Current State of Evidence-Based Long-Term Monitoring Protocols for Breast Plastic Surgery Patients.

BACKGROUND: Recommendations for breast surveillance following breast plastic surgery are frequently changing. Establishing guidelines for long-term monitoring protocols may help identify treatable conditions and prevent untoward sequelae. We sought to evaluate the current state of evidence-based long-term monitoring protocols for patients following breast augmentation, reduction, and breast reconstruction. METHODS: Official guidelines from various American societies and international societies were analyzed for alignment in evidence-based recommendations regarding breast surveillance. RESULTS: The most recent US FDA update recommends magnetic resonance imaging or ultrasound starting 5-6 years after surgery and every 2-3 years thereafter. Discrepancies exist among professional societies: the American Society of Plastic Surgeons (ASPS) aligns with the FDA, while the American Society of Breast Surgeons and American College of Radiology (ACR) find no role for imaging for asymptomatic cases. Ultrasound is first-line for any implant concerns, with MRI if necessary. European societies oppose routine breast implant imaging. Breast reduction patients lack unique screening protocols; monitoring aligns with age and cancer risk factors. Following mastectomy and breast reconstruction, most organizations advocate for annual clinical examinations, with more frequent examinations initially. Evidence suggests that physical examination is sufficient to detect local cancer recurrence, with imaging only indicated if there is concern for recurrence. No surveillance imaging is recommended by the American Society of Clinical Oncology, National Comprehensive Cancer Network, or ASPS; however, ACR recommends mammography for autologous reconstruction only. CONCLUSION: Multispecialty and regulatory body alignment may promote provider and patient adherence. Ongoing studies of long-term outcomes are needed to strengthen the level of evidence for monitoring guidelines.

Accuracy and Reproducibility of Linear and Angular Measurements in Virtual Reality: a Validation Study.

The purpose of this experimental study is to validate linear and angular measurements acquired in a virtual reality (VR) environment via a comparison with the physical measurements. The hypotheses tested are as follows: VR linear and angular measurements (1) are equivalent to the corresponding physical measurements and (2) achieve a high degree of reproducibility. Both virtual and physical measurements were performed by two raters in four different sessions. A total of 40 linear and 15 angular measurements were acquired from three physical objects (an L-block, a hand model, and a dry skull) via the use of fiducial markers on selected locations. After both intra- and inter-rater reliability were evaluated using inter-class coefficient (ICC), equivalence between virtual and physical measurements was analyzed via paired t test and Bland-Altman plots. The accuracy of the virtual measurements was further estimated using two one-sided tests (TOST) procedure. The reproducibility of virtual measurements was evaluated via ICC as well as the repeatability coefficient. Virtual reality measurements were equivalent to physical measurements as evidenced by a paired t test with p values of 0.413 for linear and 0.533 for angular measurements and Bland-Altman plots in all three objects. The accuracy of virtual measurements was estimated to be 0.5 mm for linear and 0.7° for angular measurements, respectively. Reproducibility in VR measurements was high as evidenced by ICC of 1.00 for linear and 0.99 for angular measurements, respectively. Both linear and angular measurements in the VR environment are equivalent to the physical measurements with high accuracy and reproducibility.

Maximizing Mentorship Throughout Your Breast Imaging Career.

Unlike many other subspecialties in radiology, breast radiologists practice in a patient-facing and interdisciplinary environment where team building, communication, and leadership skills are critical. Although breast radiologists can improve these skills over time, strong mentorship can accelerate this process, leading to a more successful and satisfying career. In addition to providing advice, insight, feedback, and encouragement to mentees, mentors help advance the field of breast radiology by contributing to the development of the next generation of leaders. During the mentorship process, mentors continue to hone their listening, problem-solving, and networking skills, which in turn creates a more supportive and nurturing work environment for the entire breast care team. This article reviews important mentorship skills that are essential for all breast radiologists. Although some of the principles apply to all mentoring relationships, ensuring that every breast radiologist has the skills to be both an effective mentor and mentee is key to the future of the profession.

Applications of Augmented Reality in Otolaryngology: A Systematic Review.

OBJECTIVE: Augmented reality (AR) is a rapidly developing technology. The aim of this systematic review was to (1) identify and evaluate applications of AR in otolaryngology and (2) examine trends in publication over time. DATA SOURCES: PubMed and EMBASE. REVIEW METHODS: A systematic review was performed according to PRISMA guidelines without temporal limits. Studies were included if they reported otolaryngology-related applications of AR. Exclusion criteria included non-English articles, abstracts, letters/commentaries, and reviews. A linear regression model was used to compare publication trends over time. RESULTS: Twenty-three articles representing 18 AR platforms were included. Publications increased between 1997 and 2018 ( P < .05). Twelve studies were level 5 evidence; 9 studies, level 4; 1 study, level 2; and 1 study, level 1. There was no trend toward increased level of evidence over time. The most common subspecialties represented were rhinology (52.2%), head and neck (30.4%), and neurotology (26%). The most common purpose of AR was intraoperative guidance (54.5%), followed by surgical planning (24.2%) and procedural simulations (9.1%). The most common source of visual inputs was endoscopes (50%), followed by eyewear (22.2%) and microscopes (4.5%). Computed tomography was the most common virtual input (83.3%). Optical trackers and fiducial markers were the most common forms of tracking and registration, respectively (38.9% and 44.4%). Mean registration error was 2.48 mm. CONCLUSION: AR holds promise in simulation, surgical planning, and perioperative navigation. Although level of evidence remains modest, the role of AR in otolaryngology has grown rapidly and continues to expand.