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Incorporation of a Social Virtual Reality Platform into the Residency Recruitment Season

Guichet, Phillip L; Huang, Jeffrey; Zhan, Chenyang; Millet, Alexandra; Kulkarni, Kopal; Chhor, Chloe; Mercado, Cecilia; Fefferman, Nancy
RATIONALE AND OBJECTIVES/OBJECTIVE:The Covid-19 pandemic ushered a sudden need for residency programs to develop innovative socially distant and remote approaches to effectively promote their program. Here we describe our experience using the social virtual reality (VR) platform Mozilla Hubs for the pre-interview social during the 2020-2021 radiology residency virtual recruitment season, provide results of a survey sent to assess applicants' attitudes towards the VR pre-interview social, and outline additional use-cases for the emerging technology. MATERIALS AND METHODS/METHODS:A VR Meeting Hall dedicated to the pre-interview social was designed in Mozilla Hubs. To assess applicants' impressions of the Mozilla Hubs pre-interview social, applicants were sent an optional web-based survey. Survey respondents were asked to respond to a series of eleven statements using a five-point Likert scale of perceived agreement: Strongly Agree, Agree, Neutral, Disagree, Strongly Disagree. Statements were designed to gauge applicants' attitudes towards the Mozilla Hubs pre-interview social and its usefulness in helping them learn about the residency program, particularly in comparison with pre-interview socials held on conventional video conferencing software (CVCS). RESULTS:Of the 120 residency applicants invited to the Mozilla Hubs pre-interview social, 111 (93%) attended. Of these, 68 (61%) participated in the anonymous survey. Most applicants reported a better overall experience with Mozilla Hubs compared to CVCS (47/68, 69%), with 10% (7/68) reporting a worse overall experience, and 21% (14/68) neutral. Most applicants reported the Mozilla Hubs pre-interview social allowed them to better assess residency culture than did pre-interview socials using CVCS (41/68, 60%). Seventy-two percent of applicants reported that the Mozilla Hubs pre-interview social positively impacted their decision to strongly consider the residency program (49/68). CONCLUSION/CONCLUSIONS:Radiology residency applicants overall preferred a pre-interview social hosted on a social VR platform, Mozilla Hubs, compared to those hosted on CVCS. Applicants reported the use of a social VR platform reflected positively on the residency and positively impacted their decision to strongly consider the program.
PMID: 34217613
ISSN: 1878-4046
CID: 4965632

Screening Breast MRI Primer: Indications, Current Protocols, and Emerging Techniques

Samreen, Naziya; Mercado, Cecilia; Heacock, Laura; Chacko, Celin; Partridge, Savannah C.; Chhor, Chloe
Breast dynamic contrast-enhanced MRI (DCE-MRI) is the most sensitive imaging modality for the detection of breast cancer. Screening MRI is currently performed predominantly in patients at high risk for breast cancer, but it could be of benefit in patients at intermediate risk for breast cancer and patients with dense breasts. Decreasing scan time and image interpretation time could increase cost-effectiveness, making screening MRI accessible to a larger group of patients. Abbreviated breast MRI (Ab-MRI) reduces scan time by decreasing the number of sequences obtained, but as multiple delayed contrast enhanced sequences are not obtained, no kinetic information is available. Ultrafast techniques rapidly acquire multiple sequences during the first minute of gadolinium contrast injection and provide information about both lesion morphology and vascular kinetics. Diffusion-weighted imaging is a noncontrast MRI technique with the potential to detect mammographically occult cancers. This review article aims to discuss the current indications of breast MRI as a screening tool, examine the standard breast DCE-MRI technique, and explore alternate screening MRI protocols, including Ab-MRI, ultrafast MRI, and noncontrast diffusion-weighted MRI, which can decrease scan time and interpretation time.
ISSN: 2631-6110
CID: 4922592

OK Boomer: Are We Oversupporting Junior Faculty and Neglecting Career Planning for Mid and Senior Rank?

