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The National Academy of Medicine Plan for Health Workforce Well-Being identifies seven priority areas, including creating positive work environments, addressing burnout and stress, promoting transparency and equity in compensation, providing education and training to promote resilience, enhancing community and social support systems, addressing the stigma associated with seeking help for mental health and substance use disorders and fostering leadership commitment and accountability for workforce well-being. This paper will explore the National Plan for Health Workforce Well-Being, providing an overview of the seven priority areas and offering strategies for implementation in radiology. [ABSTRACT FROM AUTHOR]

The incidence and mortality rate of breast cancer continues to rise in Guyana. One key factor contributing to this issue is that Guyana does not have a national breast cancer screening program nor the resources or infrastructure to support one. As a result, it is important to consider cost-effective solutions that can promote the early detection of breast cancer. The literature suggests a promising intervention could address gaps in frontline healthcare providers' knowledge and understanding of breast health. Providers who receive dedicated curricular training in breast health in conjunction with learning the clinical breast exam (CBE) and ultrasound tend to show an increase in their early detection rates. With this in mind, we sought to evaluate an existing breast health curriculum in Georgetown, Guyana, by measuring provider fund of knowledge before and after the intervention. Over 1 week, sixty-two participants, mostly nursing students, were divided into two groups. Each group participated in the two-and-a-half-day course. Participants were given a pretest assessment and then went through an intensive 8-module course complete with CBE training and ultrasound demonstration before taking a posttest. We found that while only one of the sixty-two participants passed the initial pretest assessment, forty of the sixty-two participants passed the posttest. Statistical analysis showed that the difference in test scores between the pretest and the posttest was statistically significant. While more studies are needed, these findings suggest that focusing on the breast health knowledge of providers in Guyana and other similar countries may be a highly effective yet cost-friendly intervention that could significantly improve early detection rates and ease the breast cancer disease burden. • Low- and middle-income countries have a high burden of breast cancer disease. • A lack of breast cancer screening in Guyana contributes to increased mortality. • Increasing provider knowledge of breast health supports holistic breast care. • Education of nurses promotes earlier detection of breast cancer. [ABSTRACT FROM AUTHOR]

