Emerging research suggests the combination of digital breast tomosynthesis (DBT) and synthesized mammography (SM) is significantly more effective than digital mammography alone at detecting invasive breast cancer in women with dense breasts.

In a new sub-analysis from the multicenter, randomized TOmosynthesis plus SYnthesized MAmmography (TOSYMA) trial, researchers compared the invasive breast cancer detection rate (iCDR) of digital mammography and the iCDR of DBT and SM across women with different breast densities. The study authors reviewed data from 99,558 women with 49,762 women in the DBT and SM arm of the study and 49,796 women in the digital mammography group, according to the study, which was 

Employing the Breast Imaging Reporting and Data System (BI-RADS), the study authors found that digital mammography had an iCDR of 3.6 per 1,000 screenings for women in BI-RADS category A (almost entirely fatty breast tissue) in comparison to an iCDR of 2.7 for the combination of DBT and SM.

However, for increasing levels of breast density, the researchers found the iCDR was significantly higher for the combination of DBT and SM. For women in BI-RADS category C (heterogeneously dense breasts), digital mammography had a 6.1 iCDR in comparison to an 8.3 iCDR for DBT and SM, according to the study. When assessing women with extremely dense breasts (BI-RADS category D), the study authors noted a more than threefold higher iCDR (8.1) for DBT and SM in comparison to digital mammography alone (2.3 iCDR).

“Although there is no consensus on the optimal approach, the TOSYMA trial results may suggest that especially women with extremely dense breasts could benefit from a transition from DM to DBT plus SM screening,” wrote Stefanie Weigel, M.D., who is affiliated with the Clinic for Radiology and Reference Center for Mammography at the University of Munster in Germany, and colleagues.

The study authors also noted the highest positive predictive value of recall among women in BI-RADS category C (17.3 percent for DBT and SM versus 12.7 percent for digital mammography alone). The lowest positive predictive value of recall occurred among women in BI-RADS category D (13.5 percent for DBT and SM in comparison to 8 percent for digital mammography), according to the study.

, Cindy S. Lee, M.D. and Linda Moy, M.D., said the study findings are promising for women with extremely dense breasts who are reluctant to have magnetic resonance imaging (MRI) screening.

“These results are good news for women with extremely dense breast tissue,” noted Dr. Lee, an associate professor at New York University, and Dr. Moy, a professor of radiology at New York University. “This category of breast tissue is a risk factor for breast cancer and limits the detection of cancer with digital mammography. Although supplemental screening with breast (ultrasound) or breast MRI is being increasingly recommended in average-risk women with extremely dense breasts, many women cannot tolerate a breast MRI or prefer not to have one.”

In regard to study limitations, Weigel and colleagues pointed out the results were drawn from one round of screening in an ongoing breast cancer screening program. They also acknowledged that the analyses in the study were exploratory, and a potential for reader bias toward the test arm of the study.

Articles

In a large study of nearly 100,000 women, researchers found that the combination of digital breast tomosynthesis (DBT) and synthesized mammography had more than triple the detection rate for invasive breast cancer in extremely dense breasts in comparison to digital mammography alone.

Digital Breast Tomosynthesis and Breast Density: What a New Study Reveals

A new artificial intelligence (AI)-powered neuroimaging platform may offer adjunctive benefits for timely assessment and treatment decisions in neurovascular emergencies.

 is automated screening for challenging cases involving possible intracerebral hemorrhages (ICHs) and large vessel occlusions (LVOs), according to TeraRecon, the manufacturer of the platform.

The company said TeraRecon Neuro enables radiologists to modify the platform’s algorithm to optimize AI outputs. TeraRecon noted the TeraRecon Neuro platform, viewable on diagnostic desktop viewers and via a mobile app, also enhances the assessment of brain function with six customizable computed tomography (CT) perfusion maps.

“We believe the best use case scenario is not autonomous AI, but rather expert clinical supervision that is augmented by AI-driven insights. TeraRecon Neuro was designed to accommodate all care team members and workflows, while simultaneously maintaining standardization across the care continuum to ensure timely delivery of coordinated care for numerous neurovascular emergencies,” noted Dan McSweeney, the president of TeraRecon.

TeraRecon Neuro reportedly offers six automated and customizable computed tomography (CT) perfusion maps that facilitate assessment of brain function in hemorrhagic and ischemic neurological cases.

TeraRecon Launches AI-Driven Neuroimaging Platform

Did the United States Preventative Services Task Force (USPSTF) go far enough in 2021 with modification of its criteria recommendations for low-dose computed tomography (LDCT) lung cancer screening to help address disparities in screening access?

 assessing data from 17,421 people diagnosed with a lung nodule, researchers compared the 2013 USPSTF criteria (

 30 pack-year history of cigarette smoking and active smoking or quit duration < 15 years in people 55 to 80 years of age) versus 2021 USPSTF criteria, which expanded the initial age criteria to 50 and reduced the pack-year history to 

 20. The study authors also examined the potential impact of increasing the quit duration to 25 years (USPSTF2021-QD25), reducing the pack-year history to 

 10 years (USPSTF2021-PY10), and the combination of those two criteria modifications (USPSTF2021-QD25-PY10).

