MRI-guided needle localization: Indications, tips, tricks, and review of the literature.

We describe the history of, indications for, and techniques involved in MRI-guided needle localization (MRI-NL). MRI-NL continues to be a safe, effective method of sampling lesions that are only detected with MRI, particularly for anatomically challenging lesions such as those near the chest wall, the nipple, the skin, and/or in close proximity to implants.

Overutilization of Health Care Resources for Breast Pain.

OBJECTIVE: The objective of this study is to analyze the incidence of women with breast pain who present to an imaging center and assess the imaging findings, outcomes, and workup costs at breast imaging centers affiliated with one institution. MATERIALS AND METHODS: Demographic characteristics of and imaging findings for female patients presenting with breast pain at three community breast imaging centers between January 1, 2014, and December 31, 2014, were reviewed. Patients who were pregnant, were lactating, had a history of breast cancer, or presented with palpable nipple or skin findings were excluded. RESULTS: A total of 799 patients met the study criteria. Pain was diffuse in 30%, was focal in 30%, and was not localized in 40%. Of the 799 patients with breast pain, 790 (99%) presented for a diagnostic evaluation; 759 (95%) of these evaluated patients had negative findings. A benign sonographic correlate was detected in the area of pain in 5% of patients (39/799). One patient had a single cancer detected in the contralateral asymptomatic breast. When correlations between breast pain and the presence of cancer in the study patients were compared with the concurrent cancer detection rate in the screening population (5.5 cases per 1000 examinations performed), breast pain was not found to be a sign of breast cancer (p = 0.027). Patients younger than 40 years (316/799) underwent a total of 454 workup studies for breast pain; all findings were benign, and the cost of these studies was $87,322. Patients 40 years or older (483/799) underwent 745 workup studies, for a cost of $152,732. CONCLUSION: Breast pain represents an area of overutilization of health care resources. For female patients who present with pure breast pain, breast imaging centers should consider the following imaging protocols and education for referring physicians: an annual screening mammogram should be recommended for women 40 years or older, and reassurance without imaging should be offered to patients younger than 40 years.

Phyllodes Tumor of the Breast: Ultrasound-Pathology Correlation.

OBJECTIVE: The purpose of this study is to evaluate the sonographic and histopathologic features distinguishing benign from borderline and malignant phyllodes tumors. MATERIALS AND METHODS: The ultrasound examinations of women with pathologically proven phyllodes tumors from 2004 to 2011 were retrospectively reviewed. The sonographic features of benign, borderline, and malignant phyllodes tumors were compared and analyzed using the American College of Radiology's BI-RADS ultrasound lexicon. Fisher exact test and Wilcoxon rank sum test were used for statistical analysis. RESULTS: Fifty-nine women were included in the study; 28 benign (47%), 19 malignant (32%), and 12 borderline (20%) phyllodes tumors were identified. Significant univariate predictors of increased risk of borderline or malignant phyllodes tumors were patient age greater than 55 years (p = 0.014), irregular lesion shape (p = 0.011), and longest lesion dimension greater than 7 cm (p = 0.0022) at sonography. No significant differences were observed in lesion margins, boundaries, echo patterns, or posterior acoustic features. CONCLUSION: There is substantial overlap in the sonographic features of benign and borderline or malignant phyllodes tumors. Understanding the clinical and sonographic features of phyllodes tumors may aid the radiologist in predicting biological behavior, including the likelihood of benign versus borderline or malignant phyllodes tumors at pathologic analysis.

The Impact of Patient Demographics on the Selection of Breast Imaging Centers.

