Faculty Bibliography

BACKGROUND:Electrical impedance scanning (EIS) measures changes in breast tissue associated with breast cancer (Br-Ca) development. The T-Scan(tm2000 (ED is designed to use EIS to identify women ages 30-39 with elevated risk of breast cancer (i.e., T-Scan+ women). AIM/OBJECTIVE:To estimate the relative probability of breast cancer in a T-Scan+ woman compared to a randomly selected young woman. METHODS:A prospective, two-cohort trial was conducted in pre-menopausal women. The Specificity (S(p))-Cohort evaluated T-Scan specificity in 1,751 asymptomatic women ages 30-39. The Sensitivity)S(n))-Cohort evaluated T-Scan sensitivity in 390 women ages 45-30 scheduled for biopsy. Specificity, sensitivity, and conservative estimate of disease prevalence were used to calculate relative probability. RESULTS:In the S(p)-Cohort, 93 of 1,751 women were T-Scan+ (S(p) = 94.7%; 95% CI: 93.7-95.7%). In the S(n)-Cohort, 23 of 87 biopsy-proven cancers were T-Scan+ (S(n) = 26.4%; 95% CI: 17.4-35.4%). Given S(p) = 94.7%, S(n) = 26.4% and prevalence of 1.5 cancers/1,000 women (ages 30-39), the relative probability of a T-Scan+ woman having Br-Ca is 4.95: (95% CI: 3.16-7.14). CONCLUSION/CONCLUSIONS:EIS can identify a subset of young women with a relative probability of breast cancer almost five times greater than in the population of young women at-large. T-Scan+ women have a sufficiently high risk of Br-Ca to warrant further surveillance or imaging.

Tremendous confusion exists concerning the issues of physician certification and practice accreditation in obstetric and gynecologic ultrasonography. Certification speaks to physician competence. All obstetrician-gynecologists who have finished residency training since 1982 are deemed 'competent' to perform obstetric and gynecologic ultrasonography by virtue of their training. Those trained before 1982 need to be able to describe their level of experience in performing obstetric and gynecologic ultrasonography. Accreditation deals with issues of patient safety and quality control, including equipment calibration, transducer cleaning and disinfection, universal precautions and Occupational Safety and Health Administration regulations, ultrasound examination protocols, and qualifications of nonphysician personnel performing ultrasound examinations. A new field of radiology benefit managers has arisen in response to attempts by health insurers to manage care, and reduce their costs and utilization. They have adopted ultrasound accreditation, originally intended to enhance patient safety, to help restrict utilization. Currently two organizations are recognized as accrediting bodies: The American Institute of Ultrasound in Medicine (AIUM), which recognizes obstetric and gynecologic residency training as evidence of competency, and The American College of Radiologists, which does not. Obstetrician-gynecologists should realize that AIUM's accreditation is their 'lifeboat' in this time of increasing interference by health care insurers into decision making in clinical practice

Abnormal uterine bleeding is an important clinical concern and accounts for much medical intervention. This article presents an ultrasound-based approach to help exclude endometrial carcinoma and identify the source of bleeding for better clinical management. Saline infusion sonohysterography can help to triage patients to (1) no anatomic pathology, (2) globally thickened anatomic pathology that may be evaluated with blind endometrial sampling, or (3) focal abnormalities that must be evaluated under direct vision