Valerie P. Jackson

RADPEER scoring white paper.

The ACRs RADPEER program began in 2002; the electronic version, e-RADPEER, was offered in 2005. To date, more than 10,000 radiologists and more than 800 groups are participating in the program. Since the inception of RADPEER, there have been continuing discussions regarding a number of issues, including the scoring system, the subspecialty-specific subcategorization of data collected for each imaging modality, and the validation of interfacility scoring consistency. This white paper reviews the task force discussions, the literature review, and the new recommended scoring process and lexicon for RADPEER.

Sonography of the breast

Quality mammography remains the primary modality used to image the breast. Sonography currently is the most useful adjunctive technique to mammography, having roles in differentiating cystic from solid masses and in guiding interventional procedures. This article reviews these and other indications for breast ultrasound studies, including evaluation of palpable masses not visible in radiographically dense breasts, masses not completely evaluable with mammography, young patients especially susceptible to radiation damage, and abscesses. Ultrasound interpretation of cysts and solid masses are discussed, as are the relative disadvantages of ultrasound as a breast cancer screening tool.

Evaluation of the vertebral arteries with duplex sonography

Using duplex sonography, we have routinely evaluated the vertebral arteries as part of the carotid artery examination in 453 consecutive patients over a 6-month period. Sixty-two of these 906 vessels could not be adequately evaluated, primarily because these vessels lay too deep within the vertebral structures, resulting in a technical failure rate of 6.8%. For the remaining 844 vessels, 74.4% were considered normal by Doppler flowmeter spectral analysis. Angiographic correlation was available for 224 vessels; of 155 judged normal by duplex sonography, 144 (93%) were shown to be normal or have only mild atherosclerotic disease. Eleven vessels were considered either occluded or to have severe disease by duplex sonography, and angiography showed this to be the case in 10 (91%) vessels. Unusually strong vertebral artery flow was associated with hemodynamically significant carotid or contralateral vertebral atherosclerotic disease or subclavian steal 82% of the time. Twelve cases of subclavian steal, only one of which was symptomatic, were identified by duplex sonography; four of these were confirmed by angiography. Angiographic correlation was available for 229 vessels in which duplex evaluation showed vertebral artery flow to be moderately damped. In 11 of these (38%), angiography showed greater than 50% stenosis. Angiography judged the remaining 18 vessels in this group normal; these vessels may represent a small subgroup of patients with normal anatomy or only mild atherosclerotic disease, but with hemodynamic dysfunction that can be identified with the duplex technique.

Volumetric Assessment of Breast Tissue Composition from FFDM Images

We present first results from a new automated algorithm for the volumetric measurement of the composition of breast tissue from digital mammograms. The new algorithm overcomes issues in previous implementations through better segmentation and use of additional information We measure the success of the new algorithm using an overall quality metric based upon the results from a large multi-site, multi-vendor, multi-detector set of digitally acquired mammograms.

The value of good medical student teaching: Increasing the number of radiology residency applicants

RATIONALE AND OBJECTIVES The authors attempted to define the value of good medical student teaching to the profession of radiology by examining the effect of radiology course improvements on the number of 4th-year students applying to radiology residencies. MATERIALS AND METHODS Course evaluation and residency application data were obtained from six consecutive classes of 4th-year medical students at the study institution, and these data were compared with national data. RESULTS Between 1995 and 2000, the number of 4th-year U.S. medical students applying to radiology increased 1.6 times. At the study institution, that number increased 4.5 times, a statistically significant difference (P = .020, chi2 test). Student survey data indicate that this increase reflects a general increase in the quality of radiology teaching in the study institution and specific changes in a required 2nd-year medical school course. CONCLUSION These results strongly suggest that good medical student teaching pays important dividends, not only to the departments that provide it but also to the profession of radiology as a whole. Exposing students to good radiology teaching early in their medical school careers is especially important. Radiology departments that provide outstanding medical student education should be studied to help develop a model of educational best practices.

Comparison of Mammography, Sonography, and Magnetic Resonance Imaging in the Detection of Silicone-Gel Breast Implant Rupture

Silicone-gel breast implant rupture is difficult to diagnose preoperatively. A variety of radiological methods have been used for diagnosis. This study prospectively compares film-screen mammography, high-resolution sonography, and magnetic resonance imaging in the diagnosis of implant rupture using predetermined diagnostic criteria. Thirteen patients (24 implants) underwent film-screen mammography, sonography, and magnetic resonance imaging to evaluate the integrity of their implants. All patients subsequently underwent surgical removal of the implants. Preoperatively, the integrity of each implant was rated on a three-level classification system on the basis of one modality by a reviewer who was unaware of the results of the other two modalities. The three imaging modalities achieved the following sensitivities and specificities, respectively: mammography, 69% and 82%; sonography, 54% and 64%; MRI, 69% and 55%. Even though each modality addresses some of the limitations of the others, in this group of patients, there was no clearly superior imaging tool.

