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To explore the effectiveness of the video medium and YouTube platform in conveying residency program and community information to prospective applicants during the 2020-2021 virtual residency interview cycle. To garner insights on the virtual-only residency interview experience and our video-centered approach through survey data collected from interviewing candidates for potential implementation in future application cycles.13 custom content videos were produced highlighting our radiology residency program and uploaded onto a newly created YouTube channel and the institutional website during the late summer through fall of the 2020-2021 residency interview cycle. Feedback on the videos was generated using YouTube analytics and an anonymous 10-question survey sent to interviewing candidates.As of September 29, 2021, the date when residency programs could begin reviewing ERAS applications for the 2021-2022 cycle, the videos amassed 4487 views with over 149 hours' worth of material viewed. 57 of 114 interviewed candidates responded to the survey. Feedback was overwhelmingly positive with 84% of respondents agreeing that the videos positively influenced their decision to apply to our program, 77% of respondents judging our video-based format to be overall more effective in delivering residency program information than text-based media (website, email etc.), and 86% feeling adequately informed about the program through the virtual interview process and provided electronic resources. 79% of respondents felt our videos to be more informative than the resources from other radiology programs encountered during the interviewing cycle. Finally, a majority 72% of respondents are open to virtual interviewing in the future.Our program's video-centered approach was one of many creative media solutions employed by residency programs across the nation to help make virtual interviewing an adequate replacement to the traditional in-person interviewing experience. While further investigation is needed to determine which methods communicate residency program information best in the virtual setting, our initial experience and data show the video-centered approach to be overwhelmingly positive with applicants and at a minimum, we've established a baseline process and aesthetic for others to improve upon.

Evaluate whether the Breast Cancer Locator™ (BCL), a novel guidance system based on supine MRI images, can be safely and effectively deployed by several surgeons at multiple sites.Patients with palpable breast cancer underwent supine MRI at their local institution. A three dimensional (3D) digital image of the tumor in the breast was derived from supine MRI images and used to generate 1) an interactive 3D virtual image of the tumor in the breast (Visualizer) and 2) a plastic bra-like form that allowed the surgeon to place a central wire and bracketing wires in the breast (BCL). The primary objective was to determine the proportion of patients who had the central localization wire deployed within the cancer on specimen mammogram.Fourteen patients were enrolled at 4 different sites by 6 surgeons. BCLs were successfully manufactured for all patients. The central wire was deployed within the tumor on specimen mammogram in 12 of the 13 patients who had a central wire placed (92%). The cancer was excised with negative margins in 14/14 cases (100%). No adverse events occurred.Supine MRI image acquisition was accomplished successfully across multiple sites. Multiple surgeons utilized the BCL system to localize cancers accurately and safely.

Breast imaging capacity in Tanzania is currently very limited. In a country of almost 60 million people, mammographic units are exceedingly rare. The few existing units are compromised by lack of maintenance and quality control and extremely limited technologist training. Breast cancer incidence continues to increase in East Africa, while the ability to accurately diagnose and differentiate benign and malignant breast disease remains a challenge. However, as ultrasound technology improves and becomes more affordable, there is increased access to devices including hand-held point of care ultrasound. Additionally, there has been a recent expansion in the training of academic radiologists in Tanzania, creating an opportunity for possible sustainable improvement of breast imaging and intervention. Our initial efforts at the Muhimbili Academic Medical Center (MAMC) included social media advertising for symptomatic and asymptomatic women, followed by screening (clinical breast exam) and subsequent ultrasound imaging of symptomatic women. We then initiated a workflow for ultrasound-guided breast intervention, performed biopsies, reviewed results by local pathologists, and brought the postbiopsy patients back for radiologic–pathologic correlation, wound assessment, and coordination of follow-up and treatment.

