Faculty Bibliography

OBJECTIVE: Our aim was to evaluate the frequency and outcomes of incidental breast lesions detected on abdominal MRI examinations. MATERIALS AND METHODS: Abdominal MRI reports for 11,462 women imaged at our institution from November 2007 through December 2014 were reviewed to identify those reporting an incidental breast lesion. Available breast imaging and pathology results were assessed to identify outcomes in these lesions. RESULTS: Incidental breast lesions were described in the MRI reports of 292 (3%) patients who underwent abdominal MRI during the study period; breast imaging was recommended for 192 of these 292 (66%) patients. Sixty-three of the 192 (33%) patients for whom follow-up breast imaging was recommended underwent such imaging at our institution. Twenty-one of these 63 (33%) lesions underwent biopsy or surgery; histologic sampling of these lesions yielded seven incidental cancers (invasive ductal, n = 6; invasive lobular, n = 1) and 14 benign diagnoses. Three additional cancers (invasive ductal, n = 2; invasive lobular, n = 1) and three benign diagnoses were discovered at pathology at outside institutions. Of the remaining 165 patients without a histologic diagnosis, the lesions in 95 (58%) patients were presumed to be benign because of stability over time. Seven of the 10 patients with a diagnosis of incidental cancer (age range, 53-86 years; mean +/- SD, 67.0 +/- 10.6 years) had not undergone screening mammography at our institution. The frequency of incidental breast cancer was 11% of patients subsequently undergoing follow-up breast imaging at our institution, 3% of all patients with reported breast lesions, and 0.09% of patients undergoing abdominal MRI examinations. CONCLUSION: Although incidental breast lesions were rarely detected on abdominal MRI, a considerable number of these lesions were found to represent breast cancer, particularly when leading to a recommendation for follow-up breast imaging. Therefore, it is important for radiologists interpreting abdominal MRI examinations to carefully evaluate for the presence of breast abnormalities.

RATIONALE AND OBJECTIVE: The purpose of this study was to evaluate themes related to patients' experience in undergoing mammography, as expressed on Twitter. METHODS: A total of 464 tweets from July to December 2015 containing the hashtag #mammogram and relating to a patient's experience in undergoing mammography were reviewed. RESULTS: Of the tweets, 45.5% occurred before the mammogram compared to 49.6% that occurred afterward (remainder of tweets indeterminate). However, in patients undergoing their first mammogram, 32.8% occurred before the examination, whereas in those undergoing follow-up mammogram, 53.0% occurred before the examination. Identified themes included breast compression (24.4%), advising other patients to undergo screening (23.9%), recognition of the health importance of the examination (18.8%), the act of waiting (10.1%), relief regarding results (9.7%), reflection that the examination was not that bad (9.1%), generalized apprehension regarding the examination (8.2%), interactions with staff (8.0%), the gown (5.0%), examination costs or access (3.4%), offering or reaching out for online support from other patients (3.2%), perception of screening as a sign of aging (2.4%), and the waiting room or waiting room amenities (1.3%). Of the tweets, 31.9% contained humor, of which 56.1% related to compression. Themes that were more common in patients undergoing their first, rather than follow-up, mammogram included breast compression (16.4% vs 9.1%, respectively) and that the test was not that bad (26.2% vs 7.6%, respectively). CONCLUSION: Online social media provides a platform for women to share their experiences and reactions in undergoing mammography, including humor, positive reflections, and encouragement of others to undergo the examination. Social media thus warrants further evaluation as a potential tool to help foster greater adherence to screening guidelines.

OBJECTIVE: The objective of this study was to identify geographic and temporal patterns related to the frequencies of online searches within the United States for information on imaging-based cancer screening tests. MATERIALS AND METHODS: Google Trends, a web-based tool for identifying the frequency of online searches, was used to determine, on both a monthly and a geographic basis, the relative frequency of searches for imaging-based cancer screening tests in the United States from 2004 through 2014. Findings were evaluated qualitatively. RESULTS: Searches for "mammography" decreased slightly overall, although they peaked in October (Breast Cancer Awareness Month) in most years and spiked in November 2009 (when the updated U.S. Preventive Services Task Force screening mammography guidelines were released). The frequency of searches for "tomosynthesis" increased rapidly from 2009 through 2014. On the other hand, the frequency of searches for "lung cancer screening" decreased slightly from 2006 through 2010, increased rapidly from 2011 through 2014, and exhibited a spike in November 2010 (when the results of the National Lung Screening Trial were released). Searches for "virtual colonoscopy" decreased substantially from 2004 through 2010, remained stable from 2011 through 2014, and spiked in months coinciding with the publication of the results of large relevant clinical trials and a press release announcing that the president of the United States was undergoing virtual colonoscopy. The frequency of searches for "prostate MRI" was stable from 2006 through 2010 and increased rapidly from 2011 through 2014. Searches for "prostate MRI biopsy" increased rapidly in 2013 and 2014. These searches occurred predominantly in densely populated areas (e.g., searches for "lung cancer screening," "prostate MRI," and "tomosynthesis" were highest in New York City). CONCLUSION: Online search patterns indicate geographic and short- and long-term temporal variation in the interest in cancer screening examinations among the U.S. POPULATION: These trends may indicate pending shifts in the use of these examinations.

