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Navigating professional growth for women in radiology: A practical guide for mentorship, sponsorship, and coaching
No full textHistorically, women in radiology are underrepresented in radiology and face disproportionate barriers to career advancement related to work-life integration, gender bias, and relative lack of female role models. Given these challenges, women must be proactive and seek out mentorship and sponsorship to help navigate career obstacles and to guide career direction. At times of inflection, coaching can play a role in helping to clarify next steps through self-discovery of one\u27s strengths, limitations, and desired goals. In this manuscript, we provide practical tips for women on how to successfully navigate mentorship, sponsorship and coaching during a career in radiology.
Keywords: Career advancement; Coaching; Mentorship; Professional growth; Sponsorship; Women in radiology
The Impact of Radioactive Iodine on Outcomes Among Pediatric and Adolescent Thyroid Cancer Patients: A SEER Database Analysis
No full textBackground/objectives: Pediatric populations with well-differentiated thyroid cancer typically have favorable prognoses. However, the role of radioactive iodine (RAI) ablation in these patients remains uncertain. This investigation evaluates the national trends, therapeutic practices, and the impact of RAI on clinical outcomes.
Methods: Patients aged 21 years or younger with differentiated thyroid cancer, identified from the SEER database between 2000 and 2019, were analyzed. We compared the treatment approaches and survival outcomes of patients who underwent RAI ablation with those who did not.
Results: This retrospective cohort study encompassed 5318 pediatric patients, with 55.9% (n = 2973) who underwent RAI ablation. RAI utilization declined from 65% to 38.4% in 2019. Compared with those who did not undergo RAI, RAI patients presented with a larger tumor size (mean size: 27.7 vs. 20.4 mm), a higher T3/T4 stage (35.8% vs. 15.3%), nodal metastases (60.7% vs. 28.8%), and distant metastases (2.7% vs. 0.9%) (all p \u3c 0.001). Despite this, RAI was not an independent predictor of recurrence, second malignancy, or mortality. The analysis showed no significant differences in long-term survival between the RAI and non-RAI groups (p \u3e 0.05), with African American patients having an increased risk of mortality (HR = 3.81; p = 0.038). Cancer-directed surgery emerged as a protective factor (HR = 0.08; p = 0.018), while RAI treatment did not significantly affect mortality risk (p = 0.09).
Conclusions: Excellent pediatric thyroid cancer outcomes were achieved regardless of RAI use. Further research should clarify appropriate RAI indications while addressing racial outcome inequities.
Keywords: SEER database; clinical outcomes; differentiated thyroid carcinoma; pediatric thyroid cancer; racial disparities in cancer treatment; radioactive iodine ablation
Comparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department
No full textBackground: Acute bronchiolitis (AB) is the most common lower respiratory tract infection in infants. Clinician diagnosis and management vary due to limited objective assessment tools. Point-of-care lung ultrasound (LUS) offers a promising diagnostic and prognostic tool in the emergency department (ED), however, the time to perform LUS is of concern in the emergency setting.
Methods: Infants ≤ 12 months diagnosed with AB in the emergency department were enrolled. Two LUS techniques were performed sequentially: a 12-segment lawnmower approach and a posterior paravertebral waterfall technique. LUS were scored (0-36 for lawnmower; 0-6 for waterfall). Respiratory support (RS) was categorized into three levels: no RS (room air), low RS (wall O2 or heated high flow nasal cannula \u3c 1L/kg), and high RS (heated high flow nasal cannula ≥ 1L/kg or positive pressure). Clinical data, including RS at 12 and 24 h, maximum RS, disposition, and length of stay, were extracted via chart review and compared to mean LUS scores for each technique. Calculated areas under the curve (AUC) were compared using the Youden Index (J).
Results: 82 infants were enrolled. The mean waterfall scanning time was 1.65 min (SD 0.55) compared to the lawnmower\u27s 7.65 min (SD 1.45). The difference between mean LUS scores for the waterfall technique was statistically significant for all disposition comparisons and nearly all RS comparisons. While the lawnmower AUC was greater than the waterfall AUC for all RS and disposition comparisons, the Youden Index (J) was statistically significantly different for only two of the eight comparisons.
Conclusion: The posterior-only LUS technique is faster than the lawnmower technique, provides comparable information for disposition, and has a stronger association with LOS, but is less associated with RS. The waterfall technique may be a suitable alternative to more time-intensive, thorough techniques.