Cancer immunotherapies are drugs that modulate the body's own immune system as an anticancer strategy. Checkpoint inhibitor immunotherapies interfere with cell surface binding proteins that function to promote self-recognition and tolerance, ultimately leading to upregulation of the immune response. Given the striking success of these agents in early trials in melanoma and lung cancer, they have now been studied in many types of cancer and have become a pillar of anticancer therapy for many tumor types. However, abundant upregulation results in a new class of side effects, known as immune-related adverse events (IRAEs). It is critical for the practicing radiologist to be able to recognize these events to best contribute to care for patients on checkpoint inhibitor immunotherapy. Here, we provide a comprehensive system-based review of immune-related adverse events and associated imaging findings. Further, we detail the best imaging modalities for each as well as describe problem solving modalities. Given that IRAEs can be subclinical before becoming clinically apparent, radiologists may be the first provider to recognize them, providing an opportunity for early treatment. Awareness of IRAEs and how to best image them will prepare radiologists to make a meaningful contribution to patient care as part of the clinical team. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To evaluate a weakly supervised deep learning approach to breast Magnetic Resonance Imaging (MRI) assessment without pixel level segmentation in order to improve the specificity of breast MRI lesion classification.Materials and Methods: In this IRB approved study, the dataset consisted of 278,685 image slices from 438 patients. The weakly supervised network was based on the Resnet-101 architecture. Training was implemented using the Adam optimizer and a final SoftMax score threshold of 0.5 was used for two class classification (malignant or benign). 278,685 image slices were combined into 92,895 3-channel images. 79,871 (85%) images were used for training and validation while 13,024 (15%) images were separated for testing. Of the testing dataset, 11,498 (88%) were benign and 1531 (12%) were malignant. Model performance was assessed.Results: The weakly supervised network achieved an AUC of 0.92 (SD ± 0.03) in distinguishing malignant from benign images. The model had an accuracy of 94.2% (SD ± 3.4) with a sensitivity and specificity of 74.4% (SD ± 8.5) and 95.3% (SD ± 3.3) respectively.Conclusion: It is feasible to use a weakly supervised deep learning approach to assess breast MRI images without the need for pixel-by-pixel segmentation yielding a high degree of specificity in lesion classification. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To evaluate the clinical significance of mammographically occult additional tumors identified more than 2cm away from the primary breast cancer on preoperative magnetic resonance imaging (MRI).Materials and Methods: An Institutional Review Board approved review of consecutive preoperative breast MRIs performed from 1/1/08 to 12/31/14, yielded 667 patients with breast cancer. These patients underwent further assessment to identify biopsy proven mammographically occult breast tumors located more than 2cm away from the edge of the primary tumor. Additional MRI characteristics of the primary and secondary tumors and pathology were reviewed. Statistical analysis was performed using SPSS (v. 24).Results: Of 667 patients with breast cancer, 129 patients had 150 additional ipsilateral mammographically occult tumors that were more than 2cm away from the edge of the primary tumor. One hundred twelve of 129 (86.8%) patients had one additional tumor and 17/129 (13.2%) had two or more additional tumors. In 71/129 (55.0%), additional tumors were located in a different quadrant and in 58/129 (45.0%) additional tumors were in the same quadrant but ≥2cm away. Overall, primary tumor size was significantly larger (mean 1.87± 1.25 cm) than the additional tumors (mean 0.79 ± 0.61cm, p < 0.001). However, in 20/129 (15.5%) the additional tumor was larger and in 26/129 (20.2%) the additional tumor was ≥1cm. The primary tumor was significantly more likely to be invasive (81.4%, 105/129) compared to additional tumors (70%, 105/150, p = 0.03). In 9/129 (7.0%) patients, additional tumors yielded unsuspected invasive cancer orhigher tumor grade. The additional tumor was more likely to be nonmass lesion type (37.3% vs 24% p = 0.02) and focus lesion type (10% vs 0.08%, p < 0.001) compared to primary tumor.Conclusion: Mammographically occult additional tumors identified more than 2cm away from the primary breast tumor on MRI are unlikely to be surgically treated if undiagnosed and may be clinically significant. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Recent changes in radiology curriculum and access to residency program information, including the introduction of various online resources and the Interventional Radiology integrated pathway, may influence the rank list order of medical student applicants. The purpose of this study is to assess factors that affect the rank lists of medical students applying to our radiology residency program in the 2016-2017 academic year.Materials and Methods: After IRB approval, an anonymous online 19 question survey was emailed to 622 applicants to our diagnostic radiology and/or interventional radiology integrated pathway. Applicants ranked 35 unique factors that may influence their residency rank list order from 1 (not important at all) to 5 (very important), listed their top five 'very important' factors, and ranked various sources of information used to learn about residency programs. General applicant demographic questions were also included.Results: Response rate was 18.8% (117/622). The 5 most important factors affecting applicant ranking of programs are perceived happiness of the residents and faculty (4.69), fellowship and job placement of recent graduates (4.34), interactions with programs' current residents (4.33), stability of the department and program (4.29), and geographic location of the program (4.27). The top 5 resources for learning about residency programs were interactions with current residents at the program (4.47), program director (3.87), and interviewing faculty (3.87). Individual program websites were ranked more highly than internet message boards and forums as an information source.Conclusion: Medical students consider a large number of factors and resources in determining their rank lists, with factors encountered during the interview day playing a significant role in shaping the applicants' view of a residency program. [ABSTRACT FROM AUTHOR]

The magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and its clinical significance as a biomarker of breast cancer risk has been proposed based on qualitative studies. Previous BPE quantification studies lack appropriate correlation with BPE qualitative assessments. The purpose of this study is to validate our three-dimensional BPE quantification method with standardized BPE qualitative cases. An Institutional Review Board-approved study reviewed 500 consecutive magnetic resonance imaging cases (from January 2013-December 2014) using a strict inclusion criteria and 120 cases that best represented each of the BPE qualitative categories (minimal or mild or moderate or marked) were selected. Blinded to the qualitative data, fibroglandular tissue contours of precontrast and postcontrast images were delineated using an in-house, proprietary segmentation algorithm. Metrics of BPE were calculated including %BPE ([ratio of BPE volume to fibroglandular tissue volume] × 100) at multiple threshold levels to determine the optimal cutoff point for BPE quantification that best correlated with the reference BPE qualitative cases. The highest positive correlation was present at ×1.5 precontrast average signal intensity threshold level (r = 0.84, P < 0.001). At this level, the BPE qualitative assessment of minimal, mild, moderate, and marked correlated with the mean quantitative %BPE of 14.1% (95% CI: 10.9-17.2), 26.1% (95% CI: 22.8-29.3), 45.9% (95% CI: 40.2-51.7), and 74.0% (95% CI: 68.6-79.5), respectively. A one-way analysis of variance with post-hoc analysis showed that at ×1.5 precontrast average signal intensity level, the quantitative %BPE measurements best differentiated the four reference BPE qualitative groups (F [3,117] = 106.8, P < 0.001). Our three-dimensional BPE quantification methodology was validated using the reference BPE qualitative cases and could become an invaluable clinical tool to more accurately assess breast cancer risk and to test chemoprevention strategies. [ABSTRACT FROM AUTHOR]

