Diagnostic Imaging brings you coverage of ARRS 2022 annual meeting.

Coverage of ARRS 2022 Annual Meeting

Has digital breast tomosynthesis (DBT) lived up to the initial hype when it comes to breast cancer detection?

In her recent lecture on DBT at the Society of Breast Imaging (SBI)/American College of Radiology (ACR) conference, Debra Monticciolo, MD, FACR, FSBI, said DBT and two-dimensional (2D) digital mammography (DM) “are closer cousins than we expected.”

In five European studies comparing DM/DBT to DM that were published prior to 2018, the cancer detection rate (CDR) was incrementally better than that of DM, but Dr. Monticciolo said there are key caveats to consider with these studies. These studies emphasized biennial screening, which increases CDR and most of these studies had an older population (over 50 years of age) with a higher underlying prevalence of disease, which increases CDR, pointed out Dr. Monticciolo, the Dr. Robert and Alma Moreton Centennial Chair in Radiology and a professor of radiology and vice-chair for research with Baylor Scott and White Health, Texas A&M University.

Dr. Monticciolo said the American retrospective studies (emphasizing annual screening) prior to 2018 showed variable results in comparing CDRs between DBT and DM. Of the subsequent retrospective American studies published in 2018 and beyond comparing DM/DBT and DM, “there is no statistically significant difference in many of the studies for CDR,” noted Dr. Monticciolo, a past president of the American College of Radiology and the Society of Breast Imaging.

There is also conflicting data when it comes to comparing recall rates between DM/DBT and DM, according to Dr. Monticciolo. She noted that DM/DBT had a 4.14 average recall rate in five European studies published prior to 2018 and DM had a 3.58 average recall rate. Yet in U.S. retrospective studies prior to 2018, the average recall rate was 8.0 for DM/DBT and 11.3 for DM. However, in seven recent studies published in 2018 and beyond, Dr. Monticciolo pointed to improved recall rates with DBT, noting average recall rates of 7.72 for DBT and 9.0 for DM.

In her SBI/ACR lecture, Dr. Monticciolo also looked at the viability of synthesized mammography (SM) in possibly replacing the use of DM in DM/DBT. While the use of SM reduces image acquisition and the combination of SM/DBT reportedly reduces radiation dose by approximately 40 percent in comparison to DM/DBT, Dr. Monticciolo said there has a been a slow adoption of SM among radiologists since the availability of the technology in 2013. She noted one 2017 study of over 1,150 breast radiologists found that approximately 75 percent had SM but utilized DM/DBT.

This boils down to inferior spatial resolution for SM, according to Dr. Monticciolo, the section chief of breast imaging at Baylor Scott and White Healthcare, Texas A&M University. She said SM accentuates high contrast objects, but problems arise at points close to resolution threshold.

“There isn’t a breast imager anywhere who would rather read (a SM image) than a standard DM view,” maintained Dr. Monticciolo. “ … There is no question that SM is an inferior image.”

She noted that a 2021 meta-analysis compared SM/DBT versus DM and DM.DBT. In 11 studies that compared SM/DBT and DM, the use of SM/DBT resulted in a higher CDR.Yet in seven studies that compared SM/DBT with DM/DBT, there was no difference in CDR, according to Dr. Monticciolo. She noted the authors of the meta-analysis found that SM/DBT screening offered similar detection rates for all cancer, invasive cancer, and ductal carcinoma in situ (DCIS) in comparison to DM/DBT as well as a lower biopsy rate and recall rate.

Dr. Monticciolo said three other meta-analyses published in 2021 found equivalent CDR between SM/DBT and DM/DBT.

She added that the recently published STORM-2 trial found that SM/DBT and DM/DBT were equivalent in regard to CDR, and both had a higher CDR than DM. However, while these findings held up for patients 60 years of age and younger, “the (CDR) advantage of SM/DBT disappears and the advantage of DM/DBT narrows” for patients over the age of 60,” noted Dr. Monticciolo.

“If you’re doing SM/DBT, you can feel good because the outcomes are probably going to be equivalent with DM/DBT,” summarized Dr. Monticciolo. “If you’re using DM/DBT, you can feel good because you are giving your patient the highest resolution exam that you can and as long as you stay within the federal (radiation) exposure limits, it’s completely safe.”