Wire-localized excision of non-palpable breast cancer is imprecise, resulting in positive margins 15–35% of the time. Women with a confirmed diagnosis of non-palpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) were randomized to a new technique using preoperative supine magnetic resonance imaging (MRI) with intraoperative optical scanning and tracking (MRI group) or wire-localized (WL group) partial mastectomy. The main outcome measure was the positive margin rate. In this study, 138 patients were randomly assigned. Sixty-six percent had IBC and DCIS, 22% had IBC, and 12% had DCIS. There were no differences in patient or tumor characteristics between the groups. The proportion of patients with positive margins in the MRI-guided surgery group was half that observed in the WL group (12 vs. 23%; p = 0.08). The specimen volumes in the MRI and WL groups did not differ significantly (74 ± 33.9 mL vs. 69.8 ± 25.1 mL; p = 0.45). The pathologic tumor diameters were underestimated by 2 cm or more in 4% of the cases by MRI and in 9% of the cases by mammography. Positive margins were observed in 68% and 58% of the cases underestimated by 2 cm or more using MRI and mammography, respectively, and in 15% and 14% of the cases not underestimated using MRI and mammography, respectively. A novel system using supine MRI images co-registered with intraoperative optical scanning and tracking enabled tumors to be resected with a trend toward a lower positive margin rate compared with wire-localized partial mastectomy. Margin positivity was more likely when imaging underestimated pathologic tumor size.

PURPOSE: Little is known about the three-dimensional shape of breast cancer. Implicit to approaches that localize the center of the tumor for breast conserving surgery (BCS) of non-palpable cancers is the assumption that breast cancers are spherical about a central point, which may not be accurate. METHODS: Pre-operative supine breast MRI images were obtained of 83 breast cancer patients undergoing partial mastectomy using supine MRI guided resection techniques. Three-dimensional (3D) tumor models were derived after radiologists outlined tumor edges on successive MRI slices. Ideal resection volumes were determined by adding 1 cm in every dimension to the actual tumor volume. Geometrically defined parameters were used to define tumor shapes and associations between clinical variables and shapes were examined. RESULTS: Seventy five patients had invasive cancer. Breast cancers were categorized into 4 tumor shapes: 34% of tumors were discoidal, 29% segmental, 19% spherical and 18% irregular. If hypothetical spherical excisions were performed, nonspherical cases would excise 143% more tissue than the ideal resection volume. When the 3D shape of each tumor was provided to the surgeon during MR-guided BCS, the percentage of tissue overexcised in non-spherical cases was significantly less (143% vs. 66% , p < 0.001). CONCLUSIONS: Information obtained from a supine MRI can be used to generate 3D tumor models and rapidly classify breast tumor shapes. The vast majority of invasive cancers and DCIS are not spherical. Knowledge of tumor shape may allow surgeons to excise breast cancer more precisely.

Rationale and Objectives This study aims to provide objective performance data and feedback, including examination volumes, recall rates, and concordance with faculty interpretations, for residents performing independent interpretation of screening mammography examinations. Method and Materials Residents (r) and faculty (f) interpret screening mammograms separately and identify non-callbacks (NCBs) and callbacks (CBs). Residents review all discordant results. The number of concordant interpretations (fCB-rCB and fNCB-rNCB) and discordant interpretations (fCB-rNCB and fNCB-rCB) are entered into a macro-driven spreadsheet. These macros weigh the data dependent on the perceived clinical impact of the resident's decision. Weighted outcomes are combined with volumes to generate a weighted mammography performance score. Rotation-specific goals are assigned for the weighted score, screening volumes, recall rate relative to faculty, and concordance rates. Residents receive one point for achieving each goal. Results Between July 2013 and May 2017, 18,747 mammography examinations were reviewed by 31 residents, in 71 resident rotations, over 246 resident weeks. Mean resident recall rate was 9.9% and significantly decreased with resident level (R), R2 = 11.3% vs R3 = 9.4%, R4 = 9.2%. Mean resident-faculty discordance rate was 10% and significantly decreased from R2 = 12% to R4 = 9.6%. Weighted performance scores ranged from 1.1 to 2.0 (mean 1.6, standard deviation 0.17), but did not change with rotation experience. Residents had a mean goal achievement score of 2.6 (standard deviation 0.47). Conclusions This method provides residents with easily accessible case-by-case individualized screening outcome data over the longitudinal period of their residency, and provides an objective method of assessing resident screening mammography performance.

