Stephanie K. Patterson

Does medical school performance predict radiology resident performance

RATIONALE AND OBJECTIVES The authors performed this study to examine the relationship, if any, of a large number of measures of medical school performance with radiology residency performance. MATERIALS AND METHODS Applications of 77 radiology residents enrolled from 1991 to 2000 were reviewed. Medical school grades, deans letter summary statements, letters of recommendation, selection to Alpha Omega Alpha (AOA), and National Board of Medical Examiners (NBME) and U.S. Medical Licensing Examination (USMLE) Step 1 scores were recorded. Student t tests, analysis of variance, and correlation coefficients were used to examine the relationship between these measures of medical school performance and subsequent performance during radiology residency as determined by rotation evaluations, retrospective faculty recall scores, and American College of Radiology (ACR) and American Board of Radiology (ABR) examination scores. Resident performance was also correlated with prestige of the medical school attended. RESULTS Preclinical grades of Honors or A; clinical grades of Honors or A in medicine, surgery, and pediatrics; and high NBME/USMLE scores strongly predicted success on the ABR written clinical examination but did not predict rotation performance. Most other measures of medical school performance, including outstanding Deans letters and letters of recommendation, AOA selection during the senior year, and high medical school prestige did not predict high examination scores or superior rotation performance during residency. CONCLUSION Success on the ABR examination can be predicted by medical school success in preclinical courses, some clinical courses, and USMLE examination scores. Deans letters, letters of recommendation, AOA selection during the senior year, and medical school prestige do not appear to predict future resident performance as reliably.

Outcome of Men Presenting with Clinical Breast Problems: The Role of Mammography and Ultrasound

Abstract:  The purpose of this study was to determine the outcome of men presenting with clinical breast problems for breast imaging and to evaluate the role of mammography and ultrasound in the diagnosis of benign and malignant breast problems. We retrospectively reviewed clinical, radiographic, and pathologic records of 165 consecutive symptomatic men presenting to Breast Imaging over a 4 year period. We assessed the clinical indication for referral, mammographic findings, sonographic findings, histologic results, and clinical outcomes. Patients ranged in age from 22 to 96 years. Breast Imaging Reporting and Data System (BI‐RADS) category 4 and 5 mammograms and solid sonographic masses were considered suspicious for malignancy. Six of 165 men (4%) had primary breast carcinoma, which were mammographically suspicious in all 6 (100%). Five were invasive ductal carcinoma and one was ductal carcinoma in situ (DCIS). Of 164 mammograms, 20 (12%) were suspicious. Six were cancer and 14 were benign. Clinical follow‐up for 2 years or biopsy results were available for 138 of the 165 men (84%). Twelve with benign mammographic findings had benign biopsies. All men with benign mammography not undergoing biopsy were cancer free. Sensitivity for cancer detection (mammography) was 100% and specificity was 90%. Positive predictive value (mammography) was 32% (6 of 19) and the negative predictive value was 100%. Sonography was performed in 68 of the 165 men (41%). Three of three cancers (100%) were solid sonographic masses. There were 9 of 68 false‐positive examinations (13%). Sensitivity and negative predictive value for cancer detection (ultrasound) was 100% and specificity was 74%. The most common clinical indication for referral was mass/thickening (56%). Mammography had excellent sensitivity and specificity for breast cancer detection and should be included as the initial imaging examination of men with clinical breast problems. The negative predictive value of 100% for mammography suggests that mammograms read as normal or negative need no further examination if the clinical findings are not suspicious. A normal ultrasound in these men confirms the negative predictive value of a normal mammogram.

Women's mammography experience and its impact on screening adherence.

Objectives: Although rates for first‐time and recent mammography screening have increased for women in the US in the past decade, rates for repeat mammography remain low. This study aimed to conduct an analysis of womens mammography experience, to examine the rates of repeat mammography and to identify the significant predictors of repeat mammography within 12 and 18 months of the index mammogram.