Articles

A closer look at the literature suggests the combination of digital breast tomosynthesis (DBT) and two-dimensional (2D) digital mammography (DM) has relatively equivalent cancer detection rates as using DM alone, according to a recent presentation at the Society of Breast Imaging (SBI)/American College of Radiology (ACR) conference.

Is Digital Breast Tomosynthesis Superior to Digital Mammography?

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

I am a RVU generator. It is not exactly how I envisioned my career shaping up. Sure, as a diagnostic radiologist, I expected much of my professional value to be expressible in terms of case volume. However, I also thought I would be doing substantial amounts of “on the clock” stuff away from the workstation, whether it was planning strategy, optimizing group efficiency, and even forming policy. In other words, there is an interest in “bigger picture” kinds of stuff.

There are various reasons why that hasn’t happened yet. In the meantime, if I want to philosophize about the greater meaning of my work, it’s going to be in terms of lives I have saved, improved, or at least prevented from getting worse as result of cases I have read.

In the abstract, this is not a hard concept to grasp. Rads can interpret some pretty complex imaging, to say nothing of how we manage when we are given less than ideal tools to work with (technically limited studies, poorly chosen protocols or even modalities for the clinical scenario, irrelevant/wrong/non-existent histories, etc.). Functioning as the “doctor’s doctor,” how could we not be doing important work?

Start trying to quantify it, though, and one rapidly gets brought back to Earth. Muddling through a typical worklist, it is very easy to wind up with a “how much of what I’m doing really makes a difference” feeling. Plow through a few dozen portable ICU chest images, for instance, endlessly describing a bunch of tubes and lines and how one can’t rule out edema on this one or pneumonia on that one. Heck, it seems like they order daily chest films in the ICU without waiting to see what we had to say about the previous films.

Maybe you do a lot of mammos and every so often, somebody publishes a study about how screening doesn’t have a statistical benefit on survival across the population. Perhaps you cover ERs, see trauma pan-scans on patients wrecking their ATVs and realize the same patients trashed their snowmobiles last winter. Did it matter that you identified their rib fractures last year when they just went out and broke some new ones now?

Then there’s the matter of rads not being the only ones looking at imaging studies. There is an assortment of jacks-of-all-trade (ER docs, PAs, NPs) glancing at X-rays, sonographers essentially giving prelims on their scans to whomever asks, and subspecialists like orthopedic surgeons or neurosurgeons proudly boasting that they read their subspecialty images better than we do. It is easy to come away with the sense that even if we didn’t make some key diagnosis (or rule it out), others would.

More than once in a blue moon, I’ve had the notion that, even with all this going on, even with the ever-increasing volume of unnecessary imaging that gets thrown our way to dilute things, there are times where we stand between good and bad outcomes. In our diagnostic rad roles, we have the chance to do what nobody else can or will. As an individual trying to distinguish himself, I may sometimes do what other rads wouldn’t.

Such moments, as rare as they might be in this sea of other factors, are our “delta.” It is the difference that we can make because of how we perform when we’re doing our thing.

Of course, we don’t knowwhen those moments are afoot. If I catch a non-obvious fracture, I don’t know until after the fact whether the ER staff noticed it or sent the patient home to follow up with their primary care doc. If I think I see a suspicious density on a mammo and suggest diagnostic workup or biopsy, I won’t know until afterward if I was sounding the alarm over something benign or malignant. Even if it was bad news, I would have to be omniscient to know whether I made a difference in the quality/quantity of that patient’s life. Maybe the tumor would have been slow growing and instead the patient dies earlier from complications of the chemotherapy that I helped make happen.

It’s only with a very indirect, been doing this for decades, instinctive kind of feel that I have come to sense what my delta might be. I try to underestimate it in order to keep myself humble and my expectations low.

For instance, I think it’s a reasonable hope that as I do my best work, perhaps there will be one case in 10 in which I might say something more helpfully than another rad might have (or refrain from saying something unhelpful). Meanwhile, if you take the population of rads as a whole, it seems safe to say that in at least one out of 10 cases, we produce better outcomes than some other doc would have (ER denizens and surgical subspecialists alike).