Catanzano, Tara; Robbins, Jessica; Slanetz, Priscilla; Mercado, Cecilia; Chhor, Chloe; Connolly, Mark; Bhargava, Puneet; Canon, Cheri
PMID: 33413905
ISSN: 1558-349x
CID: 4752412

Preserving Radiology Resident Education During the COVID-19 Pandemic: The Simulated Daily Readout

Recht, Michael P; Fefferman, Nancy R; Bittman, Mark E; Dane, Bari; Fritz, Jan; Hoffmann, Jason C; Hood, Joseph; Mercado, Cecilia L; Mahajan, Sonia; Sheth, Monica M
RATIONALE AND OBJECTIVES/OBJECTIVE:The educational value of the daily resident readout, a vital component of resident training, has been markedly diminished due to a significant decrease in imaging volume and case mix diversity. The goal of this study was to create a "simulated" daily readout (SDR) to restore the educational value of the daily readout. MATERIALS AND METHODS/METHODS:To create the SDR the following tasks were performed; selection of cases for a daily worklist for each resident rotation, comprising a combination of normal and abnormal cases; determination of the correct number of cases and the appropriate mix of imaging modalities for each worklist; development of an "educational" environment consisting of separate "instances" of both our Picture Archive Communication System and reporting systems; and the anonymization of all of the cases on the worklists. Surveys of both residents and faculty involved in the SDR were performed to assess its effectiveness. RESULTS:Thirty-two residents participated in the SDR. The daily worklists for the first 20 days of the SDR included 3682 cases. An average of 480 cases per day was dictated by the residents. Surveys of the residents and the faculty involved in the SDR demonstrated that both agreed that the SDR effectively mimics a resident's daily work on rotations and preserves resident education during the Coronavirus Disease 2019 crisis. CONCLUSION/CONCLUSIONS:The development of the SDR provided an effective method of preserving the educational value of the daily readout experience of radiology residents, despite severe decreases in imaging exam volume and case mix diversity during the Coronavirus Disease 2019 pandemic.
PMID: 32553278
ISSN: 1878-4046
CID: 4484992

The veterans administration diabetes risk cohort: profile and diabetes incidence [Meeting Abstract]

Kanchi, R; Thorpe, L; Lopez, P M; Elbel, B; Mercado, C; Siegel, K R; Avramovic, S; Alemi, F; Schwartz, M D
Background: The Veterans Administration (VA) cares for over 8 million U.S. veterans annually, approximately 20% of whom have prevalent diabetes. To foster research and intervention opportunities, we developed the VA Diabetes Risk (VADR) Cohort using the VA electronic health record, a national cohort of diabetes-free U.S. veterans receiving primary care at the VA since January 1, 2008. This cohort provides important opportunities to study community-level risk factors for diabetes, such as attributes of the food environment, via geospatial linkage to residence information. We describe here the cohort profile and diabetes incidence by sub-group.
Method(s): To be eligible, diabetes-free patients had to have at least 2 primary care visits at least 30 days apart prior to enrollment. Diabetes incidence was defined as having >=2 inpatient or outpatient encounters with diabetes ICD-9/10 codes, any prescription of diabetes medicine, or one encounter with diabetes ICD-9/10 codes and >=2 hemoglobin A1C >=6.5%. The incidence of diabetes was calculated as the number of new cases diagnosed per 1000 person-years (PY) through December 31, 2018. Demographic and comorbidities data were abstracted using diagnostic codes, labs, prescriptions, and vital signs.
Result(s): The VADR cohort consisted of 6.17 million veterans, the majority of whom were male (91.7%) and non- Hispanic (NH) white (75.7%). Nearly half were above 60 years of age at enrollment (48.8%). The diabetes incidence rate was 27.0 per 1000 PY, increasing with age from 13.3 per 1000 PY among adults <45 years old to 41.8 per 1000 PY among those 65 years and older. Incidence was higher among men than women (34.6 vs. 18.6 per 1000 PY) and higher among NH black patients compared to NH white patients (38 vs. 31.7 per 1000 PY).
Conclusion(s): The VADR cohort provides a novel infrastructure for examination of community-level risk factors for diabetes among veterans, and facilitates assessment of the impact of national or regional strategies to prevent or manage diabetes in veterans
ISSN: 1939-327x
CID: 4674822

Assessing the impact of an orientation week on acclimation to radiology residency

