Electronic alerts to improve management of heparin-induced thrombocytopenia.

Background: Heparin-induced thrombocytopenia (HIT) is a difficult clinicopathologic diagnosis to make and to treat. Delays in identification and appropriate treatment can lead to increased morbidity and mortality. Objectives: To use electronic health alert interventions to improve provider diagnosis and management of heparin-induced thrombocytopenia through guideline-based, accurate care delivery. Methods: This quality improvement initiative developed 3 electronic health record-based interventions at our 750-bed academic medical center to improve the initial management of suspected HIT between 2018 and 2021: 1. an interruptive alert to recommend discontinuation of active heparin products when signing a heparin-platelet factor 4 test (PF4) order, 2. integrated 4T score calculation in the heparin-PF4 test order, and 3. interruptive alert suggesting not to order heparin-PF4 tests when the 4T score is <4. Changes in practice were assessed over defined time periods pre and post each intervention. Results: Intervention 1 resulted in heparin discontinuation in more patients, with 65% (191 heparin orders/293 heparin-PF4 enzyme-linked immunosorbent assay tests) of cases continuing heparin prealert and only 54% (127 heparin orders/235 heparin-PF4 enzyme-linked immunosorbent assay tests) postinterruptive alert (95% CI 2.3-19.9; P = .015). Intervention 2 increased appropriate heparin-PF4 test ordering from 40.4% (110/272) preintervention to 79.1% (246/311) (95% CI 30.9-46.4; P < .00001) postintervention, with inappropriate PF4 ordering defined as testing when 4T score was <4. Intervention 3 did not lead to reduction in heparin-PF4 testing in the control group (96 inappropriate orders/402 total orders, 24%) compared to the randomized alert group (56 inappropriate orders/298 total orders; 19%) (95% CI -1.2 to 11.5; P = .13). Conclusion: Implementation of unique electronic health record interventions, including both diagnostic and management interventions, led to improved guideline-based, accurate care delivery with 4T score calculation and cessation of heparin for patients with suspected HIT.

Faecal immunochemical tests can improve colonoscopy triage in patients with iron deficiency: A systematic review and meta-analysis.

BACKGROUND: Use of the faecal immunochemical test (FIT) to triage patients with iron deficiency (ID) for colonoscopy due to suspected colorectal cancer (CRC) may improve distribution of colonoscopic resources. We reviewed the diagnostic performance of FIT for detecting advanced colorectal neoplasia, including CRC and advanced pre-cancerous neoplasia (APCN), in patients with ID, with or without anaemia. METHODS: We performed a systematic review of three databases for studies comprising of patients with ID, with or without anaemia, completing a quantitative FIT within six months prior to colonoscopy, where test performance was compared against the reference standard colonoscopy. Random effects meta-analyses determined the diagnostic performance of FIT for advanced colorectal neoplasia. RESULTS: Nine studies were included on a total of n=1761 patients with ID, reporting FIT positivity thresholds between 4-150 µg haemoglobin/g faeces. Only one study included a non-anaemic ID (NAID) cohort. FIT detected CRC and APCN in ID patients with 90.7 % and 49.3 % sensitivity, and 81.0 % and 82.4 % specificity, respectively. FIT was 88.0 % sensitive and 83.4 % specific for CRC in patients with ID anaemia at a FIT positivity threshold of 10 µg haemoglobin/g faeces. CONCLUSIONS: FIT shows high sensitivity for advanced colorectal neoplasia and may be used to triage those with ID anaemia where colonoscopic resources are limited, enabling those at higher risk of CRC to be prioritised for colonoscopy. There is a need for further research investigating the diagnostic performance of FIT in NAID patients.

Reversal of direct oral anticoagulants: Guidance from the SSC of the ISTH: R1.

The currently approved direct oral anticoagulants (DOACs) are increasingly used in clinical practice. Although serious bleeding risks are lower with DOACs compared to vitamin K antagonists, bleeding remains the most frequent side effect. Andexanet-alfa and idarucizumab are the currently approved specific reversal agents for oral FXa inhibitors and dabigatran, respectively. Our prior guidance document was published in 2106, but with more information available on the utility and increased use of these reversal agents and other bleeding management strategies, we have updated this ISTH guidance document on DOAC reversal. In this narrative review, we compare the mechanism of action of specific and non-specific reversal agents, review the clinical data supporting their use, and provide guidance on when reversal is indicated. In addition, we briefly discuss the reversal of oral FXIa inhibitors, a new class of DOACs currently under clinical development.

