Publications

OBJECTIVE: Understand radiologists' opinions regarding remote breast imaging and determine whether having home workstations is associated with greater job satisfaction or less burnout.

METHODS: A 43-question survey on remote breast imaging was distributed to Society of Breast Imaging members (July 6 to August 2, 2023). Questions regarding job satisfaction and burnout were included. Pearson's chi-squared tests compared demographic variables and responses. Multiple-variable logistic regression assessed associations between home workstations and job satisfaction or burnout.

RESULTS: In total, 424 surveys were completed (response rate 13%, 424/3244). Among the third (31%, 132/424) of breast imaging radiologists with home workstations, top motivations included flexibility/work-life balance (67%; 88/132) and decreased commute time (51%, 67/132). Most felt that working from home improved their efficiency (65%, 86/132). Perceived drawbacks among all breast imaging radiologists included the inability to perform US or physical examination (71%, 300/424) and impaired patient contact (47%, 198/424). Most (57%, 240/424) wished for more breast imaging remote reading opportunities, and one-third (32%, 136/424) saw themselves in a 100% remote reading practice in the future. The majority (60%, 228/388) felt that remote reading would majorly or moderately improve radiologist wellness, but no significant association was found between having home workstations and job satisfaction (P = .301) or burnout (P = .140).

CONCLUSION: The majority of breast imaging radiologists want more opportunities to work remotely, perceiving that it improves work-life balance and efficiency, albeit at the expense of patient contact. However, those currently working from home did not have higher job satisfaction or lower burnout.

PURPOSE: To evaluate the diagnostic performance of quantitative measures derived from [18F]FDG PET/CT, [18F]FEC PET/CT, and DW-MRI in the detection of lymph node metastases in endometrial and cervical cancer with comparison to standard visual PET analysis with histology as the reference standard.

METHODS: Subanalysis of quantitative data from the prospective multicentre MAPPING study. Nodal and tumour SUVmax from [18F]FDG PET/CT and [18F]FEC PET/CT and ADCmean from DW-MRI were documented. Nodal-to-tumour ratios (NTR) and SUVmax-to-ADCmean ratio (STAR) were calculated. Optimal cut-offs of quantitative measures were compared to visual assessment on a regional basis using histopathology as the reference standard.

RESULTS: Scans from 112 patients (36 cervical and 76 endometrial cancers; 340 nodal regions) were eligible for quantitative image analysis. Lower ADCmean on DW-MRI was observed in metastatic nodes for cervical cancer but not for endometrial cancer. Quantitative measures were significantly higher in malignant than benign nodal regions on [18F]FDG PET/CT and [18F]FEC PET/CT in endometrial cancer. SUVmax cut-offs showed similar performance to visual assessment in the diagnosis of metastatic lymph nodes in endometrial cancer whilst ADCmean cut-offs showed significantly lower specificity than visual assessment. Interobserver agreement was excellent for SUVmax measurements on both [18F]FDG PET/CT and [18F]FEC PET/CT, but poor for ADCmean on DW-MRI.

CONCLUSION: Quantitative measures from [18F]FDG PET/CT, [18F]FEC PET/CT, or DW-MRI did not outperform visual assessment in the detection of nodal metastases in endometrial cancer. Therefore, the implementation of these quantitative measures as standalone diagnostic tools in routine clinical practice is not recommended.

PURPOSE: The aim of this study was to understand the utilization of arterial thrombectomy (AT) and venous thrombectomy (VT) by provider specialty, region, and diagnosis code in the Medicare population.

METHODS: Common Procedural Terminology (CPT) codes 37184 to 37188 claims for AT and VT between January 2017 and December 2022 were analyzed from the Medicare standard analytic file 5% sample claims database. Data fields included provider specialty, geographic region, place of service, and number of procedures. A secondary analysis was performed of thrombectomy claims by International Classification of Diseases, 10th rev, codes for venous thromboembolism (VTE) or arterial thromboembolism.