OBJECTIVE: To provide insight into the impact of radical prostatectomy (RP) on prostate cancer-specific mortality (PCSM) in a primarily PSA screen-detected cohort of men with localized prostate cancer. METHODS: Between 2000 and 2013, 1864 men consented to participate in a prospective longitudinal outcomes study following RP for localized prostate cancer (PCa) by a single surgeon. Men lost to follow-up were queried to the National Death Index to acquire mortality data. RESULTS: From our cohort of 1864 men (median age 59 years, median pre-operative PSA 5.0, median follow-up 9.1 years), Kaplan-Meier analysis demonstrated 10-year all-cause mortality and PCSM of 4.6% and 1.4%, respectively. Ten-year PCSM for low, intermediate, and high D'Amico risk were 0.9%, 1.0%, and 7.4%, respectively (p<0.001). For men with post-operative Gleason score 4-6, 7, and 8-10, 10-year PCSM was 0.8%, 1.0%, and 11.5%, respectively (p<0.001). Men with pT2, pT3a, and pT3b disease had 10-year PCSM of 0.7%, 2.6%, and 9.5%, respectively (p<0.001). Pathological stage and grade were the only significant independent predictor of PCSM at 10 years (p=0.002, p=0.025, respectively). CONCLUSIONS: In our series with up to 13 years of follow-up from the National Death Index, 10-year PCSM following RP for clinically localized PCa was very low and strongly predicted by pathological stage and grade. Death unrelated to PCa was a rare event, suggesting that we are identifying candidates for RP who are likely to live long enough to benefit from surgical intervention.

PURPOSE: The aim of this study was to evaluate use of the microblogging social network Twitter by academic radiology departments (ARDs) in the United States. METHODS: Twitter was searched to identify all accounts corresponding with United States ARDs. All original tweets from identified accounts over a recent 3-month period (August to October 2014) were archived. Measures of account activity, as well as tweet and link content, were summarized. RESULTS: Fifteen ARDs (8.2%) had Twitter accounts. Ten (5.5%) had "active" accounts, with >/=1 tweet over the 3-month period. Active accounts averaged 711 +/- 925 followers (maximum, 2,885) and 61 +/- 93 tweets (maximum, 260) during the period. Among 612 tweets from active accounts, content most commonly related to radiology-related education (138), dissemination of departmental research (102), general departmental or hospital promotional material (62), departmental awards or accomplishments (60), upcoming departmental lectures (59), other hospital-related news (55), medical advice or information for patients (38), local community events or news (29), social media and medicine (27), and new departmental or hospital hires or expansion (19). Eighty percent of tweets (490 of 612) included 315 unique external links. Most frequent categories of link sources were picture-, video-, and music-sharing websites (89); the ARD's website or blog (83); peer-reviewed journal articles (40); the hospital's or university's website (34), the lay press (28), and Facebook (14). CONCLUSIONS: Twitter provides ARDs the opportunity to engage their own staff members, the radiology community, the department's hospital, and patients, through a broad array of content. ARDs frequently used Twitter for promotional and educational purposes. Because only a small fraction of ARDs actively use Twitter, more departments are encouraged to take advantage of this emerging communication tool.

OBJECTIVE: To examine public and media response to the United States Preventive Services Task Force's (USPSTF) draft (October 2011) and finalized (May 2012) recommendations against prostate-specific antigen (PSA) testing using Twitter, a popular social network with over 200 million active users. MATERIALS AND METHODS: We used a mixed methods design to analyze posts on Twitter, called "tweets." Using the search term "prostate cancer," we archived tweets in the 24 hour periods following the release of the USPSTF draft and finalized recommendations. We recorded tweet rate per hour and developed a coding system to assess type of user and sentiment expressed in tweets and linked articles. RESULTS: After the draft and finalized recommendations, 2042 and 5357 tweets focused on the USPSTF report, respectively. Tweet rate nearly doubled within two hours of both announcements. Fewer than 10% of tweets expressed an opinion about screening, and the majority of these were pro-screening during both periods. In contrast, anti-screening articles were tweeted more frequently in both draft and finalized study periods. From the draft to the finalized recommendations, the proportion of anti-screening tweets and anti-screening article links increased (p= 0.03 and p<0.01, respectively). CONCLUSIONS: There was increased Twitter activity surrounding the USPSTF draft and finalized recommendations. The percentage of anti-screening tweets and articles appeared to increase, perhaps due to the interval public comment period. Despite this, most tweets did not express an opinion, suggesting a missed opportunity in this important arena for advocacy.

