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Grimm, Lars Johannes L

Positions:

Assistant Professor of Radiology

Radiology, Breast Imaging
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2009

M.D. — Yale University School of Medicine

Grants:

Molecular and Radiologic Predictors of Invasion in a DCIS Active Surveillance Cohort

Administered By
Surgery, Advanced Oncologic and Gastrointestinal Surgery
AwardedBy
Breast Cancer Research Foundation
Role
Collaborator
Start Date
October 01, 2016
End Date
September 30, 2017

Development of a personalized evidence-based algorithm for the management of suspicious calcifications

Administered By
Radiology, Breast Imaging
AwardedBy
Ge-Aur Radiology Research
Role
Principal Investigator
Start Date
July 01, 2015
End Date
June 30, 2017

Publications:

Can algorithmically assessed MRI features predict which patients with a preoperative diagnosis of ductal carcinoma in situ are upstaged to invasive breast cancer?

To assess the ability of algorithmically assessed magnetic resonance imaging (MRI) features to predict the likelihood of upstaging to invasive cancer in newly diagnosed ductal carcinoma in situ (DCIS).We identified 131 patients at our institution from 2000-2014 with a core needle biopsy-confirmed diagnosis of pure DCIS, a 1.5 or 3T preoperative bilateral breast MRI with nonfat-saturated T1 -weighted MRI sequences, no preoperative therapy before breast MRI, and no prior history of breast cancer. A fellowship-trained radiologist identified the lesion on each breast MRI using a bounding box. Twenty-nine imaging features were then computed automatically using computer algorithms based on the radiologist's annotation.The rate of upstaging of DCIS to invasive cancer in our study was 26.7% (35/131). Out of all imaging variables tested, the information measure of correlation 1, which quantifies spatial dependency in neighboring voxels of the tumor, showed the highest predictive value of upstaging with an area under the curve (AUC) = 0.719 (95% confidence interval [CI]: 0.609-0.829). This feature was statistically significant after adjusting for tumor size (P < 0.001).Automatically assessed MRI features may have a role in triaging which patients with a preoperative diagnosis of DCIS are at highest risk for occult invasive disease.4J. Magn. Reson. Imaging 2017.

Authors
Harowicz, MR; Saha, A; Grimm, LJ; Marcom, PK; Marks, JR; Hwang, ES; Mazurowski, MA
MLA Citation
Harowicz, MR, Saha, A, Grimm, LJ, Marcom, PK, Marks, JR, Hwang, ES, and Mazurowski, MA. "Can algorithmically assessed MRI features predict which patients with a preoperative diagnosis of ductal carcinoma in situ are upstaged to invasive breast cancer?." Journal of magnetic resonance imaging : JMRI (February 9, 2017).
PMID
28181348
Source
epmc
Published In
Journal of Magnetic Resonance Imaging
Publish Date
2017
DOI
10.1002/jmri.25655

Focal Breast Pain: Does Breast Density Affect the Need for Ultrasound?

This study aimed to determine the utility of directed ultrasound and digital mammogram for evaluating focal breast pain in women with different mammographic breast densities.This institutional review board-approved and Health Insurance Portability and Accountability Act-compliant retrospective study included 413 cases of focal breast pain in 369 women (mean age 53 years). All cases were evaluated with both mammogram and ultrasound and had at least 2 years of imaging follow-up. Exclusion criteria were non-focal, axillary, or radiating pain; palpable or skin changes; pregnancy or lactation; and history of trauma or infection. Breast density, imaging findings, and biopsy results were recorded. Specificity, positive predictive values, and negative predictive values were calculated.Eighteen percent (76 of 413) of cases demonstrated an imaging correlate. Of these, 74% (56 of 76) occurred in dense breasts and 26% (20 of 76) in nondense breasts. Seventy percent (14 of 20) of lesions in nondense breasts were seen with mammography and ultrasound, whereas 30% (6 of 20) were detected only with ultrasound. Of lesions detected in dense breasts, 29% (16 of 56) were seen with mammography and ultrasound, whereas 71% (40 of 56) were detected only with ultrasound. Thirty-one percent (24 of 76) of cases were biopsied, 42% (10 of 24) of which were detected by ultrasound only. No cancer was detected in initial workup. At 2-year follow-up, three women, all with dense breasts, developed cancer in the same quadrant as the initial pain.Directed ultrasound, when performed in conjunction with digital mammography for the evaluation of focal breast pain in women with nondense breasts, is of low utility and may contribute to unnecessary intervention as a result of incidental findings.

Authors
Cho, MW; Grimm, LJ; Johnson, KS
MLA Citation
Cho, MW, Grimm, LJ, and Johnson, KS. "Focal Breast Pain: Does Breast Density Affect the Need for Ultrasound?." Academic radiology 24.1 (January 2017): 53-59.
PMID
27746121
Source
epmc
Published In
Academic Radiology
Volume
24
Issue
1
Publish Date
2017
Start Page
53
End Page
59
DOI
10.1016/j.acra.2016.09.004

A computer vision-based algorithm to predict false positive errors in radiology trainees when interpreting digital breast tomosynthesis cases

Authors
Wang, M; Wang, M; Grimm, LJ; Mazurowski, MA
MLA Citation
Wang, M, Wang, M, Grimm, LJ, and Mazurowski, MA. "A computer vision-based algorithm to predict false positive errors in radiology trainees when interpreting digital breast tomosynthesis cases." Expert Systems with Applications 64 (December 2016): 490-499.
Source
crossref
Published In
Expert Systems with Applications
Volume
64
Publish Date
2016
Start Page
490
End Page
499
DOI
10.1016/j.eswa.2016.08.023

Active Surveillance for DCIS: The Importance of Selection Criteria and Monitoring.

Authors
Grimm, LJ; Shelley Hwang, E
MLA Citation
Grimm, LJ, and Shelley Hwang, E. "Active Surveillance for DCIS: The Importance of Selection Criteria and Monitoring." Annals of surgical oncology 23.13 (December 2016): 4134-4136.
PMID
27704372
Source
epmc
Published In
Annals of Surgical Oncology
Volume
23
Issue
13
Publish Date
2016
Start Page
4134
End Page
4136
DOI
10.1245/s10434-016-5596-2

Reply to "Reducing Gender Discrepancies in Academic Radiology".

Authors
Grimm, LJ; Ngo, J; Pisano, ED
MLA Citation
Grimm, LJ, Ngo, J, and Pisano, ED. "Reply to "Reducing Gender Discrepancies in Academic Radiology"." AJR. American journal of roentgenology 207.5 (November 2016): W105-.
PMID
27490634
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
207
Issue
5
Publish Date
2016
Start Page
W105

Suspicious breast calcifications undergoing stereotactic biopsy in women ages 70 and over: Breast cancer incidence by BI-RADS descriptors.

To determine the malignancy rate overall and for specific BI-RADS descriptors in women ≥70 years who undergo stereotactic biopsy for calcifications.We retrospectively reviewed 14,577 consecutive mammogram reports in 6839 women ≥70 years to collect 231 stereotactic biopsies of calcifications in 215 women. Cases with missing images or histopathology and calcifications associated with masses, distortion, or asymmetries were excluded. Three breast radiologists determined BI-RADS descriptors by majority. Histology, hormone receptor status, and lymph node status were correlated with BI-RADS descriptors.There were 131 (57 %) benign, 22 (10 %) atypia/lobular carcinomas in situ, 55 (24 %) ductal carcinomas in situ (DCIS), and 23 (10 %) invasive diagnoses. Twenty-seven (51 %) DCIS cases were high-grade. Five (22 %) invasive cases were high-grade, two (9 %) were triple-negative, and three (12 %) were node-positive. Malignancy was found in 49 % (50/103) of fine pleomorphic, 50 % (14/28) of fine linear, 25 % (10/40) of amorphous, 20 % (3/15) of round, 3 % (1/36) of coarse heterogeneous, and 0 % (0/9) of dystrophic calcifications.Among women ≥70 years that underwent stereotactic biopsy for calcifications only, we observed a high rate of malignancy. Additionally, coarse heterogeneous calcifications may warrant a probable benign designation.• Cancer rates of biopsied calcifications in women ≥70 years are high • Radiologists should not dismiss suspicious calcifications in older women • Coarse heterogeneous calcifications may warrant a probable benign designation.

Authors
Grimm, LJ; Johnson, DY; Johnson, KS; Baker, JA; Soo, MS; Hwang, ES; Ghate, SV
MLA Citation
Grimm, LJ, Johnson, DY, Johnson, KS, Baker, JA, Soo, MS, Hwang, ES, and Ghate, SV. "Suspicious breast calcifications undergoing stereotactic biopsy in women ages 70 and over: Breast cancer incidence by BI-RADS descriptors." European radiology (October 17, 2016).
PMID
27752832
Source
epmc
Published In
European Radiology
Publish Date
2016

Predicting false negative errors in digital breast tomosynthesis among radiology trainees using a computer vision-based approach

Authors
Wang, M; Zhang, J; Grimm, LJ; Ghate, SV; Walsh, R; Johnson, KS; Lo, JY; Mazurowski, MA
MLA Citation
Wang, M, Zhang, J, Grimm, LJ, Ghate, SV, Walsh, R, Johnson, KS, Lo, JY, and Mazurowski, MA. "Predicting false negative errors in digital breast tomosynthesis among radiology trainees using a computer vision-based approach." Expert Systems with Applications 56 (September 2016): 1-8.
Source
crossref
Published In
Expert Systems with Applications
Volume
56
Publish Date
2016
Start Page
1
End Page
8
DOI
10.1016/j.eswa.2016.01.053

Recommendations to Reduce Diagnostic Radiology Resident Misrepresentation in Postinterview Communications.