Prabhu, Vinay; Rispoli, Joanne M; Chhor, Chloe M; Mercado, Cecilia L; Fefferman, Nancy R
PURPOSE/OBJECTIVE:Acclimating residents to radiology residency requires attention to new responsibilities, educational material, and social cohesion. To this end, we instituted a structured orientation week for incoming residents and assessed its impact. PROCEDURES/METHODS:During the first weeks of July 2016 and 2017, first year residents attended a five day orientation free of clinical duties, consisting of didactics, hands-on training sessions, and social events. After two orientation cohorts, residents who completed orientation week, and two cohorts who had not, were given a voluntary, anonymous survey using Likert scale questions (1 [worst] to 5 [best]) regarding preparedness for responsibilities, learning, and social cohesion. Residents were asked which components were or would have been helpful. Independent samples t-tests were performed to evaluate differences between the two groups (two-tailed p < 0.05). FINDINGS/RESULTS:21/37 (57%) residents participated. Higher percentages of residents who participated in the orientation week gave scores ≥4 when asked about preparedness for rotations (70% vs. 36%), learning new material (80% vs. 36%), and class cohesiveness (90% vs. 70%). Mean scores on these questions were also higher for these residents with regards to: preparedness for new responsibilities (3.7 vs. 2.9), learning new material (3.8 vs. 2.9), and class cohesiveness (4.5 vs. 3.8), with differences approaching significance (p = 0.09-0.15). Individual components receiving most votes of ≥4 were social outings, resident lunches, didactic lectures, and PACS training. CONCLUSION/CONCLUSIONS:A weeklong orientation program free of clinical duties was valued by residents and contributed to acclimation to new responsibilities, education, and social cohesion.
PMID: 32387799
ISSN: 1873-4499
CID: 4430812

Atypical Ductal Hyperplasia and Lobular Neoplasia: Update and Easing of Guidelines

Lewin, Alana A; Mercado, Cecilia L
OBJECTIVE. Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS) are among high-risk lesions that have been previously recommended for surgical excision when diagnosed on core needle biopsy. Recent studies have examined whether imaging surveillance is a reasonable alternative to surgical management for these lesions. This article synthesizes the evidence regarding management of atypical hyperplasia and LCIS diagnosed on core needle biopsy and clinical implications of these diagnoses on future breast cancer risk as well as highlights areas of further research needed to improve practice guidelines for these high-risk lesions. CONCLUSION. Although surgical excision is still recommended after diagnosis of ADH on core needle biopsy, in specific circumstances ALH and LCIS can safely be managed by imaging surveillance.
PMID: 31825261
ISSN: 1546-3141
CID: 4238852

Missing targets after nipple-sparing mastectomy: A multi-disciplinary approach to avoid an undesirable outcome

Zeng, Jennifer; Mercado, Cecilia; Axelrod, Deborah; Guth, Amber; Darvishian, Farbod
PMID: 29315983
ISSN: 1524-4741
CID: 2906462

Frequency and outcomes of biopsy-proven fibroadenomas recommended for surgical excision

Lee, Shimwoo; Mercado, Cecilia L; Cangiarella, Joan F; Chhor, Chloe M
Our aim was to investigate the outcomes of fibroadenomas recommended for surgical excision due to large size (>2cm) or interval growth. A retrospective review of our institutional radiology database from 2007 to 2015 was performed. We identified 167 biopsy-proven fibroadenomas recommended for surgical consultation. Of these, 75 (45%) cases actually underwent excision, 7 (9%, 95% CI: 4-18%) of which were upgraded to phyllodes tumors upon histopathological examination. Our results support the current recommendation to surgically excise breast lesions diagnosed as fibroadenomas with size >2cm or with interval growth due to the considerable risk of finding phyllodes tumors.
PMID: 29258029
ISSN: 1873-4499
CID: 2885852

Ductal Carcinoma In Situ: The Whole Truth

Parikh, Ujas; Chhor, Chloe M; Mercado, Cecilia L
OBJECTIVE: Ductal carcinoma in situ (DCIS) is a noninvasive malignant breast disease traditionally described as a precursor lesion to invasive breast cancer. With screening mammography, DCIS now accounts for approximately 20% of newly diagnosed cancer cases. DCIS is not well understood because of its heterogeneous nature. CONCLUSION: Studies have aimed to assess prognostic factors to characterize its risk of invasive potential; however, there still remains a lack of uniformity in workup and treatment. We summarize current knowledge of DCIS and the ongoing controversies.
PMID: 29045181
ISSN: 1546-3141
CID: 2743092