The expanded LDCT screening criteria of the 2021 USPSTF criteria led to an 11 percent increase in the number of people diagnosed with lung cancer in comparison to the 2013 USPSTF criteria, according to the study, which was published in the 

. However, the study authors found the USPSTF2021-PY10 criteria, the USPSTF2021-QD25 criteria and the USPSTF2021-QD25-PY10 criteria led to 26 percent, 28 percent, and 37 percent increases, respectively, in the number of diagnosed lung cancer cases in comparison to 2013 USPSTF criteria.

Out of the 501 people diagnosed with lung cancer in the USPSTF2013 cohort, 48 percent were women and 20 percent were Black. Out of the 588 patients diagnosed with lung cancer in the USPSTF2021cohort, 66 percent were female, and 21 percent were Black. In regard to the 184 additional people who were diagnosed with lung cancer in the USPSTF2021-CD25-PY10 group (but not eligible for screening with the 2013 USPSTF criteria), the researchers pointed out that 57 percent were female, and 24 percent were Black.

“LDCT screening, as currently implemented, exacerbates racial and sex-based disparities because women and racial minorities develop lung cancer at a younger age and with less intense cigarette tobacco exposure than White men, upon whose risk the eligibility criteria are mostly based. This inequitable access is particularly unfortunate because lung cancer screening seems to be disproportionately more effective in Black persons and women,” wrote study co-author Raymond U. Osarogiagbon, MBBS, FACP, the director of the Multidisciplinary Thoracic Oncology Program and the Thoracic Oncology Research (ThOR) Group at Baptist Cancer Center in Memphis, Tn., and colleagues.

Noting a higher risk of lung cancer among Black and female populations with lower than 20 pack-years of tobacco exposure, the study authors emphasized the importance of a lower pack-year threshold for LDCT screening.

“When we reduced the pack-year requirement to 10 years, overall eligibility increased an additional 13% and the percentages of eligible persons who were Black or female increased further beyond that seen when moving from USPSTF2013 to USPSTF2021,” pointed out Osarogiagbon and colleagues. “This pack-year reduction also showed a minimal drop in the proportion of individuals with lung cancers identified.”

Noting study limitations inherent to retrospective analysis, the study authors also said the inclusion criteria of pulmonary nodule identification suggests a higher-risk population with Lung-RADS 3 and 4. Accordingly, Osarogiagbon and colleagues said extrapolation of these findings to general populations may be limited.

Modifications to pack-year history and smoking quit duration thresholds beyond those recommended in the 2021 United States Preventative Services Task Force (USPSTF) criteria for low-dose computed tomography lung cancer screening may more than double the number of increased lung cancer cases physicians would see with application of the 2021 USPSTF screening criteria.

Study Looks at Potential Impact of Expanded Eligibility for Low-Dose CT Lung Cancer Screening

In health care, our practice finds its purpose — and its heart — in making a positive impact. We strive to do good for our patients, our co-workers, and our profession. Fundamentally, it is why we are all here. However, for many, there is a deep desire to do more. As individuals, we are presented with countless opportunities to serve others, opportunities to stretch beyond the bounds of our standard practice and our comfort zones as volunteers.

Volunteering offers us the chance to lift others up, elevate our career journeys, advance our institutions, and add our voices to the diversity of thought anchoring our profession.

Recognizing the Connection Between Service and Leadership

From the very beginning of my career in medicine, I have seen leadership and service as one and the same. Volunteering is so closely connected to serving others, improving the quality of our practice, and enhancing patient care. Volunteering is inherently part of how we develop our skills as leaders and our understanding of the nuances of our community. Volunteering is not a job. Volunteer work speaks to us as people and individuals. It helps us give back.

I am deeply passionate about giving back, and that passion has guided me into leadership with the volunteer community at the American Registry for Diagnostic Medical Sonography (ARDMS). Volunteering not only helps us channel our distinct sense of purpose. It may, in some moments, be that essential reminder of why we do what we do and what really matters in our work in health care. It rejuvenates our purpose, invigorates our joy, and inspires our leadership.

It also offers us a competitive edge. Volunteers at ARDMS work directly with examination and program development, sharing knowledge and exchanging expertise. Volunteering in these spaces provides opportunities that our workplace may not. My personal volunteer journey has allowed me to be an author, an educator, and a resident expert in sonography. I have been able to travel and explore with more thought and purpose around my practice, and my “why.”

As individuals, we must build and embrace our own sense of how to lead and do good, how to be better people and how to make a mark in both our personal and professional communities. When I volunteer with my church, I am able to take an entirely different journey – and touch a whole different group of people.

