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COVID-19 halted all cancer screening services at the beginning of the pandemic, and slowly those scans have become more and more available -- but, not necessarily for everyone.

In many instances, racial and minority patients continue to face the same healthcare disparities that made it difficult for them to access the services at the outset. Now, the fear and trepidation associated with the pandemic are layered on top. 

Despite these difficulties, there are things healthcare institutions and providers can do to help. In this episode of 

 spoke with Shalmon Kalnicki, M.D., chair of radiation and oncology at Montefiore and Albert Einstein College of Medicine about the challenges these patients continue to face with cancer screenings. Not only did he share with us how COVID-19 has impacted this existing problem, but he also outlined the steps institutions can take to improve this situation.


In this podcast episode, Dr. Shalom Kalnicki, from Montefiore and Albert Einstein College of Medicine, discusses the disparities minority patients face with cancer screenings and what can be done to increase access during the pandemic.

The Reading Room: Racial and Ethnic Minorities, Cancer Screenings, and COVID-19

For masses interpreted as BI-RADS category 4 and 5 presentations on breast ultrasound, the authors of a new study found that the presence of echogenic rind had an 81 to 85 percent specificity for malignancy.

Echogenic Rind on Breast Ultrasound Associated with High Specificity for Malignancy

The Voluson Performance 18 and 16 ultrasound devices reportedly combine enhanced imaging capabilities with AI-enabled efficiencies.



GE HealthCare Launches AI-Powered Voluson Performance 18 and 16 Ultrasound Systems

While the research reveals key benefits with portable imaging, particularly point-of-care ultrasound applications with AI capabilities, these authors note challenges with variability in training and advocate for radiologist-led oversight.

Portable Imaging and Radiology: Where Things Stand with Point-of-Care Diagnostics

The MyLab A50 and MyLab A70 ultrasound platforms reportedly enable a variety of detailed and multiparametric evaluations, including assessments for liver elastography and strain analysis echocardiography.



FDA Clears New Ultrasound Systems from Esaote

Could the NeedleVue LC1 Ultrasound System reinvent real-time ultrasound-assisted needle guidance for interventional procedures? 

FDA Clears Emerging Ultrasound Device for Interventional Procedures

Welcome to Diagnostic Imaging’s Weekly Scan, which offers an opportunity to catch up on the most well-viewed radiology content of the past week.

In light of emerging research suggesting an 

increased incidence of breast cancer among women under the age of 40

, Drs. Jean Seely, MD, Zeeshan Shah, MD and Amy Patel, MD, discussed what they’re seeing in practice and emphasized increased vigilance to facilitate early detection.

In a new retrospective study published earlier this week in the 

the impact of radiation exposure from medical imaging

 in a cohort of over 3.7 million children. They estimated that radiation exposure from imaging may be associated with 10.1 percent of hematologic cancers in this patient population.

, Drs. Noa Antonissen and Colin Jacobs discussed new research suggesting that a CT-based deep learning model may facilitate 

a nearly 40 percent reduction in false positives with indeterminate lung nodules

Multiple nuclear medicine societies, including the Society of Nuclear Medicine and Molecular Imaging, unveiled 

guidelines this week for PET myocardial perfusion imaging (MPI)

. Check out our takeaways from the new recommendations on appropriate protocols and keys for interpretation of PET MPI.

In a new breast ultrasound study focusing on BI-RADS category 4 and 5 mass presentations, researchers noted that the 

 had an 81 to 85 percent specificity for malignancy.

Diagnostic Imaging's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest conference reports.

Diagnostic Imaging's Weekly Scan: September 14 — September 20

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

While the final rule for the Mammography Quality Standards Act (MQSA) with respect to a national standard for breast density notification on mammography reports was issued in March 2023, implementation has been a significant undertaking.

“For states that did not have a breast density law before, I think this is a very heavy lift,” noted Stamatia Destounis, M.D., FACR, FSBI, FAIUM, a breast imaging specialist with Elizabeth Wende Breast Care in Rochester, N.Y., and chair of the American College of Radiology (ACR) Breast Imaging Commission.