Are clinics not affiliated with a Menopause Society Certified Practitioner more likely to offer guideline-nonconcordant treatment compared to clinics affiliated with a Menopause Society Certified Practitioner?

OBJECTIVE: To identify clinics in Ohio, Michigan, and Pennsylvania that advertise menopause treatment on their website and evaluate whether clinics not affiliated with a Menopause Society Certified Practitioner (MSCP) are more likely to offer guideline-nonconcordant treatment compared to clinics affiliated with an MSCP. METHODS: We performed an Internet search to identify clinics advertising on their website menopause treatment in Ohio, Michigan, and Pennsylvania. We checked clinic personnel against The Menopause Society directory of practitioners to determine if the clinic was affiliated with an MSCP. RESULTS: We identified 174 clinics (41% in OH, 28% in PA, and 31% in MI). Thirteen percent of clinics were affiliated with an MSCP. Clinics with an MSCP are significantly less likely to advertise hormone testing (primary outcome; odds ratio [OR], 0.11; 95% confidence interval, 0.02-0.39), compounded hormone therapy (OR, 0.06; 95% confidence interval, 0.001-0.41), and bioidentical hormone therapy (OR, 0.07; 95% confidence interval, 0.001-0.26), compared to clinics without an MSCP-affiliated clinics that are also less likely to advertise that hormone therapy will help maintain youth or help with weight loss. CONCLUSIONS: Our pilot study has shown that in the states of Ohio, Michigan, and Pennsylvania, clinics with an MSCP were more likely to advertise on their website an adherence to The Menopause Society's guidelines and not advertise for compounded or bioidentical hormones, recommend hormone testing, or advertise hormones for a youthful appearance or weight loss.

Feasibility and preliminary effects of the Fit2ThriveMB pilot physical activity promotion intervention on physical activity and patient reported outcomes in individuals with metastatic breast cancer.

PURPOSE: Physical activity research among patients with metastatic breast cancer (MBC) is limited. This study examined the feasibility and potential benefits of Fit2ThriveMB, a tailored mHealth intervention. METHODS: Insufficiently active individuals with MBC (n = 49) were randomized 1:1 to Fit2ThriveMB (Fit2ThriveMB app, Fitbit, and weekly coaching calls) or Healthy Lifestyle attention control (Cancer.Net app and weekly calls) for 12 weeks. Fit2ThriveMB aimed to increase daily steps via an algorithm tailored to daily symptom rating and step goal attainment. The primary outcome was feasibility defined as ≥ 80% completion rate. Secondary feasibility metrics included meeting daily step goal and wearing the Fitbit ≥ 70% of study days, fidelity, adherence to intervention features and safety. Secondary outcomes included physical activity, sedentary time, patient reported outcomes (PROs), health-related quality of life (QOL) and social cognitive theory constructs. A subsample (n = 25) completed functional performance tests via video conferencing. RESULTS: The completion rate was 98% (n = 1 died). No related adverse events were reported. Fit2ThriveMB participants (n = 24) wore the Fitbit 92.7%, met their step goal 53.1%, set a step goal 84.6% and used the app 94.1% of 84 study days. Intent-to-treat analyses indicated trends toward improvements in activity, QOL, and some PROs, social cognitive theory constructs, and functional performance tests favoring the Fit2ThriveMB group. Significant effects favoring Fit2ThriveMB were observed for self-efficacy and goal-setting. However, some PROs and functional performance improvements favored the control group (p-values > 0.05). CONCLUSIONS: Fit2ThriveMB is feasible and safe for patients with MBC and warrants further evaluation in randomized controlled trials with larger sample sizes. Registration Clinicaltrials.gov NCT04129346, https://clinicaltrials.gov/ct2/show/NCT04129346.

Evaluation of knowledge and practices on antibiotic use: a cross-sectional study on self-reported adherence to short-term antibiotic utilization among patients visiting level-1 hospitals in Lusaka, Zambia.