Is Past Academic Productivity Predictive of Radiology Resident Academic Productivity

RATIONALE AND OBJECTIVES The authors performed this study to determine whether academic productivity in college and medical school is predictive of the number of publications produced during radiology residency. MATERIALS AND METHODS The authors reviewed the records of 73 radiology residents who completed their residency from 1990 to 2000. Academic productivity during college, medical school, and radiology residency, other postgraduate degrees, and past careers other than radiology were tabulated. The personal essay attached to the residency application was reviewed for any stated academic interest. Residents were classified as being either previously productive or previously unproductive. Publication rates during residency and immediately after residency were compared for the two groups. For the productive residents, a correlation analysis was used to examine the relationship between past frequency of publication and type of previous activity. Least-squares regression analysis was used to investigate the relationship between preresidency academic productivity, advanced degrees, stated interest in academics, and other careers and radiology residency publications. RESULTS There was no statistically significant difference in the number of articles published by those residents who were active and those who were not active before residency (P = .21). Only authorship of papers as an undergraduate was weakly predictive of residency publication. CONCLUSION These selected measures of academic productivity as an undergraduate and during medical school are not helpful for predicting publication during residency. There was no difference in publication potential between those residents who were academically productive in the past and those who were not.

Mammographic appearance of breast cancer in African-American women: Report of 100 consecutive cases

RATIONALE AND OBJECTIVES The authors determined the mammographic appearance of breast carcinoma in African-American women and compared it with that in a white cohort. MATERIALS AND METHODS The authors reviewed the mammograms, clinical records, and pathology records of 97 consecutive African-American women with 100 confirmed breast cancers and 110 white women with 111 confirmed breast cancers. RESULTS The mammograms obtained in African-American women were positive in 94 cases (94%), and those obtained in white women were positive in 99 cases (89%). Forty-seven percent of malignancies in African-American women appeared as calcifications, alone or with a mass, and 41% appeared as a mass only. There was no statistically significant difference in the frequency of these two findings between the African-American and the white populations. There was no statistically significant difference in the breast parenchymal pattern between the two groups. The most common tumor location in both races was the upper outer quadrant. CONCLUSION Breast carcinoma in African-American women is similar to that in white women in terms of mammographic appearance, location, and breast density. The mammographic appearance should not be an impediment to the detection of breast cancer in African-American women.

Update on new technologies in digital mammography

Despite controversy regarding mammography’s efficacy, it continues to be the most commonly used breast cancer-screening modality. With the development of digital mammography, some improved benefit has been shown in women with dense breast tissue. However, the density of breast tissue continues to limit the sensitivity of conventional mammography. We discuss the development of some derivative digital technologies, primarily digital breast tomosynthesis, and their strengths, weaknesses, and potential patient impact.

Sonographically-guided metallic marker placement at time of wire localization for intraductal or cystic lesions: a method to verify lesion retrieval.

RATIONALE AND OBJECTIVES To propose deploying a metallic marker using sonographic guidance immediately before wire localization for excisional biopsy to identify intraductal or complex cystic lesions at specimen radiography. MATERIALS AND METHODS Institutional review board approval was obtained for this study and is Health Insurance Portability and Accountability Act compliant. The clinical, radiographic, and pathologic records of 21 patients, ages 21-78 years, with 22 intraductal or complex cystic masses who underwent excisional biopsy with wire localization immediately after sonographically-guided marker placement were reviewed. The procedure mammogram, ultrasound, and specimen radiographs were reviewed and evaluated for the presence of a metallic marker, lesion, or both. Pathology of all specimens was recorded and reviewed for concordance. RESULTS Twenty-one (95%) of the markers were visualized on specimen radiographs. No lesions were apparent on specimen radiographs. Mammographic findings in 17 were negative (17/22; 77%); 3 circumscribed or partially obscured masses (3/22; 14%), 1 focal asymmetry (1/22; 5%), and 1 architectural distortion (5%) were also seen. Sonographic findings were 12 intraductal masses (12/22; 55%) and 10 complex cystic masses (10/22; 45%). Median and average size of all lesions were 9 mm (intraductal masses: median, 6 mm, mean, 7; complex cystic masses: median, 10 mm, mean, 11). All lesions were benign and all pathology was concordant with imaging findings. CONCLUSIONS Given the high rate of marker retrieval on specimen radiography and pathologic concordance, marker placement at the time of wire localization is an efficient way to confirm retrieval of intraductal or complex cystic lesions.