Of course, no matter who ultimately looks at a case, let’s keep in mind that an awful lot of imaging doesn’t contain actionable results relevant to the patient who got imaged. Either the imaging was a “fishing expedition,” it was the wrong type of study to order for the clinical interest, or no imaging was warranted in the first place. Assigning that a one in 10 probability might seem cynical to some but not to anybody whose worklists resemble those I have seen.

So, I’m looking at 10 percent for me versus other rads, 10 percent for rads versus other docs, and 10 percent for imaging studies overall. I can reasonably expect my delta to be at least one case in 10,000. My pace of reading cases has varied with the types of infrastructure offered by my last couple of jobs, but that translates to at least twice per year.

Does that seem rare? Of course, I’d like it to be greater, but I did set out intending to underestimate. Even going with two lives per year, that will turn out to be 34 since fellowship. Add another 20 for each decade I keep plugging away before I call it quits (or it gets called quits for me). That’s a few dozen folks who got to live longer and/or better purely because I was involved in their care.

I would consider that a decent accomplishment for my career.

Amid a glut of unnecessary imaging requests, common worklist frustrations and perceptions from other clinicians that they can interpret medical images just as well, recognizing your role as a humble difference maker may provide the ultimate RVU for patients.

What is Your Radiology Delta?

'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: May 15-May 21

Slideshows

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

In sharp contrast to previous reporting of side effects from clinical trials of COVID-19 vaccines, new findings from breast ultrasound research revealed a 

significantly longer duration of axillary lymphadenopathy among people who had COVID-19 vaccination

The retrospective study, which was recently published in the 

, involved 111 patients (mean age of 52) who developed unilateral axillary lymphadenopathy within eight weeks after having the Pfizer or Moderna COVID-19 vaccine. Initial breast ultrasound examination revealed a 4.7 mm mean cortical thickness of the largest axillary lymph node. Patients had subsequent ultrasound exams at four- to 12-week intervals until there was resolution of the condition, according to the study.

Researchers found that the mean resolution of axillary lymphadenopathy occurred 97 days after the initial ultrasound exam and 127 days after initial administration of COVID-19 vaccination. For the 60 patients who had the Pfizer COVID-19 vaccine, the mean resolution of axillary lymphadenopathy since the first vaccine dose took 117 days in comparison to 139 days since the first dose for the 51 patients who had the Moderna COVID-19 vaccine.

 Previous clinical trials for COVID-19 vaccines had noted an average one to 10-day duration of axillary lymphadenopathy.

“The prolonged resolution time supports a follow-up interval of at least 12 weeks for suspected vaccine-related lymphadenopathy and avoidance of delaying screening mammography after vaccination,” wrote Michele B. Drotman, M.D., chief of the Division of Breast Imaging and associate professor of clinical radiology at Weill Cornell Medical College, and colleagues.

In order to address patient anxiety and help prevent overdiagnosis of the increased frequency of unilateral axillary lymphadenopathy during the initial vaccine rollout, the Society of Breast Imaging (SBI) initially recommended a delay of breast screening exams until four to six weeks after a second dose of a COVID-19 vaccine. In 2021, the SBI also recommended short-term imaging follow-up at four to 12 weeks for unilateral axillary lymphadenopathy that was suspected to be vaccine-related. In March 2022, the SBI issued an updated recommendation of 12 or more weeks for follow-up imaging, a change that appears to align with the findings by Dr. Drotman and colleagues.

“The presence of subclinical lymphadenopathy and the long resolution time of lymphadenopathy, as observed in this study, should reassure radiologists and patients when lymph nodes suspected to be vaccine-related persist over multiple visits,” emphasized Dr. Drotman and colleagues.

Other predictive factors of a longer duration of axillary lymphadenopathy included greater cortical thickness on the initial ultrasound exam and having the second vaccine dose after initial ultrasound examination, according to the study.