Background: Antimicrobial resistance (AMR) is a global public health problem affecting healthcare systems. Short-term antibiotic non-adherence is thought to be one of the factors contributing to antibiotic resistance. This study aimed to evaluate knowledge and practices towards short-term antibiotic use on self-reported adherence among patients visiting level-1 hospitals in Lusaka, Zambia. Methods: This was a multicentre institutional-based cross-sectional study conducted among 385 adult participants from 11 September to 30 September 2023 using an adopted structured questionnaire. Analysis of the data involved descriptive and inferential statistics, where significance was determined at P < 0.05. Results: Of the 335 participants, 56.7% displayed good knowledge and 77.3% low adherence towards antibiotic use. 54.6% thought that antibiotics were effective for viral infections, and 43.9% correctly recognized the definition of AMR. Being in formal employment (crude OR: 2.5, CI: 1.08-5.78, P: 0.032) was significantly associated with a higher likelihood of good knowledge about antibiotics while being divorced (adjusted OR: 2.5, CI: 1.23-6.10, P: 0.013) and having good knowledge (adjusted OR: 2.9, CI: 1.73-5.10, P = 0.048) were significantly associated with a higher likelihood of adherence to antibiotics. Regarding antibiotic practices, half (50. 0%) of the respondents had utilized antibiotics in the previous year while 58.2% had taken antibiotics for addressing a common cold. Furthermore, 74% reported to have bought antibiotics without a prescription. Conclusions: This study found that participants attending level-1 hospitals had relatively good knowledge and poor adherence towards antibiotic use. Additionally, the participants demonstrated poor antibiotic use practices in almost all statements related to antibiotic usage.

The Montana Postural Care Project: A pilot study implementing posture care management in a rural, low-resource region.

Background: Mobility impairment limits control of posture and body alignment. This leads to altered body shapes, co-occurring problems with pain and sleep, cardiopulmonary concerns, digestive health issues, and emergent health outcomes, which further complicate functions of daily living. 24-hour posture care management was developed to remedy these challenges by restoring body symmetry. Objective: To determine the feasibility of introducing posture care management to a rural-based, medically complex patient population, evaluate response of body symmetry, and examine its impact on pain and sleep quality. Methods: This pilot study employed a longitudinal, quasi-experimental study design from March 2016 to September 2018. The posture care management intervention introduced positioning support for use when lying down, a personalized training workshop for caregiver teams, and in-home initial and follow-up assessments to provide materials and collaboratively develop a personalized care plan. Participants were followed pre-post for 6-9 months. Results: A total of 73 participants enrolled in the study; 55 (75 %) completed. The majority were male (55 %) with a median age of 11. Most caregivers were immediate family members, and most participants had 1+ diagnosis characterized as a neurodevelopmental disorder. A majority of participants improved body symmetry (56-76 %), and 53 % with comparable information saw improvement in body symmetry with no worsening of pain or sleep quality. Conclusion: This study established the feasibility of administering posture care management in North America. These findings provide preliminary evidence of improvements in body symmetry and address concerns that posture care management can interfere with pain and sleep. Future research should consider levels of caregiver engagement and explore remote-monitored options of a posture care management intervention.

Effect of the number of passes on diagnostic performance of EUS-fine needle biopsy of solid pancreatic masses: A systematic review and meta-analysis.

BACKGROUND AND AIMS: The optimal number of passes to maximize the diagnostic ability of endoscopic ultrasound fine needle biopsy (EUS-FNB) of solid pancreatic masses (SPMs) is not well known. We conducted a systematic review to evaluate the impact of the incremental number of passes on diagnostic accuracy, tissue adequacy, and diagnostic yield for EUS-FNB of SPMs. METHODS: We searched MEDLINE, EMBASE, Scopus, and Cochrane Central for randomized controlled trials (RCTs) comparing per-pass diagnostic outcomes of FNB needles in patients with SPMs. Meta-analysis was conducted using random effects models. A separate analysis was performed on studies that used contemporary Franseen and fork-tip needles. RESULTS: Overall, 19 RCTs (N=3,552) were identified. For EUS-FNB of SPMs, three passes with any FNB needle outperformed two passes for accuracy (OR=1.58; 95%CI 1.20-2.09; I2=0%), adequacy (OR=1.97; 95%CI 1.30-2.83; I2=61%) and yield (OR=2.12; 95%CI 1.37-3.27; I2 14%). Adding a fourth or fifth pass resulted in no significant improvement in diagnostic parameters. When using contemporary FNB needles, adding a second to a single pass significantly improved accuracy (OR=1.80; 95%CI 1.23-2.63; I2=0%), adequacy (OR=2.19; 95% CI 1.65-2.90; I2=0%) and yield (OR=2.72; 95%CI 1.50-4.95; I2=0%). Adding a third pass to a second pass with contemporary needles improved adequacy (OR=2.96; 95%CI 1.97-4.46; I2=0%) but did not provide better diagnostic accuracy or yield. CONCLUSION: Two passes with Franseen or Fork-tip needles and three passes with any FNB needle suffice to provide optimal diagnostic performance for EUS-FNB of SPMs, without additional diagnostic benefits with more passes. Our results can inform future guidelines and quality benchmarks.