Wire-localized excision of nonpalpable breast cancer is imprecise, resulting in positive margins 25-30% of the time.Patients underwent preoperative supine magnetic resonance imaging (MRI). A radiologist outlined the tumor edges on consecutive images, creating a three-dimensional (3D) view of its location. Using 3D printing, a bra-like plastic form (the Breast Cancer Locator [BCL]) was fabricated, with features that allowed a surgeon to (1) mark the edges of the tumor on the breast surface; (2) inject blue dye into the breast 1 cm from the tumor edges; and (3) place a wire in the tumor at the time of surgery.Nineteen patients with palpable cancers underwent partial mastectomy after placement of surgical cues using patient-specific BCLs. The cues were in place in5 min and no adverse events occurred. The BCL accurately localized 18/19 cancers. In the 18 accurately localized cases, all 68 blue-dye injections were outside of the tumor edges. Median distance from the blue-dye center to the pathologic tumor edge was 1.4 cm, while distance from the blue dye to the tumor edge was5 mm in 4% of injections, 0.5-2.0 cm in 72% of injections, and2 cm in 24% of injections. Median distance from the tumor center to the BCL-localized wire and to the clip placed at the time of diagnosis was similar (0.49 vs. 0.73 cm) on specimen mammograms.Information on breast cancer location and shape derived from a supine MRI can be transferred safely and accurately to patients in the operating room using a 3D-printed form.

This study aims to provide objective performance data and feedback, including examination volumes, recall rates, and concordance with faculty interpretations, for residents performing independent interpretation of screening mammography examinations.Residents (r) and faculty (f) interpret screening mammograms separately and identify non-callbacks (NCBs) and callbacks (CBs). Residents review all discordant results. The number of concordant interpretations (fCB-rCB and fNCB-rNCB) and discordant interpretations (fCB-rNCB and fNCB-rCB) are entered into a macro-driven spreadsheet. These macros weigh the data dependent on the perceived clinical impact of the resident's decision. Weighted outcomes are combined with volumes to generate a weighted mammography performance score. Rotation-specific goals are assigned for the weighted score, screening volumes, recall rate relative to faculty, and concordance rates. Residents receive one point for achieving each goal.Between July 2013 and May 2017, 18,747 mammography examinations were reviewed by 31 residents, in 71 resident rotations, over 246 resident weeks. Mean resident recall rate was 9.9% and significantly decreased with resident level (R), R2 = 11.3% vs R3 = 9.4%, R4 = 9.2%. Mean resident-faculty discordance rate was 10% and significantly decreased from R2 = 12% to R4 = 9.6%. Weighted performance scores ranged from 1.1 to 2.0 (mean 1.6, standard deviation 0.17), but did not change with rotation experience. Residents had a mean goal achievement score of 2.6 (standard deviation 0.47).This method provides residents with easily accessible case-by-case individualized screening outcome data over the longitudinal period of their residency, and provides an objective method of assessing resident screening mammography performance.

Rectus sheath hematoma (RSH) is an uncommon but significant cause of acute abdominal pain in patients presenting to the Emergency Department. RSHs are often misdiagnosed as other more common causes of abdominal pain. This case describes a 23-year-old male presenting with acute abdominal pain, scrotal swelling, and associated scrotal pressure. The case highlights the uniqueness of this particular presentation and the clinical features, risk factors, diagnosis, and treatment of RSH.

Background Although increased capsular volume has been implicated in shoulder instability, there is a paucity of clinical evidence to quantify the size of the capsule with specific instability conditions of the shoulder. Hypothesis Shoulder capsular area, as measured by magnetic resonance arthrography, is increased with specific patterns of shoulder instability. Study Design Cross-sectional study; Level of evidence, 4. Methods During an 8-month period, all patients with a diagnosis of anterior (n = 19), posterior (n = 14), or multidirectional (n = 13) instability of the shoulder and who were assessed with a magnetic resonance arthrogram were reviewed. A group of 10 control patients without clinical instability were also identified. The magnetic resonance arthrograms of all groups were randomly mixed, and 5 reviewers recorded measures of capsular length and area and determined labral abnormalities. The magnetic resonance arthrogram measurements were compared between groups, and interobserver agreement was determined. Results The cross-sectional area of the capsule was increased in patients with posterior ( P = .017) or multidirectional instability ( P = .021) versus controls, but not in patients with anterior instability. Additionally, the posteroinferior cross-sectional area was increased in patients with posterior ( P = .001), multidirectional ( P = .003), and anterior ( P = .008) instability. In patients with a posterior labral tear, the mean axial ( P = .043) and mean posteroinferior sagittal cross-sectional area ( P = .011) was increased, but there were no differences in cross-sectional area for those with an anterior labral tear. The overall interobserver reliability was very good (correlation coefficient range, 0.68–0.94). Conclusion Our results reinforce the concept that capsular elongation and laxity, either preexisting or acquired, play a role in certain instability conditions of the shoulder. Additional work is needed to determine how to correlate surgical decision making with the cross-sectional area measurements demonstrated in this study.