The study authors acknowledged the potential for selection bias in the retrospective single-center study. Determining a more precise time for resolution of the lymphadenopathy was hampered by variability in the time between follow-up ultrasound exams and subsequent four to 12-week follow-up intervals, according to Dr. Drotman and colleagues. They also noted that patients with concurrent breast cancer were excluded from this study and that unilateral lymphadenopathy requires careful assessment in this patient population.

1. Lane EG, Eisen CS, Drotman MB, et al. Time for resolution of COVID-19 vaccine-related lymphadenopathy and associated factors. 

 2022 May 18. doi: 10.2214/AJR.22.27687. Online ahead of print.

2. Local reactions, systemic reactions, adverse events, and serious adverse events: Moderna COVID-19 vaccine. Centers for Disease Control and Prevention. Available at: 

https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/reactogenicity.html

3. Local reactions, systemic reactions, adverse events, and serious adverse events: Pfizer COVID-19 vaccine. Centers for Disease Control and Prevention. Available at: 

https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/reactogenicity.html

While COVID-19 vaccine clinical trials noted that post-vaccine axillary lymphadenopathy lasted for one to 10 days, emerging breast ultrasound research found a mean resolution of 127 days after a first vaccine dose.

New Study Points to Longer Duration of Axillary Lymphadenopathy After COVID-19 Vaccine

Perhaps the biggest challenge in radiology right now is the current global shortage of iodinated contrast media (ICM), which is most commonly utilized for computed tomography (CT) exams. With the temporary shortage expected to last until the end of June, radiology departments and larger medical facilities are scrambling to address this issue, which can have a significant impact on patient care.

With this in mind, we recently spoke with two professors from the Yale School of Medicine: Dr. Joseph Cavallo, an Assistant Professor of Radiology and Biomedical Imaging, and Dr. Jay Pahade, an Associate Professor and Vice-Chair of Quality and Safety for Radiology and Biomedical Imaging.

co-authored an article on strategies that imaging facilities may take to address this acute shortage of iodinated contrast media.

 They outline three central strategies including ICM dose reduction, utilization of alternative imaging modalities and possible deferment of imaging deemed to be non-urgent in nature.

Dr. Pahade called ICM a mission critical agent.

“Most institutions rely heavily on contrast-enhanced CT for the management of their patients both inside and outside of the emergency department (ED). Almost every critical diagnosis in medicine has some arm tied to CT imaging in one fashion or another,” emphasized Dr. Pahade.

For additional insights on the shortage of iodinated contrast media, watch the video below.

Videos

In a recent video interview, two radiology professors from the Yale School of Medicine discussed the impact of the iodinated contrast media (ICM) shortage and potential strategies, ranging from ICM dose reduction to possible deferment of non-urgent imaging, that may provide a viable path moving forward. 

Emerging Strategies for Managing the Acute Shortage of Iodinated Contrast Media

A new study of over 3.9 million Korean women found that the combination of benign breast disease and dense breasts led to elevated 10-year risks for the development of breast cancer.

In a retrospective review drawing from the National Health Insurance Service-National Health Information Database (NHIS-NHID) in Korea, researchers assessed 3,911,348 Korean women who had mammography screening between January 2009 to December 2010. Study participants who had normal breasts (Breast Imaging Reporting and Data System (BI-RADS) category 1) or benign breast disease (BI-RADS category 2) at the time of this screening were included in the study, 

which was recently published in Radiology

Among the 58,321 women who developed breast cancer during a median follow-up of 10.6 years, researchers found a higher proportion of benign breast disease (18.4 percent) and dense breasts (55.4 percent) at the baseline screening in comparison to those who did not develop breast cancer (13.3 percent and 38.4 percent respectively).

Women who had no breast disease and BI-RADS category A breast density (almost entirely fatty tissue) at the baseline screening had a .73 percent risk of breast cancer at 10 years, according to the study. In contrast, the study authors noted a 2.18 percent risk for women who had baseline benign breast disease and BI-RADS category C breast density (heterogeneously dense) and a 2.64 percent risk for the combination of benign breast disease and BI-RADS category D breast density (extremely dense) at 10 years.

