Background The forthcoming Breast Imaging Reporting and Data System (BI-RADS) version 2025 (hereafter, v2025) manual recommends auditing breast MRI examinations performed to evaluate the extent of disease in women newly diagnosed with breast cancer. Purpose To investigate the feasibility of this recommended audit using preoperative breast MRI examinations performed over 2 years, report the calculated metrics, and identify any clinical or imaging characteristics associated with improved MRI performance metrics. Materials and Methods Consecutive breast MRI examinations performed from January 2021 to December 2022 at The University of Texas MD Anderson Cancer Center were retrospectively reviewed, excluding screening, diagnostic, neoadjuvant chemotherapy response, and nondiagnostic or incomplete preoperative MRI examinations. Recommended audit calculations were performed as described in the BI-RADS v2025 manual: abnormal interpretation rate (AIR) (percentage of positive preoperative MRI examinations), positive predictive value of biopsies recommended (PPV2) (percentage of all distinct BI-RADS category 4 or 5 findings, not examinations, with a tissue diagnosis of cancer at image-guided biopsy), positive predictive value of biopsies performed (PPV3) (percentage of BI-RADS category 4 or 5 findings, not examinations, with preoperative image-guided biopsy revealing a tissue diagnosis of cancer), and additional cancer detection rate (ACDR) (number of additional malignant lesions diagnosed beyond the primary cancer per 1000 MRI examinations). Total time collecting data and performing calculations was recorded. Characteristics of benign and malignant BI-RADS 4 or 5 lesions were compared using the Wilcoxon rank sum test and Fisher exact test. Logistic regression was used to determine characteristics associated with malignancy. Results A total of 1533 preoperative MRI examinations were included (median patient age, 54.6 years; IQR, 45.5-65.2 years; all female), with 464 MRI examinations revealing 609 suspicious breast findings. Subsequent image-guided biopsy for 432 of these findings revealed 139 malignancies. The overall AIR was 30.3% (95% CI: 28.0, 32.6), overall PPV2 was 22.8% (95% CI: 19.5, 26.1), overall PPV3 was 32.2% (95% CI: 27.8, 36.6), and overall ACDR was 90.7 per 1000 examinations (95% CI: 74.3, 107.1). Seven radiologists spent a combined total of 141 hours collecting data and performing audit calculations. Older patient age (odds ratio, 1.04; 95% CI: 1.02, 1.05; P < .001) and presence of lesions ipsilateral to the index malignancy (odds ratio, 1.81; 95% CI: 1.20, 2.75; P = .005) were associated with higher odds of malignancy. Conclusion Auditing of preoperative breast MRI examinations performed to evaluate disease extent, as recommended in the forthcoming BI-RADS v2025 manual, was feasible and yielded metrics within expected ranges based on limited prior data. © RSNA, 2025.

Suspicious non-calcified mammographic findings have not been evaluated with modern mammographic technique, and the purpose of this work is to compare the likelihood of malignancy for those findings. To do this, 5018 consecutive mammographically guided biopsies performed during 2016–2019 at a large metropolitan, community-based hospital system were retrospectively reviewed. In total, 4396 were excluded for targeting calcifications, insufficient follow-up, or missing data. Thirty-seven of 126 masses (29.4%) were malignant, 44 of 194 asymmetries (22.7%) were malignant, and 77 of 302 architectural distortions (AD, 25.5%) were malignant. The combined likelihood of malignancy was 25.4%. Older age was associated with a higher likelihood of malignancy for each imaging finding type (all p ≤ 0.006), and a possible ultrasound correlation was associated with a higher likelihood of malignancy when all findings were considered together (p = 0.012). Two-view asymmetries were more frequently malignant than one-view asymmetries (p = 0.03). There were two false-negative biopsies (98.7% sensitivity and 100% specificity). In conclusion, the 25.4% likelihood of malignancy confirms the recommendation for biopsy of suspicious, ultrasound-occult, mammographic findings. Mammographically guided biopsies were highly sensitive and specific in this study. Older patient age and a possible ultrasound correlation should raise concern given the increased likelihood of malignancy in those scenarios.