Noting that breast density notification has been the law since January 2013 in New York, Dr. Destounis emphasized the importance of ongoing education for staff, patients and referring physicians. She recalled it taking about three to four years before physicians started asking questions about breast density.

In anticipation of the nationwide standard for breast density notification going into effect on September 10, 2024, Dr. Destounis said her facility revamped their website and emphasized social media to spread the word to patients. Accordingly, she has seen an “uptick of calls and appointments” for patients seeking genetic counseling at her facility, which has led to increased supplemental breast MRI screening.

“Many go ahead and schedule their supplemental screening with their mammogram,” added Dr. Destounis.

In order to accommodate the increased imaging volume. Dr. Destounis said her facility has hired more staff, expanded hours during the week and added weekend hours as well.

While the ongoing educational, logistical, and staffing challenges can be onerous, Dr. Destounis emphasized that every week, she is seeing cases of small invasive breast cancers on ultrasound and linear ductal enhancement on breast MRI that cannot be found on standard mammography.

(Editor’s note: For related content, see “

Current Insights on National Breast Density Notification for Mammography Reports

Looking at Next Steps to Reinforce National Breast Density Notification

Long-Term Study Shows Merits of Contrast-Enhanced Mammography for Women with Higher Breast Cancer Risk

For more insights from Dr. Destounis, watch the video below.

In a recent interview, Stamatia Destounis, MD, discussed the impact of national breast density notification for mammography reports.

Addressing the Early Impact of National Breast Density Notification for Mammography Reports

In a recent interview, Stamatia Destounis, M.D., discussed the impact of national breast density notification for mammography reports and key considerations with staffing and ongoing education for patients, staff and referring providers on the merits of supplemental breast imaging.

Stacy Smith-Foley, M.D., was pleased to see the United States Preventive Services Task Force (USPSTF) realign with the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) in recommending mammography screening to begin at 40 years of age for women of average risk for breast cancer.

However, in a recent interview, Dr. Smith-Foley expressed disappointment with the 

USPSTF’s lack of support for supplemental imaging in women with dense breasts and continued mammography screening for women 75 and older

, as well as the emphasis on biennial mammography screening for women 40 to 74 years of age.

Yearly mammography screening gives women the best chance for early breast cancer detection, emphasized Dr. Smith-Foley, the medical director of the Breast Center at the Central Arkansas Radiation Therapy Institute (CARTI) in Little Rock, Arkansas.

“When women skip their mammogram intentionally or unintentionally, … we tend to find more advanced disease. The breast cancer is larger, it is more extensive, it is more often a higher grade and more frequently involves the axilla with local regional metastasis. What I see in clinical practice is that when we have these gaps or delays (with mammography screening), the disease is more extensive,” explained Dr. Smith-Foley.

Biennial Mammography Over Annual Mammography? USPSTF Issues Updated Breast Cancer Screening Recommendations

Mammography Study Shows Link Between Enlarged Axillary Lymph Nodes and Higher Risks for Diabetes and Cardiovascular Disease

Breast MRI and Dense Breasts: A Closer Look at Early Findings from a New Prospective Trial

Dr. Smith-Foley also disagrees with the USPSTF’s assertion of insufficient evidence to continue annual mammography screening in women 75 and older.

“I have a whole collection of patients under my care in their 80s and 90s who presented to me with locally advanced breast cancer that would have been detected at an earlier stage if they had been participating in yearly screens,” maintained Dr. Smith-Foley.

For more insights from Dr. Smith-Foley, watch the video below.

Stacy Smith-Foley, MD discusses shortcomings with the recently updated USPSTF breast cancer screening recommendations.

Where the USPSTF Breast Cancer Screening Recommendations Fall Short: An Interview with Stacy Smith-Foley, MD

In a recent interview, Stacy Smith-Foley, M.D., shared her perspective on the shortcomings of the recently issued breast cancer screening recommendations from the United States Preventive Services Task Force (USPSTF).

Overtreatment of patients with prostate cancer has been a significant issue and may have impacted between one to two million men with the disease, suggested Steven Raman, M.D., in a recent interview.