Authors
Grimm, LJ; Avery, CS; Maxfield, CM
MLA Citation
Grimm, LJ, Avery, CS, and Maxfield, CM. "Recommendations to Reduce Diagnostic Radiology Resident Misrepresentation in Postinterview Communications." Journal of the American College of Radiology : JACR 13.8 (August 2016): 964-966.
PMID
27209597
Source
epmc
Published In
Journal of the American College of Radiology
Volume
13
Issue
8
Publish Date
2016
Start Page
964
End Page
966
DOI
10.1016/j.jacr.2016.03.024

Interobserver variability in identification of breast tumors in MRI and its implications for prognostic biomarkers and radiogenomics.

To assess the interobserver variability of readers when outlining breast tumors in MRI, study the reasons behind the variability, and quantify the effect of the variability on algorithmic imaging features extracted from breast MRI.Four readers annotated breast tumors from the MRI examinations of 50 patients from one institution using a bounding box to indicate a tumor. All of the annotated tumors were biopsy proven cancers. The similarity of bounding boxes was analyzed using Dice coefficients. An automatic tumor segmentation algorithm was used to segment tumors from the readers' annotations. The segmented tumors were then compared between readers using Dice coefficients as the similarity metric. Cases showing high interobserver variability (average Dice coefficient <0.8) after segmentation were analyzed by a panel of radiologists to identify the reasons causing the low level of agreement. Furthermore, an imaging feature, quantifying tumor and breast tissue enhancement dynamics, was extracted from each segmented tumor for a patient. Pearson's correlation coefficients were computed between the features for each pair of readers to assess the effect of the annotation on the feature values. Finally, the authors quantified the extent of variation in feature values caused by each of the individual reasons for low agreement.The average agreement between readers in terms of the overlap (Dice coefficient) of the bounding box was 0.60. Automatic segmentation of tumor improved the average Dice coefficient for 92% of the cases to the average value of 0.77. The mean agreement between readers expressed by the correlation coefficient for the imaging feature was 0.96.There is a moderate variability between readers when identifying the rectangular outline of breast tumors on MRI. This variability is alleviated by the automatic segmentation of the tumors. Furthermore, the moderate interobserver variability in terms of the bounding box does not translate into a considerable variability in terms of assessment of enhancement dynamics. The authors propose some additional ways to further reduce the interobserver variability.

Authors
Saha, A; Grimm, LJ; Harowicz, M; Ghate, SV; Kim, C; Walsh, R; Mazurowski, MA
MLA Citation
Saha, A, Grimm, LJ, Harowicz, M, Ghate, SV, Kim, C, Walsh, R, and Mazurowski, MA. "Interobserver variability in identification of breast tumors in MRI and its implications for prognostic biomarkers and radiogenomics." Medical physics 43.8 (August 2016): 4558-.
PMID
27487872
Source
epmc
Published In
Medical physics
Volume
43
Issue
8
Publish Date
2016
Start Page
4558
DOI
10.1118/1.4955435

Breast MRI radiogenomics: Current status and research implications.

Breast magnetic resonance imaging (MRI) radiogenomics is an emerging area of research that has the potential to directly influence clinical practice. Clinical MRI scanners today are capable of providing excellent temporal and spatial resolution, which allows extraction of numerous imaging features via human extraction approaches or complex computer vision algorithms. Meanwhile, advances in breast cancer genetics research has resulted in the identification of promising genes associated with cancer outcomes. In addition, validated genomic signatures have been developed that allow categorization of breast cancers into distinct molecular subtypes as well as predict the risk of cancer recurrence and response to therapy. Current radiogenomics research has been directed towards exploratory analysis of individual genes, understanding tumor biology, and developing imaging surrogates to genetic analysis with the long-term goal of developing a meaningful tool for clinical care. The background of breast MRI radiogenomics research, image feature extraction techniques, approaches to radiogenomics research, and promising areas of investigation are reviewed. J. Magn. Reson. Imaging 2016;43:1269-1278.

Authors
Grimm, LJ
MLA Citation
Grimm, LJ. "Breast MRI radiogenomics: Current status and research implications." Journal of magnetic resonance imaging : JMRI 43.6 (June 2016): 1269-1278.
PMID
26663695
Source
epmc
Published In
Journal of Magnetic Resonance Imaging
Volume
43
Issue
6
Publish Date
2016
Start Page
1269
End Page
1278
DOI
10.1002/jmri.25116

Imaging of Proximal Tibiofibular Joint Instability: A 10 year retrospective case series.

Detail the imaging findings in patients with proximal tibiofibular instability treated with surgical stabilization.Retrospective analysis of preoperative imaging in patients with clinically confirmed tibiofibular instability.Operative fixation of the 16 patients was as follows: 11 using a fiberwire suture construct and 5 using screw fixation. Proximal tibiofibular ligamentous abnormalities were present in 100% of acute (< 6 months) and 85.7% of chronic (>6 months) instability cases who underwent MRI.MRI is sensitive in the evaluation of tibiofibular ligamentous integrity in proximal tibiofibular instability. Chronic instability should be considered in younger adults with isolated tibiofibular osteoarthritis.

Authors
Burke, CJ; Grimm, LJ; Boyle, MJ; Moorman, CT; Hash, TW
MLA Citation
Burke, CJ, Grimm, LJ, Boyle, MJ, Moorman, CT, and Hash, TW. "Imaging of Proximal Tibiofibular Joint Instability: A 10 year retrospective case series." Clinical imaging 40.3 (May 2016): 470-476.
PMID
27133689
Source
epmc
Published In
Clinical Imaging
Volume
40
Issue
3
Publish Date
2016
Start Page
470
End Page
476
DOI
10.1016/j.clinimag.2015.12.011

Men (and Women) in Academic Radiology: How Can We Reduce the Gender Discrepancy?

There is a chronic gender imbalance in academic radiology departments, which could limit our field's ability to foster creative, productive, and innovative environments. We recently reviewed 51 major academic radiology faculty rosters and discovered that 34% of academic radiologists are women, but only 25% of vice chairs and section chiefs and 9% of department chairs are women.Active intervention is needed to correct this imbalance, which should start with awareness of the issue, exposing medical students to radiology early in their training, and implementing better mentorship programs for female radiologists.

Authors
Grimm, LJ; Ngo, J; Pisano, ED; Yoon, S
MLA Citation
Grimm, LJ, Ngo, J, Pisano, ED, and Yoon, S. "Men (and Women) in Academic Radiology: How Can We Reduce the Gender Discrepancy?." AJR. American journal of roentgenology 206.4 (April 2016): 678-680.
PMID
27003048
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
206
Issue
4
Publish Date
2016
Start Page
678
End Page
680
DOI
10.2214/ajr.15.15277

Radiology Trainee Performance in Digital Breast Tomosynthesis: Relationship Between Difficulty and Error-Making Patterns.

The aim of this study was to better understand the relationship between digital breast tomosynthesis (DBT) difficulty and radiology trainee performance.Twenty-seven radiology residents and fellows and three expert breast imagers reviewed 60 DBT studies consisting of unilateral craniocaudal and medial lateral oblique views. Trainees had no prior DBT experience. All readers provided difficulty ratings and final BI-RADS(®) scores. Expert breast imager consensus interpretations were used to determine the ground truth. Trainee sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated for low- and high-difficulty subsets of cases as assessed by each trainee him or herself (self-assessed difficulty) and consensus expert-assessed difficulty.For self-assessed difficulty, the trainee AUC was 0.696 for high-difficulty and 0.704 for low-difficulty cases (P = .753). Trainee sensitivity was 0.776 for high-difficulty and 0.538 for low-difficulty cases (P < .001). Trainee specificity was 0.558 for high-difficulty and 0.810 for low-difficulty cases (P < .001). For expert-assessed difficulty, the trainee AUC was 0.645 for high-difficulty and 0.816 for low-difficulty cases (P < .001). Trainee sensitivity was 0.612 for high-difficulty and .784 for low-difficulty cases (P < .001). Trainee specificity was 0.654 for high-difficulty and 0.765 for low-difficulty cases (P = .021).Cases deemed difficult by experts were associated with decreases in trainee AUC, sensitivity, and specificity. In contrast, for self-assessed more difficult cases, the trainee AUC was unchanged because of increased sensitivity and compensatory decreased specificity. Educators should incorporate these findings when developing educational materials to teach interpretation of DBT.

Authors
Grimm, LJ; Zhang, J; Lo, JY; Johnson, KS; Ghate, SV; Walsh, R; Mazurowski, MA
MLA Citation
Grimm, LJ, Zhang, J, Lo, JY, Johnson, KS, Ghate, SV, Walsh, R, and Mazurowski, MA. "Radiology Trainee Performance in Digital Breast Tomosynthesis: Relationship Between Difficulty and Error-Making Patterns." Journal of the American College of Radiology : JACR 13.2 (February 2016): 198-202.
PMID
26577878
Source
epmc
Published In
Journal of the American College of Radiology
Volume
13
Issue
2
Publish Date
2016
Start Page
198
End Page
202
DOI
10.1016/j.jacr.2015.09.025

Residency Postinterview Communications: More Harm Than Good?