Axillary staging in breast cancer is performed with physical exam and axillary imaging. Suspicious lymph nodes are biopsied and clipped prior to surgery to identify the previously biopsied node during surgery. Conventional mapping techniques of blue dye and radioisotope do not always accurately identify the clipped lymph node and therefore many techniques have been described to improve the identification of the clipped lymph node. Most of these techniques rely on axillary ultrasound to identify the previously biopsied lymph node or previously placed clip. A marker such as a fiducial reflector is then placed percutaneously. In this case report we describe a novel technique of Computed tomography (CT) identification of a previously clipped lymph node with CT guided placement of a fiducial reflector (SAVI SCOUT). The SAVI SCOUT was then identified and successfully excised with the previously biopsied lymph node. CT guided placement of SAVI SCOUT is a novel technique for the identification and retrieval of a previously biopsied axillary lymph node in breast cancer patients. • The technique of placing a fiducial reflector into a previously biopsied lymph node using CT guidance is novel approach. • When US is unsuccessful at identifying a previously biopsied lymph node, CT guidance can be utilized to locate the clip. • Fiducial reflectors placed using ultrasound or CT guidance can be identified and successfully excised during surgery. [ABSTRACT FROM AUTHOR]

Abstract Purpose Evaluate possible association between BPE and breast cancer tumor type/prognostic markers. Methods IRB approved retrospective study from 1/2010–1/2014 identified 328 patients who had breast MRI and available clinical/pathology data. BPE was categorized according to BI-RADS. The association between BPE and breast cancer molecular subtype/prognostic factors was evaluated. Results No significant association was present between high BPE and the following: HER2+ tumors, basal tumors, tumors with axillary nodal disease, high nuclear grade tumors, high Ki-67 index tumors or larger tumors. Conclusion Patients with high BPE may be at increased risk for breast cancer but not necessarily for those cancer subtypes with a poor prognosis. Highlights • No significant association was present between high BPE and Luminal B, HER2+ or basal subtypes of breast tumor. • No significant association between high BPE and axillary nodal disease, high grade tumors, high Ki-67 or larger tumors. • Patients with high BPE may be at increased risk for breast cancer but not necessarily for those with a poor prognosis. [ABSTRACT FROM AUTHOR]

Purpose To compare surgical outcomes of SAVI SCOUT reflector localization (SSL) versus wire localization (WL) for breast tumors. Methods Retrospective review of 42 SSL cases and 42 WL cases. WL patients were consecutively matched for clinical-pathologic features. Final surgical outcome measures were tumor specimen volume, margin status, and re-excision rates. Results No significant differences were present in median specimen volumes (SSL-15.2 cm 3 vs. WL-16.3 cm 3 ), positive margin rate (SSL-9.5% vs. WL-7.1%), close margin rate (SSL-7.1% vs. WL-11.9%) or re-excision rate (SSL-7.1% vs. WL-9.5%). Conclusion SSL is an acceptable alternative to WL with no significant differences in surgical outcomes. [ABSTRACT FROM AUTHOR]

Objective Worry about developing breast cancer (BC) has been associated with participation in screening and genetic testing and with follow-up of abnormal screening results. Little is known about the scope and predictors of BC worry in Hispanic and immigrant populations. Methods We collected in-person interview data from 250 self-identified Hispanic women recruited from an urban mammography facility (average age 50.4 years; 82% foreign-born). Women reported whether they worried about developing breast cancer rarely/never (low worry), sometimes (moderate worry), or often/all the time (high worry). We examined whether sociocultural and psychological factors (e.g., acculturation, education, perceived risk), and risk factors and objective risk for BC (e.g., family history, Gail model 5-year risk estimates, parity) predicted BC worry using multinomial and logistic regression. Results In multivariable models, women who perceived higher absolute BC risk (odds ratio, 1.66 [95% confidence interval, 1.28–2.14] for a one-unit increase in perceived lifetime risk) and comparative BC risk (e.g., odds ratio, 2.73, 95% confidence interval, 1.23–6.06) were more likely to report high BC worry than moderate or low BC worry. There were no associations between BC worry and indicators of objective risk or acculturation. Conclusions In Hispanic women undergoing screening mammography, higher perceptions of BC risk, in both absolute and comparative terms, were associated independently with high BC worry, and were stronger predictors of BC worry than indicators of objective BC risk, including family history, mammographic density, and personal BC risk estimates. [ABSTRACT FROM AUTHOR]