However, the emergence of magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) appears to be a promising option for men with intermediate risk 

, a treatment that has a more favorable side effect profile than surgery and radiation, according to Dr. Raman, a professor of radiology, urology and surgery at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

In research presented at the recent Society of Interventional Radiology (SIR) conference, Dr. Raman noted the use of MRI-guided TULSA led to a 92 percent reduction in median prostate volume (from 37.3 ml to 2.8 ml) and a 48 percent reduction in the presence of Gleason Grade (GG) 2 PCa at one year.

At five years after treatment with MRI-guided TULSA, Dr. Raman and colleagues found that 87 percent of patients had preserved erectile function and 92 percent had recovered pad-free continence.

Dr. Raman says the use of MRI guidance and thermometry are more advantageous than prior ultrasound monitoring of thermal ultrasound treatments and key to the success of the TULSA procedure.

“What I don’t like about (ultrasound monitoring) is you don’t know how hot (it is) getting and where exactly you are treating. With MRI, thermometry is an important tool. MRI images the entire prostate as you’re treating it and while you’re treating it, you’re seeing how hot things get in the prostate and outside the prostate,” explained Dr. Raman. “This is an important safety tool to minimize damage to the nerve, the sphincter, and other things, and that results in much better outcomes.”

Emerging Insights on MRI-Guided Transurethral Ultrasound Ablation for Prostate Cancer

Can MRI-Guided Transurethral Ultrasound Ablation Have an Impact for Localized Prostate Cancer?

Can MRI Findings Help Predict Toxicity After Radiotherapy for Prostate Cancer?

For more insights from Dr. Raman, watch the video below.

In a recent interview, Steven Raman, M.D., discussed MRI-guided transurethral ultrasound (TULSA) in the treatment of intermediate risk prostate cancer. 

A Closer Look at MRI-Guided Transurethral Ultrasound Ablation for Intermediate Risk Prostate Cancer

In a recent interview, Steven Raman, M.D., discussed the use of MRI-guided transurethral ultrasound (TULSA) in the treatment of intermediate risk prostate cancer and key research findings with one- and five-year outcomes. 

Reportedly 365,000 people in the United States had breast augmentation procedures in 2021.

 Emerging research comparing digital breast tomosynthesis (DBT) use in women with and without breast implants found a 22 percent lower cancer detection rate for women with breast implants. Yet there are currently no imaging guidelines specifically geared to breast cancer screening in patients with breast implants.

Society of Breast Imaging (SBI) conference

, Stephen Rose, M.D, pointed out the breast implants may obscure between nine to 44 percent of glandular tissue on imaging. In a recent video interview, Dr. Rose said there are a number of factors, ranging from age of the implant and fibrosis to implant size, implant-related scarring and breast size, that can affect interpretation of breast imaging in patients with breast implants.

In retrospective research presented at the SBI conference, Dr. Rose and colleagues reviewed data from 350,845 DBT exams (including 20,929 DBT exams for women with breast implants) performed at 49 community-based outpatient imaging centers in 2019. In addition to the aforementioned lower cancer detection rate in women with implants, Dr. Rose and colleagues found that women with breast implants had a nearly 5.5 percent increase in ductal carcinoma in situ (DCIS) and a 4.8 percent higher incidence of positive lymph node involvement in detected cancers.

Breast Reconstruction: Current Principles and Emerging Concepts in Imaging

Study Highlights Use of Contrast-Enhanced Mammography in Women with Breast Implants

Has the time come for imaging guidelines that are more specific to the nuances and supplemental imaging needs for women with breast implants?

“Other than the same guidelines we use for women without breast implants, there really hasn’t been any specific guidelines by our societies that suggest doing more (for women with breast implants),” noted Dr. Rose, the founder and president of Rose Imaging Specialists. “It’s all been pretty anecdotal recommendations and it’s not like this is an insignificant number of patients. In some of our populations, 10 to 15 percent have implants.”

For more insights from Dr. Rose, watch the video below.

1. The Aesthetic Society. Aesthetic Plastic Surgery National Databank Statistics 2020-2021. Available at: https://cdn.theaestheticsociety.org/media/statistics/2021-TheAestheticSocietyStatistics.pdf . Accessed June 14, 2023.

