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COVID-19 halted all cancer screening services at the beginning of the pandemic, and slowly those scans have become more and more available -- but, not necessarily for everyone.

In many instances, racial and minority patients continue to face the same healthcare disparities that made it difficult for them to access the services at the outset. Now, the fear and trepidation associated with the pandemic are layered on top. 

Despite these difficulties, there are things healthcare institutions and providers can do to help. In this episode of 

 spoke with Shalmon Kalnicki, M.D., chair of radiation and oncology at Montefiore and Albert Einstein College of Medicine about the challenges these patients continue to face with cancer screenings. Not only did he share with us how COVID-19 has impacted this existing problem, but he also outlined the steps institutions can take to improve this situation.


In this podcast episode, Dr. Shalom Kalnicki, from Montefiore and Albert Einstein College of Medicine, discusses the disparities minority patients face with cancer screenings and what can be done to increase access during the pandemic.

The Reading Room: Racial and Ethnic Minorities, Cancer Screenings, and COVID-19

An emerging nomogram model for intra-tumoral heterogeneity quantification with breast MRI demonstrated an average 85 percent sensitivity in external validation testing for predicting pathologic complete response to neoadjuvant chemotherapy for breast cancer.

Breast MRI Quantification of Intra-Tumoral Heterogeneity May Help Predict Response to Neoadjuvant Chemotherapy

Demonstrating no significant difference with radiologist detection of clinically significant prostate cancer (csPCa), a biparametric MRI-based AI model provided an 88.4 percent sensitivity rate in a recent study.

New bpMRI Study Suggests AI Offers Comparable Results to Radiologists for PCa Detection

In a new study involving over 120 women, nearly two-thirds of whom had a family history of breast cancer, ultrafast MRI findings revealed a 5 percent increase in malignancy risk for each second increase in the difference between lesion and background parenchymal enhancement (BPE) time to enhancement (TTE). 

Could Ultrafast MRI Enhance Detection of Malignant Foci for Breast Cancer?

A systematic review of 147 clinical trials assessing neoadjuvant systemic therapy for breast cancer also revealed that mid-treatment imaging was utilized in 56 percent of the studies.

Imaging-Based Treatment Modifications Only Used in 15 Percent of Neoadjuvant Systemic Therapy Trials for Breast Cancer

Abbreviated MRI demonstrated a 95.3 percent specificity for rectal cancer and provided strong agreement with the full MRI protocol for T staging and detection of extramural venous invasion, according to newly published research.

Can Abbreviated MRI Have an Impact in Rectal Cancer Staging?

While the final rule for the Mammography Quality Standards Act (MQSA) with respect to a national standard for breast density notification on mammography reports was issued in March 2023, implementation has been a significant undertaking.

“For states that did not have a breast density law before, I think this is a very heavy lift,” noted Stamatia Destounis, M.D., FACR, FSBI, FAIUM, a breast imaging specialist with Elizabeth Wende Breast Care in Rochester, N.Y., and chair of the American College of Radiology (ACR) Breast Imaging Commission.

Noting that breast density notification has been the law since January 2013 in New York, Dr. Destounis emphasized the importance of ongoing education for staff, patients and referring physicians. She recalled it taking about three to four years before physicians started asking questions about breast density.

In anticipation of the nationwide standard for breast density notification going into effect on September 10, 2024, Dr. Destounis said her facility revamped their website and emphasized social media to spread the word to patients. Accordingly, she has seen an “uptick of calls and appointments” for patients seeking genetic counseling at her facility, which has led to increased supplemental breast MRI screening.

“Many go ahead and schedule their supplemental screening with their mammogram,” added Dr. Destounis.

In order to accommodate the increased imaging volume. Dr. Destounis said her facility has hired more staff, expanded hours during the week and added weekend hours as well.

While the ongoing educational, logistical, and staffing challenges can be onerous, Dr. Destounis emphasized that every week, she is seeing cases of small invasive breast cancers on ultrasound and linear ductal enhancement on breast MRI that cannot be found on standard mammography.

