RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current ... more RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current practices of reporting breast arterial calcification (BAC) on mammography and to determine perceptions about the value of BAC communication and follow-up recommendations among radiologists. MATERIALS AND METHODS In September 2020, an 18-item online survey was emailed to radiologist members of the American College of Radiology (ACR). Questions included radiologist demographics, current BAC reporting practices, follow-up recommendations, and perceptions about BAC. Five-point Likert scales were used and multivariate analysis was performed. RESULTS Of 598 completed survey responses, up to 87% (522/598) of ACR radiologist members include BAC in mammogram reports. However, only 41% (212/522) of respondents report BAC 'always' or 'most of the time'. Radiologist factors significantly associated with BAC reporting include years in practice and fellowship training with those in practice longer more likely to report BAC (OR 1.10, 95% CI, [1.01-1.20], p = 0.023) and those with fellowship training less likely to report BAC (OR 0.63, 95% CI, [0.42-0.94], p = 0.024). When BAC is reported, 69% (360/522) simply indicate the presence of BAC, 23% (121/522) provide a subjective grading of BAC burden, and 1% (6/522) calculate a BAC score. Among the radiologists reporting BAC, 58% (301/522) make no subsequent recommendations, while the remainder recommend primary care follow-up (39%; 204/522), cardiology evaluation (13%; 68/522), and/or coronary calcium scoring CT (11%; 59/522). Overall, there was agreement from 66% (392/598) of respondents that BAC is a cardiovascular risk factor. However, there was no consensus on whether patients and/or providers should be informed about BAC or whether reporting of BAC should become a standardized practice in breast imaging. Older and more experienced radiologists are more likely to agree that BAC is a cardiovascular risk factor (p = 0.022), providers should be informed about BAC (p = 0.002 and 0.006), BAC reporting should be a standardized practice (p = 0.004 and 0.001), and feel more comfortable informing patients about BAC (p = 0.001 and 0.003). CONCLUSION Radiologists' reporting practices and perceptions regarding BAC are not homogeneous. Although many radiologists report BAC to varying degrees, it is not routinely reported or recommended for follow-up in mammogram reports. Experienced radiologists are more likely to include and value BAC in their breast imaging practice.
RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current ... more RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current practices of reporting breast arterial calcification (BAC) on mammography and to determine perceptions about the value of BAC communication and follow-up recommendations among radiologists. MATERIALS AND METHODS In September 2020, an 18-item online survey was emailed to radiologist members of the American College of Radiology (ACR). Questions included radiologist demographics, current BAC reporting practices, follow-up recommendations, and perceptions about BAC. Five-point Likert scales were used and multivariate analysis was performed. RESULTS Of 598 completed survey responses, up to 87% (522/598) of ACR radiologist members include BAC in mammogram reports. However, only 41% (212/522) of respondents report BAC 'always' or 'most of the time'. Radiologist factors significantly associated with BAC reporting include years in practice and fellowship training with those in practice longer more likely to report BAC (OR 1.10, 95% CI, [1.01-1.20], p = 0.023) and those with fellowship training less likely to report BAC (OR 0.63, 95% CI, [0.42-0.94], p = 0.024). When BAC is reported, 69% (360/522) simply indicate the presence of BAC, 23% (121/522) provide a subjective grading of BAC burden, and 1% (6/522) calculate a BAC score. Among the radiologists reporting BAC, 58% (301/522) make no subsequent recommendations, while the remainder recommend primary care follow-up (39%; 204/522), cardiology evaluation (13%; 68/522), and/or coronary calcium scoring CT (11%; 59/522). Overall, there was agreement from 66% (392/598) of respondents that BAC is a cardiovascular risk factor. However, there was no consensus on whether patients and/or providers should be informed about BAC or whether reporting of BAC should become a standardized practice in breast imaging. Older and more experienced radiologists are more likely to agree that BAC is a cardiovascular risk factor (p = 0.022), providers should be informed about BAC (p = 0.002 and 0.006), BAC reporting should be a standardized practice (p = 0.004 and 0.001), and feel more comfortable informing patients about BAC (p = 0.001 and 0.003). CONCLUSION Radiologists' reporting practices and perceptions regarding BAC are not homogeneous. Although many radiologists report BAC to varying degrees, it is not routinely reported or recommended for follow-up in mammogram reports. Experienced radiologists are more likely to include and value BAC in their breast imaging practice.
