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This review summarizes the pathway of Mullerian and Wolffian duct development, anomalies that result from disruptions to this pathway, and the characteristics on advanced imaging that identify them.In-office evaluation for reproductive anomalies is usually inadequate for the diagnosis of congenital reproductive anomalies. Magnetic resonance imaging (MRI) has usurped invasive diagnostic methods including laparoscopy, hysteroscopy, and vasography as the new gold standard. Because of its superior soft-tissue delineation and the availability of advanced functional sequences, MRI offers a sophisticated method of distinguishing reproductive anomalies from one another, characterizing the degree of defect severity, and evaluating for concomitant urogenital anomalies non-invasively and without radiation exposure to the patient. Congenital anomalies of the Mullerian and Wolffian duct can be incredibly nuanced, requiring prompt and accurate diagnosis for management of infertility. Definitive diagnosis should be made early with MRI.

As radiology programs seek to recruit and retain diverse and competitive applicants, it is important to critically review existing department policies to ensure they meet the needs of their residents. To evaluate a radiology program's inclusivity measures, an interdepartmental committee developed an "LGBTQ inclusion index" and performed an LGBTQ inclusion audit to identify gaps in policy and to craft proposals for administrative review.An LGBTQ inclusion index was compiled through the collaboration of an interdisciplinary committee of residents, faculty, institutional and community representatives. Five inclusion milestones were identified relating to department policy, department facilities, institutional culture, department culture, and community engagement. Milestones were scored as 0, for milestone not at all met, 1, for milestone partially met, and 2, for milestone completely met, with a total score of 10. Program scores were calculated for the 2018-2021 academic years.The radiology program LGBTQ inclusion index score increased over the course of the study period. The program LGBTQ inclusion index score was 4 of 10 in 2018 and 2019, but after formation of an LGBTQ inclusion task force by the diversity and inclusion committee, increased to 7 of 10 in 2020. The LGBTQ inclusion audit identified several areas that required improvement and the committee drafted proposals to address these gaps. By 2021, the program scored 9 of 10 on the inclusion index.Promoting an inclusive and affirming radiology department is an important step to providing culturally competent healthcare and mitigating health disparities. An LGBTQ inclusion audit and a robust department diversity committee can help to identify and address gaps in policy, facilities, and culture.

As of January 2022, Step 1 of the United States Medical Licensing Examination (USMLE) has changed to pass/fail grading. The purpose of this study was to share survey results and communicate changes Diagnostic (DR) and integrated Interventional (IR) Radiology residency program directors (PDs) will make and aspire to make, given this change.An online survey was sent to DR and IR PDs. Data was collected over four months. Custom R programming and MATLAB language scripts were used to evaluate the survey responses. Chi squared tests were used to determine statistical significance for multiple choice questions regarding PD views of Step 1 transitioning to pass-fail. Paired t-tests were used to differentiate pre- and post-values for questions in which PDs ranked criteria for resident selection.After USMLE Step 1 becomes pass/fail, most respondents will use Step 2 CK scores as a more important factor than previously, believe medical schools should share National Board of Medical Examiners (NBME) shelf exam scores, do not believe students will be better prepared clinically, and believe a student's medical school rank will be considered more.The added emphasis on Step 2 CK scores, NBME shelf exam scores, class rank, and a student's medical institution may negate the positive impacts of changing Step 1 to pass/fail. Alternatively, it may present an opportunity for programs to evaluate students more broadly.

Paid family and medical leave policies are increasingly popular in today's competitive labor market and provide well-documented advantages to all stakeholders. Implementing paid leave for radiologists can seem daunting due to overlapping legal and institutional policies, logistical challenges and call coverage, as well as industry-specific special considerations such as resident education and historical workplace attitudes. This toolkit can empower radiology leaders to implement written paid leave policies in their home institutions and demonstrate that equitable, compassionate institutional policies for paid leave are financially favorable, widely desirable, and increasingly achievable with the right tools in hand.