Keywords: Bronchiolitis; Emergency medicine; Lung ultrasound; Pediatrics; Point-of-care ultrasound
Echocardiography parameters and cardiac geometry in pregnancy by race and ethnicity
No full textObjectives: The objective of this study was to assess transthoracic echocardiography (TTE) parameters in pregnancy by race and ethnicity.
Methods: We performed a retrospective cohort study of pregnant individuals without cardiovascular disease who underwent a perinatal TTE between October 2017 and May 2022. Demographics and echocardiographic parameters were compared by race/ethnicity. Multivariate regression analysis was performed for TTE parameters after adjusting for age and hypertension.
Results: During the study period, 369 individuals had TTEs with a mean age of 31.8 ± 6.0 years old. Subjects were 55.3% White, 24.7% Hispanic, 14.1% Black, and 6.0% Asian. TTE parameters of left ventricular (LV) ejection fraction and LV mass index differed by race/ethnicity, though no difference was seen in cardiac geometry.
Conclusion: The differences in TTE parameters may not be clinically significant as most values fall within normal clinical ranges. Further prospective studies are needed to better evaluate cardiac outcomes by differences in echocardiographic parameters in pregnancy.
Keywords: Transthoracic echocardiography; ethnicity; pregnancy; race
2025 SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Atrial Appendage Occlusion
No full textBackground: Left atrial appendage occlusion (LAAO) devices reduce the risk of atrial fibrillation-associated stroke relative to no oral anticoagulation. However, uncertainty and practice variation persist in the areas of patient selection, periprocedural imaging, adjunctive antithrombotic therapy, and management of peridevice leak (PDL) and device-related thrombus. The Society for Cardiovascular Angiography & Interventions and Heart Rhythm Society developed these evidence-based guidelines to support clinicians, patients, and other stakeholders in management decisions regarding LAAO.
Methods: The Society for Cardiovascular Angiography & Interventions and Heart Rhythm Society convened a balanced, multidisciplinary guideline panel with \u3c 50% of members reporting significant conflicts of interest with the industry. Evidence Foundation, a registered 501(c)(3) nonprofit organization, provided methodological support for guideline development. The guideline panel formulated and prioritized clinical questions following the Grading of Recommendations Assessment, Development, and Evaluation approach in a population, intervention, comparison, outcome format. A technical review team of clinical and methodological experts conducted systematic reviews of the published evidence, synthesized data, and graded the certainty of evidence across outcomes. The guideline panel then developed recommendations and supporting statements informed by the technical review and using the Grading of Recommendations Assessment, Development, and Evaluation evidence-to-decision framework.
Results: The guideline panel developed 8 evidence-based recommendations to address variations in care related to LAAO. The panel also identified 2 knowledge gaps.
Conclusions: Key recommendations address patient selection for LAAO, periprocedural imaging, adjunctive antithrombotic therapy, and management of PDL and device-related thrombus. The panel also recommended necessary future research regarding the use of single antiplatelet therapy following LAAO and regarding the management of PDL.
Keywords: anticoagulation; antiplatelet therapy; atrial fibrillation; left atrial appendage occlusion; procedural imaging; stroke
A randomized, phase III study of sacituzumab govitecan versus treatment of the physician\u27s choice in patients with endometrial cancer after platinum-based chemotherapy and immunotherapy: the ASCENT-GYN-01 study (GOG-3104/ENGOT-en26/APGOT-EN2)
No full textBackground: Patients with recurrent or metastatic endometrial cancer who have progressed on or after platinum-based chemotherapy and PD-(L)1 inhibitor therapy have limited treatment options and a poor prognosis. Sacituzumab govitecan is a trophoblast cell-surface antigen 2-directed antibody-drug conjugate approved for certain types of breast cancer. In the phase II TROPiCS-03 trial, sacituzumab govitecan demonstrated encouraging efficacy and manageable safety in heavily pretreated patients with advanced or metastatic endometrial cancer.
Primary objective(s): The ASCENT-GYN-01 trial aims to assess the efficacy and safety of sacituzumab govitecan versus treatment of the physician\u27s choice in patients with endometrial cancer who have received platinum-based chemotherapy and PD-(L)1 inhibitor therapy. The primary objective is to compare the effect of sacituzumab govitecan versus treatment of the physician\u27s choice on progression-free survival, assessed by blinded independent central review, and on overall survival.
Study hypothesis: Patients with pretreated recurrent or persistent endometrial cancer will have improved progression-free survival and overall survival with sacituzumab govitecan compared with treatment of the physician\u27s choice.
Trial design: ASCENT-GYN-01 (ClinicalTrials.gov identifier NCT06486441) is a randomized, open-label, global phase III study. Patients will be randomized in a 1:1 ratio to receive sacituzumab govitecan or treatment of the physician\u27s choice (doxorubicin or paclitaxel).