Maternal Body Mass Index Associates with Prenatal Characteristics and Fecal Microbial Communities.

The maternal microbiome plays a vital role in shaping pregnancy outcomes, but there remains a substantial gap in understanding its precise relationships to maternal health, particularly in relation to potential effects of body mass index (BMI) on gut microbial diversity. The aim of this observational study was to assess maternal characteristics in association with pre-pregnancy BMI and to further assess microbial diversity in association with specific maternal characteristics. Eighty-four pregnant women were recruited during their third trimester of pregnancy from various prenatal clinics across the state of Michigan. The participants completed an enrollment questionnaire including self-reported pre-pregnancy BMI; stool samples were collected to assess the fecal microbial community composition. Pre-pregnancy obesity (BMI 30+) was associated (univariably) with antibiotic use before pregnancy, ever smoked, lower education level, and being unmarried. The gut microbiota alpha diversity was significantly different for pregnant women by pre-pregnancy BMI category (normal, overweight, obese). The beta diversity was unique for the gut microbiotas of pregnant women within each BMI category, by education level, and by marital status. Multivariable models revealed that pre-pregnancy BMI, maternal education, marital status, and maternal age were associated with the microbial diversity of the gut microbiota during pregnancy. These results give new insight into the relationship between a woman's microbiome during pregnancy and their prenatal health, along with an understanding of the relationships between socioeconomic factors and microbial diversity.

Women in Radiology: Challenges and Opportunities.

Improving the status of women in radiology is crucial to better work environments. There is strong evidence in the business world that women leaders improve the workplace by making it more financially viable and by increasing collaboration, job satisfaction, and engagement. Diverse leadership fosters innovation, and women approach problem-solving with unique insights and collaborative styles. Gender diversity in leadership correlates with improved patient outcomes because women leaders prioritize patient-centered care and communication. Women create sustainable, productive work and improve radiology. Women serve as powerful role models, inspiring the next generation of women in radiology and addressing gender disparities. Increasing women leaders in radiology is essential to increase the number of women in radiology. This article summarizes many challenges women face when taking leadership roles: organizational biases prioritizing male viewpoints and marginalizing women's voices and contributions, a lack of role models, a lack of time ("second shift"), a lack of confidence, a lack of interest or perceived benefit, a lack of support, burnout, and previous poor experiences. While systemic issues are difficult to overcome, this article assists in the training and development of women radiologists by offering strategies to enhance job satisfaction and bring new and valuable perspectives to leadership.

Inflammasomes: emerging therapeutic targets in hidradenitis suppurativa?

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterised by recurrent inflammatory lesions, which affect skin and hair follicles in intertriginous areas. HS has a multifactorial aetiology resulting in barrier dysfunction associated with aberrant immune activation. There is increased evidence for the role of inflammasomes in the pathophysiology of inflammatory skin diseases, including HS. Inflammasomes are multiprotein complexes activated following exposure to danger signals including microbial ligands and components of damaged host cells. Inflammasome activation induces many signalling cascades and subsequent cleavage of pro-inflammatory cytokines, most notably interleukin (IL)-1ß, which have a role in HS pathogenesis. Limited immunotherapies are approved for treating moderate-to-severe HS, with variable response rates influenced by disease heterogeneity. Inflammasomes represent attractive targets to suppress multiple inflammatory pathways in HS including IL-1ß and IL-17. This review aims to summarise the role of inflammasomes in HS and to evaluate evidence for inflammasomes as therapeutic targets for HS treatment.

Clinical outcome assessments of disease burden and progression in late-onset GM2 gangliosidoses.