Risk calculators have offered a viable tool for clinicians to stratify patients at risk of prostate cancer (PCa) and to mitigate the low sensitivity and specificity of screening prostate specific antigen (PSA). While initially based on clinical and demographic data, incorporation of multiparametric magnetic resonance imaging (MRI) and the validated prostate imaging reporting and data system suspicion scoring system has standardized and improved risk stratification beyond the use of PSA and patient parameters alone. Biopsy-naïve patients with lower risk profiles for harboring clinically significant PCa are often subjected to uncomfortable, invasive, and potentially unnecessary prostate biopsy procedures. Incorporating risk calculator data into prostate MRI reports can broaden the role of radiologists, improve communication with clinicians primarily managing these patients, and help guide clinical care in directing the screening, detection, and risk stratification of PCa.

The gender pay gap is not a problem of the past. Women continue to receive less pay for equal work and radiology is one of four medical specialties with the largest gender pay gap. Numerous social factors contribute to the gender pay gap; however, radiology can close the gender pay gap through intentional strategies, including acknowledging the gender pay gap, eliminating bias and minority taxes through progressive compensation and parental leave models, devaluing overwork, developing longitudinal mentorship and sponsorship, and demanding transparent institutional policies. Patient care and overall organizational success will improve when the barriers resulting in the gender pay gap are eliminated.

Navigating parental leave can be challenging in all fields of medicine, but it can be especially challenging for leaders balancing clinical, research, and administrative duties. As women take on more leadership roles, we have the opportunity to better define the current challenges and identify potential strategies for navigating successful parental leave while balancing the demands of leadership. This manuscript provides a commentary on the challenges and strategies for navigating parental leave in leadership positions in radiology, an important topic for shaping how parental leave is both viewed and valued in the future. Specifically, we highlight challenges and strategies for administrative responsibilities, reporting personnel, emails, microaggressions, research, empowerment, and prioritization.

For the past 40 years the American Association for Women in Radiology (AAWR) has continued to support efforts to achieve its founding goals of improving the visibility of women in radiology, advancing the professional and academic standing of women in radiology, and identifying and addressing issues faced by women in radiology. In the past 5 years, the AAWR has made great strides to support women in radiology through amplifying the voices of women heard at the American College of Radiology (ACR) Annual Meeting, initiating the AAWR Research & Education Capital Campaign, establishing the fellows of the AAWR, and advocating for practicing radiologists and trainee parental leave. The many accomplishments of the AAWR over the past 40 years and the committed future work of the AAWR ensure the voices of women in radiology are heard and the needs of women in radiology are recognized.

Despite increasing representation in medical schools and surgical specialties, recruitment of women into radiology has failed to exhibit commensurate growth. Furthermore, women are less likely than men to advance to leadership roles in radiology. A women-in-radiology (WIR) group provides a robust support system that has been shown to produce numerous benefits to the group's individual participants as well as the group's institution or practice. These benefits include development of mentor-ship relationships, guidance of career trajectories, improved camaraderie, increased participation in scholarly projects, and increased awareness of gender-specific issues. This article describes a recommended pathway to establishing a WIR group, with the goal of fostering sponsorship and promoting leadership, recruitment, and advancement of women in radiology. We consider barriers to implementation and review resources to facilitate success, including a range of resources provided by the American Association for Women in Radiology. By implementing the provided framework, radiologists at any career stage can start a WIR group, to promote the advancement of their female colleagues.

Epigastric pain can have multiple etiologies including myocardial infarction, pancreatitis, acute aortic syndromes, gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, and hiatal hernia. This document focuses on the scenarios in which epigastric pain is accompanied by symptoms such as heartburn, regurgitation, dysphagia, nausea, vomiting, and hematemesis, which raise suspicion for gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, or hiatal hernia. Although endoscopy may be the test of choice for diagnosing these entities, patients may present with nonspecific or overlapping symptoms, necessitating the use of imaging prior to or instead of endoscopy. The utility of fluoroscopic imaging, CT, MRI, and FDG-PET for these indications are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