Authors
Grimm, LJ; Avery, CS; Maxfield, CM
MLA Citation
Grimm, LJ, Avery, CS, and Maxfield, CM. "Residency Postinterview Communications: More Harm Than Good?." Journal of Graduate Medical Education 8.1 (February 2016): 7-9.
Source
crossref
Published In
Journal of graduate medical education
Volume
8
Issue
1
Publish Date
2016
Start Page
7
End Page
9
DOI
10.4300/JGME-D-15-00062.1

Recurrence-free survival in breast cancer is associated with MRI tumor enhancement dynamics quantified using computer algorithms.

The purpose of this study is to investigate the association between breast cancer recurrence-free survival and breast magnetic resonance imaging (MRI) tumor enhancement dynamics which are quantified semi-automatically using computer algorithms.In this retrospective IRB-approved study, we analyzed data from 275 breast cancer patients at a single institution. Recurrence-free survival data were obtained from the medical record. Routine clinical pre-operative breast MRIs were performed in all patients. The tumors were marked on the MRIs by fellowship-trained breast radiologists. A previously developed computer algorithm was applied to the marked tumors to quantify the enhancement dynamics relative to the automatically assessed background parenchymal enhancement. To establish whether the contrast enhancement feature quantified by the algorithm was associated with recurrence-free survival, we constructed a Cox proportional hazards regression model with the computer-extracted feature as a covariate. We controlled for tumor grade and size (major axis length), patient age, patient race/ethnicity, and menopausal status.The analysis showed that the semi-automatically obtained feature quantifying MRI tumor enhancement dynamics was independently predictive of recurrence-free survival (p=0.024).Semi-automatically quantified tumor enhancement dynamics on MRI are predictive of recurrence-free survival in breast cancer patients.

Authors
Mazurowski, MA; Grimm, LJ; Zhang, J; Marcom, PK; Yoon, SC; Kim, C; Ghate, SV; Johnson, KS
MLA Citation
Mazurowski, MA, Grimm, LJ, Zhang, J, Marcom, PK, Yoon, SC, Kim, C, Ghate, SV, and Johnson, KS. "Recurrence-free survival in breast cancer is associated with MRI tumor enhancement dynamics quantified using computer algorithms." European journal of radiology 84.11 (November 2015): 2117-2122.
PMID
26210095
Source
epmc
Published In
European Journal of Radiology
Volume
84
Issue
11
Publish Date
2015
Start Page
2117
End Page
2122
DOI
10.1016/j.ejrad.2015.07.012

Computational approach to radiogenomics of breast cancer: Luminal A and luminal B molecular subtypes are associated with imaging features on routine breast MRI extracted using computer vision algorithms.

To identify associations between semiautomatically extracted MRI features and breast cancer molecular subtypes.We analyzed routine clinical pre-operative breast MRIs from 275 breast cancer patients at a single institution in this retrospective, Institutional Review Board-approved study. Six fellowship-trained breast imagers reviewed the MRIs and annotated the cancers. Computer vision algorithms were then used to extract 56 imaging features from the cancers including morphologic, texture, and dynamic features. Surrogate markers (estrogen receptor [ER], progesterone receptor [PR], human epidermal growth factor receptor-2 [HER2]) were used to categorize tumors by molecular subtype: ER/PR+, HER2- (luminal A); ER/PR+, HER2+ (luminal B); ER/PR-, HER2+ (HER2); ER/PR/HER2- (basal). A multivariate analysis was used to determine associations between the imaging features and molecular subtype.The imaging features were associated with both luminal A (P = 0.0007) and luminal B (P = 0.0063) molecular subtypes. No association was found for either HER2 (P = 0.2465) or basal (P = 0.1014) molecular subtype and the imaging features. A P-value of 0.0125 (0.05/4) was considered significant.Luminal A and luminal B molecular subtype breast cancer are associated with semiautomatically extracted features from routine contrast enhanced breast MRI.

Authors
Grimm, LJ; Zhang, J; Mazurowski, MA
MLA Citation
Grimm, LJ, Zhang, J, and Mazurowski, MA. "Computational approach to radiogenomics of breast cancer: Luminal A and luminal B molecular subtypes are associated with imaging features on routine breast MRI extracted using computer vision algorithms." Journal of magnetic resonance imaging : JMRI 42.4 (October 2015): 902-907.
PMID
25777181
Source
epmc
Published In
Journal of Magnetic Resonance Imaging
Volume
42
Issue
4
Publish Date
2015
Start Page
902
End Page
907
DOI
10.1002/jmri.24879

Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT.

The purpose of this study is to determine the prevalence of left renal vein compression in patients with varicoceles.Abdominal and pelvis contrast-enhanced CT images from 100 male patients with varicoceles (mean age 50.6 years) and 100 matched control patients (mean age 49.8 years) were retrospectively reviewed. The diameter of the left renal vein was measured as it crosses between the aorta and superior mesenteric artery and was classified as compressed if there was greater than 50% narrowing. The diameter of the left gonadal vein was measured at the origin. Comparison of the prevalence of left renal vein compression was made via a Chi-squared test and the gonadal vein diameter via a t test.The distribution of varicoceles was 68 on the left, 24 bilateral, and 8 on the right. Compression of the left renal vein was significantly more common in the left varicocele (78%, 53/68) than in the bilateral varicocele (42%, 10/24, p = 0.002), right varicocele (13%, 1/8, p < 0.001), or control group (10%, 10/100, p < 0.001). In the subgroup analysis, the gonadal vein diameter was significantly greater in the left varicocele (mean 5.6 mm) than in the bilateral varicocele (mean 4.6 mm, p = 0.018), right varicocele (mean 3.2 mm, p < 0.001), and control group (mean 3.1 mm, p < 0.001).Left renal vein compression by the superior mesenteric artery is a major contributor to left-sided varicoceles.

Authors
Lewis, DS; Grimm, LJ; Kim, CY
MLA Citation
Lewis, DS, Grimm, LJ, and Kim, CY. "Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT." Abdominal imaging 40.8 (October 2015): 3147-3151.
PMID
26210372
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
8
Publish Date
2015
Start Page
3147
End Page
3151
DOI
10.1007/s00261-015-0512-y

Benefits and Harms of Breast Cancer Screening: A Systematic Review.

Patients need to consider both benefits and harms of breast cancer screening.To systematically synthesize available evidence on the association of mammographic screening and clinical breast examination (CBE) at different ages and intervals with breast cancer mortality, overdiagnosis, false-positive biopsy findings, life expectancy, and quality-adjusted life expectancy.We searched PubMed (to March 6, 2014), CINAHL (to September 10, 2013), and PsycINFO (to September 10, 2013) for systematic reviews, randomized clinical trials (RCTs) (with no limit to publication date), and observational and modeling studies published after January 1, 2000, as well as systematic reviews of all study designs. Included studies (7 reviews, 10 RCTs, 72 observational, 1 modeling) provided evidence on the association between screening with mammography, CBE, or both and prespecified critical outcomes among women at average risk of breast cancer (no known genetic susceptibility, family history, previous breast neoplasia, or chest irradiation). We used summary estimates from existing reviews, supplemented by qualitative synthesis of studies not included in those reviews.Across all ages of women at average risk, pooled estimates of association between mammography screening and mortality reduction after 13 years of follow-up were similar for 3 meta-analyses of clinical trials (UK Independent Panel: relative risk [RR], 0.80 [95% CI, 0.73-0.89]; Canadian Task Force: RR, 0.82 [95% CI, 0.74-0.94]; Cochrane: RR, 0.81 [95% CI, 0.74-0.87]); were greater in a meta-analysis of cohort studies (RR, 0.75 [95% CI, 0.69 to 0.81]); and were comparable in a modeling study (CISNET; median RR equivalent among 7 models, 0.85 [range, 0.77-0.93]). Uncertainty remains about the magnitude of associated mortality reduction in the entire US population, among women 40 to 49 years, and with annual screening compared with biennial screening. There is uncertainty about the magnitude of overdiagnosis associated with different screening strategies, attributable in part to lack of consensus on methods of estimation and the importance of ductal carcinoma in situ in overdiagnosis. For women with a first mammography screening at age 40 years, estimated 10-year cumulative risk of a false-positive biopsy result was higher (7.0% [95% CI, 6.1%-7.8%]) for annual compared with biennial (4.8% [95% CI, 4.4%-5.2%]) screening. Although 10-year probabilities of false-positive biopsy results were similar for women beginning screening at age 50 years, indirect estimates of lifetime probability of false-positive results were lower. Evidence for the relationship between screening and life expectancy and quality-adjusted life expectancy was low in quality. There was no direct evidence for any additional mortality benefit associated with the addition of CBE to mammography, but observational evidence from the United States and Canada suggested an increase in false-positive findings compared with mammography alone, with both studies finding an estimated 55 additional false-positive findings per extra breast cancer detected with the addition of CBE.For women of all ages at average risk, screening was associated with a reduction in breast cancer mortality of approximately 20%, although there was uncertainty about quantitative estimates of outcomes for different breast cancer screening strategies in the United States. These findings and the related uncertainty should be considered when making recommendations based on judgments about the balance of benefits and harms of breast cancer screening.