RESULTS: Thrombectomy claims increased by 38%, with a 137% increase in VT (compound annual growth rate [CAGR] +19%) compared with a 7% increase in AT (CAGR +1%). Dominant VT specialties were radiology (34%), surgery (29%), and cardiology (20%). Dominant AT specialties were surgery (41%), cardiology (35%), and radiology (17%). Cardiology demonstrated a 19% decrease in AT (CAGR -4%), whereas radiology experienced a 47% increase (CAGR +5%). The majority of AT and VT claims were performed in the Southeast and Midwest, accounting for 62% of AT and 57% of VT. Dominant place of service for both AT and VT was outpatient hospital (76% of AT, 78% of VT). International Classification of Diseases, 10th rev, analysis demonstrated a 712% increase in AT claims for pulmonary embolism (CAGR 52%).

CONCLUSIONS: VT and AT for VTE continue to rise at a higher rate than non-VTE claims, with a 712% increase in AT for pulmonary embolism and 137% increase in VT. Radiology remains the dominant VT specialty and experienced the greatest increase in AT claims as a specialty.

PURPOSE: Cardiac imaging is an integral part of modern diagnostic imaging and a subject heavily tested on the Radiology Core exam. Therefore, radiology residency programs should provide adequate training in this area. This study aims to investigate the current state of cardiac imaging training within radiology residency programs in the United States.

MATERIALS AND METHODS: Survey questionnaires using the Research Electronic Data Capture (REDCap) platform were sent to heads of cardiac/cardiothoracic sections in all US radiology residency programs for which valid email addresses were available.

RESULTS: Of 163 questionnaires sent, there were 70 responses, with 82.9% completing the entire survey. In total, 85.9% reported having a cardiac imaging rotation, with 58.8% being 4 weeks, mostly in a single block. Sixteen programs (31.4%) offered a longer cardiac experience (6 to 12 wk). In total, 90.7% reported having a designated person responsible for cardiac imaging, a radiologist in 68.5% and a combined radiologist and cardiologist in 22.2%. The responsible person for reporting cardiac CT was a radiologist in 40.7%, with a combined radiologist and cardiologist in 59.3%. For cardiac MRI studies, there was combined responsibility in 69.0%, either on alternate days of coverage or with the radiologist interpreting noncardiac findings. A total of 65.5% reported having ≥6 cardiac case conferences yearly, and 75.9% had ≥6 cardiac lectures. In total, 65.6% of programs offered cardiothoracic fellowships, with 87.2% dedicating ≥3 months to cardiac imaging. Only 18.6% had dedicated cardiovascular fellowships.

CONCLUSION: Our research offers crucial insights into the current trends in cardiac imaging education and practice within radiology residency programs, so that professional societies can develop guidelines to structure a more uniform and thorough approach toward cardiac imaging education.

Nonpregnant and pregnant women who present with acute pelvic pain can pose a diagnostic challenge in the emergency setting. The clinical presentation is often nonspecific, and the differential diagnosis may be very broad. These symptoms are often indications for pelvic US, which is the primary imaging modality when an obstetric or gynecologic cause is suspected. Interpretation of pelvic US may be challenging and a source of confusion and misinterpretation for radiologists. Additionally, cognitive biases in imaging interpretation can contribute to diagnostic errors. Cognitive biases represent systematic errors due to failure of the mental shortcuts that the brain subconsciously uses to produce quicker judgments. There are multiple different types of cognitive biases, all of which may lead to perceptual and interpretive errors. Familiarity with common and uncommon pelvic US findings in the setting of pelvic pain is imperative to assist with prompt and accurate diagnosis. Awareness of potential biases when interpreting pelvic US findings further helps hone the interpretation. The authors illustrate the imaging findings in several peer learning cases of nonpregnant and first-trimester pregnant patients who presented with acute pelvic pain in the emergency setting. Several nonobstetric and nongynecologic causes of acute pelvic pain are included for which pelvic US was the first imaging modality used in diagnosis. Diagnostic errors and cognitive biases in interpretation related to these cases are highlighted. The radiologist's awareness of potential cognitive biases in image interpretation may help to refine the differential diagnosis and mitigate errors. ©RSNA, 2025 Supplemental material is available for this article.