Major inclusion/exclusion criteria: Patients aged 18 years and older with documented evidence of recurrent or persistent endometrial cancer (endometrial carcinoma or carcinosarcoma) will be enrolled. Up to 3 prior lines of systemic therapy for endometrial cancer are allowed, including platinum-based chemotherapy and PD-(L)1 inhibitor therapy, either in combination or separately. Key exclusion criteria include uterine leiomyosarcoma or endometrial stromal sarcomas and prior treatment with a trophoblast cell-surface antigen 2-directed antibody-drug conjugate or topoisomerase I inhibitor.
Primary endpoint(s): Dual primary endpoints are progression-free survival assessed by blinded independent central review and overall survival.
Sample size: Approximately 640 patients.
Estimated dates for completing accrual and presenting results: June 2029.
Trial registration: NCT06486441; GOG-3104; ENGOT-en26; APGOT-EN2.
Keywords: ASCENT-GYN-01; Endometrial Cancer; Immunotherapy; Platinum-Based Chemotherapy; Sacituzumab Govitecan
Feasibility of Telementoring for Cricothyroidotomy in Critical Care Transport Team Members
No full textObjective: Although endotracheal intubation is the cornerstone of advanced airway management, there are cases where surgical airway becomes the only alternative. Since the coronavirus disease 2019 pandemic, there has been increased telemedicine physician consultation, including in trauma and emergency care. The objective of this study is to reveal that telemedicine was a viable means of coaching a prehospital clinician through a simulated cricothyroidotomy.
Methods: Paramedic and registered nurse participants from a critical care transport team were observed performing surgical cricothyroidotomy on a task trainer during 2 separate quarterly airway skills assessments. During the control session, participants completed a bougie-assisted cricothyroidotomy with no assistance. During the intervention, session participants used a trauma surgeon through video conferencing as a procedural coach. Skill completion was timed, performance was rated using a global rating scale, and participants completed the National Aeronautics and Space Administration Task Load Index.
Results: There were 15 participants with paired observations available for analysis. There was no significant difference in total task time between solo and telementored sessions (effect size -22.47 [-52.82 to 7.89], P = .13). There was no significant difference in overall global rating scale between solo and telementored sessions (difference -0.27 [-1.63 to 1.10], P = .68). There were no differences in overall task load (difference 3.93 [-1.20 to 9.07], P = .12) or in any of the individual task load components between the solo and telementored sessions.
Conclusion: Telementorship was not associated with changes in procedural performance, task load, or time to complete a surgical cricothyroidotomy in a critical care transport team
Use of Point-of-care Ultrasound for Detection of Urethral Foreign Bodies: A Case Series
No full textIntroduction: Urethral foreign bodies are an uncommon presentation in the emergency department (ED) and can be difficult to assess and diagnose. There are examples in the literature of ultrasound detecting urethral foreign bodies. While not standard of practice, point-of-care ultrasound (POCUS) may be a useful tool for this unique pathology.
Case series: We describe three cases in which POCUS was used in the care of patients presenting with urethral foreign bodies. Ultrasound aided in diagnosis and helped facilitate further management.
Conclusion: While urethral foreign bodies are relatively uncommon, they can lead to significant morbidity, which makes their prompt identification and treatment important. Ultrasound provides a rapid means of evaluation that allows the patient to stay under observation by ED staff while removing exposure to radiation or contrast
Outcome data for non-invasive prenatal testing suggestive of an atypical sex chromosome abnormality of fetal/placental origin
No full textThis study was designed to identify outcome data for non-invasive prenatal testing (NIPT) results suggestive of an atypical sex chromosome abnormality of fetal/placental origin. A single-center descriptive case series was performed between January 1, 2022 and August 1, 2024, which identified 16 cases, 11 of which completed diagnostic testing. Of those 11 cases, only 2 were found to have detectable chromosomal abnormalities of the fetus (monosomy X and mosaic monosomy X). The majority of the 9 cases without detectable fetal chromosome abnormalities cannot be assessed for the presence of confined placental mosaicism due to the lack of CVS testing; however one confirmed case was identified. While this case series is limited in size, it highlights examples that can be used by clinicians in counseling patients about possible outcomes for these atypical NIPT results. These cases also showcase the importance of pre and post-test counseling, due to the complexity of results. Larger studies are needed to elucidate the mechanisms underlying these findings and to further guide patient counseling.
Keywords: non‐invasive prenatal testing; sex chromosome aneuploidies
