Connecting the Dots: Where Priorities Like Mammography, Reporting and Data Systems and Artificial Intelligence Intersect

Dr.McGinty(updated)_andcroppedThis post was contributed by Geraldine McGinty, MD, MBA, FACR, chair of the ACR Board of Chancellors

We’re now more than halfway through Breast Cancer Awareness Month, and our Mammography Saves Lives campaign has been hard at work educating women and providers on the importance of annual mammograms starting at age 40 – something that we’re committed to all year long.

And if you’ve been practicing medicine for a while, you’re also likely familiar with the ACR Reporting and Data Systems (RADS), which provide a standardized framework for reporting on imaging findings with the goals of reducing the variability of terminology in reports and easing communication between radiologists and referring physicians.

Lastly, similar to Mark Twain, the rumors of radiology’s death at the hands of artificial intelligence (AI) are greatly exaggerated. As the work of the ACR Data Science Institute (ACR DSI) is demonstrating, collaboration between radiology professionals, industry leaders, government agencies, and patients is leading to the development and implementation of AI applications that will help radiology professionals improve medical care.

When viewing these efforts from a high level, it’s clear that they’re significant to radiology, but it may seem that they’re largely unrelated to one another, working in silos. But what makes an article we recently published in the JACR so exciting is seeing how these efforts converge.

The study’s authors used Breast Imaging Reporting and Data System (BI-RADS) data from the University of California, Irvine Machine Learning Repository and the Digital Database for Screening Mammography repository. Two sets of models were trained: M1 and M2. M1 used lesion shape, margin, density and patient age information from data set 1 and image texture parameters from data set 2. M2 used the same image parameters as M1, but also used BI-RADS classification provided by radiologists.

Overall, the model that used BI-RADS classification from radiologists (M2) outperformed the model that did not (M1). In simpler terms: AI algorithms perform significantly better when they include a radiologist’s opinion.

The study results demonstrate that a radiologist-augmented workflow is feasible in AI, allowing better management of patients and disease classification.

By educating women on the importance of starting mammography at age 40, leveraging the data available in BI-RADS and bringing radiologists and AI algorithms together, we can play a leading role in reducing breast cancer death rates nationwide.

  • Do you and/or your practice participate in any, or all, of the above efforts?
  • Have you heard that the ACR DSI is making a big announcement at the ACR Quality & Safety Conference next Friday, Oct. 26? What are you anticipating?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).


Lung Cancer Screening’s Lifesaving Double Impact

Ella KazerooniThis post was contributed by Ella Kazerooni, MD, FACR, executive sponsor of the Lung Cancer Screening 2.0 Committee, chair of the American college of Radiology Lung Cancer Screening Resources Committee and chair of the ACR Lung-RADS® committee.

Evidence to support annual lung cancer screening  with low-dose computed tomography (LDCT) in high-risk patients received a double boost recently.

The Nelson Study , presented at the recent IASLC World Conference on Lung Cancer, showed that LDCT screening reduced lung cancer deaths by 26 percent in men and up to 61 percent in women (a 44 percent reduction overall if male and female cohort were evenly split).

And just this week, a paper in Annals of Internal Medicine predicted that lung cancer deaths would continue to drop in coming decades — in part due to LDCT. The authors stated that LDCT could not only reduce lung cancer deaths via early detection but also boost smoking cessation rates.

So, not only would LDCT cut older current and former smokers’ risk of dying from lung cancer nearly in half, but it also leads more people to stop smoking — which could save more lives.

Lung cancer kills more people each year than breast, colon and prostate cancers combined. Once implemented nationwide, this cost-efficient test would be the most effective cancer screening exam in history.

Yet, LDCT remains underutilized due to referring providers being uninformed or unaware of the benefits, and due to under coverage by Medicare. Let your referring providers know that they should consider these lifesaving exams for their high-risk patients.

  • The ACR Lung Cancer Screening resources page offers a number of materials to help us spread the word and learn how to start and maintain safe and effective lung cancer screening programs in our practices or hospitals.
  • I would also invite you to check out the American Lung Association® Saved by the Scan campaign. This may be a useful resource to link from your practice website.
  • is another tremendous resource for patients. The lung cancer screening section explains to patients what lung cancer screening exams are, how to prepare for them, benefits and risks, and more.
  • The National Lung Cancer Roundtable (NLCRT), a national coalition of public, private and voluntary organizations and invited individuals, dedicated to reducing the incidence of and mortality from lung cancer in the United States, offers a variety of resources as well.  

We have tools available to educate our referring providers and patients about lung cancer screening and how it can help many high-risk patients. I invite you to use them.

  • Does your practice or hospital offer lung cancer screening?
  • What have you found works well in informing patient and providers about lung cancer screening?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

Demystifying the Mammography Discussion

DEBRA MONTICCIOLO MD FACRThis post was contributed by Debra Monticciolo, MD, FACR, former chair of the American College of Radiology (ACR) Breast Imaging Commission.

I recently authored an editorial titled “Demystifying the Mammography Discussion.” I am glad that many people nationwide have read it, but also sad that it had to be written.

Some, who are not experts in breast cancer care, have been allowed to misuse (or exaggerate) terms like “overdiagnosis” and “false positive” to confuse women and their doctors about when – or even if – women should get a mammogram.

This misinformation and resulting confusion has even caused some organizations to soften their recommendations that women get tested starting at 40 – even though medical professionals know that moving away from this approach could lead to thousands of unnecessary deaths each year.

This has to stop.MSL Infographic Hi Rez

As radiologists, we have to demystify the mammography discussion for women and their providers by replacing this confusion with facts. The ACR and Society of Breast Imaging have created tools to help us do that.

The Mammography Saves Lives website has been updated with downloadable videos and other resources to help us explain the benefits and risks of mammography, what overdiagnosis is (and isn’t), why “false positive” is a misnomer,  (and overblown), and the impact of breast density on mammography effectiveness.

During National Breast Cancer Awareness Month, the nation’s eyes are focused on this terrible disease. There is no better time for us to step up, use the ACR/SBI resources and demystify the mammography discussion. Our patients’ lives may depend on it.

  • What are some things that you or your practice are doing in your communities to educate women and their providers on the importance of getting annual mammograms starting at age 40?

Please provide your thoughts the comments section below or on the Engage discussion board (login required).