Purpose: To describe anatomic measurements of the rotator interval (RI) on magnetic resonance arthrogram (MRA) images and to assess the relationship between increased dimensions of the RI and instability conditions of the shoulder. Methods: Three groups of patients with clinical instability were treated arthroscopically (anterior [A = 19 patients], posterior [P = 14 patients], and multidirectional [M = 13 patients]), and a group of 10 control patients without clinical instability were also identified. The MRAs of all groups were randomized, and 5 blinded reviewers recorded RI anatomic measurements of: (1) sagittal measures of the distance between the subscapularis (SSc) and supraspinatus (SS) tendons at 3 anatomic landmarks across the RI, and (2) the sagittal position of the long head of the biceps (LHB) relative to the most anterior aspect of the SS. Results: The rotator interval distance between the SS and SSc tendons was nearly identical for all groups of instability, and was also not different from control groups. On the sagittal oblique sequences, the distance from the LHB tendon to the anterior edge of the SS tendon was significantly increased in posterior (7.4 mm) instability versus both the control group (2.4 mm; P = .025) and those with anterior instability (4.5 mm; P = .041), with the LHB in a consistent anterior position. The remainder of the measures was not statistically different between the groups. Conclusions: The distance between the SS and SSc and the overall size of the RI was well preserved in all instability patterns and control conditions. The LHB tendon assumes a more anterior position relative to the supraspinatus tendon in patients with posterior instability versus those patients with anterior instability or those without clinical instability. Additional work is necessary to further define objective radiographic evidence of RI insufficiency in patients with shoulder instability. Level of Evidence: Level III, prognostic case-control study.

Case Report A 38-year-old woman presented to the emergency department with a 1-day history of sharp, episodic abdominal pain, nausea, and vomiting. She had experienced prior episodes of similar pain the last 2 years previously, and all were self-limited. Examination showed a nondistended abdomen with normal bowel sounds and tenderness to palpation in both upper quadrants with no organomegaly, rebound, or guarding. No masses were noted and Murphy’s sign was absent. A complete blood count revealed a mildly elevated WBC and mild anemia (hemoglobin, 8.4 g/dL) with normal platelets and differential. She had normal liver function tests, a mildly elevated amylase of 139 U/L (normal range, 36–128 U/L), and normal lipase. Initial imaging was an acute abdominal series, which was normal. Right upper quadrant sonography was performed that showed a thick, hyperechoic septation in the midportion of the gallbladder with apparent separation of the gallbladder into two compartments. The distal compartment contained diffuse low-level echoes while the proximal compartment was anechoic and contained multiple gallstones. The central septation itself was complex with multiple thin echogenic septa separating small hypoechoic cystic regions for approximately half of its length and a thick septation for the remainder (Figs. 1A and 1B). The gallbladder wall was otherwise not thickened, bile ducts were normal, and a small amount of pericholecystic fluid was present. The patient had no Murphy’s sign on sonography. The patient was admitted and had an abdominal CT scan that showed the complex septation within the gallbladder and cholelithiasis as seen on comparison sonography (Fig. 1C). The remainder of the abdominal CT was unremarkable. Specifically, no evidence of additional intrahepatic or biliary ductal lesions was seen. The presumptive diagnosis was focal adenomyomatosis and cholecystitis. The patient later had a laparoscopic cholecystectomy without complications. Surgical pathology showed a firm, circumferential submucosal mass measuring 1.2 × 0.8 × 0.8 cm, closing off the gallbladder lumen and segregating the distal and the proximal compartments. The total gallbladder measurements were 5.0 × 3.5 × 0.5 cm. The local and Armed Forces Institute of Pathology diagnosis described smooth-muscle hypertrophy, marked hypertrophy of nerves, and multiple cysts lined by benign cuboidal epithelium with cilia consistent with biliary cystadenoma of the gallbladder.