(Editor’s note: For related content, see “

Current Insights on National Breast Density Notification for Mammography Reports

Looking at Next Steps to Reinforce National Breast Density Notification

Long-Term Study Shows Merits of Contrast-Enhanced Mammography for Women with Higher Breast Cancer Risk

For more insights from Dr. Destounis, watch the video below.

In a recent interview, Stamatia Destounis, MD, discussed the impact of national breast density notification for mammography reports.

Addressing the Early Impact of National Breast Density Notification for Mammography Reports

In a recent interview, Stamatia Destounis, M.D., discussed the impact of national breast density notification for mammography reports and key considerations with staffing and ongoing education for patients, staff and referring providers on the merits of supplemental breast imaging.

Stacy Smith-Foley, M.D., was pleased to see the United States Preventive Services Task Force (USPSTF) realign with the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) in recommending mammography screening to begin at 40 years of age for women of average risk for breast cancer.

However, in a recent interview, Dr. Smith-Foley expressed disappointment with the 

USPSTF’s lack of support for supplemental imaging in women with dense breasts and continued mammography screening for women 75 and older

, as well as the emphasis on biennial mammography screening for women 40 to 74 years of age.

Yearly mammography screening gives women the best chance for early breast cancer detection, emphasized Dr. Smith-Foley, the medical director of the Breast Center at the Central Arkansas Radiation Therapy Institute (CARTI) in Little Rock, Arkansas.

“When women skip their mammogram intentionally or unintentionally, … we tend to find more advanced disease. The breast cancer is larger, it is more extensive, it is more often a higher grade and more frequently involves the axilla with local regional metastasis. What I see in clinical practice is that when we have these gaps or delays (with mammography screening), the disease is more extensive,” explained Dr. Smith-Foley.

Biennial Mammography Over Annual Mammography? USPSTF Issues Updated Breast Cancer Screening Recommendations

Mammography Study Shows Link Between Enlarged Axillary Lymph Nodes and Higher Risks for Diabetes and Cardiovascular Disease

Breast MRI and Dense Breasts: A Closer Look at Early Findings from a New Prospective Trial

Dr. Smith-Foley also disagrees with the USPSTF’s assertion of insufficient evidence to continue annual mammography screening in women 75 and older.

“I have a whole collection of patients under my care in their 80s and 90s who presented to me with locally advanced breast cancer that would have been detected at an earlier stage if they had been participating in yearly screens,” maintained Dr. Smith-Foley.

For more insights from Dr. Smith-Foley, watch the video below.

Stacy Smith-Foley, MD discusses shortcomings with the recently updated USPSTF breast cancer screening recommendations.

Where the USPSTF Breast Cancer Screening Recommendations Fall Short: An Interview with Stacy Smith-Foley, MD

In a recent interview, Stacy Smith-Foley, M.D., shared her perspective on the shortcomings of the recently issued breast cancer screening recommendations from the United States Preventive Services Task Force (USPSTF).

Overtreatment of patients with prostate cancer has been a significant issue and may have impacted between one to two million men with the disease, suggested Steven Raman, M.D., in a recent interview.

However, the emergence of magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) appears to be a promising option for men with intermediate risk 

, a treatment that has a more favorable side effect profile than surgery and radiation, according to Dr. Raman, a professor of radiology, urology and surgery at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

In research presented at the recent Society of Interventional Radiology (SIR) conference, Dr. Raman noted the use of MRI-guided TULSA led to a 92 percent reduction in median prostate volume (from 37.3 ml to 2.8 ml) and a 48 percent reduction in the presence of Gleason Grade (GG) 2 PCa at one year.

At five years after treatment with MRI-guided TULSA, Dr. Raman and colleagues found that 87 percent of patients had preserved erectile function and 92 percent had recovered pad-free continence.

Dr. Raman says the use of MRI guidance and thermometry are more advantageous than prior ultrasound monitoring of thermal ultrasound treatments and key to the success of the TULSA procedure.

