Novant Health is a four-state integrated network of physician clinics, outpatient centers and hospitals. Its network consists of more than 1,600 physicians and 29,000 employees at more than 640 locations, including 15 medical centers and hundreds of outpatient facilities and physician clinics. The organization was formed on 1 July 1997 by the merger of Carolina Medicorp of Winston-Salem, North Carolina and Presbyterian Health Services of Charlotte, North Carolina. Headquartered in Winston-Salem, North Carolina, Novant Health serves more than 4 million patients annually. In 2019, Novant Health was ranked #38 in Forbes' annual ranking of America's Best Employers for Diversity, #3 in Diversity MBA Magazine's annual ranking of Best Places to Work for Women & Diverse Managers, and #6 in North Carolina in Forbes' annual ranking of America's Best Employers by State.
Background Interstitial brachytherapy needles utilize radio-opaque markers that are expensive, not MR-safe, and have significant artifacts on CT/MRI. Here, we demonstrate the feasibility of 3D-printed radio-opaque markers composed of metal-infused polylactic acid (PLA) and test their use on CT-based localization of interstitial brachytherapy needles. Methodology Radio-opaque markers were 3D-printed using PLA filament infused with copper. Solid and hollow markers were designed, with hollow markers capable of containing viscous contrast media. Hollow markers were constructed heterogeneously with a single stripe of copper PLA along the length of a metal-free PLA to allow for feasibility testing of detecting dual contrast media using both CT and MRI. Markers were imaged via CT inside a prostate phantom and compared directly against steel and nitinol markers. Comparisons were performed in both soft tissue and air density regions. CT metal artifact (CTMA) was computed via standard deviation in the volume around each marker. Contrast-to-noise ratios (CNRs) were evaluated using CT imaging for all tested markers using identical methodology. Artifact differences between markers were compared by evaluating the standard deviations of fixed volumes around each voxel. Results The average CNR for solid and hollow copper PLA markers was 1.99 ± 0.07 and 1.23 ± 0.21 in tissue and 2.48 ± 0.10 and 2.99 ± 0.15 in air, respectively. The average CNR for wire and nitinol markers was 1.31 ± 0.02 and 2.33 ± 0.05 in tissue and 1.86 ± 0.01 and 2.76 ± 0.01 in air, respectively. CTMA for solid and hollow copper PLA markers were 13.62 and 8.80 HU in tissue and 9.99 and 13.66 HU in air, respectively. The average artifact for the nitinol and wire markers was 75.93 and 18.06 HU in tissue and 50.71 and 16.64 HU in air, respectively. Conclusions Solid copper PLA 3D-printed markers have superior visibility to commercially available steel marker wires. Both types of printed markers exhibited reduced imaging artifacts when compared with commercially available markers. Printed markers can improve the accuracy of interstitial planning and can be inexpensively produced in-house.
Occupational radiation exposure has a clear association with long-term health effects and has a particular impact on women, trainees, and supporting staff. There is a reliance on limited, traditional radiation protection and nonergonomic equipment, which carries associated orthopedic injury rates with adverse impacts on both individual career trajectories and health systems, and with significant challenges to widespread implementation of enhanced radiation protection devices. During the 2025 Society for Cardiovascular Angiography & Interventions Scientific Sessions in Washington, DC, a multidisciplinary Think Tank summit was convened and included representatives from multiple stakeholders, including other professional societies, advocacy groups, and industry partners. The focus of discussion was on the dual dangers of both ionizing radiation and the musculoskeletal injuries associated with current-generation protection equipment. This document summarizes the main points of discussion and outlines actionable next steps to advocate for more widespread implementation of enhanced radiation protection technologies and imaging systems in order to achieve ALARA+ (as low and as light as reasonably achievable).
