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Limited data exist to guide appropriate use of magnetic resonance imaging (MRI) screening in women with a personal history of breast cancer. We developed an algorithm to inform the use of MRI screening in patients with a personal history, implemented it, and evaluated initial implementation at our community and academic practice sites.A multidisciplinary committee of providers developed the initial algorithm on the basis of available literature and consensus. To evaluate projected MRI utilization based on the initial algorithm and inform algorithm revision, charts of patients 80 years of age diagnosed and treated in 2010 with stage 0-III breast cancer (n = 236) were reviewed. The revised algorithm was implemented into the electronic medical record (September 2013). Thirteen months after implementation (2014-2015), chart review of patients with a personal history of breast cancer who underwent screening MRI was performed to assess algorithm adherence.Before algorithm development, 9% (20/236) of patients received MRI screening (6 genetic mutation/family history, 4 occult primary, 8 young age/breast density, 2 unknown). Use of MRI screening was projected to increase to 25% with algorithm implementation. In postimplementation review, we identified 183 patients with a personal history of breast cancer who underwent screening MRI, with 94% algorithm adherence.We successfully developed and implemented an algorithm to guide MRI screening in patients with a personal breast cancer history. Clinicians can use this algorithm to guide patient discussions regarding the utility of MRI screening. Further prospective study, including cancer detection rates, biopsy rate, and mortality, are necessary to confirm the algorithm's usefulness.

Rationale and Objectives The BI-RADS Atlas 5th Edition includes screening breast magnetic resonance imaging (MRI) outcome benchmarks. However, the metrics are from expert practices and clinical trials of women with hereditary breast cancer predispositions, and it is unknown if they are appropriate for routine practice. We evaluated screening breast MRI audit outcomes in routine practice across a spectrum of elevated risk patients. Materials and Methods This Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all consecutive screening breast MRI examinations from July 1, 2010 to June 30, 2013. Examination indications were categorized as gene mutation carrier (GMC), personal history (PH) breast cancer, family history (FH) breast cancer, chest radiation, and atypia/lobular carcinoma in situ (LCIS). Outcomes were determined by pathology and/or ≥12 months clinical and/or imaging follow-up. We calculated abnormal interpretation rate (AIR), cancer detection rate (CDR), positive predictive value of recommendation for tissue diagnosis (PPV2) and biopsy performed (PPV3), and median size and percentage of node-negative invasive cancers. Results Eight hundred and sixty examinations were performed in 566 patients with a mean age of 47 years. Indications were 367 of 860 (42.7%) FH, 365 of 860 (42.4%) PH, 106 of 860 (12.3%) GMC, 14 of 860 (1.6%) chest radiation, and 8 of 22 (0.9%) atypia/LCIS. The AIR was 134 of 860 (15.6%). Nineteen cancers were identified (13 invasive, 4 DCIS, two lymph nodes), resulting in CDR of 19 of 860 (22.1 per 1000), PPV2 of 19 of 88 (21.6%), and PPV3 of 19 of 80 (23.8%). Of 13 invasive breast cancers, median size was 10 mm, and 8 of 13 were node negative (61.5%). Conclusions Performance outcomes of screening breast MRI in routine clinical practice across a spectrum of elevated risk patients met the American College of Radiology Breast Imaging Reporting and Data System benchmarks, supporting broad application of these metrics. The indication of a personal history of treated breast cancer accounted for a large proportion (42%) of our screening examinations, with breast MRI performance in this population at least comparable to that of other screening indications.

Education policymakers are investing in information and communications technology (ICT) without a research base on how ICT improves outcomes. There is limited research on the effects of different types of ICT investments on outcomes. The Kenya Primary Math and Reading (PRIMR) study implemented a randomized controlled trial comparing the effects and cost of three interventions – e-readers for students, tablets for teachers, and the base PRIMR program with tablets for instructional supervisors. The results show that the ICT investments do not improve literacy outcomes significantly more than the base non-ICT instructional program. Our findings show that cost considerations should be paramount in selecting ICT investments in the education sector.