We have all been blessed with unique strengths, expertise, and specialized skills. If we choose to leverage our gifts for good, we have the opportunity to make change in ways both seen and unseen, and that contribution can continue to grow, evolve, and be shared in our communities. We can ignite that drive in others.

There is a certain sense of pride we capture through service. Our expertise carries immediate, tangible value. When we lend our expertise to addressing a distinct need in a given moment, our greatest strengths can shine. This is empowering and deeply validating.

Yet our service, at its best, also finds us humbled. In my personal journey at ARDMS, one of my greatest accomplishments as a volunteer came from being challenged. When I entered the conversation around assessment development with other subject matter experts, I didn’t always feel like a leader.

• I realized that I was not the most knowledgeable person in the room

• I understood that I needed to sharpen my knowledge and expand my learning and expertise.

• I was encouraged, as a professional, to actively evaluate and elevate my practice.

Volunteering presented me the opportunity and the need to think differently. My experience was certainly not unique. As volunteers with fellow experts in our field, we may be challenged to learn new things or be inspired in our practice. We may take what we have learned from our role and return to our institutions energized and better practitioners than when we left. There are little differences in our practices and institutions. Our stories and those of our patients have unique aspects. We all have the chance to learn when we come together.

Contributing to the Conversation Driving Our Profession

Best practices lead, guide, and advance our profession. They are the tools that keep us safe. Institutions like ARDMS cannot work in a vacuum. If we want our voices to guide the future of health care, we need to join the professional conversation. Likewise, serving as a volunteer and sharing in the dialogue around crafting the assessment practices and professional guidelines of tomorrow help us put our expertise into real, tangible action on a much larger and perhaps global scale.

However, it’s about more than sharing our expertise. Volunteering in professional societies is a vital experience for health-care leaders. We find that we are sharpening our technical skills, building our leadership capabilities, and advancing the value of our professional dialogue. We improve our problem solving. We reach outside of the pointed skills required of our routine role, testing ourselves and adding our unique expertise to the room as creators and innovators.

Volunteering opportunities in the program and policy space, in particular, improve our critical thinking and our collective thought. We face the challenge to think outside the box. When we join a volunteering initiative, we embrace the opportunity to work with extremely knowledgeable people, take risks with them and be comfortable driving our profession forward as a community.

When we think of collaboration, it feels “fun and cohesive,” but that is not always the case. We may find our perspectives challenged. This is the essential collaboration that health care demands.

The idea of embracing disagreement does not come naturally to us, especially when approaching the conversation with strangers. It can be intimidating.

This diversity of thought brings us forcibly outside of our comfort zones. I believe it makes us braver. It has made me a better facilitator of brainstorming sessions and conversations in my personal and professional life. I “borrow” these lessons and carry them with me to every group including my team at work, at home with my kids and to my community.

There are more opportunities to volunteer now than ever, and they offer us an invaluable way to channel our “why.” Here are some resources you may wish to explore to help you get started in volunteering.

Visit the websites of organizations you are affiliated with as part of your profession. Most non-profit organizations rely on volunteer subject matter experts to fulfill mission-critical roles. Here are some organizations in the ultrasound and medical imaging space.

• American Institute of Ultrasound in Medicine (AIUM)

• American Registry for Diagnostic Medical Sonography (ARDMS)

• American Society of Echocardiography (ASE)

• Society for Vascular Ultrasound (SVU)

• Society of Diagnostic Medical Sonography (SDMS)

• Alliance for Physician Certification and Advancement (APCA)

I never could have guessed how I would be stretched and how I would grow as a volunteer. The opportunities have been amazing. When we approach a chance to serve with the belief that we will impact other lives, it’s inevitable that we walk away having changed our own.

Ms. Williams is vice-chair of the American Registry for Diagnostic Medical Sonography (ARDMS).

The opportunities and challenges in volunteering enable us to sharpen our leadership skills and get to the heart of our “why.”

Volunteering in the Ultrasound Community

Standard radiology reports often follow a narrative or free-form format, allowing the radiologist to highlight radiologic findings of importance while diminishing those insignificant to the clinical context. Unsurprisingly, researchers have noted that less than four percent of radiology reports are written at an eighth-grade level, with the average report requiring college-level reading skills.

 In the past, institutions have placed an embargo on radiology reports. While patients may request access to them, the embargo allowed referring providers a few days to review the report and discuss the results with the patients and their families.

However, with the widespread adoption of electronic health records (EHR) and the 2016 passage of the 21st Century Cures Act, patients now have unprecedented speed and access to their radiology reports. Quite often, patients will have read their reports before their referring providers. Since the 21st Century Cures Act, there has been a 78.3 percent spike in patient calls regarding radiology reports.

 Disruptive innovations and new legislation have pressured radiologists to provide reports that balance the clarity of information with manageable language for providers and patients.