“What I don’t like about (ultrasound monitoring) is you don’t know how hot (it is) getting and where exactly you are treating. With MRI, thermometry is an important tool. MRI images the entire prostate as you’re treating it and while you’re treating it, you’re seeing how hot things get in the prostate and outside the prostate,” explained Dr. Raman. “This is an important safety tool to minimize damage to the nerve, the sphincter, and other things, and that results in much better outcomes.”

Emerging Insights on MRI-Guided Transurethral Ultrasound Ablation for Prostate Cancer

Can MRI-Guided Transurethral Ultrasound Ablation Have an Impact for Localized Prostate Cancer?

Can MRI Findings Help Predict Toxicity After Radiotherapy for Prostate Cancer?

For more insights from Dr. Raman, watch the video below.

In a recent interview, Steven Raman, M.D., discussed MRI-guided transurethral ultrasound (TULSA) in the treatment of intermediate risk prostate cancer. 

A Closer Look at MRI-Guided Transurethral Ultrasound Ablation for Intermediate Risk Prostate Cancer

In a recent interview, Steven Raman, M.D., discussed the use of MRI-guided transurethral ultrasound (TULSA) in the treatment of intermediate risk prostate cancer and key research findings with one- and five-year outcomes. 

Examining the impact of training sessions for magnetic resonance imaging (MRI) technologists at the University Hospitals Cleveland Medical Center in Ohio, researchers saw significant improvements in image acquisition and processing for breast MRI exams, according to new study findings presented at the Society for Breast Imaging (SBI) 2024 Breast Imaging Symposium in Montreal.

In a recent interview, Shahrzad Tavana, M.D., pointed out a 25 percent improvement in the compliance rate for correct breast positioning within the coil (from 52 percent pre-training to 77 percent post-training) and a 29 percent improvement with ensuring an optimal field of view (from 62 percent pre-training to 91 percent post-training.

“The ideal field of view for a breast MRI is from the clavicle to the inframammary fold with the axilla included bilaterally,” noted Dr. Tavana, a chief resident in diagnostic radiology at the University Hospitals Cleveland Medical Center in Ohio. “Sometimes we noticed that some of the breast MRs being done included the spine in the field of view. Sometimes, the axilla wasn’t adequately covered. All of these affect the resolution.”

Study Shows BPE Quantification on MRI Helps Predict Risk of Breast Cancer Recurrence

MRI Surveillance Associated with 80 Percent Reduction in Breast Cancer Mortality for Women with BRCA1

Five Takeaways from New Breast MRI Literature Review

Dr. Tavana and her colleagues also a 39 percent improvement in accuracy with the submission of MRI sequences to PACS (from 47 percent pre-training to 86 percent post-training). The training also led to reduced false positive scans, decreased recall rates and improved efficiency in the reading room, according to Dr. Tavana.

“Our project underscored the importance of a collaborative effort between the radiologists and the MRI technologists,” emphasized Dr. Tavana. “It resulted in improved quality of the breast MRs that we perform here.”

For more insights from Dr. Tavana, watch the video below.

Shahrzad Tavana, M.D., discusses the impact of training session for MRI technologists in improving MRI acquisition and processing.

Improving the Quality of Breast MRI Acquisition and Processing

Discussing findings from a new study presented at the Society for Breast Imaging (SBI) conference, Shahrzad Tavana, M.D., detailed the significant impact of training sessions for MRI technologists in improving breast positioning, optimal field of view and accuracy of sequence submissions to PACS for breast MRI exams.



The purchase of new and cutting-edge imaging equipment comes with a lot of excitement—and a learning curve. That's where Canon Medical Education comes in, providing a host of education solutions for clients that include both in-person and virtual training and continuing education opportunities.

The education arm of Canon Medical Systems USA provides a customizable plan to ensure that all imaging associates are well-trained and comfortable operating advanced equipment including MR and CT, as well as vascular and cath applications, among others. 

Understanding that every learner is different, Canon offers educational opportunities that include in-person, at their Institute of Advanced Imaging in Irvine, California; on-site training at a client facility; online and instructor-led courses in their Canon Learning Center; as well as CE and non-CE webinars and special programs.

