Faculty Bibliography

Further advancement of the care experience for transgender and gender diverse (TGD) patients can substantially benefit from implementing expanded electronic health record (EHR) systems that capture sexual orientation and gender identity (SOGI) information, along with processes for acquiring and maintaining accuracy of these data fields. Once this is in place, it could advance existing and create new opportunities in radiology for providing sensitive care to TGD patients. Using gender sensitive language in radiology reports and during imaging appointments shows respect and demonstrates inclusivity for TGD patients. Theoretically, using appropriate gender labels in healthcare could lead to improved patient experiences and outcomes. Here, we summarize EHR features that can lead to improved care experiences among TGD patients, and how they could be applied in radiology.

Access to radiology reports and images through a patient portal offers several advantages. The purpose of this study was to characterize patient's interactions with their radiology results. This was a retrospective study that evaluated radiography, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, exams performed between July 2020 and June 2021 for patients aged 12 and older. Exam information, access logs of radiology reports and images, and patient demographics were obtained from the electronic health record and image viewing software. Descriptive statistics were computed. The study included 1,685,239 exams. A total of 54.1% of reports were viewed. MRI and PET reports were viewed with the greatest frequency (70.2% and 67.6%, respectively); 25.5% of exam images were viewed, with the greatest frequency for MRI (40.1%). Exams were shared a total of 17,095 times and downloaded 8409 times; 64% of reports were viewed for patients aged 18-39 and 34% for patients aged 80 and greater. The rate of reports viewed was greater for patients with English as their preferred language (57.1%) compared to other languages (33.3%). Among those viewed, 56.5% of reports and 48.2% of images were viewed multiple times; 72.8% of images were viewed on smartphones, 25.8% on desktop computers, and 1.4% on tablets. Patients utilize a portal to view reports and view and share images. Continued efforts are warranted to promote the use of portals and create patient-friendly imaging results to help empower patients.

Current disparities in the access to diagnostic imaging for Black patients and the underrepresentation of Black physicians in radiology, relative to their representation in the general U.S. population, reflect contemporary consequences of historical anti-Black discrimination. These disparities have existed within the field of radiology and professional medical organizations since their inception. Explicit and implicit racism against Black patients and physicians was institutional policy in the early 20th century when radiology was being developed as a clinical medical field. Early radiology organizations also embraced this structural discrimination, creating strong barriers to professional Black radiologist involvement. Nevertheless, there were numerous pioneering Black radiologists who advanced scholarship, patient care, and diversity within medicine and radiology during the early 20th century. This work remains important in the present day, as race-based health care disparities persist and continue to decrease the quality of radiology-delivered patient care. There are also structural barriers within radiology affecting workforce diversity that negatively impact marginalized groups. Multiple opportunities exist today for antiracism work to improve quality of care and to apply standards of social justice and health equity to the field of radiology. An initial step is to expand education on the disparities in access to imaging and health care among Black patients. Institutional interventions include implementing community-based outreach and applying antibias methodology in artificial intelligence algorithms, while systemic interventions include identifying national race-based quality measures and ensuring imaging guidelines properly address the unique cancer risks in the Black patient population. These approaches reflect some of the strategies that may mutually serve to address health care disparities in radiology. ^© RSNA, 2023 See the invited commentary by Scott in this issue. Quiz questions for this article are available in the supplemental material.

The use of digital breast tomosynthesis (DBT) in breast cancer screening has become widely accepted, facilitating increased cancer detection and lower recall rates compared with those achieved by using full-field digital mammography (DM). However, the use of DBT, as compared with DM, raises new challenges, including a larger number of acquired images and thus longer interpretation times. While most current artificial intelligence (AI) applications are developed for DM, there are multiple potential opportunities for AI to augment the benefits of DBT. During the diagnostic steps of lesion detection, characterization, and classification, AI algorithms may not only assist in the detection of indeterminate or suspicious findings but also aid in predicting the likelihood of malignancy for a particular lesion. During image acquisition and processing, AI algorithms may help reduce radiation dose and improve lesion conspicuity on synthetic two-dimensional DM images. The use of AI algorithms may also improve workflow efficiency and decrease the radiologist's interpretation time. There has been significant growth in research that applies AI to DBT, with several algorithms approved by the U.S. Food and Drug Administration for clinical implementation. Further development of AI models for DBT has the potential to lead to improved practice efficiency and ultimately improved patient health outcomes of breast cancer screening and diagnostic evaluation. See the invited commentary by Bahl in this issue. ^©RSNA, 2022.