BACKGROUND. Despite advances in prostate cancer treatment, rates of biochemical recurrence remain high, relating to lack of detection of small-volume metastatic disease using conventional imaging for initial staging. OBJECTIVE. The purpose of this study was to assess the potential use of (18)F-fluciclovine PET/MRI for initial staging of high-risk prostate cancer and evaluating response to androgen deprivation therapy (ADT). METHODS. This prospective clinical trial enrolled 14 men with newly diagnosed high-risk prostate cancer and negative or equivocal conventional staging imaging for metastatic disease between January 2018 and February 2019. All patients underwent pretreatment (18)F-fluciclovine PET/MRI including multiparametric prostate MRI; 12 underwent (18)F-fluciclovine PET/MRI after surgery or between ADT and radiotherapy. Confidence in identification of the primary intraprostatic lesion and nodal metastases was independently rated on a 0–3 Likert scale by three readers with nuclear medicine experience for (18)F-fluciclovine PET/MRI and three readers with abdominal imaging experience for MRI alone. Findings scored as 2 or 3 by at least two readers of a given modality were considered positive. A single reader measured SUV(mean), SUV(max), and volume of the MRI-defined intraprostatic lesion and SUV(max) of suspicious lymph nodes on PET before and after initiation of ADT. Changes in SUV were analyzed using nonparametric Wilcoxon signed-rank tests. RESULTS. The biopsy-proven lesion in the prostate gland was accurately identified in all 14 patients on both MRI and (18)F-fluciclovine PET/MRI. Suspected nodal metastases were detected in three patients on MRI and seven patients on (18)F-fluciclovine PET/MRI. After ADT, all patients showed decreased activity within the intraprostatic lesion and/or all suspicious lymph nodes. The primary lesion SUV(mean) was 4.5 ± 1.1 (range, 2.7–6.5) before treatment and 2.4 ± 1.1 (range, 0.0–3.6) after initiation of ADT (p = .008). For suspicious lymph nodes, the pretreatment SUV(max) was 5.5 ± 3.7 (range, 2.8–12.7) and the posttreatment SUV(max) was 2.8 ± 1.4 (range, 1.4–5.5) (p = .03). CONCLUSION. (18)F-labeled fluciclovine PET/MRI shows potential utility in initial staging of high-risk prostate cancer and in evaluating response to ADT. CLINICAL IMPACT. Given the FDA approval and widespread availability of (18)F-fluciclovine, the findings could have an impact in the immediate future in guiding initial management of patients with prostate cancer. TRIAL REGISTRATION. ClinicalTrials.gov NCT03264456

Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Incidental pancreatic cysts are increasingly detected on imaging studies performed for unrelated indications and may be incompletely characterized on these studies. Adequate morphological characterization is critical due to the small risk of malignant degeneration associated with neoplastic pancreatic cysts, as well as the risk of associated pancreatic adenocarcinoma. For all pancreatic cysts, both size and morphology determine management. Specifically, imaging detection of features, such as pancreatic ductal communication and presence or absence of worrisome features or high-risk stigmata, have important management implications. The recommendations in this publication determine the appropriate initial imaging study to further evaluate a pancreatic cyst that was incidentally detected on a nondedicated imaging study. The recommendations are designed to maximize the yield of diagnostic information in order to better risk-stratify pancreatic cysts and assist in guiding future management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

For many women, radiology residency occurs during the childbearing years and they often question when is the best time to have children. Anxiety regarding fertility and pregnancy-related complications contribute to early career burnout in women physicians and many have fertility regrets. Supporting radiologists in training and early in their career as they navigate pregnancy and childbearing is critical to achieving a diverse workforce and leadership. Herein, we explore career-related challenges of childbearing and highlight opportunities for radiologists in residency, fellowship, and early in their career, so that they can make an informed childbearing decision.

