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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

Objective Three-dimensional bioabsorbable tissue marker (BTM) placement during breast surgery is performed for the purpose of improved surgical cavity delineation for radiotherapy and improved cosmetic outcome. The purpose of this study is to evaluate the postsurgical imaging findings of BTM. Methods This Institutional Review Board-approved retrospective review included all patients implanted with BTM at breast surgery from January 2017 to September 2018. Demographics, tumor characteristics, imaging, and histologic findings were evaluated. Medical records were reviewed during a three-year period to evaluate for tumor recurrence. Results Ninety-seven patients had BTM implanted, of which 76 patients had imaging follow-up of at least 1 year. Of the 76 patients who had mammographic follow-up, 3 (3.9%) developed suspicious microcalcifications requiring biopsy, yielding ductal carcinoma in-situ in 2 patients and benign calcifications in 1 patient. Of 61 patients who had sonographic follow-up, 44 (72.1%) patients had complex fluid collections containing avascular, heterogeneously hyperechoic solid components, which remained stable or decreased in size over time; no recurrent tumors were found in this group. One patient (1.6%) had a vascular solid mass, which yielded recurrent papilloma. Four (6.6%) patients developed irregular hypoechoic masses at the surgical site, one of which corresponded with a developing asymmetry mammographically; biopsy yielded fibromatosis. Tissue sampling of the remaining three cases yielded invasive ductal carcinoma, fat necrosis, and radiation changes, respectively. Conclusion Accurate identification of the expected postoperative imaging appearance of BTM may prevent unnecessary biopsy. Suspicious findings necessitating biopsy are pleomorphic calcifications, developing asymmetry and vascular and irregular hypoechoic masses.

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.

This study assesses how member boards of the American Board of Medical Specialties (ABMS) have adhered to a 2021 ABMS policy change allowing residents a minimum of 6 weeks of parental, caregiver, and medical leave.

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.

Overall, 55% of surveyed radiology practice leaders reported that burnout was a very significant problem, and 22% reported that burnout was a significant problem. Burnout did not vary by geographical region but did vary by practice size. Overall, 71% of respondents reported stress from workplace factors, and 36% reported stress from personal or social factors very significantly affected radiologist employee wellness; both sets of factors varied by geographical region, practice size, and practice type. Only 19% of practice leader respondents reported mechanisms to assess burnout, which varied by region and practice type.

The purpose of this study was to compare the diagnostic performance of synthetic 2D imaging generated from 3D tomosynthesis (DBT) with traditional 2D full-field digital mammography (FFDM) by use of the most up-to-date software algorithm in an urban academic radiology practice.The records of patients undergoing screening mammography with DBT, synthetic 2D imaging, and FFDM between August 13, 2014, and January 31, 2016, were retrospectively collected. The cohort included all biopsy-proven breast cancers detected with screening mammography during the study period (n = 89) and 100 cases of negative or benign (BI-RADS category 1 or 2) findings after 365 days of follow-up. In separate sessions, three readers blinded to outcome reviewed DBT plus synthetic 2D or DBT plus FFDM screening mammograms and assigned a BI-RADS category and probability of malignancy to each case. The diagnostic performance of each modality was assessed by calculating sensitivity and specificity. Reader performance was assessed by ROC analysis to estimate the AUC of the likelihood of malignancy.No statistically significant difference was found in diagnostic accuracy (sensitivity, specificity, positive predictive value, or negative predictive value) between DBT plus synthetic 2D mammography and DBT plus FFDM. There was no statistically significant difference between the AUC of DBT plus synthetic 2D mammography and the AUC of DBT plus FFDM for any reader.DBT plus synthetic 2D mammography performs as well as and not worse than DBT plus FFDM in measures of diagnostic accuracy and may be a viable alternative for decreasing radiation dose without sacrificing diagnostic performance.

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.

