Live Mammographic Screening Interpretation Versus Offline Same-Day Screening Interpretation at a Tertiary Cancer Center

Breast Cancer Surveillance in Patients with a Personal History of Breast Cancer: Updates and Controversies

The increased survival rates for patients with a personal history of breast cancer (PHBC) can be attributed to early detection and advancements in breast cancer treatment. Imaging surveillance is of utmost importance due to the increased risk of local recurrence and the development of new primary breast cancer in patients with PHBC. National and international organizations recommend annual mammography for patients with PHBC; supplemental imaging modalities include contrast-enhanced mammography, whole-breast screening US, and breast MRI. However, the screening protocols and indications for supplemental imaging are significantly heterogeneous. The authors provide a review of current screening guidelines for patients with PHBC to aid understanding of the challenges involved in (a) determining when to initiate or discontinue screening mammography, (b) performing screening versus diagnostic mammography, and (c) performing offline versus live screening. The authors also provide updates on emergent supplemental imaging modalities and compliance with screening recommendations for patients with PHBC. ©RSNA, 2025.

Optimizing Screening Outcomes: A Guide for Breast Imaging Practices

Radiologists face a range of challenges to maximize the life-saving benefits of screening mammography, including pressure to maintain accuracy, manage heavy workloads, and minimize the risk of fatigue and burnout. This review provides targeted strategies to address these challenges and, ultimately, to improve interpretive performance of screening mammography. Workflow optimizations, including offline vs online and batched vs nonbatched interpretation, interrupted vs uninterrupted reading, and the importance of comparing current mammograms with prior examinations will be explored. Each strategy has strengths, weaknesses, and logistical challenges that must be tailored to the individual practice environment. Moreover, as breast radiologists contend with increasingly busy and hectic working conditions, practical solutions to protect reading environments and minimize distractions, such as the "sterile cockpit" approach, will be described. Additionally, breast radiologists are at greater risk for fatigue and burnout due to rising clinic volumes and an inadequate workforce. Optimizing the approach to reading screens is critical to helping breast imaging radiologists maintain and maximize the benefits of screening mammography, ensure the best outcomes for our patients, and maintain radiologist job satisfaction.