Authors
Myers, ER; Moorman, P; Gierisch, JM; Havrilesky, LJ; Grimm, LJ; Ghate, S; Davidson, B; Mongtomery, RC; Crowley, MJ; McCrory, DC; Kendrick, A; Sanders, GD
MLA Citation
Myers, ER, Moorman, P, Gierisch, JM, Havrilesky, LJ, Grimm, LJ, Ghate, S, Davidson, B, Mongtomery, RC, Crowley, MJ, McCrory, DC, Kendrick, A, and Sanders, GD. "Benefits and Harms of Breast Cancer Screening: A Systematic Review." JAMA 314.15 (October 2015): 1615-1634. (Review)
PMID
26501537
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
314
Issue
15
Publish Date
2015
Start Page
1615
End Page
1634
DOI
10.1001/jama.2015.13183

Abbreviated screening protocol for breast MRI: a feasibility study.

To compare the performance of two shortened breast magnetic resonance imaging (MRI) protocols to a standard MRI protocol for breast cancer screening.In this Health Insurance Portability and Accountability Act compliant, institutional review board-approved pilot study, three fellowship-trained breast imagers evaluated 48 breast MRIs (24 normal, 12 benign, and 12 malignant) selected from a high-risk screening population. MRIs were presented in three viewing protocols, and a final Breast Imaging-Reporting and Data System assessment was recorded for each case. The first shortened protocol (abbreviated 1) included only fat-saturated precontrast T2-weighted, precontrast T1-weighted, and first pass T1-weighted postcontrast sequences. The second shortened protocol (abbreviated 2) included the abbreviated 1 protocol plus the second pass T1-weighted postcontrast sequence. The third protocol (full), reviewed after a 1-month waiting period, included a nonfat-saturated T1-weighted sequence, fat-saturated T2-weighted, precontrast T1-weighted, and three or four dynamic postcontrast sequences. Interpretation times were recorded for the abbreviated 1 and full protocols. Sensitivity and specificity were compared via a chi-squared analysis. This pilot study was designed to detect a 10% difference in sensitivity with a power of 0.8.There was no significant difference in sensitivity between the abbreviated 1 (86%; P = .22) or abbreviated 2 (89%; P = .38) protocols and the full protocol (95%). There was no significant difference in specificity between the abbreviated 1 (52%; P = 1) or abbreviated 2 (45%; P = .34) protocols and the full protocol (52%). The abbreviated 1 and full protocol interpretation times were similar (2.98 vs. 3.56 minutes).In this pilot study, reader performance comparing two shortened breast MRI protocols to a standard protocol in a screening cohort were similar, suggesting that a shortened breast MRI protocol may be clinically useful, warranting further investigation.

Authors
Grimm, LJ; Soo, MS; Yoon, S; Kim, C; Ghate, SV; Johnson, KS
MLA Citation
Grimm, LJ, Soo, MS, Yoon, S, Kim, C, Ghate, SV, and Johnson, KS. "Abbreviated screening protocol for breast MRI: a feasibility study." Academic radiology 22.9 (September 2015): 1157-1162.
PMID
26152500
Source
epmc
Published In
Academic Radiology
Volume
22
Issue
9
Publish Date
2015
Start Page
1157
End Page
1162
DOI
10.1016/j.acra.2015.06.004

Frequency of Malignancy and Imaging Characteristics of Probably Benign Lesions Seen at Breast MRI.

OBJECTIVE: The purposes of this study were to evaluate the frequency, follow-up compliance, and cancer rate of MRI BI-RADS category 3 lesions and to determine the cancer rate for individual BI-RADS descriptors. MATERIALS AND METHODS: A retrospective review was conducted of breast MRI examinations with an assessment of probably benign (BI-RADS category 3) from among 4279 consecutive breast MRI examinations performed from January 2005 through December 2009. The review revealed 282 (6.6%) examinations with 332 lesions defined as BI-RADS 3. Pathologic results, 2 years of follow-up imaging findings, or both were reviewed. The frequency of BI-RADS 3 assessments, follow-up imaging compliance, and cancer yield were calculated. Three fellowship-trained breast imagers reevaluated all lesions and recorded descriptors from the MRI lexicon of the fifth edition of the BI-RADS atlas. The distribution and likelihood of malignancy for each descriptor were calculated. RESULTS: The follow-up compliance rate was 84.3% (280/332), and the malignancy rate was 4.3% (12/280). There were 50 (17.9%) individual foci, 61 (21.8%) multiple foci, 74 (26.4%) masses, and 95 (33.9%) nonmass enhancement lesions. Masses were most commonly oval (59.5% [44/74]), circumscribed (75.7% [56/74]), and homogeneously enhancing (43.2% [32/74]). Nonmass enhancement was most commonly focal (57.9% [55/95]) with heterogeneous enhancement (53.7% [51/95]) Most of the lesions had persistent kinetics (74.3% [208/280]). The background parenchymal enhancement was most commonly mild (51.1% [143/280]). CONCLUSION: MRI BI-RADS category 3 is not frequently used, and the levels of patient compliance with follow-up imaging are acceptable. The cancer yield for probably benign lesions is greater for MRI-detected than for mammographically detected lesions, especially for specific BI-RADS descriptors.

Authors
Grimm, LJ; Anderson, AL; Baker, JA; Johnson, KS; Walsh, R; Yoon, SC; Ghate, SV
MLA Citation
Grimm, LJ, Anderson, AL, Baker, JA, Johnson, KS, Walsh, R, Yoon, SC, and Ghate, SV. "Frequency of Malignancy and Imaging Characteristics of Probably Benign Lesions Seen at Breast MRI." AJR. American journal of roentgenology 205.2 (August 2015): 442-447.
PMID
26204298
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
205
Issue
2
Publish Date
2015
Start Page
442
End Page
447
DOI
10.2214/ajr.14.13530

Does Breast Imaging Experience During Residency Translate Into Improved Initial Performance in Digital Breast Tomosynthesis?

To determine the initial digital breast tomosynthesis (DBT) performance of radiology trainees with varying degrees of breast imaging experience.To test trainee performance with DBT, we performed a reader study, after obtaining IRB approval. Two medical students, 20 radiology residents, 4 nonbreast imaging fellows, 3 breast imaging fellows, and 3 fellowship-trained breast imagers reviewed 60 unilateral DBT studies (craniocaudal and medio-lateral oblique views). Trainees had no DBT experience. Each reader recorded a final BI-RADS assessment for each case. The consensus interpretations from fellowship-trained breast imagers were used to establish the ground truth. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated. For analysis, first- through third-year residents were classified as junior trainees, and fourth-year residents plus nonbreast imaging fellows were classified as senior trainees.The AUCs were .569 for medical students, .721 for junior trainees, .701 for senior trainees, and .792 for breast imaging fellows. The junior and senior trainee AUCs were equivalent (P < .01) using a two one-sided test for equivalence, with a significance threshold of 0.1. The sensitivities and specificities were highest for breast imaging fellows (.778 and .815 respectively), but similar for junior (.631 and .714, respectively) and senior trainees (.678 and .661, respectively).Initial performance with DBT among radiology residents and nonbreast imaging fellows is independent of years of training. Radiology educators should consider these findings when developing educational materials.

Authors
Zhang, J; Grimm, LJ; Lo, JY; Johnson, KS; Ghate, SV; Walsh, R; Mazurowski, MA
MLA Citation
Zhang, J, Grimm, LJ, Lo, JY, Johnson, KS, Ghate, SV, Walsh, R, and Mazurowski, MA. "Does Breast Imaging Experience During Residency Translate Into Improved Initial Performance in Digital Breast Tomosynthesis?." Journal of the American College of Radiology : JACR 12.7 (July 2015): 728-732.
PMID
26143567
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
7
Publish Date
2015
Start Page
728
End Page
732
DOI
10.1016/j.jacr.2015.02.025

Applicant to Residency Program Translation Guide.

Authors
Grimm, LJ; Desser, TS; Bailey, JE; Maxfield, CM
MLA Citation
Grimm, LJ, Desser, TS, Bailey, JE, and Maxfield, CM. "Applicant to Residency Program Translation Guide." Journal of the American College of Radiology : JACR 12.6 (June 2015): 622-623.
PMID
25620237
Source
epmc
Published In
Journal of the American College of Radiology
Volume
12
Issue
6
Publish Date
2015
Start Page
622
End Page
623
DOI
10.1016/j.jacr.2014.07.035

Accessory veins in nonmaturing autogenous arteriovenous fistulae: analysis of anatomic features and impact on fistula maturation.

