Breast radiology malpractice suits: Characteristics of frequency and outcomes- national and statewide distinctions.

The purpose of this study was to determine the frequency and outcomes of breast malpractice suits among all enrollees in One Call Medical Inc.'s panel of interpreting radiologists nationally and to evaluate state-by-state variations. The 8401 radiologists enrolled had 4764 suits, of which 826 were related to breast disease. In New York and New Jersey, the ratio of breast suits to One Call Radiologists was 0.28 and 0.27, twice as much as in any other state. Breast suits in radiology have a wide variation in frequency across the country with New York and New Jersey far exceeding all others in relative frequency and number of radiologists with multiple breast suits.

Quantitative characterization of human breast tissue based on deep learning segmentation of 3D optical coherence tomography images.

In this study, we performed dual-modality optical coherence tomography (OCT) characterization (volumetric OCT imaging and quantitative optical coherence elastography) on human breast tissue specimens. We trained and validated a U-Net for automatic image segmentation. Our results demonstrated that U-Net segmentation can be used to assist clinical diagnosis for breast cancer, and is a powerful enabling tool to advance our understanding of the characteristics for breast tissue. Based on the results obtained from U-Net segmentation of 3D OCT images, we demonstrated significant morphological heterogeneity in small breast specimens acquired through diagnostic biopsy. We also found that breast specimens affected by different pathologies had different structural characteristics. By correlating U-Net analysis of structural OCT images with mechanical measurement provided by quantitative optical coherence elastography, we showed that the change of mechanical properties in breast tissue is not directly due to the change in the amount of dense or porous tissue.

Single fiber OCT imager for breast tissue classification based on deep learning.

We investigated a deep learning strategy to analyze optical coherence tomography image for accurate tissue characterization based on a single fiber OCT probe. We obtained OCT data from human breast tissue specimens. Using OCT data obtained from adipose breast tissue (normal tissue) and diseased tissue as confirmed in histology, we trained and validated a convolutional neural network (CNN) for accurate breast tissue classification. We demonstrated tumor margin identification based CNN classification of tissue at different spatial locations. We further demonstrated CNN tissue classification in OCT imaging based on a manually scanned single fiber probe. Our results demonstrated that OCT imaging capability integrated into a low-cost, disposable single fiber probe, along with sophisticated deep learning algorithms for tissue classification, allows minimally invasive tissue characterization, and can be used for cancer diagnosis or surgical margin assessment.

Spatial coordinate corrected motion tracking for optical coherence elastography.

We develop a spatial coordinate corrected (SCC) motion tracking method for optical coherence elastography. SCC motion tracking refers the instantaneous velocity field extracted from optical coherence tomography (OCT) data to the laboratory coordinate system and accurately reconstructs the displacement field established during the mechanical excitation (compression) process. We acquired image data from compression OCE experiments on human breast tissue specimens, and reconstructed the displacement field through Doppler analysis of OCT data. Our results suggested that SCC tracking enables accurate reconstruction of displacement field, and enables effective identification mechanical heterogeneity that can be used as a biomarker for cancer diagnosis and tumor margin assessment.

Spatial coordinate corrected motion tracking for optical coherence elastography.

We investigate a spatial coordinate correction (SCC) method to track motion with high accuracy for optical coherence elastography (OCE). Through SCC, we refer the displacement field tracked by optical coherence tomography (OCT) in the loaded sample to individual material points defined in a fixed coordinate system. SCC allows OCE to perform spatially and temporally unambiguous tracking of displacement and enables accurate mechanical characterization of biological tissue for cancer diagnosis and tumor margin assessment. In this study, we validated the effectiveness of motion tracking based on SCC using experimental OCE data obtained from ex vivo human breast tissues.

Providing Trainees With an Introduction and Decision-Making Framework for Pursuing an Academic Residency Position.

Introduction: Medical students are a significant source of the future academic medicine workforce, but surprisingly little is typically done to promote academic medicine career awareness during the early stages of medical education. To raise awareness among medical students of the critical role an academic residency plays in pursuing a future academic career, we developed a workshop that describes what an academic residency entails and what to consider when selecting such a program. Methods: The six-step Kern model was applied to develop a multimodal workshop to help trainees understand characteristics of and explore their interest in an academic residency program. The 60-minute workshop consists of a PowerPoint presentation, reflection exercise, and case scenarios to help trainees learn and apply new skills in selecting a residency program. The workshop was offered to diverse medical students at nine different medical schools across the country between July 2016 and May 2017. Results: Of the 115 workshop participants who completed the evaluation form, over 95% agreed or strongly agreed that each of the learning objectives was met. A paired t test of learner responses pre- and postworkshop demonstrated significantly increased confidence in finding an academic residency position. Discussion: This workshop fills an important gap in raising medical students' awareness of how to pursue an academic medicine career by highlighting the critical role of an academic residency program. Participants liked the use of vignettes and small-group discussion to better prepare them in exploring and benefiting from an academic residency position.