In other words, patients who had a combination of benign breast disease and BI-RADS category C or BI-RADS category D (extremely dense) breast density had a nearly threefold or greater 10-year risk for breast cancer in comparison to women who had no breast disease and BI-RADS category A breast density.

“Our findings strengthen the evidence suggesting that benign breast disease and breast density are important factors that should be carefully considered when stratifying breast cancer risk and should be incorporated in future breast cancer risk models,” wrote senior author Boyoung Park, M.D., Ph.D, who is affiliated with the Hanyang University College of Medicine in Seoul, Korea, and colleagues.

In a subsequent subgroup analysis, Park and colleagues found the combination of breast density and benign breast disease was associated with higher risks for developing invasive breast cancer and ductal carcinoma in situ (DCIS).

Given the overall findings of the study, the authors suggested that supplemental screening could be beneficial for this patient population and noted recent studies on the topic, including 

one study that found supplemental magnetic resonance imaging (MRI) in comparison to mammography alone reduced interval cancers in women with BI-RADS category D breast density in a two-year screening period

In regard to study limitations, Park and colleagues noted no biopsy results were available from the NHIS-NHID database utilized for the study. As per the Korean national cancer screening guidelines, the study authors pointed out that further workup and periodic mammography screenings are not recommended for those diagnosed via mammography with benign breast disease. Although the application of BI-RADS categories can vary with ability and experience level, the study authors acknowledged that at several screening centers, one radiologist interpreted the BI-RADS breast density and classification categories.

Researchers found that Korean women with a combination of benign breast disease and BI-RADS category C or BI-RADS category D breast density had a nearly threefold or greater 10-year risk for breast cancer.

Large Study Finds Elevated 10-Year Breast Cancer Risks in Women with Dense Breasts and Benign Breast Disease

Emphasizing that magnetic resonance imaging (MRI) is the most sensitive imaging test for the detection of breast cancer, Linda Moy, MD, FSBI, FACR, FISMRM, discussed a variety of tips for maximizing lesion conspicuity, minimizing false positives, and improving consistency in interpreting exam findings during her recent lecture at the Society of Breast Imaging (SBI)/American College of Radiology (ACR) conference.

Here are a few pertinent points from Dr. Moy’s lecture:

1. In order to facilitate optimal breast imaging with MRI, ensure the system:

• allows good fat saturation over both breasts;

• has a bilateral breast coil with prone positioning;

• has sufficient magnetic field gradients to facilitate fast gradient-echo imaging; and

• has sufficient magnetic field strength with good magnetic field homogeneity.1

2. While one study found that 1.5 T and 3 T MRI scanners are both suitable for breast MRI, Dr. Moy said 3T scanners are preferred for ultrafast MRI imaging as minimum spatial resolution is difficult to achieve with other scanners.2

3. In regard to coils, Dr. Moy emphasizes that radiologists should ensure the current hardware and software of the MRI system can accommodate the number of channels in the breast coil.

4. When it comes to axial versus sagittal imaging, sagittal imaging offers a small field of view with high spatial resolution and field uniformity, according to Dr. Moy, a professor of radiology at the New York University Grossman School of Medicine. She adds that you can get twice the number of slices in less than two minutes of acquisition time.

5. Dr. Moy said axial imaging is preferred with multiplanar reformation in the sagittal plane. She noted this approach makes it easier for radiologists to appreciate bilateral focal background parenchymal enhancement (BPE).

6. When it comes to slice thickness, Dr. Moy noted that thin slices are beneficial in evaluating foci and minimizing partial volume effects on diffuse non-mass enhancement (NME) (e.g. ductal carcinoma in situ (DCIS)).

7. In regard to breast MRI enhancement patterns, the ideal time to maximize cancer detection and normal BPE is at 90 seconds.

8. Obtain the first scan 60 to 90 seconds after contrast injection to maximize conspicuity of the cancer.

9. For high-quality breast MRI, Dr. Moy recommends multiphase T1-weighted contrast-enhanced scanning. Key aspects would include high in-plane spatial resolution (1 mm pixel sizes), thin slices (

2.5 mm thickness) and adequate temporal resolution (one to two minutes).