The appropriate management of nonmaturing arteriovenous (AV) fistulae continues to be a controversial issue. While coil embolization of accessory side-branch veins can be performed to encourage maturation of nonmaturing AV fistulae, the true efficacy and optimal patient population are not well understood. Fistulagrams performed on nonmaturing AV fistulae were retrospectively reviewed in 145 patients (86 males, median age 63 years) for the presence of accessory veins. Fistula and accessory vein measurements were obtained, as were rates of eventual fistula maturation after accessory vein coil embolization. Of 145 nonmaturing fistulae, 49 (34%) had a stenosis without any accessory veins, 76 (52%) had a stenosis and one or more accessory veins, and 20 (14%) had an accessory vein without concurrent stenosis. Eighteen AV fistulae had one or more accessory veins without coexisting stenosis. Nine fistulae had a caliber decrease immediately downstream from the accessory vein. Coil embolization of dominant accessory veins with a caliber decrease immediately downstream (n = 6) resulted in a 100% eventual fistula maturation rate versus 67% for fistulae without this configuration (n = 6, p = 0.15). Accessory vein size was not correlated with maturation rates (p = 0.51). The majority of nonmaturing fistulae with accessory veins had a coexisting stenosis. Higher maturation rates may result with selected anatomic parameters, although additional studies with more robust sample sizes are needed prior to definitive conclusions.

Authors
Engstrom, BI; Grimm, LJ; Ronald, J; Smith, TP; Kim, CY
MLA Citation
Engstrom, BI, Grimm, LJ, Ronald, J, Smith, TP, and Kim, CY. "Accessory veins in nonmaturing autogenous arteriovenous fistulae: analysis of anatomic features and impact on fistula maturation." Seminars in dialysis 28.3 (May 2015): E30-E34.
PMID
25482275
Source
epmc
Published In
Seminars in Dialysis
Volume
28
Issue
3
Publish Date
2015
Start Page
E30
End Page
E34
DOI
10.1111/sdi.12333

Interobserver Variability Between Breast Imagers Using the Fifth Edition of the BI-RADS MRI Lexicon.

OBJECTIVE: The purpose of this study was to assess the interobserver variability of users of the MRI lexicon in the fifth edition of the BI-RADS atlas. MATERIALS AND METHODS: Three breast imaging specialists reviewed 280 routine clinical breast MRI findings reported as BI-RADS category 3. Lesions reported as BI-RADS 3 were chosen because variability in the use of BI-RADS descriptors may influence which lesions are classified as probably benign. Each blinded reader reviewed every study and recorded breast features (background parenchymal enhancement) and lesion features (lesion morphology, mass shape, mass margin, mass internal enhancement, nonmass enhancement distribution, nonmass enhancement internal enhancement, enhancement kinetics) according to the fifth edition of the BI-RADS lexicon and provided a final BI-RADS assessment. Interobserver variability was calculated for each breast and lesion feature and for the final BI-RADS assessment. RESULTS: Interobserver variability for background parenchymal enhancement was fair (ĸ = 0.28). There was moderate agreement on lesion morphology (ĸ = 0.53). For masses, there was substantial agreement on shape (ĸ = 0.72), margin (ĸ = 0.78), and internal enhancement (ĸ = 0.69). For nonmass enhancement, there was substantial agreement on distribution (ĸ = 0.69) and internal enhancement (ĸ = 0.62). There was slight agreement on lesion kinetics (ĸ = 0.19) and final BI-RADS assessment (ĸ = 0.11). CONCLUSION: There is moderate to substantial agreement on most MRI BI-RADS lesion morphology descriptors, particularly mass and nonmass enhancement features, which are important predictors of malignancy. Considerable disagreement remains, however, among experienced readers whether to follow particular findings.

Authors
Grimm, LJ; Anderson, AL; Baker, JA; Johnson, KS; Walsh, R; Yoon, SC; Ghate, SV
MLA Citation
Grimm, LJ, Anderson, AL, Baker, JA, Johnson, KS, Walsh, R, Yoon, SC, and Ghate, SV. "Interobserver Variability Between Breast Imagers Using the Fifth Edition of the BI-RADS MRI Lexicon." AJR. American journal of roentgenology 204.5 (May 2015): 1120-1124.
PMID
25905951
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
204
Issue
5
Publish Date
2015
Start Page
1120
End Page
1124
DOI
10.2214/ajr.14.13047

Can breast cancer molecular subtype help to select patients for preoperative MR imaging?

PURPOSE: To assess whether breast cancer molecular subtype classified by surrogate markers can be used to predict the extent of clinically relevant disease with preoperative breast magnetic resonance (MR) imaging. MATERIALS AND METHODS: In this HIPAA-compliant, institutional review board-approved study, informed consent was waived. Preoperative breast MR imaging reports from 441 patients were reviewed for multicentric and/or multifocal disease, lymph node involvement, skin and/or nipple invasion, chest wall and/or pectoralis muscle invasion, or contralateral disease. Pathologic reports were reviewed to confirm the MR imaging findings and for hormone receptors (estrogen and progesterone subtypes), human epidermal growth factor receptor type 2 (HER2 subtype), tumor size, and tumor grade. Surrogates were used to categorize tumors by molecular subtype: hormone receptor positive and HER2 negative (luminal A subtype); hormone receptor positive and HER2 positive (luminal B subtype); hormone receptor negative and HER2 positive (HER2 subtype); hormone receptor negative and HER2 negative (basal subtype). All patients included in the study had a histologic correlation with MR imaging findings or they were excluded. χ(2) analysis was used to compare differences between subtypes, with multivariate logistic regression analysis used to assess for variable independence. RESULTS: Identified were 289 (65.5%) luminal A, 45 (10.2%) luminal B, 26 (5.9%) HER2, and 81 (18.4%) basal subtypes. Among subtypes, significant differences were found in the frequency of multicentric and/or multifocal disease (luminal A, 27.3% [79 of 289]; luminal B, 53.3% [24 of 45]; HER2, 65.4% [17 of 26]; basal, 27.2% [22 of 81]; P < .001) and lymph node involvement (luminal A, 17.3% [50 of 289]; luminal B, 35.6% [26 of 45]; HER2, 34.6% [nine of 26]; basal 24.7% [20 of 81]; P = .014). Multivariate analysis showed that molecular subtype was independently predictive of multifocal and/or multicentric disease. CONCLUSION: Preoperative breast MR imaging is significantly more likely to help detect multifocal and/or multicentric disease and lymph node involvement in luminal B and HER2 molecular subtype breast cancers. Molecular subtype may help to select patients for preoperative breast MR imaging.

Authors
Grimm, LJ; Johnson, KS; Marcom, PK; Baker, JA; Soo, MS
MLA Citation
Grimm, LJ, Johnson, KS, Marcom, PK, Baker, JA, and Soo, MS. "Can breast cancer molecular subtype help to select patients for preoperative MR imaging?." Radiology 274.2 (February 2015): 352-358.
PMID
25325325
Source
epmc
Published In
Radiology
Volume
274
Issue
2
Publish Date
2015
Start Page
352
End Page
358
DOI
10.1148/radiol.14140594

Incorporating breast tomosynthesis into radiology residency: Does trainee experience in breast imaging translate into improved performance with this new modality?

© 2015 SPIE.Digital breast tomosynthesis (DBT) is a powerful new imaging modality that has the potential to transform breast cancer screening practices. The advantages over mammography include improved sensitivity and specificity as well as the detection of additional invasive cancers. While this modality holds many advantages, the best means of incorporating DBT into radiology training programs is currently not well understood. The initial performance of a trainee in DBT might depend on the amount of previous radiology training, in particular breast imaging experience. In our study, we tested the DBT interpretive skills of radiology trainees with different levels of breast imaging training, but with no prior DBT experience. We recruited 16 radiology trainees to review 60 DBT studies. A fellowship-trained expert breast radiologist reviewed the studies and provided the gold standard interpretations. Receiver operating characteristic analysis was used to evaluate the performance of the trainees. Our results show that there is no notable difference in trainee performance in DBT, regardless of the number of years of general radiology experience. These results provide guidance to breast imaging educators as they prepare new curricula to teach DBT. These curricula should provide a base training which will likely be suitable for all trainee levels.

Authors
Grimm, LJ; Zhang, J; Johnson, KS; Lo, JY; Mazurowski, MA
MLA Citation
Grimm, LJ, Zhang, J, Johnson, KS, Lo, JY, and Mazurowski, MA. "Incorporating breast tomosynthesis into radiology residency: Does trainee experience in breast imaging translate into improved performance with this new modality?." January 1, 2015.
Source
scopus
Published In
Proceedings of SPIE
Volume
9416
Publish Date
2015
DOI
10.1117/12.2082810

Survey of the incidence and effect of major life events on graduate medical education trainees.

This study aims to assess the incidence of major life events during graduate medical education (GME) training and to establish any associations with modifiable activities and career planning.The authors surveyed graduating GME trainees from their parent institution in June 2013. Demographic information (clinical department, gender, training duration) and major life events (marriage, children, death/illness, home purchase, legal troubles, property loss) were surveyed. Respondents were queried about the relationship between life events and career planning. A multivariable logistic regression model tested for associations.A total of 53.2% (166/312) of graduates responded to the survey. 50% (83/166) of respondents were female. Major life events occurred in 96.4% (160/166) of respondents. Male trainees were more likely (56.1% [46/82] vs. 30.1% [25/83]) to have a child during training (p=0.01). A total of 41.6% (69/166) of responders consciously engaged or avoided activities during GME training, while 31.9% (53/166) of responders reported that life events influenced their career plans. Trainees in lifestyle residencies (p=0.02), those who experienced the death or illness of a close associate (p=0.01), and those with legal troubles (p=0.04) were significantly more likely to consciously control life events.Major life events are very common and changed career plans in nearly a third of GME trainees. Furthermore, many trainees consciously avoided activities due to their responsibilities during training. GME training programs should closely assess the institutional support systems available to trainees during this difficult time.