Duplex sonography of the breast

A commercially available duplex ultrasound unit was used to examine 54 breast lesions in 44 women. The 7.5 MHz imaging probe contained a 3 MHz pulsed Doppler crystal, and the 10 MHz imaging probe contained a 4.5 MHz pulsed Doppler crystal. Doppler signals were elicited from normal breast tissue in only one patient. No Doppler signals were found in the five cysts examined in this study. For the 35 solid masses with biopsy or adequate follow-up that were examined with one or both probes, the sensitivity of Doppler for the diagnosis of carcinoma was 69%, the specificity 59%, positive predictive value 50%, negative predictive value 76%, and the accuracy 63%. Because of intermittent malfunction of the 10/4.5 MHz probe, some patients were examined with only the lower frequency probe. For the 34 solid lesions with biopsy or adequate follow-up that were examined with the 7.5/3 MHz probe, the sensitivity was 62%, specificity 38%, positive predictive value 50%, negative predictive value 72%, and accuracy 62%.

A preliminary analysis of the ultrasound imaging characteristics of malignant breast masses as compared with X-ray mammographic appearances and the gross and microscopic pathology†

Thirty correctly diagnosed carcinomas were chosen for retrospective analysis of their ultrasound and X-ray imaging characteristics, and correlated with pathologic examination. It was determined that the ultrasound image correlated will with that revealed by radiographic techniques. The posterior attenuation shadow and the jagged wall were the prime indicators of malignancy in this study, occurring in 90 and 87% of the cases, respectively. However, in about 67% of these masses, attenuation shadowing was revealed only by close-interval (1mm) stepwise scanning. A nonhomogeneous internal echo pattern was found in 73% of the cases. Thirteen of the 30 masses showed disturbed architecture away from the overt lesion when imaged by ultrasound techniques. Seventy per cent of these showed histological abnormalities in remote regions. Finally, it was shown that the attenuation shadowing exhibited by malignant breast masses is related to the collagen content of the lesion, expressed as fibrosis.

Developing tomorrow's academic radiologists: A 3-month residency elective in education

RATIONALE AND OBJECTIVES The shortage of academic radiologists reveals an urgent need to attract more residents into academic careers. A great deal of attention has been focused on research, but few programmatic initiatives have addressed the development of the next generation of radiology educators. The purpose of this study was to develop and test a new 3-month residency elective in education. MATERIALS AND METHODS A large academic radiology department developed a 3-month education elective, during which two residents would be relieved of clinical duties and focus full-time on tasks related to their development as educators, including the completion of a major educational project. RESULTS Two residents, in their 3rd year and 4th year of residency, respectively, proposed to collaborate in developing a Web-delivered tutorial for the departments senior medical student clerkship. At the end of 3 months, their radiology tutorial was introduced. In its 1st month, it received a mean rating of 4.3 on a five-point scale. The residents stated that the elective had enabled them to develop important skills in instructional technology, put into practice their enhanced understanding of learning psychology, and substantially strengthened their overall commitment to academic careers. CONCLUSION It is vital that residency programs focus on developing the next generation of radiology educators. This ongoing education elective represents one successful model.

Variation of transducer frequency output and receiver band-pass characteristics for improved detection and image characterization of solid breast masses

A new approach has been used for ultrasound detection of small benign and malignant breast masses, namely, control of scattering in such a manner that a small mass can be easily recognized because of the effect of the scattering on the contrast between the mass and the surrounding normal tissue. Maintenance of good resolution as scattering is varied is an essential aspect of this approach. Image contrast is dependent on a number of instrumentation parameters but, in a fundamental sense, it is related to differences in the amount of scattering between a solid breast mass and the surrounding normal tissue. In the subject studies, modification of image contrast is accomplished by varying either the center frequency output of the transducer or the band-pass of the receiver. These approaches take advantage of differences in the frequency dependence of scattering coefficients of solid breast masses and normal tissue. A unique technique for varying center frequency without switching transducers was developed, namely, use of a wide bandwidth, co-polymer PVDF transducer, in combination with certain instrumentation conditions which allow the center frequency output of a single ultrasound transducer to vary over a relatively wide frequency range. Using this technique, an automatic B-mode ultrasound imaging breast instrument which allows emission of 3.5, 4.5, 6.5 and 11 MHz ultrasound frequencies from the same co-polymer transducer was used to examine patients with solid breast masses. Both a wide band-pass receiver, similar to that commonly used in clinical ultrasound systems and a tunable receiver (which allows variation of the band-pass from wide to narrow) was used with this automated system. Using the standard receiver system, it was found that there are advantages to having a range of transducer frequencies immediately available for breast examination. These include: (1) improved detection of masses located in highly attenuating regions of breast (by decreasing frequency); (2) availability of diagnostically relevant information at some one frequency which may not be apparent at other frequencies. Using the multiple frequency system and the standard receiver, it was found that the most appropriate examination frequencies for detection and diagnosis of fibroadenomas are higher frequencies (8 to 11 MHz). This is particularly true in the case of fibroadenomas in fatty breasts.(ABSTRACT TRUNCATED AT 400 WORDS)