Patterns of transorbital intracranial injury: a review and comparison of occult and non-occult cases.

The authors present an illustrative case of occult transorbital penetrating intracranial injury in a child, and review the literature concerning patterns of low-velocity, non-projectile injury during the era of modern CT and MRI study. Review of the mechanism of injury and analysis of surface entry site of penetration in 38 cases suggests recurring patterns of injury in occult and non-occult cases. A classification system based on surface entry zone site is applied to these injuries. Knowledge of the classification system should increase clinical suspicion for this type of often occult, penetrating orbito-cranial injury and direct appropriate investigation to provide earlier detection and diagnosis of the transorbital, intracranial penetration.

Quantitative optical coherence elastography based on fiber-optic probe for in situ measurement of tissue mechanical properties.

We developed a miniature quantitative optical coherence elastography (qOCE) instrument with an integrated Fabry-Perot force sensor, for in situ elasticity measurement of biological tissue. The technique has great potential for biomechanics modeling and clinical diagnosis. We designed the fiber-optic qOCE probe that was used to exert a compressive force to deform tissue at the tip of the probe. Using the space-division multiplexed optical coherence tomography (OCT) signal detected by a spectral domain OCT engine, we were able to quantify the probe deformation that was proportional to the force applied, and to quantify the tissue deformation corresponding to the external stimulus. Simultaneous measurement of force and displacement allowed us to extract Young's modulus of biological tissue. We experimentally calibrated our qOCE instrument, and validated its effectiveness on tissue mimicking phantoms and biological tissues.

Robust motion tracking based on adaptive speckle decorrelation analysis of OCT signal.

Speckle decorrelation analysis of optical coherence tomography (OCT) signal has been used in motion tracking. In our previous study, we demonstrated that cross-correlation coefficient (XCC) between Ascans had an explicit functional dependency on the magnitude of lateral displacement (δx). In this study, we evaluated the sensitivity of speckle motion tracking using the derivative of function XCC(δx) on variable δx. We demonstrated the magnitude of the derivative can be maximized. In other words, the sensitivity of OCT speckle tracking can be optimized by using signals with appropriate amount of decorrelation for XCC calculation. Based on this finding, we developed an adaptive speckle decorrelation analysis strategy to achieve motion tracking with optimized sensitivity. Briefly, we used subsequently acquired Ascans and Ascans obtained with larger time intervals to obtain multiple values of XCC and chose the XCC value that maximized motion tracking sensitivity for displacement calculation. Instantaneous motion speed can be calculated by dividing the obtained displacement with time interval between Ascans involved in XCC calculation. We implemented the above-described algorithm in real-time using graphic processing unit (GPU) and demonstrated its effectiveness in reconstructing distortion-free OCT images using data obtained from a manually scanned OCT probe. The adaptive speckle tracking method was validated in manually scanned OCT imaging, on phantom as well as in vivo skin tissue.

Readability assessment of internet-based patient education materials related to mammography for breast cancer screening.

RATIONALE AND OBJECTIVES: The US Department of Health and Human Services (USDHHS) recommends that Internet-based patient education materials (IPEMs) be written below the sixth-grade reading level to target the average American adult. This study was designed to determine the readability of IPEMs regarding mammography for breast cancer screening. MATERIALS AND METHODS: Three-hundred mammography-related Web sites were reviewed for IPEMs. Forty-two IPEMs that met the Health on the Net Foundation Code of Conduct were assessed for readability level with four readability indices that use existing algorithms based on word and sentence length to quantitatively analyze Internet sources for language intricacy including the following: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG; GFOG). Results were compared to national recommendations, and intergroup analysis was performed. RESULTS: No IPEMs (0%) regarding mammography were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 49.04 ± 10.62; FKGL, 10.71 ± 2.01; SMOG, 13.33 ± 1.67; and Gunning FOG, 14.32 ± 2.18. These scores indicate that the readability of mammography IPEMs is written at a "difficult" level, significantly above the recommended sixth-grade reading level (P < .05) determined by the USDHHS. CONCLUSIONS: IPEMs related to mammography are written well above the recommended sixth-grade level and likely reflect other IPEMs in diagnostic radiology.

Women as radiologists: are there barriers to entry and advancement?