To learn more about Canon's educational offerings, 

Canon Medical Systems offer a range of in-person and virtual educational opportunities for their clients. 

Education in Radiology: Canon's Customized Approach

Morris Panner didn’t want to call the familiar PACS system outdated or antiquated. However, he did suggest that radiology is on the cusp of a revolution with medical image and data management that parallels the ongoing emergence of the radiologist from the reading room to being a key member of the interdisciplinary team in facilitating optimal patient outcomes.

“The PACS system is no longer a new invention. It is important and you can always improve it but what people are really looking for now is how to free that data, take that pixel information, share it, use it with other types of data and advance the liquidity and flexibility in data management. That was the revolution that came out of the SIIM (Society for Imaging Informatics in Medicine) meeting this year,” noted Panner, the president of Intelerad Medical Systems, in a recent video interview.

recent survey research showing an increasing patient acceptance of artificial intelligence (AI)

, and the more gradual “try it” phase for many radiologists as they discern the most optimal fit for AI in their current workflows. To that end, Panner also reviewed key aspects of Intelerad’s Enterprise Imaging and Informatics Suite. It is Panner’s hope that by emphasizing improved efficiency and quality in radiology workflows, the system can “free up brain space for great diagnostics.”

For more insights from Morris Panner, watch the video below.

In a video interview, Morris Panner, the president of Intelerad Medical Systems, discussed key observations from the recent Society for Imaging Informatics in Medicine (SIIM) conference, recent research about artificial intelligence (AI) adoption and emerging goals for enhancing the efficiency of radiology workflows.

What's Next in Medical Image and Data Management in Radiology?

The temporary shortage of iodinated contrast media (ICM) has been a huge issue in the radiology community, not to mention the overarching impact on the health-care field. While there is proverbial light at the end of the tunnel with the 

recent announcement from GE Healthcare about resuming full production of Omnipaque products

, Sean Bryant, M.D. said there are key takeaways that radiologists can utilize in the next couple of weeks as contrast supply begins to be restored and moving forward.

In a recent video interview, Dr. Bryant, the owner and president of Diversified Radiology, discussed the impact of the ICM shortage in the neuroradiology space. In addition to appropriate use of alternative imaging, such as substituting magnetic resonance imaging (MRI) or non-contrast computed tomography (CT) for contrast-enhanced CT scans, Dr. Bryant said the guidelines from the American College of Radiology (ACR) and the American Society of Health-System Pharmacists (ASHP) have been helpful in managing the ICM shortage.

Dr. Bryant said the ICM shortage also was an opportunity to reassess imaging protocols and educate patients as well as referring clinicians on alternatives to high contrast imaging. In emergency departments, oncology care and in-patient services in a hospital, Dr. Bryant noted that clinicians at times opt for high contrast without knowing the most optimal study to order for a given clinical scenario.

For additional insights from Dr. Bryant, watch the video below.

In a recent video interview on the current iodinated contrast media shortage, neuroradiologist Sean Bryant, MD discussed imaging alternatives, emphasized communication with referring physicians on optimal studies, and discussed the ongoing need to prevent “protocol creep” with timely updates of imaging protocols.

Lessons Learned from the Iodinated Contrast Media Shortage: A Neuroradiologist's Perspective

Despite the technological advances in transferring electronic health information, medical imaging data, to this day, is predominantly exchanged between instiutions via physical media (such as a CD or flash drive) that patients carry to an appointment at another facility.

Emphasizing the impact of this seemingly dated practice on workflow efficiencies within radiology and the broader field of health care, Arun Krishnaraj, MD, MPH and David Larson, MD, MBA, said the continued reliance on patients to transport medical images via physical media (such as a CD or flash drive) can lead to delays in patient care.