Accordingly, let us take a closer look at the current concerns and preferences of physicians and patients on radiology reports, immediate solutions, such as structured reporting, patient summaries, and infographics to improve patient inclusivity, and long-term goals to redesign the traditional report and implement an interactive radiology report.

What Referring Physicians and Patients Prefer to See in Radiology Reports

Historically, patient concerns about radiology reports have centered around accessibility and comprehension. Most patients wanted their report as quickly as possible regardless of the result.

 Electronic health records and the Cures Act have primarily resolved this concern. The content of radiology reports remains a crucial barrier to comprehension. By analyzing patient discussions in online forums, Alarifi and colleagues categorized three major subthemes for the improvement of radiology reports: report representation, image utilization, and understanding.

 Patients wanted a well-formatted report with structured information and clear content display. The images needed to be clearly shown and appropriately adjusted for brightness and contrast to eliminate any ambiguity in visualization. Finally, patients wanted a better understanding of medical jargon and instructions and access to additional resources to aid their comprehension.

From the providers’ perspective, more than 90 percent of referring clinicians surveyed valued an itemized, structured report over ones provided in a free-form style.

 In practice, however, a survey of 265 United States radiologists found that only 51 percent used structured reporting consistently.

 Moreover, the referring providers often misinterpreted the radiology report similarly to patients despite being the intended audience. In a study performed by Rosenkrantz and colleagues, when radiologists used an expression other than “cyst” or “benign cyst” to describe low-risk incidental lesions, this resulted in increased alarm and higher follow-up by both the patient and referring physicians.

 The fact that referring providers have misunderstandings about radiology reports is a notable area for improvement.

Assessing the Pros and Cons of Structured Reporting

Structured reporting is not new in radiology. The most established form of structured reporting is the Breast Imaging Reporting and Data System (BI-RADS) format, which was developed to address concerns about confusing interpretations. Initiatives are already in place to aid radiologists in transitioning from free-form radiology reports. The RSNA Radiology Reporting Initiative developed a free library of templates (

 ) based on best practices to enable consistent, high-quality reports.

The advantages of a structured reporting format are numerous. First and foremost, structured reporting reduces diagnostic errors. A checklist and systematic search pattern minimize cognitive biases arising from a radiologist’s “satisfaction of search,” in which a radiologist prematurely stops searching for additional diagnoses after finding the initial diagnosis.

 Quattrocchi and colleagues found a 28.5 percent increase in clinically significant extraspinal findings in structured reporting compared to free-form reporting.

 Reducing such cognitive biases can improve patient care and the overall report.

The systematic method also improves referring provider’s comprehension of the report. While physicians may be the intended audience for the radiology report, discrepancies between radiologists and referring clinicians arise due to non-standard terminology. Bosmans and colleagues found that 17 percent of referring providers found radiology reporting unnecessarily complicated.

Structured report templates can prompt radiologists to incorporate critical findings with clinical conditions while reducing syntactic and semantic errors. A computed tomography (CT) coronary angiography study demonstrated such benefits when referring physicians’ comprehension improved with a structured report.

 In a separate pancreatic cancer study, a structured report improved surgeons’ confidence in tumor resectability.

 In this manner, referring providers can better utilize the radiologist’s expertise to enhance their clinical acumen.

Admittedly, structured reporting has its shortcomings. “Eye dwell problem,” or the tendency for the radiologist to focus on the word template rather than the imaging itself, has the potential to disrupt workflow.

 Complicated cases with multiple abnormalities may exacerbate this issue. In these cases, the disease process may render radiology insufficient in conveying all of the findings to the intended audiences. Direct communication with the referring provider or the patient could be necessary. A structured report’s utility can be helpful in organizing the findings and highlighting key areas of concern.

Perspectives on Making the Radiology Report More Patient-Friendly

While structured reporting may bridge the gap between radiologists and fellow clinicians, there is still a sizable disparity between the patient and the radiologist. This is where consumer-friendly supplementation can have an impact in complementing the radiology report.

Several methods of implementation are currently being tested. The most direct and simplistic solution is creating a “patient summary statement.” A radiologist would summarize the pertinent findings, briefly explain the clinical correlation, and inform patients with follow-up instructions in patient-friendly language.

 In a patient-centered section, the radiologist could focus the patient on areas of clinical concern and minimize potential distractions in the findings. Furthermore, the benefit is the increase of patient inclusivity without significant disruption to a radiologist’s workflow.

A more detailed, consumer-friendly report would be the creation of an infographic directed explicitly at the patient. Von Eckstaedt and colleagues at the University of Virginia redesigned the traditional radiology report with an infographic for lung cancer screening patients.

 The infographic provides brief information about low-dose CT scans, patient results, and follow-up instructions. More importantly, the report is filled with visual aids that correlate with the simplified language to improve patient comprehension.

