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Objective To examine the effects of COVID-19 pandemic on our department's Radiology Consultation Service (RCS) related to breast imaging, and how utilization of the provided services may have differed as compared to prior to the pandemic. Materials and methods A retrospective cohort study of patients and health care providers who consulted the RCS, as well as those patients who had a screening mammogram and/or ultrasound between January 1, 2019 and September 1, 2020. Consultations were performed by an RRA, RN and one of 17 breast imaging radiologists assigned to consults on daily. Descriptive statistics were performed to describe the study subject population. Results Between January 1, 2020 and July 31, 2020, a total of 1623 consultations were performed, in comparison to the control period from the year prior (January 1, 2019 to July 31, 2019), when a total of 1398 consultations were performed, representing a 16% increase in one year. Between March 1, 2020 and June 30, 2020, a total of 679 consultations were performed, in comparison to the control period from the year prior (March 1, 2019 to June 30, 2019), when 583 consultations were performed, representing a 16.5% increase in a four-month period. 350 out of 679 (36.8%) consultations addressed COVID concerns. Conclusions While much of radiology experienced an unprecedented decrease in imaging studies during the initial peak of COVID-19 crisis, the RCS at our institution showed a significant increase in services provided, evolving to address pressing concerns related to COVID-19.

OBJECTIVE Although extensive analyses evaluating screening mammography for breast cancer have been published, some utilized databases do not distinguish between modes of detection, which confounds the conclusions made about the impact of screening mammography. METHODS A retrospective cohort study of women at our institution with pathologically-proven breast cancer from January 2015 to April 2018 was conducted. Subjects were categorized by their mode of diagnosis: screening or non-screening. Patient demographics, tumor characteristics, and treatments were compared between detection methods using Wilcoxon rank-sum test for continuous variables and chi-squared or Fisher's exact test. RESULTS 1026 breast cancers were analyzed. 80.8% of screen-detected breast cancers were invasive. Compared to symptomatically detected cancers, screen-detected were smaller (median size 8 mm vs. 15 mm, p

What is Imposter Syndrome, whom does it affect, and when, and why is it important to recognize? In this multidisciplinary article, the phenomenon is defined and discussed by a psychiatrist, followed by strategic advice by a radiologist, interventional radiologist and radiation oncologist.

Committed to teaching, Dr. Goske developed an academic niche for herself focusing on educational initiatives. She co-created the widely successful Cleveland Clinic Webbased Curriculum for radiology residents, which reached acclaimed success with 65 modules used by 25,000 registrants in 53 countries and over 400 residency programs. With her natural curiosity, enthusiasm and perseverance, Dr. Goske subsequently had the vision to develop a worldwide coalition that included people from all aspects of radiology to broadcast a simple message, image gently. The influential and longstanding campaign, Image Gently, served to educate radiologists, medical physicists, radiologic technologists and most importantly, parents. Dr. Goske wanted to empower parents and the radiology community to improve pediatric patient safety and work towards decreasing radiation exposure in children. She continued her impactful work by establishing the Quality Improvement Registry in CT Scans in children in 2011 and worked as the pediatric radiology representative on the American College of Radiology's Dose Index Registry in 2013. Focused on compassionate patient care, Dr. Goske's overarching goal was to improve the patient experience throughout the many advancements in radiology. Her excellence in patient care, innovative approaches to education and safety, and collaborative ability to bring out the best in radiology led to her being the 2018 recipient of the ACR Gold Medalist, only the ninth woman ever to do so.

Breastfeeding has medical and economic benefits and providing an environment supportive of breastfeeding should be a priority in radiology to promote diversity, equity and inclusion. Most breastfeeding radiologists do not meet their breastfeeding goals and inadequate time for pumping is the most commonly cited barrier. The UCSF lactation credit model sets the standard for breastfeeding support in medicine by providing protected time without productivity penalties and it should be adapted and implemented across radiology practices to more fully support breastfeeding radiologists and radiation oncologists.

