Breast Cancer in Older Adults.

Breast cancer primarily is a disease of older women, yet most clinical trials and reports have failed to include older patients. As a result, there has been little evidence on which to base care decisions, including screening mammography recommendations. A decade after changes in screening recommendations for older women, research now is beginning to emerge. This article outlines evidence to increase clinicians' understanding of how breast cancer presents and progresses in older women and how to support personalized decision-making regarding screening and management.

Dose Reduction Techniques in Pediatric Computed Tomography.

Reducing dose while maintaining diagnostic image quality is an essential and complex aspect of computed tomography (CT). In particular, children are more sensitive to the effects of ionizing radiation, and all imaging professionals involved in pediatric CT examinations must optimize dose and image quality for individual examinations. The CT community must continue to improve dose levels and variance from these examinations with attention to protocols and techniques and the use of advanced technology. This article examines the effects of CT radiation on pediatric patients and standard and new methods for optimizing dose and image quality in pediatric CT examinations.

Interventional Breast Imaging.

The importance of medical imaging in breast care is established and the role of breast imaging evolving. Imaging also plays a vital role in the performance of interventional procedures such as biopsies. This article summarizes breast imaging modalities and the use of imaging in interventional procedure guidance and breast cancer detection, evaluation, and management.

Patient-Centered Care in Breast Imaging.

Patient-centered care is an approach to health care delivery emphasizing engagement with patients and families, cultural competence, communication, and shared decision-making. When planned and implemented thoughtfully, patient-centered care leads to a slow and deliberate culture change in an organization or department. Transitioning to patient-centered care in breast imaging presents unique challenges but evolving opportunities to improve patient satisfaction.

Radiation Dose in Breast Imaging.

Screening mammography introduces low doses of radiation per examination and in regular intervals over decades for women who have annual screening. Further, advanced breast imaging modalities and follow-up imaging methods contribute to additional radiation exposure in radiosensitive breast tissue. This article reviews the effects of radiation on the breasts, summarizes dose measurements and estimates for breast imaging modalities, and discusses efforts to optimize dose in breast imaging.

Neuroimaging of Sports Concussions.

Concussions resulting from sports activities have received attention in recent years, and failure to prevent head injury has undergone scrutiny. Although many factors contribute to sports concussion incidence, determining when an athlete can return to play is crucial to minimizing long-term effects of concussion. To date, neuroimaging plays a limited role in concussion evaluation, but conventional and advanced neuroimaging techniques are contributing to the body of research on their future use in evaluation.

Precision Medicine in Breast Cancer.

Breast cancer care has improved markedly in recent decades, but new advancements in diagnosis and treatment depend on translating genomics and precision medicine into clinical care. This article discusses the basics of genomics, breast cancer biomarkers and subtypes, and the effects of genomic advancements on future breast cancer diagnosis, treatment, and survival. The article also presents challenges related to introducing precision medicine into cancer care and the role of imaging in breast cancer diagnosis and treatment in precision medicine.

Computed Tomography of Thoracolumbar Spine Trauma.

Thoracolumbar spine trauma typically occurs when high-energy forces damage bony and ligamentous spinal structures and, in severe cases, the spinal cord. These injuries often cause considerable neurological deficits as a result of the damage. Computed tomography (CT) is the imaging method of choice for determining injury severity in most victims of multiple trauma. In addition to describing various types of thoracolumbar trauma, this article discusses the role of CT in emergency diagnosis and management of thoracolumbar injuries.

Breast Cancer Screening Benefits: Research and Controversies.

The debate regarding the efficacy of breast cancer screening with mammography has intensified since about 2009, as the literature has reported on benefits, harms, and effectiveness of the technology in breast cancer diagnosis. As a result, women and their referring clinicians have been confused by conflicting reports in medical journals and the media. This article provides an overview of research and methodology used to generate these reports and the effects of contradictory research, screening recommendation changes, and the controversy over mammography efficacy on patients and the public.

Digital Breast Imaging Workflow.

Most breast imaging programs have replaced film-screen mammography systems with digital mammography. Other breast imaging methods, such as digital breast tomosynthesis, complement the tools available for screening and diagnosis of breast cancer. This article examines digital mammography, other digital breast imaging modalities, and the effects of these technologies on practice, quality, efficiency, and the technologist's role in patient care.

Breast Imaging Artifacts.

Artifacts appear on breast images for a number of reasons. Radiologic technologists play an important role in identifying artifacts that can help or hinder breast cancer diagnosis and in minimizing artifacts that degrade image quality. This article describes various artifacts that occur in breast imaging, along with their causes. The article focuses on artifacts in mammography, with a heavy emphasis on digital mammography, and on magnetic resonance imaging of the breast. Artifacts in ultrasonography of the breast, digital breast tomosynthesis, and positron emission mammography also are discussed.

Breast disease in children and adolescents.

Breast abnormalities and disease are rare in the young developing breast. Malignancy is even more uncommon. Yet evaluation and management of breast disease in infants, children, and adolescents requires a conservative approach to preserve developing structures and cosmetic appearance. Diagnosing breast disease in young patients can be made more difficult by developing breast anatomy, which is denser than adult breasts. In addition, ordering physicians, radiologists, and radiologic technologists must carefully consider the use of ionizing radiation in the diagnosis and management of pediatric breast disease.

Adverse effects of breast cancer treatment.

As breast cancer outcomes improve and more people with breast cancer survive longer following diagnosis, many survivors must deal with the effects of treatment. Some adverse effects last a short time and have little influence on breast cancer patients' quality of life, yet others can cause long-term complications and add to increased morbidity and mortality among survivors. This article reviews the adverse effects of breast cancer treatments and how they affect the health and quality of life of those receiving treatment. The article also explains how adverse effects can interrupt treatment and how physicians and survivors can manage adverse effects of breast cancer treatment.

Women and heart disease.

Heart disease is known more as a killer of men than women, but U.S. women have surpassed men in prevalence of and mortality from cardiovascular diseases. Although recent years have witnessed an upswing in education, awareness, and clinical research focused on heart disease in women, much work remains to reach a sufficient understanding of the differences in risk, presentation, and management of heart disease between the sexes to improve outcomes for women. Medical imaging has enhanced diagnosis and management of heart disease in women, especially by enabling less invasive approaches.

Breast cancer: age-related factors.

The literature on breast cancer inevitably includes age as a risk factor for the disease, and there is considerable controversy regarding the best age for women to start screening mammography. A woman's breast develops and changes over the course of her lifetime, and at various times is more or less susceptible to cancer. Developmental differences also affect breast imaging. This article focuses on the age groups outside the majority of women who receive breast cancer diagnoses, instead emphasizing effects of age on the very youngest and oldest women.

Managing transition to a hybrid operating room.

Managers of interventional radiology departments and medical imaging personnel who work in surgical suites deal with regular technical innovations in their work, but large-scale innovations seldom come along that transform markets and require massive architectural, training, and technological changes. The hybrid interventional/operating suite is one such massive change. This article presents an overview of the transition to hybrid procedures and designs, the benefits and challenges of the new delivery method, and change management issues for managers of cardiovascular and vascular interventional departments.

Breast cancer survivorship and surveillance.

Mammography and other imaging modalities help diagnose initial breast cancers in nearly 200 000 women per year in the United States. Advances in these methods and in breast cancer treatment mean that more people with a personal history of breast cancer are living longer, and these survivors face ongoing risk of breast cancer recurrence, distant metastasis, and death. Survivors also need regular follow-up and surveillance or diagnostic imaging to detect these recurrences early. This article focuses on breast cancer survivors, their follow-up, and surveillance imaging.