Patients in the study had an overwhelmingly positive response with 65.2 percent preferring the infographic to the traditional report.

 Although this approach is more involved than a patient summary, consumer-friendly infographic reports can potentially organize complex and less structured data into a medium suitable for patient use. Conversely, routine radiology procedures may utilize a predesigned infographic template for multiple patients, thus, expediting workflow. Due to the novelty of the approach, the effects of infographics have not been quantified in the radiology literature at the time of this publication.

Exploring Future Directions for Radiology Reports

While patient summaries and infographics can increase patient inclusivity, the core content of a radiology report would remain inaccessible due to the technical, medically specific terminologies necessary for the precise, accurate, relevant description of image findings. Proposals for report redesign and interactive radiology reports seek to remedy that problem.

Based on suggestions and concerns from patients, Alarifi and colleagues sought to redesign a patient-friendly radiology report. The redesign included much of the previously mentioned solutions, including structured reporting, a patient summary section, and follow-up instructions. Two standouts of the redesign include the annotation of written findings and a correlating clinical imaging section.

The clinical imaging section further enhances the written findings, using annotated diagrams with anatomical references as a visual aid. An impressive aspect of the imaging section is the personalized clinical context in which the patient’s radiography sits between “normal case” and “worst case” scenario reference images. The visual differences between the patient’s image and the clinical references allow the patients to examine their disease process without reading complicated medical jargon.

The reception to the redesigned radiology report was positive with more than 70 percent of respondents marking “agree” or “strongly agree” to the questions about understanding the report. Another notable aspect of the study was that improvements in the redesign were unrelated to age, gender, economic status, ethnicity, and health literacy.

 Utilizing clinical images to correlate the written findings may be a potential direction toward a more patient-friendly report. Additionally, referring providers may also use the annotated and reference images as a visual aid to enhance treatment discussions with patients and their families.

A redesigned radiology report may take some time before it is fully optimized to achieve a readily accessible level. There may also be multiple competing strategies individualized to different institutions before standardization.

Another proposed solution is an interactive radiology report like Scanslated.

 Kemp and colleagues' interactive web-based application uses natural language processing to annotate a patient radiology report. After a radiologist completes the report, the software processes it before making it available to the patient in 48 hours. The patient can log on to his or her account and review the patient-friendly report. Unlike many other annotated reports, a standout feature of Scanslated is its inclusion of animated diagrams.

The developers of Scanslated hope to improve patient education and health literacy through user interaction with the program. The pilot study did reveal a notable increase in engagement. Patients who opened the annotated links spent an average of 5.8 minutes compared to 1.8 minutes for those who just read the text.

 The pilot study also received positive responses with 85 percent of respondents believing the application improved their understanding.

 The advantage of natural language processing to annotate a report would be the rapid deployment of such services across different institutions and clinics.

Both studies demonstrated marked improvements in patients’ subjective understanding of the radiology report. While quantification and confirmation of patient knowledge are necessary to optimize the best approach to patient-centered reporting, the studies reaffirmed patients’ appetite for greater engagement and comprehension.

Recognizing The Opportunity with Emerging Patient Empowerment and Value-Based Care

Including patients as a new target audience for radiology reports presents an extraordinary opportunity for radiology. As health care shifts from volume-based to value-based care, patients increasingly take ownership of their health and engage in shared decision-making. Despite challenges, direct access and immediacy of radiology reports increase the visibility of radiologists as an integral part of the patient care process. Radiology reports play a vital role in patient autonomy as it is often an essential piece of data utilized by patients seeking second opinions or consultations.

Therefore, greater adoption of structured reporting and the tailoring of patient-centric subsections are immediate and impactful methods to promote patient inclusivity and improve peer clinician communication. Referring physicians can more readily learn from the radiologist’s expertise, and patients can now receive concrete and actionable plans from their radiology reports. Importantly, this promotes a greater connection and interaction between the patient and his or her health-care team.

The future steps of redesigning and utilizing interactive radiology reports would continue to break down barriers to health-care access and literacy. The current push for patient-centered radiology reports creates a unique opportunity for radiologists to elicit the needs of patients directly. It also allows patients to shape the delivery and communication of their health information. While the development and adoption of redesigned reports are still in the early stages, the overwhelming support from patients offers clear assurances in favor of patient-centered radiology reports.

1. Martin-Carreras T, Cook TS, Kahn Jr CE. Readability of radiology reports: implications for patient-centered care. 

2. Mehan Jr WA, Gee MS, Egan N, Jones PE, Brink JA, Hirsch JA. Immediate radiology report access: a burden to the ordering provider. 

3. Basu PA, Ruiz-Wibbelsmann JA, Spielman SB, Van Dalsem 3rd VF, Rosenberg JK, Glazer GM. Creating a patient-centered imaging service: determining what patients want. 