Background Women should be evaluated for breast cancer risk by age 30 to assess for screening need. Recent trends in breast cancer in this population may further inform recommendations. Objective The aim of this study was to analyze trends over time in the rate of breast cancer, tumor characteristics and treatment in women under age 40. Methods Retrospective cohort study of women under age 40 at our institution diagnosed with breast cancer from January 2007 to April 2018 was conducted. Patient demographics, tumor characteristics and treatment outcomes were collected. Descriptive statistics and the Mann-Kendell Trend test were calculated. Two-proportion z-tests were used to compare proportions of stage, pathology and treatment between 2007-2013 and 2014–2018. Results 197 women under age 40 were treated for a new diagnosis of breast cancer at our institution. A higher proportion of women were diagnosed with invasive carcinoma in 2013–2018 (91%) compared to 2007–2012 (78%), p = 0.008. A higher proportion of women were diagnosed with advanced stage disease (stage III-IV) in 2013–2018 (24%) compared to 2007–2012 (2%), p = 0.001. No statistically significant evidence for an increasing trend of overall rate of breast cancer over the last 11 years (p = 0.419) was observed. Conclusions While no statistically significant increase in overall rate of breast cancer was noted, an increase in invasive and later staged breast cancers was observed. Clinical impact Rise in more aggressive cancers in a population that is largely not screened may have implications both on the individual young woman's morbidity as well as on a public health level.

Committed to teaching, Dr. Goske developed an academic niche for herself focusing on educational initiatives. She co-created the widely successful Cleveland Clinic Webbased Curriculum for radiology residents, which reached acclaimed success with 65 modules used by 25,000 registrants in 53 countries and over 400 residency programs. With her natural curiosity, enthusiasm and perseverance, Dr. Goske subsequently had the vision to develop a worldwide coalition that included people from all aspects of radiology to broadcast a simple message, image gently. The influential and longstanding campaign, Image Gently, served to educate radiologists, medical physicists, radiologic technologists and most importantly, parents. Dr. Goske wanted to empower parents and the radiology community to improve pediatric patient safety and work towards decreasing radiation exposure in children. She continued her impactful work by establishing the Quality Improvement Registry in CT Scans in children in 2011 and worked as the pediatric radiology representative on the American College of Radiology's Dose Index Registry in 2013. Focused on compassionate patient care, Dr. Goske's overarching goal was to improve the patient experience throughout the many advancements in radiology. Her excellence in patient care, innovative approaches to education and safety, and collaborative ability to bring out the best in radiology led to her being the 2018 recipient of the ACR Gold Medalist, only the ninth woman ever to do so.

Each year, the American College of Radiology (ACR) has awarded its highest honor, the ACR Gold Medal, to an individual for distinguished, extraordinary service to the ACR or to the discipline of radiology. While this prestigious award was established almost a century ago, only ten women have received the honor throughout its history. This article seeks to highlight the life and achievements of one of these women, Dr. Kay Vydareny. Despite encountering barriers facing women in the medical field during medical school and residency in the 1960-70s, Dr. Vydareny went on to embark on a remarkable, enduring career. Early in her career, she began to build a professional network of fellow women colleagues through the American Association of Women Radiologists (AAWR), eventually serving as AAWR President in 1984. In addition to the AAWR, she served in leadership roles in many professional radiological organizations including the ACR. She was elected the first female speaker of the ACR Council Steering Committee in 1993, served on the Board of Chancellors from 1995 to 2002, and was President in 2001. At the same time, she maintained a passion for medical education. In honor of her distinguished and extraordinary service to radiology full of many groundbreaking firsts, she was awarded the ACR Gold Medal in 2005. She was only the fifth woman ever to receive this award. Throughout her outstanding career, Dr. Vydareny has continually been a dedicated and thoughtful educator, mentor, and leader who has made a lasting impact on the field of radiology.

A 68-year-old woman with a history of multifocal uterine leiomyomas presented with left groin pain and was referred for cross-sectional imaging to assess for the presence of an inguinal hernia. In this patient, MRI demonstrated a round ligament leiomyoma encased in the proximal left inguinal canal. Leiomyomas are the most common benign gynecologic tumors, however round ligament leiomyomas are very rare. The purpose of this case report is to highlight a rare manifestation of a common entity.

To determine which modalities [2D mammography (2D), digital breast tomosynthesis (DBT), whole breast sonography (WBS)] are optimal for screening depending on breast density.Institutional retrospective cohort study of 2013 screening mammograms (16,789), sorted by modalities and density.Cancer detection is increased by adding WBS to 2D (P=.02) for the overall study population. Recall rate was lowest with 2D+DBT (10.2%, P.001) and highest with 2D+DBT+WBS (23.6%, P.001) for the overall study population as well.Women with dense and nondense breasts benefit from reduced recall rate with the addition of DBT; however, this benefit is negated with the addition of WBS.

