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

February 12, 2021
Whitney J. Palmer

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

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 American Journal of Roentgentology 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 Annals of Internal Medicine, 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.

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