Rationale and Objectives Breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) scanning protocols vary widely. The purpose of this study was to determine the effects of postcontrast timing on delayed-phase lesion kinetics assessment and ability to discriminate malignant from benign lesions. Materials and Methods Following institutional review board approval, we retrospectively reviewed all lesions assessed on magnetic resonance examinations from April 2005 to June 2006. DCE-MRI was performed with 90-second temporal resolution. Delayed-phase kinetic parameters including percentages of persistent, plateau, and washout, and categorizations of predominant and worst curve type were compared between 4.5 and 7.5 minutes postcontrast. Ability to discriminate benign and malignant lesions based on delayed-phase kinetic parameters was compared between postcontrast timings by receiver operating characteristic (ROC) analysis. Results Two hundred eighty consecutive breast lesions (206 malignant and 74 benign) were evaluated in 228 women. Comparing kinetics assessments at 7.5 versus 4.5 minutes: volume percentage of washout increased in malignancies by a mean of 9.4% (P .05). There were no significant differences between timings in area under ROC curves for delayed-phase kinetic parameters. Conclusions The choice of delayed postcontrast timing more strongly affects the kinetics assessments for malignancies than benign breast lesions, but our results suggest that a shortened breast DCE-MRI protocol may not significantly impact diagnostic accuracy. Furthermore, worst curve type classifications are least affected by postcontrast timing and may provide reliable assessment of delayed-phase kinetics across protocols.

Rationale and Objectives At the authors' level 1 trauma center, postgraduate year 3 and 4 radiology residents interpret urgent overnight imaging studies, which are reviewed by attending radiologists the next morning. The goals of this study were to determine the discrepancy rate for torso computed tomography between resident radiologists' preliminary interpretations and attending radiologists' final interpretations and to identify adverse patient events secondary to the delayed diagnoses. Materials and Methods All torso computed tomographic studies interpreted by weekday night residents (8 pm to 8 am ) from January 1, 2005, to March 13, 2007, were evaluated retrospectively. Major discrepancies between the residents' interpretations and the attending radiologists' interpretations were compiled. Exams with major discrepancies were additionally reviewed by two radiology residents and an attending emergency radiologist. The medical records of patients with major discrepant findings were also reviewed to identify adverse events that occurred because of the delays in final interpretation. Results A total of 4768 chest, abdominal, and/or pelvic computed tomographic studies were interpreted during the study period. A total of 112 major discrepancies were collected. In 17 cases (15%), two additional radiology residents and an attending emergency radiologist agreed with the initial residents' interpretations, decreasing the major discrepancy rate to 95 of 4768 (2.0%), consistent with data from the literature (0.4%–10%). Management was changed in 16 patients (0.3%) because of the major discrepancies: 13 patients underwent additional investigations, and 3 patients were recalled to the emergency room. No mortality or morbidity was directly attributed to the delays in diagnosis. Conclusion At the authors' institution, there was a 2.0% discrepancy rate between residents' preliminary interpretations and attending radiologists' final interpretations of overnight torso computed tomography, with a small rate of additional intervention as a result of the major discrepancies. No adverse patient effects were directly attributable to discrepant interpretations. In discrepant cases, there was a 15% disagreement rate (17 of 112) between attending radiologists, suggesting some degree of interreader variance in interpretation. In addition, this disagreement rate among attending radiologists may imply that these cases were complex. Because there is educational value in overnight call, independent radiology resident coverage should continue.

We report a case of distal radioulnar joint (DRUJ) arthroplasty with a Scheker prosthesis. Arthropathy of the DRUJ can occur as the result of a variety of mechanisms, including inflammatory arthritis, osteoarthritis, and post-traumatic arthritis. Resection of the distal ulna is often performed to relieve pain at the DRUJ. However, this can also disrupt the stability of the entire forearm, leading to convergence instability of the stump of the ulna against the radius. Several DRUJ prostheses have been developed to replace the mechanical function of the ulnar head in patients with pain related to distal ulnar resection and post-traumatic arthritis. However, most of them are designed to be used in patients with intact soft tissue and stabilizing ligaments at the DRUJ. These devices, therefore, are not appropriate for use in patients who have undergone resection of the DRUJ. The Scheker prosthesis was designed for patients who are symptomatic after ablation of the DRUJ from trauma or prior surgical resection. It uses a two plate and ball design, which has a unique appearance on post-operative radiographs.

In an era of constant and growing uncertainty, short or long-term planning becomes increasingly difficult. To cope with this uncertainty planners attempt to compensate with more rapid information systems and early warning systems, provided by prediction models and business and consumer surveys. The author assesses the value of the qualitative as opposed to the quantitative data contained in business surveys and its significance as an indicator of the business climate.

This paper describes the extent and objectives of private industrial planning in the Federal Republic of Germany. The IFO-Institute conducted an extended survey of the scope and type of industrial planning in 1965, and repeated some of the questions on the incentives to investment planning at the end of 1969. The different results of the two surveys are likely to be typical not only for the Federal Republic but to reflect in some respects industrial planning habits in other Western countries. The IFO survey covered 1,600 firms representing a third of the total industrial turnover in West Germany, and included questions on: The intensity of planning, the frequency of longer term planning, the scope of the plans, the use of official forecasts, the impulses for planning and the motives for capital expenditure, in manufacturing industry.