INTRODUCTION:Neuropathic pain is a debilitating and often treatment-resistant condition with significant personal and societal burden. As conventional pharmacologic options frequently fall short, there is a growing need for targeted, durable solutions. AREAS COVERED:Dorsal root ganglion (DRG) stimulation has emerged as a promising neuromodulation technique offering anatomically targeted therapy for focal neuropathic syndromes. This review examines the anatomical underpinnings, mechanisms of action, clinical evidence, technological innovations, procedural techniques, and safety considerations associated with DRG stimulation, while highlighting current challenges and future directions in expanding its role within modern pain management. Literature was searched in PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL from 2010 through 2024. This narrative review synthesizes the anatomic rationale, mechanistic hypotheses, clinical evidence by indication, procedural technique, safety considerations, and emerging technological developments in DRG stimulation. EXPERT OPINION:DRG stimulation represents a significant advancement in interventional pain medicine. With its dermatomal targeting and clinical efficacy in anatomically discrete pain syndromes, it can be considered as a option in appropriately selected patients. Continued innovation, real-world outcome data, and improved access will be key to realizing its full therapeutic potential.
BACKGROUND Transgender and gender diverse (TGD) persons face significant health disparities. We aimed to explore the scope of family physicians’ TGD care and physician factors related to the provision of TGD health care in North Carolina. METHODS Family physicians in North Carolina were invited to complete an observational survey from January 2024 to September 2024, exploring their training, beliefs, and practices related to care for TGD patients. Descriptive statistics characterized the responses, and bivariate analyses explored potential factors associated with whether physicians offered primary care or gender-affirming care (GAC) to TGD patients. Sub-analysis of data compared responses across regions of the state. RESULTS Of the 181 attending family physicians who completed the survey, 66.9% reported participating in some type of training in TGD patient care. Overall, 82.9% of respondents reported providing primary care to TGD patients, and 47.5% reported that they provided GAC to TGD patients. The most commonly reported barrier to providing any care to TGD patients was insufficient training. Bivariate analyses revealed additional physician, clinic, and training factors that may be associated with whether family physicians provide primary care or GAC to TGD patients. LIMITATIONS The present study is limited by a small sample size, with high likelihood of selection bias. CONCLUSIONS This study provides an initial snapshot into family medicine physician practices with regard to primary care and GAC for TGD patients. Our findings highlight the need for an increased focus on training, both mandatory and optional. We also identified key opportunities for targeted outreach, such as residency programs.
Background: Adenomyoepithelioma (AME) of the breast is a rare biphasic neoplasm characterized by proliferation of epithelial and myoepithelial cells. Although most AMEs demonstrate indolent behavior, malignant transformation has been reported, and diagnostic uncertainty often complicates clinical management. Given the rarity of AME, most data are limited to case reports and small series, leaving optimal management undefined. Objectives: To describe the clinical presentation, imaging characteristics, histopathologic features, and outcomes of patients with breast AME. Design: Retrospective single-institution case series. Methods: We retrospectively reviewed 15 patients diagnosed with breast AME between 2010 and 2023. Demographic, clinical, imaging, core needle biopsy (CNB) findings, surgical pathology, and outcomes data were analyzed. Results: The median age at diagnosis was 56 years. More than half of the patients (53.3%) were asymptomatic at presentation. Mammography most frequently demonstrated discrete ovoid masses (61.5%), and ultrasound most often showed hypoechoic lesions (66.7%) with lobulated margins (50%). Core needle biopsy identified benign AME in 38.4% of cases, while 61.5% yielded indeterminate findings with AME included in the differential. Five patients underwent CNB alone without surgical excision. Of the 9 patients who underwent both CNB and excision, 6 (66.7%) had AME on final pathology, whereas 3 were upgraded (2 invasive carcinoma, 1 atypical ductal hyperplasia). Of the 3 cases with cytologic atypia on CNB, 1 was upgraded to invasive carcinoma. Over a median follow-up of 10 months, no recurrences, metastases, or breast cancer-related deaths were observed. Conclusions: Breast AME generally follows a benign clinical course, but diagnostic challenges exist due to histologic heterogeneity. Core needle biopsy features such as cytologic atypia may indicate higher malignancy risk. These findings highlight the ongoing dilemma of when observation is sufficient versus when surgical excision is warranted. Our results add to the limited body of evidence and align with prior reports, underscoring the need for larger, multicenter studies with longer follow-up to clarify long-term outcomes and optimal management strategies.