OBJECTIVE. The purpose of this study was to assess perspectives and information relating to CT radiation risk on Twitter, a popular microblogging social network. MATERIALS AND METHODS. Publicly available posts on Twitter ("tweets") containing both the words "CT" and "radiation" were identified from the 1st week of each month in 2013. Type of user posting and source of linked articles were recorded. Two reviewers assessed the content of tweets and links regarding CT's benefit-to-risk ratio (favorable, unfavorable, etc.). RESULTS. Six hundred twenty-one relevant tweets were tweeted by 557 unique users, of whom 90 (16%) were physicians (17 of these were radiologists), 30 (5%) were medical practices or hospitals, 34 (6%) were patients, 8 (1%) were physicists or technologists, and 395 (71%) were other types of users. Two hundred twenty-seven tweets included user commentary regarding CT's benefit-to-risk ratio, of which 134 (59%) were unfavorable or concerned, 65 (29%) were neutral, 22 (10%) were informative regarding CT dose reduction strategies, and only 6 (3%) were favorable. Four hundred seventy-two tweets (76%) included links to a total of 99 unique articles, of which 25 (25%) were unfavorable or concerned, 10 (10%) were favorable, 25 (25%) were neutral, and 39 (39%) were informative regarding CT dose reduction. Article types were non-peer-reviewed medical sources (n = 50), lay press (n = 15), peer-reviewed medical journals (n = 13), blogs (n = 12), advertisements (n = 5), and informational websites (n = 4). CONCLUSION. The large majority of content on Twitter was either unfavorable or concerned regarding CT radiation risk. Most articles were not peer-reviewed and were posted by nonphysicians; posts by physicians were largely by nonradiologists. More active engagement on Twitter by radiologists and physicists and increased dissemination of peer-reviewed articles may achieve a more balanced representation and alleviate concerns regarding CT radiation risk on social networks.

Sore throat is a common complaint in the outpatient and emergency room settings. Typically, little workup is necessary and includes visual inspection with or without swabs for bacterial infection. We present a case that demonstrates an important entity to be excluded by simple history and physical examination in patients presenting with pain in the throat or neck. The most important cause of pneumomediastinum is previous instrumentation. Spontaneous pneumomediastinum is uncommonly seen in young adults. Most cases of spontaneous pneumomediastinum are uncomplicated, as mediastinal pressures rarely mount to dangerous levels. However, when the patient presents with distended neck veins, cyanosis or marked dyspnoea, further action is necessary. Lastly, since pneumomediastinum can be caused by oesophageal rupture and occasionally present with concurrent pneumothorax, these dangerous entities must be excluded.

PURPOSE: The prevalence of lower urinary tract symptoms increases with age and impairs quality of life. Radical prostatectomy has been shown to relieve lower urinary tract symptoms at short-term followup but the long-term effect of radical prostatectomy on lower urinary tract symptoms is unclear. MATERIALS AND METHODS: We performed a prospective cohort study of 1,788 men undergoing radical prostatectomy. The progression of scores from the self-administered AUASS (American Urological Association symptom score) preoperatively, and at 3, 6, 12, 24, 48, 60, 84, 96 and 120 months was analyzed using models controlling for preoperative AUASS, age, prostate specific antigen, pathological Gleason score and stage, nerve sparing, race and marital status. This model was also applied to patients stratified by baseline clinically significant (AUASS greater than 7) and insignificant (AUASS 7 or less) lower urinary tract symptoms. RESULTS: Men exhibited an immediate worsening of lower urinary tract symptoms that improved between 3 months and 2 years after radical prostatectomy. Overall the difference between mean AUASS at baseline and at 10 years was not statistically or clinically significant. Men with baseline clinically significant lower urinary tract symptoms experienced immediate improvements in lower urinary tract symptoms that lasted until 10 years after radical prostatectomy (13.5 vs 8.81, p <0.001). Men with baseline clinically insignificant lower urinary tract symptoms experienced a statistically significant but clinically insignificant increase in mean AUASS after 10 years (3.09 to 4.94, p <0.001). The percentage of men with clinically significant lower urinary tract symptoms decreased from baseline to 10 years after radical prostatectomy (p = 0.02). CONCLUSIONS: Radical prostatectomy is the only treatment for prostate cancer shown to improve and prevent the development of lower urinary tract symptoms at long-term followup. This previously unrecognized long-term benefit argues in favor of the prostate as the primary contributor to male lower urinary tract symptoms.