Background Mammography-guided vacuum-assisted biopsies (MGVAB) can be done with stereotaxis or digital breast tomosynthesis guidance. Both methods can be performed with a conventional (CBA) or a lateral arm biopsy approach (LABA). Marker clip migration is relatively frequent in MGVAB (up to 44%), which in cases requiring surgery carries a risk of positive margins and re-excision. We aimed to compare the rates of clip migration and hematoma formation between the CBA and LABA techniques of prone MGVAB. Our HIPAA compliant retrospective study included all consecutive prone MGVAB performed in a single institution over a 20-month period. The LABA approach was used with DBT guidance; CBA utilized DBT or stereotactic guidance. The tissue sampling techniques were otherwise identical. Results After exclusion, 389 biopsies on 356 patients were analyzed. LABA was done in 97 (25%), and CBA in 292 (75%) cases. There was no statistical difference in clip migration rate with either 1 cm or 2 cm distance cut-off [15% for CBA and 10% for LABA for 1 cm threshold (p = 0.31); 5.8% or CBA and 3.1% or LABA for 2 cm threshold (p = 0.43)]. There was no difference in the rate of hematoma formation (57.5% in CDB and 50.5% in LABA, p = 0.24). The rates of technical failure were similar for both techniques (1.7% for CBA and 3% for LABA) with a combined failure rate of 1%. Conclusions LABA and CBA had no statistical difference in clip migration or hematoma formation rates. Both techniques had similar success rates and may be helpful in different clinical situations.

Objectives Compare four groups being screened: women without breast implants undergoing digital mammography (DM), women without breast implants undergoing DM with digital breast tomosynthesis (DM/DBT), women with implants undergoing DM, and women with implants undergoing DM/DBT. Methods Mammograms from February 2011 to March 2017 were retrospectively reviewed after 13,201 were excluded for a unilateral implant or prior breast cancer. Patients had been allowed to choose between DM and DM/DBT screening. Mammography performance metrics were compared using chi-square tests. Results Six thousand forty-one women with implants and 91,550 women without implants were included. In mammograms without implants, DM ( n = 113,973) and DM/DBT ( n = 61,896) yielded recall rates (RRs) of 8.53% and 6.79% (9726/113,973 and 4204/61,896, respectively, p < .001), cancer detection rates per 1000 exams (CDRs) of 3.96 and 5.12 (451/113,973 and 317/61,896, respectively, p = .003), and positive predictive values for recall (PPV1s) of 4.64% and 7.54% (451/9726 and 317/4204, respectively, p < .001), respectively. In mammograms with implants, DM ( n = 6815) and DM/DBT ( n = 5138) yielded RRs of 5.81% and 4.87% (396/6815 and 250/5138, respectively, p = .158), CDRs of 2.49 and 2.92 (17/6815 and 15/5138, respectively, p > 0.999), and PPV1s of 4.29% and 6.0% (17/396 and 15/250, respectively, p > 0.999), respectively. Conclusions DM/DBT significantly improved recall rates, cancer detection rates, and positive predictive values for recall compared to DM alone in women without implants. DM/DBT performance in women with implants trended towards similar improvements, though no metric was statistically significant. Key Points • Digital mammography with tomosynthesis improved recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women without implants. • Digital mammography with tomosynthesis trended towards improving recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women with implants, but these trends were not statistically significant — likely related to sample size.

During the COVID-19 pandemic, mentorship relationships have undergone significant strain. Sudden changes in the practice environment have caused radiologists to focus their attention to more immediate and essential clinical needs, thus leaving important extracurricular non-clinical endeavors like mentorship by the wayside. However, mentorship is essential more than ever during the pandemic to build strength and resilience in radiology. Specifically, mentorship can foster job resilience, facilitate career development, promote diversity, support wellness, and stimulate future practice growth during this pandemic. Practical actions are described that mentors can follow to help develop and sustain mentorship relationships during the pandemic. SUMMARY: Mentorship is critical now during the COVID-19 pandemic to build strength and resilience in radiology.