The terms "cornual," "interstitial," and "angular" pregnancies are used inconsistently in the literature. Some sources use "interstitial" and "cornual" synonymously, while others reserve "cornual" for gestations in bicornuate or septate uteri; others distinguish interstitial from angular pregnancy, while in practice, many physicians are unfamiliar with the latter designation. This article aims to clarify the terms and review the literature with respect to diagnosis and prognosis, with attention to the potential roles of 3D ultrasound and magnetic resonance imaging.

Purpose The aim of this study was to determine the recall rate of screening ultrasound with automated breast volumetric scanning (ABVS) in women with dense breasts (BI-RADS density classification 3 or 4 on mammogram). Materials and Methods In this retrospective cohort study, at the end of the “first quarter” (August–October 2013) of use, our practice database was searched for all ABVS examinations performed and specifically, the positive examinations (defined as abnormal/BI-RADS 0) for which patients were recalled for additional imaging evaluation with handheld ultrasound (HHUS); the latter group was reviewed with respect to final BI-RADS and pathology if relevant. Results During the 3-month study time period, 558 ABVS studies were performed: 453 (81%) were initially BI-RADS 1 or 2 and 105 (19%) were BI-RADS 0-incomplete and recalled, corresponding with an overall recall rate of 19%; specifically, the recall rate trended down from 24.7% in August to 12.6% in October. To date, 98 of the 105 recalled women have returned for HHUS, with the resultant final BI-RADS as follows: 25/98=25% BI-RADS 1, 46/98=47% BI-RADS 2, 13/98=13% BI-RADS 3, 14/98=15% BI-RADS 4, and 0/98=0% BI-RADS 5. All biopsies performed to date of the ABVS-detected BI-RADS 4 lesions have yielded benign results, with the most common pathology being fibroadenoma. Conclusion The recall rate of screening ABVS in women with dense breasts at our institution was under 20% overall during its first quarter of use, and trended down from nearly 25% in the first month to under 13% in the third. The clinical implication is that ABVS does have a learning curve, but that is a potentially feasible way to meet the increasing demands for screening ultrasound in women with dense breasts.

In this case report, the history and imaging of two patients with invasive lobular carcinoma (ILC) in the skin are presented, followed by a discussion of both benign and malignant intradermal findings on breast ultrasound. Although the majority of dermal findings are benign, these cases are a reminder that malignancy can manifest within the skin. The purpose of presenting these cases together is to remind breast imagers of the importance of considering malignancy in the differential diagnosis of intradermal lesions on breast ultrasound, especially in special circumstances such as a personal history of breast cancer or associated clinical findings.

Celiac artery trunk thrombosis is a rare complication of pancreatitis. Only two other cases have been reported in the English-language literature. Here, we present the clinical and multimodality imaging findings for a woman with pancreatitis who had continued pain after normalization of pancreatic enzyme levels and was unexpectedly found to have occlusion of her celiac trunk on follow-up MRI. She was managed as an outpatient and had spontaneous resolution 2 weeks later.

Wandering spleen, a rare entity, is caused by the absence or laxity of the normal anchoring splenic ligaments. Only three neonatal cases have been reported in the English-language literature. We present the clinical and multimodality imaging findings of a newborn with laceration and hemorrhage of a wandering spleen. The course was complicated by the concurrent diagnosis of glucose-6-phosphate dehydrogenase deficiency, which confused the clinical picture when a falling hematocrit raised the question of rebleeding several days after presentation.

This series presents the history and imaging of patients who had cosmetic fat augmentation following mastectomy and reconstruction. The cases provide the useful reminder that a complete surgical history is essential when assessing the imaging of a post-operative breast patient and that speaking directly with patients can be a critical step in putting together a complete clinical picture and adding value to their care.

A 63-year old female with right breast cancer underwent lumpectomy, with axillary lymph nodes negative for metastatic carcinoma but demonstrating noncaseating granulomatous lymphadenitis. These histopathologic findings, in conjunction with thoracic lymphadenopathy and diffuse splenic nodules on computed tomography, were consistent with sarcoidosis. This unusually novel case of concomitant diagnosis of breast cancer and sarcoidosis case reminds both the radiologist and pathologist to keep in mind the possibility of alternate or new diagnoses when reading their respective studies.