This article explores the development of computer-aided detection (CAD) and artificial or augment... more This article explores the development of computer-aided detection (CAD) and artificial or augmented intelligence (AI) for breast radiology examinations and describes the current applications of AI in breast imaging. Although radiologists in other subspecialties may be less familiar with the use of these technologies in their practices, CAD has been used in breast imaging for more than two decades, as mammography CAD programs have been commercially available in the United States since the late 1990s. Likewise, breast radiologists have seen payment for CAD in mammography and breast MRI evolve over time. With the rapid expansion of AI products in radiology in recent years, many new applications for these technologies in breast imaging have emerged. This article outlines the current state of reimbursement for breast radiology AI algorithms within the traditional fee-for-service model used by Medicare and commercial insurers as well as potential future payment pathways. In addition, the ...
The novel SARS-CoV2 (COVID-19) pandemic has had a major impact on breast radiology practices. Ini... more The novel SARS-CoV2 (COVID-19) pandemic has had a major impact on breast radiology practices. Initially, nonessential imaging studies, including screening mammography, were curtailed and even temporarily halted when lockdowns were instituted in many parts of the United States. As a result, imaging volumes plummeted while health care institutions worked to ensure safety measures were in place to protect patients and personnel. As COVID-19 infection levels started to stabilize in some areas, breast radiology practices sought guidance from national organizations, such as the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and radiology specialty societies, to develop strategies for patients to safely return for screening mammograms and other outpatient imaging studies. Postponement of breast cancer screening has led to delays in cancer diagnosis and treatment that could negatively affect patient outcomes for years to come. In order to continu...
OBJECTIVE Lobular intraepithelial neoplasia-atypical lobular hyperplasia and lobular carcinoma in... more OBJECTIVE Lobular intraepithelial neoplasia-atypical lobular hyperplasia and lobular carcinoma in situ-is a noninvasive breast lesion occasionally found in core needle biopsy and surgical biopsy specimens. The objective of this study is to identify the increased incidence of lobular carcinoma in situ with current stereotactic biopsy techniques. METHODS Biopsy results from 1993 to 2004 were reviewed retrospectively. 2,940 stereotactic biopsies were performed using a 14-gauge gun-type needle; 1,807 stereotactic biopsies were performed using an 11-gauge vacuum-assisted needle; and 2,724 ultrasound-guided biopsies were performed using a 14-gauge gun-type needle. RESULTS The incidence of lobular intraepithelial neoplasia was 0.4% using the stereotactic 14-gauge technique, 0.4% using the ultrasound-guided 14-gauge technique, and 1.7% using the 11-gauge stereotactic technique. The increased rate of detection of lobular carcinoma in situ with an 11-gauge needle was statistically significant...
plaques hemorragiques. Objectif: Comparer la caracterisation des plaques carotidiennes par imager... more plaques hemorragiques. Objectif: Comparer la caracterisation des plaques carotidiennes par imagerie a haute resolution, reconnue comme moyen efficace pour demontrer la presence ou absence d'une hemorragie au sein de la plaque, avec celle obtenue par reconstruction tridimensionnelle par Doppler puissance. Materiels et methodes : Douze plaques carotidiennes chez dix patients ont ete caracterisees par imagerie conventionnelle utilisant une echelle de gris a haute resolution et par Doppler puissance tridimensionnel. Resultats : Huit plaques etaient homogenes et quatre etaient heterogenes. La reconstruction tridimensionnelle par Doppler puissance a mis en evidence des plaques lisses dans sept cas (types 3 et 4) et des plaques irregulieres dans cinq cas dont quatre etaient heterogenes et une homogene. Toutes les plaques lisses etaient homogenes en Doppler puissance tridimensionnel. Conclusion : L'utilisation du Doppler puissance tridimensionnel donne une bonne caracterisation des ...