4. Alarifi M, Patrick T, Jabour A, Wu M, Luo J. Understanding patient needs and gaps in radiology reports through online discussion forum analysis. 

5. Bosmans JML, Weyler JJ, De Schepper AM, Parizel PM. The radiology report as seen by radiologists and referring clinicians: results of the COVER and ROVER surveys. 

6. Powell DK, Silberzweig JE. State of structured reporting in radiology, a survey. 

7. Rosenkrantz AB. Differences in perceptions among radiologists, referring physicians, and patients regarding language for incidental findings reporting. 

8. Lee CS, Nagy PG, Weaver SJ, Newman-Toker DE. Cognitive and system factors contributing to diagnostic errors in radiology. 

9. Quattrocchi CC, Giona A, Di Martino AC, et al. Extra-spinal incidental findings at lumbar spine MRI in the general population: a large cohort study

10. Ghoshhajra BB, Lee AM, Ferencik M, et al. Interpreting the interpretations: the use of structured reporting improves referring clinicians' comprehension of coronary CT angiography reports. 

11. Brook OR, Brook A, Vollmer CM, Kent TS, Sanchez N, Pedrosa I. Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning.

12. Babu AS, Brooks ML The malpractice liability of radiology reports: minimizing the risk. 

13. Gunn AJ, Gilcrease-Garcia B, Mangano MD, Sahani DV, Boland GW, Choy G. JOURNAL CLUB: structured feedback from patients on actual radiology reports: a novel approach to improve reporting practices. 

14. Von Eckstaedt HV, Kitts B, Swanson C, Hanley M, Krishnaraj A. patient-centered radiology reporting for lung cancer screening. 

15. Alarifi M, Patrick T, Jabour A, Wu M, Luo J. Designing a consumer-friendly radiology report using a patient-centered approach. 

16. Kemp J, Short R, Bryant S, Sample L, Befera N. Patient-friendly radiology reporting -- implementation and outcomes. 

In a thorough review of the literature, these authors discuss current approaches and emerging initiatives to increase the understanding of radiology reports by referring physicians as well as patients. 

Reinventing Radiology Reports in the Age of Value-Based Care

Is magnetic resonance imaging (MRI) a worthwhile screening tool for breast cancer?

, researchers compared the use of screening mammography versus a combination of screening mammography and MRI in women with high-risk breast lesions.

 Out of 699 patients included in the study, 542 patients had atypical ductal or lobular hyperplasia, and 157 patients had lobular carcinoma in situ, according to the study.

After a median follow-up period of 25 months (including a median of two MRI exams in the combination screening group), the study authors found an identical breast cancer detection rate of 3.6 percent for patients who had mammography alone and those who had mammography and MRI.

The researchers also pointed out that the combination screening group had a significantly higher biopsy rate (30.5 percent) than the mammography-only group (12.6 percent). Out of the five cancers detected in the combination screening group, the study authors noted that only two were detected on MRI.

“Collectively, these early findings question the benefit of screening MRI for this population, with a cost of nearly a threefold increased rate of breast biopsies during surveillance of patients receiving MRI,” wrote study co-author Tari A. King, M.D., chief of the Division of Breast Surgery and vice-chair for Multidisciplinary Oncology within the Department of Surgery at Brigham and Women’s Hospital in Boston, and colleagues.

The researchers noted that breast MRI was more often reserved for younger patients; those with a family history of breast cancer and/or a history of lobular carcinoma in situ; and/or extremely dense breasts.

King and colleagues said the three mammographically occult cancers in the study were detected in women with heterogeneously dense or extremely dense breasts. Citing the findings from a recently published trial by Bakker and colleagues, the study authors suggested that MRI screening is still warranted for women with dense breasts.

“Selective MRI use for patients with extremely dense breasts is likely appropriate due to reduced sensitivity of (mammography) in this setting and lower interval cancer rates observed with supplemental MRI than with (mammography) alone in the recent DENSE randomized controlled trial,” maintained King and colleagues.

The study authors acknowledged that the small sample size in the combined mammography/MRI group (159 patients), a low event rate (five detected cancers in 699 patients) and short follow-up period (a median of 25.2 months) were limitations of the study. King and colleagues also pointed out that a lack of information on prior breast screening in the group with mammography and MRI prohibited comparison of baseline and follow-up screens.

1. Laws A, Katlin F, Hans M, et al. Screening MRI does not increase cancer detection or result in an earlier stage at diagnosis for patients with high-risk breast lesions: a propensity score analysis. 

 2022 Sep 28. doi: 10.1245/s10434-022-12568-z. Online ahead of print.

2. Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI screening for women with extremely dense breast tissue. 

In a study involving nearly 700 patients with atypical ductal or lobular hyperplasia, or lobular carcinoma in situ, researchers found no difference in four-year breast cancer detection rates between women who had screening mammography and breast magnetic resonance imaging (MRI), and women who only had mammography screening.