BACKGROUND Currently, there are several different recommendations for screening mammography from major national health care organizations, including: 1) annual screening at ages 40 to 84 years; 2) screening annually at ages 45 to 54 years, then biennially at ages 55 to 79 years; and 3) biennial screening at ages 50 to 74 years. METHODS Mean values of six Cancer Intervention and Surveillance Modeling Network (CISNET) models were used to compare these three screening mammography recommendations in terms of benefits and risks. RESULTS Mean mortality reduction was greatest with the recommendation of annual screening at ages 40 to 84 years (39.6%), compared with the hybrid recommendation of screening annually at ages 45 to 54 years, then biennially at ages 55 to 79 years (30.8%), and the recommendation of biennial screening at ages 50 to 74 years (23.2%). For a single-year cohort of US women aged 40 years, assuming 100% compliance, more breast cancers deaths would be averted over their lifetime with annual screening starting at age 40 (29,369) than with the hybrid recommendation (22,829) or biennial screening ages 50-74 (17,153 based on 2009 CISNET estimates, 15,599 based on 2016 CISNET estimates). To achieve the greatest mortality benefit, this single-year cohort of women would have the greatest total number of screening mammograms, benign recalls, and benign biopsies performed over the course of screening by following annual screening starting at age 40 years (90.2 million, 6.8 million, and 481,269, respectively) than by following the hybrid recommendation (49.0 million, 4.1 million, and 286,288, respectively) or biennial screening at ages 50 to 74 years (27.3 million, 2.3 million, and 162,885, respectively). CONCLUSION CISNET models demonstrate that the greatest mortality reduction is achieved with annual screening of women starting at age 40 years. Cancer 2017;123:3673–3680. © 2017 American Cancer Society

Purpose The aim of this study was to investigate the natural history of untreated screen-detected breast cancer. Methods A prospective cohort survey of Society of Breast Imaging fellows concerning the appearance on subsequent mammography of untreated breast cancer detected on screening mammography was conducted. Results A representative sample of the 108 actively practicing Society of Breast Imaging fellows (n = 42 [39%]) participated, each reporting outcomes data from his or her entire screening mammography practice. Among all practices, 25,281 screen-detected invasive breast cancers and 9,360 cases of screen-detected ductal carcinoma in situ were reported over the past 10 years. Among these cancers, there were 240 cases of untreated invasive breast cancer and 239 cases of untreated ductal carcinoma in situ, among which zero were reported to have spontaneously disappeared or regressed at next mammography. Conclusions Among 479 untreated breast cancers detected on screening mammography, none spontaneously disappeared or regressed. An unknown percentage of these cancers represent overdiagnosis, but because all untreated screen-detected cancers were visible and suspicious for malignancy at next mammographic examination, delaying the onset of screening or increasing the interval between screenings should not reduce the frequency of overdiagnosis.

To assess the trends of women in voluntary leadership roles in the ACR from 2001 to 2015.Retrospective leadership records from 2001 to 2015 were collected from the ACR Membership Database based on member demographics, gender, and participation in leadership roles at the national and state level. Data were sorted by gender and year to assess the proportion of women in each leadership position relative to total member/representation counts.Overall, there were increasing numbers of women represented in ACR leadership. From 2001 to 2015, there were increasing rates of women achieving fellowship in the College (7%-11%), now at parity with male member rates. Representation by women has risen from 7% to 21% for state chapter presidents and from 14% to 18% for state councilors. Comparing rolling 5-year averages from 2001-2005 and 2011-2015 showed statistically significant increases (P.05) in these leadership roles. Women members of the council steering committee rose from 13% in 2001 to 19% in 2015, peaking at 24% in 2014. The Board of Chancellors (BOC) showed the largest increase in women, from 9% to 33%, with a peak at 37% in 2014. However, no BOC chairs were women, one council speaker was a woman, two women were ACR presidents, and two women were vice presidents.Women's participation in ACR leadership has increased significantly at the state level and in fellowship recognition. Although there are increasing numbers of women on the BOC, top positions remain male-dominated at the national level.