Authors
Grimm, LJ; Nagler, A; Maxfield, CM
MLA Citation
Grimm, LJ, Nagler, A, and Maxfield, CM. "Survey of the incidence and effect of major life events on graduate medical education trainees." Medical education online 20 (January 2015): 27597-.
PMID
26070948
Source
epmc
Published In
Medical Education Online: an electronic journal
Volume
20
Publish Date
2015
Start Page
27597
DOI
10.3402/meo.v20.27597

Recurrence-free survival in breast cancer is associated with MRI tumor enhancement dynamics quantified using computer algorithms

© 2015 Elsevier Ireland Ltd. All rights reserved.Purpose The purpose of this study is to investigate the association between breast cancer recurrence-free survival and breast magnetic resonance imaging (MRI) tumor enhancement dynamics which are quantified semi-automatically using computer algorithms. Methods In this retrospective IRB-approved study, we analyzed data from 275 breast cancer patients at a single institution. Recurrence-free survival data were obtained from the medical record. Routine clinical pre-operative breast MRIs were performed in all patients. The tumors were marked on the MRIs by fellowship-trained breast radiologists. A previously developed computer algorithm was applied to the marked tumors to quantify the enhancement dynamics relative to the automatically assessed background parenchymal enhancement. To establish whether the contrast enhancement feature quantified by the algorithm was associated with recurrence-free survival, we constructed a Cox proportional hazards regression model with the computer-extracted feature as a covariate. We controlled for tumor grade and size (major axis length), patient age, patient race/ethnicity, and menopausal status. Results The analysis showed that the semi-automatically obtained feature quantifying MRI tumor enhancement dynamics was independently predictive of recurrence-free survival (p = 0.024). Conclusion Semi-automatically quantified tumor enhancement dynamics on MRI are predictive of recurrence-free survival in breast cancer patients.

Authors
Mazurowski, MA; Grimm, LJ; Zhang, J; Marcom, PK; Yoon, SC; Kim, C; Ghate, SV; Johnson, KS
MLA Citation
Mazurowski, MA, Grimm, LJ, Zhang, J, Marcom, PK, Yoon, SC, Kim, C, Ghate, SV, and Johnson, KS. "Recurrence-free survival in breast cancer is associated with MRI tumor enhancement dynamics quantified using computer algorithms." European Journal of Radiology 84.11 (2015): 2117-2122.
Source
scival
Published In
European Journal of Radiology
Volume
84
Issue
11
Publish Date
2015
Start Page
2117
End Page
2122
DOI
10.1016/j.ejrad.2015.07.012

Radiogenomic analysis of breast cancer: luminal B molecular subtype is associated with enhancement dynamics at MR imaging.

PURPOSE: To investigate associations between breast cancer molecular subtype and semiautomatically extracted magnetic resonance (MR) imaging features. MATERIALS AND METHODS: Imaging and genomic data from the Cancer Genome Atlas and the Cancer Imaging Archive for 48 patients with breast cancer from four institutions in the United States were used in this institutional review board approval-exempt study. Computer vision algorithms were applied to extract 23 imaging features from lesions indicated by a breast radiologist on MR images. Morphologic, textural, and dynamic features were extracted. Molecular subtype was determined on the basis of genomic analysis. Associations between the imaging features and molecular subtype were evaluated by using logistic regression and likelihood ratio tests. The analysis controlled for the age of the patients, their menopausal status, and the orientation of the MR images (sagittal vs axial). RESULTS: There is an association (P = .0015) between the luminal B subtype and a dynamic contrast material-enhancement feature that quantifies the relationship between lesion enhancement and background parenchymal enhancement. Cancers with a higher ratio of lesion enhancement rate to background parenchymal enhancement rate are more likely to be luminal B subtype. CONCLUSION: The luminal B subtype of breast cancer is associated with MR imaging features that relate the enhancement dynamics of the tumor and the background parenchyma.

Authors
Mazurowski, MA; Zhang, J; Grimm, LJ; Yoon, SC; Silber, JI
MLA Citation
Mazurowski, MA, Zhang, J, Grimm, LJ, Yoon, SC, and Silber, JI. "Radiogenomic analysis of breast cancer: luminal B molecular subtype is associated with enhancement dynamics at MR imaging." Radiology 273.2 (November 2014): 365-372.
PMID
25028781
Source
epmc
Published In
Radiology
Volume
273
Issue
2
Publish Date
2014
Start Page
365
End Page
372
DOI
10.1148/radiol.14132641

Radiology resident mammography training: interpretation difficulty and error-making patterns.

RATIONALE AND OBJECTIVES: The purpose of this study was to better understand the concept of mammography difficulty and how it affects radiology resident performance. MATERIALS AND METHODS: Seven radiology residents and three expert breast imagers reviewed 100 mammograms, consisting of bilateral medial lateral oblique and craniocaudal views, using a research workstation. The cases consisted of normal, benign, and malignant findings. Participants identified abnormalities and scored the difficulty and malignant potential for each case. Resident performance (sensitivity, specificity, and area under the receiver operating characteristic curve [AUC]) was calculated for self- and expert-assessed high and low difficulties. RESULTS: For cases classified by self-assessed difficulty, the resident AUCs were 0.667 for high difficulty and 0.771 for low difficulty cases (P = .010). Resident sensitivities were 0.707 for high and 0.614 for low difficulty cases (P = .113). Resident specificities were 0.583 for high and 0.905 for low difficulty cases (P < .001). For cases classified by expert-assessed difficulty, the resident AUCs were 0.583 for high and 0.783 for low difficulty cases (P = .001). Resident sensitivities were 0.558 for high and 0.796 for low difficulty cases (P < .001). Resident specificities were 0.714 for high and 0.740 for low difficulty cases (P = .807). CONCLUSIONS: Increased self- and expert-assessed difficulty is associated with a decrease in resident performance in mammography. However, while this lower performance is due to a decrease in specificity for self-assessed difficulty, it is due to a decrease in sensitivity for expert-assessed difficulty. These trends suggest that educators should provide a mix of self- and expert-assessed difficult cases in educational materials to maximize the effect of training on resident performance and confidence.

Authors
Grimm, LJ; Kuzmiak, CM; Ghate, SV; Yoon, SC; Mazurowski, MA
MLA Citation
Grimm, LJ, Kuzmiak, CM, Ghate, SV, Yoon, SC, and Mazurowski, MA. "Radiology resident mammography training: interpretation difficulty and error-making patterns." Academic radiology 21.7 (July 2014): 888-892.
PMID
24928157
Source
epmc
Published In
Academic Radiology
Volume
21
Issue
7
Publish Date
2014
Start Page
888
End Page
892
DOI
10.1016/j.acra.2014.01.025

A proposal to reduce misrepresentation of medical student research activities in ERAS.

Authors
Grimm, L; Maxfield, C
MLA Citation
Grimm, L, and Maxfield, C. "A proposal to reduce misrepresentation of medical student research activities in ERAS." Academic medicine : journal of the Association of American Medical Colleges 89.6 (June 2014): 833-. (Letter)
PMID
24865825
Source
epmc
Published In
Academic Medicine
Volume
89
Issue
6
Publish Date
2014
Start Page
833
DOI
10.1097/acm.0000000000000255

Predictors of an academic career on radiology residency applications.

RATIONALE AND OBJECTIVES: To evaluate radiology residency applications to determine if any variables are predictive of a future academic radiology career. MATERIALS AND METHODS: Application materials from 336 radiology residency graduates between 1993 and 2010 from the Department of Radiology, Duke University and between 1990 and 2010 from the Department of Radiology, Stanford University were retrospectively reviewed. The institutional review boards approved this Health Insurance Portability and Accountability Act-compliant study with a waiver of informed consent. Biographical (gender, age at application, advanced degrees, prior career), undergraduate school (school, degree, research experience, publications), and medical school (school, research experience, manuscript publications, Alpha Omega Alpha membership, clerkship grades, United States Medical Licensing Examination Step 1 and 2 scores, personal statement and letter of recommendation reference to academics, couples match status) data were recorded. Listing in the Association of American Medical Colleges Faculty Online Directory and postgraduation publications were used to determine academic status. RESULTS: There were 72 (21%) radiologists in an academic career and 264 (79%) in a nonacademic career. Variables associated with an academic career were elite undergraduate school (P = .003), undergraduate school publications (P = .018), additional advanced degrees (P = .027), elite medical school (P = .006), a research year in medical school (P < .001), and medical school publications (P < .001). A multivariate cross-validation analysis showed that these variables are jointly predictive of an academic career (P < .001). CONCLUSIONS: Undergraduate and medical school rankings and publications, as well as a medical school research year and an additional advanced degree, are associated with an academic career. Radiology residency selection committees should consider these factors in the context of the residency application if they wish to recruit future academic radiologists.

Authors
Grimm, LJ; Shapiro, LM; Singhapricha, T; Mazurowski, MA; Desser, TS; Maxfield, CM
MLA Citation
Grimm, LJ, Shapiro, LM, Singhapricha, T, Mazurowski, MA, Desser, TS, and Maxfield, CM. "Predictors of an academic career on radiology residency applications." Academic radiology 21.5 (May 2014): 685-690.
PMID
24629444
Source
epmc
Published In
Academic Radiology
Volume
21
Issue
5
Publish Date
2014
Start Page
685
End Page
690
DOI
10.1016/j.acra.2013.10.019

Predicting error in detecting mammographic masses among radiology trainees using statistical models based on BI-RADS features.