Study Finds No Benefit to MRI Screening in Women with High-Risk Breast Lesions

The Philips Ultrasound 5000 Compact Series, which reportedly facilitates real-time collaboration and streamlined workflows, has garnered 

510(k) clearance from the Food and Drug Administration (FDA)

Philips noted the portable device provides a combination of enhanced image quality and remote consultation capability (via Philips Ultrasound Collaboration Live tele-ultrasound) that facilitates clinical decision support with mobile efficiency. In addition to general imaging and utility in the obstetrics and gynecology fields, Philips said the Ultrasound 5000 Compact Series enables timely assessments in cardiology and point-of-care ultrasonography.

“Globally, clinicians are faced with increasing pressures to deliver higher patient throughput for quick, confident diagnoses via ultrasound exams while receiving more and more requests to perform rapid ultrasound exams at the bedside,” noted Matthijs Groot Wassink, the general manager of Point-of-Care Ultrasound at Philips. “Until now, portable ultrasound systems have typically meant decreased performance, lack of advanced features, and lower grade image quality. With this clearance for our next-generation portable Philips Ultrasound 5000 Compact Series, clinicians now have the ability to make quicker and more confident diagnoses.”

In order to facilitate consistency and efficiency with use of the Ultrasound 5000 Compact Series, Philips said the new portable device offers the same features, touch screens and user interfaces as the company’s EPIQ and Affiniti ultrasound systems.

Offering the benefits of real-time collaboration and integrated connectivity, the portable ultrasound device may be utilized in a variety of clinical settings ranging from cardiology to obstetrics and gynecology.

Philips Gets FDA Clearance for Ultrasound 5000 Compact Series

Eric Postal, MD, is a diagnostic radiologist with the University of Pittsburgh Medical Center. 

I recently got an unexpected series of emails in regard to a comment I made on a Twitter thread. The thread had begun with a lament about radiology departments directing their efforts and budget to newfangled things like artificial intelligence (AI) rather than traditional elements of their infrastructure (PACS, radiology information system (RIS), dictation software).

I had commented that, unfortunately, it’s not as flashy to boast “We have the same type of software products as everybody else, but our products are quality” as it is to brag “We have something cutting-edge that nobody else does,” even if the cutting-edge stuff doesn’t get the job done. I added that the sad truth of the matter is people who have authority to allocate resources are often more motivated by flash than function.

For a typical radiologist’s perspective and many non-rads, this seems a no-brainer. Why would valuable resources be thrown after gimmicky new fripperies that might not even work instead of applying them to tools that are routinely used to make ends meet?

For instance, suppose I have a clunker of a car that routinely fails to start, stalls out or otherwise dies midway to my destination, not to mention getting lousy mileage whenever it does manage to work. Shouldn’t I make fixing it a priority or replacing the whole thing with something more reliable and efficient? Wouldn’t this be a better approach than tricking it out with a new paint job, spoilers, and ground effects?

Now suppose I depend on that car to make my living. Perhaps I need it to commute to my job or perhaps it is central to my job (such as driving for Uber). Making the vehicle more reliable enables me to keep paying my bills. Fixing/replacing it will not only “pay for itself,” it may improve my bottom line as I subsequently need fewer emergency repairs, get more gigs done and/or bonuses for actually showing up on time, etc.

None of this will happen if I instead choose to detail my vehicle. Guys on the street corner might be impressed as I drive by (assuming I don’t break down in front of them), but they’re not the ones paying my bills or talking to my boss, clients, etc. about what a cool driver I must be.

Even if someone related to my livelihood sees my tricked-out vehicle, he or she might not be impressed with my choices. Instead, if that person has heard I often cite car trouble as a reason I fail to show up, he or she might decide I’m not a smart or reliable person. Alternately, that person may resent having to cover for me at times and here I am blatantly doing nothing to improve the situation.

Seeing someone make such seemingly illogical choices, I always try to remember there are any number of things I might not know or understand about their situation. There could be a reasonable explanation that would have me nod and think, “Okay, now that makes sense.”

Without that intel, though, I’m liable to think that the individual either doesn’t understand things well enough to make better decisions or doesn’t care to make better decisions. My conclusion will surely be colored by the details of the situation. I am unlikely to assume a teenager who tricks out his clunker car has a wise rationale. However, if a CEO does something that makes no sense to me, I have to imagine he or she may have valid reasons.

Still, someone in command of a radiology group who decides to throw resources at AI instead of PACS, RIS, voice recognition, etc. is far from immune to scrutiny. This is especially the case if the latter stuff—the tools that literally make it possible for the rads to pay the bills and keep the group afloat—is constantly breaking down, working at a fraction of the speed/efficiency it should be, contributing to lower quality work, or burning out the rads who have to live with it.