The late-onset GM2 gangliosidoses, comprising late-onset Tay-Sachs and Sandhoff diseases, are rare, slowly progressive, neurogenetic disorders primarily characterized by neurogenic weakness, ataxia, and dysarthria. The aim of this longitudinal study was to characterize the natural history of late-onset GM2 gangliosidoses using a number of clinical outcome assessments to measure different aspects of disease burden and progression over time, including neurological, functional, and quality of life, to inform the design of future clinical interventional trials. Patients attending the United States National Tay-Sachs & Allied Diseases Family Conference between 2015 and 2019 underwent annual clinical outcome assessments. Currently, there are no clinical outcome assessments validated to assess late-onset GM2 gangliosidoses; therefore, instruments used or designed for diseases with similar features, or to address various aspects of the clinical presentations, were used. Clinical outcome assessments included the Friedreich's Ataxia Rating Scale, the 9-Hole Peg Test, and the Assessment of Intelligibility of Dysarthric Speech. Twenty-three patients participated in at least one meeting visit (late-onset Tay-Sachs, n = 19; late-onset Sandhoff, n = 4). Patients had high disease burden at baseline, and scores for the different clinical outcome assessments were generally lower than would be expected for the general population. Longitudinal analyses showed slow, but statistically significant, neurological progression as evidenced by worsening scores on the 9-Hole Peg Test (2.68%/year, 95% CI: 0.13-5.29; p = 0.04) and the Friedreich's Ataxia Rating Scale neurological examination (1.31 points/year, 95% CI: 0.26-2.35; p = 0.02). Time since diagnosis to study entry correlated with worsening scores on the 9-Hole Peg Test (r = 0.728; p < 0.001), Friedreich's Ataxia Rating Scale neurological examination (r = 0.727; p < 0.001), and Assessment of Intelligibility of Dysarthric Speech intelligibility (r = -0.654; p = 0.001). In summary, patients with late-onset GM2 gangliosidoses had high disease burden and slow disease progression. Several clinical outcome assessments suitable for clinical trials showed only small changes and standardized effect sizes (change/standard deviation of change) over 4 years. These longitudinal natural history study results illustrate the challenge of identifying responsive endpoints for clinical trials in rare, slowly progressive, neurogenerative disorders where arguably the treatment goal is to halt or decrease the rate of decline rather than improve clinical status. Furthermore, powering such a study would require a large sample size and/or a long study duration, neither of which is an attractive option for an ultra-rare disease with no available treatment. These findings support the development of potentially more sensitive late-onset GM2 gangliosidoses-specific rating instruments and/or surrogate endpoints for use in future clinical trials.

Portal Vein Doppler Is a Sensitive Marker for Evaluating Venous Congestion in End-Stage Kidney Disease.

INTRODUCTION: Determining ultrafiltration volume in patients undergoing intermittent hemodialysis (IHD) is an essential component in the assessment and management of volume status. Venous excess ultrasound (VExUS) is a novel tool used to quantify the severity of venous congestion at the bedside. Given the high prevalence of pulmonary hypertension in patients with end-stage kidney disease (ESKD), venous Doppler could represent a useful tool to monitor decongestion in these patients. METHODS: This is a prospective observational study conducted in ESKD patients who were admitted to the hospital requiring IHD and ultrafiltration. Inferior vena cava maximum diameter (IVCd), portal vein Doppler (PVD), and hepatic vein Doppler (HVD) were performed in all patients before and after a single IHD session. RESULTS: Forty-one patients were included. The prevalence of venous congestion was 88% based on IVCd and 63% based on portal vein pulsatility fraction (PVPF). Both mean IVCd and PVPF displayed a significant improvement after ultrafiltration. The percent decrease in PVPF was significantly larger than the percent decrease in IVCd. HVD alterations did not significantly improve after ultrafiltration. CONCLUSIONS: Our study revealed a high prevalence of venous congestion in hospitalized ESKD patients undergoing hemodialysis. After a single IHD session, there was a significant improvement in both IVCd and PVPF. HVD showed no significant improvement with one IHD session. PVPF changes were more sensitive than IVCd changes during volume removal. This study suggests that, due to its rapid response to volume removal, PVD, among the various components of the VExUS grading system, could be more effective in monitoring real-time decongestion in patients undergoing IHD.

Acquired von Willebrand syndrome during extracorporeal membrane oxygenation support: a comprehensive review of current evidence: communication from the ISTH SSC on perioperative and critical care thrombosis and hemostasis.