OBJECTIVE: Studies show that health care tailored to patient preferences results in significant improvements in physician performance, patient satisfaction, and health outcomes. Limited information in the literature exists on the factors driving patient preferences for establishing care at specific breast imaging centers. In this study, we identified factors that drive cohort preferences in the selection of a breast imaging center. MATERIALS AND METHODS: An 18-question survey was deployed in a large metropolitan area to gather information on patient demographics and preferences for breast imaging center location and radiologist training level. Cluster analysis and the K-means method were used to classify patients into groups on the basis of their answers about preference. Clusters were tested for significant differences by location, reason for visit, age, education, marital status, ethnicity, insurance, history of cancer, and income. RESULTS: A total of 1682 survey responses (18% of total patient visits) were obtained. Four distinct cohorts (comprising 876 patients) based on patient care preferences were identified: convenience optimizers (n = 109, 12.4%), ambivalent patients (n = 237, 27.1%), medical center seekers (n = 324, 37.0%), and expertise seekers (n = 206, 23.5%). Each cohort showed distinct preferences for imaging center location and radiologist training. Cohorts were differentiated on the basis of patient education level, ethnicity, and patient cancer history. Across the cohorts, there were no significant differences in age, marital status, insurance, income, and other demographic factors. CONCLUSION: Patient preferences for breast imaging care and location vary and are correlated with specific demographic characteristics. An understanding of these population characteristics can shape organizational strategies for improving patient-centered care and outcomes.

Interinstitutional outside imaging transfer: Benefits, challenges, and evolving technology.

The interinstitutional transfer of outside images in radiology is a critical aspect of modern healthcare, enabling seamless collaboration among healthcare institutions and enhancing patient care. This paper explores the significance of interinstitutional image transfer in radiology, its challenges, and the technological advancements that have facilitated efficient image sharing. This practice offers several benefits, such as improving diagnostic accuracy, treatment planning, and patient outcomes. However, we also highlight the ethical and security issues involved in exchanging sensitive medical data between institutions. Through a review of existing literature and case studies, this manuscript discusses the advancements made in interinstitutional image transfer and the future potential of this evolving field.

Appropriate Use of Medical Interpreters in the Breast Imaging Clinic.

More than 25 million Americans have limited English-language proficiency (LEP) according to the U.S. Census Bureau. This population experiences challenges accessing health care and is least likely to receive preventive health care, including screening mammogram. In a setting where the breast radiologist does not speak the language of their patient, using certified medical interpreter services is fundamental. Medical interpreter use is associated with improved clinical care and patient satisfaction and can potentially increase adherence to screening mammograms and follow-up in patients with LEP. Title VI of the Civil Rights Act requires interpreter services for patients with LEP who are receiving federal financial assistance. Failure to provide interpretative services when necessary is considered discriminatory and illegal. The use of untrained medical interpreters, including ad hoc interpreters (eg, family, friends, or untrained staff), is associated with more medical errors, violation of confidentiality, and poor health outcomes. Types of medical interpretation services available to address language barriers include in-person interpretation, telephone and video remote interpretation, and qualified bilingual staff. Proper training and certification of medical interpreters is essential to prevent misinterpretations and ensure patient safety. When using an interpreter service, speak to and maintain eye contact with the patient, address the patient directly and seat the interpreter next to or slightly behind the patient, use visual aids whenever possible, and have the patient repeat the information to verify comprehension. Breast radiologists can address disparities in breast cancer screening and treatment by promoting effective communication.

Responsive Web-based Breast Imaging Core Curriculum for International Radiology Residents with Self-Assessment: A Pilot Study.

RATIONALE AND OBJECTIVES: Lack of uniformity in radiology resident education is partially attributable to variable access to subspecialty education. Web-based courses improve standardization, but with growing emphasis on competency based education, more evaluation of their effectiveness is needed. We created a responsive web-based breast imaging curriculum for radiology residents including self-assessment and a satisfaction survey. MATERIALS AND METHODS: Two global academic institutions collaboratively developed a breast imaging curriculum to address radiology residents' educational needs. This virtual course comprised 11 video lectures, nine didactic (with attached pre-test and post-test assessments) and two case review sessions. In April 2020, this optional curriculum was made available to all 56 radiology residents in one residency program cluster in Singapore, to be accessed alongside the breast imaging rotation as a supplement. A voluntary anonymous satisfaction survey was provided upon completion. RESULTS: A total of 39 of the 56 radiology residents (70%) completed the course. For the average score of nine lectures (maximum score 5), there was a significant increase in mean pre and post - test scores (mean = 2.2, SD = 0.7), p < 0.001. The proportion of residents with improvement between the pre-test score and the post-test score ranged from 74% to 100% (mean, 84%). Thirty three of the 39 participants (85%) completed the satisfaction survey, and all agreed or strongly agreed that the curriculum increased their knowledge of breast imaging. CONCLUSION: This web based breast imaging curriculum supplement was viewed positively by participating residents and improved their self-assessed knowledge. Curriculum access could be expanded to improve global radiology education.