10. For patients with higher BPE, there are no significant decreases in sensitivity and cancer detection rates.

2. Dietzel M, Wenkel E, Hammon M, et al. Does higher field strength translate into better diagnostic accuracy? A prospective comparison of breast MRI at 3 and 1.5 Tesla. 

In a recent lecture at the Society of Breast Imaging (SBI)/American College of Radiology (ACR) conference, Linda Moy, MD, reviewed key tips for optimizing magnetic resonance imaging (MRI) of the breast.

Ten Key Considerations with Breast MRI

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

 for the artificial intelligence (AI)-enabled algorithms Saige-Dx™, which aids in detecting suspicious findings on mammograms, and Quantib® Prostate 2.0, which may bolster reporting of prostate magnetic resonance imaging (MRI) exams.

Saige-Dx reportedly enhances the detection of suspicious lesions on mammograms and reduces recalls, according to RadNet. Built on advanced deep learning algorithms, Saige-Dx decreased false positive rates and improved the ability of 18 radiologists to detect cancer in a study that preceded the FDA 510(k) clearance, noted DeepHealth, a subsidiary of RadNet.

Quantib Prostate 2.0 provides automated segmentation of prostate zones and glands as well as lesion localization on the PI-RADS sector map, according to RadNet.

The company noted that the software program enhances the quality and speed of reporting with prostate MRI exams. RadNet said other benefits of Quantib Prostate 2.0 include PSA density calculation, PI-RADS scoring support and one-click segmentation of possible lesions.

“Artificial intelligence will have a transforming impact on radiology and cancer care, and we are committed to delivering those advances to patients and health-care providers,” noted Howard Berger, the president and chief executive officer of RadNet. “ … We believe that these AI tools will play an important role in the early detection and diagnosis of cancer, resulting in improved survival rates and better patient outcomes.”

Could the emerging artificial intelligence platforms Saige-Dx and Quantib Prostate 2.0 improve cancer detection with mammography and prostate MRI?

RadNet Gets FDA Nods for AI-Powered Mammography and Prostate MRI Software Algorithms

A decent chunk of my daily radiological workload comes with “prelim” interpretations. Sometimes they come from residents. Some of them come from other health-care personnel. I don’t know that I would be able to identify the source for any particular case. It is not readily apparent. Maybe this is by design but there is a lot to be said for double-blinding in quality assurance (QA). Without knowing, I tend to assume it is coming from a resident rad but that is pure instinct.

After the most important aspect of prelim reads (identifying when there is a difference of opinion and communicating it to the clinicians), it seems to me the second priority is for the prelim reader to get feedback about when he or she has done well, or when the prelim reader has something to learn.

I don’t expect the prelim folks to always be enthusiastic about it. Given the usual structure of QA systems, I wouldn’t be surprised if the majority of participants preferred to opt out of it. One can’t be thrilled with the constant lurking threat of peers or superiors reaching out to say “Hey, you screwed up.”

Still, I perceive the whole prelim/final interplay to be mutually beneficial, a kind of professional handshake. The prelim reader gets to do a cursory read, learn stuff, and potentially have errors caught/corrected by someone else, and the final reader gets an extra set of eyes reviewing things while not having to work 24/7/365.

As a final reader guy, I therefore consider it my part of the bargain to provide whatever value I can, sometimes communicating stuff to the prelim readers beyond the mere (in)accuracy of their reads. This may be in the form of pointers or interesting tidbits. I do concede though that sometimes my days are so hectic that I don’t communicate as much as I would like to.

A recent case in point has prompted me to share my advice with my readers since I never caught up with the prelim reader who inspired it. There was a random emergency room (ER) or urgent care X-ray of an extremity. The prelim reader noted “No obvious fracture.”

I didn’t see one either and moved on. However, something about that prelim stuck in my mind. After a little while, I put my finger on it: Hey, prelim person, is that the limit of your value? You’re only willing to say there is nothing obvious on the images?

The study was good quality. There wasn’t any diagnostic limitation. Indeed, it was a simple three-view X-ray, not advanced imaging of any kind. I know folks can say stuff like “No gross pathology” if they want to underscore that they’re not getting the best view of things.