During extracorporeal membrane oxygenation (ECMO) support, the high shear stress in the ECMO circuit results in increased proteolysis of von Willebrand factor (VWF), loss of VWF high-molecular-weight multimers, and impaired ability to bind to platelets and collagen. These structural changes in VWF are consistent with acquired von Willebrand syndrome (AVWS) type 2A and may contribute to the bleeding diathesis frequently observed in ECMO patients. We performed a systematic review of all clinical studies evaluating the prevalence and associated outcomes of AVWS in ECMO patients. Our findings suggest that almost all ECMO patients develop partial or complete loss of VWF high-molecular-weight multimers within a few hours of device implantation. The AVWS persists as long as the patient is supported by ECMO. Weaning from ECMO rapidly and completely resolves the AVWS. Nevertheless, few studies have reported bleeding outcomes in ECMO patients with AVWS, and the extent to which AVWS contributes to the bleeding diathesis during ECMO support cannot be determined by current evidence. Data supporting the use of VWF concentrates to prevent bleeding complications in ECMO patients remain limited.

Yttrium immobilization through biomineralization with phosphate by the resistant strain Mesorhizobium qingshengii J19.

AIMS: Yttrium (Y) holds significant industrial and economic importance, being listed as a critical element on the European list of critical elements, thus emphasizing the high priority for its recovery. Bacterial strategies play a crucial role in the biorecovery of metals, offering a promising and environmentally friendly approach. Therefore, gaining a comprehensive understanding of the underlying mechanisms behind bacterial resistance, as well as the processes of bioaccumulation and biotransformation, is of paramount importance. METHODS AND RESULTS: A total of 207 Alphaproteobacteria strains from the University of Coimbra Bacteria Culture Collection were tested for Y-resistance. Among these, strain Mesorhizobium qingshengii J19 exhibited high resistance (up to 4 mM Y) and remarkable Y accumulation capacity, particularly in the cell membrane. Electron microscopy revealed Y-phosphate interactions, while X-ray diffraction identified Y(PO3)3·9H2O biocrystals produced by J19 cells. CONCLUSION: This study elucidates Y immobilization through biomineralization within phosphate biocrystals using M. qingshengii J19 cells.

The genomic and cellular basis of biosynthetic innovation in rove beetles.

How evolution at the cellular level potentiates macroevolutionary change is central to understanding biological diversification. The >66,000 rove beetle species (Staphylinidae) form the largest metazoan family. Combining genomic and cell type transcriptomic insights spanning the largest clade, Aleocharinae, we retrace evolution of two cell types comprising a defensive gland-a putative catalyst behind staphylinid megadiversity. We identify molecular evolutionary steps leading to benzoquinone production by one cell type via a mechanism convergent with plant toxin release systems, and synthesis by the second cell type of a solvent that weaponizes the total secretion. This cooperative system has been conserved since the Early Cretaceous as Aleocharinae radiated into tens of thousands of lineages. Reprogramming each cell type yielded biochemical novelties enabling ecological specialization-most dramatically in symbionts that infiltrate social insect colonies via host-manipulating secretions. Our findings uncover cell type evolutionary processes underlying the origin and evolvability of a beetle chemical innovation.

Prompt-gamma track-length estimator with time tagging from proton tracking.

The design of prompt-gamma detectors necessitates numerous Monte Carlo simulations to precisely develop and optimize the detection stages in proton therapy. Alongside the advancement of MC simulations, various variance reduction methods have been explored to speed-up calculations. Among these techniques, track-length estimators are interesting scoring methods for achieving both speed and accuracy in Monte Carlo simulations of rare events. This paper introduces an extension of the GATE vpgTLE module that incorporates the prompt-gamma emission time, which is tagged from the proton tracking, enhancing its utility for studies focused on detector design and optimization that rely on time measurements. The results obtained from a clinical radiotherapy plan are presented. We demonstrate that the new vpgTLE tally with time tagging is accurate, except for certain prompt-gamma lines corresponding to long mean-life nuclei.

Auditing Abbreviated Breast MR Imaging: Clinical Considerations and Implications.

Abbreviated breast MR (AB-MR) imaging is a relatively new breast imaging tool, which maintains diagnostic accuracy while reducing image times compared with full-protocol breast MR (FP-MR) imaging. Breast imaging audits involve calculating individual and organizational metrics, which can be compared with established benchmarks, providing a standard against which performance can be measured. Unlike FP-MR imaging, there are no established benchmarks for AB-MR imaging but studies demonstrate comparable performance for cancer detection rate, positive predictive value 3, sensitivity, and specificity with T2. We review the basics of performing an audit, including strategies to implement if benchmarks are not being met.