Unless that AI is somehow going to counterbalance the bargain basement nature of the other infrastructure (or it magically comes with a reliable, separate stream of revenue to pay for itself), it sure looks like whoever decided to get that AI either doesn’t understand or doesn’t care how badly the existing infrastructure is hurting the group.

That can easily happen when the decision-maker is someone who doesn’t work “in the trenches” with the other radiologists. Someone who doesn’t regularly experience the inefficiencies and other flaws in the infrastructure might not be all that motivated to fix them. She or he might not even get that there is anything to fix.

At the very least, a leader who doesn’t put in time on the worklists but listens to and respects working rads would have a chance of understanding what needs fixing and/or replacing. I emphasize that second part because it’s all too common to be dismissive: “Oh, you know radiologists, they always complain about X.”

Such an understanding paves the way to appreciating that improving the rads’ tools can boost overall productivity, quality of work, and team morale by a staggering amount. This more than pays for itself and maybe helps a rad group afford extras like AI in future years when the technology will unquestionably be better than it currently is and likely cheaper as well.

Take away that firsthand (or close secondhand) comprehension of the state of affairs, and it’s not hard to imagine why leadership might leave a crummy infrastructure in place. Why throw more resources at new PACS, RIS, etc. when, as far as you can tell, the systems you already have seem to get the job done? Besides, everybody has that stuff. Let’s go get ourselves some sort of AI instead and be the first rad group in town with one!

Addressing upgrades of traditional infrastructure used in everyday radiology practice may be a more practical use of resources than investment in artificial intelligence (AI) technology that is still evolving.

Flash Versus Function: Does the AI Focus in Radiology Compromise Our Infrastructure Needs?

's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest case quizzes and conference reports. Review the slideshow below to see this week's top content:

Diagnostic Imaging's Weekly Scan: September 25-October 1

Slideshows

Catch up on the top radiology content of the past week.

In-utero opioid exposure may lead to smaller fetal brain size and increased risk for breech presentations, according to a new prospective, multicenter, magnetic resonance imaging (MRI) study.

recently published case-control study in the 

, researchers assessed single fetal MRI exams obtained during the third trimester for 65 women with a mean age of 29. Twenty-eight of the fetuses had opioid exposure, according to the study. Reported opioid use included fentanyl, heroin, morphine, hydrocodone and oxycontin.

After performing 14 two-dimensional biometric fetal brain measurements, the study authors found that seven of the measurements were smaller in fetuses with opioid exposure in comparison to those without opioid exposure. The statistically significant differences included the brain biparietal diameter (72.9 mm vs. 74.1 mm); the anterior-posterior pons (11.6 mm vs. 12.1 mm); the cerebral fronto-occipital diameter (93.8 mm vs. 95.0 mm); and the bone biparietal diameter (79.0 mm vs. 80.3 mm).

“Despite the current widespread availability, overall ease of performance, and safety profile of fetal MRI, studies of the brain on fetal MRI in opioid-exposed fetuses are scarce,” wrote lead author Usha D. Nagaraj, MD, a pediatric neuroradiologist affiliated with the Cincinnati Children’s Hospital Medical Center, and colleagues. “To our knowledge, the present study represents one of the largest such studies to date and adds to the prior literature by illustrating that impaired head growth begins in utero.”

The study authors also found a 21 percent higher incidence of increased amniotic fluid volume (29 percent vs. 8 percent) and an 18 percent higher frequency of breech position (21 percent vs. 3 percent) with opioid-exposed fetuses in comparison to those without opioid exposure.

“Opioid exposure during pregnancy may cause a disruption in fetal neuromuscular development, potentially at the microstructural level, that results in breech presentation,” suggested Nagaraj and colleagues.

Acknowledging the small sample size of the study, the authors noted that future studies with larger sample sizes are necessary to corroborate the study findings. Noting that 71 percent of the opioid-exposed fetuses were also exposed to nicotine, the study authors conceded the possible effect of this exposure on the study findings as previous research has demonstrated a link between prenatal nicotine exposure and smaller brain size.

 With the data coming from single MRI scans obtained during the third trimester, the researchers said they could not assess the potential impact of opioid exposure on longitudinal brain development or during earlier time periods of pregnancy.

1. Nagaraj UD, Kline-Faith BM, Zhang B, et al. MRI findings in third-trimester opioid-exposed fetuses with focus on brain measurements: a prospective multicenter case-control study. 

 2022 Sep 28. Doi: 10.2214/AJR.22.28357. Online ahead of print.

2. Radhakrishnan R, Vishnubhotla RV, Guckien Z, et al. Thalamocortical functional connectivity in infants with prenatal opioid exposure correlates with severity of neonatal opioid withdrawal syndrome. 

Researchers found that in utero opioid exposure resulted in seven out of 14 2D biometric measurements of the fetal brain being smaller on magnetic resonance imaging (MRI) scans in comparison to fetuses without opioid exposure. 