In a recent video interview, Stephen Rose, M.D., reviewed a variety of factors that can impact interpretation of breast imaging for women with breast implants and discussed recent research showing a 22 percent reduction in cancer detection rate for this population in comparison to women without breast implants.

Radiology Challenges with Breast Cancer Screening in Women with Breast Implants

Recently published research suggests an emerging handheld ultrasound technique could be beneficial for breast cancer screening in underserved populations with limited or no access to conventional imaging modalities.

, assessed volume sweep imaging (VSI) of 170 palpable breast lumps with a handheld ultrasound probe (Butterfly iQ, Butterfly Network). The handheld VSI ultrasound scans were performed by medical students who received less than two hours of training on the VSI protocol and had no prior ultrasound training, according to the study.

The researchers found that the VSI handheld ultrasound technique had a 97 percent sensitivity for breast masses and an 87 percent agreement with conventional ultrasound devices on Breast Imaging-Reporting and Data System (BI-RADS) assessments.

In a recent video interview, Thomas Marini, MD, discussed the VSI technique, the study findings, and the global need for increased access to ultrasound imaging.

“The Pan-American Health Organization (PAHO) estimates that two-thirds of people in the world don’t have access to any form of medical imaging and that 70 to 80 percent of their conditions can be diagnosed with basic modalities like ultrasound and X-ray,” noted Dr. Marini, who is affiliated with the University of Rochester Medical Center.

For more insights from Dr. Marini, watch the video below.

In a recent video interview, Thomas Marini, MD discussed the need for ultrasound access to facilitate breast cancer screening in underserved populations and the potential utility of volume sweep imaging, a handheld ultrasound technique that requires minimal training and has a high rate of agreement with conventional ultrasound on BI-RADS assessments.

Can Volume Sweep Imaging with Ultrasound be a Viable Option for Breast Cancer Screening in Underserved Countries?

The purchase of new and cutting-edge imaging equipment comes with a lot of excitement—and a learning curve. That's where Canon Medical Education comes in, providing a host of education solutions for clients that include both in-person and virtual training and continuing education opportunities.

The education arm of Canon Medical Systems USA provides a customizable plan to ensure that all imaging associates are well-trained and comfortable operating advanced equipment including MR and CT, as well as vascular and cath applications, among others. 

Understanding that every learner is different, Canon offers educational opportunities that include in-person, at their Institute of Advanced Imaging in Irvine, California; on-site training at a client facility; online and instructor-led courses in their Canon Learning Center; as well as CE and non-CE webinars and special programs.

To learn more about Canon's educational offerings, 

Canon Medical Systems offer a range of in-person and virtual educational opportunities for their clients. 

Education in Radiology: Canon's Customized Approach

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor, Whitney Palmer.

Before we get to our featured interview – a re-visit with Dr. Anupam Basu in light of this week’s announcement from the U.S. Preventive Services Task Force about its changing recommendation for lung cancer screenings – here are the top stories of the week.

Speaking of that change in lung cancer screening recommendation – the U.S. Preventive Services Task Force announced two significant changes to its existing guidance about when smokers should begin low-dose CT for lung cancer screening. The original recommendation supported annual low-dose CT screening for smokers or former smokers who were between ages 55 and 80 who had 30 pack-year histories or who had stopped smoking within the last 15 years. Based on new research on screening efficacy, the Task Force published their amendments in 

. The new guidance now supports annual screening for smokers and non-smokers between ages 50 and 80 with 20 pack-year histories or smoking cessation within the past 15 years. This move, the Task Force says will give 6.4 million more people access to screening – that’s an 81 percent increase. The hope, the Task Force said, is that this move will make it easier for previously under-screened groups to get the scans they need for earlier detection and earlier treatment. This could be particularly impactful with African American smokers who have worse outcomes with lung cancer despite having pack-year histories that fell below the previous 30-year threshold. The supporting research also revealed making this change helped avoid more deaths – between 469 and 588 per 100,000 for patients with 20 pack-year histories versus 381 per 100,000 for patients with 30-year histories, and they also gained more life years – 6,018-to-7,596 years per 100,000 patients compared with 4,882 per 100,000 for patients with 30-year histories. Still, the research did point to more false positives, over-diagnosis, and other radiation-induced cancer deaths with the increased eligibility for screening.