The purpose of this study is to explore Breast Imaging-Reporting and Data System (BI-RADS) features as predictors of individual errors made by trainees when detecting masses in mammograms.Ten radiology trainees and three expert breast imagers reviewed 100 mammograms comprised of bilateral medial lateral oblique and craniocaudal views on a research workstation. The cases consisted of normal and biopsy proven benign and malignant masses. For cases with actionable abnormalities, the experts recorded breast (density and axillary lymph nodes) and mass (shape, margin, and density) features according to the BI-RADS lexicon, as well as the abnormality location (depth and clock face). For each trainee, a user-specific multivariate model was constructed to predict the trainee's likelihood of error based on BI-RADS features. The performance of the models was assessed using area under the receive operating characteristic curves (AUC).Despite the variability in errors between different trainees, the individual models were able to predict the likelihood of error for the trainees with a mean AUC of 0.611 (range: 0.502-0.739, 95% Confidence Interval: 0.543-0.680,p < 0.002).Patterns in detection errors for mammographic masses made by radiology trainees can be modeled using BI-RADS features. These findings may have potential implications for the development of future educational materials that are personalized to individual trainees.

Authors
Grimm, LJ; Ghate, SV; Yoon, SC; Kuzmiak, CM; Kim, C; Mazurowski, MA
MLA Citation
Grimm, LJ, Ghate, SV, Yoon, SC, Kuzmiak, CM, Kim, C, and Mazurowski, MA. "Predicting error in detecting mammographic masses among radiology trainees using statistical models based on BI-RADS features." Medical physics 41.3 (March 2014): 031909-.
PMID
24593727
Source
epmc
Published In
Medical physics
Volume
41
Issue
3
Publish Date
2014
Start Page
031909
DOI
10.1118/1.4866379

Predicting error in detecting mammographic masses among radiology trainees using statistical models based on BI-RADS features

Authors
Grimm, LJ; Ghate, SV; Yoon, SC; Kuzmiak, CM; Kim, C; Mazurowski, MA
MLA Citation
Grimm, LJ, Ghate, SV, Yoon, SC, Kuzmiak, CM, Kim, C, and Mazurowski, MA. "Predicting error in detecting mammographic masses among radiology trainees using statistical models based on BI-RADS features." Medical Physics 41.3 (February 26, 2014): 031909-031909.
Source
crossref
Published In
Medical physics
Volume
41
Issue
3
Publish Date
2014
Start Page
031909
End Page
031909
DOI
10.1118/1.4866379

Predictors of an academic career on radiology residency applications

Rationale and Objectives: To evaluate radiology residency applications to determine if any variables are predictive of a future academic radiology career. Materials and Methods: Application materials from 336 radiology residency graduates between 1993 and 2010 from the Department of Radiology, Duke University and between 1990 and 2010 from the Department of Radiology, Stanford University were retrospectively reviewed. The institutional review boards approved this Health Insurance Portability and Accountability Act-compliant study with a waiver of informed consent. Biographical (gender, age at application, advanced degrees, prior career), undergraduate school (school, degree, research experience, publications), and medical school (school, research experience, manuscript publications, Alpha Omega Alpha membership, clerkship grades, United States Medical Licensing Examination Step 1 and 2 scores, personal statement and letter of recommendation reference to academics, couples match status) data were recorded. Listing in the Association of American Medical Colleges Faculty Online Directory and postgraduation publications were used to determine academic status. Results: There were 72 (21%) radiologists in an academic career and 264 (79%) in a nonacademic career. Variables associated with an academic career were elite undergraduate school (P=.003), undergraduate school publications (P=.018), additional advanced degrees (P=.027), elite medical school (P=.006), a research year in medical school (P<.001), and medical school publications (P<.001). A multivariate cross-validation analysis showed that these variables are jointly predictive of an academic career (P<.001). Conclusions: Undergraduate and medical school rankings and publications, as well as a medical school research year and an additional advanced degree, are associated with an academic career. Radiology residency selection committees should consider these factors in the context of the residency application if they wish to recruit future academic radiologists. © 2014 AUR.

Authors
Grimm, LJ; Shapiro, LM; Singhapricha, T; Mazurowski, MA; Desser, TS; Maxfield, CM
MLA Citation
Grimm, LJ, Shapiro, LM, Singhapricha, T, Mazurowski, MA, Desser, TS, and Maxfield, CM. "Predictors of an academic career on radiology residency applications." Academic Radiology 21.5 (January 1, 2014): 685-690.
Source
scopus
Published In
Academic Radiology
Volume
21
Issue
5
Publish Date
2014
Start Page
685
End Page
690
DOI
10.1016/j.acra.2013.10.019

Ultimate publication rate of unpublished manuscripts listed on radiology residency applications at one institution.

PURPOSE: This study was designed to assess the ultimate publication rate of unpublished manuscripts listed on radiology residency applications. METHOD: A retrospective review was performed on all 628 Electronic Residency Application Service applications submitted to a single-institution radiology residency program in 2010. Publication status of unpublished manuscripts listed as "accepted," "in press," "provisional accepted," or "submitted" was assessed two years later by searching PubMed, Google Scholar, and journal- or conference-specific Web sites. Manuscripts were considered "published" if they appeared in a peer-reviewed journal with the applicant as an author. Impact factors of proposed and publishing journals were compared. RESULTS: Five hundred fourteen (81.8%) of the 628 applicants listed a total of 1,431 manuscripts: 952 (66.5%) "published," 64 (4.5%) "in press," 95 (6.6%) "accepted," 27 (1.9%) "provisional accepted," and 293 (20.5%) "submitted." After two years, 81.3% (52/64) of "in press," 58.9% (56/95) of "accepted," 70.4% (19/27) of "provisional accepted," and 43.7% (128/293) of "submitted" manuscripts were published (P < .01). The proposed and publishing journal matched in 50.8% (65/128) of "submitted" manuscripts (P < .01). The impact factor of the proposed versus publishing journal was 4.189 versus 2.898 (P < .01) for "submitted" manuscripts. CONCLUSIONS: One-third of manuscripts listed on radiology residency applications were unpublished at the time of application. More than half of those listed as "submitted," and approximately one-third of those listed as "accepted," "in press," or "provisional accepted," remained unpublished after two years. Residency selection committees should consider these publication rates when assessing applicants.

Authors
Grimm, LJ; Maxfield, CM
MLA Citation
Grimm, LJ, and Maxfield, CM. "Ultimate publication rate of unpublished manuscripts listed on radiology residency applications at one institution." Academic medicine : journal of the Association of American Medical Colleges 88.11 (November 2013): 1719-1722.
PMID
24072127
Source
epmc
Published In
Academic Medicine
Volume
88
Issue
11
Publish Date
2013
Start Page
1719
End Page
1722
DOI
10.1097/acm.0b013e3182a7f903

Incidental detection of nutcracker phenomenon on multidetector CT in an asymptomatic population: prevalence and associated findings.

OBJECTIVE: To determine the prevalence of nutcracker phenomenon (left renal vein compression by the superior mesenteric artery) and secondary anatomic findings using multidetector computed tomographic (CT) angiography in an asymptomatic population. METHODS: Ninety-nine consecutive CT angiograms for potential renal transplant donors (mean age, 39.0 years; 42 males) without variant renal vein anatomy were reviewed retrospectively. The diameters of the maximal left renal vein, left renal vein between the aorta and superior mesenteric artery, and draining gonadal and lumbar veins were measured. Sex, age, hematuria, proteinuria, and abdominal or flank pain were recorded. RESULTS: Twenty-three patients had 50% to 70% stenosis, and 4 patients had greater than 70% stenosis of the left renal vein. Dilated gonadal and lumbar veins were found in 16 and 28 patients, respectively. Four patients had hematuria. These findings were not significantly associated with left renal vein compression. CONCLUSIONS: Nutcracker phenomenon and dilated veins originating from the left renal vein are common incidental CT findings and nonspecific for the diagnosis of nutcracker syndrome.

Authors
Grimm, LJ; Engstrom, BI; Nelson, RC; Kim, CY
MLA Citation
Grimm, LJ, Engstrom, BI, Nelson, RC, and Kim, CY. "Incidental detection of nutcracker phenomenon on multidetector CT in an asymptomatic population: prevalence and associated findings." Journal of computer assisted tomography 37.3 (May 2013): 415-418.
PMID
23674014
Source
epmc
Published In
Journal of Computer Assisted Tomography
Volume
37
Issue
3
Publish Date
2013
Start Page
415
End Page
418
DOI
10.1097/rct.0b013e3182873235

Radiology education in China.

Authors
Wang, YE; Liu, M; Jin, L; Lungren, MP; Grimm, LJ; Zhang, Z; Maxfield, CM
MLA Citation
Wang, YE, Liu, M, Jin, L, Lungren, MP, Grimm, LJ, Zhang, Z, and Maxfield, CM. "Radiology education in China." Journal of the American College of Radiology : JACR 10.3 (March 2013): 213-219.
PMID
23571062
Source
epmc
Published In
Journal of the American College of Radiology
Volume
10
Issue
3
Publish Date
2013
Start Page
213
End Page
219
DOI
10.1016/j.jacr.2012.11.006

Assessing the utility of the ventilation phase in ventilation-perfusion imaging for acute pulmonary embolism.