10555 Background: The COVID-19 surge in March 2020 resulted in a hiatus placed on screening mammography programs in support of shelter-in-place mandates and diversion of medical resources to pandemic management. The COVID-related economic recession and ongoing social distancing policies continued to influence screening practices after the hiatus was lifted. We evaluated the effect of the hiatus on breast cancer stage distribution on the diverse patient population of a health care system in New York City, the first pandemic epicenter in the United States. Methods: Breast cancer patients diagnosed January 1, 2019 to December 31, 2020 were analyzed, with comparisons of stage distribution and mammography screen-detection for three intervals: Pre-Hiatus, During Hiatus (March 15, 2020 to June 15, 2020), and Post-Hiatus. Results were stratified by African American (AA), White American (WA), Asian (As) and Hispanic/Latina (Hisp) self-reported racial/ethnic identity. Results: A total of 894 patients were identified; of these, 549 WA, 100 AA, 104 As, and 93 Hisp comprised the final race/ethnicity-stratified study population. Overall, 588 patients were diagnosed Pre-Hiatus, 61 During-Hiatus, and 245 Post-Hiatus. Nearly two-thirds (65.5%) of the Pre-Hiatus cases were screen-detected versus 49.2% During-Hiatus and 54.7% Post-Hiatus (p = 0.002). Frequency of tumors diagnosed < 1 cm declined from 41.9% Pre-Hiatus to 31.7% Post-Hiatus (p = 0.035). WA patients were more likely to have screen-detected disease compared to AA in the Pre-Hiatus period (69.1% vs. 56.1%; p = 0.05) but non-significantly more likely to have screen-detected disease compared to As and Hisp patients (66.2% vs. 56.9%; p = 0.08). In the Post-Hiatus period, the frequency of screen-detected disease was highest among WA patients (63.0%) compared to all other racial/ethnic groups (AA; 48.1%, As-33.3%, and Hisp-40%; p = 0.007). Similar patterns were observed for frequency of tumors diagnosed ≤1cm Pre-Hiatus (WA-44.3% vs AA-26%, p = 0.02; and vs. As-41.3%, Hisp-48%; p = 0.09), and Post-Hiatus (WA-37.7% vs. AA-18.2%, As-30.8%, Hisp-23.5%; p = 0.25). Conclusions: The 3-month pandemic-related mammography screening hiatus resulted in a more advanced stage distribution for New York City breast cancer patients, and worsened pre-existing race/ethnicity-associated disparities, especially for AA pts.

Clinical depression affects physicians, including radiologists. Medical professionals, including radiologists, may be more comfortable treating a patient than being one, and psychiatric issues may be regarded as taboo for discussion, so the issue of clinical depression in the specialty and subspecialty has not received widespread attention. Specifically, a review of the national and international literature in PubMed, Scopus, and Google reveals few publications dedicated to the issue of clinical depression in radiology; although statistically, they must exist. The purpose of this report is to define the terms and describe the manifestations and scope of the issues related to clinical depression, with special attention given to risk factors unique to radiologists, such as working in low ambient light or near different fields of magnetic strength. By the end of the article, it is the authors' hope that the reading radiologist will be aware of, and open to, the possibility of clinical depression in a colleague or within his or herself because clinical depression is common and it is important to get help.

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.

Women are, and have always been, underrepresented in radiology. This gender disparity must be addressed. Women bring a different perspective to the workplace; and their collaborative, empathetic, and compassionate approach to patient care and education is an asset that the radiology community should embrace and leverage. Radiologic organizations should focus on removing barriers to the entry of women physicians into radiology as a specialty and to their career advancement. Organizations should address bias, promote physician well-being, and cultivate a safe and positive work environment. Radiology leaders committed to increasing gender diversity and fostering an inclusive workplace have the opportunity to strengthen their organizations. This article outlines the key steps that practice leaders can take to address the needs of women in radiology: (a) marketing radiology to talented women medical students, (b) addressing recruitment and bias, (c) understanding and accommodating the provisions of the Family and Medical Leave Act of 1993 and the Fair Labor Standards Act for both trainees and radiologists in practice, (d) preventing burnout and promoting well-being, (e) offering flexible work opportunities, (f) providing mentorship and career advancement opportunities, and (g) ensuring equity. ©RSNA, 2018.