Introduction The Memorial Sloan Kettering Cancer Center (MSKCC) Preprostatectomy nomogram is a widely used resource that integrates clinical factors to predict the likelihood of adverse pathology at radical prostatectomy. Adoption of magnetic resonance imaging targeted biopsy (TB) permits optimized detection of clinically-significant cancer over systematic biopsy (SB) alone. We aim to evaluate the prognostic utility of the MSKCC Preprostatectomy nomogram with TB pathology results. Methods Men who underwent SB and magnetic resonance imaging TB who later underwent radical prostatectomy at our institution were included. Patient information was entered into the MSKCC Preprostatectomy nomogram using 5 biopsy reporting schemes with TB reported by both individual core (IC) and aggregate group (AG) methods. The likelihood of extraprostatic extension, seminal vesicle invasion, and lymph node involvement as predicted by the nomogram for each biopsy reporting schema were compared to radical prostatectomy pathology. Results We identified 63 men from January 2014 to November 2017. On receiver operating characteristic analysis, IC-TB, AG-TB, SB plus IC-TB, and SB plus AG-TB exhibited similar, if not improved, area under the curve compared to SB alone in predicting extraprostatic extension (0.671, 0.674, 0.658, and 0.6613 vs. 0.6085). This was similarly observed for seminal vesicle invasion prediction using SB plus IC-TB compared to SB alone (0.727 vs. 0.733). For lymph node involvement, superior but nonsignificant area under the curve was observed for AG-TB (0.647) compared to IC-TB (0.571) and SB alone (0.524) Conclusions Using TB pathology results either alone or combined with SB pathology results as input to the MSKCC Preprostatectomy nomogram appears comparable for prognosticating adverse pathology on radical prostatectomy compared to SB alone, but robust validation is warranted prior to adoption into clinical practice.

Common misconceptions about radiology and radiation oncology exist and may dissuade women from pursuing these specialties. The American Association for Women in Radiology (AAWR) Medical Student Outreach Subcommittee began a multi-year social media campaign aimed at addressing these myths. Here, we outline several myths presented in this social media campaign and provide a combination of literature review and experts' opinions to deconstruct and dispel them.

We aim to investigate if the addition of MRI-US fusion biopsy (FB) can aid in radiation planning and alter the boost field in cases of stereotactic body radiation therapy (SBRT) for prostate cancer with a simultaneous integrated boost (SIB) to a magnetic resonance imaging (MRI)-defined intraprostatic lesion.Patients undergoing SBRT with SIB for biopsy-proven prostatic adenocarcinoma and a pre-radiation MRI were retrospectively reviewed. 36.25 Gy in 5 fractions was delivered to entire prostate along with SIB of 40 Gy to an MRI-defined intraprostatic lesion. Demographic, radiation planning details, and post-procedural outcomes were compared between patients undergoing systematic transrectal ultrasound (TRUS) biopsy followed by MRI to those undergoing an MRI followed by a FB prior to radiation planning.Forty-three patients underwent systematic TRUS biopsy followed by MRI and 46 patients underwent FB prior to radiation planning. Patients undergoing systematic TRUS biopsy had a smaller prostate volume when compared to the FB cohort (37.58 ± 13.78 versus 50.28 ± 26.76 cc, p = 0.007). No differences in prostate planning target volume (PTVprostate) and boost volume (PTVboost) were noted, but those undergoing TRUS biopsy prior to MRI had a higher integrated boost volume density (IBVD = PTVboost/total prostate volume) (0.16 ± 0.09 versus 0.13 ± 0.06, p = 0.045). No differences were observed in genitourinary or gastrointestinal toxicity rates.Compared to systematic TRUS biopsy, implementation of prebiopsy prostate MRI and FB allows for safe and feasible SBRT in patients with significantly larger prostate volumes without increasing SIB cancer-directed treatment volumes, oncologic outcomes, quality of life measures, or treatment-related toxicities.

For the past 40 years the American Association for Women in Radiology (AAWR) has continued to support efforts to achieve its founding goals of improving the visibility of women in radiology, advancing the professional and academic standing of women in radiology, and identifying and addressing issues faced by women in radiology. In the past 5 years, the AAWR has made great strides to support women in radiology through amplifying the voices of women heard at the American College of Radiology (ACR) Annual Meeting, initiating the AAWR ResearchEducation Capital Campaign, establishing the fellows of the AAWR, and advocating for practicing radiologists and trainee parental leave. The many accomplishments of the AAWR over the past 40 years and the committed future work of the AAWR ensure the voices of women in radiology are heard and the needs of women in radiology are recognized.