A case of juvenile papillomatosis, aka "Swiss cheese disease".

history, prognostic factors, and impact of treatment have not been yet well established. The presentation of PBL is very similar to that of a carcinoma. Even radiological differentiation is not possible. Generally, PBL shows no calcifications on mammogram and often shows a homogeneous faint tumor shadow without either microcalcification or spiculation. High resolution ultrasound usually reveals a hypoechoic mass with coarse internal echo. Tissue diagnosis is the mainstay for correct diagnosis.

ROC study: effects of computer-aided diagnosis on radiologists' characterization of malignant and benign breast masses in temporal pairs of mammograms

We conducted an observer performance study using receiver operating characteristic (ROC) methodology to evaluate the effects of computer-aided diagnosis (CAD) on radiologists’ performance for characterization of masses on serial mammograms. The automated CAD system, previously developed in our laboratory, can classify masses as malignant or benign based on interval change information on serial mammograms. In this study, 126 temporal image pairs (73 malignant and 53 benign) from 52 patients containing masses on serial mammograms were used. The corresponding masses on each temporal pair were identified by an experienced radiologist and automatically segmented by the CAD program. Morphological, texture, and spiculation features of the mass on the current and the prior mammograms were extracted. The individual features and the difference between the corresponding current and prior features formed a multidimensional feature space. A subset of the most effective features that contained the current, prior, and interval change information was selected by a stepwise procedure and used as input predictor variables to a linear discriminant classifier in a leave-one-case-out training and testing resampling scheme. The linear discriminant classifier estimated the relative likelihood of malignancy of each mass. The classifier achieved a test Az value of 0.87. For the ROC study, 4 MQSA radiologists and 1 breast imaging fellow assessed the masses on the temporal pairs and provided estimates of the likelihood of malignancy without and with CAD. The average Az value for the likelihood of malignancy estimated by the radiologists was 0.79 without CAD and improved to 0.87 with CAD. The improvement was statistically significant (p=0.0003). This preliminary result indicated that CAD using interval change analysis can significantly improve radiologists’ accuracy in classification of masses and thereby may increase the positive predictive value of mammography.

Ensuring Excision of Intraductal Lesions: Marker Placement at Time of Ductography

RATIONALE AND OBJECTIVES To propose grid coordinate marker placement for patients with suspicious ductogram findings occult on routine workup. To compare the success of marker placement and wire localization (WL) with ductogram-guided WL. MATERIALS AND METHODS A retrospective search of radiology records identified all patients referred for ductography between January 2001 and May 2008. Results for 16 patients referred for ductogram-guided WL and 5 patients with grid coordinate marker placement at the time of ductography and subsequent WL were reviewed. Surgical pathology results and clinical follow-up were reviewed for concordance. RESULTS Nine of 16 patients (56.3%) underwent successful ductogram-guided WL. Eight of nine patients had papillomas, one of which also had atypical ductal hyperplasia (ADH). One of nine patients had ectatic ducts with inspisated debris. Seven patients who failed ductogram-guided WL eventually underwent open surgical biopsy. Four of seven patients had papillomas, one of which also had lobular carcinoma in situ. Remaining patients had ADH (1/7) and fibrocystic changes with chronic inflammation (3/7). All five (100%) patients with grid coordinate marker placement underwent successful WL and marker excision. Pathology results included three papillomas, papillary intraductal hyperplasia, and fibrocystic change. CONCLUSION Grid coordinate marker placement at the time of abnormal ductogram provided an accurate method of localizing ductal abnormalities that are occult on routine workup, thus facilitating future WL. Marker placement obviated the need for repeat ductogram on the day of surgery and ensured surgical removal of the ductogram abnormality.