K. Rebecca Hunt

Follow-up of benign results of stereotactic core breast biopsy

RATIONALE AND OBJECTIVES The purpose of this study was to obtain long-term follow-up data on women with benign histologic results of a breast stereotactic core needle biopsy (CNB). MATERIALS AND METHODS Mammography charts of 300 consecutive women who underwent prone stereotactic CNB with digital radiography were reviewed. Women with frankly malignant or suspicious histologic findings (51 patients) or a technically unsuccessful stereotactic CNB (one patient) were excluded. The remaining 248 benign core biopsies in 229 women were included in the study. RESULTS Follow-up mammograms were obtained for 152 lesions with benign histologic results following stereotactic CNB. The mean length of follow-up after stereotactic CNB was 34.6 months. Cancer was diagnosed in six women who underwent surgical biopsies 1/2 to 30 months after benign stereotactic CNB. An initial chart review demonstrated that no follow-up data were available for 64 lesions, and information was missing for an additional seven. CONCLUSION SCNB remains a sampling procedure that can result in false-negative histologic results. Intrinsic procedural issues were identified that could minimize the potential for missing a malignancy. Goals for patient compliance with follow-up recommendations fell short of expectations.

Occurrence of Fibroadenomas in Postmenopausal Women Referred for Breast Biopsy

OBJECTIVE: To examine the occurrence of breast fibroadenomas in postmenopausal patients referred for breast biopsy.

Prospective Comparison of Plain Abdominal Radiography with Conventional and Digital Renal Tomography in Assessing Renal Extracorporeal Shock Wave Lithotripsy Patients

Most publications citing the effectiveness of renal extracorporeal shock wave lithotripsy have used plain abdominal radiography to assess residual calculi after treatment. We compared radiologist sensitivity and specificity in the detection of calculi on plain abdominal radiographs versus conventional film-screen and digital renal tomograms in extracorporeal shock wave lithotripsy patients. Of the patients 50 were imaged before and within 24 hours after lithotripsy. Six radiologists evaluated the resultant 300 studies for the presence and location of calculi. The mean sensitivity for digital tomograms was 83% for pre-lithotripsy and post-lithotripsy studies, which was significantly higher than for plain abdominal radiography and conventional tomography after lithotripsy. However, there were significantly more false positive stone diagnoses associated with digital tomogram interpretation. Signal detection analysis verified the over-all superiority of digital tomography for post-extracorporeal shock wave lithotripsy imaging. Calculus detection by conventional and digital tomography is superior to detection by plain abdominal radiography. However, because we did not perform delayed imaging, it is not possible to say what impact digital tomography might have on the management of extracorporeal shock wave lithotripsy patients.

Academic radiology and doctor discontent: the good news and the bad news.

“Many American doctors are unhappy with the quality of their professional lives” (1). Physicians in all specialties are frustrated by outside forces that interfere with their ability to deliver ideal medical care. Managed care and other forces have decreased their income, and, perhaps because of these forces, disability claims among physicians have escalated (1). There are increased workloads and falling levels of reimbursement coupled with intrusive paperwork and increasing pressures from managed care organizations, licensing agencies, and government entities. The malpractice environment continues to be unpleasant for physicians. Academic physicians are not immune from these stresses. The academic physician is caught between the demands of the marketplace and the demands of providing quality teaching and research. Recent surveys have shown that the workload per radiologist has increased substantially in the past decade (2,3). Private, nonacademic, non-multispecialty practice radiologists perform an average of 12,300 procedures per year (3). Academic radiologists perform an average of 8,000 procedures per year. The average workload for all radiologists has increased 13% between 1991–1992 and 1995–1996 (3). Academic radiologists average less time away from work than full-time nonacademic radiologists in group practice (2). Academic radiologists have, on average, less vacation time and less sick time, but they and nonacademic radiologists have a similar number of days away from work for continuing medical education and professional meetings (2,3). While academic radiologists have a smaller average workload than other radiologists, their workweek is as long as, if not longer than, that of other radiologists. The American College of Radiology (ACR) 1995 survey of radiologists showed that full-time posttraining radiologists reported working, on average, 50 hours per week and 5.l days per week, while academic radiologists reported working, on average, 53 hours per week and 5.3 days per week (2). The perception of radiologists in our own university department and that of our colleagues in other academic radiology departments is that conditions have deteriorated considerably in the past decade. Many believe that academic time is disappearing, salaries are decreasing, and clinical workloads are increasing. To gauge the accuracy of these perceptions, we sent a simple one-page questionnaire to all members of the Association of University Radiologists in which we asked about the quality of their academic lives. We informally looked at such issues as clinical workloads, the amount of academic time, the amount of managed care, and one’s perception of his or her academic productivity today compared with that 5 years ago. We sent out 1,200 surveys and received responses from 521 individuals (43%) at 188 institutions. In this editorial we refer to the survey only in the context of examining our thesis that there is at present a good news/ bad news environment for the academic radiologist. The radiologists in our department are expected to perform clinical work 4 full days per week, and they receive 1 academic day per week free from clinical duties. While we perceive of this as not being conducive for good acaAcad Radiol 2001; 8:509–511

Sonographic Image Degradation after Barium Enema

RATIONALE AND OBJECTIVES.The authors previously showed that barium does not interfere with abdominal sonography performed after a biphasic upper gastrointestinal tract examination. This study was designed to assess the impact of a barium enema (BE) examination on the quality of abdominal sonography performed immediately after the barium enema. METHODS.Forty patients scheduled for routine barium enemas (22 air contrast and 18 solid column) were prospectively examined with abdominal sonography before and after their BEs. The resulting 80 sonograms were randomized; three radiologists blindly assessed the quality of images of each of six anatomic areas (aorta, pancreas, porta hepatis, gallbladder, and the right and left lobes of the liver). RESULTS.There was no statistically significant degradation of the images for the right and left lobes of the liver and the pancreas. However, the images for the gallbladder, porta hepatis, and aorta had a statistically significant (P < .05) degradation of their ultrasound quality following barium enema. CONCLUSIONS.Unlike upper gastrointestinal tract examination, BE examination does interfere with the quality of a subsequent abdominal ultrasonography. Thus, when both studies are required, sonography should be performed first.