Summary Multiparametric magnetic resonance imaging (MRI)/ultrasound fusion targeted prostate biopsy has been shown to outperform systematic biopsy in the detection of clinically significant prostate cancer. Aside from tumor grade, tumor biomarkers such as phosphatase and tensin homolog (PTEN) and ETS-related gene (ERG) have prognostic significance in prostate cancer and may help direct management of patients with low-grade tumors. Our objective was to compare the detection of PTEN and ERG expression in MRI-targeted versus systematic prostate biopsies. We compared immunohistochemical expression for PTEN and ERG on prostate biopsy cores from patients with Grade Group (GG) 1 or GG2 prostate cancer who had undergone systematic biopsy with concurrent targeted biopsy. Fifty-three cases had both systematic and MRI-targeted prostate tissue available for staining for PTEN; and 52 cases, for ERG. ERG positivity was seen in 37/52 (71.2%) cases, and PTEN loss was seen in 15/53 (28.3%) cases. The detection of ERG expression was not significantly different between MRI-targeted and systematic biopsy (P = .4). Targeted biopsy was superior to systematic biopsy in the detection of PTEN loss (P = .02). MRI-targeted cores detected 14/15 (93.3%) cases of PTEN loss compared to 7/15 (46.7%) cases detected by systematic cores. Most cases with PTEN loss showed heterogeneous expression in both systematic and targeted cores. In 14/15 (93.3%) cases with PTEN loss, GG was the same between targeted and systematic biopsy. Targeted biopsy is superior to systematic biopsy in the detection of PTEN loss in GG1 and GG2 tumors. Inclusion of targeted cores may be helpful for evaluation of certain prognostic biomarkers.

OBJECTIVE. The purpose of this article is to discuss quantitative methods of CT, MRI, and ultrasound (US) for noninvasive staging of hepatic fibrosis. Hepatic fibrosis is the hallmark of chronic liver disease (CLD), and staging by random liver biopsy is invasive and prone to sampling errors and subjectivity. Several noninvasive quantitative imaging methods are under development or in clinical use. The accuracy, precision, technical aspects, advantages, and disadvantages of each method are discussed. CONCLUSION. The most promising methods are the liver surface nodularity score using CT and measurement of liver stiffness using MR elastography or US elastography.

Multiparametric magnetic resonance imaging (MP-MRI) targeted biopsy has been shown to identify more clinically-significant cancers and reduce the detection of clinically-insignificant disease when compared to systematic biopsy; however, the wide-spread accessibility of MP-MRI is limited. A potential strategy for reducing the cost, study time, and contrast-associated risks associated with MP-MRI is elimination of the dynamic contrast-enhanced (DCE) sequence, relying instead on biparametric MRI (BP-MRI). BP-MRI has been shown to have a diagnostic accuracy and cancer detection rate that are equivalent to those of MP-MRI. We modeled the potential cost of BP-MRI compared to MP-MRI to determine what cost savings would occur if DCE was eliminated from these studies. When controlled for a 45 min time window that allows for one full MP-MRI or three full BP-MRI studies, the BP-MRI 45 min gross profit is $1531.32. This is an increase in gross profit of $892.58 for the 45 min time window or $10,710.98 in a 9-h business day when performing BP-MRI compared to MP-MRI for prostate cancer detection. BP-MRI has the potential to result in substantial cost benefit and increased access to MRI in the diagnostic workflow and risk-stratification of men being evaluated for prostate cancer when compared to conventional MP-MRI. • Multiparametric magnetic resonance imaging (MP-MRI) has been shown to identify more clinically-significant cancers and reduce the detection of clinically-insignificant disease. • Biparametric magnetic resonance imaging (BP-MRI) has diagnostic accuracy and cancer detection rates that are equivalent to those of MP-MRI. • BP-MRI reduces cost, study time, and contrast-associated risk by eliminating the dynamic contrast-enhanced (DCE) sequence. • BP-MRI has the potential to increase access to advanced imaging for men being evaluated for prostate cancer.

Life is sometimes described as a complex tapestry and progress is not linear, but twisted like stitches, contributing to the final fabric. When tension arises, the most recent stitches unravel first. The COVID-19 pandemic is pulling back the thread of humanity's progress. Those disproportionately affected by the pandemic's tension are those whose progress is most recent and, therefore most tenuous, including women in medicine. The profession of radiology, recently acknowledged by practice leaders as experiencing burnout as a very significant problem (Parikh et al., 2020 [1]), is rapidly facing an untenable situation.

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.