Could it be that the prelim reader wanted to emphasize that the final read guy has greater skills/experience to the point where there is subsequent appreciation of subtle pathology the prelim reader isn’t equipped to identify? Recognizing one’s own limitations is a good thing, and people like a reasonable dose of humility.

Let’s go with that notion for a moment: I 

 have issues with throwing in that “obvious.” What do you suppose it says to everyone else involved? As the final read guy, it puts the notion in my mind that maybe the prelim readers didn’t look too carefully. Maybe the referring clinician gets the same impression or, if the referrer wrote the prelim him- or herself, everyone else involved in the patient’s care gets that impression about the care that was rendered.

What if the patient got a look at the prelim? If you went to an ER because you thought your leg might be broken and the person responsible for treating you, someone you trusted to be an experienced professional, shrugged, and said you had no “obvious” injury, would that reassure you or would you feel like your case was casually dismissed?

I hear “obvious” applied to a fracture, and I think of something that doesn’t take a radiologist, physician, or other health-care individual to identify it. Google images for “fracture” and most of the pix you see will be things that a grade-schooler could look at and say, “That’s broken.”

I think we can hold ourselves to a higher standard than that—and this includes residents, physician assistants (PAs), and even medical students. If you are in a position to be rendering even preliminary interpretations, you’ve accomplished enough in life that you don’t need to be hedging by saying you’re only liable to find “obvious” stuff. Your opinion is worth more than that.

Alternatively, if you believe you can or should only be on the hook for seeing “obvious” abnormalities, you probably shouldn’t be rendering even preliminary interpretations.

Besides, when you do inevitably miss something, nobody’s going to consider your error any more forgivable because you used hedging terms like “obvious” or “gross.”

One other thought struck me with the “obvious” prelim comment. Some folks get so accustomed to throwing around words like that, it becomes a thoughtless reflex. It stops meaning anything to them, but others still hear it.

Possibly my best preceptor from medical school, a guy I have referenced in this column before, regularly corrected or otherwise commented on the verbiage of his house staff and students. H would tell interesting stories of word origins, and even address grammar and pronunciation. One of his enduring lessons was words matter, if not to you, then at least to your audience.

One of the interns on my rotation with that preceptor routinely used “basically.” Any time he was presenting a patient or giving an update on developments since previous rounds, he would launch with that word. He made it surprisingly far into the first week of that month before the preceptor called him on it. “You use that word a lot,” he observed. “Does it add anything to what you’re saying? It seems more like a nervous habit. You’re not simplifying anything for our benefit, are you?”

Of course, he wasn’t and knocked it off almost immediately. Darned if he did not immediately sound more professional and confident in his presentations.

Is it a thoughtless verbal reflex or a failure to go beyond a surface read of imaging?

Questioning 'Obvious' Notations from Prelim Readers

Recognizing the shift from age-based breast cancer screening to screening programs that are more focused on risk stratification, Volpara will be 

spotlighting its Volpara Risk Pathways™ software

 at the annual Society of Breast Imaging (SBI)/American College of Radiology (ACR) conference in Savannah, Ga. this week.

Drawing upon patient data from mammography reporting systems or electronic health records, Volpara Risk Pathways reportedly facilitates the identification and management of patients who are at high risk for breast cancer, according to Volpara. The company said the software’s assessment of an individual’s risk for breast cancer enables enhanced triage decisions for supplemental imaging and/or genetic testing.

Volpara will also spotlight the Analytics in Action program, which offers on-site training from Mammography Educators.

“The Analytics in Action program is designed to help deliver high-quality, personalized breast cancer screening by improving image quality, reducing errors, and increasing proficiency and efficiency. We are excited for our partnership with Volpara to deliver hands-on, personalized training sessions designed not only to help address common positioning performance issues but also to create a culture of quality and continuous improvement that ultimately will result in better screening and better patient care,” noted Louise Miller, R.T. (R)(M)(ARRT), CRT, FSBI, FNCBC, the director of education and co-founder of Mammography Educators.

The company will spotlight the breast cancer risk stratification software Volpara Risk Pathways and a new mammography training collaboration with Mammography Educators.