It has been no secret that the COVID-19 pandemic has had a chilling effect on cancer screenings nationwide – fear of viral exposure, a shortage of PPE for providers, a patient’s inability to pay for the service, and inconsistent guidance from the CDC all created the perfect storm for fewer patients coming in for the screenings they need, particularly screening mammography and lung cancer screenings. This week, 

, and interventional and diagnostic radiologist from The Ohio State University took a look at the lingering impact of the pandemic and how radiology practices should proceed to bring patients back in for screening services in a safe, efficient way.

Patients do not typically seek treatment for unintentional weight loss in the emergency department, but for the 5 percent to 7 percent who do, CT scans can help providers shed light on what might be behind the problem. In a study published in 

investigators from University Hospitals Cleveland Medical Center and Case Western Reserve University showed that, as a first-line imaging approach, CT can offer a true-positive rate of 48.8 percent for identifying organic causes of unintentional weight loss. For their study, they included 133 patients who had chest, abdomen, or pelvis CT scans in their emergency department between 2004 and 2020. Based on their analysis, they determined CT made 65 true-positive detections – 41 cases of non-malignant gastrointestinal conditions and 30 cases of cancer. They also saw that elevated white blood cell counts and physical exam irregularities were also significantly associated with CT abnormalities.

And, finally, this week, we’re taking a look back at an interview with Dr. Anupam Basu from Cook County Hospital in light of this week’s lung cancer screening announcement from the U.S. Preventive Services Task Force. He recently published a study in the 

Journal of the American College of Radiology

 that revealed the previous 30 pack-year history was too high a threshold for African American smokers. He spoke with us about the details of his findings, what they mean for African American smokers, and how radiologists can use this information. Here’s what he had to say.

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

USPSTF lung cancer screening recommendation update; Cancer screenings and COVID-19; and CT and unintentional weight loss.

Diagnostic Imaging's Weekly Scan: March 12, 2021

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor Whitney Palmer.

Before we get to our featured interview with Dr. Prachi Agarwal about the prevalence of sexual harassment and gender discrimination in radiology, here are the top stories of the week.

By now, you’ve heard the news that the COVID-19 vaccine can cause unilateral axillary adenopathies that mimic breast malignancies. To date, the information you’ve been given about how to approach and handle these findings has been geared toward when you identify them on mammography or ultrasound. But, what about breast MRI? This week, radiologists from the Hospital of the University of Pennsylvania shared recommendations in the 

 based on their experience with a patient who presented with these findings on breast MRI 13 days post-vaccine. For these instances, they recommended: adding questions about COVID-19 vaccinations dates and laterality of administration to all breast imaging intake forms, assessing the lymphadenopathy as BI-RADS 3, recommending ultrasound follow-up 6-to-8 weeks after the second vaccine dose, and scheduling screening MRI 6-to-8 weeks after the second dose, when clinically appropriate, to minimize the chance of detecting reactive lymphadenopathies that could prompt more imaging. They also pointed out that providers can anticipate COVID-19 vaccine-related adenopathies to follow the same timeline of responses to the influenza vaccine seen on FDG PET/CT – adenopathies will appear within 14 days of vaccine administration, and they will likely disappear after that two-week period.

Current guidance from the U.S. Preventive Services Task Force might point to biennial mammography screening for women starting at age 50, but new research from the University of Texas MD Anderson Cancer Center reveals that starting baseline screening for women at age 40 is cost-effective. In a study published in the

investigators used a microsimulation model with 500,000 average-risk women born in 1970 to examine seven mammography screening situations. They determined that capturing a baseline at age 40 is associated with the greatest reduction in breast cancer mortality, and it is cost-effective. But, it also is associated with the highest rates of false positives and over-diagnosis. The second preferred screening strategy was annual screenings for dense-breasted women between ages 40 to 75, followed by biennial screening for non-dense breasted women between ages 50 and 75.