Objective To compare batch reading and interrupted interpretation for modern screening mammography. Methods We retrospectively reviewed digital mammograms without and with tomosynthesis that were originally interpreted with batch reading or interrupted interpretation between January 2015 and June 2017. The following performance metrics were compared: recall rate (per 100 examinations), cancer detection rate (per 1,000 examinations), and positive predictive values for recall and biopsy. Results In all, 9,832 digital mammograms were batch read, yielding a recall rate of 9.98%, cancer detection rate of 4.27, and positive predictive values for recall and biopsy of 4.40% and 35.5%, respectively. There were 49,496 digital mammograms that were read with interrupted interpretation, yielding a recall rate of 11.3%, cancer detection rate of 4.44, and positive predictive values for recall and biopsy of 3.92% and 30.1%, respectively. Of the digital mammograms with tomosynthesis, 7,075 were batch read, yielding a recall rate of 6.98%, cancer detection rate of 5.37, and positive predictive values for recall and biopsy of 7.69% and 38.0%, respectively. Of the digital mammograms with tomosynthesis, 24,380 were read with interrupted interpretation, yielding a recall rate of 8.30%, cancer detection rate of 5.41, and positive predictive values for recall and biopsy of 6.52% and 33.3%, respectively. For both digital mammograms without and with tomosynthesis, recall rates improved with batch reading compared with interrupted interpretation (P < .001), but no significant differences were seen for other metrics. Discussion Batch reading digital mammograms without and with tomosynthesis improves recall rates while maintaining cancer detection rates and positive predictive values compared with interrupted interpretation.

Junior radiologists in nonacademic settings currently face multiple challenges, including clinical productivity, climbing the ladder to partnership, maintenance of certification, and administrative requirements. Mentorship of junior radiologists in nonacademic settings can ease their transition into nonacademic practice, foster comradery, increase radiologist retention, and support career growth. Strategies to implement and sustain effective mentorship in nonacademic radiology practice settings are described.

Sponsorship is a proven effective strategy to smash glass ceilings in business and academic medicine. The purpose of this article is to highlight the differences among sponsorship, mentoring, and coaching and to describe the value of sponsorship, challenges of implementation, and specific actions to support sponsorship in academic radiology. Sponsorship can be an effective strategy to smash radiology's glass ceiling and promote diversity.

The National Institute of Health Research and Charities Consortium for Hospice and Community Research have stated that the goal for all hospices is to be research active and to be recruiting into portfolio studies by 2022. This poster draws on a case study from one research nurse as she sought to develop research capacity at a hospice in the West Midlands. The poster aims to highlight four key areas the innovative role covers showing how a research nurse is central to:Facilitating engagement with research at the hospice. From introducing (sceptical) staff to the range of research studies they can be involved in to the opportunities to embed research into the daily work of both the in–patient and day servicesBeing a bridge between the often–competing pressures of clinical care and research by finding novel solutions to obstaclesEmpowering staff by encouraging them to be a part of research in everyday practice as well as being a resource for staff by supporting them with academic assignments producing posters for conferences and disseminating research findings through journal discussionsBuilding future research opportunities by developing a research nurse network where ideas and good practice can be shared widely across different organisations.

Balancing the clinical, educational, and research responsibilities of academic radiologists can prove to be extremely challenging, especially for young faculty members newly out of training. Mentorship should no longer be considered a luxury but instead a necessary tool for helping junior faculty members navigate through all the many health care changes with "confidence and resilience" [ 1 Ackroyd R. Adamson K.A. Mentoring for new consultants. J R Coll Physicians Edinb. 2015; 45: 143-147 Crossref PubMed Scopus (11) Google Scholar ]. A paucity of literature exists concerning mentorship outside the medical school or residency setting. Specifically, very few articles have been found addressing mentorship in the setting of diagnostic radiology, with minimal relevance to junior academic faculty members beginning their careers. In this article, we define mentorship and discuss the challenges faced by junior faculty members in academic radiology, the value of mentorship in helping junior faculty members overcome these challenges, stages of mentorship, strategies to implement mentorship, and threats to successful sustained mentorship in radiology.

Radiologists seek mentors to facilitate career advancement and to help overcome professional and personal challenges. Characteristics of effective mentors include altruism, honesty, active listening skills, a collaborative approach, and accessibility. Characteristics of effective mentees include being respectful of mentors' input and time, being an active listener, and being open to feedback. Radiology departments should consider establishing structured processes for identifying and preparing mentors. Strategies to support mentor-mentee relationships include effective pairing of mentors with mentees, maintenance of confidentiality, clear definition of expectations, voluntary participation, and allowing mentees to change mentors without judgment or repercussions. A culture shift is needed in radiology departments to enable successful mentor-mentee relationships.