INTRODUCTION Despite their name, radial scars (or complex sclerosing lesions) are idiopathic lesi... more INTRODUCTION Despite their name, radial scars (or complex sclerosing lesions) are idiopathic lesions of the breast unrelated to prior trauma or surgery. The etiology of radial scars is hypothesized to be a localized inflammatory reaction or chronic ischemia with subsequent slow infarction. The prevalence of radial scars ranges from 0.1-2.0 per 1,000 screening mammograms and 1.7%-14% on autopsy specimens. Although suspected radial scars are frequently sampled initially with percutaneous image-guided core needle biopsy, the general recommendation is to surgically excise these lesions because of the association of atypical ductal hyperplasia and carcinoma in up to 50% of cases.
Background Heavy metals in tattoo ink can be deposited in axillary lymph nodes, mimicking maligna... more Background Heavy metals in tattoo ink can be deposited in axillary lymph nodes, mimicking malignant calcifications. High-density foci in axillary lymph nodes can be the sequelae of a benign or malignant process. Case Report A 34-year-old female presented with left breast discomfort. Mammography showed suspicious left breast calcifications for which biopsy revealed multicentric ductal carcinoma in situ. Imaging also showed high-density foci in her left axillary lymph nodes suspicious for nodal metastases; however, biopsy of the lymph nodes found the high-density foci to be pigment-laden histiocytes from tattoo ink metallic deposits. Conclusion High-density foci in axillary lymph nodes on mammography can be evidence of calcifications or metal deposits and can be the manifestation of a benign or malignant process. Thus, this finding may warrant additional diagnostic workup (including mammography, ultrasound, and possibly biopsy) and correlation with clinical history.
The Department of Radiology at the Ochsner Health System has been a central player in the develop... more The Department of Radiology at the Ochsner Health System has been a central player in the development of ultrasound nationally and internationally for much of the history of this technology. In the following article, we review the progress of ultrasound in our institution.
Despite their name, radial scars (or complex sclerosing lesions) are idiopathic lesions of the br... more Despite their name, radial scars (or complex sclerosing lesions) are idiopathic lesions of the breast unrelated to prior trauma or surgery. The etiology of radial scars is hypothesized to be a localized inflammatory reaction or chronic ischemia with subsequent slow infarction.[1][1] The prevalence
RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current ... more RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current practices of reporting breast arterial calcification (BAC) on mammography and to determine perceptions about the value of BAC communication and follow-up recommendations among radiologists. MATERIALS AND METHODS In September 2020, an 18-item online survey was emailed to radiologist members of the American College of Radiology (ACR). Questions included radiologist demographics, current BAC reporting practices, follow-up recommendations, and perceptions about BAC. Five-point Likert scales were used and multivariate analysis was performed. RESULTS Of 598 completed survey responses, up to 87% (522/598) of ACR radiologist members include BAC in mammogram reports. However, only 41% (212/522) of respondents report BAC 'always' or 'most of the time'. Radiologist factors significantly associated with BAC reporting include years in practice and fellowship training with those in practice longer more likely to report BAC (OR 1.10, 95% CI, [1.01-1.20], p = 0.023) and those with fellowship training less likely to report BAC (OR 0.63, 95% CI, [0.42-0.94], p = 0.024). When BAC is reported, 69% (360/522) simply indicate the presence of BAC, 23% (121/522) provide a subjective grading of BAC burden, and 1% (6/522) calculate a BAC score. Among the radiologists reporting BAC, 58% (301/522) make no subsequent recommendations, while the remainder recommend primary care follow-up (39%; 204/522), cardiology evaluation (13%; 68/522), and/or coronary calcium scoring CT (11%; 59/522). Overall, there was agreement from 66% (392/598) of respondents that BAC is a cardiovascular risk factor. However, there was no consensus on whether patients and/or providers should be informed about BAC or whether reporting of BAC should become a standardized practice in breast imaging. Older and more experienced radiologists are more likely to agree that BAC is a cardiovascular risk factor (p = 0.022), providers should be informed about BAC (p = 0.002 and 0.006), BAC reporting should be a standardized practice (p = 0.004 and 0.001), and feel more comfortable informing patients about BAC (p = 0.001 and 0.003). CONCLUSION Radiologists' reporting practices and perceptions regarding BAC are not homogeneous. Although many radiologists report BAC to varying degrees, it is not routinely reported or recommended for follow-up in mammogram reports. Experienced radiologists are more likely to include and value BAC in their breast imaging practice.
RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current ... more RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current practices of reporting breast arterial calcification (BAC) on mammography and to determine perceptions about the value of BAC communication and follow-up recommendations among radiologists. MATERIALS AND METHODS In September 2020, an 18-item online survey was emailed to radiologist members of the American College of Radiology (ACR). Questions included radiologist demographics, current BAC reporting practices, follow-up recommendations, and perceptions about BAC. Five-point Likert scales were used and multivariate analysis was performed. RESULTS Of 598 completed survey responses, up to 87% (522/598) of ACR radiologist members include BAC in mammogram reports. However, only 41% (212/522) of respondents report BAC 'always' or 'most of the time'. Radiologist factors significantly associated with BAC reporting include years in practice and fellowship training with those in practice longer more likely to report BAC (OR 1.10, 95% CI, [1.01-1.20], p = 0.023) and those with fellowship training less likely to report BAC (OR 0.63, 95% CI, [0.42-0.94], p = 0.024). When BAC is reported, 69% (360/522) simply indicate the presence of BAC, 23% (121/522) provide a subjective grading of BAC burden, and 1% (6/522) calculate a BAC score. Among the radiologists reporting BAC, 58% (301/522) make no subsequent recommendations, while the remainder recommend primary care follow-up (39%; 204/522), cardiology evaluation (13%; 68/522), and/or coronary calcium scoring CT (11%; 59/522). Overall, there was agreement from 66% (392/598) of respondents that BAC is a cardiovascular risk factor. However, there was no consensus on whether patients and/or providers should be informed about BAC or whether reporting of BAC should become a standardized practice in breast imaging. Older and more experienced radiologists are more likely to agree that BAC is a cardiovascular risk factor (p = 0.022), providers should be informed about BAC (p = 0.002 and 0.006), BAC reporting should be a standardized practice (p = 0.004 and 0.001), and feel more comfortable informing patients about BAC (p = 0.001 and 0.003). CONCLUSION Radiologists' reporting practices and perceptions regarding BAC are not homogeneous. Although many radiologists report BAC to varying degrees, it is not routinely reported or recommended for follow-up in mammogram reports. Experienced radiologists are more likely to include and value BAC in their breast imaging practice.
This article explores the development of computer-aided detection (CAD) and artificial or augment... more This article explores the development of computer-aided detection (CAD) and artificial or augmented intelligence (AI) for breast radiology examinations and describes the current applications of AI in breast imaging. Although radiologists in other subspecialties may be less familiar with the use of these technologies in their practices, CAD has been used in breast imaging for more than two decades, as mammography CAD programs have been commercially available in the United States since the late 1990s. Likewise, breast radiologists have seen payment for CAD in mammography and breast MRI evolve over time. With the rapid expansion of AI products in radiology in recent years, many new applications for these technologies in breast imaging have emerged. This article outlines the current state of reimbursement for breast radiology AI algorithms within the traditional fee-for-service model used by Medicare and commercial insurers as well as potential future payment pathways. In addition, the ...
The novel SARS-CoV2 (COVID-19) pandemic has had a major impact on breast radiology practices. Ini... more The novel SARS-CoV2 (COVID-19) pandemic has had a major impact on breast radiology practices. Initially, nonessential imaging studies, including screening mammography, were curtailed and even temporarily halted when lockdowns were instituted in many parts of the United States. As a result, imaging volumes plummeted while health care institutions worked to ensure safety measures were in place to protect patients and personnel. As COVID-19 infection levels started to stabilize in some areas, breast radiology practices sought guidance from national organizations, such as the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and radiology specialty societies, to develop strategies for patients to safely return for screening mammograms and other outpatient imaging studies. Postponement of breast cancer screening has led to delays in cancer diagnosis and treatment that could negatively affect patient outcomes for years to come. In order to continu...