PURPOSE: In consideration of the fact that women constitute only 25% of radiology residents, even though they constitute 45% of medical students, this study was conducted to determine if the trend of women choosing radiology as a career differs from that for other medical specialties and if there are differences on the basis of the gender of program directors or geographic location. The authors also wished to determine if constraints exist that prevent women from advancing into positions of leadership in radiology. METHOD: The percentage of women in each of the 186 radiology residency programs was compiled to determine the mean and standard deviation of women represented and from those data to examine if there were patterns of exclusion related to program size, location, or the gender of program directors. The membership and committee lists of the ACR and the Radiological Society of North America (RSNA) were examined to gauge the participation of women as leaders in these 2 organizations, as were the mastheads of Radiology and the American Journal of Roentgenology. The number of female chairs of academic departments was also examined. RESULTS: Over the past decade, the percentage of women in diagnostic radiology residencies has remained remarkably constant at or slightly above 25%. There was no discernable prejudice against women applicants by program size, location, or program director gender. In both the ACR and the RSNA, women are represented in positions of leadership approximately in proportion to their percentage in the general membership. Journal mastheads have fewer women than might be expected given the participation of women in academic radiology. There are a small but increasing number of women chairing academic radiology departments. CONCLUSION: The relatively low percentage of women in diagnostic radiology residencies is not a reflection of the gender of program directors. Women are represented in positions of influence and authority in major organizations in American radiology in proportion to the overall number of women in the organization. However, women continue to be underrepresented in radiology chair positions. Explanations must be sought for the relative unattractiveness of radiology to prospective women residents and barriers to the advancement of women in academic radiology.

Embolization of isolated lumbar artery injuries in trauma patients.

PURPOSE: The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. METHODS: All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. RESULTS: In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. CONCLUSIONS: In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery.

Angiographic findings and embolotherapy in renal arterial trauma.

PURPOSE: To evaluate the angiographic findings and embolotherapy in the management of traumatic renal arterial injury. METHODS: This is a retrospective review of 22 patients with renal trauma who underwent arteriography and percutaneous embolization from December 1995 to January 2002. Medical records, imaging studies and procedural reports were reviewed to assess the type of injury, arteriographic findings and immediate embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians and by clinical chart review. RESULTS: Arteriography was performed in 125 patients admitted to a State Trauma Center with suspected internal bleeding. Renal arterial injury was documented in 22 and was the result of a motor-vehicle accident (10), auto-pedestrian accident (1), gunshot (4) or stab wounds (6) and a fall (1). Percutaneous renal arterial embolization was undertaken in 22 of 125 (18%) patients to treat extravasation (11), arterial pedicle rupture (5), abnormal arteriovenous (3) or arteriocalyceal (2) communication and pseudoaneurysm (3). One of the pseudoaneurysms and one of the arteriovenous fistulae were found in addition to extravasation. All 22 patients (16 men, 6 women) were hemodynamically stable, or controlled during arteriography and embolotherapy. Selective and/or superselective embolization of the abnormal vessels was performed using coils in 9 patients, microcoils in 9 patients and Gelfoam pledgets in 3 patients. In one patient Gelfoam pledgets mixed with polyvinyl alcohol (PVA) particles were used for embolization. Immediate angiographic evidence of hemostasis was demonstrated in all cases. Two initial technical failures were treated with repeat arteriography and embolization. There was no procedure-related death. There was no non-target embolization. One episode of renal abscess after embolization was treated by nephrectomy and 3 patients underwent elective post-embolization nephrectomy to prevent infection. Follow-up ranged from 1 month to 7 years (mean 31 months). No procedure-related or delayed onset of renal insufficiency occurred. CONCLUSION: In hemodynamically stable and controlled patients selective and superselective embolization is a safe and effective method for the management of renal vascular injury.

Histopathologic evaluation of tissue extracted on the radiofrequency probe after ablation of liver tumors: preliminary findings.

OBJECTIVE: Our aim was to evaluate the histologic characteristics of tissue extracted on the probe immediately after radiofrequency ablation of malignant tumors in the liver. MATERIALS AND METHODS: From April to December 2001, 20 radiofrequency ablations were performed in 19 patients with primary (n = 17) and metastatic (n = 2) liver masses. Track ablation according to device protocol was performed after each ablation. Tissue was adherent to the probe after all radiofrequency probe passes. All pieces of tissue found on the probe were collected and preserved in formalin. RESULTS: Tissue was examined by the study pathologist. In eight (40%) of 20 specimens, coagulation necrosis was present. In five (25%) of 20 specimens, possibly nonviable tissue was extracted, although some cell characteristics were identified. In seven (35%) of 20 specimens with hepatocellular carcinoma, possibly viable tissue was found. Five specimens were identified as hepatocellular carcinoma, and two, as cirrhotic nodules. CONCLUSION: Histopathologic evaluation of the tissue extracted on the radiofrequency probe after ablation is feasible. This study showed that coagulation necrosis was clearly present in at least 40% of the patients, which proves that nonviable tissue can be seen immediately after ablation. Whether this pathologic finding has prognostic value is not known.