In their quest to change this dynamic, Drs. Krishnaraj and Larson recently co-authored a provocative article, “

Moving Toward Seamless Interinstitutional Electronic Image Transfer

ournal of the American College of Radiology (JACR)

. In the article and in a video interview with 

, Drs. Krishnaraj and Larson discussed the potential creation of a “linked multi-hub model” that would facilitate electronic transmission of medical images through image exchange companies that would connect different health-care facilities.

“Everyone in the imaging community should really see this as a call to arms to work with our imaging vendor exchange communities to solve this problem for the benefit of patients,” emphasized Dr. Krishnaraj, Chief of the Division of Body Imaging with the Department of Radiology and Medical Imaging at the University of Virginia School of Medicine.

For more insights from Drs. Krishnaraj and Larson, watch the video below:

In a recent video interview, Arun Krishnaraj, MD, MPH and David Larson, MD, MBA, discussed the continued use of physical media to transport medical images between different health-care facilities, resulting inefficiencies and delays with patient care, and the initiative to create a linked multi-hub model to end this dated practice once and for all.

'A Call to Arms' for Electronic Transfer of Medical Images Between Institutions

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor, Whitney Palmer.

Before we get to our featured interview – a re-visit with Dr. Anupam Basu in light of this week’s announcement from the U.S. Preventive Services Task Force about its changing recommendation for lung cancer screenings – here are the top stories of the week.

Speaking of that change in lung cancer screening recommendation – the U.S. Preventive Services Task Force announced two significant changes to its existing guidance about when smokers should begin low-dose CT for lung cancer screening. The original recommendation supported annual low-dose CT screening for smokers or former smokers who were between ages 55 and 80 who had 30 pack-year histories or who had stopped smoking within the last 15 years. Based on new research on screening efficacy, the Task Force published their amendments in 

. The new guidance now supports annual screening for smokers and non-smokers between ages 50 and 80 with 20 pack-year histories or smoking cessation within the past 15 years. This move, the Task Force says will give 6.4 million more people access to screening – that’s an 81 percent increase. The hope, the Task Force said, is that this move will make it easier for previously under-screened groups to get the scans they need for earlier detection and earlier treatment. This could be particularly impactful with African American smokers who have worse outcomes with lung cancer despite having pack-year histories that fell below the previous 30-year threshold. The supporting research also revealed making this change helped avoid more deaths – between 469 and 588 per 100,000 for patients with 20 pack-year histories versus 381 per 100,000 for patients with 30-year histories, and they also gained more life years – 6,018-to-7,596 years per 100,000 patients compared with 4,882 per 100,000 for patients with 30-year histories. Still, the research did point to more false positives, over-diagnosis, and other radiation-induced cancer deaths with the increased eligibility for screening.

It has been no secret that the COVID-19 pandemic has had a chilling effect on cancer screenings nationwide – fear of viral exposure, a shortage of PPE for providers, a patient’s inability to pay for the service, and inconsistent guidance from the CDC all created the perfect storm for fewer patients coming in for the screenings they need, particularly screening mammography and lung cancer screenings. This week, 

, and interventional and diagnostic radiologist from The Ohio State University took a look at the lingering impact of the pandemic and how radiology practices should proceed to bring patients back in for screening services in a safe, efficient way.

Patients do not typically seek treatment for unintentional weight loss in the emergency department, but for the 5 percent to 7 percent who do, CT scans can help providers shed light on what might be behind the problem. In a study published in 

investigators from University Hospitals Cleveland Medical Center and Case Western Reserve University showed that, as a first-line imaging approach, CT can offer a true-positive rate of 48.8 percent for identifying organic causes of unintentional weight loss. For their study, they included 133 patients who had chest, abdomen, or pelvis CT scans in their emergency department between 2004 and 2020. Based on their analysis, they determined CT made 65 true-positive detections – 41 cases of non-malignant gastrointestinal conditions and 30 cases of cancer. They also saw that elevated white blood cell counts and physical exam irregularities were also significantly associated with CT abnormalities.