The objective of our study was to assess utilization of the Family and Medical Leave Act (FMLA) in radiology practices in 2016 and compare with 2015 utilization.The Practice of Radiology Environment Database was used to identify practice leaders, and these leaders were asked to complete the annual American College of Radiology Commission on Human Resources workforce survey. The 2017 survey, which asked about 2016 experiences, again included questions about the number of radiologists in each practice who took FMLA, reasons why, and how absences were covered.Twenty-six percent (477/1811) of practice leaders responded to the survey. Of these respondents, 73% (346/477) answered FMLA questions, and 23% (80/346) of those answered affirmatively that a radiologist in their practice had taken FMLA leave in 2016 (previously 15% in 2015; p = 0.15). The reasons for FMLA leave included taking care of a newborn or adopted child (57%, previously 49%; p = 0.26), personal serious health condition (35%, previously 42%; p = 0.31), caring for an immediate family member (8%, unchanged), and engaging in active military duty (1%, unchanged). Although more women (72%) than men (32%) took FMLA leave for the first reason (p0.01), more men (63%) than women (18%) took FMLA leave for the second (p0.01), and there was no significant difference between women (10%) and men (5%) taking leave to care for an immediate family member (p = 0.18). Most practices (80%) again made no workforce changes to cover absences due to FMLA leave (previously 82%).Utilization of FMLA leave in radiology practices in 2016 was similar to that in 2015 and represents the beginning of longitudinal accrual of data on this important topic for both male and female radiologists.

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.

OBJECTIVE. The purpose of this article is to review the clinical, imaging, and pathologic features of leiomyoma variants. CONCLUSION. Fortunately, most of these variants are rare and have a benign natural history, given currently there are no significant series to establish definitive clinical or imaging findings that can reliably distinguish among them. Although there are some suggestive features, the diagnosis of a leiomyoma variant is usually made postoperatively at pathologic examination.

Granulomatous lobular mastitis (GLM) is an uncommon condition that typically occurs in parous, reproductive-aged women and can simulate malignancy on the basis of clinical and imaging features. A distinctive histologic pattern termed cystic neutrophilic granulomatous mastitis (CNGM) is seen in some cases of GLM and has been associated with Corynebacterium infection. We sought to further characterize the clinical, imaging, and histopathologic features of CNGM by studying 12 cases and attempted to establish the relationship of this disease with Corynebacterium infection. Patients were women ranging in age from 25 to 49 years (median: 34 y), and all presented with a palpable mass that was painful in half of the cases. In 2 of 9 cases, imaging was highly suspicious for malignancy (BI-RADS 5). CNGM was characterized by lobulocentric granulomas with mixed inflammation and clear vacuoles lined by neutrophils within granulomas. Gram-positive bacilli were identified in 5/12 cases. In 4 patients, the disease process worsened after the diagnostic core biopsy, with the development of a draining sinus in 2 cases. No growth of bacteria was seen in any microbial cultures. No bacterial DNA was identified by 16S rDNA polymerase chain reaction for 1 case that showed gram-positive bacilli on histology. Patients were treated with variable combinations of surgery, antibiotics, and steroids. The time to significant resolution of symptoms ranged from 2 weeks to 6 months. Similar to other forms of GLM, CNGM can mimic malignancy clinically and on imaging. When encountered in a needle core biopsy sample, recognition of the characteristic histologic pattern and its possible association with Corynebacterium infection can help guide treatment.

