Disruptive Behavior: Impact on Diversity, Equity, and Inclusion (DEI) in Radiology, From the AJR Special Series on DEI.

Radiology has recognized the need to increase the diversity of its workforce for decades; however, women and people of color remain disproportionately underrepresented. A welcoming and inclusive environment is essential to physician recruitment and retention, but disruptive behavior in the workplace can be a barrier to achieving this goal. Disruptive behavior can be overt or subtle, can be intentional or inadvertent, and can occur in different settings throughout a radiologist's career, including during patient care, among colleagues, from department leadership, and even from professional societies. The purpose of this article is to provide an overview of where a radiologist may encounter disruptive behaviors, the impact that such behaviors can have on the physician's and practice's well-being, and tips for how to address and mitigate these behaviors in the future.

Multimodality Multisystem Imaging of Pregnancy-Related Changes: Featuring Neurologic, Cardiothoracic, Breast, Gynecologic, and Musculoskeletal Issues.

ABSTRACT: Pregnancy and the puerperium are a time of significant physiologic change, and with an average of 4 million births in the United States yearly, radiologists encounter pregnancy-related imaging findings regularly. While many of these findings represent physiologic changes, a significant number represent pathology, making it paramount for radiologists to distinguish between the two. This case-based article reviews imaging findings within the nervous, cardiovascular, pulmonary, breast, gynecologic, musculoskeletal, digestive, hematologic, and integumentary systems throughout pregnancy and the postpartum period.

Comprehensive Imaging Review of the Superior Vena Cava.

The superior vena cava (SVC) is the largest central systemic vein in the mediastinum. Imaging (ie, radiography, computed tomography [CT], magnetic resonance [MR] venography, and conventional venography) plays an important role in identifying congenital variants and pathologic conditions that affect the SVC. Knowledge of the basic embryology and anatomy of the SVC and techniques for CT, MR imaging, and conventional venography are pivotal to accurate diagnosis and clinical decision making. Congenital anomalies such as persistent left SVC, partial anomalous pulmonary venous return, and aneurysm are asymptomatic and may be discovered incidentally in patients undergoing imaging evaluation for associated cardiac abnormalities or other indications. Familiarity with congenital abnormalities is important to avoid image misinterpretation. Acquired abnormalities such as intrinsic and extrinsic strictures, fibrin sheath, thrombus, primary neoplasms, and trauma can produce mild narrowing to complete occlusion, the latter leading to SVC syndrome. Each imaging modality plays a role in evaluation of the SVC, helping to determine the site, extent, and cause of pathologic conditions and guide appropriate management. Commonly performed interventional procedures for fibrin sheath and benign and malignant strictures include low-dose thrombolytic infusion, fibrin sheath disruption, venous angioplasty, and stent placement.

Volumetric brain assessment of long-term head and neck cancer survivors.

BACKGROUND: Radiation therapy (RT) for locally advanced head and neck cancer (HNC) often exposes subcortical brain structures to radiation. We performed this study to assess region-specific brain volumetrics in a population of long term HNC survivors. METHODS AND MATERIALS: Forty HNC survivors were enrolled at a mean of 6.4 years from completion of RT. Patients underwent a research MRI protocol that included a 3D T1- weighted whole-brain scan on a 3 Tesla MRI scanner. Voxel based morphometry was performed using the Computational Anatomy Toolbox with the Neuromorphometrics atlas. Healthy controls from the Human Connectome Project were used as a comparison cohort. Study participants also completed a comprehensive neurocognitive assessment. RESULTS: The final study cohort consisted of 38 participants after excluding 2 participants due to image quality. HNC survivors displayed widespread reduction in gray matter (GM) brain region volumes that included bilateral medial frontal cortex, temporal lobe, hippocampus, supplemental motor area, and cerebellum. Greater radiation exposure was associated with reduced GM volume in the left ventral diencephalon (r = -0.512, p = 0.003). Associations between cognition and regional GM volumes were identified for motor coordination and bilateral cerebellum (left, r = 0.444, p = 0.009; right, r = 0.372, p = 0.030), confrontation naming and left amygdala (r = 0.382, p = 0.026), verbal memory and bilateral thalamus (left, r = 0.435, p = 0.010; right, r = 0.424, p = 0.012), right amygdala (r = 0.339, p = 0.050), and right putamen (r = 0.364, p = 0.034). CONCLUSIONS: Reductions in GM were observed within this cohort of primarily non-nasopharyngeal HNC survivors as compared to a control sample. GM volumes were associated with performance in multiple cognitive domains. Results of this exploratory study support the need for investigation of anatomic brain changes as an important translational corollary to cognitive problems among HNC survivors.

Longitudinal brain volumetrics in glioma survivors.

