89%) indicated a general interest in reports with embedded images and completed the remainder of the survey questions. Of 142 respondents, 103 (73%) agreed or strongly agreed that reports with embedded images could improve the quality of interactions with radiologists; 129 respondents (91%) agreed or strongly agreed that having access to significant images enhances understanding of a text-based report; 110 respondents (77%) agreed or strongly agreed that multimedia reports would significantly improve referring physician satisfaction; and 85 respondents (60%) felt strongly or very strongly that multimedia reports would significantly improve patient care and outcomes. CONCLUSIONS: Creating accessible, readable, and automatic multimedia reports should be a high priority to enhance the practice and satisfaction of referring physicians, improve patient care, and emphasize the critical role radiology plays in current medical care.

Multifaceted management of the postthrombotic syndrome.

The postthrombotic syndrome (PTS) is a frequent cause of chronic pain, swelling, ulceration, and disability in patients with lower extremity deep vein thrombosis (DVT). As interventional radiologists are consulted on more patients with chronic DVT and PTS, their management strategies must be informed by a balanced understanding of the different facets of chronic DVT care and the available treatment options. This article provides an overview of the important elements of a multifaceted approach to the management of patients with PTS that includes pharmacological, physiological, and endovascular aspects of care.

An Egr-1 master switch for arteriogenesis: studies in Egr-1 homozygous negative and wild-type animals.

BACKGROUND: Arteriogenesis has been implicated as an important biologic response to acute vascular occlusion. The early growth response 1 (Egr-1) gene encodes an immediate-early response transcription factor that is upregulated by changes in vascular strain and that in turn upregulates a number of putative angiogenic and arteriogenic growth factors. We therefore hypothesized that early growth response 1 might be a critical arteriogenic messenger that induces revascularization in the setting of acute vascular occlusions. METHODS: Wild-type or Egr-1-/- (null) C57 BL mice, or Sprague-Dawley rats, underwent unilateral iliofemoral artery excision and subsequent analyses for angiogenesis and arteriogenesis through cell-specific immunohistochemistry. Rats were also administered an adenoviral vector encoding for Egr-1 (AdEgr group), noncoding vectors (AdNull group), or saline, after which these animals were assessed by means of serial laser Doppler perfusion imaging and morphologic examination of rat foot-pad ischemic lesions. RESULTS: Egr-1 wild-type mice demonstrated an equivalent number of capillaries but a greater number of arterioles following excision versus Egr-1 null mice. AdEgr group rats demonstrated greater distal perfusion from 7 to 21 days after excision compared with control animals (P < .02), which approximated normal perfusion at 21 days after excision. AdEgr group rats also demonstrated greater arteriolar density and less severe ischemic foot-pad lesions than control animals. CONCLUSION: These data suggest the importance of Egr-1 as a critical and potentially therapeutic mediator of revascularization after vascular occlusion and implicate arteriogenesis (collateral vessel formation) as a critical component of this process.