PURPOSE: This study aims to identify patient characteristics that allow the exclusion of the ventilation phase in ventilation-perfusion imaging for the evaluation of acute pulmonary embolism (PE). MATERIALS AND METHODS: A total of 500 consecutive ventilation-perfusion reports with an indication for possible acute PE were retrospectively reviewed. Information on ventilation abnormalities, perfusion defects, PIOPED classification, age, sex, chest radiograph results, and presence of respiratory disease was recorded. Patients with moderate and large perfusion defects were analyzed to assess the utility of the ventilation phase on the final PIOPED classification. RESULTS: Moderate (n=39) or large (n=26) perfusion defects were seen in 65 (13%) studies. Of these, 46 studies (70.8%) had defects unmatched on ventilation and three (4.6%) had triple-match defects, resulting in 49 reports (75.4%) classified as intermediate (n=28) or high (n=21) probability for PE. There was a statistically significant association between unmatched defects and a clear chest radiograph (P=0.03) and an association approaching statistical significance with younger age (P=0.05). There was a strong association with respiratory disease (P=0.12) and no association with patient sex (P=0.82). The percentage of studies with unmatched defects increased from 70.8 to 76.7% (33/43, P=0.39) if patients with respiratory disease were excluded, to 82.4% (28/34, P=0.14) if abnormal chest radiographs were excluded, and to 95.7% (22/23, P=0.01) if both were excluded. CONCLUSION: There may be a subset of patients - younger patients with clear chest radiographs and no respiratory disease - for whom the ventilation phase can be excluded and the determination of a PE is based solely on perfusion abnormalities.

Authors
Grimm, LJ; Coleman, RE
MLA Citation
Grimm, LJ, and Coleman, RE. "Assessing the utility of the ventilation phase in ventilation-perfusion imaging for acute pulmonary embolism." Nuclear medicine communications 34.1 (January 2013): 1-4.
PMID
23111382
Source
epmc
Published In
Nuclear Medicine Communications
Volume
34
Issue
1
Publish Date
2013
Start Page
1
End Page
4
DOI
10.1097/mnm.0b013e32835afb99

Ultimate publication rate of unpublished manuscripts listed on radiology residency applications at one institution

PURPOSE: This study was designed to assess the ultimate publication rate of unpublished manuscripts listed on radiology residency applications. METHOD: A retrospective review was performed on all 628 Electronic Residency Application Service applications submitted to a single-institution radiology residency program in 2010. Publication status of unpublished manuscripts listed as "accepted," "in press," "provisional accepted," or "submitted" was assessed two years later by searching PubMed, Google Scholar, and journal- or conference-specific Web sites. Manuscripts were considered "published" if they appeared in a peer-reviewed journal with the applicant as an author. Impact factors of proposed and publishing journals were compared. RESULTS: Five hundred fourteen (81.8%) of the 628 applicants listed a total of 1,431 manuscripts: 952 (66.5%) "published, " 64 (4.5%) "in press," 95 (6.6%) "accepted," 27 (1.9%) "provisional accepted," and 293 (20.5%) "submitted." After two years, 81.3% (52/64) of "in press," 58.9% (56/95) of "accepted," 70.4% (19/27) of "provisional accepted," and 43.7% (128/293) of "submitted" manuscripts were published (P < .01). The proposed and publishing journal matched in 50.8% (65/128) of "submitted" manuscripts (P < .01). The impact factor of the proposed versus publishing journal was 4.189 versus 2.898 (P < .01) for "submitted" manuscripts. CONCLUSIONS: One-third of manuscripts listed on radiology residency applications were unpublished at the time of application. More than half of those listed as "submitted," and approximately one-third of those listed as "accepted," "in press," or "provisional accepted," remained unpublished after two years. Residency selection committees should consider these publication rates when assessing applicants.

Authors
Grimm, LJ; Maxfield, CM
MLA Citation
Grimm, LJ, and Maxfield, CM. "Ultimate publication rate of unpublished manuscripts listed on radiology residency applications at one institution." Academic Medicine 88.11 (2013): 1719-1722.
Source
scival
Published In
Academic Medicine
Volume
88
Issue
11
Publish Date
2013
Start Page
1719
End Page
1722
DOI
10.1097/ACM.0b013e3182a7f903

Radiology education in China

Authors
Wang, YE; Liu, M; Jin, L; Lungren, MP; Grimm, LJ; Zhang, Z; Maxfield, CM
MLA Citation
Wang, YE, Liu, M, Jin, L, Lungren, MP, Grimm, LJ, Zhang, Z, and Maxfield, CM. "Radiology education in China." Journal of the American College of Radiology 10.3 (2013): 213-219.
Source
scopus
Published In
Journal of the American College of Radiology
Volume
10
Issue
3
Publish Date
2013
Start Page
213
End Page
219
DOI
10.1016/j.jacr.2012.11.006

Effectiveness of a breath-hold monitoring system in improving the reproducibility of different breath-hold positions in multiphasic CT imaging.

This study tests whether the utilization of an electronic breath-hold monitoring device improves breath-hold reproducibility during computed tomographic (CT) scanning. Two cohorts of 40 patients underwent dual-phase abdominal CT scans, either with a breath-hold monitoring device or with the standard breath-holding technique. Two blinded readers measured the differences in diaphragmatic position between phases. There was no statistical difference in diaphragmatic position (P=.14) between the monitored (8.5±11.5 mm) and control (5.6±5.2 mm) cohorts. Ten percent of patients from the monitored cohort had greater than 20 mm of deviation, versus 0%-2.5% for the control cohort. Reproduction of breath-holding position remains challenging, even with a monitoring system.

Authors
Grimm, LJ; Feuerlein, S; Bashir, M; Nelson, RC
MLA Citation
Grimm, LJ, Feuerlein, S, Bashir, M, and Nelson, RC. "Effectiveness of a breath-hold monitoring system in improving the reproducibility of different breath-hold positions in multiphasic CT imaging." Clinical imaging 36.6 (November 2012): 754-757.
PMID
23154005
Source
epmc
Published In
Clinical Imaging
Volume
36
Issue
6
Publish Date
2012
Start Page
754
End Page
757
DOI
10.1016/j.clinimag.2012.01.040

Can the localization of primary colonic tumors be improved by staging CT without specific bowel preparation compared to optical colonoscopy?

OBJECTIVES: To investigate the ability of staging computed tomography (CT) without bowel preparation to accurately localize colonic tumors compared to optical colonoscopy. METHODS: The local institutional review board approved this retrospective and HIPAA-compliant study. Forty-six patients with colonic adenocarcinoma, preoperative colonoscopy, and staging CT within 60 days of resection were included. Patients underwent contrast enhanced CT imaging without bowel preparation or oral contrast. The colon was divided into four segments with the operative reports used as the standard. Rectal and cecal cancers were excluded. CT scans were reviewed by 5 readers in a segmental binary fashion using a 5-point confidence scale in two sessions blinded and unblinded to the colonoscopy report. RESULTS: At surgery 49 tumors were found in 46 patients. Readers detected 86.1%, 74.3%, and 66.9% of lesions with 92.0%, 94.1%, and 95.4% accuracy for confidence scores of ≥ 3, ≥ 4, and 5. CT interobserver agreement was good (κ=0.82) for the unblinded and moderate (κ=0.60) for the blinded read. Colonoscopic localization was only 78.7% accurate with 2 tumors undiscovered. Colonoscopic accuracy was low in the descending colon (57.1%) and the transverse colon (55.6%). CONCLUSIONS: Preoperative staging CT is more accurate than colonoscopy in the localization of colonic tumors.

Authors
Feuerlein, S; Grimm, LJ; Davenport, MS; Haystead, CM; Miller, CM; Neville, AM; Jaffe, TA
MLA Citation
Feuerlein, S, Grimm, LJ, Davenport, MS, Haystead, CM, Miller, CM, Neville, AM, and Jaffe, TA. "Can the localization of primary colonic tumors be improved by staging CT without specific bowel preparation compared to optical colonoscopy?." European journal of radiology 81.10 (October 2012): 2538-2542.
PMID
22209431
Source
epmc
Published In
European Journal of Radiology
Volume
81
Issue
10
Publish Date
2012
Start Page
2538
End Page
2542
DOI
10.1016/j.ejrad.2011.12.004

The Effect of Left-Sided Versus Right-Sided Contrast Infusion on Attenuation of the Main Pulmonary Artery When Performing Computed Tomography Angiograms of the Chest

Authors
Grimm, LJ; Cornfeld, D; Mojibian, HR
MLA Citation
Grimm, LJ, Cornfeld, D, and Mojibian, HR. "The Effect of Left-Sided Versus Right-Sided Contrast Infusion on Attenuation of the Main Pulmonary Artery When Performing Computed Tomography Angiograms of the Chest." Journal of Computer Assisted Tomography 34.1 (January 2010): 52-57.
Source
crossref
Published In
Journal of Computer Assisted Tomography
Volume
34
Issue
1
Publish Date
2010
Start Page
52
End Page
57
DOI
10.1097/RCT.0b013e3181ad2cfe
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