OBJECTIVE: Radiation therapy (RT) is used selectively for patients with low-grade glioma (LGG) given the concerns for potential cognitive effects in survivors, but prior cognitive outcome studies among LGG survivors have had inconsistent findings. Translational studies that characterize changes in brain anatomy and physiology after treatment of LGG may help to both contextualize cognitive findings and improve the overall understanding of radiation effects in normal brain tissue. This study aimed to investigate the hypothesis that patients with LGG who are treated with RT will experience greater brain volume loss than those who do not receive RT. METHODS: This retrospective longitudinal study included all patients with WHO grade 2 glioma who received posttreatment surveillance MRI at the University of Alabama at Birmingham. Volumetric analysis of contralateral cortical white matter (WM), cortical gray matter (GM), and hippocampus was performed on all posttreatment T1-weighted MRI sequences using the SynthSeg script. The effect of clinical and treatment variables on brain volumes was assessed using two-level hierarchical linear models. RESULTS: The final study cohort consisted of 105 patients with 1974 time points analyzed. The median length of imaging follow-up was 4.6 years (range 0.36-18.9 years), and the median number of time points analyzed per patient was 12 (range 2-40). Resection was performed in 79 (75.2%) patients, RT was administered to 61 (58.1%) patients, and chemotherapy was administered to 66 (62.9%) patients. Age at diagnosis (ß = -0.06, p < 0.001) and use of RT (ß = -1.12, p = 0.002) were associated with the slope of the contralateral cortical GM volume model (i.e., change in GM over time). Age at diagnosis (ß = -0.08, p < 0.001), midline involvement (ß = 1.31, p = 0.006), and use of RT (ß = -1.45, p = 0.001) were associated with slope of the contralateral cortical WM volume model. Age (ß = -0.0027, p = 0.001), tumor resection (ß = -0.069, p < 0.001), use of chemotherapy (ß = -0.0597, p = 0.003), and use of RT (ß = -0.0589, p < 0.001) were associated with the slope of the contralateral hippocampus volume model. CONCLUSIONS: This study demonstrated volume loss in contralateral brain structures among LGG survivors, and patients who received RT experienced greater volume loss than those who did not. The results of this study may help to provide context for cognitive outcome research in LGG survivors and inform the design of future strategies to preserve cognition.

Promoting Progress and Learning from Mistakes: Results of a Radiology Department LGBTQ Inclusion Audit.

RATIONALE AND OBJECTIVES: As radiology programs seek to recruit and retain diverse and competitive applicants, it is important to critically review existing department policies to ensure they meet the needs of their residents. To evaluate a radiology program's inclusivity measures, an interdepartmental committee developed an "LGBTQ inclusion index" and performed an LGBTQ inclusion audit to identify gaps in policy and to craft proposals for administrative review. MATERIALS AND METHODS: An LGBTQ inclusion index was compiled through the collaboration of an interdisciplinary committee of residents, faculty, institutional and community representatives. Five inclusion milestones were identified relating to department policy, department facilities, institutional culture, department culture, and community engagement. Milestones were scored as 0, for milestone not at all met, 1, for milestone partially met, and 2, for milestone completely met, with a total score of 10. Program scores were calculated for the 2018-2021 academic years. RESULTS: The radiology program LGBTQ inclusion index score increased over the course of the study period. The program LGBTQ inclusion index score was 4 of 10 in 2018 and 2019, but after formation of an LGBTQ inclusion task force by the diversity and inclusion committee, increased to 7 of 10 in 2020. The LGBTQ inclusion audit identified several areas that required improvement and the committee drafted proposals to address these gaps. By 2021, the program scored 9 of 10 on the inclusion index. CONCLUSION: Promoting an inclusive and affirming radiology department is an important step to providing culturally competent healthcare and mitigating health disparities. An LGBTQ inclusion audit and a robust department diversity committee can help to identify and address gaps in policy, facilities, and culture.

Quantitative iodine content threshold for discrimination of renal cell carcinomas using rapid kV-switching dual-energy CT.

PURPOSE: Determine iodine content threshold discriminating papillary renal cell carcinomas (pRCC) from complex cysts (CCs) using rapid kV-switching dual-energy CT (rsDECT). MATERIALS AND METHODS: IRB-approved retrospective study of 72 consecutive patients with pathologic diagnosis of renal cell carcinoma, who underwent rsDECT from 2011 to 2015. Controls included consecutive patients with CC during same period. Iodine content of each pRCC (n = 27) was measured on rsDECT workstation for arterial (n = 15) or nephrographic phase (n = 12), and compared to iodine content for clear cell renal cell carcinomas (ccRCC, n = 46) and complex cysts (n = 54). An optimal iodine content threshold was estimated using logistic regressions and Youden's J based on maximum specificity and sensitivity. RESULTS: Iodine threshold of 1.28 mg/cc was optimal to discriminate between pRCCs and CCs for nephrographic phase (sens 1.0, spec 0.96, PPV 0.92, and NPV 1.0, AUC 0.997, acc 0.97, p < 0.0001). Iodine threshold of 1.22 mg/cc was the optimal cutoff value to discriminate between pRCCs and CCs in the arterial phase (sens 0.67, spec 0.97, PPV 0.91, NPV 0.85, AUC 0.76, and acc 0.84, p = 0.006). The optimal threshold to discriminate between ccRCCs and pRCCs was 1.85 mg/cc in the arterial phase (sens 0.87, spec 0.92, PPV 0.87, NPV 0.92, p < 0001) and 2.71 mg/cc in the nephrographic phase (sens 1.0, spec 1.0, PPV 1.0, NPV 1.0, p < 0.0001). CONCLUSIONS: Quantitative iodine values on rsDECT discriminate between papillary RCC and complex cysts, and between papillary RCC and clear cell RCC, the former addressing an important clinical challenge particularly when an unenhanced series has not been performed. These rsDECT thresholds differ from values derived from dual-source DECT technology.