OBJECTIVE: To compare the association of single maximum diameter and average cyst diameter of pancreatic cysts measured on magnetic resonance cholangiopancreatography (MRCP) with segmented cyst volume and secondarily evaluate the effect of average cyst diameter on screening guideline classification.

METHODS: Consecutive patients with pancreatic cysts < 3 cm on MRCP in 2017 were retrospectively identified. The single maximum diameter and perpendicular short axis diameter of pancreatic cysts obtained on coronal MRCP were measured and their average was taken to determine average cyst diameter. Calculated volume approximations based on single maximum diameter and average cyst diameter were compared with segmented cyst volume. Subsequently, patients were classified based on average cyst diameter versus single maximum diameter according to a currently used screening guideline. Intraclass correlation was used to assess interobserver agreement. Williams's test was used to compare between-group correlation coefficients.

RESULTS: The mean value of single maximum diameters and average cyst diameter of the 86 included cysts were 15.4 ± 7.3 mm and 12.6 ± 6.1 mm, respectively. The mean volume of segmented cysts was 1,521 ± 1,983 mm3. Interreader agreement for measurement of cyst diameters was excellent (r = 0.99). The volume calculated based on the average cyst diameter correlated better to segmented cyst volume (r = 0.88) than single maximum diameter (r = 0.73, P < .0001). Of 86 patients, 24 (28%) were classified to a less stringent follow-up strategy by using average cyst diameter.

DISCUSSION: The average cyst diameter more accurately reflects the segmented cyst volume than a single maximum diameter. Utilization of average cyst diameter in existing screening guidelines reclassified 28% of patients into lower-risk screening groups, which would reduce subsequent surveillance imaging overall.

PURPOSE: Organizing pneumonia is an inflammatory disorder that may co-exist with malignancy in the lung or elsewhere in the body. We aimed to assess patients with a lung biopsy diagnosis of organizing pneumonia for subsequent pathology confirmation of co-existing malignancy.

METHODS: In this retrospective IRB-approved, HIPAA-compliant study, 1314 consecutive patients who underwent CT-guided lung biopsy for suspected lung cancer or metastatic disease from 02/2014 to 04/2022 at a single tertiary referral hospital were identified. In 98/1314 (7.5%) patients, biopsies showed organizing pneumonia, which represented our study cohort. Clinical outcomes, including follow-up imaging and repeat tissue sampling if performed, were evaluated through chart review. Descriptive statistics were calculated.

RESULTS: There were 43/98 (44%) females, mean age was 66 ± 14 years, mean lesion size 2.9 ± 2.1 cm, and 11/98 (11.2%) had prior history of malignancy. Of 98 patients initially diagnosed with organizing pneumonia on lung biopsy, 11 (11.2%) were subsequently found to have malignancy. Among these, 6 (54.5%) had pulmonary metastases and 5 (45.5%) had primary lung cancer. Malignancies were confirmed through percutaneous re-biopsy in 3/11 (27%) and bronchoscopic, endoscopic, or surgical procedures in 8/11 (73%).

CONCLUSION: Malignancy can co-exist with organizing pneumonia in a substantial percentage of initial lung biopsies. Therefore, repeat tissue sampling should be considered when there is high clinical suspicion of malignancy despite an initial histopathological diagnosis of organizing pneumonia. This is especially relevant in lesions that demonstrate FDG avidity on PET/CT or an increase in size on interval imaging, or in instances where the biopsy core sizes are small or where the biopsies have intraprocedural complications.