Integration of the Community-Based Academic Radiologist With the Academic Radiology Department: A Strategic Imperative.

Academic radiology departments are expanding into the community with deployment of community-based academic radiologists (CBARs). The remote practice locations, unique workplace challenges, and limited opportunities for meaningful collegial interactions can become drivers for radiologist isolation, dissatisfaction, and burnout. Integration of CBARs with the academic radiology department with which they are affiliated is a strategic imperative to mitigate radiologist isolation and potential burnout. Committed physician leadership by the academic radiology department can support integration. Strategies to strengthen integration include bidirectional clinical coverage systems, pairing new CBARs with established academic radiologist mentors at the academic center, encouraging CBARs to serve on academic committees and collaborate on research projects with radiologists at the academic center, and recognizing CBARs for their achievements in the areas of clinical productivity, practice development, community outreach, collegiality, and innovation.

Step by step: Planning a needle localization procedure.

In patients with nonpalpable early-stage breast cancer eligible for breast conservation surgery (BCS), wire-guided localization (WGL) is widely accepted as a standard technique for preoperative image-guided lesion localization. In preparation for this procedure, lesion location, size, type and configuration play important roles in preoperative localization planning. Successful preoperative planning requires review of all pertinent imaging studies, imaging reports and pathology reports, with special attention to pre- and post-biopsy imaging and evaluation of the targeted lesions and the type and the position of the marker clips. Preoperative communication with the surgeon is key in the planning process to ensure that clarity in localization objectives are reached in complex cases. This pictorial essay will provide a methodical, step by step approach to planning successful image-guided preoperative needle localizations. These steps include selection of the imaging modality, the equipment, the procedure and intraoperative specimen radiography. The case-based review will also include key steps and considerations during the planning stage, the procedure stage, and the post-procedure stage. These same techniques can also be applied to newer, non-wire image-guided breast localization techniques now available for widespread commercial use.

Preoperative localization of breast lesions: Current techniques.

Image-guided preoperative localization of breast lesions is a common procedure. This article describes several commercially available localization options-wire localization, radioactive seed localization, localization with a radiofrequency reflector, and magnetic seed localization-and outlines the advantages and disadvantages of each. This information may help radiologists initiate conversations at their facilities with surgeons, pathologists, and hospital administration as they seek to add value and provide patient-centered care.

Collaborative Branding of Partnered Health Systems in Radiology.

In an effort to expand clinical reach and achieve economies of scale, academic radiology practices are strategically expanding into the community by establishing partnerships with existing community health systems. A challenge with this model is to effectively brand the collaboration in a way that underscores the strengths of both partners. In this article, the authors look at the benefits and risks of cobranding and review cobranding strategies for implementation by academic radiology practices considering partnership-based network expansion.

The Community-Based Academic Radiologist.

As academic radiology practices expand into the community, the lines that have historically distinguished the academic from private practice radiologist are becoming increasingly blurred. In this article, we introduce the new concept of the community-based academic radiologist and address some of the unique challenges and opportunities faced by these radiologists navigating this new hybrid role of academician and radiologist in community-based private practice.

Building Relations with Radiology Administrators.

In some radiology departments, the lack of alignment between administrators and radiologists can pose significant challenges. This article describes how differences in background and priorities between administrators and radiologists can contribute to conflict and presents strategies on how to manage the conflict in a way that can leverage positive change. Strategies to build relations between radiologists and radiology administrators are described.

Implementing the SAVI SCOUT System in Community Radiology Practice.

SAVI SCOUT is a new localization system approved by the FDA to aid in the surgical excision of nonpalpable breast lesions. This article provides a practical overview of the technical details of SAVI SCOUT use and presents important clinical and operational factors for radiologists to consider before implementation of SAVI SCOUT in community practice.