And, finally, this week, we’re taking a look back at an interview with Dr. Anupam Basu from Cook County Hospital in light of this week’s lung cancer screening announcement from the U.S. Preventive Services Task Force. He recently published a study in the 

Journal of the American College of Radiology

 that revealed the previous 30 pack-year history was too high a threshold for African American smokers. He spoke with us about the details of his findings, what they mean for African American smokers, and how radiologists can use this information. Here’s what he had to say.

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

USPSTF lung cancer screening recommendation update; Cancer screenings and COVID-19; and CT and unintentional weight loss.

Diagnostic Imaging's Weekly Scan: March 12, 2021

Before we get to our featured interview with a multi-institutional panel about efforts to expand radiology education and the use of radiology technologies globally, here are the top stories of the week.

The “sweet spot” recall rate for screening mammography is actually lower than the currently accepted level, according to new research. Rather than the 12 percent-to-14 percent recognized, new research published in the 

shows that the appropriate recall rate for 2D digital mammography and 3D tomosynthesis is 7 percent-to-9 percent. Following this new benchmark could potentially reduce the number of women who are called back for additional diagnostic imaging. To identify the optimal recall rate, the team examined nearly 1.1 million 2D and 3D exams from women between the ages of 40 and 79 from January 2005 until December 2017. Based on their evaluation, they identified an overall mean recall rate for mammography of 10.7 percent and a cancer detection rate of 4 per 1,000 studies. The biopsy recommendation rate was 1.6 percent. When they drilled down, though, they discovered that 2D analog exams had the highest recall rate at 11.2 percent, followed by 2D digital exams at 10.8 percent and 3D tomosynthesis at 9.4 percent. 3D tomosynthesis also had the highest mean biopsy recommendation rate at 1.93 percent, followed by 2D digital and 2D analog exams at 1.55 percent and 1.47 percent, respectively. These results, they said, showed that a recall rate of 7 percent-to-9 percent maximized cancer detection and minimized unnecessary biopsy.

Using MRI, instead of CT, for follow-up in men who have been treated for early-stage testicular cancer reduces their exposure to additional radiation and could lower their risk of developing future cancers. Currently, treatment for these men involves removing the affected testicle and following the patient with CT for five years. However, new research presented at the 

 conference this month shows that MRI performs just as well at detecting any cancer relapse without the extra exposure. Investigators reached this conclusion by testing three follow-up protocols – the standard seven CT scans, three CT scans, and the same regimens with MRI – with 669 men with stage-one testicular cancer who had their affected testicle removed. Only 12 percent of the men had a relapse, 10 of which were advanced disease at detection. Of the cancers, nine were detected in the three-scan group, and only one was picked up in the seven-scan group, indicating that any additional CT scans after three years are unnecessary. CT detected eight cancers while MRI identified two – this difference, however, was not significant, the team noted.

Sore muscles, achy joints, and swollen toes – it’s not what we typically think of when we talk about COVID-19. But, these symptoms are proof that the virus does not only attack the body – it pushes the body to attack itself. In a study released this week in 

investigators revealed that CT, MRI and ultrasound scans show evidence of how the virus can kick-start rheumatological issues in some patients. By examining scans from patients who presented between May 2020 and December 2020, the team pinpointed several causes of these musculoskeletal symptoms, including edema, inflammation, hematomas, and gangrene. In addition, some images revealed blood clots or nerves that were bright and enlarged, indicating injury. If radiologists know to look for these findings, they can better identify patients who might benefit from a referral to a rheumatologist or a dermatologist for more extensive treatment, the team said.

 spoke with several of the radiologists from Penn Medicine (Abass Noor, M.D.), the Children’s Hospital of Philadelphia (Kassa Darge, M.D.), the University of Texas Southwestern (Ajay Kohli, M.D.), and the University of California at San Francisco (Bhavya Rehani, M.D.) who are currently involved in efforts to expand radiology education and technologies to resource-limited areas globally. They discussed the importance of these efforts, what has been accomplished to date, and what the future holds. Here’s what they shared.

Mammography "Sweet Spot" Recall Rate; MRI for Early-Stage Testicular Cancer Follow-Up; COVID-19 and Body Self-Attack; Plus, Global Radiology

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