Background Male breast cancer incidence is rising. There may be a potential role in selective screening in men at elevated risk for breast cancer, but the effectiveness of such screening remains unexplored. Purpose To evaluate patterns of male breast imaging utilization, to determine high-risk screening outcomes, and to delineate risk factors associated with cancer diagnosis. Materials and Methods This retrospective study reviewed consecutive male breast imaging examinations over a 12-year period (between 2005-2017). Examination indications, biopsy recommendations, and pathologic results were correlated with patient characteristics. Fisher exact test, Mann-Whitney test, Spearman correlation, and logistic regression were used for statistical analysis. Results A total of 1869 men (median age, 55 years; range, 18-96 years) underwent 2052 examinations yielding 2304 breast lesions and resulting in 149 (6.5%) biopsies in 133 men; 41 (27.5%) were malignant and 108 (72.5%) were benign. There were 1781 (86.8%) diagnostic and 271 (13.2%) screening examinations. All men undergoing screening had personal or family history of breast cancer and/or genetic mutations. There was a significant increase in the number of examinations in men relative to the number of examinations in women over time (Spearman correlation, r = 0.85; P < .001). Five node-negative cancers resulted from screening mammography, yielding a cancer detection rate of 18 per 1000 examinations (95% confidence interval [CI]: 7, 41), with cancers diagnosed on average after 4 person-years of screening (range, 1-10 person-years). Mammographic screening sensitivity, specificity, and positive predictive value of biopsy were 100% (95% CI: 50%, 100%), 95.0% (95% CI: 93.1%, 98%), and 50% (95% CI: 22.2%, 77.8%). Older age (P < .001), Ashkenazi descent (P < .001), genetic mutations (P = .006), personal history (P < .001), and first-degree family history (P = .03) were associated with breast cancer. Non-first-degree family history was not associated with cancer (P = .09). Conclusion There is potential benefit in screening men at high risk for developing breast cancer. Such screening may have increased over time. © RSNA, 2019.

BACKGROUND:Prescription medications are among the most common causes of sexual dysfunction, and patients are often hesitant to seek help when experiencing these symptoms. OBJECTIVE:In this review, we identified the available evidence of sexual side effects in men using systemic dermatologic medications and suggest screening protocols and actions that may improve a patient's symptom where possible. METHODS:A systematic review was conducted of all articles in the PubMed database published from the time of inception to May 2018 to identify studies evaluating use of systemic dermatologic medications in men with evidence of sexual side effects. Subsequently, a secondary in-depth literature review was performed for each individual medication. RESULTS:5497 articles were reviewed in the primary systematic review. A total of 59 articles covering 11 systemic dermatologic medications met inclusion criteria. We identified level 1 evidence for sexual side effects as a primary outcome in patients taking finasteride. LIMITATIONS/CONCLUSIONS:Many included studies were limited by sample size and methodology. CONCLUSION/CONCLUSIONS:The information in this review may serve as a reference of side effects when deciding on a therapeutic agent and a guide to identify patients to screen for sexual dysfunction.

OBJECTIVE:To use Twitter to characterize public perspectives regarding artificial intelligence (AI) and radiology. METHODS AND MATERIALS/METHODS:Twitter was searched for all tweets containing the terms "artificial intelligence" and "radiology" from November 2016 to October 2017. Users posting the tweets, tweet content, and linked websites were categorized. RESULTS:Six hundred and five tweets were identified. These were from 407 unique users (most commonly industry-related individuals [22.6%]; radiologists only 9.3%) and linked to 216 unique websites. 42.5% of users were from the United States. The tweets mentioned machine/deep learning in 17.2%, industry in 14.0%, a medical society/conference in 13.4%, and a university in 9.8%. 6.3% mentioned a specific clinical application, most commonly oncology and lung/tuberculosis. 24.6% of tweets had a favorable stance regarding the impact of AI on radiology, 75.4% neutral, and none were unfavorable. 88.0% of linked websites leaned toward AI being positive for the field of radiology; none leaned toward AI being negative for the field. 51.9% of linked websites specifically mentioned improved efficiency for radiology with AI. 35.2% of websites described challenges for implementing AI in radiology. Of the 47.2% of websites that mentioned the issue of AI replacing radiologists, 77.5% leaned against AI replacing radiologists, 13.7% had a neutral view, and 8.8% leaned toward AI replacing radiologists. CONCLUSION/CONCLUSIONS:These observations provide an overview of the social media discussions regarding AI in radiology. While noting challenges, the discussions were overwhelmingly positive toward the transformative impact of AI on radiology and leaned against AI replacing radiologists. Greater radiologist engagement in this online social media dialog is encouraged.

PURPOSE/OBJECTIVE:To evaluate transgender patient care, gender inclusivity, and transgender health-related policies at breast imaging facilities across the United States. METHODS:A survey on breast imaging facilities' policies and practices regarding transgender care was distributed to the membership of the Society of Breast Imaging, consisting of approximately 2,500 breast radiologists across the United States. The survey was conducted by e-mail in January 2018. RESULTS:There were 144 survey respondents. Responses showed that 78.5% of facilities have gender-neutral patient bathrooms, 9.0% have a separate waiting area for transgender patients, and 76.4% do not have dominant pink hues in their facilities, although 54.2% have displays with female gender content. Also, 58.0% of intake forms do not ask patients to provide their gender identity, although 25.9% automatically populate with female phrases. Within the electronic health record, 32.9% lack a distinct place to record patients' preferred names and 54.9% lack a distinct place to record patients' gender pronouns. The majority (73.4%) do not have explicit policies related to the care of transgender patients. Only 14.7% of facilities offer lesbian, gay, bisexual, and transgender training. CONCLUSION/CONCLUSIONS:Our national survey demonstrates that many breast imaging facilities do not have structures in place to consistently use patients' preferred names and pronouns, nor provide inclusive environments for transgender patients. All breast imaging facilities should recognize the ways in which their practices may intensify discrimination, exclusivity, and stigma for transgender patients and should seek to improve their transgender health competencies and foster more inclusive environments.