In this case series, we present the history and imaging of several male patients with breast complaints. Given the rise in men presenting with breast cancer, from 1 in 100,000 in the 1970s to 1.5 in 100,000 in 2012 [1,2], these cases presented here together provide the useful reminder that a comprehensive clinical history and focal physical examination is critical when assessing the symptomatic male (as well as female) patient with a breast complaint.

Due to an increasing number of breast cancer diagnoses in younger women anecdotally noted at our institution, we conceived of this study %was to retrospectively review the records of women diagnosed with breast cancer under the age of 40 for potentially alterable versus unalterable risk factors in their history. Between 2007 and 2013, there were 52 patients less than 40 years of age with breast cancer at our institution: 79% (41/52) presented with a clinical abnormality (palpable mass, nipple discharge or inversion) and 21% (11/52) were asymptomatic but diagnosed on early screening mammograms. Seventy-five percent (39/52) of the cancers had an invasive component and 87% (45/52) were intermediate to high grade. Sixty percent (31/52) of subjects had stage 0 or I disease, but 40% (21/52) had later stage disease (stage II or greater). The vast majority of the cancers were ER+ (82%) and PR+ (78%). Fifty-six percent (28/50; 2 unknown) of the subjects had a documented history of hormonal contraception. Fifty-three percent (27/51; 1 unknown) of had no family history of breast cancer whatsoever, and 80% (41/51) had no family history of breast cancer in a first degree relative. Six were positive for BRCA 1, 2, or a variant (6/52 = 12%).

Objectives A chorionic bump on first-trimester sonography has been considered a risk factor for nonviability in pregnant patients with this rare finding, although the strength of this association has recently been questioned. We performed a systematic review and meta-analysis to summarize the association between a chorionic bump and nonviability. Methods A comprehensive literature search was performed. We included all studies except case reports. A meta-analysis was performed using a random-effects model. Results After screening 5 studies, 2 studies with a total of 67 patients met inclusion criteria. These were combined with a study (n = 52) from our institution. Overall, the live birth rate was 62% (74 of 119). Fifty-one chorionic bump pregnancies were otherwise normal (ie, pregnancies in which a gestational sac, a yolk sac, and an embryo with a heartbeat was seen at some point), and in this subset, the live birth rate was 83% (42 of 51). There was no significant relationship found between vaginal bleeding and live birth (P = .857); there was no significant difference in bump volume between live birth and no live birth (P = .198); and for the subset analysis of pooled odds ratios for the relationship between live birth and history of infertility, there was no significant relationship found (P = .186). Conclusions A chorionic bump remains a risk factor for nonviability in pregnancy; however, if the pregnancy is otherwise normal, then most result in live birth.

Rationale and Objectives: The primary role of radiology in the preclinical setting is the use of imaging to improve students' understanding of anatomy. Many currently available Web-based anatomy programs include either suboptimal or overwhelming levels of detail for medical students.Our objective was to develop a user-friendly software program that anatomy instructors can completely tailor to match the desired level of detail for their curriculum, meets the unique needs of the first- and the second-year medical students, and is compatible with most Internet browsers and tablets.Materials and Methods: RadStax is a Web-based application developed using free, open-source, ubiquitous software. RadStax was first introduced as an interactive resource for independent study and later incorporated into lectures. First- and second-year medical students were surveyed for quantitative feedback regarding their experience.Results: RadStax was successfully introduced into our medical school curriculum. It allows the creation of learning modules with labeled multiplanar (MPR) image sets, basic anatomic information, and a self-assessment feature. The program received overwhelmingly positive feedback from students. Of 115 students surveyed, 87.0% found it highly effective as a study tool and 85.2% reported high user satisfaction with the program.Conclusions: RadStax is a novel application for instructors wishing to create an atlas of labeled MPR radiologic studies tailored to meet the specific needs their curriculum. Simple and focused, it provides an interactive experience for students similar to the practice of radiologists.This program is a robust anatomy teaching tool that effectively aids in educating the preclinical medical student.