For radiation oncologists, seeing their therapy in action could lead not only to validation of efficacy, but also to opportunities for potential improvement. With a new method, known as Cherenkov imaging, these providers now have the ability to capture imaging and real-time video of the beam shining directly on the patient’s skin. This technique, developed at the Dartmouth-Hitchcock Norris Cancer Center in concert with a Dartmouth spin-off company DoseOptics, LLC, uses BeamSite cameras they created and shows real-time images of the treatment-beam shape, as well as intensity levels that are proportional to the radiation dose. The captured data can verify dose accuracy and beam delivery in a way standard quality assurance measures cannot. Dartmouth researchers tested the technique with 64 patients who received treatment for breast cancer, sarcoma, lymphoma, or other concerns, and in a study published in 

The International Journal of Radiation Oncology, Biology, Physics

, they explained that using Cherenkov imaging showed six patients could have benefited from beam adjustments. Even though only 1 percent of radiation therapies typically need correction, the investigators said it takes the guess work out of radiation therapy and can improve the experience for both patient and provider.

And, finally, this week, Diagnostic Imaging spoke with Dr. Prachi Agarwal from Michigan Medicine about the prevalence of sexual harassment and gender discrimination within radiology. She shared her insights on how these experiences impact how female radiologists see in industry and the potential of their careers, as well as what institutions can and should do to change the culture and improve inclusivity. Here’s what she had to say.

COVID-19 Vaccine-Related Adenopathies on Breast MRI; Baseline Mammography at 40; Cherenkov Imaging to Improve Radiation Therapy Improvement; and Sexual Harassment and Gender Discrimination in Radiology

Diagnostic Imaging's Weekly Scan: Feb. 12, 2021

 Weekly Scan. I’m senior editor Whitney Palmer.

Before we get to our featured interview of the week with Dr. Jennifer Marin from the University of Pittsburg Medical Center about advanced imaging utilization rates with pediatric patients, here are the top stories of the week.

After all the anticipatory talk about whether a portable, low-field MRI would be able to produce images that were accurate and of diagnostic quality, a study was published this week in 

 shows it can effectively assess patients in the intensive care unit for brain injury just as well as conventional imaging methods. According to a team from Yale New Haven Hospital, the 64mT MRI that can plug into a standard electrical outlet in any room matched the performance of standard imaging with both patients who were infected with COVID-19 and those who were virus free. They tested the technology between Oct. 30, 2019, and May 20, 2020, with 50 patients, 20 of whom were COVID-19-positive. The remaining patients had suffered ischemic, hemorrhagic, or subarachnoid stroke or they had traumatic brain injury or a brain tumor. All patients also underwent conventional CT or MRI as a comparison scan. Based on their analysis, the portable MRI identified neurological findings in 29 of the 30 infection-free patients – a performance that corresponded to the results of conventional imaging except for one diffuse subarachnoid hemorrhage. In addition, the portable system pinpointed findings in eight of the 20 COVID-19 patients, including intracranial hemorrhage, cerebral infarction, diffuse cerebral edema, and leukoencephalopathy. This performance was identical to that of conventional imaging. These results, the team said, show the potential for portable assessment of neurological injury in other scenarios, including the emergency department, mobile stroke units, and resource-limited environments.

And, when it comes to COVID-19, cardiac MRI can have an important role to play with competitive athletes who have recovered from the virus. In a study published in 

 a team of investigators from The Ohio State University shared their results. The team conducted cardiac MRI on 26 competitive athletes with an average age of 19.5 years who ran track or played football, soccer, lacrosse, or basketball. Twelve athletes reported mild infection with sore throat, shortness of breath, fatigue, or fever, while the remaining 14 individuals were asymptomatic. Based on the scans, the team determined four athletes had evidence of myocarditis based on the presence of myocardial edema and myocardial injury. Other athletes also experienced myocardial inflammation. Based on these results, the team said, cardiac MRI can potentially identify a high-risk cohort for adverse outcomes. It may also be able to effectively risk stratify which athletes can safely resume competitive play as the scan has a high negative predictive value for ruling out myocarditis.

Portable, Low-field MRI; COVID-19 and Cardiac MRI; High-Intensity Focused Ultrasound; Coronary CTA Guidance; and Pediatric Advanced Imaging Utilization

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