OBJECTIVE Lobular intraepithelial neoplasia-atypical lobular hyperplasia and lobular carcinoma in... more OBJECTIVE Lobular intraepithelial neoplasia-atypical lobular hyperplasia and lobular carcinoma in situ-is a noninvasive breast lesion occasionally found in core needle biopsy and surgical biopsy specimens. The objective of this study is to identify the increased incidence of lobular carcinoma in situ with current stereotactic biopsy techniques. METHODS Biopsy results from 1993 to 2004 were reviewed retrospectively. 2,940 stereotactic biopsies were performed using a 14-gauge gun-type needle; 1,807 stereotactic biopsies were performed using an 11-gauge vacuum-assisted needle; and 2,724 ultrasound-guided biopsies were performed using a 14-gauge gun-type needle. RESULTS The incidence of lobular intraepithelial neoplasia was 0.4% using the stereotactic 14-gauge technique, 0.4% using the ultrasound-guided 14-gauge technique, and 1.7% using the 11-gauge stereotactic technique. The increased rate of detection of lobular carcinoma in situ with an 11-gauge needle was statistically significant...
plaques hemorragiques. Objectif: Comparer la caracterisation des plaques carotidiennes par imager... more plaques hemorragiques. Objectif: Comparer la caracterisation des plaques carotidiennes par imagerie a haute resolution, reconnue comme moyen efficace pour demontrer la presence ou absence d'une hemorragie au sein de la plaque, avec celle obtenue par reconstruction tridimensionnelle par Doppler puissance. Materiels et methodes : Douze plaques carotidiennes chez dix patients ont ete caracterisees par imagerie conventionnelle utilisant une echelle de gris a haute resolution et par Doppler puissance tridimensionnel. Resultats : Huit plaques etaient homogenes et quatre etaient heterogenes. La reconstruction tridimensionnelle par Doppler puissance a mis en evidence des plaques lisses dans sept cas (types 3 et 4) et des plaques irregulieres dans cinq cas dont quatre etaient heterogenes et une homogene. Toutes les plaques lisses etaient homogenes en Doppler puissance tridimensionnel. Conclusion : L'utilisation du Doppler puissance tridimensionnel donne une bonne caracterisation des ...
INTRODUCTION Despite their name, radial scars (or complex sclerosing lesions) are idiopathic lesi... more INTRODUCTION Despite their name, radial scars (or complex sclerosing lesions) are idiopathic lesions of the breast unrelated to prior trauma or surgery. The etiology of radial scars is hypothesized to be a localized inflammatory reaction or chronic ischemia with subsequent slow infarction. The prevalence of radial scars ranges from 0.1-2.0 per 1,000 screening mammograms and 1.7%-14% on autopsy specimens. Although suspected radial scars are frequently sampled initially with percutaneous image-guided core needle biopsy, the general recommendation is to surgically excise these lesions because of the association of atypical ductal hyperplasia and carcinoma in up to 50% of cases.
Background Heavy metals in tattoo ink can be deposited in axillary lymph nodes, mimicking maligna... more Background Heavy metals in tattoo ink can be deposited in axillary lymph nodes, mimicking malignant calcifications. High-density foci in axillary lymph nodes can be the sequelae of a benign or malignant process. Case Report A 34-year-old female presented with left breast discomfort. Mammography showed suspicious left breast calcifications for which biopsy revealed multicentric ductal carcinoma in situ. Imaging also showed high-density foci in her left axillary lymph nodes suspicious for nodal metastases; however, biopsy of the lymph nodes found the high-density foci to be pigment-laden histiocytes from tattoo ink metallic deposits. Conclusion High-density foci in axillary lymph nodes on mammography can be evidence of calcifications or metal deposits and can be the manifestation of a benign or malignant process. Thus, this finding may warrant additional diagnostic workup (including mammography, ultrasound, and possibly biopsy) and correlation with clinical history.
The Department of Radiology at the Ochsner Health System has been a central player in the develop... more The Department of Radiology at the Ochsner Health System has been a central player in the development of ultrasound nationally and internationally for much of the history of this technology. In the following article, we review the progress of ultrasound in our institution.
Despite their name, radial scars (or complex sclerosing lesions) are idiopathic lesions of the br... more Despite their name, radial scars (or complex sclerosing lesions) are idiopathic lesions of the breast unrelated to prior trauma or surgery. The etiology of radial scars is hypothesized to be a localized inflammatory reaction or chronic ischemia with subsequent slow infarction.[1][1] The prevalence
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